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

1. Diabetics have a greater risk of experiencing and of dying from a CHD event than age matched non-diabetics. 2. The excess risk is particularly notable in insulin dependent female diabetics who seem to lose the usual 'protection' accorded to women. 3. The cause or causes of the excess risk are not known. There are a variety of 'risk factors' observed in diabetics which, in sum, may contribute. 4. At least in insulin-dependent diabetics some cardiac morbidity and mortality may also be due, not to coronary heart disease, but to a cardiomyopathy secondary to intramural obstructive vascular disease and/or disordered myocardial metabolism. 5. No therapy has yet been convincingly proved to reduce (or to increase) the risk of cardiac morbidity or mortality. Nevertheless, in treating diabetics there is an a priori case for using diets designed to lower plasma lipid levels as well as the blood sugar, for early treatment of hypertension and for discouraging cigarette smoking.
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PMID:Diabetes and the heart: coronary heart disease. 33 40

The seeds of premature coronary heart disease are often sown in childhood and it is the developing arteries of children which are the most susceptible. Paediatricians and all who work with them have the earliest and most promising opportunities for prevention. Coronary protection can be added to the potential advantages of breast feeding and to ensure appropriate fatty acid balance throughout weaning. It is reasonable to accept the strong consensus of opinion on diet reflected in the reports of the eighteen national committees. They are: to reduce total fat intake to 30-35% of the energy, to restrict consumption of saturated fat, cholesterol, sugar, and salt, to increase unrefined carbohydrate and polyunsaturated fat, and to maintain a P/S balance of 1.0-1.5:1. Food is the fundamental coronary risk factor, but others may add insult to injury. Smoking, hypertension, obesity, lack of exercise, and stress, each of which is related to behaviour, may start in childhood. Smoking doubles the overall risk CHD and increases it ten times in males under 45 years old. Good habits, including food preferences and eating patterns learned early, are those most likely to be continued. School meals require and should match revised nutritional education. The co-operation of the food industry is essential and can be anticipated, but it requires a clear lead by paediatricians. The nutritional advice should come from the medical profession. Every contact with children and their parents provides an opportunity for enquiry and giving advice.
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PMID:Perspectives in coronary prevention. 34 32

The effectiveness of treatment for mild hypertension (diastolic pressures of 85 to 105 mm Hg) has not been conclusively demonstrated. Both the costs of a carefully designed clinical trial and the likelihood that it will produce definitive answers will depend importantly on the sample size. This paper presents sample-size estimates under a variety of assumptions regarding the characteristics of the population to be studied, the degree of blood pressure control to be achieved, and the health benefits to be expected. Under a central set of assumptions, the estimated sample size per group is 22,700 with death as an endpoint and 14,000 with morbid events (CHD and stroke) as endpoints. As individual assumptions are varied one at a time, required sample sizes range from 10,900 to 101,100 and from 6,800 to 63,100 for the respective endpoints. Results are most sensitive to the degree of blood pressure control actually achieved to the expected health benefits from blood pressure control. They are also highly sensitive to the sex composition of the population and to expected dropout rates. The choice of sample size will depend on the decision maker's assessment of the likelihood that each assumption will be fulfilled and on the degree of willingness to risk an inconclusive study result. By making explicit the effect of variation in each assumption, decision making is rendered more susceptible to critical examination by outside reviewers.
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PMID:Sample-size estimation: a sensitivity analysis in the context of a clinical trial for treatment of mild hypertension. 37 22

Observations relating to hypertension in humans and rat experiments have been reviewed from several viewpoints including clinical medicine, pathophysiology, epidemiology, and genetics. It seems likely that much of essential hypertension results from excessive salt intake by individuals with an inherited inability to excrete sodium efficiently which is compensated by blood pressure elevation. A few major genes are likely responsible for a few basic mechanisms involving renal membranes and hormones controlling sodium transport. Excess hypertension in blacks, diabetics, the elderly, and oral contraceptive users can be explained by this theory. If hypertension and other genetically predisposed CHD risk factors are to be fully understood, future studies are needed with detailed data on both genetic and environmental factors, and analytic tools that allow an adequate examination of their interactions.
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PMID:Salt, hypertension, and genetic-environmental interactions. 39 27

The recent increase in coronary heart disease is real and the causes must mainly be environmental. Consequently the condition should largely be preventable. The application of what is already known is likely to be a far more effective way of reducing the mortality rate than all attempts at palliative treatment, but vigorous action will be necessary. Much greater sums are being expended on coronary-care units and cardiac surgery than in preventing the need for them, although there is little evidence that they have significantly lowered the over-all mortality rate. Conventional treatment is immensely expensive. Prevention could in the long run be much cheaper. Cardiologists on their own are unlikely to succeed in a program of prevention. They need the help of many others, including community nurses, nutritionists, public health workers, sociologists, and of course general practitioners, but they have responsibility for leadership and for providing background knowledge. For the detection of certain risk factors, health examinations are necessary and should be part of general practice. Also, advice is best given on an individual basis. The chief-known risk factors (hyperlipidemia, hypertension, smoking, physical inactivity) could be controlled. CHD occurs in adults but atherosclerosis starts many years before. Prevention should begin with appropriate infant feeding, whenever possible with breast milk, and continue into childhood, when habits are formed and attitudes to life can best be influenced. It should be possible to bring up children virtually free from risk factors. It may never be possible to prove the effectiveness of such a multifactorial program by prospective controlled intervention studies, but the evidence indicates strong probability. The stakes are too high to delay action any longer. Physicians daily give advice in areas where the evidence is much less certain. Such a program for the control of coronary artery disease is urgently needed and could become one of the most rewarding activities for the medical profession.
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PMID:The cardiologist's responsibility for preventing coronary heart disease. 124 24

