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

A retrospective analysis of 202 consultations for preoperative cardiology evaluation was conducted. The most common problems generating the consultation were: (1) abnormal electrocardiogram, 45 patients; (2) chest pain, 36 patients; (3) history of myocardial infarction, 27 patients; (4) dysrhythmia, 25 patients; and (5) hypertension, 23 patients. The most common diagnoses by the consultants were: (1) arteriosclerotic heart disease, 46 patients; (2) angina, 20 patients; and (3) hypertension, 40 patients. Mitral valve prolapse was the most common valvular disease (18 patients). Of the consultation requests, 108 asked for an evaluation; 79 asked for a "clearance"; 9 did not specifically ask for anything; and 6 asked a highly specific question. Most consultations provided a diagnosis (96%), addressed the problem (80%), and provided logical recommendations (96%). A minority of the consultations "cleared" a patient (28%), provided for follow-up care (41%), or suggested intraoperative monitoring techniques (41%). Out of the 189 patients who eventually had surgery, 137 patients had no change in their preoperative therapy, while 52 patients had a change in preoperative therapy. There was no difference in the incidence of complications between these two groups. An important finding was that 15% of the study group (31 patients) had disease processes (hypertension and angina) that were newly diagnosed by the consultant or felt to be not adequately treated before the consultation. It is concluded that few requesting anesthesiologists and surgeons ask for clarification of a specific problem, while most responses from the cardiology consultants provided necessary information. In addition, the preoperative cardiac consultation was found to identify medical conditions requiring long-term care and follow-up.
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PMID:The value to the anesthesia-surgical care team of the preoperative cardiac consultation. 252 Oct 24

Plasma concentrations of immunoreactive atrial natriuretic peptide (mean (SEM] were measured in 135 patients admitted to two coronary care units with myocardial infarction, ischaemic chest pain, or non-ischaemic chest pain. Concentrations were significantly higher in patients with acute myocardial infarction not treated with systemic thrombolysis (60.4 (14.3) pg/ml) than in patients with non-ischaemic chest pain (21.1 (4.3) pg/ml). Patients with ischaemic chest pain had intermediate values (39.3 (7.1) pg/ml). Patients with acute myocardial infarction treated with intravenous streptokinase had normal concentrations of plasma atrial natriuretic peptide (20.2 (3.6) pg/mg), which were significantly lower than those in patients with myocardial infarction not given streptokinase. These changes could not be explained by factors such as age, pre-existing hypertension, renal dysfunction, or cardiac failure, nor treatment other than streptokinase. Raised plasma concentrations of atrial natriuretic peptide in acute myocardial infarction may be a homoeostatic response acting to reduce atrial pressures by natriuresis, diuresis, and venodilatation. The lower concentrations of atrial natriuretic peptide in patients with acute myocardial infarction treated with streptokinase may reflect a short term beneficial haemodynamic effect of streptokinase.
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PMID:Plasma atrial natriuretic peptide in patients with acute myocardial infarction: effects of streptokinase. 252 82

Hypertension and left ventricular (LV) hypertrophy are independent risk factors for the development of coronary artery disease. To determine whether patients at higher risk for coronary artery disease can be identified, 40 asymptomatic hypertensive men with LV hypertrophy were prospectively studied using exercise thallium-201 scintigraphy and exercise radionuclide angiography. Endpoints indicative of coronary artery disease were defined as the subsequent development of typical angina pectoris, which occurred in 8 patients during a median follow-up of 38 months, or myocardial infarction, which did not occur. The exercise electrocardiogram was interpreted by standard ST-segment criteria and by a computerized treadmill exercise score. Abnormal ST-segment responses were present in 16 of the 40 hypertensives (40%), whereas the treadmill score was positive in 8 of those same 40 patients (20%). Scintigraphic perfusion defects assessed both visually and semiquantitatively were observed in 8 of 40 (20%) patients. An abnormal ejection fraction response to exercise was present in 40% (16 of 40) of patients, and 3 of 40 (7.5%) developed new wall motion abnormalities during exercise. Six of 8 patients with either perfusion defects or abnormal treadmill score developed typical angina during follow-up. All 5 patients with concordant positive exercise scintigrams and treadmill score developed chest pain during follow-up and had coronary artery disease confirmed by coronary angiography. However, only 7 of 16 (44%) patients with positive ST changes or abnormal ejection fraction responses during exercise developed chest pain during follow-up. In contrast, of 32 patients with negative scintigrams only 2 developed atypical chest pain syndromes, and significant coronary artery disease was excluded by angiography in 1 patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Usefulness of thallium-201 scintigraphy in predicting the development of angina pectoris in hypertensive patients with left ventricular hypertrophy. 252 66

