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

The discovery of biologically active peptides in mammalian atria represents an important advance in the area of cardiovascular and renal research. Atrial natriuretic factor has been isolated from atrial cardiocytes and is released into the blood after atrial stretch. It has been shown to possess important physiologic actions affecting renal hemodynamics and electrolyte excretion, smooth muscles, blood pressure and the renin-angiotensin-aldosterone system. Its participation in the pathophysiology of congestive heart failure, arrhythmia, hypertension, chronic renal failure and chronic liver disease is reviewed.
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PMID:[Atriopeptin: a new hormone in water-salt regulation]. 215 6

There was no significant difference in forearm muscle blood flow, measured by the clearance of (133)Xenon when 38 patients with liver disease were compared with 38 normal subjects. Patients with a clinically hyperdynamic circulation, finger clubbing, and previous portocaval anastomoses were included in the study. The changes in forearm skeletal muscle blood flow and pulse rate caused by a head-up tilt of 70 degrees were measured in 15 patients with chronic liver disease and 15 age-matched controls. Head-up tilting resulted in significantly less peripheral vasoconstriction and tachycardia in the group with liver disease than in the control group. These results suggest an impairment of baroreceptor-mediated sympathetic reactivity in liver disease. Such a defect might explain the relative rarity of hypertension in patients with cirrhosis.
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PMID:Skeletal muscle blood flow and neurovascular reactivity in liver disease. 471 2

We studied the effect of diabetes mellitus (DM) on mortality rate in 42,595 patients in the statewide Myocardial Infarction Data Acquisition System (MIDAS), which included patients with myocardial infarction from 90 nonfederal hospitals in New Jersey during the years 1986 and 1987. Of these patients 9695 (22.8%) had DM. DM was more prevalent among female, black, and older patients. DM was associated with higher mortality rates, both in-hospital (21.5% vs 19.2%, p < 0.001) and during 3-year follow-up (46.7% vs 37.8%, p < 0.001). This relation persisted in both men and women, blacks and whites, and all age groups. DM was an independent predictor of mortality by multivariate Cox proportional hazards regression analysis after adjustments were made for gender, race, age, hypertension, left ventricular dysfunction, chronic pulmonary disease, chronic liver disease, and anemia. This effect of DM was most pronounced in the younger age groups. Relative risk was 1.87 for age group 30 to 49, 1.36 for 50 to 69, and 1.17 for 70 to 89 years (p < 0.0001).
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PMID:Effect of diabetes mellitus on short- and long-term mortality rates of patients with acute myocardial infarction: a statewide study. Myocardial Infarction Data Acquisition System Study Group. 761 Nov 23

Monitoring treatment efficacy in patients with portal venous hypertension has been limited by the difficulty of direct or indirect assessment of portal vein pressure. The majority of currently available haemodynamic tests, such as hepatic vein wedge pressure or azygos vein flow measurement by thermodilution catheter, are invasive which has restricted their application. We describe a non-invasive cine phase contrast magnetic resonance technique for quantitative measurements of bulk volume flow and for demonstrating flow changes during the cardiac cycle in the azygos vein. The technique was used to analyse the azygos vein flow in seven adult volunteers and five patients with biopsy-confirmed chronic liver disease, portal hypertension and endoscopically proven oesophageal varices. In the volunteers the mean volume flow rates varied between 81 and 241 ml/min with a mean for the group of 171 ml/min. The patients had a significantly higher mean volume flow rate of 628 ml/min (p < 0.01), with a range of 339 to 945 ml/min. These preliminary results suggest that cine phase contrast magnetic resonance angiography is a practical non-invasive method for measuring absolute azygos vein flow, and may provide a non-invasive method of monitoring portal hypertension.
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PMID:Non-invasive measurement of azygos venous blood flow using magnetic resonance. 766 58

Thirty-one patients with portal venous hypertension underwent phase-contrast cine magnetic resonance (MR) angiography to validate the technique for assessment of main portal vein patency and blood flow direction. Correlative findings from Doppler ultrasonography, conventional angiography, and surgery were acquired in 30, 17, and 16 patients, respectively. Findings from MR angiography correlated well with those of the other methods for determining portal vein patency and flow direction. The main portal vein was patent in 29 patients and was thrombosed in two patients at MR angiography. With the use of a 40-mm slab projection acquisition that required 5 minutes, the splenic and superior mesenteric veins, as well as extensive varices (when present), were seen in the majority of cases. Phase-contrast cine MR angiography is an accurate method of rapidly assessing morphologic characteristics, patency, and flow direction of the portal venous system and thus is a useful method for evaluating the condition of patients with chronic liver disease.
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PMID:Phase-contrast cine MR angiography in chronic liver disease. 847 82

Data was compiled from a wide variety sources in order to construct a demographic profile of elderly women in Latin America. Data was organized into a cross-classification matrix based on three age groups (midlife, young old, and old old) and three country types (highly rural, mixed, and highly urban). The macro-level overview takes into account such factors as education, family structure, and employment. Smaller reports and research project reports of micro conditions are used to help explain the macro trends. Women older than 40 represented 9-20% of the population of the region (of 21 Latin American and Caribbean countries). 6-14% of midlife women were widowed, with the highest concentrations in urban countries. Widows and single women comprised about 20-35% of midlife women and 50-65% of older women. Female household headship increased with age from 9-23% in midlife to 24-41% among women 60 years and older. In all countries with the exception of Uruguay, women had less primary schooling than men. Women's salaried employment in the formal sector decreased rapidly with increasing age. For example, in highly urban countries the range of employment was from 34% of women in midlife to only 4% among women 65 years and older. Women were working, but often in the informal sector or as prostitutes or beggars. Women's health conditions included 12-37% with chronic anemia and many with signs of premature aging (early onset of diabetes, hypertension, and osteoarthritic joint changes). Depression among older women may have been as high as 40%. The strain of maintaining a double work load of child care and housekeeping and employment is unmeasured. Regardless of the level of development, older women suffered primarily from heart disease. Breast cancer was more common in urban countries. Highly rural or mixed countries had greater incidence of cervical cancer. Chronic liver disease was appearing in some countries. In highly rural countries infectious diseases and malnutrition still contributed significantly to causes of death. Most women did not have social security coverage. Evidence points to women's remarkable responses (creativity, initiative, and persistence) to fulfilling survival needs.
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PMID:Older women in Latin America: the health and socioeconomic situation of this important subgroup. 857 13

