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

A retrospective study was conducted of 101 hospitalized patients who had one or more episodes of syncope. The etiology of syncope was established with relative ease in 61% of these patients. History and physical examination revealed the cause in 34%, resting ECG in 11% and 24-h ECG monitoring in 16%. Additional tests (electroencephalograms, Doppler studies of the cervical arteries, computerized tomography of the brain, ultrasonography of the heart and cardiac catheterization) either were noncontributory or did not contribute to confirmed diagnoses already established by other means. Cardiac causes were responsible for the syncope in 34% and noncardiac causes in 27%. Comparison between diagnosed and undiagnosed patients revealed no significant differences with respect to age, number of syncopal episodes or presence of hypertension or diabetes. There were, however, significantly more women, and a lower frequency of ischemic heart disease and other associated diseases in the undiagnosed group. It is concluded that all patients with syncope should undergo ambulatory ECG and 24-h ECG monitoring, and that hospitalization should be reserved for patients whose clinical condition requires admission or when further investigation is necessary.
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PMID:Syncope: a retrospective study of 101 hospitalized patients. 391 52

Between 1960 and 1983, 38 patients underwent multiple operations for treatment of recurrent renovascular hypertension. There were 23 women and 15 men who ranged in age from eight to 69 years old (a mean of 48.5 years). The cause of hypertension requiring repeat operation was determined roentgenographically, three patients had new disease of the contralateral nonoperated renal artery, 21 patients had a new lesion of the ipsilateral (previously operated) renal artery and 14 patients had new lesions of both the previously operated and nonoperated renal arteries. Thirty patients underwent a secondary unilateral operation and eight had a bilateral operation. Sixteen patients had unilateral renal artery revascularization, 14 had unilateral nephrectomy, three had bilateral revascularization and five had unilateral revascularization with contralateral nephrectomy. There were three operative deaths (an operative mortality of 7.9 per cent). At hospital dismissal, 30 of 35 patients were improved. Follow-up study ranged from seven months to 23 years (a mean of 7.2 years). There were eight (22.9 per cent) late deaths. Secondary revascularization alone produced improvement in 77 per cent. Nephrectomy alone produced improvement in 80 per cent. We conclude that secondary revascularization is the treatment of choice in patients with recurrent renal artery stenosis. Nephrectomy should be reserved for patients who cannot undergo a revascularization procedure for technical or medical reasons.
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PMID:Repeat revascularization versus nephrectomy in the treatment of recurrent renovascular hypertension. 394 Apr 7

Sixty-seven patients with idiopathic membranous glomerulonephritis (iMGN) were analyzed clinically. Their mean age was 39.3 years, and 47 (70%) of them were male. Fifty (74.6%) showed nephrotic syndrome (NS) initially and five (7.5%) had additionally chronic renal failure. Hypertension was present in 27%. During the follow-up (mean 6.7 years) renal death occurred in four patients 12-151 (mean 84.2) months after the diagnosis of iMGN. Four patients died of non-renal causes. The actuarial life-table survival at 5, 10 and 15 years was 94%, 83% and 69%, respectively. To some extent renal function deteriorated in 13 patients (19%). These patients were older (49.9 vs. 36.8 years, p less than 0.01) than those with preserved renal function, and many of them had serum creatinine levels of 125 mumol/l or more initially. Sex did not correlate with the development of renal insufficiency. Patients with slight proteinuria never showed loss of renal function. The retrospective comparison of survival in patients who did (N = 31) or did not (N = 19) receive corticosteroids and/or immunosuppressive drugs for the treatment of NS revealed no evident difference at 5 or 10 years. This clinical analysis emphasizes the fairly favorable outcome of patients with iMGN. Hence a reserved view must be taken when treatment with potentially dangerous agents is considered in a disease with unknown etiology and pathogenesis.
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PMID:Survival in idiopathic membranous glomerulonephritis. 395 13

