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

1. Using the MRC trial placebo group as the data source, we examined relationships between cardiovascular risk, gender, and blood pressure (BP) at screening, on entry to the trial, and after 3 months of follow up. 2. Blood pressure on entry to the trial (162/98 mmHg) was significantly higher than at the second screening (154/95 mmHg) visit and at 3 months (144/91 mmHg). The entry BP was higher, and the changes from screening to entry and from entry to 3 months were greater in females. Females had a low cardiovascular risk, but because of the greater changes of BP at entry they were over-represented at the top of the entry BP distribution, whereas males were over-represented at the bottom. The result of these effects was that the relationship between cardiovascular risk and entry BP was shifted to the right and was flatter than the corresponding curves measured at screening or after 3 months of follow up. 3. In consequence, the severity of hypertension in the trial population was overestimated from measurement of BP at entry, and the capacity of trial entry BP to predict cardiovascular risk was weakened. 4. BP on entry to the MRC Trial was affected by a pressor effect that diminished the value of BP as a cardiovascular risk factor because it differentially affected sub-populations by gender.
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PMID:Effect of sex-related changes in blood pressure at entry to the MRC trial on prediction of cardiovascular risk. 803 73

The concept of microalbuminuria is reviewed. Measuring the urinary albumin excretion rate and testing for microalbuminuria is well established in the control and treatment of patients with insulin-dependent diabetes mellitus. Microalbuminuria predicts nephropathy and early cardiovascular death. In the presence of microalbuminuria frequent examinations are warranted for early detection of retinopathy, blood-pressure rise, and for optimizing the glycemic control. In patients with non-insulin-dependent diabetes, the independent value of microalbuminuria as a cardiovascular risk factor is not yet clarified. The urinary albumin excretion rate should be measured at diagnosis, because the indications are that presence of microalbuminuria reinforces the urge to intervene against other well-documented cardiovascular risk factors (hypertension, dyslipidemia, tobacco, and obesity). In the nondiabetic population, there is accumulating evidence that an elevated urinary albumin excretion rate is associated with early cardiovascular morbidity and mortality. Large scale cross-sectional and prospective studies are needed in order to clarify further the role of microalbuminuria as an independent risk factor in the background population.
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PMID:Microalbuminuria: an important diagnostic tool. 808 48

The measurement of blood pressure in epidemiological studies is difficult to standardize between centres in multi-centre studies and between repeat surveys over time. The use of standard mercury sphygmomanometers is common but especially prone to measurement error in terms of departure from the protocol and variation in measurement technique. Data from Australia's cardiovascular risk factor prevalence surveys on 21 independent populations, distributed geographically and temporally, has been examined to assess the effect of these errors on cross-sectional and trend analyses. The examination showed that last digit preference for zero may inflate estimates of proportions having high blood pressure. A tendency to record identical duplicate measurements could contribute 0.85 mmHg to time trends or geographic differences in mean systolic blood pressure (but not diastolic blood pressure). Epidemiological studies for geographic and trend differentials in systolic blood pressure need to be mindful of these effects in their analysis. There was some evidence of deterioration in data quality during data collection but no evidence that observers were influenced in their recording practice by observable respondents' characteristics. Training procedures for blood pressure measurement are of critical importance and adherence to the measurement protocol should be continuously monitored during data collection to ensure comparability of results.
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PMID:Blood pressure measurement error: its effect on cross-sectional and trend analyses. 813 39

Single cardiovascular risk factor intervention is probably not sufficient to prevent atherosclerosis progression. There is a lack of data on concomitant use of hypocholesterolemic agents and antihypertensive drugs with respect to possible interactions and adverse experiences. We studied 293 patients (below 65 years of age) under treatment with either lisinopril (n = 144) or nifedipine (n = 149) for mild to moderate hypertension for 10 weeks, and with serum cholesterol above 6.5 mmol/L, who were randomized to either lovastatin 20 mg every day or placebo in a double-blind, double-dummy design for 6 weeks. Lovastatin effectively lowered cholesterol by 16% and 15% in the lisinopril and nifedipine group respectively (P < .01 compared to placebo for both groups) without any negative impact on the antihypertensive efficacy of either lisinopril or nifedipine. The drugs in combination were well tolerated and did not affect the well-being of the patients, and did not cause any more adverse effects than the antihypertensive agents alone. Liver enzymes increased slightly during lovastatin therapy, while no case of myopathy was reported. Combined therapy with lovastatin and antihypertensive therapy can be safely undertaken.
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PMID:Effect and tolerability of combining lovastatin with nifedipine or lisinopril. 821 32

