Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of anthropometric measurements of triceps (TSF) and subscapular skinfolds (SSF) and mid-upper arm muscle circumference (MAMC) was examined as far as the diagnosis of energy-protein malnutrition (EPM) is concerned. The study was undertaken in five groups of patients (n = 231): arterial hypertension (AH, n = 63), chronic obstructive pulmonary disease (COPD, n = 17), hemodialyzed chronic renal failure (CRF, n = 19), critically ill patients with an acute event (CA, n = 42) and critically ill patients with chronic diseases (CCD, n = 90). The results were compared to those obtained in a group of healthy individuals (control group, n = 102). The control group and the group of patients were allocated in subgroups according to sex and age (less than 50 and more than 50 years). It was expected that significant differences would be found for the anthropometric values between the control subgroups and the COPD, the CRF and the CCD subgroups of patients. For the skinfold thicknesses (TSF and SSF), significant differences were found between CRF, CCD subgroups and the control subgroups under fifty years of age; however, the differences were not significant when the subgroups over fifty were analyzed. Concerning the MAMC, significant differences were found: 1 degree) between the CRF subgroups (males and females) and the control subgroups under fifty years of age; 2 degrees) between the CCD male subgroups (younger and older subgroups) and the respective control subgroups and 3 degrees) between the COPD and the control subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The use of skinfolds and of the muscle circumference of the upper arm in the diagnosis of protein-energy malnutrition in adults patients: a critical study]. 134 Jun 6

In order to evaluate the hemodynamic effects of INPV, eight patients with COPD (FEV1/FVC, 54 +/- 6 percent; mean +/- SD), respiratory failure (PaO2, 52 +/- 6 mm Hg; PaCO2, 56 +/- 4 mm Hg), and clinical signs of inspiratory muscle fatigue underwent right cardiac catheterization while performing 20 minutes of INPV by a cuirass ventilator at a pressure (-20 to -40 cm H2O) able to reduce the diaphragmatic electromyographic activity. Patients showed a mild basal pulmonary artery hypertension. During INPV, no changes in the mean values of HR (from 79 +/- 20 to 80 +/- 18 beats per minute), systolic BP (141 +/- 19 to 139 +/- 16 mm Hg), CO (5.2 +/- 0.8 to 5.1 +/- 1.3 L/min), mean PAP (23.8 +/- 3.8 to 23.9 +/- 4.4 mm Hg), RAP (4.3 +/- 2.6 to 5.5 +/- 2.5 mm Hg), PWP (10.3 +/- 4.5 to 9.4 +/- 2.9 mm Hg), TPR (369 +/- 76 to 392 +/- 124 dynes.s.cm-5), and PVR (199 +/- 51 to 233 +/- 94 dynes.s.cm-5) were observed. Direct systemic BP monitoring could be performed in six patients. During INPV, three patients showed "pulsus paradoxus," as assessed by an inspiratory fall in systolic BP of 11, 13, and 20 mm Hg, respectively. We conclude that INPV by cuirass ventilator does not induce adverse hemodynamic effects in patients with COPD who have pulmonary artery hypertension.
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PMID:Hemodynamic effects of negative-pressure ventilation in patients with COPD. 218 97

Normal sleep provides a period of physiologically reduced workload for the cardiovascular system for almost one third of the human life span. Snoring, the most common disorder of sleep, heralds the presence of an unstable upper airway and alerts perceptive clinicians to the possibility of OSA. Epidemiologic evidence has implicated snoring as an independent risk factor for the development of hypertension, ischemic heart disease, and cerebral infarction. However, many investigators would attribute these adverse cardiovascular effects to the substantial prevalence of OSA in habitual snorers. The detrimental effects of OSA on hemodynamics and cardiac rhythm have been well documented, and recent data have linked OSA with increased cardiovascular mortality. Worsening hypoxemia during sleep likely contributes to the nocturnal mortality observed in patients with severe COPD. Effective treatment to prevent nocturnal hypoxemia is available for OSA and COPD, with current evidence supporting beneficial effects on survival.
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PMID:Cardiovascular effects of sleep disorders. 218 99

