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

The main points covered in this review are as follows: 1. Hypertension is a major determinant of cardiovascular disease (CVD). As such it is a major cause of mortality, potential years of life lost, morbidity and long-term disability. 2. The incidence of CVD is directly related to BP. It is likely that this extends over the full range of BP although some writers believe that a J-curve of risk exists for CHD. 3. The relationship between long-term disability from CVD and BP requires further study. 4. Because of regression dilution bias, the gradient in risk of stroke and CHD with BP has been underestimated in the past. Recent research suggests that the risk of stroke increases at least tenfold and CHD sixfold over a range of usual DBP of 30 mmHg (equivalent to approximately 50 mmHg baseline DBP). 5. The population attributable risk (PAR) of CVD related to general elevation of BP in the population from a mean daily excess of sodium intake of 100 mmol/day is at least 30%. In typical industrialised countries the PAR for stroke and CHD from clinical hypertension is 36% and 22%, respectively. These estimates of PAR provide a guide to the maximum benefit that could result from either restriction of sodium intake in the whole population or ideal management of all persons with hypertension. In practice such targets are unlikely to be realised. 6. Recent analyses of clinical trials of treatment of hypertension suggest that the risk of stroke is reduced at all levels of initial BP to the extent predicted from observational studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Review of the benefits of treating hypertension. 129 6

This study investigated the cardiorespiratory (CR) responses at rest and during submaximal (0-W) functional electrical stimulation (FES)-induced leg cycle ergometer (LCE) exercise prior to and following a progressive intensity FES-LCEa exercise training program in spinal cord injured (SCI) subjects. Seven quadriplegics and six paraplegics participated in FES-LCE training three sessions per week for approximately 12 weeks (36 sessions). Monitored CR responses, including oxygen uptake (VO2), pulmonary ventilation (VE), respiratory exchange ratio (RER), arteriovenous O2 difference (a-vO2), blood pressure (BP), heart rate (HR), stroke volume (SV), total peripheral resistance (TPR), and cardiac output (Q), were determined before and after training. Power output (PO) increased significantly (p < .05) over the duration of the training program, indicating increased in strength and endurance of the paralyzed muscles used. Respiratory responses were not significantly altered by training in both groups. FES-LCE training significantly increased resting HR and SBP in quadriplegics and lowered SBP, DBP, and MAP in paraplegics. In both groups, HR and BP during submaximal exercise significantly decreased and SV and Q significantly increased after completion of the training program. These results suggest that FES-LCE training improves peripheral muscular and central cardiovascular fitness in SCI subjects. Posttraining HR and BP may also be more stable in quadriplegics and alleviate hypotension. This therapeutic exercise may ultimately lead to improved rehabilitation outcome and reduced stress during activities of daily living, and possibly reduce the risks for secondary CR disabilities.
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PMID:Functional electrical stimulation leg cycle ergometer exercise: training effects on cardiorespiratory responses of spinal cord injured subjects at rest and during submaximal exercise. 144 77

Every 4 hours for 24 hours, 14 clinically healthy young individuals (6 women and 8 men), 26 +/- 4 years of age, measured systolic (S) and diastolic (D) blood pressure (BP) by sphygmomanometer and heart rate by ECG and did impedance cardiography under usual living conditions. Stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were calculated. Time series of SBP, DBP, HR, SV, CO and TPR were analyzed by single and population-mean cosinor. A circadian cardiovascular rhythm is demonstrated by rejection of the zero amplitude assumption in the population-mean cosinor test for SBP, DBP, HR, SV, CO and TPR (P < 0.01). TPR peaks around 0400 (-61 degrees from local midnight), in antiphase with all other variables, their acrophase occurring around 1600 (-240 degrees). A circadian rhythm of statistical significance or of borderline statistical significance is found for all variables except TPR in women. Circadian rhythm characteristics were otherwise mostly similar in men and women with a statistically significant gender difference found by parameter tests only for the MESOR and amplitude of SBP.
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PMID:Circadian relations among cardiovascular variables of young adults. 147 12

