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

Hypertensive patients with various renal lesions and a mean plasma creatinine of 2mg/100ml showed increases (p is less than 0.05) in mean exchangeable sodium and plasma renin activity, while blood volume was not altered significantly. Patients with mild renal failure and normal blood pressure demonstrated no consistent abnormalities in these parameters. Blood pressure correlated significantly with exchangeable sodium and with the 'sodium-renin' and 'blood volume-renin' products; but not with circulating renin or volume individually. This suggests that subtle abnormalities in the physiological sodium/volume-renin feedback mechanism may occur already in the earliest stages of renal disease and may contribute to the hypertension in such patients.
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PMID:Blood pressure, circulating renin and the body sodium/volume state in patients with mild renal failure. 93 20

Twenty-six patients with radiological unilateral chronic pyelonephritis, 36 patients with bilateral chronic pyelonephritis, 14 patients with papillary necrosis and nine patients with obstructive atrophy have been followed from five to 135 months for a total of 374 patient years. Serial changes in renal function and pyelographic appearances have been correlated with bacteriuria, analgesic ingestion, blood pressure and reflux. The calculated survival rate at five years was 95 per cent for patients with bilateral pyelonephritis and 92 per cent for patients with papillary necrosis. The ten-year survival rate was 86 per cent and 56 per cent respectively. The survival rate for patients with unilateral pyelonephritis and obstructive atrophy was 100 per cent at five and ten years. Bacteriuria was not associated with deteriorating renal function determined by serial plasma creatinine estimations. Although all patients in whom there was some radiographic change had bacteriuria on later review, other factors, including excess analgesic intake, reflux and stones were recognized in most. There was a high incidence of analgesic ingestion among patients whose renal function declined and in whom there was some change in serial radiographs. The prevalence of hypertension among patients with normal renal function was 12 and 28 per cent for patients with unilateral pyelonephritis and bilateral pyelonephritis respectively. There was a significant increase in both blood urea and plasma creatinine in all patients with hypertension (diastolic pressure greater than 90 mm Hg) and a much higher prevalence of hypertension in patients whose plasma creatinine exceeded 1.3 mg/100 ml. Thrity per cent of patients with unilateral pyelonephritis and 50 per cent with bilateral pyelonephritis had vesicoureteric reflux of varying degrees. There was no evidence to suggest that major degrees of reflux (grade 3) was associated with further renal damage. These observations indicate the benign course of the majority of patients with radiological pyelonephritis. Control of blood pressure, and analgesic intake will help to preserve renal function whilst prevention of symptomatic urinary infection by long term low dose therapy will reduce morbidity.
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PMID:A prospective study of patients with radiological pyelonephritis, papillary necrosis and obstructive atrophy. 94 Sep 21

1. Blood pressure, blood volume and renal blood flow were determined in 101 men; forty-three were normal subjects and fifty-eight were untreated permanent essential hypertensive patients with normal renal function and equilibrated sodium balance. 2. A significant negative pressure-volume relationship was observed overall. The relationship could be expressed as a hyperbola whose slope expressed the reduction in blood volume per unit rise in pressure: the higher the blood pressure, the lower the slope. Thus essential hypertensive subjects have a smaller decrement in blood volume per unit rise in pressure than normal subjects. 3. The relation between change in blood volume and change in pressure was confirmed in each individual by defining for each a ration deltaV/deltaP, statistically identical with the hyperbolic slope dV/dP. The deltaV/deltaP ratio was found to be well correlated with the renal blood flow and the creatinine clearance. No correlation existed between the total blood volume and these two renal parameters. 4. It is concluded that the present study demonstrates a blood volume regulation disturbance in essential hypertension and provides evidence from human studies that a renal defect accompanies high blood pressure.
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PMID:The pressure-volume relationship in normotensive and permanent essential hypertensive patients. 94 74

Three hundred and forty-six nulliparous women with pregnancy-induced hypertension prior to term were monitored in a high-risk pregnancy unit while awaiting fetal maturity. Management included ambulation as desired, regular hospital diet without salf restriction, blood pressure measured 4 times daily, weight and urine protein determined 3 times each week, creatinine clearance determined weekly, and serial sonography to monitor fetal growth. Sedation and antihypertensive agents were not prescribed. Delivery was delayed until term unless hypertension persisted or recurred following an initial salutary response. Factors other than hypertension that contributed to the decision to effect delivery were 1) rapid weight gain, 2) decreasing creatinine clearance, 3) appearance of significant proteinuria, 4) suspected fetal growth retardation, and 5) the development of severe headache or scotomata. With this method of management the perinatal mortality rate was 9/1000. Only 5 infants developed the respiratory distress syndrome and all survived. There were 26 women who left the unit against medical advice. Severe hypertension subsequently developed in 7 of these women and 4 of their fetuses were stillborn. The perinatal mortality rate among this group of patients was 154/1000. It is concluded that the nulliparous patient with pregnancy-induced hypertension prior to term can be safely managed by hospitalization and close observation as a viable alternative to prompt delivery.
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PMID:Management of pregnancy-induced hypertension in the nullipara. 94 68

