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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Arteriosclerosis is the hallmark of hypertension and of its complications, namely stroke, coronary artery disease and ischaemic renal failure. The earliest morphological change in the arteriosclerotic process is vascular smooth muscle hypertrophy and hyperplasia. Angiotensin II is an important growth factor in vascular smooth muscle cells. The chronic administration of ACE inhibitors will reverse many of the changes of vascular hypertrophy in experimental animal models, and will improve vascular compliance in hypertensive patients. Some differences have been reported between different ACE inhibitors with respect to blood pressure-lowering effect and regression of medial hypertrophy in spontaneously hypertensive rats.
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PMID:Reversal of structural changes in hypertensive arteries--a major prospect for the future. 192 14

Active treatment has produced a dramatic decline in the 'mechanical' complications of hypertension (haemorrhagic stroke, congestive heart failure, renal failure, and aortic dissection) but has had no effect on the 'thrombotic' complications (thrombotic stroke, and myocardial infarction). There is a growing body of opinion that this failure is related to changes in the metabolism of lipoproteins and carbohydrates induced by anti-hypertensive drugs, which actively counteract the beneficial effects of a lowered blood pressure. The literature on this subject is extensive, but the results are inconclusive and much remains to be learned. In the light of present knowledge, it would appear to be prudent to choose anti-hypertensive drugs with care, concentrating upon proven agents which produce minimal biochemical disturbances, rather than using drugs which are known to have marked effects on lipoprotein metabolism.
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PMID:The metabolic effects of diuretics and other antihypertensive drugs: a perspective as of 1989. 197 68

The bulk of the mortality (60%) in hypertension occurs in those with mild to moderate elevations of blood pressure, and the chief hazard is coronary disease. Although progression in the severity of hypertension has been slowed with drug therapy, the benefits for coronary outcome and all-cause mortality have been equivocal. Only a 10% reduction in coronary heart disease morbidity and mortality has been shown, an improvement that is not only small, but is statistically insignificant. Only vascular events such as renal failure, stroke, aortic dissection and cardiac failure have been reduced by antihypertensive therapy. Recent trials comparing beta-blockers with other antihypertensive drugs have failed to show the expected promise based on their effectiveness following a myocardial infarction. However, two large trials suggest that they may be effective against coronary heart disease in male non-smokers. A number of possible reasons for this therapeutic failure to reduce coronary heart disease have been postulated. The trials may have been too short to significantly affect the atherosclerotic progression. Also, sample sizes were too small to detect a sizeable reduction in coronary heart disease events. Furthermore, no attention was paid to improvements in the coronary heart disease risk profile, since drugs currently in use are known to have adverse effects on blood lipids, glucose tolerance and uric acid. It is even possible that a predisposition to sudden death is associated with antihypertensive therapy. The trials suggest that in attempts to prevent coronary heart disease, control of smoking and of serum lipids are particularly important in hypertensive persons and may be more effective than controlling the blood pressure alone.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Implications of the primary prevention trials against coronary heart disease. 198 70

Plasma homocyst(e)ine (the sum of free and bound homocysteine, homocystine, and the mixed disulfide homocysteine-cysteine, expressed as homocysteine) levels were determined by high performance liquid chromatography in 214 patients with symptomatic (claudication, rest pain, gangrene, amputation) lower extremity arterial occlusive disease and/or symptomatic (stroke, cerebral transient ischemic attacks) cerebral vascular disease and in 103 control persons. Mean plasma homocyst(e)ine was significantly higher in patients than in controls (14.37 +/- 6.89 nmol/ml vs 10.10 +/- 2.16, p less than 0.05). Thirty-nine percent of patients (83 of 214) had plasma homocyst(e)ine values greater than control mean + 2 standard deviations. Plasma homocyst(e)ine values were contrasted to age, male sex, diabetes, hypertension, smoking, renal failure, and plasma cholesterol. No difference was found in the incidence and/or level of any of these risk factors when patients with normal plasma homocyst(e)ine were compared to those with elevated plasma homocyst(e)ine, both by univariate and multivariate analysis. Patients with elevated plasma homocyst(e)ine were more likely to demonstrate clinical progression of lower extremity disease and of coronary artery disease, but not of cerebral vascular disease than were patients with normal plasma homocyst(e)ine, and the rate of progression was more rapid (p = 0.002). Progression of lower extremity disease as assessed in the vascular laboratory was also more common in patients with elevated plasma homocyst(e)ine (p = 0.01). We conclude that elevated plasma homocyst(e)ine is an independent risk factor for symptomatic lower extremity disease or cerebral vascular disease or both. Symptomatic patients with lower extremity disease and with elevated plasma homocyst(e)ine also appear to have more rapid progression of disease.
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PMID:The association of elevated plasma homocyst(e)ine with progression of symptomatic peripheral arterial disease. 198 84

We describe a patient with scleroderma (CREST syndrome) and central nervous system vasculitis. While angiography demonstrated segmental symmetrical arterial narrowing characteristic of vasculitis, results of leptomeningeal biopsy were normal. There was no evidence of systemic vasculitis, renal failure, or malignant hypertension previously thought to be required to explain central nervous system dysfunction in patients with scleroderma. Signs and symptoms attributable to vasculitis were reversible with aggressive immunosuppressive therapy.
Stroke 1991 Mar
PMID:Scleroderma and central nervous system vasculitis. 200 13