The main points covered in this review are as follows: 1. Hypertension is a major determinant of cardiovascular disease (CVD). As such it is a major cause of mortality, potential years of life lost, morbidity and long-term disability. 2. The incidence of CVD is directly related to BP. It is likely that this extends over the full range of BP although some writers believe that a J-curve of risk exists for CHD. 3. The relationship between long-term disability from CVD and BP requires further study. 4. Because of regression dilution bias, the gradient in risk of stroke and CHD with BP has been underestimated in the past. Recent research suggests that the risk of stroke increases at least tenfold and CHD sixfold over a range of usual DBP of 30 mmHg (equivalent to approximately 50 mmHg baseline DBP). 5. The population attributable risk (PAR) of CVD related to general elevation of BP in the population from a mean daily excess of sodium intake of 100 mmol/day is at least 30%. In typical industrialised countries the PAR for stroke and CHD from clinical hypertension is 36% and 22%, respectively. These estimates of PAR provide a guide to the maximum benefit that could result from either restriction of sodium intake in the whole population or ideal management of all persons with hypertension. In practice such targets are unlikely to be realised. 6. Recent analyses of clinical trials of treatment of hypertension suggest that the risk of stroke is reduced at all levels of initial BP to the extent predicted from observational studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Review of the benefits of treating hypertension. 129 6

With improvements in life expectancy and as more and more people have access to modern medicine, non-communicable diseases are emerging as a health problem in both urban and rural communities in Myanmar. Of all non-communicable diseases, cardiovascular diseases (CVD) are known to be the major health problem. Since many studies that have been conducted in both developed and developing countries have shown a difference between rural and urban communities with regard to cardiovascular diseases, our study had the objective of finding out the prevalence of ischemic heart disease, hypertensive heart disease and rheumatic heart disease in a rural and urban community. The risk of obesity and smoking in the occurrence of CVD was also studied. A cross-sectional survey was conducted in three urban townships of Yangon City (Sanchaung, Latha and Pabedan) and one rural township of Hmawbi. The results showed that CVD were a health problem in both the urban and rural communities. Coronary heart disease was seen to be more prevalent in the urban townships than in the rural Hmawbi Township, but hypertension (HT) and rheumatic heart diseases (RHD) were more prevalent in the rural township of Hmawbi. Obesity which has been blamed as the major risk factor for CHD and HT in the developed countries was not found to be a risk factor in the study townships, but smoking was.
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PMID:Prevalence of cardiovascular diseases in rural area of Hmawbi and urban Yangon city. 134 45

In a randomized, double-blind study oral doses of 50 mg carvedilol (Dilatrend) were compared with 40 mg propranolol in 16 male patients with coronary heart disease, CHD [12 without significant stenoses following percutaneous transluminal coronary angioplasty (PTCA), 4 with multivessel disease]. Bicycle ergometry in the supine position was performed before and 80 min after drug application; measurements were done at rest, during and after exercise. Clinically, the total exercise time and the onset of angina and exhaustion were noted, while the investigated hemodynamic parameters were heart rate, systemic and pulmonary pressures and resistances, cardiac index, and lower limb blood flow. Clinically, carvedilol improved the exercise tolerance more than propranolol as regards angina and exhaustion. Hemodynamically, carvedilol did not lead, as the classic betablocker propranolol does, to an increase in systemic or pulmonary resistance, to a decrease in cardiac output, or to an increase of the pulmonary capillary wedge pressure during exercise, but instead caused opposite changes. In contrast to propranolol, the post exercise lower limb blood flow had increased significantly. The differences in action between the two betablockers can be explained by the vasodilating properties of carvedilol. Due to these acute effects, carvedilol may be preferred to propranolol in the treatment of CHD patients with hypertension, peripheral occlusive artery disease, and/or coronary vasospasm.
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PMID:Acute hemodynamic effects of carvedilol in comparison with propranolol in patients with coronary heart disease. 135 Apr 91

The concentrations of Cd, Cr, Cu, Mn, Ni, Pb, and Zn were estimated in hair and nails of urban residents of New Delhi. Particularly, hair levels of Cu and Mn in hypertensive males, Cr and Zn in hypertensive females, and Zn in CHD and diabetic females, and nail levels of Zn in CHD and hypertensive females were significantly lower than controls. Thus, it is observed that there exists some positive correlation between element levels in hair and nails and CHD, hypertension, and diabetes of these subjects.
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PMID:Elements in hair and nails of urban residents of New Delhi. CHD, hypertensive, and diabetic cases. 138 25

The authors report about the long-term response (one and three years) of blood pressure and heart frequency under rest and load (50 W) in patients with hypertension, coronary heart disease, essential hypertension and after aortocoronary venous-bypass operation (ACVB) (n = 65) under regular visits (twice a week) to the Finnish sauna. In comparison, 68 hypertensive patients who took a regular kinesiotherapy (running and swimming) were studied. Besides the parameters of heart circulation mentioned above, peripheric microcirculation (M. tibialis anterior) by means of xenon-133 muscle clearance and central hemodynamics by means of LVEF (single probe with In 113) were studied in CHD-patients. Cardiac output at rest and under 50 W load was recorded in hypertensive patients. It was shown that regular balneotherapy had a positive effect on regulation of blood pressure and hemodynamics in patients with hypertension or CHD with hypertension, as had kinesiotherapy in hypertensive patients.
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PMID:[Potential use of the sauna in the long-term treatment of hypertensive cardiovascular circulation disorders--a comparison with kinesiotherapy]. 141 Sep 79


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