Primary biliary cirrhosis is regarded as one of the optimal indications for orthotopic liver transplantation in adults. With the decrease in the operative mortality, the analysis of the potential long-term complications including disease recurrence is becoming increasingly relevant. The purpose of this study was to evaluate the long-term results of liver transplantation for primary biliary cirrhosis in our center. From 1988, 14 patients were transplanted for this indication and all of them were alive with a mean follow-up of 43 months by the end of June 1995. At that time, all complications related to chronic liver disease were reversed by the transplant except for osteopenia. Lumbar column fractures and overweight were the major inconveniences encountered. Hypertension and diabetes related to antirejection therapy disappeared during the first year of follow-up in all but one patient. Recurrence of the disease was not encountered in this series where a triple association of immunosuppressive therapy was maintained in each patient. At long-term, the frequency of disease recurrence in the liver allograft seems quite low and even in this situation immunosuppressive agents may alter the evolution of the disease. All patients (n - 12) who had at least 1 year of follow-up had a normal level of bilirubin and their quality of life was good to excellent. These results, confirmed by the international experience, support the notion that patients suffering from primary biliary cirrhosis should be transplanted as early as complications from this chronic liver disease occur.
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PMID:[Follow-up and results of liver transplantation for primary biliary cirrhosis]. 868 Nov 15

We report a case of a patient with long-standing prehepatic portal hypertension. The patient (a 43-year-old parous 2012 female with a history of 2 full-term pregnancies and normal deliveries, plus a spontaneous abortion) incurred spontaneous abortion at the 7th week of gestation. An early, spontaneous abortion avoided this patient running severe risks in late pregnancy. The overall estimated risk of bleeding in patients with portal hypertension, reported in the literature, is 400 times greater than in normal pregnancy. The association with aneurysm of splenic artery increases the likelihood of bleeding because intra-abdominal pressure adds to the risk of rupture of the aneurysms. In our opinion, a patient of fertile age, with pre-hepatic hypertension and associated chronic liver disease, should be treated with contraceptives to avoid any pregnancy-induced risk of complications.
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PMID:Portal hypertension in a pregnant woman. 878 70

This review describes recent progress in the accumulation of knowledge about the endothelins (ETs), a family of vasoactive 21-amino acid polypeptides, in chronic liver disease. Particular prominence is given to the dynamics of ET-1 and ET-3 and their possible relation to the disturbed circulation and neurohumoral dysregulation found in cirrhosis. Recent studies have shown that the ET system is highly activated in most cirrhotic patients. Circulating ET-1 and ET-3 levels have a positive relation to the severity of the disease and fluid retention, with the highest values recorded in patients with functional renal failure. Studies on liver biopsies have revealed synthesis of ET-1 in hepatic endothelial and other cells, and recent investigations have identified the hepatosplanchnic system as a major source of ET-1 and ET-3 spillover into the circulation, with a direct relation to portal venous hypertension. In addition, marked associations with disturbance of systemic haemodynamics and with abnormal distribution of blood volume have been reported. Although the pathophysiological importance of the ET system in chronic liver disease is not completely understood, similarities to other vasopressive and antinatriuretic regulatory systems (i.e. the sympathetic nervous system, renin-angiotensin-aldosterone and vasopressin) are apparent, with respect to kinetics and haemodynamic dysregulation. Cirrhosis seems to be a pathophysiological condition with indications of the occurrence of ETs, not only as local modulators, but also as a system with potential importance for systemic regulation.
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PMID:Endothelins in chronic liver disease. 890 9

The association of pulmonary hypertension with portal hypertension, also called portopulmonary hypertension (PPHTN), is a known complication of chronic liver disease. Previously, the presence of PPHTN was considered to be a contraindication to orthotopic liver transplantation (OLT). Although there are selected case reports of successful OLT in the setting of PPHTN, an excessive mortality rate is associated with OLT and PPHTN. Heretofore, therapy for chronic management of PPHTN was lacking. Recently, continuous intravenous infusion of epoprostenol has been demonstrated to improve symptomatology and survival in the general population of patients with primary pulmonary hypertension. We now report the use of epoprostenol in the more specific instance of PPHTN. Over a period of 6-14 months, epoprostenol (10-28 ng/kg/min) therapy was associated with a 29-46% decrease in mean pulmonary artery pressure, a 22-71% decrease in pulmonary vascular resistance, and a 25-75% increase in cardiac output in a group of four patients. These results suggest that effective chronic therapy for PPHTN is available. In conjunction with inhaled nitric oxide as acute intraoperative therapy, epoprostenol infusion represents an additional therapeutic option for treatment of PPHTN in the liver transplant candidate.
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PMID:Continuous intravenous infusion of epoprostenol for the treatment of portopulmonary hypertension. 904 58


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