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

Coronary heart disease is the leading cause of death among patients with non-insulin-dependent diabetes mellitus (NIDDM). NIDDM patients have a high frequency of dyslipidemia, which along with obesity, hypertension, and hyperglycemia may contribute significantly to accelerated coronary atherosclerosis. Because risk factors for coronary heart disease are additive and perhaps multiplicative, even mild degrees of dyslipidemia may enhance coronary heart disease risk. Therefore, therapeutic strategies for management of NIDDM should give equal emphasis to controlling hyperglycemia and dyslipidemia. The National Cholesterol Education Program recently issued guidelines for treatment of hyperlipidemia in adults including diabetic patients. Because of the unique features of diabetic dyslipidemia, however, we suggest that certain modifications in these guidelines be made to meet specific needs of diabetic patients. For example, therapeutic goals for serum cholesterol reduction should be lower in diabetic patients than in nondiabetic subjects. Particular emphasis should be given to weight reduction in NIDDM patients. In some diabetic patients, monounsaturated fatty acids may be a better replacement for saturated fatty acids than carbohydrates. The target for cholesterol lowering should include both very-low-density lipoprotein and low-density lipoprotein (LDL) (non-high-density lipoprotein) rather than LDL alone. To obtain a substantial reduction of cholesterol levels, drug therapy may be required in many patients. However, first-line drugs for nondiabetic patients (nicotinic acid and bile acid sequestrants) may be less desirable in NIDDM patients than hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors and even fibric acids. In fact, HMG CoA reductase inhibitors may be the drugs of choice for NIDDM patients with elevated LDL cholesterol and borderline hypertriglyceridemia, whereas gemfibrozil appears preferable for NIDDM patients with severe hypertriglyceridemia.
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PMID:Management of dyslipidemia in NIDDM. 219 Jul 70

Screening for dyslipoproteinemias should be undertaken in all individuals older than 20 years of age at least once every 5 years. The initial screening, as recommended by the Adult Treatment Guidelines Panel of the National Cholesterol Education Program, is to determine the concentration of total blood cholesterol. This initial determination can be made on blood obtained in the nonfasting state. Further evaluation of the patient's lipoprotein concentrations is dependent upon the presence of other cardiovascular risk factors. in the absence of definite coronary heart disease, hypertension, diabetes mellitus, a family history of coronary artery disease, cigarette smoking, or severe obesity, the patient with a total blood cholesterol concentration less than 200 mg/dL requires no specific instruction and should have a repeated screening performed within 5 years. Patients with blood cholesterol concentrations greater than 200 mg/dL should have their lipoprotein profiles determined if they have atherosclerotic cardiovascular disease or two other cardiovascular disease risk factors. The lipoprotein profile includes the determination of fasting cholesterol and triglyceride and HDL cholesterol concentrations. From these values, the LDL cholesterol concentration can be calculated. This LDL cholesterol concentration is central in selecting the appropriate therapy. HDL cholesterol concentrations may be useful in evaluating patients with ischemic heart disease. Concentrations of HDL cholesterol less than 35 mg/dL are associated with increased risk for coronary artery disease. Although there is currently no convincing evidence that support the specific treatment of depressed HDL cholesterol concentrations, therapy directed to modulating lipoprotein metabolism in patients with heart disease and low HDL concentrations may be of benefit. Patients with recurrent abdominal pain, pancreatitis, and eruptive xanthomatosis frequently have fasting hypertriglyceridemia concentrations exceeding 1000 mg/dL. These patients should be identified in order to effectively reduce their triglyceride concentrations, which can prevent these complications.
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PMID:Detection and evaluation of dyslipoproteinemia. 219 76

The occupational health nurse should be attuned to issues and research regarding prevention of CVD. Risk reduction programs in industry should adhere to the recommendations of groups such as the Adult Treatment Panel of the National Cholesterol Education Program, the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, and the American Health Association. Despite significant reductions in CVD mortality, continued research is needed to further our knowledge of CVD risk factors among high risk populations.
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PMID:Cardiovascular disease risk factor reduction and the occupational health nurse. 220 44

