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 recent decades were marked by a noticeable growth of the number of patients over 70 years with abdominal aortic aneurysms (AAA). As a rule, in view of the high incidence of coexistent cardial pathology and arterial hypertension in patients of this age group with AAA, the risk of the forthcoming operation may be fairly high. The aim of the work was to study the effect of the initial cardial status of the patients and lesion of the target organs in arterial hypertension on the results of surgical treatment of patients over 70 years with abdominal aortic aneurysms. The study accrued 50 patients with atherosclerotic aneurysms of the abdominal aorta who underwent operation on a scheduled basis over the period 1990-2000. The patients age varied from 70 to 85 years. The mean age was 73.2-/+2.9 years. The aneurysmal diameter varied from 4 to 12 cm (mean 6.9-/+2.09 cm). Aneurysms up to 5 cm in diameter were present in 15 (25.4%) patients, those up to 7 cm in 23 (40%), and aneurysms exceeding 7 cm were identified in 21 (35.6%) patients. 43 (72.9/5%) patients were in the patient group with an asymptomatic disease course and 16 (27.1%) patients were in a group with symptomatic AAA, Coexistent CAD was discovered in 96.6% and arterial hypertension in 62.5% of patients. The mean incidence of coexistent CAD and arterial hypertension constituted 1.64-/+0.3. The initial cardial status of the patients was evaluated according to the point classification proposed by Rutherford. Lesion of the target organs was evaluated according to the WHO classification (1996). Analysis of the results obtained has demonstrated that despite the presence of CAD in the majority of patients over 70 years with AAA, its severity was equal to 0-2 points and the mean point of postoperative cardial events in these patients turned out minimal (within the range of one point). In the presence of arterial hypertension and lesion of the heart as a target organ, the risk of cardial complications was 1,5-2 times as increased depending on the severity of initial cardial pathology.
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PMID:[The impact of cardiac status and arterial hypertension on the results of surgical treatment of patients over 70 years with abdominal aortic aneurysms]. 1281 96

This paper analyzes the short-term results of 463 consecutive primary reconstructive operations on the carotid bifurcation based on the standards of "quality". In 383 (82.7%) cases, the patients were operated on for stenosis of the internal carotid artery (ICA); 60 (13%) patients had combination of stenosis and kingking of the ICA and 20 (4.3%) presented with isolated kinking of the ICA. Classic open carotid endarterectomy (CEAE) was performed in 240 cases, eversion CEAE in 144, resection with ICA redressment in 45, and ICA grafting in 28 cases. The perioperative lethality accounted for 1.54% (7 cases), per 463 operations, with the standard of "quality" being equal to 2%. Myocardial infarction was the cause of death in 5 cases, one patient developed homolateral stroke which eventuated in lethal outcome, and one more patient developed lethal stroke in the contralateral hemisphere. The incidence of homolateral strokes which did not eventuate in lethal outcome accounted for 1.94% (9 cases). The indicator "stroke plus lethality from stroke" in the general patient group was 2.38% which is even lower versus the standard of "quality" for asymptomatic patients and constitutes 3%. Among asymptomatic patients proper, the indicator "stroke plus lethality from stroke" was equal to 0, among TIA patients to 0 at a 5% standard, and in patients with initial stroke, initial stroke, it amounted to 3.19% at a 7% standard. Perioperative strokes were not recorded in patients with ICA kingking or at ICA grafting. The basic factor of the risk of perioperative neurologic deficit was a history of stroke. Patients with different stages of cerebrovascular insufficiency did not significantly differ as regards age, sex distribution, the presence of CAD, arterial hypertension, diabetes mellitus, the degree of stenosis of the operated ICA and the time of its clamping at operation. Patients with a history of strokes differed significantly from the general group only in the incidence of lesion of the contralateral ICA and in the frequency of the use of internal shunt. Analysis of the risk factors of perioperative stroke in patients with a history of strokes has shown that they were diabetes mellitus and the use of internal shunt. The development of perioperative stroke among patients with a history of stroke was not influenced by the incidence of contralateral ICA lesion, the standing of cerebral circulatory distress or the size of an ischemic focus. The initial character of ICA lesion and the type of reconstruction did not affect the origin of perioperative focal deficits or lethality.
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PMID:What influences the standards of "quality" of carotid endarterectomy? 1465 36

