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

We studied the clinical, hemodynamic and angiographic findings of 34 women (W) and of 184 men (M) with significant (greater than or equal 50%) CAD. W, compared to M, presented a higher incidence of systemic hypertension (p less than .025), while less frequent were among W smoking habits (p less than .001), history of old myocardial infarction (MI) (p less than .005), and patients in III-IV NYHA class (p less than .025). Left ventricular (LV) dP/dt was higher in W than in M (p less than .005). At coronary arteriography, single vessel disease (SVD) was more frequently found in W than in M (70% vs 23%, respectively, p less than .001); this findings was more evident in patients under 50 years of age (100% vs 30%, respectively, p less than .055). Prevalence of left anterior descending (LAD) over right (RCA) and circumflex (Cx) coronary artery stenoses was more marked in W than in M, especially in patients under 50 years of age (SVD of the LAD in 67% and of RCA in 33% of young W). Poor angiographic run-off of LAD was found in 21% of W, and only in 10% of M. In 2 of the 3 W with poor run-off of LAD operated on, a coronary bypass on the distal LAD was no technically feasible. At left ventriculography, a lower frequency of LV segmental wall motion abnormalities was found in W than in M, especially in patients with no history of MI (p less than .001). In summary, W with significant CAD, compared to age matched M, presented in our experience with a higher frequency of SVD and of LAD stenoses, and with a better LV contractile performance at left ventriculography. Furthermore, in W LAD more frequently showed a poor angiographic run-off. Such findings may bear important implications on the indication and results of coronary surgery in W with CAD.
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PMID:[Coronary artery disease (CAD) in females. Coronary arteriographic findings in 34 women and comparison with 184 males with cad]. 732 32

The effects of anaesthesia for major abdominal vascular surgery on coronary flow regulation and mechanisms of myocardial ischaemia were studied in 56 patients with CAD, using a randomized, partly double-blinded protocol. After induction with fentanyl (3 micrograms.kg-1) and thiopentone (2-4 mg.kg-1) and tracheal intubation, principal anaesthetics were nitrous oxide/oxygen (60/40) with isoflurane (n = 20), halothane (n = 19) or fentanyl (15-20 micrograms.kg-1) (n = 17). Conventional invasive techniques and coronary venous retrograde thermodilution were used to assess systemic and coronary haemodynamics. Coronary vascular resistance was estimated from myocardial oxygen extraction. Myocardial ischaemia was diagnosed by 12-lead ECG and/or anterior wall motion abnormalities by cardiokymography and/or myocardial lactate production. When adjustment of anaesthetic dose was insufficient for haemodynamic control, i.v. phenylephrine and nitroglycerine were administered to treat hypotension and hypertension or cardiac failure respectively. Measurements were performed at four specific intervals; awake, before surgery and 10 and 30 min after abdominal incision. Comparable changes of systemic haemodynamics and myocardial oxygen consumption were observed in the three groups. Coronary vasodilation was evidenced in isoflurane patients only and was linearly dose-dependent (P < 0.001). Partial Least Squares Projections to Latent Structures modelling with cross validation confirmed this dose-dependency and ruled out a clinically measurable influence by intervention drugs or simultaneous systemic haemodynamic abnormalities. The incidence of myocardial ischaemia during anaesthesia and surgery was comparable in the three groups (35, 37 and 24%, respectively) and there was an association with systemic haemodynamic aberrations in 19 of the 27 ischaemic episodes. In contrast to ischaemic halothane and fentanyl patients, isoflurane patients with ischaemia had significantly lower myocardial oxygen extraction (P = 0.008 and P = 0.001, respectively), indicating that the oxygen extraction reserve was not utilized in a normal way during ischaemia.
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PMID:Anaesthesia for abdominal vascular surgery in patients with coronary artery disease (CAD), Part I: Isoflurane produces dose-dependent coronary vasodilation. 788 99

