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

To evaluate the morbidity associated with obstructve sleep apnea syndrome (OSAS), we undertook a seven-year follow-up study of 198 OSAS patients seen between 1972 and 1980. The patients had been submitted to tracheostomy (71 patients) or had received a weight-loss recommendation (127 patients). Despite a lower mean apnea index (AI) (43 vs 69) and a lower mean body mass index (BMI) (31 vs 34 kg/m2) at entry, excessive daytime sleepiness (EDS) and vascular morbidity were significantly higher in the conservatively treated group. The relative risk (odds ratio) of finding EDS in the conservatively treated group, after adjustment for BMI at seven-year follow-up, was 3.7 (95 percent confidence interval [CI] = 2.6-5.3). The relative risk of developing new vascular problems in the same population, estimated by Cox models, was 2.3 (95 percent CI = 1.5-3.6). The effect of tracheostomy, independent of age, BMI, and AI at entry, was highly significant. At entry, 56 percent of the population already had a vascular problem, particularly hypertension, thus emphasizing the need for earlier treatment of the sleep-related abnormal breathing.
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PMID:Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. 229 60

Snoring was investigated in a survey of respiratory disease in Hispanic-Americans of a New Mexico community. A population-based sample of 1222 adults was studied with questionnaires and measurements of height, weight, and blood pressure. The age-adjusted prevalence of regular loud snoring was 27.8% in men and 15.3% in women. Snoring prevalence increased with age and obesity in both men and women. Cigarette smoking was also associated with snoring, but chronic obstructive lung disease and alcohol consumption were not. Snorers more frequently had hypertension, ischemic heart disease, and excessive daytime sleepiness. In contrast to other studies, after adjustment for confounding factors, there was no effect of snoring on hypertension (odds ratio, 1.0; 95% confidence interval, 0.7 to 1.5), but an effect on myocardial infarction was still demonstrable (odds ratio, 1.8; 95% confidence interval, 0.9 to 3.6). The association of snoring with sleepiness suggests that respiratory disturbance of sleep related to upper airway obstruction, such as sleep apnea, occurs more frequently in snorers in this population.
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PMID:Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity. 231 Feb 78

The safety and efficacy of indoramin and prazosin added to hydrochlorothiazide (HCTZ) were compared in a double-blind trial involving 209 patients with mild to moderately severe essential hypertension. Patients whose supine diastolic blood pressure (SDBP) did not decrease to less than or equal to 90 mm Hg after 6 weeks of HCTZ therapy had indoramin or prazosin added to their regimen. Mean SDBP during 6 months of combination therapy with either regimen decreased by approximately 10 mm Hg from that at the final evaluation during HCTZ therapy (p less than 0.001); differences between the groups were not statistically significant. Mean heart rate was unchanged, whereas mean weight increased (p less than 0.001) above final HCTZ values by approximately 2 kg in both groups. Mean weight increased significantly (p less than 0.01) from baseline values, however, only in the prazosin/HCTZ group. Approximately 95% of the patients in each group had clinically significant decreases in SDBP. Fatigue or tiredness and dizziness were the most commonly reported adverse effects, and their frequencies were not significantly different in the two groups. Cardiac arrhythmias occurred only in patients in the prazosin/HCTZ group and were significantly (p less than 0.05) more frequent than among patients in the indoramin/HCTZ group; less severe adverse experiences, i.e., dry mouth, ejaculatory problems, drowsiness, and sedation, were significantly (p less than 0.05) more frequent in the indoramin/HCTZ group. When added to HCTZ, indoramin and prazosin are equally safe and effective in the treatment of hypertension.
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PMID:Antihypertensive effects of indoramin and prazosin in combination with hydrochlorothiazide. 242 99

Ketanserin, the specific S2 serotonin antagonist, is undergoing evaluation for the therapy of hypertension of all degrees of severity. We studied 20 patients with severe hypertension [diastolic blood pressure (DBP) greater than 120 mm Hg after 40 min of supine rest]. In the first dose-ranging study on eight patients, multiple i.v. injections of 5 mg ketanserin were administered every 4 min (mean 38 mg). Only 4 patients responded adequately (DBP less than 100 mm Hg), 2 responded partially, and 2 did not respond to ketanserin. The major adverse effect of ketanserin, found in all patients, was severe dose-dependent sleepiness. A second double-blind crossover study with ketanserin and placebo (12 patients) assessed neural side effects. The supine DBP dropped from a mean of 134 +/- 4 mm Hg to 112 +/- 4 mm Hg 20 min after ketanserin when the sedation score rose from 0 to 1.2 +/- 0.3 (range 1-3) and the dizziness score from 0.1 +/- 0.1 to 1.4 +/- 0.3 (range 1-3; both p less than 0.01 vs. 1-2 min after ketanserin). Only 7 of 12 patients responded adequately to ketanserin. Twelve of the 20 patients were subsequently given nifedipine 10 mg sublingually; the DBP fell from a mean of 128 +/- 3 mm Hg to 101 +/- 4 mm Hg (p less than 0.001) after 40 min without side effects. Ketanserin does not appear to be a suitable agent for the acute therapy of severe hypertension because of: the imperfect and short-lived blood pressure control; the variability of the hypotensive effect; and sleepiness and dizziness as significant side effects.
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PMID:Effects of intravenous ketanserin on severely hypertensive patients with double-blind crossover assessment of central side-effects. 243 87

