Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnosis coronary artery disease is classically based on patient's symptoms and morphology, as analyzed by angiography. The importance of risk factors for the development of coronary atherosclerosis and disturbance of coronary vasomotion is clearly established. However, microembolization of the coronary circulation has also to be taken into account. Microembolization may occur as a single or as multiple, repetitive events, and it may induce inflammatory responses. Spontaneous microembolization may occur, when the fibrous cap of an atheroma or fibroatheroma (Stary i.v. and Va) ruptures and the lipid pool with or without additional thrombus formation is washed out of the atheroma into the microcirculation. Such events with progressive thrombus formation are known as cyclic flow variations. Plaque rupture occurs more frequently than previously assumed, i.e. in 9% of patients without known heart disease suffering a traffic accident and in 22% of patients with hypertension and diabetes. Also, in patients dying from sudden death microembolization is frequently found. Patients with stable and unstable angina show not only signs of coronary plaque rupture and thrombus formation, but also microemboli and microinfarcts, the only difference between those with stable and unstable angina being the number of events. Appreciation of microembolization may help to better understand the pathogenesis of ischemic cardiomyopathy, diabetic cardiomyopathy and acute coronary syndromes, in particular in patients with normal coronary angiograms, but plaque rupture detected by intravascular ultrasound. Also, the benefit from glycoprotein IIb/IIIa receptor antagonist is better understood, when not only the prevention of thrombus formation in the epicardial atherosclerotic plaque, but also that of microemboli is taken into account. Microembolization also occurs during PTCA, inducing elevations of troponin T and I and elevations of the ST segment in the EKG. Elevated baseline coronary blood flow velocity, as a potential consequence of reactive hyperemia in myocardium surrounding areas of microembolization, is more frequent in patients with high frequency rotablation than in patients with stenting and in patients with PTCA. The hypothesis of iafrogenic microembolization during coronary interventions is now supported by the use of aspiration and filtration devices, where particles with a size of up to 700 microns have been retrieved. In the experiment, microembolization is characterized by perfusion-contraction mismatch, as the proportionate reduction of flow and function seen with an epicardial stenosis is lost and replaced by contractile dysfunction in the absence of reduced flow. The analysis of the coronary microcirculation, in addition to that of the morphology and function of epicardial coronary arteries, and in particular appreciation of the concept of microembolization will further improve the understanding of the pathophysiology and clinical symptoms of coronary artery disease.
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PMID:Coronary microembolization--its role in acute coronary syndromes and interventions. 1060 63

Aspirin (acetylsalicylic acid) should be administered to patients on day 1 of an acute myocardial infarction (MI) and continued indefinitely. Early intravenous beta-blockade should be used during acute MI. beta-blockers should be continued indefinitely. Angiotensin-converting enzyme (ACE) inhibitors should be used in patients with acute MI with ST-segment elevation in two or more anterior precordial leads. ACE inhibitors should be used during and after acute MI in patients with chronic heart failure (CHF) or with a left ventricular ejection fraction < or =40%. There are no class I indications for using calcium channel antagonists during and after acute MI. Intravenous heparin should be used in patients with acute MI undergoing coronary revascularisation and in patients at high risk for systemic embolisation. Enoxaparin should be used in patients with non-Q-wave MI. Thrombolytic therapy should be considered in patients with acute MI with ST-segment elevation in contiguous leads of a 12-lead electrocardiogram or with left bundle branch block. Platelet glycoprotein IIb/IIIa inhibitors should be administered intravenously as an adjunct to heparin and aspirin in patients with non-Q-wave MI. Intravenous nitroglycerin should be used: (i) for the first 24 to 48 hours in patients with acute MI and CHF, large anterior MI, persistent ischaemia or hypertension; and (ii) continued beyond 48 hours in patients with recurrent angina pectoris or persistent pulmonary congestion. Long-acting nitrates should be given after MI, along with beta-blockers, to patients with angina pectoris. There are no class I indications for using intravenous magnesium during acute MI. The routine use of antiarrhythmic drugs other than beta-blockers during and after acute MI is not recommended.
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PMID:Drug treatment of elderly patients with acute myocardial infarction: practical recommendations. 1177 21

