Chinese Treatments for High Blood Pressure

Hypertension Exercise Program

Blue Heron Health News has a blood pressure program that promises to help you lower your blood pressure with just 3 easy exercises. The creator has used these exercises effectively on himself, and he has tweaked them to make them as effective as possible. He personally used them for two weeks straight and lowered his own blood pressure drastically. For the next few weeks, he noticed that his blood pressure when up and down a little, but it never went back to as high as it was, and now he is sharing this method to reduce high blood pressure with confidence through Blue Heron. Along with the main program, you also get a bonus called The Natural Blood Pressure Lifestyle Report. This report complements the blood pressure program by helping you understand how high blood pressure occurs, how you can tweak your diet and lower it, different herbal medications that can help, and how your lifestyle can influence your blood pressure in a big way, plus much more. More here...

Hypertension Exercise Program Overview

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Man with Hypertension and Fever

A 75-year-old man with longstanding hypertension developed a fever and upper respiratory illness 2 weeks prior to admission. The fever ranged between 103 and 104 F (39.4 and 40.0 C), and there were no localized pulmonary findings or productive cough. This illness did not respond to a cephalosporin, and thus amantadine was begun one week prior to admission. Four days prior to admission the patient's family stopped all medications, including his antihypertensive drugs, because they felt he was having a reaction to the medicine.

Selection of antihypertensive drug in diabetes mellitus

ACE inhibitors, nondihydropyridine CCBs, TDs, and bBs reduced CV complications in patients who had diabetes and hypertension in several long-term, large, RCTs (Tables 3 and 4). Limited data is available with direct comparisons of various drugs in diabetic, hypertensive patients (Table 5). There was no convincing evidence from several large RCTs (eg, CAPPP 26 , Swedish Trial in Old Patients with Hypertension 2 STOP-2 68 , Nordic Diltiazem NORDIL study 69 , and Intervention as a Goal in Hypertension Treatment INSIGHT 70 ) that newer agents, such as ACE inhibitors and CCBs, are better than diuretics and bBs in reducing CV events in treating hypertension in the general population. Because diabetes is an important and independent risk factor for CV morbidity and mortality and because most diabetics die of CV complications 1 , subgroup analysis of diabetic, hypertensive patients in these trials revealed that most required multiple drugs for adequate control of their BP. In the CAPPP trial,...

Diabetes Mellitus And Arterial Hypertension Differentially Affect Macrophage Recruitment And Collateral Growth

Further indication of the restriction of macrophage involvement to the early prolif-erative phase of collateral development and the physiological importance of the late remodeling phase came from experiments investigating the influence of different risk factors, namely the metabolic syndrom and arterial hypertension on collateral growth 64 . We investigated at which level two prominent risk factors, diabetes mellitus type II and arterial hypertension, impair collateral formation and assessed proliferative index (PI BrdU infusion), macrophage accumulation (M0 ED 2 staining), collateral score (post-mortem angiography), collateral conductance (CC collateral flow pressure gradient under maximal vasodilatation) and effect of MCP-1 treatment one week after femoral artery occlusion in normotensive Zucker Fatty Diabetic (ZDF) rats and control animals (ZDL rats). Results were compared with those of ZDF and ZDL rats rendered hypertensive via the Goldblatt method. While diabetic animals showed...

No of antihypertensive agents Trial Target BP mm Hg 1234

Multiple antihypertensive agents are needed to achieve target blood pressure. BP, blood pressure DBP, diastolic blood pressure MAP, mean arterial pressure SBP, systolic blood pressure. (Adapted from Bakris GL, Williams M, Dworkin L, et al. Preserving renal function in adults with hypertension and diabetes a consensus approach. Am J Kidney Dis 2000 36(3) 646-61 with permission.) Fig. 4. Multiple antihypertensive agents are needed to achieve target blood pressure. BP, blood pressure DBP, diastolic blood pressure MAP, mean arterial pressure SBP, systolic blood pressure. (Adapted from Bakris GL, Williams M, Dworkin L, et al. Preserving renal function in adults with hypertension and diabetes a consensus approach. Am J Kidney Dis 2000 36(3) 646-61 with permission.) The Losartan Intervention for Endpoint Reduction in Hypertension trial also demonstrated beneficial effects of ARBs in the prevention of stroke events. To conclude, pharmacologic therapy to block the renin-angiotensin...

Chromiumiii Supplementation In Lowering Blood Pressure Hypertension And Cholesterol

With elevated insulin levels exhibit increased levels of LDL cholesterol, decreased high-density lipoprotein (HDL) cholesterol, and high blood pressure compared to individuals with normal insulin levels 12, 13 . Furthermore, as blood pressure increases steadily, especially in aging individuals, high blood pressure can lead to essential hypertension or age-related hypertension as well as diabetic hypertension all of which are associated with insulin perturbations 12, 13 . Many drugs lower circulating cholesterol levels, but they are not infrequently associated with severe side effects. Numerous studies have shown that Cr(III) can prevent hypertension by lowering harmful LDL cholesterol and increasing beneficial HDL cholesterol and even reverse atherosclerosis 12, 17 . Abraham et al. in 1991 reported that rabbits on a high cholesterol diet followed with chromium(III) chloride showed a significant regression of atherosclerosis plaques while rabbits without chromium showed no improvement...

Animal Models of Venous Hypertension

The underlying disturbance leading to varicose vein formation is venous hypertension and valvular incompetence. There are a few animal models that have investigated the effect of acute and chronic venous hypertension on molecular changes of the vein wall and valvular function. By creating a femoral artery and vein arterio-venous fistula an acute rat model of venous hypertension evaluated valvular changes and vein wall biochemical characteristics. At three weeks, three of four rats had demonstrable venous reflux and increased venous pressure (94 9 mm Hg, control 11 2 mm Hg) compared to the contralateral control femoral vein. The pressurized veins were dilated with valve leaflets, and length and width were reduced. There was a significant inflammatory response represented by leukocytes infiltrating the entire vein wall, and upregulation of P-selectin and intercellular adhesion molecules. In this study there were no differences in MMP-2 or MMP-9 at three weeks, and interestingly the...

New Doctor for a Man with Diabetes and Hypertension

In addition to diabetes, other medical issues included chronic hypertension and gastroesophageal reflux disease. His daily medications were insulin, hydrochlorothiazide, enalapril, aspirin, and omeprazole. He was a nonsmoker. His mother had a history of chronic hypertension and died at age 71 of complications of end-stage renal disease and congestive heart failure. The physician diagnosed mild, nonproliferative diabetic retinopathy and mild chronic renal disease secondary to diabetes mellitus and hypertension. She was interested in quantifying the current renal dysfunction and stratifying the patient's risk for future endstage renal disease. Incorporating knowledge of the patient's plasma creatinine, age, and African-American race, she estimated a glomerular filtration rate (GFR) of 65 mL min per 1.73 m2 using the Modification of Diet in Renal Disease study (MDRD) equation see Eq. (9.3) that she had recently read about. She used the GFR calculator on the National Kidney Foundation...

Hypertension

Age-adjusted rates of hypertension declined substantially in whites aged 2074 years between 1976-1980 and 1988-1994 (from 43.9 to 24.4 in men and from 32.1 to 19.3 in women) (National Center for Health Statistics 2000). These rates reflect the total prevalence during each of the 4- to 6-year data collection cycles. However, hypertension rates among Mexican Americans remained essentially the same during the same periods, with a total age-adjusted prevalence rate of 25.2 for men and 22.0 for women in a 1988-1994 survey (National Center for Health Statistics 2000). Latinos are less likely than whites to have their blood pressure under control (Pavlik et al. 1996). Progress toward awareness, treatment, and control of hypertension in Latinos requires increasing attention to community awareness, facilitating access to care for this group, and sensitizing clinicians.

