UMLS:C0042373 - FACTA Search

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Query: UMLS:C0042373 (vascular disease)
17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The predictors of retinal vascular abnormalities in patients with elevated BP have not been studied extensively in children or adults. The purpose of this study was to investigate potential correlates of arteriolar narrowing, tortuosity and arteriovenous nicking in a population of children and adolescents with essential hypertension. A total of 97 subjects, aged 6-23 years, were studied. Retinal vascular abnormalities were determined by photographs of the optic fundus which were interpreted independently by two opthalmologists. In 50 subjects (51%) there were one or more abnormalities. Potential correlates of retinal abnormalities included: (1) demographic factors, (2) body size, (3) level of BP and duration of hypertension, (4) family history of cardiovascular disease, (5) treatment with antihypertensive medication, (6) dietary sodium intake, (7) laboratory analyses, (8) the reactivity of BP and heart rate to playing a video game, and (9) cardiovascular reactivity to exercise. Using stepwise multiple logistic regression, the variables that were independently associated with the presence of retinal vascular abnormalities were family income, dietary sodium intake, fasting blood glucose, pulse pressure during mental stress and the change in SBP from rest to maximum exercise. In addition, subjects with more than one retinal vascular abnormality had higher average DBP during follow-up in the Hypertension Clinic and a smaller rise in SBP from rest to maximum exercise. Identification of these independent predictors of retinal vascular abnormalities and factors associated with more than one abnormality may provide insight into the pathogenesis of hypertensive vascular disease.
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PMID:Determinants of retinal vascular abnormalities in children and adolescents with essential hypertension. 834 88

The relationship between von Willebrand factor antigen (vWFAg, a specific endothelial cell product) and hypertension was examined. Circulating vWFAg levels were measured in serum from patients attending a hypertension clinic and in normotensive controls. The vWFAg was higher in those patients with uncontrolled hypertension at 131 +/- 34 IU/dl than in controls (90 +/- 30 IU/dl) and in those whose hypertension was controlled 104 +/- 29 IU/dl (P < 0.001). Levels of vWFAg correlated with both SBP (r = 0.42, P < 0.0002) and DBP (r = 0.25, P < 0.05), but serum from neither group of patients was more cytotoxic to cultured endothelial cells in vitro than was serum from controls. Neither symptoms of cardiovascular or peripheral vascular disease or two of its risk factors (hypercholesterolaemia or smoking, alone or in combination) appeared to further increase vWFAg in patients with uncontrolled hypertension. However, vascular disease and the same risk factors did increase vWFAg to 133 +/- 36 IU/dl in those patients with controlled hypertension (P < 0.001). These data indicate a relationship between vWFAg and hypertension and suggest that endothelial damage may indeed be important in the vascular complications of hypertension.
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PMID:von Willebrand factor and endothelial damage in essential hypertension. 852 95

An overview of the 17 completed randomised trials of antihypertensive treatment demonstrates that a 5-6 mm Hg reduction in DBP reduced stroke risk by 38% (SD 4) and CHD risk by 16% (SD 4). These results indicate that a few years' treatment with diuretic- or beta-blocker-based therapy produces most or all of the long-term stroke avoidance and much of the long-term CHD avoidance that would be predicted from observational epidemiological studies, given the blood pressure reductions that were achieved in the trials. The relative risk reductions were similar in trials of older and younger patients, although the absolute reduction in events was more than twice as great in the trials in older patients. From these results it can be estimated that in fully compliant patients at similar risk of vascular disease to those included in the trials, antihypertensive treatment for 5 years would prevent one major vascular event among every 20 older patients and one major vascular event among every 60 younger patients. Obviously the benefits of treatment will be greater among those at higher risk than the patients included in the previous trials. The greatest benefits are likely to be achieved in those with a history of vascular disease since their risk of future events is particularly high. Among such patients it is possible that blood pressure reduction will confer worthwhile benefits in those without hypertension, as well as those with hypertension. It is also possible that the benefits of treatment will be determined by the size of the blood pressure reduction and by the choice of the anti-hypertensive agent. However, each of these possibilities requires confirmation in large scale randomised controlled trials.
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PMID:Blood pressure lowering for the primary and secondary prevention of coronary and cerebrovascular disease. 857 Oct 98

