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)

The 24-hour urinary excretion of kallikrein (K) and prostaglandin E2 (PGE2), which reflects their intrarenal synthesis, was measured in 7 normal women (NW), 10 women with essential hypertension (EH), 26 normal pregnant women (NP), 12 women with hypertension in pregnancy (HP), and 4 women with toxemia. All pregnant women were in the last trimester of their pregnancy (week 24-40). K was raised in NP (99.6 +/- 8.1 KU/24 h) and HP (106.5 +/- 8 KU/24 h) compared to NW (57 +/- 8.23 KU/24 h) (p less than 0.05). PGE2 excretion was decreased in EH (403.25 +/- 90.6 ng/24 h) compared to NW (508.6 +/- 80.26 ng/24 h). During pregnancy PGE2 was increased to 1,088 +/- 93.2 ng/24 h in NP and significantly more in HP, 1,885 +/- 40 ng/24 h (p less than 0.002). In this regard it differed from K. These data may suggest that, in addition to K, other factors (as angiotensin II and/or antidiuretic hormone) possibly activate renal PGE2 production in HP. In toxemia, K (23 +/- 6.1 KU/24 h) and PGE2 (583 +/- 172.83 ng/24 h) were markedly decreased. The above results suggest that the renal kallikrein-kinin and prostaglandin systems may play a role in sodium homeostasis during pregnancy. Their exact influence on the pathogenesis of hypertension in nonpregnant, pregnant, and toxemic subjects awaits further investigation.
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PMID:Urinary kallikrein in normal pregnancy, pregnancy with hypertension, and toxemia. 385

In an open, controlled trial, treatment with a combination of metoprolol and hydralazine was compared with non-pharmacological management of mild and moderate hypertension in pregnancy. One hundred and sixty-one women participated in the study. The drug-treated group showed significantly better blood pressure control than the group not given antihypertensives. Induction of labor before term, because of maternal or fetal complications, was somewhat more frequent in the control group. Nine women in the treatment group and 5 in the control group developed albuminuria. Three infants in the drug-treated group died perinatally, and one in the control group. The outcome for the newborns was similar in both groups concerning birth weight, head circumference and Apgar score and in the frequencies of respiratory distress, bradycardia and hypoglycemia. The better blood pressure control achieved with these drugs makes it possible to treat the patient at home and reduce the risk of emergency delivery, but treatment does not seem to be mandatory for a good outcome of the pregnancy in cases of mild and moderate hypertension during pregnancy.
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PMID:A prospective controlled trial of metoprolol-hydralazine treatment in hypertension during pregnancy. 390 22

In order to quantify the frequency of placental tissue changes in pregnancies complicated by hypertension and the correlation with the severity of the disease we studied 15 term-placentas of healthy women and 33 placentas of patients with pregnancy hypertension using phase contrast microscopy. Applying microscopy (phase contrast) a total of 50 fields were inspected from 5 different, representative areas of each placenta. We counted the (absolute) number of fields with trophoblastic hyperplasia; trophoblast sprouts; with interstitial edema; with hemorrhagia and with fibrinoid degeneration and necrosis. Trophoblastic hyperplasia as well as interstitial edema were rare in term-placentas of healthy women. Typically in hypertensive pregnancies these findings together with trophoblast sprouts increased proportionally to severity. We conclude that these results indicate a retardation of maturation of placenta tissues in hypertensive pregnancy. Although hemorrhagia and fibrinoid degeneration were observed in all placentas they were more frequent in pregnancies complicated by hypertension. This might be a consequence of changed placental perfusion of the intervillous space. In immature placentas hemorrhagia and fibrinoid degeneration induce additional restriction of placental capacity which seems to be responsible for decreased fetal birth weight and arterial cord pH. When morphological alterations of placenta tissue, e.g. trophoblast sprouts, trophoblast hyperplasia, stroma edema, hemorrhagia and fibrinoid degenerations were quantified and correlated to blood pressure of the mother, we found a positive correlation. Increased numbers of trophoblastic sprouts and trophoblastic hyperplasia indicate a placental immaturity whereas edema, hemorrhagia and degenerations can be taken as the result of elevated blood pressure.
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PMID:Placental morphology and clinical correlations in pregnancies complicated by hypertension. 390 46

