UMLS:C0020538 - FACTA Search

Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Target Concepts:

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

Large, placebo-controlled RCTs that involve only diabetic patients who have hypertension have not been performed. Subgroup analyses of hyper-tension control from several recent RCTs un-equivocally demonstrated greater benefit in diabetic populations (see Table 3) with ACE inhibitors, TDs, and CCBs. Treatment with fBs(atenolol) also was beneficial in diabetic patients who had hypertension in the actively-controlled UKPDS. The results of three RCTs support intensive BP control in diabetic patients (see Table 4). In these trials, diabetic patients gained more benefit than nondiabetic patients. Such an effect is consistent with the fact that diabetics are at higher risk for CV events. Although there are limited data from RCTs with head-to-head comparison of newer agents (eg,ACE inhibitors, ARBs, CCBs) to show that these drugs are better than diuretics and betaBs in reducing CV events by treating hypertension in the diabetic population, the available data support ACE inhibitors (and ARBs if ACE inhibitors are not tolerated) as an initial drug of choice in diabetic,hypertensive patients (see Table 5). Most diabetic patients require three or four drugs to control their BP to target range; as such, it is not necessary to justify the choice of any single class of drug. Tight BP control is cost-effective and is more rewarding than hyperglycemic control in diabetic,hypertensive patients. The optimal goal in diabetics should be to achieve BP that is less than 130/80 mm Hg. Appropriate action should be taken if BP is greater than 140/85 mm Hg. In subjects who have diabetes and renal insufficiency,the BP should be decreased to less than 125/75 mm Hg to delay the progression of renal failure. Limited data suggest that an ACE inhibitor or an ARB is the agent of choice, especially in patients who have proteinuria or renal insufficiency. betaBs can be the first-line agent in diabetics who have CAD. TDs and CCBs are the second line drugs.AAAs should be avoided. Most hypertensive patients require more than one agent to adequately control their BP. There is no evidence to support one combination regimen over the others, nevertheless, the combination of an ACE inhibitor with a TD or a fPB may be more beneficial and cost effective than other combinations in the diabetic population. Large outcome studies that compare different combination therapies in hypertensive,diabetic patients are needed.
...
PMID:Diabetes and hypertension, the deadly duet: importance, therapeutic strategy, and selection of drug therapy. 1569 43

HTN in patients who have diabetes should be managed aggressively; the goal BP of less than 130/80 mm Hg should be attained if clinicians seek to reduce cardiovascular morbidity and mortality for these patients. Along with instituting medical therapy after HTN is detected, lifestyle modifications need to be managed aggressively, together with strict glycemic and lipid control. Early management and optimization of treatment of HTN can delay and possibly prevent progression of cardiovascular complications,such as CAD, CKD, peripheral vascular disease, and cerebrovascular disease. Studied approaches to treat HTN in diabetics have included ACEIs and ARBs. Either class of medication, generally in combination with a thiazide diuretic, should be considered as initial therapy. Calcium antagonists, BBs, and alpha-antagonists also have a role in this population of patients, usually as third- and fourth-line add-ons. The importance of using agents that block RAAS is becoming understood better. Typically, three or more antihypertensive medications plus lifestyle interventions are required to achieve a goal BP of less than 130/80 mm Hg. Managing patients who have diabetes and HTN is a dynamic, ever-changing challenge. Early and aggressive antihypertensive therapy pays off;it is hoped that the insights in this article enable clinicians to meet the challenge more successfully.
...
PMID:Hypertension management in type 2 diabetes mellitus: recommendations of the Joint National Committee VII. 1575 22

The phenotypes of CAD related to arterial hypertension co-occurrence were analysed in 174 male patients and 117 control men for the associations with the polymorphisms of the MTHFR gene (677C>T and 1298A>C) and the PON1 gene (-108C>T) in relation to age at diagnosis (less or equal and more than 50 years). We noted the increased frequency of the three MTHFR genotypes: CC/AC, CT/AA and CC/CC in the CAD group (65.5%) in comparison to the control group (45.3%), corresponding to the 2.3-fold increased risk of CAD for men with these genotypes (95%CI (1.4-3.7); p=0.0005). The higher increase in risk of CAD was noted for the younger men (OR=3.6; 95%CI(1.6-8.3); p=0.002) and lower for the older (OR=1.8; 95%CI(1.0-3.4); p=0.03). In the normotensive men the greater impact on CAD risk had the homozygous genotypes; the 2.3-fold higher risk was associated with MTHFR CC/AC, CC/CC and TT/AA genotypes (95%CI(1.2-4.4); p=0.01). After adjustment for age, the association between CAD and MTHFR was significant only for the younger normotensive men (OR=2.8; 95%CI (1.0-8.0); p=0.04). Additionally, we found that the younger part of the control group was characterized by higher frequency of the low expression PON1 -108T allele and PON1 -108TT genotype (0.54 and 31.9% respectively) in comparison to the older men (0.41 and 17.1% respectively; p=0.03).
...
PMID:Age and hypertension related changes in genotypes of MTHFR 677C>T, 1298A>C and PON1 -108C>T SNPs in men with coronary artery disease (CAD). 1607 91

