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

Asthma in pregnancy has been associated with maternal and fetal morbidity and mortality. This study examines the relations of asthma in pregnancy, its severity and its treatment to the labor process, maternal and fetal parameters. Hundred and one consecutive asthmatic women, who gave birth to single babies between November 1993 and November 1994 at the Soroka Medical Center were studied. A group of 77 nonasthmatic women, matched for age and ethnic origin, who gave birth to single babies during the same period served as controls. A larger percentage of asthmatic women suffered from respiratory and urinary tract infections than in the control group (p < 0.001). Severe asthma was associated with a higher rate of infections than milder asthma (p = 0.01). The incidence of smoking was higher among asthmatic women than among controls (p = 0.037). No association was found between socioeconomic status and smoking or infections. No association was found between maternal asthma or maternal use of corticosteroids and the following: maternal hypertension, maternal diabetes, low birth weight (< 2,500 g), preterm delivery (< 37 weeks), adequacy of weight to gestational age and Apgar scores. Three infants with congenital heart defects were born to asthmatic mothers. When the presentation of the fetus was not cephalic, all the asthmatic women were delivered by cesarean section, versus only 60% in the control group (p = 0.08). Labor was induced with oxytocin more often in the asthma group than in the control group (p = 0.07). We conclude that the labor and neonatal outcome in pregnant asthmatic women treated medically is good, even when asthma is severe and when the patient is treated with corticosteroids. There is, however, a relation between asthma in pregnancy, especially if severe, and predisposition to infections.
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PMID:Influence of asthma in pregnancy on labor and the newborn. 958 Sep 25

The neuropeptides arginine vasopressin (AVP) and oxytocin (OT) have been implicated in the genesis of hypertension due to deoxycorticosterone acetate (DOCA)-salt treatment of uninephrectomized rats. In this work, we studied if DOCA treatment of intact rats in doses arousing a salt appetite (a prehypertensive state), modulated mRNA for AVP and OT in the hypothalamus. Male Sprague-Dawley rats were offered both tap water and 3% NaCl in separate bottles and received vehicle or subcutaneous injections of 10 mg DOCA on alternate days for 7 days (4 injections) or 17 days (9 injections). They developed a preference for 3% NaCl solutions 24-48 h after treatment. Brain slices from rats killed on the 8th or 18th day were exposed to 35S-labeled probes encoding prepro-AVP mRNA or OT mRNA, respectively. Expression of these mRNAs was measured in the magnocellular and parvocellular divisions of the paraventricular nucleus (PVN) and magnocellular cells of the supraoptic nucleus (SON). No changes were obtained in neuropeptide mRNA levels in the parvocellular division of the PVN between control and the two groups of DOCA-treated rats. However, DOCA-treated animals presented an increased number of grains per cell for AVP mRNA in the magnocellular division of the PVN and in magnocellular cells of the SON, as shown by group mean comparisons and frequency histograms. No changes were detected for OT mRNA. In a second series of studies, control or DOCA-treated rats were offered 3% NaCl or water as the only choice. Animals drinking 3% NaCl showed increased AVP and OT mRNA levels, whether they received DOCA or not. However, AVP mRNA levels in both nuclei were higher in DOCA-treated rats drinking 3% NaCl than in controls drinking salt solution. In comparison, control and DOCA-treated rats drinking water showed lower levels of AVP mRNA. OT mRNA levels in the SON remained unchanged in the same groups. The results suggest that in the magnocellular cells of the PVN and SON, increments in AVP mRNA are obtained following increments in salt intake produced by either mineralocorticoid treatment or exclusive salt drinking. In rats offered salt solution and water to drink, DOCA effects on AVP mRNA developed before changes occurred in serum sodium levels. Because combined DOCA + salt treatment induced a higher response in terms of AVP mRNA expression, we suggest that AVP could be a target of the central effects of the mineralocorticoid.
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PMID:Increased expression of magnocellular vasopressin mRNA in rats with deoxycorticosterone-acetate induced salt appetite. 970 77

