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

1. Hemofiltration is like hemodialysis a technically safe method for long term treatment of end stage renal failure. 2. Electrolyte balance in hemofiltration is more important compared to hemodialysis. 3. Hemodialysis should be prefered in patients with dialysis discomfort dialysis resistent hypertension polyneuropathy.
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PMID:Clinical experience in hemofiltration. 740 19

There is a well established connection between hyperinsulinemia and hypertension, and activation of the sympathetic nervous system (SNS) by insulin has been proposed as one mechanism. In short term infusion studies, hyperinsulinemia during the euglycemic glucose clamp examination is associated with increased norepinephrine concentration. However, many of the studies lack sufficient control groups. The euglycemic glucose clamp examination could possibly, by discomfort from iv cannulas, the use of heating cuffs, and prolonged immobilization, by itself increase SNS activity. To examine this, we included nine controls, who had saline instead of glucose and insulin infused iv, among other healthy young men (n = 50) who underwent the euglycemic hyperinsulinemic glucose clamp. During hyperinsulinemic clamp, the plasma norepinephrine concentration increased from 0.87 +/- 0.06 to 1.06 +/- 0.05 nmol/L; in the control study, it increased from 0.99 +/- 0.14 to 1.21 +/- 0.11 nmol/L, a significant treatment effect (P < 0.001, by repeated measures analysis of variance), but no group x treatment effect (P = 0.17), i.e. there was no difference between the groups. There were no significant changes in systolic or diastolic blood pressure, heart rate, or plasma epinephrine concentration during the clamps, nor any differences between the groups. We conclude that the increase in plasma norepinephrine concentration observed during an euglycemic glucose clamp examination may be attributed to the procedure itself, and that the inclusion of a control group is mandatory when assessing SNS activity.
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PMID:The glucose clamp procedure activates the sympathetic nervous system even in the absence of hyperinsulinemia. 759 18

Autosomal dominant polycystic kidney disease is the most common genetic disorder encountered by nephrologists. Clinically relevant areas of which the physician must be knowledgeable are reviewed, emphasizing recent genetic advances with clinical implications for patients and their families. Recent information on hypertension, infection, pain and discomfort, hepatic cysts, and intracranial aneurysms is summarized.
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PMID:Clinical aspects of autosomal dominant polycystic kidney disease. 760 41

In an attempt to locate biochemical markers specific for fetal distress we measured the amniotic concentrations of beta-endorphin, ACTH, cortisol, dopamine, norepinephrine and epinephrine with its major metabolite metanephrine (MN) in pregnancies with documented fetal well-being and pregnancies complicated by hypertension and fetal distress. While higher levels of cortisol and MN were found only in a selected subgroup of highly compromised subjects (p < 0.001 and p < 0.005, respectively), beta-endorphin increased significantly under conditions of moderate or severe intrauterine sufferance (p < 0.001 in both cases). Due to higher levels of the opioid even during the initial stage of fetal discomfort we evaluated its characteristics as a possible clinical marker. Specificity was 88.5%, whereas the sensitivity of 65.6% in the moderately compromised subgroup increased to 88.9% in severely suffering fetuses. Although more accurate and mainly real-time information on the fetal health status is obtained by means of biophysical methods, the determination of amniotic fluid beta-endorphin might be of clinical usefulness in prenatal diagnosis.
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PMID:Stress mediators in the amniotic compartment in relation to the degree of fetal distress. 781 78

