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

To identify a relationship between atherosclerotic vascular disease and differences in blood pressure between the right and left arms, blood pressure differences between arms were measured in patients with peripheral vascular disease (PVD, n = 58), in patients with coronary artery disease (CAD, n = 38), and in patients with no evidence of atherosclerotic disease, who served as a control group (n = 38). The incidence and magnitude of right and left arm pressure difference determined by the oscillometric technique were compared between the patient groups. The incidence of systolic pressure difference greater than or equal to 20 mmHg between arms in patients with PVD (21%) was greater than that in either those with CAD (3%) (P less than or equal to 0.05) or control subjects (0%) (P less than 0.01). The incidence of systolic pressure difference greater than or equal to 45 mmHg between arms in patients with PVD (10%) was greater than that in either those with CAD (0%) (P less than 0.05) or control subjects (0%) (P less than 0.05). Patients with PVD also had a greater incidence of right and left arm difference than did those with CAD or controls for mean and diastolic blood pressures. Of all patients with a systolic difference greater than 10 mmHg, neither the right nor the left arm blood pressure was consistently higher: 21 of 35 (60%) had a higher pressure in the right arm, and 14 of 35 (40%) had a higher pressure in the left arm (P = 0.33). Gender, diabetes, hypertension, smoking, and age were not associated with a difference in blood pressure between the right and left arms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Right- and left-arm blood pressure discrepancies in vascular surgery patients. 188 53

Although it is universally accepted that the grade of reduction of district blood flow in PVD is directly correlated to alteration of the haemorheological pattern, there is still no uniformity of opinion regarding the existence of a specific rheological alteration in PVD. The scope of our study was to discover the existence of possible PVD-specific markers; we thus carried out a comparative evaluation of the rheological characteristics in blood of controls and patients affected with PVD. Eighty-nine males between the ages of 50 and 65 years (median 58 +/- 1 SE) were studied, all with a stage II vascular pathology with clinical onset of less than three months. Exclusion criteria were: diabetes mellitus, hyperlipaemia, stable hypertension, presence of vascular disease in other districts, cardio-circulatory problems and serious medical or surgical pathologies, previous vascular surgery, a history of acute thrombo-embolic episodes, and chronic alcoholism. Each patient, after a drug wash-out of 20 days, was monitored for haemorheological parameters. At the same time, the above parameters were measured in a group of 50 male controls of the same age range. All 139 subjects were smokers (10-15 cigarettes average per day). Our results indicate that modification in the bio-humoral (fibrinogen and plasma globulins) parameters, a reduced red blood cell filterability and a relative increase in the number of activated polymorphonucleate cells are probably specific haemorheological markers of the clinical onset of PVD.
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PMID:Haemorheological markers in 89 patients with stage II peripheral vascular disease (PVD). 372 72

Scanning 3000 cases admitted for rehabilitation after cerebrovascular accident over a 20 year period produced a sample of 1369 subjects, without age restrictions, admitted within six months of a first stroke of thrombotic etiology. In this sample, survival rates showed no significant difference between men and women. Age at onset, however, clearly influenced survival changes; the expected mean survival was 6 years at 40 and 2 at age 80; average loss of life was 14 years for the whole sample, meaning a vital prognosis two to three times worse than that of the general population. At least 86% of the sample presented one or more of five etiological antecedents to stroke: hypertensive heart disease, peripheral vascular disease, diabetes mellitus, myocardial infarction and atrial fibrillation. In 87% of those, HHD and/or PVD were present. Presence of hypertension significantly lowered life expectancy and so did PVD; their influence is felt from the earliest stages. In contrast, diabetes mellitus, the next most common factor, has a late influence, starting about the fifth year after stroke. MI and AF were present in relatively fewer patients, but they contributed towards a considerable decrease in life expectancy, evident from the first stages, the more drastic reduction being observed in the AF group.
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PMID:Hemiplegics after a first stroke: late survival and risk factors. 665 53