Results of arteriographic investigation of patients with deteriorating renal function or poorly controlled hypertension have revealed that thrombosis of the renal artery is not an uncommon exacerbating factor. Seventeen patients with one or more occluded renal arteries had an operation to improve renal function or to control hypertension. Stenosis of the contralateral renal artery was present in addition to the occlusion in four patients. Reconstructive arterial procedures were performed in 15 patients and nephrectomy was performed in two. Eight patients with renal failure had marked improvement in renal function after revascularization of the occluded renal arteries. The group had a mean preoperative serum creatinine value of 7.95+/-1.81 (S.E.) milligrams per cent which fell postoperatively to 3.91+/-1.21 (S.E.) milligrams per cent at a mean follow-up period 20 months. Preoperative control of hypertension was difficult in 16 of the 17 patients. Postoperatively, the blood pressure fell to normal levels in six patients, and in an additional eight patients, it did so with the administration of antihypertension therapy. The hypertension was unchanged in two patients. Plasma renin activity was measured in 14 of the patients with hypertension. It was elevated in 13 patients and normal in one patient. Postoperatively, the blood pressure was unchanged in the patient with normal plasma renin activity, but in 12 of the 13 patients with elevated plasma renin activity, the blood pressure returned to normal levels. It is concluded that patients with occluded renal arteries should be treated surgically. The major benefits of an aggressive approach to this condition are reversal of renal failure and control of hypertension.
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PMID:Reversal of renal failure and control of hypertension in patients with occlusion of the renal artery. 95 62

A retrospective analysis of 235 patients at the National Institutes of Health who met at least five criteria for systemic lupus erythematosus (SLE) indicated that 45% were hypertensive. Approximately two thirds of these hypertensive patients had creatinine clearances of more than 60 ml/min and nonnephrotic range proteinuria. Only 16% of normotensive patients had creatinine clearances of less than 60 ml/m9n. A subgroup of 36 patients with SLE and with biopsy-proved diffuse renal disease were studied. For these patients, the presence of hypertension could not be correlated with the degree of proteinuria or hematuria, with the level of serum complement, or with the presence of casts, focal necrosis, crescent formation, or interstitial inflammation. Hypertensive patients had a median age of 24.5 years; the majority had creatinine clearances of more than 60 ml/min. In SLE, hypertension is not necessarily associated with advanced renal disease, and high blood pressure may occur relatively early in the course of the disease.
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PMID:Hypertension and renal disease in systemic lupus erythematosus. 96 43

Interrelations among blood pressure, exchangeable sodium, blood volume and plasma renin activity were studied in 40 normal subjects and in 40 patients with early stage kidney disease (mean plasma creatinine, 2 mg/100 ml). Findings in eight normotensive patients did not differ significantly from those in normal subjects. However, 32 hypertensive patients showed increases (p less than 0.05) in mean exchangeable sodium and in the products of the logarithm of plasma renin activity and exchangeable sodium or blood volume. In normal subjects, blood pressure did not correlate with any of the parameters measured. In the patients, it correlated significantly (p less than 0.05) with duration of hypertension (r = 0.70), exchangeable sodium (r = 0.34) and with sodium-renin (r = 0.38) or volume-renin (r = 0.30) products, but not with blood volume or circulating renin individually. Multiple regression analysis with blood pressure as a dependent variable, and duration of hypertension and the sodium-renin or volume-renin products as independent variables, revealed correlation coefficients of 0.77 and 0.76, respectively. These findings suggest that hypertension accompanying early stage kidney disease may depend at least partly on subtle abnormalities in the sodium volume-renin feedback mechanism as well as on a factor related to the duration of preexisting hypertension.
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PMID:Hypertension associated with early stage kidney disease. Complementary roles of circulating renin, the body sodium/volume state and duration of hypertension. 98 72