One hundred and eighty three hypertensive pregnant women were randomly assigned to antihypertensive treatment with oxprenolol (96 women) or methyldopa (87 women). Control of hypertension was equivalent in both treatment groups, and in 64 (35%) cases hydralazine had to be added to the treatment to achieve the therapeutic goal (diastolic blood pressure below 85 mm Hg). Five perinatal deaths occurred, one in the oxprenolol group and four in the methyldopa group. Detailed analysis confirmed a previous report of greater fetal growth in the group treated with oxprenolol; this trend was present regardless of severity of hypertension and parity. With increasing duration of treatment the differences between the two groups diminished, and there was no difference after 10 weeks of treatment, a finding that may explain some of the reported discrepancies among therapeutic studies. As hypertension in pregnancy may pursue an accelerated course, necessitating urgent delivery, and there is no satisfactory method of predicting the duration of treatment in individual patients fetal benefit is most likely to be achieved by treatment with oxprenolol, provided that there is no maternal contraindication to treatment with beta blockers.
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PMID:Antihypertensive treatment in pregnancy: analysis of different responses to oxprenolol and methyldopa. 392 74

The course and outcome of 169 pregnancies in 156 women with chronic hypertension were studied. Antihypertensive medications were given if the diastolic blood pressure exceeded 90 mmHg. A number of major associated medical problems were found. Left ventricular hypertrophy, a serum creatinine greater than 1.0 mg%, and a diastolic pressure greater than 100 mmHg at less than 20 weeks' gestation were high-risk indicators. The overall perinatal mortality was 28.4 of 1000 (versus hospital of 25.6 of 1000). Despite antihypertensive therapy, one-third of the patients developed superimposed preeclampsia. The poorest outcome occurred in patients with superimposed preeclampsia necessitating delivery at 27 to 34 weeks' gestation (perinatal mortality = 238 of 1000). Antepartum fetal heart rate testing was abnormal in 10% of the patients with intrauterine growth retardation occurring in 15%. The incidence of fetal growth retardation was fourfold higher (20 versus 5%) in patients treated with antihypertensive drugs, particularly methyldopa as a single agent. However, this may have been related more to the study design than to a detrimental effect of the drug. The perinatal outcome in this study is similar to the outcome of studies in which antihypertensive therapy was withheld. This indicates that controlling the blood pressure is merely one aspect of the management of chronic hypertension in pregnancy. Accurate dating, attention to associated medical problems, antenatal fetal assessment by ultrasound and heart rate monitoring, and carefully timed delivery are additional important factors.
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PMID:Chronic hypertension in pregnancy. 394 29

A blind prospective survey of foeto-maternal bleeding in 200 primiparous pregnancies was carried out in an investigation of a possible association between foeto-maternal bleeding and hypertension in pregnancy. Evidence of foeto-maternal bleeding was found in 61% of 36 hypertensive pregnancies, and in 51% of 160 normotensive pregnancies, a difference which is not statistically significant.Significant differences between the hypertensive and the normotensive groups were found when foeto-maternal bleeding was related to gestation. In pregnancies that became hypertensive more foetal cells were found in the maternal circulation before week 36 than in normotensive pregnancies. In patients with oedema of the abdominal wall during pregnancy the incidence of foeto-maternal bleeding was significantly increased.These findings seem to explain why pre-eclamptic toxaemia is a significant predisposing factor in women who later develop Rh antibodies. It is recommended that anti-D gammaglobulin should be offered to all Rh-negative women with Rh-positive infants following a hypertensive pregnancy. Consideration should also be given to the question of administering anti-D gammaglobulin during Rh-negative hypertensive pregnancies if this procedure is proved to be both safe to mother and foetus and effective.The results provide contributory evidence that the placental vascular changes in toxaemic pregnancies precede the clinical signs and are not the result of hypertension.
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PMID:Association between foeto-maternal bleeding and hypertension in pregnancy. 418 29