Carotid duplex ultrasonography is the noninvasive procedure of choice for evaluating ECAD. However, carotid angiography should be performed before doing carotid endarterectomy. Multivariate logistic regression analysis showed that significant prognostic variables for ECAD in an elderly population are (1) cigarette smoking, (2) serum total cholesterol, (3) serum HDL cholesterol (inverse association), (4) diabetes mellitus, and (5) prior CAD. Patients with 80-100% ECAD develop a higher incidence of ABI and TIA than patients with 40-80% ECAD. Patients with 40-80% ECAD develop a higher incidence of ABI and TIA than patients with 0-40% ECAD. Patients with ECAD have a higher prevalence of prior CAD and develop a higher incidence of new coronary events than patients without ECAD. In patients with ECAD, significant prognostic variables for new coronary events are (1) silent ischemia, (2) prior CAD, (3) serum HDL cholesterol (inverse association), and (4) cigarette smoking. Risk factors for ECAD and CAD should be treated in patients with ECAD. Cigarette smoking must be stopped. Hypertension, dyslipidemia, and diabetes mellitus should be treated. Aspirin, 325 mg/d, should be administered to patients with ECAD. Ticlopidine hydrochloride, 250 mg two times per day should be considered in patients with ECAD who are unable to tolerate aspirin or who develop cerebrovascular events on aspirin. Carotid endarterectomy should be considered in symptomatic patients with 70-99% ECAD.
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PMID:Extracranial carotid arterial disease. 818 62

Hypertension is present in epidemic proportions in adults of industrialized societies and is associated with a markedly increased risk of developing numerous cardiovascular pathologies. There is a continuing debate as to the efficacy of aggressive pharmacological therapy in individuals with mild to moderate elevations in blood pressure. This has led to a search for nonpharmacological therapies, such as exercise training, for these individuals. The available evidence indicates that endurance exercise training by individuals at high risk for developing hypertension will reduce the rise in blood pressure that occurs with time. Thus, it is the position of the American College of Sports Medicine that endurance exercise training is recommended as a nonpharmacological strategy to reduce the incidence of hypertension in susceptible individuals. A large number of studies indicate that endurance exercise training will elicit a 10 mm Hg average reduction in both systolic and diastolic blood pressures in individuals with mild essential hypertension (blood pressures 140-180/90-105 mm Hg). Endurance exercise training also has the capacity to improve other risk factors for cardiovascular disease in hypertensive individuals. Endurance exercise training appears to elicit even greater reductions in blood pressure in patients with secondary hypertension due to renal dysfunction. The mode (large muscle activities), frequency (3-5 d.wk-1), duration (20-60 min), and intensity (50-85% of maximal oxygen uptake) of the exercise recommended to achieve this effect are generally the same as those prescribed for developing and maintaining cardiovascular fitness in healthy adults. Exercise training at somewhat lower intensities (40-70% VO2max) appears to lower blood pressure as much, or more, than exercise at higher intensities, which may be important in specific hypertensive populations. Physically active and fit individuals with hypertension have markedly lower rates of mortality than sedentary, unfit hypertensive individuals. Thus, it seems reasonable to recommend exercise as the initial treatment strategy for individuals with mild to moderate essential hypertension. A follow-up period should assess the efficacy of the patient's exercise program, and adjunct therapies should be implemented according to the individual patient's blood pressure and CAD risk factor goals. Individuals with more marked elevations in blood pressure (> 180/105 mm Hg) should add endurance exercise training to their treatment regimen only after initiating pharmacologic therapy. Resistive, or strength, exercise training is not recommended to lower blood pressure in individuals with hypertension when done as their only form of exercise training.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:American College of Sports Medicine. Position Stand. Physical activity, physical fitness, and hypertension. 779 75

