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

The value of measurements of the fibrinolytic factors, tissue plasminogen activator and plasminogen activator inhibitor, for predicting death and non-fatal cardiovascular events was studied in 213 consecutive patients with angiographically documented coronary artery disease. In the course of 4-year follow-up, 47 patients (22.1%) had at least one cardiovascular event. We found the incidence of cardiovascular events to be positively associated with high tissue plasminogen activator antigen concentration, in addition to previous myocardial infarction, low ejection fraction, hypertension, high body mass index and high triglyceride levels. Cholesterol was not found to be associated with cardiovascular events. A high concentration of tissue plasminogen activator antigen thus implies an increased risk of cardiovascular events in patients with severe angina pectoris.
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PMID:Tissue plasminogen activator and other risk factors as predictors of cardiovascular events in patients with severe angina pectoris. 190 50

Hyperlipidemia is prevalent in hypertension, but the cause of this association is unknown. Treatment of hypertension with thiazide diuretics accentuates the hyperlipidemia, perhaps by causing potassium or sodium depletion. To assess the role of hypokalemia in thiazide hyperlipidemia, I measured lipid concentrations while using a spironolactone-thiazide regimen to prevent potassium wastage during the treatment of hypertension. Blood pressure decreased substantially, but hyperlipidemia occurred despite the maintenance of normal serum potassium. To test a role of sodium balance, I measured lipid levels during periods of sodium feeding and placebo therapy. Cholesterol levels decreased during sodium administration. Carrying this information to therapy, I participated in a multicenter comparison of enalapril and indapamide therapy in resistant hypertension. Both regimens caused minor metabolic effects, but indapamide provided superior antihypertensive potency. This evidence suggests that sodium feeding improves lipid metabolism, but sodium diuresis enhances an antihypertensive effect. Low-dose therapy combining a diuretic, such as indapamide, with a nondiuretic agent promises to improve metabolic tolerance and maximize hypertension control. This strategy optimally lowers overall cardiovascular risk.
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PMID:Hyperlipidemia in hypertension: causes and prevention. 192 88

Cardiovascular disease remains the major cause of death in the industrialized world with dyslipidemia, hypertension and cigarette smoking leading a long list of risk factors. Recently, controversy arose from some critical articles expressing concern about the evaluation and interpretation of statistical data of epidemiologic studies. One study using covariance analysis reported an absence of the widely accepted negative association between coronary heart disease (CHD) and high density lipoprotein (HDL) cholesterol. Also criticism was expressed regarding the cost-effectiveness of preventive measures such as the use of lipid lowering drugs on life expectancy. Because of such recent scientific controversy and discussions already taking place in the media, we have summarized in this article recent epidemiologic evidence including a meta-analysis of the major epidemiologic studies on HDL. We have directed particular attention to 3 large epidemiological studies, i.e., the Familial Atherosclerosis Treatment Study (FATS), the Program on the Surgical Control of the Hyperlipidemias (POSCH), and the Cholesterol Lowering Atherosclerosis Study (CLAS), all of which have clearly demonstrated a desirable effect of intensive lipid lowering therapy on coronary lesions.
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PMID:[Risk factors for coronary heart disease]. 194 9

The aim of this study was to evaluate the decision of the Dutch Cholesterol Consensus Meeting in 1987 to screen selected groups of persons for the identification of individuals with hypercholesterolemia. During 8 weeks serum cholesterol levels were measured in all 305 newly referred patients to the outpatient clinic of general internal medicine of the University Hospital Nijmegen. Information on age, sex, smoking habits and the selection variables was obtained. Of the patients 4 were referred because of hypercholesterolemia, 11 were excluded because of disease which could influence cholesterol levels. The results of 270 patients were available for evaluation. For statistical analysis the t test and linear and logistic regression analysis were used. Of the patients 87 individuals (32%) would have been candidates for selective screening; in 20 (23%) serum cholesterol levels were increased (greater than or equal to 6.5 mmol/l). Selective screening would have identified 20 of 42 hypercholesterolemic individuals (48%). Age showed a significant correlation with serum cholesterol levels (p less than 0.001); after correction for age, selective screening did not identify more hypercholesterolemic patients (p greater than 0.4). The serum cholesterol level appeared to be higher in the group meeting the selection criteria (p = 0.04). Among these criteria only hypertension was significantly correlated with serum cholesterol levels (p = 0.02) but sensitivity and predictive value for hypercholesterolemia were low. To identify a larger proportion of hypercholesterolemic individuals selective screening does not appear useful. If selective screening is chosen however, it should focus on hypertensive patients, also because the identification of patients with several risk factors is important from a prevention point of view.
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PMID:[The value of selective screening for the diagnosis of hypercholesterolemia]. 200 86

