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

It is claimed that long-term treatment with beta-blockers improves cardiac function and exercise capacity in patients with various forms of congestive heart failure. This was first reported by Waagstein and coworkers in patients with idiopathic dilated cardiomyopathy in 1975 and was later confirmed in 8 further studies in this type of patient. A total of 211 patients with idiopathic dilated cardiomyopathy were treated for 12-19 months. About two thirds of the patients have improved to some extent. Seven other studies reported favourable long-term effects of beta-blockers in 120 patients with other forms of dilated cardiomyopathy, e.g. caused by coronary artery disease, adriamycin, diabetes, or valvular heart disease. Pooled data from 10 studies on 153 patients with various forms of cardiomyopathy, showed that ejection fraction was improved by 40% from 27 to 38%. Only two studies were inconclusive, both with only one month's treatment. In all studies with favourable effects of long-term beta-blockade, treatment was given for more than 2 months and in most cases for about 6 months. A number of beta-blockers have been used in the studies, including acebutulol, alprenolol, bucindolol, labetalol, metoprolol, practolol and propranolol. In most cases, a rather low dose was given initially and there was a stepwise increase in the dosages. After 6-8 weeks most patients were given beta-blockers in daily doses comparable to those given in patients with angina pectoris and hypertension. There is at present no indication that one beta-blocker is superior to others. It therefore seems reasonable to believe that the effects are due to beta 1-blockade.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:New therapeutic strategies in chronic heart failure: challenge of long-term beta-blockade. 168 18

Up to now only 30 to 40% of patients who die suddenly can be identified as likely candidates before the event. Risk factors in these asymptomatic subjects include a familial history of coronary artery disease, high blood cholesterol levels, hypertension, smoking and, more importantly, an abnormal ECG at rest or during exercise. The predictive value of these abnormalities is too low to justify more detailed clinical investigations in most of these asymptomatic subjects. Exceptions might be the group of patients with multiple risk factors and competitive sportsmen. Sudden cardiac death is a well known complication in patients with hypertrophic and dilated cardiomyopathy. Risk factors in hypertrophic cardiomyopathy include a familial history of this disease, syncope and increasing age. Furthermore, in the adult, the presence of nonsustained episodes of ventricular tachycardia during Holter monitoring seems to indicate an increased risk of sudden cardiac death. In idiopathic dilated cardiomyopathy, the presence of frequent episodes of ventricular pairs and/or episodes of ventricular tachycardia during Holter monitoring, together with a reduced left ventricular ejection fraction, characterises the patient at risk of sudden cardiac death. In patients with coronary artery disease, the patient at risk of sudden cardiac death can be identified by investigating the following: coronary anatomy; global and regional left ventricular function; the presence of ischaemia during rest and/or exercise; the presence of late potentials, by means of the signal-averaged ECG; the presence of spontaneous ventricular arrhythmias (especially sustained and nonsustained ventricular tachycardia); and the results of electrophysiological testing. On the basis of these investigations, 3 subgroups can be distinguished: patients at low risk, medium risk, and high risk of sudden cardiac death.
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PMID:Can we predict sudden cardiac death? 171 71

An epidemiologic study of idiopathic dilated cardiomyopathy was carried out in order to identify possible risk factors for this often fatal cause of heart failure in young adults. Possible associations with black race and other genetic and environmental factors were examined by comparing newly diagnosed cases ascertained from four Baltimore hospitals (n = 95) with neighborhood controls (n = 95), matched on sex and 5-year age intervals. Matched and unmatched relative odds and conditional logistic regression coefficients were obtained to describe the associations. Statistically significant, independent associations were observed between idiopathic dilated cardiomyopathy and black race, low annual income, and history of asthma (p less than 0.05). The black predominance (relative odds = 2.7, 95% confidence interval 2.0-3.4) was not explained by income, alcohol consumption, cigarette usage, body mass index, hypertension, or asthma. A possible interactive effect was observed between black race and history of asthma and other atopic diseases. Thus, blacks, especially those with a history of hypersensitivity, may represent a high-risk subgroup in need of preventive care or early intervention.
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PMID:The epidemiology of idiopathic dilated cardiomyopathy in a biracial community. 229 52

