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

This paper reports the results of a retrospective study carried out with special reference to the survival rate in a series of 101 selected cases including patients with complete heart block (CHB) combined or not combined with Adams-Stokes attacks and patients with arrhythmic syncope without ECG evidence of CHB. All these patients were treated in our Department during 1958-68, none being artificially paced. Twenty-seven patients were alive at the end of the follow-up, i,e 6-15 years after admission to this Department on account of syncopal episodes or CHB. The survival rate--higher in females than males--was lower in the cases of CHB combined with Adams-Stokes attacks than in the cases of asymptomatic CHB. This applied also to the instances in which a complicating disease such as ischaemic heart disease (IHD), hypertension, diabetes, digitalis intoxication or cardiac enlargement coexisted. The survival rate in the 68 cases of CHB was higher at one year (68%) as well as at 5 years (37%) than that reported by other investigators. When assessing the survival rate in cases treated with artificial pacemakers, it is important to study the individual case histories with special reference to a previous or coexisting condition such as IHD, hypertension, diabetes or the presence of cardiac enlargement. The present results support the view that the indications for treatment with artificial pacing should be wide, albeit that the prognosis in this series was more favourable than might have been anticipated from observations by others.
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PMID:Prognosis of patients with complete heart block or arrhythmic syncope who were not treated with artificial pacemakers. A long-term follow-up study of 101 patients. 101 54

The records of 483 patients admitted to the emergency room because of syncope were reviewed. Thirty seven patients (7.7%) were found to suffer from transient ischemic attack- (TIA) related syncope. This group is the subject of this report. Of these patients, 28 (76%) were men (mean age 71 years). Seven patients reported previous syncopal episodes. Past history revealed a high rate of ischemic heart disease (70%) and hypertension (68%). Concurrent neurologic symptoms, which led to the diagnosis of TIA-related syncope, included mainly vertebrobasilar symptoms: vertigo (in 55% of the patients), ataxia (46%), parasthesia (41%). Two patients most probably were presenting bilateral carotid artery disease. Various diagnostic tests (including electroencephalography, computed tomography, sonography, and cerebral angiography) were used to exclude other causes of syncope. During follow-up (mean 14.5 months) four patients (11%) had an additional episode of TIA and in three of them syncope reappeared. One patient had a complete stroke. We conclude that TIA is a much more frequent explanation for syncope than has been previously argued. These patients tend to be elderly males with high incidence of ischemic heart disease and hypertension. The concurrent neurologic symptoms, leading to the diagnosis, represent mainly vertebrobasilar territory ischemia.
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PMID:Transient ischemic attack-related syncope. 204 43

Blood pressure measurements obtained in a physician's office may not represent a patient's blood pressure during an entire day. Ambulatory blood pressure monitoring (ABPM) provides multiple readings over time. This review of the literature on ABPM addresses the current state of ABPM methods, normal blood pressure profiles, the clinical and research uses of ABPM, cost considerations, and recommendations for use of ABPM in selected circumstances. Current ABPM devices use either auscultatory or oscillometric methods to determine blood pressure. A rigorous comparison of these methods is needed to determine whether one method is more reliable. A nonbiased assessment of all available equipment is necessary. Normative data provided by ABPM research are needed for populations by age, race, gender, body habitus, and conditions, such as pregnancy. While ABPM is not cost-effective for all hypertensive patients, it can assist in the evaluation of such problems as target organ complications, syncopal episodes, episodic hypertension, and autonomic dysfunction.
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PMID:National High Blood Pressure Education Program Working Group report on ambulatory blood pressure monitoring. 212 25

The records of 483 patients admitted to the emergency room because of syncope were reviewed. Forty-one patients were found to have drug-related syncope. Thirty-nine experienced syncope related to drugs administered for cardiovascular disease. The most frequently associated diseases were anginal syndrome (22 patients), hypertension (13 patients), and a history of myocardial infarction (6 patients). Thirty-eight patients experienced symptomatic orthostatic hypotension following drug taking (nitrates in 19 patients, beta blockers in 10 patients, nifedipine in 3 patients, prazosin and quinidine in 2 patients each, methyldopa and verapamil in 1 patient each). One patient developed complete heart block as a result of digoxin intoxication. Two patients developed the characteristic picture of anaphylactic reaction (1 with ampicillin, 1 with dipyrone). During one-year follow-up, without the offending medications, no further syncopal episodes were reported by these patients. We conclude that drug-related syncope was more common among our patients with syncope than had been reported previously. It is suggested that drug-related syncope should be taken into consideration in any patient with syncope who is treated by any of the above-mentioned drugs.
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PMID:Drug-related syncope. 280 62

A retrospective study was conducted of 101 hospitalized patients who had one or more episodes of syncope. The etiology of syncope was established with relative ease in 61% of these patients. History and physical examination revealed the cause in 34%, resting ECG in 11% and 24-h ECG monitoring in 16%. Additional tests (electroencephalograms, Doppler studies of the cervical arteries, computerized tomography of the brain, ultrasonography of the heart and cardiac catheterization) either were noncontributory or did not contribute to confirmed diagnoses already established by other means. Cardiac causes were responsible for the syncope in 34% and noncardiac causes in 27%. Comparison between diagnosed and undiagnosed patients revealed no significant differences with respect to age, number of syncopal episodes or presence of hypertension or diabetes. There were, however, significantly more women, and a lower frequency of ischemic heart disease and other associated diseases in the undiagnosed group. It is concluded that all patients with syncope should undergo ambulatory ECG and 24-h ECG monitoring, and that hospitalization should be reserved for patients whose clinical condition requires admission or when further investigation is necessary.
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PMID:Syncope: a retrospective study of 101 hospitalized patients. 391 52