The purpose of this study was to estimate the prevalence and risk factors of silent CAD in asymptomatic type 2 diabetic patients aged over 40 years. A total of 172 asymptomatic type 2 diabetic patients, mean age 54.42 years, with normal resting electrocardiogram were included in the study. Technetium-99m (Tc-99m) tetrofosmin cardiac single photon emission computed tomography myocardial scintigraphy with exercise testing or dipyridamole injection was performed on all patients. If this test was positive, coronary angiography was carried out and was considered to be positive with a stenosis of > or =70%. Abnormal perfusion pattern was found in 14 patients (8.14%). Significant coronary artery stenosis was found in 13 subjects (7.56%), confirming a high positive predictive value (92.86%) of this diagnostic procedure. A significant correlation was observed between silent CAD and male sex, retinopathy, hypertension, post-prandial blood glucose level, and low HDL-cholesterol level. Sex (OR=4.026; 95% CI, 1.187-13.659), hypertension (OR=5.564; 95% CI, 1.446-21.400) and retinopathy (OR=3.766; 95% CI, 1.096-12.948) were risk factors for CAD. Overall, 14.06% of asymptomatic male patients with type 2 diabetes mellitus presented silent CAD with significant angiographically documented coronary stenosis. This finding, along with the high positive predictive value of a noninvasive technique, indicates that routine screening for silent CAD would be useful in this patient subgroup especially when they have retinopathy or hypertension.
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PMID:Silent coronary artery disease in patients with type 2 diabetes mellitus. 1474 Feb 77

Dyslipidaemia is common in patients with Type 2 diabetes and is held to be responsible for considerable CVD-related morbidity and mortality. Patients with Type 2 diabetes are at high risk from complications associated with atherosclerosis and should therefore receive preventive interventions. At the level of the adipocyte, impaired insulin action leads to increased rates of intracellular hydrolysis of triglycerides with the release of NEFA. The rise in NEFA provides substrate for the liver that, in the presence of impaired insulin action and relative insulin deficiency, is associated with complex alterations in plasma lipids: * Plasma VLDL levels are raised. (i). Increased VLDL levels are associated with post-prandial hyperlipidaemia that is compounded by impaired LPL activity. The latter may be independently associated with CAD. (ii). Remnant particles can deliver more cholesterol to macrophages than LDL-C particles. Thrombogenic alterations in the coagulation system also ensue from hypertriglyceridaemia. * Plasma HDL-C levels are reduced. (i). The reduction in cardioprotective HDL-C means a reduction of cholesterol efflux from the tissues--the first step in reverse cholesterol transport to the liver from peripheral tissues. (ii). The antioxidant and antiatherogenic activities of HDL-C are reduced when circulating levels are low. * LDL-C particles become small and dense. Small, dense LDL-C particles are held to be more atherogenic than their larger, buoyant counterparts because they (a) are more liable to oxidation and (b) may more readily adhere to and subsequently invade the arterial wall. The atherogenicity of LDL-C may also be enhanced by nonenzymatic glycation. Metabolic and lipid abnormalities can often be improved with lifestyle changes, including dietary modification, weight loss, smoking cessation and increased exercise. Although attainment of better glycaemic control may improve diabetic dyslipidaemia, pharmacological intervention is usually required. Several large-scale clinical trials, including 4S and more recently HPS, have clearly demonstrated the benefits of statins in reducing cardiovascular events. By virtue of their high absolute risk of CVD, many patients with Type 2 diabetes may achieve a greater risk reduction than their non-diabetic counterparts. For example, in 4S there was a 43% reduction in total mortality risk among patients with diabetes compared with 29% for non-diabetics and a reduced risk of MI by 55% vs. 32% for diabetic and non-diabetics, respectively. In the diabetic subgroup in HPS, there were reductions of approximately 25-30% in the risk of first major vascular events. More recently, the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) was halted early because of a significant reduction in cardiovascular events compared with placebo. Surprisingly an analysis of subgroups failed to show significance among the diabetic population, although the sample size, shortened follow-up period and higher drop-in statin use among diabetics on placebo may have affected results. The Collaborative Atorvastatin Diabetes Study (CARDS), involving 2800 patients with Type 2 diabetes, was halted 2 years early in June 2003 because patients allocated atorvastatin had significant reductions in MI, stroke and surgical procedures compared with those receiving placebo. The UKPDS demonstrated that the appearance and progression of certain microvascular complications of Type 2 diabetes could be reduced by treatment directed at hyperglycaemia and hypertension. In addition, correction of dyslipidaemia in patients with diabetes is important in reducing the high toll from macrovascular disease. The subjects in the HPS had similar lipid profiles to the participants in UKPDS, suggesting that additional benefit would accrue from a therapeutic assault on the main cardiovascular risk factors simultaneously. We now have firm evidence that appropriate use of statins in patients with Type 2 diabetes can significantly reduce cardiovascular morbidity and mortality.
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PMID:Lipoprotein abnormalities and their consequences for patients with type 2 diabetes. 1498 18