ISH is a distinct pathogenetic entity defined by SBP readings of greater than or equal to 160 and DBP less than 90 mmHg. The etiology, although not well understood, is in some manner related to a reduction in connective tissue elasticity of large blood vessels and an increase in aortic impedance or a decrease in aortic wall compliance. The pathophysiologic consequences include an increased resistance to systolic ejection of blood and a disproportionate increase in SBP. Although not directly related, there is an important increase in peripheral vascular resistance. The prevalence of ISH in several studies is about 7 percent in those over age 60 and increases with age to nearly 20 percent in those over age 80. There is higher prevalence in females and nonwhites. The guidelines for detection of ISH are similar to those for blood pressure evaluation in general. Precautions for detection and evaluation in the elderly include multiple blood pressure measurements in the fasting state and sitting and supine blood pressure measurements before and during therapy. Pseudohypertension, although rare, should be kept in mind. There is a clear risk associated with ISH for stroke, CVD, and premature death, which increases with age and rising levels of SBP. ISH can be controlled effectively with pharmacologic therapies. A reasonable goal is a 20 mmHg reduction in systolic pressure. Proof of reduced risk for stroke, CHD, and death in those with controlled ISH remains to be demonstrated. The SHEP pilot study has demonstrated feasibility of addressing this issue. The full-scale SHEP study addresses this issue and has completed recruitment of the desired sample size and is in follow-up phase. Scheduled completion is in 1991. While we wait for the SHEP full-scale trial results, the prudent approach is for nonpharmacologic therapy and use of pharmacologic agents in that group of patients who demonstrate a large cardiovascular risk burden or increasing symptoms specifically associated with hypertension. The decision to treat must be on an individual patient basis. Pharmacologic therapy is possible in most patients with few or no adverse effects. The "low and slow" approach to therapy is helpful in minimizing these adverse effects. Low-dose diuretics have been documented to be effective in blood pressure control. Chlorthalidone, 12.5 or 25 mg per day, is suggested. Other agents, such as beta-blockers, reserpine, ACE inhibitors, and calcium channel blockers, are best used as Step 2 agents.
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PMID:Systolic hypertension in the elderly: controlled or uncontrolled. 218 67

Nitrendipine is a second-generation dihydropyridine calcium antagonist selective for hypertension. The aim of this study was to assess whether, in addition to reduce resting blood pressure, nitrendipine also affects the cardiovascular reactivity to physical and psychologic stress. Ten essential hypertensive patients, out of treatment for at least 2 weeks, underwent a symptom-limited dynamic maximal exercise and a mental arithmetic stress test (MAT) after placebo (1 week) and 1 and 5 weeks of active treatment with nitrendipine (20 mg q.i.d.). To evaluate the cardiovascular response to exercise and its changes during treatment, the slope of the regression line (if statistically significant) of the blood pressure, heart rate, and rate-pressure product (RPP) values against workload were considered, together with exercise capacity, blood pressure, and pressure-rate product at the peak of maximal exercise. During mental stress, indexes of stroke volume (SVI), cardiac output (COI), and peripheral resistance (TPRI) were obtained by Doppler transcutaneous aortovelography (TAV). Resting systolic and diastolic BP were significantly reduced during treatment. The average length of exercise was 7.3, 7.64, and 8.0 min after, respectively, placebo, 1, and 5 weeks of treatment. Peak systolic and diastolic BP, peak RPP, and RPP slope were consistently decreased after treatment, significantly for peak DBP and RPP. During mental arithmetics, a significant increase of BP and HR and a decrease of SVI were observed on placebo; both BP and SVI responses disappeared after 5 weeks on nitrendipine, whereas the HR increase was unchanged. Peak values of COI and TPRI during MAT were significantly increased and decreased, respectively, after nitrendipine, whereas basal values showed similar changes, but not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardiovascular reactivity to physical and psychologic stress during long-term treatment with nitrendipine in essential hypertension. 246 98

The major risk factors for coronary disease are blood pressure, blood lipids and cigarette smoking. Major advances have been made over the past 20 years in altering these factors and this has been accompanied by a dramatic reduction in new incidence myocardial infarction (MI) and stroke. Several questions remain however, concerning the best treatment approaches for 'mild' hypertension (DBP = 90-104 mmHg). One major question is the potential ability of different classes of antihypertensive drugs to prevent fatal and non-fatal coronary heart disease. Underscoring this question is the recognition that drug classes differ in their lipid effects. Thiazide diuretics tend to increase total and low density lipoprotein (LDL)-cholesterol, increase triglycerides and slightly lower high density lipoprotein (HDL)-cholesterol. On the other hand alpha 1-antagonists have been shown to influence lipids favourably by lowering total cholesterol, LDL-cholesterol and increasing HDL-cholesterol. Other agents such as calcium channel blockers and ACE inhibitors appear to be lipid neutral. The cost effectiveness of various treatments for hypertension depends not only on direct drug costs but also on the less well-defined indirect costs associated with possible differences in disease rates between treatments. Estimates of disease occurrence with various lipid changes can be modelled after the results of the Coronary Primary Prevention Trial (CPPT) and cost estimates of various diseases (i.e. acute MI) can be estimated from diagnosis-related group data, insurance data and physician survey data.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidemiological and cost implications of antihypertensive treatment for the prevention of cardiovascular disease. 251 65

