Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085580 (essential hypertension)
 14,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

210 patients receiving antihypertensive treatment underwent non-invasive ambulatory blood-pressure monitoring for the first time. 44 suffered from chronic renal failure, 51 had been renal transplanted, 36 had chronic glomerulonephritis, 36 had renovascular hypertension, and 43 had essential hypertension with severe end-organ damage. We analyzed the Circadian rhythm and the rate of insufficient antihypertensive treatment. While mean daytime systolic and diastolic blood pressure were not different between groups, patients with chronic renal failure, renal transplant or glomerulonephritis showed a very high rate (95-72%) of absent nighttime blood-pressure reduction. In patients with renovascular hypertension or complicated essential hypertension there was a lower rate (69-40%) of absent nighttime blood pressure reduction. The ambulatory blood-pressure monitoring led to a modification of antihypertensive treatment in 78% of patients because of nighttime hypertension. We think that ambulatory blood-pressure monitoring is an essential tool for physicians treating patients with renal disease or complicated essential hypertension.
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PMID:[The value of noninvasive 24-hour blood pressure measurement in patients with renoparenchymal, renovascular or severe essential hypertension]. 151 8

To elucidate the pathophysiologic significance of the family of endothelin (ET) peptides, we have investigated plasma and urinary immunoreactive (ir-) ET levels and its molecular forms in normal and pathological conditions. Plasma and urine ET were extracted with an Amprep C2 column. The molecular form of ET was determined by a combination of radioimmunoassay and reverse-phase high-performance liquid chromatography. Although plasma ir-ET was composed mainly of big ET and endothelin-1 (ET-1) in normal subjects, that in acute myocardial infarction, chronic renal failure (CRF), essential hypertension, and vasospastic angina pectoris was characterized by an increase of high molecular ir-ET in addition to increases in big ET and ET-1. Urinary ir-ET in both normal subjects and patients with CRF was composed mainly of a high molecular form in addition to big ET and ET-1. These results suggest that the biosynthetic and/or degradation process of ET under pathological conditions appears to be different from that under normal conditions.
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PMID:Molecular form of immunoreactive endothelin in plasma and urine of normal subjects and patients with various disease states. 172 26

Calcium-entry blockers exert several characteristic effects on the kidney that potentiate their antihypertensive effect. Long-term therapy with nitrendipine, a dihydropyridine derivative, lowers blood pressure while maintaining renal hemodynamics within limits similar to pretreatment values in essential hypertension with normal renal function. This is accompanied by a persistent natriuretic effect that probably facilitates its antihypertensive action and is not followed by changes of the renin-angiotensin-aldosterone system. Preliminary data also seem to indicate that nitrendipine could be safely used in patients with arterial hypertension and chronic renal failure.
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PMID:Renal effects of nitrendipine. 172 95

Duplex Doppler ultrasonography may explore renal perfusion in frequent diseases such as renal obstruction, reno-vascular hypertension, acute or chronic renal failure or diabetic renal complications by measuring Pourcelot's resistive index (RI) of renal parenchyma arteries for each kidney. A statistical and prospective study was performed on 574 patients. In healthy patients, the RI values, equal for each kidney were included in 0.45 and 0.7 (mean RI = 0.59). For other values, there was a renal pathology. Patients with idiopathic hypertension (mean RI = 0.59) or non obstructive dilatation (mean RI = 0.61) did not have an RI significantly different from healthy patients. In cases of renal obstruction, there was a significant increase in the RI for the pathological kidney (mean RI of 0.73). The sensitivity and the specificity was 100% for acute obstructions examined during the first 48 hours. In contrast, in case of renal artery stenosis greater than 70% there was a significant decrease in the RI for pathological kidney. So the RI increased significantly in both kidneys: when there was renal failure with active disease within the tubulo-interstitial compartment (mean RI of 0.77); in all cases of diabetic nephropathy (mean RI of 0.74) where the RI increased early before laboratory signs. Duplex Doppler ultrasonography may be an original method for renal explorations by providing not only morphological data but also physiological data with the perfusion study.
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PMID:[Duplex Doppler ultrasonography of intra-renal arteries. Normal and pathological aspects]. 177 87

