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Query: UMLS:C0085580 (essential hypertension)
 14,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results of computer-assisted static and dynamic renal scintigraphy in 57 patients with renovascular hypertension (RVH) and 23 patients with essential hypertension (EH) are presented. The following parameters were quantified: renal size (RS), count density (CD), relative unilateral renal clearance (RRC), mean parenchymal transit time (PTT), difference of time-to-peak of activity (tmaxd) to stenosed minus non-stenosed side, effect of frusemide (FE) and renal parenchymal radionuclide retention (RI). Among 57 stenosed renal arteries we detected 54 (true-positive cases) and missed three (false-negative cases); among 23 patients with EH and no significant haemodynamic renal artery stenosis, we found 21 cases correctly negative and two patients falsely positive. These data yielded a sensitivity of 95% and a specificity of 92%. The quantification of renal radionuclide studies in renal artery stenoses minimizes false-positive results and increases their specificity. This study shows that, because of its sensitivity, quantitative renal scintigraphy reliably allows the assessment of the functional haemodynamic effects of a renovascular lesion (significant stenosis) in the diagnostic work-up and during follow-up after surgical reconstruction or percutaneous transluminal angioplasty (PTA). The evaluation of renal function is in general greatly supported by the quantitative parameters, yet particularly after medication with converting enzyme inhibitors and after intervention.
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PMID:Quantitative static and dynamic renal scintigraphy with diuresis stimulation in renovascular hypertension. 268 41

Essential hypertension has long been assumed to be a multifactorial disease. However, recent evidence suggests that it is a syndrome rather than a disease with a common symptom--an elevated blood pressure. One large segment of the hypertensive population--approximately 60%--has in common an increased blood pressure sensitivity to salt intake. Further analysis of this subgroup suggests that it is also heterogeneous, consisting of at least six major entities: renal parenchymal disease, bilateral renal artery stenosis, primary aldosteronism, acromegaly, low renin essential hypertension, and the most recently described entity--nonmodulating essential hypertension. This subset's name is derived from the fact that sodium intake does not modify (modulate) renovascular and adrenal responses to angiotensin II, as occurs in normotensives and modulating hypertensive patients. The following abnormalities have been reported in these patients: (1) a failure of renal blood flow to increase with salt loading; (2) a reduced ability to excrete a salt load; (3) reduced renin suppression both by salt and angiotensin II; and (4) a hypertensive response to salt load. These patients also have a strong family history for hypertension and an increase in erythrocyte sodium countertransport. With a better understanding of the mechanisms underlying the elevated blood pressure in a specific patient, a more rational approach to therapy is possible. For example, in the salt-sensitive hypertensive patient a diuretic would be the presumed treatment of choice. While this is correct for some salt-sensitive hypertensives, in nonmodulators diuretics may be relative ineffective while converting enzyme inhibitors may be more effective because they specifically correct the underlying pathophysiologic derangement.
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PMID:Sodium-sensitive essential hypertension: emerging insights into an old entity. 269 48

iv-DSA is an excellent method for detecting suspected stenosis of the renal arteries. In essential hypertension among 19 patients a frequency of 15.8% was found, in patients with accelerated hypertonus (n = 23) the percentage of renal artery stenosis was twice this rate (30.4%). In case of a positive or unclear outcome of iv-DSA, intraarterial angiography with ever ready PTRA is advisable.
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PMID:[Diagnostic strategy in suspected renovascular hypertension]. 279 29

Enalapril maleate (MK-421) is a new non-sulfhydryl-containing converting-enzyme inhibitor that has been shown to be effective and well tolerated in patients with essential hypertension. Data on its effectiveness and safety in patients with renovascular hypertension are limited and have involved predominantly short-term observations. This is particularly true with respect to the long-term effects of enalapril on renal function. We report our experience using the combination of enalapril and hydrochlorothiazide (HCTZ) in a group of nine patients with moderate to severe hypertension associated with renal artery stenosis. The enalapril-HCTZ combination successfully controlled blood pressure in seven patients during a six-week period of study. Adverse effects were not noted, and detailed renal hemodynamic studies did not reveal any significant changes of renal plasma flow and glomerular filtration rate during this time interval. Five patients were continued on this regimen for a period of six to 18 months. In this group of patients, the regimen continued to be well tolerated and to provide excellent blood pressure control: glomerular filtration rate was maintained in two patients and variable grades of decrease were noted in three. The mechanism of this delayed renal dysfunction as well as its relationship to enalapril treatment remain unclear. The long-term impact of converting-enzyme inhibition on renal function requires further study.
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PMID:Enalapril in the management of hypertension associated with renal artery stenosis. 282 70

Plasma renin activity (PRA) is markedly increased by captopril. There is not enough separation between the changes in PRA of patients with renal artery stenosis (RAS) to separate them reliably from those with essential hypertension. A minimal response may suggest primary aldosteronism. Captopril does increase the ratio of PRA in the venous blood from a kidney with RAS to that of the contralateral kidney. Captopril, 25 to 50 mg orally, given before renal vein PRA sampling will increase the sensitivity and specificity of the test. Treatment with current antihypertensive drugs need not be discontinued. Scleroderma renal crisis (SRC) used to be uniformly lethal within a few months. Modern, aggressive antihypertensive therapy has made survival of 2 or more years common. Not all patients respond, and some progress to renal failure despite good BP control. Captopril has been used with success in some patients with idiopathic edema. In conclusion, captopril markedly enhances the accuracy of renal vein renin assay for the diagnosis of RAS and is of major value in the treatment of SRC.
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PMID:Special uses for captopril. 288 46

