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)

By using a computerized database, we have catalogued the presence of 29 co-morbid risk factors in 683 patients with end-stage renal disease who started dialysis from 1970 through 1989, with follow-up through 1992. The authors hypothesized that current end-stage renal disease patients have more serious co-morbid risk factors impacting upon their mortality rate. Quantitation of dialysis patient co-morbidity, as a measure of patient illness, is lacking in the general nephrology literature. Seven co-morbid risk factors have been reserved for new dialysis patients: hypertension, low albumin, cerebral vascular disease, peripheral vascular disease, pre-existing cardiac disease, abnormal EKG/old myocardial infarction, and congestive heart failure. Except for low serum albumin, the proportion of patients with the six other co-morbid risk factors has increased significantly over this 20-year period (p < 0.0001, chi-square test for hypertension, peripheral vascular disease, pre-existing cardiac disease, abnormal EKG/old myocardial infarction, and congestive heart failure, and p < 0.006 for cerebral vascular disease). In addition, the co-morbid risk factors of hypertension, low serum albumin, and pre-existing cardiac disease at the start of dialysis were strongly prognostic of survival. The Cox proportional hazards regression model identified these three risks, among other factors, that were significantly associated with a decreased survival, with risk ratios ranging from 1.40-1.66. These results support the authors' hypothesis that incoming end-stage renal disease patients, who recently start dialysis, are sicker than in the earlier years of the authors' program. If the authors' patients reflect the national end-stage renal disease population, the presence of co-morbid risk factors may, in part, explain the continuing high mortality of dialysis patients.
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PMID:The impact of co-morbid risk factors at the start of dialysis upon the survival of ESRD patients. 872 82

The purpose was 1) To assess the prevalence of abdominal aortic aneurysms (AAA) in elderly males with atherosclerosis and 2) to evaluate the value of physical exam (PE) by a vascular surgeon in detecting AAA. A total of ninety-six males older than 55 years referred to vascular surgery clinic with atherosclerotic disease were screened prospectively with PE by a vascular surgeon, followed by ultrasonography (US). Atherosclerosis was documented by ankle brachial index and duplex US. Patients who had recently undergone a vascular procedure, aortography, laparotomy, abdominal computed tomography, or US were excluded. Mean age was 67 years. Patients were 67 per cent Caucasian, 32 per cent black, and 1 per cent Hispanic. Presenting complaints were related to claudication (83%), carotid disease (19%), both (3%), and subclavian stenosis (1%). Patient characteristics included cigarette smoking (85%), hypertension (67%), cardiac disease (51%), diabetes (45%), stroke (18%), and chronic obstructive pulmonary disease (8%). One (1%) 3.7 cm AAA was detected by US. Sensitivity of PE was 100 per cent and specificity 92 per cent. Twenty-two (23%) patients were too obese for us to feel the aortic pulse. Screening cost was $14,250. The prevalence of AAA in this population is very low. AAA screening should be reserved for patients with a positive PE or who are too obese for the examiner to feel the aortic pulse.
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PMID:Abdominal aortic aneurysm screening in elderly males with atherosclerosis: the value of physical exam. 881 72

Children presenting with hypertension should be considered for emergency treatment when there is evidence of end-organ toxicity. Complications of extreme hypertension may be very serious, even life threatening, with the potential for life-long sequelae. Of greatest significance is damage to the central nervous system. Treatment of hypertensive emergencies should be directed toward the lowering of blood pressure enough to reduce toxicity, but not at a rate likely to cause hypoperfusion of vital organs. This blood pressure reduction should, in general, be carefully controlled in an intensive care unit, with attention to central nervous system, cardiac, and renal function. Intravenous agents are preferable under these circumstances, due to greater ease in modulating blood pressure. In the absence of specific contraindications, a continuous infusion of nicardipine or sodium nitroprusside is preferable. Intravenous labetalol by bolus injection, followed by continuous infusion, also may be used. Oral agents should be reserved for circumstances in which symptoms of end-organ toxicity are mild or absent. Since general pediatricians have limited experience with the treatment of hypertensive emergencies, consultation with physicians experienced in treating hypertensive emergencies is suggested when possible.
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PMID:Hypertensive crisis in children. 882 60