The lipoprotein (Lp) pattern was analysed in patients with suspected unstable coronary artery disease (UCAD), to compare the pattern as a prognostic instrument regarding subsequent coronary events with smoking, hypertension, diabetes mellitus and with the result of an early exercise test. Included were 295 patients with UCAD. Blood samples for Lp values were obtained in the acute phase and after one year. Apolipoprotein-A1, Apolipoprotein-B (Apo-B), Lipoprotein(a) (Lp[a]) HDL-Cholesterol, Cholesterol (Chol) and Triglycerides (TG). were estimated in serum. During the 1-year follow-up coronary events (myocardial infarction, cardiac death, coronary artery by-pass surgery) occurred in 48 patients. The severity of CAD, overweight, smoking and beta-blockade influenced the Lp-pattern. Chol-, TG- and Apo-B-levels were highest in the group with a coronary event. Apo-B turned out to be the second best predictive variable in multiple regression analysis, in men. In women no such analysis was done because of very few coronary events during follow-up. Nevertheless, the exercise test variables, ST depression and pain were more predictive of coronary events than Apo-B in men.
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PMID:Prognostic importance of plasma lipoprotein-analyses in patients with unstable coronary artery disease. 831 57

Despite methodological differences in the limited number of studies reviewed, it appears that cardiovascular responses at rest and during exercise in the cold differ between patients with CAD and healthy subjects (Figures 1 and 2). This difference remains, even when attempting to control for investigation time and conditions. Typical exercise time reported for patients with CAD exercising in the cold is 4 to 8 minutes, where HR and SBP are generally the same or higher. Data corresponding to a similar time frame (5-15 minutes) in healthy subjects show HR to be lower or no different, whereas SBP was similar in both studies. Logically, healthy subject's RPP values would be similar or lower in the cold, which may be a teleological development to conserve myocardial oxygen uptake in the face of elevated sympathetic stimulation during cold exposure. The lower HR would offset the cold-induced hypertension and also help to preserve cardiac output. In healthy subjects, cardiac output is similar in the cold despite a higher stroke volume (SV) due to the lower HR. However, the similar cardiac output reported by Epstein and colleagues in patients with CAD, both at rest and during exercise at 15 degrees C, was obtained by increases in SV and HR. A blunted peripheral vasoconstriction response in older subjects could lead to reduced central blood volume with a corresponding decrease in venous return and SV. An inability to maintain an appropriate SV in the cold by patients with CAD may be responsible for the elevated HR to maintain cardiac output. However, in healthy subjects, SV appears to have a triphasic response.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A review of heart rate and blood pressure responses in the cold in healthy subjects and coronary artery disease patients. 852 83

Positron emission tomography (PET) offers the unique capability of measuring specific flow (flow per unit of mass) in man by means of a regional, tridimensional, noninvasive approach. Using PET, myocardial perfusion abnormalities secondary to microvascular disorders have been investigated in arterial hypertension (AH), dilated and hypertrophic cardiomyopathy (CM), as well as in ischemic heart disease (CAD). In AH, regional perfusion at rest is within the normal range, while the coronary reserve and flow response to increase in metabolic demand are blunted. These flow abnormalities are independent of the degree of cardiac hypertrophy and the severity of AH; appropriate anti-ipertensive therapy is able to improve the perfusion abnormalities after long term treatment, independently of the effect on myocardial hypertrophy. Both dilated and hypertrophic CM demonstrate abnormal vasodilating capability, which has been shown to be present in the subclinical form of dilated DM; the reduction of coronary reserve is not related to the presence and extent of the hemodynamic impairment in dilated CM, and involves also nonhypertropied myocardium in asymmetric hypertrophic CM. These findings indicate a primary involvement of coronary microcirculation in non advanced forms of dilated and hypertrophic CM. Finally, in patients with CAD, myocardial territories supplied by angiographically normal coronary arteries show abnormal coronary reserve and flow during pacing tachycardia, indicating that, even in absence of epicardial coronary artery obstruction, microcirculation is impaired in subjects with coronary atherosclerosis. This abnormality can smooth perfusion differences between control and jeopardized regions. Accordingly, the absence of a perfusion defect during stress might indicate the presence of either a non significant stenosis or a diffuse impairment in microcirculatory function. Nuclear perfusion imaging with conventional perfusion tracers does not allow measurements of absolute blood flow, rather it provides an estimation of perfusion inhomogeneities. Although the agreement with the angiographic documentation of coronary artery disease has been frequently considered to characterize the diagnostic reliability of these techniques, the evaluation of myocardial perfusion provides an independent tool for the functional assessment of patient with heart disease. The possibility to obtain measurements of regional myocardial blood flow, provided by positron emission tomography, helps to identify the mechanisms affecting flow regulation in the myocardium. This tool thus provides a new rationale for the application of perfusion imaging, to obtain a more precise characterization of these patients, beyond the agreement with the morphological angiographic picture.
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PMID:The role of coronary microvascular dysfunction in the genesis of cardiovascular diseases. 868 Oct 18

