When to treat symptomless essential hypertension

1982 ◽  
Vol 20 (14) ◽  
pp. 53-54
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Failure ◽  
Essential Hypertension ◽  
Drug Therapy ◽  
Arterial Pressure ◽  
Drug Treatment ◽  
Absolute Risk ◽  
Sodium Restriction ◽  
Cardiovascular Morbidity And Mortality

The risk of cardiovascular morbidity and mortality increases in proportion to the arterial pressure at all ages and in both sexes. Most authorities regard blood pressure above 140 mmHg systolic, 90 mmHg diastolic as abnormal. The absolute risk of raised blood pressure is greater in men than women, men being more liable to coronary disease. Raised blood pressure predisposes to stroke, cardiac ischaemia and heart failure, progressive renal failure, retinal lesions and malignant hypertension. Lowering the blood pressure reduces the risks of these complications. Non-drug measures which can help and are worth considering before drug therapy include regular meditation, sodium restriction, weight reduction, and cessation of cigarette smoking. The efficacy of these is however less well proven than that of drug treatment. This article discusses when drug treatment should be considered. Barritt1 presents the arguments in more detail.

RELATIONSHIP BETWEEN CARDIOVASCULAR DISEASES AND ANATOMOSIS OF ARTERIOVENOUS FISTULAR IN PATIENTS WITH REGULARLY HEMODIALYSIS

2017 ◽  
pp. 88-92
Author(s):  
Van Hien Pham ◽  
Huu Vu Quang Nguyen ◽  
Tam Vo
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Cardiovascular Diseases ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Negative Correlation ◽  
Mean Value ◽  
The Mean

Background: Cardiovascular diseases are the leading cause of death in patients with chronic renal failure. When a patient undergoes dialysis, making AVF or AVG causes cardiovascular events. Understanding the relationship between complications: hypertension, heart failure, AVF or AVG (formation time, position, diameter) helps us monitor, detect, prevent and treatment of complications to limit the risk of death in patients with dialysis. Objective: Relationship between cardiovascular diseases and anatomosis of arteriovenous fistular in patients with regularly hemodialysis at Cho Ray Hospital. Methods: A cross-sectional study was conducted at Cho Ray Hospital from 2015 to 2016. The survey some cardiovascular diseases are done by clinical examination, tests for diagnostic imaging such as X-ray, electrocardiogram and echocardiogram: heart and diameter of anastomosis AVF, AVG. Results: The study population included 303 patients with chronic renal failure who were dialysis. Of which, patients aged 25-45 accounted for the highest proportion (43.9%). The proportion of male and female patients was similar (48.5% and 51.5% respectively). The mean value of systolic blood pressure on patients made AVF, AVG less than 12 months is higher than patients made AVF, AVG over 12 months, and there is negative correlation (r = -0.43) between AVF, AVG and systolic blood pressure (p <0.05). The mean value of diastolic blood pressure on patients made AVF, AVG less than 12 months is lower than patients made AVF, AVG over 12 months, and and there is positive correlation (r = -0.43) between AVF, AVG and diastolic blood pressure (p <0.05) (p <0.05). The prevalence of patients with heart failure made AVF, AVG over 12 months is higher than that of the under 12 months group, there is a negative correlation (r = - 0.43) between AVF, AVG diameter and EF index (p <0.05). Conclusion: It is important to note the diameter of anastomosis AVF, AVG in patients with chronic renal failure dialysis to limit cardiovascular complications, especially heart failure. Key words: Chronic kidney disease, hemodialysis.

Solitary Kidney and Ageing as Causes of Low Renin and Aldosterone Concentrations: Relevance to ‘Low-Renin’ Essential Hypertension

1976 ◽  
Vol 51 (s3) ◽  
pp. 177s-180s ◽  
Author(s):  
R. Gordon ◽  
Freda Doran ◽  
M. Thomas ◽  
Frances Thomas ◽  
P. Cheras
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Plasma Renin Activity ◽  
Plasma Volume ◽  
Plasma Renin ◽  
Renin Activity ◽  
Dietary Sodium ◽  
Sodium Restriction ◽  
Normotensive Subjects ◽  
The Mean

