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

Within the Targeted Programme of the Italian National Research Council "Preventive and Rehabilitative Medicine" subproject: Risk Factors, organized in nine centers on a national scale, the Operative Unit of Palermo carried out a transverse epidemiological study on a randomized population sample of western Sicily: Casteldaccia, 1984. 1.200 subjects subdivided by age in four decades (20-29; 30-39; 40-49; 50-59 years) and by sex (600 males and 600 females) were enlisted; the participation was 60.25% (No. 723; M = 364; F = 359). Following standardized procedures main cardiovascular risk factors were measured: glycaemia (GOD-PAP), triglycerides (enzymatic), total cholesterol (CHOD-PAP), HDL-cholesterol (MgCl2 dextran sulphate), apolipoproteins A1 and B (R.I.D.), B.M.I. (kg/m2), smoking habits and systolic and diastolic blood pressure (according to WHO manual on Cardiovascular Survey Methods). A questionnaire was used to record the familiar anamnesis, medical history of subjects, term of possible hyperglycaemia, current therapy (use of insulin, oral hypoglycaemic agent, dietetic treatment). The prevalence of diabetes mellitus was 8.16% (59/723): 4.67% (17/364) in males and 11.69% (42/359) in females. The most frequent risk factors associated with diabetes mellitus were; overweight (81%), hypercholesterolemia (49%), hypertriglyceridemia (45%), hypertension (37%) and cigarette smoking (15%).
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PMID:Prevalence of diabetes mellitus and of associated risk factors for atherosclerosis in a randomized population sample of western Sicily. Casteldaccia study. 280 36

The majority of epidemiological studies on the benefits and risks of oral contraceptive (OC) use have been conducted during the late 1960s and early 1970s when OCs had 50 mcg of estrogen. Based on these studies, the risk of death due to OC use for nonsmokers 35-39 years old was lower than using no contraceptive at all (14.1 deaths/100,000 women/year vs. 25.7 deaths/100,000 women/year). In addition to smoking, other contraindications include women with a history of angina, myocardial infarction, blood clots or stroke, estrogen dependent cancer, hypertension, a known lipid disorder, and women with hepatitis or cirrhosis of the liver. Suitable 35 year old candidates for OC use would be nonsmokers with blood group O, at low risk for cardiovascular disease, and who might receive additional benefits, including those with severe dysmenorrhea or hypermenorrhea and possibly those who have a strong family history of osteoporosis, early menopause, or ovarian cancer. Practitioners should take a thorough history of these women and give a physical examination with a blood pressure check. They should also administer screening tests, such as a PAP test, mammograms, a lipoprotein profile, and a glucose test. After the practitioners have deemed these women to be healthy based on the examination and the results of the screening test, they then should prescribe only a low dose OC containing 50 mcg of estrogen. Today most estrogen based OCs contain 35 mcg and research on their effects have not yet begun. Scientists expect to find that the dose response effects for risks for thromboembolism, myocardial infarction, stroke, and gallbladder disease to be lower in users of the low dose preparations.
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PMID:Risks and benefits of oral contraceptive use in women over 35. 323 16

Mild pulmonary artery hypertension (PAP, 29.6 +/- 10.6 mm Hg, mean +/- SD) due to a 3-fold elevation of pulmonary vascular resistance (PVR, 2.2 +/- 1.1 mm Hg X L/min) is a common finding in severe ARDS. A vasodilator such as nitroprusside (151 micrograms/kg X min) can be administered in early ARDS and will lower PAP and PAOP (capillary wedge pressure) while increasing cardiac output (CO) from 6.9 to 8.75 L/min X M2 and venous admixture from 23% to 31.6%. This suggests diffuse vasoconstriction is present in early ARDS. In 19 patients with severe ARDS, 13 had vascular occlusions on balloon occlusion angiography, and these occlusions correlated with increased post mortem counts of PA thrombi. At autopsy, there was a considerable increase of PA medial thickness and a reduction of lumen diameter. This hemodynamic and morphologic evidence suggests both vasoconstrictor and anatomic changes play major roles elevating the PVR in ARDS.
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PMID:Vascular components of ARDS. Clinical pulmonary hemodynamics and morphology. 361 11