The effect of cilazapril, a new inhibitor of angiotensin-converting enzyme, in a dosage of 2.5 or 5 mg once daily, was compared with that of hydrochlorothiazide 25 or 50 mg in 169 patients with mild to moderate hypertension. Blood pressure at entry was 158/103 mm Hg (cilazapril) and 160/103 mm Hg (hydrochlorothiazide). Cilazapril 2.5 mg caused a decrease in blood pressure of 14.7 +/- 2.3/12.6 +/- 1.2 mm Hg compared with a decrease of 12.6 +/- 2.2/10.2 +/- 1.2 mm Hg with hydrochlorothiazide 25 mg. Those patients who required an increase of dosage to the higher level then showed decreases of 15.0 +/- 2.1/14.3 +/- 1.2 (cilazapril) and 19.7 +/- 1.9/13.3 +/- 1.2 hydrochlorothiazide. All decreases in blood pressure were statistically significant but were not statistically different from each other. Fifty-one percent of patients reached a sitting diastolic blood pressure of 90 mm Hg or less receiving 2.5 mg of cilazapril and an additional 28 percent of patients reached this goal receiving 5 mg. The figures for patients receiving hydrochlorothiazide were comparable: 36 and 35 percent. Twenty-one adverse events remotely, possibly, or probably related to therapy were reported with cilazapril and 32 with hydrochlorothiazide. Three patients withdrew from cilazapril because of mild angioedema, headaches, and chest pain, respectively, and three patients withdrew from hydrochlorothiazide treatment because of fatigue, dizziness, and gastric hemorrhage. Hydrochlorothiazide caused a decrease in potassium levels and an increase in levels of cholesterol, uric acid, urea and - gamma cilazapril had no adverse biochemical effects. Cilazapril lowered blood pressure to the same extent as hydrochlorothiazide. Young patients had better responses to cilazapril than to hydrochlorothiazide. It is concluded that cilazapril is an effective and safe drug for patients with mild to moderate hypertension.
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PMID:Efficacy of cilazapril compared with hydrochlorothiazide in the treatment of mild-to-moderate essential hypertension. Multicentre Study Group. 253 59

Cilazapril is a structurally new angiotensin-converting enzyme inhibitor that lacks a sulfhydryl moiety. Its duration of action is consistent with a once-daily regimen. Cilazapril was studied in multiple-dose trials that included more than 4,500 hypertensive patients worldwide. Approximately 450 patients received cilazapril as monotherapy for more than one year, and another 430 patients were treated with cilazapril in combination with hydrochlorothiazide for more than six months. Cilazapril at doses of 2.5 to 5 mg once daily is clinically and statistically significantly more effective than placebo and as effective after eight weeks of therapy as hydrochlorothiazide, atenolol, propranolol sustained release, captopril, and enalapril at the doses recommended by the manufacturers. The overall incidence of adverse events observed during cilazapril therapy is comparable with that seen with placebo in double-blind studies. Cilazapril 2.5 to 5 mg once daily seems to be better tolerated than hydrochlorothiazide and atenolol. Only five adverse events were reported at an incidence of 1 percent or more in controlled trials; these were headache, dizziness, fatigue, nausea, and chest pain, which all occurred at a frequency similar to that with placebo. Overall, cilazapril is effective and well-tolerated in the treatment of patients with hypertension.
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PMID:Cilazapril: a new non-thiol-containing angiotensin-converting enzyme inhibitor. Worldwide clinical experience in hypertension. 253 61

The prognostic value of the exercise testing as well as coronary risk factors was assessed in 890 patients (pts) with a history of myocardial infarction (MI, n = 114) or chest pain (typical angina; TA, n = 134, others; OTH, n = 642) in relation to cardiac events (cardiac death, non-fatal MI). Clinical questionnaires and symptomatic-maximal graded treadmill exercise were performed in all pts. Follow-up was obtained prospectively by mail or telephone interview annually. Twenty eight pts were lost to follow-up. In the remaining 862 pts (96.9%), the mean follow-up duration was 3.1 +/- 1.4 (mean +/- SD) years. During follow-up period, 39 cardiac events (21 cardiac death, 18 non-fatal MI) (4.5%) occurred. Cardiac event rates in pts with MI, TA, and OTH were 16.2%, 9.8%, and 1.3%, respectively. Univariate analyses revealed that the event rate was influenced by age, sex (male), hypertension, diabetes mellitus, and HDL-cholesterol among coronary risk factors, and by anginal pain during exercise, ST depression, poor exercise tolerance, and abnormal blood pressure response among treadmill exercise findings. By Cox proportional hazard model analysis, the history of MI, age, TA, and ST depression (within 6 minutes of Bruce protocol) was significantly independent predictors for future cardiac events in all pts; and age, sex, and TA in pts without MI. In conclusion, the exercise testing combined with conventional coronary risk factor analysis was effective means in predicting future cardiac events.
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PMID:[A prospective study of future cardiac events in subjects who underwent treadmill exercise testing]. 260 49

