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

Analysis of a further series of 125 consecutive unselected adults who were admitted to hospital with hypertension has advanced the study of arterial abnormalities and parenchymal hypoplasia, as demonstrated by selective renal arteriography, further in the direction of the parenchyma. An index of arterioparenchymal thinning is described. The authors list the features and incidence of polar arteries arising from the aorta (46%), polar arteries of non-aortic origin (31%), stenosing dysplasia (26%) and other arterial malformations, as well as biapical hypoplasia (67%), monofocal hypoplasia (37%), and the main types of renal dysgenesis (30%) which they found. The incidence of these abnormalities confirms the previous study of polar arteries arising from the aorta, and gives much more extensive information on the topic of parenchymal hypoplasia in so-called essential hypertension in the adult.
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PMID:[Kidney parenchymatous hypoplasia and arterial dysplasia in adult arterial hypertension. Data of selective renal arteriography]. 81 82

The results of 76 selective renal angiographies in 33 patients with the use of adrenalin and acetylcholine are presented (17 cases of renovascular hypertension, 7-chronic pyelonephritis, 5-essential hypertension, 2-nephroptosis, 1-kidney tumor). The pecularities of the method essential for the success of the examination and prevention of complications are described. The importance of pharmacoangiography with adrenalin for the determination of the length of renal vessels lesion in cases of fibrous dysplasia was demonstrated, as well as that of the acetylcholine test for examining the state of the vascular bed of the contralateral kidney, the same procedures being applied in cases of chronic pyelonephritis. Typical pharmacoangiographic symptoms of different forms of nephrogenic hypertension are described.
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PMID:[Renal angiography with the use of vasoactive drugs and its value in the diagnosis of vasorenal hypertension]. 88 99

Because the cause of hypertension is reversible in only 5 percent of patients, extensive initial work-up should only be considered in selected cases. Secondary causes should be suspected in patients whose hypertension begins before age 30 or after age 50 and in patients whose hypertension suddenly worsens after a long period of good control, becomes severe or malignant, or remains refractory to maximal medical therapy. A sudden reduction in renal function in a hypertensive patient and the discovery of a unilateral small kidney may also raise suspicion of a secondary cause. Renovascular disease, one of the most common secondary causes of hypertension, is usually the result of atherosclerosis in older patients and the result of fibromuscular dysplasia in younger patients. Physical examination seldom contributes to the diagnosis. The classic upper abdominal or flank bruit occurs in only 30 to 50 percent of patients with renovascular disease, and is not uncommon in patients with essential hypertension. The gold standard for diagnosis of renovascular disease remains the arteriogram. Transluminal renal angioplasty may be performed during arteriography if a high-grade stenosis is identified. Other management options include medical therapy and surgical revascularization with grafts.
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PMID:Percutaneous angioplasty for renovascular hypertension due to fibromuscular dysplasia. 132 61

Secondary hypertension represents about 5-10% of all forms of hypertension, renal and renovascular being the commonest forms. Renal artery stenosis is the principal cause of renovascular hypertension due to atheromatous disease or fibromuscular dysplasia. Rapid sequence intravenous pyelogram, isotope renogram, captopril test and digital subtraction angiography or conventional arteriography, are the diagnostic procedures in the diagnosis of renal artery atenosis. Hypertension is also very common in parenchymal renal disease, mainly in chronic renal insufficiency. In this condition, the mechanism is more related to volume dependent factors than in renovascular hypertension which is mainly renin dependent. In the treatment of renal or renovascular hypertension the same type of drugs have been generally used as in essential hypertension although with some specific indications like the use of angiotensin-converting enzyme inhibitors in unilateral renal artery stenosis or furosemide in case of renal insufficiency. Revascularization by angioplasty or surgical bypass, may be indicated in renovascular hypertension.
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PMID:[Hypertension from the nephrologist's point of view]. 183 18

Renovascular hypertension is caused by two distinct conditions with different causes, fibromuscular dysplasia and atheroma. Diagnosis of the former is both simpler and more rewarding, whereas atheromatous lesions of the renal artery may be secondary to essential hypertension. It is therefore important to establish existence of functional renal ischemia as well as an anatomical lesion. Universal screening of all hypertensive patients is not recommended because of the relatively low prevalence of the disease and insufficient accuracy of available screening tests. When renovascular hypertension is clinically suspected, an oral captopril test is the most reliable office screening test. After this, digital subtraction angiography with renal vein renins or captopril renography are appropriate steps. However, the latter procedure, while promising, requires further evaluation. Duplex scanning of the renal arteries also comes into this category. Arteriography is done last, so that if renal ischemia is indicated, angioplasty can be attempted at the same time as arteriography.
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PMID:Diagnosis and evaluation of renovascular hypertension. Indications for therapy. 199 96

