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

Diabetes mellitus is commonly associated with systolic and diastolic hypertension, and a wealth of epidemiological data suggest that this association is independent of age and obesity. Much evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive patients, whether obese or of normal body weight, are compared with age- and weight-matched normotensive controls, a heightened plasma insulin response to a glucose challenge is found consistently. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. Using the insulin/glucose clamp technique in combination with tracer glucose infusion and indirect calorimetry, it has been demonstrated that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal (glycogen synthesis), and correlates directly with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms: sodium retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and proliferation of vascular smooth-muscle cells. Physiological maneuvers, such as caloric restriction (in the overweight patient) and regular physical exercise, can improve tissue sensitivity to insulin; good evidence indicates that these maneuvers also can lower blood pressure in both normotensive and hypertensive individuals. Insulin resistance and hyperinsulinemia also are associated with an atherogenic plasma lipid profile. Elevated plasma insulin concentrations enhance very-low-density lipoprotein (VLDL) synthesis, leading to hypertriglyceridemia. Progressive elimination of lipid and apolipoproteins from the VLDL particle leads to an increased formation of intermediate density and low-density lipoproteins, both of which are atherogenic. Last, insulin per se, independent of its effects on blood pressure and plasma lipids, is known to be atherogenic. The hormone enhances cholesterol transport into arteriolar smooth-muscle cells and increases endogenous lipid synthesis by these cells. Insulin also stimulates the proliferation of arteriolar smooth-muscle cells, augments collagen synthesis in the vascular wall, increases the formation of and decreases the regression of lipid plaques, and stimulates the production of a variety of growth factors. In summary, insulin resistance appears to be a syndrome that is associated with a clustering of metabolic disorders, including type II diabetes mellitus, obesity, hypertension, lipid abnormalities, and atherosclerotic cardiovascular disease.
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PMID:Insulin resistance, hyperinsulinemia, and coronary artery disease: a complex metabolic web. 128 37

We performed retrospective study of the relationship between the severity and duration of hypertension and echocardiographically-detected left ventricular hypertrophy (echo-LVH) in patients with untreated essential hypertension. The subjects consisted of 92 untreated essential hypertensives who were observed for more than 5 years from the onset of diastolic hypertension (greater than or equal to 95 mmHg), and whose left ventricular (LV) mass index was measured at the end of the observation period. On the basis of the frequency of diastolic hypertension during the observation period, the population was categorized in 3 groups. In Group I (32 cases), diastolic hypertension was observed in more than 80% of blood pressures obtained throughout the entire observation period. In Group II (38 cases), diastolic hypertension was observed in 33 to 80% of the observation period. In Group III (22 cases), diastolic hypertension was observed in less than 33% of the observation period. The average diastolic blood pressure during the entire observation period in each group were 101.0, 96.0, and 90.7 mmHg in groups I, II, and III, respectively. The LV mass index was significantly higher in groups I (114.6 g/m2) and II (105.3 g/m2) than in group III (90.7 g/m2) (p less than 0.01). The prevalence of echo-LVH (more than 121 g/m2) was 34.4%, 18.4%, and 4.8% in groups I, II, and III, respectively. The average diastolic blood pressure in patients with echo-LVH (99.3 +/- 5.1 mmHg) was significantly higher than in patients without echo-LVH (95.7 +/- 4.7 mmHg). We concluded that the degree and duration of diastolic pressure elevation are closely correlated to the LV mass index.
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PMID:Relationship between blood pressure and left ventricular mass in male patients with essential hypertension. 184 Jan 13

Diabetes mellitus is commonly associated with systolic/diastolic hypertension, and a wealth of epidemiological data suggest that this association is independent of age and obesity. Much evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive patients, whether obese or of normal body weight, are compared with age- and weight-matched normotensive control subjects, a heightened plasma insulin response to a glucose challenge is consistently found. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. With the insulin/glucose-clamp technique, in combination with tracer glucose infusion and indirect calorimetry, it has been demonstrated that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal (glycogen synthesis), and correlates directly with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms: Na+ retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and proliferation of vascular smooth muscle cells. Physiological maneuvers, such as calorie restriction (in the overweight patient) and regular physical exercise, can improve tissue sensitivity to insulin; evidence indicates that these maneuvers can also lower blood pressure in both normotensive and hypertensive individuals. Insulin resistance and hyperinsulinemia are also associated with an atherogenic plasma lipid profile. Elevated plasma insulin concentrations enhance very-low-density lipoprotein (VLDL) synthesis, leading to hypertriglyceridemia. Progressive elimination of lipid and apolipoproteins from the VLDL particle leads to an increased formation of intermediate-density and low-density lipoproteins, both of which are atherogenic. Last, insulin, independent of its effects on blood pressure and plasma lipids, is known to be atherogenic. The hormone enhances cholesterol transport into arteriolar smooth muscle cells and increases endogenous lipid synthesis by these cells. Insulin also stimulates the proliferation of arteriolar smooth muscle cells, augments collagen synthesis in the vascular wall, increases the formation of and decreases the regression of lipid plaques, and stimulates the production of various growth factors. In summary, insulin resistance appears to be a syndrome that is associated with a clustering of metabolic disorders, including non-insulin-dependent diabetes mellitus, obesity, hypertension, lipid abnormalities, and atherosclerotic cardiovascular disease.
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PMID:Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. 204 34