Two case control studies were performed to evaluate whether smoking may affect myocardial function. Cardiomyopathy subjects had a greater pack year smoking history than 52 control subjects with no CAD (p < 0.02) and were more likely to have diabetes (p < 0.10), but they did not differ from controls with respect to age, alcohol intake, or the presence of hypertension. The risk of cardiomyopathy doubled with an increase of 39 pack years. Smoking history was not related to ejection for fraction for subjects with severe coronary artery disease. These results suggest that smoking may be an important risk factor for idiopathic congestive cardiomyopathy.
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PMID:Smoking and idiopathic congestive cardiomyopathy. 877 33

The risks associated with cardiac catheterization and coronary angiography increase with advancing age while at the same time, cardiovascular morbidity and mortality also rise. This means that the risks attendant on the two invasive diagnostic procedures can be accepted if they can be expected to identify the prognostically best form of treatment for the individual patient. Even in old age, CAD patients undergoing PTCA or coronary surgery are at an advantage in terms of long-term results and quality of life over patients receiving medical treatment only. From this it follows that the geriatric patient must not be excluded from such diagnostic and therapeutic procedures. Similarly, in the case of coronary thrombolysis following myocardial infarction, age per se must not be considered a contraindication. Finally, hypertension needs to be treated rigorously in the elderly too, albeit with consideration being given to certain differential therapeutic aspects.
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PMID:[Diagnosis and therapy of cardiovascular diseases in elderly patients. Do different criteria apply?]. 890 Sep 65

High serum cholesterol and LDL-cholesterol level and high blood pressure are risk factors for cardiovascular disease (CVD). CVD risk factors usually occur simultaneously, fact that enhance personal and population CVD risk. Data from interventional studies suggest that reducing CAD risk factors significantly lowered risk of CAD. Fluvastatin, a statine, has been used in hypercholesterolemic populations. We report on a clinical trial (random selection) of fluvastatin vs. placebo on hipercholesterolemic patients (total cholesterol > or = 240 mg/dl and/or low-density lipoprotein cholesterol (LDL-C) > or = 160 mg/dl) on treatment of mild to moderate high blood pressure. Forty Latin-American patients were randomized to placebo or 40 mg per day for 8 weeks of fluvastatin. Fluvastatin patients had a clinical and statistical significant reduction on total cholesterol (27.7%) and LDL-C (39.1%) Vs a non-significant reduction on the placebo group (6.9% total cholesterol and 9.1% LDL-C). One patient had elevated aspartate (AST) and alanine (ALT) aminotransferases (three times the local laboratory upper normal levels) associated with a chronic alcohol consumption, reverted 6 weeks after protocol completion. There was no important secondary effects; also there was no differences on this regard between placebo and verum group. Fluvastatin proved to be safe and well tolerated for this group of patients under a wide range of high blood pressure treatment.
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PMID:[Clinical trial with sodium fluvastatin in patients with hypercholesterolemia associated with mild and moderate essential arterial hypertension]. 929 41


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