Portal hypertension

Liver cirrhosis is the commonest cause of portal hypertension but it may also occur when the liver is congested in chronic heart failure or with portal vein thrombosis, for example following trauma or infection. Portal hypertension causes splenomegaly and ascites. Portosystemic shunting causes varices to form and, particularly if there is severe underlying liver disease, it causes hepatic encephalopathy. Ascites is the accumulation of fluid in the peritoneal space. Portal hypertension increases hydrostatic pressure in intestinal and mesenteric capillaries, causing fluid leakage. The protein concentration of this ascitic fluid is low (transudate) and it lacks antibacterial factors, such as complement, so that it is prone to becoming infected, resulting in spontaneous bacterial peritonitis.

High Blood Pressure

High blood pressure (or hypertension) is nearly as dangerous as high cholesterol. People with this condition are more than twice as likely to suffer a heart attack as those with normal blood pressure are. Because fifty million Americans have hypertension, it's a major cause of atherosclerosis, to say nothing of the death and disability that it brings about through stroke and other hypertensive diseases such as kidney failure. To determine if you have high blood pressure, look up your numbers in Table 4.2. What if your systolic blood pressure is high but your diastolic is not, or vice versa Use the higher category to determine your status. For example, if your blood pressure is 162 85 millimeters of mercury (mm Hg) you have Stage 2 hypertension. Because high blood pressure usually begins gradually between ages twenty and fifty, all adults should have their blood pressure checked regularly. Blood pressure checks every three years usually suffice for people with normal or optimal levels....

Precipitating Factors

There are causes of infarction other than acute atherothrombotic coronary occlusion. Prolonged vasospasm can induce infarction, and spontaneous dissections are becoming more commonly appreciated, especially in pregnant females. Other conditions can also cause the death of cardiomyocytes and lead to a biochemical signal of myocyte damage, but should not be confused with myocardial infarction. These include (1) trauma that may precipitate myocardial contusion (2) toxic reactions to chemotherapy agents, such as Adriamycin, or myocardial depressant substances released with sepsis (3) heat-induced injury after cardioversion (4) increases in wall stress with impairment of subendocardial perfusion caused by severe hypo- or hypertension and or (5) injury caused by catechol-amine release in patients with acute neurological catastrophes. Pulmonary embolism is another common cause of biomarker increase.

Strategy and Selection of Drug Therapy139

The coexistence of hypertension and diabetes dramatically and synergistically increases the risk of microvascular and macrovascular complications. Overwhelming evidence supports aggressive treatment of hypertension in diabetic patients. Tight blood pressure control is cost-effective and is more rewarding than glycemic control. The optimal goal of blood pressure control in diabetics should be 130 80 mm Hg. In subjects who have diabetes and renal insufficiency, the blood pressure should be lowered to 125 75 mm Hg to delay the progression of renal failure. The choice of an antihypertensive agent should be based on proven effects on morbidity and mortality rather than on surrogate parameters, such as lipid or glucose. Limited data suggest that an angiotensin-converting enzyme (ACE) inhibitor is the agent of choice, especially in those who have proteinuria or renal insufficiency. b-Blockers can be the first-line agent in diabetics who have coronary heart disease. Thiazide diuretics and...

Dietary components and health

The general increase, however, in the quantity and variety of food available has mostly been accompanied by the emergence of degenerative conditions such as CVD, various types of cancer, non-insulin dependent diabetes mellitus, obesity, osteoporosis and hypertension. Documenting and monitoring dietary patterns has therefore become a priority in the formulation of dietary recommendations and the planning of national food, nutrition and agricultural policies (Soci t Fran aise de Sant Publique. Health and Human Nutrition, 2000).

Basic Scientific Discovery and Application to New Drug Development

In the course of reviewing the matter, the Joint Economic Committee examined a list of 21 major drugs, which was put together apparently as an example of drug products that might justify royalty to the government. One of these agents, captopril (trade name Capoten), was discovered and developed by E.R. Squibb & Sons in the 1970s. At that time, Charles Smith (one of the authors editors) was vice president for R& D at The Squibb Institute for Medical Research. One of Squibb's academic consultants, Professor Sir John Vane of the Royal College of Surgeons in London brought the idea of opening a new pathway to treat the so-called essential hypertension by inhibiting an enzyme known as the angiotensin converting enzyme (ACE). This biochemical system was certainly known at that time but, in Squibb's experience in the field of hypertension treatment, was not generally thought to play a major role in the common form of the disease, then known as essential hypertension. The company...

Nutritional Background

More recently, the complex relationship between diet and heart disease has been reviewed by Ashwell (1993). While it is acknowledged that CHD is a multifactorial disorder, it is considered that diet is one component which can be modified by everybody. The report concludes that the development of CHD can be viewed simplistically as a three-stage process starting from an initial arterial injury that is followed by atherosclerosis and the formation of a blood clot which eventually blocks the artery thus causing a heart attack. Each stage can be influenced by several physiological conditions (e.g., high blood pressure, high levels of plasma lipids, and low levels of antioxidants), and these can be affected by controllable factors, including diet. A round table model was derived to elucidate the relationships between the stages of the disease, physiological conditions, and dietary components. The level and composition of the fats consumed is shown to be of importance at all three stages,...

Diseases and disorders

Liver damage is often caused by infections or drugs and may be acute or chronic. Acute liver disease can rapidly progress to liver failure, or can resolve, either spontaneously or with appropriate treatment. Chronic liver disease may cause cirrhosis, which is characterized by a variety of signs and symptoms and changes throughout the body, including the effects of hepatic portal venous hypertension.

Therapeutic Strategies in Diabetes and Cardiovascular Disease

Prakash Deedwania, who has had a long and productive interest in diabetes and cardiovascular disease, was willing to organize and contribute to articles on this topic. This broad topic has been divided between two issues of the Cardiology Clinics. The first issue (November 2004) dealt with pathophysiology, clinical epidemiology, and the relationship between diabetes and other diseases such as heart failure and hypertension. The second issue deals

Reference Interval SI Units

Over the next several days the hematological picture improved spontaneously hemoglobin rose to 12 g dL (7.45 mmol L), hematocrit to 36 (0.36), and platelet count to 191 x 103 mL (191 x 109 mL). Serum electrolytes, acid-base values, and urea nitrogen, determined during this period of hemodialysis, stabilized. A disintegrinlike and metallopro-teinase domain with thrombospondin Motifs-13 (ADAMTS-13) enzyme level performed by a reference laboratory was normal, ruling out TTP. The patient remained in acute renal failure until the 22nd hospital day when urine output increased to 500-1000 mL d. Renal biopsy performed on the 22nd hospital day showed regenerating tubules consistent with improving ATN. By the 27th hospital day, urine output was > 1500 mL day, and serum urea nitrogen and creatinine were decreasing without further dialysis. When serum potassium fell to 3.1 mmol L, oral potassium supplementation was initiated. After an uneventful diuretic phase, the patient was discharged with...

The Role of Intensive Glycemic Control in the Management of Patients who have Acute Myocardial Infarction

An alternative explanation for the relationship between glucose levels that are measured upon hospital admission and prognosis is the link between insulin resistance, the metabolic syndrome, and cardiovascular (CV) disease. Metabolic syndrome is characterized by insulin resistance and the association with traditional (the deadly quartet'' of obesity, hypertension, glucose intolerance, atherogenic dyslipidemia) and novel (endothelial dysfunction, proinflamma-tory state, hypercoagulability) risk factors for the development of CV disease and DM 17,18 . The metabolic syndrome is present in approximately 30 of middle-aged men 17 and is associated with a threefold to fourfold increase in CV mortality as compared with controls, even when patients who had known CV disease and DM were excluded from analysis 18 . Patients who have insulin resistance and frank DM also may have a host of associated conditions (Box 1) that may contribute to a poor CV prognosis.

