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

Lipid and carbohydrate metabolism variables were studied in twenty-eight patients with chronic renal failure (mean GFR 7.7 +/- 2.5 ml/min) and uraemic symptoms. 71% of the patients had hypertriglyceridaemia (greater than or equal to 2.2 mmol/l). Total serum cholesterol was normal while VLDL cholesterol was high and alpha-lipoprotein cholesterol was low. The fractional elimination rate of Intralipid was low and inversely correlated to serum triglyceride levels. Intravenous glucose tolerance was reduced with normal or slightly increased fasting blood glucose and insulin values before and during the test. Serum triglycerides were correlated to plasma insulin but not to residual renal function or serum urea levels. The cause of hypertriglyceridaemia and lowering of alpha-Lp cholesterol is not unequivocally clear. Present evidence indicate that retarded catabloism of triglyceride-rich lipoproteins is important but accentuated release of triglyceride-rich lipoproteins may have occurred in a number of cases. The commonly used treatment with beta-blocking agents for hypertension in chronic renal failure may accentuate certain of the metabolic responses in uraemia.
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PMID:Lipid and carbohydrate metabolism in uraemia. 23 60

1. Seven latent hypertensive patients and seven matched controls were subjected to standardized mental stress and orthostatic provocation. 2. Mental stress increased blood pressure by approximately 25%, heart rate by 25 beats/min, plasma glycerol by 50% and plasma cyclic AMP by 25% in both groups. Plasma glucose and renin activity were unchanged. Plasma noradrenaline and adrenaline were essentially unchanged during stress. 3. There was an insignificant tendency towards higher noradrenaline levels in latent hypertensive subjects and two of these subjects displayed an exaggerated noradrenaline response to standing. 4. Our results indicate that the physiological responses to mental stress are caused by selective neuronal activation, rather than by generalized sympatho-adrenal activation. Latent hypertension does not seem to be associated with adrenergic hyperactivity or receptor supersensitivity, except possibly in individual cases.
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PMID:Sympatho-adrenal and cardiovascular response to mental stress and orthostatic provocation in latent hypertension. 23 22

Eight patients on chronic haemodialysis for six months to 7 years with hypertension resistant to ultrafiltration and antihypertensive therapy, received Captopril (SQ 14, 225) an orally active inhibitor of converting enzyme. With this therapy, blood pressure was controlled in the 4 patients with the highest plasma renin activity. In the other 4, this treatment had to be supplemented with "isovolumetric salt subtraction", i.e. following conventional dialysis, 1-2 litres of ultrafiltrate were replaced by an equal volume of 5% glucose. The slight hyponatraemia induced by this procedure (plasma sodium 128mmol/L) was well tolerated. This procedure allows the removal of an excess of body sodium and seems to be effective even when conventional ultrafiltration during dialysis has failed. Administration of Captopril either alone or combined with "isovolumetric salt subtraction" induced good control of blood pressure in all 8 patients.
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PMID:Captopril and salt subtraction to treat "uncontrollable" hypertension in haemodialysis patients. 23 15

The typical patient with diabetes mellitus seen at major hospitals in Papua New Guinea between 1974 and 1977 had florid symptoms, a very high blood glucose, was non-obese and non-ketotic and, frequently had neuropathy and proteinuria. In 25% hypertension was present which was significantly more common in the presence of proteinuria. Diagnosis was often delayed by failure to test urine for glucose and treatment was usually ineffective so that coma, usually non-ketotic, severe infections and gangrene occurred frequently. Although not as common as in other South Pacific countries, diabetes is increasing in Papua New Guinea. The provision of simple adequate facilities to test urine for glucose in all hospitals and the establishment of diabetic out-patient clinics in major centres to instruct both patients and other health workers are essential to improve treatment and reduce mortality and morbidity.
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PMID:The clinical characteristics of diabetes mellitus in Papua New Guinea. 29 6

Thirteen patients with advanced hypertensive disease insufficiently controlled by conventional drugs were treated with minoxidil in combination with a beta-blocking agent and a thiazide in a long-term study. A reduction from 214 +/- 5/122+/3 to 166 +/- 7/95 +/- 3 mm Hg in the mean supine blood pressure was obtained. The dosage range of minoxidil was 7.5-35 mg per day (mean 18.8 mg), and in all cases beta-blockade was necessitated by the occurrence of reflex tachycardia. Only two of the patients were found to be unsatisfactorily controlled on combined therapy. In five cases, minoxidil was disontinued during the observation period, but only in three cases was the discontinuation due to side effects, v.z. sodium retention and augmented hair growth. Stable diabetes developed in one patient, and in two cases of established, dietetically treated diabetes oral antidiabetic drugs had to be administered. Five non-diabetic patients showed no significant changes in fasting plasma glucose and the K values in intravenous glucose-tolerance tests. Minoxidil seems to be a safe and potent antihypertensive drug for long-term use in severe arterial hypertension, but it cannot be recommended for routine treatment.
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PMID:Long-term experiences with minoxidil in combination treatment of severe arterial hypertension. 30 92