Protamine administration has been associated with cardiac decompensation secondary to acute pulmonary vasoconstriction and subsequent right ventricular failure. To determine whether protamine infusion produced alterations in right ventricular performance, we evaluated both right and left ventricular function in patients receiving protamine infusion. The dose of protamine administered was calculated as adequate to reverse heparin as measured by the activated clotting time (ACT). Indices of right and left ventricular function obtained included right atrial pressure, right ventricular pressure, right ventricular ejection fraction, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, blood pressure, and heart rate. These measurements were obtained prior to protamine administration, at 1/2 total protamine dose, at completion of protamine infusion, and prior to sternal closure. No significant changes in right ventricular ejection fraction, right ventricular end-diastolic pressure, mean pulmonary artery pressure, or pulmonary vascular resistance were seen at any point during the study. Left ventricular function remained unchanged. Even in patients who are possibly at an increased risk (pulmonary artery hypertension, PAP greater than 25 mm Hg), no deterioration in right or left ventricular function could be demonstrated following protamine administration. These data suggest that protamine does not consistently exert a significant detrimental effect on right ventricular performance.
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PMID:Protamine: does it alter right ventricular function? 377 55

Hydralazine was administered short-term to 13 patients who had stable interstitial lung disease (ILD), pulmonary arterial hypertension (PAH); mean pulmonary arterial pressure ( [PAP]=26 +/- 9 mm Hg), and cor pulmonale (CP). All patients were studied at rest and during exercise. After intravenous hydralazine at rest, there were statistically significant increases in cardiac index (CI) (p less than 0.001), arterial oxygen saturation (SaO2) (p less than 0.01), and mixed venous saturation (S-vO2) (p less than 0.01). Pulmonary vascular resistance (Rp) (p less than 0.005) and systemic resistance (Rs) decreased (p less than 0.001), and PAP did not change. During exercise, PAP did not change; however, CI (p less than 0.01), PaO2 (p less than 0.001), and S-vO2 (p less than 0.01) increased further. The increase in Rp was significantly reduced (p less than 0.01). After continuation of oral hydralazine therapy in 12 patients for 7 days, PAP at rest was not statistically different from control; Rp and Rs remained decreased (p less than 0.001). The same results were found for CI, PaO2, S-vO2, and Rs during exercise. Although PAP did not change from control values, the drug significantly reduced the increase in Rp (p less than 0.005). Vasodilator therapy with hydralazine could be useful in patients with stable ILD who have inflammation with minimal to moderate fibrosis and PAH and might be used as an adjunct to conventional therapy for ILD and CP.
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PMID:Hemodynamic effect of hydralazine in interstitial lung disease patients with cor pulmonale. Immediate and short-term evaluation at rest and during exercise. 398 68

Although it is well known that the pulmonary circulation is altered in patients with pulmonary arterial or venous hypertension, the resultant hemodynamic behavior has not been systematically studied. We undertook to do so in a group of patients with pulmonary hypertension of diverse etiology. We measured pulmonary arterial (PAP) and occlusive wedge pressures and cardiac output at rest (i.e., standing) and during progressive upright treadmill exercise in 51 patients. Forty-two had chronic, stable, cardiac failure secondary to ischemic, myopathic or valvular heart disease and were grouped according to whether their mean PAP was less than (normotensive) or greater than (hypertensive) 19 mm Hg, and nine had pulmonary vascular disease of diverse etiology and were considered separately. In the majority of patients, we found that irrespective of whether the hypertension was arterial or venous in origin or etiology: the mean PAP-flow relationship was linear; pulmonary capillary wedge pressure was greater than or equal to the average closure pressure of the pulmonary vascular bed and could therefore be used as the downstream pressure in calculating pulmonary vascular resistance; and pulmonary vascular resistance declined with exercise. Notable exceptions to the third observation were patients with valvular heart disease or a resting pulmonary vascular resistance greater than 800 dyne-sec-cm-5.
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PMID:The pressure-flow response of the pulmonary circulation in patients with heart failure and pulmonary vascular disease. 406 71

The inhalation of toxic gases or vapours is capable of resulting in pulmonary oedema (P.O.), the mechanism of which corresponds, on the basis of a number of hemodynamic studies carried out, to that which characterises the so-called "lesional" pulmonary oedema, which is different from so-called "hemodynamic" oedema. Classically PAP, PCP and P wedge pressure have virtually normal values (normalisation of pulmonary arterial hypertension by correction of hypoxemia). CI and SWILV are normal or increased and pulmonary resistances are virtually normal. The origin of the oedema is thus related to an increase in alveolo-capillary permeability. The inhalation of toxic gases or vapours with a caustic or irritant action, or containing particles, however, usually adds on an obstructive syndrome, similar to a severe asthmatic attack. Under such conditions, the marked reduction in intrathoracic pressure during inspiration definitely favours pulmonary oedema by decreasing intra-alveolar pressure and by the accumulation of blood in the pulmonary circulation, and is capable of masking pulmonary arterial hypertension. Raised pressure, related to expiratory effort, on the contrary, decreases venous return and may result in collapse of the capillaries. Whilst the principal mechanism of PO by the inhalation of toxic gases or vapours is related to an increase in alveolo-capillary permeability, it is nevertheless important not to under-estimate the role of variations in intra-thoracic pressures which may constitute a provoking or at least aggravating element.
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PMID:[Pulmonary edema of toxic origin. Hemodynamic data]. 611 Dec 79