Can Epilepsy Be Prevented

Many cases of epilepsy can be prevented by wearing seatbelts and bicycle helmets, putting children in car seats, and other measures that prevent head injury and other trauma. Prescribing medication after first or second seizures or febrile seizures also may help prevent epilepsy in some cases. Good prenatal care, including treatment of high blood pressure and infections during pregnancy, can prevent brain damage in the developing baby that may lead to epilepsy and other neurological problems later. Treating cardiovascular disease, high blood pressure, infections, and other disorders that can affect the brain during adulthood and aging also may prevent many cases of epilepsy. Finally, identifying the genes for many neurological disorders can provide opportunities for genetic screening and prenatal diagnosis that may ultimately prevent many cases of epilepsy.

Definition of the metabolic syndrome

The clustering of insulin resistance, dysglycaemia, dyslipidaemia and hypertension was originally defined as syndrome X in 1988 (Reaven, 1988). Definitions of the metabolic syndrome that also include a measure of central obesity have been developed between 1999 and 2001 by the World Health Organization (WHO Consultation, 1999), the European Group for the Study of Insulin Resistance (EGIR Balkau and Charles, 1999) and the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults abbreviated to Adult Treatment Panel (ATP-III) (NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood > 140 90 or treated for hypertension Triglycerides > 2.0 or HDL-cholesterol < 1.0 or treated for dyslipidaemia Fasting plasma glucose > 6.1, but non-diabetic > 130 85 or treated for hypertension Triglycerides > 1.7 HDL-cholesterol < 1.0 (men), < 1.3 (women) Fasting plasma glucose > 6.1

Internal Medicine Psychiatry

Based on a recent survey of program directors, most internist-psychiatrists practice both specialties in an academic setting.8 A smaller group works in the private sector, particularly outpatient clinics and integrated treatment programs. Those who work in state psychiatric facilities focus heavily on psychiatric diagnosis while also managing chronic medical diseases like diabetes and hypertension. Regardless of practice setting, combined training in internal medicine and psychiatry provides focused, in-depth, biopsychosocial training while expanding and sharpening primary care skills.

Selection and Interpretation of Laboratory Results

Decreased renal function in nephrotic patients at initial presentation, as indicated by high serum creatinine and serum urea nitrogen, usually suggests the presence of nephritis or other renal disease. Renal failure is indicated by increased serum urea nitrogen and serum creatinine concentrations and may be accompanied by hyperkalemia, hypertension, and fluid overload culminating in congestive heart failure. Urine output is not a reliable sign of renal failure, since decreased urine volume usually results from the physiological response to hypoalbuminemia. Because of their apparently volume-contracted state, patients with nephrotic syndrome may increase tubular reabsorption of urea and exhibit mild to moderate increases in serum urea nitrogen concentrations without concomitant increases in creatinine (which is not reabsorbed). Rarely, intrarenal edema and low renal blood flow rates may cause a marked decrease in glomerular filtration.3 This decrease is difficult to differentiate from...

Penetrating Aortic Ulcer

A penetrating aortic ulcer is an entity described by Stanson et al. 26 as an ulceration of a plaque of atheroma that extends through intima into internal elastic lamina. It occurs generally in elderly patients (over 75 years) with hypertension, multiple-risk factors (smoking) and severe complex atheroma plaques. Symptoms are similar to those of aortic dissection. Penetrating ulcers involve a classic descending aorta. Circular and longitudinal extensions are less important than hematoma. The typical TEE aspect consists in a thick atherosclerotic plaque with a deep crater limited by irregular edges (Fig. 4.13). Color Doppler imaging enhances the detection of the ulcer and measurement of the crater dimensions. There is no intimal flap, nor false lumen. An-giography was the first method of diagnosis and showed a localized additional contrast image. CT and MRI are more efficient in the diagnosis of complications. It has been proved that a penetrating ulcer has a severe potential of...

Structurebased drug design

The first structure-based search in 1975 discovered the antihypertensive agent captopril. Over the next 15 years, millions of dollars were spent in this area with few results. This has begun to change now because of advances in nuclear magnetic resonance, x-ray crystallography, and computer model-ing.124-127 Traditionally, pharmaceutical companies have discovered new

Early Manifestations Of Inflammation

The suggestion that inflammation may be involved in CVD comes from the evidence for elevated endothelial permeability,2 a process that tends to involve inter-endothelial junctions. This can readily be observed in acute models of venous hypertension (see Figure 7.1). Although there are a large number of mediators (histamine, platelet activating factor, cytokines) that have the ability to elevate endothelial permeability, most of them when acutely applied to a tissue act transiently via mechanisms that involve nitric oxide,7 actin polymerization, and selected small GTPases.815 This serves as an indication that already an early event in CVD

Effect of glycemic control on cardiovascular disease

Many of the features of insulin resistance that are present before the onset of hyperglycemia remain operative during the natural history of the diabetes mellitus and contribute greatly to atherosclerosis and associated comorbidities 13,14 . Insulin resistance contributes to the development of atherosclerosis through multiple recognizable risk factors, such as hypertension, dyslipidemia, and hypercoagulability (see Fig. 1) 15 . role in a variety of other metabolic abnormalities, including high levels of plasma triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, hypertension, abnormal fibrinolysis, and coronary heart disease 15,16 . This cluster of abnormalities has been called the insulin resistance syndrome or the metabolic syndrome 17 . The National Cholesterol Education Program Adult Treatment Panel III recently recognized the metabolic syndrome as a secondary therapeutic target for the prevention of cardiovascular diseases 15 . Patients who have the metabolic...

Evaluation and Management of New Onset Ascites

Although cirrhosis of the liver with resulting portal hypertension is the most common cause of ascites, there are many other possible etiological factors, such as right-sided Fortunately for the patient under discussion, his ascites was due to portal hypertension and was noninfected with a low granulocyte count. It resolved relatively easily with diuretics and a sodium-restricted diet.

Screening for Anxiety Disorders and Psychosocial Problems

When patients report both anxiety and somatic complaints, it is easy to assume that their apprehensiveness is a result of their medical condition. That is often true, of course, but sometimes the opposite relationship holds. Even when a medical disorder is present, not all anxiety is normal. Anxiety disorders are significantly more common in patients with chronic medical illnesses than in those without. Furthermore, anxiety disorders can provoke, maintain, or worsen certain medical conditions (e.g., hypertension, gastroesophageal reflux, myofascial pain). Whether or not a patient has a medical disorder, then, nervousness or worry should prompt a search for an anxiety disorder.

Causes of Memory Problems

Like Michael, many patients with memory problems who come for evaluation discover that the cause is something that they never imagined could impair their ability to think and remember. Often, the cause is a common condition (such as depression) or a disorder that increases the risk of cerebrovascular disease and heart disease (such as poorly controlled high blood pressure or diabetes). Other causes of memory loss are hormonal changes that occur naturally during certain stages of life. For women, hormonal fluctuations following childbirth and around menopause can make them feel less sharp. Men also go through a phase of significant hormonal change as they age a drop in testosterone level has been linked with age-related memory problems. Still other causes of memory loss are unhealthy habits (such as excessive alcohol use and getting too little exercise or sleep) or a lack of intellectual challenge. Fortunately, many causes of memory dysfunction are preventable or treatable. You can...

