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

A new system is proposed for treating the spectrum of patients with high blood pressure. It is based on studies of the renin axis using renin profiling, pharmacologic probes and our bipolar vasoconstriction-volume hypothesis. The new system does not require renin profiling, pharmacologic testing or a vasoconstriction-volume analysis for widespread application. But these procedures, whenever available, will make treatment more efficient and more certain, and at the same time provide better base line definition. In the new system, all patients, except the elderly and those with congestive heart failure, bradycardia or a history of asthma, are treated first with propranolol alone, a procedure which will diminish or normalize blood pressure in many patients with high and noraml renin levels. For nonresponders, diuretic therapy is then superimposed. Subsequently, a propranolol subtraction trial picks out the low-renin patients who will usually respond to a diuretic alone. This program is likely to be fully effective in possible up to 85 per cent of patients. For the residual smaller fraction, drugs such as hydralazine, methyl DOPA, clonidine, reserpine or guanethidine are then added in traditional trial and error fashion. The proposed system has the theoretic attraction for long-term commitment, implicit in antihypertensive therapy, of achieving blood pressure control in large fractions with one drug instead of two or with two drugs instead of three or more. Moreover, the large groups who respond to therapy with propranolol alone (most high-renin and normal-renin patients) or to diuretics alone (most low-renin patients) gain the advantage of simple, more specific, long-term (i.e., antirenin or antivolume) therapy. The use of propranolol alone has practical and theoretic advantages over diuretics. Control may be achieved with even fewer side effects and without hypokalemia and chronic dehydration with its possibly adverse consequences (hyperuricemia, azotemia, hyperlipidemia, hyperreninemia, increased blood viscosity). Also, propranolol provides more direct control of the increased peripheral resistance and of neurogenically-induced swings in blood pressure. At the same time, the new system efficiently exploits the long-term use of diuretic therapy alone in low-renin patients in whom volume excess seems a causal factor. And it tends to avoid the use of diuretics in high-renin patients and of beta-blockers in low-renin patients in whom these drug types may be contraindicated.
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PMID:Modern system for treating high blood pressure based on renin profiling and vasoconstriction-volume analysis: a primary role for beta blocking drugs such as propranolol. 1 Jul 30

It is reported of 726 patients incidentally elected and mainly with life-shortening risk factors. 341 (47.1p.c.) showed an increased concentration of neutral fats and/or total cholesterol in the serum. Type IV (49.8 p.c.) according to Fredrickson was observed most frequently, followed by type IIb (31.1 p.c.) and by type IIa (19.1 p.c.). Most of the patients with hyperlipoproteinemia were overweight (53.1 p.c.), 33.6 p.c. suffered from arterial hypertension, 25.3 p.c. from diseases of the liver, 10.9 p.c. from coronary heart diseases, and 8.7 p.c. from manifest diabetes mellitus. The distribution of different types of hyperlipoproteinemia among the various diseases deviates from that of the total number of patients observed in this study. Cases of hyperlipoproteinemia were observed most frequently in diseases of the kidney with arterial hypertension (62.7 p.c.), coronary heart diseases (60.8 p.c.), manifest gout (60.0 p.c.), manifest diabetes mellitus (58.7 p.c.), and hyperuricemia without symptoms (55.8 p.c.). Type-IV-hyperlipoproteinemia was observed most frequently within the different groups of patients with life-shortening risk factors. An exception was the group of patients suffering from malignancies. Type IIb was found most frequently within the group of patients suffering from malignancies.
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PMID:[Frequency and distribution of types of hyperlipoproteinemia with life-shortening risk factors among ambulant patients (author's transl)]. 17 Apr 97