In order to investigate the effects of beta-blockade on haemodynamic response to stress, 2 groups of volunteers received either propranolol or mepindolol sulphate under basal conditions and under the stress of mental arithmetic. In control conditions, increases occurred in heart rate (HR), cardiac output (CO) and systolic and diastolic blood pressure in response to calculation stress. Stress-induced increases in HR and CO were significantly reduced by propranolol. Systolic blood pressure during calculation stress under propranolol was slightly less than in control conditions. However, diastolic blood pressure under stress was higher with propranolol than in the control study. Mepindolol sulphate also reduced HR and CO under calculation stress but it produced no significant change in diastolic pressure. A significant increase in plasma adrenaline occurred under stress. The level was not altered by propranolol but was reduced to less than 50% of the untreated stress value by mepindolol. Since beta-blocking agents suppress an increase in heart rate in stressful situations but either fail to prevent or even potentiate increased diastolic pressure, their use in patients without hypertension should be reserved for those showing pathological stress reactions. They do not appear to be indicated for the management of stressful situations in general.
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PMID:Stress, catecholamines and beta-blockade. 612 6

The pharmacokinetics, clinical efficacy, and adverse effects of three calcium-channel blocking agents--verapamil, nifedipine, and diltiazem--are reviewed. Verapamil, nifedipine, and diltiazem are absorbed well after oral dosing, but absolute bioavailability of each is reduced substantially by a first-pass effect. Each drug is metabolized extensively (verapamil and diltiazem to moderately active metabolites) by the liver. A substantial percentage of each drug is bound to plasma proteins, but the binding is of clinical importance only for nifedipine (92--98% protein bound). Intravenous verapamil has become the agent of first choice for treatment of acute paroxysmal supraventricular tachycardia (PSVT); use of chronic oral verapamil therapy for prophylaxis remains controversial. Verapamil and diltiazem have been evaluated with mixed results for atrial flutter and fibrillation. For treatment of myocardial ischemia, calcium-channel blockers may be of some value (possibly in combination with nitrates of B blockers). All three agents have been studied in patients with exertional angina with good results. Calcium-channel blockers appear to be equal with nitrates for treatment of variant angina. Patients with hypertropic cardiomyopathy have been treated with verapamil and nifedipine with promising results. Nifedipine has been effective for treatment of essential hypertension. Adverse effects of calcium-channel blockers have been relatively minor or infrequent. Diltiazem overall has the best side-effect profile, with adverse effects causing discontinuation of therapy in about 2--10% of patients; verapamil in intermediate (8--10%) and nifedipine the worst (17%) in this respect. The most common side effects generally are fatigue, headache, dizziness, skin rash, and peripheral edema. While they generally should be reserved for patients in whom more conventional therapy has failed (except those with PSVT), calcium-channel blockers appear to have a valid role as reserve agents for exertional and variant angina, cardiomyopathy, and hypertension.
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PMID:Update on calcium-channel blocking agents. 635 66

Renal digital subtraction arteriography (RDSA) is a relatively safe, simple, and inexpensive means of detecting the presence of renovascular disease in hypertensive patients. We report our own 15-month experience with RDSA, performed on 166 patients because of hypertension, and review the literature. Twenty-eight of the patients had arteriography. Using this as a measure, the sensitivity of RDSA was 83% and its specificity 96%. RDSA findings are usually conclusive. Addition of plain films following the procedure permits evaluation of renal parenchyma, collecting systems, ureters, and bladder. Arteriography should be reserved for those patients with positive RDSA to be treated by surgery or angioplasty, and for the small number of patients who have a non-diagnostic RDSA. If renal vein renin sampling is done first, RDSA may be performed at the same time. As RDSA becomes more available there will be little place for rapid sequence urography in the investigation of hypertension. In patients suspected of having renovascular hypertension, the primary mode of investigation should be renal DSA.
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PMID:Digital subtraction arteriography in the diagnosis of renovascular hypertension. 636 24