1. As experimental models of reduced nephron population in man, (a) twelve men aged 15–32 years who had one kidney removed 1–13 years previously and (b) fourteen normotensive men aged 70–90 years were studied. Results were compared with those in eighteen normotensive men aged 18–28 years and eleven men aged 19–33 years with essential hypertension. 2. While the subjects followed a routine of normal diet and daily activity, measurements were made, after overnight recumbency and in the fasting state, of plasma volume and renin activity on one occasion in hospital and of blood pressure on five to fourteen occasions in the home. Blood pressure was also measured after standing for 2 min and plasma renin activity after 1 h standing, sitting or walking. Twenty-four hour urinary aldosterone excretion was also measured. 3. The measurements were repeated in the normotensive subjects and subjects in (a) and (b) above after 10 days of sodium-restricted diet (40 mmol of sodium/day). 4. The mean plasma renin activity (recumbent) in essential hypertensive subjects was higher than in normotensive subjects. In subjects of (a) and (b) above, it was lower than normotensive subjects, and was not increased by dietary sodium restriction in subjects of (a). 5. The mean aldosterone excretion level was lower in old normotensive subjects than in the other groups, and increased in each group after dietary sodium restriction. 6. Mean plasma volume/surface area was not different between the four groups and in normotensive, essential hypertensive and nephrectomized subjects but not subjects aged 70–90 years was negatively correlated with standing diastolic blood pressure.

scholarly journals A CASE STUDY ON ESSENTIAL HYPERTENSION MANAGING THROUGH AYURVEDA W.S.R. RAKTAGATA VYAN VAISHAMYA

2021 ◽  
Vol p5 (4) ◽  
pp. 2965-2968
Author(s):  
Ruhi Zahir ◽  
Iqbal Khan
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Risk Factor ◽  
Essential Hypertension ◽  
Cardiovascular Diseases ◽  
High Blood Pressure ◽  
Direct Reference ◽  
Major Risk Factor ◽  
End Stage

Essential hypertension is high blood pressure that doesn't have any known etiopathology. Most of sufferers (85%) are asymptomatic and as per available reports, in more than 95% cases of hypertension under lying cause is not found. It is estimated that 600 million people are affected worldwide. Hypertension is a major risk factor for the development of cardiovascular diseases (CVD). Its impact is greatest on stroke, MI and end stage is renal failure as it’s known as a Silent Killer. Hence there is no direct reference of hypertension in Ayurvedic classics by name as well as by its path physiological views. Many works have been carried out on hypertension to evaluate the perfect diagnosis and mode of treatment on the basis of Different nomenclatures also have been adopted by Ayurveda experts like Raktagata Vata, Raktagata Vyana Vaisamya, Uccha Rakta Chapa, Raktavrita Vata, Siragata Vata etc. Keywords: Essential hypertension, Raktagata Vyana Vaisamya, Uccha Rakta Chapa, Cardiovascular diseases, Silent Killer.

scholarly journals Clinical discussion: gout therapy in a comorbid patient

2020 ◽  
pp. 154-162
Author(s):  
M. S. Eliseev ◽  
A. M. Novikova
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Drug Therapy ◽  
Chronic Renal Failure ◽  
Metabolic Disorders ◽  
Calcium Pyrophosphate ◽  
Symptomatic Therapy ◽  
Prophylactic Therapy ◽  
Inflammatory Drugs

The data accumulated to date suggests that it is extremely rare for a gout patient to have only his or her main disease and no accompanying pathology. One of the frequent situations is a combination with another microcrystal arthritis, a disease of calcium pyrophosphate crystals deposition. In addition, diseases of the kidneys (including chronic renal failure), cardiovascular system, gastrointestinal tract, as well as metabolic disorders directly associated with gout or indirectly related to taking medications necessary to control the disease, not only affect the quality and longevity of life of the patient, but also create difficulties for its curation. The prescription of drug therapy, both symptomatic and pathogenetic, in such cases involves an assessment of all the associated risks, and the choice of drugs, in addition to efficiency, should be based on their safety profile in relation to comorbid pathology. This article analyzes the main principles and approaches to the treatment of gout and the disease of calcium pyrophosphate crystals deposition in the presence of concomitant diseases (arterial hypertension, chronic kidney disease, chronic heart failure, obesity, dyslipidemia, etc.) on the example of a 50-year-old patient. The possibilities of combined symptomatic therapy including colchicine, non-steroidal anti-inflammatory drugs and glucocorticoids are shown. The necessity and tactics of choice of preventive prophylactic therapy for arthritis attacks and use of phebuxostat in the presence of contraindications for prescription or ineffectiveness of allopurinol are also discussed.

