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

Prospective observational studies show clearly that the risks of stroke, coronary heart disease and premature death are related directly to BP. Furthermore, the results of prospective, randomised intervention studies indicate that effective BP control reduces these risks. Although the number of patients being treated for hypertension has approximately doubled in the last 20 years, premature morbidity and mortality remain higher than in the normotensive population. This may relate to the inadequate level of BP control achieved in many patients. Two large studies have shown that DBP can be reduced to < 90 mmHg in almost all patients if antihypertensive therapy is intensified, and preliminary evidence suggests that this can be done without increasing the incidence of side-effects. The level to which BP should be reduced to achieve an optimum reduction in cardiovascular morbidity and mortality is currently being investigated in the Hypertension Optimal Treatment (HOT) Study.
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PMID:The hidden truth: what do the clinical trials really tell us about BP control? 756 96

The National Institutes of Health Consensus Development Conference on Optimal Calcium Intake brought together experts from many different fields including osteoporosis and bone and dental health, nursing, dietetics, epidemiology, endocrinology, gastroenterology, nephrology, rheumatology, oncology, hypertension, nutrition and public education, and biostatistics, as well as the public, to address the following questions: (1) What is the optimal amount of calcium intake? (2) What are the important cofactors for achieving optimal calcium intake? (3) What are the risks associated with increased levels of calcium intake? (4) What are the best ways to attain optimal calcium intake? (5) What public health strategies are available and needed to implement optimal calcium intake recommendations? and (6) What are the recommendations for future research on calcium intake? The consensus panel concluded that: A large percentage of Americans fail to meet currently recommended guidelines for optimal calcium intake. On the basis of the most current information available, optimal calcium intake is estimated to be 400 mg/day (birth-6 months) to 600 mg/day (6-12 months) in infants; 800 mg/day in young children (1-5 years) and 800-1,200 mg/day for older children (6-10 years); 1,200-1,500 mg/day for adolescents and young adults (11-24 years); 1,000 mg/day for women between 25 and 50 years; 1,200-1,500 mg/day for pregnant or lactating women; and 1,000 mg/day for postmenopausal women on estrogen replacement therapy and 1,500 mg/day for postmenopausal women not on estrogen therapy. Recommended daily intake for men is 1,000 mg/day (25-65 years). For all women and men over 65, daily intake is recommended to be 1,500 mg/day, although further research is needed for this age group. These guidelines are based on calcium from the diet plus any calcium taken in supplemental form. Adequate vitamin D is essential for optimal calcium absorption. Dietary constituents, hormones, drugs, age, and genetic factors influence the amount of calcium required for optimal skeletal health. Calcium intake, up to a total intake of 2,000 mg/day, appears to be safe in most individuals. The preferred source of calcium is through calcium-rich foods such as dairy products. Calcium-fortified foods and calcium supplements are other means by which optimal calcium intake can be reached in those who cannot meet this need by ingesting conventional foods. A unified public health strategy is needed to ensure optimal calcium intake in the American population. The full text of the consensus panel's statement follows.
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PMID:Optimal calcium intake. 759 55

To what level blood pressure should be brought by antihypertensive treatment is a question with relevant clinical bearing that hypertensiologists have regrettably not yet investigated in a direct way. As a consequence of the lack of direct data on this problem, a dispute has been going on for some time as to whether a decrease in blood pressure below 85 mmHg increases, rather than further decreasing, the coronary risk of the hypertensive patients (the "J-curve" hypothesis). The problem has been finally approached through the design and the initiation of an appropriate large controlled trial, the Hypertension Optimal Treatment (HOT) study.
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PMID:[Which is the optimal pressure level to be obtained with antihypertensive treatment?]. 763 83

The management of essential hypertension can no longer be directed toward an isolated reduction in arterial pressure. Optimal reduction in the risk factors associated with hypertension and cardiovascular disease hopefully will reduce coronary heart disease, angina, fatal and nonfatal myocardial infarction, left ventricular hypertrophy, congestive heart failure, and sudden death. Hypertension is a genetic and acquired syndrome that consists of dyslipidemia, insulin resistance and carbohydrate intolerance, central obesity, renal abnormalities, structural abnormalities of smooth muscle, and ion transport abnormalities (membranopathy). The selection of pharmacologic agents should improve the components of the hypertensive syndrome by utilizing the "subsets of hypertension approach" to treatment.
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PMID:The management of hypertension and associated risk factors for the prevention of long-term cardiac complications. 769 47

