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

The purpose of this study was to determine whether vaginal rings delivering 17 beta estradiol and norgestrel would be an appropriate contraceptive method for hypertensive women. Vaginal rings with 17 beta estradiol and levonorgestrel have 3 advantages over oral contraceptives (OCs): extradigestive administration, use of estradiol, and regular and stable release of contraceptive hormones. 8 of the 12 moderately hypertensive patients participating in the study developed hypertension during OC treatment. 3 of them regained normal blood pressure after discontinuing OCs and the other 9 were treated with an antihypertensive during the study. Blood pressure was measured twice before the vaginal rings were used and on the 21st day of the 1st, 2nd, 4th, 6th, 9th and 12th cycles. The only significant variation in boood pressure observed during the study was a decline in diastolic pressure between the 1st and 2nd consultation before treatment. Thereafter variations in pressure did not exceed 5 mm Hg in either direction. The validity of the results was reinforced by the fact that blood pressure was measured 5 times at 3 minute intervals at each consultation and that there were no significant modifications after use of the rings was discontinued. No fall an antithrombin III or rise in plasma triglycerides was observed. This study indicates that 17 beta estradiol administered by extradigestive route short circuits the portal system, causing no alteration of blood pressure. Vaginal rings appear to be a suitable contraceptive method for hypertensive women.
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PMID:[Vaginal ring contraception in hypertensive women]. 1228 Feb 8

Every Dane has an identity number, allowing one to follow persons despite name and/or address changes. Every Dane discharged from a hospital has at least one diagnosis that is stored in the national patient register. This allows researchers to find women in a specific age group who have had a cerebral thrombosis, regardless of residence. Dr. Ojvind Lidegaard, a Danish gynecologist, has conducted a retrospective case control study to clarify the relationship between oral contraceptives (OCs) and the risk of cerebral thrombosis. He analyzed data on all Danish women aged 15-44 who had experienced a cerebral thrombosis between 1985 and 1989. After conducting a multivariate analysis, he found that OCs with 50 mcg estrogen had an odds ratio of 2.9 for cerebral thromboembolic attack, those with 30-40 mcg estrogen had an odds ratio of 1.8, and progestogen-only OCs had an odds ratio of 0.9. He concluded that the lower the content of estrogen in OCs, the lower the risk of cerebral thrombosis. He estimated the relative risk for the new 20 mcg OCs to be 1.2-1.3. His study found that the most significant contributor to risk of cerebral thrombosis is age. The odds increase by about 10 times between age 20 and age 40. Cigarette smoking alone increases the risk by 50%. At the University of Pisa in Italy, women using OCs with 30 mcg estrogen had higher levels of fibrinogen and fibrinopeptide A (blood coagulating factors) than did those using OCs with 20 mcg estrogen. Neither OC affected the anticoagulant antithrombin III, however. In fact, the 20 mcg OC induced no changes in hemostatic parameters. These studies show that estrogen contents of OCs determine the risk of cerebral thrombosis. Dr. Lidegaard claims that women can use low-dose OCs until age 50, assuming they do not smoke. He believes these OCs can be safely used by smokers until they reach age 35-40. Women who should not use OCs include those who have had a thrombosis or have high blood pressure or coagulation disorders.
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PMID:The case for a lower dose pill. Assessing the impact of estrogen dose. 1231 51

