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

A long-term study of established hypertension helped identify a well defined group of 10 patients who differed both clinically and hemodynamically from 59 patients with the more frequent form of this disease. Their cardiac output was significantly increased (P less than 0.001) despite a severe elevation of arterial pressure (average 212/125 mm Hg plus or minus 13.5/7.3[standard error[). All had labile hypertension of long standing (16.2 years average) that was difficult to control and always symptomatic; in all, the diagnosis of pheochromocytoma had to be specifically excluded. Increased myocardial contractility was suggested by (1) significant elevation of the rate of rise of isovolumic pressure (P less than 0.001), and (2) high ratio of cardiac output to cardiopulmonary volume (P less than 0.005). Beta adrenergic blockade with propranolol helped to alleviate symptoms and to control tachycardia but failed by itself to reduce arterial pressure.
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PMID:Hyperkinetic heart in severe hypertension: a separate clinical hemodynamic entity. 112 21

The study population included 51 patients, aged 34-67 years with essential arterial hypertension treated with 3-5 hypotensive drugs at the Outpatient Antihypertensive Department. Based upon frequent measurements of elevated arterial blood pressure values they were found to be therapy resistant. 24-h ambulatory blood pressure monitoring recorded at one hour intervals (Space Labs) excluded 8 patients (15.7%) from the resistant hypertension group as the number of values > 140/90 mm Hg did not exceed 25% of the measurements. In these patients white coat hypertension was the reason for diagnosing resistance. In 18 patients (35.3%) the initial diagnosis was confirmed as the number of increased values was 80-100%. The severity of eye fundus changes, higher blood pressure values and male predominance characterized the resistant group. The use of long-term noninvasive automatic blood pressure recording helps us to exclude pseudo-resistance and avoid further intensification of treatment.
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PMID:["White coat hypertension" syndrome in resistant essential hypertension]. 130 69

The assessment of white coat hypertension is complicated by the lack of generally agreed-on normal limits of ambulatory blood pressure. To assess the influence of four of these limits on the prevalence of white coat hypertension and the corresponding distribution of left ventricular hypertrophy, we performed 24-hour ambulatory blood pressure monitoring and echocardiographic studies in 346 untreated patients with essential hypertension and 47 age-matched normotensive control subjects. The upper limits of normal daytime ambulatory blood pressure were lower using standards drawn from clinically normotensive populations than using standards drawn, partly or entirely, from general populations. The prevalence of white coat hypertension differed markedly using the different standards, being 12.1%, 16.5%, 28.9%, and 53.2% (chi 2 = 346.0, p less than 0.0001). Left ventricular mass index averaged 77 g/m2 in the control group, 85 g/m2 in the two groups with white coat hypertension defined by using standards drawn from normotensive populations (both comparisons not significant versus control group), and 90 and 98 g/m2 in the two groups with white coat hypertension defined by using the other two standards (both p less than 0.01 versus control group). The prevalence of echocardiographic left ventricular hypertrophy was 0% in the control group, 2.4% and 3.5% in the two groups with white coat hypertension defined by using standards drawn from normotensive populations, and 9.0% and 14.7% in the other two groups with white coat hypertension (p less than 0.05 and p less than 0.01, respectively, versus control group).(ABSTRACT TRUNCATED AT 250 WORDS)
Hypertension 1992 Oct
PMID:Variability between current definitions of 'normal' ambulatory blood pressure. Implications in the assessment of white coat hypertension. 139 90

Office blood pressure measured by a physician is often higher than under the usual ambulatory conditions. Therefore, alternative methods such as self-assessment of blood pressure and ambulatory blood pressure measurements are increasingly promoted. The purposes of this study, covering 613 referred patients, were (1) compare office blood pressure with continuous ambulatory blood pressure measurements, (2) compare office blood pressure with blood pressure values recorded by a trained technician in the absence of a physician and (3) analyze the interpretation of the blood pressure profiles by the referring physicians. Office blood pressure exceeded average ambulatory blood pressure in 94% of the patients and also the blood pressure values recorded by a technician in 88%. According to the office blood pressure there were 523 patients with elevated blood pressure, 20 with isolated increased systolic blood pressure and 70 with normal blood pressure. Office blood pressure was higher (systolic +17 +/- 18 and diastolic +9 +/- 12 mm Hg, p less than 0.0001) than the average value of the ambulatory blood pressure profile, whereas the latter did not differ significantly from blood pressure values measured by the technician (systolic -1 +/- 12 and diastolic -2 +/- 9 mm Hg). 190 of the 523 (36%) patients had white-coat hypertension according to the ambulatory blood pressure measurements. Conventional blood pressure measurements by the technician yielded a high sensitivity (84%) and specificity (87%) for distinguishing white coat hypertension. Analysis of the questionnaires showed that opinions about normal limits of ambulatory blood pressure vary considerably.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Diagnostic value of ambulatory daily blood pressure profile: comparison with measurements performed by a laboratory technician]. 141 88