Blood glucose and plasma insulin levels were studied under fasting conditions and following an i.v. and an oral glucose load, respectively, in nine males with moderate hypertension before treatment, after one month on placebo and after three months on the cardioselective beta-receptor blocking agent metoprolol. The studies were performed under metabolic ward conditions. The reproducibility of blood glucose and plasma insulin values following an i.v. glucose load was very good. Medication with metoprolol caused no changes in the fasting levels of blood glucose or plasma insulin, nor in the blood glucose response following a glucose load given i.v. or orally. The initial and total integrated insulin response to the i.v. administration of glucose was similar before and during metroprolol. Following oral glucose both the total integrated blood glucose response and the insulin response were unaffected by treatment with metoprolol.
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PMID:Glucose tolerance and insulin release in hypertensive patients treated with the cardioselective beta-receptor blocking agent metoprolol. 33 95

Cardiovascular complications of oral contraceptives (OCs) are discussed. OCs are safe for most young women for temporary birth control, however, they should not be used by women over age 35 who want no more children. Problems such as hypertension, increased tendency to clot, a rise in triglycerides, and a decrease in glucose tolerance occur in 5-10% of women of any age who take OCs for 5 years. These factors in turn are responsible for complications such as thromboembolism, heart attack, and stroke which occur with increased frequency among OC users. Most who take OCs suffer more subtle disturbances in blood pressure, and biochemical and hormonal levels which may pose additional risks for cardiovascular disease. It is concluded that the risks of OC use often outweigh the benefits, however, prudent use of OCs will improve the balance between risk and benefit.
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PMID:Cardiovascular complications of oral contraceptives. 34 38

Three hundred forty nine hypertensive patients above the age of 60 have entered the double-blind multicentre trial of the European Working Party on High blood pressure in the Elderly (EWPHE). After stratification and randomisation half were treated with one or two capsules containing 25 mg hydrochlorothiazide and 50 mg triamterene and if blood pressure control was insufficient methyldopa was added up to 2 g daily; the other half received matching placebo. No significant differences between the groups were present prior to randomisation. A significant blood pressure difference of 25/10 mm Hg was obtained between the groups and maintained during two years of follow-up. No major disturbances in serum potassium or serum sodium were noted with the present drug combination. However, during the initial phase an increase in serum creatinine and serum uric acid was noted in the actively treated group, which was maintained for two years. Also glucose tolerance was impaired after 2 years in the actively treated group. A favourable influence on prognosis by active treatment can be expected on the basis of the blood pressure reduction and in the absence of major electrolytes disturbances. But this benefit must be proven by observed statistical differences in terminating events between the groups. Therefore the patients are being followed for a longer period of time and more patients are admitted into the trial.
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PMID:Antihypertensive therapy in patients above age 60. Third interim report of the European Working Party on High blood pressure in Elderly (EWPHE). 35 97

Surgical procedures can be accomplished successfully in patients with uremia provided certain principles of perioperative management are observed. Preoperative dialysis minimizes the biochemical derangements and improves fluid balance, hypertension and hemostasis. Drug schedules are adjusted in consideration of abnormal metabolism in renal disease. Anesthetic management is modified in recognition of potentially adverse or altered activity of anesthetic agents and neuromuscular relaxants. The lightest plane of anesthesia consistent with expeditious operative technique is maintained, since adequate tissue oxygenation is dependent upon increased cardiac output in these invariably anemic patients. Intraoperative hyperventilation sustains the usual compensatory mechanism for uremic metabolic acidosis in the conscious patient, thereby averting increments in serum potassium levels associated with increasing acidosis. Postoperative morbidity may include shunt thrombosis, infection, impaired wound healing, bleeding, pericarditis, pleuritis and pancreatitis. Hypervolemia and hyperkalemia are best managed by early postoperative dialysis. A period of nutritional support using intravenous essential L-amino acids and hypertonic glucose appears promising, especially when gastrointestinal dysfunction exists.
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PMID:Renal failure and the surgeon. 40 28

This study explored racial patterns of heart rate in a large population of employed Chicagoans: 39,665 adults screened in Chicago firms between late 1967 and early 1973. Of these, 30,876 were white or black adults age 18--64 with complete data, and not on drug therapy for hypertension. Mean heart rates of young black men and women were significantly lower than mean heart rates of young white men and women. This difference was not present for the age groups 35 and older. The difference was present in both smokers and non-smokers; in normotensives and in persons with elevated blood pressure; and could not be explained by differences in relative body weight. The difference persisted after simultaneous adjustment for differences in the mean values of systolic blood pressure, relative weight, serum cholesterol, post-loaded plasma glucose, and number of cigarettes smoked per day.
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PMID:Racial patterns of heart rate in an employed adult population. 47 64


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