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

The study population consisted of 248 patients with at least five-year (mean 8.7+/-4.2 yrs.) history of drinking, mean age (48+/-4.2 years), including 132 subjects with arterial hypertension (mild or moderate according to WHO/ISH guidelines) and 116 normotensives. A group of 48 patients with essential arterial hypertension not consuming alcohol served as controls. Groups of alcoholics with hypertension, alcoholics with normal blood pressure and the controls were compared with respect to differences in standard BP measurements and 24hr blood pressure monitoring, left ventricular mass index, systolic and diastolic left ventricular function by echocardiography. In alcohol-dependent subjects the left ventricular mass index progressed with the increasing declared consumption of ethanol and duration of abuse. The incidence of LVH in drinking hypertensives (28%) did not differ from that in non drinking hypertensives (26%), p>0.05. In hypertensives irrespective of ethanol consumption delayed relaxation was a marker of left ventricular diastolic dysfunction. The present study did not confirm the hypothesis that left ventricular hypertrophy was responsible for diastolic impairment in alcohol abusers. Chronic ethanol consumption significantly deteriorated left ventricular diastolic function irrespective of its effect on blood pressure and left ventricular mass. In patients with the highest level of ethanol consumption and the longest duration of abuse ejection fraction was significantly lower than in patients with the lowest level of alcohol consumption and the shortest duration of abuse (EF 61.8% vs. EF 67.4%, p<0.05). Thus, the deterioration of systolic function is significantly related with the level of alcohol consumption and duration of abuse.
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PMID:The effect of chronic alcohol consumption on systolic and diastolic left ventricular function. 1580 94

In civilized countries blood pressure is increased in association with age. Elderly population is lately increased both in Japan and Western countries and therefore elderly hypertensive patients are expected to increase. Recently, several guidelines and statements for the treatment of hypertension, such as JNC 7, 2003 ESH/ESC, 2003 WHO/ISH, and BSH IV, are reported in Western countries. In Japan, Japanese Society of Hypertension reported guidelines for management of hypertension in 2000 (JSH 2000) and JSH 2000 is now revised and a new version was published at the end of 2004 (JSH 2004). In this article, management of hypertension (when starts the treatment, target blood pressure level, and choice of drugs, etc) in the elderly is described based on these guidelines and statements.
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PMID:[Treatment of elderly hypertension based on various hypertension management guidelines--comparison between European and American guidelines and Japanese guidelines]. 1594 74

The study objective was to assess the prevalence, level of awareness of treatment, and control of hypertension in a general population. We conducted a cross-sectional survey on 1837 adults 40-69 years old. Hypertension and control level are defined according to the WHO/ISH recommendations. HBP is defined as SBP > or = 140 and or DBP > or = 90 mm Hg and the use of blood pressure-lowering medication. Hypertension is controlled by medication if SBP < 140 and DBP < 90 mm Hg. We conduct analysis by socio demographic variable, medical history and CHDs risk factors. 44.3% of adults was hypertensive. The prevalence of hypertension was higher among women (48.2% versus 38.7% on men) and it increases in both genders with age, body mass index. Only 41% of the hypertensive were aware of having hypertension, among them, 74.1% declare that they are treated but only 13.2% were controlled. The study highlights the problem of the hypertension in a developing country. It contributes to identify the huge iceberg of this CVDs risk factor. The national strategy must focus on the population life style and drugs management. The question is how much will be the cost of HBP and CVDs control for a country which has a limited resources.
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PMID:[Hypertension prevalence, awareness, treatment and control: results from a community based survey]. 1609 50

The Task Force of the National Heart, Lung and Blood institute issued the first standardized, algorithmic approach to treating hypertension in 1973. The concept of a stepped-care approach was born at that time. Their initial recommendation for antihypertensive drug therapy was diuretics. Subsequent Joint National Committee (JNC) Reports on Detection, Evaluation, and Treatment of High Blood Pressure recommended that initial drug therapy be either a diuretic or beta-adrenergic blocker, and then either of these two drugs, and then a calcium channel blocker (CCB) or an angiotensin-converting enzyme inhibitor (ACE-inhibitors). The JNC-V then recommended any of the four classes or an alpha-beta-blocker as initial therapy, but diuretics and b-blockers were preferable. That diuretics or beta-blockers should be the initial drug for noncomplicated hypertensive patient was also the recommendation of the Sixth Joint National committee report. Safety issues that arose after introduction ACE inhibitors and CCBs have since been mostly resolved. Drug treatment thresholds varied among the US, Canadian, British and WHO/ISH recommendations despite the fact that all were based on the same set of data. The concept of "the lower the blood pressure the better without causing symptoms" was the rule until the J-curve hypothesis emerged and generated a long debate. Now the current evidence supports the old concept, at least for some conditions such as hypertension in diabetic patients or in those with nephrotic-range proteinuria. Despite the repeated recommendations that thiazide-diuretics are preferred as the initial agent in hypertension treatment, many clinicians ignore these guidelines. This practice has added a signficant cost to hypertension treatment worldwide.
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PMID:The need for evidence in hypertension management: historical perspective. 1627 Jul 57