Matrix Metalloproteinases

This suggests that the previously documented abnormal elastic properties and the increased risk for aneurysm formation in patients with BAVs may reflect the increased activity of these matrix-degrading proteins within the aortic wall. Several risk factors for aneurismal dilatation, including hypertension and hyperhomocysteinemia, are known to induce the expression of MMPs. These data suggest the need of

Calcium channel blocker See calcium entry

Calcium entry blocker Any of group of drugs that act by slowing the influx of calcium ions into muscle cells, resulting in decreased arterial resistance and myocardial oxygen demand. These drugs are used in treating angina hypertension and supraventricular tachycardia, but may cause hypotension. They have been shown to provide protection against coronary artery disease. Included in this group are nicardipine, nifedipine, verapamil, and diltiazem.

Angiotensin Converting Enzyme ACE Inhibitors

ACE inhibitors are a class of blood pressure drugs that works by dilating blood vessels. In addition to controlling high blood pressure, ACE inhibitors have long been prescribed for people with heart failure. Recent studies have shown that these drugs also help people with coronary artery disease and those at high risk for developing it.

Or Nonsyndromic Monogenic Disorders Presenting Aortic Aneurysms or Dissections

O Hypertension or pulsatile blood flow can propagate the dissection. O Pregnancy O Syphilis O Crack cocaine use Fig. 5.13. Diseases affecting the media of the aorta with predisposition to dissection. Aortic dissection is commoner in patients with hypertension, connective-tissue disorders, congenital aortic stenosis, or bicuspid aortic valve, and in those with first-degree relatives with history of thoracic dissections

Coronary Artery Disease and Its Risk Factors

What's bad for your heart is also bad for your brain. Conditions that are risk factors for cerebrovascular disease and heart disease, such as high cholesterol, hypertension, and diabetes, increase the risk of memory problems. Controlling these disorders with medication, dietary changes, and exercise can help keep your memory in optimal condition. Hypertension. Regardless of age, you're more prone to memory impairment if you have high blood pressure than if you have normal blood pressure. Moreover, your memory impairment is likely

Calcium Channel Blockers

Like beta-blockers, calcium channel blockers control high blood pressure. Calcium channel blockers are vasodilators, meaning they dilate the coronary arteries. By doing so, they increase blood flow to the heart and cut its workload by reducing blood pressure and the force of the heart's contractions.

Treatment of Acute Rejection

Both tacrolimus and CsA have similar renal and hepatic toxicities, but they differ in other toxic side effects. Patients treated with tacrolimus have a higher incidence of diabetes mellitus but a lower incidence of hypertension, hyper-lipidemia, and hirsutism.31 Tacrolimus is more potent than CsA in enhancing peripheral nerve regeneration and is therefore commonly used in human hand transplantation.32 Adding sirolimus to combination regimens has allowed the dose of calcineurin inhibitors to be reduced, thus decreasing the nephrotoxicity associated with calcineurin inhibitors without decreasing graft survival.33 The main side effects of sirolimus are hypercholesterolemia, leukopenia, and thrombocytopenia and, unlike calcineurin inhibitors, hypertension, nephrotoxicity, and hepatotoxicity are not common.26

Memory Loss Following Heart Surgery

You have hypertension if your systolic blood pressure (the pressure while the heart is beating) is consistently 140 mm Hg or higher or if your diastolic blood pressure (the pressure between beats) is consistently 90 mm Hg or higher. We think that hypertension impairs memory by damaging tiny blood vessels that terminate in the brain's white matter, the bundles of axons that transmit messages throughout the brain and central nervous system. Lesions, or abnormalities, in white matter occur to some degree in virtually everyone older than age sixty and contribute to age-related memory loss. But people with hypertension have more extensive white matter damage than same-age peers with normal blood pressure. Research suggests that hypertension that is inadequately treated might also predispose you to dementia. There's an additive effect brain imaging studies suggest that increased blood pressure can cause small strokes, which can then cause dementia. Hypertension also...

Populationlevel Preventive Interventions

Preventive interventions at the population level may be classified as universal, selective, and indicated, borrowing the classification developed by Gordon (IOM, 1994b). A universal measure is one that would be desirable for everyone in an eligible population. It would focus on shifting the entire population distribution rather than on targeting only relatively high-risk individuals, as illustrated earlier in this chapter. It would likely involve an agreed-on public policy requiring broad-based public understanding and political support. A selective preventive measure is one that is desirable only when an individual is a member of a subgroup of the population whose risk of becoming ill is above average. These are the more traditional population-oriented public health education interventions targeted toward the high-risk segments of the population. Finally, an indicated preventive measure is one that is applicable to persons who, on examination, manifest a risk factor, condition, or...

Central nervous system lymphoma See primary

Cerebrovascular accident (CVA) A stroke. A general term most commonly applied to cere-brovascular conditions that accompany either ischemic or hemorrhagic lesions. These conditions are usually secondary to atherosclerotic disease, hypertension, or a combination of both. Also called apoplexy or simply a shock.

Atherothrombosis Phases

Cholesterol transport, plaque rupture was more associated with increased total choles-terol HDL ratio than with either smoking or hypertension (29). HDL may exert an antiapoptotic effect on vascular endothelial cells, which suggests that a plaque may be less vulnerable to disruption and rupture (30).

Atrial natriuretic factor Obsolete name for atrial natriuretic peptide

Atrial natriuretic peptide ANP A polypetide hormone found mainly in the atrium of the heart of many species of vertebrates. It is released in response to atrial stretching and thus to elevated blood pressure. ANP acts to reduce blood pressure through stimulating the rapid excretion of sodium and water in the kidneys (reducing blood volume), by relaxing vascular smooth muscle (causing vasodilation) and through actions on the brain and adrenal glands.

Referral to Specialists

Case Example A 64-year-old executive consulted her physician because of concerns about declining function at work. For the past several months, she had had difficulty following discussions similar to those she had led in the past, but she reported no other difficulties. History and physical examination showed no new problems since her last routine assessment 13 months before, and her mild hypertension was well controlled. On mental status examination there was no evidence of mood disorder and her MMSE score was 28 30, but on the latter test she missed the date by three days and could not copy the interlocking pentagons. Her physician initiated an evaluation for reversible causes of dementia and ordered a head MRI because of her young age. When these tests were normal, he referred her to a neuropsychiatrist for further differential diagnosis and to a neuropsychologist for more extensive cognitive assessment. Neuropsychological testing demonstrated deficits in memory, language, and...

Circulating Cells With Angiogenic Potential As Effectors And Biosensors Of Pathological Changes In Dm

Recently, the evidence was generated that individuals with DM present with reduced numbers of circulating cells with markers of immaturity, so-called endothelial progenitor cells (EPC). It has to be noted, however, that there is still no consensus in the field over the definition of EPC In fact, EPC is partly used for early and immature progenitor cells (such as CD133 + VEGFR2+ CD34+ CD45low), but also for in vitro modified monocytic cells. With regard to DM, the number of CD34 + VEGFR2+ circulating EPC 69 was decreased in the circulation of individuals with DM type 2 with and without PAD. The presence of DM-related PAD decreased the number of circulating CD34 + CD133 + VEGFR2+ EPC, which are real immature cells based on the expression of the CD133 molecule 70 . It was also shown that only DM type 1 has an adverse influence on the number of circulating CD34+ angioblasts 71 . Some ex vivo data indicate that the number of EPC, generated in vitro from blood-derived mononuclear cells...

Differential Diagnosis

Hypokalemic hypertension with metabolic alkalosis encompasses 2 of all cases of hypertension. The differential diagnosis includes aldosteronoma (also termed aldosterone-producing adenoma), bilateral adrenal hyperplasia with aldosterone hypersecretion (also known as idiopathic primary hyperaldosteronism), adrenal adenomas secreting desoxy-corticosterone, glucocorticoid-remedial hypertension (or dexamethasone-suppressible hypertension), apparent mineralocorticoid excess, Liddle syndrome (a gain-of-function mutation in the b or g subunits of the epithelial sodium channel of the distal convoluted tubule and collecting duct), renin-secreting juxtaglomerular apparatus tumors, and secondary hyperaldosteronism from renovascular disease or intrinsic renal disease.