Utilization rates of aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and statins singly and as part of a multidrug regimen before hospitalization were measured in 109,540 patients with a history of coronary artery disease presenting with acute myocardial infarction to 1,283 hospitals participating in the National Registry of Myocardial Infarction-4. The profile of patients receiving none or only 1 of these therapies was compared with that of patients receiving any 3 or all 4 agents. Most patients (58%) with a history of coronary artery disease presenting with acute myocardial infarction were on none or only 1 of these effective medications at hospital admission. Only 21% of patients were on >or=3 of these therapies. Older age, female gender, and Medicare or no insurance coverage was significantly associated with previous receipt of <or=1 agent. Patients from New England or with a history of diabetes mellitus, hypertension, or hyperlipidemia were more likely to have received >or=3 of these therapies. In conclusion, data from this large national registry have indicated that most patients with a history of CAD were not receiving the recommended combination of cardiac medications before their AMI.
...
PMID:Use of combination evidence-based medical therapy prior to acute myocardial infarction (from the National Registry of Myocardial Infarction-4). 1618 17

Carotid atherosclerotic plaque remodelling and increased risk of symptomatic plaque rupture seem to be partially mediated by matrix metalloproteinases (MMPs). In this study, we have investigated whether different MMPs are related to carotid atherosclerosis or to recent ischaemic brain disease. Eighty-four consecutive patients undergoing carotid endarterectomy for symptomatic and asymptomatic disease were studied. Plaques were analysed by ultrasound and later by morphology. Plasma MMP-2, MMP-8 and MMP-9 levels were quantified by ELISA. MMP expression and activity in carotid plaques was analysed by Western blotting and in situ zymography. Results were analysed with respect to plaque stability, morphology, symptomatic disease, presence of vascular risk factors and plasma markers of acute inflammation as high sensitivity C-reactive protein (hsCRP), fibrinogen, D-dimer and white blood cell counts. Patients with hypoechogenic plaques on ultrasound had more plasma MMP-8 (p = 0.04) and increased MMP activity as assessed by in situ zymography. Asymptomatic patients with plaque progression had more active intraplaque MMP-8 than asymptomatic patients without plaque progression. Presence of recent intraplaque haemorrhage or past history of CAD was related to increased activity of MMPs as assessed by in situ zymography (p < 0.01, CI 95% 0.8-1.0). Plasma MMP-8 and MMP-9, but not MMP-2 levels, decrease with time after ischaemic stroke. Patients with hypertension had more intraplaque active MMP-9 than normotensive (p = 0.03, CI 95% 0.7-1.0). Hypoechogenic carotid plaques had increased MMP activity and asymptomatic patients with plaque progression show increase intraplaque MMP-8 levels.
...
PMID:Intraplaque MMP-8 levels are increased in asymptomatic patients with carotid plaque progression on ultrasound. 1625 88

Systemic factors and blood flow velocity related to atherosclerosis have been examined mainly separately or by in vitro studies. The aim of our study was to investigate the association between local coronary blood flow (corrected TIMI frame count, CTFC) and systemic atherosclerosis-related inflammatory parameters such as soluble intercellular adhesion molecule-1 (sICAM-1), interleukin-6 (Il-6), high sensitivity C-reactive protein (hsCRP) and von Willebrand factor (vWF) in humans. We enrolled the following groups of ischemic heart disease (IHD) patients: patients with coronary stenosis and stable (CAD, n = 96) or unstable angina (ACS, n = 27), patients with documented myocardial ischemia and normal coronary angiogram (NEG, n = 68). Patient groups showed only marginal differences in CTFC or sICAM-1 levels. In contrast, when IHD patients were studied individually, general positive correlation was found between CTFC and sICAM-1 level (r = 0.33; in NEG r = 0.25; in CAD r = 0.37; in ACS r = 0.61), being the strongest in ACS. The relation was independent from age, gender, BMI, smoking, hypertension, diabetes, previous myocardial infarction, family history of IHD, medication, hsCRP, IL-6 and vWF levels. (odds ratio, OR = 6.4; CI 95%: 2.43-16.84; p < 0.05). Nevertheless, correlation between CTFC and IL-6, hsCRP, vWF levels was not found. These results indicate inverse correlation between coronary blood flow and adhesion molecule production independently from conventional cardiovascular risk factors and inflammatory markers.
...
PMID:Inverse correlation between coronary blood flow velocity and sICAM-1 level observed in ischemic heart disease patients. 1629 92

