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

Contrary to opinions generally accepted in the past, CHD is very common in both African-American men and women, with incidence rates approaching those of US Caucasians. Higher prevalence of hypertension, diabetes, cigarette smoking, and obesity all contribute to the high level of CHD in African-Americans. Additional research is needed about the interrelations and management of various risk factors for CHD in African-Americans outside of the sudden death of African-Americans outside of the hospital is urgent, and special attention should be given to accessibility and use of health services by minority populations.
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PMID:Coronary artery disease in African-Americans. 201 70

Heart disease is the leading cause of death for Asian-Americans and Pacific-Islanders, Hispanic-Americans, and Native Americans. Generally, heart disease death rates are lower in these population groups than in Caucasians, with the notable exception of Native Americans under the age of 35. Of particular interest are data for southwestern US Native Americans and Mexican-Americans, which indicate low CHD prevalence rates despite high rates of obesity, diabetes mellitus, increasing hypertension, and low socioeconomic status. Much more research is needed to explain these and other observations. Intervention in those risk factors already identified is necessary, particularly in prevention of obesity and diabetes.
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PMID:Heart disease in Asians and Pacific-Islanders, Hispanics, and Native Americans. 201 71

Important features of the racial patterns in CHD at the present time are summarized in Table 15-10. Many of these conclusions follow inevitably from the economic disadvantage suffered by blacks, and the overwhelming importance of hypertension in this population. More knowledge is needed regarding the value of standard diagnostic tools in distinguishing noncoronary from coronary chest pain symptoms. A hard look is also needed at questions of access for blacks, particularly to angioplasty and thrombolytic therapy. There is additional growing evidence that the gains against CHD have been concentrated primarily among the educated and affluent. New strategies will need to be developed if we are to repeat the kind of gains against cardiovascular disease among blacks in the 1990s that were made in the 1970s and 1980s.
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PMID:Coronary heart disease: black-white differences. 204 5

Development of strategies to prevent CHD in blacks is impeded by the virtual absence of clinical trials demonstrating the feasibility and effectiveness of interventions in blacks. The wholesale generalization that interventions effective (or ineffective) in whites are similarly effective in blacks may risk the employment of worthless or even dangerous interventions in blacks. Using available epidemiologic data, a number of risk factors may be more important in blacks than whites by virtue of higher prevalence, increased relative risk, or both. These may include hypertension, lipoprotein (a), smoking, diabetes, and obesity. Thus, health agencies might emphasize these risk factors when developing preventive programs targeted at black populations. Prevention programs may best seek to prevent the onset of risk factors found highly prevalent in black communities, rather than the costly and side-effect-prone interventions to treat risk factors once established. Thus, there is a role for community-based as well as a high-risk approaches. The community-based approaches should seek to work with organizations such as churches, which traditionally play strong roles in the black community. Physicians treating black patients should be aware of the potentially different roles played by risk factors, and treat aggressively those individuals identified to be at high risk. Risk factor management should be emphasized, rather than reduced, in patients with already established CHD. CHD has been clearly shown to be preventable; both blacks and whites should benefit from specific interventions aimed toward this worthy goal.
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PMID:Prevention of coronary heart disease in black adults. 204 9

The authors review the problems of the use of MR tomography (MRT) in cardiology on the basis of experience gained with examination of 1131 patients. It is pointed out that the use of MRT is most desirable in congenital diseases of the heart and vessels, aortal aneurysms, para- and intracardial formations. In CHD, cardiomyopathies, pericarditis and congenital heart diseases, MRT can be employed provided the other noninvasive research methods (primarily echocardiography) are of insufficient information content. In addition to investigations into diseases of the heart and vessels, MRT can be applied to examinations of the kidneys, adrenals and brain in patients suffering from arterial hypertension. The merits and shortcomings of MRT are discussed as compared to the other instrumental research methods allowing organ images to be obtained.
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PMID:[Use of magnetic resonance tomography in cardiology]. 205 76

Atherosclerosis is more common and severe in DM. The purpose of this study was to compare the blood lipids profile and the prevalence of different coronary risk factors (CRF) in a mexican population with CHD (coronary heart disease) and DM compared with non DM patients. All had a history of myocardial infarction. Patients with nephropathy or other secondary causes of dyslipidema were excluded. There were two groups of 45 patients, 32 males, 13 females; age was 60 +/- 1 (SEM), body mass index (BMI) 26 +/- 6. Diabetes duration was 10 +/- 1 years. Diabetic individuals referred smoking in 58%, high blood pressure 55%, obesity (IQ greater than 27) 42%. There were no statistical differences with the non DM group. The mean values of total cholesterol, LDL cholesterol and triglycerides were similar in diabetics and non diabetics. HDL cholesterol was significantly lower in diabetic females (p less than 0.01). Hypoalphalipoproteinemia (HDL-C less than or equal to 30 mg/dL) was the most common abnormality in both groups (52% DM vs 38% nonDM) (p less than 0.01) Type IV phenotype was present in 40 vs 29% (NS). Lipid values were not related to BMI, metabolic control or diabetes type of treatment. To conclude, non insulin dependent diabetic patients with CHD have a high prevalence of CRF. Lipid abnormalities, particularly hypoalphalipoproteinemia and hypertriglyceridemia, could be a cause for the increased atherogenic risk, particularly in females.
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PMID:[Diabetes mellitus and ischemic cardiopathy: their relation to changes in plasma lipids and other coronary risk factors]. 209 Nov 76