Effects of Aortic Cross Clamping and Surgical Treatment

Aortic cross-clamping results in hypertension proximal to the clamp, and hypotension distal to the clamp. Cross-clamping therefore results in a reduction in spinal blood inflow from the thoracic and lumbar regions. The blood flow proximal to the clamp, including cerebral blood flow, increases, resulting in an increase in CSF pressure, which further reduces spinal perfusion pressure 13, 20 . The reduction in spinal perfusion pressure from aortic clamping is further exacerbated if the distal aorta or intercostals are bleeding freely, as a consequence of steal phenomena 21 . Avoidance of steal - for example, by clamping the distal aorta above the celiac arteries, or by clamping segmental vessels -has been shown to reduce spinal ischemia in pig models 9 . The severity of spinal cord ischemia is directly proportional to the duration of aortic clamping this has

Sometimes requires discontinuation Contraindicated in active hepatic renal and coronary artery disease

Cholesterol, this predominantly is in the larger, buoyant particles of LDL cholesterol which may be less atherogenic 90,98,108 . Concomitantly, the small, dense LDL cholesterol particles decreased with thiazolidinedione therapy 98,109 . Winkler et al 110 studied the effect of pioglita-zone on LDL subfractions in normolipidemic, nondiabetic patients who had arterial hypertension. They used a monocentric, double-blind, randomized, parallel-group study that compared 45 mg pioglitazone (n 26) and a placebo (n 28) that were given once daily for 16 weeks. Fifty-four moderately hypertensive patients (LDL cholesterol, 2.8 mmol L 0.8 mmol L HDL cholesterol, 1.1 mmol L 0.3 mmol L triglycerides, 1.4 mmol L (median range 0.5-7.1 mmol L) were studied at baseline and on treatment. Pioglitazone reduced dense LDLs by 22 (P 0.024). If insulin resistance causes hypertension, then improving insulin sensitivity should have the potential to lower blood pressure. The effects of thiazolidinediones on blood...

Endovascular Therapies

The observation of some cases of paraplegia with endovascular grafting, however, implies that, at least in some patients, loss of intercostal blood supply to the cord can, by itself, result in spinal infarction. This may occur in patients in whom the distal spinal or collateral system is anatomically deficient 4 , or has previously been compromised by disease or surgery 12 . Although the logical extension is that this observation supports intercostal reimplantation, it cannot be asserted with any certainty that intercostal implantation would necessarily have prevented such events the patients with paraplegia following endovascular stent grafting may represent the same subset of patients who would have become paraplegic with open repair regardless of the surgical approach (as all surgical approaches have a consistent basal paraplegia rate of about 5 which has not been influenced by technique or adjuncts). Sophisticated analysis and modeling of large datasets of endo-vascular and open...

Toxicity Potentiators

Histamine appears not to be the sole factor in causing toxicity as cases of toxicity have also been observed where the histamine content has been low (Arnold and Brown, 1978 Murray et al., 1982 Taylor, 1986 Clifford et al., 1989 Soares and Gloria, 1994). Strong evidence exists that biogenic amines, such as putrescine, cadaverine, spermine, and spermidine, in fish tissue can potentiate the toxic effect of histamine by inhibiting intestinal histamine-metabolizing enzymes (such as diamine oxidase Hungerford and Arefyev, 1992 ), increasing histamine uptake, and liberating endogenous histamine in intestinal fluids (Chu and Bjeldanes, 1981 Hui and Taylor, 1983 Ibe et al., 1991 Halasz et al., 1994). It has been reported that fish implicated in a scombroid poisoning incident contained high levels of inhibitors that interfere with histamine metabolism. Monoamineoxidase inhibiting drugs used for the treatment of depression, hypertension, and tuberculosis have also been observed to potentiate...

The Hypertensive Accountant

A 45-year-old accountant was, at his request, referred by his general practitioner to a hypertension unit for investigation because recent need for additional medications had caused unwanted side effects. Diagnosed approximately 10 years previously, his hypertension was, until the past 12 months, under good control blood pressure (BP) approximately 140 90 mm Hg with the angiotensin-converting enzyme inhibitor ramipril 5 mg daily. His BP had recently risen to 150 100-170 110 mm Hg. Following addition of the b-adrenoceptor blocker atenolol 50 mg daily, the BP normalized, but the patient now felt lethargic. He denied headaches, palpitations, sweating episodes, muscle weakness, paresthesia, urinary tract symptoms, or any past history of renal or other cardiovascular disease. He was a nonsmoker, drank little alcohol, tried to follow a no-added-salt diet, and had noticed no recent weight change. There was no family history of hypertension. Physical examination revealed a patient of normal...

Definition of the Disease

By definition, PAL is characterized by aldosterone production that is excessive to the body's requirements and autonomous with regard to its normal chronic regulator, the renin-angiotensin II (AII) system. This results in excessive sodium reabsorption via amiloride-sensitive epithelial sodium channels within the distal nephron, leading to hypertension and suppression of renin-AII. Urinary loss of potassium, exchanged for sodium at the distal nephron, will result in hypokalemia only if severe and prolonged enough. Once thought to be rare, this condition is now known to be the most common specifically treatable and potentially curable form of hypertension, and may be present in up to 10 of hypertensives. The large majority of patients with PAL are not hypokalemic unless diagnosis is unnecessarily delayed through lack of screening.

Coping With Intraoperative Emergencies

Today, many surgical patients are quite sick with multiple medical problems, leading to rather complicated intra-operative courses. Under general anesthesia, even a patient with only a history of high blood pressure can create problems for the anesthesiologist. Maintaining the patient's blood pressure within normal limits is quite challenging in the face of faulty sympathetic responses and other homeostatic mechanisms. Moreover, bad things typically happen all at once.

Confirmation of Diagnosis and Subtype Differentiation

For these reasons, adrenal venous sampling is the only dependable way to differentiate bilateral from unilateral PAL. Some centers therefore perform this procedure in all patients with PAL (other than those with FH-I). To avoid effects of posture and diurnal variation on steroid concentrations, sampling should be performed in the morning after overnight recumbency, and stress should be avoided, with any venous cannulation delayed until the start of the procedure. An adrenal to peripheral venous cortisol gradient of at least 3.0 indicates successful cannulation. Calculation of the aldosterone cortisol ratio for each adrenal and peripheral venous sample corrects for differences in dilution of adrenal with nonadrenal venous blood and is essential for interpretation. If the aldoster-one cortisol ratio on one side is significantly (> 2 times) higher than the simultaneous peripheral venous ratio, with a ratio no higher than peripheral on the other side, the study is considered to show...

Additional Reading

Diagnostic investigations in primary aldosteronism. In Clinical Medicine Series on Hypertension, A. Zanchetti, ed., McGraw-Hill International (UK) Ltd., Maidenhead, 2001, pp. 101-14. Mulatero, P., Rabbia, F., Milan, A. et al. Drug effects on aldosterone plasma renin activity ratio in primary aldosteronism. Hypertension 40 897-902, 2002.

