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

We analyzed the association of clinical findings with impaired functional status, i.e., activities of daily living (ADLs), in a sample of 240 patients diagnosed with Alzheimer's disease by NINCDS/ADRDA or DSM-III-R criteria. Logistic regression models were used to determine independent predictors of both the number of ADL impairments and number of ADL impairments characterized as moderate to severe. Two psychiatric problems, behavioral disorders and apathy, as well as a history of hypertension were significantly associated with ADL impairment independent of age, sex, race, and cognitive impairment. Behavioral disorders and apathy were also significantly associated with moderate to severe ADL impairment, but hypertension was not significant at this level.
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PMID:Functional status and clinical findings in patients with Alzheimer's disease. 143 Aug 52

Episodes of depression and acute psychosis in two patients receiving propranolol hydrochloride are described, and the literature on propranolol-induced depression and psychosis is reviewed. A 42-year-old woman developed severe depression, marked apathy, social withdrawal, and anorexia after taking propranolol hydrochloride (80 mg/day) for three months to control her hypertension. Five days after the dose was reduced to 40 mg/day, there was a major improvement in her depressive symptoms, with a complete resolution in eight days. Upon rechallenge with 80 mg/day of propranolol, she again experienced depressive symptoms. Atenolol 50 mg/day was substituted for the propranolol therapy, and she exhibited a complete remission of her depression. The second patient was a 63-year-old man who had been taking propranolol hydrochloride 160 mg/day for three months without incident. Because of an increased frequency of anginal attacks, the dosage was increased to 240 mg/day. Within two days, he demonstrated such agitation, excitement, and combativeness that he had to be controlled with a 25-mg dose of methotrimeprazine. When the propranolol dose was reduced to 160 mg/day, his psychotic symptoms rapidly cleared. However, when the dose was subsequently increased to 200 mg/day, he again showed increased agitation. After substituting atenolol 100 mg/day for propranolol, the patient's mental status returned to normal. Both of these patients experienced symptoms that were temporarily associated with propranolol. Both patients were subsequently controlled without symptoms with atenolol therapy. Propranolol is a highly lipophilic beta blocker that achieves high concentrations in the brain. When continued beta-blocking therapy is necessary or beta blockade is indicated, a weakly lipophilic agent such as atenolol is indicated.
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PMID:Propranolol-induced depression and psychosis. 398 22

This paper reviews the diagnosis and treatment of geriatric patients. Careful distinction between true depression and dysphoria or normal sadness and thoughts of death among elderly patients must be made. The dexamethasone suppression test is useful in such a distinction in older patients, although its usefulness in younger adults is less certain. The aging process alters the pharmacokinetics of cyclic antidepressants. In particular, metabolism is delayed so that accumulation in the blood stream occurs, leading to prolonged elimination half-life. Side effect patterns of the cyclic antidepressants suggest that secondary amines are less toxic as a group than tertiary amines, and thus may be preferred as the treatments of first choice. Monoamine oxidase inhibitors are underutilized in the treatment of depressed older patients and should be considered, particularly when the depression includes symptoms of apathy and anergia. Special attention must be paid to the depressed elderly patient with cardiovascular disease or hypertension. Suggestions for treatment are provided.
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PMID:Clinical guidelines for the use of antidepressant drugs in geriatric patients. 404 42

Among the diseases or symptoms most frequently associated with stress are peptic ulcers, coronary heart disease (CHD), high blood pressure, backaches, and breathing disabilities. Many who have not experienced these severe symptoms have had milder ones, such as tension, cold hands, colds, headaches, tight muscles, and irritability, or feelings of disorganization, apathy, boredom, dissatisfaction, and even moderate levels of hostility. Although unpleasant, many people accept these as the cost of doing business or simply living. This need not be the case. If the mild symptoms are managed, more severe ones like CHD and ulcers may be avoided altogether. However severe or mild the symptoms, the important question is: "How can the symptoms be managed and even eliminated?" The answer is to become aware of stress and to engage in stress management strategies. These strategies are addressed here in some detail.
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PMID:Dealing with the effects of work-related stress. 708 Dec 83