We compared the levels of microparticles, platelet activation markers, soluble cell adhesion molecules, and soluble selectins between hypertensive patients with and without type 2 diabetes and control subjects. Binding of anti-glycoprotein IIb/IIIa and anti-glycoprotein Ib monoclonal antibodies to platelets did not differ significantly between the hypertensive patients and controls, but platelet expression of activation markers (CD62P, CD63, PAC-1, and annexin V) was higher in the hypertensive patients. Platelet-derived microparticle (PDMP) and monocyte-derived microparticle (MDMP) levels were significantly higher in the hypertensive patients than in the controls. Soluble ICAM-1, VCAM-1, P-selectin, and E-selectin levels were also higher in the hypertensive patients, and they were significantly higher in the hypertensive patients with diabetes. After treatment with efonidipine, the levels of PDMPs, CD62P-, CD63-, PAC-1-, and annexin V-positive platelets, sICAM-1, sVCAM-1, sP-selectin, and sE-selectin all decreased significantly. The MDMP levels decreased, and the decrease was significant in the hypertensive patients with diabetes. These findings suggest that administration of efonidipine to hypertension patients with diabetes may prevent the development of cardiovascular complications caused by cell adhesion molecules or activated platelets and monocytes.
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PMID:Effects of efonidipine on platelet and monocyte activation markers in hypertensive patients with and without type 2 diabetes mellitus. 1214 59

Women with acute coronary syndromes who present for percutaneous revascularization have clinical characteristics that place them at higher risk for adverse events. These women are older with an increased incidence of hypertension, diabetes, and congestive heart failure. At angiography, women with epicardial coronary disease tend to have smaller diameter vessels, which predict an increase in procedural complications. Recent observations suggest that in the new device era, women with unstable angina/non-Q myocardial infarction may have clinical outcomes similar to their male counterparts; however, women who present with acute ST-elevation myocardial infarction and undergo catheter-based revascularization procedures remain at increased risk for adverse events. Although adjunctive glycoprotein IIb/IIIa antagonists may improve procedural outcomes, women undergoing catheter-based revascularization procedures are at increased risk for hemorrhagic complications. Despite these high-risk features, catheter-based reperfusion therapies remain an effective treatment strategy in women with acute coronary syndromes.
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PMID:Catheter-based revascularization strategies for acute coronary syndromes in women. 1243 67

Diabetes mellitus is associated with an increased prevalence of and morbidity from coronary artery disease, which is present in at least 25% of diabetic patients. Diabetes mellitus is a risk factor for recurrent cardiovascular events after myocardial infarction and after percutaneous coronary intervention procedures or coronary artery bypass surgery. Less than half of the increase in cardiovascular events with diabetes mellitus is accounted for by the presence of traditional cardiac risk factors such as hypertension, hypercholesterolemia, and hypertriglyceridemia. Vascular inflammation reflected by increased levels of high-sensitivity C-reactive protein, endothelial dysfunction associated with hyperglycemia and hyperinsulinemia, impaired fibrinolysis mediated by hyperinsulinemia, and increased platelet aggregation are now recognized as promoting the development of arteriosclerosis in diabetic patients. These factors may be present long before a diagnosis of diabetes mellitus is established. Platelets in diabetic subjects appear to be in an activated state even in the absence of vascular injury, as evidenced by greater expression of the fibrinogen-binding glycoprotein IIb/IIIa receptor, which constitutes the final common pathway of platelet activation and allows for cross-linking of individual platelets by fibrinogen molecules and formation of thrombus. Platelet inhibition with intravenous glycoprotein IIb/IIIa inhibitors has been shown to reduce morbidity and mortality in patients undergoing percutaneous coronary intervention for acute coronary syndromes, and diabetic patients appear to derive an even greater relative benefit from this treatment. The ACC/AHA 2002 guidelines for the management of acute coronary syndromes recommend the use of abciximab in diabetic patients undergoing stent implantation.
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PMID:Targeting the use of glycoprotein IIb/IIIa antagonists--the diabetic patient. 1243 33

