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

Preoperative medical evaluation of the hypertensive patient has a dual focus: (1) to establish an appropriate level of blood pressure control before anesthesia and surgery; and (2) to assess the degree of cardiovascular impairment, with particular attention to brain, heart, and kidney. Close communication between clinician and anesthesiologist can do much to ensure the patient's safety. Interpretation of the results of the preoperative examination is aided by the clinician's prior knowledge of the patient: the onset and history of his hypertension, his record of compliance to an antihypertensive regimen, his blood pressure response during previous hospitalizations and surgical procedures. Though there is no longer any question that antihypertensive medications should be continued in the preoperative period, side-effects of thiazide therapy may need treatment before or during surgery. Again, the clinician's fuller knowledge of the patient will help to alert the anesthesiologist to the need for special caution.
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PMID:The preoperative patient wit hypertension. 52 89

Serum N-acetyl-beta-D-glucosaminidase (NAG) levels were measured in 1080 residents in Tanushimaru, Fukuoka, aged 20 to 84 years old, during a periodical epidemiological survey performed in 1982. Thirteen pregnant women were excluded from this study. Serum NAG levels showed an increase with age, but were not different between sexes. We found high serum NAG values in those with high blood pressure, high serum total cholesterol, low serum HDL-cholesterol, or reduced creatinine clearance rate, and women with high serum uric acid, increased skinfold thickness, or high hematocrit. Multiple regression equation was as follows: NAG = 3.53 + 0.07 (age) + 0.14 (hematocrit) + 0.03 (total skinfold thickness) + 0.04 (systolic blood pressure) - 0.03 (HDL-cholesterol) - 0.04 (mean blood pressure) - 0.01 (creatinine clearance). The multiple correlation coefficient was 0.37 (F = 24.4). We suggest that NAG may be a useful index in screening cardiovascular impairment and for cardiovascular risk factors.
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PMID:Serum N-acetyl-beta-D-glucosaminidase activity in a large population--a useful index of cardiovascular impairment. 396 64

Sixteen patients with progressive systemic sclerosis (PSS), including 3 with the "CREST" (calcinosis, Raynaud's, esophageal dysfunction, sclerodactyly, and/or telangiectasias) variant, were evaluated with resting M-mode echocardiography and noninvasive measurements of cardiac output at rest and during submaximal exercise to determine the nature and extent of any cardiovascular impairment. No patient had arterial hypertension, significant renal impairment, clinical evidence of large vessel coronary artery disease, or severe pulmonary dysfunction. The duration of disease was 1 to 12 years (9 to 30 for patients with the CREST variant). Echocardiographic abnormalities included increased right ventricular dimension (3 patients), reduced left ventricular ejection fraction (3 patients), and pericardial effusion (3 patients). Cardiac index (CI) and stroke volume index (SVI) at rest were similar for patients and controls. Patients and controls were exercised to similar heart rates (130 +/- 3 vs 124 +/- 4; p, NS). Total peripheral resistance (TPR) was higher for patients (1123 +/- 81 vs 810 +/- 44 dyn X s X cm-5) and their mean SVI failed to increase significantly compared with sitting rest values (30 +/- 2 vs 35 +/- 3 ml/m2). The control subjects had the expected increase in SVI (36 +/- 2 vs 51 +/- 5; p less than 0.01). Ten patients with an abnormal hemodynamic response to exercise had a normal echocardiographic circumferential fiber shortening (VCF) or ejection fraction (EF) at rest. The data indicate that PSS patients have a greater degree of cardiovascular dysfunction than would be predicted from clinical data and laboratory evaluation of cardiovascular and pulmonary function at rest. Multiple mechanisms, including right and left ventricular dysfunction and abnormal vasoconstrictor activity, are likely to contribute to the reduction in exercise capacity seen in patients with PSS.
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PMID:Cardiovascular function in patients with progressive systemic sclerosis (scleroderma). 621 13

Plasma and vascular kinins stimulate the production of endothelium-derived nitric oxide, prostacyclin and hyperpolarizing factor (which regulates the function of vascular smooth muscle), and endothelial interactions with blood cells. The role of kinins in vasomotion is determined by the rate of production of the peptides by kininogenases and their degradation by kininases, in particular angiotensin-converting enzyme (ACE). Acute increases in plasma kinin levels during exercise or myocardial ischemia indicate that the metabolism of the peptides is fine tuned to the systemic or local metabolic demands. The release of endothelial vasodilators is impaired (or counterbalanced by the release of chemical or functional antagonists) in atherosclerosis, hypertension, diabetes, subarachidonic hemorrhage, and following postischemic injury. ACE-inhibitors potentiate the action of kinins and normalize endothelial function. In septic shock, hypotension triggered by overproduction of kinins leads to cardiovascular impairment and end-organ damage. Thus the balance in the metabolism of kinins modulates the control of blood flow by the endothelium.
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PMID:Kinins and endothelial control of vascular smooth muscle. 759 12