The causes of renal vascular hypertension are outlined. These are guided by the influence on the renin-angiotensin mechanism. The so-called essential hypertension is not infrequently caused by an early nephrosclerosis, which can be diagnosed very early through electrone microscopy. Renal artery stenosis, caused by fibrodysplasia or arteriosclerosis represents a special case of renal vascular hypertension which can be treated effectively by balloon catheter dilatation. The results in 240 patients are presented where these therapeutic principles were applied.
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PMID:[Renovascular hypertension--diagnosis and therapeutic possibilities]. 293 36

The blood pressure response to surgery or percutaneous transluminal angioplasty (PTA) was determined an average of 3 years after treatment. In atherosclerotic disease, 85% of patients benefited. Furthermore, the extremely low overall cure rate of 6% (4/67) suggests that renal artery stenosis due to atherosclerosis is rarely a sole cause of hypertension, but more likely is an atherosclerotic complication of essential hypertension that develops in patients who are cigarette smokers. In fibrodysplastic disease both treatments were likely to improve the blood pressure. However, surgery resulted in a 41% rate of loss of the operated kidney. The response to PTA or surgery is strongly influenced by the etiology of the lesion being treated.
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PMID:Renal vascular hypertension. Surgery vs. dilation. 294 21

To evaluate cardiovascular status in human renovascular hypertension, quantitative echocardiographic findings were compared in 42 patients with arteriographically documented renovascular hypertension and 46 age- and sex-matched patients with essential hypertension. Left ventricular (LV) fractional shortening, a measure of systolic performance at rest, was subnormal (less than 26%) in 8 of 42 renovascular hypertensive patients (19%), 0 of 42 essential hypertensive patients (p less than 0.005) and 1 of 79 normal subjects (1%) (p less than 0.005). Fractional shortening was equally reduced in patients with arteriosclerotic and nonarteriosclerotic causes of renal artery stenosis (32 +/- 9% vs 32 +/- 6%, both p less than 0.025 compared with 36 +/- 5% in patients with essential hypertension). The depressed function in renovascular hypertension appeared to be a result of greater LV dilation (p less than 0.02) and septal but not LV free wall hypertrophy (p less than 0.01) that failed to offset the pressure load, allowing end-systolic stress, a measure of myocardial afterload, to increase to abnormal levels (101 +/- 47 X 10(3) dynes/cm2, p less than 0.001 vs 68 +/- 19 in essential hypertension). These data indicate that human renovascular hypertension is associated with more adverse cardiac involvement than essential hypertension of similar severity. In addition, the 14 patients with bilateral renovascular stenosis had a higher cardiac index (3.9 +/- 1.1 liters/min/m2) than the 28 with unilateral stenosis (3.2 +/- 1.1 liters/min/m2, p less than 0.05). This result supports the proposition that bilateral renovascular disease is analogous to 1-clip 1-kidney experimental renovascular hypertension, while unilateral renovascular disease resembles the 1-clip 2-kidney model.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardiac structure and function in renovascular hypertension produced by unilateral and bilateral renal artery stenosis. 294 68

In 46 patients with renovascular hypertension who underwent renal angioplasty, proteinuria (more than 150 mg/24 hours) was more pronounced than in patients with essential hypertension. The highest levels were seen in patients in whom 1 renal artery was totally occluded. There was no difference between patients with unilateral vs bilateral renal artery stenosis. Proteinuria could not be correlated with serum creatinine level, and in 28% of the patients with renovascular hypertension, proteinuria was present despite a normal creatinine level. Renal angioplasty produced a significant diminution in proteinuria when it resulted in a cure of the hypertension, but no diminution was achieved if blood pressure did not decrease.
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PMID:Proteinuria in renovascular hypertension and the effects of renal angioplasty. 294 92

We have measured the basal circulating level of atrial natriuretic factor (ANF) in hypertensive patients. Plasma ANF concentrations in 101 patients with mild untreated, essential hypertension and in 64 normotensive controls were 14.9 +/- 11.1 vs 11.9 +/- 7.7 pg/ml, p = NS respectively. Plasma ANF levels in the patients were correlated with mean arterial pressure (r = 0.35, p less than 0.001) and age (r = 0.38, p less than 0.001). Sixteen patients with uncontrolled hypertension despite treatment, had significantly higher plasma ANF levels (33.5 +/- 27.3 pg/ml, p less than 0.001). Forty other patients with hypertension were subjected to an abdominal aortography and a renal vein catheterism, in order to rule out renovascular hypertension. Of these subjects, 16 were without significant renal artery stenosis, 12 had left renovascular hypertension and 12 others right renovascular hypertension. Plasma ANF levels were maximal in the aorta and there were no differences between the ANF levels in the renal veins, whether the stenosis was on the right or left side. In conclusion, plasma ANF levels were not elevated in 101 untreated patients with mild essential hypertension. Together with the evidence of elevated intra atrial pressure in mild essential hypertension, as found by others, this suggests that ANF secretion might be impaired in this disease.
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PMID:[Determination of the atrial natriuretic factor in patients with essential and renovascular hypertension]. 295 39


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