The clinical expression of heterozygous familial hypercholesterolemia (FH) is highly variable even in patients carrying the same LDL receptor (LDL-R) gene mutation. This variability might be due to environmental factors as well as to modifying genes affecting lipoprotein metabolism. We investigated Apo E (2, 3, 4), MTP (-493G/T), Apo B (-516C/T), Apo A-V (-1131T/C), HL (-514C/T and -250G/A), FABP-2 (A54T), LPL (D9N, N291S, S447X) and ABCA1 (R219K) polymorphisms in 221 unrelated FH index cases and 349 FH relatives with defined LDL-R gene mutations. We found a significant and independent effect of the following polymorphisms on: (i) plasma LDL-C (Apo E, MTP and Apo B); (ii) plasma HDL-C (HL, FABP-2 and LPL S447X); (iii) plasma triglycerides (Apo E and Apo A-V). In subjects with coronary artery disease (CAD+), the prevalence of FABP-2 54TT genotype was higher (16.5% versus 5.2%) and that of ABCA1 219RK and KK genotypes lower (33.0% versus 51.5%) than in subjects with no CAD. Independent predictors of increased risk of CAD were male sex, age, arterial hypertension, LDL-C level and FABP-2 54TT genotype, and of decreased risk the 219RK and KK genotypes of ABCA1. These findings show that several common genetic variants influence the lipid phenotype and the CAD risk in FH heterozygotes.
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PMID:Genetic polymorphisms affecting the phenotypic expression of familial hypercholesterolemia. 1548 89

