Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Haemodialysis is frequently complicated by side-effects both during and after treatment. Hypotension and muscle cramps have been attributed to depletion of intravascular volume; headache and fatigue have been attributed to rapid changes in intracellular and extracellular osmolality. An evidence-based systematic review of the English language literature was used to evaluate these hypotheses. Four studies have addressed the morbidity associated with changes in intravascular volume. These data suggest that during haemodialysis the vascular space is refilled from the interstitial space. Overhydrated patients are less likely to experience hypotension than are dehydrated patients, perhaps at the risk of congestive heart failure and hypertension. Intradialytic changes in haematocrit reflect changes in vascular volume and may be used to predict intradialytic hypotension. Eight studies have addressed the morbidity associated with changes in osmolality. In two of these studies the investigators reported clinical benefit for patients with patient-specific sodium profiles during dialysis. Four studies lacked sufficient statistical power to detect an effect of sodium profiling on patient symptoms. Two studies suggest a clinically important decrease in intradialytic symptoms during treatment with sodium-profiled dialysate. A definitive test of these hypotheses will require a randomized, blinded study of the clinical impact of sodium/ultrafiltration modelling on patient symptoms.
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PMID:Sodium and water profiling in chronic uraemia. 904 39

To determine the prevalence of leg cramps in elderly outpatients and their association any underlying diseases and concomitant drug intake, we conducted a cross-sectional study using an in-depth questionnaire. A total of 365 patients aged 65 years and over (mean 78.5 years) attending our outpatient clinic participated in the study. The prevalence of leg cramps was 50%. Cramps were commoner in females (56%) than in males (40%). Although reported to occur anytime throughout the 24 hours, cramps were most prevalent at night (62%). In many patients, leg cramps were a long-standing complaint: 20% had been suffering with them for more than 10 years, whereas only 9% of patients reported them first starting within the last six months. Only 73 (40%) sufferers had informed their practitioner; of these, 39 (53%) received treatment, of whom 26 gained benefit. Leg cramps were strongly associated with peripheral vascular disease (odds ratio 2.9, 95% CI 1.89-4.55, p < 0.00001), arthritis (odds ratio 2.26, 95% CI 1.48-3.45, p = 0.0001) and female gender (odds ratio 1.96, 95% CI 1.28-3.03, p = 0.002). Heart failure, hypertension, diabetes mellitus and stroke were not significantly associated. Except for a causal association with analgesic use, no positive association could be shown with any other class of drugs, including diuretics.
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PMID:Leg cramps in the elderly: prevalence, drug and disease associations. 1069 32

