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

The exercise tests performed by 197 patients aged 65 years or more (mean age 68.8) have been reviewed, including 43 healthy subjects, 20 with high blood pressure, 10 with mitral valve disease and 125 with demonstrated coronary artery disease. All tests were done on an electrical cycloergometer, with load increases of 30 W every 3 min. Eighty-four (42.6%) achieved at least 85% of their maximal predicted heart rate. The reasons for non-achievement of this heart rate were limitation by symptoms (30.2%), betablocker therapy (25.8), exhaustion (20.2%), pain in lower extremities (14%) and non-adaptation to cycloergometer (10%). The maximum load achieved and the duration of exercise were significantly lower in mitral and coronary patients. Functional aerobic capacity was decreased in coronary and mitral patients. The VO2 max was directly determined in 45 patients. Mean values (ml kg-1 min-1) were 33.3 +/- 3.5 in normals, 15.4 +/- 6.2 in coronary and 15.8 +/- 4.1 in mitral patients. The incidence of arrhythmias during exercise was higher in hypertensive (55%) than in mitral (40%), normal (33.3%) and coronary patients (32.8%). In 5 patients the test had to be interrupted because of ventricular tachycardia. The yield of ST depression (greater than 0.1 mV) or elevation (greater than 0.2 mV) in the diagnosis of coronary artery disease was 0.62 sensitivity and 0.93 specificity. We conclude that stress test is a useful tool in cardiovascular diagnosis among older patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnostic value of stress testing in the elderly. 652 42

Diabetes mellitus predisposition is observed in the increased insulin activity of the pancreatic islet, followed by its exhaustion, and in its congenital or postnatal decreased activity. The former is seen in obese subjects, in large-born children and their mothers or in the children, whose mothers suffered from diabetes mellitus during pregnancy. The latter is discovered in hereditary diabetes mellitus, in hypertension and angiosclerosis. To avert diabetes mellitus in predisposed subjects a fixed-calory diet should be recommended for the pancreatic islet protection. Systematic blood and urine examinations are to be performed for revealing the initial pancreatic islet damage. Prophylactic treatment of these patients is realized by endocrinologists and the selection for therapy is carried out by special physicians.
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PMID:[Prediabetic states and the prevention of diabetes mellitus]. 676 Jan 78

The present study was carried out on male rats, using three models of experimental hypertension: cerebroischemic, single clamp bilateral and combined, induced by ischemia of the brain and one of the kidneys. The authors determined DA, NA, A in the hypothalamus and medulla oblongata as well as A, NA in plasma in view of the connection between CA (catecholamine) and cerebral and renal renin-angiotensin system (RAS). In rats with cerebral hypertension there was activation of noradrenergic neurons in the hypothalamus and medulla oblongata. There were no changes in the content of A. In rats with renal hypertension the activation of noradrenergic neurons in the hypothalamus was due to exhaustion of NA stores with normal amount of DA, but still the adrenergic neurons were activated. In rats with combined hypertension there was lowering of NA and DA in the hypothalamus, but A was not altered, e.g. the changes, observed singly and in cerebral and renal hypertension were combined. In the three forms of hypertension there were similar changes in medulla oblongata (reduced DA, increased NA and unaltered) and in plasma (A without significant changes). The changes in the level of CA in cerebral and combined hypertension could be explained by a change in the sinocarotid reflex, but in the renal-with the increased level of plasma angiotensin. The authors suggest that the connection between cerebral CA and cerebral RAS is not a direct one and RAS is not directly involved in the inverse interrelationships between cerebral and renal RAS.
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PMID:[Central and peripheral catecholamines in combined cerebral and renal hypertension]. 701 87

Persistent overloading causes fatigue followed by exhaustion and then ill-health resulting from homeostasis violation and reduced resistance. A breakdown is inevitable if the struggle continues. This course can be illustrated by a shaped performance-arousal curve. The paradigm clarifies the effects of psychosocial handicaps (low curves), of training (high curves), of arousal reduction (= relaxation), and of arousal rising from normal to destructive levels. The paradigm accommodates catastrophe theory and provides an unambiguous basis for screening and intervention in hypertension and coronary heart disease where there is a self-defeating struggle to close the ever widening gap between the actual performance capability and the intended.
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PMID:The human function curve - a paradigm for our times. 718 56