Forty-four patients suffering a stroke for the first time were examined within 10 h of the onset of symptoms; the tests performed on their admission to hospital, and thereafter on the third and seventh day, were 24-h Holter EKG with spectral analysis of heart rate variability, evaluation of arterial blood pressure and the levels of catecholamine in the blood and 24-h urine. The dynamic EKG on admission revealed that 31 (70.5%) out of the 44 patients already had arrhythmia. These alterations were observed in 9 (75%) out of 12 haemorrhagic patients with a significant (P < 0.05) prevalence compared to 22 (68.8%) of the 32 ischaemic ones. Arrhythmia showed up in 16 (76.2%) out of 21 cases with right hemisphere lesions and in 12 (63.2%) out of 19 cases of left hemisphere lesions; this difference was also significant (P<0.05). Arrhythmia was still present in 19 (43.2%) patients after 3 days and only in 2 (6.5%) patients after 7 days. The spectral analysis parameters on admission and after 3 days were significantly (P < 0.05) modified in patients with stroke plus arrhythmia, compared to patients with stroke alone and to control subjects, whereas no further differences were observed on the seventh day. Moreover, the percentage of patients with arterial hypertension and high levels of catecholamine greatly decreased from the third day onwards. A transient autonomic nervous system imbalance with prevalent sympathetic activity may justify this cardiovascular impairment during the hyperacute phase of stroke.
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PMID:Transient autonomic nervous system dysfunction during hyperacute stroke. 1108 9

The management of hypertension in the elderly requires careful diagnosis, which is not always easy in this population because of the increased variability of blood pressure. The practitioner is faced with three questions in this diagnostic approach: how to evaluate the patient's real blood pressure level, how to assess the degree of cardiovascular impairment and concomitant disease and finally how to evaluate the subject's global cardiovascular risk. Self-monitoring of blood pressure, which allows measurement of blood pressure by the patient himself in his usual environment, provides a better assessment of the elderly patient's real blood pressure level.
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PMID:[How to diagnose hypertension in the elderly?]. 1255 74

Nitric oxide (NO) is essential for normal function of the cardiovascular system. This study has determined whether chronic administration of l-arginine, the biological precursor of NO, attenuates the development of structural and functional changes in hearts and blood vessels of deoxycorticosterone acetate (DOCA)-salt hypertensive rats. Uninephrectomized rats treated with DOCA (25 mg every 4th day sc) and 1% NaCl in the drinking water for 4 wk were treated with l-arginine (5% in food, 3.4 +/- 0.3 g x kg body wt(-1) x day(-1)). Changes in cardiovascular structure and function were determined by echocardiography, microelectrode studies, histology, and studies in isolated hearts and thoracic aortic rings. DOCA-salt hypertensive rats developed hypertension, left ventricular hypertrophy with increased left ventricular wall thickness and decreased ventricular internal diameter, increased inflammatory cell infiltration, increased ventricular interstitial and perivascular collagen deposition, increased passive diastolic stiffness, prolonged action potential duration, increased oxidative stress, and inability to increase purine efflux in response to an increased workload. l-Arginine markedly attenuated or prevented these changes and also normalized the reduced efficacy of norepinephrine and acetylcholine in isolated thoracic aortic rings of DOCA-salt hypertensive rats. This study suggests that a functional NO deficit in blood vessels and heart due to decreased NO synthase activity or increased release of reactive oxygen species such as superoxide may be a key change initiating many aspects of the cardiovascular impairment observed in DOCA-salt hypertensive rats. These changes can be prevented or attenuated by administration of l-arginine.
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PMID:l-Arginine attenuates cardiovascular impairment in DOCA-salt hypertensive rats. 1592 20

Acromegaly causes a number of disorders in the cardiovascular system, resulting from chronic exposure to high levels of GH and IGF-1. Such disorders are the main responsible for increased mortality rates among acromegalic patients. Among several forms of cardiovascular impairment is acromegalic cardiomyopathy, an entity that is initially characterized by a hyperdynamic state, followed by concentric left ventricular hypertrophy and diastolic dysfunction due to relaxation deficit, culminating in systolic dysfunction and sometimes heart failure. In addition, arrhythmias and heart valve diseases are also relevant, especially mitral and aortic, ischemic heart disease, hypertension, and glucose and lipid metabolism disorders. This review approaches the main clinical and prognostic aspects of these entities, the effects of acromegaly treatment on them, and the respective consequences on patient survival.
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PMID:[Cardiovascular disturbances in acromegaly]. 1919 49

Due to advances in oncological care, the number of patients exposed to and surviving after anticancer chemotherapy is steadily increasing. Anticancer agents, however, are often associated with side-effects including cardiotoxicity which has been identified as one of the most serious and potentially life threatening complications. Cardiotoxicity manifestations range from asymptomatic alterations of heart and vasculature function to arterial hypertension, myocardial ischemia, arrhythmias (including QT-prolongation) and overt heart failure. Post-chemotherapy cardiovascular impairment has been associated with increased morbidity and may also contribute to increased mortality in these patients, both early and late after chemotherapy. This review article describes pathophysiology, clinical manifestation, diagnostic algorithms, monitoring and therapy of cardiotoxicity caused by anticancer agents. We also outline and discuss a variety of problems associated with patient management from the viewpoint of clinical cardiology according to latest published findings.
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PMID:[Cardiotoxicity of cancer therapy]. 2169 28

Sleep apnoea is a common, yet underestimated, chronic disorder with a major impact on morbidity and mortality in the general population. It is quickly becoming recognized as an independent risk factor for cardiovascular impairment. Hypertension, coronary artery disease, diabetes, cardiovascular rhythm and conduction abnormalities, cerebrovascular disease, and heart failure have all been linked to this syndrome. This review will explore the critical connection between sleep apnoea and chronic cardiovascular diseases while highlighting established and emerging diagnostic and treatment strategies.
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PMID:Importance and management of chronic sleep apnoea in cardiology. 2242 82


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