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

The authors studied 8 patients (4 males and 4 females) with Cushing's syndrome due to ectopic ACTH secretion. Chronological age ranged from 15 to 45 years and duration of the disease ranged from 3 to 48 months. All patients presented typical signs of Cushing's syndrome, blood hypertension, and four of them had hyperpigmentation of the skin. Five patients had fasting hyperglycemia and all patients but one had serum hypokalemia (serum K = 2.2 to 3.9mEq/l). The circadian rhythm of cortisol was absent in all patients and basal cortisol levels were elevated in all patients but one. Basal ACTH levels evaluated in 7 patients were elevated in 6 (29 to 1050 pg/ml-MRC). One patient presented normal depression of urinary 17-OH after two days of dexamethasone and normal increase of urinary 17-OH and serum 11-dexycortisol after methyrapone. Four patients had carcinoid tumor (3 thymic and 1 bronchial), two had pancreatic islets cell tumors, one had bilateral pheochromocytoma and medular carcinoma of the thyroid, and one had oat cell carcinoma of the lung and medular carcinoma of the thyroid. Thoracic X-rays identified the ectopic ACTH secretion tumor in four cases, all confirmed by CT scan. Abdominal CT showed a difuse enlargement of the adrenals in seven cases and bilateral nodules in one case (pheochromocytomas). Six patients died within 3 years of the diagnosis. The authors concluded that clinical and hormonal findings could mislead the findings of ACTH ectopic secretion and Cushing's disease, and suggest that thoracic X-rays and CT scans of the skull, thorax, and abdome should be done in all cases of Cushing's syndrome.
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PMID:[Cushing syndrome due to ectopic ACTH secretion]. 255 51

In man a close interrelationship exists between hyperadrenergic states, myocardial ischemia, necrosis, infarction and sudden cardiac death. Persistent high catecholamine levels may also be associated with increased vascular endothelial turnover and permeability to calcium and lipoproteins, increased blood velocity, abnormal blood flow patterns and atheroma formation. There are thus good reasons to predict a cardiovascular protective effect of beta-blockers. Animal data indicate that in spite of apparently adverse plasma lipoprotein changes beta-blockers retard atheromatous plaque formation under conditions of high cholesterol diet with or without stress. A slow heart rate, as well as a reduction in calcium influx and inhibition of both esterification of arterial wall cholesterol (by ACAT) and endothelial permeability to lipoproteins, may be central to this process. Beta-blockers benefit a spectrum of conditions related to the atheromatous process and myocardial necrosis. These are silent ischemia; stable (including mixed), unstable and preinfarction angina; periinfarction events (including myocardial rupture and dissection of the ascending aorta); and myocardial necrosis associated with stress conditions such as head injuries and subarachnoid hemorrhage. In one study coronary deaths in hypertensive men, particularly in smokers, were significantly reduced by metoprolol (a beta 1-selective blocker) compared to a diuretic. In contrast in the MRC study of mild hypertension only nonsmoking men with mild to moderate hypertension who received a nonselective beta-blocker appeared to experience fewer myocardial infarctions. Recent clinical data showed that moderate-severe hypertensives who were optimally controlled by atenolol-based treatment over a 10-year period were less likely to die from myocardial infarction than those suboptimally controlled, irrespective of a rise in serum triglyceride levels. Thus the net effect of acute beta-blockade in hyperadrenergic states, including myocardial infarction, is to limit cardiovascular damage. Chronic beta-blockade inhibits atheroma formation (in animals) and beneficially modifies the incidence of stroke and myocardial infarction, which in man are the long-term consequences of hypertension.
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PMID:The beta-receptor, atheroma and cardiovascular damage. 257 Apr 26