Dont Take Two Aspirin and Call Me in the Morning

A 13-year-old girl presented to the emergency department of a tertiary medical center complaining of a severe headache and her heart beating too fast. Her mother reported a 3-month history of headaches occurring 2-3 times per week, bilateral in nature, occurring with sudden onset at any time of day, and lasting less than one hour. The headaches had been increasing in severity. The patient denied nausea, vomiting, photophobia, paresthesias, and aura. She was sleeping 8-10 hours each night and was not allowed any caffeinated beverages. She had not begun menses. Over-the-counter analgesics were ineffective and used only a few times. The patient had no history of upper respiratory infection, seasonal allergies, or sinusitis during the previous 3 months. She had no significant past medical history she had received all her immunizations. Family history included hypertension, coronary artery disease, and thyroid cancer in her deceased paternal grandfather, migraine headaches in her mother,...

Avoidable Risk Factors

Fortunately, most of the risk factors for coronary artery disease can be partially or totally addressed. Many are unhealthy habits, such as smoking and lack of exercise. Others, such as high blood cholesterol and obesity, can be partly or mostly due to poor diet choices, although genetic susceptibilities can dramatically influence the response to those choices. Some are treatable illnesses such as depression and high blood pressure. And still others are circumstances, such as social isolation and stress, that can be mitigated to some degree. By addressing the risk factors that you have some control over, it's possible to reduce your vulnerability to coronary artery disease by a third or more.

Multifactorial and Polygenic Disorders

Multifactorial conditions are believed to have both environmental and genetic components. Multiple genes may play a role in the expression of the condition (polygenic inheritance). Height and skin color are good examples of conditions in which multiple genes and the environment are involved in phenotypic expression. Many isolated birth defects such as pyeloric stenosis, clubfoot, scoliosis, and neural tube defects are believed to have a multifactorial etiology. Common illnesses in adults, such as diabetes, asthma, hypertension, epilepsy, and mental disorders are also thought to have multiple genetic and environmental factors at the root of their expression.

The Doctorpatient Relationship

Most important, to have rewarding relationships with patients, a dermatologist must have excellent listening skills. In a way, dermatologists are part physicians, part counselors. As external manifestations of disease, skin disorders can affect the mental well-being of patients who are concerned that others are looking at their skin. You must take the time to discern how patients feel about their skin disease. This is important when it comes to evaluating the effects of treatment. You must be able to see and feel this disorder to properly empathize with your patients. Skin disease has much more of an effect on patient's psyches than high blood pressure or diabetes or anything else that may be internal. This is a unique aspect of dermatology.

Anger Whats Your Score

Several studies have demonstrated that people with a low threshold for anger have a greater probability of high blood pressure and heart disease. When compared with calmer people, these individuals experience rage and fury more often, more intensely, and for longer periods of time.

Current Sources Of Lead

In 1991 a comprehensive review of available data resulted in the maximum tolerable blood level for children being reduced to 100 g litre in the USA. The Centers for Disease Control in the USA state that above this level there is a risk of adverse developmental effects in children such as reduced IQ, growth retardation, and lower hearing acuity. Lead levels above this in the blood in adults was associated with an increased risk of hypertension. The equivalent 'intervention level' for blood lead in the UK has been set at 250 g litre, but, apparently, 'cognitive deficits' have been detected at levels below this. Such effects are often difficult to measure, and three bodies (the Medical Research Council, a Royal Commission, and the Department of Health) which separately evaluated the data in the UK found that studies on this effect of lead have been inadequate and that the case was not proven. Studies are still being published which purport to

What is the optimal target blood pressure

JNC VII 19 recommends the target BP to be less than 130 85 mm Hg in diabetics who have hypertension. The ADA 22 and the CMA 23 have pushed the target even lower, with a goal for diastolic BP of less than 80 mm Hg. What is the evidence for these recommendations Three, randomized, actively-controlled trials provided some direct evidence regarding the need for aggressive BP control (see Table 4) 3,52,75 . In the ABCD trial 75 , 470 patients who had type 2 diabetes with a baseline BP of approximately 155 98 mm Hg were assigned randomly to intensive BP control (achieved 132 78 mm Hg) or less tight control (achieved 138 86 mm Hg). There was a 49 reduction in the intensive BP control group in all-cause mortality however, this benefit was not due to differences in MI, cerebrovascular events, or congestive heart failure. The J-curve phenomenon was not reported in the ABCD trial however, it is difficult to rely on this information because of the small sample size. No adverse consequence was due...

Laboratory Tests Ignored

A 75-year-old white female with a past medical history significant for hypertension, Alzheimer's disease, and chronic diarrhea presented to the emergency department (ED) with a complaint of 5 days of watery diarrhea (four to five stools per day), fever, and weakness. She reported that a week ago she had attended a funeral where she had some Lebanese food, and 4 days prior to arrival at the ED she began having loose bowel movements, some with bright red blood in them. The patient denied vomiting, but reported some nausea. The patient denied having shortness of breath or chest pain, but did admit to some diffuse abdominal pain associated with the diarrhea. She has had a fever of 100.9 F, generalized weakness, anorexia, and malaise, and her diarrhea has been sporadic over the past few months. This complaint had been extensively worked up in two previous admissions to the ED, but besides mild chronic inflammation seen on biopsy, no other cause for the symptoms was determined. The past...

Prefers knowing a little about everything in medicine

To be a good family physician, you must be content knowing something about everything, but not everything about anything. It comes as no surprise that family physicians must be adept at approaching the widest variety of clinical complaints. According to the US Department of Health and Human Services, the most common problems prompting a visit to the physician are related to coughing and the throat. Family physicians encounter these problems on a daily basis. But the scope of disease and their symptoms is much wider. They commonly treat medical conditions (hypertension, diabetes, headaches, rashes), surgical problems (diverticulosis, suspi- Family physicians commonly manage complicated acute and chronic diagnoses. In a recent survey, the majority (62 ) of patients stated that they had a family physician as their individual source of care.5 The same study found that family physicians treated many complex medical problems, including diabetes, heart disease, hypertension, anxiety,...

Homocysteine Measurement A Fallen Star

One problem with interpreting Lp(a) values is that different ethnic populations vary widely in their normal ranges. Most experts don't recommend treating high Lp(a). However, when it occurs in people who have a very strong family history for heart disease but no other cholesterol problems, high total cholesterol, coronary artery disease, or damage to organs caused by high blood pressure, then it makes sense to intensify protective strategies, 72, including diet, exercise, and drug therapy. Lifestyle changes don't

Clinical Aspects of Marine Seafood Toxin Syndromes 7231 General Issues

Other characteristics of the toxins and toxin-contaminated seafood can also complicate diagnoses. For example, although these toxins are typically associated with ingestion of seafood, they can contaminate other species (due to specific environmental conditions or other biologic parameters that are not yet understood). Both gonyautoxin (a paralytic shellfish poison) and tetrodotoxin have been reported in xanthid crabs, with different relative amounts of the two toxins in crabs harvested from different geographic areas, probably depending on the specific exogenous source of the toxins (Tsai et al., 1995, 1997). In an investigation of an outbreak in Taiwan associated with eating mussels, the occurrence of hypertension in the victims led investigators to postulate that tetrodotoxin, and not paralytic shellfish poisons, caused the cases (Yang et al., 1995). Because of the similar biologic activity and because these toxins can be found together in the same animals, some investigators...

Interpreting New Medical Information Finding a Doctor Who Matches Your

That each of these studies worked backward, from heart disease to risk factor. The results don't mean that almost everyone with at least one of these factors will develop heart disease. But the results do make a strong case for paying attention to all four of the majors. Although the emphasis of this book is on cholesterol, the others deserve equal focus. If you have high blood pressure, high cholesterol, diabetes, a smoking habit, or any combination of these, focusing on them will help you live better and probably longer. Exercise, healthier eating habits, and getting to a healthy weight can do wonders for high blood pressure, high cholesterol, and diabetes. A variety of drugs can help get these under control and protect against their cardiovascular complications. And various approaches are helping more and more people stop smoking.

