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 authors reviewed 3133 consecutive autopsies performed in the 5 year period from 1986 to 1990 in Queen Mary Hospital (Hong Kong), and 96 cases of aortic aneurysms were found. The incidence was 1 in 33 autopsies. The ratio of male to female was 1.8 to 1, and the disease was most common in the eighth decade of life. The majority of death was due to rupture (70%) or related atherosclerotic diseases (14%), and the majority of aneurysms were not suspected before autopsies (62%). Most of the non-dissecting aneurysms were found in the abdominal aorta, the infra-renal portion. For dissecting aneurysms, Daily's type A was much more common. Hypertension was recognized in a high proportion of cases. Accompanying diseases like syphilis, Takayasu's disease, ischemic heart disease, cerebrovascular accident, diabetes mellitus, peripheral vascular disease, and chronic obstructive airway disease were also noted.
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PMID:Aortic aneurysm at autopsy: a five year survey in Hong Kong. 162 28

We examined the perioperative course of 1013 patients who had undergone coronary surgery between 1984 and 1987, to identify preoperative examination findings which are suitable as risk indicators in coronary surgery. The features we paid attention to were: anamnestic data, parameters of coronary disease, haemodynamic parameters and accompanying illnesses. We considered a perioperative course as complicated when systolic blood pressure dropped to 80 mmHg or less for longer than 15 min, when reconnection to the heart-lung-machine was necessary, when an intra-aortal balloon counterpulsation was required, when the patient had to have mechanical ventilation for longer than 24 h, when resuscitation took place, or when the patient died in the hospital. The Chi-square test was used for statistical analysis. Very good risk indicators (p less than 0.001) were: age greater than 60 y, resuscitation history, more than two bypass grafts, SvO2 70%, ejection fraction less than 50% and cardiac index less than 2.5 l/min*m2. Good risk indicators (p less than 0.001) were: functional capacity less than 50 watts, more than one previous myocardial infarction and LVEDP greater than 20 mmHg. LCA-stenosis, arterial hypertension with diastolic blood pressure values above 100 mmHg, and obstructive airway disease were identified as suitable risk indicators (p less than 0.05). The following findings were combined with significantly increased mortality: female sex, age over 60 years, two or more previous myocardial infarctions, history of resuscitation, mixed venous oxygen saturation below 70% and the need for three or more bypass grafts for complete revascularisation.
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PMID:[Risk indicators in coronary surgery]. 193 47

This study was initiated to assess the efficacy and safety of celiprolol in a large number of hypertensive patients. Patients received a once-daily dose of 200 mg celiprolol for the first 3 weeks. If blood pressure was not lowered satisfactorily, the investigator was asked to raise the dose to 300 mg celiprolol or add a diuretic for the next 3 weeks. The study included 2,694 patients, 2,311 of whom were evaluable over a period of 3 weeks, 1,876 over 6 weeks. On admission 10% had isolated systolic hypertension, 38% mild diastolic hypertension, 35% moderate diastolic hypertension, and 17% severe diastolic hypertension. Concomitant diseases were diabetes mellitus, chronic obstructive airway disease, and peripheral arterial disease. BP was lowered in patients with hypertension of all degrees of severity. There was no obvious relation between efficacy and age or with duration of disease. Only 229 patients received 300 mg celiprolol; 223 patients additionally received a diuretic. Heart rate decreased by a mean of 8 beats/min and was lowered mostly in patients with tachycardia. In no case did heart rate fall below 50. Side effects were rare and in most cases not serious. Treatment was discontinued owing to suspected adverse effects in 58 patients (2.15%). In conclusion, celiprolol administered for up to 6 weeks appeared to be safe in the management of hypertension.
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PMID:Results of the Austrian celiprolol postmarketing surveillance study. 242 58

