Gene/Protein Disease Symptom Drug Enzyme Compound
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Estrogenic compounds are the most important group of drugs that can induce hypertension. Studies have shown an incidence of significant hypertension amounting to less than 1% after 1 year of taking oral contraceptives and about 2% after 5 years. The ratio of the incidence of hypertension among ''takers'' to that of ''nontakers'' has been assessed at 1.8 by 1 study and 2.6 by another. Small but significant increments in systolic and diastolic pressures can be discerned during the first 2 years of treatment. Cessation of treatment has resulted in pressures returing to pretreatment levels within 3 months. In those previously normal the highest readings during oral contraceptive use were only 155/90 mm of Hg. Severe hypertension is more likely to occur in the predisposed, and malignant hypertension has been reported. Previous hypertension, toxemia of pregnancy, obesity, and nephropathy are predisposing conditions. Although progestagens, used alone, do not cause clinical hypertension the incidence of hypertension associated with an estrogen-progestogen combination was directly related to the dose of progestagen used. Weight gain is often observed in oral contraceptive users and is occasionally accompanied by edema and hypertension. There is a marked increase in the circulating level of renin substrate (angiotensinogen) which is caused by the estrogen component of the pill. The increase in renin substrate is associated with increase in plasma levels of renin activity, angiotensin 2, and aldosterone, together with a fall in plasma renin concentration. The suppression of plasma renin concentration can persist for weeks after stopping the pill. The factors responsible for hypertension are probably intrinsic and may be either neural, vascular, or renal. Patients taking oral contraceptives should have blood pressure checks at 6-month intervals, and more frequently in high risk cases. In the management of those with only mild blood pressure elevation, such patients should change to a preparation with the lowest available estrogen dosage, 30 mcg of ethinyl estradiol, or reserve the method for use during crucial periods of family planning. With moderate hypertension the oral contraceptive should be suspended for 3-6 months. If the blood pressure falls, oral contraceptives should not be resumed but another method recommended. Continuing hypertension requires further study and possibly elective sterilization. Severe hypertension requires withdrawal of the pill, urgent investigation, and treatment. Other drugs may cause hypertension. Management of these patients is outlined. Structural formulae of progesterone, norethisterone acetate, medroxyprogesterone acetate, and norgestrel are shown.
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PMID:Drug-induced hypertension: pathogenesis and management. 18 40

The anatomical-pathological findings of 15 woolly monkeys were comparable with those described in man with essential benign or malignant hypertension. Kidneys revealed arterio- and arteriolosclerosis or an onion peel-like proliferation, in some cases necrotizing endarteritis. Obesity due to restricted physical activity, unnatural feeding, and psychical and physical stress could have contributed to the development of this condition. Further, high vulnerability of the genus woolly monkey is postulated. Thus, essential hypertension of woolly monkeys appears to be a multifactorial disease.
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PMID:The woolly monkey (Lagothrix lagothricha): a possible model for human hypertension research. 258 76

The survival has been determined for the 404 patients who presented to the Hammersmith Hospital Hypertension Clinic during the years 1962 to 1966 and in whom the untreated blood pressure was known. The fifteen year survival ranged from 72% for young men aged 30-49 at presentation to 27% for men aged 60-69. Sixty-eight percent of the deaths were cardiovascular or renal, 33% of all deaths were from ischaemic heart disease (IHD), 17% from stroke and 3% from renal causes. Death from any cause was predicted with statistical significance by age, the presence of accelerated or malignant hypertension, impaired renal function, smoking at presentation and systolic blood pressure. Death was not predicted by hypokalaemia, hyperuricaemia (after adjusting for renal function) and obesity.
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PMID:Fifteen year survival of patients presenting with hypertension to a hospital clinic. 376 39

During a 1-year period all Black patients admitted to two medical wards in the Johannesburg General Hospital were screened for malignant hypertension. Of the 62 patients eligible for inclusion in the study, 51 were thought to have essential malignant hypertension (hospital prevalence 2,2%). There was a striking absence of the cardiovascular and hypertensive risk factors usually described -- excessive smoking, alcohol consumption and obesity. The presenting features and complications were similar to those described in other series. Cardiac failure was present in 45% of the patients, neurological complications in 33%, and advanced renal failure in 47%. Twenty patients required dialysis. No evidence of ischaemic heart disease or atheromatous vascular disease was found. Red cell fragmentation was present in 25% of the patients. The hospital mortality rate was 25%. Only 24% of the patients had previously been diagnosed as having hypertension, although 43% had been examined by a doctor during the preceding 2 years. Of the patients discharged to the hypertension clinic, only 28% returned for short-term follow-up. Malignant hypertension is therefore a major medical and social problem in the Johannesburg Black community.
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PMID:The malignant phase of essential hypertension in Johannesburg Blacks. A prospective study. 708 52

The purpose of this study was to evaluate the utility of computed tomography (CT) renal angiogram (CTRA) in the management of childhood hypertension. This is a retrospective study of 24 children with clinical suspicion of renovascular disease who underwent CTRA examinations. CTRA demonstrated surgically correctable etiology of hypertension in 38% of the patients [5 with renal artery stenosis (RAS) and 4 with renal pathology]. In 5 patients, CTRA findings of RAS were confirmed by catheter angiogram. CTRA missed RAS in 1 patient in whom catheter angiogram showed beaded narrowing of the renal artery. All 6 patients with RAS had resolution of hypertension immediately after angioplasty or surgery. One patient with diffuse renal artery stenosis had an ipsilateral multicystic dysplastic kidney. In this patient hypertension resolved spontaneously as the dysplastic kidney shrunk in size. Seven patients had a renal etiology for hypertension. In 3 of these patients hypertension resolved after nephrectomy. Malignant hypertension in the 4th patient with reflux nephropathy was controlled medically after she underwent bilateral ureteral reimplantation. The remaining 3 patients with renal etiology were managed medically. We found that the etiology was central for hypertension in 4 patients with brain abnormalities, obesity in 1 overweight patient, essential hypertension in 4 patients, and thoracic aorta coarctation in 1 patient. Our study showed that in all except 1 instance CTRA could diagnose a surgically correctable cause for hypertension. CTRA provided useful information for the management of pediatric hypertension in all our patients.
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PMID:Utility of computed tomographic renal angiogram in the management of childhood hypertension. 1221 28