All the antihypertensive trials that have compared active treatment with placebo have given similar and, at the same time, different results. In all trials the therapeutic quotient is above 1, indicating that in all trials mortality and morbidity may be lower (by at least 20%) in the actively treated group. However, the prevented event rate, an absolute measure of benefit, indicates a very large benefit (24 events prevented every 100 patient-years) in the trials involving severe hypertension, and a quite small rate (0.15 event prevented every 100 patient-years) in the MRC mild hypertension trial. Although, taken as a whole, the results of treatment of mild hypertension may appear only moderately encouraging, a considerably greater benefit is observed when a mildly elevated diastolic blood pressure is associated with other risk factors, such as the male sex, cigarette smoking, high blood cholesterol level and elevated systolic blood pressure. Emphasis has been placed, in recent years, upon other limitations in the success of antihypertensive therapy, and it has been stressed that the very effective prevention of cerebrovascular events in the treated hypertensive has not been matched by an equally effective prevention of coronary events. It has also been shown that the risk in treated hypertensives remains higher than that of the general population. Understanding the limitations of current antihypertensive therapy may help in extending treatment successes in the future. A hypothesis that has been recently advanced is that some of the failures of antihypertensive therapy may result from excessive lowering of blood pressure especially in hypertensive patients with ischaemic heart disease (the problem of the 'J'-shaped curve).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The risk of hypertension: successes and failures of antihypertensive treatment. 269 92

Five hypertension intervention trials (HDFP, MRFIT, Australian National BP Study, IPPPSH, MRC) were analyzed for the effect of smoking on antihypertensive therapy and final outcome in coronary and all-cause mortality. In addition, an observational study of primary screenees for MRFIT was reviewed. Thus, the hypertensive population evaluated in this paper amounts to 135,851 patients. HDFP revealed that smokers had about twice the mortality rates compared to nonsmokers regardless of the treatment group to which they were randomized. The annual incidence of events in the Australian Study among nonsmokers in the placebo group was even lightly lower than in smokers under active therapy. The results of the MRFIT showed that smoking had a particularly deleterious impact on those hypertensives whose cholesterol levels were elevated. In this group, the coronary death rates were 10 times higher than in nonsmokers with lower cholesterol levels. Although the treatment with beta-blockers reduced the coronary event rates in the MRC and in IPPPSH, this beneficial effect was absent in smokers. However, in trials in which diuretic treatment is effective in nonsmokers, it is equally effective in smokers.
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PMID:Smoking habits and antihypertensive treatment. 289 44

Mild hypertension is defined as a state in which diastolic blood pressures ranging from 90 to 104 mm Hg are persistently observed. Systolic blood pressure is increasingly being recognised as a risk factor in its own right. Strictly speaking, the lessons learnt from the prospective trials in mild hypertension apply mainly to the stratum of mild diastolic hypertension. In this review, randomised placebo-controlled blind trials in uncomplicated mild hypertension (USPHS, ANBPS, MRC trials) will serve as the main data base from which to derive practical guidelines, in terms of benefits and risks, of early treatment.
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PMID:Guidelines for the treatment of mild hypertension. 304 57

In this review approaches to the treatment of hypertension were appraised by considering data from recent trials. Two main questions were asked: at what level of blood pressure is treatment justified, and which drugs should be used? It is now well established that increases in both systolic and diastolic blood pressure are correlated with an increased risk of cardiovascular disease, heart attack or stroke. However, since patients are often asymptomatic, treatment must be justifiable in terms of reversing the risk of cardiovascular disease. The Australian Therapeutic Trial demonstrated that therapy was beneficial in patients whose diastolic pressure was at or above 95 mm Hg before treatment. Three recent large studies (EWPHE, IPPPSH and MRC) have provided interesting data on the level of blood pressure at which to start treatment and the most appropriate drugs to use. In one, treatment in the elderly, which raises particular concern, has been investigated. The MRC trial compared bendrofluazide with propranolol and showed a reduction in the incidence of stroke; however, to prevent 1 stroke, 850 patients would have to be treated for 1 year. Nevertheless, the benefits of therapy were clearly greater when diastolic blood pressure was at the upper end of the range 90-110 mmHg. Myocardial infarctions, which account for more deaths than stroke in mild to moderate hypertensives, do not appear to be reduced by treatment, whether or not this includes a beta-blocker. This is difficult to reconcile with the established 'cardioprotective' action of beta-blockers post-myocardial infarction. Other important factors affecting cardiovascular disease are governed by the patient's life-style, especially whether or not the patient smokes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Future approaches to the treatment of hypertension in the light of results from recent trials. 328 69