Several imaging techniques, both noninvasive and minimally invasive, have now been applied widely for determining cardiovascular performance in patients with chronic respiratory disease, particularly COPD. Moreover, some of these techniques are useful for evaluating response to therapeutic intervention in these patients. The plain chest radiograph is useful primarily for detecting the presence of pulmonary artery hypertension in patients with COPD. Radionuclide angiocardiography, using either first-pass techniques or the gated equilibrium technique, is particularly useful for determining right and left ventricular ejection fraction. Echocardiography has evolved as a technique for assessing right ventricular size and function and, in some cases, the degree of pulmonary artery hypertension.
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PMID:Imaging techniques for assessing pulmonary artery hypertension and right ventricular performance with special reference to COPD. 219 41

We used pulsed Doppler echocardiography to examine the systolic ejection flow from the right ventricle in 66 patients with chronic obstructive pulmonary disease. Adequate recordings were obtained in 60 patients, in conjunction with right heart catheterization. Patients without pulmonary artery hypertension at rest (mean pulmonary artery pressure less than 20 mm Hg) underwent an exercise test which identified a group with PAH during exercise (MPAP greater than 30 mm Hg). The patients were divided into four groups: group 1, or control group: 17 healthy nonsmokers without normal respiratory function data; group 2: COPD without PAH (n = 12); group 3: PAH during exercise (n = 26); group 4: PAH at rest (n = 22). Analysis of Doppler data included time to peak velocity, right ventricular pre-ejection period, and ejection period. Pulsed Doppler echocardiography was a simple and reliable method of detecting PAH. Latent PAH, revealed by the exercise test, was accompanied by significant changes in Doppler findings, confirming the sensitivity of the method.
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PMID:Pulsed Doppler echocardiography in the diagnosis of pulmonary hypertension in COPD. 237 58

Cor triatriatum presenting in adulthood is extremely rare. We describe a case of adult cor triatriatum in which the diagnosis was initially masked by the concomitant existence of COPD. Cardiac catheterization revealed only slightly elevated pulmonary wedge pressure despite severe pulmonary arterial hypertension. Both the primary lung disease and cor triatriatum greatly accentuated the pulmonary vascular disease which led to a reduction of pulmonary blood flow. Consequently, pulmonary venous obstruction was masked and was not reflected by measuring pulmonary wedge pressure. The diagnosis was made by two-dimensional echocardiography and left ventriculography.
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PMID:Cor triatriatum masked by coexisting COPD in an adult. 276 32

Older patients with both hypertension and pulmonary disease pose a challenge to the physician. Satisfactory blood-pressure control must be achieved without exacerbating the concomitant pulmonary disease. Diuretics may interfere with mucus production and cause acid-base and electrolyte abnormalities. The beta-adrenergic blocking agents should be avoided because of their risk of inducing bronchospasm. If a beta blocker must be used, it should be combined with an alpha- and beta-adrenergic blocker, or an agent with intrinsic sympathomimetic activity or beta 1 selectivity. The direct and indirect vasodilators may be used safely in these patients, but the risk of worsening any underlying coronary artery disease must be kept in mind when prescribing either hydralazine or minoxidil. The calcium channel blockers and ACE-inhibitors have the best safety record in treating the elderly who have hypertension and COPD. For these patients, the calcium channel blockers offer the advantage of simultaneous therapy of coronary artery disease, whereas hypertensive patients with congestive heart failure would be more likely to benefit from an ACE-inhibitor. The ability to treat hypertension without precipitating unwanted adverse reactions or dangerous side effects is one of the arts of medicine. Fortunately, the range of drugs available to today's physician allows safe and efficacious treatment of the elderly patient who has both hypertension and pulmonary disease.
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PMID:Managing the elderly patient with both hypertension and pulmonary disease. 288 48