This article examines the effect of dose level of both estrogens and progestins as factors in the cardiovascular risk of oral contraceptives (OCs), and also examines the roles of blood pressure, coagulation factors, and lipid metabolism. A large number of epidemiologic studies have demonstrated the connection between OC use and thromboembolic disease since the 1st such study appeared 2 decades ago, but the early studies concerned formulations with much higher estrogen doses than those currently used, taken by women who were older and more likely to smoke than at present. Very few epidemiologic studies dealing with the newer formulations are yet available. It is easier to analyze the dose-response relations for the progestins than for the estrogens given that the 2 estrogens primarily used, ethinyl estradiol (EE) and mestranol, were used for a series of progestins at different doses to examine their effects with a constant dose of estrogen. Nevertheless, the epidemiologic studies show increased risks of thrombotic accidents and a dose-response relation for both the estrogen and progestin components. It is likely that different mechanisms are responsible. The effects of OCs on blood pressure have been monitored carefully since the 1st observations of hypertension in OC users. Blood pressure elevations are usually attributed to the estrogen, but there is evidence of a progestin role as well. Some studies have found differences in blood pressure at the same estrogen dose but with different progestin content. It is very likely that blood pressure undergoes physiologic variations depending on hormonal fluctuations. The mechanism by which some OC users develop hypertension is poorly understood, but it may be related to changes in the renin-angiotensin-aldosterone system. Androgenic progestins accentuate sodium retention, which may play a role. Researchers have shown that the lipid profiles of women at different stages of life are different, whether or not they use OCs. Among young women HDL cholesterol levels decline and LDL levels increase among users relative to nonusers of OCs. On the other hand, old women receiving estrogen substitution therapy tend to have more favorable lipid profiles than do women of the same age not receiving estrogen. Coagulation factors, especially factors VII and fibrinogen, have been established as important cardiovascular risk factors in men. Some studies have shown the levels of factors VII and fibrinogen to be elevated in OC users. These procoagulant alterations are also observed in women receiving estrogen substitution, but unlike OC users such women appear to be protected by age-related increases in the level of antithrombin III. Smoking is an important influence on the fibrinogen level, which probably explains part of the increased risk of myocardial infarct among OC users.
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PMID:[Cardiovascular risks of oral contraceptives: dose-response relationship]. 1234 20

Levels of fibrinogen, von Willebrand factor, d-dimer, antithrombin III, protein C, plasminogen, and plasminogen activator inhibitor were measured in 62 men and 37 women with ischemic heart disease before and after 20-min venous occlusion. Women compared with men had higher baseline levels of fibrinogen (4.046-/+0.1785 and 3.584-/+0.1591 g/l, respectively, p=0.021), von Willebrand factor (122.1-/+9.31 and 99.5-/+6.16%, respectively, p=0.035), plasminogen activator inhibitor (4.8-/+0.31 and 2.9-/+0.27 IU/l, respectively, p=0.009). Levels of antithrombin III, protein C, and plasminogen in women were higher than in men both at baseline (108.5-/+1.65 and 100.7-/+1.60 %, p=0.001; 129.1-/+2.91 and 107.2-/+3.79%, p=0.001; 113.6-/+2.13 and 104.1-/+1.89%; p=0.001, respectively) and after venous occlusion. There were no gender differences in dynamics of parameters of hemostasis during venous occlusion. Multifactorial regression analysis showed that gender was independently (of age, duration of hypertension, smoking, body mass index, and total cholesterol level) related to only antithrombin III and protein C levels.
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PMID:[Gender differences in the state of the system of hemostasis in patients with ischemic heart disease]. 1249 45

To better understand potentially reversible causes of idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, and an apparent association of IIH with polycystic-ovary syndrome (PCOS), we assessed associations of IIH with coagulation disorders and with PCOS in 38 women with well-documented IIH. Fifteen women were found to have PCOS; 14 of them were obese, with a body-mass index (BMI) greater than 30 kg/m(2), and 10 were extremely obese (BMI > or = 40). Factor VIII concentration was high (>150%) in 9 of 38 (24%) IIH cases, compared with 0 of 40 healthy adults controls (P(f) =.0009). Familial aggregation of high concentrations of factor VIII, associated with thrombophilia, was documented in all 5 of the 9 high-level factor VIII probands' families who were sampled. Activated partial thromboplastin time (APTT) was prolonged (> or =31.5 seconds) in 10 of 38 (26%) IIH cases, compared with 1 of 32 (3%) controls (P(f) =.009) and, in 4 of these cases, was accompanied by the lupus anticoagulant. Plasminogen activator inhibitor activity (PAI-Fx) was high (>21.1 U/mL) in 9 of 38 cases (24%), compared with 1 of 40 controls (3%) (P(f) =.006). Lipoprotein A was high (> or =35 mg/dL) in 13 of 37 cases (35%), compared with 5 of 40 controls (13%) (P(f) =.03). IIH cases did not differ (P >.05) from controls for homocysteine, proteins C and S, free S, antithrombin III, ACLAs IgG and IgM, dilute Russell's viper venom time, Factor XI, factor V Leiden G1691A, G20210A prothrombin, C677T MTHFR, plasminogen activator inhibitor 4G/5G, or platelet glycoprotein PL A1A2 mutations. Exogenous estrogens (n = 23), clomiphene (n = 1), or pregnancy (n = 4) accompanied the first appearance of IIH in 28 women. PCOS and coagulation disorders, often augmented by exogenous estrogens or pregnancy, are associated with IIH.
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PMID:Idiopathic intracranial hypertension: associations with coagulation disorders and polycystic-ovary syndrome. 1287 84