We present a case of a 79-year-old woman with periods of syncope, complete heart block (CHB), and ventricular standstill during periods of increased vagal tone following sublingual nifedipine for hypertension. The syncopal episodes were associated with periods of elevated vagal tone (micturition and vomiting) with one monitored episode showing a clear time course of emesis; CHB then ensued, progressing to ventricular standstill with loss of consciousness that resolved over several minutes. Although nifedipine is not thought to affect conduction at current clinical dosages, it seems likely that the additive effects of nifedipine and elevated vagal tone produced the observed conduction abnormalities. This is the first case report of nifedipine administration followed by syncope and conduction disturbances.
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PMID:Syncope and conduction disturbances following sublingual nifedipine for hypertension. 403 65

Captopril, an orally active angiotensin-converting enzyme inhibitor, has been administered to 81 patients with different types of clinical hypertension. Most of the patients had previously uncontrollable high blood pressure. In order to achieve a satisfactory blood pressure control during long-term captopril therapy, a concomitant decrease in total body sodium was required in more than half of the patients. During our first two years of clinical experience with this new antihypertensive agent, side effects developed in 46.9 per cent of the patients and necessitated the withdrawal of the drug in 23.4 per cent of all patients. Only a few side effects such as hypotensive or syncopal episodes and cold extremities appeared to be due to the chronic blockade of the renin-angiotensin system. The most frequent and the most serious adverse reactions such as skin rash, altered taste, pancytopenia, and pemphigus foliaceus seemed to be specifically drug related. The incidence of cutaneous and taste problems was markedly higher in patients with impaired renal function in whom retention of captopril has been previously demonstrated. This suggests that the occurrence of adverse reactions to captopril could be lowered in the future by using smaller daily doses and by titrating them according to the renal function.
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PMID:Safety and efficacy of chronic therapy with captopril in hypertensive patients: an update. 646 Jul 91

In an open study 30 hypertensive outpatients have been treated with Indapamide in a dosage of 2,5 mg daily in the morning for eight weeks. In the course of this treatment a highly significant decrease of blood pressure could be observed. The antihypertensive effect came up gently in the beginning. Indapamide has been well tolerated by all patients. The rate of adverse reactions was low. Syncopal episodes did not occur. The biochemical data monitored (fasting glucose level, creatinine, urea, potassium, sodium, calcium, chloride) did not show any significant deviation. According to the present data Indapamide may be used as basic medication in the treatment of genuine hypertension. The gentle effect in the beginning prevents syncopal episodes, however a sufficient period of treatment, at least eight weeks, is needed to assess the success of the therapy.
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PMID:[Ambulatory treatment of hypertension]. 740 72

A 72-year-old African-American man with frequent recurrent syncope was found to have severe refractory orthostatic hypotension with concomitant supine hypertension. Pharmacotherapy was successful in controlling his supine hypertension but was unable to resolve his severe orthostatic hypotension. Temporary fixed rate tachypacing was only minimally effective in preventing syncope during upright tilt, while variable rate pacing based on degree of blood pressure fall was far superior. Following these observations, an adaptive rate pacing system controlled by right ventricular preejection interval was implanted (Precept DR Model 1200). The system adequately sensed the patient's fall in blood pressure when sitting or standing and augmented its rate accordingly, thus preventing syncope. While supine, the pacing rate fell to 60 ppm, thereby, avoiding an exacerbation of his concomitant supine hypertension. Over a 3-month follow-up period, he has had no further orthostatic or syncopal episodes. We conclude that adaptive rate pacing using right ventricular preejection interval may be an effective treatment for severe refractory orthostatic hypotension.
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PMID:Adaptive rate pacing controlled by right ventricular preejection interval for severe refractory orthostatic hypotension. 768 8

Seven patients with acute dissection of ascending aorta are presented and the role of two-dimensional echocardiography in the early diagnosis of this condition is emphasized. There were 5 male and 2 female patients. The mean age of the patients was 36.7 +/- 11.2 years. The presenting symptoms were chest pain in 7, associated interscapular pain in 4, dyspnoea in 4 and syncopal episodes in 2 patients. Examination revealed hypertension in 3, pulses paradoxus in 2, asymetrically weak carotid and brachial pulses in 3, aortic regurgitation in 5 and neurological deficit in 2 patients. Echocardiography showed aortic root diameter of 42mm and the presence of an intimal flap in all the 7 patients and flap oscillations in 6 patients. Echocardiographic evidence of pericardial effusion was present in 6, cardiac tamponade in 3, aortic regurgitation in 5 and regional left ventricular wall motion abnormality in 1 patient. Surgical correction was done in 5 patients with 60% success rate. Two patients received only medical treatment. Aortic root dilatation of 60 mm, presence of an oscillating flap, evidence of cardiac tamponade and regional wall motion abnormality were found to be associated with poor prognosis.
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PMID:Role of two-dimensional echocardiography in early diagnosis of suspected acute dissection of ascending aorta. 836 60


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