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Mayo Clinic Proceedings Nov 1989The contributions in this symposium address the causes of both essential and secondary hypertension, optimal diagnostic techniques, treatment regimens, and long-term...
The contributions in this symposium address the causes of both essential and secondary hypertension, optimal diagnostic techniques, treatment regimens, and long-term management of the hypertensive patient through a continued-care program. The intended emphasis is on issues that will have practical use in patient assessment and evaluation of therapeutic options. In particular, our goal was to provide current information that could enhance the care of the hypertensive patient.
Topics: Antihypertensive Agents; Humans; Hypertension; Sodium, Dietary; United States; Weight Loss
PubMed: 2593723
DOI: No ID Found -
The American Journal of Cardiology Feb 1989Hypertensive encephalopathy is a rare complication of severe or malignant hypertension. When treated promptly it is potentially reversible without leaving long-term... (Review)
Review
Hypertensive encephalopathy is a rare complication of severe or malignant hypertension. When treated promptly it is potentially reversible without leaving long-term neurologic damage. It can be difficult to differentiate from cerebrovascular accidents or uremia. Acute elevations of intracranial pressure cause acute elevations of blood pressure--the Cushing reflex. This association is less clear for chronic elevations of intracranial pressure, which could occur with tumors. In patients with hypertensive encephalopathy, there are usually diffuse neurologic signs, evidence of visual upset, variable alterations in conscious level, and often a history of rather gradual onset and more systemic symptoms beforehand. The optic fundi show the characteristic hemorrhages, exudates and papilledema, while the urine usually contains protein red cells and casts. Early treatment is mandatory but need not be by the parenteral route, and any blood pressure reduction should be gradual. Vigorous antihypertensive therapy under such circumstances can lead to problems with relative hypotension and underperfusion of vital organs such as the brain, the heart and the kidneys.
Topics: Animals; Brain Diseases; Humans; Hypertension; Hypertension, Malignant; Intracranial Pressure; Reflex
PubMed: 2643847
DOI: 10.1016/0002-9149(89)90398-6 -
American Journal of Hypertension Nov 1997The aim of this study was to evaluate whether sustained hypertensives with high clinic blood pressure, despite multiple drug treatment, show a true resistant... (Clinical Trial)
Clinical Trial
The aim of this study was to evaluate whether sustained hypertensives with high clinic blood pressure, despite multiple drug treatment, show a true resistant hypertension or a "white-coat effect," and whether the pretreatment white-coat effect is maintained despite pharmacological therapy. The occurrence of resistant hypertension was determined in 250 consecutive essential hypertensives who had had an ambulatory blood pressure monitoring before treatment assignment. Twenty-seven of 250 hypertensives with persistently high clinic blood pressure despite 3 months of adequate pharmacological therapy underwent further ambulatory blood pressure monitoring. Using our internal standards, seven patients had a true resistant hypertension whereas 20 subjects showed a large white-coat effect (white-coat resistant hypertension), ie, high clinic blood pressure (> 140/90) but "normal" ambulatory daytime (< 139/90 mm Hg) and 24 h (135/85 mm Hg) blood pressure. Using other cutoff points for ambulatory blood pressure, 134/90 and 135/85 mm Hg for daytime blood pressure, 10 and 13 patients, respectively, were reclassified as true resistant hypertensives and 17 and 14, respectively, were white-coat resistant hypertensives. Interestingly, in white-coat resistant hypertensives the large differences between clinic and ambulatory daytime blood pressure (white-coat effect), recorded before treatment assignment, were not affected by drugs and remained constant over time. Left ventricular mass index in white-coat resistant hypertensives was significantly lower than in truly resistant hypertensives, suggesting that prognosis could differ between these groups. In this study, using either our internal standards or some other cutoffs reported in the literature, the white-coat phenomenon was an important cause of resistant hypertension. The use of ambulatory blood pressure monitoring in these patients may avoid misdiagnosis of resistant hypertension, unnecessary overtreatment, and expensive procedures to look for possible secondary hypertension.
