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

The effects of diltiazem hydrochloride on exercise-induced changes in cardiovascular response, plasma renin activity, platelet function and blood coagulability were evaluated with multistage treadmill exercise in 20 patients who had systemic hypertension of stage 1 to 2 (World Health Organization classification). Heart rates, blood pressure, and pressure-rate product at rest, at peak exercise and in the recovery period were significantly reduced after 4 weeks of diltiazem administration, 180 mg/day. Plasma renin activity tended to increase after the medication. However, platelet adenosine diphosphate-induced aggregation sensitivity, prothrombin time, activated partial thromboplastin time, plasma fibrinogen concentration and antithrombin III activity did not change significantly. It is concluded that diltiazem could ameliorate the hyperresponsiveness of heart rate and BP to exercise in hypertensive patients without affecting blood coagulability.
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PMID:Effects of diltiazem hydrochloride on cardiovascular response, platelet aggregation and coagulating activity during exercise testing in systemic hypertension. 351 20

The aim of our study was to evaluate the fibrinolytic system in patients with retinal branch vein occlusion (RVO). The following tests were carried out: prothrombin time, partial thromboplastin time (PTT), fibrinogen degradation products, euglobulin lysis time, fibrinogen, pasminogen, antithrombin III, alpha 2-antiplasmin and alpha 2-macroglobulin. Comparing the results of patients with those of normal controls, only the fibrinogen increase and PTT shortening were significantly different. All other tests taken into account were within normal limits. Only the patients without other associated diseases (diabetes or hypertension) showed a significant activation of fibrinolysis (either with respect to normal or to other RVO patient groups). In conclusion, no important fibrinolytic impairment was seen in our longstanding RVO patients. Fibrinolytic activation seen in patients without verified associated diseases may be related to the presence of a sound endothelium, still able to release plasminogen activators in response to RVO. The fibrinogen and PTT changes in RVO were probably due to other associated diseases.
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PMID:Fibrinolytic behavior in long-standing branch retinal vein occlusion. 369 97

Decreased plasma levels of antithrombin III (AT III) are observed in women with severe pregnancy-induced or aggravated hypertension. Low AT III levels correlate with the platelet count and with symptoms of maternal and foetal morbidity. Therefore, in clinical practice both the platelet count and the plasma AT III levels provide significant information regarding the clotting disturbances in toxemic patients. Established AT III deficiency may explain the enhanced post-partum thrombosis risk in these patients. Primary prophylaxis in patients undergoing caesarean section with oral anticoagulants is preferred because of an observed enhanced bleeding tendency upon heparin prophylaxis.
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PMID:Blood coagulation in pregnancy induced hypertension. 386 26

Combined oral contraceptives (OCs) induce elevations of blood pressure and can aggravate preexisting hypertension. They alter lipoprotein metabolism and coagulation factors, increasing vascular risks. Combined OCs are therefore contraindicated for hypertensive women. Intravaginal contraceptive rings releasing 17 beta estradiol and levonorgestrel have the triple advantage of extradigestive administration, use of the natural estrogen estradiol, and continuous and stable hormone release. 12 patients with moderate hypertension were studied to determine whether vaginal rings would be an appropriate contraceptive choice for hypertensive women. 8 of the 12 developed hypertension while using combined OCs. They observed a 6 month wait between termination of OC use and inclusion in the study or initiation of antihypertensive therapy. In 3 cases, blood pressure spontaneously returned to normal. The 9 other patients received an antihypertensive drug during the study. The vaginal rings were left in place for 3 weeks and removed for 1 week to permit withdrawal bleeding. When in place they delivered an average of 293 + or - 54 mcg/day of levonorgestrel and 133 + or - 34 mcg/day of estradiol. Clinical and gynecological examinations and blood pressure measurements were repeated during 2 control cycles before treatment, on the 21st day of cycles 1, 2, 4, 6, 9, and 12 of use, and 1 month after termination of use. Blood pressure was measured 5 times by an oscillometric automatic device. Modification of antihypertension treatment was not required in any case. No variation in systolic pressure greater than 5 mm Hg or of diastolic pressure greater than 4 mm Hg was observed. Plasma renin substrate and plasma antithrombin III were not affected by the treatment. Sex binding protein was reduced by 72% on average. The results confirm the utility of a method of hormone administration that bypasses the liver. Highly significant reductions in total cholesterol, high density lipoprotein cholesterol, phospholipids, and triglycerides were observed and could be interpreted to reflect the androgenic potency of levonorgestrel. The vaginal ring may become a very interesting contraceptive alternative for hypertensive women.
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PMID:[Contraception in the hypertensive woman using a vaginal ring delivering estradiol and norgestrel]. 393 50