The time course of recovery of left atrial mechanical function after electrocardioversion of atrial fibrillation was examined in 25 patients with atrial fibrillation by recording pulmonary venous and transmitral flow velocities and interatrial septal motion during atrial systole within a day (16 +/- 5 hours) and ten days after cardioversion of atrial fibrillation by transesophageal and transthoracic Doppler and M-mode echocardiography. There were 6 patients with hypertension, 4 with ischemic heart disease, 2 with alcoholic heart, 5 with dilated cardiomyopathy, and 8 without underlying heart disease. The peak velocities of the atrial systolic waves of the transmitral and pulmonary venous flow velocities (A and PVA, respectively) and first systolic wave (PVS1) of pulmonary venous flow, durations of both atrial systolic waves, and amplitude of interatrial septal motion during atrial systole increased significantly ten days after cardioversion compared with those measured within a day of cardioversion in all patients except the 5 patients with dilated cardiomyopathy. Peak velocity of the second systolic wave (PVS2) of pulmonary venous flow increased, and that of the early diastolic and diastolic waves (E and PVD, respectively) of transmitral and pulmonary venous flow decreased ten days after cardioversion compared with those within a day of cardioversion. These results suggested that active atrial systolic (A and PVA) and relaxant (PVS1) parameters obtained from transmitral and pulmonary venous flow velocities are good indicators of left atrial mechanical function after cardioversion of atrial fibrillation.
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PMID:[Changes in pulmonary venous and transmitral flow velocity patterns after cardioversion of atrial fibrillation]. 759 57

Cross-sectional data from the Epidemiology of Diabetes Complications Study were used to examine the relationships between waist to hip circumference ratio (WHR) and the presence of diabetes complications in IDDM adults ages 18-45 years (N = 586). Significantly higher WHRs were observed among both genders with proliferative retinopathy or peripheral vascular disease and only among males with either neuropathy or nephropathy compared to those free of these complications. Logistic regression to determine the strength of association between WHR and each complication demonstrated that although WHR was significantly related to each complication (except nephropathy among females), WHR was only independently related to neuropathy in males and PVD in females in the final model when hypertension, LDL- and HDL-cholesterol and fibrinogen were included. These findings suggest that WHR acts as a marker of risk for diabetes complications mainly through an influence on other complication risk factors.
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PMID:The association of waist/hip ratio with diabetes complications in an adult IDDM population. 773 Aug 70

1. Donor age is now a predominant factor influencing graft outcome. 2. A new finding here is that recipient peripheral vascular disease, PVD is also a major factor. This factor was independent of whether the patient had diabetes or not. Presensitization, as shown by a high PRA is additive to PVD. 3. Hypertension in the donor was important only when a history of more than 10 years was noted in the older donors over age 50. 4. Angina and cardiovascular disease in the patient resulted in a slightly higher death rate, but was only of importance in patients over age 50. 5. Cadaver donor pretreatment was of importance only in donors over age 30. 6. White patients with private insurance had a slightly higher graft survival rate than those on Medicare or Medicaid. Black patients with private insurance had almost the same graft survival as White patients with private insurance. The lowest graft survival was noted for Black patients on Medicaid.
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PMID:Impact of new variables reported to the UNOS registry. 991 14

Our purpose was to examine prospectively the relationship between systemic hypertension and vascular events in patients with SLE. SLE patients followed in the University of Toronto Lupus Clinic presenting between 1980 and 1988 and within one year of their diagnosis of SLE were identified. Standard definitions were used for hypertension and for all vascular events (MI, angina, CVA, PVD). The presence of traditional CAD risk factors, along with disease- and therapy-related risk factors for the development of vascular disease, were compared in the hypertensive and normotensive group. A multivariate logistic regression was performed to determine the best predictor of a vascular event. One hundred and fifty patients were identified in our inception cohort [75 hypertensive (50%) and 75 (50%) normotensive]. Seventeen hypertensive patients (22.7%) had at least one vascular event as compared to six (8.0%) normotensive patients (p = 0.022). The vascular events included 7 with CAD, 5 with CVA, and 5 with PVD in the hypertensive group while in the normotensive group 3 patients developed CAD, 2 CVA and 1 PVD. Fifteen deaths were recorded in the hypertensive group as compared to eight deaths in the non-hypertensive groups (P = 0.09). The groups were comparable with respect to associated risk factors, except for higher frequency of hypercholesterolemia (P = 0.003), azotemia (P = 0.001) and corticosteroid use (P = 0.038) in the hypertension group. In a multivariate analysis the best predictor of a vascular event was hypercholesterolemia (OR 6.9, 95% CI 2.4-24.8, P < 0.001). We conclude that systemic hypertension is associated with an increased frequency of vascular events in SLE. This is best explained by its association with hypercholesterolemia.
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PMID:Vascular events in hypertensive patients with systemic lupus erythematosus. 1143 83

