Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The hypotensive effects of spinal anesthesia were investigated in 60 patients aged 75 years or older and divided into two groups: 30 normotensive patients (group 1) and 30 treated hypertensive patients (group 2). In both groups, spinal anesthesia was performed in lateral decubitus position with 3 ml 0.5% isobaric bupivacaine. Hemodynamic measurements were performed before the establishment of spinal blockade and repeated during the 60 minutes following intrathecal injection. Median cephalad level (T10) and ranges of sensory blockade were similar in the two groups. Changes from baseline to lowest blood pressures showed significant decreases in group 2 compared with group 1:10.7% in SPB, 11.2% in MBP, and 14.8% in DBP. Hypotension was observed in three group 1 patients and ten group 2 patients. Five patients in group 2 (but none in group 1) had a SBP decrease of 40% from baseline or more. The decreases in MBP and DBP were persistent after 60 minutes. These results suggest that pre-existing hypertension can be recognized as an important factor to explain blood pressures changes during isobaric bupivacaine spinal anesthesia in elderly patients.
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PMID:A comparison of cardiovascular responses of normotensive and hypertensive elderly patients following bupivacaine spinal anesthesia. 248 66

Calcium channel blocking agents are considered to be particularly effective in reducing blood pressure (BP) in low renin essential hypertension and in primary aldosteronism. The aim of this study was to compare the acute BP response to nicardipine in 2 opposite situations of stimulation of the renin angiotensin system: eight patients (49 +/- 13 years, mean arterial BP (MAP) 123 +/- 8 mmHg) with primary aldosteronism (active renin less than 5 pg/ml, group 1) and nine patients (38 +/- 17 years, MAP: 107 +/- 13 mmHg) with renovascular hypertension and high level of active renin (greater than 25 pg/ml, group 2). They had not taken any antihypertensive treatment since at least one week. After 60 minutes in the supine position (T0) nicardipine was infused at a rate of 7.5 mg/h during 10 minutes (T10), 15 mg/h from the 10th to 20th minute (T20) and 30 mg/h during the last ten minutes (T30). Thus, a total cumulative dose of 8.75 mg was administrated in 30 minutes. BP was recorded by an indirect oscillometric method (Sentrom) every 2 minutes and renin was assayed through an immuno-radiometric procedure (IRMA). There was an important and similar BP fall in the 2 groups (Gr 1: T10-6 p. 100, T20-17 p. 100, T30-25 p. 100; Gr 2: T10-7 p. 100, T20-13 p. 100, T30-18 p. 100) with a very significant dose-effect relation (r = 0.67, p less than 0.001). There was also an important increase in heart rate similar in the 2 groups (+35 p. 100, +25 p. 100, ns).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Acute response to calcium inhibitors in secondary arterial hypertension: does renin play a role?]. 314 97

Changes in sympathetic nervous function of the rat caused by acute and chronic treatment with cadmium ((Cd2+) have been studied in vivo by measurement of changes in blood pressure and plasma dopamine-beta-hydroxylase (DBH) activity. In anaesthetized animals, acute injection of Cd2+ (0.1-1 microM) caused an initial fall followed by a rise in both diastolic and systolic blood pressure, plasma DBH activity increased in a dose-dependent manner. Animals subjected to repeated treatment with Cd2+ (0.5, 1 microM) daily for 12 days became markedly hypertensive, the increases in the systolic pressure being greater than those seen in the diastolic pressure. In pithed animals the blood pressure responses of the treated animals to electrical stimulation of the lower sympathetic outflow (T10-L1) and tyramine injection (35, 70, 140 nmol kg-1) were markedly decreased, whilst responses to low doses of noradrenaline (NA) (7, 15, 30 nmol kg-1) were potentiated compared with untreated animals. In addition, plasma DBH activities following sympathetic outflow stimulation and tyramine administration were markedly increased and decreased respectively compared with untreated controls. The data suggest that a correlation exists between changes in sympathetic nervous function and the induction of hypertension caused by Cd2+.
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PMID:The effects of cadmium ions on blood pressure, dopamine-beta-hydroxylase activity and on the responsiveness of in vivo preparations to sympathetic nerve stimulation, noradrenaline and tyramine. 611 20