Optimal treatment for Langerhans Cell Histiocytosis (LCH) has not yet been established. Preliminary reports suggest some effect of cyclosporine (CSA), both alone or in combination with steroids and/or vinblastine, in untreated cases. Twelve children (6 females and 6 males, age at diagnosis 3 months to 4 years) with biopsy proven, systemic LCH received oral CSA (12 mg/kg/day in two divided doses given daily) as a second-line therapy following chemotherapy including vinblastine and/or etoposide (10 cases) or steroid alone (one case); one child was not pretreated. A total of 16 CSA courses were administered to the 12 patients: 8 were completed, 4 were interrupted as unsuccessful, and 4 are still ongoing. CSA related toxicity consisted of hypertrichosis and transient hypertension and was never limiting. Treatment was associated with a clinical response in 8/12 patients: 3 had a complete response and are off therapy, and 5 had a partial response; disease reactivation following first favorable response required additional CSA courses in 3 patients. Four patients failed to respond to CSA: two died of progressive disease, while two had a favorable response to CSA + VP16. Favorable response to CSA was not related to CSA trough and peak levels and was usually observed during the first 2 weeks of CSA therapy. CSA is effective for treatment of LCH also in pretreated children with progressive disease including life-threatening organ dysfunction. Long-lasting complete remission may be achieved after 6 to 12 months of CSA therapy. When disease reactivation occurs after treatment withdrawal, a second course may be followed by favorable response. As minimal or no adverse effects are observed during or after prolonged CSA therapy, this may also be safely used in young patients.
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PMID:Cyclosporine therapy for refractory Langerhans cell histiocytosis. 775 96

The Hypertension Optimal Treatment (HOT) Study is a prospective, randomized, multicenter trial being conducted in 26 countries. Its main aim is to evaluate the relationship between three levels of target diastolic blood pressure (< or = 90, < or = 85 or < or = 80 mmHg) and cardiovascular morbidity and mortality in hypertensive patients. In addition, the study will examine the effects on morbidity and mortality of a low dose, 75 mg daily, of acetylsalicylic acid (ASA, aspirin) or placebo. In the HOT Study, basic antihypertensive treatment is initiated with the calcium antagonist felodipine at a dose of 5 mg daily. If target blood pressure is not reached, additional antihypertensive therapy with either an angiotensin converting enzyme (ACE) inhibitor or a beta-adrenoceptor blocking agent is given. Further dosage adjustments are made in accordance with a set protocol. As a fifth and final step, a diuretic may be added. Inclusion of patients was stopped on April 30, 1994. At that time 19,196 patients had been randomized. There were 9,055 (47%) women and 10,141 (53%) men with an average age of 61.5 +/- 7.5 (SD) years. At enrollment, 52% of patients were receiving antihypertensive treatment. These patients entered a wash-out period of at least 2 weeks before randomization. The average randomization blood pressure in untreated patients was 169 +/- 14/106 +/- 3 mmHg and in the treated patients 170 +/- 14/105 +/- 3 mmHg. On August 15, 1994, blood pressure data were available for 14,710 and 10,275 patients, who had completed 3 and 6 months treatment, respectively. The average reduction in diastolic blood pressure was 22 mmHg after 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The Hypertension Optimal Treatment (HOT) Study--patient characteristics: randomization, risk profiles, and early blood pressure results. 786 89

Renovascular disease, particularly when associated with atherosclerosis, is a common cofactor in accelerating hypertension and deteriorating renal function. With increased longevity and effective antihypertensive medications, the prevalence of vascular lesions affecting renal viability is increasing, possibly accounting for 15% of end-stage renal disease. Renal vascular lesions alter renin release and multiple associated mechanisms related to adrenergic and vascular regulation. Several new diagnostic modalities, including captopril renography, duplex ultrasonography, and magnetic resonance angiography, are being applied for noninvasive diagnosis. Advances in interventional radiologic procedures, including endovascular stents and surgical revascularization, offer the potential for both improved blood pressure management and salvage of renal function. Optimal management of renovascular disease depends on careful assessment of the progression of each patient and associated risk of intervention.
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PMID:Renovascular hypertension. 792 18

