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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this review is to compare the prevalence of complications and response to different treatment for hypertension in African and European Americans. African Americans when compared to European Americans respond less favorably to beta-blockers (BB's) and angiotensin converting enzyme inhibitors (ACEI's). Nevertheless the observed response of African Americans to ACEI's and BB's is significant and these agents are very effective in this subgroup. African American race is not a clinically significant predictor of poor response to any class of antihypertensive therapy and there is little justification to use racial profiling as a criterion for choice of medication. Evidence to restrict or defer usage of BB's and ACEI's in African Americans is lacking. The mortality from hypertensive heart disease, stroke, and the incidence of hypertensive renal disease is higher in African Americans which leads some investigators to postulate that hypertension in African Americans is intrinsically different from whites. They therefore search for a separate etiology and suggest specific approaches to treatment. Awareness of racial differences in hypertension outcomes evolved in the U.S. in an historical context that does not fully appreciate that race is often a surrogate for many social and economic factors that influence health status and health care delivery in the U.S. Poor outcomes in African Americans occur in many diseases including hypertension.
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PMID:Prevalence of complications and response to different treatments of hypertension in African Americans and white Americans in the U.S.. 826 2

In a one year period (March 1990 to March 1991) the pattern of diseases in geriatric patients (over 60 years of age) admitted to the medical wards at Kenyatta National Hospital (KNH) was studied. In all, there were 1296 patients (M:F = 1.7:1) in this age group forming 11.5% of all admissions during the study period. 1008 (77.8%) of the geriatric patients were between 60 and 79 years of age. Most of the admissions (86.4%) were first admissions. The mean number of diseases per geriatric patient was 1.4. Hypertension and Cardiomyopathy were the commonest single diseases recorded, making up 43.9% of all diseases in this patient population. The commonest neurological diagnosis was stroke, which occurred in a setting of hypertension or cardiomyopathy in all the patients in whom it was diagnosed. The mean duration (+/- 2SD) of stay in the hospital in this patient population was 43 (+/- 19) days. Eighty eight (6.8%) of the patients died, the commonest cause of death being heart failure due to cardiomyopathy or hypertensive heart disease. It is concluded that geriatric patients form a sizeable proportion of our medical admissions and that a large proportion suffer from diseases of the cardiovascular system. It is thus recommended that further studies be carried out on the pattern of diseases in such patients and optimal management strategies for their ailments be outlined.
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PMID:The pattern of geriatric admissions in the medical wards at the Kenyatta National Hospital. 851 26

We describe the case of a 73-year-old man with cardiac failure due to hypertensive heart disease, chronic atrial fibrillation, prior ischemic stroke and acute ischemia of the left leg probably embolic in nature, in whom transthoracic echocardiography (TTE) detected a large left atrial mass compatible with thrombus. Transesophageal echocardiography (TEE) was performed to better evaluate the atrial mass. TTE showed a mass that was firmly attached to the wall of the left atrium, compact, homogeneous and stationary, indicating a relatively low embolic risk. On the other hand TEE clearly detected a marked motility and echographic unhomogeneity of the atrial mass, suggesting a poorer prognosis and urgent surgical referral due to high impending embolik risk. This case further supports the superiority of TEE to TTE in the assessment of intracardiac masses and, in particular, of embolik risk in a patient with left atrial thrombosis.
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PMID:[Role of transesophageal echocardiography in the evaluation of the potential embolic risk in left atrial thrombosis. Report of a clinical case]. 853 6

The aim of this review is to assess the prevalence of complications and responses to various antihypertensive drug therapies in ethnic minority groups in the United States. In some instances, these comments are extended to responses of citizens in their countries of origin. The incidence of hypertension, mortality from hypertensive heart disease, stroke, and hypertensive renal disease are higher in African Americans. Although some Hispanic Americans have a lesser risk for hypertension, they have a greater risk for other risk factors such as diabetes and dyslipidemia. There is a similar association between income and mortality for both African Americans and Hispanic Americans. When compared to European Americans and other ethnic minorities, African Americans respond less favorably to beta blockers and angiotensin-converting enzyme (ACE) inhibitors. Nevertheless, the observed response in African Americans to ACE inhibitors and beta blockers is clinically significant. The available literature indicates that Asian American responses to calcium antagonists seem to be more favorable than responses to ACE inhibitors and equivalent to their responses to diuretic and beta blocker therapy. Although there are few published studies of drug efficacy in Hispanic Americans, there appears to be no hierarchy in response to the various antihypertensive drug classes. Ethnicity is not an accurate criterion for predicting poor response to any class of antihypertensive therapy. Thus, there is little justification to use racial profiling as a criterion for the avoidance of selected drug classes because of presumed lack of efficacy. Observed differences in the incidence of hypertension and its poor outcomes have led some investigators to postulate that the etiology of hypertension in ethnic minority groups is intrinsically different from whites. Awareness of racial differences in hypertension outcomes evolved in the United States within a historical context that does not fully appreciate that race is often a surrogate for many social and economic factors that influence health status and healthcare delivery. Poor outcomes in ethnic minority groups occur in many diseases, not only hypertension. The goal of ethnicity-related research should be to describe the diversity of disease expression in humans and to target at-risk groups for prevention and early intervention. The use of racial descriptors to explain genetic differences in ethnic groups should take a lesser priority.
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PMID:The impact of ethnicity on response to antihypertensive therapy. 887 72

