UMLS:C0028754 - FACTA Search

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Query: UMLS:C0028754 (obesity)
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General use of ambulatory noninvasive 24-h blood pressure monitoring in many patients has shown that new criteria for arterial hypertension are useful. A classification of circadian blood pressure in "dippers" and "nondippers" (no physiologic drop of blood pressure) needs to be specified. An altered circadian blood pressure profile, like that in nondippers, was used as a diagnostic criterion for secondary hypertension. Recent epidemiologic studies in patients with essential hypertension have shown that nondippers are at higher risk for cardiovascular complications such as myocardial infarction and cerebrovascular insult. The studies also revealed that sleep-related breathing disorders (SRBD) are characterized by increased cardiovascular risk. Increases in blood pressure caused by SRBD could be documented, with the highest amount occurring during REM sleep. A study performed in a general practice showed a high incidence (40/112) of nondippers in a group of snoring middle-aged men with obesity and daytime fatigue. This indicates diagnostic and therapeutic consequences for the control of 24-h blood pressure, including nocturnal breathing pattern and daytime symptoms due to SRBD. The goal of antihypertensive drug therapy is to reduce blood pressure significantly during the day and during the night in different stages of wakefulness and sleep. A new protocol was designed to investigate blood pressure over 24 h under a standardized load, including nocturnal hypertension. The angiotensin-converting enzyme (ACE) inhibitor cilazapril was used in this test procedure and showed a significant and clinically relevant mean blood pressure reduction of 10.0 mm Hg (versus placebo 4.3 mm Hg) over 24 h.
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PMID:Nocturnal hypertension and cardiovascular risk: consequences for diagnosis and treatment. 789 92

BP has been measured in secondary school children in Nottingham as part of a routine health appraisal since 1988. School nurses who have received appropriate training refer children with a BP greater than the 95th centile for age and sex (Task Force USA 1987) initially to a community paediatrician or general practitioner. Of 14,570 children checked, only 23 patients (14 female) with a mean age of 13.9 years (range 10-15.8 years) were referred to a paediatric nephrology clinic to be seen in consultation with a dietitian. In 12 of 23 children there was a family history of hypertension and in seven a family history of other cardiovascular disease. No patient with secondary hypertension was identified; 14 patients (61%) were overweight or obese (nine) on the basis of percentage weight for height at the time of referral. BP values have tended to normalise on follow-up. Although six of 22 patients lost weight with dietetic support, eight patients gained weight. The school surveillance programme for BP is felt by the school nurses to be a valuable health educational tool and has resulted in few hospital referrals. Although initial dietetic advice may be of value, obesity remains a significant problem for the majority of adolescents in this group.
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PMID:Hypertensive adolescents detected by a school surveillance programme: a problem of obesity. 806 76

Through the benefit of a large body of normative data on blood pressure throughout childhood, along with the clinical practice of regular blood pressure measurement in the young, mild elevation of blood pressure can be detected in the young. Unlike secondary hypertension in the young which is more severe, slight to mild elevations in blood pressure during childhood may be an early expression of essential hypertension. Mildly elevated blood pressure in the young is usually associated with other risk factors including obesity, family history of cardiovascular disease, and metabolic alterations in lipids and insulin. Environmental factors, which include health related behaviors can modulate the expression of the risk factors including elevated blood pressure. The extent to which the health behaviors of diet and exercise can be modified in the young may be important for risk factor intervention during the early phases of hypertension.
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PMID:Hypertension in childhood and adolescence. 826 92

Use of prescription diuretics and incidence of renal cell cancer have increased in the United States in the past 25 years. Recent interview-based epidemiologic studies have reported an association between diuretic use and renal cell cancer risk. Our study evaluated this hypothesis using, for the first time, medical records as the source of the information on prescription diuretic use. Using medical records of women from a prepaid health plan, we identified 191 cases and 191 controls matched on age, membership duration, and membership at diagnosis. Diuretics use and history of potential confounding factors were ascertained by a standardized review of the medical records of each subject, without reference to case or control status. There was a strong and statistically significant association between renal cell cancer and prescription diuretics (odds ratio [OR] adjusted for hypertension, smoking, and obesity = 2.9, 95 percent confidence interval [CI] = 1.7-4.7). Risk tended to increase with dose, measured by number of prescriptions. Since renal cancer can induce hypertension, which is treated by diuretics, and thereby confound the association with diuretics, we examined diuretic use 10 or more years prior to diagnosis when secondary hypertension would be unlikely. The OR for prescriptions 10 or more years before diagnosis was 3.5 (CI = 1.7-7.4). Our results support earlier reports of an excess risk of renal cell cancer among users of prescription diuretics and indicate need for further study to evaluate this relationship, especially due to the extensive use of diuretics and the increasing incidence of this cancer.
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PMID:Increased risk of renal cell cancer among women using diuretics in the United States. 828 Aug 33

