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

Because of their action as cerebral vasodilators, dihydropyridine calcium antagonists have received intense scrutiny for their potential benefit in ameliorating the devastating consequences of delayed cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). From October, 1987, to September, 1989, 41 North American neurosurgical centers in the Cooperative Aneurysm Study accrued 906 patients with recent (Days 0 to 7) aneurysmal SAH into a prospective randomized double-blind placebo-controlled trial of high-dose intravenous nicardipine to test whether treatment with this agent improved overall outcome. Eligible patients received 0.15 mg/kg/hr of either nicardipine or placebo by continuous infusion for up to 14 days following hemorrhage. The 449 patients randomly assigned to the nicardipine-treated group and the 457 patients assigned to the placebo-treated group were balanced with regard to prognostic factors for ischemic deficits from vasospasm and for overall outcome. Other medical and surgical interventions were used with similar frequency in both groups, except that antihypertensive agents were used less frequently in the nicardipine-treated patients (26% of the nicardipine-treated group vs. 43% of the placebo-treated group, p < 0.001), and more patients in the placebo-treated group had intentional hypervolemia, induced hypertension, and/or hemodilution administered therapeutically for symptomatic vasospasm (38% of the placebo-treated group vs. 25% of the nicardipine-treated group, p < 0.001). The incidence of symptomatic vasospasm during the treatment period was higher in the placebo-treated group (46%) than in the nicardipine-treated group (32%) (p < 0.001). Despite the reduction in symptomatic vasospasm in the nicardipine-treated group, overall outcome at 3 months was similar between the two groups. Fifty-five percent of nicardipine-treated patients were rated as having a good recovery according to the Glasgow Outcome Scale at follow-up review and 17% were dead, compared to 56% and 18%, respectively, in the placebo-treated group (not statistically significant). These data suggest that high-dose intravenous nicardipine treatment is associated with a reduced incidence of symptomatic vasospasm in patients with recent aneurysmal SAH, but not with an improvement in overall outcome at 3 months when compared to standard management in North America. It is postulated that, while nicardipine prevents vasospasm, hypertensive/hypervolemic therapy may be effective in reversing ischemic deficits from vasospasm once they occur.
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PMID:A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. 845 Mar 26

Hypertension can be a cause as well as a consequence of renal disease. Fluid overload or activation of the renin angiotensin system by glomerular ischemia leads to an elevation of systemic blood pressure in acute as well as chronic renal disease. Furthermore in the latter disorder an increased activity of the sympathetic nervous system as well as metabolic disorders contribute to hypertension. Accordingly antihypertensive therapy in patients with renal insufficiency is diverse. Additionally in chronic kidney disease one has to consider the variable effects of different antihypertensive drugs on intrarenal hemodynamics.
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PMID:[Antihypertensive therapy in renal failure]. 857 52

To investigate a possible pathophysiological role of human adrenomedullin (AM), we measured the plasma concentration of immunoreactive-AM (ir-AM) in 38 patients with end-stage renal disease (ESRD) on hemodialysis (HD) and 38 healthy subjects (age and sex matched). In addition, plasma ir-AM was characterized by a reverse-phase high performance liquid chromatography. The mean value (+/- SEM) of plasma AM in the patients before HD (10.1 +/- 0.67 fmol/ml) was markedly higher than that in the control group (2.9 +/- 0.13 fmol/ml, p < 0.001), but plasma AM levels were not altered by HD. There was a significant correlation between plasma AM levels and mean blood pressure (MBP) in a group of subjects including both patients before HD and healthy subjects (p < 0.01). In chromatographic study, the major peak of ir-AM in the plasma from patients on HD, as well as healthy subjects, emerged at an elution time identical to that of synthetic AM, indicating that the active form of AM was present in the circulating blood. The secretion of AM seemed to be increased in response to the conditions elicited by ESRD such as hypervolemia and/or hypertension, and reduced renal excretion of the peptide may also contribute to its high plasma level.
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PMID:Plasma concentration of human adrenomedullin in patients on hemodialysis. 871 51