A double-blind controlled, randomized, parallel, multicenter 12-week study was conducted to compare the antihypertensive efficacy of lisinopril with that of metoprolol in treatment of moderate to severe hypertension. Initially, 118 patients were recruited on lisinopril and 61 on metoprolol; and for the purpose of efficacy analysis at week 8, 115 patients on lisinopril and 60 on metoprolol were included. The doses of lisinopril or metoprolol were 40-80 mg/day and 100-200 mg/day, respectively. At week 4, the pretreatment diastolic blood pressure of 111 mm Hg was decreased to 97 mm Hg (p less than 0.01) with lisinopril: metoprolol decreased the diastolic blood pressure from 110 to 99 mm Hg (p less than 0.01). Similar decreases were noted at week 8; however, the drop in blood pressure with lisinopril was not significantly different from that with metoprolol. Systolic blood pressure also demonstrated a decrease of about 18 mm Hg with lisinopril and 12 mm Hg with metoprolol (p less than 0.01). This larger decrease in systolic blood pressure with lisinopril was statistically significant at week 4 (p less than 0.05). These decreases in systolic blood pressures were maintained at week 8, again with statistical significance (p less than 0.01). Of the 118 lisinopril-treated patients, four were discontinued from lisinopril therapy because of headache, dizziness, rash, flushing, or lymphadenopathy. Four patients out of 61 (9.8%) were discontinued from metoprolol therapy because of fatigue, somnolence, asthenia, weight gain, flatulence, tremor, or bronchospasm. In conclusion, lisinopril 40-80 mg once daily is as effective as metoprolol 100-200 mg once daily in reducing diastolic blood pressure in patients with moderate to severe hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of antihypertensive efficacy of lisinopril compared to metoprolol in moderate to severe hypertension. 244 53

The antihypertensive effect of the combination of ketanserin, a new antiserotonergic agent, and thiazide has been evaluated in 35 patients with arterial hypertension of mild to moderate degree in the greater than 50-year-old age group. Twenty patients were given ketanserin (20 mg) + hydrochlorothiazide (25 mg) (treatment A) while the others were given ketanserin (40 mg) + hydrochlorothiazide (12.5 mg) (treatment B) once daily, for a period of 6 weeks. Twenty-four-hour blood pressure, measured by an automatic recorder, was significantly reduced by both combinations. In particular, treatment A reduced blood pressure from 169 +/- 15/95 +/- 6 mm Hg before treatment to 146 +/- 11/83 +/- 8, 149 +/- 13/82 +/- 10, 143 +/- 12/81 +/- 9, and 151 +/- 14/84 +/- 7 mm Hg at 2, 6, 8, and 24 h, respectively, after the last dose of drug. With treatment B, blood pressure was reduced from 167 +/- 11/97 +/- 7 mm Hg before treatment to 152 +/- 12/89 +/- 8, 151 +/- 15/85 +/- 8, 150 +/- 16/86 +/- 8, and 158 +/- 13/91 +/- 7 mm Hg at 2, 6, 8, and 24 h, respectively. Heart rate was not affected by both treatments despite the fact that ketanserin has been proved to induce a marked vasodilation. Cardiac workload (systolic blood pressure X heart rate) was slightly reduced by the treatments. Treatment A only induced transient dizziness after the first dose of drug; treatment B, on the other hand, induced drowsiness and more marked dizziness, which in one case was also observed after repeated doses of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Antihypertensive efficacy of the combination of ketanserin + thiazide in hypertensives older than 50 years. 244 60

