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

The principal risk factors conducive to the development of cardiovascular diseases in young and middle-aged subjects with chronic cerebrovascular insufficiency due to Stage I or II essential hypertension were under study. Thirty-four male patients with the initial manifestations of inadequate blood supply to the brain (IMIBS), 35 male patients with stages I or II dyscirculatory encephalopathy (DE), and 32 and 33 female patients with the same conditions, respectively, were examined. Hypertensive cerebral crises were significantly more frequent in DE patients of both sexes than in IMIBS patients, and a tendency to a longer standing of arterial hypertension was observed in DE patients as against those with IMIBS. The results of the examinations evidence that excessive body mass, hypokinesia and psychoemotional stress, as well as an 'accumulation' of risk factors were conducive to the development of DE in essential hypertension patients with IMIBS. Basing on the discriminant analysis of risk factors, the authors have developed a method for predicting the development of DE in patients with IMIBS of a hypertensive origin. Use of this method will essentially improve the efficacy of prophylactic and therapeutic measures in IMIBS patients.
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PMID:[The prediction of the development of circulatory encephalopathy in hypertension patients with the initial manifestations of brain blood supply insufficiency]. 785 79

The present communication is concerned with 672 abdominal aneurysmectomies performed over a period of 24 years. All aneurysms with diameter 4 cm and above, were considered for surgery. Emphasis is given on factors determining post operative results and late survival. There was an age ranging from 38 to 92 years (mean 68.3). Elective surgery was performed in 434 cases with mortality 2.8%. In 100 symptomatic patients mortality was 4%. In 115 cases emergency undertaking was necessary. From this particular group, 80 cases represent formal rupture with mortality 41%. In the remaining 35 patients with symptomatology compatible with "impending rupture" mortality was 6%. There were 5 cases with inflammatory aneurysm with no incidence of death and 18 with simultaneous renal reconstruction. Mortality in the latter group was 11%. Risk factors including heart disease, hypertension and other associated pathology, were responsible for the majority of early deaths within the period of 30 post operative days and late mortality. Concerning late deaths, cardiac cases were predominant (24%), followed by cerebrovascular insufficiency (8%), cancer (5%) and chronic pulmonary disease (6%). In the overall follow-up, parameters such as hypertension with and/or without associated heart disease, symptomatology due to aneurysm and other associated pathology, were comparatively used in selective group of patients. Late mortality was investigated among three groups of patients and classified according to the 60, 70 and 80 decade of life. An entry form listing pertinent data was constructed and completed on the base of direct information from 489 (72.7%) and indirect from 183 (27.3%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Abdominal aneurysmectomy and determinants of improved results and late survival. Surgical considerations in 672 operations and 1-15 year follow-up. 819 70

The present study outlines the clinical profile and patterns of extracranial vascular abnormalities detected by continuous wave doppler ultrasonography (CWDU) in 100 patients with cerebrovascular insufficiency states. Males outnumbered females (65:35); completed stroke (CS) was a more common mode of presentation than transient ischaemic attacks (TIA); carotid strokes were more common than vertebro-basilar ones; and hypertension was the most common predisposing factor. The CWDU evaluation revealed extracranial vascular disease in 73% of patients. Vascular occlusions were more common in patients with TIA. Overall, 33% of the patients had evidence of proximal obstruction of the cerebral vessels below the neck. The clinical prediction of vascular territory (carotid or vertebro-basilar) matched with the findings on CWDU, but evidence of subclinical multiple-vessel involvement could be detected in 48% of the patients.
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PMID:Profile of extracranial cerebrovascular disease in Kelantan: a study by continuous wave Doppler ultrasonography. 834 Nov 72

Clinically significant arterial occlusive disease developed in 26 patients at between 5 months and 44 years (mean(s.d.) 10.7(12.0) years) following radiation therapy. Therapeutic radiation was associated with lesions of the carotid artery (nine patients), subclavian-axillary arteries (seven) and the abdominal aorta and its branches (10). Clinical presentations included transient ischemic attack, stroke, vertebrobasilar insufficiency, carotid bruit, upper- or lower-extremity ischemia and renovascular hypertension. Surgery for cerebrovascular insufficiency included carotid endarterectomy with vein patch, interposition grafting or subclavian-to-carotid bypass. Carotid or subclavian-to-axillary bypass was performed for upper-extremity ischemia. A combination of endarterectomy and Dacron or saphenous vein grafts was used for infrarenal reconstruction. Tunnels were placed orthotopically. Musculocutaneous flaps assisted in healing selected wounds. Ureteral catheters were useful adjuncts in abdominal vascular reconstructions. There were no operative deaths, strokes or amputations. One patient had recurrent transient ischemic attacks following subclavian-to-carotid bypass. The mean(s.d.) postoperative follow-up was 48.1(39.6) months. Patients presenting with end-organ ischemia following radiation therapy can be managed successfully with aggressive surgical revascularization using a broad spectrum of reconstructive techniques.
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PMID:Management of arterial occlusive disease following radiation therapy. 886 26

