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

In patients with uncomplicated mild to moderate hypertension, studies employing a double-blind randomized cross-over factorial design have been used to obtain more precise estimates of the hypotensive and biochemical effects of individual antihypertensive drugs and of their interactions when used in combination. Order and carry-over effects have been controlled. In studies with beta-blockers and diuretics, the hypotensive effects of the individual drugs have been confirmed and in combination their effects are additive. With the angiotensin-converting enzyme inhibitor, enalapril (20 mg daily) the hypotensive effect was additive with that of a diuretic, hydrochlorothiazide (50 mg daily). When enalapril was combined with the beta-blocker atenolol (50 mg daily) there was little additional hypotensive effect, despite similar hypotensive effects of the individual agents separately. The mechanism of this attenuated effect is unclear. The design is suitable for evaluation of other antihypertensive combinations.
Nephron 1987
PMID:Cross-over factorial studies with antihypertensive drugs. 289 43

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.
Nephron 1987
PMID:Smoking habits and antihypertensive treatment. 289 44

Recombinant human erythropoietin (r-HuEPO) has been used for the treatment of renal anaemia in haemodialysed patients for more than 2 years. The recommended initial dose is 50 U/kg, intravenously, three times a week, subsequent to the dialysis procedure; if the increase in the haemoglobin level were insufficient after the 4-week therapy, the single doses should be elevated in steps of 25 U/kg each. A weekly total dose of about 200 U/kg (divided into 2 or 3 applications) will normally be adequate to stabilize the haemoglobin value at a level ranging between 10 and 12 g/dl. Patients on r-HuEPO require regular medical supervision, as--along with increasing haematocrit--hypertension and thrombosis of the arteriovenous fistula can develop. A slight increase in serum creatinine and potassium was observed in some of the studies.
Nephron 1989
PMID:Treatment of anaemia in haemodialysis patients with recombinant erythropoietin. 291 79

The intra-arterial administration of fibrinolytics in a massive embolism to the renal artery of a solitary functioning kidney determined quick normalization of the severe renal failure and hypertension.
Nephron 1989
PMID:Normalization of renal function and blood pressure after dissolution with intra-arterial fibrinolytics of a massive renal artery embolism to a solitary functioning kidney. 291 52

A retrospective analysis of renal vein renin results has been done in 96 patients with renal artery stenosis and hypertension studied in two Italian centers (Sassari and Pisa) with respect to the outcome of either surgery or percutaneous transluminal angioplasty (PTA). In all patients the renal vein renin ratio and the V-A/A ratios for the affected and unaffected kidney were calculated. Each patient underwent surgery (75) of PTA (21): 71 subjects were cured, 17 improved whereas the arterial pressure did not vary after revascularisation procedure in 8 patients. In the Pisa series all 54 patients showed a lateralisation with contralateral renin suppression and 95% of them benefitted from surgery. In the Sassari series 42 patients were submitted to PTA or surgery, not only on the basis of a positive renal vein renin study but taking into account a complete clinical evaluation: 8 of them were cured or improved in spite of negative renal vein renin criteria. In the two series, the better predictive index appeared to be the suppression of the renin secretion from the contralateral kidney while the high/low renin ratio showed a consistent amount of false-positive and false-negative results. Our retrospective study demonstrates that the renal vein test in hypertensive patients with renal artery stenosis is highly predictive of the curability of the disease, particularly when contralateral suppression of renin secretion is present. On the other hand, since patients with negative renin indexes can also take benefit from surgery of PTA, the renin parameters cannot be adopted as the sole criterion in making the decision to operate.
Nephron 1986
PMID:Renal vein renin in renovascular hypertension: the experience of two Italian centers. 294 10

To assess the diagnostic and prognostic value of renal venous renin levels in renovascular hypertension, 95 patients with severe unilateral renal artery stenosis were studied. Surgery (n = 52) or percutaneous transluminal dilation (n = 43) were done irrespective of renal venous renin levels. Lateralization of renin secretion as assessed by the PRA ratio and the renin secretion index was found in the majority of patients (66% and 88%, respectively). Patients with fibromuscular hyperplasia had more frequently PRA ratios less than 1.5 than those with arteriosclerotic stenosis (p less than 0.05). The renin secretion index proved to have a higher sensitivity (92%) and predictive value (92%) for a successful outcome of both surgery and PTA than the PRA ratio (69% and 89%, respectively), while the specificity was the same with both parameters (42% and 43%, respectively). The contralateral suppression index was most specific in predicting an unfavorable outcome. However, with all ratios used, a considerable number of false-negative and false-positive tests were observed both with surgery and PTA, a finding limiting the value of the method in selecting patients for these interventions. Other factors, such as age of the patient, kidney function and the underlying arterial disease turned out to be equally important prognostic factors. Thus, although cure after both surgery and PTA is more likely in the presence of lateralized renin secretion and contralateral suppression, the method does not allow to exclude patients with severe renal artery stenosis, hypertension and negative renal venous renin tests from these interventions.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephron 1986
PMID:Renal venous renin determinations in renovascular hypertension. Diagnostic and prognostic value in unilateral renal artery stenosis treated by surgery or percutaneous transluminal angioplasty. 294 11