Atrial fibrillation (AF) is a common arrhythmia in patients with hypertensive heart disease. In addition, the presence of hypertension in patients with AF constitutes an important risk factor for the development of thromboembolic events and probably also selects out those individuals who may be resistant to drug therapy. AF in patients with hypertensive heart disease may lead to a number of serious clinical sequelae including stroke, left atrial myopathy, left ventricular dysfunction, and congestive heart failure. This needs to be treated aggressively since many patients may become quite symptomatic when AF develops in the setting of diastolic and systolic dysfunction, regular features of hypertensive heart disease. There are several treatment approaches that may be considered in such patients ranging from interventions to prevent thromboembolic events, drugs and procedures for control of the ventricular response, and drug and non-pharmacologic therapy specifically designed to prevent AF or to restore normal sinus rhythm. This review article will cover each of these components of therapy of AF and will attempt to focus on those therapies that might be best suited for patients with hypertensive heart disease.
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PMID:Management of atrial fibrillation in patients with hypertension. 941 79

The incidence of end-stage renal disease (ESRD) has increased 9% a year over the past 10 years, due primarily to diabetic nephropathy and hypertensive nephrosclerosis. Over this period of time, mortality rates for hypertensive heart disease and stroke have decreased substantially, in large part because of greater recognition and improved therapy of hypertension. Why then is there an increasing incidence of ESRD in diseases in which hypertension plays a significant role in causation and/or progression of renal failure? Is it possible that a lower level of blood pressure than usually recommended is necessary to prevent kidney disease (particularly in blacks) or to prevent or slow progression in most forms of renal failure? Furthermore, are there specific renoprotective drugs? This report will focus primarily on large prospective studies that may provide information to answer these questions.
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PMID:Hypertension and chronic renal failure: the use of ACE inhibitors. 942 71

Clinic blood pressure measurements have only limited ability to determine which hypertensive patients are at greatest risk of cardiovascular events. Ambulatory blood pressure monitoring allows for noninvasive measurement of blood pressure throughout the 24-hour period. This may help to clarify discrepancies between blood pressure values obtained in and out of the clinic and confirm the presence of white-coat hypertension, broadly defined as an elevated clinic blood pressure but a normal ambulatory blood pressure. Ambulatory blood pressure values have been shown to have a better relationship to cardiovascular morbidity and mortality and end-organ damage than clinic blood pressure values. Further, patients with white-coat hypertension appear to be at greater risk of cardiovascular morbidity and end-organ damage than a normotensive population, although they are at less overall risk than a hypertensive population. Hypertensive heart disease is characterized by diastolic dysfunction, increased left ventricular mass, and coronary flow abnormalities. Left ventricular hypertrophy increases the risk of coronary heart disease, congestive heart failure, stroke, ventricular arrhythmias, and sudden death. A variety of invasive and noninvasive techniques are described herein that measure left ventricular mass, diastolic function, and coronary blood flow abnormalities. Most antihypertensive treatments promote regression of left ventricular hypertrophy and reversal of diastolic dysfunction, which may decrease symptoms of congestive heart failure and improve survival.
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PMID:Ambulatory blood pressure monitoring and echocardiography--noninvasive techniques for evaluation of the hypertensive patient. 1044 67

The increased cardiovascular morbidity and mortality in hypertension are related to the target organs (ie, heart, brain, kidneys) involvement from vascular disease. Left ventricular hypertrophy (LVH), the major expression of cardiac involvement, is both a structural and functional adaptation to the afterload imposed by the vascular disease. Without this adaptation, cardiac failure would result much earlier in the natural history of hypertensive heart disease (HHD). However, LVH imposes an independent risk that is even greater than the risk associated with the height of systolic or diastolic pressure. The mechanisms that explain this risk have not been defined precisely; several have been postulated. Among these are the following: 1) coronary hemodynamic alterations associated with HHD (ie, increased coronary vascular and minimal vascular resistance, reduced coronary blood flow and flow reserve, and increased blood viscosity); 2) enhanced predisposition for lethal cardiac arrhythmias, cardiac failure, and accelerated atherosclerosis of the coronary arteries (with exacerbation of the ischemia); and 3) collagen deposition and ventricular fibrosis. From the earliest controlled therapeutic trials, deaths from stroke and coronary heart disease were significantly reduced. However, more recent data have indicated that the prevalence of cardiac failure (CHF) continues to rise progressively. The nature of the CHF is no longer primarily from systolic dysfunction, but is now chiefly from diastolic dysfunction. Diastolic dysfunction occurs primarily in the elderly hypertensive patient or in the patient with ischemic heart disease, both of which are associated with increased collagen deposition. Indeed, these effects continue to be suggested by the data from the Framingham Heart Study as well as NHANES-III that indicate CHF is the most common diagnosis occurring in hospitalized patients over 65 years of age. In this report, both experimental and clinical evidence demonstrating that increased ventricular fibrosis occurs in the spontaneously hypertensive rats and in hypertensive patients are provided, and that treatment with the newer antihypertensive agents reduce ventricular hydroxyproline (ie, collagen) content while, at the same time, improve coronary hemodynamics.
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PMID:Fibrosis and ischemia: the real risks in hypertensive heart disease. 1141 56

