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

The angiotensin antagonist saralasin (1-sar-8-ala-angiotensin II) was given to 27 patients with different forms of secondary hypertension. The blood pressure fell in 6 of 7 patients with renal artery stenosis and in 4 of 10 patients with terminal renal failure on regular hemodialysis. No change or a rise in blood pressure was observed in 3 patients with Cushing's syndrome, 4 patients with primary aldosteronism, 3 patients with hypertension and a unilateral small kidney of other than renovascular origin, and 6 patients with terminal renal failure. It can be concluded from the results that angiotensin II is involved in the pathogenesis of renovascular hypertension and in some cases of hypertension accompanying chronic renal failure.
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PMID:[Effect of the angiotensin antagonist saralasin (1-sar-8-ala-angiotensin II) on the blood pressure in secondary hypertension]. 101 96

1. The anti-hypertensive effect of converting enzyme inhibition was evaluated in twenty-three hypertensive patients (seven renovascular, four essential, four malignant, one scleroderma, three chronic renal failure, four primary or idiopathic aldosteronism). 2. In sixteen patients a single injection (1--4 mg/kg) of the inhibitor produced an immediate anti-hypertensive effect, which lasted up to 16 h. In six patients the anti-hypertensive effect of the inhibitor was significantly improved after sodium depletion. 3. Plasma renin activities increased and plasma aldosterone concentrations decreased consistently except in idiopathic aldosteronism. 4. Converting enzyme inhibition provides a direct way of defining the degree of renin-dependency of the hypertension. Accordingly, it can be used diagnostically and for planning appropriate therapy. Therapeutically, it could be advantageous in hypertensive emergencies because of its safety, specificity and capacity to reduce aldosterone secretion.
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PMID:The use of angiotensin-converting enzyme inhibitor in the diagnosis and treatment of hypertension. 107 92

In seven patients with chronic renal failure in an advanced stage 17 episodes of upper abdominal pain, hypertension, vomiting and (in some of them) coma occurred during peritoneal dialysis with sorbitol-containing dialysate. The signs recurred in some of the patients but did not when glucose-containing dialysate of otherwise identical composition was used. Very high levels of sorbitol in CSF and serum were measured in the comatose patients. The precipitating factor is probably a reduced metabolic breakdown of sorbitol in renal failure with preferential intracellular deposition of sorbitol and subsequent cellular oedema. To avoid this dangerous reaction it is necessary to use glucose instead of sorbitol in peritoneal dialysates, despite the technical problems of sterilisation. Where this is not possible, glucose should be added in order to reduce the sorbitol concentration in the dialysate to less than 15g/l.
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PMID:[Severe side-effects during peritoneal dialysis caused by sorbitol-containing dialysate (author's transl)]. 114 25

"Overloading" with salt and water, i.e., increasing extracellular fluid, can, if maintained for a period, lead to hypertension in which the main hemodynamic abnormality is increased peripheral resistance. There is evidence that salt and water overload is the chief factor in the hypertension of the majority of patients suffering from chronic renal failure. "Overloading" occurs not only when the contents of a container are increased, but also when the capacity of a container is decreased. Reduction of the compliance of the interstitial space would reduce its capacity to hold fluid without increase in pressure. Evidence is presented that the presence of the kidney affects interstitial space compliance; bilateral nephrectomy decreases interstitial space compliance four fold. Hypertension induced by renal artery partial constriction and removal of the other kidney is also associated with reduction of interstitial space compliance; a sudden rise in interstitial space compliance may be the primary factor in the course of events that leads to the rapid fall in blood pressure which occurs when the constriction is removed from the renal artery. It is suggested that the kidney secretes a hormone which increases interstitial space compliance and that this represents a physiological mechanism which enables animals to store water in the interstitial space without undue rise in interstitial tissue pressure. The role of this mechanism in hypertension and in chronic renal failure is discussed.
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PMID:Renal control of interstitial space compliance: a physiological mechanism which may play a part in the etiology of hypertension. 119 16

Cardiac output, total peripheral vascular resistance, renal, extrarenal, forearm muscle and skin hemodynamics and an indicator of the splanchic vascular resistance were estimated in 20 subjects with chronic renal disease without signs of chronic renal failure and without anemia. The data were compared with a group of subjects with essential hypertension. The high blood pressure of chronic renal disease of mild or moderate severity was maintained in the first place by a high cardiac output, this being due to a rise of the stroke volume, while the heart rate was only slightly increased. The total peripheral vascular resistance was within the normal range in most of the subjects. The vascular resistance in the skin was slightly raised, that in the splanchnic area and muscle unchanged in renal hypertension. The possible pathogenic mechanisms are considered.
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PMID:General and regional hemodynamics in hypertension in chronic renal disease. 119 19

