Diagnosis Of Primary Hypertension Research Articles

A genome wide scan for early onset primary hypertension in Scandinavians.

With the aim of identifying hypertension susceptibility loci, we performed a genome wide scan in Scandinavian sib-pairs with early onset primary hypertension. To be classified as affected, a diagnosis of primary hypertension at age </=50 years was required. Two hundred and forty three patients with onset of primary hypertension at 40.0+/-7.7 (mean+/-SD) years from 91 families (91 sib-ships with a mean of 2.7 and a range of 2-6 affected members per sib-ship) were genotyped with 362 microsatellite markers with a density of approximately 10 cM. Loci obtaining nominal P</=0.016 (LOD score >/= 1.0) were fine mapped with additional markers. Multipoint non-parametric linkage analysis was performed using GENEHUNTER v 2.0. Using simulations, a nominal P</=0.0002 was determined to be a genome wide significant evidence of linkage. In the 10 cM genome wide scan, nominal P</=0.016 were found on chromosomes 1 at 81 cM (P=0.007), 2 at 115 cM (P=0.006), 3 at 108 cM (P=0.006), 14 at 45 cM (P=0.0002) and at 99 cM (P=0.001), 17 at 42 cM (P=0.015) and 19 at 89 cM (P=0.007). After fine mapping of these loci, one of the chromosome 14 loci just obtained the level of genome wide significance (P=0.0002 at 41 cM) and the chromosome 2 locus reached suggestive evidence of linkage (P=0.002 at 118 cM). Our data suggest a hypertension susceptibility locus on chromosome 14 around 41 cM. The locus on chromosome 2 is also promising as it has been implicated in hypertension and blood pressure regulation in earlier genome scans.

Evaluation of the Initial Care of Hypertensive Patients

Patterns of patient care were evaluated retrospectively from the records of 994 patients hospitalized at a university hospital, a community hospital, and two Veterans Administration hospitals. Arterial pressure was not obtained by the admitting physician in 26% of the patients; and in those in whom a blood pressure was recorded, it was elevated in 18%. Of 200 patients discharged with the primary diagnosis of hypertension, the history, physical examination, and diagnostic evaluation were clearly inadequate. Thus, unless physician-recognition and adequate evaluation are improved (through education) the practice of massive public health screening programs seems pointless.

Antihypertensive drug versu symptomatic treatment in primary hypertension. Effect on survival.

An effort was made to determine the possible role of antihypertensive drugs in lengthening the life of patients with primary hypertension. The 58 patients satisfied rigid criteria for the diagnosis of primary hypertension, and all had had it for at least five years. They were divided into two equal, matched groups, 16 of the 29 matched patient-pairs being male. The test group received a variety of antihypertensive drugs sufficient to maintain blood pressures at or below 160/104 mm. Hg. None of these drugs were given to the contratest group. Both groups received sedatives, analgesics, digitalis, and diuretics as needed and were otherwise treated alike. Within the subsequent seven-year period of observation, 16 patients in each group died, and no significant difference between the two groups was found.