This paper reviews evidence for the effectiveness of stress management techniques in reducing three risk factors for coronary heart disease: Type A behaviour, raised serum cholesterol, and hypertension. Preliminary evidence suggests that such interventions not only reduce individual risk factors, they can also reduce mortality and morbidity to CHD. Consideration now has to be given to the most effective system of delivery of such interventions.
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PMID:Stress management approaches to the prevention of coronary heart disease. 217 8

Hypertension has been demonstrated to be a clear risk factor for CHD. The finding that hypertension is a risk factor has been demonstrated in observation studies, actuarial data and clinical trials. The relationship between blood pressure and CHD is strong. As blood pressure rises, risk for cardiovascular events increases. This is true for both sexes, for blacks and whites, and for all age categories. Clinical trials, both large and small, have demonstrated that lowering blood pressure can reverse the risk and reduce morbidity and mortality. This cause-and-effect relationship has been replicated consistently, and there is not one well-controlled trial of adequate size that has failed to show this finding. It is important to know which concept of risk to use in developing hypertensive programs. The concept of relative risk is useful to determine whether a public health program is needed within a population, but it has less value in identifying which subset of the population in which to intervene. In essence, relative risk is used to mandate a program but cannot determine where the program should be directed. Hypertension attributable risk describes which individuals are at greatest risk and serves to guide planners as to which groups have the greatest mortality once blood pressure becomes elevated. Population attributable risk becomes the most useful tool in identifying or locating those communities of highest-risk individuals.
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PMID:Hypertension as a risk factor. 218 66

ISH is a distinct pathogenetic entity defined by SBP readings of greater than or equal to 160 and DBP less than 90 mmHg. The etiology, although not well understood, is in some manner related to a reduction in connective tissue elasticity of large blood vessels and an increase in aortic impedance or a decrease in aortic wall compliance. The pathophysiologic consequences include an increased resistance to systolic ejection of blood and a disproportionate increase in SBP. Although not directly related, there is an important increase in peripheral vascular resistance. The prevalence of ISH in several studies is about 7 percent in those over age 60 and increases with age to nearly 20 percent in those over age 80. There is higher prevalence in females and nonwhites. The guidelines for detection of ISH are similar to those for blood pressure evaluation in general. Precautions for detection and evaluation in the elderly include multiple blood pressure measurements in the fasting state and sitting and supine blood pressure measurements before and during therapy. Pseudohypertension, although rare, should be kept in mind. There is a clear risk associated with ISH for stroke, CVD, and premature death, which increases with age and rising levels of SBP. ISH can be controlled effectively with pharmacologic therapies. A reasonable goal is a 20 mmHg reduction in systolic pressure. Proof of reduced risk for stroke, CHD, and death in those with controlled ISH remains to be demonstrated. The SHEP pilot study has demonstrated feasibility of addressing this issue. The full-scale SHEP study addresses this issue and has completed recruitment of the desired sample size and is in follow-up phase. Scheduled completion is in 1991. While we wait for the SHEP full-scale trial results, the prudent approach is for nonpharmacologic therapy and use of pharmacologic agents in that group of patients who demonstrate a large cardiovascular risk burden or increasing symptoms specifically associated with hypertension. The decision to treat must be on an individual patient basis. Pharmacologic therapy is possible in most patients with few or no adverse effects. The "low and slow" approach to therapy is helpful in minimizing these adverse effects. Low-dose diuretics have been documented to be effective in blood pressure control. Chlorthalidone, 12.5 or 25 mg per day, is suggested. Other agents, such as beta-blockers, reserpine, ACE inhibitors, and calcium channel blockers, are best used as Step 2 agents.
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PMID:Systolic hypertension in the elderly: controlled or uncontrolled. 218 67

In 2208 boys aged 15 to 22 years the incidence of risk factors of atherosclerosis were determined. The risk factors were found in 33.7% of boys. The level of risk factors in youth has increased with age (p = 0.001), especially hypertension (p = 0.001) and smoking (p = 0.001). The authors concluded that the most important methods of prevention of atherosclerosis in youth should be: identification of high-risk individuals (overweight, hypertension, hyperlipidemia, family history of CHD and PAD, ischemic postexercise ST segment depression), health education and motivation for change, modification nutritional habits in cases of hyperlipidemia and overweight (prevention of early atherosclerotic lesions in childhood), early diagnosis and control of hypertension, practice of low salt intake, avoidance of smoking, sufficient physical activity (prevention of atherosclerotic disease mainly in adulthood).
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PMID:Epidemiology of risk factors of atherosclerosis and preventive program for youth. 221 95


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