Twenty nine patients with chronic renal failure associated with severe essential hypertension, 10 of whom being on programmed hemodialysis, were treated with captopril, a converting enzyme inhibitor (n = 21) and sectral-400, a cardioselective beta-blocker (n = 11). Blood pressure (BP) changes and renin-angiotensin-aldosterone system parameters were studied by radioimmunoassay. When given in a daily dose of 25 to 100 mg for a long time, captopril provided a good and satisfactory antihypertensive effect in 9 patients; a weak or no effect was achieved in 9 and 5 patients, respectively. BP lowered by an average of 14.7%. There were 72% and 17.9% increases in active and total renin levels, respectively, and a reduction in the proportion of inactive in total renin. With sectral-400, 400-1200 mg/day, good, weak or no effects were observed in 6, 3, and 2 patients, respectively. BP decreased by an average of 13%, there were 59% and 12% reductions in active and total renin levels, respectively, whereas the content of inactive renin showed a 21% increase, suggesting a diminution of renin synthesis and activation. The initially higher plasma aldosterone levels in most patients (by an average of 4.2 times) decreased significantly by 23% with the two drugs. Thus, in severe essential hypertension it is advisable to use blockers of the renin-angiotensin system in patients with chronic renal failure, captopril is particularly indicated in those who have a high renin activity, and the hyperkinetic syndrome is an additional indicator for sectral-400 use.
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PMID:[The treatment of severe arterial hypertension in patients with chronic kidney failure with captopril and beta-adrenoblockaders]. 187 23

Pathophysiologic and hereditary mechanisms impacting on the kidneys are crucial for the initiation and maintenance of essential hypertension. An appreciation of these renal mechanisms is important for the institution of appropriate antihypertensive therapy. The clinician must develop a physiologic algorithm to control systemic blood pressure while maintaining adequate blood supply to the kidneys. This approach is particularly important in patients at higher risk for progressive renal insufficiency (i.e., older patients, blacks, diabetics, and those with chronic renal failure). Better perfusion reduces the likelihood of activating the compensatory neurohormonal systems that augment the intrarenal effects of the renin-angiotensin-aldosterone and sympathetic nervous systems, which ultimately may be responsible for renal structural changes leading to nephrosclerosis. In addition, dietary concerns are also important, particularly in the patients with evidence of early renal disease. Controlling blood pressure in a physiologic way by using drugs that can potentially dampen neurohormonal systems may prevent or at least delay the development of nephrosclerosis. Thus, the clinician should use an individualized therapeutic approach to the patient with hypertension. If nonpharmacologic means of blood pressure control are unsuccessful, an attempt should be made to blend the specific physiologic needs of the patient with specified pharmacologic antihypertensive mechanisms, paying particular attention to the preservation of renal function and perfusion.
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PMID:Hypertension and the kidney. 194 86

The aim of this study was to assess the blood pressure profile of chronic renal failure in comparison with essential hypertension. Thirty hypertensive patients with chronic renal failure due to non-vascular nephropathies were matched by age, sex, and mean 24 h blood pressure, with 30 patients affected by uncomplicated mild-to-moderate essential hypertension. They were studied in an open hospital ward. Diet, meal times, sleep times, and activity schedules were standardized. Noninvasive, automatic, blood pressure recordings were performed for 48 h at sampling intervals of 15 min. The mean 24 h blood pressure almost coincided in the two groups. However, in essential hypertension a mean (+/- SD) nocturnal fall of systolic and diastolic blood pressure was found (12.7 +/- 3.8 and 12.9 +/- 4.8 mm Hg, respectively), while renal patients displayed an average nocturnal increase of 2.7 +/- 8.9 mm Hg and 3.7 +/- 7.8 (P less than .001). The renal patients had also higher heart rates, with a significantly blunted nocturnal fall (4.4 +/- 4.5 beats/min as compared to 9.3 +/- 3.1 beats/min of essential hypertension; P less than .001). Among the renal patients, the day-night blood pressure changes showed no significant correlation with age, creatinine clearance, hematocrit, nocturnal change in heart rate, or day or night mean blood pressure levels. These data suggest that an abnormal day-night pattern of blood pressure is present in chronic renal failure patients independently from external interfering factors. Hence, casual measurements of blood pressure confined to daytime may underestimate a hypertensive condition associated with chronic renal failure.
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PMID:Loss of nocturnal decline of blood pressure in hypertension due to chronic renal failure. 200 93