We are actively seeking methods to prevent and to limit the progression of angiopathy in patients with non-insulin-dependent diabetes mellitus (NIDDM). In the present study, we conducted a clinical and epidemiological survey to clarify the clinical factors responsible for the development and progression of diabetic microangiopathy (MI) and macroangiopathy (MA). A total of 107 patients (58 female and 49 male) were randomly selected from 145 NIDDM patients. Twenty-four patient variables were selected for analysis. We identified PWV, UAI, RETINOP, MCV-T, SCV-S, MCV-P, SBP, and DBP as responsible factors and carried out stepwise multiple regression analyses. The following explanatory variables were found to be significant: age > SCV-S (P < 0.0001) for the criterion variable PWV, BUN > HbA1c > MCV-P > HT-drug > HDL-C (P < 0.0001) for log(e) UAI, DM-thera > SBP (P < 0.0001) for RETINOP, MCV-P (P < 0.0001) for MCV-T, IRI > SBP > MCV-P > S-CR (P < 0.0002) for SCV-S, MCV-T > SCV-S > DM-thera (P < 0.0001) for MCV-P, DBP > HT-drug > BUN > MCV-P (P < 0.0001) for SBP, and SBP > PWV > sex (P < 0.0001) for DBP. In summary, responsible factors for MI and MA in NIDDM had metabolic and blood pressure factors in common. Moreover, MI was a responsible factor for MA, which becomes a responsible factor for MI because it is a responsible factor for blood pressure factors. Thus, all the responsible factors for MA represented by MI and PWV had metabolic and blood pressure factors in common. The results of this study suggest that metabolic and blood pressure factors must be controlled to prevent and to limit the progression of diabetic MI and MA in NIDDM patients.
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PMID:Significance of metabolic and blood pressure factors in relation to microangiopathy and macroangiopathy in patients with non-insulin-dependent diabetes mellitus. 867 6

Endothelin-1 (ET-1), a novel 21-amino acid vasoconstrictive peptide secreted by endothelial cells, has been thought to play a role in various forms of vascular disease. Diabetes mellitus is well known for its association with microvascular damage. To investigate whether ET-1 levels may be related to microangiopathy in diabetes mellitus, plasma ET-1 levels were measured in two groups of diabetic patients: A) 47 patients with non-insulin dependent diabetes mellitus (NIDDM) and retinopathy (28 M, 19 F; mean age 60.7+/-8.5 yrs) but without nephropathy (microalbuminuria < 30 mg/day) and hypertension (SBP < 140, DBP < 90 mmHg); group A was divided in three subgroups based on the severity of retinopathy: a) 16 with background retinopathy; b) 21 with pre-proliferative retinopathy; c) 10 with proliferative retinopathy. B) 8 patients with insulin-dependent diabetes mellitus (IDDM) recently diagnosed (6 M, 2 F; 16.4+/-3.8 yrs) without complications. C) 28 healthy subjects (HS) (16 M, 12 F; 47.8+/-11.8 yrs) as controls. In the NIDDM group the ET-1 concentration was significantly higher (17.3+/-2.4 pg/ml) than both in the HS (8+/-4.7 pg/ml) and IDDM patients (10.2+/-3.7 pg/ml) (p < 0.0001). In the subgroups with retinopathy the ET-1 levels were a) 15.1+/-4.3 pg/ml; b) 22.2+/-6.8 pg/ml and c) 16.6+/-5.1 pg/ml. These values were significantly elevated as compared to HS (p<0.001; p < 0.0001; p < 0.002, respectively), being the highest levels of ET-1 observed in the NIDDM patients with pre-proliferative retinopathy. In conclusion our study revealed that the ET-1 concentrations are elevated in NIDDM patients with retinopathy especially in those patients with pre-proliferative retinopathy.
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PMID:Circulating endothelin-1 in non-insulin-dependent diabetic patients with retinopathy. 922 11

Two specific endothelial cell products, von Willebrand factor and soluble E-selectin, were measured together with serum lipids, lipoprotein(a), systolic and diastolic blood pressure (SHP, DBP) in a follow up study of 162 patients attending a dedicated lipid clinic. Patients were further classified by the presence or absence of symptomatic vascular disease and smoking. After a mean of 49 months, 45 patients experienced a cardiovascular event (fatal or nonfatal myocardial infarction, stroke, or arterial surgery) and 11 developed non-cardiovascular diseases, including cancer. In univariate analysis, existing vascular disease (P < 0.01), increased levels of von Willebrand factor (P < 0.0001) and low density lipoprotein cholesterol (P < 0.02), greater age (P < 0.01), and lower levels of soluble E-selectin (P < 0.03) were all predictive of future vascular events. However, in multivariate analysis, only increased von Willebrand factor was predictive (P < 0.001). von Willebrand factor was also higher in patients who developed non-cardiovascular disease relative to those free of disease (P < 0.05). Our data support the hypothesis that increased levels of von Willebrand factor are an indicator of poor prognosis in patients with atherosclerosis or its risk factors.
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PMID:von Willebrand factor and soluble E-selectin in the prediction of cardiovascular disease progression in hyperlipidaemia. 924 60

