Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Data clearly indicate that treatment with antihypertensive drugs reduces the incidence of all strokes in men (by 34%), women (by 38%), elderly persons (by 36%), including those older than 80 years (by 34%), younger persons, those with systolic and diastolic hypertension, persons with isolated systolic hypertension, and in those with a history of stroke or transient ischemic attack (by 28%). Blood pressure should be reduced to less than 140/90 mm Hg. The overall data also suggest that reduction of stroke in persons with hypertension is related more to a reduction in blood pressure than to the type of antihypertensive drugs used.
 ...
PMID:Treatment of hypertension and prevention of ischemic stroke. 1475 55

More than 186,000 strokes occur every year in Italy, responsible for 10-12% of total mortality. Despite the reduction in mortality and disability, the incidence of stroke is persistently high and mortality within the first month is about 30%; furthermore, the severe residual disability is about 40% in survivors. Large clinical outcome trials have defined the strict correlation between stroke and systolic and diastolic hypertension, and several meta-analyses and intervention studies showed that reduction of blood pressure, independently of the drug used (diuretics, beta-blockers, calcium antagonists, angiotensin-converting enzyme inhibitors), decreases significantly (> or = 30%) stroke mortality and morbidity in hypertensives. Despite numerous and effective antihypertensive drugs, stroke mortality and morbidity in hypertensive subjects remain persistently higher than in normotensive ones. Two recent clinical studies confirmed the great efficacy of angiotensin II antagonists in reducing stroke relative risk in hypertensive patients at elevated cardiovascular risk. The LIFE study demonstrated that an active treatment is superior to another one in reducing the prefixed endpoint. This important result has conferred great expectancy on angiotensin II antagonists and on their possible "class effect". Considering the recent intervention trials and the correct interpretation of the evidence-based medicine, we should not consider all principles as belonging to the same category, equally effective in the prevention of cardiovascular risk. The concept of "class effect" has not a real scientific value and cannot replace the experimental results of clinical studies which represent the only bench test for the efficacy of a drug.
 ...
PMID:[What is new about stroke prevention?]. 1497 61

Several studies have shown that pharmacological treatment of systolic-diastolic hypertension or isolated systolic hypertension in elderly persons would result in several years in a significant decrease (more than 40%) of stroke. Occurrence of strokes decreased in the Czech Republic in years 1985 till 2002 by more than 40%, which represents about two thirds of the decrease observed in the USA. Nevertheless, we cannot be satisfied with the treatment of hypertension in the Czech Republic because only 18% of patients are effectively treated for the hypertension, with BP < 140/90 mm Hg. Not well controlled hypertension results namely from the minimal use of the combination treatment. From the point of prognosis for the hypertensive patients older than 50 years, the level of systolic pressure is more important than the diastolic pressure. The risk of development of the stroke rises from the level of systolic blood pressure 115 mmHg almost linearly. Calcium channel blockers or diuretics represent the most appropriate therapy of the isolated systolic hypertension of elderly patients. The risk of stroke is higher also in persons with elevated blood pressure in the morning. That is why in elderly patients the use of drugs effectively controlling blood pressure during 24 hours is necessary. Recent studies (HOPE study, PROGRESS study) have demonstrated that the reduction of blood pressure decreases the occurrence of stroke not only in hypertensive patients, but also in the normotensive persons during the primary and secondary prevention. Review data show that 27% of ischemic strokes and 57% of hemorhagic strokes, which happened in the "treated" hypertensive patients, are due to not well controlled hypertension. Missing treatment of hypertension is responsible for 22.8% of strokes in men and 25.4% in women. The given data show a big reserve for the possibility to decrease further the stroke incidence in the population.
 ...
PMID:[Treatment in the primary prevention of stroke--still not fully used option]. 1558 13

