Natural Ways to Treat Hypertension
1.1 Primary pulmonary hypertension c) Portal hypertension d) HIV-associated pulmonary hypertension Pulmonary hypertension is classified into three clinical stages 1. Latent pulmonary hypertension is characterized by mean pulmonary arterial pressures (PAP) below 21 mmHg with an exercise-induced increase to values above 30 mmHg. The patients suffer from dyspnea upon exercise. 2. At the stage of manifested pulmonary hypertension, mean PAP exceeds 25 mmHg at rest. Patients already suffer from dyspnea during light exercise. 3. Severe pulmonary hypertension is characterized by a severely reduced cardiac output at rest, which cannot be increased upon exercise due to the increase in right ventricular afterload. Thus, patients are unable to perform any physical activity without distress.
Hypertension should be treated when blood pressure increases to higher than 170 mm Hg systolic or 105 mm Hg diastolic. Treatment consists of intravenous hydralazine (Apresoline), 6.25 to 25.0 mg every four to six hours. Recent studies have also used oral labetalol (Normodyne, Trandate) , 600 mg PO qid, or oral nifedipine, 20 mg PO q4h. Maintaining the blood pressure between 140 and 150 mm Hg systolic and between 90 and 100 mm Hg diastolic decreases the risk of placental hypoperfusion.
Various humoral and cardiovascular systems play a role in controlling blood pressure. Among them are the renin-angiotensin-aldosterone system, endothelin, oxida-tive stress, obesity, and the sympathetic nervous system. Aging is associated with changes in most of these systems, and this could impact the roles they may play in mediating hypertension. The following will be a concise overview of the humoral factors that could affect blood pressure in aging individuals and that are subsequently investigated in models of age-related increases in blood pressure. Superoxide is known to interact with nitric oxide (NO) to cause quenching of NO and to produce peroxy-nitrite, one of the most potent oxidative compounds known (Pryor and Squadrito, 1995). Thermodynamically speaking, the reaction of NO and superoxide is preferential since the rate of reaction is more rapid than the reaction rate of superoxide and its scavenger, superoxide dismutase (Pryor and Squadrito, 1995). The interaction between...
The use of transgenic animal models to study the role that specific genes play in causing hypertension has been a focus of much research. However, to our knowledge there are no studies in which the mice were allowed to age. With the exception of a few models that are severely hypertensive and will not survive more than a few weeks or months, the lack of data in aging hypertensive trans-genics likely reflects the specific interest of the investigators who developed the strains that is, the animals were developed to answer a question not involving aging. Following we describe the most common transgenic hypertensive strains. TGR(mREN2)27. TGR(mREN2)27 is the first rat model of hypertension caused by a defined genetic defect. The TGR(mREN2)27 harbors the murine Ren-2 gene on the genetic background of the SD rat. These transgenic rats develop fulminant hypertension at an early age despite low levels of renin in plasma and kidney. High expression of the renin transgene in extrarenal tissues...
The SHR is a commonly used model of hypertension (Reckelhoff, 2001). These animals develop increases in blood pressure beginning at six to seven weeks of age and reach a stable level of hypertension by 17 to 19 weeks of age. Inhibitors of the renin-angiotensin system reduce blood pressure in SHR, suggesting a role for the RAS in mediating the hypertension. Removal of the renal nerves also reduces blood pressure in SHR, suggesting that the sympathetic nervous system is important in mediating the hypertension. Because increased sympathetic activity can stimulate renin release from the kidney, it is possible that the up-regulated RAS in SHR may be due to increased sympathetic activation. In addition to the RAS and sympathetic nervous system in mediating the hypertension in SHR, treatment with antioxidants also reduces blood pressure, suggesting a role for oxidative stress in the hypertension of SHR. For example, treatment with tempol, a superoxide scavenger, reduces blood pressure...
In addition to the common genetic models of hypertension discussed earlier, there are also nongenetic models in which the hypertension is caused by infusion of a drug or by dietary manipulations or by placing a clip on the renal artery. The following is a list of such models. DOCA and salt model in aging animals This model of hypertension is a model of mineralo-corticoid hypertension developed by implanting the rats with deoxycorticosterone acetate (DOCA) pellets (typically 100 mg) and treating them with salt water (1 ). This is another model of salt-sensitive hypertension. The hypertension develops rapidly, usually within a week of the DOCA being implanted. The systems that mediate the hypertension include oxidative stress since antioxidants reduce the blood pressure (Elhaimeur et al., 2002). Agonists of serotonin receptor 5HT1A and antagonists of serotonin receptor 5HT2B reduce the blood pressure in DOCA-salt treated rats, implicating serotonin in the hypertension (Shingala and...
Abnormal pressure-natriuresis in hypertension Substantial evidence supports the theory that some form of renal dysfunction plays a role in the development and maintenance of hypertension. A common defect that has been characterized in all forms of hypertension studied to date is a shift in the pressure-natriuresis relationship (Guyton et al., 1972 Hall et al., 1990). The pressure-natriuresis relationship refers to the fact that increased arterial pressure elicits a marked increase in sodium excretion. According to the renal body fluid feedback concept, a long-term increase in arterial pressure or hypertension occurs as a result of a reduction in renal excretory function or a rightward shift in the pressure-natriuresis relationship. In kidneys from normo-tensive individuals, when sodium intake is increased, the blood pressure will increase transiently to increase sodium excretion. When the sodium load has been excreted, the blood pressure returns to normal levels. However, in a...
A number of genome-wide genetic linkage studies of hypertension in affected relative pairs (Caulfield et al., 2003 Kardia et al., 2003 Rao et al., 2003 von Wowern et al., 2003), quantitative levels of blood pressure (de Lange et al., 2004 James et al., 2003) or other study designs have been undertaken in an attempt to localize genes with substantial effects. Candidate gene investigations comparing case control allele frequencies have also been widely applied in studies of hypertension. (e.g. the upper 5 or even better, upper 1 of the blood pressure distribution adjusted for age and sex). Only a few linkage investigations to date could be said to approach these power requirements, notably the British Genetics of Hypertension Study (BRIGHT) (Caulfield et al., 2003) and the NIH HyperGen study (Rao et al., 2003). BRIGHT, which is the largest individual study, comprises more than 2000 affected sibpairs selected to be in the upper 10 5 of the blood pressure distribution. Based on...
Treatment of hypertension varies and may include exercising and water, reducing the volume of body fluids. Sympathetic inhibitors block the synthesis of neurotransmit-ters, such as norepinephrine, or block receptor sites of effector cells. Table 15B describes how drugs that treat hypertension work. Hypertension Drugs to Treat Hypertension Drugs to Treat Hypertension
CoQ10 has been studied both as stand-alone and adjunctive treatment in hypertension. According to a review of 8 studies, supplemental CoQ10 results in a mean decrease in systolic blood pressure of 16 mmHg and in diastolic blood pressure of 10 mmHg (Rosenfeldt et al 2003). The effect on blood pressure has been reported within 10 weeks of treatment at doses usually starting at 100 mg daily. One small 10-week open study of 26 subjects with essential hypertension study found that an oral dose of 50 mg taken twice daily also reduced total serum cholesterol levels with a
All forms of hypertension studied to date are caused by a defect in the handling of sodium and water by the kidney. There is a shift to the right in the pressure-natriuresis relationship (higher blood pressure) in which a hypertensive individual must increase blood pressure in order to excrete a normal sodium load. There are sex differences in blood pressure control in humans and animals, with males having higher blood pressure than females. However, blood pressure increases in some women after menopause. The mechanisms that play a role in hypertension, and have been studied extensively, include the renin-angiotensin-aldosterone system, endo-thelin, oxidative stress, the sympathetic nervous system, androgen estrogen ratio, and obesity. Rats and mice are commonly used for the study of hypertension and aging. There are both genetic and nongenetic models of hypertension in which the animals exhibit increases in blood pressure spontaneously or are genetically predisposed to increase blood...
