UMLS:C0020538 - FACTA Search

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

Empirical evidence from the Diabetes Control and Complication Trial (DCCT) suggests that maintaining normal glycemic control can prevent both micro vascular and macro vascular diseases in persons diagnosed with type 2 diabetes mellitus (T2DM) (DCCT, 1993). Adults with T2DM are also more likely to have hypertension (73% [HTN]) and patients with both are 2 to 4 times more likely to develop diabetic complications compared with the general population (CDC, 2005). The purpose of this descriptive study was to 1) describe the quality of diabetes care received by Gullah families who participated in the Project SuGar research study; and 2) compare the Gullah's quality of care to the national sample in the Center for Disease Control (CDC) Diabetes Report Card using the two indicators of blood pressure and HbA1c. This was a secondary analysis from a parent study that compared selected data to the CDC Diabetes Report Card, the National Health and Nutrition Examination Survey (NHANES III), and the Behavioral Risk Factor Surveillance System (BRFSS). Socio-demographic and clinical data were obtained from 1,057 research participants (N = 1,057). Overall, when compared to the national sample in the CDC Report Card, the HbA1c greater than 9.5% mg/dL was higher among the Gullahs, (30.2% vs. 18%), and blood pressure greater 140/90 mmHg was lower (29% vs. 34%) among the participants. Almost half of the Gullahs (45.9%) self-reported neurovascular complications such as foot pain, claudication, and renal complications of kidney infection and dialysis (7.3%). The Gullah study participants are at risk for diabetes-related complications. Results suggest a quality gap in diabetes care and it suggests health disparities in outcome measures as well. Optimal care that is consistent with clinical guidelines could have a significant impact on decreasing complications and health disparities.
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PMID:The quality of diabetes care to Gullah families of South Carolina. 1939 50

The relationship between HTNand other components of the CMSis complex. However, there is growing evidence that enhanced activation of the RAAS is a key factor in the development of endothelial dysfunction and HTN. Insulin resistance is induced by activation of the RAAS and resulting increases in ROS. This insulin resistance occurs in cardiovascular tissue and in tissues traditionally considered as targets for the action of insulin, such as muscle and liver. Indeed, there is a mounting body of evidence that the resultant insulin resistance in cardiovascular tissue and kidneys contributes to the development of endothelial dysfunction, HTN, atherosclerosis, CKD, and CVD.77 RAAS-associated signaling by way of the AT1R and MR, triggers tissue activation of the NADPH oxidase enzymatic activation and increased production of ROS. Oxidative stress in cardiovascular tissue is derived from both NADPH oxidase and mitochondrial generation of ROS, and is central to the development of insulin resistance, endothelial dysfunction, HTN, and atherosclerosis. Pharmacologic blockade of the RAAS not only improves blood pressure, but alsohas a beneficial impact on inflammation, oxidative stress, insulin sensitivity, and glucose homeostasis. Several strategies are available for RAAS blockade, including ACE inhibitors, ARBs, and MR blockers, which have been proven in the clinical trials to result in improved CVD and CKD outcomes. New research in these areas will allow for a better understanding of the relationship between HTN, insulin resistance, and activation of the RAAS, which could result in newer alternatives for a more comprehensive management of HTN in the setting of the CMS..
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PMID:The renin angiotensin aldosterone system in hypertension: roles of insulin resistance and oxidative stress. 1942 92

Peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonists have been shown to protect the cerebral vasculature, including the blood-brain barrier. In the present study, we investigated the effect of the PPAR-gamma agonist rosiglitazone on changes in venous permeability during chronic hypertension induced by nitric oxide synthase inhibition. Female Sprague-Dawley rats were either treated with N(G)-nitro-L-arginine methyl ester (L-NAME; 0.5 g/l in drinking water) for 5 wk (HTN; n = 8), L-NAME for 5 wk plus the PPAR-gamma agonist rosiglitazone (20 mg/kg in food) for the last 3 wk (HTN + Rosi; n = 5), L-NAME for 5 wk plus the superoxide dismutase mimetic Tempol (1 mmol/l in drinking water) for the last 3 wk (HTN + Tempol; n = 8), or were untreated controls (n = 9). Fluid filtration (J(v)/S) and hydraulic conductivity (L(p)) of cerebral veins were compared in vitro between groups after a step increase in pressure from 10 to 25 mmHg to mimic the change in hydrostatic pressure during acute hypertension. Hypertension increased J(v)/S by 2.2-fold and L(p) by 3.2-fold. Rosiglitazone treatment after 2 wk of hypertension completely reversed the increased J(v)/S and L(p) that occurred during hypertension, whereas Tempol had no effect. These results demonstrate that rosiglitazone was effective at reversing changes in venous permeability that occurred during chronic hypertension, an effect that does not appear to be related to its antioxidant properties. Our findings suggest that PPAR-gamma may be a key regulator of blood-brain barrier permeability and a potential therapeutic target during hypertension.
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PMID:PPAR-gamma agonist rosiglitazone reverses increased cerebral venous hydraulic conductivity during hypertension. 1966 38

Hypertension is a common condition that is a well-described risk factor for the development of cerebrovascular disease, myocardial infarction and heart failure. Medical therapy for hypertension may not only prevent development of these potentially devastating illnesses but may be used to treat high blood pressure, which coexists with these conditions. Therapeutic response to medical therapy for hypertension is variable and may be related to the individual genetic profile of patients. We have described here only several of the HTN-related polymorphisms that may impact clinical response in patients who have high blood pressure and coexisting conditions. Future studies are needed to identify other potential genotypes that may influence therapeutic response in addition to clinical trials of specific medical therapy in individual patients based on specific genotypes.
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PMID:Vascular tone and the genomics of hypertension. 1994 60

Sickle cell disease (SCD) is associated with early mortality. We sought to determine the incidence, cause, and risk factors for death in an adult population of patients with SCD. All patients aged >/=18 years seen at the Adult Sickle Cell Center at Duke University Medical Center between January 2000 and April 2005 were enrolled. Forty-three patients (21 males and 22 females) died during the study period. The median age of survival was 39 years for females (95% CI: 34-56), 40 years for males (95% CI: 34-48), and 40 years overall (95% CI: 35-48). Cardiac causes of death accounted for 25.6% (11/43 patients); pulmonary, 14.0% (six patients); other SCD related, 32.6% (14 patients); unknown, 14.0% (six patients); and others, 14.0% (six patients). Pulseless electrical activity arrest, pulmonary emboli, multiorgan failure, and stroke were the most frequent causes of death. Among the deceased patients, the most common premorbid conditions were cardiopulmonary: acute chest syndrome/pneumonia (58.1%), Pulmonary hypertension (pHTN; 41.9%), systemic HTN (25.6%), congestive heart failure (25.6%), myocardial infarction (20.9%), and arrhythmias (14.0%). Tricuspid regurgitant jet velocity was significantly higher (3.1 m/sec vs. 2.6 m/sec, P < 0.001) and hemoglobin significantly lower (8.3 g/dL vs. 9.2 g/dL, P < 0.05) in deceased patients when compared with patients who lived, respectively. With improved preventive and therapeutic advances, including hydroxyurea therapy, acute complications such as infection are no longer the leading cause of death; instead, causes of death and premorbid conditions are shifting to chronic cardiopulmonary complications. Further, arrhythmia leading to premature death is under-recognized in SCD and warrants further investigation.
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PMID:Cardiopulmonary complications leading to premature deaths in adult patients with sickle cell disease. 2002 50

