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

The long-term efficacy and tolerance of spironolactone in essential hypertension was evaluated among 20,812 patients referred to the Broussais and St. Joseph systemic hypertension clinics between 1976 and 1985 by using information prospectively collected in the computerized ARTEMIS data bank. In 182 patients (51 men, 131 women) treated with spironolactone alone during a mean follow-up period of 23 months, a mean dose of 96.5 mg decreased systolic and diastolic blood pressure (BP) by 18 and 10 mm Hg, respectively, below pretherapeutic levels. The BP decrease was greater with doses of 75 to 100 mg (12.4% and 12.2%) than with doses of 25 to 50 mg (5.3 and 6.5%, p less than 0.001), but no additional decrease was found with doses above 150 mg. Plasma creatinine level increased modestly (8.3 mumol/liters), as did plasma potassium level (0.6 mmol/liters) (both p less than 0.001); uric acid level increased, but not significantly (10.5 mumol/liter). Fasting blood glucose and total cholesterol levels did not change, triglyceride levels increased slightly (0.1 mmol/liter, p less than 0.05). These changes were similar in both sexes and were not influenced by length of follow-up. Among the 699 men prescribed spironolactone alone or in association with another antihypertensive treatment, 91 cases of gynecomastia developed (13%). Gynecomastia was reversible and dose-related; at doses of 50 mg or less the incidence was 6.9%, but 52.2% for doses of 150 mg or higher. Despite limitations inherent in the interpretation of data banks, it is concluded that spironolactone administered in daily practice reduced BP without inducing adverse metabolic adverse effects and that in patients with essential hypertension, doses should be kept below 100 mg.
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PMID:Efficacy and tolerance of spironolactone in essential hypertension. 366 95

The hemodynamic effects of two types of anesthesia on aortofemoral bypass surgery were studied in a randomised prospective trial. Epidural anesthesia supplemented with nitrous oxide (group I) and total intravenous anesthesia combining fentanyl and a continuous infusion of etomidate (group II) were compared. A high incidence of preoperative disease was found and all 18 patients were classified in ASA classes III-IV. It is concluded that epidural anesthesia provides excellent anesthetic and hemodynamic stability provided that an optimal filling pressure is maintained. Total intravenous anesthesia resulted in significant hypertensive reactions during surgery, which were not specifically related to crossclamping. Decreasing the high SVRI with vasodilatory treatment was necessary to treat hypertension in all those patients with preoperative hypertensive disease. No problems were seen in the intravenous group patients without preoperative hypertension. Cardiac work was higher in the intravenous group due to the high impedance of the cardiovascular system provoked by the absence of vasodilatory properties with this type of intravenous anesthesia. Monitoring of PWP and CI by Swan-Ganz catheter is shown to be very useful for optimalization of hemodynamics and fluid management especially during crossclamping, when normal Frank-Starling relationships might not be valid anymore. The effect of vasodilatory treatment, crossclamping and declamping could be carefully evaluated.
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PMID:A hemodynamic study of epidural versus intravenous anesthesia for aortofemoral bypass surgery. 409 93

Concurrently controlled, randomized clinical trials play an important role in the validation of treatment and control measures of cardiovascular disease. As such trials have been carried to conclusion, a great deal has been learned not only about the treatment of the disease but also about the methodology of clinical trials. Seven recently completed clinical trials, the Coronary Drug Project, the Aspirin Myocardial Infarction Study, the Anturane Reinfarction Trial, the Hypertension Detection and Follow-Up Program and three drug trials of betablockers, are reviewed from the perspective of both their clinical and methodological significance.
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PMID:Overview of recent clinical and methodological advances from clinical trials of cardiovascular disease. 612 42

