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

The Program FLAG was initiated by the Scientific Society of Arterial Hypertension in order to assess achievability of WHO/ISH target blood pressure (BP) levels in conventional ambulatory practice. Overall 2829 patients (mean age 53.1 years, 65% women) were enrolled in 17 cities of 5 regions in Russia. Nineteen, 68, 10 and 3% of patients had 1-st, 2-nd, 3-rd degree of blood pressure elevation and isolated systolic hypertension, respectively. During treatment with angiotensin converting enzyme inhibitor fosinopril (10-20 mg/day) -/+ hydrochlorothiazide BP level 140/90 mm Hg or 'positive effect' (BP lowering et least by 10%) were achieved in 62.1 and 88.8% of cases, respectively. Average BP level decreased from 162.8/98.7 to 134.2/82.5 mm Hg and lowering of systolic and diastolic BP was 17 and 16%, respectively. The regimen of antihypertensive therapy used in the program was well tolerated and safe (adverse effects were registered in 8.3% of patients, in 5.2% of patients these effects lead to withdrawal of fosinopril). The therapy was equally effective in men and women irrespective of age. The results allow to recommend the treatment scheme tested in the FLAG program for use in multiple patients with hypertension.
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PMID:[FLAG--a program of achievability of target blood pressure levels during treatment of patients with hypertension with fosinopril]. 1249 25

The application of chemometric methods to 1H NMR spectroscopic data has been documented for pathophysiological processes. In this study we show the application of 1H NMR-based metabonomics to investigate a relationship between serum metabolic profiles and hypertension. Although hypertension can be defined using blood pressure measurements, the underlying aetiology and metabolic effects are not so readily identified. Serum profiles for patients with low/normal systolic blood pressure (SBP < or = 130 mm Hg; n = 28), borderline SBP (131-149 mm Hg; n = 19) and high SBP (> or = 150 mm Hg; n = 17) were acquired using 1H NMR spectroscopy. Orthogonal signal correction followed by principal components analysis were applied to these NMR data in order to facilitate interpretation, and the resulting chemometric models were validated using Soft Independent Modelling of Class Analogy. Using 1H NMR-based metabonomics, it was possible to distinguish low/ normal SBP serum samples from borderline and high SBP samples. Borderline and high SBP samples, however, were indiscriminate from each other. Our preliminary results showed that there was a relationship between serum metabolic profiles and blood pressure which, in part, was due to lipoprotein particle composition differences between the samples. Furthermore, our results indicated that serum pathology associated with blood pressure is apparent at SBP values > 130 mm Hg, which the WHO and ISH currently define as the limit between normal and high-normal.
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PMID:Application of chemometrics to 1H NMR spectroscopic data to investigate a relationship between human serum metabolic profiles and hypertension. 1257 99

In spite of considerable progress, the control of hypertension in most countries is still insufficient. One of the reasons may be the poor awareness of the blood pressure (BP) cutoff values that define hypertension. The aim of this report is to verify the hypothesis that patients with hypertension accept higher BP levels as normal. The study was performed during a street-based BP screening project carried out across Poland, in summer 1997. In 444 persons who voluntarily participated in Cracow's part of the project, BP was taken on the left arm, in the sitting position, after a minimum of 5 min of rest, using a semiautomated device (Digital Blood Pressure UA-702). A questionnaire investigated participants' age, weight, height, level of education, history of hypertension and perception of normal values of BP. We compared measured BP values with those perceived as normal, and with the values recommended by WHO/ISH guidelines (<140/90 mmHg). To analyse the data we used Student's t-test and linear regression with adjustment for age and body mass index (BMI). Hypertensive subjects, compared with normotensives, were less aware of normal BP values (47.4 vs 83.9%, P<0.001, for systotic blood pressure, and 77.4 vs 88.4%, P<0.01, for diastotic blood pressure). Measured BP was positively related to BP values stated as normal. A similar relation was observed for age and BMI. In conclusion, poor awareness of normal BP values in hypertensives can be an important factor hindering better BP control. Education strategies might prove to be highly effective in helping to tackle the epidemics of hypertension.
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PMID:Normal blood pressure values as perceived by normotensive and hypertensive subjects. 1257 85