The aim of this study was to investigate the effects of recombinant human erythropoietin (rh-EPO) in patients with cancer-related anaemia. Thirty-six ambulatory patients who had malignant neoplasms and haemoglobin (Hb) values of < 11 g/dl (Pretoria is 1,310 m above sea level) entered the study. Patients with renal insufficiency or anaemia caused by bleeding or haemolysis, and patients with iron deficiency or megaloblastic anaemia, were not entered in the study. 22 IU/kg rh-EPO was given subcutaneously 3 times/week. The dose was escalated if Hb values did not rise after 4 weeks. All 36 patients were evaluable for toxicity. Side effects ascribed to rh-EPO were pain or discomfort at the site of injection (12 patients), heart palpitations (3 patients), skin rash (2 patients) and hypertension, deep vein thrombosis, and myalgia in 1 patient each. Thirty of the 36 patients who entered the study were evaluable for response. There were 16 females and 14 males among the evaluable patients. Median age was 64.5 years. Response, defined as an increase of Hb of at least 2 g/dl or to 12.5 g/dl, for at least 1 month, was documented in 12 patients. This was accompanied by an improvement in performance status and occurred within 1 month in 5 of the 12 patients who responded. rh-EPO has a limited but measurable therapeutic value for patients with cancer-associated anaemia.
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PMID:Recombinant human erythropoietin in the treatment of cancer-related anaemia. 797 Apr 93

This randomised, double-blind, parallel group study was to compare the safety, tolerance and diagnostic efficacy of iomeprol and iopamidol, both at an iodine concentration of 150 mgI/ml, in 40 patients with arterial hypertension who required renal intra-arterial digital subtraction angiography (IA-DSA) for suspected renovascular stenosis. All patients underwent extensive pre- and post-contrast clinical, instrumental and laboratory controls for safety assessments. The tolerance to the test contrast media was evaluated in terms of discomfort associated with the injection of the test compounds. Image quality was prospectively graded by two independent readers according to a five-point scale as follows: 1, insufficient; 2, sufficient; 3, good; 4, excellent; E, excessive. The quality of vascular opacification in the region of interest was rated as diagnostic in 87.8% of radiographs obtained in the iomeprol group and in 84.5% in the iopamidol group, without significant differences between the two study groups. The results of angiography were always useful for subsequent patient management. The procedure was always well tolerated. There were no clinically significant changes in vital signs, ECG and laboratory parameters during the study in both groups. The results of our study show that iomeprol 150 mgI/ml, and iopamidol 150 mgI/ml are equally effective, well tolerated and safe contrast agents when used for IA-DSA.
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PMID:A double-blind comparative study of the safety and efficacy of iomeprol in renal intra-arterial digital subtraction angiography. 802 May 22

1062 patients with moderate to severe hypertension were enrolled in an open-label multicenter trial investigating the antihypertensive efficacy and safety of the preconstituted formulation enalapril (20 mg) and hydrochlorothiazide (12.5 mg) over a treatment period of 12 weeks. According to the inclusion criteria of the study protocol 489 patients had to be excluded from statistical evaluation of efficacy. Results were calculated from 573 patients (339 females, 234 males, mean age 59.1 +/- 12.3 years) of whom 89% (n = 510) received the standard dosage of 1 tablet daily. They revealed a significant reduction (p < 0.001) of both diastolic and systolic blood pressure (BP) from a mean of 108.2 +/- 7.8 mm Hg (182.2 +/- 17.6 mm Hg) before treatment to a mean of 88.4 +/- 6.7 mm Hg (152.6 +/- 10.8 respectively) after 12 weeks of treatment. 81% responded to therapy defined as a lowering of diastolic BP < 90 mm Hg. Heart frequency dropped significantly (from a mean of 77.8 +/- 10.6 to a mean of 71.7 +/- 8.0, p < 0.01), too. Adverse effects leading to discontinuation were seen in 2.8% (n = 30) of all participating patients. Cough and gastrointestinal discomfort were the most frequent side effects. None of the safety parameters i.e. serum potassium and creatinine changed during the period of investigation. In conclusion, the preconstituted formulation enalapril (20 mg) and hydrochlorothiazide (12.5 mg) was shown to be an effective and well tolerated treatment not only for patients with newly diagnosed moderate to severe hypertension, but also for nonresponders to previous antihypertensive therapy.
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PMID:[Antihypertensive effectiveness of enalapril and hydrochlorothiazide as a combination drug]. 821 15