Angiotensin II receptor blockers (ARBs) represent a new class of effective and well tolerated orally active antihypertensive agents. Recent clinical trials have shown the added benefits of ARBs in hypertensive patients (reduction in left ventricular hypertrophy, improvement in diastolic function, decrease in ventricular arrhythmias, reduction in microalbuminuria, and improvement in renal function), and cardioprotective effect in patients with heart failure. Several large long-term studies are in progress to assess the beneficial effects of ARBs on cardiac hypertrophy, renal function, and cardiovascular and cerebrovascular morbidity and mortality in hypertensive patients with or without diabetes mellitus, and the value of these drugs in patients with heart disease and diabetic nephropathy. The ARBs specifically block the interaction of angiotensin II at the AT1 receptor, thereby relaxing smooth muscle, increasing salt and water excretion, reducing plasma volume, and decreasing cellular hypertrophy. These agents exert their blood pressure-lowering effect mainly by reducing peripheral vascular resistance usually without a rise in heart rate. Most of the commercially available ARBs control blood pressure for 24 h after once daily dosing. Sustained efficacy of blood pressure control, without any evidence of tachyphylaxis, has been demonstrated after long-term administration (3 years) of some of the ARBs. The efficacy of ARBs is similar to that of thiazide diuretics, beta-blockers, angiotensin-converting enzyme inhibitors or calcium channel blockers in patients with similar degree of hypertension. Higher daily doses, dietary salt restriction, and concomitant diuretic or ACE inhibitor administration amplify the antihypertensive effect of ARBs. The ARBs have a low incidence of adverse effects (headache, upper respiratory infection, back pain, muscle cramps, fatigue and dizziness), even in the elderly patients. After the approval of losartan, five other ARBs (candesartan cilexetil, eprosartan, irbesartan, telmisartan, and valsartan) and three combinations with hydrochlorothiazide (irbesartan, losartan and valsartan) have been approved as antihypertensive agents, and some 28 compounds are in various stages of development. The ARBs are non-peptide compounds with varied structures; some (candesartan, losartan, irbesartan, and valsartan) have a common tetrazolo-biphenyl structure. Except for irbesartan, all active ARBs have a carboxylic acid group. Candesartan cilexetil is a prodrug, while losartan has a metabolite (EXP3174) which is more active than the parent drug. No other metabolites of ARBs contribute significantly to the antihypertensive effect. The variation in the molecular structure of the ARBs results in differences in the binding affinity to the receptor and pharmacokinetic profiles. The differences observed in lipid solubility, absorption/distribution, plasma protein binding, bioavailability, biotransformation, plasma half-life, and systemic elimination influence the time of onset, duration of action, and efficacy of the ARBs. On the basis of the daily mg dose, the antihypertensive potency of the ARBs follows the sequence: candesartan cilexetil > telmisartan approximately = losartan > irbesartan approximately = valsartan > eprosartan. After oral administration, the ARBs are rapidly absorbed (time for peak plasma levels = 0.5-4 h) but they have a wide range of bioavailability (from a low of 13% for eprosartan to a high of 60-80% for irbesartan); food does not influence the bioavailability, except for valsartan (a reduction of 40-50%) and eprosartan (increase). A limited dose-peak plasma levels/areas under the plasma level-time curve proportionality is observed for some of the ARBs. Most of these drugs have high plasma protein binding (95-100%); irbesartan has the lowest binding among the group (90%). The steady-state volumes of distribution vary from a low of 9 L (candesartan) to a high of 500 L (telmisartan). (ABSTRACT TRUNCATE
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PMID:Clinical pharmacokinetics of angiotensin II (AT1) receptor blockers in hypertension. 1085 85

A 41-year-old woman, who presented with (apparent) essential hypertension, was treated with atenolol and candesartan. This treatment, however, was unsuccessful. After the addition of hydrochlorothiazide (HCT) to the combination, she developed hypokalaemia with muscle cramps and weakness. This hypokalaemia persisted for more than 4 weeks after discontinuation of HCT and starting potassium suppletion. As a result of polyuria (> 4000 ml/day) found in a 24-hour urine collection, it was discovered that the patient drank at least 3 litres of liquorice tea a day. She had denied eating liquorice sweets, a well-known cause of hypertension in the Netherlands, but no one had thought of asking her if she drank liquorice tea. Blood pressure and serum potassium normalized about 2 months after she stopped drinking liquorice tea, and medication was withdrawn. In a patient presenting with hypertension and hypokalaemia, who denies eating liquorice sweets, one should consider the consumption of other products containing liquorice such as liquorice tea. In the Netherlands liquorice tea is increasingly popular and has recently become available on a large scale. Therefore more cases such as the one described may be expected in coming years.
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PMID:['Licorice hypertension' also caused by licorice tea]. 1133 59

Intradialytic hypotension (IDH) occurs during 25% to 50% of end-stage renal disease (ESRD) hemodialysis (HD) treatments. The development of IDH signals both technology- and patient-dependent limitations expressed across a broad range of symptoms, from nausea and muscle cramps to ischemic injury. While traditional thinking has emphasized the link between hypertension and cardio-cerebrovascular injury, more recent studies of ESRD patients have stimulated significant interest in hypotension and poor outcomes. Theoretically, hypotension can contribute to the increased relative risk of death in ESRD by several mechanisms, which include acute coronary syndrome, autoregulation dysfunction, ischemia, and arrhythmogenicity. Endothelial abnormalities (increased procoagulation, thrombogenecity risk, and alterations in coronary flow reserve) and altered vascular distribution within the myocardium provide an environment for vascular injury. The current symposia will examine the pathophysiology of IDH, the specific HD prescription modifications to prevent IDH, and newer pharmacologic interventions to treat IDH and will highlight the approach to several clinical cases based on the information presented. It is becoming increasingly important to identify patients at "high risk" for IDH, to customize the HD prescription to the individual patient, to use drug therapy to prevent IDH events, and to track the prevalence of chronic hypotension and the incidence of IDH complications in the dialysis unit.
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PMID:Setting the stage. 1160 55