6 patients, 37-55 years old, who underwent heart transplantation in Belgium, have been followed in our clinic for the past 2 years. All had suffered for 6-12 months from congestive heart failure which had not responded to intensive medical treatment and were considered terminal. 5 had had ischemic heart disease and 1 idiopathic dilated cardiomyopathy. After transplantation all patients were again in good physical condition and 5 of them had resumed a productive lifestyle. In 3, follow-up endomyocardial biopsies revealed episodes of "moderate rejection" of the transplant, all of which were successfully treated with pulse courses of corticosteroids and increased cyclosporine dosage. Mild renal failure developed in 3, and in 3 systemic hypertension, controlled by antihypertensive drugs. 4 patients examined in our department and found suitable for transplantation died before a compatible donor was found. In 2 other patients heart transplantation was not possible due to severe pulmonary hypertension. Heart transplantation is recommended for patients with terminal congestive heart failure unresponsive to medical treatment. Early transplantation prevents irreversible changes in the pulmonary vessels which would make operation impossible, and lowers operative risk.
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PMID:[Follow-up of heart transplants]. 265 Dec 34

During the intervening years since metoprolol was first reviewed in the Journal (1977), it has become widely used in the treatment of mild to moderate hypertension and angina pectoris. Although much data have accumulated, its precise mechanisms of action in these diseases remain largely uncertain. Optimum treatment of hypertension and angina pectoris with metoprolol is achieved through dose titration within the therapeutic range. It has been clearly demonstrated that metoprolol is at least as effective as other beta-blockers, diuretics and certain calcium antagonists in the majority of patients. Although a twice daily dosage regimen is normally used, satisfactory control can be maintained in many patients with single daily doses of conventional or, more frequently, slow release formulations. Addition of a diuretic may improve the overall response rate in hypertension. Several controlled trials have studied the effects of metoprolol administered during the acute phase and after myocardial infarction. In early intervention trials a reduction in total mortality was achieved in one moderately large trial of prolonged treatment, but in another, which excluded patients already being treated with beta-blockers or certain calcium antagonists and where treatment was only short term, mortality was significantly reduced only in 'high risk' patients. Overall results with metoprolol have not demonstrated that early intervention treatment in all patients produces clinically important improvement in short term mortality. Thus, the use of metoprolol during the early stages of myocardial infarction is controversial, largely because of the requirement to treat all patients to save a small number at 'high risk'. This blanket coverage approach to treatment may be more justified during the post-infarction follow-up phase since it has been shown that metoprolol slightly, but significantly, reduces the mortality rate for periods of up to 3 years. Metoprolol is generally well tolerated and its beta 1-selectivity may facilitate its administration to certain patients (e.g. asthmatics and diabetics) in whom non-selective beta-blockers are contraindicated. Temporary fatigue, dizziness and headache are among the most frequently reported side effects. After a decade of use, metoprolol is well established as a first choice drug in mild to moderate hypertension and stable angina, and is beneficial in post-infarction patients. Further study is needed in less well established areas of treatment such as cardiac arrhythmias, idiopathic dilated cardiomyopathy and hypertensive cardiomegaly.
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PMID:Metoprolol. An updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in hypertension, ischaemic heart disease and related cardiovascular disorders. 294 80