Type V hyperlipemia is not very common. The series of 54 cases descrubed here is the largest reported to date. Our observations were recorded when lipidograms showed the presence of chylomicrons and a large pre-beta-lipoprotein spot in the serum of fasting subjects. Type V hyperlipemia was often combined with other metabolic syndromes such as diabetes, hyperuricemia or gout, or obesity. Chronic alcoholism was also noted in half our subjects, in whom hyperlipemia quickly regressed after alcohol consumption ceased. Ischemic arterial complications, chiefly coronary, were found in one third of our cases, and the vascular risks accompanying this type of hyperlipemia rose considerably in patients with high blood pressure. Various type of treatment were administered, but all subjects were put on a special diet, comprising either the elimination of alcoholic drinks only, or, in addition to this, reduced carbohydrate or calorie intake. As a rule, these measures resulted in a distinct regression of lipid anomalies. Clofibrate or derivatives proved effective in cases where hyperlipemia failed to respond to dietary measures.
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PMID:[Type V hyperlipemia. 54 cases (author's transl)]. 22 80

The prevalence of clinical and sub-clinical occlusive arterial disease and of risk factors implicated in the pathogenesis of arteriosclerosis was assessed in 21 patients with chronic renal failure, 27 on maintenance haemodialysis and 51 renal allograft recipients. Clinical occlusive arterial disease was present in 27 patients, and sub-clinical arterial disease in 34. Myocardial infarction, cerebral thrombosis and lower limb arterial thrombosis had occurred only in the transplant recipients; these patients had, however, been followed for a longer period of time than the other two groups. In the allograft recipients, the cumulative incidence of any occlusive arterial disease was 416 per 1000, and that of coronary heart disease was 267 per 1000 at six years. Hypertension was present in 76 per cent of patients prior to renal replacement therapy. Following institution of definitive therapy, hypertension was of shorter duration and less common in haemodialysis patients than in renal transplant recipients. Uraemic and haemodialysis patients with occlusive arterial disease had required antihypertensive medication for significantly longer than those free of arterial disease. Transplant recipients with hypertension had a greater mean serum creatinine, were receiving a larger maintenance dosage of corticosteroids and less frequently had undergone prior bilateral nephrectomy than those transplant patients without hypertension. Serum lipid levels were elevated in 62 per cent of patients. In the uraemic and haemodialysis patients hypertriglyceridaemia was the predominant abnormality while in the transplant recipients combined hypertriglyceridaemia/hypercholesterolaemia was more frequent. Despite regular aluminium hydroxide therapy 81 per cent of uraemic and haemodialysis patients had a calcium X phosphate product higher than normal. Arterial and/or soft tissue calcification as demonstrable in 20-38 per cent of patients within each group, but could not be related to the calcium X phosphate product of radiographic evidence of hyperparathyroidism. Glucose intolerance was present in 71 per cent of the uraemic and haemodialysis patients and 33 per cent of the transplant recipients. Hyperuricaemia, cigarette smoking, obesity and a sedentary existence were also prevalent. The majority of patients had several risk factors implicated in the pathogenesis of arteriosclerosis. Occlusive arterial disease is a major problem in patients with end stage renal disease, being no less common after transplantation than with long-term maintenance dialysis. The aetiology is multifactorial.
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PMID:Occlusive arterial disease in uraemic and haemodialysis patients and renal transplant recipients. A study of the incidence of arterial disease and of the prevalence of risk factors implicated in the pathogenesis of arteriosclerosis. 32 93

Timolol, 10 to 40 mg daily, given to 103 patients with uncomplicated arterial hypertension induced significant increments of serum potassium at all dose levels (p less than 0.05). The magnitude of the increments was dependent on daily timolol dosage. When hydrochlorothiazide and amiloride were added, serum potassium decreased (p less than 0.001), but a major determinant of the magnitude of the decrease was the dosage change of the timolol. Serum uric acid was influenced in a paradoxical way during timolol monotherapy; there was a rise in all 3 dosage groups (p less than 0.02) but the lowest group showed the largest increase and vice versa. On addition of hydrochlorothiazide and amiloride, there was a further increase in serum uric acid, the magnitude of which depended on the concomitant reduction in the dose of timolol, with reductions in dose causing a larger rise in serum uric acid and increments, a smaller rise. The increments of serum uric acid were greater in females than in males during both treatment periods. The results indicate that beta blockers induce dose-dependent rises in serum potassium and may counteract undesirable effects of diuretics on serum potassium. Beta blockers seem to have a paradoxical effect on serum uric acid and may aggravate the hyperuricemia induced by diuretics.
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PMID:Serum potassium and uric acid changes during treatment with timolol alone and in combination with a diuretic. 38 Aug 67