Normal pregnancy is associated with significant hemodynamic changes and vasodilation in the uterine and systemic circulation in order to meet the metabolic demands of the mother and developing fetus. Hypertension in pregnancy (HTN-Preg) and preeclampsia (PE) are major complications and life-threatening conditions to both the mother and fetus. PE is precipitated by various genetic, dietary and environmental factors. Although the initiating events of PE are unclear, inadequate invasion of cytotrophoblasts into the uterine artery is thought to reduce uteroplacental perfusion pressure and lead to placental ischemia/hypoxia. Placental hypoxia induces the release of biologically active factors such as growth factor inhibitors, anti-angiogenic proteins, inflammatory cytokines, reactive oxygen species, hypoxia-inducible factors, and antibodies to vascular angiotensin II receptor. These bioactive factors affect the production/activity of various vascular mediators in the endothelium, smooth muscle and extracellular matrix, leading to severe vasoconstriction and HTN. As an endothelial cell disorder, PE is associated with decreased vasodilator mediators such as nitric oxide, prostacyclin and hyperpolarizing factor and increased vasoconstrictor mediators such as endothelin, angiotensin II and thromboxane A(2). PE also involves enhanced mechanisms of vascular smooth muscle contraction including intracellular free Ca(2+) concentration ([Ca(2+)](i)), and [Ca(2+)](i) sensitization pathways such as protein kinase C, Rho-kinase and mitogen-activated protein kinase. Changes in extracellular matrix composition and matrix metalloproteases activity also promote vascular remodeling and further vasoconstriction in the uterine and systemic circulation. Characterization of the predisposing risk factors, the biologically active factors, and the vascular mediators associated with PE holds the promise for early detection, and should help design specific genetic and pharmacological tools for the management of the vascular dysfunction associated with HTN-Preg.
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PMID:Risk factors and mediators of the vascular dysfunction associated with hypertension in pregnancy. 2004 38

Hemorrhagic fever with renal syndrome (HFRS), also known as mice fever is an acute viral zoonosis and it appears in the natural focus after the human contact with Hantaan virus infected mice. The objective (purpose) of this study was to investigate the prevalence of specific antibodies in HFRS, in convalescent persons (collective immunity in endemic hearths). In this project we applied the epidemiological method of studying with retrospective-perspective, the serological method for determination and detecting antibodies from the persons of epidemical focus and statistical methods. The disease diagnosis is based on the epidemiological, clinical and serological records. The collected samples have been sent to referral laboratory in Medical Faculty-Institute of Microbiology Ljubljana for laboratory confirmation. From the results we came to conclusion that in the territory of Republic of Kosovo, the HFRS is still a serious health, economic and biological problem. The lethality rate from HFRS in 1986 was 15.4%, 1986-89 10.8%, from 1995-2006 8.70%. The lowest rates of morbidity, mortality and lethality of HFRS compared with the previous periods of time, prove collective immunity growth in Dukagjini valley. For collective immunity research and to conduct the persistence of antibodies for viral corresponding (relative) antigen, after the disease, the samples were collected in the time period of May-June 2008, with 203 persons that were tested with serological method IIF (Indirect immune fluorescence) from which 187 cases (92.1%) resulted sero-negative and 16 cases (7.9%) resulted sero-positive with HFRS. This proves the collective immunity increase for HFRS. From 13 recovered patients previously diagnosed with HFRS (1986-1989-1995), levels of antibodies were screened in 2008 with IIF. Out of 13 persons, positive antibodies were found in 10 cases, while 3 cases were negative for antibodies (HTN, PUU, and DOB). After 13, 19 and 22 years HTN, PUU and DOB antibodies persisted in level (1:16-1:512). Based on the gathered results, we came to conclusion that it is necessary to compile the National Strategy of Surveillance for the Kosovo Health System for a 5 year period, for avoiding this high risk disease.
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PMID:Collective immunity of the population from endemic zones of hemorrhagic fever with renal syndrome in Kosovo. 2008 64

