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

Uncontrolled hypertension increases the workload of the left ventricle causing the development of hypertrophy and an increase in myocardial oxygen consumption that may precipitate ischemia because of inadequate oxygen delivery related to accelerated coronary atherosclerosis. Control of the hypertension should prevent the further development of hypertrophy, delay the development of fibrosis and possibly also slow the rate of development of atherosclerosis. Furthermore, when myocardial function is impaired because of hypertrophy or other myocardial diseases, the level of blood pressure becomes an important determinant of left ventricular performance. Regardless of the level of arterial pressure, vasodilator drugs that lower arterial pressure may result in marked improvement in left ventricular performance and relief of symptoms of left ventricular failure. Therefore, control of blood pressure in the presence of heart disease may involve treatment of normotensive patients to bring them into a lower normotensive range as well as the more traditional treatment of hypertensives to bring them into the normotensive range. Although this scenario is consistent with conventional wisdom and clinical experience, intricacies of the relationship between hypertension, hypertrophy, myocardial oxygen delivery, atherosclerosis and intramyocardial blood flow distribution remain poorly understood. Until these aspects of the natural history of heart disease are better worked out therapy will remain largely empirical.
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PMID:Heart disease in the hypertensive patient. 14 Feb 80

During a 10 year study of women with reflux nephropathy 20 women had plasma creatinine concentrations in the range 0.2-0.4 mmol/l (2.3-4.5 mg/100 ml). Six experienced pregnancies exceeding 12 weeks' gestation. Pregnancy was associated with rapid deterioration in function in all six, resulting in end stage renal failure in four women within two years after delivery despite adequate control of blood pressure. Of the 14 women who did not have a prolonged pregnancy, four had periods of uncontrolled hypertension, all of which were related to non-compliance or loss from follow up, or both. Uncontrolled hypertension was also associated with accelerated renal failure, and all four women progressed quickly to end stage renal failure. The remaining 10 women were observed for from five to 10 years; in all 10 renal function deteriorated slowly, and none reached end stage renal failure within seven years. It is concluded that pregnancy in patients with reflux nephropathy and moderately severe renal failure has a deleterious effect on renal function.
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PMID:Effect of pregnancy on moderate renal failure in reflux nephropathy. 308 45

Among 151 patients with IgA nephritis, 18/151 (12%) had hypertension at presentation and 50/151 (33%) were hypertensive after an interval of 65 +/- 40 (Mean +/- SD) months. Hypertensive patients (n = 50) had a higher incidence of glomerulosclerosis, medial hypertrophy of blood vessels, tubular atrophy, poorly selective proteinuria and extension of immunodeposits to peripheral capillary walls compared to normotensive patients (n = 101). Chronic renal failure occurred more commonly among hypertensives compared to normotensive patients (42%) versus 14%. However, the time taken for patients to reach renal impairment or end stage renal failure was not significantly different. The cumulative renal survival for the hypertensive group was 78% after 8 years compared to 91% in the normotensive group (p less than 0.05). In the second part of the study, patients who were hypertensive at presentation (n = 18) were compared with those who developed hypertension on follow up (n = 32). Apart from a shorter duration of follow up for patients with hypertension and a higher incidence of glomerulosclerosis, there were no significant differences in their clinical presentation, laboratory indices or other histological parameters. The incidence of chronic renal failure and the time taken to reach end stage renal failure were not different. Uncontrolled hypertension was an important cause for rapid deterioration to end stage renal failure within 3 years, compared to 8 years when hypertension was controlled.
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PMID:Hypertension in IgA nephropathy. 326 7

