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

Rhythm parameters of peripheral arterial rest blood flow (RF) as a potential predictor of peripheral arterial disease (PAD) have been investigated. Three groups of subjects have been studied: a. six apparently healthy subjects; b. seven high risk (hypertension, diabetes, hypercholesterolaemia, hypertriglyceridaemia, erythrocytosis) subjects; c. four occlusive PAD selected patients with one 'pre-symptomatic' leg. RF has been measured by 'strain-gauge plethysmography' every min for 25 min, 4 times/day. Right fore-arm, right leg and left leg have been assessed. Data have been analyzed by 'single and population mean cosinor'. Significant circadian rhythms have been detected in apparently healthy subjects. Mesor and amplitude can differ according to single individual's area. Mesor is higher in upper limb. RF circadian rhythm parameters differ in subjects with various vascular risk load. Sometimes, PAD-symptomatic limb shows higher mesor than pre-symptomatic one, suggesting conditions of reactive post-ischemic hyperemia or a role of RF in PAD. Circadian dyschronia can be detected in PAD limbs but also in high risk subjects, perhaps an example of chronoprotopathology. These results suggest the possibility of a clinical use of RF rhythm parameters as predictors of vascular protopathology.
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PMID:An attempt to establish early signals of peripheral arterial disease (PAD): the use of rhythm's parameters of peripheral blood flow (RF). 717 71

The presenting symptom complex, diagnostic features, and therapeutic alternatives for obstructive and central sleep apnea are discussed in relation to two illustrative patients. Heavy snoring and restlessness during sleep in an obese individual, usually a male, may indicate obstructive apnea. Daytime hypersomnolence, intellectual deterioration, mental depression, impotence, cardiac arrhythmias, cor pulmonale, systemic hypertension, and erythrocytosis are the most common complications. Tracheostomy, the classic form of therapy, can be replaced by pharmacologic intervention in most patients. The clinical presentation of central apnea is less dramatic, but neurological and cardiac complications can occur. Therapy is less well established for this entity. Knowledge of the increased incidence of these disorders and awareness of more subtle complications indicate that sleep apnea should be placed in the differential diagnosis of pulmonary and systemic hypertension, hypersomnolence states, mental deterioration, psychiatric illness, and even insomnia.
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PMID:Diagnosis and therapy of sleep apnea. 722 83

We compared some of our latest experiments on blood pressure control and erythrocytosis in spontaneously hypertensive rats with Gaar's computer-simulated studies, which suggest that erythrocytosis is a key to understanding the hemodynamic changes in hypertension. We tested two of Gaar's several predictions: (i) peripheral vascular resistance decreases when the feedback control of erythrocytosis is blocked and (ii) in primary hypertension, blood volume is increased slightly. We also studied the interrelation of systolic blood pressure and plasma renin substrate in spontaneously hypertensive rats, and the effect of diet on renin, blood pressure, and erythrocytosis. Our data showed that (i) on a percentage basis the renin system supports blood pressure essentially in the same manner in normal and hypertensive rats, (ii) peripheral vascular resistance decreased when erythrocytosis was partially blocked by feeding a low-iron diet, (iii) blood volume was similar in normal and hypertensive rats, and (iv) dextrin stimulates plasma renin, packed cell volume, and blood pressure in hypertensive rats. We conclude that blood pressure and erythrocytosis are interrelated, that the combined data of stimulated and experimental studies support the notion that primary hypertension is a blood-vessel adaptation in response to a renal energy need that may require additional oxygen.
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PMID:Blood pressure control and erythrocytosis in rats: theory and observations. 795

True erythrocytosis is a relatively common complication of successful renal transplantation. From a group of 17 patients with post-transplant erythrocytosis (PTE), four underwent selective venous catheterization of the native and transplanted kidneys because of arterial hypertension. In three who presented with active PTE at the time the procedure was performed the peripheral blood (PB) concentration of EPO was elevated, and the level of erythropoietin (EPO) in native kidney veins was significantly higher than the PB and allograft EPO levels. Additionally, only one of the three cases had high levels of plasma renin activity (PRA). The fourth patient showed normal levels of EPO and PRA in PB and in venous blood from the native and transplanted kidneys. However, the PTE had subsided 4 months before the performance of the catheterization after he redeveloped terminal renal failure; the loss of a functioning allograft might have blunted the overproduction of EPO by the native kidneys. In conclusion, in patients with PTE, inappropriate EPO production seems to originate from the diseased native kidneys, and there seems to be no correlation between the production of EPO and the PRA.
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PMID:Postrenal transplant erythrocytosis: further evidence implicating erythropoietin production by the native kidneys. 800 62