Membrane metalloendopeptidase EC 3.4.24.11 (Enkephalinase, neutral endopeptidase, NEP) is a cellular ectoenzyme, immunophenotypically identified as the leukocyte cluster of differentiation CD10 or CALLA (common acute lymphoblastic leukemia antigen). Immunological, biochemical and molecular biology techniques have identified tis cell membrane feature in various organs: brain, cardiovascular system, lung, placenta, kidney etc. The CD10 immunophenotype is a common feature of lymphoblasts in acute lymphoid leukemia not expressing the T- or B-markers. The enzymatic activity of CD10/NEP possibly influences normal lymphocyte ontogeny by proteolytic cleavage of the regulatory peptides. The substrates of CD10/NEP in the kidneys are (see the list of abbreviations) ANP, adrenomedullin and PAMP; in the brain, the substrates are enkephalins and oxytocin; in the lung, bombesin, BLP, GRP, neuromedin C, substance P and neurokinin A; in the cardiovascular system, angiotenisin II, bradykinin and CGRP; in the gut, VIP; on the neutrophil membrane, fMLP etc. Some substrates are not strictly tissue-specific, e.g. substance P. Preclinical and clinical trials explore possibilities of therapeutic application of the inhibitors of neutral endopeptidase, such as thiorphan in the management of pain, diarrhoea, depression, arterial hypertension and asthma. Other possibilities of application include the treatment of hyalinomembranous disease and prevention of neurotoxicosis in tetanus and botulism.
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PMID:[Membrane metalloendopeptidase (CD10/CALLA): distribution, physiologic and pathophysiologic functions and its inhibitors]. 974 92

A 36-yr-old pregnant woman with a history of hypertension presented at term for elective Caesarean section because of breech position. At preoperative examination, a diastolic murmur was found and transoesophageal echocardiography (TOE) revealed a large, 8.1-cm diameter ascending aortic aneurysm with severe aortic regurgitation and moderate pericardial effusion. Surgical repair was not considered to be urgently required. The patient was delivered electively by Caesarean section under epidural anaesthesia using invasive arterial pressure monitoring. TOE performed 6 h post-partum showed progressing pericardial effusion, for which emergency replacement of the aortic valve and ascending aorta were indicated. The epidural catheter was removed 4 h before starting the cardiopulmonary bypass procedure. Arterial pressure was controlled by a titrated infusion of esmolol and clonidine. To improve uterine tone, the patient received an i.v. infusion of oxytocin throughout surgery. After implantation of an aortic composite graft and weaning from cardiopulmonary bypass, the patient was transferred to the intensive care unit. Awake and receptive to neurological evaluation, her trachea was extubated 4 h after surgery. Mother and baby made an uneventful recovery.
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PMID:Emergency repair of incidentally diagnosed ascending aortic aneurysm immediately after caesarean section. 1082 16

Fetal cardiovascular responses to an altered intrauterine environment of increased myometrial contractures induced by oxytocin (OT) pulses to the ewe over the final 50 days of gestation were studied in chronically instrumented sheep. Ewes received saline (Cntl) or long-term OT treatment (LTOT, 600 microU x kg(-1) x min(-1) in 5-min pulses every 20 min) from 96 days gestational age. Fetal baroreflex responses to sodium nitroprusside (SNP) and phenylephrine (PE) were studied at 133 days gestation. OT increased contractures in LTOT ewes. Fetal blood pressure (FBP) was higher, and fetal heart rate (FHR) and slope of daily change in FBP and FHR were lower in LTOT fetuses. Fetal SNP-induced hypotension resulted in a narrow R-R interval variation range in LTOT fetuses; Cntl fetuses showed early breakdown in compensation. Baroreflex response slope during PE-induced fetal hypertension was lower in LTOT than in Cntl fetuses. Although the cortisol-to-ACTH ratio was lower in LTOT fetuses, fetal plasma ACTH and cortisol changes were similar in control and LTOT fetuses. We hypothesize that contracture-induced alterations in the intrauterine environment accelerate fetal cardiovascular development through mild hypoxemia, repetitive fetal pituitary-adrenal stimulation, and/or physical stimulation.
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PMID:Increased myometrial contracture frequency at 96-140 days accelerates fetal cardiovascular maturation. 1064 82