It has been suggested that thrombotic tendency increases the risk of myocardial infarction (MI). To investigate the association between the risk of MI at a young age and genetic thrombogenic disorders (G20210A mutation in the prothrombin gene, G1691A mutation in the factor V gene and deficiencies of protein C, protein S and antithrombin III) we conducted a case-control study among 70 survivors of MI who had experienced the event before the age of 36 and 260 healthy subjects. The G20210A mutation in the prothrombin gene was found more often in young patients with MI than among controls (11.4 versus 3.1%). The odds ratio (OR) for MI for carriers versus non-carriers was 4 (95% confidence interval [CI], 1.5 to 11.3). The adjusted OR for major cardiovascular risk factors (smoking, hypecholesterolaemia, diabetes mellitus, hypertension and obesity) was 4.3 (95% CI, 1.3 to 14). The simultaneous presence of both G20210A mutation in the prothrombin gene and smoking further increased the risk of MI compared with nonsmokers and non-carriers (OR, 58; 95% CI, 11.4-294). The G1691A mutation in factor V gene was not associated with an increased relative risk for MI (OR, 0.87; 95% CI, 0.26 to 2.5). Finally, there was no significant difference in the prevalence of deficiencies of protein C, protein S and antithrombin III between cases and controls. In conclusion, our data indicate that the G20210A mutation in the prothrombin gene was the only genetic prothrombotic risk factor associated with the risk of developing MI under the age of 36 years.
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PMID:Myocardial infarction under the age of 36: prevalence of thrombophilic disorders. 1573 21

Our aim was to study the cause and describe the clinical features of pulmonary arterial hypertension (PHT) in splenectomized beta-thalassemia (beta-Thal) patients. Ten splenectomized beta-Thal patients with systolic pulmonary artery (PA) pressure >30 mm Hg were evaluated by echocardiography, right-heart catheterization, and pulmonary angiography. Five of these patients later underwent hemodynamic studies. Echocardiography and pulmonary angiography on the 10 patients showed normal values of left ventricular systolic function and no findings of acute or chronic pulmonary embolism. Hemodynamic evaluation showed very high PA pressures associated with markedly increased pulmonary vascular resistance indices (PVRIs). Hematological evaluation of the 10 patients showed marked anemia, markedly increased numbers of nucleated red blood cells (nRBCs), and serum ferritin. Mean platelet count, plasma beta2 thromboglobulin, and thrombin-antithrombin III complex levels were significantly increased. It was concluded that PHT can be found in splenectomized beta-Thal patients. Features associated with PHT were female sex, hemoglobin E/beta-Thal, status many years postsplenectomy, marked anemia, markedly increased nRBC count, thrombocytosis, and very high serum ferritin levels. PHT was not due to pulmonary emboli. Our findings suggested that severe PHT was due to increased PVRI from thrombotic pulmonary arteriopathy, likely from chronic low-grade hypercoagulability and platelet activation after splenectomy.
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PMID:Pulmonary arterial hypertension in previously splenectomized patients with beta-thalassemic disorders. 1295 8

