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

The mechanism of recumbent hypertension induced by fludrocortisone was studied in seven patients with orthostatic hypotension. All showed increases in blood pressure in the recumbent and standing positions, and hypertensive levels were achieved on recumbency in four of them. Hypertensive retinopathy developed in two patients and cardiomegaly in one. Initial blood-pressure elevations were associated with sodium retention and plasma-volume expansion. However, with long-term treatment, plasma volume decreased to control levels despite further blood-pressure increases. Treatment did not affect plasma levels of catecholamines but did enhance pressor responsiveness to infused norepinephrine in some subjects. Hemodynamic studies indicated that hypertension in the recumbent position was related to increases in total peripheral-vascular resistance and not to changes in cardiac output. Clinically, hypertension in the recumbent position is an important risk of fludrocortisone treatment in patients with orthostatic hypotension. This unusual model of chronic mineralocorticoid-induced hypertension is not volume dependent but is related to increased peripheral-vascular resistance.
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PMID:Mineralocorticoid-induced hypertension in patients with orthostatic hypotension. 44 47

Acute arterial hypertension causes 3 types of fundus anomalies: hypertensive retinopathy, hypertensive choroidopathy and hypertensive optic neuropathy. Hypertensive retinopathy and optic neuropathy are characterised by retinal and optic disc capillary and precapillary occlusions, and a rupture of the inner hemato-retinal barrier resulting in retinal edema. Hypertensive choroidopathy is characterized by areas of choriocapillaris occlusion resulting in necrosis of the pigment epithelium which causes a rupture of the outer hemato-retinal barrier and retinal edema.
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PMID:[Macular edema in arterial hypertension]. 181 16

We produced experimental renovascular malignant arterial hypertension by modified Goldblatt's procedures, in 60 rhesus monkeys. Hypertensive retinopathy was studied in detail (by ophthalmoscopy, and stereoscopic color fundus photography and fluorescein fundus angiography on long-term follow-up). Cotton-wool spots (CWSs) were found to be an important, early retinal lesion. On ophthalmoscopy, they had a characteristic appearance. Fluorescein fundus angiography of these lesions revealed focal retinal capillary nonperfusion. The CWSs usually lasted for over 3 weeks and resolved within 6 weeks, leaving permanent obliteration of the retinal capillaries in their distribution, secondary intraretinal microvascular abnormalities, and retinal nerve fiber loss. We discuss pathogenesis and other features of CWSs. There is overwhelming evidence that CWSs are due to occlusion of the terminal retinal arterioles, resulting in acute focal inner retinal ischemia; hence the scientifically valid term for them would be 'inner retinal ischemic spots'.
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PMID:Cotton-wool spots (inner retinal ischemic spots) in malignant arterial hypertension. 274 98

Using computerized M-mode echocardiography we have investigated 58 hypertensive subjects in order to assess whether a correlation could be demonstrated between left ventricular changes induced by hypertension and age of the patients, the duration and severity of hypertension, and damage to other target organs. Various morphological changes of the left ventricle were detected: 14 patients (24%) had concentric hypertrophy of the left ventricle, 12 (20%) had asymmetric septal hypertrophy, 5 (8%) had dilated left ventricle without hypertrophy. Left ventricular mass was increased, when compared to normal controls in 24 patients (41%). With respect to functional abnormalities, the peak lengthening rate of left ventricular dimension in diastole was decreased (+dD/dt less than s-1) in 25 patients (43%). Eight of these patients (14%) also had depressed peak shortening rate of left ventricular diameter in systole (-dD/dt less than 1.9 s-1). Hypertensive retinopathy was present in 23 patients (39%) and impairment of renal function in 8 (14%). Left ventricular mass and systolic and diastolic parameters of left ventricular function did not correlate significantly either with the age of the patients, or with the duration and severity of hypertension, or with the damage present in target organs other than the heart. Left ventricular mass was inversely correlated with the index of left ventricular relaxation (r = -0.53; P less than 0.001), whereas neither the latter nor left ventricular mass were correlated with peak systolic stress. Instead, peak systolic stress was inversely correlated with peak shortening rate of left ventricular diameter, an index of systolic function (r = -0.50; P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Functional anatomy of the left ventricle in hypertensive subjects. Correlations with the clinical severity of hypertension]. 297 24

Hypertensive choroidopathy was noted in seven patients with accelerated or malignant hypertension. The acute lesion consisted of white areas of retinal pigment epithelial necrosis with overlying serous detachments of the retina. The detachments varied in size. Fluorescein staining of the damaged pigment epithelium and leakage into the subretinal space were demonstrated in several of these patients. Medical control of the BP resulted in a rapid disappearance of the detachment with minimal permanent ophthalmoscopic changes. Reperfusion of the choriocapillaris was suggested by the fluorescein angiogram. Patients with poor control of BP demonstrated at old sites of serous detachments more extensive retinal pigment epithelial pigmentary changes. Some lesions show a central hyperpigmented core surrounded by pigment atrophy (chronic Elschnig's spots). We suspect that choroidal vascular changes predominate when acute elevation of BP is present, whereas a more gradual onset of hypertension results in retinal vascular changes.
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PMID:The eye in accelerated hypertension. II. Localized serous detachments of the retina in patients. 670 70