In rat smooth muscle cell cultures two types of cells were detected. The majority of cells were small and spindle-shaped, 15% of which were labeled with H3-thymidine and displayed a nucleus/plasma relation of 1:15. Thirteen percent of the smooth muscle cell population was large and partly polynuclear. The H3-thymidine labeling was 1.3% in these rounder cells, and the nucleus/plasma ratio was 1:44. The surface area and cell shape of both types of cells were quantified morphometrically. Diabetes was induced in a group of animals by streptozotocin and hypertension by cellophane perinephritis. Data on smooth muscle cells (SMC) in culture obtained from diabetic and hypertensive rats differed from those of the controls. The percentage of small cells was significantly decreased, while the H3-thymidine index was increased in both diabetic and hypertensive rats. The number of large and polynuclear cells increased relative to the small cells, and they also displayed a higher proliferation rate as well as a change in their nucleus/plasma ratio. Another group of diabetic animals was treated with acetylsalicylic acid prior to SMC cultivation. Acetylsalicylic acid prevented the majority of changes found in cultured SMC of diabetic rats.
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PMID:Special characteristics of cultured smooth muscle cell subtypes of hypertensive and diabetic rats. 622 11

The effect on blood pressure and heart rate, following administration of the same intracerebroventricular (ivt) and intravenous (iv) doses of captopril, was compared in freely moving DOCA-salt hypertensive rats, with chronically implanted ivt, iv and intraarterial cannulae. Ivt captopril (500 micrograms) in DOCA-salt rats showed an initial pressor response followed by a long lasting hypotensive effect. The ivt effect was greater than that following iv administration. No effect was observed in normotensive controls either ivt or iv. ASA or naloxone pretreatments significantly lowered the captopril hypotensive effect, thus suggesting an involvement of prostaglandin and opioid systems in blood pressure elevation in "non renin dependent" hypertension.
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PMID:Cardiovascular responses of conscious DOCA-salt hypertensive rats to acute intracerebroventricular and intravenous administration of captopril. 634 5

Vasodepressor responses to prostacyclin, nitroprusside and arachidonic acid were compared in two groups of anaesthetized, two-kidney, one-clip Goldblatt rats. The groups were composed of rats which had high blood pressure (greater than 150 mmHg systolic) or normal blood pressure (less than 140 mmHg systolic). The vasodepressor effects of prostacyclin and nitroprusside and arachidonic acid did not differ significantly between hypertensive and normotensive groups when measured as percentages of resting blood pressure. Thus, in contrast to one-kidney Goldblatt hypertensive rats, there is no evidence for increased vascular conversion of arachidonic acid to prostacyclin in the two-kidney hypertensive model. The effect of cyclo-oxygenase inhibition on development of hypertension in one- and two-kidney Goldblatt rats was also studied by treating them daily with aspirin (200 mg/kg orally) from 3 days before until 3 weeks after clipping the renal artery. Aspirin-treated two-kidney rats developed significantly higher blood pressures than vehicle-treated controls, but the blood pressures of aspirin-treated one-kidney rats increased less after clipping than those of vehicle-treated controls. It appears paradoxical that transformation of arachidonic acid to prostacyclin is increased, while aspirin has a blood pressure lowering effect in one-kidney Goldblatt rats. It is suggested that there might be a more fundamental disturbance in arachidonate metabolism in hypertension which might contribute to increased vascular reactivity.
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PMID:Differences in arachidonic acid metabolism and effects of aspirin between one- and two-kidney Goldblatt hypertensive rats. 635 35

This study determined the cardiovascular effects of percutaneous radiofrequency coagulation of the Gasserian ganglion, performed under neuroleptanalgesia and intermittent ultrashort-acting barbiturate anaesthesia. Twelve ASA physical status class II patients were studied. Highly significant increases in mean heart rate and arterial blood pressure followed the insertion of the cannula electrode into the Gasserian ganglion (p less than 0.001). In six randomly assigned patients severe tachycardia and hypertension also accompanied the progress of the thermal lesion (p less than 0.0001). Three patients developed premature ventricular contractions, and two developed significant ST segment depression. Intravenous nitroglycerin, used during current generation, successfully controlled the hypertensive response in the other six patients. In percutaneous thermocoagulation of the Gasserian ganglion the patient's co-operation is essential. In addition to providing suitable operating conditions for both surgeons and patient, we should also be able to maintain normal and stable cardiovascular haemodynamics. Intravenous nitroglycerin used as an adjunct to light general anaesthesia safely maintained intraoperative normotension. It is also suggested that patients with coronary artery disease be adequately monitored and protected during the procedure.
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PMID:Anaesthetic considerations in percutaneous radiofrequency coagulation of the Gasserian ganglion. 642 54