Chronic transfusion of packed red blood cells, in addition to other ongoing treatment with warfarin, acetyl salicylic acid, desferrioxamine, and other supportive measures, was given to a splenectomized hemoglobin E/beta-thalassemia woman with pulmonary arterial hypertension (PHT). Serial measurements of plasma thrombin-antithrombin III complex (TAT) levels and right-sided cardiac catheterization were used to monitor changes after treatment. Reduction of plasma TAT levels from 7.5 to 3.8 microg/L (normal, 3 +/- 2.4 microg/L), pulmonary vascular resistance (PVR) from 553.8 to 238.6 dyne.sec.cm(-5) (normal, 67 +/- 30 dyne.sec.cm(-5)), and mean pulmonary arterial pressure from 51 to 32 mm Hg (normal, 9 to 19 mm Hg) occurred in tandem. Normalization of blood hypercoagulability as reflected in plasma TAT level by chronic blood transfusion was the likely basis for improvement of increased PVR, being secondary to thrombotic pulmonary arteriopathy and subsequently PHT.
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PMID:Correction of hypercoagulability and amelioration of pulmonary arterial hypertension by chronic blood transfusion in an asplenic hemoglobin E/beta-thalassemia patient. 1464

Background: Stroke mainly affects the older population, although it has also been reported in younger patients. In this study, we focused on patients 65 years of age or younger with stroke. Methods: The files of three patient populations were studied: 93 patients aged 65 years or younger with stroke (group A), 93 patients older than 65 with stroke (group B), and 604 patients without stroke representing the general population of patients admitted to our service during January 2000 (group C). We reviewed the patient files and compared patient characteristics, epidemiological features, clinical picture,imaging findings, and coagulation tests. Results: Overall, 318 patients were studied. The mean age of group A was 55 years compared to 77 years in group B and 71 years in group C. In both stroke groups (A and B), the male: female ratio was 2:1, in contrast with a balanced ratio in group C. Most of the patients in group A (63%) were of Sephardic origin compared to 39% in group B (P=0.002) and 30% in group C. The clinical picture in both stroke groups (A and B) was similar. The risk factor smoking was reported by 45% in group A and by only 29% in group B (P=0.034). Hypertension, diabetes mellitus, and hyperlipidemia were evenly prevalent in both stroke groups. The coagulation system was studied in the "young" patients (group A): hyperhomocysteinemia was found in 37%, high titers of anticardiolipin antibodies in 35%, low levels of antithrombin III in 13%, protein C deficiency in 5%, and activated protein C resistance (APCR) in 4%. Overall, 49% of the patients from group A were found to have coagulation abnormalities. Conclusions: We found in our study that the younger patient with stroke tends to be a Sephardic male with the classical risk factors as well as a history of smoking and coagulopathy. These findings suggest strict medical supervision and primary prophylaxis. This work also lays the basis for a prospective, interventional trial with younger patients.
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PMID:Clinical and ethnic characteristics of stroke in an Israeli population: a study in a community hospital population. 1524 19

The aim of the study was to evaluate the degree of platelet activation and plasma antithrombin III and alpha2-antiplasmin activities in hypertensive patients. The studied group consisted of 21 patients with hypertension. The control group included 19 healthy volunteers. The values of platelet and plasma coagulation factors were determined using the synthetic chromogenic substrates and the spectrophotometric method. Compared to the healthy individuals, the hypertensive patients show increased platelet activity confirmed by a statistically significant increase in the platelet factor 3 activity, which is likely to intensify the plasma proaggregation and procoagulation activities. In the hypertensive patients, a significant decrease in antithrombin III (the endogenous inhibitor of the coagulation system) concentration is observed. In arterial hypertension, a significant decrease in alpha2-antiplasmin activity is found, which may reflect decreased fibrinolytic activity of plasma in the hypertensive patients.
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PMID:Evaluation of platelet activation, plasma antithrombin III and alpha2-antiplasmin activities in hypertensive patients. 1531 52


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