Although verapamil is a well-established treatment for angina, cardiac arrhythmias and cardiomyopathies, this review reflects current interest in calcium antagonists as anti-hypertensive agents by focusing on the role of verapamil in hypertension. Verapamil is a phenylalkylamine derivative which antagonises calcium influx through the slow channels of vascular smooth muscle and cardiac cell membranes. By reducing intracellular free calcium concentrations, verapamil causes coronary and peripheral vasodilation and depresses myocardial contractility and electrical activity in the atrioventricular and sinoatrial nodes. Verapamil is well suited for the management of essential hypertension since it produces generalised systemic vasodilation resulting in a marked reduction in systemic vascular resistance and, consequently, blood pressure. Evidence from clinical studies supports the role of oral verapamil as an effective and well-tolerated first-line treatment for the management of patients with mild to moderate essential hypertension. Clinical studies have shown that verapamil is more effective the higher the pretreatment blood pressure and some authors have found a more pronounced antihypertensive effect in older patients or in patients with low plasma renin activity. Sustained release verapamil formulations are available for oral administration which, as a single daily dose, are as effective in lowering blood pressure over 24 hours as equivalent doses of conventional verapamil formulations given 3 times daily. As a first-line antihypertensive agent, oral verapamil is equivalent to several other calcium antagonists, beta-blockers, diuretics, angiotensin-converting enzyme (ACE) inhibitors and other vasodilators, and is not associated with many of the common adverse effects of these treatments. Verapamil may be preferred as an alternative first-line antihypertensive treatment to diuretics in elderly patients because it has similar efficacy in these patients without causing the adverse effects commonly linked with diuretic treatment. Furthermore, because verapamil does not cause bronchoconstriction, it may be used in preference to beta-blockers in patients with asthma or chronic obstructive airway disease. Reflex tachycardia, orthostatic hypotension or development of tolerance is not evident following verapamil administration. As a second- or third-line treatment for patients refractory to established antihypertensive regimens, verapamil produces marked blood pressure reductions when combined with diuretics and/or ACE inhibitors, beta-blockers and vasodilators such as prazosin.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Verapamil. An updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension. 267 May 11

A phase I trial of human recombinant tumor necrosis factor (rH-TNF) has been carried out in patients with advanced solid tumors. Sixty-six courses of the drug were given by 1 h IV infusion, daily for 5 days to 33 patients at doses of 5, 10, 20, 30, 45, 60, and 80 x 10(4) U/m2/day. All patients received isotonic saline (up to 21/day) and either indomethacin or ketoprofen. Acute toxicity resembled that seen with the phase I study of a single dose (5). Dose limiting toxicity was acute, rapidly reversible, hepatic dysfunction and hypotension. Hypertension during drug infusion and dyspnea were marked in some patients. There was one complete and one minor response, both in patients with renal cell carcinoma. The dose of 80 x 10(4) U/m2/day x 5 was poorly tolerated and the recommended starting dose for phase II studies is 60 x 10(4) U/m2/day x 5. Caution is recommended in treating patients with pre-existing hepatic function abnormalities, hypertension, hypotension or significant obstructive airway disease.
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PMID:A phase I clinical trial of recombinant human tumor necrosis factor given daily for five days. 292 76

The treatment of hypertension in patients with diabetes, obstructive airway disease, impaired renal function, or congestive heart failure (CHF) is discussed. Specifically, the value of alpha 1-adrenoceptor blocking agents in such patients is reviewed. An individualized approach to therapy is required, with careful consideration of the effects of different drugs on the existing metabolic and hemodynamic situation. In diabetic individuals, commonly used step-1 agents may impair glucose tolerance; beta-adrenergic blockade may increase blood glucose levels and significantly change response to insulin-induced hypoglycemia. Diabetic patients may also be especially sensitive to side effects of some centrally acting antihypertensive agents. In patients with obstructive airway disease, beta-blockade and alpha-stimulation worsen bronchospasm; although beta-stimulants produce bronchodilatation, they often are contraindicated in hypertensive patients due to their stimulatory effects on the heart. In patients with impaired renal function, therapy for hypertension may include problems such as an increased half-life of antihypertensive agents and retention of active metabolites. In patients with CHF, if blood pressure is not normalized with diuretics, more aggressive therapy may be required. According to results of several studies discussed, the alpha 1-adrenoceptor blocking-agent prazosin appears to be a safe and effective therapy, causing a minimum of side effects, for treatment of hypertension in patients with these conditions.
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PMID:Management of hypertension in patients with concomitant diseases. 354 75