Thirty mongrel dogs were divided into 3 groups. Group I was a normal control group (n = 4) without transplantation procedure. Group II was a transplantation control group (n = 5) with left lung allotransplantation from heart-beating donor. Group III consisted of animals (n = 8) which received lung allografts from non-heart-beating donor following brain death. In Group III, brain death was brought about by intracranial hypertension with the inflation of balloon in the subdural space of donor. After 6 hours, the mechanical ventilation was discontinued followed by cardiac arrest. Left lung was excised twenty minutes after the cardiac arrest and was washed out with cold Ep4 solution for subsequent orthotopic allotransplantation. Right pulmonary arterial occlusion test (RPAO) were carried out under right thoracotomy to evaluate graft function immediately and 7 to 14 days after the surgery. PaO2, PAP and CO were measured before and 20 minutes after RPAO. All animals in Group II and 7 of 8 animals in Group III survived more than 7 days after surgery. No significant differences in the value of PaO2, mean PAP and TPVR with RPAO among three groups at each time of assessment, showing the possibility of lung transplantation from non-heart-beating donor followed by brain death.
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PMID:Experimental study of lung transplantation from non-heart-beating donor following brain death in canine model of left lung allotransplantation. 771 27

Glomerulonephritis demonstrable by immunohistochemistry may be present at post mortem in many patients without overt renal diseases. Systematic renal biopsies in severely hypertensive patients have shown a high prevalence of clinically undiagnosed glomerulonephritis. We have examined the kidneys of 423 consecutive subjects who came to post mortem and full-filled criteria for the diagnosis of hypertension. Patients were considered to be hypertensive if this had been clinically documented during life or if the heart weight/body weight ratio was > 0.005 in the absence of known other causes of cardiac hypertrophy. Normotensive controls were selected on the basis of clinically documented normal BP or a heart weight/body weight ratio of < 0.001. Kidneys were examined by immunohistology (PAP technique using human IgA, IgG, IgM antibodies). Excluding cases with liver cirrhosis, only two of the 337 patients with hypertension (= 0.6%) and none of the 49 normotensive patients had mesangial IgA deposits (P = 0.77). This finding argues against the frequent occurrence of latent glomerulonephritis in elderly patients with manifest hypertension.
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PMID:Prevalence of immunecomplex-associated glomerulonephritis in hypertensive subjects. 800 18

Phaeochromocytoma is a rare, autonomous catecholamine secreting tumour of the sympatho-adrenergic system. Due to the continuous or phasic secretion of catecholamines from the tumour, patients present with hypertensive crisis, episodic or sustained hypertension or arrhythmia. Excessive intraoperative hypertension unable to control by usual methods should be considered to be a phaeochromocytoma. Surgical removal of identified lesions should be performed under controlled conditions and after sufficient preparation of the patient. Preoperative alpha-adrenergic blockade with prazosin and phentolamine allows an increase in intravascular volume and affords some protection against excessive intraoperative hypertension. The use of beta-adrenergic antagonists is only recommended in patients with arrhythmia (especially tachycardia) and after induction of alpha-adrenergic blockade. For operation of phaeochromocytoma, modified neuroleptic anaesthesia is a useful anaesthetic technique. Intraoperative hypertension is controlled with sodium nitroprusside and phentolamine. Intravascular volume is substituted under CVP or PAP control, and epinephrine or norepinephrine are used if necessary. During the postoperative period, hypotension or hypertension or left ventricular failure may occur. In an own study, 9 patients with phaeochromocytoma were investigated, 7 patients with other operations of the adrenal glands served as controls. Despite specific preoperative preparation and intraoperative use of antihypertensive drugs, excessive increases in blood pressure could not be avoided in some cases. Extremely high plasma levels of catecholamines up to the factor 1,000 of the normal range were found. Even in controls, considerable increases in blood pressure and catecholamine levels were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Anesthesia for patients with pheochromocytoma. Our own results and a review]. 829 3


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