Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Severe hypertension, for which no cause could be found, developed in an adolescent female. The patient's blood pressure was refractory to intensive pharmacologic intervention. After 11/2 years of medical management, the patient's intra-arterial blood pressures were found to be in the normotensive range. Individuals with labile hypertension may be refractory to pharmacologic control and may require continuous pressure monitoring in order to establish a proper diagnosis.
 ...
PMID:Refractory hypertension in an otherwise healthy adolescent. 726 34

Hypertensive patients may present to the emergency department with one of three general problems: high blood pressure due to labile hypertension, chronic hypertension, accelerated hypertension, or a hypertensive emergency; side effects from antihypertensive drugs; or acute medical or surgical illness whose management may be affected by hypertension or by drugs taken for hypertension. We describe these problems and recommend an approach to each that is appropriate in the emergency department.
 ...
PMID:Hypertension: spectrum of problems and guidelines for management. 736 63

Labile blood pressure elevation is believed to have less clinical significance than "fixed hypertension." This assertion was examined in the Framingham cohort of 5209 men and women followed for 20 years for the development of cardiovascular events in relation to three routinely measured blood pressures at each of 10 biennial examinations. Variability of pressure judged from the standard deviation about the mean of three pressures was not a consistent characteristic of subjects from one examination to the next (r = 0.07). Higher pressures were more labile than low ones, so that "fixed hypertensives" actually had more labile pressures than did so-called labile hypertensives. Lability, also increased with age. Labile hypertension, determined during a 1-hour period of observation, adds nothing to the ability of the mean blood pressure to predict cardiovascular disease. The mean, minimum and maximum of three pressures measured during an examination were equally efficient predictors of cardiovascular disease. In multivariate analysis, for any given average pressure, risk of cardiovascular events was unaffected by the degree of variability of the pressure. It is recommended that the average of a series of pressures be used to determine risk, preferably over more than one examination.
 ...
PMID:Labile hypertension: a faulty concept? The Framingham study. 737 Nov 31

Hemodynamic changes during the cold pressor test were examined in Type I labile (juvenile labile) hypertensive patients, Type II labile (middle aged labile) hypertensive patients, established hypertensive patients and normal subjects. In normal, Type I labile hypertensive and established hypertensive subjects, the pressor response during the test was accounted for chiefly by a rise in peripheral resistance. In Type II labile hypertensive patients, an increase in blood pressure during cold stimuli was accompanied by an augmented cardiac output. Therefore, Type II labile hypertension is separated clearly from other types of hypertension with respect to hemodynamic changes during the test. In Type II labile hypertensive patients, however, diazepam reduced an increase in cardiac output during the test, resulting in hemodynamic changes similar to those of normal subjects. After atropinization, the hemodynamic pattern of Type I and established hypertensives changed similar to that of Type II labile patients during the cold pressor test. It is concluded that an excessive cardiac output caused by the cold stimuli is a distinctive hemodynamic characteristics of Type II labile hypertensive patients, and this distinctive hemodynamic characteristics might be due to the decreased parasympathetic tone.
 ...
PMID:Pathophysiological characteristics of labile hypertensive patients determined by the cold pressor test. 740 Dec 72

Blood pressure variability over a 24-hour period was compared between subjects with labile and those with established hypertension. For this purpose, a computer analysis of the blood pressure tracings, obtained with continuous unrestricted monitoring, was adopted, which characterizes the blood pressure variability in a quantitative manner. The following parameters were employed: the mean, the standard deviation, the coefficient of variation, the indexes of skewness and of kurtosis. No significant differences could be found between the two groups except for the mean value of the blood pressure. It is concluded, therefore, that the term 'labile hypertension' in inappropriate.
 ...
PMID:Blood pressure variability in 'labile' and 'established' hypertension. 741 5

Several experimental evidences have shown that, under standarized conditions, circulating catecholamines (CA) or norepinephrine (NE) levels can be used as a valid index of the sympatho-adrenal activity in animal and man. This approach in the study of hypertensive patients has permitted to uncover that about 50% of patients with labile hypertension and about 30% of patients with stable hypertension had elevated CA levels at rest for 20 minutes in the supine position. The increased CA levels were mainly due to a rise in NE in stable hypertension and to a rise in epinephrine (E) in labile hypertension. On the basis of circulating CA levels, the hypertensive patients were divided into hyperadrenergic (CA levels above normal range) and normoadrenergic (CA levels within the normal range) subgroups. The hyperadrenergic labile or stable hypertensive subgroups were found to be also characterized by an enhanced CA or NE increase in response to change in position from supine to standing, by a faster heart rate and by an increased myocardial contractility, while these parameters were normal in the normoadrenergic subgroups. These findings support therefore the existence of an increased sympathetic tone and reactivity in association with hyperkinetic cardiac functions in an important population of hypertensive patients. In response to two weeks treatment with beta-blockers (either propranolol or metoprolol) hyperadrenergic stable hypertensive patients were found to be more responsive to this therapy than normoadrenergic patients although both groups had the same initial blood pressure. Moreover, this treatment lowered basal NE or CA levels and restored the enhanced CA or NE response to change in position toward normal in hyperadrenergic patients while it did not modify significantly circulating supine or standing CA and NE in normoadrenergic patients. These findings strongly support a participation of the sympathetic system in the maintenance of an elevated blood pressure in hyperadrenergic patients and raise the possibility of using a more rational approach in the therapy of hypertension.
 ...
PMID:Evidences supporting an increased sympathetic tone and reactivity in a subgroup of patients with essential hypertension. 742 61