A 67-year-old woman was admitted to our hospital with chest pain and dyspnea which occurred suddenly after vomiting. She was well until admission except for cholelithiasis and hypertension which had been pointed out 3 years earlier. Arterial blood gas analysis showed hypoxemia without hypercapnea. Chest X-ray examination on admission revealed intra-mediastinal air with a niveau behind the heart which compressed the vasculature of the left lower lobe and a small amount of air in the regions adjacent to the trachea, left main bronchus and aortic arch. The serial chest radiographs showed pneumomediastinum, subcutaneous emphysema, pneumothorax and pleural effusion in that order within 16 hours after the onset. The diagnosis of esophageal rupture was made by CT scan of the chest performed after oral administration of Gastrografin, which demonstrated extravasation of contrast medium into the mediastinum. Surgical treatment including eversion stripping and esophagogastrostomy was performed 23 hours after the onset. Pathological examination of the removed specimens revealed a rupture of the lower portion of the esophagus originated in the gastric ulcer of the cardia. In spite of intensive care, she died 45 days after surgery because of renal failure. It was considered that the most important point in the early diagnosis of esophageal rupture was to suspect this disease based on the gastric symptoms followed by the respiratory symptoms and to demonstrate pneumomediastinum in chest X-ray. Chest CT scan performed after the oral administration of contrast medium could be an useful and non-invasive diagnostic procedure.
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PMID:[A case of esophageal rupture confirmed by chest CT: characteristic changes in chest radiographs]. 261 3

In all autopsied cases from January 1980 to June 1988 (56-102 years old, 243 men and 307 women), cardiac rupture death was observed in 14 cases out of 68 deaths of acute myocardial infarction in our hospital. Cardiac rupture occurred in 2, 4, 3, and 5 cases in their 60's, 70's, 80's, and 90' respectively, and 4 in men and 10 in women. Complaints of chest pain were present in 4 cases. Cerebrovascular disease was present in 9 cases and hypertension in 7. In 9 cases, the thickness of the ruptured wall was over 14 mm. The location of the ruptured lesion was the anterior wall in 4 cases, anteroseptal in 3, anterolateral in 1, lateral in 1, posterior in 1, and apical in 1. In conclusion, the incidence of cardiac rupture was higher in female than in males, and in silent myocardial infarction than in painful one. The location of rupture was frequently in the anterior or lateral wall. Aging and hypertension would not be a worsening factor in the pathogenesis of cardiac rupture in myocardial infarction, but cerebrovascular disease might be a risk factor in respect to masking occurrence of myocardial infarction.
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PMID:[A clinicopathological analysis of cardiac rupture following acute myocardial infarction in elderly patients]. 263 25

232 consecutive patients with acute myocardial infarction were treated either with 2 x 10(6) IU urokinase as an intravenous bolus injection, or 250,000 IU streptokinase intracoronary, or 60 mg recombinant tissue-type plasminogen activator (rt-PA) over 90 min. All patients enrolled had chest pain for more than 30 min and less than 3 h before admission and a typical electrocardiogram. Contra-indications to thrombolytic treatment were absent. All bleeding complications occurring within 24 h after admission were assumed to be due to thrombolytic therapy. Bleeding complications occurred in 14 patients (6.5%). Only seven patients received a blood transfusion (3%). No correlation was evident between previous hypertension, diabetes mellitus, smoking, sex, age, fibrinogen level before and 24 h after thrombolytic therapy and bleeding complications. The risk of bleeding was not significantly different between the different thrombolytic regimens despite marked differences in the fall of the fibrinogen level. The decrease of fibrinogen following thrombolytic therapy did not influence the patency rate of the infarct vessel. Thrombolytic therapy in acute myocardial infarction is a safe treatment even among patients advanced in years and with medically controlled hypertension and diabetes mellitus, irrespective of the kind of thrombolytic treatment.
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PMID:Bleeding after thrombolysis in acute myocardial infarction. 270 62

Many studies indicate that women live longer than men but report more physical illness. This report is the first prospective study of sex ratios for morbidity and mortality due to a variety of causes in a single cohort: a random sample of 5,239 adults, aged 30 years or older in 1965, who have been followed through 1983 (19 years) by cause and age. For both cancer incidence and mortality there was a female excess before age 50 years, followed by a male excess peaking between ages 60 and 69 years. Sex ratios for ischemic heart disease mortality, on the other hand, indicated a male excess at virtually all ages, and that these sex ratios declined with age. However, three measures of heart disease morbidity (self-reported chest pain, heart trouble, and high blood pressure) demonstrated a female excess that did not vary by age. All four measures of functional disability (impaired self-care, impaired mobility, cessation of work, and reduction of work) demonstrated a female excess that did not vary by age (with the exception of a male excess in impaired self-care in adults aged 30 to 39 years). Further analyses of sex differences in health need to acknowledge the heterogeneity of the relation of sex to disease, and the complex age-sex interaction that varies remarkably with both cause and manifestation of outcome (morbidity vs. mortality).
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PMID:Sex differentials in morbidity and mortality risks examined by age and cause in the same cohort. 276 4


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