The use of oral contraceptives has resulted in a statistically significant rise in blood pressure. 2 recent studies shed light on the clinical significance of the rise and the possible identification of a subgroup of women particularly liable to this complication. In a prospective study from South Australia of 74 women, the administration of orals resulted in a significant rise in mean systolic pressure; the rise in diastolic pressure was not significant. Women with a parental history of hypertension or a history of hypertension in pregnancy showed greater increases in pressure. There was a correlation between rise in systolic pressure and patient age. In a study of 7605 California women, women of all ages on orals had on average a higher systolic but not diastolic blood pressure, and those taking the pill accounted for most cases of "clinical" hypertension--140/90 mm Hg. There was no difference between the blood pressures of past users and those who have never taken the pill. Both studies indicate that older, heavier women, and those with a history of hypertinesion in pregnancy or family history, are the ones who are liable to a rise in blood pressure when taking oral contraceptives. However, the risk of severe hypertension seems to be very low. All women given oral contraceptives should have their blood pressure checked every 6 months and likely candidates for high blood pressure should be watched especially closely.
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PMID:Blood pressure and the pill. 469 88

The relation of perinatal mortality to plasma-urate concentration and blood pressure was studied in 200 patients with pre-existing hypertension and 200 patients with pre-eclampsia of pregnancy. Perinatal mortality was markedly increased when maternal plasma-urate concentrations were raised, generally in association with severe pre-eclampsia of early onset or superimposed on pre-existing hypertension. Maternal hypertension, even severe, without hyperuricemia was associated with good prognosis for the fetus. When there was hyperuricemia, the prognosis for the fetus was poor irrespective of the level of blood pressure. Pre-eclampsia of pregnancy was associated with high perinatal mortality rate when compared with the rate in pre-existing hypertension. This study suggests that serum urate is a reliable index of fetal welfare when pregnancy is complicated by pre-eclampsia and pre-existing hypertension.
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PMID:Serum uric acid levels as an index of fetal prognosis in pregnancies complicated by pre-existing hypertension and pre-eclampsia of pregnancy. 612 72

Once the diagnosis of chronic hypertension in pregnancy has been made, many centers in the United States treat moderate to severe cases of chronic hypertension pharmacologically, hoping to delay or obviate the onset of superimposed preeclampsia and to improve perinatal outcome. Methyldopa, which is most often used, is the only antihypertensive drug for which there is no evidence of adverse effects in long-term follow-up studies of fetuses exposed to it. Newer beta-blocker drugs such as atenolol and labetalol are receiving much attention abroad. These newer drugs have fewer maternal side effects and, as yet, no adverse effects on fetuses have been seen. Clinical trials of labetalol will soon start in the United States.
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PMID:Management of the pregnant patient with chronic hypertension. 613 51

The use of beta-blocking drugs in the treatment of hypertension during pregnancy has been the subject of controversies on the basis of theoretical hazards due to the pharmacology and pharmacokinetic characteristics of these drugs. A review of the literature on the subject shows that: The danger of premature contractions, abortion or premature delivery does not seem to increase with the use of beta-blockers. The blood supply is not more impaired with beta-blockers than with other antihypertensive drugs according to fetal growth, birth-weight, frequency of perinatal deaths or APGAR score. Although beta-blocking drugs pass into fetal circulation, neonatal bradycardia, respiratory distress or hypoglycemia do not seem more frequent with beta-blockers. Beta-blockers pass from maternal plasma into milk but the 24 hour dose brought to the newborn by maternal feeding is so slight as to be negligible. Thus, the cumulative data and the favorable opinions of many authors, the greater efficiency of beta-blockers authorizes the use of these drugs in the treatment of hypertension in pregnancy, where it seems to improve the outcome of the pregnancy and the state of the fetus at birth.
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PMID:[Are the theoretical drawbacks of beta-blocker treatment in pregnancy being confirmed? A review of the literature]. 613 64


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