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

Three hundred and eighty-nine subjects, ages 21-55, with diastolic blood pressures between 90 and 115 mm Hg were studied prospectively for 7-10 years in a controlled intervention trial to determine whether pressure lowering reduces the incidence of cardiovascular complications and death. The assignment to therapy, either a combination of a diuretic and rauwolfia serpentina, or an identical placebo, was random. Adverse effects required termination in only 23 (5.9%) cases. Diastolic blood pressure (DBP) was reduced an average of 10 mm Hg (systolic equals 16 mm Hg) in the active treatment group with no change in the placebo group. The major end points of death, myocardial infarction, and stroke totaled 17 and were nearly equally divided between treatment and placebo. Other manifestations of coronary disease were also equally distributed. Complications such as electrocardiographic hypervoltage, left ventricular hypertrophy, radiogrpahic cardiomegaly, and retinopathy occurred in the placebo group at a rate of 53.1 per 100 subjects compared to 23.8 per 100 in those on active drugs. Treatment failure occurred in 24 placebo-treated cases and none of the active group. The overall effectiveness of pressure lowering in reducing these complications and treatment failure was 60%. It is concluded that given the lower level of excess risk in mild uncomplicated hypertension, and the failure of active drug therapy to protect against coronary disease, systematic follow-up without drugs while attempting hygienic intervention and control of other risk factors may be a reasonable alternative for this large group.
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PMID:Treatment of mild hypertension: results of a ten-year intervention trial. 14 29

In a randomized primary prevention trial including 3,234 men with mild to moderate uncomplicated hypertension, the effect of the beta-blocker metoprolol or a thiazide diuretic as an initial antihypertensive therapy was compared regarding the risk of sudden cardiovascular death during a follow-up ranging from 2.3 to 10.8 years (median of 4.2 years). Only men aged 40 to 64 years were included in the study. The randomization of patients into the metoprolol (n = 1,609) or diuretic group (n = 1,625) was performed after stratification for age, smoking habits, serum cholesterol, and systolic blood pressure. At baseline the two treatment groups were well matched. Metoprolol was given in a mean dose of 174 mg daily and the mean dose of thiazide diuretic was either 46 mg hydrochlorothiazide daily or 4.4 mg bendroflumethiazide daily. Identical blood pressure control was achieved using the fixed therapeutic schedule. Total and cardiovascular mortality were significantly lower for metoprolol than for diuretics, owing to fewer deaths from coronary heart disease and stroke. Of the cardiovascular deaths, 78% were classified as sudden cardiovascular deaths (occurred within 24 h after the onset of symptoms). There were significantly fewer sudden cardiovascular deaths in the metoprolol group compared to the diuretic group (32 v 45, P = .017). The present results suggest that initial antihypertensive therapy with metoprolol is associated with a lesser incidence of sudden cardiovascular deaths than initial diuretic treatment in uncomplicated hypertension.
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PMID:Primary prevention of sudden cardiovascular death in hypertensive patients. Mortality results from the MAPHY Study. 202 46

The influence of family history of hypertension, myocardial-infarction and/or stroke on the blood pressure levels of 3,194 children in the age group 5-15 years was studied. Compared to children of normotensive parents, subjects coming from families with history of uncomplicated hypertension, complicated hypertension (hypertension plus myocardial infarction or stroke) and myocardial infarction or stroke without history of hypertension tended to have significantly higher levels of both systolic and diastolic pressures (p less than 0.001) in both the sexes in all age groups studied. Further, 15 (4.83%) of the children coming from families with positive history of one of the aforesaid morbid cardiovascular events had persistent hypertension (BP greater than mean +2 SD for age and sex). On the contrary only one (0.03%) of the 2,884 children belonging to normal parents had persistent hypertension. All the 16 children with sustained hypertension had only mild hypertension and were asymptomatic. Ten (62.5%) of them were obese (weight/height2 greater than 2.26). Baseline investigations failed to detect underlying cause to account for raised blood pressures in 9 of the 16 cases that could be investigated. These findings suggest that children of people with hypertension or other morbid cardiovascular events are more likely to have persistently elevated blood pressures than children from families without such a history.
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PMID:Influence of family history of morbid cardiovascular events on blood pressure levels of school children. 205 27

