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

An expert system has been integrated to the data management system of the ARTEMIS programme for hypertensive patients. The patient database, which has been used since 1975, contains the medical records of about 20,000 patients. Information is interactively entered by physicians, nurses and secretaries on video display units. The computerised medical record has replaced the traditional handwritten medical record. The database management system is used to produce different summary reports (inpatient and outpatient care) and personalized recall letters which are mailed to the patients before their appointments. Suggestions provided by the expert system include additional information to be obtained (complementary patient interrogation, biological or radiological investigations, etc.), possible causes of hypertension, and medical prescriptions. The information base allows the description of both static knowledge (in the form of a semantic network) and dynamic knowledge (in the form of production rules). The inference system sequentially uses a combination of forward and backward chaining and performs both exact and approximate reasoning. The diagnostic performance of the expert system was evaluated in 100 cases of hypertension (50 of essential hypertension and 50 of secondary hypertension. Concordance between the diagnosis proposed by the expert system and the one proposed by the specialist was achieved in 92% of secondary hypertension cases and 88% of essential hypertension cases. It is suggested that the integration of data and knowledge management might enhance the overall acceptance by medical staff of a computerised system, and facilitate the validation of a knowledge base.
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PMID:Integrating management and expertise in a computerised system for hypertensive patients. 312 10

131 patients with essential hypertension (EH) and 30 patients with secondary hypertension (SH) of renal genesis were examined, all of them Russian inhabitants of Moscow, aged 20-56. In patients with EH increased rate of HLA-B13 and B22 antigens was determined. The highest rate of HLA-B13 antigen in this group was registered in patients without IHD, while patients with IHD had the highest rate of HLA-B22 antigen compared to controls. Patients with SH demonstrated no significant difference in HLA antigens distribution from that in controls. Besides, patients with EH had significantly increased serum concentration of circulating immune complexes (CIC), of IgA and beta 2-microglobulins as well as of three complement components (C3c, C4 and B factor). Similar changes were observed in patients with SH, excluding CIC and C3c, concentration of which did not differ from that in the control group. No strict dependence between the level of immunity humoral factors and presence of HLA-B13 and -B22 antigens was observed. The data gained suggest possible association of HLA system with EH development.
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PMID:[Various immunological aspects of essential and symptomatic hypertension]. 316 69

The endogenous digoxin-like substance seems to play an important role in the aetiology and pathogenesis of essential and secondary hypertension. Immunoreactive digoxin-like substance was determined in 52 subjects: 17 healthy ones, 15 patients with essential hypertension, 10 cases of chronic renal failure and 10 patients with acromegaly. The substance was not found in healthy subjects, in acromegaly and essential hypertension. In chronic renal failure detectable concentrations of the substance were observed but they showed no correlation with the creatinine level and other clinical data.
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PMID:[Endogenous digoxin-like substance level in essential arterial hypertension, renal failure and acromegaly]. 327 65

Long-term study of new antihypertensive drugs according to the programme worked out by the Cooperative Trial of Drugs for the Prevention of Arterial Hypertension (CTDPAH) is based on a system approach including observation of patients with essential hypertension and secondary hypertension with different initial level of arterial pressure, simultaneous study of the effect of three basic antihypertensive drugs, and evaluation of the action of these drugs with the application of a stepwise scheme. The study is long-term, cooperative (multicentral) and controlled. The first results in 387 patients, obtained in the curse of 5 to 8 months, showed that in nearly half of the patients with stable, mild or moderate hypertension it is possible to use prolonged antihypertensive monotherapy, with one third of these cases showing normalization of pressure, and other third partial effect. Most promising for long-term antihypertensive prevention proves to be prazosin, an alpha 1-postsynaptic adrenoreceptor blocking drug, which in contrast to propranolol has a marked antiatherogenic effect on blood plasma lipoproteins.
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PMID:System approach to testing hypotensive drugs for prevention of arterial hypertension. 342 70