PIH is a syndrome manifesting after the 20th week of gestation characterized by hypertension (greater then 140 90 mmHg or a greater then 30 15 mmHg increase from baseline), proteinuria ( 500 mg day), generalized edema, and complaints of headache. Severe PIH is defined as BP 160 110, pulmonary edema, proteinuria 5 gm day, oliguria, central nervous system manifestations, hepatic tenderness, or HEELP syndrome. 4. Predisposing factors multiple gestation, major uterine anomalies, chronic hypertension, chronic renal disease, diabetes, polyhydramnios, molar pregnancy, fetal hydrops. PIH chiefly affects primigravidas (especially those with vascular disorders).
Beta blockers are widely used in the management of cardiovascular disorders, including hypertension, angina pectoris, and cardiac arrhythmias. These drugs decrease the heart rate and the cardiac output, decrease blood pressure, and can decrease IOP. Although thiazide-type diuretics are used as initial therapy for most patients with hypertension, beta blockers are commonly used for stage 2 hypertension or other compelling indications.1 Systemic hypertension and glaucoma often coexist in patients, and glaucoma patients frequently use systemic cardiovascular medications.2 Beta-adrenergic blocking drugs for long-term therapy of systemic hypertension are listed in table 9.1. After oral administration of propranolol to ocular hypertensive patients, reduction of IOP occurs within 1 hour, reaching a maximum at 3 hours and lasting at least 7 hours (figure 9.1).8 The reduction of IOP is greater in patients with higher initial measurements compared with lower...
Hypertension is a well-established risk factor for atherosclerosis. High blood pressure is also associated with abnormalities in calcium homeostasis leading to hyper-calciuria (Cappuccio et al., 1999). This negative calcium balance is associated with decreased bone mineral density. In a prospective study involving 3676 white women, after adjusting for age, body weight, smoking, and baseline bone mineral density, higher blood pressure in elderly women was associated with increased bone loss at the femoral neck. Therefore, hypertension appears to be a common denominator in both osteoporosis and atherosclerosis in the elderly.
In the 1970s Yamagami et al observed a deficiency in CoQ10 in patients with hypertension (1975, 1976) and suggested that correction of the deficiency could result in hypertensive effects. Small studies were initially conducted with hypertensive patients identified as CoQ10 deficient. Since then, significant antihypertensive activity has been observed in several clinical studies (Burke et al 2001, Digiesi et al 1994, Langsjoen et al 1994), however, not all have identified the subjects' baseline CoQ10 plasma levels and whether oral administration restored levels to within the normal range. It has been suggested that CoQ10 supplementation is associated with a decrease in total peripheral resistance, possibly because of action as an antagonist of vascular superoxide, either scavenging or suppressing its synthesis (McCarty 1999).
For unclear reasons, the risk of developing AD is higher in Black and Hispanic compared to White populations. Although the influence of the ApoE4 polymorphism on increased AD risk is apparent in Blacks, it appears to be less potent compared to Whites. Interestingly, although Black populations in Africa and the United States have similar ApoeE4 allele frequencies, the risk of AD is much higher in the age-matched U.S. Black population. This suggests that unknown environmental factors such as diet or resultant comorbidities may be important culprits. Until recently, vascular dementia was the leading cause of dementia in Japan, but this is shifting to AD, despite a low ApoE4 allele frequency, as life expectancy increases and stroke risk factors such as hypertension are better managed.
This is usually of no clinical significance, and may only be an incidental finding at autopsy. However, if there is a marked increase of right-sided pressures as a result of pulmonary hypertension or other causes, the effects of the pressure and the dilatation of the right atrial cavity may lead to a progressive enlargement of the probe-patent foramen . This can then result in a clinically evident right to left shunt, or an acquired atrial septal defect (ASD).
Cardiovascular increased circulating blood volume, increased cardiac output, increased oxygen consumption, systemic hypertension, coronary artery disease, congestive heart failure, and pulmonary hypertension. Cardiac output increases by 0.1 L min kg of adipose tissue.
Clinical features include hypervolemia, hypertension, accelerated atherosclerosis, uremic pericarditis effusions, hyperkalemia, hypermagnesemia, hyponatremia, hypocalcemia, hyperphosphatemia, metabolic acidosis, chronic anemia, platelet dysfunction, delayed gastric emptying, increased susceptibility to infection, CNS changes, glucose intolerance, altered pharmacodynamics.
The elevation of blood pressure, and diastolic pressure in particular, known as hypertension, is fairly common in middle- and late life and especially among older women. The average blood pressure for adults is 120 80, but between 110 70 and 140 90 is not considered a problem. When a person's blood pressure goes over 140 90, however, some form of treatment losing weight and keeping it off, eating less salt, cutting down on alcohol, getting more exercise, and or prescribed drugs is required. High blood pressure can be a serious problem, but it is usually viewed as potentially fatal only by virtue of its association with heart (hypertensive heart disease), kidney, (hypertensive renal disease), or cerebrovascular disease. The designation essential hypertension is used when no other signs of disease are present, or malignant hypertension when the disease has progressed rapidly. Hypertension is significantly more common among blacks than among whites, the difference between the percentage...
Stage 2 (delirium excitement) is characterized by uninhibited excitation. Agitation, delirium, irregular respiration and breath holding. Pupils are dilated and eyes are divergent. Responses to noxious stimuli can occur during this stage may include vomiting, laryngospasm, hypertension, tachycardia, and uncontrolled movement.
Many supporters of a neurological explanation of age-related declines in intelligence view it as the result of small changes in the brain produced by high blood pressure, alcoholism, and other pathological conditions (Rinn, 1988). It is certainly true that intellectual functioning is affected by health status and that people with higher intellectual abilities are healthier and live longer than those with lower abilities. Self-reports of physical and mental health confirm the results of medical diagnoses in this regard (Perlmutter & As discussed in Chapter 3, organic brain disorders can have a pronounced effect on behavior and abilities. This is particularly evident in Alzheimer's disease, a disorder that afflicts approximately 20 of individuals in the 75- to 84-year age range and about 47 of those over 85 (Evans et al., 1989). An even greater percentage of older Americans suffer from hypertension, another disorder that is associated with reduced intellectual functioning (Hertzog,...
To date, there have only been a modest number of structured and evaluated interventions, which have had a primary objective of preventing or limiting weight gain. However, a broader range of projects have examined the most effective strategies for improving physical activity or encouraging specific dietary change or for combating allied chronic noncommunicable diseases such as CHD, hypertension, and diabetes. Examining the lessons
Thalamocortical fibers in the thalamic peduncles that detach from the internal capsule to enter the thalamus at its rostral and caudal poles and along its dorsal surface. Lacunar strokes of the inferior genu of the internal capsule result from involvement of anterior perforators arising from the internal carotid artery (ICA) or from the ACA. These arteries are frequently affected by hypertension and other forms of small-vessel SIVD and could be an unrecognized cause of cognitive deficits. For instance, Ghika et al. (1989) found neuropsychological deficits in up to 34 of patients with lacunes in the territory of deep perforators of the ICA system identified by brain CT.
As a general rule, individual-directed interventions bring about significant benefits to the individuals but have little impact on the population rates of disease or condition in question and vice versa for population-based interventions, which generally bring little benefit to each individual but have the potential to influence the prevalence or incidence of the condition (7). With obesity, this discrepancy is even more exaggerated (compared to, say, hypertension or hypercholesterolemia) because available individual interventions, apart from surgery, have modest long-term effects for the individuals under treatment (8,9). The efforts on population-based interventions related to obesity are much needed but are still in their infancy (1,10,11).
Action inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium, hydrogen ions, magnesium, phosphate, calcium. Indications management of mild-moderate hypertension, or edema associated with congestive heart failure, pregnancy, or nephrotic syndrome in patients unable to take oral hydrochlorothiazide. Dose (adult) 500 mg to 2 gm day PO (100-500 mg day IV at 50-100 mg min) divided in 1-2 doses (max dose 2 gm day) Dose (ped) 20 mg kg day PO (4 mg kg day IV ) in 2 divided doses.