To investigate whether the lower the blood pressure (BP) the better the prognosis for the patient with moderate-to-severe hypertension, an assessment was made of 902 patients who received the beta 1-selective beta-blocker atenolol (median dose 100 mg a day), either alone or with other antihypertensive agents, for up to 10 years (mean 6.1). 91 died, 40 from myocardial infarction, 21 from stroke, and 30 from other causes. Initial BP was a poor predictor of mortality from myocardial infarction, whereas treated systolic blood pressure (SBP) was a strong predictor. There was a J-shaped relation, confined to those with evidence of ischaemic heart disease, between frequency of death from myocardial infarction and treated DBP (phase V); the frequency was lowest at treated DBP of 85-90 mm Hg and rose with treated DBP on either side of this range.
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PMID:Benefits and potential harm of lowering high blood pressure. 288 Nov 29

Whilst recruiting for the Randomised Trial of the Treatment of Hypertension in Elderly Patients in Primary Care, 10,732 people aged 60-79 years of age (4,736 males and 5,996 females) were screened for hypertension. This constituted 78% of those eligible on the practice lists in this age range. These patients were followed up for a mean period of 2.6 years (range 0.1-11.2 years). All those leaving the practices were registered with the National Health Service Central Registry to ensure completeness of death ascertainment. 1,009 deaths were analysed and standardised mortality ratios computed for all deaths, stroke, coronary artery disease and all cardiovascular causes. Hypertensive patients included in the control group of the trial were also matched with patients found to be normotensive and their mortalities compared. Both high and low levels of SBP were associated with increased mortality producing a U-shaped curve for all deaths and J-shaped curves for cardiovascular causes. With increasing age the higher mortality associated with lower SBP became more pronounced. Similar effects were evident for DBP but in women high DBP was less dangerous than in men. Although the relative impact of hypertension declines with advancing age, the absolute impact is maintained up to the age of eighty.
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PMID:The prognostic significance of blood pressure in the elderly. 324 49

The effect of induction of epidural analgesia with 0.5 per cent bupivacaine on maternal haemodynamics was investigated in 21 patients with uncomplicated full-term pregnancies in early labour. Stroke volume, heart rate, and cardiac output (SV, HR, and CO) were measured by transcutaneous aortovelography (TAV). Systolic, diastolic, and mean arterial blood pressures (SBP, DNP, and MAP) were measured by indirect automatic oscillometry. Measurements were made with the patient in the left lateral decubitus position before and after an intravenous bolus of 500 ml of lactated Ringer's solution preceding induction of epidural analgesia, and again 30 and 45 minutes after induction. The 500 ml bolus of lactated Ringer's solution did not prevent fall of CO and BP measured 30 minutes after induction, when there were statistically significant decreases in CO and cardiac index (-10.2 and -10.6 per cent, p less than 0.05), and in SBP, DBP, and MAP (-9.7, -12.5, and -11.9 per cent, p less than 0.005, p less than 0.005 and p less than 0.01 respectively). At 45 minutes after induction, CO and cardiac index had returned to baseline values. Although the decreases in SDP and DBP persisted, the change in MAP was not statistically significant.
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PMID:Haemodynamic effects of induction of epidural analgesia in labour. 334 53

Effects of 1-[(S)-3-acetylthio-2-methylpropanoyl]-L-prolyl-L-phenylalanine (alacepril, DU-1219) a new orally active angiotensin converting enzyme (ACE) inhibitor, on cardiovascular system in experimental animals were examined. In conscious renal hypertensive dogs, alacepril (3 mg/kg p.o.) caused a marked reduction in systolic and diastolic blood pressure (SBP and DBP) and total peripheral vascular resistance (TPR), but did not change significantly heart rate (HR), cardiac output (CO), stroke volume (SV), cardiac work (CW) and electrocardiogram (ECG). Captopril (3 mg/kg, p.o.) showed similar changes in cardiovascular parameters as alacepril. In anesthetized open-chest normotensive dogs, alacepril (3-100 micrograms/kg/min for 10 min, i.v. infusion) tended to decrease DBP and TPR, but did not change significantly CO, stroke work (SW), left ventricular end diastolic pressure (LVEDP), dp/dt and HR. Captopril also showed similar effects but these changes were greater in extent than those of alacepril. In conscious renal hypertensive rats, alacepril did not affect the regional cerebral blood flow in the frontal cortex and the dorsal hippocampus after single (3 and 10 mg/kg) and successive (3 mg/kg/d for 7 days) oral administration. Captopril (10 mg/kg) significantly decreased blood flow in the frontal cortex after single oral administration. In conscious normotensive dogs, alacepril (3 and 30 mg/kg p.o.) increased renal plasma flow (RPF), urine volume (UV), urinary sodium excretion (UNaV) and urinary Na+/k+ ratio, but did not change glomerular filtration rate (GFR) and urinary potassium excretion (UKV). Captopril (3 and 30 mg/kg p.o.) also showed similar changes as alacepril. These effects of alacepril on cardiovascular system resemble those of captopril and might be considered as a favourable profile for the antihypertensive agent.
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PMID:Effect of the novel orally active angiotensin converting enzyme inhibitor alacepril on cardiovascular system in experimental animals. 351 79


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