Hypertension is more common in persons with both insulin-dependent and noninsulin-dependent diabetes. Pathophysiologic mechanisms that result in an increased prevalence of essential hypertension in noninsulin-dependent diabetes, premature diastolic hypertension in insulin-dependent diabetes, and systolic hypertension in both forms of diabetes are described. Aggressive treatment of the hypertension associated with diabetic nephropathy will result in a deceleration of renal decompensation. The commonly used antihypertensives that successfully treat hypertension in the non-diabetic population often have unacceptable side effects in the diabetic population. Rational approaches to the treatment of diabetic hypertension in general and in circumstances unique to the hypertensive diabetic individual are described.
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PMID:Hypertension in the person with diabetes. 265 May 43

A 46-year-old Caucasian male USAF aviator with a 6-year history of mild essential hypertension (medical waiver for flight duty) under unsuccessful treatment with hydrochlorothiazide, dietary modification, and exercise, was subsequently trained in yoga relaxation. After 6 weeks, medication had been discontinued, and his diastolic blood pressure remained within normal levels. The patient was subsequently returned to full flight status without recurrence of diastolic hypertension at followup 6 months later. Relaxation training, of which yoga is one type, has been reported in the medical literature to have wide clinical application. It should be considered as a nonpharmacological therapy adjunct or alternative for medical disorders among personnel in occupations (e.g., aviation) where the side effects from medications are of great concern and could be disqualifying from those duties.
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PMID:Treatment of essential hypertension with yoga relaxation therapy in a USAF aviator: a case report. 266 22

Treatment of patients with mild to moderate essential hypertension is now commonly undertaken. Clinical trials have shown a marked decrease in strokes in treated hypertensive patients. But despite reports of decreases in coronary deaths in some trials, the overall incidence of coronary events has been largely unaffected. This disappointing outcome has raised interesting issues. The patients in comparative placebo groups often do better than expected in formal trials; apart from the benefits of lifestyle changes, many of these patients appear to normalize their blood pressures during the trial. This latter effect can be due to erroneous diagnoses of hypertension at the start of the study, and this partially dilutes the likelihood of differences in outcome between the placebo- and actively treated patients. Optimal control of blood pressure is difficult to define, and controversies exist concerning whether pressures have been decreased insufficiently or excessively in clinical trials; it has been argued, too, that systolic as well as diastolic hypertension should be the target of treatment. Inadvertent treatment-induced metabolic abnormalities, especially in blood lipids, glucose, and electrolytes can weaken the antihypertensive benefits. Failure to deal with concurrent risk factors including smoking and left ventricular hypertrophy also could explain the absence of a decrease in coronary events. Newer classes of antihypertensive agents offer the potential to address these concerns and improve the cardiovascular prognosis of treated hypertensive patients.
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PMID:Antihypertensive treatment. Considerations beyond blood pressure control. 268 79

The clinical characteristics of systolic and diastolic hypertension in 75 and of systolic hypertension in 50 elderly patients have been studied and the results have been compared to those obtained in 23 normotense elderly controls and 500 young patients with essential hypertension. A greater incidence in cardiovascular and neurologic morbility was observed in the hypertense elderly, existing also a greater incidence of electrocardiographic abnormalities and impairment in renal function. The changes in blood pressure with postural changes and isometric and physical exercise were evaluated in a subgroup of these patients, finding that the elderly with hypertension, specially those with systolic hypertension, showed orthostatic hypotension, and an increase in blood pressure with exercise, reaching levels that could potentially cause the clinical complications.
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PMID:[Clinical characteristics of arterial hypertension in the elderly]. 277 50