To clarify the pathophysiologic role of intramyocardial small artery (IMSA) diseases in hypertrophied hearts, narrowings of the IMSA were quantitatively evaluated in 39 autopsied hearts, 10 from patients with typical hypertrophic cardiomyopathy (HCM), four from patients with HCM showing features mimicking dilated cardiomyopathy (DCM-like HCM), 10 from patients with hypertension, and 15 from normal adults. The relations of narrowings of the IMSA to myocytic hypertrophy, myocardial fiber disarray, and fibrosis were also examined. The external caliber and the ratio of the luminal area to the total vascular area (percent luminal area, % lumen) were calculated by an image analyzer in 85 to 203 IMSAs from each patient. The external calibers of the IMSAs were similar among groups of hearts with HCM, hypertensive hearts, and normal hearts but were greater in those with DCM-like HCM. The mean % lumen of the IMSAs was similarly reduced in the hearts with HCM (29 +/- 5% in the ventricular septum and 31 +/- 5% in the left ventricular free wall) and in hypertensive hearts (30 +/- 8% and 31 +/- 7%) compared with that in normal hearts (40 +/- 5% and 38 +/- 5%) and was the lowest in the ventricular septum of hearts with DCM-like HCM (17 +/- 3%). The mean % lumen of the IMSA was inversely correlated with heart weight (r = -.59), the mean size of myocytes (r = -.66 in the ventricular septum, r = -.63 in the free wall), and percent fibrotic area in the septum (r = -.68). The mean % lumen values of the IMSAs in the tissues with and without disarray in the hearts with HCM were similar. Thus IMSA disease is of pathophysiologic importance in patients with HCM, DCM-like HCM in particular, or with hypertension.
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PMID:Quantitative analysis of narrowings of intramyocardial small arteries in normal hearts, hypertensive hearts, and hearts with hypertrophic cardiomyopathy. 355 6

The relation between transmitral flow and diastolic mitral valve motion were examined in 17 normal persons, 14 patients with hypertension and 12 patients with idiopathic dilated cardiomyopathy. M-mode echograms were analyzed for early and late diastolic mitral leaflet separations, their ratio and E-F slope. Pulsed Doppler transmitral flow was analyzed for early and late velocities, their ratio and early flow deceleration. Early diastolic mitral valve leaflet separation was reduced in patients with hypertension (at 28 +/- 5 mm [p less than 0.05] ) and in patients with cardiomyopathy (at 22 +/- 3 mm [p less than 0.01] ). Flow velocity was also reduced in patients with hypertension (at 52 +/- 11 cm/s [p less than 0.05] ) and in patients with cardiomyopathy (at 48 +/- 15 cm/s [p less than 0.01] ). However, early leaflet separation and flow velocity were not related (r = 0.26). Late diastolic leaflet separation was similar (at 25 +/- 5 mm) in normal subjects and in those with hypertension (at 23 +/- 6 mm), but was reduced in patients with cardiomyopathy (at 18 +/- 3 mm [p less than 0.01] ). In contrast, late flow velocity was increased in patients with hypertension (at 52 +/- 12 cm/s [p less than 0.05] ) but unchanged in patients with cardiomyopathy (at 42 +/- 16 cm/s). The ratio of early to late leaflet separation was similar in all groups, whereas the ratio of flow velocities was reduced in hypertensive patients. Neither the E-F slope not early flow deceleration was altered in either pathologic group. Thus, hypertension and cardiomyopathy had similar effects in early rather than late diastole.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Variable responses of mitral valve motion and flow in systemic hypertension and in idiopathic dilated cardiomyopathy. 361 97

The authors studied Brazilian maternal mortality by examining official statistics from the country's various geographical regions, including the state of Sao Paulo, Brazil. 1980 was selected because of the possibility of working with data from the Population Census of that year. The principal causes of death in Brazil were hypertension, hemorrhage, puerperal infection, and abortion. In Sao Paulo, where the 4th digit of the IDC is used, the main cause of death was eclampsia. The 2nd was hemorrhage, and the 3rd was infection, whether due to or associated with pregnancy. As for age, the lowest maternal mortality rate occurred in the 20-29 year old age group, the rate was slightly higher for those ages 15-19, and increasing gradually in those ages 30-39 and 40-49. It was not possible to analyze the rates for those ages 10-14 and over age 50 because of lack of data on livebirths. However, there were 18 deaths and 4 deaths respectively in those groups which shows that at opposite poles of the reproductive span, there exists a considerably high mortality rate. In comparing these data with those of other countries, it was found that the majority of deaths are avoidable and that it should be possible to reduce the number considerably by means of better health care for women and by using techniques and resources which are already available. (author's modified)
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PMID:[Maternal mortality in Brazil, 1980]. 653 15