Although there are reports of ginseng causing hypertension, red ginseng is actually used as an antihypertensive agent in Korea. Ginseng is often used in practice as an adjuvant to both conventional and CAM treatments. An open clinical study of 44 hypertensive patients found red ginseng, 1.5 g three times daily (4.5 g day), to be useful as an adjuvant to antihypertensive medication (Han et al 1995). A combination of red ginseng and digoxin was found to be more beneficial than either drug alone in an open study of advanced congestive heart failure. There were no adverse reactions (Ding et al 1995). A combination of ginseng and ginkgo extracts has been found to improve circulation and lower blood pressure in a controlled single-dose study of 10 healthy young volunteers (Kiesewetter etal 1992). Korean red ginseng has also been shown to improve vascular endothelial function in patients with hypertension. The effect is thought to be mediated through increasing the synthesis of nitric oxide...
Ped 0.01 mg kg SC q15 minutes for 2 doses then q4 hrs as needed. Clearance MAO COMT metabolism. Adverse effects may cause hypertension, dysrhythmias, headache, nervousness, nausea vomiting, myocardial ischemia dysrhythmias potentiated by halothane metabolic effects increases adipose tissue lipolysis, liver glycogenolysis, inhibits release of insulin.
Various anthropometric techniques have been used to predict body fat distribution, for example trunk to total skinfold thickness ratio, sagittal diameter, waist-thigh circumference ratio, waist-hip circumference ratio (WHR), or waist circumference (WC) alone (56). Many epidemiological studies have shown that there is a clearly increased risk for metabolic disorders such as hypertension, glucose intolerance, and hyperlipidemia with increased WHR or WC, and the WHO (30) defines cutoff points for abdominal obesity at a waist circumference level of 80 cm and 95 cm for females and males, respectively, and a WHR of 0.85 and 1.00 for females and males, respectively. Like BMI, these cutoff values are based on observational studies mainly among Caucasians (30). Although all studies in various ethnic groups show a positive relationship between parameters of body fat distribution and morbidity, recent studies suggest that the relationship between anthro-pometric parameters and the actual amount...
Thus the early detection of children with vesicoureteric reflux and control of recurrent renal infection could prevent the development of scars, hypertension and chronic renal failure. Radiological investigation of children with UTIs shows normal kidneys in approximately 66 and reflux in approximately 33 .
Establish the history and current situation regarding liver disease, pancreatitis, gastritis, GI haemorhage, jaundice, abdominal pain or swelling. Assess the history and current situation regarding hypertension, arrythmias or cardiomyopathy. Establish the history and current situation regarding neuropathy, memory difficulties, cognitive impairment, psychosis or hallucinations. Establish the history and current situation regarding blackouts or fits and anxiety. Consider fetal alcohol syndrome.
Side-effects may be more pronounced in people with essential hypertension who appear to be more sensitive to the inhibition of 11 HSD by licorice than normotensive subjects (Sigurjonsdottir et al 2003). Hypercortisolism and pseudohyperaldosteronism associated with sodium retention, potassium loss and suppression of the renin-angiotensin-aldosterone system and presenting as hypertension, fluid retention, breathlessness, hypernatraemia and hypokalemia (Bernardi et al 1994, Blachley & Kn chel 1980, Dellow et al 1999, Kageyama et al 1997, Wash & Bernard 1975). Hypokalemia may present as hypotonia and flaccid paralysis, peripheral oedema, polyuria, proximal myopathy, lethargy, paraesthesiae, muscle cramps, headaches, tetany, breathlessness and hypertension (deKlerk et al 1997, Eriksson et al 1999). In practice, licorice is often mixed with the potassium-rich herb dandelion leaf, which also has mild diuretic effects. Hypertension encephalopathy may occur even at low doses in susceptible...
In general, not all placentas are sent for pathological examination. There is a variety of indications for placental examination including gross placental abnormalities, foetal death, foetal physical abnormalities, multiple births and maternal problems such as hypertension and diabetes.
For erections lasting over 4 h, apply cooling agents to the genitals and encourage moderate exercise to the legs to divert blood to the lower limbs. If the erection remains, aspirate 20-50 mL of blood from the corpus cavernosum using a 19 -21 gage butterfly using a sterile technique. This may be followed by irrigation with heparinised saline. If necessary, repeat to the other side. If there is no response proceed to ICI alpha-adrenergic agents. Either phenylephereine 10 mg (1 mL) vial diluted to 10 mL with saline and 0.5 mg (0.5 mL) injected at a time to a maximum of 10 mg (10 mL) or ephedrine 30 mg in 1 mL vial, using 15 mg (0.5 mL) should be given, and repeated once if necessary. Monitor pulse and BP continuously. Proceed with extreme caution in patients with coronary heart disease, uncontrolled hypertension, or cerebral ischemia and in men taking MAOIs as hypertensive crises may occur. See also the latest AUA guidelines (104).
Glycinuria results from a defect in renal tubular reabsorption. The defect in primary hyperoxaluria is the failure to catabolize glyoxylate formed by deamination of glycine. Subsequent oxidation of glyoxylate to oxalate results in urolithiasis, nephrocalcinosis, and early mortality from renal failure or hypertension.
Membranous ventricular septal defect (VSD) is caused by incomplete fusion of the right bulbar ridge, left bulbar ridge, and atrioventricular cushions. This defect results in a condition in which an opening between the right and left ventricles allows left-to-right shunting of blood through the interventricular (IV) foramen. Patients with left-to-right shunting complain of excessive fatigue on exertion. Initially, a membranous ventricular septal defect is associated with left-to-right shunting of blood, increased pulmonary blood flow, and pulmonary hypertension. Later, the pulmonary hypertension causes marked proliferation of the tunica intima and tunica media of the pulmonary muscular arteries and arterioles, thereby narrowing their lumen. Ultimately, pulmonary resistance becomes higher than systemic resistance and causes right-to-left shunting of blood and cyanosis. At this stage, the condition is called the Eisenmenger complex. 2. Acute myocardial infarction (MI heart attack ) most...
People who had low birth weight tend to accumulate fat on the trunk and abdomen, a pattern of adiposity found in the insulin resistance syndrome in which central obesity, impaired glucose tolerance, hypertension, and altered blood lipid concentrations occur in the same patient (9). This disorder is associated with an increased risk of coronary heart disease (10). In two studies in the United Kingdom men who had low birth weight had high ratios of waist-to-hip circumference after allowing for adult body mass index (Table 1) (11). This association with low birth weight has been replicated in a study of men in Sweden (12). In the Swedish study birth weight was also associated with truncal fat, as measured by a high ratio of subscapular to triceps skinfold thickness. After allowing for current body mass index truncal fat increased by 0.30 standard deviations with each kilogram decrease in birth weight.
ASR refers to a variety of symptoms and signs that characteristically begin 5-30 min after an intravenous heparin bolus is given to a patient with circulating HIT antibodies (Nelson et al., 1978 Warkentin et al., 1992, 1994 Popov et al., 1997 Ling and Warkentin, 1998 Warkentin, 2002b Mims et al., 2004) (Table 5 Fig. 3). Only about one quarter of at-risk patients who receive a heparin bolus develop such a reaction. The most common signs and symptoms are fever and chills, hypertension, and tachycardia. Less common are flushing, headache, chest pain, dyspnea, tachypnea, and large-volume diarrhea. In some patients, severe dyspnea is the predominant sign, termed pseudo-pulmonary embolism (Popov et al., 1997 Hartman et al., 2006) multiple small perfusion defects on radionuclide lung scans can be shown (Nelson et al., 1978 Ling and Warkentin, 1998). Fatal cardiac and respiratory arrest has been reported (Ansell et al., 1986 Platell and Tan, 1986 Hewitt et al., 1998). Cardiorespiratory...