Blood pressure (BP) data obtained during a BP screening program were analyzed to determine the prevalence of "significant" hypertension, defined by the Second National Heart, Lung, and Blood Institute Task Force on Blood Pressure Control in Children-1987 as the level of BP above which medical evaluation and intervention are recommended. In 14,686 black and white St. Paul and Minneapolis schoolchildren aged 10 to 15 years, BP was measured twice during an initial screening examination. Children with systolic BP in the upper 30 percentiles of distribution after the initial screening had their BP remeasured two additional times at a rescreening examination. The prevalence of significant hypertension was determined according to BP criteria established by the Task Force report. After the two screening BP measurements were averaged, significant systolic hypertension was found in 1.0%, significant diastolic hypertension in 3.5%, and significant systolic or diastolic hypertension, or both, in 4.2% of the students. After the rescreening examination, the percentage of students remaining with significant hypertension was reduced to 0.3% for systolic, 0.8% for diastolic, and 1.1% for systolic or diastolic hypertension, or both. These results show that significant hypertension is uncommon in pre-high-school students and confirm the need for repeated BP measurements to make an accurate diagnosis of hypertension. However, the results should not detract from current recommendations to monitor BP in children on a yearly basis to detect longitudinal BP tracking patterns that may be consistent with early essential hypertension.
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PMID:Prevalence of "significant" hypertension in junior high school-aged children: the Children and Adolescent Blood Pressure Program. 278 1

Long considered a single clinical entity, essential hypertension is now recognized as a heterogeneous spectrum of pathophysiologic disturbances, based on extensive clinical, pharmacologic and biochemical evidence. Two distinctly different mechanisms for long-term vasoconstriction can be identified and quantified in the spectrum of patients with essential hypertension, although the causes of this group of disorders are still obscure. The first vasoconstrictor mechanism is renin-angiotensin mediated and involves an increase in vascular smooth muscle cytosolic free calcium mobilized from intracellular sites. The degree of activity of this mechanism can be assessed by plasma renin level and/or by the hypotensive response to circulating anti-renin-system drugs (such as CEI inhibitors and beta blockers). The second vasoconstrictor mechanism, on the other hand, is renin-independent. It appears to require antecedent renal sodium retention and to be related to abnormal membrane influx of calcium. A low plasma renin level identifies this kind of vasoconstriction, which is also characterized by a low serum ionized calcium. Low-renin vasoconstriction is correctable by sodium depletion or by calcium channel or alpha adrenergic blockade. Depending on the state of sodium balance, these two vasoconstrictor mechanisms contribute reciprocally to maintenance of arteriolar tone in models of experimental hypertension, normotensive and hypertensive people, and in the vasoconstriction of edematous states, such as congestive heart failure. One of the two mechanisms also sustains diastolic hypertension in the experimental and clinical forms of renovascular hypertension and primary aldosteronism. Thus, both experimentally and clinically, at the polar extremes of the range of plasma renin values, one of the two mechanisms predominates: it is possible that, in the medium range of renin values, both mechanisms contribute to vasoconstriction. In our proposed unifying, analytic model, arteriolar vasoconstriction is associated with increased intracellular calcium and decreased magnesium levels in vascular smooth muscle. In the vasoconstriction consequent to sodium-volume expansion, cytosolic calcium is increased by an increased membrane influx. In renin-mediated vasoconstriction, receptor-operated channels mobilize cytosolic calcium instead from intracellular stores. These interrelationships provide a basis for stratifying hypertensive patients pathophysiologically and for applying simpler, more specific, and more rational therapies. Thus, the array of modern pharmacologic agents can often be rationally directed at one or the other, or both, of these two vasoconstrictor mechanisms.
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PMID:Recognizing and treating two types of long-term vasoconstriction in hypertension. 305 33

Two different mechanisms for long-term vasoconstriction that sustain diastolic hypertension in the experimental and clinical forms of primary aldosteronism and renovascular hypertension can also be identified and quantified among patients with essential hypertension. The first is renin-independent, requires antecedent sodium retention, and appears related to abnormal membrane transport of calcium. This vasoconstriction is identified by low plasma renin and ionized calcium values and is correctable by sodium depletion or calcium channel or alpha-blockade. The second is renin-mediated but also involves an increase in cytosolic calcium. This mechanism is quantifiable by the plasma renin level and by the hypotensive response to an anti-renin-system drug (CEI inhibitor, saralasin, beta-blocker). At the very extremes of the range of plasma renin values encountered in hypertensive patients, one of the two mechanisms predominates, whereas in the medium range of renin values either or both mechanisms can be operative.
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PMID:Pathophysiology of diastolic hypertension. 307 77


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