To develop a screening test for identifying renovascular hypertension, the blood pressure and plasma renin activity responses to an oral test dose of captopril were studied in 246 quietly seated hypertensive patients. The following criteria were developed that exploit the hyperresponsiveness of renin secretion in renovascular hypertensive patients: a 60-minute post-captopril plasma renin activity of 12 ng/ml per hour or more and an absolute plasma renin activity increase of 10 ng/ml per hour or more, along with a 150 percent increase in plasma renin activity (or a 400 percent increase if the baseline plasma renin activity was below 3 ng/ml per hour). Retrospectively, the test identified, among 200 hypertensive patients without evidence of renal dysfunction, all 56 patients with proved renovascular disease. In this group, false-positive results occurred only in two of 112 patients with essential hypertension and in six with secondary hypertension. Nine untreated patients had blood pressure levels of less than 160/100 mm Hg. The test was neither as sensitive nor specific in the 46 patients with renal insufficiency. This study demonstrates that the renin response to oral captopril is a useful screening test for identifying patients with unilateral or bilateral renovascular disease. Since the test also characterizes the renin dependency of the hypertension, it may have other diagnostic and therapeutic uses.
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PMID:The captopril test for identifying renovascular disease in hypertensive patients. 351 33

Since 1981, we have made diagnoses of secondary hypertension using state of art imaging equipment in 18 pediatric patients. The most valuable tests were ultrasound in identifying renal parenchymal disease, computed body tomography for adrenal tumors and intra-arterial renal angiography for renovascular disorders. Based on our experience, we have formulated an algorithm for the evaluation of the hypertensive pediatric patient. The initial step is careful clinical and laboratory screening to identify those patients that are likely to have essential hypertension and who should not undergo imaging tests. In the cases where there is a possible secondary etiology, renal ultrasound is usually performed first to identify parenchymal disease. If catecholamines are elevated, then abdominal computed tomography is the initial test. If no etiology is identified from these noninvasive studies, then direct intraarterial renal angiography is performed. The authors do not feel that excretory urography, radionuclide renography, intravenous digital subtraction angiography or selective renal vein sampling for renin are useful or practical screening tests for renovascular hypertension.
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PMID:Pediatric hypertension: an approach to imaging. 353 73

The presence of hypertension in domestic animals is poorly described. Values for hypertension were established in dogs using a direct blood pressure measurement. A protocol was devised to recognize and characterize primary (essential) and secondary hypertension. Essential hypertension was associated with marked elevations in blood pressure and can be shown to be a hereditary disease in dogs. Secondary hypertension is more common and most frequently associated with Cushing's disease and renal failure. Treatment to reduce blood pressure in both groups can be achieved using pharmacologic agents which are more effective than sodium restriction alone. Hypertension appears to be an underdiagnosed disease in dogs. The significance of chronic hypertension in dogs in terms of vascular pathology is not yet clear.
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PMID:Hypertension and renal function. 357 94

Isolated systolic hypertension is common in the elderly population and has only recently been recognized as a pathophysiologic process. In the past it was considered to be part of the normal aging process. Assessment of isolated systolic hypertension is covered, including the differentiation between isolated systolic hypertension, essential hypertension and secondary hypertension. Non-pharmacologic therapy, the treatment of first choice, and pharmacologic therapy are discussed, including treatment considerations related to the aging process. Also included are patient education guidelines and indications for physician referral. Isolated systolic hypertension is an important clinical entity in the growing elderly population and can be appropriately diagnosed and managed by the nurse practitioner in primary care.
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PMID:Protocol: isolated systolic hypertension in the elderly. 358 82

In this review article are surveyed the results of the workshop on Hypertension in Childhood (Obergurgl 1986, authors: H. Bachmann, Essen, W. Hoffmann, Homburg/Saar, H. Frisch, Wien, H. W. Seyberth, Heidelberg, A. Beitzke, Graz). At first normal blood pressure conditions in childhood and the applicability of normal value tables for blood pressure are considered. Different methods of measurement and possible relationship to hypertension in adult age are discussed. Besides, essential hypertension forms of secondary hypertension in childhood are reviewed stressing aspects concerning differential diagnosis and indication for antihypertensive therapy.
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PMID:[Hypertension in childhood]. 358 95

Using a comprehensive protocol, the efficacy of simple clinical data, including history, physical examination, and urinalysis, in the discrimination of essential or secondary hypertension was investigated by a review of 103 patients, aged 2 weeks to 18 years, consecutively referred for investigation. Essential hypertension (55/103 mm Hg) was the most common diagnosis, even in infancy, whereas various renal disorders formed the next most common diagnostic category (21/103 mm Hg). Family history and the presence of "fixed" vs "labile" hypertension were of no value in detecting secondary hypertension. Urinalysis was useful in detecting inflammatory renal lesions but not structural disorders of the kidney. This study emphasizes the need for thorough investigation, including renal imaging, of asymptomatic hypertensive children and suggests a useful protocol to achieve this end.
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PMID:Investigation of pediatric hypertension. Use of a tailored protocol. 367 73


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