The E65K polymorphism in the beta1-subunit of the large-conductance, Ca2+-dependent K+ (BK) channel, a key element in the control of arterial tone, has recently been associated with low prevalence of diastolic hypertension. We now report the modulatory effect of sex and age on the association of the E65K polymorphism with low prevalence of diastolic hypertension and the protective role of E65K polymorphism against cardiovascular disease. We analyzed the genotype frequency of the E65K polymorphism in 3924 participants selected randomly in two cross-sectional studies. A five-year follow-up of the cohort was performed to determine whether cardiovascular events had occurred since inclusion. Estrogen modulation of wild-type and mutant ion channel activity was assessed after heterologous expression and electrophysiological studies. Multivariate regression analyses showed that increasing age upmodulates the protective effect of the K allele against moderate-to-severe diastolic hypertension in the overall group of participants (odds ratio [OR], 0.35; P=0.006). The results remained significant when analyses were restricted to women (OR, 0.18; P=0.02) but not men (OR, 0.46; P=0.09). This effect was independent of the reported acute modulation of BK channels by estrogen. A five-year follow-up study also demonstrated a reduced age- and sex-adjusted hazard ratio of 0.11, 95% CI, 0.01 to 0.79 of K-carriers for "combined cardiovascular disease" (myocardial infarction and stroke) compared with EE homozygotes. Our study provides the first genetic evidence for the different impact of the BK channel in the control of human blood pressure in men and women, with particular relevance in aging women, and highlights the E65K polymorphism as one of the strongest genetic factors associated thus far to protection against myocardial infarction and stroke.
 ...
PMID:Protective effect of the KCNMB1 E65K genetic polymorphism against diastolic hypertension in aging women and its relevance to cardiovascular risk. 1629 91

The cardiocirculatory changes in hyperthyroidism seem to be an accommodation to the increased metabolic demands and lead to an increased perfusion of the peripheral tissues. Due to the influence of elevated thyroid hormone levels, contractility, stroke volume, resting heart rate, and contraction and relaxation velocity of the left ventricle increase. Caused by direct effect on the smooth vascular muscle, systemic vascular resistance is decreased with the consequence of a diminished afterload and an increased cardiac efficiency. The activation of the renin-angiotensin-aldosteron system and the increased production of erythropoietin additionally lead to an increased blood volume, which increases cardiac preload together with the increased venous backflow. Manifest hypothyroidism is characterized by bradycardia and diastolic dysfunction in rest and systolic dysfunction at stress. Despite a slight increase of diastolic blood pressure due to an increased systemic vascular resistance, blood pressure remains nearly stable because of diminished cardiac output. Hypercholesterinaemia and diastolic hypertension in hypothyroid patients can lead to the development of arteriosclerosis and coronary heart disease (CHD). Also subclinical hypothyroidism is associated with a significantly higher risk for arteriosclerosis and CHD, whereas subclinical hyperthyroidism seems to be associated with an increased mortality for all reasons, especially for cardiovascular diseases.
 ...
PMID:[Thyroid and cardiovascular system]. 1642 99

There is overwhelming evidence that pharmacologic treatment of isolated systolic hypertension (ISH) (systolic blood pressure >or=140 mm Hg and diastolic blood pressure <90 mm Hg) reduces cardiovascular events and extends longevity in the elderly; in the very old (80 years or older), the evidence supports decreased incident stroke and heart failure, but is less convincing in terms of longevity. Thus, the inherent increased risk for ISH vascular events highlights the importance of its control. Importantly, ISH in the elderly, primarily related to large artery stiffness, remains more difficult to control than diastolic hypertension in the young, which is primarily related to increased peripheral vascular resistance. Appropriate lifestyle and pharmacologic intervention is indicated in individuals with systolic blood pressure >or=140 mm Hg in general and >or=130 mm Hg in persons with diabetes or chronic kidney disease. Lifestyle intervention may reduce the need for extensive antihypertensive therapy and minimize associated cardiovascular risk factors. To date, only a small percentage of older ISH patients are being treated to goal. Reaching target systolic blood pressure levels most often requires the use of polypharmacy that includes a diuretic and perhaps specific agents that target arterial stiffness and early wave reflection.
 ...
PMID:Hypertension in older people: part 2. 1684 7

