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

The antihypertensive effect of once and twice daily hydrochlorothiazide administration was compared in 24 ambulatory patients with essential hypertension. Hydrochlorothiazide 100 mg daily taken as a single morning dose or as a twice daily divided dose was administered to 24 previously diagnosed hypertensive patients in a double-blind cross-over fashion for 12 weeks. No patient received other antihypertensive agents or medications known to influence blood pressure. Sitting and standing blood pressure, weight, pulse, tablet count, and subjective complaints of side effects were obtained at study weeks 3 and 6 on each treatment schedule. There was no significant difference between the mean sitting systolic (133 and 131 mm Hg) or diastolic (85 and 84 mm Hg) blood pressure measurements at study weeks 3 and 6 for each treatment schedule. Comparison of standing mean systolic and diastolic blood pressure and mean arterial pressure produced similar results. Subjective complaints of medication side effects, including orthostasis or urinary frequency, did not differ between treatment schedules. This study suggests that hydrochlorothiazide may be effectively administered once daily for the treatment of hypertension.
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PMID:Antihypertensive effect of hydrochlorothiazide administered once or twice daily. 676 88

This 20 year old man suffered increasingly from multifocal bone- and back pain over the last 6 months. Painful weakness of the left leg with dysesthesia of the 4th and 5th toe, a weight loss of 15 kg and polydipsia and pollakiuria had developed. The clinical workup disclosed hard tumors in the right mandible and tibia, a waddling gait with bilateral sign of Trendelenburg, reduced muscular force in the left leg with missing achilles tendon reflex and a loss of sensibility in the distal S1 segment, epigastric tenderness on pressure and hypertension with a value of 160/100 mmHg. X-rays revealed multiple cystic bone lesions at all sites. Hypercalcemia and massively elevated parathyroid hormone were measured. Since the parathyroids were enlarged on sonography, primary hyperthyroidism with fibrosing osteitis v. Recklinghausen was diagnosed.
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PMID:[Bone pain, polydipsia, polyuria]. 818 45

Recent epidemiological studies have shown that hypertensive men are more likely to undergo surgical intervention for irritative voiding symptoms from BPH than age-matched controls. Indeed, noradrenergic nerves which regulate vascular tone also participate in the functional component of bladder outlet obstruction due to BPH. Newer, less invasive therapies for BPH such as thermal therapy can relieve symptoms yet do not eliminate obstruction based on urodynamic studies. Coincidentally, drugs such as alpha-adrenoceptor antagonists, which have been thought to relieve obstruction due to a peripheral effect, can be given intrathecally in animals to relieve urinary frequency due to obstruction. Taken together these observations implicate both peripheral and central sympathetic pathways in the motor control of the urinary bladder especially with disease states. We have used the hypertensive and behaviourally hyperactive spontaneously hypertensive rat (SHR), to investigate the roles sympathetic pathways or micturition. Elevated nerve growth factor (NGF) derived from vascular and bladder smooth muscle cells of the SHR appears to direct morphological, biochemical, and functional changes. The increase in NGF can apparently be explained by stabilization of its mRNA leading to increased synthesis in NGF. Bladders from SHRs develop a profuse noradrenergic hyperinnervation compared with the control WKY strain. Since afferents supplying the SHR bladder are hypertrophied, changes in afferent pathways are also likely. These differences in innervation and NGF in the SHR may explain changes in function. SHRs void 3 times as frequently as their genetic controls. Urinary frequency can be reduced by alpha-adrenoceptor antagonists. Cystometrograms performed in SHRs reveal lower bladder capacities and micturition volumes and the presence of unstable contractions compared with the WKY rat. Intrathecal, rather than intra-arterial administration of the alpha-adrenoceptor antagonist doxazosin reduces unstable contractions in the SHR. In vitro muscle bath studies have shown enhanced responses of SHR bladder smooth muscle to alpha-adrenoceptor agonists. It is likely that upregulation of NGF production causes sensory and possibly noradrenergic pathways to elicit hyperactive voiding. Increase in NGF in the adult bladder due to pathological conditions yields similar, yet distinct, consequences for voiding behaviour and innervation. Likewise, increased NGF in adult bladders following obstruction or inflammation triggers neuronal hypertrophy, enhanced reflex activity and urinary frequency. In contrast to the SHR, hyper-innervation is not observed. Moreover, peripheral or spinal alpha-adrenoceptor blockade eliminates urinary frequency following obstruction. These observations support the role for sympathetic pathways in the motor function of the bladder, especially in congenital or adult disease states. A similar process may underlie the neuroplasticity involved in alterations after obstruction or inflammation of the lower urinary tract in humans. The SHR strain raises the possibility that a common genetic defect exists capable of predisposing to both hypertension and overactivity of the urinary bladder. Whether a genetic predisposition to sustained bladder overactivity in response to inflammatory stimuli in obstruction exists in humans is an intriguing prospect.
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PMID:The spontaneously hypertensive rat: insight into the pathogenesis of irritative symptoms in benign prostatic hyperplasia and young anxious males. 1008 14