Applying the basic principles, therapy guides to our hypothetical cases can be constructed. The 60 year old man with postoperative abdominal perineal resection with hypertension and parkinsonism may well need a transurethral resection of the prostate; however, other options include decreasing his anticholinergic-type medications, such as antiparkinsonism medications, changing his hypertensive therapy from beta blockers such as propranolol and metoprolol to alpha blockers such as methyldopa and prazosin. Bethanacol would seldom be helpful alone, but with an alpha blocker could help if not contraindicated by the presence of vascular disease. The second example, a 45 year old woman with stress incontinence, may be assisted with improved storage by an anticholinergic agent, an alpha enhancer, a mucosal enhancer, and if pertinent, switching hypertensive therapy from an alpha blocker to a beta blocker. The last example, a T10 paraplegic with a spastic, hyperreflexic bladder, can have improved storage with anticholinergics, decreased sphincter tone with alpha blockers, as well as decreased sphincter tone with alpha blockers, as well as decreased spasms through suppression of hyperactive spinal cord activity with baclofen.
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PMID:Micturition neuropharmacology. 684 91

Intra-arterial blood pressure (BP) and heart rate (HR) were continuously recorded in five patients with spinal cord injuries at different levels who were undergoing electro-ejaculation. In three patients with lesions at C7, C5 and T4 insertion of the electrode and electrical stimulation caused severe hypertension and bradycardia. In a patient with a T7/8 lesion and in another with a T10 lesion there were either moderate or minimal cardiovascular changes. Severe hypertension during electro-ejaculation is a serious problem in patients with high lesions and is probably part of the syndrome of autonomic dysreflexia. In the three patients with high spinal cord lesions the procedures were repeated during an intravenous infusion of Prostaglandin E2. Resting BP was lowered and resting HR raised. The level of BP recorded during electrical stimulation was substantially reduced. This enabled larger stimuli to be used for a longer period and resulted in successful ejaculation in two patients.
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PMID:Severe hypertension in patients with high spinal cord lesions undergoing electro-ejaculation--management with prostaglandin E2. 744 81

A case is presented of a woman who, for six years, had been treated for depression with 45 mg daily of the monoamine oxidase inhibitor (MAOI), phenelzine, and who continued taking the drug throughout her pregnancy and labour. Well-documented and potentially fatal interactions between MAOIs and opioids, notably meperidine, meant that her labour analgesia needed careful planning. Opioid- and epinephrine-free epidural bupivacaine analgesia was instituted early with small increments of bupivacaine 0.25% to produce a T10 block, after which an infusion of 8 ml.hr-1 bupivacaine 0.125% was used to maintain analgesia. After 14 hr labour, the epidural was extended uneventfully to allow Caesarean section to be performed for failure to progress. Pressor agents were avoided as indirect-acting drugs can produce severe hypertension. The child appeared normal and the mother had an uncomplicated postoperative course. Epidural analgesia contributed to the safe conduct of labour and Caesarean delivery.
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PMID:Anaesthetic management of labour and delivery in a woman taking long-term MAOI. 755

It has been reported that since 1982 the incidence in persons with spinal cord injury (SCI) of hypertension is commoner than it is in the general population of the same age groups in Japan. In the current study, we examined outpatient morbidity rates and standardised outpatient morbidity ratios (SOMR) according to the site of injury, as well as blood pressure levels and history of disease, and compared the incidences with those for the general population. The subjects consisted of 195 men with SCI. All were engaged in light work at special centres while living with other persons at the centres. The mean age was 49.5 years old, and the average post-injury period was 17.9 years. With respect to the site of injury, 19 patients had had injuries at the level of C-T5, 24 at T6-T10, 139 at T11-L1, and 13 at L2 or lower. The SOMR (general population = 100) for hypertension was closely related to the site of injury, i.e. 0 at C-T5, 250 at T6-T10, 221 at T11-L1 and 308 at L2 or below. Among the patients treated with antihypertensive agents (41 persons), 17.1% were under treatment for renal diseases, 4.9% for diabetes, and 4.9% for hepatic disorders. In 68% of the SCI persons examined, however no disease (such as renal disease, diabetes mellitus, hepatic disease or endocrine abnormality) could be regarded as a cause of secondary hypertension. In addition, the survey revealed that the body weight of SCI persons was lower than that of the general populations.
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PMID:Morbidity rates of complications in persons with spinal cord injury according to the site of injury and with special reference to hypertension. 802 34