Brachial pulse pressure (PP) is an established risk marker for cardiovascular disease. PP is largely determined by the stroke volume in young subjects, although the progressive amplification of pulse wave from central to peripheral arteries could make brachial PP not representative of the central PP in the young. With advancing age, brachial PP better reflects the progressive stiffening of aorta and the large elastic arteries. PP correlates with vascular and cardiac hypertrophy, although the association with cardiac hypertrophy seems more closely attributable to systolic blood pressure (BP). An association has been noted in several longitudinal studies between PP and the incidence of major cardiovascular events. However, some longitudinal studies carried out in subjects with predominantly systolic and diastolic hypertension showed that PP is the dominant predictor of coronary events, while mean BP is the major predictor of cerebrovascular events. Such an assumption may not be held in subjects with isolated systolic hypertension, where a wide PP seems to predict coronary and cerebrovascular events to a similar extent. From a pathophysiological standpoint, a wide PP might reflect diffuse atherosclerotic processes potentially involving also the large coronary arteries. Some data suggest that a wide PP could also represent a direct and independent stimulus for progression of atherosclerosis.
 ...
PMID:Does brachial pulse pressure predict coronary events? 1707 5

Although isolated systolic hypertension (ISH) increases the risk of coronary heart disease and stroke, more than any other hypertension subtype, the prevalence and risk factors associated with ISH in the Korean population are not known. The 2001 Korean National Health and Nutrition Survey was a cross-sectional and nationally representative survey conducted in 2001. The prevalence of ISH by age and body mass index (BMI) was examined in 6601 Korean adults over 20 years of age. After adjusting for age, 4.32+/-0.32% of Korean adults had ISH, 5.28+/-0.37% had isolated diastolic hypertension and 5.82+/-0.36% had systolic/diastolic hypertension. The overall prevalence of ISH was found to increase directly with advancing age and increasing BMI. Although the ISH was found to be more common in men overall (4.81+/-0.50% in men, 4.12+/-0.37% in women), it was more common in women over 70 years of age. Independent variables associated with risk for ISH included advanced age, BMI, triglyceride (TG) levels, monthly income and alcohol intake. However, gender, fasting blood glucose, total cholesterol and high-density lipoprotein cholesterol levels, residential area, education level and smoking were found not to be significantly associated with ISH risk. The findings of the present study demonstrate that the prevalence of untreated ISH in Korea was lower than in Western countries. Age, BMI, TG levels, monthly income and alcohol intake were associated with ISH.
 ...
PMID:The prevalence and risk factors associated with isolated untreated systolic hypertension in Korea: the Korean National Health and Nutrition Survey 2001. 1710 91

Approximately one-third of the adult population has hypertension. Large-scale clinical trials have convincingly demonstrated that the treatment of isolated systolic and systolic/diastolic hypertension reduces rates of total mortality, cardiovascular mortality, and stroke in older adults, yet control of systolic hypertension remains poor. This article reviews systolic blood pressure as a cardiovascular risk factor and discusses effective management of elevated systolic blood pressure. The role of combination therapy is emphasized, focusing on the combination of a calcium-channel blocker and an angiotensin-converting enzyme inhibitor. In addition to blood pressure-lowering efficacy, the combination of these two classes of metabolically neutral agents may offer benefit in terms of tolerability and cognitive function.
 ...
PMID:Systolic hypertension. 1758 94

Isolated systolic hypertension, an elevation in systolic but not diastolic pressure, is the most prevalent type of hypertension in those aged 50 or over, occurring either de novo or as a development after a long period of systolic-diastolic hypertension with or without treatment. The increase in blood pressure with age is mostly associated with structural changes in the arteries and especially with large artery stiffness. It is known from various studies that rising blood pressure is associated with increased cardiovascular risk. In the elderly, the most powerful predictor of risk is increased pulse pressure due to decreased diastolic and increased systolic blood pressure. All evidence indicates that treating the elderly hypertensive patient will reduce the risk of cardiovascular events. However, there is no evidence yet for the very elderly. This population is particularly susceptible to side effects of treatments and the reduction of blood pressure, although reducing the risk of cardiovascular events such as stroke, may result in increased mortality.
 ...
PMID:Blood pressure and ageing. 1730 14


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>