AGE-RELATED CARDIOVASCULAR CHANGES: Age-related changes in vascular structure and function may contribute to isolated systolic hypertension and target-organ damage. These include cardiac hypertrophy, systolic as well as diastolic dysfunction, congestive heart failure, coronary artery disease, cardiac arrhythmias, cerebrovascular diseases, peripheral vascular diseases and renal insufficiency. POTENTIAL ADVANTAGES OF CALCIUM ANTAGONISTS IN THE ELDERLY: Dihydropyridine calcium anatagonists have been advocated as first choice agents for the treatment of hypertension in the elderly on the grounds that (1) they may be more active in lowering blood pressure because of the predominantly low renin status in elderly hypertensives, (2) they may be better tolerated because side effects related to the activation of the sympathetic system may be less frequent because of attenuation of baroflexes during ageing and (3) they may have beneficial effects on a variety of concomitant cardiovascular diseases which are frequently present in the elderly. These assumptions, however are not always proven in clinical practice. ADVANTAGES OF NICARDIPINE: Additional to its potent vasodilatator action, nicardipine has anti-ischemic effects in both the coronary and the cerebral circulation, including antiplatelet and hemorrheological effects, and protection at ther cellular level against calcium overload and ischemia. The results of a large number of studies in cerebrovascular insufficiency suggest that nicardipine, may favourably affect the cerebral circulation and may improve the patient's cognitive function. Nicardipine may decrease left ventricular mass by about 4-12% and may reduce both the frequency and the severity of arrhythmias. The anti-anginal effects of nicardipine are well established. The drug is also able to decrease the progression of new atherosclerotic lesions in coronary arteries and is consequently potentially beneficial in elderly hypertensives with coronary artery disease. Nicardipine has no clinically significant negative inotropic effect. Nevertheless, in congestive heart failure, the use of calcium antagonists is usually not recommended because of the lack of clinical benefit and of possible harmful effects, including sympathetic and renin-angiotensin system stimulation. Although kidney protection may be provided by a strict and long-term control of blood pressure, the effects of nicardipine on long-term protection of renal function are not clear at present. RECENT CONTROVERSY CONCERNING SHORT-ACTING CALCIUM ANTAGONISTS: Much-debated recent case-control studies suggest that hypertensive patients treated with short-acting calcium antagonists may have an increased incidence of myocardial infarction and possibly of cardiovascular and total mortality. However, only well designed prospective comparative trials can answer this question.
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PMID:Concomitant diseases in elderly hypertensives: the position of nicardipine. 912 Jun 65

267 patients with vascular encephalopathy and initial manifestations of cerebrovascular insufficiency as the result of hypertension and cerebral atherosclerosis were observed by means of complex vegetological methods. The signs of peripheral autonomic insufficiency were revealed in 89% patients with vascular encephalopathy and in 64% ones with initial manifestations of cerebrovascular insufficiency. Cardiovascular tests directed to evaluation of the autonomic insufficiency were suggested to use for the prognosis of decompensation of cerebrovascular blood supply in such patients.
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PMID:[Peripheral autonomic disorders in patients with the initial manifestations of cerebral blood supply insufficiency]. 941 May 94

Combined catamnestic studies were made in 310 individuals 16 to 80 years old with a history of mild closed craniocerebral injury (MCCCI) for their health status. Of these, 200 subjects had, prior to MCCCI, arterial hypertension, chronic first-second degree cerebrovascular insufficiency, gastric and duodenal ulcer, chronic cholecystitis, hepatocholecystitis, gastroduodenitis. In a catamnestic follow-up 1 year following MCCCI many patients exhibited abnormal psychoneurologic and vegetovisceral changes. Prognostic factors have been derived for late outcomes of MCCCI using A. Val'd's sequential analysis.
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PMID:[The sequelae of a mild closed craniocerebral trauma and the prognosis of its late outcomes in patients with a unfavorable preinjury background]. 958 44