Although intravenous cyclosporine A (CsA) previously has been shown to cause a robust sympathetically mediated increase in blood pressure in the rat, the underlying mechanism by which CsA increases the activity of the sympathetic nervous system is unknown. To determine the relative contributions of central neural versus peripheral reflex mechanisms in causing this sympathetic activation, we recorded efferent renal sympathetic nerve activity and blood pressure during intracerebroventricular or intravenous infusion of CsA, the latter performed in intact rats and in those with sinoaortic denervation, cervical or subdiaphragmatic vagotomy, or dorsal rhizotomy (T10 through L1). In intact rats, intravenous CsA (5 mg/kg), as expected, tripled renal sympathetic nerve activity and increased mean arterial pressure by 27 +/- 4 mm Hg (P < .05). The new findings are that this sympathoexcitatory effect of intravenous CsA (1) was not duplicated by central administration (either into the cerebroventricular system or directly onto the ventrolateral surface of the medulla), (2) was unaffected by sinoaortic denervation, but (3) was greatly attenuated by either cervical or subdiaphragmatic vagotomy or by dorsal rhizotomy. In additional experiments, we found that intravenous cyclosporine increased the multiunit activity of subdiaphragmatic but not cardiopulmonary vagal afferents. From these data, we conclude that in the rat CsA-induced increases in sympathetic activity and blood pressure are caused mainly by activation of excitatory neural reflexes arising in the subdiaphragmatic region. These reflex mechanisms use at least two different afferent neural pathways: one involving the subdiaphragmatic vagi and the other involving the low thoracic dorsal spinal roots.
Hypertension 1994 May
PMID:Mechanism of cyclosporine-induced sympathetic activation and acute hypertension in rats. 817 78

A retrospective review is presented of neurologic complications in our first 143 consecutive adult patients (208 liver transplants in 143 adults and 18 children) undergoing liver transplantation. Nineteen (13.2%) of the 143 patients developed neurologic complications in the postoperative period. Immunosuppression was initiated intraoperatively with steroids with the addition of azathioprine on Day 1 and cyclosporine, adjusted by RIA to a level of 400-600 ng/ml, on Day 2 post-transplantation. Azathioprine is discontinued in the third month. Fourteen of the 19 patients (73.6%) presented with CNS complications characterized by: diffuse multifactorial encephalopathy (5 patients); leukoencephalopathy (2 patients) which required temporary (1 case) or permanent (1 case) discontinuation of cyclosporine A; hemorrhage (in 2 cases due to arterial hypertension and coagulopathy and another due to unknown causes); ischemic/anoxic injury secondary to cardiorespiratory arrest (2 patients) or arteriothrombosis (1 patient); and myelopathy (1 patient) due to vertebral compression (T10-T11) secondary to osteoporosis. The diagnostic studies most often employed were computed tomographic (CT) (85.7%) and electroencephalography (EEG) (42.8%). Five of 19 patients (26.3%) suffered peripheral nervous system (PNS) complications: 1 patient with reversible Claude-Bernard-Horner Syndrome caused by central venous catheterization during anesthesia; 2 patients with peroneal nerve palsy due to compression below the knees by operating room table supports; 1 patient with an irreversible lesion of the right recurrent laryngeal nerve secondary to prolonged intubation and central venous catheterization; and 1 patient with a reversible lesion of the left brachial plexus secondary to inadvertant hyperextension of the upper extremity on the O.R. table due to the need for dialysis and catheterization of the axillary vein for veno-venous bypass.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Neurologic complications in liver transplantation. 838 Sep 46

Autonomic dysreflexia (AD) is a characteristic syndrome that occurs in spinal cord injury (SCI) patients with lesions above the sympathetic outflow at T6 and rarely in those with lesions below T10. Symptoms are initiated by noxious stimuli below the level of injury which result in massive sympathetic discharges from the isolated cord. These produce what may be called a sympathetic storm manifest by severe life threatening hypertension. Anesthesiologists and surgeons dealing with SCI patients must know how to recognize this syndrome, how to prevent its occurrence and how to manage it aggressively. Choice of anesthesia is frequently difficult and, in particular, it may be difficult to decide which type of anesthesia is best for patients susceptible to the syndrome. Therefore, we have conducted a retrospective study of SCI patients in the Department of Veterans Affairs Medical Center, Long Beach, California, where the Spinal Cord Injury Service is one of the largest in the country.
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PMID:Surgical aspects of autonomic dysreflexia. 926 84


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