We deal in this paper with the concept of health smart home (HSH) designed to follow dependent people at home in order to avoid the hospitalisation, limiting hospital sojourns to short acute care or fast specific diagnostic investigations. For elderly people the project of such a HSH has been called AISLE (Apartment with Intelligent Sensors for Longevity Effectiveness). For this purpose, system having three levels of automatic measuring (1) the circadian activity, (2) the vegetative state, and (3) some state variables specific of certain organs involved in precise diseases, has been developed within the framework of a 'Health Integrated Smart Home Information System' (HIS2). HIS2 is an experimental platform for technologic development and clinical evaluation, in order to ensure the medical security and quality of life for patients who need home based medical monitoring. Location sensors are placed in each room of the HIS2, allowing the monitoring of patient's successive daily activity phases within the patient's home environment. We proceed with a sampling in an hourly schedule to detect weak variations of the nycthemeral rhythms. Based on numerous measurements, we establish a mean value with confidence limits of activity variables in normal behaviour permitting to detect for example a sudden abnormal event (like a fall) as well as a chronic pathologic activity (like a pollakiuria), allowing us to define a canonical domain within which the patient's activity is qualified to be 'predictable'. Alerts are set off if the patient's activity deviates from a predictable canonical domain. Moreover, we can follow the cardio-respiratory state by measuring the intensity of the respiratory sinusal arrhythmia in order to quantify the integrity of the bulbar vegetative system, and we finally propose to carefully watch abnormal symptoms like arterial pressure or presence of plasma proteins in the expired air flow for early detecting respectively hypertension or pulmonary oedema.
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PMID:Multi-sensors acquisition, data fusion, knowledge mining and alarm triggering in health smart homes for elderly people. 1236 Aug 54

Retroperitoneal fibrosis is an inflammatory disease, which is either idiopathic or secondary to infection, neoplasm, hemorrhage, aortic aneurysm or drugs. This is a rare disease usually presenting constitutional symptoms, abdominal, back or flank pain and urinary frequency. Treatment includes surgical relief of urethral obstruction and corticosteroids. There is no clear evidence of the beneficial effect of corticosteroids treatment on the course of retroperitoneal fibrosis. We report a patient diagnosed with retroperitoneal fibrosis with an unusual presentation--uncontrolled HTN and renal failure due to renal arteries obstruction, without any abdominal symptoms. This patient responded to steroids and tamoxifen. A review of the literature is also presented.
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PMID:[Retroperitoneal fibrosis--clinical response to steroid treatment]. 1269 65

Diuretic use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n=172) had a mean age of 79+/-7.5 (+/-S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients, respectively, reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio (OR)=3.48; 95% confidence interval (CI)=1.73-7.03) and urgency (74% versus 57% non-diuretic; OR=2.17; 95% CI=1.11-4.24) but not with incontinence (OR=1.74; 95% CI=0.87-3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR=3.09; 95% CI=1.20-7.97) and urgency (adjusted OR=2.50; 95% CI=1.00-6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR=2.54; 95% CI=1.09-5.91), which lost significance after propensity adjustment (adjusted OR=1.88; 95% CI=0.57-6.17). Overall summary mean Urge-IIQ score was 1.83+/-0.85 with 1.75+/-0.86, 1.68+/-0.76, and 2.03+/-0.88, respectively, for no diuretic, non-loop, and loop-diuretic patients (one-way analysis of variance (ANOVA) p=0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use.
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PMID:Association of diuretic use and overactive bladder syndrome in older adults: a propensity score analysis. 1875 58

OBJECTIVES To evaluate the number of medical and urological conditions associated with nocturia in a cohort of older men who were primary-care enrolees, and to assess the feasibility and efficacy of using a multicomponent intervention to reduce nocturia and its bother. SUBJECTS AND METHODS Men aged > or =50 years and with two or more episodes of nocturia were recruited from the primary-care clinics at one Veterans Affairs Medical Center to participate in a 4-week, open-label, prospective pilot study. A multicomponent intervention composed of behavioural therapy and targeted drug therapy was administered according to a specified protocol based upon identified risk factors for nocturia. Outcome measures included self-reported nocturia and bother on the American Urological Association (AUA)-7 Symptom Index, 3-day bladder diaries and self-reported sleep-related measures recorded using 7-day sleep diaries. RESULTS Fifty-five men completed the protocol (mean age 67 years, sd 8.3); they had a mean of 4.5 of nine defined conditions potentially related to nocturia. Highly prevalent conditions included moderate-to-severe benign prostatic hyperplasia (87%), hypertension (86%) and urinary frequency (71%). The mean diary-recorded nocturia decreased from 2.6 to 1.9 (P < 0.001), and bother score reduced from 3.1 to 1.1, representing a change from a 'medium' to a 'very small' problem (on a 5-point scale). Sleep diary-derived measures also improved significantly (time to initiate sleep, time to return to sleep after awakening, quality of sleep). CONCLUSIONS Given that individual older patients often have multiple coexistent risk factors for nocturia, identifying a principal cause of nocturia, a concept emphasized in treatment guidelines, proved to be difficult. Implementing a multicomponent behavioural intervention combined with drug(s) was feasible in older men and reduced nocturia frequency, bother from nocturia, and time to initiate sleep, within 4 weeks. These promising results merit repeating using a randomized, controlled trial.
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PMID:A multicomponent behavioural and drug intervention for nocturia in elderly men: rationale and pilot results. 1922 Feb 47

