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

The effect of nitrendipine on the cardiovascular responses to tracheal intubation was studied in a placebo-controlled, randomised, double-blind trial. Thirty patients (ASA physical status 1) undergoing elective surgery received either 5 or 10 mg nitrendipine, or a placebo orally 3 h before induction of anaesthesia (n = 10 for each group). Anaesthesia was induced with sodium thiopentone 5 mg/kg i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg/kg i.v. Patients receiving the placebo showed a significant increase in the mean arterial pressure and the rate-pressure product in response to tracheal intubation. These increases following intubation were reduced in nitrendipine-treated patients compared with the placebo group (P < 0.05). Oral administration of nitrendipine (5 or 10 mg, 3 h before induction of anaesthesia) was able to attenuate the hypertensive response to tracheal intubation in ASA 1 patients under light anaesthesia. We propose this pharmacological technique with supplementary doses of opioids and/or benzodiazepines for the management of patients with hypertension or coronary artery disease.
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PMID:Attenuation of the pressor response to tracheal intubation with oral nitrendipine. 824 56

The risk factors predominating in patients with peripheral arterial occlusive disease are cigarette smoking and diabetes. Moreover, hypertension and hyperlipidemia play an important role. Especially younger patients profit from elimination or treatment (primary or secondary prevention), whereas in elderly patients these measures are no longer crucial. In patients with intermittent claudication, the quality of life may be improved by physical training, vasoactive medicaments, optimal management of concomitant diseases and the different modalities of catheter therapy. According to the special situation in critical ischemia, surgical or catheter revascularization is preferred. If these two techniques cannot be used, intra-arterial or intravenous prostanoids are still promising. Aspirin and in second priority ticlopidine are suited for secondary prevention of arteriosclerosis not only in the extracranial, but also in the peripheral vascular region. After endarterectomy and catheter therapy, aspirin improves the long-term outcome by reducing the incidence of restenoses. Better results are obtained by oral anticoagulation in patients with emboli and after local thrombolysis.
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PMID:[Treatment strategies in arterial occlusive diseases]. 827 1

There were 160 incidents associated with regional anaesthesia amongst the first 2000 incidents reported to the Australian Incident Monitoring Study. They were categorised into 6 groups; epidural anaesthesia (83), spinal anaesthesia (42), brachial plexus blocks (14), intravenous local anaesthesia (4), ocular blocks (3), and local infiltration (14). The largest single cause of incidents involved circulatory problems; these occurred in all the groups except brachial plexus block (30 cases of hypotension, 7 of arrhythmias, 3 of cardiac arrest, 2 of hypertension and 1 of myocardial ischaemia). There were 24 drug errors, of which 10 involved the "wrong drug" and 4 "inappropriate use". With the exception of these, all the remainder involved problems specific to regional anaesthesia: 26 inadvertent dural punctures; 19 failed or inadequate blocks; 14 dural puncture headaches (all cured by blood patches); 10 inadvertent total or high spinal blocks (of which 7 required artificial ventilation); 5 blocks on the wrong side or in the wrong patient; 3 late hypoxic incidents and a variety of miscellaneous problems. Three-quarters of all incidents occurred in the presence of an anaesthetist and over 90% in patients of ASA Groups I-III. Rapid recognition by the anaesthetist prevented many potentially life threatening events, and the only death was as a result of surgical bleeding.
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PMID:The Australian Incident Monitoring Study. Problems with regional anaesthesia: an analysis of 2000 incident reports. 827 90

Ornipressin (OR), a synthetic derivative of natural vasopressin, is widely used in combination with local anaesthetics in order to reduce surgical bleeding and systemic absorption of the local anaesthetic. As shown previously in experimental studies, OR causes severe coronary vasoconstriction. The myocardial oxygen balance is compromised by an increase in myocardial oxygen demand due to hypertension and impaired oxygen delivery following coronary vasoconstriction. We describe the case of a 19-year-old male who was admitted to the hospital for elective tonsillectomy. There was no evidence of systemic or cardiovascular disease (ASA I). Following the induction of anaesthesia with thiopentone 4 mg/kg and ventilation with N2O/O2 (FiO2:0.25), vecuronium was administered to facilitate orotracheal intubation. Anaesthesia was maintained with N2O/O2 (FiO2:0.33) and 2 MAC isoflurane. After reaching an anaesthetic steady state with stable haemodynamic conditions, peritonsillar infiltration with a prilocaine solution containing a total of 0.8 IU OR (0.1 IU/ml) produced marked tachycardia and hypertension. Concomitantly, distinct ST-segment-depression was observed in a lead II ECG. Hypertension and tachycardia occurred within 3 min after the local infiltration with prilocaine/OR. Maximum ST-segment depression and haemodynamic changes were recorded 11 min after infiltration, with an increase in heart rate from 58 to 136 min and a rise in blood pressure from 115/50 to 217/130 mmHg. Considering experimental results, the ECG changes in this case show clear evidence that even in healthy humans OR-induced systemic haemodynamic changes may be complicated by severe myocardial ischaemia due to coronary vasoconstriction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Signs of a severe myocardial ischemia following peritonsillar infiltration with ornipressin (POR 8)]. 831 91

