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

Experimental, epidemiological and clinical evidence indicates that salt plays a major role in the pathogenesis of arterial hypertension. Endocrine and membrane ion transport studies suggest a genetic disposition with regard to salt susceptibility. In the industrialized countries sodium intake in children probably exceeds the physiological needs. However, a reduction of salt consumption in the general paediatric population cannot be recommended as the longterm risk benefit ratio is currently unknown. In children with manifest arterial hypertension sodium intake should be reduced below 2 mval/kg/day. Diuretic therapy is an important part of antihypertensive treatment. Thiazides and in renal insufficiency furosemide are the drugs of choice. The side effects of diuretic therapy, such as hypokalemia, hyperuricemia, and hyperlipidemia, in children require further investigation.
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PMID:[Reduction of table salt and diuretic therapy in arterial hypertension in childhood]. 357 12

Four classes of etiologic agents that cause human illness have been discovered. Sometimes members of two or more classes of agents cooperate to cause illness. Knowledge of etiology is necessary if a disease is to be eradicated. The leading causes of death in the United States have changed dramatically in the last century. Infection has been replaced by chronic illnesses of obscure etiology. Ischemic heart disease is the leading cause of death in middle age and is the major obstacle to becoming old. There are numerous similarities between animals deficient in copper and people with ischemic heart disease. The most important of these similarities are glucose intolerance, hypercholesterolemia, abnormal electrocardiogram, hyperuricemia, and hypertension, as these characteristics are predictive of risk of ischemic heart disease. No other nutritional insult has produced these characteristics in experiments with animals; men fed diets low in copper have been found to have increased cholesterol, decreased glucose tolerance, and abnormal electrocardiograms. The process that results in ischemic heart disease is remarkably similar to that of copper deficiency. Links have been found between copper metabolism and several hypotheses on the origin of ischemic heart disease. Several aspects of the lipid hypothesis can be interpreted in terms of copper metabolism. More features of the etiology, pathogenesis, and pathophysiology of ischemic heart disease can be explained in terms of copper deficiency than can be explained by any other environmental insult.
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PMID:Ischemic heart disease. A major obstacle to becoming old. 358 Oct 19

In over 30 years of surveillance of 2873 women, 574 developed initial clinical manifestations of CHD. A number of antecedent metabolic risk factors proved atherogenic, including blood lipids, glucose tolerance, uric acid, and menopause. Serum total cholesterol predicts as strongly in women as in men. The predictive power of cholesterol is strengthened when the total cholesterol is partitioned into its atherogenic LDL and protective HDL fractions. Contrary to the case in men, triglyceride may be a contributor to risk in older women. A total-to-HDL cholesterol ratio exceeding 7.5 equalizes the risk in men and women. Impaired glucose tolerance also eliminates the female CHD risk advantage over men, conferring a three-fold increased risk. Serum uric acid, although lower in women than in men, is equally predictive in the sexes. Central obesity confers an increased CHD risk in women and predisposes to diabetes, hyperuricemia, hypertension, and an unfavorable LDL/HDL cholesterol ratio. A combination of obesity, low HDL cholesterol, and impaired glucose tolerance predisposes especially. Age-adjusted risk of CHD is increased two- to threefold compared to pre menopausal women, even when induced surgically without removing the ovaries. It is not clear whether post menopausal estrogen replacement eliminates this excess risk. Fibrinogen is higher in women than in men, and is increased with hypertension, diabetes, hypercholesterolemia, high hematocrit, and cigarette smoking. At any level of multivariate risk, fibrinogen added to the CHD risk in women.
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PMID:Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study. 360

The incidence of arterial hypertension in patients with gouty nephropathy was studied. A reverse correlation dependence was established between the clearance of uric acid and the values of systolic and diastolic pressure, directing the clinicians to controlling the hyperuricemia, in parallel with the prescription of hypotensive agents. Attention is drawn to the higher incidence of hyperlipidemia in patients with gouty nephropathy and hence--the possibility of more frequent coronary incidents. Renal insufficiency advanced earlier in the patients with gouty nephropathy and arterial hypertension.
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PMID:[Arterial hypertension in gouty nephropathy]. 376 79

Studies were undertaken to determine whether there is an association between elevated levels of intermediate-density lipoproteins (IDL) (Sf 12-60 lipoproteins) and coronary artery disease. Forty-five to sixty-five-year-old men with objectively documented coronary artery disease (n = 58) who were free of known risk factors (diabetes, hypertension, obesity, hyperuricemia, and hypercholesterolemia) were compared with similar men who were free of coronary artery disease (n = 52). Smokers could not be excluded. The coronary artery disease group had a higher rate of cigarette smoking (NS, due to large variations); higher concentrations of triglycerides in their plasma (p = .003) and higher levels of very low-density lipoproteins (VLDL) (p = .007), IDL (p = .016), and low-density lipoproteins (LDL) (p = .04); as well as somewhat lower levels of high-density lipoprotein (HDL) cholesterol (p = .04). Chi-squared analysis demonstrated a strong association between coronary artery disease and IDL apolipoprotein (apo) B (p = .006), coronary artery disease and IDL triglyceride (p = .032), and coronary artery disease and IDL apo B times IDL triglyceride (p = .006) when the top quintile of the population was compared with the bottom quintile for each of these variables. Stepwise logistic regression analysis resulted in rejection of an association between coronary artery disease and HDL cholesterol, plasma triglyceride, VLDL triglyceride, or LDL triglyceride. However, it did show that coronary artery disease was most strongly associated with smoking and that the second strongest association was with IDL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The association of increased levels of intermediate-density lipoproteins with smoking and with coronary artery disease. 379 98

