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

Sodium nitroprusside was administered to 58 neonates, including 11 with severe respiratory distress syndrome, 15 with persistent pulmonary hypertension of the newborn, 28 with clinical shock, three with systemic hypertension, and two with pulmonary hypoplasia, all refractory to conventional intensive therapy. Nitroprusside was infused at 0.2 to 6.0 micrograms/kg/min for periods of 10 minutes to 126 hours. Infants with severe respiratory distress syndrome had increased PaO2 and decreased PaCO2 or peak inspiratory pressure, and nearly all (82%) survived. Infants with persistent pulmonary hypertension of the newborn had variable responses; improvement did not correlate with survival, but survival (47%) was identical to that in an earlier series of infants given tolazoline. Infants in shock had improved perfusion, urine output, and serum bicarbonate levels, and these responses were significantly related to survival. Hypertension was controlled in all three hypertensive infants. Adverse effects were very uncommon. Toxic effects were not observed. Sodium nitroprusside is effective and can be used safely in circulatory disorders in the neonate.
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PMID:Use of sodium nitroprusside in neonates: efficacy and safety. 391 95

The relationship between five conditions of chronic fetal stress and the incidence of infant respiratory distress syndrome (RDS) was investigated among 614 premature (less than or equal to 36 weeks) infants delivered at the University of Washington Hospital from 1977 to 1980. The strongest association found was a protective effect of abnormal antepartum testing (nonreactive nonstress test, positive contraction stress test, or low or falling maternal urinary estriols). Among the 45 infants with abnormal antepartum testing, the probability of RDS was 15.0 versus 33.8% for the infants without the complication (odds ratio = 0.35, P less than or equal to .01, adjusted for gestational age and mode of delivery). Rupture of the membranes for greater than 24 hours (N = 151), amnionitis (N = 63), and vaginal bleeding beginning more than 24 hours before delivery (N = 108) were each associated with a reduced risk of RDS (adjusted odds ratios = 0.63, 0.51, and 0.58, respectively, P less than or equal to .05). Hypertensive disease of pregnancy was not associated with a decreased risk of RDS; in fact, the opposite trend occurred (N = 96, odds ratio = 1.67, P = .07). The associations with RDS were not explained by differences between births with and without each complication in terms of gestational age, mode of delivery, absence of labor, administration of antenatal steroids, and other complications of pregnancy. This study adds support to the hypothesis that certain conditions associated with chronic fetal stress lead to an acceleration in pulmonary maturity.
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PMID:Chronic fetal stress and the risk of infant respiratory distress syndrome. 394 Mar 39

This study investigated the effects of NaCl supplementation (5 mEq/kg/day) on the arterial pressure of pregnant and nonpregnant sheep with and without reduction of uteroplacental perfusion pressure. In pregnant sheep receiving NaCl supplementation during the third trimester, reduction of aortic pressure caudal to the kidneys to 65% of the upstream pressure (occlusion) caused a progressive increase in mean arterial pressure from 89 +/- 3 to 110 +/- 3 mm Hg over 2 weeks. Occlusion was accompanied by a decrease in urine flow. Six of seven sheep died or were killed because of severe respiratory distress. No abnormalities were detected in nonpregnant sheep or pregnant sheep receiving NaCl supplementation only. Pregnant sheep that were occluded but received no supplementary NaCl did not become hypertensive but aborted about 2 weeks after occlusion. These results indicate that reduction of uteroplacental perfusion pressure causes hypertension in NaCl-supplemented pregnant sheep but not in sheep receiving a normal, low sodium diet.
Hypertension 1986 Jan
PMID:Effects of sodium chloride on pregnant sheep with reduced uteroplacental perfusion pressure. 394 87

Among 7052 patients studied between 1976 and 1982 in a collaborative project on antepartum fetal heart rate monitoring, 337 patients had a previous stillbirth as a reason for testing. Overall a previous stillbirth history significantly increased the risk of having a positive result on a contraction stress test, primarily among hypertensive patients. Patients with a previous stillbirth also had a significantly higher incidence of respiratory distress syndrome in their neonates attributable to premature intervention for maternal indications (primarily among hypertensive women and patients with clinical intrauterine growth retardation). Low Apgar scores were found to be significantly increased in diabetics with previous stillbirths primarily due to neonates with congenital malformations. Premature intervention by labor induction or cesarean section was more common among patients with a previous stillbirth for both maternal indications and abnormal antepartum fetal heart rate studies. Previous stillbirth would appear therefore to be a significant risk factor primarily when associated with a diagnosis of hypertension or clinical intrauterine growth retardation.
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PMID:The significance of a previous stillbirth. 396 9