A study was done in 75 patients who underwent induction of labour with Prostaglandin E2 gel. All these patients had an unripe cervix. The commonest indications were post-datism, intrauterine growth retardation and pregnancy-induced hypertension. All patients were primigravidas with singleton pregnancy and beyond 35 weeks of pregnancy. The mean Bishop score at the time of instillation was less than three. The improvement of another 2-3 points within six hours and by 7-8 points within 12 hours was found after instillation of the gel. 92% of the patients went into spontaneous labour and 8% required reinstillation. The incidence of failed induction was 1.33%. The mean duration of latent phase was 10.34 hours. Induction delivery time was 16.43 hours. 68.1% patients required augmentation of labour and 31.9% did not require augmentation of labour with oxytocin drip. The incidence of vaginal delivery was 81.33% and that of caesarean section was 17.33%. The commonest indication of caesarean section was foetal distress.
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PMID:Prostaglandin E2 gel In ripening of cervix in induction of labour. 1073 47

We have previously shown that oxytocin receptors are present in the heart and that perfusion of isolated rat hearts with oxytocin results in decreased cardiac flow rate and bradycardia. The mechanisms involved in the negative inotropic and chronotropic effects of oxytocin were investigated in isolated dog right atria in the absence of central mechanisms. Perfusion of atria through the sinus node artery with 10(-6) mol/L oxytocin over 5 minutes (8 mL/min) significantly decreased both beating rate (-14.7+/-4.9% of basal levels, n=5, P<0.004) and force of contraction (-52.4+/-9.1% of basal levels, n=5, P<0.001). Co-perfusion with 10(-6) mol/L oxytocin receptor antagonist (n=3) completely inhibited the effects of oxytocin on frequency (P<0.04) and force of contraction (P<0.004), indicating receptor specificity. The effects of oxytocin were also totally inhibited by co-perfusion with 5x10(-8) mol/L tetrodotoxin (P<0.02) or 10(-6) mol/L atropine (P<0.03) but not by 10(-6) mol/L hexamethonium, which implies that these effects are neurally mediated, primarily by intrinsic parasympathetic postganglionic neurons. Co-perfusion with 10(-6) mol/L NO synthase inhibitor (L-NAME) significantly inhibited oxytocin effects on both beating rate (-1.85+/-1.27% versus -14.7+/-4.9% in oxytocin alone, P<0.05) and force of contraction (-24.9+/-4.4% versus -52.4+/-9.1% in oxytocin alone, n=4, P<0.04). The effect of oxytocin on contractility was further inhibited by L-NAME at 10(-4) mol/L (-8.1+/-1.8%, P<0.01). These studies imply that the negative inotropic and chronotropic effects of oxytocin are mediated by cardiac oxytocin receptors and that intrinsic cardiac cholinergic neurons and NO are involved in these actions.
Hypertension 2001 Aug
PMID:Negative inotropic and chronotropic effects of oxytocin. 1150 92