Eighteen patients with mild to moderately severe hypertension were treated, after a run-in period of placebo for three weeks, with a combination of 160 mg sotalol and 25 mg hydrochlorothiazide for three months. Fifteen patients responded well and, after one month of treatment, had a sustained diastolic blood pressure of less than 100 mm Hg. Additional treatment reduced the blood pressure even further during the second month, with a significant fall in blood pressure after the first month of treatment. The degree of severity of the hypertension did not seem to have an effect on blood pressure response to treatment. Serum potassium values decreased significantly during treatment. They remained within the normal range, and no clinical symptoms of hypokalemia were observed. One patient developed hyperuricemia and had to be withdrawn from the study.
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PMID:Once-a-day treatment with sotalol and hydrochlorothiazide in patients with essential hypertension. 38 41

In 240 patients with peripheral circulatory disorders (Fontaine Stage II) who had participated in intensive physiotherapeutic interval training daily for 6 weeks between October 1974 and July 1976, it was established that the therapeutic results were not related to age or sex. The "risk" factors of smoking, diabetes mellitus, hypertriglyceridemia, hypercholesterolemia and hyperuricemia individually show no connection with the results. Only overweight, hypertension and coronary heart disease appear to have an unfavorable influence. It is distinctly recognizable that the more risk factors there are combined in a patient with intermittent claudication, the less chance he has of success in physiotherapeutic vessel training.
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PMID:[Important prognostic factors for the results of physiotherapeutic exercises in intermittent claudication (author's transl)]. 41 58

Hyperuricaemia was present in 18 out of 73 men with untreated mild hypertension and was related significantly to alcohol intake, serum aspartate transaminase activity, and obesity. In the whole group the mean serum urate concentration correlated highly significantly with alcohol intake and activities of serum aspartate and alanine transferases but not with ponderal index, serum creatinine concentration, age, or blood pressure. Hypertension and hyperuricaemia are related at least in part through their common association with frequent alcohol use. A serum urate concentration exceeding 0.5 mmol/l (8--4 mg/100 ml) in a man with untreated hypertension is highly suggestive of heavy alcohol consumption. There was no evidence that hyperuricaemia had a deleterious effect on renal function.
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PMID:Hyperuricaemia in hypertension: role of alcohol. 43 9

In 196 patients with angina pectoris selective coronary angiography was performed, and the extent of angiographically proven coronary artery stenoses was described by means of a coronary score. A significant correlation between the degree of atherosclerotic lesions on the one hand and hypertriglyceridemia, hypercholesterolemia as well as smoking habits on the other hand was detected. No correlation between other risk factors, such as hypertension, diabetes mellitus, hyperuricemia and obesity, and the coronary score was observed.
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PMID:[Coronary risk factors and extent of angiographically proven coronary artery stenoses (author's transl)]. 46 94

Ticrynafen is an orally administered diuretic that is similar to the thiazides in its therapeutic actions, but unlike the thiazides, it increases urate excretion and lowers serum uric acid levels. Ticrynafen is useful in the treatment of hypertension and in selected cases of chronic congestive heart failure. At present, it appears to be indicated primarily in patients with these disorders who have a history of gout. Patients who are currently receiving a thiazide should not have their therapy arbitrarily changed to ticrynafen because of asymptomatic hyperuricemia.
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PMID:Evaluation of a new uricosuric diuretic--ticrynafen. 51 60


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