Hypertension is investigated among Asians and Pacific islanders in California. Descriptive rates are provided for four Asian and Pacific islander ethnic-sex-age subgroupings. Overall, Filipinos have rates of hypertension nearly equal to those of American blacks and, in some large demographic categories, have prevalence rates comparable to blacks. Uncontrolled hypertension is shown to be related to overall health levels measured by life expectancy, chronologic age, and relative body weight. Change in dietary patterns toward the adoption of American foods increases both relative body weight and the risk of hypertension. The adjusted rates of hypertension are similar for men and women after the effects of relative body weight, alcohol consumption, and other variables are removed. A psychologic dimension of variables, including excess alcohol intake and proneness to depression and boredom, increases prevalence of high blood pressure. Social support mechanisms such as marriage, religious affiliation, and a large number of friends are associated with lower levels of hypertension. Many predictor variables are analyzed along with reasons for the high prevalence rates of hypertension for Filipinos and low rates for Japanese.
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PMID:Hypertension among Asians and Pacific islanders in California. 672 Jun 67

The incidence of cerebrovascular accidents (CVA) in Accra during three periods--1960-1968, 1976-1983, and 1990-1993, was compared. There was dramatic increase in the incidence between 1990-1993. Uncontrolled hypertension due to non-compliance with drug therapy seems to be the main cause. The economic plight of the people may explain the non compliance. The case fatality was between 41.9% to 50.3% for the years 1990-1993. Cardiovascular diseases, notably hypertension and CVA, have become the major causes of morbidity and mortality in Accra.
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PMID:Current trends in the incidence of cerebrovascular accidents in Accra. 784 Oct 98

Uncontrolled hypertension is a significant problem among African-Americans residing in inner city environments. To help address the problem, we are developing community-based hypertension control programs in African-American communities located in Milwaukee, Wisconsin and Chicago, Illinois. The Milwaukee program focuses on an entire, diverse inner city area, while the Chicago program is targeted to several more homogeneous African-American neighborhoods. The investigators hypothesize that the success of a hypertension control program will depend on carefully tailoring the educational approaches to the specific characteristics of the target area. Therefore, the study areas that have been selected differ with regard to community size and diversity, community 'stressors' (poverty, unemployment, crime, etc), and types of organizations which are present in the community. This paper describes the background and the rationale for community hypertension control programs in the inner city. The initial approaches to establishing the program by developing interfaces with the community and the gathering of baseline data through household surveys are described.
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PMID:Planning for a community-based hypertension control program in the inner city. 887 17

To identify the clinical correlates of recurrent heart failure hospitalization in a large urban hospital serving predominately African-American patients, and to provide further insight into modifiable risks for heart failure readmissions, a retrospective period prevalence review of the records of all adult patients admitted with a primary diagnosis of heart failure (International Classification of Diseases-9 code 428.0) between January and December 1995 was performed. The main outcome was the number of heart failure hospitalizations over 12 months. Twelve hundred patients were identified. Mean age was 64 +/- 16 years, 94% were black, 57% were women, and 40% were > or = 65 years old. Ninety-eight percent had a history of systemic hypertension and 55% had uncontrolled hypertension. Other comorbidities were left ventricular (LV) hypertrophy (64%), coronary artery disease (52%), and tobacco abuse (28%). Sixty-five percent of patients were on angiotensin-converting enzyme (ACE) inhibitors, 51% on calcium antagonists, and 8% on beta blockers. Most patients had suboptimal dosing of ACE inhibitors and there was inappropriate use of calcium antagonists in 56% of patients with moderate or severe systolic dysfunction. Diabetes mellitus and echocardiographic wall motion abnormality were independently associated with frequent admissions for women but not for men. Medication-related increase in heart failure hospitalization was seen for calcium antagonists in patients with severe LV dysfunction (odds ratio 2.24, 95% confidence intervals 1.0 to 5.03; p <0.03). Uncontrolled hypertension, underdosing of ACE inhibitors, and overuse of calcium antagonists in patients with significant LV dysfunction are potential targets for intervention.
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PMID:Gender differences and practice implications of risk factors for frequent hospitalization for heart failure in an urban center serving predominantly African-American patients. 1023 94