In the renomedullary interstitial cells of rats with Selye's "endocrine kidney" in the phase of beginning hypertension there appeared bilateral stress hypergranulation and an ultrastructural pattern of intensive prostaglandin synthesis. In the interstitial tissue of the left medulla there appeared light and dense (fibroblast- or macrophage-like) cells. Along with the stabilization of hypertension a relative degranulation of interstitial cells in the right kidney and an absolute degranulation in the left kidney took place. Necrobiotic changes, appearing in the ischaemic kidney, reflected an exhaustion of morphological substrates of prostaglandin synthesis. The changes in the interstitial cells, possessing endocrine activity, present the decisive links in the genesis of experimental malignant hypertension in rats.
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PMID:Ultrastructural investigation of renomedullary interstitial cells in "endocrine kidney". 747 59

Patients with chest pain and normal epicardial coronary arteries are characterized by an impairment of myocardial perfusion reserve. Functional and morphological abnormalities of the intramyocardial arterioles are suggested to be responsible for this, possibly as a consequence of hypertension and/or left ventricular hypertrophy. In an attempt to isolate predisposing factors of microvascular angina we investigated 34 patients (15 f, 19 m) with a mean age of 53 +/- 7 years. They were diagnosed as microvascular angina without hypertension or left ventricular hypertrophy. Parameters such as plasma insulin, glucose, cholesterol, LDL-cholesterol, triglycerides, (VLDL-cholesterol) and fibrinogen were determined for a metabolic profile. Furthermore, insulin and glucose were measured after an oral glucose load of 100 g glucose (OGTT) over 3 h. All parameters were compared to a control group of 15 healthy people matched for age and body mass index. In the study population systolic blood pressure was within normal limits at 137 +/- 17 mm Hg and thus higher than control at 124 +/- 11 mm Hg (p < 0.02). Furthermore, diastolic blood pressure was 85 +/- 7 mm Hg compared to 78 +/- 9 mm Hg in controls (p < 0.02). Insulin was significantly elevated in patients with microvascular angina 90 min (median: 101 vs 54 microU/ml; p < 0.01) and 120 min (median: 88 vs 51 microU/ml; p < 0.05) after ingestion of 100 g glucose. The fasting glucose was elevated at 98 +/- 12 compared to 87 +/- 7 mg/dl in controls (p < 0.01). Glucose concentration was also elevated after 30 min at 176 +/- 28 compared to 148 +/- 32 mg/dl (p < 0.02), after 45 minutes (198 +/- 35 compared to 152 +/- 53 mg/dl) (p < 0.01) and 60 minutes (193 +/- 44 compared to 145 +/- 54 mg/dl) (p < 0.01). In microvascular angina parameters such as total cholesterol: (244 +/- 46 vs 199 +/- 29 mg/dl (p < 0.01)), LDL-cholesterol (157 +/- 41 vs 122 +/- 18 mg/dl (p < 0.01)) and fibrinogen: (377 +/- 150 vs to 285 +/- 69 mg/dl (p < 0.03)) were elevated. These findings suggest a pathogenetic role of insulin resistance, hyperlipoproteinemia and elevated levels of fibrinogen for impaired myocardial coronary reserve. This metabolic constellation as well as exhaustion of coronary reserve is often found in hypertensive patients and may identify microvascular angina as an early stage of hypertensive heart disease before manifest hypertension has developed.
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PMID:[The significance of insulin resistance and hyperlipidemia in microvascular angina (syndrome X)]. 773 10