Davids Medical History

In taking his medical history, I learned that David had hypertension and high cholesterol. Though he was taking medication for both conditions, they weren't being adequately controlled. He had been to a hospital emergency department five months earlier with chest pain, which turned out to be benign. A recent physical examination, blood tests, and a chest x-ray were normal. His primary care physician had also ordered a brain MRI, which was normal.

The Asymptomatic Iron

A 65-year-old Caucasian male presented to his primary care physician for a routine physical exam prior to retiring. He had enjoyed excellent health throughout his life, and did not report any new symptoms at the time. His past medical history included elevated prostate-specific antigens that had been evaluated with multiple negative prostate needle biopsies, and hypercholesterolemia treated with diet and medication. Family history was notable for cardiovascular disease, hypertension, and breast cancer. He did not smoke, and consumed less than one beer or glass of wine per week. On direct questioning, he did not acknowledge chest pain, shortness of breath, arthralgias, fatigue, cold intolerance, or decreased libido.

The Prognosis Of Longterm Recovery Of Memory Function

In the case of head injury patients, most studies have shown a close relationship between degree of residual memory disturbance and duration of posttraumatic amnesia (PTA), whether this is assessed concurrently during the acute phase of recovery or retrospectively some months or years later (for reviews of such studies, see Levin et al., 1987 and Richardson, 2000). By contrast, variables such as duration of coma or particular components of the Glasgow Coma Scale have generally shown an inconsistent relationship with final levels of recovery of memory function. More general pathophysiological indices have also shown a variable relationship with memory outcome, e.g. intracranial hypertension in the acute phase has no clear relationship with longer-term recovery of memory functioning (Levin et al., 1990 Uzzell et al., 1990). Wilson et al. (1988) found that degree of long-term residual memory deficit was not closely related to features of MR scans taken within the first 3 weeks of injury,...

Vocabulary Builder

Octreotide A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. it inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. nih

Six Months Later A Sharper Memory

Eighteen times in a row, he looked forward more than ever to the chance that the matches gave him to just hang out and catch up. His blood pressure had dropped so much that he was hopeful that he would soon be able to shed one of the antihypertensive medicines he was taking. His cholesterol level had dropped below 200, and he was committed to further improvement. He had begun using a handheld microcassette recorder to make note of observations and thoughts that required future attention.

What the surgeon wants to know about postoperative assessment

Patients who have acute infective endocarditis who present with aortic regurgitation or mitral regurgitation with hemodynamic evidence of elevated LV end-diastolic or left atrial pressures (eg, premature closure of MV with AR, rapid decelerating MR signal by continuous-wave Doppler, or moderate or severe pulmonary hypertension)

Indications for Surgery

Uncontrollable hypertension and or pain despite maximal medical therapy (with modern drug regimes these circumstances are rare). Flg. 17.2. This patient had an uneventful type B aortic dissection initially treated with antihypertensive drugs. He developed sudden hoarseness owing to the rapid expansion of the postdissection aneurysm. The dissection extended retrogradely into the arch. The image on the left shows a CT scan with an Flg. 17.2. This patient had an uneventful type B aortic dissection initially treated with antihypertensive drugs. He developed sudden hoarseness owing to the rapid expansion of the postdissection aneurysm. The dissection extended retrogradely into the arch. The image on the left shows a CT scan with an

Pulmonology and Critical Care

Despite taking care of the most critically ill patients, these technically superb specialists never lose their cool under pressure. Although considered two separate subspecialties, most clinicians undergo training in both fields. Pulmonology entails the diagnosis and treatment of diseases of the lungs and upper airways, whether infectious, inflammatory, or cancerous in origin. Every day, they interpret arterial blood gas studies and pulmonary function tests. These specialists often serve as consultants to patients requiring expert management of emergent problems like pulmonary hypertension, hemoptysis, and pulmonary embolism. Continuity of care is also important in pulmonary medicine, particularly for patients with chronic problems such as asthma, emphysema, and occupational lung damage. In the multidisciplinary world of critical care, these physicians deal with more than just disorders of the lung. They take care of very sick patients who have life-threatening multi-organ system...

Why Consider A Career In Internal Medicine

Internists are knowledgeable in many aspects of medical care. They treat acute and chronic conditions, not to mention common and rare disease entities. Even if you choose another specialty, no physician can avoid the basics of internal medicine. For instance, orthopedic surgeons have to treat hypokalemia, obstetricians-gynecologists need to be well versed in the management of hypertension, and psychiatrists must be able to recognize the signs and symptoms of hypothyroidism. Internal medicine is, in a way, the foundation for all fields of medicine. If you are excited by the prospect of providing care for adults as a diagnostician, healer, motivator, and patient advocate, you would certainly find a career in internal medicine rewarding.

Ethnic variation in individual components of the metabolic syndrome

During the late 1980s there emerged the concept of an insulin resistance syndrome (also called the metabolic syndrome, Reaven's syndrome or syndrome X) where risk factors for CVD - hypertriglyceridaemia, lowered high-density lipoprotein (HDL)-cholesterol and hypertension - were associated with impaired glucose homeostasis in association with central adiposity (Reaven, 1988). At around the same time there was emerging evidence of ethnic differences in the presentation of the metabolic syndrome.

Noninvasive Treatments for OSA

Continuous positive airway pressure generally leads to a great improvement in the amount of time spent in restorative deep sleep, which in turn leads to improved alertness the next day. In many cases, CPAP also reduces or eliminates hypertension. For some people, CPAP is a lifelong treatment.

Prevention Of Type 2 Diabetes

Post-challenge) Low insulin secretion Insulin resistance syndrome (low HDL-C, high triglycerides, hypertension, fibrinolytic defects, glucose intolerance) Low magnesium level Low chromium level High plasma non-esterified fatty acids Low sex hormone binding globulin Low physical activity Cigarette smoking

The european guidelines Introduction

The ESC Committee for Practice Guidelines (CPS) supervises and coordinates the development and subsequent publication of new or updated guidelines produced by expert groups or consensus panels (Task Forces) within the European community. One such Task Force, the Third Joint Task Force of European and other Societies on CVD Prevention in Clinical Practice, formed to represent eight societies across Europe. Historically, the European Atherosclerosis Society, the ESC, and the European Society of Hypertension collaborated and published a set of guidelines in 1994 on the prevention of CHD in clinical practice. The first guideline revision was published in 1998 by the Second Joint Task Force. This revision set lifestyle, risk factor, and therapeutic goals for the prevention of CHD. In the Second Joint Task Force, the European Society of General Practice Family Medicine, the European Heart Network, and the International Society of Behavioral Medicine joined the original three societies. Two...

Composite definitions of the metabolic syndrome

The only data on ethnic differences in composite definitions of the metabolic syndrome in the UK have come from our group. We pooled the Southall (McKeigue, Shah and Marmot, 1991) and Brent (Chaturvedi et al, 1993), studies that were conducted to an identical protocol to give data on the prevalence of the metabolic syndrome using both WHO and ATP-III criteria in European, South Asian and African-Caribbean populations in London. In the total pooled sample of 2346 Europeans, 1711 South Asians and 803 African-Caribbeans, the age-standardized prevalence of the metabolic syndrome varied by gender and the criteria used but was highest in South Asians (29-46 per cent) and lowest in Europeans (9-19 per cent), with African-Caribbeans having an intermediate prevalence (15-27 per cent) (Tillin etal., 2005). For the more widely used ATP-III definition there were significant ethnic differences in the relative contribution of the four constituent features of the metabolic syndrome (Table 2.2). Most...