P1674High intensity interval exercise program in heart failure patients seems to benefit cardiac power along with aorto-ventricular mechanical pump capacity and cardiorespiratory indices

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Chrysohoou ◽  
A Angelis ◽  
G Titsinakis ◽  
D Tsiachris ◽  
P Aggelopoulos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pulse Wave Velocity ◽  
Pulse Wave ◽  
Intervention Group ◽  
Control Group ◽  
Interval Exercise ◽  
Cardiac Power

Abstract Background Cardiac power has been suggested as the most power predictor of mortality in heart failure (HF) patients. In those patients aorta elastic properties and compensation is lost, systolic (and pulse) pressure are therefore reduced and associated with a decrease in ejection duration and pump efficiency. Cardiac rehabilitation programs have showed enhancement in cardiac performance and quality of life in HF patients. Aim Aim of this work was to evaluate the effect of high-intensity interval exercise (i.e., 30 sec at 100% of max workload, followed by 30 sec at rest, on a day-by-day 30 minutes working-out schedule for 12 weeks), on cardiac power, diastolic function indices, right ventricle performance and cardiorespiratory parameters among chronic HF patients. Methods 72 consecutive HF patients (NYHA class II-IV, ejection fraction <50%) who completed the study (exercise training group, n=33, 63±9 years, 88% men, and control group, n=39, 56±11 years, 82% men), underwent cardiopulmonary stress test, non-invasive high-fidelity tonometry of the radial artery, pulse wave velocity measurement using a SphygmoCor device, and echocardiography before and after completion of the training program. Cardiac power output (CPO) (W) was calculated as mean arterial pressure × CO/451, where mean arterial pressure = [(systolic blood pressure − diastolic blood pressure)/3] + diastolic blood pressure. Results Both groups reported similar medical characteristics and physical activity status. General mixed effects models revealed that the intervention group increased 6MWT (by 13%, p<0.05); increased cycle ergometry WRpeak (by 25%, p<0.01), showed higher O2max by 31% (p<0.001) and lower VE/VCO2 (p=0.05), whereas patients in the control group showed nosignificant changes in the aforementioned indices. Also, in the intervention group Emv/Vp was decreased by 14% (p=0.06); E to A ratio by 24% (p=0.004) and E to Emv ratio by 8% (p=0.05); while Stv increased by 25% (p=0.01). Most importantly, the intervention group reduced pulse wave velocity by 9% (p=0.05) and increased augmentation index by 26%; and VTI by 4% (p=0.05); Those parameters were not significantly changed on control group (all p>0.05). Conclusion Hight intensity exercise rehabilitation program revealed beneficial effect on left ventricular diastolic indices and right ventricle performance. As, in those patients compensation of the aorta is also lost and the LV cannot generate the extra force necessary to completely overcome the late systolic augmented pressure, the increase in the augmented pressure (AIa) observed in the intervention group reflects the benefit in aorto-ventricular coupling and cardiac power that boosts systolic pressure and restores a positive influence in pressure, like in early stages of HF. Acknowledgement/Funding None

The Relation of Arterial Pressure with Plasma and Body Electrolytes is Similar in Conn's Syndrome and Essential Hypertension

1982 ◽  
Vol 63 (s8) ◽  
pp. 89s-92s ◽  
Author(s):  
C. Beretta-Piccoli ◽  
D. L. Davies ◽  
J. J. Brown ◽  
J. B. Ferriss ◽  
R. Fraser ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Arterial Pressure ◽  
Potassium Concentration ◽  
Young Patients ◽  
Plasma Potassium ◽  
Surgical Removal ◽  
Exchangeable Sodium ◽  
Plasma Urea ◽  
Conn’S Syndrome