The aim of this study was to determine the prevalence and profile of renal artery stenosis (RAS) in NIDDM population with severe hypertension. 60 consecutive NIDDM with severe HT (> or = 3 hypotensive drugs), 42 F/18 M (SR: 2.8), mean age: 66.6 +/- 6.5 years, diabetes duration: 14.1 +/- 6 years have had metabolic, ABPM and renal investigations: color duplex scan (CDS) (with renal us): n = 60, and/or arteriography: n = 17). 13 (21.5%) renal artery stenosis > or = 70%: 8 unilateral/5 bilateral were proved by arteriography. We compared classic HT (n = 47) versus renovascular HT (n = 13). There was no difference for age (years): 64.8 +/- 8 versus 70.6 +/- 6.4, HT duration (years): 11.6 +/- 6.8 versus 12.3 +/- 6. B.M.I.: 31.5 +/- 6 versus 27.6 +/- 3.3, HBA1C (%): 8.9 +/- 2.2 versus 8.8 +/- 0.9, cholesterol (mmol/L): 5.7 +/- 1.3 versus 5.5 +/- 0.6. Significant difference (p < 0.05) was noticed for S.R. (F/M): 2.9 versus 1.16, diabetes duration (years): 11.7 +/- 5 versus 16.5 +/- 8, frequency of retinopathy (%): 30 versus 61, smoking (%): 10 versus 40, triglycerides (mmol/L): 1.9 +/- 1.1 versus 2.6 +/- 1.1, and (p < 0.01) for blood pressure level (mmHg) (SBP: 142 +/- 20 vs 155 +/- 7, DBP: 81 +/- 13 vs 87 +/- 10, MBP: 103 +/- 16 vs 111 +/- 6), frequency (%) of HT escape (> or = 140/SBP, > or = 90/DBP) on ABPM: 40 versus 75 and 24 versus 40, insulin requirence (%): 36 versus 69, macroangiopathy (%): 51 versus 100 (coronaropathy: 34 vs 61, legs arteritis: 21 vs 69, carotid stenosis: 17 vs 30) and for renal function: frequency (%) of micro-macroalbuminuria: 36 versus 92 creatinaemia (mmol/L): 80 +/- 24 versus 124 +/- 44, creatinaemia clearance (mmL/min): 65 +/- 30 versus 40 +/- 12 while are found 5 renal insufficiencies (> or = 120 mmol/L). In NIDDM population with severe HT, renovascular HT is frequent (21.5%), and RAS must be evocated in unstable HT and/or renal injury with macro angiopathy, old NIDDM (> 15 years), requiring insulin. Colour duplex scan (+ renal US) mays lead to arteriography to confirm renal artery stenosis.
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PMID:[Prevalence and profile of renovascular disease in type II diabetic patients with severe hypertension]. 940 9

During essential and secondary arterial hypertension it is possible to observe changes in microcirculation perfusion associated with a reduction in tissue oxygenation due in part to hemorheological changes such as an increase in blood viscosity or the formation of the red blood cell "rouleaux" which favour an increase in peripheral resistance and can cause or worsen arterial hypertension. We studied 21 healthy subjects (11 male and 10 female aged 42 +/- 4) and 26 hypertensive subjects (14 male and 12 female aged 49 +/- 3). The patients were non smokers and non suffering from respiratory or haemathological pathologies. They were not undergoing antihypertensive or vasodilatory pharmaceutical treatment. The patients suffered from mild hypertension (II WHO) with Peripheral Occlusive Arterial Disease (POAD II "a" acc. to Leriche-Fontaine class.). The patients showed an increase in cholesterolaemia (6.42 +/- 0.81 mmol/l) and trygliceridaemia (2.73 +/- 0.09 mmol/l) at an average level. The patients were studied in standard conditions with a constant temperature of 22 degrees C. We measured SBP, DBP, MBP, and the HR. We also measured the elongation index (EI) (with shear stress range 0.30 to 30 pascals) using LORCA, acc. to Hardeman method (1994), in order to study the erythrocyte deformability and aggregation kinetics in dynamic condition. To evaluate deformability in static conditions we calculated the Erythrocyte Morphologic Index (EMI), acc. to Forconi method, via the bowl/discocyte ratio (for 100 red blood cells fixed in glutaraldehyde at 0.3% and observed with an optical microscope under immersion in glycerol). Peripheral oxygenation was taken transcutaneously (TcpO2). To establish the level of vascular disease we used the Regional Perfusion Index (RPI = TcpO2 foot/TcpO2 subclavean) and doppler guided Winsor Index (WI). The Student "t" test and linear regression were used for the statistical analysis. Our data confirm a reduction in peripheral tissue oxygenation in hypertensives especially if suffering from vascular disease which correlates significantly (p < 0.01) with a reduction in red blood cell deformability. This itself can increase peripheral resistances and favour the onset of hemorheological complications, at a cerebral-vascular level, which are frequent in hypertensives.
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PMID:Hemorheology in complicated hypertension. 1071 62