The aim of this study was to evaluate the relationship between serum testosterone levels and arterial blood pressure (BP) in the elderly. We studied 356 non-diabetic, non-smoking, non-obese men aged 60 to 80 years and untreated for hypertension. All subjects were evaluated in the morning after an overnight fast. Evaluation included measurements of the following: BP (by mercury sphygmomanometer, Korotkoff I and V), body weight, height and free testosterone (T) plasma levels (by radioimmunoassay). According to the BP values, the subjects were classified as normotensives (NT; n=112; SBP/DBP<140/90 mmHg), systolic and diastolic hypertensives (HT; n=127; SBP/DBP>140/90 mmHg), and isolated systolic hypertensives (ISH; n=117; SBP>140 mmHg and DBP<90 mmHg). T values decreased with increasing age in all 3 groups and was significantly lower in HT (-15%) and ISH men (-21%) than in NT men (p<0.05). In each group, the T levels showed a highly significant negative correlation with BMI (p<0.001). A significant negative correlation was also found between T levels and SBP in NT (r=-0.35, p<0.001), ISH (r=-0.67, p<0.001), and HT (r=-0.19, p<0.05) men, whereas a negative correlation with DBP was observed only in the NT men (r=-0.19, p<0.05). Adjusting for the BMI confirmed a significant difference in plasma T levels between ISH and NT men, but not between HT and NT men. Multiple regression analysis employing BP as a dependent variable confirmed a strong relationship between T levels and SBP in all 3 groups, whereas a significant relationship between T levels and DBP was found only in NT men. In conclusion, although further studies are needed to clarify the relationship between plasma T levels and BP, our findings suggest that in elderly men with ISH, the reduced plasma levels of testosterone might contribute to the increased arterial stiffness typical of these subjects.
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PMID:Serum testosterone levels and arterial blood pressure in the elderly. 1639 65

To examine the impact of age on the relationship between blood pressure (BP) levels and each of cardiovascular disease mortality and all-cause mortality, a total of 30,226 men and 58,798 women aged 40-79 years who had no history of stroke or heart disease underwent health checkups in Ibaraki-ken, Japan, in 1993 and were followed through 2002. Risk ratios for mortality by BP category based on the 1999 WHO-ISH guidelines were calculated by age subgroups (40-59 years, 60-79 years) using a Cox proportional hazards model. Compared with optimal BP levels, the multivariate risk ratios of cardiovascular mortality for stage 2 or 3 hypertension were 5.99 (95% confidence interval: 2.13-16.8) in middle-aged men and 4.09 (1.70-9.85) in middle-aged women. These excess cardiovascular mortality risks were larger in the 40-59 years age group than in the 60-79 years age group for both genders (p for interaction = 0.01 for both). In men, the population attributable risk percents of cardiovascular mortality were 60% for younger men and 28% for older men, while for women they were 15% for younger women and 7% for older women. Weaker but significant excess risks of total mortality were observed for stage 2 or 3 hypertension in men of both age groups and in the older age group for women. The impact of BP on the risk of cardiovascular mortality was larger among middle-aged persons than among the elderly in both men and women. Our findings indicate the importance of BP control to prevent cardiovascular disease among middle-aged individuals.
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PMID:Age-specific relationship between blood pressure and the risk of total and cardiovascular mortality in Japanese men and women. 1655 79

Nebivolol has been adequately tested in clinical efficacy trials of patients with mild hypertension. Clinical efficacy trials or their meta-analyses did not accurately predict the outcome of subsequent large studies. The primary objective was to assess the efficacy/safety of nebivolol 5-10 mg daily in a nationwide study of patients with mild hypertension. Secondary objectives were (1) to compare efficacy/safety as monotherapy versus add-on therapy and (2) to assess the effect of nebivolol on ISH. This was an open-label, 6-week follow-up study of 6,356 patients with mild hypertension or ISH, as defined by the 1999 World Health Organization guidelines, recruited from 2,700 facilities. Previous monotherapies were continued except for beta-blockers. Results are reported as means+/-SDs. Intention-to-treat analysis is given. A total of 5,740 patients completed the study; of the withdrawals, 90% were lost for follow-up or were noncompliant, 38% were untreated before, 23% had beta-blockers. In the accumulated data, mean systolic and diastolic blood pressures fell by 24+/-14 and 13+/-9 mm Hg (both P<0.001). The differences between the blood pressure-reducing effects of nebivolol monotherapy and add-on therapy were not statistically significant: 28+/-16 and 22+/-14 mm Hg for systolic and 15+/-11 and 11+/-8 mm Hg for diastolic blood pressures. Adverse events were limited to 0.5% of the patients, no serious adverse events were observed. In the ISH patients, diastolic blood pressure fell by 4+/-6 mm Hg compared with 15+/-10 mm Hg in the no-ISH patients (P<0.01). Efficacy-safety effects of nebivolol in patients with mild hypertension can be generalized in a nationwide assessment. The efficacy of nebivolol as monotherapy and as the efficacy as add-on therapy are very similar. Nebivolol is highly efficacious in patients with ISH.
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PMID:Nationwide efficacy-safety study of nebivolol in mildly hypertensive patients. 1677 59