Prenatal Care Date of first exam, number of visits has size been equal to dates infections, hypertension, diabetes. Obstetrical H istory Dates of prior pregnancies, gestational age, route (C-section with indications and type of uterine incision), weight, complications, length of labor, hypertension. Past Medical History Illnesses, asthma, hypertension, diabetes, renal Family History Hypertension, diabetes, bleeding disorders.
The issue of aspirin use remains unresolved. The AFASAK trial showed aspirin to be of no benefit in the prevention of embolism. SPAF showed ASA was effective but only in patients under 74 years of age. SPAF III demonstrated that in low-risk patients, aspirin was effective in preventing embolism. Low-risk patients were defined as those without a history of embolism, hypertension, or recent heart failure, and who were not women over the age of 75. Aspirin is a prudent choice for patients without these risk factors.
In Braunwald Heart Disease A Textbook of Cardiovascular Medicine. Sixth ed. Braunwald E, Zipes DP, and Libby P eds. W. B. Saunders Company, 2001. Figure 49. Lung, Histologie section. Plexogenic arteriopathy in pulmonary hypertension (Hematoxylin and Eosin, 40X) Figure 50. Pseudoaneurysm (arrow) in pulmonary hypertension, histologic section. The internal elastic lamina is disrupted (Elastic stain, 40X). Figure 50. Pseudoaneurysm (arrow) in pulmonary hypertension, histologic section. The internal elastic lamina is disrupted (Elastic stain, 40X).
Depolarization of the plasma membrane in vascular smooth muscle cells activates voltage-gated, L-type Ca2+ channels, leading to an influx of Ca2+, which binds to calmodulin. This, in turn, leads to the activation of myo-sin light chain kinase, phosphorylation of the regulatory light chains of the myosin molecule, and crossbridge cycling to produce vessel contraction. In contrast, hyper-polarization of the smooth muscle membrane closes voltage-gated Ca2+ channels, resulting in the reversal of these processes and vasodilation. Indeed, in the intact organism, normal levels of vascular tone appear to rely on the tonic activation of L-type Ca2+ channels and the subsequent intracellular signaling cascade that mediates smooth muscle contraction. For example, pharmacological blockers of L-type Ca2+ channels reduce vascular resistance in most circulatory beds in vivo and profoundly lower blood pressure in the absence of neural compensatory mechanisms. Thus, L-type Ca2+ channels appear to...
The activities of renin in plasma and serum are measured in the diagnosis of hypertension. The natural substrate for renin is angiotensin. Several synthetic peptides have been used in renin assays. Recently, Nakamura-lmajo et al. (1992) used N-(2-pyridyl)glycine (pg) as a fluorescent tag on a nonapeptide.
Elucidation of the molecular components of the TGFP superfamily signal transduction pathways has provided important insights into human disease many human syndromes and illnesses, both hereditary and spontaneous, have been attributed to mutations in this signaling pathway. For instance, mutations in receptors are associated with hereditary hemmorhagic telangiactasia, primary pulmonary hypertension, persistant mullerian duct syndrome, juvenile polyposis syndrome, and colorectal and gastric carcinomas. Mutations in Smads have also been associated with cancers, particularly those of the colon and gastrointestinal tract. Undoubtedly, further elucidation of the molecular mechanisms in this signaling pathway promises to provide new insights into cellular regulation and physiology in health and disease.
More importantly, the profiles of disease and disability vary substantially across ethnic and cultural groups. Whereas the most prevalent chronic conditions among older non-Hispanic whites are cardiovascular disease, stroke, and cancer, African American elderly evidence elevated rates of hypertension and renal disease, and Hispanic elderly evidence increased rates of diabetes, cirrhosis, and gallbladder disease (Fried & Wallce, 1992 Markides, Rudkin, Angel, & Espino, 1997). Differences in disability rates are also apparent. In comparison to older non-Hispanic whites, for example, older African Americans and Hispanics appear to experience greater rates of disability, whereas the rates among older Asian Americans appear to be lower (Guralnik & Simonsick, 1993). Differences in other factors such as health behaviors associated with mental disorders are also evident. Older African American males, for example, have higher rates of smoking, and older Hispanics have elevated rates of obesity,...
The argument that fetal life represents a critical period for adiposity has not been totally resolved, the evidence from the infants of mothers with diabetes notwithstanding. Several large studies have shown an association between high birth weight and child adiposity (75-78) or adult adiposity after controlling for gestational age (77,78), but most did not adjust for confounding variables such as parental fatness, maternal smoking, gestational diabetes, or socioeconomic status (79). Conversely, low birth weight may be associated with an increase in intra-abdominal fat deposition that may in turn account for an increased likelihood of risk factors for cardiovascular disease, including hypertension, diabetes, and hyperlipidemia (80). However, the association between lower birth weight and the development of overweight has not been clearly demonstrated. Although babies with lower birth weight have been shown to have an increased risk of syndrome X and of heart and pulmonary disease in...
Initiation of antepartum fetal surveillance at 32-34 weeks of gestation is appropriate for most at-risk patients. However, in pregnancies with multiple or particularly worrisome high-risk conditions (eg, chronic hypertension with suspected intrauterine growth restriction), testing might begin as early as 26-28 weeks of gestation. C. Frequency of testing. If the maternal medical condition is stable and CST results are negative, the CST is typically repeated in 1 week. Other tests of fetal well-being (NST, BPP, or modified BPP) are typically repeated at weekly intervals, but in the presence of certain high-risk conditions, such as postterm pregnancy, type 1 diabetes, intrauterine growth restriction, or pregnancy-induced hypertension, NST, BPP, or modified BPP testing are performed twice weekly. Chronic or pregnancy-induced hypertension
Osteoporosis and cardiovascular disease are common disorders that increase with aging. Accumulating evidence indicates that both disorders may share common pathophysiologic mechanisms as well as risk factors. Besides age and sedentary lifestyle, diabetes, hypertension, dyslipidemia, estrogen deficiency, and hyperhomo-cysteinemia are common risk factors for both disorders. Furthermore, therapeutic agents for osteoporosis have antiatherosclerotic properties and agents such as statins that are atheroprotective, and appear to increase bone mass and perhaps protect against fractures.
The evidence that childhood overweight increases the risk ofcomorbidity in both childhood and in adulthood emphasizes the need to identify overweight children with other risk factors as early as possible. The Expert Committee (37) also recommends that all children and adolescents with a BMI 85th centile be screened for complications, evaluated, and possibly treated, depending on the findings. The complications that should be sought include hypertension, dyslipidemias, orthopedic disorders, sleep disorders, gallbladder disease, and insulin resistance. In addition, a recent large change in a child's BMI should also be evaluated. The Expert Committee emphasized that clinicians should also seek signs of exogenous obesity such as genetic syndromes, endocrinologic disease, and psychologic disorders. In addition to screening, the committee advocated that an in-depth medical assessment be done for all children and adolescents with a BMI 95th centile.
Preeclampsia refers to the sudden development of maternal hypertension, edema, and proteinuria usually after week 32 of gestation. Eclampsia includes the additional symptom of convulsions. a. Risk factors include nulliparity, diabetes, hypertension, renal disease, twin gestation, or hydatidiform mole (produces first trimester preeclampsia), b- The cause is abnormal placentation producing a mechanical or functional obstruction of the spiral arteries of the uterus. C. Treatment consists in delivery of the baby as soon as possible.
History of the Present Illness Oliguria, current and baseline creatinine and BUN. Diabetes, hypertension history of pyelonephritis, sepsis, heart failure, liver disease peripheral edema, dark colored urine, rashes or purpura. Hypovolemia secondary to diarrhea, hemorrhage, over-diuresis glomerulonephritis, interstitial nephritis. Excessive bleeding, flank pain, anorexia, insomnia, fatigue, malaise, weight loss, paresthesias, anemia.