Because of the presumed non-atherosclerotic pathogenesis, the potential link between spontaneous cervical artery dissection (sCAD) and common risk factors for atherosclerosis has never been investigated systematically. Therefore, this prospective, multicentre, case-control study compared the frequency of tobacco use, hypertension, diabetes mellitus, and hypercholesterolaemia among a group of consecutive patients with sCAD (n = 153), a group of patients with ischaemic stroke, not related to CAD (non-CAD), and a group of controls. As opposed to the other variables, a trend towards a significant association was seen when the prevalence of hypertension was compared among patients with sCAD and controls (26.8% v 17.0%; odds ratio (OR) 1.79; 95% confidence interval (CI), 0.98 to 3.27; p = 0.058). Hypertension was also significantly associated with the subgroup of patients with sCAD and cerebral infarction (OR, 1.94; 95% CI, 1.01 to 3.70; p = 0.045), particularly when involving the vertebral arteries (OR, 2.69; 95% CI, 1.20 to 6.04; p = 0.017). These findings might help define the spectrum of pathogenic conditions predisposing to sCAD and provide information to help investigate the combined effect of such susceptibility factors in future studies.
...
PMID:Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study. 1636 4

The aim of the study was to evaluate the endothelium dependent FMD of the brachial artery in patients with LVDD. Endothelial function was assessed in 36 male patients (mean age 49+/-6 years) with LVDD due to CAD (22 patients) and essential hypertension (14 patients) as well as in 18 male patients (control group) without LVDD (12 patients with CAD and 6 with hypertension) of matched age. Our studies had showed significant decrease of FMD in patients with LVDD compared to those without LVDD (4.67%+/-1.68 vs. 6.12%+/-2.54, p<0.05). At the same time FMD in both groups appeared to be significantly lower than in healthy subjects. Post-ISDN vasodilation was almost similar in both groups of patients and lower than in controls. The post-ISDN vasodilatation did not differ regarding presence of LVDD or causative disease (CAD or arterial hypertension) and its extent was lower than in healthy controls. A weak correlation was found between FMD and post-ISDN vasodilatation (r=0.231, p>0.05). Data obtained suggest that endothelial dysfunction exists in patients with diastolic dysfunction. Based on these results it is considered that patients with early stages CAD and arterial hypertension depressed FMD might be indicator of LVDD.
...
PMID:Flow-mediated dilation in patients with left ventricular diastolic dysfunction. 1636 63

Leptin plays an important role in satiety signaling and is related to obesity. Variants of leptin gene (LEP) have been associated to differences in plasma leptin levels and obesity-related phenotypes. The purpose of this study was to evaluate the association of LEP 3'HVR and leptin concentrations and obesity-related traits in our population. Anthropometrics and systolic/diastolic pressure were measured in 210 unrelated Brazilian individuals. Blood samples were collected for quantification of leptin, glucose and lipids and DNA extraction. LEP 3'HVR polymorphic region was amplified by PCR and fragments were analyzed by polyacrylamide gel electrophoresis. Obesity was associated with hypertension, hyperglycemia, obesity-related traits, plasma leptin and serum lipids (p < 0.05). The frequency of LEP 3'HVR class I alleles (I/I + I/II genotypes) was higher in obese (p = 0.043) than in non-obese individuals. Multivariate logistic regression showed that the risk for obesity is nine times higher in hypertensive individuals and two times higher in class I alleles carriers. The presence of class I alleles was associated with increased BMI and WC. Plasma leptin was related to class I alleles in women (p < 0.05). No association was found between LEP 3'HVR and hypertension or risk factors for CAD in our sample. Our results suggest that LEP 3'HVR is an important predictor for obesity-related traits and leptin plasma levels.
...
PMID:LEP 3'HVR is associated with obesity and leptin levels in Brazilian individuals. 1676 76

The aim of our research was to assess the role of vasoactive factors of endothelium (NO and endothelin-1) during diastolic dysfunction of the left ventricle and to determine the effects of nebivolol in the early treatment period of endothelial dysfunction. In the investigation were included 36 male patients (mean age 49+/-6 years) with LVDD due to CAD (22 patients) and essential hypertension (14 patients) as well as in 18 male patients (control group, 12 patients with CAD and 6 with hypertension) without LVDD of matched age, who underwent 2 week treatment with 5 mg nebivolol (Nebilet, Berlin-Chime) . The endothelial dysfunction was assessed by (a) a noninvasive method, brachial artery ultrasound during reactive hyperemia, measured by flow-mediated vasodilatation (FMD), which indirectly reflects the amount of NO and (b) measurement of the amount of ET-1 in the plasma by method of an enzyme-linked immunoassay (ELISA). According to the results of our studies FMD (%) was increased by 73% among the patients with DD of LV whereas among the patients without DD was increased by 66% (p<0,05). Furthermore, statistically none significant decrease of endothelin-1 levels were observed and no difference was found among the groups of patients. Importantly, statistically significant increase of early ventricular filling was found: E/A ratio with Doppler echocardiography at the end of 2 week period treatment reached 1,10+/-0,04 vs. 0,92+/-0,01 before the treatment (p<0,05). Positive correlation was found between FMD (%) and the relaxation capability of the left ventricle (r=0,38, p<0,05). Based on these results we can conclude that endothelial dysfunction might be indicator of LVDD, and by treating the former we can prevent the diastolic dysfunction.
...
PMID:[Effects of nebivolol on endothelial dysfunction in patients with diastolic dysfunction of left ventricle]. 1678 65

<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>