Preliminary results of this retrospective-prospective analysis of renal hypertension in 110 children indicate that hypertension may be secondary to a wide variety of acute progresive, and chronic renal diseases which may be either congenital or acquired. Affected children may be detected at any time from infancy through adolescence. Symptoms usually associated with acute glomerulonephritis (i.e., headache, swelling, nausea, vomiting, anorexia, fatigue, dizziness, and fever) occur in both acute and chronic renal diseases associated with hypertension. Headache and swelling are the most common symptoms in this series. Peripheral edema, rales, and increased heart size were found in between 10 and 25% of these children. Differential diagnosis may be approached by a consideration of causes of acute and chronic hypertension. The child with chronic renal disease usually presents with a long history of fatigability, poor growth, and pallor, and laboratory tests reveal elevation of the creatinine and BUN along with anemia, hypocalcemia, and hyperphosphatemia. In contrast, the child with acute renal disease and hypertension presents with a history of prior good health followed by the abrupt onset of signs and symptoms of renal disease; laboratory tests usually reveal modest elevations of creatinine and BUN, anemia is unusual, an abnormal urinalysis is common, and serum calcium and phosphorous levels are usually normal. Renovascular and asymmetric renal parenchymal disease represent uncommon but important conditions because surgery may be curative. Treatment may be surgical, medical, or combined. Surgical conditions include renal trauma, hydronephrosis, asymmetric renal disease, and renal arterial disease. Adequate blood pressure control without medication can be expected following surgery in instances of unilateral involvement with a normal contralateral kidney. Meticulous assessment of the contralateral kidney is needed to determine that it is normal. If surgery is unsuccessful or is not indicated, pharmacologic therapy is initiated with a stepwise regimen starting with the mildest agent (e.g., thiazides) and then adding additional antihypertensive drugs when adequate blood pressure control has not yet been achieved. The goal of therapy is the lowest, safest, tolerated blood pressure levels. Long-term, carefully designed studies of antihypertensive agents for children with renal hypertension are not available. The need for collection and critical analysis of data concerning the clinical course of children with renal hypertension is evident from a review of the literature and from the preliminary data presented in this series. The presentation of such information and a critique of outcome variables will provide a basis for program planning for affected children and improvement in patient care where indicated.
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PMID:Renal hypertension in children. 99 44

A screening study for coronary disease, chronical bronchitis, diabetes mellitus, hypertension, peripheral circulatory disturbance and overweight is described. 2429 persons aged over 40 years and working in two factories were studied. Typical laboratory tests, a short standardised examination by a physician and a questionnaire were used. In a 10 per cent sample the questionnaire was repeated by an interview and the serum was sent to the laboratory not only by mail, but also by a special car transport in a cooled transport box. The results of the laboratory tests are presend according to age, sex and factory. The family doctor had to be informed in nearly 70 per cent of the men and about 60 per cent of the women because of at least one suspicious symptom or sign. There was a pathological value of glucose in the urine in 14.7 per cent, a rise of glucose in the blood (above 113 mg per cent) in 5.7 per cent, of triglicerides (above 181 mg per cent) in 12.6 per cent, of cholesterol (above 264 mg per cent) in 15.4 per cent, of uric acid (male above 7.7 mg per cent, female above 7.1 mg per cent) in 6.8 per cent, of creatinine (above 1.3 mg per cent) in 6.4 per cent and the presence of albumin in urine in 2.2 per cent of the cases.
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PMID:[Preventive screening in two factories. I. Methods and results (author's transl)]. 100 75

Twenty-six patients with the syndrome of inappropriate secretion of antidiuretic hormone were reviewed. The underlying diseases were bronchogenic carcinoma (12 cases); myxoedema (five cases); diseases of the nervous system (five cases); bronchopneumonia, carcinoma of the oesophagus, acute intermittent porphria and chlorpropamide therapy (each one case). Serum sodium levels ranged between 104 and 125 mEq per litre. Eighteen patients presented neurological manifestations, which in 14 were considered to be due to hyponatraemia. Neurological signs included disorders of consciousness (stage I and II coma), extrapyramidal signs, asterixis and epileptic seizures. An hyponatraemic coma was the first manifestation of the syndrome in five cases. In all cases where the EEG was recorded it showed non-specific signs of metabolic coma. The fundi never showed signs of intracranial hypertension. Blood urea and creatinine levels were invariably low in the euthyroid patients; these values were normal or elevated in patients with myxoedema and hyponatraemia. Hypokalaemia was frequent, and hypocalcaemia constant. In eleven cases an excess of water intake revealed the clinical syndrome: six patients were excessive beer drinkers and five had received extensive intravenous infusions. In one case the deleterious effect of diuretics was evident, and in another, the syndrome became evident during radiotherapy of an oesophageal tumour. Treatment of the syndrome was successful in all cases. A review of the literature concerning the various pathogenic mechanisms corresponding to the different underlying diseases is presented. The concept of aberrant hormonal production by a tumour is illustrated by an electron microscopic study.
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PMID:Clinical, biological and pathogenic features of the syndrome of inappropriate secretion of antidiuretic hormone. A review of 26 cases with marked hyponatraemia. 100 53


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