Twenty-nine patients with terminal renal failure were treated by periodic hemodialysis for 2 to 18 months. Serial determinations of blood pressure, blood volume, cardiac output, exchangeable sodium and plasma renin activity were performed. Bilateral nephrectomy was performed in 17 patients and followed by a fall in blood pressure. Cardiac index was elevated in all patients but the blood pressure changes were mainly related to resistance changes. In non-nephrectomized patients, mean arterial pressure was directly correlated to plasma volume (P less than 0.0001), exchangeable sodium (P less than 0.01) and plasma renin activity (P less than 0.001). In anephric patients, mean arterial pressure was only directly correlated to plasma volume (P less than o.005). The slope of the curve relating arterial pressure to plasma volume was significantly shallower in nephrectomized than in non-nephrectomized patients, indicating a lower sensitivity of pressure to volume changes. The study provides evidence that, in hypertensive patients with chronic renal failure, the positive pressure-volume relationship is the fundamental cause of the high blood pressure and that the renin-angiotensin system acts mainly by changing the sensitivity of this mechanism.
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PMID:Overhydratation and renin in hypertensive patients with terminal renal failure: a hemodynamic study. 119 20

Following aortic surgery nearly two thirds of patients (65%) have demonstrable renal tubular damage, which is related to the disease process (aneurysmal disease being more commonly associated with renal damage than occlusive disease), the duration of aortic cross clamping and the volume of blood transfused. No relationship appears to exist between age, pre-operative hypertension, or chronic renal failure, and post operative renal tubular function.
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PMID:Renal function following aortic surgery. 119 41

Elevated serum DBH (dopamine-beta-hydroxylase) activity was found in essential hypertension. The elevated level was not reduced when blood pressure was brought to normotensive level by administration of thiazide or rauwolfia. In contrast, serum DBH activity was low in both normotensive and hypertensive patients treated on prolonged hemodialysis. However, there was no correlation between serum DBH activity and blood pressure level. It was suggested that the pathogenesis of high blood pressure might be different between essential hypertension and hypertension with chronic renal failure, and that measurement of serum DBH activity might help for clinical differentiation of essential hypertension from certain forms of secondary hypertension.
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PMID:Serum dopamine-beta-hydroxylase activity in essential hypertension and in chronic renal failure with hypertension. 119 6

The course and prognosis of chronic renal failure are much worse in hypertensive patients than in normotensive patients with otherwise similar basic disease. Therefore, antihypertensive measures with a combination of diuretics, beta-blockers, and vasodilators have clearly been shown to improve the progression of diabetic nephropathy. Treatment of hypertension with angiotensin-converting enzyme (ACE) inhibitors has also been shown to have a favorable effect on the prognosis of chronic renal failure. In the past few years, more knowledge about the pathogenesis of hypertension and the development of hypertension-induced organ damage has been followed by changing attitudes to antihypertensive therapy and the introduction of calcium antagonists for the treatment of hypertension, even in chronic renal failure. ACE inhibitors and calcium antagonists seem to be advantageous in the prognosis of chronic renal failure as they act on the humoral and trophogenic factors now known to be important in antihypertensive therapy.
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PMID:The effect of antihypertensive therapy on the course of renal failure. 128 93

The calcium antagonist verapamil has been demonstrated to be effective in reducing hypertension in patients in whom sodium intake was not restricted. The present study evaluated the effect of verapamil in reducing hypertension in patients with chronic renal failure on low or high sodium diets. Also, the present study evaluated the effect of verapamil on proteinuria in chronic renal failure patients who were administered a normal and low protein diet. The results reveal that verapamil-SR 240 mg daily is effective in reducing hypertension in patients with chronic renal failure and the effect of verapamil is equal in patients on a high or low sodium intake. In addition, verapamil-SR 240 mg daily is effective in maintaining reduced proteinuria in chronic renal failure patients on low protein diet and may prevent proteinuria in such patients on a normal protein diet. Therefore, verapamil-SR 240 mg daily appears to be an excellent choice for the treatment of hypertensive chronic renal failure patients.
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PMID:The antihypertensive effect of verapamil in patients with chronic renal failure. 128 13


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