Vasopressin (VP) and oxytocin (OT), the neurohypophysial hormones of mammals, are generally seen as being involved only in water balance and in parturition and lactation, respectively. In this review, new aspects of their physiology and pathophysiology are explored. Although VP is generally thought of as the antidiuretic hormone (ADH), it also is a highly potent vasoactive peptide. The physiology of VP, both as ADH and as a pressor peptide, is reviewed, and recent evidence suggesting that VP has a role in the maintenance of blood pressure and possibly in the pathogenesis of hypertension is presented. Clinical aspects of diabetes insipidus and of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) are reviewed. The importance of identifying cases of SIADH secondary to other pathologies and in which the control of VP secretion is normal is stressed. To distinguish these cases of pseudo-SIADH from those in which the VP secretion control mechanisms respond abnormally, the term SAADH, or syndrome of appropriate secretion of vasopressin, is proposed. The role of OT in lactation and parturition is reviewed. Recent evidence suggesting that the fetus may, at least in part, be responsible for the initiation of labor is presented.
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PMID:The neurohypophysis. 1168 4

Emergency treatment of such major complications of pregnancy as obstructed labor, hemorrhage, infection, hypertension disorders, and the effects of unsafe abortion, helps ameliorate morbidity and prevent mortality. Access to life-saving treatment (e.g., antibiotics, Cesarean sections, and blood transfusions) in developing countries is limited. Maternal mortality in one area of The Gambia, for example, is 2200 per 100,000 births. Improving access to care depends upon the availability of these services in communities, trained health personnel, service improvements, transportation provision, and community education. Detection of complications and early referral to an appropriate facility with a supportive and professional environment is key to saving lives. Political will and public pressure are needed before improvement in services can be successfully accomplished; politicians may ignore women with low status. Barriers to care are physical, cultural, technical, and economic. Cost or distance from home may prevent women from seeking care. Infection, hemorrhage, and uterine injury are frequently related to unsafe abortions, particularly among teenage women. Hospitals must be equipped with a reliable management system, surgical facilities, and clinical services. The WHO recommends upgrading community health centers with trained personnel, adequate supervision, and equipment. In Uganda, midwives are specially trained in advanced skills for use in remote areas: administration of oxytocin to evacuate the uterus and reduce bleeding, use of antibiotics for infections, and surgical repair of vaginal tears. Nurses in Zaire are trained to do Cesarean sections. In Sierra Leone and Nigeria, doctors are encouraged to receive training in obstetrics and to be posted in rural areas. In Sierra Leone, young men are trained to bring pregnant women in to care on stretchers. Maternity waiting homes near hospitals are another means to save lives. Lack of permission from a male relative may prevent use of medical care. Time, money, and women's place in society determine whether a woman receives care. Superstitions, such as difficult labor being blamed on the woman's unfaithfulness, interfere. Women with knowledge of complications may not have available services. Cost of care may discourage or delay decisions. Governments must support maternal health policies.
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PMID:Access to care save lives. 1228 2

Dopamine is an important transmitter in the CNS and PNS, critically regulating numerous neuropsychiatric and physiological functions. These actions of dopamine are mediated by five distinct receptor subtypes. Of these receptors, probably the least understood in terms of physiological functions is the D5 receptor subtype. To better understand the role of the D5 dopamine receptor (DAR) in normal physiology and behavior, we have now used gene-targeting technology to create mice that lack this receptor subtype. We find that the D5 receptor-deficient mice are viable and fertile and appear to develop normally. No compensatory alterations in other dopamine receptor subtypes were observed. We find, however, that the mutant mice develop hypertension and exhibit significantly elevated blood pressure (BP) by 3 months of age. This hypertension appears to be caused by increased sympathetic tone, primarily attributable to a CNS defect. Our data further suggest that this defect involves an oxytocin-dependent sensitization of V1 vasopressin and non-NMDA glutamatergic receptor-mediated pathways, potentially within the medulla, leading to increased sympathetic outflow. These results indicate that D5 dopamine receptors modulate neuronal pathways regulating blood pressure responses and may provide new insights into mechanisms for some forms of essential hypertension in humans, a disease that afflicts up to 25% of the aged adult population in industrialized societies.
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PMID:Mice lacking D5 dopamine receptors have increased sympathetic tone and are hypertensive. 1248 73


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