Home blood pressure readings by self-monitoring (14 readings in 7 days) have been compared to readings taken in the clinic in 937 participants of the Tecumseh Blood Pressure Study. In the absence of firm criteria "hypertension at home" was defined as having home readings in the upper decile of the whole population. If a clinic reading exceeded 140 and/or 90 mmHg a subject was categorized as having clinic "hypertension". Two hypertensive groups emerged; one with both clinic and home hypertension ("sustained" N = 47) and one with high clinic but normal home blood pressure ("white coat" N = 50). Groups with "white coat" and "sustained" hypertension were very similar. Both groups were overweight, had faster heart rates, elevated cholesterol, insulin, triglyceride and decreased HDL levels. Blood pressure readings at previous exams (age 5, 8, 21 and 22) were elevated in both the "sustained" and white coat hypertension group compared to the normotensive controls. Subjects with white coat hypertension were not hyperresponders to the stress of mental arrythmetrics or to isometric exercise. The white coat hypertensives did not show abnormal anger, excessive submissiveness, or anxiety. The pathophysiology of the reproducible elevation of the clinic blood pressure in the white coat hypertensives remains unclear. Because of a higher risk of coronary heart disease and a risk for late development of sustained hypertension, subjects with white coat hypertension should be counselled on nonpharmacologic methods to control the blood pressure elevation and to ameliorate coronary risk factors.
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PMID:White coat hypertension: a follow-up. 154 Oct 46

Hypertension is quite common in the elderly population. Isolated systolic hypertension and diastolic hypertension are associated with cardiovascular complications. Like younger patients, the elderly may have labile hypertension. On the other hand, pseudohypertension, auscultatory gap, and postural hypotension are peculiar to the elderly. Obesity, atherosclerosis, arteriosclerosis, baroreceptor insensitivity, decline in renal function, physical inactivity, and insomnia are factors that can lead to or aggravate hypertension in older patients. Secondary hypertension should be suspected if elevated blood pressure first appears late in life or becomes resistant to previously adequate treatment. Spontaneous hypokalemia can indicate primary aldosteronism. Elevation in the serum creatinine level of a patient taking an angiotensin-converting enzyme (ACE) inhibitor suggests bilateral renovascular hypertension. The goal of antihypertensive therapy is to prevent morbidity, disability, and death from complications and to maintain quality of life. Psychosocial factors may play an important role in controlling hypertension. Nonpharmacologic treatment, such as weight loss, salt restriction, and exercise, should always be tried prior to and in conjunction with medical therapy. Antihypertensive drugs often cause side effects and should be prescribed with caution. Always start with a low dose and gradually increase it if necessary. All drugs that reduce blood pressure in the younger individual also work in the elderly. ACE inhibitors and calcium blockers are particularly useful because of their low incidence of adverse effects.
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PMID:Hypertension in elderly patients. The special concerns in this growing population. 154 24

The study was conducted to estimate the frequency of white coat hypertension, ie, hypertension when in contact with the doctor only, in patients with newly diagnosed hypertension. We studied 159 consecutive patients (median age 47 years, 86 women) referred from primary health care to a hypertension clinic. For all patients, their general practitioner had decided to treat the hypertension pharmacologically, but the treatment had not yet begun. The blood pressure measurements reported from the referring doctors were 164.1 +/- 18.1/104.3 +/- 7.1 mm Hg (mean +/- SD). Measured at the hypertension clinic with random zero sphygmomanometer the pressures were 156.8 +/- 22.5/99.8 +/- 11.7 mm Hg. The indirectly measured day-time ambulatory blood pressures were 145.2 +/- 18.1/95.9 +/- 11.5 mm Hg. When a cut-off level of 90 mm Hg diastolic was applied, all patients were considered hypertensive by the referring doctors' measurements; the random zero office measurements regarded 18.3% of the patients as normotensive. The ambulatory measurements regarded a further 24.8% as normotensive (white coat hypertensive), whereas five patients considered normotensive by office measurements were hypertensive when evaluated by ambulatory monitoring (reverse white coat phenomenon). The difference between systolic office measurements and the daytime ambulatory blood pressures was significantly larger for female patients; age was positively correlated and weight negatively correlated to this difference. No significant difference was found for the diastolic measurements. It is concluded that white coat hypertension is present in approximately a quarter of the patients with newly diagnosed hypertension. By implementing ambulatory monitoring in clinical practice some of the overdiagnosing will possibly be avoided, but further studies on the subject are needed.
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PMID:White coat hypertension diagnosed by 24-h ambulatory monitoring. Examination of 159 newly diagnosed hypertensive patients. 155 Jun 67