The determination of the angiotensin I-converting enzyme activity (ACE, kininase II, peptidyldipeptide hydrolase, EC 3.4.15.1) is necessary to control the course and the treatment of sarcoidosis, as well as to monitor the therapeutic use of enzyme inhibitors such as captopril in hypertension or congestive heart failure. Numerous synthetic substrates are known with which to measure the enzyme activity. A discontinuous method using hippuryl-L-histidyl-L-leucine was tested and improved. The cleavage product, hippurate, reacts with cyanuric chloride to give a yellow complex which can be measured at 405 nm using a spectral line photometer. Enzyme activity, kinetic constants and activation energy are dependent on the chloride ion concentration. Optimal test concentrations are 1.1 mol/l potassium chloride and 3.0 mmol/l hippuryl-L-histidyl-L-leucine at pH 8.3. Higher substrate concentrations effect an inhibition of the enzyme reaction. A Michaelis constant of 0.9 mmol/l was found with serum as enzyme source. An activation energy of 57 kJ/mol was obtained from the relation between the logarithm of velocity of enzyme reaction and reciprocal value of absolute temperature. Furthermore, a linear dependence on chloride ion concentration was observed. The histogram of the enzyme activities in sera from 146 healthy volunteers shows a non-gaussian distribution. The reference interval at 25 degrees C is characterized by a median of 24 units/l with the 2.5th and the 97.5th percentiles at 13 units/l and 42 units/l, respectively. The corresponding values at 37 degrees C are 27 units/l and 86 units/l with a median of 48 units/l. No significant sex and age dependence could be found. A potent ACE inhibitor such as captopril leads to a rapid decrease of the enzyme activity within 60 min after oral administration. In the following hours, the enzyme activity slowly increases.
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PMID:Optimized determination of angiotensin I-converting enzyme activity with hippuryl-L-histidyl-L-leucine as substrate. 795 11

The Hypertension Optimal Treatment (HOT) Study is a prospective, randomized, multicenter study which will be conducted in some 20 countries world-wide. Two major issues will be investigated: i) What is the optimal target diastolic blood pressure during antihypertensive treatment with regard to the reduction in cardiovascular morbidity and mortality? In order to address this question patients will be randomized to three different therapeutic goals: a diastolic blood pressure < or = 90 mmHg, < or = 85 mmHg or < or = 80 mmHg; ii) The second aim is to evaluate the effect of a low dose acetylsalicylic acid (ASA, aspirin) 75 mg o.d. in comparison with placebo on cardiovascular morbidity and mortality. The first aim will be investigated in accordance with the PROBE design (Prospective Randomized Open Blinded Endpoint evaluation), whereas the evaluation of aspirin versus placebo will be conducted under double blind conditions. It is estimated that 1,100 clinical events will be needed in order to answer the question regarding the relationship between target diastolic blood pressure and major cardiovascular events. The collection of these events will require the enrollment of at least 18,000 hypertensive men and women aged 50-80 years to be followed for 2.5 years (about 40,000 patient years). All patients will be given felodipine 5 mg o.d. as basic antihypertensive treatment with the addition of a beta-blocker or an ACE-inhibitor in a second step, with further predetermined increments in dosage as required in order to obtain the randomized therapeutic goal.
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PMID:The Hypertension Optimal Treatment Study (the HOT Study). 819 35

Overweight is associated with a higher risk of cardiovascular and metabolic disease. Pregnancy in obese women frequently results in an increased incidence of maternal complications (gestational diabetes, hypertension, toxemia) and adverse perinatal outcome (macrosomia, perinatal mortality). Cesarean deliveries are also more frequent in obese women, mainly because of cephalopelvic dysproportion due to macrosomia. Optimal treatment for gestational diabetes is difficult to achieve, although hyperglycemia further impairs maternofoetal prognosis. The incidence of intrauterine growth retardation is not increased in obese pregnancy. A successful obstetrical outcome may be achievable through multidisciplinary antenatal management.
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PMID:[Obstetrical complications of maternal overweight]. 819 42


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