Recent studies of obstructive sleep apnea and its comorbidity with other systemic diseases have stimulated interest in the relationship of apnea to renal disease and hypertension. Polysomnographic sleep studies in patients on dialysis who complain of day-time fatigue or sleepiness reveal significant apnea in up to 73% of those studied. Abnormalities in respiratory controller mechanisms from chronic hypocarbia, metabolic acidosis, and uremic toxins have been blamed for the occurrence of apnea in this setting. Proteinuria and sometimes nephrotic syndrome have been recognized in morbidly obese patients with sleep apnea syndrome. Renal biopsies of such patients have shown glomerulomegaly and focal segmental sclerosis. It is postulated that these lesions may result from increased glomerular filtration and blood flow. Elevated urine output, sodium and chloride excretion, and atrial natriuretic peptide have been well demonstrated in obstructive apnea patients and correct to control levels with treatment of the apnea. Both acute (with each apnea) and chronic daytime blood pressure elevation are frequently observed in sleep apnea patients, and occult sleep apnea is postulated as one possible cause of "primary" hypertension in middle-aged men. In younger patients, such hypertension seems to be more reversible with the elimination of apnea. In older patients, however, the cure of systemic hypertension cannot be guaranteed with the elimination of the apnea, and asymptomatic apnea patients tend not to tolerate the bother and discomfort of apnea treatment with nasal continuous positive airway pressure. Therefore, aside from a careful history regarding sleep symptomatology, polysomnographic studies of clinic populations with primary hypertension to search for apnea as a cause cannot be recommended.
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PMID:Obstructive sleep apnea and the kidney. 830 38

Recently, dental patients with cardiovascular diseases, especially hypertensive and ischemic heart disease, have been increasing. Performing dental procedures on these patients could bring about the acute exacerbations of preexisting cardiac diseases. Anxiety, tension, pain, and discomfort during dental treatment and the catecholamines contained in local anesthetic solutions are thought to be causative factors. Consequently, it is important to decide whether the procedure concerned could safely be performed by dental staffs in the dental clinic. Systemic management in dental treatment includes the application of psychosedation, proper selection of the vasoconstrictor in the anesthetic solution, and control of blood pressure by vasodilating agents under continuous careful monitoring. By these means, the magnitude of hemodynamic fluctuation should be kept minimal. Management of hypertension, ischemic heart disease, and cardiomyopathies will be explained.
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PMID:The systemic management of cardiovascular risk patients in dentistry. 832 5

We tested Portapres, an innovative portable, battery-operated device for the continuous, noninvasive, 24-hour ambulatory measurement of blood pressure in the finger. Portapres is based on Finapres, a stationary device for the measurement of finger arterial pressure. Systems were added to record signals on tape, to alternate measurements between fingers automatically each 30 minutes, and to correct for the hydrostatic height of the hand. We compared the pressure as measured by Portapres with contralateral intrabrachial pressure measured with an Oxford device. Results were obtained in eight volunteers and 16 hypertensive patients. Time lost due to artifact was about 10% for each device. In two patients a full 24-hour Oxford profile was not obtained. In the remaining 22 subjects finger systolic, diastolic, and mean pressures differed +1 (SD 9), -8 (6), and -10 (6) mm Hg, respectively, from intrabrachial pressure. These diastolic and mean pressure underestimations are similar to what was found earlier for Finapres, are typical for the technique, and are systematic. Avoiding brisk hand movements resulted in fewer waveform artifacts. The hand had to be kept covered to continue recording at low outside temperatures. Sleep was not disturbed by Portapres, and arterial pressure showed a marked fall during siesta and nighttime. There were no major limitations in behavior, and no discomfort that originated from continuous monitoring was reported. Measurements continued normally during physical exercise. Portapres provides for the first time continuous 24-hour, noninvasive ambulatory blood pressure waveform monitoring and offers real and obvious advantages over current noninvasive and invasive devices.
Hypertension 1993 Jan
PMID:Feasibility of ambulatory, continuous 24-hour finger arterial pressure recording. 841 25


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