We report the case of a 57-year-old right-handed woman, with a history of hypertension, who, in February 1990, suddenly developed behavioral and cognitive abnormalities. Prior to the onset of her illness she had been normal. On examination, neuropsychological testing (Wechsler Mental Test, Wechsler Adult Intelligence Scale Revised, Knox Cube Test) elicited attention abnormalities, decreased recent memory, apathy, reduced spontaneity and initiative and left hemiparesia. CT scan showed small low density areas in the head of both caudate nuclei and right internal capsule, indicating infarction. Two years later, the deficit had partially resolved. Apathy persisted; psychometry showed an IQ of 57. Bilateral damage to the head of the caudate nuclei disrupt cortical-subcortical connections. The caudate nucleus is an essential component of basal ganglia-thalamo-cortical circuitry and its contribution to cognitive functions and behavior appears to be important.
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PMID:[Bilateral infarction of the caudate nuclei]. 748 98

At examination of 360 hypertensive subjects living in rural areas it was found that the examinees were quite indifferent to their health. This is explained by poor knowledge of hypertension and its complications, inadequacy of the patients psychophysical condition, lack of medical prevention activity. A questionnaire survey of the physicians-in-charge revealed that 24% of them were unaware of the risk factors, 68% did not care for relevant correction, though they had diagnosed the risk factors in themselves. In self-rating the physicians were not confident, showed indifference to own health and future. The authors believe that the condition of the patients was in many respects due to social and psychological dysadaptation of their physicians who had lost their interest in preventive medicine.
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PMID:[The possibilities of preventing hypertension and the characteristics of the psychological set for its management in rural inhabitants]. 799 14

The authors demonstrated that isradipine reduces the blood pressure assessed at rest in patients with mild to medium severe hypertension. The antihypertensive action was enhanced by administration of beta-blockers. In a loading test the pressor response to strain was reduced in particular as regards diastolic pressure; from this in may be concluded indirectly that a vasodilatating effect is involved. The authors recorded a rise of plasma renin activity which may be associated with previous vasodilatation. Parameters of lipid metabolism were influenced by isradipine. The indifference of isradipine as regards the effect on functions indicated by biochemical screening was again confirmed in the present investigation. The undesirable effects typical for calcium antagonists were manifested in a very small percentage of the investigated subjects and in a small number of repeated examinations. The reason for discontinuation of treatment in one patient was an effects which does not threaten the patient (flush). Isradipine is an effective antihypertensive drug with very good tolerance.
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PMID:[The antihypertensive effect of isradipine and additional pharmacodynamic effects]. 850 74

Age-standardized death rates from cardiovascular diseases (0-64 years) of male populations in postcommunistic Central and Eastern Europe are now several times higher than those in Western Europe. This phenomenon is only partly explainable by the higher prevalence of "classical" cardiovascular risk factors (smoking, hypertension, hypercholesterolemia). Socio-economic background of the cardiovascular epidemic in the USA and Western Europe after 1950, and in the Soviet bloc in 1960-1990 was substantially different. It is suggested that the influence of further risk factors should be considered: oxidative stress caused by prolonged disorders in life style (alcoholism, smoking), high degree of environmental pollution and nutritional disbalances (chronic deficiency of antioxidants due to low consumption of fruits, vegetables and vegetable oils); psychosocial factors-chronic stress, tension, anger, hostility, frustration and apathy leading to a lowered interest in one's own health. The situation in postcommunist countries is unique and its analysis could provide important new information about the etiology of cardiovascular diseases and their prevention.
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PMID:High cardiovascular mortality in postcommunist countries: participation of oxidative stress? 889 49