It has been clearly demonstrated that ageing and arterial hypertension are both associated with an increased prevalence of left ventricular hypertrophy (LVH), which is a powerful risk factor for cardiovascular (CV) events. The objective of this study was to assess the impact of echocardiographic LVH in profiling the absolute CV risk stratification according to the 1999 World Health Organization-International Society of Hypertension (WHO/ISH) guidelines in elderly hypertensive patients. A total of 223 never-treated elderly patients (> or =65 years) with essential hypertension (98 men, 125 women, mean age 72+/-5 years) referred to our outpatient hospital clinic were included in the study. They underwent the following procedures: (1) medical history, physical examination, and clinic blood pressure; (2) routine blood chemistry and urine analysis and (3) electrocardiogram. The risk was initially stratified according to the routine procedures suggested by WHO/ISH guidelines and subsequently reassessed by adding the results of echocardiography (LVH as left ventricular mass index >51 g/m(2.7) in men and >47g/m(2.7) in women). According to routine classification, 56% (n=125) were medium-risk patients, 29% (64) high-risk and 15% (34) very-high-risk patients. The overall prevalence of LVH was 56% (48% in medium-risk and 62% in high-risk or very-high-risk patients, P<0.01). A marked change in risk stratification was observed when echocardiographic LVH was taken into consideration: medium-risk patients decreased to 29% and high-risk patients rose to 56% (P<0.01). In conclusion, ultrasound assessment of cardiac target organ damage is extremely useful in obtaining a more valid assessment of global cardiovascular risk in elderly hypertensives, because stratification based on diagnostic routine procedures can underestimate the overall risk in a large fraction (48%) of medium-risk subjects.
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PMID:Change in cardiovascular risk profile by echocardiography in medium-risk elderly hypertensives. 1257 87

The ISH Statement on blood pressure lowering and stroke prevention was finalized after presentation and discussion at the World Health Organization and International Society of Hypertension (WHO-ISH) Meeting on Stroke and Blood Pressure, held in Melbourne Australia, 5-7 December 2002. The meeting was conducted under the auspice of the Austin Hospital Medical Research Foundation, Melbourne.
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PMID:International Society of Hypertension (ISH): statement on blood pressure lowering and stroke prevention. 1265 5

The ISH statement on the management of blood pressure in acute stroke was finalized after presentation and discussion at the World Health Organization and International Society of Hypertension (WHO-ISH) Meeting on Stroke and Blood Pressure, held in Melbourne, Australia, 5-7 December 2002. The meeting was conducted under the auspices of the Austin Hospital Medical Research Foundation, Melbourne.
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PMID:International Society of Hypertension (ISH): statement on the management of blood pressure in acute stroke. 1265 6

Autonomic effect of various stimuli on haemodynamic variables is usually tested by changes in blood pressure (BP) and/or heart rate (HR). It is known that increased sympathetic drive of ventricles can interfere with repolarization process. This study was focused on reactive changes of maximal spatial T vector (sTmax), R-R and QTc intervals, in relation to BP changes in 79 boys and men, averaged age 17 +/- 2 years, 36 from them were adolescents with elevated BP (high normal or hypertension I according to WHO/ISH 1999) (ZTK), 19 normotensives (NTK), and 24 normotensive sportsmen. R-R, QTc intervals and maximal spatial T vector were recorded by a PC (Cardiag METE, Prague) with Frank lead system while sitting in mid-respiratory position, during mental arithmetic (MA), after handgrip and during passive head-up tilting to 60 degrees. BP was measured simultaneously by a cuff sphygmomanometer, using phases 1 and 5 of Korotkoff sounds. MA resulted in significant BP increase in all subgroups, however the reactive changes of systolic BP as well as magnitude of R-R shortening, sTmax decline were about two times higher, and in the case of QTc lengthening three times higher in sportsmen. Handgrip provoked in all subgroups in average the less reactive changes of diastolic BP, sTmax, R-R, and QTc intervals. Head-up tilting evoked in all subgroups a significant increase of diastolic BP that was again higher in sportsmen vs. ZTK and NTK. R-R intervals became significantly (p < or = 0.02) and more often shortened in sportsmen vs. ZTK and NTK. Relatively more evident decline of sTmax (more than 20%) in ZTK was the highest change from all observed parameters to all tested stimuli. Our results indicate that for analysis of effect stimuli, which modulate balance in autonomic nervous system, it is helpful to pay attention also to the parameters of repolarization process that may represent a sensitive indicator of sympathetic tonization in myocardial ventricles.
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PMID:[Effect of adrenergic stimuli on electrocardiographic and vectorcardiographic characteristics of ventricular repolarization]. 1274 40

