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)

In 58 female patients with the primary empty sella (PES) syndrome, a study of the CSF dynamics was done by evaluating both the absorptive reserve by a lumbar infusion test at constant rate, and/or the ICP increase occurring during REM phase of nocturnal physiological sleep. In 33, prolactin (PRL) dynamics were also investigated evaluating both the response to sequential stimulating test with thyrotropin-releasing hormone (TRH) and metoclopramide (MCP) and/or the circadian variation of PRL levels. Impairment of CSF dynamics was found in the 84% who had a hormonal pattern characterized by an increase of the PRL response to TRH and MCP and a decrease of the PRL circadian variation. Twenty-one patients with impaired CSF dynamics underwent CSF shunting procedures with disappearance of the signs of intracranial hypertension. They also had restoration of normal PRL dynamics but the endocrine alterations improved only moderately. Altered CSF dynamics play a role in the pathogenesis of the PES syndrome. A correlation between elevated ICP and the hypothalamo-hypophyseal control of PRL secretion may exist.
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PMID:Cerebrospinal fluid pressure and prolactin in empty sella syndrome. 210 18

A prospective, placebo-controlled, comparative evaluation was conducted on two widely prescribed, sympatholytic antihypertensive agents with known CNS effects. In order to separately assess these effects in younger and older male hypertensives, patients were assigned to either of two treatment studies based on age. For study I, 24 males aged 31-59 (mean = 49.8; SD = 7.4) with mild hypertension (mean DBP = 100.2 mm Hg; SD = 8.0) received 3 months of treatment with propranolol (20-80 mg bid), clonidine (0.1-0.3 mg bid), or double-blind placebo in a counterbalanced, crossover design. For study II, 23 elderly hypertensive males (mean DBP = 102.6 mm Hg; SD = 8.2) aged 60-78 years (mean = 65.1; SD = 4.6) were randomized to propranolol (20-40 mg bid) or double-blind placebo therapy. Patients received cognitive testing, mood assessments, and all-night polysomnographic evaluations before and after each treatment period. Multivariate analysis of EEG sleep data was statistically significant for study I, with significant univariate effects on four of the six primary sleep variables: total sleep time was reduced, sleep maintenance decreased, REM latency increased, and percent total REM time was reduced. A similar MANOVA analysis for the effects of treatment on the sleep of older patients (study II) was not significant. However, propranolol administration was found to be associated with a significant decline in cognitive performance in these patients. Significant mood effects were observed with each of the study drugs, and nocturnal penile tumescence (NPT) was significantly decreased in both younger and older patients. Overall, this research suggests that distinct patterns of CNS effects are associated with each of the antihypertensive agents studied.
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PMID:CNS side effects of centrally-active antihypertensive agents: a prospective, placebo-controlled study of sleep, mood state, and cognitive and sexual function in hypertensive males. 227

Simultaneous overnight recordings of intracranial pressure (ICP) and electroencephalography (EEG) were conducted on 85 neurosurgical patients with intracranial hypertension and/or ventriculomegaly. Intracranial pressure waves were classified into five types according to the pattern of appearance, and their correlation with sleep cycles and clinical conditions of patients were investigated. A-waves appeared exclusively in patients with long-standing intracranial hypertension, and episodic B-waves appeared in patients with chronic hydrocephalus or a postoperative tumor-free condition. When these episodic pressure waves appeared, the patients were conscious and sleep cycles including REM stage were observed. Persistent, high pressure B-waves were seen mostly in patients with an acute phase of intracranial hemorrhages. The consciousness of these patients ranged from drowsy to stupor. EEG showed alternate appearances of light sleep and waking rhythms in accordance with cyclic oscillations of B-waves which coincided with periodic, apneic respiratory rhythms. When markedly regular B-waves of moderately high pressure appeared continuously, the patients were severely impaired in consciousness and were mainly in a subacute phase of intracranial hemorrhages. EEG showed continuous slow activities and sleep stages were not scored in these patients. No characteristic clinical features were found in patients whose ICP remained within normal range without pressure waves throughout the recording.
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PMID:Overnight recordings of intracranial pressure and electroencephalography in neurosurgical patients. Part I: Intracranial pressure waves and their clinical correlations. 260 35