The objective of this study was to determine the safety of the glycoprotein IIb/IIIa receptor inhibitor eptifibatide in patients at high risk for adverse clinical outcomes and to determine risk factors for eptifibatide-associated bleeding. Consecutive patients (n = 175) who presented with an acute coronary syndrome and who were at high risk for adverse clinical outcomes were prospectively observed for eptifibatide-associated bleeding, which was classified according to Thrombolysis in Myocardial Infarction (TIMI) and Global Use of Strategies to Open Occluded arteries (GUSTO) criteria. High risk was defined as unstable angina or non-Q-wave myocardial infarction with at least one of the following: left ventricular ejection fraction < 40%, diabetes mellitus, ST segment depression or transient ST segment elevation, serum [troponin I] > 2.5 ng/mL, and recurrent angina symptoms after initiation of conventional antianginal therapy. Bleeding incidences in the patients in this study were compared with those in the 4722 eptifibatide-treated patients in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial. Compared to PURSUIT patients, the population in this study was similar in age but had a higher proportion of females, African Americans, hypertension, diabetes, prior myocardial infarction, heart failure, and revascularization. Bleeding incidences in this study's patients were similar to or lower than those in the PURSUIT population: TIMI major 1.1% versus 10.8%, TAMI minor 12.6% versus 13.1%, GUSTO severe 1.7% versus 1.5%, GUSTO moderate 3.9% versus 11.3%, and GUSTO mild 19.7% versus 26.1%. Renal dysfunction was an independent risk factor for TIMI (odds ratio = 9.1 ([95% CI= 1.6-52.5]) and GUSTO (odds ratio = 6.1 [95% CI = 1.2-30.0]) bleeding. In conclusion, despite being at higher risk for adverse outcomes, patients administered eptifibatide according to this study's institutional guidelines had comparable or lower bleeding rates than in the PURSUIT trial. Renal dysfunction is an independent risk factor for eptifibatide-induced bleeding.
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PMID:Bleeding associated with eptifibatide targeting higher risk patients with acute coronary syndromes: incidence and multivariate risk factors. 1246 32

Little comparative data exist for glycoprotein IIb/IIIa inhibitors in acute coronary syndromes (ACS). Two hundred twenty-eight patients were studied: 114 received tirofiban (TI) and 114 received abciximab (AB) for either unstable angina (UA) or myocardial infarction (MI). All patients received aspirin, heparin, and ticlopidine or clopidogrel. Baseline characteristics were similar between the 2 groups for admitting diagnosis (UA vs MI), age, gender, ejection fraction, diabetes mellitus, prior coronary artery disease, prior myocardial infarction (MI), prior bypass surgery, hypertension, congestive heart failure, hyperlipidemia, MI type (Q vs non-Q), or location. Drug administration time (mean) was 13 hours (AB) and 24 hours (TI). All AB was administered in the catheterization laboratory as compared to TI (34% in laboratory and 66% before laboratory). More AB patients received angioplasty or stent (92% vs 80%, p = 0.008) while more TI patients had CABG (10% vs 3%, p = 0.027). In-hospital complications including death, MI, urgent revascularization, cerebrovascular accidents or transient ischemic attacks, and access site bleeding were similar (p = NS). Multivariate predictors of events (odds ratios) were prior coronary artery bypass graft (2.3), diabetes (1.7), and prior percutaneous transluminal coronary angioplasty (1.7), but not the agent used. Over a mean follow-up of 13 months, the individual endpoints of death, MI, revascularization, or hospitalization were similar for both groups. The AB patients had improved freedom from revascularization (100% vs 81%, p = 0.015) in an emergent setting and TI patients had improved freedom from revascularization (93% vs 77%, p = 0.038) with elective procedures. Tirofiban and abciximab appear effective and safe when used for ACS when recommended dosing and precautions are followed. Major adverse outcomes are rare and bleeding complications uncommon.
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PMID:Differential benefits and outcomes of tirofiban vs abciximab for acute coronary syndromes in current clinical practice. 1267 97