Antithrombin III activity was measured prospectively in 127 pregnant women within four weeks of delivery, and the results were tabulated with respect to the clinical diagnosis of their hypertensive disorder. Plasma antithrombin III activity was significantly lower than controls in women with preeclampsia and in women with chronic hypertension and superimposed preeclampsia (P less than .001). In contrast, women with chronic hypertension alone had antithrombin III activities similar to controls. Based on discriminant analysis, an antithrombin III activity of less than 70% was selected as indicative of the preeclampsia-eclampsia syndrome. The sensitivity and specificity of plasma antithrombin III for preeclampsia was 76 and 91%, respectively. Importantly, an antithrombin III activity in excess of 70% accurately predicted the absence of preeclampsia in 89% of study patients. Although gestational ages at delivery were similar in preeclamptic women with antithrombin III activity above and below 70%, women with antithrombin III activity above 70% delivered larger infants and experienced less fetal distress during labor. These findings suggest antithrombin III measurement may be useful in the management of hypertensive pregnant patients who are unresponsive to bedrest.
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PMID:Antithrombin III activity in women with hypertension during pregnancy. 397 56

From the pre-natal follow-up it was remarkable that cases have been admitted relatively late. Hints to a possible development of preeclampsia could be seen from patients history or the routine check up, for example the registration of edema, fetal growth retardation and oligohydramnios. For early diagnosis of preeclampsia we recommend: Calculation of mean arterial blood pressure or its non-invasive measurement; determination of hematocrit, uric acid and total plasma protein (in particular hemorheologic measurements). Hypomagnesemia in preeclampsia, as described by some authors, was also seen in our cases. The complex symptomatology of preeclampsia could be attributed to a generalised disturbance of microcirculation, which leads to definite reactions of the organs concerned. The microcirculatory failure is caused by vasoconstriction, hemoconcentration, hyperviscosity and hypercoagulation (up to DIC and consumption coagulopathy). The resulting symptoms and syndromes can be: EPH, HELLP, hemolytic-uremic Syndrome, hepato-renal Syndrome, thrombocyte and antithrombin III deficiency etc. The drug of choice for treatment of preeclampsia is magnesium sulfate. Its application is based on long-term clinical experience and new aspects on the physiologic and pharmacologic role of magnesium. The recommendations of the German High Blood Pressure League to use calcium antagonists as a basis in the treatment of high blood pressure can be fulfilled particularly in pregnancy by the physiologic calcium antagonist Mg++. Magnesium sulfate should be given in a dosage of 24-72 g daily. The dose should also be made dependent from urinary output. Further treatment patterns of preeclampsia should be adjusted according to each case. The present results also support our hypothesis that magnesium deficiency (besides predisposing factors) could be responsible for the development of preeclampsia (present model shown in detail). Consequently, the early and long-term substitution of magnesium in pregnancy could help reduce preeclampsia.
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PMID:[Pathophysiology and clinical aspects of pre-eclampsia]. 404 84

Plasma beta-thromboglobulin (BTG) was measured in 25 patients with pregnancy-induced hypertension (PIH), 7 of whom had severe PIH, and in 23 healthy gravidae. Also platelet counts, spontaneous platelet aggregation in vitro, and coagulation studies such as fibrinogen, fibrinogen degradation products and antithrombin III (AT III) were carried out: fetal outcome was judged by birthweight, placental weight and venous umbilical pH. Plasma BTG values of the PIH and severe PIH patients were significantly higher than those of the controls (P less than 0.05), suggesting enhanced platelet activation in the former. Compared with the controls, the entire PIH group was found to have significantly lower AT III values (P less than 0.05), more positive protamine sulphate tests (P less than 0.025), and higher plasma urate concentrations (P less than 0.01), but increased BTG values were more often observed than abnormal coagulation tests. No relationship could be demonstrated between the BTG level and fetal outcome. The significant increase in plasma BTG in PIH indicates enhanced platelet activation in these patients.
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PMID:Plasma beta-thromboglobulin in normal pregnancy and pregnancy-induced hypertension. 618 11

Heymann nephritis was induced in rats with spontaneous hypertension (group HN), and renal lesions were investigated at the twentieth and thirty-sixth week. An identical group given antihypertensive drugs (group HN-AH), an identical group given anticoagulant drugs (group HN-AC), and a nonimmunized control group of spontaneously hypertensive rats (controls) were also examined. Massive proteinuria, hypoalbuminemia, and hyperlipidemia were present in groups with induced Heymann nephritis (HN, HN-AH, and HN-AC). Coagulation studies demonstrated a shortening of prothrombin time, an increase in serum fibrinogen and thrombocytes, and a reduction of antithrombin III in the groups HN and HN-AH. Necrotizing lesions were observed only in group HN and without further elevation in blood pressure. Intravascular thrombosis was prominent at the twentieth week, and marked fibrinoid necrosis appeared at the thirty-sixth week. These vascular lesions were not observed in the HN-AH, HN-AC, and control groups. Thus, a state of hypercoagulability in addition to high blood pressure probably contributes to the genesis of necrotizing vascular lesions in spontaneously hypertensive rats with nephritis.
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PMID:Necrotizing vascular lesions in spontaneously hypertensive rats with nephrotic syndrome: hypercoagulability as a contributory factor. 638 12