For hypertensive patients with renal diseases (RD), strict blood pressure (BP) control has been recommended in recent hypertension guidelines, such as JNC VI, JNC 7, WHO/ISH 1999 and ESH-ESC 2003. We assessed the current status of BP control and the changes of BP control before and after the publication of these guidelines in 489 hypertensive patients with or without RD (age, 19-89 years, mean 59+/-13 years) who visited the hypertension and kidney outpatient clinic at Kyushu University Hospital. The clinical characteristics of RD and non-RD patients were assessed (RD patients: age, 20-89 years, mean 60+/-13 years, n=311; non-RD patients: age, 19-86 years, mean 58+/-13 years, n=178). In addition, we compared the BP control status in 2003 to that in 1996. In 2003, the BP in RD patients was 134+/-16/78+/-10 mmHg and that in non-RD patients was 138+/-12/83+/-9 mmHg. When strict BP control was defined as <130/80 mmHg, the frequency of strict BP control in RD patients was 28.9% in 2003. In addition, the BP levels of RD patients in 2003 were significantly lower than those in 1996 (134+/-16/78+/-10 mmHg vs. 141+/-17/85+/-10 mmHg, p<0.05 for both systolic blood pressure [SBP] and diastolic blood pressure [DBP]), and the frequency of strict BP control in RD patients was higher in 2003 than in 1996 (28.9% vs. 11.8%, p<0.01). The BP levels of non-RD patients in 2003 tended to be lower than those in 1996 (138+/-12/83+/-9 mmHg vs. 141+/-13/85+/-9 mmHg, n.s.). In 2003, angiotensin II receptor blockers (ARBs) were more frequently prescribed to RD patients than to non-RD patients. Furthermore, the use of ARBs was markedly increased in 2003 compared with 1996. In conclusion, in our outpatient clinic, BP levels in hypertensive patients with RD have improved in recent years, and were lower than those in hypertensive patients without RD, which may in part reflect the physicians' awareness of the importance of strict BP control in RD patients, as suggested by several recent hypertension guidelines.
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PMID:Improvement of blood pressure control in hypertensive patients with renal diseases. 1754 Dec 7

The purpose of this study was to determine the relationship between hypertension and onset of cardiovascular disease in Japan. As part of an ongoing epidemiological survey of cardiovascular diseases in Hokkaido, Japan, 1,798 subjects (806 males and 992 females; mean age in the initial year of the survey, 58.6+/-11.8 years) were selected, after excluding subjects who had been taking antihypertensive drugs, from a total of 2,136 subjects who had undergone medical examinations in 1991 in the town of Tanno and in 1992 in the town of Sobetsu, two rural communities in Hokkaido. Height, weight, casual systolic and diastolic blood pressures in the sitting position and blood biochemical values of all subjects were measured, and the subjects were divided into blood pressure level groups according to the 1999 World Health Organization/International Society of Hypertension (WHO/ISH) criteria. The follow-up survey was concluded at the end of August in 1999. The endpoints in this study were onset of circulatory disease or death due to circulatory disease. During the follow-up period, circulatory diseases (ischemic heart disease or stroke) occurred in 94 of the subjects. The incidence rates of cardiovascular disease (per 1,000 persons/year) for subjects divided into blood pressure groups according to the 1999 WHO/ISH blood pressure classification were 6.24 for the optimal+normal blood pressure level group, 11.26 for the normal high blood pressure level group, and 15.83 for the grade 1-3 hypertension group. Thus, the incidence rate of circulatory disease increased as the blood pressure level increased, and there was a significant difference between the incidence rate in subjects in the grade 1-3 hypertension group and the incidence rate in subjects in the optimal+normal blood pressure level group (p<0.05). In a Cox's proportional hazards model with onset of circulatory disease as the endpoint, diastolic blood pressure was shown to be an independent risk factor with a relative risk of 1.01. The results suggest that hypertension is an independent risk factor for onset of circulatory disease.
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PMID:Influence of hypertension on the incidence of cardiovascular disease in two rural communities in Japan: the Tanno-Sobetsu [corrected] study. 1791 14

A cross-sectional study was carried out in Udo, a rural community in Ovia South-west LGA of Edo State to assess the level of awareness of high blood pressure status, treatment and control. Cluster sampling method was used to select participants and data collection was by researcher administered questionnaire. Blood pressure measurement was by standardized method. A total of 590 respondents with mean age 30.7 +/- 14.6 years participated in the study. The prevalence of hypertension was 20.2% using the WHO/ISH criteria of SBP > or = 140 mmHg and/or DBP > or = 90 mmHg. Twenty two (18.5%) of the hypertensives were aware of their high blood pressure status. Awareness was higher in females, increased with age and decreased with higher educational status. Of those aware of their condition, 77.3% were on treatment and ofthese, 29.4% had adequate blood pressure control. This study has revealed a low level of awareness of high blood pressure status and control in this rural community. Therefore, there is urgent need for regular community-based hypertension screening programmes.
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PMID:Awareness of high blood pressure status, treatment and control in a rural community in Edo State. 1807 46


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