Unsatisfactory blood pressure (BP) control so often described in treated hypertensive populations is also explained by insufficient physicians' awareness of experts' guidelines. We assessed awareness of current recommendations about hypertension management in a general practice setting, using the World Health Organization/International Society of Hypertension (WHO/ISH) 1999 guidelines as reference. In a regionwide survey, a total of 5133 physicians (three-quarters of all active general practitioners in Lombardy, a region of north-western Italy) were contacted by letter and received a multiple choice 10-item questionnaire. Data on physicians' demographic characteristics, information on hypertension prevalence and their perception of BP control among their patients were also requested in an additional form. The number of answers in agreement with WHO/ISH guidelines was used as an awareness measure. This was considered adequate if correct answers to six out of 10 questions, including an appropriate definition of hypertension, were provided. Of the 1256 returned questionnaires (a 24.5% response rate), 1162 were suitable for analysis. The mean score of correct answers was 5.3 points and only 20.1% of the study population correctly answered at least six of the questions (including that on the definition of hypertension in the elderly). Guidelines awareness was negatively related to increase in physicians' age and duration of clinical practice and by the male gender. Finally, the physicians reported a high rate of achieved BP control, and those who were considered to have achieved highest rates (>75%) of control in their patients had a lower rate of adequate knowledge than those who reported less-successful therapeutic results (18 vs 25%, P<0.01), suggesting that they ignored or disregarded the goal BP recommended by the guidelines. This large regional survey shows that a sufficient degree of guidelines awareness is present in a minority of primary-care physicians in the Italian region of Lombardy. Therefore, further efforts are required to intensify information strategies for improving professional education, training and practice organization aimed at achieving therapeutic goals. Physicians with longer duration of clinical practice represent a particularly relevant target group for these interventions.
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PMID:Awareness of hypertension guidelines in primary care: results of a regionwide survey in Italy. 1287 11

Approaches to formalization of medical guidelines can be divided into model-centric and document-centric. While model-centric approaches dominate in the development of clinical decision support applications, document-centric, mark-up-based formalization is suitable for application tasks requiring the 'literal' content of the document to be transferred into the formal model. Examples of such tasks are logical verification of the document or compliance analysis of health records. The quality and efficiency of document-centric formalization can be improved using a decomposition of the whole process into several explicit steps. We present a methodology and software tool supporting the step-by-step formalization process. The knowledge elements can be marked up in the source text, refined to a tree structure with increasing level of detail, rearranged into an XML knowledge base, and, finally, exported into the operational representation. User-definable transformation rules enable to automate a large part of the process. The approach is being tested in the domain of cardiology. For parts of the WHO/ISH Guidelines for Hypertension, the process has been carried out through all the stages, to the form of executable application, generated automatically from the XML knowledge base.
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PMID:Step-by-step mark-up of medical guideline documents. 1290 85

The frequency of arterial hypertension occurrence in polish population amounts to 30-40%, among diabetics is significantly higher-70%. According to the WHO/ISH Guidelines all hypertensive patients with diabetes are included into the "high risk group" independent of hypertension stage. Pharmacological treatment of hypertension is this group of patients has a particular meaning. Among hypertensive patients the degree of blood pressure lowering is more effective for cardiovascular risk reduction than choice of drug. This fact is well documented in clinical trials comparing antihypertensive efficacy of old and new antihypertensive drugs (for example UKPDS, STOP 2, INSIGHT). From the other point of view renal protection and metabolic benefits, as well as reduction of target organ damage are more advantageous for angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists and calcium antagonists than for diuretics and beta-blockers. Despite fast progress in clinical research on new antihypertensive drugs (especially AT1 receptor inhibitors) ACE-I seem to still remain still the "first choice" for hypertensive diabetics. Adequate blood pressure control among diabetic hypertensives is of special importance and usually needs appropriate combined antihypertensive therapy. Our review presents detailed information about treatment advantages and disadvantages of drugs from different antihypertensive classes in light of current clinical trials and international guidelines.
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PMID:[Antihypertensive treatment for patients with hypertension and diabetes type II--current clinical research]. 1293 58


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