Erythrocytosis (i.e., elevation in red cell mass) frequently develops after renal transplantation and is associated with increased risk of thromboembolic incidents and hypertension. Because it has been reported that enalapril may induce anemia in renal allograft recipients, we have undertaken a prospective study to estimate the efficacy and safety of enalapril therapy for erythrocytosis and to establish the mechanism by which enalapril reduces red cell mass. Seventeen (12 male and 5 female) long-term renal allograft recipients with increased hematocrit value (> 55% for male and > 50% for female) and elevated red cell mass as determined with 51Cr-labeled autologous erythrocytes were treated with enalapril. After 3 months of therapy, enalapril was withdrawn and patients were observed in order to differentiate spontaneous remission of erythrocytosis from effects of enalapril therapy. After 3 months of the treatment, mean hematocrit decreased from 51.1% (range 47-56%) to 42.9% (range 37-51%; P < 0.01). Red cell mass significantly decreased during this period (from 46.7 ml/kg, range 32.5-60.7 ml/kg, to 32.9 ml/kg, range 20.1-60.1 ml/kg; P < 0.01). Serum erythropoietin levels also changed from 12.2 mIU/ml (range 1.0-33.0 mIU/ml) at baseline to 5.4 mIU/ml (range 0.7-24.2 mIU/ml; P < 0.05). During the following 3 months without enalapril treatment, an increase in hematocrit was noted, reaching 51.7% (range 46-58%; P < 0.05). No serious side effects of enalapril were observed during the study, but there was a need to reduce other hypotensive drugs in some patients. Serum creatinine did not change significantly during enalapril therapy (1.49 mg/dl, range 0.9-2.3 mg/dl, and 1.55 mg/dl, range 1.0-2.3 mg/dl; before and after 3 months of therapy, respectively). Our study proves that enalapril can be safely and effectively used to treat posttransplant erythrocytosis. The effect of enalapril on red cell mass results from reducing erythropoietin production.
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PMID:Correction of posttransplant erythrocytosis with enalapril. 816 3

Hypertension is a major complication in kidney transplantation and contributes to the high cardiovascular mortality of renal transplanted recipients. The aim of the present study was to evaluate the therapeutic effect of phlebotomy on blood pressure in posttransplant hypertension associated with erythrocytosis. In 12 renal transplanted patients (7 male, 5 female, aged 29-52 years) with erythrocytosis (defined by hematocrit > 52% or hemoglobin > 170 g/l), a 24-hour-monitoring of blood-pressure and heart rate (SpaceLabs SL90207) was performed before, 2 and 6 weeks after phlebotomy. Patients with iron-deficiency and/or transplant rejection were excluded from the study. Ten of 12 patients were on antihypertensive treatment before phlebotomy. Phlebotomy (500 ml) was repeated three times on average within the first two weeks, until hematocrit decreased below 45%. The phlebotomy therapy lowered the hematocrit after two weeks from 54.8 +/- 2.8% to 44.3 +/- 4.2% and 43.0 +/- 5.6% after six weeks. Before phlebotomy, the blood pressure was systolic 153.2 +/- 15.1 mmHg and diastolic 95.2 +/- 9.5 mmHg. After repeated phlebotomy, there was a significant decrease of blood pressure to systolic 139.0 +/- 14.1 and diastolic 85.3 +/- 8.2 mmHg (p < 0.01). Without change of hematocrit and hemoglobin, there was no further change of blood pressure after six weeks (systolic 140.1 +/- 9.9 mmHg, diastolic 86.3 +/- 9.5 mmHg). The heart rate did not change significantly during the therapy. The antihypertensive treatment could be reduced in most of the patients. The present study demonstrates the therapeutic effect of phlebotomy in posttransplant hypertension associated with erythrocytosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Therapeutic efficiency of phlebotomy in posttransplant hypertension associated with erythrocytosis. 826 83

Pregnancy carries substantial maternal and fetal risks in patients with uncorrected or palliatively corrected cyanotic congenital heart disease (CHD). In tricuspid valve Ebstein's anomaly, pregnancy is well tolerated. Maternal mortality in tetralogy of Fallot seems to be less than 10%, but it exceeds 50% in Eisenmenger's syndrome and primary pulmonary hypertension (PPH). Maternal hematocrit greater than 60%, arterial oxygen saturation lower than 80%, right ventricular hypertension, and syncopal episodes are poor prognostic signs. Maternal risk could be reduced by vaginal delivery. Continuous monitoring of arterial and central venous pressure, electrocardiography, and pulse oximetry are recommended for every anesthetic procedure. The use of a pulmonary artery catheter is controversial and probably should be avoided in parturients with cyanotic CHD or PPH. The choice of anesthetic technique and drugs per se is of secondary importance and should be governed by individual preferences. Titration of anesthetic drugs, general anesthesia with controlled ventilation, or, preferably, regional anesthesia with spontaneous breathing should be used cautiously to avoid worsening of the preexisting condition. Prevention of excessive erythrocytosis, volume and blood loss substitution, cardiocirculatory pharmacologic support, prophylaxis of infective endocarditis, and judicious use of anticoagulant drugs should be applied as indicated by the type and presentation of CHD. Poor outcome of pregnancy in PPH requires an early consideration of heart-lung or lung transplantation. Multidisciplinary team effort and prolonged monitoring in the intensive care unit are mandatory to ensure a favorable outcome for cyanotic CHD and PPH parturients.
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PMID:Cyanotic congenital heart disease and pregnancy: natural selection, pulmonary hypertension, and anesthesia. 837 15