In the present retrospective study, the effect of various therapeutic procedures (surgery, percutaneous transluminal dilatation and antihypertensive drugs) was analyzed in 202 patients with renovascular hypertension. The results show that each of the three methods effectively lowers blood pressure. However, marked differences were observed in pretreatment clinical and laboratory data among the three groups. These differences were most probably caused by different selection criteria before submitting the patient to a given therapeutic regime. Our findings also demonstrate that on the basis of the present analysis a direct comparison between surgery, dilatation and medical therapy is not possible.
Nephron 1986
PMID:Surgery, transluminal dilatation and medical therapy in the management of renovascular hypertension. 294 13

Technical aspects of percutaneous transluminal angioplasty in renovascular hypertension include knowledge about the pathophysiology of dilation, certain radiological and physiological markers, criteria for patient selection, and, finally, the catheter technique. Important factors for a successful procedure are overdilation and adequate pressure and time of balloon inflation. Radiological markers are inflation and deflation profiles of the balloon as well as determination of the pressure gradient across the stenosis. Main criteria for patient selection are renin-dependent hypertension and less frequent improvement of kidney function. Following dilation the most common adjunct medical therapy is low-dose application of aspirin for a period of 6 months.
Nephron 1986
PMID:Technical aspects of percutaneous transluminal angioplasty in renovascular disease. 294 14

Fourteen patients with renovascular hypertension complicated by renal impairment and/or a nonfunctioning kidney underwent percutaneous transluminal angioplasty of the remaining kidney(s) for the purpose of improving blood pressure control and/or renal function. The outcome of percutaneous transluminal angioplasty in these individuals was evaluated over periods ranging from 1 to 72 months. All patients had atherosclerotic renovascular hypertension as judged by the X-ray appearance of the stenotic lesions of the renal artery as well as evidence of aortic atherosclerosis. Four of the 14 subjects demonstrated a decrease in serum creatinine greater than or equal to 20% following the procedure, and an equal number showed a similar increase in serum creatinine. In the 1st month following the procedure, 5 patients required dialysis because of deterioration of renal function, 4 of whom subsequently died. Over the entire population, only 4 subjects showed improvement in blood pressure and renal function which persisted for 18 to 72 months. One of these subjects had a recurrence of renovascular hypertension and underwent successful repeat dilatation for bilateral disease after 2 years following the initial angioplasty. This patient remains improved. These observations confirm that when renovascular hypertension occurs in an older population with cardiac and renal disease or occurs in a solitary functioning kidney, the remote prognosis is not good. The improvement rate of 29% with dilatation alone in this population appears to be less than that observed following surgical intervention in a similar population. Thus, transluminal angioplasty should be reserved for those subjects who are not surgical candidates or who refuse surgical intervention.
Nephron 1986
PMID:Percutaneous transluminal angioplasty in complicated renal vascular hypertension. 294 15

In 60 patients with hypertension and unilateral renal artery stenosis (URAS) radio-hippuran renograms were performed before and 6 weeks after anatomically adequate percutaneous transluminal angioplasty (PTA). Two characteristics of the renographic curves have been analyzed: the difference in time to peak (DTP) between the affected and contralateral kidneys, which would be expected to be positive in blood flow impairment, and the relative hippuran uptake (RHU) in the second minute by the affected kidney as compared with the total uptake by both kidneys: this would be less than 50% in the case of stenosis. Before PTA, both variables were predominantly abnormal. The DTP did not predict the blood pressure response to PTA. The group of patients with a RHU between 25 and 45% comprised all cured patients and predicted a more favorable response of the blood pressure than a RHU of less than 25% and especially more than 45% which group contained 83% patients whose blood pressure failed to respond after PTA. After PTA the DTP did normalize in the majority of patients, but this was not related to the blood pressure response. The RHU increased in patients in whom it had been low initially, but frequently remained low (less than 45%). The increase of the RHU was significantly higher in patients with a favorable blood pressure response. Pretreatment with captopril did intensify the abnormal curves of hippuran and of DTPA renograms in 6 patients with URAS who did respond favorably to PTA. There was no such deterioration in 2 patients whose blood pressure did not change sufficiently after PTA or in 4 patients without renal artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephron 1986
PMID:Renography: prediction of blood pressure after dilatation of renal artery stenosis. 294 16


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