Diagnosis Of Hypertensive Disease Research Articles

CHANGES OF COGNITIVE FUNCTION IN PATIENTS WITH HYPERTENSION WITH CONCOMITANT DIABETES MELLITUS TYPE 2

Relevance. Till now there is no clear clinical trial understanding of the relationship between hypertension (AH) and the patient's cognitive function.
 Objective: the investigation of changes in cognitive function in patients with hypertension with concomitant type 2 diabetes mellitus (DM2).
 Materials and methods. 215 people were examined: Group I (n = 131) – stage II hypertensive disease (HD); Group II (n = 46) – HD, combined with diabetes mellitus2; Group III, control (n = 38) – without a diagnosis of HD and diabetes mellitus2. All examined blood pressure (BP), echocardiogram. Clinical complaints, anamnestic data, and neuropsychiatric testing data were used to diagnose moderate cognitive impairment (MCI). Used modified diagnostic criteria J. Touchon, R. Petersen. To assess cognitive function used: Short scale of assessment of mental state (Mini-Mental State Examination - MMSE); Frontal Assessment Battery (FAB); clock drawing test; test for literal and categorical associations; Schulte tables; the Global Deterioration Scale (GDS) and the Clinical Dementia Rating (CDR).
 Result. In patients with HD, the most significant risk factors for moderate cognitive impairment are hypercholesterolemia and overweight (with OR 1.8), obesity (OR 1.6), the presence of concomitant diabetes mellitus2, which, especially in overweight, significantly impairs cognitive function ( OR 2.56). Deterioration of cognitive function correlates with the duration of HD, cholesterol levels. Concomitant diabetes mellitus2 in patients with HD creates a statistically significant additional negative effect on the results of cognitive function. In patients with HD with a distorted daily blood pressure profile, the neurodynamic component of cognitive function is first of all affected - conceptualization, repetition, the reaction of choice. The relationship between cognitive function and daily monitoring of blood pressure often have a U-shaped relationship, where the maximum indicators of cognitive function are at the level of the optimal recommended blood pressure figures (130-139 mm Hg for SBP, and 75-85 mm Hg for DBP, and the daily index within 10%).
 Conclusions. There is a dependence on changes in cognitive function on the presence of risk factors and signs of subclinical damage to target organs. The nonlinear U-shaped character of the relationship between the average daily, average night, and average daily blood pressure and the results of screening tests and scales for assessing cognitive function are shown.

Nitric Oxide in the Prevention of Pre-eclampsia (NOPE): A Double-Blind Randomized Placebo-Controlled Trial Assessing the Efficacy of Isosorbide Mononitrate in the Prevention of Pre-eclampsia in High-Risk Women.

Pre-eclampsia contributes to maternal and fetal morbidity and mortality all over the world. Endothelial dysfunction is postulated to be the crux of the pathogenesis. Recent meta-analysis of aspirin trials showed aspirin to be effective when started early in pregnancy (at ≤16-week gestation). We aimed to study the effect of low-dose prophylactic isosorbide mononitrate (ISMN) 20mg/day on the incidence of hypertensive diseases in high-risk women receiving standard aspirin prophylaxis. Design: Randomized double-blind placebo-controlled parallel-arm superiority trial. Setting: Antenatal clinic of a tertiary teaching hospital, South India. Participants and methods: One hundred women fulfilling NICE guideline criteria for aspirin prophylaxis recruited at 12-16weeks were randomized to receive either 20mg/day of ISMN or placebo, in addition to 75mg/day of oral aspirin from recruitment till delivery. Main outcome measure: Rate of hypertensive disorder of pregnancy (HDP). Sample Size: One hundred women (50 in each arm) to detect a decrease of HDP from 20% in the placebo group to 5% in the ISMN group with a power of 80% and at 0.05. One hundred women (50 in each arm) participated and completed the trial. Intention to treat analysis of these 100 women showed that the groups were comparable in terms of age, BMI, parity, and vascular indices (such as mean arterial pressure, uterine artery pulsatility index, flow-mediated vasodilatation index, brachial-ankle pulse wave velocity, Ankle-Brachial Index, brachial arterial stiffness index, and ankle arterial stiffness index). The rate of hypertensive disorders (gestational hypertension, pre-eclampsia, or superimposed pre-eclampsia) was not significantly different between the groups (14/50, 28% in ISMN vs. 12/50, 24% in placebo group; p=0.7). The mean gestational age at diagnosis of hypertensive disease (35.4 vs. 36weeks, ISMN vs. placebo groups, p=0.7) or the rate of severe disease (8/50, 16% in ISMN vs. 7/50, 14% in the placebo group; p=0.9) did not differ significantly between the two groups. Stillbirths (1 vs. 2), NICU admission rates (18 vs. 10%), and neonatal mortality (2 vs. 2) were also similar between the groups. The results of the randomized controlled trial of nitric oxide in the prevention of pre-eclampsia (NOPE) showed that in high-risk women receiving standard aspirin prophylaxis from less than 16weeks, there is no significant reduction in the incidence of hypertensive disorders of pregnancy in the ISMN group, to the desired extent. There was no significant effect on the severity of disease, gestational age at diagnosis of disease or maternal-perinatal morbidity due to low-dose isosorbide mononitrate.