A safe and effective hantavirus vaccine is highly desirable since hantaviruses are distributed worldwide and cause an acute and often fatal disease (hemorrhagic fever with renal syndrome, HFRS). Virus-like particles (VLPs) displaying functional viral proteins could provide effective vaccines against a few viruses, but their ability to induce hantavirus-specific immune response has not been adequately investigated. To measure the immunogenicity of Hantaan virus-like particles (HTN-VLPs) vaccine, we generated recombinant HTN-VLPs by co-expressing Hantaan virus nucleocapsid (N) protein and glycoproteins (Gn and Gc) in Chinese hamster ovary (CHO) cells. We compared intramuscular versus subcutaneous administration of HTN-VLPs for the ability to induce specific immune response against Hantaan virus infection. Mice that received both intramuscular and subcutaneous immunizations of HTN-VLPs were sufficiently stimulated specific antibody response against Hantaan virus N protein and glycoproteins, which was comparable to Chinese commercial inactivated bivalent hantaviruses vaccine. Moreover, vaccination with HTN-VLPs also resulted in the induction of higher levels of specific cellular response to N protein than that of inactivated vaccine. Our results provide an important insight towards the development of hantaviruses-like particles as a potential candidate vaccine for the control and prevention of hantaviruses infection.
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PMID:Hantavirus-like particles generated in CHO cells induce specific immune responses in C57BL/6 mice. 2043 2

Childhood HTN (hypertension) has become a widely investigated topic within the last decade due to its increasing prevalence. In the present review, we examine new developments and trends that have significantly contributed to aetiology, diagnosis, evaluation and management of childhood HTN. Many recent reports document an increasing prevalence of HTN, mainly essential HTN, in children worldwide. This is probably related to the increase of childhood obesity, although obesity is not the only factor. Evidence has been accumulating to suggest a rather complex interplay between obesity, uric acid level, dietary sodium intake, inflammation, inheritance and other factors, which lead to increased risk of developing HTN in childhood and adulthood. The detection and monitoring of HTN has significantly improved with the use of ABPM (ambulatory blood pressure monitoring), which allows not only for a more accurate classification and staging of HTN, but also for the calculation of more sophisticated parameters such as the AASI (ambulatory arterial stiffness index). Measurement of arterial stiffness enables assessment of arterial dysfunction, which may precede structural vascular changes evaluated by carotid intima media thickness. Sustained HTN eventually leads to end-organ damage [LVH (left ventricular hypertrophy), central nervous system], which in turn increases the risk of cardiovascular morbidity and mortality. New developments in childhood HTN, as outlined in the present review, will hopefully contribute to better screening and management of HTN in children.
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PMID:Hypertension in children: new trends and challenges. 2047 51

Cardiovascular disease (CVD) is the leading cause of death worldwide. Understandably, cardiometabolic risk assessment is an integral component of every adult health evaluation. Customary assessment measures are, however, inadequate: as two-thirds of sudden cardiac deaths occur in clinically healthy individuals. Novel indicators favoring early recognition of adverse cardiometabolic risk in disease-free adults are clearly needed. Clinically healthy disease-free adults with prehypertension (PreHTN: BP120-139/80-89 mm Hg) have an adverse cardiometabolic risk profile. A statistical analysis of disease-free adult NHANES participants was conducted from 1999 to 2006. Overall prevalence of PreHTN in disease-free adults was 36.3%. Prevalence was higher in men (P<0.001) increasing with age up to 70 years (P<0.001). Prevalence correlated strongly with indicators of adverse cardiometabolic risk profile: it was higher with increasing body mass index (BMI) and waist circumference (WC) (P<0.001 for both). Means were significantly higher for BMI, WC, glucose, insulin, hemoglobin A1c, homeostasis model assessment, pulse pressure, C-reactive protein, total cholesterol and triglycerides in subjects with PreHTN (vs. desirable BP: P<0.05 for all). Prevalence of two or more unfavorable risk factors (other than high BP) was 30% higher in disease-free adults with PreHTN vs. desirable BP (prevalence ratio: 1.30; 95% CI: 1.22, 1.39). Detection of PreHTN (a precursor for subsequent HTN), during annual health maintenance in disease-free adults, (especially with one or more of the recognized CVD risk correlates), could become an early marker of adverse cardiometabolic risk profile. Clinical care designed to prevent progression from PreHTN to HTN (JNC 7 recommendation) may attenuate risk.
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PMID:Prehypertension in disease-free adults: a marker for an adverse cardiometabolic risk profile. 2053 13

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