Reasons for the current emphasis on cholesterol as coronary risk factor are multiple. On one hand current studies have shown that primary as well as secondary prevention of ischemic heart disease is a realistic possibility with lipid lowering measures. On the other hand new drugs are actually available which permit a potent and adapted therapy of hyperlipidemias. According to new guidelines of the Swiss "lipid task force" screening for hypercholesterolemia is recommended. A cholesterol value greater than 6.5 mmol/l should be investigated and treated. Because a great proportion of adult Swiss fall into this category (approximately 1/3) it is essential that all those are efficiently treated that have markedly abnormal cholesterol values or present with other risk factors such as smoking and hypertension or have a personal or familiar history of ischemic heart disease. Because progression is likely in patients with or after manifest ischemic heart disease even when hypercholesterolemia is mild (over 5.2 mmol/l) all patients presenting with an infarct should be investigated for dyslipidemia. Cholesterol, triglycerides and HDL should be determined. Dietary measures are the basis of every attempt to reduce hyperlipidemia. Most importantly intake of saturated fats prevailing in animal products should be restricted. The next important step is reduction of dietary cholesterol and in obese patients also caloric restriction. Lipid lowering agents are recommended in patients at risk who do not respond to or comply with dietary regimens. According to type of dyslipidemia bile-acid-binding resins, fibrates, nicotinic acid or HMG-CoA reductase inhibitors are available.
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PMID:[Lipid-lowering therapy in the prevention of coronary heart disease]. 221 47

The U.S. Preventive Services Task Force recommendations for screening for hypertension and high blood cholesterol are generally consistent with preexisting national guidelines promulgated by the Joint National Committee for Detection, Evaluation, and Treatment of High Blood Pressure and the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Cholesterol in Adults. While a welcome addition to the armamentarium of the clinician, the Task Force recommendations represent only a partial solution to our current epidemic of blood-pressure- and cholesterol-related cardiovascular disease. A meaningful reduction in society's burden of cardiovascular disease can be achieved only by complementing the Task Force recommendations with community-based mass treatment strategies aimed at shifting the distribution of blood pressure and cholesterol toward a biologically more normal pattern.
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PMID:Reflections on the U.S. Preventive Services Task Force recommendations for screening for hypertension and hypercholesterolemia. 223 Oct 58

Fasting and one hour post-glucose load blood samples were obtained from 497 participants in the Hypertension Detection and Follow-up Program (HDFP), 79.8% of whom were on antihypertensive therapy at the time of their five-year examination. Major findings include a positive correlation between glucose/insulin ratio and serum potassium (P = 0.0014) and a weaker negative correlation between fasting insulin and serum potassium (P = 0.004). These data are compatible with a primary effect of hypokalaemia producing insulin 'resistance'. In addition, the glucose load was followed by a mean reduction in serum potassium of 0.135 +/- 0.525 meq/l (P less than 0.001). Twenty percent of participants experienced a drop of more than 0.5 meq/l. Cholesterol was associated with the fasting glucose/insulin ratio (P less than 0.032). The results are compatible with the hypothesis that prevention of hypokalaemia may prevent certain metabolic effects attributed to thiazide.
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PMID:The effect of thiazide therapy on glucose, insulin and cholesterol metabolism and of glucose on potassium: results of a cross-sectional study in patients from the Hypertension Detection and Follow-up Program. 228 39

The National Cholesterol Education Program treatment guidelines define a plasma total cholesterol of less than 200 mg/dl as "desirable" and recommend no further evaluation of plasma lipid or lipoprotein levels in patients with coronary artery disease (CAD). To determine the prevalence of dyslipidemias in the presence of coexistent CAD and total cholesterol less than or equal to 200 mg/dl, a retrospective case-control study of 1,000 patients who underwent diagnostic coronary angiography was performed. Of 351 patients with total cholesterol less than or equal to 200 mg/dl, 76% of the men (244) and 44% of the women (107) had angiographically demonstrated CAD. In men with CAD and total cholesterol less than or equal to 200 mg/dl, there was a significantly greater prevalence of low levels of high density lipoprotein (HDL) cholesterol (less than or equal to 35 mg/dl), age greater than 50 years, systemic hypertension and diabetes mellitus compared to non-CAD control subjects. In women with CAD and total cholesterol less than or equal to 200 mg/dl, HDL cholesterol less than or equal to 45 mg/dl and diabetes mellitus were also significantly prevalent. Multiple logistic regression analyses revealed that HDL cholesterol, hypertension and age in men and very low density lipoprotein cholesterol in women were significantly associated with CAD after adjustment for other risk factors. These results suggest that a complete lipid and lipoprotein analysis be obtained in all patients with CAD, irrespective of the plasma (or serum) total cholesterol level.
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PMID:Dyslipidemias with desirable plasma total cholesterol levels and angiographically demonstrated coronary artery disease. 229 75