Echocardiographic measurement of left ventricular mass has provided a way of evaluating the undesirable effects of high blood pressure on the heart in the same way as for obesity, excess salt intake and blood hyperviscosity. Recently, the left ventricular mass was shown to correlate (r = 0.81) with the hemodynamic stimuli of blood pressure, stroke volume and left ventricular contractility. Prospective trials at Cornell and Framingham indicate that left ventricular mass is a powerful predictive factor of the risk of complications in hypertension. In the first of these trials, we demonstrated in a 5 year follow-up study of 140 men with uncomplicated hypertension that the incidence of death, myocardial infarction or angina requiring myocardial revascularisation, was four times greater in patients with increased left ventricular mass and that this association was independent of the blood pressure levels. Then, in a 10 year follow-up study of hypertensive patients of both sexes, we established that the left ventricular mass was the most powerful predictive factor of mortality and morbidity and that this was so marked (15% death rate in subjects with LVH vs 1% in subjects with normal left ventricular mass--p less than 0.00001--, cardiovascular accidents in 26% of subjects with LVH compared with 12% in subjects with normal left ventricular mass--p less than 0.0001) that only left ventricular mass and age were independant predictive factors of morbid events in multiple variable analysis. In the Framingham study, the frequency of coronary events in a 4 year follow-up period of healthy subjects from the original cohort (average age 69 years) was significantly related to the left ventricular mass and independent of other risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Relationship between left ventricular mass and prognosis of arterial hypertension]. 208 Aug 92

Among the many classes of diuretics available, thiazides have emerged as the most appropriate category for the treatment of uncomplicated hypertension. Potassium-sparing agents may be added according to need or in fixed-combination therapy. Thiazides act on the cortical diluting segment of the renal tubule. The potassium-sparing agents interfere with the Na(+)-K+ exchange process in the terminal part of the distal tubule. Thiazides have been the cornerstone of therapy in nearly all prospective therapeutic, mild and moderate hypertension trials conducted to date. They have, therefore, proved their value in the prevention of hypertensive cardiovascular complications such as stroke and congestive heart failure. The physiologic changes occurring during antihypertensive treatment with thiazides have been extensively studied. The initial response to a thiazide is characterized by a mildly negative change in sodium and fluid balance. The resulting slight contraction in plasma volume is followed by reductions in cardiac output and blood pressure. Because these reductions are disproportionate, vascular resistance rises initially. In the longer term, plasma volume is partly restored, and cardiac output re-attains the baseline level. Thus, the reduction in blood pressure ultimately appears to be based on vasodilation. The mechanisms of this biphasic vascular response are not completely understood. This lack of insight, however, does not detract from the proven value of thiazides in treating hypertensive subjects.
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PMID:Diuretics and blood pressure reduction: physiologic aspects. 221 85

Changes in hemodynamic variables regulating systolic function were examined by M-mode echocardiography in 14 patients with long-duration primary uncomplicated hypertension treated with nitrendipine once daily (20 mg). At the end of treatment (8th week) blood pressure and peripheral resistance were greatly reduced (p less than 0.0001), while the indices of cardiac function (ejection fraction and cardiac index) showed significant increases (p less than 0.01). The variations in ejection fraction were analyzed by multiple linear regression and were mainly influenced by the decrease in end-systolic stress (contribution: 60%). At baseline, despite no radiographic or clinical signs of heart failure, 6 of the studied patients showed impaired systolic function, likely due to the strength of other variables (age, risk factors); in those patients, systolic function was clearly enhanced at the end of treatment, while no change was found in patients with initial normal pump function. Changes in cardiac output were due to a significant increase in heart rate in patients with normal pump function and to improved stroke volume in the others. Left ventricular mass index was slightly reduced (p less than 0.005), primarily because of the reduction in end-diastolic volume (p less than 0.01). When analyzed by the 2 subgroups (with or without impaired systolic function), the left ventricular mass index appeared to be significantly reduced only in those patients with normal basal pump function. This difference was most likely due to the different effects of treatment on end-diastolic volume.
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PMID:Noninvasive assessment of hemodynamic changes during therapy with nitrendipine in arterial hypertension. 359 5

Aim of this study was to evaluate the antihypertensive efficacy, tolerability, drug plasma levels and hemodynamic effects after long-term treatment with the slow release (SR) formulation of verapamil (240 mg od). After a wash-out period of two weeks, 96 subjects (39 M, 57 F; mean age: 55 +/- 8.4 years; recruited in 9 centers) with mild to moderate, uncomplicated hypertension received verapamil 240 mg SR od for 24 weeks. The following parameters were considered: systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), ECG, echocardiogram, routine blood and urine chemistries, drug plasma levels. In addition, hemodynamic parameters were assessed in 30 subjects. A significant decrease in SBP and DBP (p < 0.01) was observed already after 1 week of treatment and was evident during all the study. HR was significantly reduced after 4 weeks (p < 0.01). No changes of ECG and echocardiographic parameters occurred. A significant increase in drug plasma levels was measured after 12 and 24 weeks of treatment (p < 0.05), when compared to the values recorded after 1 week. After 24 weeks drug levels were slightly decreases, even if not significantly, when compared to the values observed at the 12th week. No significant changes of cardiac output (CO), cardiac index (CI), stroke volume (SV) were evident. Total vascular resistances (TVR) decreases significantly (p < 0.001) 80 subjects completed the study. These results confirm the antihypertensive efficacy and tolerability of SR formulation of verapamil and suggest that the effective mechanism by which it reduces blood pressure is the progressive reduction of TVR without a sympathetic reflex stimulation. This hemodynamic effect is achieved by small drug concentrations. In conclusion, SR formulation of verapamil allows a good therapeutic control in hypertensive subjects when it is administered od and, therefore, it can be considered a drug of first choice in the treatment of arterial hypertension.
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PMID:[Plasma levels and noninvasive hemodynamic profile of slow release verapamil (240 mg). A multicenter study]. 776 76