Changes in intracranial pressure (ICP) during sleep were investigated in 37 patients with chronic intracranial hypertension or chronic hydrocephalus, in whom episodic pressure waves characterized by A-waves or episodic B-waves were seen in Part I of this paper. The patients were conscious, and sleep stages including REM sleep were observed in all of them. During non-REM sleep, ICP significantly rose in Stage II on many occasions, and was always lower in Stage IV than in other sleep stages. A marked elevation of ICP was seen in REM sleep. ICP changes during REM sleep were characterized by frequent appearances of the pressure waves; 88.9% of A-waves and 95.1% of episodic B-waves appeared during REM sleep. The initiation of REM sleep scored on EEG began 1 to 2 minutes prior to or at the onset of the episodic pressure waves. The episodic pressure waves are assumed to be induced by the intracranial conditions in REM sleep, when increased brain activity and reduced sympathetic tone are known to occur simultaneously.
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PMID:Overnight recordings of intracranial pressure and electroencephalography in neurosurgical patients. Part II: Changes in intracranial pressure during sleep. 260 36

In order to describe variation in AP and ICP during OSA, six patients with severe OSA were examined, with determination of ICP, AP, CVP, respiration, tcPO2, tcPCO2, and nocturnal sleep polygraphy. During apnea, elevations of AP and ICP were observed, related to the apneic episodes. The elevations in pressure were only observed in relation to apneic episodes. While awake, none of the patients showed pressure elevations. There were highly significant correlations between duration of apnea and variation in AP and ICP and between variations in AP and ICP. Values for ICP while awake were above normal (greater than 15 mm Hg; intracranial hypertension) in four of six patients. Morning ICP was higher than evening ICP. Systolic, mean, and diastolic ICP and AP increased during sleep above awake values. The ICP increased during NREM stages 1 to 4, and the highest values were observed during REM sleep. Vascular response was not changed during REM sleep, and the higher ICP during REM could solely be explained by the longer apneas during REM sleep. The CPP decreased during apnea.
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PMID:Intracranial pressure and obstructive sleep apnea. 291 75

Snoring usually is trivial and unimportant, but it can turn into a social or medical problem. Obesity, hypertension and heart disease are more frequent among snorers than among nonsnorers, and especially snorers with hypersomnia during the day are at risk. Hypersomnia in association with snoring usually signifies obstructive sleep apnea. Increased resistance in the upper airways, together with negative inspiratory pharyngeal pressure and muscular hypotonia during deep non-REM and REM sleep, lead to collapse of the pharynx, hypoxia and hypercapnia. Only after arousal from sleep does muscle tone return, pharyngeal obstruction reopen and airflow resume. Since this process can occur 300 or 400 times a night, repetitive alveolar hypoventilation leads to pulmonary-arterial hypertension and cor pulmonale, and the repetitive sympathetic activations can cause systemic hypertension or serious cardiac arrhythmias. The countless arousals deprive the sufferer of deep non-REM and REM sleep and their consequence is sleep fragmentation. The symptoms are excessive daytime sleepiness, intellectual deterioration and personality and behavioral changes. Oronasomaxillofacial, endocrine and neuromuscular anomalies and diseases predispose to sleep apnea, and alcohol or CNS-depressant drugs can favour its occurrence. Diagnosis is made by nighttime oxymetry, and if this is abnormal, by polysomnography. After polysomnography it is possible to distinguish between obstructive and nonobstructive sleep apnea, and the decisions for an adequate treatment can be made.
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PMID:[Dangerous snoring. Sleep-apnea syndrome]. 331 92

A patient is described who developed apnea, hypertention, and tachycardia following the excision of bilateral carotid body tumors. Hypertension and tachycardia resulted, most probably, from bilateral ablation of the carotid sinus and/or the nerve of Hering. These phenomena have been described in the literature. The pathogenesis of the apneic attacks may be related to the ablation of the peripheral sensory organs (both carotid bodies), interference with the function of the respiratory automatic control system, and impaired control of ventilation during non-REM sleep. Temporary unilateral paralysis of the hypoglossal nerve with partial airway obstruction possibly represented a mechanical trigger. The apneic attacks subsided but bouts of hypertention and tachycardia persist.
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PMID:Sleep apnea following bilateral excision of carotid body tumors. 663 20