Treatment recommendations for hypertension as outlined in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) are constantly evolving and being refined as new information on the disease becomes evident. Uncontrolled hypertension is a major antecedent of stroke, heart failure, coronary heart disease, and end-stage renal disease. The increasing incidences of both cardiovascular and renal diseases fuel the need for improved control of hypertension. In fact, according to the National Health and Nutrition Examination Survey (NHANES), about 69% of Americans whose blood pressure is greater than 140/90 mm Hg are aware of it, about half are getting treatment for it, and only about one-quarter are adequately controlled. These observations fuel the need for improved patient management guidelines. JNC VI makes several changes from the previous JNC V to assist physicians in the diagnosis, treatment, and improved management of patients with hypertension. These changes include reporting adult blood pressure in two new ways, via staging and risk factor classification. A high-normal classification (systolic: 130 to 139 mm Hg, or diastolic: 85 to 89 mm Hg) is included in JNC VI because of the clinical importance of such blood pressure contributing to cardiovascular disease. Additionally, clinicians are advised to assign a patient to one of three risk categories that, in addition to hypertension stage, influence the decision to select antihypertensive drug therapy. Lifestyle modification is an important component at each stage. These and other changes and highlights of recent studies supporting the need for more intensive blood pressure control are discussed in this paper.
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PMID:Overview of JNC VI: new directions in the management of hypertension and cardiovascular risk. 1047 99

Left ventricular diastolic properties are important markers of pump function and are frequently abnormal when myocardial insults alter tissue structure. Alterations can be limited to the early diastolic phase (early active relaxation) or to late diastolic filling (late ventricular compliance), but more often involve regulation of both phases of diastole. In asymptomatic patients with arterial hypertension, left ventricular relaxation is often prolonged, independently, at least in part, of cardiac loading conditions and left ventricular geometry, but this abnormality is associated with early signs of systolic dysfunction. Uncontrolled hypertension, diabetes, and obesity are most often associated with ischemic heart disease and impaired diastolic function. Reducing blood pressure with antihypertension therapy will reduce myocardial afterload, regress LVH, and improve systolic and diastolic function. In patients with symptoms of CHF with a normal ejection fraction, however, changes in therapy may be indicated. Greater emphasis should be placed on using medications that decrease myocardial load, but also reduce the effects of neurohormonal activation. (c)2001 by Le Jacq Communications, Inc.
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PMID:Diastolic dysfunction in arterial hypertension. 1141 76

Uncontrolled hypertension leads to an increased risk of cardiovascular disease and stroke. Hypertensive patients with concomitant type 2 diabetes are at even greater risk of cardiovascular complications; also, this high-risk patient population is at increased risk of renal disease and, ultimately, renal failure. Prospective morbidity and mortality trials have demonstrated that tight blood pressure control improves the cardiovascular prognosis and provides target organ protection. Current treatment guidelines recommend a target blood pressure of < 130/85 mm Hg for patients with hypertension and diabetes. Angiotensin II (A-II), a major component of the renin-angiotensin system, plays an essential role in the pathophysiology of hypertension and diabetes-related renal disease. Currently, the treatment of choice for hypertensive patients with diabetes is angiotensin-converting enzyme (ACE) inhibition, but most of the data are limited to patients with type 1 diabetes. Although ACE inhibition is clearly a mechanism for blocking A-II formation, inhibition at this site may not be complete, as alternate pathways exist for A-II formation. Thus, for interrupting the renin-angiotensin system, A-II receptor antagonists theoretically provide advantages over ACE inhibitors in that they directly inhibit A-II by binding to the AT(1) receptor subtype. The objectives of this review are to: 1) provide an overview of the associated risk of cardiovascular complications with concomitant hypertension and diabetes; 2) demonstrate the cardiovascular benefits of effective blood pressure control in this patient population; 3) review the current treatment guidelines for managing high-risk hypertensive patients; and 4) discuss major, ongoing clinical studies with A-II receptor antagonists in patients with concomitant hypertension, type 2 diabetes, and renal disease. (c)2001 Le Jacq Communications, Inc.
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PMID:Management of high-risk hypertensive patients with diabetes: potential role of angiotensin II receptor antagonists. 1149 50


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