The concept of microalbuminuria is reviewed. Measuring the urinary albumin excretion rate and testing for microalbuminuria is well established in the control and treatment of patients with insulin-dependent diabetes mellitus. Microalbuminuria predicts nephropathy and early cardiovascular death. In the presence of microalbuminuria, frequent examinations are warranted for early detection of retinopathy, hypertension and for optimizing the glycaemic control. In patients with non-insulin dependent diabetes, the independent value of microalbuminuria as a cardiovascular risk factor is not yet clarified. The urinary albumin excretion rate should be measured at diagnosis, because the indications are that presence of microalbuminuria reinforces the urge to intervene against other well-documented cardiovascular risk-factors (hypertension, dyslipidemia, tobacco and obesity). In the non-diabetic population there is accumulating evidence that an elevated urinary albumin excretion rate is associated with early cardiovascular morbidity and mortality. Large scale cross-sectional and prospective studies are needed in order to further clarify the role of microalbuminuria as an independent risk factor in the background population.
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PMID:[Microalbuminuria--a valuable diagnostic parameter]. 827 36

Two cardiovascular risk factor surveys were carried out in 1984/85 and 1989/90 in the Augsburg study region of the international World Health Organization (WHO) Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) project. Independent random samples of the 25- to 64-year-old population were examined at each survey. Five-year changes in blood pressure (BP) and hypertension parameters were monitored in a population not targeted by any formal intervention program. Response rates in both surveys ranged close to 80%. Evaluation of selected quality indicators confirmed comparability of the two surveys in terms of BP measurement quality. Small but consistent decreases in mean systolic and diastolic BP were observed, particularly for women 35 years and older, whereas BP changes in men were less pronounced and inconsistent. Likewise, downward shifts of the 10th, 50th, and 90th percentiles of systolic and diastolic BP occurred in women and their slopes of BP rise with age decreased while such changes were less clear in men. The age-standardized prevalence of men and women with hypertensive BP (HBP; > or = 160/95 mm Hg) decreased slightly. This contrasted with rises in the prevalence of actual hypertension (those with HBP plus those taking antihypertensive drugs) for 45- to 64-year-old men, which originated from changes in hypertension management involving a more frequent drug treatment of borderline-hypertensive men (140 to 159/90 to 94 mm Hg) in 1989/90. There were notable overall increases in the awareness, treatment, and control of men and women with hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Five-year changes in population blood pressure and hypertension prevalence. Results from the MONICA Augsburg surveys 1984/85 and 1989/90. 827 18

The cardiovascular risk factor plasminogen activator inhibitor type 1 (PAI-1) has been associated with abdominal obesity, hypertension, hypertriglyceridemia, hyperinsulinemia, glucose intolerance, and type II diabetes, conditions known to be linked with insulin resistance. To determine whether PAI-1 is related to insulin resistance, we studied nine obese nondiabetics and 10 obese type II diabetics by means of a sequential hyperinsulinemic euglycemic clamp study. Plasma PAI-1 antigen (Ag) correlated significantly with peripheral insulin resistance, represented by the insulin level at which peripheral glucose uptake (PGU) is half-maximal ([ED50PGU] r = .87, P < .001). Multiple regression analysis including indices of hepatic and peripheral insulin action, fasting plasma insulin levels, triglyceride levels, blood pressure (BP), waist to hip ratio (WHR), and body mass index (BMI) disclosed ED50PGU to account for 76% of the variance of PAI-1 Ag. We suggest that PAI-1 contributes to the increased cardiovascular risk encountered with insulin resistance.
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PMID:The cardiovascular risk factor plasminogen activator inhibitor type 1 is related to insulin resistance. 834 17