Colloid osmotic pressure of umbilical cord plasma was measured in 242 healthy infants, in 34 infants with respiratory distress syndrome (RDS), in 18 infants with asphyxia, in 13 infants who were small for gestational age, in 15 infants born to mothers with diabetes mellitus, and in 18 infants born to mothers with pregnancy-induced hypertension. In healthy infants, colloid osmotic pressure correlated highly significantly with umbilical cord blood total protein level, gestational age, and birth weight. In infants with RDS, no correlation between colloid osmotic pressure and gestational age or birth weight was found. Infants with RDS and gestational age between 36 and 38 weeks had significantly lower colloid osmotic pressure than healthy infants, whereas colloid osmotic pressure of infants with RDS and gestational age between 32 and 35 weeks did not differ from that of healthy infants of corresponding gestational age. Healthy term infants delivered by cesarean section had significantly lower colloid osmotic pressure than infants delivered vaginally. Infants with asphyxia had significantly higher colloid osmotic pressure than healthy infants. Colloid osmotic pressure is related to the lung maturity of the near-term and term neonate. Infants with a colloid osmotic pressure greater than 16 mm Hg are unlikely to develop RDS.
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PMID:Colloid osmotic pressure of umbilical cord plasma in healthy and sick newborn infants. 398 8

The use of beta-blocking drugs in the treatment of hypertension during pregnancy has been the subject of controversies on the basis of theoretical hazards due to the pharmacology and pharmacokinetic characteristics of these drugs. A review of the literature on the subject shows that: The danger of premature contractions, abortion or premature delivery does not seem to increase with the use of beta-blockers. The blood supply is not more impaired with beta-blockers than with other antihypertensive drugs according to fetal growth, birth-weight, frequency of perinatal deaths or APGAR score. Although beta-blocking drugs pass into fetal circulation, neonatal bradycardia, respiratory distress or hypoglycemia do not seem more frequent with beta-blockers. Beta-blockers pass from maternal plasma into milk but the 24 hour dose brought to the newborn by maternal feeding is so slight as to be negligible. Thus, the cumulative data and the favorable opinions of many authors, the greater efficiency of beta-blockers authorizes the use of these drugs in the treatment of hypertension in pregnancy, where it seems to improve the outcome of the pregnancy and the state of the fetus at birth.
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PMID:[Are the theoretical drawbacks of beta-blocker treatment in pregnancy being confirmed? A review of the literature]. 613 64

South Africa is unique in many ways, including the state of health of its children. Discussion focuses on vital statistics -- perinatal and infant mortality rates, disease profiles, nutritional status; and demographic and socioeconomic data -- African communities, Indian communities, coloured communities, and social expenditure. The perinatal mortality rate for africans in Natal and Kwa Zulu varies from 19.7-51.9/1000 in the smaller hospitals. At the main teaching hospital in Durban, the King Edward viii, it was 75.8/1000 in 1980. The most common causes of death in the rural babies weighing more than 1500 gm were septicemia, asphyxia, meconium aspiration, and tetanus neonatorum. In those under 1500 mg the most common causes were respiratory distress, intracranial hemorrhage, and hypothermia. The main causes of the high perinatal mortality among Africans at King Edward viii Hospital were amniotic fluid infection syndrome, abruptio placenta, hypoxia, hypertension, and congenital syphilis. Accurate data for infant mortality rates for Africans are unavailable. Available data show considerable variation. The official infant mortality rates given by the State Health Department for 1975 for the country as a whole were 20.1/1000 for whites, 100.2/1000 for Africans, 104.0/1000 for coloureds, and 34.7/1000 for Asians. Black children under age 5 make up 16% of the total population but account for 55% of total deaths, whereas white children of this age make up 11% of the population and account for only 7% of total deaths. Of the 7688 admissions of African children to King Edward viii Hospital in 1980, more than 80% were due to infections, and the overall mortality in these patients was 20%. The percentage of children below the 3rd centile for weight was 6-12% for infants under 1 year old, 20-55% in children aged 1-6 years, and 30-70% in school age children. The percentage stunted (below 3rd centile for height) varied from 22-66% in preschool children. At King Edward viii Hospital, approximately 40% of children admitted are malnourished. In the main the majority of blacks are poor, illiterate, and living in overcrowded conditions. Many are unemployed or employed away from home, which causes serious disruption of family life with such consequences as teenage pregnancies and malnutrition. The mortality rates, disease profiles, and socioeconomic status of the whites in Sourh Africa are similar, and often superior, to those in Western countries. The reason for this discrepancy in the state of health and socioeconomic development of population groups is the government's policy of separate but unequal development; the policy of apartheid that reserves 87% of the land for 16% of the people, the white minority.
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PMID:The health of children in South Africa: some food for thought. 614 93