To examine the efficacy and usefulness of captopril-enhanced renal vein renin (RVR) measurements in detecting the functional significance of renal artery stenosis found in hypertensives, we compared these values in 22 patients with arteriographically documented renovascular hypertension due to unilateral (URVH: 14 patients) or bilateral renal artery stenosis (BRVH: 8 patients) and 12 patients with high renin essential hypertension (EHT). Before captopril administration, RVR ratio was less than 1.5 in 8 patients (36.4%) with renovascular hypertension and all patients (100%) with EHT. Captopril enhanced the lateralization of renal vein renin in renovascular hypertension; the postcaptopril RVR ratio was greater than 2.0 in 18 patients (81.8%) and greater than 1.5 in all the patients (100%). On the other hand, RVR ratio remained unchanged in most patients with EHT. There was no significant difference in the postcaptopril RVR ratios between URVH and BRVH. However, the postcaptopril RVR ratio was higher in atherosclerosis (10 patients) than in fibromuscular dysplasia (11 patients) (P less than .05). Captopril also elucidated contralateral renin suppression as expressed by a contralateral/peripheral renin ratio of less than 1.0, which was associated with a favorable outcome of unilateral surgical intervention. Captopril-stimulated RVR indices were valuable in detecting the functionally significant renal artery stenosis and predicting surgical curability in renovascular hypertension.
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PMID:Captopril-stimulated renal vein renin in hypertensive patients with or without renal artery stenosis. 208 Oct 13

The prevalence and patterns of the hypertension syndrome (AH) in young subjects require further study. An examination of 879 young subjects revealed AH in 14.6 per cent; in 84 inpatients borderline AH was found in 20.2, essential hypertension in 17.9 and symptomatic AH in 61.9 per cent, in 22.6 per cent AH was attended by signs of connective-tissue dysplasia and minor developmental abnormalities (mitral valve prolapse, nephroptosis, pathology of cervical spine, structural disorders of the lid slit and floor of the auricle, etc.). Manifestations of connective-tissue dysplasia and minor developmental abnormalities have a bearing on the AH formation and course in this group of patients. Further detailed study of the AH course in young subjects with these manifestations is required.
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PMID:[Arterial hypertension syndrome in young persons]. 277 Feb 10

Atherosclerosis, aorto-arteritis and fibromuscular dysplasia are the most common causes of vasorenal hypertension. Determination of plasma renin activity is a valuable diagnostic test at early stages of vasorenal hypertension. HLA studies demonstrated significantly elevated antigens B8 and B12 in patients with essential hypertension, and antigen A9 in patients with affected renal arteries. These findings may expand the possibilities of differential diagnosis for the selection of patients, eligible for angiographic investigation. A less than three-years duration of the disease in the presence of high plasma renin activity is a favorable prognostic criterion.
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PMID:[Ways of improving the diagnosis and prognosis in vasorenal hypertension]. 307 42

To study long-term effects of captopril on renal function in patients with various forms of severe hypertension, serum creatinine values were monitored in 76 patients under captopril therapy over a period of up to 3 years. Three different groups were formed: patients with essential hypertension (n = 37); patients with renovascular hypertension (n = 20); patients with renal parenchymatous hypertension (n = 19). In each of the three groups reduction in blood pressure was accompanied by increases in serum creatinine. However, both changes were more pronounced in patients with renovascular hypertension. In this group only the rise in creatinine was statistically significant and showed a slight progression with duration of captopril treatment. Group specific analysis revealed that the increase was smaller in patients with unilateral (n = 16) renovascular disease than in those with bilateral (n = 4) involvement, but in the former it was still significantly higher than in patients with essential or renal parenchymatous hypertension. Separation of patients according to the underlying disease of renovascular hypertension showed that renal function deteriorated less in patients with arteriosclerotic origin (n = 10) than in those with fibromuscular dysplasia (n = 8). Statistical evaluation of subjects with renovascular and essential hypertension still revealed significant differences in creatinine when the patients with initial plasma renin activity (PRA) below and above 6 ng/ml X 3 h were compared separately. A significant correlation (r = 0.73; P less than 0.05) between blood pressure reduction and creatinine changes was obtained only for patients with renovascular hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term effect of captopril on kidney function in various forms of hypertension. 638 63

The erythrocyte Na+/Li(+)-countertransport activity was studied in patients with essential hypertension (n = 59), chronic glomerulonephritis (n = 30), chronic pyelonephritis (n = 26), renovascular hypertension (n = 35) and pheochromocytoma (n = 3). The erythrocyte Na+/Li(+)-countertransport (SLC) activity was on average higher (p < 0.02) in the patients with essential hypertension as compared to those with secondary hypertension, although a clear distinction between both groups was not possible. After surgical treatment of the patients with atherosclerotic renal artery stenosis, fibromuscular dysplasia or pheochromocytoma, no change in erythrocyte SLC activity was observed. However, blood pressure was significantly reduced.
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PMID:Red blood cell sodium-lithium countertransport in patients with essential and renal hypertension. 800 44


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