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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Systolic arterial hypertension in subjects with regional cerebral ischemia is considered and discussed as regards its frequency and its pathogenetic meaning, and criteria concerning the way of treating it. Systolic arterial hypertension presents a very high frequency in these subjects. At times it is accompanied by moderate diastolic hypertension, to which may be attributed, by way of hypothesis, a compensatory meaning. Considering the pathogenesis of systolic hypertension, the antihypertensive drugs at our disposal do not offer any valid and rational indication. We advance the opinion that a lowering of blood pressure in these subjects may be more harmful than helpful.
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PMID:Systolic arterial hypertension and cerebral ischemia. 75 39

In hypertensive patients over 50 years of age, the high prevalence of renovascular hypertension (31 per cent), the low operative risk for its correction (1 to 2 per cent), and the frequency of benefit from operation (80 to 87 per cent) support an aggressive attitude toward screening and management. Diastolic hypertension greater than 105 mm Hg in the older patient warrants investigation. If such a patient has advanced atherosclerosis with evidence of significant cardiac disease or cerebrovascular disease, the indications for operative management of renovascular hypertension correlated with the severity of hypertension, difficulty of control, and imminence of renal function deterioration. If complicating risk factors are not severe, any patient with diastolic hypertension greater than 105 mm Hg is considered an appropriate operative candidate. In contrast, when risk factors are severe, operative management is undertaken only when hypertension is difficult to control or deterioration of renal function is thought to be secondary to the renal artery stenosis. In these patients the risk of operation is obviously greater and the long term benefits are more limited. Nevertheless, based on our experience, we feel the risk of poorly controlled hypertension or impending renal failure is even higher and justifies operative intervention. Hypertension accelerates the progress of atherosclerosis, and halting or slowing the unrelenting course of atherosclerosis is worthwhile objective if this can be done without unnecessary risk.
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PMID:Surgical management of renovascular hypertension in older patients. 85 6

In order to study the prevalence of hypertension and some of the factors relevant to its natural history, cross-sectional surveys were performed during the period 1967 to 1973 in five small Peruvian communities, two located at sea level and three above 13,000 feet of altitude. In total, 4,359 persons were studied at sea level (1,970 males and 2,389 females) and 3,055 at high altitude 2,189 males and 866 females). At high altitude, the age-adjusted prevalence of hypertension (particularly systolic) was definitely low; diastolic hypertension was more frequent in men than in women, and it was commoner than systolic hypertension. The reverse was observed in communities at sea level. Long-term blood pressure changes observed in natives accustomed to high altitudes but living at sea level, as well as in white persons usually living at sea level but residing at high altitude, appear to indicate that environmental forces are more important than genetic predispositions in determing the rarity of hypertension in the highlands. Among the environmental forces, chronic hypoxia seems to play an important causal role.
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PMID:Altitude and hypertension. 87 68

Fifty-three of 4,369 patients with acute myocardial infarction died of myocardial rupture. The incidence of rupture varied directly, among men, with the systolic blood pressure on admission to the coronary care unit (CCU), and the highest systolic pressure while in the CCU. Rupture occurred in 0.3% of the men with systolic pressures on admission to the CCU between 110-129 mm Hg, increasing to 2.0% of men with pressures between 170-189 mm Hg. Similarly, 0.3% of the men with a highest systolic pressure less than 150 mm Hg had a rupture, while 1.6% of those with pressures between 170-189 mm Hg ruptured. Diastolic blood pressure, past history of hypertension, and sustained hypertension after infarction were not related to the occurrence of rupture. Eighteen of the 53 patients who sustained rupture had systolic hypertension (greater than or equal to 150 mm Hg) sometime during the 24 hours before rupture, and 14 had diastolic hypertension (greater than or equal to 95 mm Hg). Hypertension appears to be one of several variables interacting to influence the occurrence of myocardial rupture.
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PMID:Effect of hypertension on myocardial rupture after acute myocardial infarction. 91 41

Thirteen patients were followed for 4-46 months after removal of an aldosterone producing adenoma. Normotension was achieved in all cases but two in whom moderate diastolic hypertension was easily managed on diuretic therapy. All were cured of hypokalemia and symptoms related to low plasm potassium. Persistaent selective hypoaldosteronism was seen in one patient. A gratifying regression of symptoms and signs related to arterial hypertension was seen. Medical treatment with aldosterone antagonists may "cure" the patient to the same extent as surgery. The present results encourage the use of surgical treatment in these young patients since a life-long drug therapy--with its attendant problems--is the only alternative.
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PMID:Conn's syndrome. A follow-up of thirteen surgically treated cases. 107 48

Transplant renal artery stenosis occurred in 12 of 101 consecutive kidney transplants. Stenoses were all located in the renal artery distal to the anastomosis. Two separate forms of stenosis are recognized: angulation and segmental. All transplant patients with severe diastolic hypertension, refractory to medical management, and an audible abdominal bruit should undergo angiography. Surgical correction of the stenosis was accomplished in nine of 12 patients with cure of their hypertension.
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PMID:Homotransplant renal artery stenosis. 108