Hypertension in pregnancy has implications for both maternal and fetal welfare. Extrapolation from concepts of mechanisms operating in hypertension in general to pregnancy-related hypertension is not justified. In the latter, the major features are a hyper-adrenergic state, plasma volume reduction and an increased systemic resistance. A reduction in uteroplacental perfusion may result from or may activate the mechanisms that elevate blood pressure. Humoral factors (e.g. hormonal attenuation of vascular reactivity) and prostacyclin deficiency may be central to the disordered physiology. Treatment of hypertension in pregnancy should aim at avoiding the vascular damage due to blood pressure elevation but not cause a reduction in uteroplacental perfusion. Unlike earlier antihypertensive regimens using centrally acting sympatholytics, adrenergic neuron blockers or diuretics, regimens using beta-blockers or combinations of beta-blockers with alpha-blockers or vasodilating agents such as hydralazine permit effective blood pressure control, even in severe hypertension, and pregnancy can often proceed until term or until fetal maturity is secured. Adverse effects on the fetus (growth retardation, cardiorespiratory depression, hypoglycaemia, hyperbilirubinaemia) formerly attributed to beta-blockers are more likely related to poorly controlled hypertension. Specific benefits of maternal beta-adrenoceptor blockade are suggested by evidence for prevention of proteinuric deterioration and a decrease in the incidence and severity of respiratory distress in premature infants. Hypertension in pregnancy still presents a formidable therapeutic challenge and requires comprehensive management with close monitoring of fetal welfare. The presence or development of proteinuria in a hypertensive pregnant woman implies a major increase in risk to the fetus and warrants immediate admission to hospital for specialist management.
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PMID:Hypertension in pregnancy. Pathophysiology and management. 614 40

The major premise by which weight reduction is used as a medical therapy is the fact that obesity is a primary risk factor in the onset and severity of many medical diseases. Hypertension, coronary artery disease, adult onset diabetes mellitus, complications of major abdominal and thoracic surgery, cancer of the breast and colon, and degenerative joint disease are prevalent diagnoses. The data to support weight reduction use as a medical therapy derive primarily from studies of cardiovascular disease. These studies show lowering of blood pressure and reduction of risk factors for glucose intolerance, angina, and hyperlipidaemia. The magnitude of weight loss (percent reduction in excess body weight) is important; 10 per cent reduction is a firm threshold in obese patients (greater than 130%- less than 200% ideal body weight). Success at achieving this medical therapy is most frequent using very low calorie diets which average 30-40% reduction of excess body weight. Mild and moderate hypertension will respond in 90% of patients. Type II diabetes mellitus patients can become free of exogenous insulin requirement. Response to general anaesthesia and control of respiratory distress syndrome will improve if preoperative weight loss is achieved. Improved cardiovascular fitness and relief of exertional dyspnoea are other clinically important outcomes of very low calorie diet therapy. A high priority exists to investigate the use of comprehensive professional weight control therapy as medical treatment.
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PMID:Benefits of reducing--revisited. 624 29

We describe the results of a prospective study in which 120 women who developed hypertension in the last trimester of pregnancy were randomly allocated in double blind manner to atenolol or placebo. The mean duration of treatment was five weeks. The only difference between groups during the neonatal period was in respiratory distress syndrome, mainly related to spontaneous premature labour, which occurred in six placebo group babies but in none from the atenolol group. Fifty five children from each group have been followed to 1 year of age. All in the atenolol group are developing normally but one child from the placebo group is brain damaged. These findings do not suggest any short or medium term paediatric complications after the use of beta blockers in pregnancy.
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PMID:First year of life after the use of atenolol in pregnancy associated hypertension. 639 90


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