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 24,015 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The prevalence of primary and secondary hypertension and of heart and kidney involvement was thoroughly studied in 689 hypertensive subjects derived from a blood pressure screening examination of a total population sample of Swedish men (n = 7,452). The prevalence of secondary hypertension was found to be only 5%, the prevalence of surgically curable hypertension being even lower. Left ventricular hypertrophy and slight heart enlargement were each found in about one-third of the hypertensive patients, while severe heart enlargement, left ventricular hypertrophy on ECG, proteinuria, abnormal serum creatinine and urinary sediment were each found in about 5%. On the basis of these findings, a minimum pre-treatment workup in uncomplicated hypertension is proposed.
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PMID:Pre-treatment workup for antihypertensive treatment. 127 68

The authors investigated the incidence of arterial hypertension during acute glomerulonephritis in adults and during the period after glomerulonephritis. Hypertension was recorded in 34% of 126 patients treated on account of acute glomerulonephritis (mean age 23 +/- 6 years). Only in six patients the diastolic pressure was higher than 15.3 kPa. At the end of hospitalization hypertension persisted in four subjects. After a three-year interval following glomerulonephritis hypertension was recorded in 15% of 119 examined subjects. In 7 subjects it was isolated, in another 11 associated with a pathological finding in urine. Four to twenty years after acute glomerulonephritis (mean 11.5 years) in a group of 81 subjects hypertension was recorded in 31%. In six patients it was an isolated finding, in 19 instances it was associated with a pathological finding in urine and possibly impaired renal function. In adult age transient hypertension is associated with about one third of all cases of acute glomerulonephritis. Subsequent presence of hypertension in these patients is frequent and increases with the follow up period. Without an invasive examination it is not possible differentiate secondary hypertension from essential hypertension, in particular in subjects with isolated hypertension or hypertension associated with mild proteinuria.
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PMID:[Incidence of arterial hypertension during and after acute glomerulonephritis]. 205 96

Plasma concentrations of the recently isolated potent vasoconstrictory peptide endothelin were measured in 382 patients. The investigations were performed by means of a sensitive radioimmunoassay specific for Endothelin-1, 2. The results from 110 healthy volunteers displayed a normal range of 44.67 +/- 3.51 pg/ml. Significantly raised levels were found in 33 patients with chronic end-stage renal failure both before and after hemodialysis. In contrast, 35 patients with compensated renal insufficiency did not differ from the normals. Sixty-five patients after kidney transplantation revealed significantly elevated levels, as did 27 patients with acute myocardial infarction, 8 after coronary bypass surgery, and 5 with liver cirrhosis. The mean values of 27 patients with untreated hypertension, 22 with secondary hypertension, of various causes and 16 with coronary artery disease were comparable to the normal population. The values were significantly decreased in 9 pregnant women with hypertension and proteinuria. A marked decline was found in 5 patients with systemic lupus erythematodes, while 20 patients with rheumatoid arthritis demonstrated only a slight decrease. The pathophysiological role of endothelin as a local or circulating hormone in regulating systemic blood pressure or release of other hormones remains to be determined.
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PMID:[Plasma endothelin in normal probands and patients with nephrologic-rheumatologic and cardiovascular diseases]. 221 2

Data describing the 5,485 participants in the stepped-care group of the Hypertension Detection and Follow-up Program were reviewed to determine the apparent prevalence of renal parenchymal and reversible, secondary hypertension. The investigation was limited and was not designed to identify all cases of secondary hypertension. Baseline prevalence of proteinuria was 3.6%, pyuria 7.1%, hematuria 5.1%, and elevated serum creatinine level (greater than or equal to 1.7 mg/dL) 2.7%. The combined occurrence of an elevated serum creatinine level plus one or more urinary abnormalities was noted in 0.95%. Initial review of case reports revealed six participants with hypertension secondary to use of birth control pills and three participants with hypertension that was proved to be secondary to renovascular disease. Specific laboratory or historical criteria were used as indications for more intensive investigation in an additional 65 participants. Among these individuals, one participant with renovascular disease and three with possible primary hyperaldosteronism were identified. A rapid-sequence intravenous urogram or radionuclide scan was performed on another subgroup of 62 participants whose hypertension was "poorly" controlled (diastolic BP, greater than or equal to 95 mm Hg). Fifty-nine studies were negative, one was positive, and two were equivocal. These results suggest that the frequency of clinically relevant cases of reversible, secondary hypertension, at least among individuals with mild to moderate elevation of blood pressure, is low.
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PMID:Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program. 387 6