Despite the availability and use of effective methods for limiting infarct size with thrombolytic agents and primary angioplasty, patients experiencing a myocardial infarction (MI) are at increased risk for a second cardiac event in the post-MI period (e.g., reinfarction, heart failure, and sudden death). For this reason, postinfarction risk management is crucial. An extensive data base has firmly established the efficacy of beta blockers in reducing cardiovascular risk following acute MI. The full advantages of angiotensin-converting enzyme (ACE) inhibitors have only recently begun to emerge as the result of a growing understanding of the mechanisms of adverse outcomes following MI. The importance of lipid-lowering agents, in particular the "statins," should be considered in all post-MI patients, especially since recent studies have conclusively shown improved survival and reduced rates of MI and coronary artery bypass surgery in this population with this therapy. Aspirin is now considered a standard part of the early management of the acute infarct patient as well as for secondary prevention in post-MI patients. At present, chronic anticoagulation with warfarin should be reserved for selected patients. The nondihydropyridine calcium antagonists diltiazem and verapamil can be considered for post-MI use only in patients in whom beta blockers are contraindicated and who have preserved systolic function and/or those without clinical heart failure. In contrast, the dihydropyridine calcium antagonists, particularly nifedipine, have no role in secondary prevention. Although long-term benefits are minimal, nitrates continue to be useful in post-MI patients with residual ischemia (angina or silent ischemia), heart failure (systolic or diastolic), or postinfarction hypertension. Antiarrhythmic agents, except amiodarone, are relatively contraindicated in post-MI patients. Recent data show that vitamin E reduces the rate of nonfatal MI. Its role in cardiovascular death and overall mortality remains to be clarified. Despite their demonstrated value, agents used in secondary prevention generally appear to be underutilized. In addition, when pharmacologic therapies are administered for secondary prevention, they are often prescribed at lower doses than those tested and proved in trials. A greater appreciation for the efficacy and safety profiles of these agents could lead to more widespread use and more pronounced reductions in morbidity and mortality among post-MI patients.
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PMID:Pharmacologic therapies after myocardial infarction. 890 Mar 39

alpha 1-Receptor antagonists are potent blood pressure lowering drugs, although the use of alpha 1-receptor antagonists by physicians in the treatment of hypertension has been somewhat reserved. The major concern are symptoms of orthostatic dysregulation and syncopes. However, reports on a long-acting second generation of alpha 1-adrenoceptor antagonists demonstrate that orthostatic dysregulation is not more frequent in patients treated with these compounds as compared to other antihypertensive drugs. Since blood pressure readings at patients' work sites are of greater prognostic value for the fatal events of cardiovascular disease, the impact of any antihypertensive agent on cardiovascular reactivity during stress becomes most important. Long-acting alpha-adrenoceptor antagonists control blood pressure during stressful events, ie, stimulation of the sympathetic nervous system without altering the physiologic hemodynamic profile. Sustained elevated blood pressure imposes a burden on the cardiovascular system, in particular on arteries, arterial resistance vessels, the cerebrovascular circulation, the kidneys, and the heart. Since the extent of target organ damage is responsible for the impaired prognosis of the hypertensive patient, regression of early hypertensive organ alterations is a most desirable therapeutic goal. In a series of clinical trials we found that alpha 1-receptor antagonists reduced left ventricular hypertrophy (an independent risk factor for cardiovascular mortality and morbidity), lowered total peripheral resistance (related to vascular resistance vessels), improved glomerular filtration rate, and had no effect or improved lipid metabolism, glucose tolerance, and insulin resistance. Hence, alpha 1-adrenoceptor antagonists emerged as attractive agents for antihypertensive therapy.
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PMID:Overview of alpha 1-adrenoceptor antagonism and recent advances in hypertensive therapy. 893 46

Uncommon headache syndromes can be classified into two broad categories: (1) urgent conditions, including subarachnoid hemorrhage, giant cell arteritis and bacterial meningitis, and (2) special syndromes, such as cluster headache, migraine with aura and headache caused by benign intracranial hypertension. In this article, uncommon headaches are differentiated from the common migraine and the tension headache, which fall into a third category. If a neurologic abnormality is detected during the physical examination, aggressive medical diagnostic intervention is required. Because of its cost, neuroimaging should be reserved for specific situations that herald life-threatening or acutely reversible conditions; it should not be used in the work-up of nonspecific headache. The diagnosis of common headaches can be simplified by considering tension and common migraine syndromes to exist at different points on a headache spectrum.
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PMID:Recognizing uncommon headache syndromes. 894 Sep 58

Renal artery stenosis (RAS) is the commonest secondary cause of hypertension and may result in renal ischaemia with resultant renal failure. Recent studies hve suggested that colour Doppler ultrasound, with spectral analysis of the intrarenal waveforms, can identify those patients with a significant RAS. A prospective study was performed in which colour Doppler ultrasound was compared with angiography in 73 patients (143 kidneys) presenting for renal angiography. Colour Doppler ultrasound was unsuccessful in 16% of kidneys due to a combination of technical failures and small kidney size. Accessory renal vessels were present in 14% of kidneys on angiography but none was detected by ultrasound. Of the 120 kidneys that had both examinations, no significant difference in intrarenal pulsatility or resistive index was noted between the angiographically stenosed and normal arteries. There were significant differences for intrarenal peak and end diastolic velocities, and acceleration time and index. Of these measurements, acceleration time was the best indicator of RAS. The probability of detecting a high grade RAS in an individual patient did not reach 90% until the acceleration time was prolonged to more than 0.12 s. Intrarenal colour Doppler ultrasound is not a general screening test for RAS and it should be reserved for selected patient groups where the incidence of disease is high. Patients with prolonged acceleration times of more than 0.12 s have a high likelihood of at least 70% RAS and should proceed directly to angiography.
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PMID:Colour Doppler ultrasound in renal artery stenosis: intrarenal waveform analysis. 898 84

