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

Hypertension is quite common in the elderly population. Isolated systolic hypertension and diastolic hypertension are associated with cardiovascular complications. Like younger patients, the elderly may have labile hypertension. On the other hand, pseudohypertension, auscultatory gap, and postural hypotension are peculiar to the elderly. Obesity, atherosclerosis, arteriosclerosis, baroreceptor insensitivity, decline in renal function, physical inactivity, and insomnia are factors that can lead to or aggravate hypertension in older patients. Secondary hypertension should be suspected if elevated blood pressure first appears late in life or becomes resistant to previously adequate treatment. Spontaneous hypokalemia can indicate primary aldosteronism. Elevation in the serum creatinine level of a patient taking an angiotensin-converting enzyme (ACE) inhibitor suggests bilateral renovascular hypertension. The goal of antihypertensive therapy is to prevent morbidity, disability, and death from complications and to maintain quality of life. Psychosocial factors may play an important role in controlling hypertension. Nonpharmacologic treatment, such as weight loss, salt restriction, and exercise, should always be tried prior to and in conjunction with medical therapy. Antihypertensive drugs often cause side effects and should be prescribed with caution. Always start with a low dose and gradually increase it if necessary. All drugs that reduce blood pressure in the younger individual also work in the elderly. ACE inhibitors and calcium blockers are particularly useful because of their low incidence of adverse effects.
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PMID:Hypertension in elderly patients. The special concerns in this growing population. 154 24

In 1986, we reported two anatomoclinical observations of a familial condition that we called "fatal familial insomnia" (FFI). We now present the pedigree as well as the clinical and neuropathologic findings in five new subjects. The pedigree includes 288 members from six generations. Men and women are affected in a pattern consistent with an autosomal dominant inheritance. The age of onset of the disease varies between 37 and 61 years; the course averages 13 months with a range of 7 to 25 months. Progressive insomnia (polygraphically proven in two cases); autonomic disturbances including hyperhidrosis, hyperthermia, tachycardia, and hypertension; and motor abnormalities including ataxia, myoclonus, and pyramidal dysfunction, were present in every case, but with variable severity and time of presentation. Sleep and autonomic disorders were the earliest signs in two subjects, motor abnormalities were dominant in one, and others had intermediate clinical patterns. Pathologically, all the cases had severe atrophy of the anterior ventral and mediodorsal thalamic nuclei. Other thalamic nuclei were less severely and inconsistently affected. In addition, most of the cases had gliosis of the cerebral cortex, a moderate degree of cerebellar atrophy with "torpedoes," and severe atrophy of the inferior olivary nuclei. One case also showed spongy degeneration of the cerebral cortex. We conclude that all the lesions were primary, and that FFI is a multisystem disease in which the different structures are primarily affected with different severity. The insomnia appears to correlate best with the major thalamic pathology. The possibility that FFI belongs to the group identified as prion diseases or diseases transmitted by unconventional agents is examined.
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PMID:Fatal familial insomnia: clinical and pathologic study of five new cases. 173 58

The relations between insomnia and blood pressure were investigated in 151 patients (56 men and 95 women). It was found that 37.1% of the patients were normotensive, whereas 31.8% suffered from arterial hypertension and 31.1% from arterial hypotension. There was practically no difference between normotensives and hypertensives in respect of disturbed behavioral patterns of sleep, but an entirely different picture was presented by the arterial hypotensives. Characteristic features of hypotonic insomnias were (mostly in women) prolonged time before falling asleep, frequent awakening at night associated with tachycardia and long-lasting increased excitability, starting difficulties in the morning, depressive conditions, compulsive yawning and falling asleep during daytime, tiredness, lack of "drive" and reduced physical and mental efficiency. This pattern of signs and symptoms was enhanced by hypnotics and tranquilisers. During sleep blood pressures down to 50/35 Torr were measured. It is assumed that the low blood pressure results in hypoxic and hypoglycaemic conditions in the brain. Spontaneous awakening is considered to be an emergency reaction triggered by the deficient cerebral blood flow.
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PMID:[Relationship between insomnia and arterial hypotension]. 186 93

There is increasing interest in the way in which drugs impair performance. This has arisen because some may impair day-to-day skills of those whose occupations demand vigilance and motor skill, and of those who are involved in decision making or where interpersonal relations are crucial. For many years the position was adopted, at least in certain occupations where impaired performance could be a danger to others, that the use of any drug should preclude employment. However, recent advances in therapeutics and a greater understanding of drug action in man has made this rather uncomplicated view of life less tenable, and there is now an increasing desire that advances in therapy should, if at all possible, be available to occupational groups, such as airline pilots. In this way the adverse effect which a drug may have on performance has become an important aspect of its clinical profile. Hypnotics appropriate for transient insomnia, which may arise from the irregularity of rest inherent in many occupations, need to be free of residual effects, antihistamines that are sedative must be avoided, and drugs used in the management of mild hypertension, often during the important years of middle life, must be as free as possible from central effects. And it must be emphasized that these drugs are often used by active, healthy or near healthy individuals. The issues involved in the safe use of a particular drug by a particular individual are complex, and as with all aspects of therapeutics it is sometimes necessary to balance efficacy and adverse effects.
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PMID:Medication and skilled work. 197 Aug 97