As well as neoplasms, vascular alterations including vasculitis and perivasculitis have been described as further cardiovascular manifestations in HIV-infected patients. In particular, the function of the pulmonary vessels can deteriorate, resulting in pulmonary arterial hypertension and, consequently, right heart dilatation (Mehta 2000). For further information on pulmonary arterial hypertension see the chapter HIV-associated pulmonary hypertension (PAH) . Pulmonary artery hypertension
Pulmonary hypertension is caused by vasoconstriction, reduction of arterial elasticity by structural remodeling of the vessel walls, obstruction of vessels, as well as vessel rarification. All forms show the development of functional alterations (reversible vasoconstriction) and structural changes (vascular remodeling), often occurring in combination with intravascular thrombosis. The increase of right ventricular afterload induces right ventricular hypertrophy and or dilatation. Chronic pulmonary hypertension is divided into five groups according to the classification developed at the 1998 World Symposium on Primary Pulmonary Hypertension in Evian (modified in Venice, 2003). HIV-associated pulmonary hypertension belongs to group number one (PAH)
For the diagnosis of chronic pulmonary hypertension, right heart catheterization is still considered to be the gold standard. Essential parameters of pulmonary hemo-dynamics can be evaluated. The main parameter is pulmonary resistance, which can be abnormal even without affecting pulmonary arterial pressure. A test for reversibility of vasoconstriction should be performed at the stage of manifested pulmonary hypertension in order to identify patients responding to vasodilatory therapy. These responders are identified using oxygen insufflation or vasodilators during right heart catheterization. For example, during nitric oxide inhalation these patients show a decrease in pulmonary arterial pressure of 30 and a simultaneous normalization of cardiac output.
Various modalities of general treatment have been established for the therapy of pulmonary hypertension on the basis of empirical data. These are In the later stages of pulmonary hypertension, volume retention may cause an enormous increase in right ventricular preload followed by congestive hepatomegaly, edema and ascites formation. Volume retention is not only caused by chronic right heart failure but also by stimulation of the renin-angiotensin system followed by elevated aldosterone levels. For this reason, a combination of loop diuretics (e.g. furosemide 20-80 mg per day) and aldosterone antagonists (e.g. aldactone 50 -200 mg per day) has proved to be successful. The usual contraindications, as well as the risk of dehydration followed by a critical decrease of right ventricular preload, have to be considered. A preload of about 6-10 mmHg is needed for optimal right ventricular performance. Figure 1. Diagnostic and therapeutic algorithm suggestion for diagnostic procedures on...
HIV patients suffering from exercise-induced dyspnea should be tested for pulmonary hypertension when other pulmonary or cardiac diseases (e.g. restrictive or obstructive ventilation disorders, pneumonia, coronary heart disease) have been excluded. The incidence of pulmonary hypertension is elevated by a factor of 1,000 in HIV patients compared to the general population. Estimated numbers of unreported cases are not included. A suspected diagnosis of pulmonary hypertension can be substantiated by non-invasive diagnostic methods (e.g. echocardiography). Since new therapeutic options have recently become available, correct diagnosis is essential. Further diagnosis and treatment of patients suffering from every kind of pulmonary hypertension should be performed in specialized centers with experience in the treatment of pulmonary hypertension and HIV infection. Figure 2. Therapeutic algorithm of pulmonary arterial hypertension depending on severity and vasoreactivity (adapted from World...
Short-axis method of cardiac dissection. (A) Normal heart, with ventricular cross-section oriented for evaluation. (B) Old transmural myocardial infarct, involving inferior wall of left ventricle, with secondary left ventricular dilation. (C) Right ventricular hypertrophy and dilation due to chronic pulmonary hypertension. (D) Complete atrioventricular septal defect, showing the common atrioventricular valve. Fig. 3-2. Short-axis method of cardiac dissection. (A) Normal heart, with ventricular cross-section oriented for evaluation. (B) Old transmural myocardial infarct, involving inferior wall of left ventricle, with secondary left ventricular dilation. (C) Right ventricular hypertrophy and dilation due to chronic pulmonary hypertension. (D) Complete atrioventricular septal defect, showing the common atrioventricular valve.
The study of intermediate phenotypes for hypertension is attractive for a number of reasons. Firstly, such phenotypes may be under a greater degree of genetic control than the final phenotype, and thus studies of moderate size may suffice to detect genetic effects. Secondly, study of an intermediate phenotype may enable the blood pressure phenotype to be subdivided into more genetically tractable subphenotypes. Thirdly, in order to study these phenotypes, ascertainment from the extremes of the population with its concomitant practical difficulties may not be required. Fourthly, many compounds that can be measured in blood have smaller measurement errors than can be achieved for blood pressure in very large numbers of subjects. By contrast with the hypertension phenotype, robust associations between markers in some genes and particular traits have been described as yet, however, the relevance of these traits to hypertension has not been shown. We discuss two such robust associations...
There are four main types of stroke cerebral thrombosis, cerebral embolism, subarachnoid hemorrhage, and intracerebral hemorrhage. Cerebral thrombosis and cerebral embolism, known as ischemic strokes, are caused by blood clots that block an artery supplying the brain, either in the brain itself or in the neck. They account for 70-80 of all strokes. Subarachnoid hemorrhage and intracerebral hemorrhage are hemorrhagic strokes that occur when a blood vessel bursts around or in the brain, either from trauma or excess internal pressure. Hypertension (high blood pressure) and atherosclerosis are usually contributing factors in these types of strokes. SUBARACHNOID HEMORRHAGE. In this type of stroke, blood spills into the subarachnoid space between the brain and cranium. As fluid builds up, pressure on the brain increases, impairing its function. Hypertension is a frequent cause of these types of stroke, but vessels with preexisting defects, such as an aneurysm, are also at risk for rupture....
After exposure (Vincent et al., 2001) a similar exposure to carbon black had no effect. Studies have been conducted on rats pretreated with MCT, to induce a model of pulmonary hypertension. Such animals demonstrate hypertrophy of the media of the pulmonary muscular arteries, but this was not affected by concentrated, freshly generated, DEPs (Cassee et al., 2002). The MCT-treated animals did demonstrate an increase in bromodeoxyuridine labelling of Clara cells in the terminal bronchioles, which was enhanced by treatment with DEPs. This treatment also induced a significant increase in plasma fibrinogen (Cassee et al., 2002).
Intracranial hypertension is defined as a sustained increase in ICP above 15 mmHg. When intracranial pressure exceeds 30 mmHg, cerebral blood flow progressively decreases and a vicious cycle is established ischemia causes brain edema, which in turn increases intracranial pressure, resulting in more ischemia.
A growing body of evidence indicates that small weight losses, as little as 5-10 of initial weight, are sufficient to improve many of the health complications of obesity including essential hypertension, type 2 diabetes, and dyslipidemia (39-41). The data reviewed above, however, suggest that exercise alone will not help the majority of overweight and obese individuals reach this weight loss goal. That is a principal reason that expert panels have recommended that exercise be combined with diet. As discussed in the next sections, the combination of diet and exercise is likely to produce a more satisfactory outcome than either approach used alone.
Symptoms nausea vomiting, mental status changes (drowsiness progressing to coma), personality changes, visual changes, neck stiffness, focal deficits, hypertension, bradycardia, absent brain stem reflexes, decerebrate posturing, fixed and dilated pupils, respiratory rhythm changes (irregular rhythm or apnea). 2. Signs headache, papilledema, posturing, bulging fontanelles in infants, seizures, altered patterns of breathing, cushing's reflex (hypertension and bradycardia).
There are limited animal and human data on the cardiovascular effects of C. aurantium. When administered to rats, C. aurantium and synephrine both raised blood pressure in a dose-dependent manner (31). In another study in rats, repeated oral C. aurantium extract led to dose-dependent cardiovascular toxicity and mortality (32). Two studies using synephrine or C. aurantium in rats with induced portal hypertension (by portal vein ligation) have been conducted (31,33). In these studies, both synephrine and C. aurantium significantly reduced portal venous pressure. Interestingly, C. aurantium had a greater effect on portal hypertension than synephrine alone.