The authors report the successful control of labile hypertension associated with orthostatic hypotension in a 75-year-old male patient, by means of L-DOPS, a synthetic precursor of norepinephrine in combination with antihypertensive drugs. He had been known to be hypertensive for 15 years and developed a persistent floating sensation 2 years age. Despite good control of hypertension after admission, orthostatic hypotension was still observed. Passive tilt produced a blood pressure reduction of 60/20 mmHg. Spectral analysis of heart rate variability showed a disturbance in the activation of the sympathetic nervous system. Treatment with L-DOPS attenuated the blood pressure reduction in response to passive tilt (35/12 mmHg) and improved the sympathetic response. Because of an increase in blood pressure by L-DOPS, addition of either a calcium channel blocker or an angiotensin-converting enzyme inhibitor was necessary. These combinations of treatment successfully controlled blood pressure as well as orthostatic hypotension.
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PMID:[An elderly case of hypertension with persistent orthostatic hypotension]. 156 Jun 12

Mental stress seems clearly and inextricably linked to the development and maintenance of high blood pressure. Blood pressure evaluated during ambulation, work, or mental stress instead of at rest or in the physician's office consistently improves the ability to predict the target-organ damage often associated with all forms of hypertension. An improved understanding of the relationship between emotional arousal and high blood pressure has accelerated knowledge surrounding the stress-related entities of white-coat hypertension, borderline or mild hypertension, circadian blood pressure changes, labile hypertension, and ambulatory or work-related hypertension. Further development and refinement of diagnostic testing devices such as ambulatory blood pressure monitors and standardized mental stress testing protocols with simultaneous blood pressure determination should improve the evaluation of the diagnostic accuracy, therapeutic efficacy, and prognostic significance associated with stress-related blood pressure elevations. These advances may be especially important because most of the morbidity and mortality associated with hypertension is seen in those with only mild to moderate elevations in blood pressure. Pharmacologic intervention directed at stress-related hypertensive entities may be helpful but remains controversial. Certainly, if instituted, drug therapy should be directed toward preservation of the target organs. Therapeutic intervention through nonpharmacologic modalities appears to be the logical treatment of choice for these hypertensive subgroups. Combined hygienic interventions may be especially powerful. Combinations of lifestyle treatment modalities optimizing nutrition, exercise, weight control, and stress management should obviate the need for medications in many cases of stress-related hypertension. Improved recognition and clinical evaluation of the relationship between environmental stress and hypertension will assist the primary care physician in the management of the blood pressure variations associated with daily life.
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PMID:Stress and hypertension. 194 91

Pheochromocytoma is an unusual but potentially devastating tumor. Although a high index of suspicion is necessary, the likelihood of a pheochromocytoma is lower in the absence of the typical symptoms and findings. Nonetheless, screening must be broadened to include patients with a lower risk of the disease, such as those with resistant or labile hypertension who are minimally symptomatic. Extensive diagnostic evaluations should be reserved for those whose clinical or laboratory findings are more suggestive. Symptoms in a group of patients in whom a pheochromocytoma was seriously considered but excluded overlap symptoms in patients with a pheochromocytoma. Certain symptoms are useful: flushing to suggest a non-pheochromocytoma illness; visual symptoms, flank pain, and pallor to suggest that a pheochromocytoma is more likely. Combinations of symptoms can be of value: 2 or more symptoms from the triad of headache, palpitations, and diaphoresis were present in the majority of pheochromocytoma patients, but in a smaller number of non-pheochromocytoma patients. The presence of the entire triad is more specific, but less sensitive. New hypertension, or hypertension associated with unexplained orthostatic hypotension, are suggestive of an underlying pheochromocytoma. Twenty-four-hour urine studies are consistently abnormal in patients with a pheochromocytoma, but are also elevated in a significant proportion of non-pheochromocytoma patients. Values greater then 1.5-2-fold above the upper limit of normal are very suggestive that a pheochromocytoma is present, and warrant a more intensive subsequent evaluation. Imaging studies are reliable in the diagnosis of pheochromocytoma, and can help to confirm or exclude the disease. Patients with a higher clinical likelihood and any elevated urinary testing, or with a lower clinical likelihood and persistently and/or significantly elevated urinary testing, should have imaging studies performed. This combination of clinical screening, 24-hour urinary testing, and imaging studies is a useful and reliable approach to patients suspected of harboring a pheochromocytoma.
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PMID:A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience. 198 66


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