We have treated 128 patients aged 40 +/- 9 years (60 males and 68 females), all with essential hypertension (W.H.O. I and II), over a period of 10 yr. The treatment was performed with clonidine at a dose that ranged from 0.150 to 1,200 mg (twice daily). Forty-two patients also received a diuretic (HCTZ 25 mg daily). Mean blood pressure decreased significantly from 169 +/- 10 mm Hg systolic, 107 +/- 3 diastolic to 145 +/- 6 mm Hg (p less than 0.001) 90 +/- 3 mm Hg diastolic (p less than 0.001). Side effects occurred during the first month. These were drowsiness 28%, dry mouth 35%, constipation 13%, dizziness 9%, postural hypotension 2%, and male impotence 3.3% (2/60). Side effects still present after 120 months of treatment were drowsiness 11.7%, dry mouth 26.6%, constipation 14.1%, dizziness 4.7%, and male impotence 1.7% (1/59). The number of patients who discontinued treatment resulting from side effects were 3.34%, all of them within the first 6 months. There were no changes in renal or liver function or in serum electrolytes or lipids. Retinopathy improved in most patients. Electrocardiogram (ECG) improved in 45 patients with LVH. It is concluded that clonidine provided sustained blood pressure control with minimum side effects during 10-year therapy for hypertension.
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PMID:Safety aspects of long-term antihypertensive therapy (10 years) with clonidine. 245 59

Twenty Nigerians with labile essential hypertension (LEH) were asked to record their blood pressure and pulse rate for 14-16 hours using the Remler Portable Ambulatory Blood Pressure Recorder while exposing themselves to the stress of Lagos traffic. The average blood pressure (systolic and diastolic) and pulse rate for the test day (ASBP, ADBP and APR) were determined in a cross-over randomised open design before (C), after one week on placebo bidaily (P1), after one week on bromazepam 1.5 mg bidaily (B), after one week on placebo bidaily (P2) and after one week on labetalol 100 mg bidaily (L). Allocation to the active drugs was randomised. All drugs were administered at 8.00a.m. and 8.00p.m. respectively. The maximum blood pressure (systolic and diastolic) and pulse rate MxSBP, MxDBP and MxPR were similarly determined. Both B and L significantly reduced ASBP, ADBP, APR, MxSBP, MxDBP and MxPR but L produced a much greater reduction in the above parameters than B. Side effects observed included drowsiness with B (two subjects) and postural dizziness with L (one subject). Both drugs were effective in controlling LEH but L was more effective than B in reducing stress hypertension.
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PMID:Comparative effects of labetalol and bromazepam on ambulatory blood pressure of Nigerians with labile and stress hypertension. 256 2

Sleep apnea and obstructive snoring are sleep related breathing disorders (SRBD). Nevertheless, there is only a quantitative difference between snoring and the obstructive form of sleep apnea. Snoring occurs in at least 20% of the population; 50% of the 50 year old male snore. Although in most of the cases only harmless snoring is concerned. It becomes serious if it leads as the independent SRBD "obstructive snoring" to a continuous oxygen desaturation and a sleep disturbance or, if in cases of sleep apnea a postapnoic snoring is concerned. The snoring pattern "loud and irregular" is always a sign for a serious SRBD. Still, no exact statement can be given concerning the frequency of obstructive snoring. However, the prevalence of sleep apnea in men of the mean age group has been determined to 10%. By the so-called sleep apnea syndrome are summarized clinical pictures with symptoms and findings caused by sleep apnea, respectively with those which can be reduced by sufficiently early introduced therapy. Most frequent symptoms and findings are: hypertension, loud and irregular snoring, daytime sleepiness and nocturnal cardiac arrhythmias. Especially hypersomnia has always to be taken seriously. In relation with other symptoms and findings associated with apnea it is always an indication for the examination for sleep apnea and obstructive snoring.
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PMID:[Snoring and sleep apnea syndrome]. 266 55

The clinical records of 25 ambulatory patients who received clonidine (Catapres-TTS) for periods of one to 19 months were reviewed to determine the effectiveness and long-term patient tolerance of this transdermal antihypertensive medication. In 11 patients with mild to moderate hypertension in whom Catapres-TTS was initiated as monotherapy or added to an oral diuretic, significant blood pressure reduction was observed during the initial four weeks of therapy. In 14 patients who had more severe hypertension and who were receiving multiple antihypertensive agents, Catapres-TTS did not result in significantly reduced blood pressure. Daily home blood pressure measurements in five patients showed no day-to-day variations in blood pressure during the seven days each patch was worn. Catapres-TTS was discontinued in 11 patients because of localized contact dermatitis (six patients), patient dissatisfaction (three patients), and physician's decision (two patients). In three patients, localized contact dermatitis developed only after continuous use for periods of four to 13 months. Other adverse effects such as drowsiness and dry mouth were less apparent than with comparable doses of oral clonidine, and did not necessitate discontinuation of therapy in any patient. Black patients appear to tolerate Catapres-TTS better than whites. Catapres-TTS appears to be effective in patients with mild to moderate hypertension and may be a useful alternative to oral clonidine in patients experiencing drowsiness or dry mouth with the oral preparation.
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PMID:Patient acceptance of transdermal clonidine. A retrospective review of 25 patients. 273 24


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