We have measured the blood pressure to 1500 children aged between 6 and 14 years by sphingomanometric method, using various cuffs according to the recommendations of the A.H.A. Systolic and diastolic pressure was taken and the average value and standard deviations were calculated for each age. On the ground of the values equal or higher than 97 degrees percentil was the presence of 99 subjects afflicted with not secondary hypertension. We noticed that blood pressure increases with the age, is independent of sex, but bears relationship to the presence of obesity (out of 72 obese subjects, 25 were afflicted with hypertension), of menarca (17 hypertensive menstruated out of 27) and of family hypertension (31 hypertensive parents out of 41 examined). Neither relation was found between children's hypertension and socio-economical level nor between hypertension and presence of pathological proteinuria.
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PMID:[Juvenile hypertension. Epidemiological study of 1500 children between 6 and 15 years of age]. 737 49

This study represents a retrospective analysis of pregnancies with chronic arterial hypertension and their outcomes. The aim was to evaluate the influence of arterial hypertension on 101 essential and 109 cases of secondary hypertension in comparison to the control group consisting of 499 normotensive pregnancies. According to the obtained data, 27.7% of the women with chronic hypertension had proteinuria, 61% had bacteriuria and 58.6% had superimposed EPH gestosis. The occurrence of EPH gestosis among the controls was 5.6%, that is significantly less than in the experimental group (X2 = 282.8%; p < 0.001). The outcomes of pregnancies associated with chronic hypertension were: 19% preterm deliveries compared to the controls in which only 9.2% preterm deliveries occurred (X2 = 14.4; p < 0.001). Newborns from pregnancies with essential hypertension were significantly heavier, weighing 3177 +/- 734 g, than those from pregnancies with secondary hypertension, which weighted 2578 +/- 932 g. Perinatal mortality was higher in the study group and significantly higher in the pregnancies with associated secondary hypertension (30.3%) than in pregnancies associated with essential hypertension (15.8%).
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PMID:[Fetal growth in pregnant women with chronic hypertension]. 817 92

Patients with mild to moderate hypertension require only a simple schedule of investigations, especially if there is a history of stroke or hypertension in first degree relatives. Tests are necessary to profile other cardiovascular risk factors and to detect target organ damage with only limited screening for secondary hypertension. Careful history, physical examination, repeated blood pressure measurements over months and measurements of body mass index, random cholesterol, routine blood chemistry and urinalysis using impregnated paper strips are all that are required. More detailed investigations can be reserved for special groups such as those with peripheral vascular disease or abnormal renal function before or after treatment with angiotensin converting enzyme inhibitors or significant proteinuria or hypokalaemia. Patients with essential hypertension who are smokers with lipid abnormalities may go on to develop superimposed renovascular disease. Severe hypertension at any age and especially if there is a reliable negative family history also merits special consideration. Resistance to antihypertensive treatment is more often due to non-compliance or non-steroidal anti-inflammatory drug use or alcohol abuse than to underlying secondary causes.
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PMID:Hypertension: investigation, assessment and diagnosis. 820 68

Multivariate analysis of overall clinicomorphological signs in 58 patients with membranoproliferative glomerulonphiritis (MPG) and investigation of functional survival outlined independent prognostic factors valuable for predicting progression of chronic renal failure. These were: exacerbation > 1 time in 3 years, secondary hypertension, concentration of serum creatinine > 0.13 mmol/l, marked tubulointerstitial changes, global glomerular sclerosis > 30%, 24-hour proteinuria > 8 g.
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PMID:[Factors predicting chronic renal failure in membranoproliferative glomerulonephritis]. 899 8

Renal artery stenosis (RAS) is a common cause of secondary hypertension, with the activation of the renin-angiotensin-aldosterone system being the pathophysiologic hallmark of the disease. Renovascular hypertension, ischemic nephropathy, proteinuria, and flash pulmonary edema are the main clinical syndromes associated with RAS. The prevalence of RAS is on the rise, owing to an increasing prevalence of diabetes and atherosclerotic disease among our aging population. This rise in RAS prevalence poses major challenges for clinicians making diagnostic and treatment decisions. Although renal angioplasty is of proven benefit in fibromuscular dysplasia, randomized trials in atherosclerotic RAS have not shown any advantage for revascularization over medical therapy in terms of blood pressure control or renal function preservation. Angioplasty and surgical interventions should be reserved for patients with preserved kidney size and hemodynamically significant stenosis.
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PMID:Challenges in the diagnosis and management of renal artery stenosis. 1591 98

Pediatricians currently have improved understanding of how to best manage childhood hypertension. The goal of antihypertensive drug therapy in children with secondary hypertension is currently to reduce the blood pressure below the 90th centile. Most authors currently favor therapy with a blocker of the renin-angiotensin system (a converting enzyme inhibitor or an angiotensin II antagonist) or a calcium channel blocker. In patients with kidney disease and diabetes mellitus we generally advise therapy of hypertension with a blocker of the renin-angiotensin system especially in the presence of pathological proteinuria.
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PMID:[Childhood hypertension: current medical management]. 1596 31


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