Various tumors secrete tumor-specific substances capable of producing signs and symptoms in host organs not caused by direct tumor invasion or organ destruction. These symptoms are collectively referred to as "remote effects" or "paraneoplastic syndromes" of malignancy. Paraneoplastic syndromes are uncommon in childhood cancer. In Wilms tumor several distinct paraneoplastic syndromes have been reported: hypertension, erythrocytosis, hypercalcemia, Cushing syndrome, and acquired Von Willebrand disease. In addition some tumor-specific substances are known to be elevated in patients with a malignancy without causing specific symptoms. These so called "tumor markers" can be used to detect early recurrence in previously treated patients, or in the evaluation of patients undergoing adjuvant therapy. Five of particular interest are erythropoietin, neuron-specific enolase (NSE), hyaluronic acid (HA), hyaluronic acid-stimulating activity (HSA), and hyaluronidase.
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PMID:Serum biological markers and paraneoplastic syndromes in Wilms tumor. 838 82

Erythrocytosis is a relatively common phenomenon following renal transplantation. It is not only associated with some special clinical conditions, but also increases the risk of thromboembolism. We therefore studied the clinical manifestations and possible risk factors of erythrocytosis in our renal-transplant patients. Study of 175 patients showed that erythrocytosis, defined as Hct > or = 50%, was found in 17 patients (9.7%), 14 males and 3 females. Among these 17 patients, 13 received cadaveric grafts and the other 4 living-related grafts. True erythrocytosis, defined as erythrocytosis with elevated red blood cell (RBC) mass, was found in 7 patients. Relative erythrocytosis, defined as erythrocytosis with normal RBC mass, was found in the other 10 patients. Six patients developed acquired renal cysts of the native or graft kidneys during the post transplant period. The incidence of acquired renal cysts in the erythrocytosis group was significantly higher than that in the non-erythrocytosis group. The clinical and demographic characteristics were similar in terms of age, gender, serum albumin, and serum creatinine in the erythrocytosis and non-erythrocytosis groups. The incidences of abnormal liver function, and hypertension were similar between the 2 groups. Seventeen of the 161 patients (10.6%) receiving cyclosporine regimen developed erythrocytosis, but none of the 14 patients receiving non-cyclosporine regimen developed erythrocytosis (p > 0.05). Only one patient with true erythrocytosis had an elevated serum erythropoietin (EPO) level and no thromboembolic complications occurred in the erythrocytosis group. We conclude that: (1) the incidence of erythrocytosis in our transplant patients was 9.7%; (2) a higher incidence of acquired renal cysts was found in the erythrocytosis group; (3) most of the patients with erythrocytosis had a normal serum EPO level; (4) no thromboembolic complications occurred in our patients.
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PMID:Post-renal transplant erythrocytosis. 892 41

We present an 86-years-old woman's case with paralysis in her left hand of abrupt apparition, accompanied by arterial hypertension and dizziness. The investigation revealed erythrocytosis, leukocytosis, thrombocytosis, with normal arterial O2 saturation (O2 SAT), increased of his red cell volume and blood viscosity. The polycythaemia vera (PV) was diagnose and the paralysis disappeared, when 24 hours before a phlebotomy was practiced, and the function was recovered by the hand. We analysed the presents diagnostics criteria of the disease defined by Polycythaemia Vera Study Group (PVSG). The different treatments for PV are discussed; in addition to venesection, conventional treatment include chemotherapy with hydroxyurea and pipobroman, as well as the erythropheresis, -interferon and aspirin. All of the treatments are associated with complications; thrombotic in the case of phlebotomy; malignancies and gastrointestinal bleeding in the case of myelosuppressive treatments and aspirin. We think the optimal treatment for PV is a judicious combination of the available alternatives, depending on the phase of the disease, and the age of the patient.
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PMID:[Primary polycythaemia vera in the elderly]. 958 Jan 77


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