The accuracy of color-coded duplex sonography (CCDS) in screening hypertensive patients for renal artery stenosis (RAS) was assessed using a semi-quantitative waveform analysis. Our special aims were to separate between moderate and high grade stenoses and to evaluate the accuracy of the method in imaging both the whole course of the renal arteries and accessory renal arteries. Included in the prospective, angiographically controlled study were 135 consecutive patients with 268 renal arteries, of which 195 arteries (73%) could be visualized both proximally and distally by CCDS. Only three of 15 accessory renal arteries could be identified by CCDS. In 42 RAS > or = 50% sensitivity of CCDS was 93%, specificity 92%, and overall accuracy 92%. The sensitivity in identifying RAS > or = 75% was 92%, and none of the high grade stenoses were missed. Because of difficulties in visualizing the middle portion of the renal artery, we carefully examined this part of the artery in 116 additional patients. Whereas the proximal and the distal parts could be visualized in 77% of the renal arteries, signals from the middle third could be derived only in 60% on the right, and in 39% on the left side. Provided that the renal arteries were visualized both proximally and distally, a hemodynamically effective RAS could be excluded with high probability. Moreover, exact grading of high-grade stenoses was possible in all cases but one. An advantage of CCDS over conventional duplex sonography appears to be the time-saving examination. Since a low prevalence of RAS impairs the positive predictive value of CCDS, the examination should be reserved for patients with a strong clinical suspicion of renovascular hypertension.
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PMID:Color-coded duplex sonography for noninvasive diagnosis and grading of renal artery stenosis. 899 57

We describe the capnography tilt test (CTT) for the diagnosis of hyperventilation syncope. The CTT is a 10-min supine, 30-min head-up tilt test with simultaneous monitoring of end-tidal PCO2 (ETPCO2). Hyperventilation (HV) was defined as ETPCO2 < or = 25 mmHg. Hyperventilation syncope (HV syncope) was defined as loss of consciousness with ETPCO2 < or = 25 mmHg and no significant drop in blood pressure. Four groups of patients had the CTT: group I (n = 14), patients presenting with syncope who during a prior tilt test had lost consciousness without concomitant fall in blood pressure; group II (n = 50), syncope, primary evaluation, no prior tilt test done; group III (n = 20), generalized anxiety disorder, no syncope; group IV (n = 80), arterial hypertension, no syncope. Hyperventilation was found in 11/14 patients in group I, 5/50 in group II, 7/20 in group III, and none in group IV; HV syncope was diagnosed in seven patients, all in group I. None of the parameters measured in the evaluation, including ETPCO2, predicted HV syncope on tilting. The mechanisms of resting HV and HV during tilt are not well understood. We confirm the existence of HV syncope. The tilt test should probably be used to screen patients presenting with syncope, with the CTT reserved for patients who lose consciousness during the tilt test without an associated fall in blood pressure, as HV is not always clinically obvious.
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PMID:The capnography-tilt test for the diagnosis of hyperventilation syncope. 906 5

Current recommendations for the universal investigation of urinary tract infection (UTI) in children by ultrasonography, voiding cystourethrography, and dimercaptosuccinic acid renal scan (and sometimes intravenous pyelography as well) are not based on any convincing evidence as to the necessity or effectiveness of such a routine. Over 8% of all girls will have a UTI during childhood. About 87 individuals in a million will develop end-stage renal disease (ESRD) by the age of 60 years, caused in about 9% by pyelonephritis (PN) or reflux nephropathy. From these statistics, the maximal risk of a first diagnosed UTI progressing to ESRD is approximately 1:10,000. The risk of developing hypertension following a first UTI in childhood, without eventual evolution to ESRD, appears to be very small. The cost of the widely recommended routine imaging procedures ranges from U.S. $355 in Britain to U.S. $1,090 in the United States. The minimal cost of preventing a single progression to ESRD by early diagnosis of underlying pathology-if this were possible in all cases-would range between U.S. $5 million in Britain and U.S. $15 million in the United States. Since in many instances progressive renal damage can not be prevented, the true cost is considerably higher. Lower UTI in girls is a very common and, in most cases, benign finding in primary-care practice. It is suggested that girls with afebrile UTI, presenting with lower urinary tract symptoms alone, need not undergo any imaging procedures, but should be followed with urine examinations and cultures at the time of febrile illness. The recommended investigative routines should be reserved for UTI in infants and in girls with fever or other symptoms suggesting PN, and for proven recurrent UTI. Such a regimen will allow a marked saving in terms of costs and in terms of unnecessary radiation, psychological stress to children, and stress, inconvenience, and time loss to parents. There is no evidence that this approach will compromise the course or final outcome of this very common condition.
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PMID:Urinary tract infections in girls: the cost-effectiveness of currently recommended investigative routines. 965 67

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