Most patients with hypertension in the United States have essential (primary) hypertension (95%), the cause of which is unknown. The remaining 5% of adults with hypertension have the secondary form of hypertension, the cause and pathophysiologic process of which are known. Internists and other primary care physicians refer to this as treatable or curable hypertension, because the hypertension can be managed or even controlled with medications. Similarly, the condition is called surgical hypertension by surgeons in the belief that once the cause is determined and identified, surgical intervention will result in cure of hypertension. Secondary causes of hypertension include renal parenchymal disease, renovascular diseases, coarctation of the aorta, Cushing's syndrome, primary hyperaldosteronism, pheochromocytoma, hyperthyroidism, and hyperparathyroidism. Occasionally included in this category are alcohol- and oral contraceptive-induced hypertension and hypothyroidism, but these conditions are not discussed herein. The evaluation of secondary hypertension is of interest and can bring together different facets of anatomy, physiology, pharmacology, and radiology in the medical and surgical treatment of these disorders. Despite enthusiasm that can be generated in the evaluation of these conditions, evaluation can be expensive and should not be conducted for all patients with hypertension. Features that aid in the diagnosis of secondary hypertension include the following: 1. Onset of hypertension before the age of 20 or after the age of 50 years. The presence of hypertension at a young age may suggest coarctation of the aorta, fibromuscular dysplasia, or an endocrine disorder. Hypertension found for the first time after the age of 50 years may suggest the presence of renovascular hypertension caused by atherosclerosis. 2. Markedly elevated blood pressure or hypertension with severe end-organ damage, as in grade III or IV retinopathy. These findings suggest the presence of renovascular hypertension or pheochromocytoma. 3. Specific body habitus and ancillary physical findings. For example, truncal obesity and purple striae occur with hypercortisolism, and exophthalmos is associated with hyperthyroidism. 4. Resistant or refractory hypertension (poor response to medical therapy usually necessitating use of more than three antihypertensive medications from three different classes). 5. Specific biochemical test that suggest the existence of certain disorders, such as hypercalcemia in hyperparathyroidism, hyperglycemia in Cushing's syndrome and pheochromocytoma, and unprovoked hypokalemia with renin-producing tumors, primary hyperaldosteronism, or renin-mediated renovascular hypertension. 6. Other characteristics that may suggest secondary hypertension such as abdominal diastolic bruits (renovascular hypertension), decreased femoral pulses (coarctation of the aorta), or bitemporal hemianopias (Cushing's disease). A combination of a good history and physical examination, astute observation, and accurate interpretation of available data usually are helpful in the diagnosis of a specific causation.
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PMID:Secondary hypertension: evaluation and treatment. 894 19

Arterial hypertension could be considered a progressive ischaemic syndrome interesting the macro and the microcirculation. In order to improve the clinical and therapeutic approach to the treatment of arterial hypertension, research has centered on blood flow to evaluate the different components and their very intricate relationships influencing the micro- and the macrocirculation. Of course the main problem is to study the link between the blood flow and the peripheral tissue oxygenation. During hypertension very important alterations in rheological, mechanical and biochemical characteristics of erythrocytes and of blood flow have been shown. It is very relevant the increase in blood viscosity, the decrease in red blood cell (RBC) deformability, the formation of RBC "rouleaux" and RBC aggregates. These hemorheological determinants can favour an increase of peripheral resistances and of arterial blood pressure, causing or worsening hypertension, a decrease in oxygen transport to tissue and peripheral perfusion, a decrease of the active exchange surface area in the microvasculature, especially in complicated hypertension. We have studied 320 patients: 123 with Essential Hypertension (EH) (M 59, F 64 aged 50 +/- 25 years); 81 with Secondary Hypertension (SH) without associated other pathologies influencing hemorheology (M 42, F 39 aged 48 +/- 20 years); 116 SH with other pathologies or conditions associated influencing hemorheology such as: diabetes, lipoidoproteinosis, obesity, smoking, HD, elderly, etc. (M 48, F 68 aged 46 +/- 20 years). Using a Laser-assisted Optical Rotational Red Cell Analyzer (LORCA) acc. to Hardeman (1994) we studied Elongation Index (EI) and aggregation kinetics of red blood cells in these patients. We also evaluated TcpO2 and TcpCO2 using a transcutaneous oxymeter (Microgas 7650, Kontron Instruments). In hypertensives we found a decrease in erythrocyte deformability (evaluated with EI), in erythrocyte aggregation time, a fibrinogenaemia increase, an increase of shear rate to disaggregate erythrocytes, a decrease in cellular oxygen delivery and tissue oxygenation, an impairment of microcirculation. These changes may be involved in the development of arterial hypertension and in its pathogenesis. These patterns also are more impaired in hypertensives with diabetes, lipoidoproteinosis, etc. These patterns are not related with the age of the patients but they are significantly and directly related (p < 0.01) with the patient hypertension-age. This could be a new way to realize a better treatment in hypertensives and a prevention of cardiovascular complications (i.e.: myocardial infarction, TIA, etc.).
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PMID:Red blood cell (RBC) deformability, RBC aggregability and tissue oxygenation in hypertension. 1071 39