High K diets prevent hypertensive endothelial injury and intimal thickening. Cholesterol esters often deposit during hypercholesterolemia. Would a high K diet influence cholesterol ester deposits? In a normal rat on a normal diet, no cholesterol esters are detected in the aorta. Stroke prone SHR rats were fed for 3 months a basic diet containing 4% cholesterol, 14% coconut oil and 7% NaCl. One group of 13 rats had normal (.5%) K in the diet. Another group of 10 rats ate high (2.1%) K. Mean intraarterial blood pressures averaged 165 mm Hg in the normal K group and 161 mm Hg in the high K group (P = NS). The serum cholesterol averaged 229 mg/dL in the normal K group and 214 in the high K group (P = NS). Total aortic cholesterol esters per rat involving 16 and 18 carbon chain fatty acids averaged 187 micrograms in normal K v 68 micrograms in high K, measured by gas chromatography. These were the main esters; other esters were negligible. Thus high K reduced cholesterol ester deposits by 64% (P less than .0003), even though blood pressure and cholesterol levels were quite similar in the two groups. Both high cholesterol and high BP injure endothelial cells and increase invasion of macrophages and vascular smooth muscle cells into the intima and increase endothelial permeability to proteins. With high plasma cholesterol, these processes lead to atherosclerosis with cholesterol ester deposition. The high K diet, by protecting endothelial cells, can greatly decrease this cholesterol ester deposition. This effect could possible be useful for preventing atherosclerotic complications such as heart attacks in human hypertension.
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PMID:High K diets markedly reduce atherosclerotic cholesterol ester deposition in aortas of rats with hypercholesterolemia and hypertension. 230 40

The section for preventive cardiology within the Danish Society for Cardiology has established a lipid group with representatives from The Danish Society for Clinical Chemistry, The Danish Society for Internal Medicine, The Danish Society for Cardiology, The Danish Society of Hypertension, The Danish College of General Practitioners, and The Danish Paediatric Society. The lipid group has elaborated recommendations for clinical chemical departments regarding lipid and lipoprotein analyses. The group suggests that doctors ordering lipid and lipoprotein analyses are offered the following: S-Cholesterol (total), substance conc., (fPt)S-Triglycerides, substance conc., S-HDL-cholesterol, substance conc., and (fPt)S-LDL-cholesterol, substance conc. (calculated). It is recommended that the biological variation be minimized by sampling in a sitting position after a 15 minutes' rest and by basing the clinical decision on a minimum of 2-3 determinations with an interval of about one month. The analytical variations should be reduced to below 3% (calculated as the variation coefficient), and it is recommended that laboratories participate in external quality control systems at least four times annually by reporting at least two human reference materials with different concentrations. As the use of reference intervals dependent on age and sex, based on random samplings of the background population, are less informative, it is recommended to refer to cutoff values for the clinical decision. The following cutoff values are recommended: S-Cholesterol (total), substance conc.: 6 mmol/l, (fPt)S-Triglycerides, substance conc.; 2.5 mmol/l, S-HDL-cholesterol, substance conc.: 0.9 mmol/l (fPt)-LDL-cholesterol, substance conc. (calculated): 4.5 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Recommendations for clinical-chemical departments: lipid-lipoprotein analysis]. 765 14

A decision-analytic model was developed to project the future effects of selected worksite health promotion activities on employees' likelihood of chronic disease and injury and on employer costs due to illness. The model employed a conservative set of assumptions and a limited five-year time frame. Under these assumptions, hypertension control and seat belt campaigns prevent a substantial amount of illness, injury, and death. Sensitivity analysis indicates that these two programs pay for themselves and under some conditions show a modest savings to the employer. Under some conditions, smoking cessation programs pay for themselves, preventing a modest amount of illness and death. Cholesterol reduction by behavioral means does not pay for itself under these assumptions. These findings imply priorities in prevention for employer and employee alike.
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PMID:Can organizations benefit from worksite health promotion? 249 56


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