Ambulatory blood-pressure monitoring (ABPM) is accepted in the evaluation and management of hypertension. The use of ABPM in heart failure has received considerably less attention. Many patients with advanced heart failure experience disabling fatigue, orthostatic dizziness and symptoms of coronary and cerebrovascular insufficiency that may relate to periods of hypotension. These may be exacerbated by vasodilator drug therapy and may be difficult to evaluate by casual clinic recordings. ABPM in heart failure may help in the following: (i) evaluating time-dependent pharmacodynamic drug effects, such as peak and end-of-dose phenomena, tolerance and rebound; (ii) titrating ACE inhibitors and other drugs to highest-tolerated doses; and (iii) correlating circadian blood-pressure profiles with symptoms, quality of life, severity of heart failure, progression of ventricular and renal dysfunction, risks of stroke and myocardial infarction, and life expectancy. Devices for ABPM have been beset by problems of inaccuracy and unreliability. Standards for their manufacture and sale (including bench tests of accuracy against sphygmomanometry and intra-arterial recordings, and field tests of reliability) have been devised independently by several agencies, including the British Hypertension Society (BHS) and US Association for the Advancement of Medical Instrumentation (AAMI). A joint BHS/AAMI set of guidelines is in preparation. These guidelines emphasize the suitability of ABPM devices for hypertensive patients and those under general anesthesia, and may not be applicable to ambulant individuals with heart failure and blood pressures at or below the lower end of the evaluated ranges. Prospective studies of the accuracy and reliability of ABPM devices, their clinical utility and research potential should be undertaken in patients with heart failure before their informal and uncontrolled use in this population becomes widespread.
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PMID:Ambulatory blood pressure in heart failure. 1152 34

Multidirectional changes in the natural history of many cardiovascular syndromes have been linked to different levels of daily and monthly geomagnetic activity (GMA). Previous studies have found that in periods of high GMA, there were more admissions for acute myocardial infarction and more cases of anterior wall myocardial infarction. Results also indicated: higher out-patient mortality and a trend towards higher hospital mortality from acute myocardial infarction; higher diastolic arterial pressure in healthy subjects and in treated hypertensive patients; higher prolactin and 17-corticosteroid levels in the peripheral blood; more severe migraine attacks and more admissions for CVA and cerebrovascular insufficiency in male patients; changes in many blood coagulation cellular gradients (platelet count, basophils in the peripheral blood), a rise in platelet aggregation, fibrinogen level and a drop in leukocyte adhesiveness. Periods of low GMA showed a related increase (negative correlation) in in-hospital non-myocardial infarction-related cardiovascular deaths. Only in times of lowest GMA did inferior wall myocardial infarction exceed anterior wall myocardial infarction. Low GMA was also associated with higher levels of growth hormone and 11-ketosteroids in the peripheral blood, more sudden deaths, some increase in electrical heart instability number of ventricular and supraventricular extrasystoles and higher rate of ventricular tachycardia. The monthly occurrence of pregnancy-induced hypertension was negatively correlated with GMA level. Gender differences were noted in some of the parameters. Other studied parameters did not show changes related to GMA. These included hemoglobin level, electrolyte level, heart beat and pulse rate. Moreover, some observed cardiovascular fluctuations that were related to the level of GMA, also showed differences in the rising and dropping parts of the 11-year cycle of solar activity. It has been suggested that some of the changes observed in many clinical syndromes may be related to the concomitant activation of the serotoninergic system.
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PMID:The effect of geomagnetic activity on cardiovascular parameters. 1265 77

Diabetes-associated sequelae lead to a considerable reduction in the quality of life and conspicuous increase in mortality. Subsequent damage becomes manifest in terms of macroangiopathy as coronary heart disease, peripheral arterial occlusive disease, and cerebrovascular insufficiency. Moreover, there is high risk of diabetic nephropathy, neuropathy, and retinopathy entailing the danger of developing chronic renal failure, loss of vision, or diabetic foot syndrome. Although chronic hyperglycemia constitutes a separate risk factor for macro- and microangiopathic complications, associated disorders such as arterial hypertension and hypercholesterinemia increase the mortality risk to a significant extent. Hence, in the past few years, new concepts have been developed for improving the diagnosis, therapy, and long-term care of people with diabetes to include diligent treatment of concomitant risk factors in addition to maintaining near-normal blood glucose levels. This optimized medical care can improve the quality of life and prognosis of patients with diabetes mellitus.
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PMID:[Diabetic complications. Micro and macroangiopathic end-organ damage]. 1463 80


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