More women than men eventually develop hypertension in the United States due to their higher numbers and longer longevity. The white coat hypertension is also more common in women. Alcohol, obesity and oral contraceptives are important causes of rise in blood pressure among women. On the other hand, hormone replacement therapy may decrease cardiovascular mortality in the postmenopausal woman. Women with left ventricular hypertrophy are at a greater risk of death than men. Fibromuscular hyperplasia and primary aldosteronism are more common as causes of secondary hypertension in women. Nonpharmacologic therapy, such as weight reduction, exercise, salt and alcohol reduction, should always be tried prior to medical treatment of hypertension and are very useful adjunctive measures in controlling hypertension. ACE inhibitors and angiotensin receptor blockers are contraindicated in pregnancy and should be avoided in women with childbearing potential. Hypertension remains a major public health problem among black women. Although the antihypertensive drug therapy seems to benefit white women the least, proportionately more of them comply with their antihypertensive therapy. Hypertension is the most common chronic medical condition requiring visits to the physicians, as well as prescription medications, in the United States. The epidemiology, clinical course, response to treatment and ultimate outcome of essential hypertension may vary with gender. More women than men eventually develop hypertension in the US due to their higher numbers and longer longevity.
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PMID:Hypertension in women. 1092 86

Hypertension is a cardiovascular risk factor which needs a good evaluation before treatment. When this latter is decided, the target is to normalize high blood pressure. This requires a complete information of the patient; the latter will also receive individualized non pharmacological advices and, also, possibly different antihypertensive drugs. When blood pressure does not normalize, one must check the blood pressure measurement technique, the compliance to treatment and potential pharmacologic interferences. Secondary hypertension is only considered if resistance to therapy cannot be found. It should be remembered that obesity and sleep apnea disorders are responsible of many instances of refractory hypertension.
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PMID:[How I investigate...a refractory hypertension]. 1223 25

The objectives of this study were (1) to determine the relationship of body mass index (BMI) to primary or secondary hypertension in children and adolescents and (2) to assess BMI at the age of onset of hypertension in children and adolescents. Patient demographics, BMI, family history, presentation of disease, etiology of hypertension, medication, laboratory data, and findings from other procedures were recorded for all patients with hypertension followed in the Pediatric Nephrology Clinic at Children's Hospital, Columbus, Ohio, over a 4-year period. In total, 314 patients were studied: 218 with primary hypertension and 96 with secondary hypertension. Our patient population (166 males, 148 females) was diverse in age (13+/-6.3 years) and ethnicity (237 Caucasians, 54 African-Americans, 23 other). BMI was greater in patients with primary (27.5+/-9.2 kg/m2) versus secondary (23.9+/-9.3 kg/m2) hypertension (P=0.002). Children with primary hypertension with an increased BMI presented at an earlier age than children with secondary hypertension and an increased BMI. The age of onset (10.5+/-2.6 years) in primary hypertension was related to increased BMI (r=0.12, P=0.001); however, there was no relationship between BMI and age of onset of secondary hypertension (P=0.21). Children whose family members had essential hypertension had increased BMI compared with children without a family history of essential hypertension. Based on the logistic regression model constructed from our data, the likelihood of primary versus secondary hypertension was influenced by the presence of family history of hypertension independent of presence of obesity in the child. In conclusion, increased BMI is more common in children with primary than secondary hypertension; earlier onset of primary hypertension in the pediatric population was associated with increased BMI; the assessment of BMI is important in the evaluation of secondary as well as primary hypertension; the role of obesity in the development of secondary as well as primary hypertension in children merits further study.
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PMID:Body mass index in primary and secondary pediatric hypertension. 1550 82

Left ventricular hypertrophy is an important risk factor of cardiovascular complications during the course of hypertension. Increased QT dispersion is associated with sudden cardiac death in congestive heart failure and in other cardiovascular diseases. Our aim was to compare QT dispersion from routine ECG in hypertensive patients with and without left ventricular hypertrophy defined by echocardiography. Authors examined 71 hypertensives treated in our medical department. Left ventricular hypertrophy was defined by echocardiography (Penn convention) as left ventricular mass index > 134 g/m2 in men and > 110 g/m2 in women. QT dispersion was defined from routine ECG (QTmax - QTmin). Presence of LVH was found in 26 patients (mean age 59.3 years), absence of LVH in 45 patients (mean age 57.8 years). Hypertensives with secondary hypertension, hypertrophic cardiomyopathy, sings of ischemia in ECG, arrhythmias, myocardial infarction, heart failure, diabetes mellitus and patients treated by antiarrhythmic drugs of the Ic and III groups were excluded. Both groups of hypertensives were matched by demographic parameters, and by the presence of hypertension, obesity, hyperlipidemia and smoking habites. There were statistically significant longer QT dispersion and QTc dispersion (59.0 +/- 20.1 ms, 64.0 +/- 23.7 ms) in LVH-positive patients than in LVH-negative once (43.2 +/- 9.5 ms, 48.4 +/- 11.1 ms). Left ventricular hypertrophy in patients with hypertension brings usually a complicated course of the disease. Authors recommend to look after left ventricular hypertrophy presence in hypertensives as it carries much more complicated course of the disease. Measurment of QT dispersion adds farther stratificational information to these patients.
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PMID:[QT dispersion intervals in hypertensives with left ventricular hypertrophy]. 1563 64

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