This study evaluates the usefulness of chest x-ray in the diagnosis of pulmonary arterial hypertension. Twelve patients with severe interstitial fibrosis were studied by respiratory functional tests and right heart catheterization. A quantitative radiologic diagnosis of pulmonary arterial hypertension in pulmonary fibrosis results more difficult than in chronic obstructive airway disease, mitral stenosis or pulmonary thromboembolism. Nevertheless in case of severe interstitial fibrosis pulmonary hypertension was regularly present even if specific radiologic findings were not available. We have found some interesting correlations, i.e. a trend to a relationship between mean pulmonary pressure and right descending pulmonary artery diameter.
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PMID:[Radiological diagnosis of pulmonary arterial hypertension in idiopathic pulmonary fibrosis]. 653 84

The incidence of medical diseases in surgical patients was assessed using data gathered from 5944 consecutive anaesthetics. Medical disease which might affect anaesthetic management was present in 23.2% of patients. The commonest diseases were hypertension, anaemia, chronic obstructive airway disease, diabetes mellitus, and pulmonary tuberculosis. No significant difference was detected in sex incidence for ischaemic heart disease and cerebrovascular disease. There was a disproportionate preponderance of males with respiratory diseases. It is suggested that anaesthetics should be administered only by qualified anaesthetists, that the establishment of anaesthetic outpatient clinics is desirable, and that internal medicine should be included in anaesthetic training.
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PMID:Medical diseases in surgical patients in Hong Kong. 670 13

In 175 cases of chronic obstructive airway disease (most often chronic bronchitis) with severe ventilatory deficit in the majority of cases, the prognostic value of mean pulmonary arterial pressure (PAP) and other respiratory function parameters (FEV1, blood gases) was studied by calculation of survival rates using the actuarial method. The patients were cathetherised between 1968 and 1972 and the maximum period of follow-up is 10 years. The results demonstrated the definite prognostic value of PAP : 4 and 7 year survival rates were markedly different according to whether initial PAP was above or below 20 mmHg. However other haemodynamic (motor pressure through the pulmonary circulation) and non-haemodynamic (FEV1, PaCO2) parameters also would appear to be as useful as PAP in predicting survival in such patients. The prognosis is particularly bad in patients with severe pulmonary arterial hypertension (PAP greater than 30 mmHg). In this type of study, it is essential to bear in mind the influence of age. Survival rates differed significantly according to whether the subjects were over 60 years in age initially.
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PMID:[The prognostic significance of pulmonary arterial hypertension in chronic obstructive airway disease (author's transl)]. 730 12

Laparoscopic adrenalectomy has recently been shown to be a safe and effective procedure for treating a variety of benign adrenal tumors. Advanced age, with its concomitant comorbid conditions, has been believed to be associated with more postoperative complications in laparoscopic procedures. The purpose of this study was to evaluate the outcome of laparoscopic adrenalectomy in patients age 65 and older. From June 1992 to February 1998, 14 patients (4 men and 10 women) with a mean age of 69 years underwent 17 laparoscopic adrenalectomies. In 12 procedures, a transperitoneal lateral decubitus flank approach was used. The lesion was a nonfunctioning adenoma in three patients, aldosterone adenoma in four, Cushing's syndrome in four, and pheochromocytoma in one. A retroperitoneal lateral decubitus approach was used in five procedures. The lesion was a nonfunctioning adenoma in one patient, aldosterone adenoma in one, Cushing's adenoma in one, and pheochromocytoma in two. Seventy-eight percent of these patients had comorbid conditions, including hypertension, diabetes, chronic obstructive airway disease, coronary artery disease, and cardiac dysrhythmia. The preoperative physical status was as ASA Class II in 11 patients and ASA III in 3. Two of the 17 laparoscopies were converted to open surgery (11%), in one because of difficulties in dissecting extraperitoneally a mass >8 cm, and in the other because of difficulties in localization of a 3-cm mass. The median surgical time was 95 +/- 33 minutes. The mean analgesia requirements were 3 doses of (range 2-7) ketorolac. There were no deaths. Postoperative morbidity consisted of pulmonary atelectasis in one patient and urinary tract infection in two patients. The median hospital stay was 3 days (range 2-4 days). We conclude that laparoscopic adrenalectomy in the elderly population is safe and offers low morbidity, fast recovery, and a short hospital stay. Age alone should not be a contraindication to treating adrenal tumors laparoscopically.
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PMID:Laparoscopic adrenalectomy in the elderly. 1048 24


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