The aim of the work was to examine the degree of carotid stenosis, the structure of atherosclerotic plaques, and the predominance of the main vascular risk factors in patients with multiple lacunar and comparatively large "non-lacunar" cerebral infarctions. A study WAS made of the data on 110 patients (mean age 62.5 years) with multiple cerebral infarctions revealed by MRT and with stenoses of the internal carotid artery (ICA) of varying degrees of severity. Minor lacunar infarctions (LI) were present in 62 cases whereas comparatively large "non-lacunar" infarctions (NLI) in 48 cases. All the patients underwent standard neurologic examination, laboratory analyses, MRT of the brain with angiography (MRA) of the extra-intrecrania1 vessels, transcranial Doppler (TCD), and examination of the heart for revealing the cardioembolic nature of cerebral infarctions. Among patients with both LI and NLI, arterial hypertension was the most frequently occurring risk factor in 53 (85%) and 35 (73%) patients respectively. In the study groups, there were no appreciable differences in the incidence of high hematocrit, hyperfibrinogenemia, tobacco-smoking, and diabetes mellitus. Patients with NLI demonstrated hypercholesterolemia, CAD and atherosclerosis of the peripheral vessels significantly more often (p<0.05). In the patient group with NLI, hemodynamically significant stenoses of the ICA were predominant: in 18 (37.5%) patients, they were moderate, in 12 (25%) critical, and 7 (14.6%) patients had occlusions whereas in LI, the portion of critical stenoses and ICA occlusions was cooperatively low - in 11 (17.7%) and in 5 (8.1%) patients respectively. Both groups showed the thickening of the complex of the medial CCA layer. Ultrasonopraphy of the vessels has revealed that in patients with NLI and LI, there predominated potentially embologenic plaques, namely in 69% and in 53% of cases, respectively. Our investigations allow to assume that arterial hypertension is the most frequently occurring risk factor of cerebral infarction (both minor lacunar and large "non-lacunar"). Factors such as CAD, hypercholesterolemia, DM, hemorheological disorders, end tobacco-smoking are likely to have an unfavorable impact on both general and cerebral hemodynamics as well as on the microcirculatory bed whereby being on the whole important risk factors of cerebral infarction. Hemodynamically significant stenoses, especially critical ones, occlusions, and embologenic plaques of the ICA are pathogenetically closely linked with the development of "non-lacunar" cerebral infarctions. At the same time they, under certain conditions, may become the cause of multiple lacunar cerebral infarctions.
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PMID:[The status of carotid arteries and the main vascular risk factors in cerebral infarctions of "anterior circulation"]. 1516 92

The pathogenesis of CAD is similar in man and woman, yet some risk factors have a greater impact on the CAD risk in woman than in man. In this study we assessed the effect of the apoE gene polymorphism on lipid metabolism and risk for CAD in women younger than 65 years (premature CAD). In a cross-sectional case-control study, 147 female Caucasian patients with premature CAD (confirmed by coronarography) were compared with a control group of 114 healthy Caucasian women. The apoE allele frequencies of patients vs. controls were 5.1% vs. 5.7% for 2, 85.4% vs. 83.3% for 3, and 9.5% vs. 11% for epsilon4. The subjects with epsilon2/3 genotype had statistically significantly higher triglycerides levels than the subjects with epsilon3/3 genotype (2.23 +/- 2.13 mmol.L(-1) vs. 1.73 +/- 0.84 mmol.L(-1); p<0.05). Logistic regression analysis revealed no association between risk genotypes (3/4 and 4/4) of the apoE gene polymorphism and CAD risk (OR 0.9; 95% CI 0. 5-1.7, P=0.7). We observed metabolic clustering of diabetes mellitus, arterial hypertension, higher BMI and triglycerides, and lower HDL cholesterol in the CAD group compared to the control group. Arterial hypertension, diabetes, HDL cholesterol level, and BMI were independent risk factors for premature CAD in female population, whereas, the risk genotype of the apoE gene polymorphism was not. In conclusion, in Slovene women risk genotypes of the apoE gene polymorphism are not associated with premature CAD; a metabolic clustering of diabetes, HDL, triglycerides and arterial hypertension is frequently present in Caucasian women with premature CAD.
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PMID:Apolipoprotein E gene polymorphism effects triglycerides but not CAD risk in Caucasian women younger than 65 years. 1518 47

Lack of exercise and poor eating habits are considered to be major causes of most diseases of civilization. In consequence, endurance sports, but also an integration of physical activity in everyday life, are gaining in importance. Positive effects of regular physical exercise have been described for CAD, arterial hypertension, lipid metabolic disorders, type 2 diabetes mellitus and the metabolic syndrome. In order to achieve an optimal training effect, exercise intensity should be oriented to the individual anaerobic threshold. As a rule of thumb, 30 minutes of endurance training--ideallyevery day--is considered necessary. Prior testing of a person's ability to undertake such activities should include ECG and blood pressure measurements, spirometry and lactate determination, and contraindications must be taken into account.
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PMID:[The role of jogging in the prevention and treatment of cardiovascular disease]. 1534 34