Sections from the heart showed marked interstitial and replacement fibrosis, thickening of intramyocardial arterioles and chronic pericarditis. Sections from the lungs showed diffuse interstitial fibrosis. Smooth muscle proliferation was present, along with medial thickening of the vessels, consistent with pulmonary hypertension. Hyaline membranes characteristic of diffuse alveolar damage were also present. Sections from the liver showed periportal fibrosis and thickening of the portal artery wall. Sections from the skin showed dense dermal and subcutaneous fibrosis. There was moderate atrophy of the epidermis and dermal appendages.
Supplements of 400 g d of folate begun before conception result in a significant reduction in the incidence of neural tube defects as found in spina bifida. Elevated blood homocysteine is an associated risk factor for atherosclerosis, thrombosis, and hypertension. The condition is due to impaired ability to form methyl-tetrahydrofolate by methylene-tetrahydrofolate reductase, causing functional folate deficiency and resulting in failure to remethylate homocysteine to me-thionine. People with the causative abnormal variant of methylene-tetrahydrofolate reductase do not develop hyperhomocysteinemia if they have a relatively high intake of folate, but it is not yet known whether this affects the incidence of cardiovascular disease.
Administered to all patients with hypertension at term to prevent seizures when delivery is indicated. An intravenous loading bolus of 4 g IV ever 20 minutes, followed by continuous infusion of 2 g h. When symptomatic magnesium overdose is suspected (apnea, obtundation), it can be reversed by the intravenous administration of 10 calcium gluconate, 10 mL IV over 2 minutes. Magnesium prophylaxis must be continued in the immediate post-partum period, as the risk of seizures is highest in the intrapartum stage and during the first 24 hours following delivery.
The umbilical artery and vein are unique sites used for catheterization in new-borns. Clinically apparent thrombosis rates for umbilical vein catheters ranges from 10-20 . Long-term complications include portal hypertension and varices. Thrombosis of the umbilical artery appears to be more rare but may be associated with severe complications such as renal or mesenteric artery thrombosis or even complete aortic occlusion.
Vessels form a capillary plexus that does not extend beyond the inner nuclear layer. The branches of the central retinal artery do not anastomose and therefore are classified as anatomic end arteries. Evaluation of the retinal vessels and optic disc during the physical examination of a patient not only provides important information on the state of the eye but also provides early clinical signs of a number of conditions, including elevated intracranial pressure, hypertension, glaucoma, and diabetes.
Identifying the underlying causes of cardiovascular disease is a critical first step in successful treatment. However, as with cancer, cardiovascular disease is complex and arises from the interaction of many genes as well as environmental factors. The technologies to scan the human genome for gene mutations that may lead to cardiovascular disease are rapidly emerging in the wake of the release of a draft of the human genome sequence in 2001 (9,10). Work to date has identified the following (1) mutations in genes for ion channels and gap junctions lead to cardiac arrhythmias (11) (2) mutations in genes that encode members of the renin-angiotensin aldosterone system, epithelial sodium channels, adrenoceptors, and G proteins are associated with hypertension (12-14) and (3) mutations in genes that
In a rat model of hypertension, animals pretreated with V. myrtillus dry extract (Merck-Sharp and Dohme, Chibret, France) rich in anthocyanin glu-cosides at a dose of 50 mg 100 g body weight for 12 days prior to aortic ligation and for 14 days thereafter showed less permeability of the aorta, blood-brain barrier, and blood vessels of the skin to a tracer dye (1 tryptan blue solution), compared to untreated animals on day 7 after ligature (7). The effect was most pronounced in the brain and least pronounced in the blood vessels of the skin. The investigators proposed, based on previous experiments, that anthocyanins in bilberry extract interact with collagen to make it more resistant to the effects of collagenase, thus preserving the integrity of the basal lamina and its control of vascular permeability.
When increasing blood volume stretches muscle cells associated with the atria, the cells secrete a peptide hormone called atrial natriuretic peptide (ANP). ANP inhibits release of renin from the kidneys and of aldosterone from the adrenal cortex. The overall result is increased excretion of sodium ions and water from the kidneys and lowered blood volume and blood pressure. Researchers are investigating use of ANP to treat high blood pressure.
Cholesterol is a component in all mammalian cellular membranes and a precursor of steroid hormones, vitamin D, and bile acids. Pathophysiologically, it is thought to be an important factor in the pathogenesis of atheromatous arterial disease, hypertension, cancer of the large bowel, and other disorders (8). The intestinal cholesterol is derived mainly from two sources partly from synthesis occurring in the liver and the small intestine and partly from foods of animal origin. The main elimination routes for the plasma cholesterol are biliary excretion of cholesterol into the intestine as well as hepatic conversion of cholesterol to bile acids. The intestinal cholesterol can be absorbed to the entero-hepatic circulation or undergo microbial conversion. The major microbial metabolite is (unabsorbable) coprostanol which is excreted with the feces. The organisms responsible for the conversion are all strictly anaerobic, Gram-positive, nonspore-forming coccoid rods, probably belonging to...
Based simply on the sales successes of drugs targeting these receptors, GPCRs are attractive targets. In 2003, total sales for the top 200 prescription drugs were over 218 billion worldwide. Forty-seven of these drugs target GPCRs and comprise almost 23 of the sales at 47 billion.9 Table 3.1 depicts the 20 best-selling GPCR-targeted drugs of 2003 including salmeterol, an antiasthmatic p2-adrenergic agonist olanzapine, an antipsychotic 5-HT2 dopamine receptor antagonist and clopidrogel, an antithrombotic P2Y12-purinergic receptor antagonist, all with annual sales near 4 billion. Several GPCRs have multiple top-selling drugs targeted at them including H1-antihistamines (fexofenadine, cetirizine, and desloratadine) and antihypertensive angiotensin II receptor antagonists (losartan, valsartan, cardesartan, and irbesartan). This demonstrates the attractiveness of such targets to pharmaceutical companies. Hypertension Hypertension Hypertension Hypertension Hypertension Hypertension,...
Evaluation of patients with hilar cholangiocarcinoma is principally an assessment of resecta-bility, since resection is the only effective therapy. First and foremost, the surgeon must assess the patient's general condition and fitness for operation, which usually includes partial hepatectomy. The presence of significant comorbid conditions, chronic liver disease, and or portal hypertension generally precludes resection. In these patients, biliary drainage is the most appropriate intervention, and the diagnosis should be confirmed histologically if chemotherapy or radiation therapy is anticipated. Patients with potentially resectable tumors occasionally present with biliary tract sepsis, frequently after intubation of the biliary tree. These patients require resuscitation and treatment of the infection before surgery can be considered.
Cardiac myocytes are known to adapt to changes in hemody-namic load. Ventricular remodeling refers to changes in left ventricular geometry, mass, or volume in response to myocar-dial injury or alterations in load (e.g., hypertension). The extent of left ventricular dilation or remodeling in both ischemic and nonischemic cardiomyopathy is a strong predictor of both morbidity and mortality. Angiotensin-converting enzyme inhibitors and p-adrenergic blockers inhibit left ventricular remodeling and improve survival in patients with left ventricular dysfunction. It has been reported that chronic asynchronous electrical activation, such as chronic pacing or left bundle branch block, in the heart induces redistribution of cardiac mass (29).
Experimentally, the administration of a calcium channel antagonist is believed to help preserve myocardial function and metabolism in case studies employing normothermic ischemia, crystalloid cardioplegia, or blood cardioplegia (1). More specifically, their use was reported to prevent ATP hydrolysis and calcium influx during ischemia and improve cardioplegia delivery by coronary vasodilation. However, the potential use of calcium channel blockers for myocardial protection is considered limited because of their negative inotro-pic and dromotropic effects, which could be specifically problematic in patients with preoperative poor ventricular function. Hence, further studies are needed to determine the potential utility of newer calcium channel antagonists such as amlodipine and felodipine, agents that may elicit fewer side effects in very ill patients. The current applications of calcium channel antagonists are in patients with normal preoperative function who are at risk for...