Coronary heart disease is the leading cause of mortality among persons with diabetes mellitus, but the factors that account for this high coronary heart disease mortality remain unclear. In the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study, conducted from 1982 to 1984, 92 deaths from coronary heart disease were found to have occurred among 602 diabetic participants and 558 deaths from coronary heart disease were found to have occurred among 12,562 nondiabetic participants during the follow-up period (1971-1984; average follow-up, 10 years). Using proportional hazards analysis, the authors found age, male sex, severe overweight, and non-leisure-time physical inactivity to be significantly associated with coronary heart disease mortality among persons with diabetes. Age, male sex, current smoking, hypertension, and non-leisure-time physical inactivity were associated with all-cause mortality. Cholesterol showed a more complex relation to all-cause mortality. The strength of the associations between risk factors and all-cause and coronary heart disease mortality did not differ significantly among persons with and without diabetes. These results reinforce the importance of controlling coronary heart disease risk factors among persons with diabetes.
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PMID:Risk factors for mortality from all causes and from coronary heart disease among persons with diabetes. Findings from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. 846 Jun 29

The principles of cost-effectiveness analysis are straightforward and can be applied to set priorities among competing uses for resources. This article examines the relationship between serum cholesterol and coronary heart disease (CHD) risk, drawing on information from a number of large intervention trials. The cost-effectiveness of treatment alternatives for elevated serum cholesterol, hypertension, and symptomatic CHD are compared. Concern is expressed that the guidelines issued by the National Cholesterol Education Program extend beyond the available evidence and do not adequately take into account problems with adherence to diet and drug regimens or the cost of widespread implementation. The cost-effectiveness of drug treatment for both high cholesterol and hypertension depends on the populations at which they are targeted.
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PMID:Costs and benefits of risk factor reduction for coronary heart disease: insights from screening and treatment of serum cholesterol. 210 65

Similarities between atherosclerosis and glomerulosclerosis suggest that hyperlipidaemia may contribute to glomerular injury. Dietary supplementation with 4% cholesterol + 1% cholic acid was administered to rats 4 weeks after 1 1/3 nephrectomy and continued for 7 weeks. There was a significant increase in serum cholesterol (peak = 11.52 +/- 1.09 mmol l-1 vs. 4.73 +/- 0.31 on control diet, P less than 0.001) and triglyceride concentrations (peak = 2.31 +/- 0.27 mmol l-1 vs. 1.41 +/- 0.29, P less than 0.05) and a marked increase in beta-migrating lipoproteins. The severity of hypercholesterolaemia was significantly correlated with proteinuria (control diet: r = 0.600, cholesterol diet: r = 0.672, P less than 0.0001) as was hypertriglyceridaemia (control diet: r = 0.544, cholesterol diet: r = 0.678, P less than 0.0001). The percentage of glomeruli containing lipid deposits was increased from 21% to 60% (P less than 0.05). The kidney total cholesterol content was increased from 29.2 +/- 0.8 to 47.7 +/- 3.3 mumols g-1 dry weight (P less than 0.0001), with esterified cholesterol increasing from 7.5 +/- 0.4% to 14.5 +/- 2.1% of total (P less than 0.01). Serum cholesterol concentration was significantly correlated with both glomerular lipid deposition (rs = 0.7195, P less than 0.0001) and tissue total cholesterol content (rs = 0.6053, P less than 0.001). Lipid vacuolation was prominent in the paramesangium and within mesangial cells. Despite these changes hypertension, uraemia, proteinuria and glomerulosclerosis were not significantly increased on the cholesterol diet. Cholesterol deposition in the glomeruli occurs secondary to hyperlipidaemia in rats following subtotal nephrectomy but over 7 weeks no exacerbation of glomerulosclerosis is detectable.
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PMID:The role of lipids in the pathogenesis of glomerulosclerosis in the rat following subtotal nephrectomy. 210 41