1. Arterial pressure, exchangeable sodium (NaE), exchangeable potassium (KE) and plasma concentrations of sodium, potassium, urea, angiotension II and aldosterone were measured in 34 patients with untreated Conn's syndrome before surgical removal of their adenoma. The study was repeated in 23 patients between 3 and 12 months after the operation. 2. Plasma aldosterone, NaE and plasma sodium concentration were higher and KE and plasma potassium concentration were lower than predicted normal. Surgery corrected these abnormalities, also reducing blood pressure from an average of 183/112 to 138/86 mmHg. 3. Systolic blood pressure was positively correlated with plasma and exchangeable sodium and negatively correlated with plasma potassium concentration. The relation of NaE and arterial pressure was closer in old than in young patients. None of these correlations was significant after operation. Before operation plasma urea was insignificantly related to arterial pressure but after operation a significant and positive correlation emerged. 4. A relation between arterial pressure and NaE is to be expected in a state of mineralocorticoid excess but the different correlation in old and young patients was not expected. A similar difference exists in patients with essential hypertension.

scholarly journals Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e017723 ◽  
Author(s):  
Chau Le Bao Ho ◽  
Monique Breslin ◽  
Jenny Doust ◽  
Christopher M Reid ◽  
Mark R Nelson
Keyword(s):  
Blood Pressure ◽  
Drug Treatment ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Number Needed To Treat ◽  
Absolute Benefit ◽  
All Cause Mortality ◽  
Pressure Lowering ◽  
Lowering Drug ◽  
Post Hoc

ObjectivesIn many current guidelines, blood pressure (BP)-lowering drug treatment for primary prevention of cardiovascular disease (CVD) is based on absolute risk. However, in clinical practice, therapeutic decisions are often based on BP levels alone. We sought to investigate which approach was superior by conducting a post hoc analysis of the Australian National Blood Pressure (ANBP) cohort, a seminal study establishing the efficacy of BP lowering in ‘mild hypertensive’ persons.DesignA post hoc subgroup analysis of the ANBP trial results by baseline absolute risk tertile.Setting and participants3244 participants aged 35–69 years in a community-based randomised placebo controlled trial of blood pressure-lowering medication.InterventionsChlorothiazide500 mg versus placebo.Primary outcome measuresAll-cause mortality and non-fatal events (non-fatal CVD, congestive cardiac failure, renal failure, hypertensive retinopathy or encephalopathy).ResultsTreatment effects were assessed by HR, absolute risk reduction and number needed to treat. Participants had an average 5-year CVD risk in the intermediate range (10.5±6.5) with moderately elevated BP (mean 159/103 mmHg) and were middle aged (52±8 years). In a subgroup analysis, the relative effects (HR) and absolute effects (absolute risk reduction and number needed to treat) did not statistically differ across the three risk groups except for the absolute benefit in all-cause mortality (p for heterogeneity=0.04). With respect to absolute benefit, drug treatment significantly reduced the number of events in the high-risk group regarding any event with a number needed to treat of 18 (10 to 64), death from any cause with 45 (25 to 196) and major CVD events with 23 (12 to 193).ConclusionOur analysis confirms that the benefit of treatment was substantial only in the high-risk tertile, reaffirming the rationale of treating elevated blood pressure in the setting of all risk factors rather than in isolation.

The Effect of Acupuncture on Essential Hypertension

1975 ◽  
Vol 03 (04) ◽  
pp. 369-375 ◽  
Author(s):  
Kwong-Chuen Tam ◽  
Heung-Hung Yiu
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Acupuncture Therapy ◽  
Drug Treatment ◽  
Needle Insertion ◽  
Results Of Treatment ◽  
History Of ◽  
Duration Of Disease ◽  
Excellent Improvement ◽  
Selection Of

Twenty-eight patients with essential hypertension were treated with acupuncture therapy. Sixteen showed excellent improvement in terms of the lowering of blood pressure to normal and the disappearance of original symptoms. Eight and moderate improvement and 4 showed no response. The results of treatment seem to indicate that improvement is closely related to the duration of disease and the history of drug treatment. The selection of acupuncture loci and the techniques of needle insertion and manipulation are discussed in detail.

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