To develop criteria for determining predisposition to pulmonary edema in patients with glomerulonephritis, clinical, laboratory and X-ray examinations were made in 697 patients with glomerulonephritis at different stages of its development. X-ray examination included chest tele X-ray and its densitometric analysis. Twenty two patients underwent computerized tomography with histographic analysis. In 106 patients, X-ray findings were compared with the volume of circulating blood, cardiac and stroke indices. Changes in the lungs and pleural cavities were found in 22.7%, pulmonary edema was revealed in 15.7% of the patients. The prognostically unfavourable criteria for the development of pulmonary edema were found to be Stage II pulmonary venous hypertension with hypervolemia and peripheral edemas. The densitometrically detected increase in the density of the lower lungs in patients with Stage II venous hypertension suggests early manifestations of interstitial edema of the lung and the narrowing of the histogram angle limited by its ascending and descending lines is indicative of the fact that interstitial edema progresses to alveolar one.
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PMID:[The x-ray diagnosis of a predisposition to nephrogenic pulmonary edema in glomerulonephritis patients]. 875 10

The arterial hypertension, hyperlipidemia, fluid overload, electrolytic disorders, the presence of arteriovenous fistula and secondary hyperparathyroidism are the most essential causative factors in cardiac pathology of uremic patients. Apart from that, hemodialysis itself is not an indifferent factor. The cardiac consequences consist in prevalence of hypertrophy or dilatation of the heart including valvular annuli or sheer myocardial calcifications and even the acquired heart diseases. Their coexistence with ischaemic heart disease, systolic and especially diastolic dysfunction of the left ventricle may jeopardize life.
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PMID:[Conditions and consequences of cardiac alterations in patients with end-stage renal disease on maintenance hemodialysis]. 892 87

This article reviews the current literature on the management of hypotension during subarachnoid block in the elderly. Hypotension results from blockade of the sympathetic nervous system, which causes decreases in both systemic vascular resistance and cardiac output. Abolition of normal cardiovascular reflexes is also important and may explain unexpected cardiac arrests during subarachnoid block. Untreated block in the elderly results in decreases in systolic arterial pressure, systemic vascular resistance and central venous pressure. Cardiac output appears not to decrease as has been previously reported and heart rate is affected by several different factors. Preload to the heart should be maintained during block by giving adequate intravenous fluids and 8 ml.kg-1 is satisfactory in most cases. Adequate preloading prevents decreases in cardiac output and unexpected cardiac arrests. In this respect, mild head down till is also beneficial. Ideally, intravenous fluid should be given as the block is developing. Excessive fluid administration serves no useful purpose and can cause fluid overload and urinary retention. If systolic arterial pressure decreases by more than 25%, or to below 90 mmHg, treatment with a vasopressor is indicated. The efficacy of ephedrine has recently been questioned, as it is a poor vasoconstrictor and inotrope in the elderly. The alpha-adrenoceptor agonists may prove a more logical choice, because they increase both peripheral resistance and preload. Metaraminol by infusion (< 10 ml.h-1 of 10 mg in 20 ml) has been used successfully, though hypertension can occur.
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PMID:Hypotension, subarachnoid block and the elderly patient. 903 50