In sodium profiling, the sodium concentration in the dialysis fluid, instead of being constant, follows a time-dependent profile over the course of a hemodialysis session. The main aim of this manipulation is to avoid osmotic disequilibrium by keeping plasma osmolality in the physiological range. Further advantages of sodium profiling are a reduction in the incidence of muscle cramps, improved sodium removal, and improved vascular stability. Many different profiles have been used by various investigators. However, if sodium profiling is not appropriately conducted, sodium accumulation with resulting augmented thirst, increase of interdialytic weight gain, and hypertension may result. Sodium accumulation may, in fact, explain the reduced intradialytic morbidity reported in some short-term sodium profiling studies. Randomized, double-blind studies meeting strict statistical criteria and providing a careful control to maintain equivalent sodium balances between the compared treatments are difficult to perform and have not yet been published. However, because sodium profiling has potential benefits, provided that sodium balance is carefully controlled, it should nevertheless be regarded as a tool that experienced nephrologists can use for the treatment of patients who experience intolerable side effects during standard dialysis.
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PMID:A critical review of sodium profiling for hemodialysis. 1167 3

We report the first of two recent deaths from Irukandji syndrome. A 58-year-old male tourist was stung on the face and chest by an unidentified jellyfish in shallow water off the Whitsunday Islands, Queensland. He developed muscle cramps, sweating, anxiety, nausea and hypertension, and died 30 hours later from intracerebral haemorrhage.
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PMID:Fatal envenomation by jellyfish causing Irukandji syndrome. 1277 32

Although there are indications that beta-blockers affect the skeletal muscle in therapeutic dosages, their influence on mitochondrial disorders is unknown. A 52-year-old woman developed double vision, myalgias, muscle cramps, and hip and thigh muscle stiffness. Clinical neurologic examination revealed ptosis, dysarthria, sore neck muscles, weakness and wasting of the thighs, and generally brisk tendon reflexes. Lactate stress testing was significantly abnormal. Needle electromyography was nonspecifically abnormal and myopathic. Muscle biopsy showed mild myopathic changes, target fibers, and a single COX-negative fiber. Probable mitochondrial disorder was diagnosed. The patient had been on 30 mg of propranolol during 7 years for arterial hypertension. Shortly after discontinuation of the drug, her double vision gradually disappeared, myalgias and muscle cramps gradually resolved, and the patient reported an increase in muscle mass on repeated follow-ups. Long-term administration of propranolol may aggravate a mitochondrial disorder. Discontinuation of propranolol may result in a gradual resolution of these adverse reactions.
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PMID:Mitochondrial disorder aggravated by propranolol. 1686 49

Since 2005, several neurological diseases, including porencephaly, leukoencephalopathy and intracerebral hemorrhage without hypertension, and retinal arteriolar tortuosity have been linked to mutations in the COL4A1 gene, which encodes the alpha1 chain of type IV collagen, the main constituent of basement membranes. In three families, we observed a new syndrome that we called HANAC, for hereditary angiopathy with nephropathy, aneurysms and muscle cramps, which is associated with morphological alterations of cutaneous and renal basement membranes. This novel "basalopathy" is caused by glycine mutations in COL4A1 exons 24 and 25. We discuss phenotype-genotype correlations and the implications of the HANAC syndrome for the diagnosis of autosomal dominant hematuria, cystic kidney disease, intracranial aneurysms, and muscle cramps.
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PMID:[Hereditary angiopathy with nephropathy, aneurysms and muscle cramps (HANAC): a new basement membrane-disease associated with mutations of the COL4A1 gene]. 1923 87

An endotoxin-like reaction is a host response to an agent that induces the release of endogenous pyrogens, including cytokines. The typical reaction that is associated with gentamicin is fever and chills, rigor, shivering, tachycardia with hypertension or hypotension, respiratory symptoms and muscle cramps. We report a case of a 92-year-old patient who developed an endotoxin-like reaction in the post-operative recovery unit following 200 mg of gentamicin. The reported side effect is not included in the drug sheet or in the British National Formulary. No similar incidents were reported in the UK. We discuss the clinical picture of this rare event, along with a review of the literature and recommendations.
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PMID:Endotoxin-like reaction following once-daily gentamicin. 1938 87


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