A case of acute intestinal vascular necrosis in a 19-year-old user of oral contraceptives (OCs) is described, and hypotheses explaining the digestive complications of synthetic estrogens are reviewed. The patient had originally presented with a violent gastric pain that subsequently spread to the entire abdomen. An abrupt worsening of her condition involved cardiovascular collapse associated with a peritoneal syndrome, vomiting and dehydration, and hyperleukocytosis. Emergency opening of the peritoneum was followed by evacuation of a large quantity of fetid gas and alimentary debris, and observation of a completely necrosed stomach. A careful lavage of the entire intestinal cavity led to temporary improvement, but it became clear during an attempt at gastrectomy that further treatment would be unavailing and the patient died shortly thereafter. Estrogens were believed to be responsible for the digestive necrosis because it occurred in a young woman who had used an estrogen-rich OC for 3 years and who smoked; a hapatic biopsy confirmed the diagnosis. No traces of other risk factors such as hypertension, hyperlipidemia, diabetes, neoplasia, or obesity were observed. Recent publications indicate that OCs are responsible for a certain number of digestive problems, which may include acceleration of intestinal transit, severe diarrhea, rectorrhagia, ischemic or ulcerative colitis, intestinal infarct which is usually localized, and hepatocellular problems ranging from moderate hepatic insufficiency to malignant tumor and Budd-Chiari syndrome. OCs do not modify hemodynamic regimes, but they may cause elevation of fibrinogen and thrombin, diminution of antithrombin III acitivty, increased platelet adhesivity, and decreased fibrinolysis leading to hypercoagulability. These modifications in hemostasis occur in all OC users and are not statistically correlated with occurence of thrombotic accidents. OCs are probably responsible for parietal vascular lesions; experimental injection of synthetic estrogens is associated with both arterial and venous lesions. The most characteristic anomaly is at the level of the intima, with proliferation of smooth muscle cells and increased conjunctive tissue fibers associated with proliferation of the media or the endothelium. The absence of lipid deposits, the simultaneous appearance of arterial and venous lesions, and other evidence argues against and atheromatous origin of parietal lesions. A significant correlation has been found between high levels of anti-synthetic ethinyl estradiol antibodies and the presence of vascular lesions. It is hypothesized that these circulating immune complexes penetrate the vascular walls of OC users and produce lesions, which may depend on factors such as smoking.
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PMID:[Digestive complications of oral contraceptives: a case of extensive digestive necrosis in a young woman]. 647 54

To counter the paucity of documention on thromboembolic disorders caused by oral contraceptives (OC), a case study is presented describing the incidence of occlusion of arteria centralis retinae in a 24-year old woman after prolonged use of an OC, Bisecurin. She had taken Bisecurin for 4.5 years and had gained 20 kg during that time, but stopped usage 1 month before admission. She was hospitalized with severe deterioration of vision in the left eye. An eye examination indicated an edematous condition of the retina and reddening of the macula. Acuity of vision value for the left eye was .01 vs. 1.0 for the right, which was confirmed by fluorescein fundus angiography. Moderately decreased antithrombin III (AT III) activity was also ascertained. Treatment consisted of immediate retrobulbar injection with Tolazolin followed by Rheomacrodex, Cavinton infusions, B1 and B12 injections, Oradexon subconjunctival injection as well as vitamin B complex, Cavinton, and Colfarit tablets and a fat-free diet. Significant improvement of the left eye condition appeared 4 weeks later. Periodic follow-ups showed the healing of the condition around the macula; however, the patient suffered permanent damage to the retina due to the arterial occlusion above and below the macula. The disturbed lipid values of metabolism were also returned to normal, as borne out by normal dextrose loading results 8 months later (glucose tolerance was abnormal during examination at admission). The estrogen and progesterone components of OCs have been shown to reduce AT III levels, shorten heparin-thrombin coagulation time, increase fibrinogen levels, decrease HDL cholesterol levels, and produce excess TXA2 (thromboxan) resulting in vasoconstriction and thrombocyte aggregation. The risk of thrombosis is 6 times higher in OC users than in nonusers, although other susceptibility factors (obesity, diabetes, hypertension) also contribute to thrombosis.
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PMID:[Arterial occlusion in the ocular fundus induced by oral contraceptives]. 651 54


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