The incidence of chronic hydrocephalus requiring shunting after aneurysmal subarachnoid hemorrhage (SAH) is not precisely known. The authors investigated whether the need for ventriculoperitoneal (VP) shunting can be predicted by initial Hunt and Hess grade or Fisher computerized tomography score. One hundred eight patients who presented with SAH and underwent 116 surgical procedures for aneurysm clipping were evaluated retrospectively to determine the incidence of chronic hydrocephalus. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after the original hemorrhage and that required shunting. All SAH patients were managed in a similar fashion with induced hypervolemia, relative hemodilution, and hypertension complemented by a course of calcium channel blockers. The majority of patients underwent perioperative extracranial ventricular drainage to allow intraoperative brain relaxation and to assist intracranial pressure management. The overall mortality rate of the study group was 17%. Of the surviving patients, 20% underwent VP shunt placement secondary to chronic hydrocephalus. There were no statistically significant relationships between chronic hydrocephalus and patient age or gender, aneurysm type and size, or use of a perioperative drain. There was a high clinical correlation between chronic hydrocephalus and admission Hunt and Hess grades and Fisher grades (p < 0.05). All of the patients who survived a second bleeding episode and almost 46% of the patients who presented with intraventricular hemorrhage required placement of a VP shunt. The authors present predictive tables of chronic hydrocephalus based on the patient's admission Hunt and Hess grade and Fisher classification.
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PMID:The relationship of subarachnoid hemorrhage and the need for postoperative shunting. 934 95

The hemolytic uremic syndrome (HUS) is the end result of a variety of etiologic agents that can induce endothelial cell injury and thrombotic microangiopathy (TMA) mostly within the kidney. The typical, post-diarrheal verocytotoxin associated HUS (D + HUS) is the major cause of acute renal failure in children worldwide. In the course of HUS treatment, fluid overload is usually the result of overhydration in the context of oliguria or anuria which cause edema, hypertension, worsening of neurologic signs and cardiac failure. Appropriate and timely use of dialysis has dramatically reduced complications of renal failure and extra-renal complications are now the main causes of mortality and morbidity in D + HUS. The reasons for treatment by infusion of fresh frozen plasma and/or plasmapheresis for D + HUS are theoretical and their therapeutic effects are inconclusive. We believe that plasma administration for regular D + HUS has no value and is potentially harmful. Until new strategies become available in clinical practice, the general consensus for the moment is that careful supportive management with patience is still the most appropriate form of D + HUS therapy.
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PMID:[Advances in the treatment of hemolytic uremic syndrome (HUS)]. 908 86

This report describes a child who presented with classic hemolytic uremic syndrome (HUS) and 4 months later developed a life-threatening but reversible cardiomyopathy with global cardiac dysfunction and a left ventricular ejection fraction of 14%. There was no evidence of electrolyte abnormalities, anemia, hypertension, severe fluid overload, or viral infection. Endomyocardial biopsies were consistent with a dilated cardiomyopathy. This paper highlights the importance of considering the diagnosis of associated cardiomyopathy when presenting with late-onset edema following HUS.
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PMID:Cardiomyopathy: a late complication of hemolytic uremic syndrome. 909 Jun 71

The pathophysiology of hypertension in patients on renal replacement therapy is not yet clear, and the role of extracellular fluid overload is still a matter of debate. The main problem is the lack of techniques to determine the fluid state. Recently new noninvasive techniques have become available which make it possible to accurately determine the hydration state in these patients. We have studied the influence of the hydration state on interdialytic blood pressure in 45 patients: 21 (46.6%) using antihypertensive medication and 24 (53.4%) without antihypertensive medication. Total body water (TBW) was determined by bioelectrical impedance analysis performed just before a hemodialysis session. The TBW was then related to the fat-free mass calculated by the anthropometric method (aFFM) of Durnin. The hydration state was defined using the following formula: TBW/aFFM 100. Furthermore, for each patient the ideal TBW was calculated according to the Watson formula. The difference between TBW and ideal TBW was considered a further index of the hydration state. Ambulatory blood pressure monitoring was performed by using a Takeda 24200 recorder according to the Korotkoff method during the 24 h before the midweek hemodialysis session. Blood pressure monitoring showed a significant correlation with the hydration state of these patients. In conclusion, the hydration state seems to play a major role in interdialytic blood pressure control.
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PMID:Influence of the hydration state on blood pressure values in a group of patients on regular maintenance hemodialysis. 909 4


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