Topics: Antihypertensive Agents; Blood Pressure Monitoring, Ambulatory; Drug Resistance; Electrocardiography; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Male; Middle Aged; Patient Compliance; Prognosis
PubMed: 9397251
DOI: 10.1016/s0895-7061(97)00318-x -
Presse Medicale (Paris, France : 1983) Mar 2002EXTENSIVE AND COSTLY INVESTIGATIONS: Are not warranted in the vast majority of hypertensive patients. Characteristics identifying the patients at risk for secondary... (Comparative Study)
Comparative Study Review
EXTENSIVE AND COSTLY INVESTIGATIONS: Are not warranted in the vast majority of hypertensive patients. Characteristics identifying the patients at risk for secondary hypertension can be used to define the small percentage of patients with hypertension who require more extensive diagnostic testing and management of their condition. Exposure to certain medicines, foods or drugs may cause reversible rises in blood pressure. Renovascular and adrenal diseases cause curable forms of hypertension. IN MANY CASES, THE PATIENT'S HISTORY: Examination and simple tests can detect such exposures and disorders. Checking for secondary hypertension is therefore an early step required for the management of all patients with hypertension, provided it is based on clinical signs and inexpensive tests. This primary screening cannot exclude the possibility of renovascular or adrenal disease in a small number of asymptomatic patients. The risk of missing a diagnosis is acceptable provided that blood pressure is normalized by non-specific antihypertensive treatment. However, more extensive etiologic investigation is required in patients who subsequently develop resistant hypertension. This secondary screening requires imaging and biochemical tests that are not required for primary screening. CORRECTION OF THE CAUSES: Of secondary forms of hypertension may restore blood pressure to normal. The patient's age affects the reversibility of renovascular and adrenal hypertension after etiologic treatment: the younger the patient, the higher the probability of blood pressure normalization.
Topics: Adenoma; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adult; Age Factors; Aged; Antihypertensive Agents; Diagnosis, Differential; Female; Humans; Hyperaldosteronism; Hypertension; Hypertension, Renovascular; Iatrogenic Disease; Magnetic Resonance Imaging; Male; Middle Aged; Pheochromocytoma; Prospective Studies; Renal Dialysis; Risk Factors
PubMed: 11913083
DOI: No ID Found -
Journal of the American Academy of... Feb 2003To provide nurse practitioners (NPs) with updated information regarding the etiology, diagnosis, and treatment of childhood hypertension. (Review)
Review
PURPOSE
To provide nurse practitioners (NPs) with updated information regarding the etiology, diagnosis, and treatment of childhood hypertension.
DATA SOURCES
Extensive review of the scientific literature regarding hypertension, including the latest NIH recommendations.
CONCLUSIONS
Hypertension affects more than 350,000 American children. While the majority of hypertension in early childhood occurs from secondary causes, the incidence of essential hypertension in later childhood and adolescence is rising, raising concerns as elevated pressures in childhood "track" into adulthood. Early detection and treatment of elevated childhood pressures represent important steps in reducing long-term cardiovascular risk.
IMPLICATIONS FOR PRACTICE
NPs must be able to accurately differentiate between primary and secondary hypertension in childhood. Secondary hypertension requires prompt diagnosis and treatment, and controlling primary childhood hypertension has lifelong implications. Given the familial predisposition to hypertension, it is important for adult NPs to be aware of the risks faced by children of hypertensive patients.