Atherosclerotic renovascular disease (ARVD) is a disease of ageing. It is usually a manifestation of widespread vascular disease and although it may be symptomless, many patients with ARVD present with the effects of extra-renal vascular disease, such as peripheral vascular (PVD), coronary heart (CHD) and cerebrovascular disease. ARVD is a common cause of hypertension and chronic renal failure (CRF), and it is one of the most common renal diagnoses in elderly patients accepted on to dialysis programmes with end-stage renal failure (ESRF). The cause of renal impairment in these patients is still a matter of debate. Patients with ARVD have a high mortality, especially those with renal failure. In this review we examine the relationships between ARVD and co-morbid extra-renal vascular disease, and the impact of these associated vascular pathologies upon renal functional and mortality outcomes is considered. The latest evidence concerning the likely pathogenesis of renal dysfunction in patients with ARVD is also reviewed.
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PMID:The importance of associated extra-renal vascular disease on the outcome of patients with atherosclerotic renovascular disease. 1261 31

SCS is a viable option for treating angina pectoris and inoperable PVD. Its mechanism of action remains controversial, but successful pain relief has been consistently reported in various studies. Many clinicians are foregoing a formal trial, choosing instead to obtain an adequate area of paresthesia and implant in one session. Long-term follow-up of SCS patients treated for angina pectoris shows continued pain relief, increase in activities, and decreased use of medications. Emerging literature supports the finding that SCS is cost-effective in this patient population relative to CABG. SCS does not mask the ischemic pain that signals impending further damage of the myocardium. In patients with inoperable PVD, SCS relieves pain and improves microcirculatory blood flow. Quality of life and mobility can be improved with SCS. The beneficial effects of SCS on ulcer healing are controversial, and evidence suggests that the best candidates for the procedure are those with ischemic rest pain without tissue loss. Patients with diabetes mellitus and hypertension may have the least favorable outcomes with regard to limb salvage. No convincing data have been published on the cost-effectiveness of SCS in this patient population. SCS is a safe procedure that is minimally invasive, reversible, and associated with only infrequent side effects, the most common of which include lead migration and infection. SCS is clearly an option for the improvement of pain and the quality of life in this carefully selected subset of patients.
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PMID:Spinal cord stimulation for angina pectoris and peripheral vascular disease. 1471 20

Hypercholesterolemia is defined as excessively high plasma cholesterol levels, and is a strong risk factor for many negative cardiovascular events. Total cholesterol levels above 200 mg/dl have repeatedly been correlated as an independent risk factor for development of peripheral vascular (PVD) and coronary artery disease (CAD), and considerable attention has been directed toward evaluating mechanisms by which hypercholesterolemia may impact vascular outcomes; these include both results of direct cholesterol lowering therapies and alternative interventions for improving vascular function. With specific relevance to the microcirculation, it has been clearly demonstrated that evolution of hypercholesterolemia is associated with endothelial cell dysfunction, a near-complete abrogation in vascular nitric oxide bioavailability, elevated oxidant stress, and the creation of a strongly pro-inflammatory condition; symptoms which can culminate in profound impairments/alterations to vascular reactivity. Effective interventional treatments can be challenging as certain genetic risk factors simply cannot be ignored. However, some hypercholesterolemia treatment options that have become widely used, including pharmaceutical therapies which can decrease circulating cholesterol by preventing either its formation in the liver or its absorption in the intestine, also have pleiotropic effects with can directly improve peripheral vascular outcomes. While physical activity is known to decrease PVD/CAD risk factors, including obesity, psychological stress, impaired glycemic control, and hypertension, this will also increase circulating levels of high density lipoprotein and improving both cardiac and vascular function. This review will provide an overview of the mechanistic consequences of the predominant pharmaceutical interventions and chronic exercise to treat hypercholesterolemia through their impacts on chronic sub-acute inflammation, oxidative stress, and microvascular structure/function relationships.
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PMID:Hypercholesterolemia and microvascular dysfunction: interventional strategies. 2108 3


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