Based on the retrospective analysis of 38 cases of renovascular hypertension treated by surgical intervention, the following indications are proposed for arterial reconstructive surgery: younger age of patient, short duration of hypertension, renin-mediated hypertension and extent and functional significance of the obstructing arterial lesion, favorable level of renal function in the affected side, and renal function threatened by advanced progressive vascular disease, surgically correctable lesion, and focal, unilateral renal arterial atherosclerosis without generalized atherosclerosis, good surgical risk, and hypertension not responding to medical treatment. Although the clinical use of the angiotensin I converting enzyme inhibitor and induction of percutaneous transluminal angioplasty can provide a new approach to non-surgical treatment for renovascular hypertension, the long-term use of antihypertensive drugs induces gradual decrease in renal function. Surgical treatment is best reserved for the patient on whom the available data meet the above criteria for vascular surgery.
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PMID:[Surgical treatment of renovascular hypertension with special reference to the indications for reconstructive surgery]. 637 7

The mitral apparatus is a complex structure composed of several components, each of which can be affected by a variety of diseases, resulting in mitral regurgitation. The physiologic consequences of mitral regurgitation include reduced forward stroke volume; increased left atrial volume and pressure; and reduced resistance to left ventricular ejection. The latter explains why indices of systolic left ventricular function (ejection fraction) are often increased early in the course of mitral regurgitation. With the insidious development of mitral regurgitation, the left atrium dilates to accommodate the increase in volume, thereby reducing the atrial pressure. However, with the acute development of mitral regurgitation into a nondilated left atrium, pressure rises rapidly, producing pulmonary edema. The predominant clinical symptoms in chronic mitral regurgitation of dyspnea and fatigue result from pulmonary venous hypertension and low cardiac output. The cardinal physical finding is a mitral systolic murmur. Since the murmur can assume various configurations, the most reliable way to establish its correct origin is by bedside physiologic maneuvers. Typically, in the beat following a premature contraction or after a long pause during atrial fibrillation, the murmur of mitral regurgitation is unchanged in intensity, but murmurs due to left ventricular outflow obstruction increase. Also, isometric handgrip exercise increases the intensity of the murmur and a Valsalva maneuver decreases it during the strain phase. Echocardiography is the most useful noninvasive technique for evaluating patients with mitral regurgitation. Visualization of the mitral apparatus may establish the etiology of regurgitation, and measurement of left atrial size and left ventricular size and performance is useful for assessing the functional significance of the lesion. Doppler echocardiography can establish the diagnosis of mitral regurgitation in difficult cases with multi valve disease and can estimate the severity of the regurgitation. Cardiac catheterization and angiography are usually reserved for the patient being considered for valvular surgery. The natural history of chronic mitral regurgitation is characterized by slowly progressive symptoms, and often the onset of disabling symptoms is the result of irreversible left ventricular dysfunction. Medical therapy consists of digitalis, diuretics, and vasodilators for symptomatic patients. When symptoms occur despite this therapy, valvular surgery should be considered before left ventricular function becomes abnormal.
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PMID:Mitral valve regurgitation. 637 82

Based on the experience reported herein, the following conclusions have been made: (1) Although nonoperative means, including sclerotherapy, have an important role in the management of bleeding varices, they are not definitive means of treating recurrent variceal hemorrhage. (2) Because of the maintenance of hepatopetal flow and splanchnic venous hypertension, a selective shunt is associated with a lower incidence of encephalopathy and provides a better quality of life than does a nonselective shunt. Thus, an elective distal splenorenal shunt is the elective operation of choice for recurrent variceal hemorrhage. (3) Nonselective shunts can be performed with similar expectation of patient survival as selective shunts, but because of increased encephalopathy, should be reserved for emergency operations, in cases of unsuitable venous anatomy, and in those patients with intractable ascites. (4) A well-conceived elective shunt procedure can be performed with low operative mortality and long-term patency, results in significant survival, and is still considered the "gold standard" for treatment of variceal bleeding.
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PMID:Selective and nonselective shunts for variceal bleeding. A prospective study of 103 patients. 661 Oct 93

1. Recent evidence suggests that mild hypertensives benefit from antihypertensive drug treatment. 2. The variable course of mild hypertension suggests that drug treatment is best reserved for patients whose blood pressures do not fall in repeated observation. 3. The possibility that thiazide diuretics and beta-adrenoceptor blocking drugs may have adverse effects suggest that calcium channel blockers should be considered for the early treatment of mild hypertension.
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PMID:Hypertension and calcium antagonists. 674 50


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