Large prospective epidemiologic studies have shown that long-term use of oral contraceptives containing estrogen induce an increase in blood pressure and sharply increase the risk of hypertension. Susceptibility to the hypertensive effects of oral contraceptives is heightened where risk factors such as age, family history of hypertension, preexisting or occult renal disease, parity and obesity exist. Hypertension among pill users usually develops within the first 6 months of usage and occasionally is delayed for as long as 6 years. Anitihypertensive therapy is seldom needed as the hypertension that developes is generally mild and uncomplicated, and rapidly reverses when the pills are discontinued. However, a small percentage of patients develop severe, even life-threatening hypertension and the hypertensive effects are felt long after the pills are discontinued. Cases of malignant hypertension and irreversible renal failure requiring maintenance hemodialysis, bilateral nephrectomy, and renal transplantation have occurred following administration of oral contraceptive pills. The mechanism by which oral pills induce hypertension in susceptible women is not known and needs further research. Before oral contraceptives are prescribed, physicians should take a careful history and perform a detailed physicial examination with special attention to the cardiovascular system. Multiple blood pressure measurements should be made and routine laboratory studies including urinalysis, blood urea and nitrogen and serum creatinine should be performed. It is preferable to start with a relatively low (50 mcg) estrogenic content preparation. Patients who develop hypertension (diastolic pressure, 90 mm Hg) on oral contraceptives should stop taking the pills immediately, and should be considered to have estrogen-induced hypertension. They should never again receive estrogen-containing oral pills, although they can try pills containing only progestogen. There is no contraindication to pregnancy in these patients, as most women who become hypertensive on oral pills go on to have normotensive pregnancies. Pregnancy in women who are susceptible to essential hypertension however should be treated as high risk.
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PMID:Hypertension and oral contraceptives. 1226 83

We included in a six month-period 85 patients concerned about complicated high blood pressure. Hypertension represented 33% of 276 admissions for cardiovascular cases. Among the 55 men and 30 women concerned, average age was 57 years-old. Male to female ratio was 1,8. Cardiovascular risk factors were determined as follows: obesity: 18 cases (21%), cigarette smoking: 27 cases (32%), diabetes mellitus: 11 cases (13%), hypercholesterolaemia: 44 cases (52 %). Kidney was damaged in 36 patients (42%). Seventy patients (82%) with systolic dysfunction in 21 cases (30%) presented a left ventricular hypertrophy. Malignant hypertension was noted in 13 cases (15%). Eighteen patients (21%) had stroke and 9 died (10,5%). Drugs association was needed to control hypertension. As for everywhere in Africa, complicated hypertension is the main cause to admission for cardiovascular disease in our day-to-day practice. National preventive measures should help for systematic detection process and adequate management.
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PMID:[Descriptive study of complicated hypertension. Experience of the Principal Hospital of Dakar]. 1577 69

The purpose of this retrospective study conducted in the emergency department of the University Hospital Center in Brazzaville, Congo was to determine the prevalence and clinical characteristics of hypertensive emergencies. With a total of 76 patients admitted during the study period, the prevalence of hypertensive emergency was 4%. The sex ratio was 1 and mean patient age was 57.3 years (range, 30 to 80 years). Risk factors included obesity in 62 cases (81.6%), history of hypertension in 65 (85.5%) and low socioeconomic level in 58 (76.3%). Mean delay for consultation was 50 hours (range, 1 to 240 hours). The disease underlying the hypertensive emergency was stroke with 38 cases (50%), heart failure in 20 (26.3%), hypertensive encephalopathy in 11 (14.4%), malignant hypertension in 9 (11.8%), and renal failure in 10 (13.1%). The mean length of emergency treatment was 14.7 hours (range, 5 to 48 hours). Eight deaths (10.5%) occurred during hospitalization in the emergency department.
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PMID:[Hypertensive emergencies at the University Hospital Center in Brazzaville, Congo]. 2158 7

Resistant hypertension remains a major clinical problem despite the available multidrug therapy. Over the next decades, its incidence will likely increase given that it is strongly associated with older age and obesity. Resistant hypertension patients have an increased cardiovascular risk, thus effective antihypertensive treatment will provide substantial health benefits. The crosstalk between sympathetic nervous system and kidneys plays a crucial role in hypertension. It influences several pathophysiological mechanisms such as the central sympathetic tone, the sodium balance and the systemic neurohumoral activation. In fact, studies using several animal models demonstrated that the renal denervation prevented and attenuated hypertension in multiple species. Large reductions in blood pressure were also observed in malignant hypertension patients submitted to sympathectomy surgeries. However, these approaches had an unacceptably high rates of periprocedural complications and disabling adverse events. Recently, an innovative non-pharmacological therapy that modulates sympathetic activation has been successfully developed. Renal sympathetic percutaneous denervation is an endovascular procedure that uses radiofrequency energy to destroy the autonomic renal nerves running inside the adventitia of renal arteries. This method represents a promising new approach to the strategy of inhibiting the sympathetic nervous system. The aim of this review is to examine the background knowledge that resulted in the development of this hypertension treatment and to critically appraise the available clinical evidence.
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PMID:Renal sympathetic denervation in resistant hypertension. 2367 55