1. We examined 156 patients 33 years after CO poisoning occurred at the Miike Mikawa Mine, Fukuoka, Japan. The subjects were classified according to age as follows: between 55 and 59 years (n = 14), 60 and 69 years (n = 62), 70 and 79 years (n = 60), and 80 and 87 years (n = 18). The mean age was 69.2 years old. Concerning the duration of coma that occurred soon after the accident, 64 remained comatose from 0 to 6 hours, 46 from 6 to 12 hours and 46 from 12 to 48 hours. 2. Subjective symptoms were observed in 96.8% of the patients. Among them, forgetfulness was noted in 89.7%, followed by irritability in 66.7%, headache in 59.6%, insomnia in 55.8%, limb pain in 46.8%, dull head feeling in 42.9% and dizziness in 36.5%. 3. Intellectual disturbances were observed in 68.6% of the patients, including impression disturbance in 58.3%, memory disturbance in 51.9%, calculation disturbance in 63.5%, thinking disturbance in 61.5% and disorientation in 14.1%. 4. Apathy and disorder of volition and interest which were found in 72.4% were included in personality change because all symptoms persisted for many years. Personality change was classified as follows: weakness of emotion and will (hypobulia) in 54.4%, infantilism in 35.2%, hyperactive, talkactive and lack of inhibition in 18.5%, lack of self-possession and unstable temper in 9.6%, depression in 15.3%, neurosis in 7.6% and schizophrenic state in 2.5%. Among these symptoms of personality change, weakness of emotion and will and infantilism were conspicuous among the patients who remained in a coma for more than 6 hours soon after the accident but showed no relationship with age. 5. Neurological symptoms that were found in 48.7% of the patients were classified as sensory disturbance in 25.6%, peripheral nerve symptoms in 16.0%, pyramidal symptoms in 14.1%, ataxia and cranial nerve symptoms in 7.1%, paroxysmal symptoms in 6.4% and focal symptoms in 4.5%, extrapyramidal symptoms in 21.8% (Parkinsonism in 4.5%, tremor in 10.9% and muscle rigidity in 16.0%) and vegetative symptoms in 37.2%. 6. At the time of investigation, 5 CO poisoning patients were classified as serious cases (3.2%), 20 as comparatively serious (12.8%) medium-degree cases, 28 as comparatively mild (17.9%) medium-degree cases, 37 as comparatively serious (23.7%) mild cases, 42 as comparatively mild (26.9%) mild cases, 24 (15.4%) as having symptoms which were not problematic, and 24 (15.4%) as having symptoms that markedly worsened due to complication. 7. A total of 138 (88.4%) cases had complications were classified as follows: 78 cases (50.0%) of hypertension, 62 cases (39.7%) of cerebral infarction, 24 cases (15.4%) of cardiac disturbance, 21 cases (13.5%) of diabetes mellitus, 14 cases (9.0%) of hepatic disturbance and six cases of silicosis (3.8%). 8. Cranial MRI was carried out for 129 cases (82.7%). Of the abnormal findings identified, cerebral atrophy accounted for 72.0% (93 cases), including moderate and severe cases in 47.2% (61 cases), pallidum lesion for 37.9% (49 cases), lacunar infarction (including cerebral infarction) for 52.7% (68 cases), and hippocampal atrophy for 18.6% (24 cases). Many cases of cerebral atrophy and hippocampal atrophy were observed in patients who remained in the initial coma for more than 12 hours and were 80 years of age or old. The cases of pallidum lesion were observed in patients who remained in the initial coma for more than 6 hours, and no relationship with age was found. The other findings, cerebral atrophy and lacunar infarction showed a slight relationship with age. 9. Among the moderate and serious cases of intellectual disturbance, cerebral atrophy constituted to 62.5%, lacunar infarction 68.7% and pallidum lesion 50.0%. Among the moderate and serious cases of personality change, cerebral atrophy constituted 78.5%, lacunar infarction 35.0% and pallidum lesion 50.0%. Moreover, among extrapyramidal symptoms, pallidum lesion constituted 58.6%, cerebral atrophy 55.1% and lacun
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PMID:[Long-term follow-up study on sequelae of carbon monoxide poisoning; serial investigation 33 years after poisoning]. 1050 96

A 68-year-old right handed man with treated hypertension presented with acute-onset somnolence without hemiparesis, dysarthria or sensory disturbance. Although he became laconic and his verbal responses were only in short terms, his replies were accurate and judgmental. A cranial MRI in axial, coronal, and sagittal section revealed small hemorrhagic infarcts essentially limited to the bilateral capsular genua without involvement of the inferior thalamic peduncles. A 123I-IMP single photon emission CT disclosed remarkable hypoperfusion in the bilateral frontal cortex. After a week of somnolence, he gradually became wakeful, but was still abulic. Neuropsychological examinations revealed no memory disturbance. We consider that disconnection of the thalamo-frontal projection at the genua of the internal capsules caused somnolence, apathy, and abulia in our case. The hitherto reported cases of the genu infarcts that showed memory disturbance had the lesion involving both the inferior thalamic peduncle and its nearby mamillothalamic tract. In contrast, our case without memory disturbance had infarcts confined to the genua apparently sparing the two tracts, implicating that memory function may be preserved when such structures are intact.
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PMID:[A case of abulia without memory disturbance due to infarction of the bilateral genua of the internal capsules]. 1054 18


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