The goal of medical treatment during acute cerebral infarction is to enhance thrombolysis and inhibit the chemical alterations associated with cell death. Treatment includes avoidance of blood pressure reduction, blood glucose control, possible anticoagulation with IV heparin, and sometimes reduction of cerebral edema. Optimal treatment thereafter depends on the result of patient evaluation. Uncontrolled vascular risk factor (eg, hypertension, smoking, and diabetes) should be treated. Aspirin and ticlopidine reduce the risk of recurrent ischemic stroke. In patients with nonrheumatic atrial fibrillation, anticoagulation with warfarin reduces the risk of embolic events. Carotid endarterectomy is superior to medical management alone in reducing the risk of stroke in patients with > 70% symptomatic extracranial carotid stenosis.
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PMID:Ischemic stroke, Part 2: Optimal treatment and prevention. 844 20

The decision to anticoagulate patients with atrial fibrillation (AF) involves weighting the risk of an embolic event without therapy versus the risk of a hemorrhagic event on therapy. Improved methods of monitoring anticoagulation with the International Normalized Ratio (INR), and recent evidence of the efficacy and safety of low-dose warfarin (INR range 2.0 to 3.0) have clarified the role of anticoagulation in AF. Over the past four years, five large prospective randomized trials in patients with nonvalvular atrial fibrillation (NVAF) have reported substantial reductions in stroke in patients treated with low-dose warfarin therapy. The results of these trials, combined with previous studies, suggest that anticoagulation is the treatment of choice for patients with atrial fibrillation associated with rheumatic valvular disease, prosthetic valve disease, and now NVAF. Although the results of the prospective atrial fibrillation trials are very consistent in regard to the efficacy and safety of anticoagulation, there continues to be uncertainty regarding which subgroups of patients are at highest risk for embolic events. Subgroups that appear to be at high risk include patients with hypertension, previous embolic events, structural heart disease (enlarged left atrial size, previous myocardial infarction, left ventricular dysfunction), and older age. Young patients with no evidence of structural heart disease or hypertension (lone atrial fibrillation) have a low embolic rate and do not warrant anticoagulation. Recent studies suggest that there is little difference in the risk of stroke in patients with paroxysmal or chronic AF, therefore this factor should not have a major impact on therapeutic decisions. Anticoagulation is also recommended for patients undergoing elective cardioversion (recent onset of atrial fibrillation greater than two days in duration), and patients with atrial fibrillation and hyperthyroidism because of studies suggesting a higher rate of embolism if these patients are not anticoagulated. The role of aspirin in AF is less clear as only two of the five prospective trials randomized patients to aspirin therapy and only one documented aspirin benefit. Therefore, aspirin appears to offer less benefit but is a satisfactory alternative to warfarin therapy. Aspirin is currently recommend for patients who are poor candidates for anticoagulation or individuals with AF who are considered to be at low risk for stroke.
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PMID:Anticoagulation and atrial fibrillation. 845 50

This study was designed to compare the efficacy of an ephedrine infusion with crystalloid administration for reducing the incidence of hypotension during spinal anesthesia. Fifty-four ASA I patients scheduled for postpartum tubal ligations under spinal anesthesia were randomly allocated to receive either 15 mL/kg of crystalloid (crystalloid group) or an ephedrine infusion (infusion group). Spinal anesthesia was performed using 70-90 mg of hyperbaric 5% lidocaine. Patients in the infusion group immediately thereafter received an ephedrine infusion at a rate of 5 mg/min for the first 2 min and then 1 mg/min for the next 18 min. The incidence of hypotension was 15/27 (55%) in the crystalloid group and 6/27 (22%) in the infusion group (P < 0.05). There was no significant difference between the groups in relation to the level of anesthesia or maximal heart rate, and hypertension did not occur in either group. We conclude that a prophylactic ephedrine infusion is effective for minimizing and managing hypotension associated with spinal anesthesia and compares favorably with crystalloid administration in this patient population in terms of efficacy and incidence of side effects.
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PMID:Comparison of an ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anesthesia. 848 2