The extended use of ambulatory monitoring has permitted the identification of many conditions in which the circadian rhythm of blood pressure is altered. The common denominator seems to be an impairment of the autonomic nervous system function. We examined whether the circadian blood pressure rhythm is altered in chronic renal failure (where autonomic dysfunction is usually present) by using a standardized chronobiological inferential statistical method in hospitalized subjects. For this purpose, a group of 30 non-hemodialysis hypertensive patients with chronic renal failure was compared with a second group of 30 patients affected by uncomplicated mild-to-moderate essential hypertension. The two groups were matched by age, sex and circadian mesors of blood pressure. Diet, meal times, sleep, and activity logs were standardized. Blood pressure and heart rate recordings were obtained by using an automatic oscillometric recorder and subsequently analyzed according to the cosinor method. A mean circadian rhythm of blood pressure was documented in both groups, but while the mean acrophases occurred between 2 and 3 p.m. in essential hypertension, in renal failure they were between 11 p.m. and midnight for blood pressure and around 7 p.m. for heart rate. In addition, the mean circadian amplitudes were significantly lower in renal failure, while the mean circadian mesor of heart rate was significantly higher. Our data demonstrate that the circadian rhythms of blood pressure and heart rate are altered also in hypertension due to chronic renal failure.
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PMID:Altered circadian rhythms of blood pressure and heart rate in non-hemodialysis chronic renal failure. 208 73

99mTc-mercaptoacetyltriglycine (MAG3) has been proposed as an alternative to 131I-orthoiodohippurate (OIH) for the scintigraphic determination of effective renal plasma flow (ERPF). The purpose of this study was to compare the ERPF values determined simultaneously with MAG3 and OIH by a dual channel technique in a large group of subjects with widely ranging renal function. During the last two years, we administered a simultaneous injection of 74 MBq of MAG3 and 0.74 MBq of OIH to each subject who underwent a renal scintigraphic study in our hospital. They were 53 females and 50 males (mean age: 52 years; range: 18-70 years), either normal (30) or with a diagnosis of essential hypertension (53), chronic renal failure (14), renal calculi (5), or renal transplant (1). Plasma clearance and ERPF were calculated with both radiocompounds by using the exponential formula of Tauxe and coworkers and a single plasma concentration determination sampled 44 min after injection of the two tracers. The time-activity curves for kidney and blood were of the same bi-exponential type. The mean ratio between the two plasma clearances was 0.49. The linear regression of the ERPF values obtained with the two radiocompounds was highly significant (r = 0.69; p less than 0.0001) and is expressed by the equation: ERPF (MAG3) = 0.453 ERPF (OIH) + 25.7. These data suggest that the routine calculation of ERPF from MAG3 clearance is consistent with the results obtained from OIH clearance. In conclusion, MAG3 appears to be a good predictor of ERPF in routine clinical practice.
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PMID:99mTc-MAG3 versus 131I-orthoiodohippurate in the routine determination of effective renal plasma flow. 214 11

Plasma levels of immunoreactive N-terminal ProANP have been measured in plasma from 19 healthy individuals, 15 patients with essential hypertension, 8 cardiac transplant recipients and 8 patients with chronic renal failure using two separate radioimmunoassays (RIAs), one directed against ProANP (1-30) and the other against ProANP (79-98). The mean concentrations of ProANP (1-30) and ProANP (79-98) were elevated in these groups of patients. There were positive correlations between levels of ProANP (1-30) and ProANP (79-98), with a correlation coefficient of 0.97 (P less than 0.001, n = 50). In healthy individuals a 2-1 (isotonic) saline infusion significantly increased both ANP (99-126) (P less than 0.05, n = 8) and N-terminal ProANP (P less than 0.005, n = 8) within 15 min of the end of the infusion. Plasma N-terminal ProANP levels were still significantly elevated after 75 min (P less than 0.05, n = 8) and 225 min (P less than 0.05, n = 8), by contrast ANP (99-126) had returned to basal values. Gel filtration of plasma extracted on Sep-Pak C-18 from normal individuals and patients gave a single immunoreactive peak for N-terminal ProANP as measured by both N-terminal ProANP assays, indicating an absence of small N-terminal fragments and the presence of a single high molecular weight form. These studies demonstrate that the major circulating N-terminal ANP in man is probably ProANP (1-98) and that it is cosecreted with ANP (99-126).
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PMID:Concentrations of N-terminal ProANP in human plasma: evidence for ProANP (1-98) as the circulating form. 215 13


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