Left ventricular hypertrophy is now recognised to be an important risk factor associated with such adverse cardiovascular events as myocardial infarction, heart failure, stroke and sudden cardiac death. This is true for the general population and those with uncomplicated hypertension. Herein the what, why and how of hypertensive heart disease (HHD) is reviewed: what is it, why does a structural remodelling of the myocardium occur and how can it be prevented on the one hand or regressed on the other. Clinical and experimental studies are presented to address each of these issues.
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PMID:The what, why and how of hypertensive heart disease. 780 96

The goal of this study was to compare the direct costs associated with the prescription of thiazide diuretics, beta-receptor blockers (beta-blockers), angiotensin converting enzyme inhibitors (ACEI), a-receptor blockers (alpha-blockers), and calcium channel blockers (CCB) for the prevention of stroke, myocardial infarction (MI) and premature death in uncomplicated hypertension. We performed a cost-minimization analysis based on numbers-needed-to-treat (NNT) derived from the metaanalysis of 15 major clinical trials of hypertension treatment, and the average wholesale prices of both the most commonly prescribed and the least expensive drugs in each class. The inclusion criteria for clinical trials were that they be randomized, controlled trials of drug therapy of uncomplicated mild-to-moderate hypertension with stroke, MI, or death as endpoints. The wholesale drug costs and the total direct outpatient treatment costs to prevent a stroke, MI or death among middle-aged and elderly hypertensives were our outcome measures. The estimated wholesale drug acquisition cost to prevent one major event (MI or stroke or death) ranged from $4730 to $346,236 among middle-aged patients, and from $1595 to $116,754 in the elderly; generic diuretic or beta-blocker therapy was more economical than treatment with an ACEI, alpha-blocker, or CCB. The associated 5-year NNT was 86 for middle-aged patients and 29 for elderly patients. Diuretic therapy remained more cost-effective even under the unlikely assumption that the newer drugs were 50% more effective than diuretics at preventing these major events. The costs associated with potassium supplementation did not eliminate the advantage of diuretics. Treatment costs to prevent major hypertensive complications are much lower with diuretics and beta-blockers than with ACEI, CCB, or alpha-blockers, especially in middle-aged patients.
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PMID:Cost-minimization and the number needed to treat in uncomplicated hypertension. 963 2

The aim of this study was to evaluate changes in cerebral hemodynamics in young patients with uncomplicated hypertension before and after effective antihypertensive treatment with a beta-blocker drug. Changes in mean flow velocity in the middle cerebral artery from normal condition to hypercapnia were evaluated by means of a transcranial Doppler in 42 hypertensive patients and 21 healthy subjects comparable for age and sex distribution. We obtained hypercapnia with breath-holding and evaluated cerebrovascular reactivity with the breath-holding index (BHI). After a baseline evaluation (time 0), patients were randomly assigned to a placebo (group 1) or atenolol (group 2) therapy. The evaluation was repeated after 30 (time 1) and 60 (time 2) days of treatment. Before treatment, hypertensive patients had significantly lower BHI values (0.96 +/- 0.1 group 1 and 0.85 +/- 0.3 group 2) than controls (1.69 +/- 0.4) (P < 0.0001). During treatment, mean blood pressure significantly decreased in group 2 patients. In the same group, BHI values significantly increased with respect to the pre-treatment evaluation: 1.39 +/- 0.2 at time 1 and 1.44 +/- 0.2 at time 2 (P < 0.0001). On the contrary, mean blood pressure and BHI values remained unchanged in the placebo group. Furthermore, BHI values were significantly higher in group 2 than in group 1 patients at times 1 (P < 0.001) and 2 (P < 0.0001). These findings suggest that hypertension causes reduced capability of cerebral vessels to adapt to functional changes. This condition, which is reversible after treatment, could be implicated in the increased susceptibility to ischemic stroke in hypertension.
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PMID:Cerebral hemodynamics in young hypertensive subjects and effects of atenolol treatment. 970 Jul 13


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