Coronary artery disease is often considered a component of systemic vascular disease. The same risk factors that contribute to coronary artery disease, such as smoking, diabetes, hypertension, and hyperlipidemia, also contribute to carotid artery disease and atherosclerotic changes in the aorta this is especially true for the ascending aorta. Atheroma in the aorta can present with calcified plaques or with cheeselike soft plaques, which can be disrupted (dislodged) during (1) cannulation of the
A variability in the S1 sound can be observed in states causing variation in the velocity of the atrioventricular valve closures, such as ventricular tachycardia, atrioventricular block, ventricular pacemakers, atrial fibrillation, and so on. An accentuated S2 is present in (1) diastolic or systolic hypertension, (2) aortic coarctation, (3) aortic dilation, (4) atherosclerosis of the aorta, and (5) pulmonary hypertension it is characterized by a loud pulmonary component of the second heart sound. A diminished S2 is detected most often with aortic valvular stenosis, pulmonic stenosis, and pulmonary emphysema. (3) increased impedance of the pulmonary vasculature (as in massive pulmonary embolism or pulmonary hypertension). Persistent splitting of the S2 refers to cases in which the aortic and pulmonic components of the second heart sound remain audible during both inspiration and exhalation. Persistent splitting may be because of a delay in the pulmonary component, as occurs with...
Cerebrovascular disease is the most common disorder causing neurogenic oral and oropharyngeal dysphagia (3). Swallowing disorders have been reported in 27 to 50 of patients suffering from CVAs (4). The incidence is not limited to severe strokes, because even patients with mild-to-moderate strokes have a poorer long-term outcome directly attributable to their swallowing disorder (5). Given the complex neurophysiology associated with swallowing, a wide range of stroke locations can result in dysphagia. The gamut of cerebrovascular events, from major occlusive events to multiple small-vessel ischemic areas due to diabetes and chronic hypertension, to almost imperceptible brainstem infarcts, can result in oropharyngeal dysphagia. The extent of resulting cerebral ischemia defines the clinical presentation of the disorder. It is obvious that large occlusive ischemic events will result in a more severe dysphagia due to insults at multiple areas controlling swallowing physiology. Patients...
Association of AAA with systemic hypertension, smoking, diabetes mellitus and older age (aneurysms are rare before the 6th decade, and are mos common between the 7th and 9th decades). Even though these are all risk factors for atherosclerosis, there is a disproportionate ratio of male gender, and a known familial predisposition. The presence of an AAA in a sibling or parent, significantly increases the risk for that individual. This familial tendency and male predominance strongly suggests that additional unrecognized entities are interacting with the more common and generally modifiable risk factors, which contribute to the development of atherosclerotic AAA.
Adult 5-10 mg diluted in 10 mL NS infiltrated into area of extravasation within 12 hrs. Ped 0.1-0.2 mg kg diluted in 10 mL NS infiltrated into area of extravasation within 12 hrs. Dose (diagnosis of pheochromocytoma) Children 0.05-0.1 mg kg dose IV IM, maximum single dose 5 mg. Adult 5 mg IV IM. Dose (surgery for pheochromocytoma hypertension) Children 0.05-0.1 mg kg dose IV IM given 1-2 hrs before procedure, repeat prn every 2-4 hr until hypertension is controlled max dose 5 mg. Dose (hypertension crisis) adult 5-20 mg IV. Adverse effects may cause hypotension, reflex tachycardia, cerebrovascular spasm, arrhythmias, stimulation of gastrointestinal tract, hypoglycemia. Comments use with caution in renal impairment, coronary or cerebral arteriosclerosis. Clearance hepatic metabolism renal elimination. Contraindications pheochromocytoma, severe hypertension, bradycardia, ventricular tachyarrhythmias, narrow-angle glaucoma. Adverse effects hypertension, reflex bradycardia,...
There are two explanations for the increased prevalence of vascular disease in the elderly (1) the increased risk represents a longer duration of exposure to conditions that promote atherosclerosis (i.e., the time-dose product of the risk factors) and (2) atherosclerosis is a specific aging-associated process. It is important to note that these possibilities are not mutually exclusive and that from the perspective of a given elderly individual at risk for vascular disease, this distinction may not matter much. However, discrimination between these hypotheses has important implications for prevention of vascular disease, particularly at the population level. In the former case, preventive therapies should focus on early interventions on established risk factors such as hypercholesterolemia, hypertension, diabetes, obesity, and smoking in the latter case, specific therapies may be required to target the aging-associated mechanisms that accelerate atherosclerosis in the elderly....
Atheromatous plaques and related scarring cause narrowing of the arteries and ultimate occlusion of these vessels with ischaemia or reduction of blood supply to the structures supplied by such arteries and resultant infarction due to dead tissue formed by the lack of blood supply. According to the area involved atherosclerosis can lead to hypertension, angina pectoris, myocardial infarction, arrhythmias, paralysis, gangrene of the extremities and cerebral insufficiences leading to confusion, amnesia, personality changes or strokes.
Does the patient suffer from arterial hypertension Is the headache accompanied by other neurological symptoms or loss of consciousness Intracranial hemorrhage Spontaneous intracranial hemorrhage may occur as a sequel of long-standing poorly controlled arterial hypertension, particularly in the basal ganglia. If rupture into the ventricles occurs, ventricular tamponade and obstruction of the aqueduct may ensue, which leads to hydrocephalus. Neurosurgical ventricu-lostomy must then be performed immediately. Vascular malformations, tumors, metastases, infarction, vasculitis, and coagulopathies (including iatrogenic warfarin ) can also cause hemorrhage into the brain parenchyma. Diagnosis of an intracranial bleed is made with noncontrast CT (Fig. 11.5). MRI serves to establish the etiology of the bleed at a later time.
Recently, this approach has experienced a resurgence with epoprostenol sodium (Flolan), a freeze-dried preparation of prostacyclin itself (Mertzlufft et al., 2000 Aouifi et al., 2001). Epoprostenol is approved for use in patients with primary pulmonary hypertension. Its very short half-life (6 min) means that continuous iv infusion is necessary. Complete inhibition of heparin-dependent platelet aggregation by HIT antibodies is generally achieved by doses ranging from 15 to 30 ng kg min. One protocol that does not require intraoperative monitoring of platelet aggregation gradually increases epoprostenol infusion (in 5 ng kg min increments made at 5-min intervals) until the target rate (30 ng kg min) is reached, whereupon standard-dose UFH anticoagulation is commenced (Aouifi et al., 2001). The epoprostenol infusion is continued until 15 min following reversal of UFH with protamine. The major adverse effect is vasodilatation, leading to severe hypotension that requires intraoperative...
The cardiac control center of the medulla oblongata maintains balance between the inhibitory effects of the parasympathetic fibers and the excitatory effects of the sympathetic fibers. In this region of the brain, masses of neurons function as cardioinhibitor and cardioaccelera-tor reflex centers. These centers receive sensory impulses from throughout the circulatory system and relay motor impulses to the heart in response. For example, receptors that are sensitive to stretch are located in certain regions of the aorta (aortic arch) and in the carotid arteries (carotid sinuses). These receptors, called baroreceptors (pressoreceptors), can detect changes in blood pressure. Rising pressure stretches the receptors, and they signal the cardioinhibitor center in the medulla. In response, the medulla sends parasympathetic motor impulses to the heart, decreasing the heart rate. This action helps lower blood pressure toward normal (fig. 15.23).
Phaeochromocytoma is medullary in location, 3-5 cm in diameter and 75-150g in weight, or larger, with a pale to tan coloured cut surface. It is associated with MEN2A 2B, von Hippel Lindau disease and neurofibromatosis. Similar extra-adrenal paragangliomas are found elsewhere along sympathetic parasympathetic nervous system sites in the retroperi-toneum, mediastinum, carotid body, middle ear and urinary bladder with variable secretory capacity and functionality, e.g. chemodectomatous head and neck paragangliomas. Adrenal phaeochromocytoma has a characteristic nested Zellballen pattern its cells secreting catecholamines and inducing paroxysmal symptoms of flushing, sweating, tachycardia, tremor and hypertension. Surgical excision requires careful control of blood pressure to avoid a hypertensive crisis. Overall survival is 50 with 10 bilateral or extra-adrenal or malignant. Malignant behaviour cannot be predicted histologically, with metastases being the only reliable criterion. Spread...