From 1979 to 1989, continuous ambulatory peritoneal dialysis (CAPD) was undertaken for terminal renal failure in 104 patients (56 women and 48 men; average age 54 +/- 15.3 years at the onset of dialysis), for a total observation period of 175 patients years. Survival rate for patients and methods and dialysis effectiveness were analysed retrospectively, the incidence of peritonitis prospectively, 40 patients were aged 60 years and over. Diabetic nephropathy was the most common cause of terminal renal failure (44%). Cumulative patient survival rate was 80% in the first year of treatment; 57% of patients were still alive after two years. The cause of death in 45 of the 54 patients who had died was unrelated to CAPD, cardiac disease and cerebrovascular accident being the most frequent causes (n = 26). During the first treatment year 47% of patients contracted bacterial peritonitis, 59% during the first two years. In 9% of patients CAPD had to be discontinued within the first two treatment years because of CAPD-related complications. There was no case of sclerosing peritonitis or of ultrafiltration loss forcing CAPD termination. These data indicate that there is no plausible explanation from a medical viewpoint for the highly restrictive use of CAPD in the Federal Republic of Germany.
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PMID:[Continuous ambulatory peritoneal dialysis. Patient and method survival rate, peritonitis incidence and dialysis efficacy over 10 years]. 201 38

The use of antihypertensive drug treatment has altered the natural history of hypertension. Whereas congestive heart failure, cerebral hemorrhage, and renal failure were the major complications of untreated severe hypertension, myocardial infarction and thrombotic stroke have emerged as the major problems in treated hypertensives. None of the major therapeutic trials in hypertension have provided evidence that reducing blood pressure reduces the risk of atherosclerotic complications of hypertension. Hypertension certainly aggravates the severity of atheromatous lesions in experimental animals and, thus, may do so in humans. However, atherosclerosis is more closely related to disturbances in lipoprotein metabolism than to other factors. The common finding that serum cholesterol is raised in hypertensive patients may be due to atherosclerosis being the primary lesion, with the hypertension as a secondary complication rather than the primary lesion.
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PMID:Hypertension and vascular disease. 202 54

We have performed coronary bypass grafting in 25 patients 80 years of age or more. The patients' preoperative conditions were characterized by recent myocardial infarction (16/25, or 64%), obesity (15/25, or 60%), hypertension (14/25, or 56%), and left ventricular dysfunction (21/25, or 84%). There were no deaths in the hospital or within 30 days of operation (0/25, or 0%). Postoperative complications occurred in five cases (20%). Complications were leg incision infection (2/25, or 8%), urinary tract infection (1/25, or 4%), stroke (1/25, or 4%), and transient neurologic deficit (1/25, or 4%). There were no instances of reoperation for bleeding, perioperative myocardial infarction, renal failure, pulmonary failure, intraaortic balloon pump use, or sternotomy infection in these patients. Eleven patients (44%) were hospitalized for fewer than 10 days after operation, and all but two (23/25, or 92%) were discharged within 20 days after operation. All patients were followed up, and survival and New York Heart Association functional class were determined. Cumulative survival rate was 94% at 1 year and 88% at 5 years. The cumulative percent survival rate with class I or II function was 92% at 1 year and 80% at 5 years. No patient had recurrent angina.
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PMID:Coronary artery bypass grafting in the octogenarian. 202 43

Regular drug treatment in mild hypertension (diastolic blood pressure 90-104 mm Hg) reduces death from stroke, and other non-coronary vascular events. The optimum strategy remains sequential monotherapy with the lowest effective dose, with drug combinations as an option. A beta-adrenoceptor blocker or low-dose thiazide is good value treatment for many patients. beta-Blockers are good for young (under 50 years), anxious non-smoking men, men after myocardial infarction, and renal failure patients. Older persons over about 65 years, women, smokers, stroke victims, and liver disease patients should generally take a thiazide or calcium ion-channel blocker. Pregnant women and untreated gouty patients should avoid diuretics. Calcium blockers and angiotensin-converting enzyme inhibitors are preferable in severe or insulin-dependent diabetes and renal failure, and angiotensin manipulators or thiazides in heart failure or peripheral vessel disease. Hyperlipidaemia should not generally exclude thiazides or beta-blockers. Some hypertensive stroke patients without encephalopathy may not need antihypertensive drug treatment for the first 24-48 hours. Drug treatment should be tailored to individuals according to their general condition, physiological age, and any concurrent disease or medication. Unwanted drug reactions should not deter patients from fulfilling social and economic goals. The desired treatment end-point is a diastolic pressure of 85-89 mm Hg, but a compromise is usual in poorly motivated young men, and the elderly.
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PMID:Optimising drug management of individuals with cryptogenic hypertension. 202 55

We describe one male, 49-year-old diabetic patient in whom regressive stroke with aphasia and right-sided hemiparesia was related to multiple small emboli in the left paraventricular cortex. Simultaneous presence of several cholesterol emboli in the left eye ground and detection of an atheromatous plaque at the homolateral carotid bifurcation let assume that the cerebral emboli originated from that plaque and also consisted of cholesterol crystals. The patient was discharged on low-dose aspirin (100 mg/day) after neurologic improvement. Follow-up at one year revealed clinical stability, recurrence of the cholesterol emboli at the eye ground examination and no change of the carotid plaque. Cholesterol embolization with renal failure, hypertension and peripheral arterial occlusions causing skin ulcerations is classical in case of atheromatous aortic disease but stroke has rarely been reported in this syndrome. However, more frequent use of invasive procedures (arteriography, transluminal angioplasty, vascular surgery) or thrombolytic treatment might increase its incidence in the near future.
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PMID:Stroke secondary to multiple spontaneous cholesterol emboli. 203 5


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