The respective value of four non-invasive methods for the diagnosis of pulmonary arterial hypertension (PAH) was investigated in 63 COPD patients, using right heart catheterization as the reference method: 22 patients had no resting PAH (pulmonary artery mean pressure (PAP) less than or equal to 20 mmHg); 26 patients had mild PAH (PAP = 21-30 mmHg); and 15 patients had moderate to severe PAH (PAP greater than 30 mmHg). The specificity of ECG was 86% and the sensitivity 51% (only 38% in mild PAH). The specificity of radiological measurements was 63% and the sensitivity 46% (38% in mild PAH). Echocardiography (echo) had the best results with a specificity of 75% and a sensitivity of 78% (73% in mild PAH), but reliable echo measurements were available in only 52 out of 63 patients. Myocardial scintigraphy had a specificity of 68% and a sensitivity of 66% (58% in mild PAH). A stepwise regression analysis (including one echo, one ECG, one radiological and one functional variable) explained only 43% of the variance of PAP (multiple r = 0.66). These results suggest that no individual method is sufficiently reliable for predicting the presence of PAH, and particularly mild PAH, but the combination of echo + myocardial scintigraphy allows the prediction of PAH with a good probability. The precise level of PAH cannot be estimated, even when using multiple regression equations.
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PMID:Non-invasive diagnosis of pulmonary hypertension in chronic obstructive pulmonary disease. Comparison of ECG, radiological measurements, echocardiography and myocardial scintigraphy. 344 64

An improved method of noninvasive assessment of pulmonary arterial pressure is presented. The already existing radionuclide method for assessment of pulmonary arterial pressure based on right ventricular ejection fraction, although having a relatively good positive predictive accuracy (75 percent), lacks in specificity and correlates only weakly with pulmonary arterial pressure, r = .66. In the present study a diastolic index of the ventricular performance (right atrial early diastolic emptying rate) was used to improve the predictive value of the right ventricular ejection fraction. Phase image analysis was used to differentiate the right atrium from the rest of the cardiac structures, and right atrial emptying rate was calculated after time activity curves were generated. A reasonably good correlation was found between right atrial emptying rate and pulmonary arterial pressure, r = .75. This diastolic index, however, was limited in its ability to detect patients with COPD and normal pulmonary arterial pressure (negative predictive value 62 percent). In order to improve the predictive value of right ventricular ejection fraction, having low specificity (33 percent) but high sensitivity (93 percent), a score index was constructed, combining right ventricular ejection fraction with right atrial emptying rate (having high specificity 100 percent, but modest sensitivity 78 percent). Score index proved to be an excellent indicator of pulmonary arterial hypertension (positive predictive value 93 percent, negative predictive value 100 percent.
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PMID:Improved radionuclide method for assessment of pulmonary artery pressure in COPD. 394 Jul 91

The effects of sublingual isosorbide dinitrate (ISDN; 10 mg) or nitroglycerin (NTG; 1 mg) on pulmonary hemodynamics, gas exchange and pulmonary function were studied during right heart catheterization in two series of 27 patients with COPD. An immediate significant decrease of pulmonary arterial pressure, cardiac output and work of the right ventricle was obtained with both drugs, but NTG only was able to reduce the pulmonary vascular resistance. Arterial oxygen tension did not decrease, but venous O2 tension did, with no change in blood lactate. NTG had also a slight bronchodilating effect. After chronic use, no improvement of pulmonary function or gas exchange was observed but NTG lowered pulmonary vascular resistances significantly. The effects observed during the acute study were reproduced after six weeks with the same doses of both drugs. NTG appears effective in reducing pulmonary arterial hypertension mainly by vasodilation while the ISDN effect seems due only to the decreased cardiac output.
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PMID:Nitroglycerin and isosorbide dinitrate in pulmonary hypertension of chronic obstructive pulmonary disease. 642 15


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