Is applied to eyes with visual field and or optic nerve damage, analogous to the differentiation between ocular hypertension and glaucoma in eyes with open angles. Angle closure results from various abnormal relationships of anterior segment structures. These, in turn, result from one or more abnormalities in the relative or absolute sizes or positions of anterior segment structures or posterior segment forces that alter anterior segment anatomy.1 Angle closure results from blockage of the meshwork by the iris, but the forces causing this blockage may be viewed as originating at four successive anatomic levels (figure 12.1)
Today, the successful treatment of end-stage cardiac failure is now possible with either organ transplantation or mechanical assist devices (for those who may not initially qualify for transplantation). However, it is clear that too few suitable donor organs are available to meet the current needs (Fig. 11). It is also considered that the undersupply of organs will clearly worsen as the pool of potential donors is reduced further by the projected increased incidences of numerous factors that preclude heart donation, such as diabetes, hypertension, hypercholester-olemia, or infection with human immunodeficiency virus (HIV) or hepatitis B or C. This lack of a reliable and stable source of donor hearts serves as the main impetus for further research into expanding cardiac donor pools, the use of mechanical assist devices, and the potential for cellular-mediated transplantation.
Pseudohyperaldosteronism As Cortisol levels rise, they stimulate mineralocorticoid receptors in the distal renal tubule (Walker et al 1992). This creates pseudohyperaldosteronism, which has the same clinical features as primary aldosteronism, including sodium retention, fluid retention and oedema, hypertension, hypokalemia and metabolic alkalosis (Armanini et al 1996, Heldal & Midtvedt 2002, Kato et al 1995, vanUum et al 1998, Walker & Edwards 1994).
Another important determinant of health is the availability of and access to health services, which are any of a host of specific activities undertaken to maintain or improve health or to prevent decrements of health (Longest, Rakich, and Darr 2000, 5). Health services can be preventive (e.g., behavior modification, blood pressure screening, mammography) acute (e.g., surgical procedures, antibiotics to fight infection) chronic (e.g., control of diabetes or hypertension) restorative (e.g., physical rehabilitation of a stroke or trauma patient) or palliative (e.g., pain management or comfort measures in terminal stages of disease) in nature.
Animal models of POAG Various animal models for inducible glaucoma have been reported. Argon laser photocoagulation of the TM in rhesus monkeys results in sustained elevation of IOP and has been used extensively to study early damage to the optic nerve head (May et al., l997). Corticosteroids such as betamethasone and dexamethasone have been used to treat rabbits, dogs, and cats to develop ocular hypertension (Bonomi et al., l978). Steroid treatment generally produces progressive glaucoma, but this process is reversed after about two months after cessation of the steroid. Trabecular blockage caused by inflammation after a-chymotrypsin treatment also has been used to produce elevated IOP in rabbit and monkey eyes (Vareilles et al., l977). Some types of avian species (chicken, quail, and turkey) have been known to develop elevated IOP as a consequence of continuous exposure to light.
Hypertension Darusentan Congestive heart failure Hypertension Ambrisentan Congestive heart failure Hypertension Congestive heart failure Receptors for calcitonin gene-related peptide (CGRP) are abundant in vascular smooth muscle and endothelium, and activation of these receptors is known to cause relaxation of blood vessels. Olcegepant is an antagonist of at least some types of CGRP receptors and is in clinical development for migraine and cluster headaches. Bosentan is currently in limited clinical use as a vasodilator in pulmonary hypertension, but other small-molecule endothelin receptor antagonists are now under clinical development for broader therapeutic indications, including hypertension and congestive heart failure. Vasopressin V2 receptor antagonists are also in clinical development for congestive heart failure, based on their capacity to oppose vaso-pressin-induced vasoconstriction and renal fluid retention.
There is no gross or microscopic difference between physiologic hypertrophy of athletes and pathologic hypertrophy that results from disease states (6). However, in athletes, the heart weight is rarely increased more than 25 above the expected value. Ischemic heart disease alone, without coexistent hypertension, generally produces only mild hypertrophy, affecting all four chambers, and a heart weight of
Enlarged fat cells are the pathologic sine qua non of obesity (3-5). Enlarged fat cells tend to correlate with an android or truncal fat distribution and are often associated with metabolic disorders such as glucose intolerance, dyslipidemia, hypertension, and coronary artery disease. These derangements occur because large fat cells secrete more of the many peptides and metabolites that they make. Central adiposity is one diagnostic criterion for the metabolic syndrome. This syndrome is a complex of traits that enhance the risk of cardiovascular disease and is discussed in more detail later in this chapter (17,18). The diagnosis requires three of the following five features central obesity, hypertension, insulin resistance, dyslipidemia, or diabetes mellitus (17). Hypertension
Diabetes, smoking, hypertension, hyperlipidaemia, and so on, are all underlying causative factors for vascular impairment. Since the erectile response is a hemo-dynamic event, it is hardly surprising that damage to the vessels will result in partial or complete loss of the ability to not only achieve but also maintain an erection long enough for it to be useful to its owner and his partner. A standard vascular examination can reveal important clues that may not only indicate a vascular reason for loss of the ability to have an erection, but may also point to major undetected pathology.
Once we consider it more likely than not that this patient had ischemic disease, the question of whether it was typical or atypical is somewhat more difficult to ascertain. First, it is necessary to define these two terms. Typical ischemic heart disease is generally considered secondary to coronary atherosclerosis, with atherosclerotic plaque (s) narrowing the lumen and causing damage to the coronary artery wall. The presence of atherosclerosis may increase the possibility of superimposed coronary artery lesions including acute plaque hemorrhage or rupture, luminal thrombosis, and or coronary artery spasm. The presence of atherosclerosis does not provide information concerning the pathogenesis of the plaque, whether it is idiopathic but associated with cigarette smoking, hypercholesterolemia, hypertension, or diabetes mellitus (or combinations of all of these), or whether it may be secondary to less common risk factors such as hyperhomocysteinemia, cocaine use, or radiotherapy (chest...
Golden root (Roseroot, Rhodiola rosea L., Crassulaceae) has been used for a long time as a resource in Chinese traditional medicine. Phenylpropenoid glu-coside, such as Rosin (cinnamyl O-P-D-glucopyranoside 118a), was isolated from R. rosea as one of the major active ingredients and reported to be pharmacologically active as antioxidants and neurostimulants. Moreover, some other phenylpropenoid glucoside analogs have been isolated as bioactive substances. For instance, Sachaliside 1 (Triandrin 4-hydroxycinnamyl O-P-D-glucopyranoside 118b) and Vimalin (4-methoxycinnamyl O-P-D-glucopyranoside 118c) have been isolated from the callus cultures of the plant. In addition, Citrusin D (Coniferin 4-hydroxy-3-methoxycinnamyl O-P-D-glucopyranoside 118d) has been isolated from Citrus unshiu as an antihypertensive ingredient, and Icariside H1 (3,4,5-trimethoxycinnamyl O-P-D-glucopyranoside 118e), from Epimedium Sagittatuma (Fig. 24).
Although it was thought that people with hypertension wanting to take supplements should start with low doses, evidence does not support the concern that high-dose supplements will significantly elevate blood pressure. Suspend use of high doses ( 1000 lU day) 1 week before major surgery.
|High Blood Pressure Remedy Report||bloodpressurenormalized.com|
|The Blood Pressure Solution||mybloodpressurefix.com|
|Blood Pressure Protocol|
|Blood Pressure Reduction Guide||www.natural-blood-pressure-reduction.com|
Reducing Blood Pressure Naturally
Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.