The long-acting calcium antagonist nifedipine reduces the incidence of stroke in Eastern Asia, as shown by the Shanghai Trial Of Nifedipine in the Elderly (STONE) and the Systolic Hypertension in China (Syst-China) trials. Recent trials in Japan have shown that benidipine may be more efficient than the former drug in preventing strokes in the elderly. Benidipine, commonly prescribed in Japan for a definite depressor effect, reportedly without causing remarkable fluctuations in blood pressure (BP), is investigated herein from a chronobiological viewpoint. Eighteen subjects (nine women and nine men, 39 to 87 years of age) with essential hypertension (office and ambulatory systolic, S/diastolic, D BP values above 160/95 mm Hg and 130/80 mm Hg, respectively) were enrolled in this investigation. Ambulatory BP was monitored at 30-min intervals for at least 24 h (ABPM-630, Colin Medical) before and after 4 weeks of crossover treatment with nifedipine tablets (twice daily, 20 mg/d) and benidipine (once daily, 4 mg/d, in the morning). The results indicate that: 1) benidipine and nifedipine reduce 24-h daytime (10:00-20:00) and nighttime (00:00-06:00) averages of SBP and DBP (P < 0.001); 2) the circadian double amplitude of BP is decreased after treatment with benidipine (from 28.6 to 21.1 mm Hg SBP and from 19.7 to 15.2 mm Hg DBP; P< 0.05), while the day-night difference in SBP is increased after treatment with nifedipine (18.6 vs 27.9 mm Hg, P< 0.01); and 3) the increase in the day-night difference of heart rate (HR) is significant after treatment with benidipine (13.6 vs 18.8 beats per minute, bpm; P< 0.05), but not with nifedipine. We have previously evaluated the usefulness of the circadian amplitude of BP as a prognostic tool of cardiovascular outcome, and found that an excessive circadian SBP or DBP amplitude was associated with an increased risk of vascular disease. The fact that benidipine reduces the circadian BP amplitude may be one reason for the superiority of this treatment over nifedipine in preventing an adverse outcome. A reduced heart rate variability (HRV) also predicts adverse cardiovascular outcomes in patients with overt cardiovascular disease and in hypertensive subjects. The fact that benidipine increases the day-night difference in HR may be another reason for the positive effects of this treatment.
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PMID:Impact of circadian amplitude and chronotherapy: relevance to prevention and treatment of stroke. 1177 59

The objectives are to explore the possibility of preventive non-drug interventions on vascular disease risk by examining the associations among health-related lifestyle (HLS), disease-related illnesses (DRI), subjective quality of life (QOL), depression, and blood pressure (BP). A sample of 181 adults (73 men and 108 women, mean age 57.3 +/- 10.2 years, range 24-76 years) in Urausu, Hokkaido, Japan, wore an ambulatory BP monitor around the clock for seven consecutive days. They completed a health survey questionnaire with which their HLS and DRI were assessed. QOL and depression were rated on the Visual Analogue Scales and the Geriatric Depression Scale-Short Form, respectively. For each participant's systolic (S) and diastolic (D) BP and HR, the circadian MESOR, amplitude, and acrophase were calculated, using cosinor analysis. Associations among the variables were analyzed, using Pearson's correlation coefficient and Kendall's tau-b. DRI was positively associated with depression (P = 0.005) and with HLS (P = 0.001), and was negatively associated with QOL (P = 0.041). Depression showed a moderate and negative correlation with QOL (P < 0.001). As expected, Body Mass Index (BMI) was associated with higher DRI (P = 0.008), SBP (P < 0.001), and DBP (P = 0.002), and with less variation of SBP (P = 0.006) and DBP (P = 0.004). Obesity as assessed by BMI was found to be a good indicator of the circadian BP endpoints and illnesses, warranting further investigation into dietary intake and health outcomes. Depression was also found to be a useful indicator of DRI, HLS, and QOL.
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PMID:Depression, quality of life, and lifestyle: chronoecological health watch in a community. 1265 75

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