Coronary atherosclerosis (CAD), a chronic inflammatory disorder, arises when genetic susceptibility, intercurrent conditions such as diabetes and hypertension and environmental factors interact. Although CAD can remain stable for many years, thrombus formation at sites of plaque rupture may lead to unstable angina (UA) or myocardial infarction (MI). Already recognised as the central component of coronary thrombosis, platelets, through their interaction with monocytes and endothelial cells, may also be involved at the earliest stages of atheromatous plaque evolution. Aspirin, the prototype antiplatelet agent, covalently and irreversibly inhibits cyclooxygenase (COX) and thus inhibits platelet thromboxane (TX) A(2) biosynthesis. Anti-oxidant properties and the ability to modulate transcription of immunologically important genes have also been attributed to aspirin. Non-selective COX inhibition, however, predisposes to bleeding, predominantly secondary to dosedependent gastro-intestinal toxicity. The emerging concept of "aspirin resistance" coincides with the development of alternative antiplatelet therapy and point-of-care platelet function assays. Though variable aspirin pharmacokinetics may explain many cases, heritable factors, inducible platelet COX expression and isoprostane formation may also contribute. In future, risk factor screening and point-of-care platelet function assay may identify vulnerable patients who would benefit from additional or alternate antiplatelet therapy.
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PMID:Aspirin and coronary artery disease. 1558 21

For further improvement of coronary heart disease (CHD) management large epidemiological studies are required to characterise the real population of patients with CHD, treated in the primary care settings, and to evaluate how the guidelines are implemented in the everyday clinical practice. The aim of the Angina Treatment Pattern (ATP) survey was to characterise (i) the population of patients, treated by the primary care physicians for stable CHD, (ii) the methods applied by the primary care physicians to establish diagnosis of CHD and (iii) the pharmacological therapies for CHD. Across Poland, 397 primary care physicians were randomly selected. They recruited 7420 patients (49% men; mean age, 62 +/- 10 years; range: 25-93 years), treated for stable CHD. The duration of CHD was 7.4 +/- 6.6 years (range: 6 months-50 years), 2750 (37%) patients had myocardial infarction. The following risk factors of CHD were present: arterial hypertension in 58%, dyslipidaemia in 52%, smoking in 40%, family history of CHD in 56% and obesity or overweight in 73% of patients. Primary care physicians based a diagnosis of CHD predominantly on a history of anginal pain (in 33% patients), accompanied either by abnormal resting ECG or positive exercise test (in additional 31% patients). Only in 5% of patients, coronary angiography was applied to diagnose CAD. The following groups of drugs have been used: long-acting nitrates in 90%, anti-platelet drugs or anti-coagulants in 71% (aspirin in 65%), angiotensin-converting enzyme inhibitors in 51%, beta-blockers in 48%, calcium antagonists 31%, hypolipaemic drugs in 23% (statins in 10%) and metabolic agents in 16% of patients. Despite an extensive use of classical anti-anginal drugs (including at least one of the following: long-acting nitrates, beta-blockers, calcium antagonists in 95% of patients), 85% of patients still complained of anginal symptoms. Neither prevalence of angina among patients nor nitroglycerin intake depended on the number of anti-anginal drugs taken (monotherapy vs. combination therapy: 82% vs. 86% and 4.9 vs. 5.3 doses weekly, respectively). Among the primary care physicians, the methods used to establish a CHD diagnosis and the mode of CHD management are far from optimal. The results of the ATP study confirm the need for further intensification of activities to improve the process of diagnosis and management among patients with CHD, treated by the family doctors.
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PMID:Clinical characteristics and methods of treatment of patients with stable coronary heart disease in the primary care settings--the results of the Polish, Multicentre Angina Treatment Pattern (ATP) study. 1564 10


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