The effects of systemic hypertension on the posterior segment of the eye are discussed under the headings of hypertensive choroidopathy, hypertensive retinopathy, and hypertensive optic disc edema. The sympathetic nervous control and autoregulatory mechanisms of the retinal and choroidal vasculatures are briefly reviewed. In hypertensive choroidopathy focal occlusion of choriocapillaris leads to necrosis of retinal pigment epithelium (Elschnig spots). Hypertensive retinopathy is described in vasoconstrictive, exudative, and sclerotic phases, followed by complications of the sclerotic phase. Hypertensive optic disc edema is influenced by the blood supply and extracellular tissue fluid pressure of the optic nervehead. In baboons with hypertensive disc edema, accumulation of axoplasmic components is observed in the optic nervehead.
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PMID:Pathophysiology of hypertensive retinopathy. 715 24

Arterial hypertension is a risk factor for the development of retinal, cerebral and renal microangiopathy. Therefore, a prospective study was started to investigate the progression of retinal microangiopathy in hypertensive patients. Initially, 254 patients were examined in a cross-sectional study. Following an ophthalmological examination, retinal hemodynamics were quantified by means of video-fluorescence angiography. Moreover, blood fluidity (hematocrit, plasma viscosity and erythrocyte aggregation) was analyzed. The severity of the retinal changes was defined according to the Neubauer classification. One hundred (40%) patients showed retinal changes corresponding to stage I; 133 (52%) were classified as stage II. Hypertensive retinopathy (stage III and IV) was encountered in 20 (8%) patients. Arm-retina time was significant prolonged among the hypertensive patients compared with a control group. Arteriovenous passage time showed no significant differences between hypertensive patients and reference values. Plasma viscosity was significantly increased in hypertensive patients and showed a significant increase with progression of the retinal changes. Hematocrit and erythrocyte aggregation were normal among the patients studied. The present findings show an alteration in blood fluidity among hypertensive patients, whereas retinal microcirculation showed no significant disturbances. Follow-up studies are planned to assess the development of retinal microcirculatory changes among hypertensive patients.
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PMID:[Retinal hemodynamics in patients with arterial hypertension]. 821 36

Bilateral disk swelling and marked peripapillary and macular exudates were found on routine ophthalmologic examination in a 12 1/2-year-old girl. Eleven months later, with persistent findings, her blood pressure was found to be extremely elevated. She had an Ask-Upmark kidney, a rare form of segmental renal hypoplasia. The Ask-Upmark kidney abnormality occurs primarily in young women and is associated with hypertension. The disk edema and retinopathy resolved after the hypertension was controlled. Hypertensive retinopathy can sometimes resemble neuroretinitis.
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PMID:Hypertensive retinopathy mimicking neuroretinitis in a twelve-year-old girl. 922 May 70

Recent population-based studies suggest that the fundus lesions of hypertension also occur in people without hypertension. In experimental studies, hypertensive lesions, which used to be the backbone of older classifications of the severity of hypertension, did not correlate sufficiently with severity to allow reliable grading. Hypertensive retinopathy, choroidopathy, and optic neuropathy are independent processes. Vascular narrowing appears to occur early in the disease process, whereas retinal hemorrhages and retinal lipid may occur later. Branch vein occlusion is a complication of hypertension, whereas open-angle glaucoma may not be. Choroidal neovascularization in the fellow eyes of patients with macular degeneration is associated with high blood pressure. Laser treatment for this disorder is less effective in patients with high blood pressure than it is in normotensive individuals, which suggests that choroidal neovascularization may be an expression of chronic hypertensive choroidopathy. Hypertensive optic neuropathy, a variant of ischemic optic neuropathy, has delayed onset compared with retinopathy and, in experimental studies, has not been linked to the severity of hypertension. Given these findings, it may be better to describe than to grade fundus lesions. In either event, it is important to take blood pressures accurately. Fundus lesions suggest high blood pressure. Sphygmomanometry is more specific and reliable than funduscopy in making that diagnosis.
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PMID:Ocular manifestations of systemic hypertension. 1038 39

Hypertensive nephropathy is among the leading causes of end-stage renal disease. Once renal function is severely impaired, the effects of strict control of blood pressure on the recovery of renal function remain elusive. Published case series suggest that optimal control of blood pressure results in regression of renal failure to some extent. In the present case of biopsy-proven hypertensive nephropathy we show that renal function can substantially improve over time if blood pressure is optimally controlled. Glomerula filtration rate continuously improved in our patient from 20 ml/min at presentation to 80 ml/min over a period of three years using a fivefold antihypertensive regimen. Hypertensive retinopathy regressed from stage III to stage I, and left ventricular hypertrophy decreased from an initial septum thickness of 19 mm to 12 mm within that period of time. This case clearly illustrates that optimal control of blood pressure is mandatory in patients with pre-terminal renal failure due to hypertensive nephropathy. Such intervention can lead to a regression of hypertension-associated end-organ injury.
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PMID:Regression of hypertensive nephropathy during three years of optimal blood pressure control. 1291 87


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