The laryngeal chemoreflex was studied during quiet and REM sleep and wakefulness in premature newborn lambs. The response to reflex stimulation with a 5 sec-water infusion was evaluated during 30 sec, as % change in ventilation, heart rate and blood pressure. Apnea, hypertension and bradycardia were more pronounced during sleep than during wakefulness, when arousal was not associated with the stimulation. The response was similar during quiet and REM sleep. Arousal, which occurred in 24 and 31% of the tests respectively, resulted in a response comparable to that seen during wakefulness. The respiratory drive was evaluated by measurement of the mean inspiratory flow and was found to be decreased during both sleep states when compared to wakefulness. We propose that during sleep in the newborn period there is a decreased ability to respond to asphyxia possibly due to a functional immaturity of the arterial chemoreceptors. This results in a low incidence of arousal and a delayed termination of the pronounced poststimulus apnea resulting from laryngeal chemoreflex stimulation.
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PMID:Reflex apnea from laryngeal chemo-stimulation in the sleeping premature newborn lamb. 711 Jul 84

As a follow-up to a previous assessment of complications of sleep-disturbed breathing in 265 patients, we have reevaluated measures of sleepiness and hypertension in patients with obstructive sleep apnea (OSA) (n = 518), central sleep apnea (n = 50), and subclinical sleep-disordered breathing (SDB) (n = 107). Both subjective and objective (multiple sleep latency test [MSLT]) measures indicated that OSA patients were sleepier than those with subclinical SDB. The OSA patients weighed significantly more than the patients with central sleep apnea or subclinical SDB. They had a higher proportion of men, described more habitual sleepiness, and had a higher likelihood of feeling unrefreshed in the morning compared with the group with subclinical SDB. Among the OSA patients, there was a significant correlation between subjective and objective assessment of sleepiness, but this relationship was quantitatively very small. A forward stepwise regression analysis revealed that weight, and to a lesser degree waking time after sleep onset, could account for 65.5% of the variance in subjective sleepiness. Seventy-five percent of the variance of the mean sleep latency in the MSLT could be accounted for by the mean minimum arterial oxygen saturation in non-REM sleep and the nocturnal sleep latency. Diastolic BP was significantly higher in OSA patients compared with the patients with central sleep apnea and subclinical SDB. When covarying for weight, age, and gender, this effect lost significance. Among OSA patients taken by themselves, 98.3% of the variance in diastolic blood pressure could be accounted for by the mean minimum arterial oxygen saturation in non-REM sleep, with very small additional contributions of apnea/hypopnea index, weight, and age. In summary, among patients across a spectrum of SDB, differences in diastolic BP were primarily associated with weight, age, and gender. Among OSA patients, perhaps because of a more limited variance in weight, diastolic BP was associated with measures of SDB.
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PMID:The relationship of sleepiness and blood pressure to respiratory variables in obstructive sleep apnea. 755 70

To assess the effectiveness of cilazapril in regulating blood pressure (BP) in patients with sleep-related breathing disorders, 23 male patients (mean age, 50 years; mean body mass index, 32.7 kg/m2) with a mean apnea/hypopnea index of 49.7 and arterial hypertension (163/104 mm Hg) participated in a placebo-controlled, randomized, double-blind study. They received either cilazapril, 2.5 mg/day (n = 12) or placebo (n = 11). The effects of treatment were studied under different conditions of sleep and physical and mental load before and after 8 days of treatment. Measurements by night included cardiorespiratory polysomnography, inductive plethysmography, pulse oximetry and nasal air flow, electroencephalography, (EEG), electrooculography and electromyography, (ECG), and blood pressure (BP). Measurements by day (ECG, heart rate, and BP) were performed at rest and under physical and mental load. Systolic, diastolic, and mean BP (5 min at night; 1 s during the day), heart rate, apnea and hypopnea index, EEG data, and test reaction times were compared in both groups. The systolic and diastolic BP of patients receiving cilazapril was lower compared to baseline for all physical and mental loads. Mean BP reductions over all standardized loads was greater with cilazapril than placebo (-10 vs. -4.3 mm Hg, p < 0.05). These results show that BP is influenced similarly by mental and physical loads, and that behavior [i.e., awake state and non-rapid eye movement and rapid eye movement (NREM and REM) sleep determines BP regulation. Cilazapril is effective in reducing BP in all situations, especially during REM sleep hypertension.
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PMID:Twenty-four-hour blood pressure control: effect of cilazapril on continuous arterial blood pressure during sleep, and physical and mental load in patients with arterial hypertension and sleep apnea. 770 72


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