Trends in the Prevalence of Hospitalization Attributable to Hypertensive Diseases Among United States Adults Aged 35 and Older From 1980 to 2007

We aimed to examine the trend in the prevalence of hospitalization attributable to hypertensive disease and its subtypes among United States adults aged ≥35 years from 1980 to 2007. Data (n = 4,598,488,000 hospitalized cases) from the National Hospital Discharge Surveys were used to examine the trends of hospitalized patients with first (the reason for admission) and patients with any second to seventh (a co-morbid condition when admission) diagnosis of hypertensive disease (International Classification of Disease, 9th Revision, Clinical Modification: 401 to 405) by gender and geographic region. Age-adjusted rates of disease were calculated using the United States 2000 standard population. The results show that age-adjusted hospitalization rates due to first diagnosis of hypertensive disease increased from 1.74% to 2.06% in men (p <0.01), and from 2.0% to 2.09% in women (p = 0.06) from 1980 to 1981 to 2006 to 2007. Age-adjusted rates due to any second to seventh diagnosis of hypertensive disease significantly increased from 7.06% to 35.09% in men (p <0.001), and from 7.88% to 31.98% (p <0.001) in women from 1980 to 1981 to 2006 to 2007. Patients with second to seventh diagnosis of essential hypertension and hypertensive chronic kidney disease had the highest and the second highest annual percent increases. Subjects living in the Southern region of the United States had the highest prevalence of hospitalization due to any second to seventh diagnosis of hypertensive disease compared with all other regions in 2006 to 2007. In conclusion, the prevalence of hospitalization due to hypertensive disease significantly increased in the United States from 1980 to 2007.

Clinical value of serum lactic acid and HSP70 in the diagnosis of hypertension diseases during pregnancy

目的 通过动态观察血乳酸和血清热休克蛋白70(HSP70)在妊娠期高血压疾病中的含量变化规律,探讨其在妊娠期高血压疾病诊断中的临床价值. 方法 对30例轻度、46例重度子痫前期患者和50例非孕对照组及50例同孕龄对照组患者血清标本采用ELISA双抗体夹心法和紫外酶动力学法检测,分析各组血清HSP70、乳酸含量变化规律. 结果 (1)轻、重度子痫前期患者血清HSP70含量均明显高于同孕龄对照组和非孕对照组(P<0.01),重度子痫前期组亦显著高于轻度子痫前期组(P<0.01),随妊娠期高血压疾病程度加重HSP70含量越高,增高程度与疾病严重程度呈正相关(r=0.461、P<0.05).(2)重度子痫前期组、轻度子痫前期组血乳酸含量与同孕龄对照组比较差异均有统计学意义(P<0.05),随着病情加重,血乳酸随之增高.(3)重度子痫前期患者随子痫抽搐、引产、剖宫产手术和HELLP综合征、DIC的发生,血清HSP70、血乳酸水平明显升高. 结论 动态监测血乳酸和血清热休克蛋白70含量对妊娠期高血压疾病患者病情变化、疗效观察和预后估计有非常重要的临床价值。

RAUWOLFIA DERIVATIVES AND BREAST CANCER

During the course of a collaborative study initiated in investigate the relationship of breast cancer and the use of hormones, it was possible to study the possible relationship of rauwolfia derivatives, mainly reserpine, to breast cancer. Interviews were administered to breast cancer patients admitted to five hospitals in the Baltimore metropolitan area. The study of reserpine use was conducted for a period of approximately one and a half years and information on reserpine use was obtained on 164 breast cancer cases. Each case was matched with a control with respect to age, color, hospital of admission, and admission date. An additional set of controls was drawn from women residing in the same neighborhood as the cases. Neither reserpine, methyldopa, nor thiazides were found to be significantly associated with breast cancer. The exclusion from the analysis of hospital controls with a diagnosis of hypertensive disease and their matched cases did not significantly alter the results. Those cases who used reserpine, used more for longer periods of time than did the controls, however this was judged inconclusive due to a considerable amount of missing data. After comparison of these results with previously reported studies, it did not appear that reserpine was strongly associated with breast cancer. However, because of methodological problems and differences between the studies, a possible small overall relationship could not be definitely excluded.

The Diagnosis of Hypertensive Disease

The Diagnosis of Hypertensive Disease

Kidney biopsies in multiparous patients with vascular renal disease in pregnancy

Renal biopsies were obtained at delivery from 66 multiparas who had toxemia in one or more pregnancies and from 10 multiparas whose pregnancies were uncomplicated by toxemia. There were no renal abnormalities in this latter group.Ten individuals who had had previous pre-eclampsia and eclampsia, and 24 individuals in whom the diagnosis of hypertensive disease was made exhibited normal histologic findings. Fourteen individuals presented findings characteristic of nephrosclerosis. Six had chronic renal disease of uncertain etiology. Four had chronic pyelonephritis in the absence of clinical evidence of the disease, and 2 individuals in this group had clinically undiagnosed bilateral polycystic kidneys as an additional finding. Lupus nephritis was present in 2 patients.The so-called “reversible toxemic lesion” was present in a moderate or severe form in 18 per cent of these patients, and the status of this lesion was regarded as uncertain.Many individuals had considerable renal disease with little clinical evidence of it, while others had a clinically severe toxemia of pregnancy in the absence of demonstrable renal disease.It was impossible to predict the presence of organic renal changes or the magnitude of the renal lesion on the basis of the fundoscopic findings.It was concluded that pre-eclampsia and eclampsia did not result in permanent renal damage and evidence was presented to support the contention that an increase in hypertension, proteinuria, and edema, or the initial occurrence of these manifestations of toxemia during the last 14 weeks of gestation in an individual with renal-vascular disease was the result of an exacerbation of this disease rather than the result of superimposed pre-eclampsia.