Topics: Adolescent; Age Factors; Child; Humans; Hypertension
PubMed: 12640940
DOI: 10.1111/j.1745-7599.2003.tb00352.x -
Clinical Research in Cardiology :... Jul 2014Hypertension and hypertensive heart disease is one of the main contributors to a growing burden of non-communicable forms of cardiovascular disease around the globe. The... (Review)
Review
Hypertension and hypertensive heart disease is one of the main contributors to a growing burden of non-communicable forms of cardiovascular disease around the globe. The recently published global burden of disease series showed a 33 % increase of hypertensive disorders in pregnancy in the past two decades with long-term consequences. Africans, particularly younger African women, appear to be bearing the brunt of this increasing public health problem. Hypertensive heart disease is particularly problematic in pregnancy and is an important contributor to maternal case-fatality. European physicians increasingly need to attend to patients from African decent and need to know about unique aspects of disease presentation and pharmacological as well as non-pharmacological care. Reductions in salt consumption, as well as timely detection and treatment of hypertension and hypertensive heart disease remain a priority for effective primary and secondary prevention of CVD (particularly stroke and CHF) in African women. This article reviews the pattern, potential causes and consequences and treatment of hypertension and hypertensive heart disease in African women, identifying the key challenges for effective primary and secondary prevention in this regard.
Topics: Africa; Age Factors; Black People; Cardiovascular Diseases; Female; Heart Diseases; Humans; Hypertension; Hypertension, Pregnancy-Induced; Pregnancy; Risk Factors; Stroke
PubMed: 24468894
DOI: 10.1007/s00392-014-0660-z -
Vnitrni Lekarstvi Jun 1996Treatment of hypertension plays a key role in primary prevention of cerebrovascular attacks. Meta-analysis of 17 prospective studies of the treatment of hypertension... (Review)
Review
Treatment of hypertension plays a key role in primary prevention of cerebrovascular attacks. Meta-analysis of 17 prospective studies of the treatment of hypertension proved that reduction of the systolic and diastolic blood pressure by 8-10/5-6 mmHg leads to a reduction of fatal and non-fatal cerebrovascular attacks by 40%. In the nineties a Swedish and British investigation of systolic-diastolic hypertension in elderly subjects-STOP and MRC-provided evidence of the great impact of treatment of hypertension in primary prevention of cerebrovascular attacks also in elderly hypertensive subjects (60-80 years). It is important to treat also in advanced age frequent isolated systolic hypertension as this improves markedly the prognosis of these patients and reduces the incidence of cerebrovascular and coronary complications, as was proved by the American study SHEP. The authors demonstrate that so far only the minority of hypertensive patients is treated effectively in this country and data from abroad indicate also that treatment of hypertension is lacking in the premorbid stage in more than half the patients with a cerebrovascular attack. The drugs of choice in treatment of hypertension in the elderly are small doses of thiazide diuretics and cardioselective beta-blockers or beta-blockers with ISA. By increasing the number of treated hypertensive patients, incl. elderly patients with a hypertension, and by increasing the effectiveness of treatment it is possible to achieve a decline of the cerebrovascular mortality; our objective must be a decline of the cerebrovascular mortality by more than 50%, similarly as it happened already in the USA. Conversely the importance of treatment of hypertension in secondary prevention of cerebrovascular attacks is controversial. The authors emphasize also the importance of abstinence from smoking as well as careful treatment of diabetes and hyperlipidaemia. Antiaggregation treatment has a greater impact in secondary prevention than treatment of hypertension. As regards the latter it should suffice to reduce the blood pressure to values of cca 150-160/90 -100 mmHg and not to normal values.
Topics: Cerebrovascular Disorders; Humans; Hypertension
PubMed: 8928416
DOI: No ID Found -
Revue Medicale Suisse Sep 2022Women are less frequently affected by arterial hypertension than men during their reproductive life, but their risk catches up and exceeds men's after the menopause....
Women are less frequently affected by arterial hypertension than men during their reproductive life, but their risk catches up and exceeds men's after the menopause. There is a knowledge gap about the specificity of arterial hypertension in women, due to an under inclusion of women in clinical trials. Hypertensive disorders of pregnancy are a recognized ulterior cardiovascular risk factor, and obstetrical history must be part of the evaluation of hypertensive women. In certain cases, we propose to lower the doses of antihypertensive medications in women, due to increased efficiency and increased risk of secondary effects, most notably for thiazide diuretics and calcium channel blockers.