Thalassaemia major determines an impaired effort tolerance because of a condition of severe anaemia, progressive left ventricular dysfunction, pulmonary circulation compromise. The aim of our study is to evaluate haemodynamic response to exercise in thalassaemic patients without clinical features of heart failure. We have selected 13 patients affected by thalassaemia major (Thal+; 10-18 years). Each patient was transfused when haemoglobin values were < 9-9.5 g/dl and was treated with desferrioxamine (40 mg/kg sc) when serum ferritin values were > 2,000 ng/ml. Thal+ patients were compared with normal subjects (Thal- 10-16 years). No patient assumed hypotensive therapy, no had familiar history of hypertension. Both groups have undergone an ergometric stress test at the cycloergometer, with increase of 25 W every 2 min, up to the reaching of the maximum age-related heart rate, or up to muscle exhaustion or unbearable dyspnea, followed by a 10 min recovery phase. The following parameters were taken in consideration: systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), the product of the heart rate by the systolic blood pressure (DP), at rest, at the maximum common work (MCW), at maximum stress and in the recovery phases. At rest, only DP showed significant differences between the two groups: in Thal+ patients higher than in Thal- (p = 0.045). At the MCW, Thal+ patients had SBP (p = 0.019), DBP (p = 0.01), HR (p = 0.035) and DP (p = 0.003) higher than Thal- patients. At maximum stress only DBP showed significant differences in Thal+ patients (p = 0.019), although Thal+ patients achieved lower levels of workload (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cardiovascular adaptation to the stress test in subjects with Cooley's disease]. 780 70

To test the hypothesis that 'vital exhaustion' (VE), a state characterized by unusual fatigue, increased irritability, and feelings of demoralization, precedes the onset of myocardial infarction (MI) in females, 79 females hospitalized with a first MI (mean age: 59.3; SD = 9.3) and 90 females hospitalized in the departments of general and orthopaedic surgery (mean age: 57.4; SD = 9.1), were compared on the retrospective form of the Maastricht Questionnaire (MQ). Defining 'exhaustion' as a score above the median of the MQ, 63% of the cases and 39% of the controls were exhausted before hospitalization (chi 2 = 10.02; p < 0.00). The relative risk associated with exhaustion, after controlling for age, smoking, coffee consumption, diabetes, hypertension, non-anginal pain, and menopausal status, was estimated as 2.75 (95% CI:I.28-5.81; p < 0.01), thus corroborating the hypothesis. Exploratory analyses of the origins of exhaustion in these females showed that of all biographical characteristics, holding a job and simultaneously taking care of the household was most strongly associated with elevated exhaustion scores.
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PMID:Vital exhaustion as risk indicator for myocardial infarction in women. 790 33

Hypertension in pregnancy remains a major cause of maternal and fetal morbidity and mortality. It is a late manifestation of a multifactorial, multisystem disease, initiated very early in pregnancy, the features of which suggest an inadequate maternal response to pregnancy. There is a genetic susceptibility to pre-eclampsia. Endothelial cell dysfunction in response to an unknown factor(s) may evoke some of the hormonal anomalies. In established severe disease there is volume contraction, reduced cardiac output, enhanced vascular reactivity, platelet exhaustion and disseminated intravascular coagulation in addition to the hypertension. Delivery is associated with resolution of the hypertension. Pharmacological treatment is most suitable for early-onset, severe disease when an attempt to delay delivery is indicated. Methyldopa or beta-blockers and/or vasodilators may be used. ACE inhibitors are contra-indicated. Low-dose aspirin may be useful in prophylaxis.
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PMID:Pre-eclampsia--the 'disease of theories'. 791 88

Vascular endothelial cells are thought to play an important role in human aging as their senescence and detachment from a vascular wall may contribute to arteriosclerosis and high blood pressure in the elderly. We investigated the level of fibronectin (FN) expression in aortic endothelial cells aged in vivo, because FN is necessary for cell attachment and spreading and its increased expression had been shown in aging fibroblasts. The results showed that the steady state level of expression of FN mRNA increased with advancing donor age, while the labeling index of cultured cells decreased with age. Furthermore, the increased level of FN expression clearly correlated with an increase in cell area. In order to explore whether these changes reflected exhaustion of proliferation potential in vivo, we examined FN expression in human umbilical vein endothelial (HUVE) cells aging in vitro. Very similar results were obtained, supporting the idea that vascular endothelial cells age in vivo by using up division potential. Furthermore, we investigated the level of endothelin (ET) -1 mRNA expression during in vitro cellular aging of HUVE cells. The results showed that the expression of ET-1 gene was also up-regulated when the culture became old. It is very interesting that the genes for quite different proteins of FN and ET-1 are both up-regulated during cellular aging.
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PMID:Modulation of gene expression during aging of human vascular endothelial cells. 825 3


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