The Hypertension Optimal Treatment (HOT) Study is an ongoing prospective, randomized, multicenter trial conducted in 26 countries. Its two main aims are to evaluate the relationship between three levels of target diastolic blood pressure (< or = 90, < or = 85 or < or = 80 mmHg) and the incidence of cardiovascular morbidity and mortality in hypertensive patients and the effects on morbidity and mortality of a low dose, 75 mg daily, of acetylsalicylic acid (ASA, aspirin) compared with placebo. Altogether 19,193 patients have been recruited and randomized and one-year data are now available for all patients. This is a report on the blood pressures achieved, the tolerability and other available data after 12 months of follow-up of all patients. Special reference will be given to the subgroup of elderly patients (> or = 65 years, n = 6,113) as compared to younger patients (< 65 years, n = 13,080). On average, the target group < or = 90 mmHg in diastolic blood pressure has reached 86 mmHg, the target group < or = 85 mmHg has reached 83 mmHg and the target group < or = 80 mmHg has reached 81 mmHg. The percentage of patients that has obtained their target blood pressures is 84% in the target group < or = 90 mmHg, 72% in the target group < or = 85 mmHg and 57% in the target group < or = 80 mmHg at 12 months of follow-up. In the elderly subgroup (> or = 65 years of age) the percentage of patients at target is higher for all target groups, being 86, 76 and 61%, respectively, at 12 months. Antihypertensive treatment is initiated with a calcium antagonist, felodipine, at a dose of 5 mg once 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 dose adjustments are made in accordance with a set protocol. As a fifth and final step a diuretic may be added. Side effects have been relatively few in this large multinational series of intensively treated hypertensive patients. Only ankle edema, 2.6% and 3.0%, and coughing, 1.3% and 0.8%, in young and elderly patients, respectively, exceed a frequency of 1%, and 88% of all patients are still taking their baseline therapy felodipine after one year. The one-year data presented here indicate that it should be possible to fulfill the primary aims of the HOT Study.
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PMID:The Hypertension Optimal Treatment (HOT) Study: 12-month data on blood pressure and tolerability. With special reference to age and gender. 853 54

Aspirin and other non-steroidal anti-inflammatory drugs (NSAID) are being used increasingly. A positive correlation has been shown between epistaxis and the use of NSAID in the over 50s. This prospective study compared the NSAID intake and platelet function in 50 patients with epistaxis and 50 controls. Standard haematological parameters and the platelet response to collagen and arachidonic acid aggregation and adenosine triphosphate release were measured. The patients showed a significant increase in NSAID intake (P < 0.01, 95% confidence for the difference in the medians = 4-36%) and hypertension (for diastolic blood pressure > 100 mmHg, P < 0.01, 95% confidence for the difference in the medians = 5.9-16.1). The patients showed a significant reduction in platelet aggregation to collagen (P = 0.025). Non-steroidal anti-inflammatory drugs produce a significant platelet dysfunction which should be considered in the multifactorial aetiology of epistaxis.
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PMID:Do patients with epistaxis have drug-induced platelet dysfunction? 858 70

Aspirin renography, a new approach for the detection of renovascular hypertension, is described and compared with captopril scintigraphy. The behaviour of the new radiopharmaceutical 99mTc-ethylenedicysteine is examined for the first time in patients with impaired renal function and compared with 99mTc-mercaptoacetyltriglycine and with orthoiodohippurate. It is not yet possible to draw final conclusions about the advantages of aspirin renography and 99mTc-ethylenedicisteine over established methods and radiopharmaceuticals, respectively. In the diagnostic evaluation of renal transplants the degree of parenchymal retention is crucial. A newly described method for its quantitation is simpler and apparently more accurate than the excretion index frequently used.
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PMID:Radionuclide techniques for the evaluation of renal function: advantages over conventional methodology. 859 Oct 61


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