Topics: Antihypertensive Agents; Calcium Channel Blockers; Female; Humans; Hypertension; Male; Pregnancy
PubMed: 36103118
DOI: 10.53738/REVMED.2022.18.795.1689 -
International Journal of Cardiology Dec 2017Males are born in excess of females and the ratio is expressed as M/F (male/female births=secondary sex ratio, also known as secondary sex ratio). This is expected to...
BACKGROUND
Males are born in excess of females and the ratio is expressed as M/F (male/female births=secondary sex ratio, also known as secondary sex ratio). This is expected to approximate 1.048. Racial M/F disparities are known. A recent study in China showed that pregravid systolic hypertension is higher in women who delivered a boy than in those who had a girl. This study was carried out in order to identify the effect of pregravid hypertension in the United States on M/F by race.
METHODS
Monthly male and female live births by race for the entire US along with the presence/absence of hypertension were obtained from the website of the Centers for Disease Control and Prevention for 2007-2015 for the four racial groups: American Indian or Alaska Native, Asian or Pacific Islander, Black or African American and White.
RESULTS
This study analysed 36,364,253 live births. For White births, mothers who had chronic hypertension were likelier to have male than female offspring when compared to non-hypertensives (p=0.003). Conversely, Black or African American mothers who had hypertension were less likely to have male than female offspring when compared to non-hypertensives (p=0.022). There were F differences for/F differences for the presence or absence of hypertension for the other two races or for the total.
CONCLUSIONS
It is possible that hypothesised innate interracial periconceptual hormonal differences may modulate M/F responses to hypertension in different races.
Topics: Asian People; Black People; Female; Humans; Hypertension; Indians, North American; Infant, Newborn; Pregnancy; Pregnancy Complications, Cardiovascular; Racial Groups; Sex Ratio; United States; White People
PubMed: 28811091
DOI: 10.1016/j.ijcard.2017.08.023 -
South African Medical Journal =... Jan 2016Hypertension is the leading cause of death worldwide. Globally and locally there has been an increase in hypertension in children, adolescents and young adults<40 years... (Review)
Review
Hypertension is the leading cause of death worldwide. Globally and locally there has been an increase in hypertension in children, adolescents and young adults<40 years of age. In South Africa, the first decade of the millennium saw a doubling of the prevalence rate among adolescents and young adults aged 15-24 years. This increase suggests that an explosion of cerebrovascular disease, cardiovascular disease and chronic kidney disease can be expected in the forthcoming decades. A large part of the increased prevalence can be attributed to lifestyle factors such as diet and physical inactivity, which lead to overweight and obesity. The majority (>90%) of young patients will have essential or primary hypertension, while only a minority (<10%) will have secondary hypertension. We do not recommend an extensive workup for all newly diagnosed young hypertensives, as has been the practice in the past. We propose a rational approach that comprises a history to identify risk factors, an examination that establishes the presence of target-organ damage and identifies clues suggesting secondary hypertension, and a limited set of basic investigations. More specialised tests should be performed only where there is a clinical suspicion that a secondary cause for hypertension exists. There have been no randomised clinical trials on the treatment of hypertension in young patients. Expert opinion advises an initial emphasis on lifestyle modification. This can comprise a diet with reduced salt and refined carbohydrate intake, an exercise programme and management of substance abuse issues. Failure of lifestyle measures or the presence of target-organ damage should prompt the clinician to initiate pharmacotherapy. We recommend referral to a specialist practitioner in cases of resistant hypertension, where there is severe target-organ damage and when a secondary cause is suspected.
Topics: Adolescent; Adult; Age Factors; Disease Management; Essential Hypertension; Humans; Hypertension; Life Style; Morbidity; Risk Factors; South Africa; Young Adult
PubMed: 26933708
DOI: 10.7196/samj.2016.v106i1.10329