Hypertension, cigarette smoking, and hypercholesterolemia are the most important treatable factors that predispose patients to coronary heart disease. Numerous epidemiologic studies have investigated the importance of single risk factors and the extent of their interaction. These studies have demonstrated that the incidence of coronary heart disease is greatly augmented if more than one risk factor is present. The recent British Medical Research Council mild hypertension trial demonstrated that blood pressure reduction was highly effective in preventing stroke, although there were important differences between smokers and nonsmokers with regard to the efficacy of individual drugs. In this trial, there was no overall reduction in coronary heart disease morbidity or mortality. Other trials such as the Veterans Administration Cooperative Study on Antihypertensive Agents, the United States Public Health Service Hospital Cooperative Study, the Australian Therapeutic Trial in mild hypertension, and the European Working Party Trial on High Blood Pressure in the Elderly have failed to demonstrate significant reduction in coronary heart disease mortality. The Pooling Project and other epidemiologic studies have identified other factors that are associated with increased coronary heart disease; these include glucose intolerance, hypertriglyceridemia, hyperuricemia, obesity, lack of exercise, and, more arguably, type A personality. Methods of controlling these factors should involve both patient education programs promoting change in life-style, such as those proposed by the American Heart Association, and pharmacologic interventions. The British Medical Research Council trial and other such trials have shown the importance of interactions between antihypertensive therapy and individual risk factors, not all of which are readily predictable and some of which may be adverse. Coronary heart disease is now the leading cause of death in many countries and is the major unsolved problem in the treatment of hypertension. A successful attack on this problem would necessarily involve application of a number of measures and the tailoring of such measures to the needs of individual patients.
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PMID:Risk predictors, risk indicators, and benefit factors in hypertension. 379 98

To quantify the consequences of asymptomatic hyperuricemia, this study examined rates for a first episode of gouty arthritis based on 30,147 human-years of prospective observation. A cohort of 2,046 initially healthy men in the Normative Aging Study was followed for 14.9 years with serial examinations and measurement of urate levels. With prior serum urate levels of 9 mg/dl or more, the annual incidence rate of gouty arthritis was 4.9 percent, compared with 0.5 percent for urate levels of 7.0 to 8.9 mg/dl and 0.1 percent for urate levels below 7.0 mg/dl. With urate levels of 9 mg/dl or higher, cumulative incidence of gouty arthritis reached 22 percent after five years. Incidence rates were three times higher for hypertensive patients than for normotensive patients (p less than 0.01). The strongest predictors of gout in a proportional hazards model were age, body mass index, hypertension, and cholesterol level, and alcohol intake. When the serum urate level became a factor in the model, none of these variables retained independent predictive power. At the final examination, only 0.7 percent of participants had a serum creatinine level of 2.0 mg/dl or more, with no evidence of renal deterioration attributable to hyperuricemia. These data support conservative management of asymptomatic hyperuricemia.
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PMID:Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. 382 98

In the Hypertension Detection and Follow-up Program (HDFP), elevated blood pressure (BP) was treated by rigorous, stepped care (SC) therapy among half the participants, while the other half were referred to usual sources of care (referred care, RC). There was no program to reduce weight, however, some participants changed weight voluntarily over the first 2 yr, providing an opportunity to examine the role of weight change in the development of diuretic-induced hyperuricemia, hyperglycemia and hypercholesterolemia. There was a stepwise progression from decreased glucose, uric acid and cholesterol concentrations, and BP associated with maximum weight loss to increased values with maximum weight gain. In SC, systolic BP declined by 22.4% among weight-losers and by 17.1% among weight-gainers; in RC, it was 14.4 and 8.1%, respectively. The pattern in diastolic blood pressure and weight change was similar but not as marked. These findings suggest the potential importance of weight loss in enhancing effectiveness of antihypertensive drug treatment and attenuating increases in glucose, uric acid, and cholesterol associated with diuretic treatment of hypertension. The weight change analyses are based on postrandomization observations and do not reflect experimental changes.
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PMID:The relationship of weight change to changes in blood pressure, serum uric acid, cholesterol and glucose in the treatment of hypertension. 388 27

In 139 patients with preexisting abnormal renal function (serum creatinine level of 2.0 mg/dL or greater) undergoing cardiac angiography (141 examinations), the incidence of contrast nephropathy, defined as a 1 mg/dL or greater rise in serum creatinine, was 23% (95% confidence interval, 17% to 30%). Stepwise logistic regression analysis showed that contrast nephropathy was independently associated with class IV heart failure with low cardiac output (71% incidence in this subgroup; p less than 0.0001), multiple radiocontrast studies within 72 hours (50%; p = 0.002), dose of radiocontrast administered (p = 0.009), and insulin-dependent diabetes mellitus (44%; p = 0.007). Age, hypertension, and hyperuricemia were not associated. In patients without low cardiac output, other radiocontrast tests, or insulin-dependent diabetes mellitus, there was a 2% incidence of contrast nephropathy in those who received less than 125 mL radiocontrast and a 19% incidence in those who received 125 mL or greater.
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PMID:Risks for renal dysfunction with cardiac angiography. 395 77

A report on 12 patients with retinal vein occlusion in both eyes. In addition to advanced age (67 years on the average) the following risk factors were present, often in combination: hypertension, cardiac insufficiency, adiposity, hyperlipidemia, hyperuricemia, hypercholesterinemia, diabetes mellitus etc. The rate of retinal circulation was determined by video fluorescein angiography. A pronounced decrease in visual acuity was observed in all patients with a slower retinal circulation rate. The causes of the decrease in central visual acuity were macular edema, neovascularization with vitreal hemorrhage and rubeosis iridis with secondary glaucoma.
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PMID:[Bilateral retinal vein occlusions and general risk factors]. 397 59


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