Several recent population-based studies have provided insight into the clinical importance and impact of overactive bladder (OAB). Although OAB can affect anyone at any age, the prevalence tends to increase with advancing age. Diuretic use is also common among older adults, as the prevalence of clinical conditions such as hypertension and heart failure requiring its use increases markedly with age. By causing increased formation of urine by the kidneys, diuretics increase urinary frequency and may cause urinary urgency and incontinence. This review provides a summary of available data, focusing on the association between OAB and diuretic use in the elderly. Although there is very little research work in this area, available studies have provided insight into the possible contribution of diuretic use to OAB in the elderly. Based on a recent report, OAB symptoms are common among older adults using diuretics, particularly the loop-type, and are associated with poor quality of life. More studies are required to fully understand the association between diuretic use and OAB, particularly its impact on health-related quality of life.
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PMID:The association between overactive bladder and diuretic use in the elderly. 1986 54

OBJECTIVES: To describe the characteristics of women who have had a hysterectomy and to assess the association of a past hysterectomy on current urologic symptoms. METHODS: The Boston Area Community Health (BACH) survey is a random sample of Boston, Massachusetts residents aged 30-79 years using a stratified two-stage cluster design (3202 women; 1067 Black, 1111 Hispanic, 1024 White). Urologic symptoms, hysterectomy, co-morbidities, lifestyle factors, and medical indications for a hysterectomy were by self-report. Socioeconomic status was measured as a combination of education and income. RESULTS: Hysterectomies were reported by 587 women and 1782 women reported one or more urologic symptoms. Minorities and those of lower socioeconomic status are more likely to have had a hysterectomy, even after adjusting for age and potential medical indications for a hysterectomy. Hispanic women were least likely to report fibroids, polycystic ovarian syndrome, or genitourinary cancers, but they were more likely to have had a hysterectomy if they reported these conditions than Black or White women. Women with a hysterectomy were more likely to report lower urinary tract symptoms, painful bladder syndrome, urinary frequency, urgency, and overactive bladder after adjusting for age, race/ethnicity, socioeconomic status, body mass index, depression, diabetes, heart disease, hypertension, smoking history, alcohol use, and physical activity. CONCLUSIONS: Minorities and those of lower socioeconomic status are more likely to report having a hysterectomy and urologic symptoms (including painful bladder syndrome) may be an unintended consequence of a hysterectomy.
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PMID:Hysterectomies and Urologic Symptoms: Results from the Boston Area Community Health (BACH) Survey. 2142 14

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors are both novel and second-line therapies in type 2 diabetes mellitus, yet no well-rounded comparison of these two drugs has been published. Upon searching randomized controlled trials in databases from inception to July 2018, we collected studies on the efficacy or safety of SGLT-2 inhibitors compared with those of DPP-4 inhibitors for the treatment of type 2 diabetes mellitus. A total of 12 randomized controlled studies including 4342 patients were included in this meta-analysis. Compared with DPP-4 inhibitors, SGLT-2 inhibitors achieved greater reductions in HbA1c (SMD -0.22; 95% CI: -0.30, -0.14; p=0.000) and fasting plasma glucose (SMD -0.48; 95% CI: -0.56, -0.41; p=0.000). In addition, these reductions increased with a prolonged treatment duration from 12 to 78 weeks. Geographically, significant reductions of SGLT-2 inhibitors in HbA1c and FPG were found in North America and Europe, but not in Asia. Furthermore, SGLT-2 inhibitors showed greater reductions in body weight (SMD -0.72; 95% CI: -0.81, -0.63; p=0.000) from baseline, with an increased incidence of genital infections (OR 4.49; 95% CI: 2.96, 6.83; p=0.000) and pollakiuria (OR 2.24; 95% CI: 1.05, 4.79; p=0.037) and a decreased incidence of hypertension and hyperglycemia. Overall, the current meta-analysis demonstrated that compared to DPP-4 inhibitors, SGLT-2 inhibitors have beneficial effects on HbA1c, FPG, body weight, SBP, DBP, and HDL-cholesterol in patients with type 2 diabetes. However, SGLT-2 inhibitors are associated with increased total cholesterol and LDL-cholesterol and a higher incidence of genital infections and pollakiuria.
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PMID:SGLT-2 Inhibitors and DPP-4 Inhibitors as Second-Line Drugs in Patients with Type 2 Diabetes: A Meta-Analysis of Randomized Clinical Trials. 3026 27


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