To counter the paucity of documention on thromboembolic disorders caused by oral contraceptives (OC), a case study is presented describing the incidence of occlusion of arteria centralis retinae in a 24-year old woman after prolonged use of an OC, Bisecurin. She had taken Bisecurin for 4.5 years and had gained 20 kg during that time, but stopped usage 1 month before admission. She was hospitalized with severe deterioration of vision in the left eye. An eye examination indicated an edematous condition of the retina and reddening of the macula. Acuity of vision value for the left eye was .01 vs. 1.0 for the right, which was confirmed by fluorescein fundus angiography. Moderately decreased antithrombin III (AT III) activity was also ascertained. Treatment consisted of immediate retrobulbar injection with Tolazolin followed by Rheomacrodex, Cavinton infusions, B1 and B12 injections, Oradexon subconjunctival injection as well as vitamin B complex, Cavinton, and Colfarit tablets and a fat-free diet. Significant improvement of the left eye condition appeared 4 weeks later. Periodic follow-ups showed the healing of the condition around the macula; however, the patient suffered permanent damage to the retina due to the arterial occlusion above and below the macula. The disturbed lipid values of metabolism were also returned to normal, as borne out by normal dextrose loading results 8 months later (glucose tolerance was abnormal during examination at admission). The estrogen and progesterone components of OCs have been shown to reduce AT III levels, shorten heparin-thrombin coagulation time, increase fibrinogen levels, decrease HDL cholesterol levels, and produce excess TXA2 (thromboxan) resulting in vasoconstriction and thrombocyte aggregation. The risk of thrombosis is 6 times higher in OC users than in nonusers, although other susceptibility factors (obesity, diabetes, hypertension) also contribute to thrombosis.
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PMID:[Arterial occlusion in the ocular fundus induced by oral contraceptives]. 651 54

The effectiveness of preventive and therapeutic measures depends upon their adequacy in the individual diagnostic situation. This is also true for stroke which is a superimposed concept for different mechanisms leading to acute localized brain ischemia. For the choice of treatment we have to consider in each case the actual clinical situation, i.e. the natural stage of disease, the localization of cerebral dysfunction and its etiology and pathogenesis. Thus transient ischemic attacks (TIA), completed stroke with prolonged complete, partial or no recovery and progressive stroke (stroke in evolution) demand different treatment. Concerning pathogenesis it is important to differentiate between intracerebral hemorrhage, ischemia due to extracranial carotid stenosis or occlusion, intracranial arterial thrombosis, predominantly hemodynamic pathogenesis and embolism of cardiac origin. Prevention of stroke may be of general kind like treatment of hypertension or other risk factors for apoplexy, and there are more specific measures like surgery of vascular obliteration and treatment with agents inhibiting platelet aggregation (Aspirin) or anticoagulants. The indications for the various surgical and medical procedures are discussed. Because of the risk of hemorrhagic complications the indication for anticoagulants is limited considerably. The treatment of completed stroke has to consider the normalization of basic functions (cardiocirculatory, respiration, water-electrolyte balance a.o.). Vasoactive and especially vasodilatatory drugs are not recommended in the acute stage of stroke, as their effectiveness is not secure and may even be disadvantageous. Ischemic brain edema is treated with mannitol or sorbit and with dexamethasone although its effectiveness has not yet been proven. Low molecular dextran solution is supposed to improve microcirculation in the ischemic tissue by means of hemodilution i.e. improvement of rheological properties.
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PMID:[Prevention and therapy of stroke]. 740 3

In 1975 a check list was introduced for the pre-operative evaluation of the surgical risks. In contrast to assessing the general condition of the patient according to the ASA nomenclature, the check list is largely based on objective criteria with a point system for evaluation. The number of points determines the magnitude of risk. 140,250 anaesthesias are avaluated with regard to the frequency of cardiovascular complications. The incidence of complications increases steadily in the presence of hypertension and arrhythmia in four consecutive risk groups and in the presence of hypotension and asystole in all five groups.
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PMID:[Objective criteria for the pre-operative evaluation of the surgical risks (author's transl)]. 741 46


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