Over the past 6 years, major hypertension intervention studies in Europe, Australia, and the USA have shown disappointing results in the prevention of coronary heart disease (CHD) in spite of adequate treatment and good compliance. Recently, it has become increasingly clear that hypertensives with or without treatment display higher cholesterol levels than normotensive persons. The present review examines cholesterol levels in six intervention studies, none of which offered dietary or drug therapy for hypercholesterolemic patients. The Oslo study and the British MRC Trial reported very high average cholesterol levels and both showed no protection from CHD through intensive therapy in comparison to control patients. The Australian and the American MRFIT studies produced evidence for reduced coronary mortality among hypertensives with low in contrast to those with high cholesterol levels. The European Working Party showed indirectly that patients with marked reduction in blood pressure and cholesterol had a significantly lower cardiac mortality compared to placebo-treated patients. The IPPPSH study found that increasing cholesterol levels in hypertensives under beta blocker or diuretic therapy increased the risk of myocardial infarction. Failure to reduce cholesterol in hypertensive patients apparently is a major reason for the limited efficacy of antihypertensive treatment in the reduction of CHD.
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PMID:Failure to reduce cholesterol as explanation for the limited efficacy of antihypertensive treatment in the reduction of CHD. Examination of the evidence from six hypertension intervention trials. 330 58

Clinical practice must be based on the results of clinical trials, not on theories derived from epidemiology observations. The major trials of blood pressure reduction are described, and some of their shortcomings are discussed. Whenever drug treatment is necessary there will inevitably be a balance between benefits of treatment and unwanted effects of medication. The MRC trial of treatment in mild hypertension demonstrated that a small reduction in the risk of stroke is obtained at the cost of a variety of side effects which themselves depend on the medication used. Treatment of a diastolic pressure of 100 mm Hg or below will confer very little benefit on an individual patient.
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PMID:Mild hypertension: to treat or not to treat? 332 Jul 89

After a brief introduction on the problems involved in the interpretation of long-term trials, the methods and the results of large clinical trials, on cardioprotection (defined as the ability of a drug to reduce mortality from all causes or fatal cardiovascular events) are reviewed, with the aim of providing useful clinical information for the treatment of the hypertensive patients. At the end of the review the author draws the following conclusions: The benefits of antihypertensive therapy reported in male patients suffering from severe hypertension are such that further controlled trials with placebo are not acceptable from an ethical point of view. The incidence of fatal and non fatal cardiovascular events is relatively low in mild uncomplicated hypertension but increases three-fold in the presence or organ involvement. A statistically significant reduction of mortality from all causes and of fatal cardiovascular events has been obtained in such patients by means of antihypertensive treatment in the Australian trial, contrary to the results of the MRC trial and the Oslo study. Furthermore, the HDFP trial has shown that mortality from all causes an fatal cardiovascular events are less frequent among patients in stepped care than among those in referred care. The EWPHE trial has demonstrated that antihypertensive treatment reduces non fatal complications and probably reduces mortality in elderly hypertensive patients. Diuretics, sympatholytics and beta-blockers have been used in the large trials on cardioprotection. When several trials prove the equivalence of drugs of different efficacy and safety, it is acceptable to extend the results obtained with such drugs to the therapeutic class they belong to. An example is represented by the results of the MRC and IPPPSH trials on cardioprotection with beta-blockers in male non-smokers suffering from mild-moderate hypertension.
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PMID:[Cardiac protection and antihypertensive therapy: facts and theories]. 352 4

Membranous nephropathy was diagnosed in 54 patients between January 1975 and June 1983 in the Royal Infirmary, Glasgow. It was the commonest cause of the nephrotic syndrome and, with IgA nephropathy, the commonest primary glomerular disease. A cause was found in 10 patients. The last seven patients diagnosed were enrolled in the MRC trial. The natural history of the remaining 37 patients with idiopathic membranous nephropathy was studied. After an average observation period of 64 months, 50 per cent had stable renal function with or without proteinuria and 50 per cent had progressive renal failure or had died of other causes (five patients). Of the factors examined only heavy proteinuria and hypertension were significantly more common in patients who developed progressive renal failure. No patient who entered remission relapsed. Vascular complications were an important cause of morbidity and mortality. Incidence of events of arterial occlusion was significantly higher in these patients compared with patients with IgA nephropathy. Treatment of patients with membranous nephropathy should, therefore, be judged not only by its efficacy in preventing progressive renal failure, but also by its effect on vascular disease and by its toxicity.
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PMID:The natural history of membranous nephropathy in the West of Scotland. 377 62


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