Obesity and hypertension often coexist. The waist-hip ratio has been found to be a more accurate predictor of hypertension than either body weight or body mass index. A waist-hip ratio of 0.85 or more in men and 0.75 or more in women is a significant cardiovascular risk factor. Insulin also probably has an important role in the pathogenesis of hypertension in obese patients. Treatment of hypertension in overweight patients begins with weight loss, which is frequently achieved by combining caloric restriction and exercise. Such commonly used drugs as angiotensin-converting enzyme inhibitors, calcium blockers, alpha blockers, and beta blockers are appropriate for medical treatment of these patients.
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PMID:Hypertension in obese patients. 844 35

It is generally known that patients with primary hyperparathyroidism (pHPT) feature disturbances in carbohydrate metabolism and hypertension. The incidence and prevalence of frank diabetes mellitus is significantly increased in these patients. The etiology and pathogenesis of the vascular and metabolic aberrations in this condition are still unclear. Glucose intolerance in pHPT is characterized by severe insulin resistance associated with pancreatic beta cell hypersecretion of insulin. Hypercalcemia is thought to be mainly responsible for the impaired glucose metabolism. However, several studies demonstrated that hypophosphatemia can also induce insulin hypersecretion and impair peripheral glucose uptake. Hypertension in primary hyperparathyroidism is mainly attributed to hypercalcemia. However, high peripheral insulin levels are also proposed to contribute to the development of essential hypertension and hyperinsulinemia per se is regarded as an important independent cardiovascular risk factor. After parathyroidectomy and decrease of the calcium levels to within the normal range, the blood pressure levels of the patients with pHPT normalised very quickly, whereas normalization of the high peripheral insulin levels was only found in a subgroup of patients. Thus, hypercalcemia seems to be mainly responsible for hypertension in primary hyperparathyroidism. Another important, yet unresolved issue is the question as to whether or to which extent the disturbances in glucose homeostasis are reversible after surgical correction of pHPT. At an early stage of the disease, insulin resistance and insulin hypersecretion are fully reversible after parathyroidectomy, whereas in patients with long-standing primary hyperparathyroidism and severely impaired glucose tolerance the metabolic disturbances will only partially improve. These results argue for improved screening to identify asymptomatic patients with primary hyperparathyroidism and for early surgical intervention in this disease.
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PMID:[Diabetes mellitus and carbohydrate metabolism in primary hyperparathyroidism]. 847 26

A less favorable cardiovascular risk factor profile, but paradoxically lower coronary heart disease mortality and prevalence have been reported for Hispanic men compared to non-Hispanic white men. Since mortality and prevalence data are susceptible to bias, the patterns of coronary heart disease incidence, as well as prevalence and mortality, were investigated in a biethnic Hispanic and non-Hispanic white population of the San Luis Valley in Colorado. Little evidence was found for lower incidence, prevalence, or mortality due to coronary heart disease among Colorado Hispanics without diabetes. The risk of coronary heart disease among diabetic Hispanics appeared, however, to be approximately 50% lower than among non-Hispanic whites, especially in men. Adjustment for selected cardiovascular risk factors (age, gender, diabetes, hypertension, cigarette smoking, body mass index, and high-density lipoprotein cholesterol and triglycerides levels) did not change this ethnic pattern. The plausible explanations of a lower coronary heart disease risk among diabetic Hispanics, compared to non-Hispanic whites, include both biologic mechanisms and artifacts due to deficiencies of mortality classification or differential access to health care. The existing evidence is insufficient to conclude that the risk of coronary heart disease in the general population differs between Hispanics and non-Hispanic whites. The ethnic patterns of coronary heart disease incidence should be investigated further through population-based incidence studies.
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PMID:Is the risk of coronary heart disease lower in Hispanics than in non-Hispanic whites? The San Luis Valley Diabetes Study. 850 4


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