The relationship between hypertension, glucose metabolism, fibrinogen and plasminogen activator inhibitor of endothelial cell type (PAI-1) was studied under conditions in which the influence of obesity and adipose tissue distribution (waist/hip ratio) were controlled. Twenty-two non-obese, middle-aged men with normal blood pressure (n = 11) and untreated mild hypertension (n = 11), respectively, participated in the study. Cholesterol, triglyceride and insulin levels were higher in hypertensive men than in the control group. Glucose disposal was studied as an indicator of insulin sensitivity using the euglycaemic clamp technique. The insulin effect tended to be less marked in men with hypertension. PAI-1 was higher in hypertensive men compared to the controls. A strong positive correlation was observed between PAI-1 and insulin levels as well as blood pressure. PAI-1 and fibrinogen levels correlated negatively with the rate of glucose disposal. Thus, even in these non-obese and mildly hypertensive individuals, an enhanced metabolic risk factor profile for cardiovascular disease was found. The metabolic aberrations were related to elevated fibrinogen and PAI-1 levels which, in turn, increase the risk of thrombus formation.
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PMID:Elevated fibrinogen and plasminogen activator inhibitor (PAI-1) in hypertension are related to metabolic risk factors for cardiovascular disease. 232 74

Epidemiologic cohort studies such as Framingham, Tecumseh, Evans County and the Multiple Risk Factor Intervention Trial Cohort Study have shown, that hypercholesterolemia, hypertension and cigarette smoking are the strongest predictors for cardiovascular diseases and especially for coronary heart disease. From the intervention studies of the last two decades it has been learn that reductions of the risk factors hypercholesterolemia and hypertension have led to the predicted reductions in cardiovascular and all cause mortality. Two strategies are available for the prevention of hypercholesterolemia and hypertension: The population strategy and the high risk strategy. With regard to cholesterol and blood pressure the population approach strives for the shifting of the respective population distributions to the left i.e. to lower values. The high risk strategy on the other hand restricts itself to the 10-20% of the population with very high values. A comparison of the population and high risk strategy shows, that only the population strategy is radical in that only this strategy is capable to eliminate the causes of the incidence of hypercholesterolemia and hypertension. The high risk strategy on the other hand is unable to influence the total distribution curve. Population strategy and high risk strategy should be seen as complementary. To further reduce mortality and morbidity from cardiovascular diseases in the Federal Republic of Germany the following public health programs and health policy strategies must be applied: a) Reinforcement of the National High Blood Pressure Education Program. b) Establishment of a National High Cholesterol Education Program. c) Nationwide Anti-smoking Campaigns and Programs.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prevention of classical risk factors. A public health and health policy task]. 218 72

Atherosclerosis and its various clinical manifestations are now highly predictable and preventable diseases. Dyslipidemia appears to be a necessary cause, and hypertension and cigarette smoking are both powerful and modifiable contributing causes. Health professionals should incorporate cardiovascular risk assessment and risk factor modification within the context of their delivery of personal health services. Such services probably already have contributed to the decline of cardiovascular mortality, and the current levels of risk factors in the United States population indicate that substantial further reduction should be possibly by creating a smoke-free environment by the year 2000 and by implementing the recommendations of the National Cholesterol and High Blood Pressure Education Programs.
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PMID:Cardiovascular risk factors. 218 65


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