The cardiovascular continuum describes the way from risk factors to atherosclerosis, acute cardiovascular events (unstable angina and myocardial infarction), and development of terminal heart failure and its complications. Following this way, advances are reported in the prevention of cardiovascular disease, in noninvasive diagnostics and revascularization of coronary artery disease, and in new therapeutic options of acute myocardial infarction. The following issues are reported in detail: (1) significance of statins, inhibition of platelet aggregation and vitamins in primary and secondary prevention of cardiovascular disease, (2) comparison of the angiotensin receptor blocker losartan and the beta-blocker atenolol in hypertension (LIFE study), (3) magnetic resonance angiography for the detection of coronary stenoses, (4) advantages and disadvantages of operative and interventional coronary revascularization considering elderly patients and sirolimus-eluting stents, and (5) efficacy of glycoprotein IIb/IIIa inhibition and low molecular weight heparin in acute myocardial infarction.
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PMID:[From risk factors to symptomatic coronary artery disease. Update cardiology 2001/2002--part I]. 1271 45

The cardiovascular continuum describes the way from risk factors to atherosclerosis, acute cardiovascular events (unstable angina and myocardial infarction), and development of terminal heart failure and its complications. Following this way, advances are reported in the therapy of acute coronary syndrome, heart failure, ventricular and supraventricular tachyarrhythmias, and stroke in patients with patent foramen ovale. The following issues are reported in detail: (1) significance of statins and statin withdrawal, glycoprotein IIb/IIIa receptor blocker, acute coronary interventions, aspirin and clopidogrel in unstable coronary syndromes, (2) pathogenesis of acute pulmonary edema associated with hypertension, (3) cardiac regeneration capability after transplantation and myocardial infarction, (4) beta-blocker therapy, efficacy of additional angiotensin receptor blocker therapy and multisite biventricular pacing in symptomatic (advanced) heart failure, (5) prognosis after ablation of the atrioventricular node in patients with atrial fibrillation, (6) primary prevention with an implantable defibrillator and resumption of driving after implantation, and (7) therapeutic options after cryptogenic stroke and patent foramen ovale.
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PMID:[Update cardiology 2001/2002-part II. From unstable coronary syndrome to terminal heart failure]. 1281 17

Prior studies have reported significant gender differences in the procedural outcomes after elective percutaneous transluminal coronary angioplasty (PTCA). Many of these differences have been explained by the presence of more comorbidities and worse clinical characteristics such as older age, unstable angina, congestive heart failure, diabetes mellitus, and hypertension in women than in men. Moreover, women have a smaller vessel diameter, more coronary tortuosity and different plaque composition compared to men that can lead to a higher dissection rate and a greater number of procedural complications. Although early data on PTCA suggested worse immediate results in women than in men, more recent data suggest that this difference is less marked. The introduction of stents with a low profile and a higher tractability and pushability has allowed the extensive application of these devices even in small and tortuous vessels improving the outcome of PTCA. This improvement has been higher in women than in men leading to the equalization of the immediate outcome in the two sexes, even if the baseline characteristics remain worse in women. In particular, mortality and the need for urgent surgical revascularization have become extremely low without any differences between sexes. However, some authors have still found a higher incidence of complications in the first period after the procedure due to stent thrombosis in the stenting era. For this reason, meticulous antiplatelet treatment should be prescribed and drugs such as glycoprotein IIb/IIIa inhibitors may also be considered advisable to reduce the excess risk in the female population particularly in women with prothrombotic risk factors such as diabetes. At 6 and 12 months similar rates of death, late myocardial infarction, and repeated revascularization have been shown in the two sexes. Coronary stenting and the use of glycoprotein IIb/IIIa inhibitors have also improved the immediate results in patients with acute myocardial infarction (AMI) undergoing primary PTCA. Studies comparing the outcome differences between women and men with AMI and treated with primary PTCA are limited but all suggest that women benefit more than men from this procedure. The in-hospital mortality in patients with AMI is significantly higher in the female than in the male population with a higher incidence of intracranial hemorrhage in women among tissue-type plasminogen activator-treated patients. Vice versa, women and men have a similar or a slightly higher in-hospital mortality after primary PTCA without intracranial bleeding complications. For this reason, an earlier diagnosis of AMI, an earlier hospital admission and an earlier primary PTCA should be the aims of management in order to improve the outcome in women with AMI and to equalize the procedural results in the two sexes.
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PMID:Gender differences in the outcome of interventional cardiac procedures. 1456 77


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