This paper describes the South African cause-of-death profile in 1996, the latest year for which routine data are available. Underreporting of deaths, misclassification of causes and HIV/AIDS make face value interpretation of reported cause-of-death data difficult. Changes in subsequent years due to HIV/AIDS are considered using model projections. South Africa is undergoing a protracted bipolar transition with the coexistence of both diseases of poverty and emerging chronic diseases. In 1996 these accounted for similar proportions of the premature mortality, about 27% for males and 35% for females, with the added burden of injuries accounting for a further 35% in males and 16% in females. Tuberculosis (TB), lower respiratory tract infections, diarrhoea, HIV/AIDS, perinatal diseases, malnutrition and septicaemia contributed to the pretransitional conditions, while stroke, diabetes, ischaemic heart disease, hypertensive heart disease, asthma, chronic obstructive lung disease, cancer of the lung in men and cancer of the cervix in women contributed to the premature mortality due to non-communicable diseases. Homicide is the major cause of injury death for men while unintentional injuries are the major cause of injury death for women. Projections suggest that this triple burden (diseases of poverty, emerging chronic diseases and injuries) has now become a quadruple burden resulting from the HIV/AIDS epidemic and that without interventions to reduce mortality, by the year 2010, AIDS deaths will account for double all other causes of death combined. While efforts to improve the cause-of-death statistics are needed, the current data clearly suggest that comprehensive public health strategies to improve the health of the nation must be strengthened, and reducing the number of deaths that can be expected to result from AIDS requires urgent attention.
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PMID:South African cause-of-death profile in transition--1996 and future trends. 1224 21

Hypertensive heart disease is characterized by early development of hypertrophy and fibrosis that leads to heart failure (HF). HF develops in spontaneously hypertensive rats (SHR) after 18 months; however, it is not clear whether hypertrophy leads to altered cardiac performance at an earlier age in these rats. We studied cardiac performance in 10- to 11-month-old SHR and age-matched Wistar-Kyoto rats (WKY), using presssure-volume (PV) conductance catheter system to evaluate systolic and diastolic function in vivo at different preloads, including preload recruitable stroke work (PRSW), +dP/dt, and its relation to end-diastolic volume (+dP/dt-EDV) and preload-adjusted maximal power (PWR(max)-EDV(2)) as well as the time constant of left ventricular pressure decay, tau (tau), as an index of relaxation. The slope of the end-diastolic pressure-volume relation (EDPVR) and the ex vivo PV relation, both indexes of stiffness, were also calculated for each heart, and the Doppler E/A ratio was determined. In addition, plasma samples were obtained to assess B-type natriuretic peptide levels (BNP). We found that PRSW was higher in SHR than in WKY (174.5+/-15.6 versus 92.6+/-18.9 mm Hg; P<0.01). +dP/dt and +dP/dt-EDV were also enhanced in SHR versus WKY (9125+/-662 versus 6633+/-392 mm Hg/sec, P<0.01, and 28.14+/-4.35 versus 12.7+/-2.8 mm Hg/s per micro L, P<0.02). In addition, PWR-EDV(2) was elevated in SHR (7.3+/-1.5 versus 3.1+/-0.6 mW/ micro L(2)). Tau was prolonged in SHR (14.5+/-1 ms versus 10.8+/-0.8 for WKY, P<0.02) and EDPVR was significantly greater in SHR than in WKY (0.01+/-0.005 versus 0.004+/-0.001, P<0.05). The ex vivo pressure-volume relation was also steeper for SHR and the E/A ratio was 2.53+/-0.15 for SHR versus 1.67+/-0.08 for WKY (P<0.02). BNP was 45+/-2.5 pg/mL for SHR and 33.3+/-1.8 pg/mL for WKY (P<0.02). Taken together, these data suggest that at 10 to 11 months of age, before HF develops, SHR have increased systolic performance accompanied by delayed relaxation and increased diastolic stiffness.
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PMID:Increased systolic performance with diastolic dysfunction in adult spontaneously hypertensive rats. 1257 90


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