Secondary mania is increasingly recognized clinically, and consists of acute exhibition of manic symptoms without past or family history of affective disorder. It has been reported with toxic and metabolic disturbances, primary and metastatic brain tumors, epilepsy, and cerebrovascular events. A multifactorial etiology has been suggested. We report two men, 52 and 56 years old, who developed grandiosity, sleeplessness, irritable mood, hyperactivity, and paranoid and religious delusions, with attempted violence in one case. Both had no premorbid psychiatric history and were healthy except for hypertension. One patient had a normal neurologic examination, and the other had mild left hemiparesis and hyperreflexia. EEGs, brainstem auditory-evoked responses, and median nerve somatosensory-evoked potentials were normal. Magnetic resonance studies demonstrated infarction of the ventral pons (on the right in the patient with left-sided signs and on the left in the patient with normal neurologic examination). The two patients responded to lithium carbonate and neuroleptics and have not had further psychiatric symptoms in 18 months of follow-up. These cases emphasize the relationship of late-onset mania with predisposing brain disease, and they suggest that brainstem disturbances can influence mood, sleep, libido, and thought.
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PMID:Secondary mania after ventral pontine infarction. 213 93

To contribute more comprehensive information about the characteristics of asthma, this article analyzed patients served by the University of Alabama at Birmingham Comprehensive Asthma Program. Their physicians rated one fifth of these patients as having "severe" asthma with the remainder about equally divided between "moderate" and "mild". One in two first received a diagnosis of asthma ten or more years previously. Common comorbidities were hypertension, obesity, rhinitis, bronchitis, sinusitis, and arthritis. One half had visited an emergency room or been hospitalized for asthma in the past year. Inhaled bronchodilators and continuous theophylline were the most commonly prescribed medications. Side effects, especially tachycardia and insomnia, were common and almost exclusively associated with theophylline or corticosteroid therapy. Spirometric assessment showed chronic airflow obstruction in those with more severe asthma. Prevalence of respiratory symptoms, intensity of medication regimen, incidence of side effects, and health care utilization increased as asthma severity increased.
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PMID:Characteristics and correlates of asthma in a university clinic population. 220 37

A 52-year-old woman presented to the office about 2 and 1/2 years after the death of her husband from cancer. She had multiple hemodynamic and cardiovascular disorders such as hypertension, angina, tachycardia, dysmenorrhea, cardiac ectopics, and very cold hands and feet. The patient complained of tension and insomnia but refused to take any medications because of allergic responses to them. Hence, a relaxation and psychotherapeutic approach was adopted. Psychometric testing revealed extreme defensiveness (including repression). The patient had never mourned for her husband. Therapy helped her overcome her bereavement, tension, and insomnia. In addition, many of her physical manifestations subsided considerably during therapy.
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PMID:Repression and somatization: a case history of hemodynamic activation. 224 1

A multicenter, randomized, double-blind, comparative study was conducted in 274 patients with mild to moderate hypertension to assess the impact of nitrendipine and propranolol on quality of life. After placebo baseline, 136 patients were given nitrendipine (5-20 mg b.i.d.) and 138 were given propranolol (40-120 mg b.i.d.). Quality of life was evaluated at baseline, weeks 6-10, and weeks 14-18 of the maintenance period. At weeks 6-10, the nitrendipine group became significantly more vigorous (p less than 0.01) and less fatigued (p less than 0.05) than the propranolol group. Propranolol subjects noted decreased problems of trembling hands (p less than 0.01) and alcohol use (p less than 0.05) than the nitrendipine subjects. No other significant differences between groups in mood states, troublesome conditions (insomnia, headaches, and loss of appetite), or sexual satisfaction were noted at this visit, and patient willingness to continue study medication was marginally significantly higher (p less than 0.1) in the nitrendipine group than in the propranolol group. At weeks 14-18, the propranolol subjects perceived significantly decreased problems with the "felt worried, tense, and drank alcohol to cope" factor (p less than 0.05); however, there were no differences between groups at this visit for Profile of Mood States (POMS) scores, sex life variables, or medication preference. Based on within-group analysis, the propranolol group perceived a reduction in partner sexual satisfaction (p less than 0.05). Overall, nitrendipine seemed to be better tolerated than propranolol.
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PMID:Comparison of quality of life on nitrendipine and propranolol. 246 71

Forty-eight experimental studies of nonmechanically assisted relaxation techniques used to control a variety of clinical symptoms were synthesized using meta-analysis. Effect sizes for three types of comparisons, experimental-control, experimental-placebo, and pre-post, ranged from .43 to .66, demonstrating that treatment of any type included in the analysis moved the client from the 50th to the 67th percentile of an untreated group at minimum and from the 50th to the 75th percentile at maximum. All treatments included in the analysis except Benson's relaxation technique demonstrated evidence of effectiveness, particularly for nonsurgical samples with chronic problems such as hypertension, headache, and insomnia.
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PMID:The effects of relaxation training on clinical symptoms: a meta-analysis. 266 18

The problem of psychosomatic complaints in newly sober substance abusers is longstanding. While somatic symptoms are common in withdrawal generally, some patients experience symptoms which prevail to the point of distracting from the treatment of the addiction. This paper illustrates brief, collaborative interventions conducted in a treatment hospital for three such patients who had significant, persistent, and common psychosomatic difficulties: migraine, insomnia, and hypertension. The importance and utility of holistic, multimodal treatment of the patient is emphasized.
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PMID:Brief interventions for psychophysiological symptoms in hospitalized addicted patients. 274 9


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