To analyze the determinants of left ventricular (LV) reserve non-invasively, LV echocardiograms were taken during ergometer exercise in 52 LV disease patients (19 with hypertension [HT], 22 with aortic regurgitation [AR] and 11 with dilated cardiomyopathy [DCM] with various severities. In mild cases [HT], at exercise, fractional shortening (FS) increased, and at higher-grade exercise, an increase of LV enddiastolic diameter (Dd) was added to more increase of FS, to increase stroke volume (SV). In moderately severe cases [HT, AR or DCM], FS did not change or decreased at exercise. In severe cases [AR or DCM], FS was low at rest, and at exercise decreased further with an increase of LV systolic stress and no significant increase of Dd, resulting in a decrease of SV. The responses of LV parameters in volume-overload (AR) or dilated myocardial (DCM) hearts were poorer than in pressure-overload (HT) hearts, in moderately severe cases. In conclusion, exercise echocardiography can show non-invasively that the interrelationship among the determinants of LV reserve is different by the severities and the types of LV diseases, and this method is useful, especially in discriminating mild cases objectively.
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PMID:Evaluation of left ventricular reserve in left ventricular diseases: non-invasive analysis of its determinants by dynamic exercise echocardiography. 660 83

Pregnancy causes substantial changes in the cardiovascular system: cardiac output (40%-50%) and blood volume (40%) increase whereas systemic peripheral resistance and arterial pressure decrease. The rise in progesterone and estrogen levels accompanying pregnancy stimulates the renin-angiotensin-aldosterone system. Increased prostaglandin production follows renin activation; simultaneously, the arterial vessels show diminished angiotensin sensitivity. The result is pronounced vasodilatation. Cardiovascular diseases remain the most important nonobstetric cause of maternal death. The physiological changes in the cardiovascular system during pregnancy influence cardiac diseases in different ways. Pregnancy, labor, and delivery appear to be well tolerated in gravidae with an atrial septal defect, ventricular septal defect, and patent ductus arteriosus. Sometimes congestive heart failure occurs and appropriate medical therapy is necessary. Pregnant women with uncorrected cyanotic congenital heart disease (Eisenmenger's syndrome, tetralogy of Fallot) constitute a high-risk group because of right ventricular insufficiency and hypoxic attacks. The consequences for anaesthesia in parturients with congenital heart disease are discussed. The symptoms of acquired mitral or aortic stenosis are aggravated by the physiological changes in the cardiovascular system during pregnancy; the clinical symptoms of valve insufficiency are ameliorated by vasodilatation. Peripartum cardiomyopathy clinically shows similar features to idiopathic dilated cardiomyopathy. The basis of treatment is the same as that of congestive heart failure, with the therapeutic spectrum ranging from diet to heart transplantation. Women with hypertrophic cardiomyopathy tolerate pregnancy, labor, and delivery surprisingly well. Vaginal delivery is possible, but epidural anaesthesia is contraindicated. Hypertensive disorders associated with pregnancy are classified into three groups: chronic, transient, and pre-eclamptic hypertension. Whereas chronic and transient hypertension do not affect the outcome of pregnancy appreciably, pre-eclampsia presents a potential danger to mother and fetus. Pre-eclamptic hypertension is accompanied by low cardiac output and plasma volume. An upregulation of angiotensin receptors enhances vascular reactivity, with the consequence of high peripheral resistance. For antihypertensive therapy hydralazine, alpha-methyldopa, and magnesium sulfate are the drugs of choice. A generalised recommendation of anaesthesia for the pre-eclamptic gravida cannot be made because both general and epidural anaesthesia have risks of severe side effects.
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PMID:[Cardiovascular diseases during pregnancy. Considerations for the anesthesiologist]. 765 90


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