The fatty acid pattern of serum triglycerides and FFA in normal untrained subjects, normotensive athletes, patients with labile and stable essential hypertension as well as in hypertensives with overweight and mild hypertriglyceridemia has been evaluated by gas liquid chromatography. The most striking differences revealed the linoleic acid in triglycerides being increased in athletes and in patients with labile hypertension in comparison with normotensive untrained controls and patients with stable hypertension. On the basis of these data an enhanced need of polyunsaturated fatty acids corresponding to probands with high physical activity has been assumed in patients with an early stage of essential hypertension. The differences of arachidonic acid were not so distinct. The results can be relevant with regard to the pathogenetic role of prostaglandin precursors in the development and course of essential hypertension and atherosclerosis.
 ...
PMID:The fatty acid pattern of serum triglycerides and FFA in patients with essential hypertension of different stages, athletes, and normal subjects. 747 48

The literature on the benefits and risks of self-measurement of blood pressure and interpretation of the readings was reviewed. Self-measurement of blood pressure is useful in selected patients with high blood pressure, can be used to monitor blood pressure closely outside health care facilities, and can determine whether patients have white coat hypertension. The involvement of patients in their own blood pressure management is increased and self measurement may result in more rapid achievement of target blood pressure readings, improvement in adherence to antihypertensive therapy and decreased health care utilization. However, some patients may not be suited to monitor their own blood pressure and some may experience an increase in anxiety regarding their health. With careful training and selection of patients, most can accurately assess their blood pressure. Self-measured readings are generally lower than readings in a physician's clinic (or office) and this must be accounted for in assessing response to therapy and usual levels of blood pressure. Self-measured readings are a valuable supplement to clinic readings in many patients.
 ...
PMID:Self-measurement of blood pressure: benefits, risks and interpretation of readings. The Canadian Coalition for High Blood Pressure Prevention and Control. 748 39

Ambulatory blood pressure monitoring (ABPM) is, nowadays, one of the most powerful medical tools, in the evaluation of blood pressure (BP) behaviour during a normal daily life, particularly in hypertensive patients, and to assess with a high level of accuracy, the antihypertensive effectiveness of the pharmacological compounds. In this paper, we present the main indications and limitations of the method, and a new circadian classification of arterial hypertension based on an average deviation index (ADI), resulting of the addition of all the systolic and diastolic ambulatory measurements exceeding 140/90 mmHg recorded along the 24-hour extrahospital monitoring, and dividing the result by two. The study was carried out in 939 hypertensive patients diagnosed by means of basal blood pressure measurements (BP > 140/90 mmHg), and in 45 normal volunteers. Hypothetically, this ADI may vary only from 0 (normal curve) to 100% (complete abnormal circadian curve). From ADI 0 to 100, we have established 4 categories of circadian curves as follows: curve 0 or "normal" if the ADI varies from 0 to 5%, curve type I or "borderline" (white coat phenomenon) if ADI moves between 6 and 30%, curve type II or "diurnal" if the ADI varies from 31 to 65%, and finally curve type III or "sustained", if the ADI goes further on than 66%. The results indicate clearly a high percentage of white coat hypertension (30%) where 4% showed an ADI less than 5%. A half approximately of the patients showed diurnal hypertension, and a quarter of them, both diurnal and nocturnal hypertension, so-called sustained hypertension. 75% of all the hypertensive patients showed spontaneous normotensive values at nighttime.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[The clinical utility of the automatic ambulatory recording of the arterial pressure in the diagnosis, prognosis and treatment of arterial hypertension]. 749 31

Non-responders are frequently encountered in clinical practice, and different strategies have to be considered as well as diagnostic approaches. Nearly 50% of all hypertensive patients will require more than one drug to control blood pressure. The complexity of high blood pressure is reflected in the different responses to antihypertensive agents with varied mode of action. White coat hypertension may coexist with sustained hypertension and complicate interpretations of blood pressure measurements. Noncompliance is a challenge for the doctor, and may be difficult to solve. It depends not only on the patient-doctor relationship, but also on the patient's perception of own health and the side effect profile of the drugs. Patient education is crucial. Secondary hypertension should be excluded in truly resistant hypertension. Volume overload is frequent in essential hypertension, and volume expansion follows an excessive dietary sodium intake. These and other possibilities should be sought for when explaining failure to respond to antihypertensive therapy.
 ...
PMID:Non-responders. 750 15


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>