Diabetes mellitus is commonly associated with systolic and diastolic hypertension, and a wealth of epidemiological data suggest that this association is independent of age and obesity. Much evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive patients, whether obese or of normal body weight, are compared with age- and weight-matched normotensive controls, a heightened plasma insulin response to a glucose challenge is found consistently. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. Using the insulin/glucose clamp technique in combination with tracer glucose infusion and indirect calorimetry, it has been demonstrated that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal (glycogen synthesis), and correlates directly with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms: sodium retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and proliferation of vascular smooth-muscle cells. Physiological maneuvers, such as caloric restriction (in the overweight patient) and regular physical exercise, can improve tissue sensitivity to insulin; good evidence indicates that these maneuvers also can lower blood pressure in both normotensive and hypertensive individuals. Insulin resistance and hyperinsulinemia also are associated with an atherogenic plasma lipid profile. Elevated plasma insulin concentrations enhance very-low-density lipoprotein (VLDL) synthesis, leading to hypertriglyceridemia. Progressive elimination of lipid and apolipoproteins from the VLDL particle leads to an increased formation of intermediate density and low-density lipoproteins, both of which are atherogenic. Last, insulin per se, independent of its effects on blood pressure and plasma lipids, is known to be atherogenic. The hormone enhances cholesterol transport into arteriolar smooth-muscle cells and increases endogenous lipid synthesis by these cells. Insulin also stimulates the proliferation of arteriolar smooth-muscle cells, augments collagen synthesis in the vascular wall, increases the formation of and decreases the regression of lipid plaques, and stimulates the production of a variety of growth factors. In summary, insulin resistance appears to be a syndrome that is associated with a clustering of metabolic disorders, including type II diabetes mellitus, obesity, hypertension, lipid abnormalities, and atherosclerotic cardiovascular disease.
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PMID:Insulin resistance, hyperinsulinemia, and coronary artery disease: a complex metabolic web. 128 37

Treatment of hypertension in the elderly has so far mainly been based on clinical judgment and very few large controlled trials. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP, and MRC trials. All have shown that drug treatment of hypertension in the elderly (65-85 years) with permanent diastolic hypertension or isolated systolic hypertension reduces stroke incidence. Most patients have needed combined drug treatment with diuretics and beta-blockers. When thiazide diuretics are used, serum potassium should be followed very closely and most likely amiloride should be added to the thiazide therapy, since this was done both in the STOP and the MRC trials. Since many elderly patients with hypertension suffer from other diseases that might represent contraindications to thiazide diuretics or beta-blockers, the choice of drug must be made after careful clinical evaluation. With the newer classes of antihypertensive agents (calcium antagonists, ACE inhibitors and alpha-blockers) side effects are probably seen less often, but long-term data on morbidity and mortality are still lacking.
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PMID:Treatment of hypertension in the elderly--what have we learned from the recent trials? 129 75

In 1985 we investigated the prevalence of high normal blood pressure in 6387 inhabitants (range 15-75 years old) of the city of La Plata and its progression to arterial hypertension after four years. High normal blood pressure was defined as a systolic blood pressure (BP) < 140 mmHg and diastolic BP between 85-89 mmHg (average value of two measurements) on one occasion. Arterial hypertension was defined as a systolic BP > or = 140 mmHg and/or diastolic BP > or = 90 mmHg, both as an average of two measurements on two occasions. High normal BP prevalence was 6.62%, being higher in men than in women (p < 0.0005, Table 1). General progression to hypertension was 41.79%, being higher in the older individuals (p < 0.0005). Of the 423 individuals with high normal BP (Table 2), 268 (63.36%) were found in 1989 (Table 3). They had an incidence of hypertension of 10.45% per year, also higher in older subjects (Table 4). There were no differences between sexes. Subjects with high normal BP who subsequently developed hypertension had higher systolic BP in 1985 than those who remained normotensive (p < 0.001, Table 5). Most of them progressed to mild diastolic hypertension (29.48%) or borderline isolated systolic hypertension (6.72%, Fig. 1). In this study, progression to arterial hypertension was higher than that reported in similar studies for general population in other countries.
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PMID:[Prevalence of high normal blood pressure and progression to hypertension in a population sample of La Plata]. 130 6

SHEP (Systolic Hypertension in the Elderly Program) is a multicenter controlled therapeutic trial which included 4,736 subjects aged 60 years and over, who had isolated systolic hypertension at three consecutive visits at the outpatient clinic. The treatment, based on low doses of diuretic (chlorthalidone 12.5-25 mg daily) combined, when necessary, with a cardioselective beta-blocker (atenolol 25 to 50 mg daily), significantly reduced the incidence of cerebrovascular and coronary events; the relative risk reduction for total mortality was not statistically significant. The beneficial cardiovascular effects were observed in both sexes, and in the 80+ age group. These results show that this particular therapy applied to this form of hypertension decreases the risk of both coronary and cerebral events, as was already suggested by the meta-analysis of the controlled therapeutic trials performed with diuretics, beta-blockers and other older antihypertensive drugs in patients with permanent diastolic hypertension. They also show the limitations of this therapeutic strategy, which controlled only 50 percent of the patients who were, however, highly selected, especially concerning the absence of associated morbid conditions and treatments. The need for, and feasibility of, new controlled therapeutic trials comparing the mortality and morbidity associated with various new antihypertensive therapies must now be discussed.
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PMID:[Cooperative study of systolic arterial hypertension in the elderly patient (SHEP). Comments]. 136 12


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