Sleep Related Leg Cramps

We don't know exactly what causes sleep-related leg cramps. In most cases, there doesn't seem to be any specific trigger. Sometimes they seem to be brought on by overexertion of the muscles during the day, prolonged sitting or standing, inappropriate leg positions while sedentary, or dehydration. Electrolyte imbalances, particularly potassium or magnesium, may predispose a person to cramping such imbalances can be the result of diuretic medications used to treat problems such as heart failure or hypertension. Sleep-related leg cramps also occur more commonly in those with diabetes, peripheral vascular disease, and endocrine disorders.

Conventional Treatment

A critical event in the evaluation of patients with suspected aortic dissection is the determination of whether the ascending aorta is involved. Therapeutic strategy hinges on whether type A or type B dissection is present. In general, acute type A dissections are considered surgical emergencies, while uncomplicated type B dissections are treated medically 72 . Regardless of dissection location, however, all patients in whom there is a strong suspicion of aortic dissection should be immediately placed on antihypertensive therapy to limit dissection progression 73, 74 . Patients with acute type B dissection are at lower risk of early death from complications and tend to be older and of higher surgical risk. A large retrospective series of uncomplicated type B dissection patients from Duke University and Stanford University suggested equivalent outcome with medical and surgical treatment 84 . Consequently, the preferred treatment for most patients has therefore been medical in the form...

What Is Metabolic Syndrome continued

This cascade of changes isn't healthy. Damage to artery walls, high triglycerides, and increased chance of blood clots can lead to heart attacks and some strokes. Changes in the kidneys' ability to remove salt contribute to high blood pressure, another path to heart disease and stroke. And dwindling insulin production by the pancreas signals the start of type 2 diabetes, which greatly increases the chances of having a heart attack or stroke, as well as nerve, eye, and kidney damage.

Risk factors for diabetes

> 130 mm Hg systolic and or > 85 mm Hg diastolic or use of antihypertensive agent metabolic syndrome. Other risk factors for type 2 diabetes mellitus include age of 45 years or older, family history of diabetes (parent or siblings), physical inactivity, ethnicity (eg, Afro-American, Hispanic, Native American, Asian American, or Pacific Islander), impaired glucose tolerance, history of gestational diabetes or delivery of a baby weighing more than 9 lbs, hypertension (blood pressure > 140 90 mm Hg in adults), high-density lipoprotein (HDL) cholesterol level below 35 mg dL and triglyceride level above 250 mg dL, polycystic ovary syndrome, and history of vascular disease 10 . Park and Edington 11 applied a prediction model using sequential multilayered perception neural network architecture. High BMI was the most significant risk factor other significant factors that predicted risk over time with variations in trajectory were elevated blood pressure, stress, elevated cholesterol...

Limit of quantification See limit of detection

Lipid abnormalities Metabolic abnormalities. HAART regimens are now known to be associated with profound lipid abnormalities. protease inhibitors are associated with increases in total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels and with lipoprotein abnormalities such as increases in apolipoprotein B and lipoprotein (a) levels. The nonnucleoside reverse transcriptase inhibitors (i.e., efavirensz and nevi-rapine) often used in lieu of protease inhibitors are known to increase levels of total cholesterol but are associated with an increase in the level of high-density lipoprotein (HDL) cholesterol. insulin resistance is another metabolic consequence of protease inhibitor therapy, although progression to diabetes mellitus is not common. Truncal visceral adiposity is also becoming a common consequence in the HAART era of treatment. Hypertension and hypercoagulability impaired fibrinolysis may also appear in excess HAART-treated patients with insulin...

The renin angiotensin aldosterone system as a therapeutic target

Angiotensin-converting enzyme (ACE) inhibitors were initially developed in the late 1970s for treatment of hypertension. Their use has since been expanded to heart failure, postmyocardial infarction, and renal disease. ACE inhibitors, by blockers also have shown significant benefit in both cardiovascular and renal outcomes (Table 4) 33-45 . Losartan compared with atenolol in patients with hypertension and left ventricular hypertrophy showed reduction in composite cardiovascular mortality, myocardial infarction, and stroke in the Losartan Intervention for Endpoint (LIFE) study (relative risk RR , 13 P 0.021) 33 in the Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan (OPTI-MAAL) study, but losartan showed no difference in all-cause mortality compared with captopril in in subjects with acute myocardial infarction 38 . Also, no difference in mortality was noted with losartan compared with captoril in the ELITE II Losartan Heart Failure Survival Study of...

Complications Of Venous Thromboembolism

The major complications of venous thromboembolism are venous stasis syndrome (e.g., post-thrombotic syndrome, including dependent leg swelling and pain, stasis pigmentation and dermatitis, and dermatoliposclerosis) and venous ulcer, and chronic thromboembolic pulmonary hypertension. The overall incidence of venous stasis syndrome and venous ulcer is 76.1 and 18.0 per 100,000 person-years, respectively.39 Venous thromboembolism patients have a 17- The incidence of chronic thromboembolic pulmonary hypertension over the 21-year period, 1976 to 1996, was 6.5 per million person-years.41 Over this same time period, the incidence of acute pulmonary embolism was 485.6 per million person-years. Thus, the vast majority of acute pulmonary emboli do not progress to chronic thromboembolic pulmonary hypertension. Applying these incidence rates to the 2000 U.S. white population, approximately 1367 new chronic thromboembolic pulmonary hypertension cases occur in the United States annually.

Pathogenesis of Aortic Dissection

Chronic hypertension affects the arterial wall composition, causing intimal thickening, fibrosis and calcification, and extracellular fatty acid deposition. Moreover, adventitial fibrosis may obstruct nutrient vessels feeding the arterial wall as well as small intramural vasa vaso-rum, which may result in necrosis of smooth muscle cells and fibrosis of elastic structures rendering the vessel wall vulnerable to pulsatile forces and creating a substrate for aneurysms and dissections 1-11 . In addition to chronic hypertension, smoking and dyslipide-mia and potentially the use of crack cocaine are modulating risk factors. On rare occasions, inflammatory diseases destroy the media layers and cause weakening, expansion and dissection of the aortic wall. Iatrogenic aortic dissection may occur in association with invasive retrograde catheter interventions, or during or after valve or aortic surgery 12-14 . Given the morbidity and mortality of iatrogenic aortic dissection careful assessment is...

Inflammation And Venous Thrombosis

20-year incidence of CVI is 28 following deep vein thrombosis, although some have suggested the incidence is higher. The symptoms include swelling, discomfort, and skin changes ranging from stasis pigmentation to frank ulceration requiring chronic wound care.4 Chronic thromboembolic pulmonary hypertension (CTPH) has a two-year incidence of 3.8 following PE, leading to severe debilitation and high mortality.5

Role of renin angiotensin aldosterone system activation

Hypertension hypertension CHF, congestive heart failure CV, cardiovascular LVH, left ventricular hypertension IDNT, Irbesartan Diabetic Nephropathy Trial MI, myocardial CHF, congestive heart failure CV, cardiovascular LVH, left ventricular hypertension IDNT, Irbesartan Diabetic Nephropathy Trial MI, myocardial less well studied but seems to mediate beneficial effects that include vasodilation, inhibition of cell growth, and proliferation as well as cell differentiation 48,49 . The differential effects are shown in Fig. 1. The sequential progression of cardiovascular disease begins with the risk factors of hypertension, diabetes, smoking, metabolic syndrome, and dyslipidemia. These risk factors are independently associated with levels of angioten-sin II that in turn trigger the cascade of events. Progression to atherosclerotic disease and left ventricular hypertrophy leads to plaque destabili-zation in the face of uncontrolled risk factors, with acute coronary syndrome and myocardial...

Chromium Supplementation And Cardiovascular Disease Risk

The observations reported for the HPFS cohort appear to be consistent with observations reported from the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer (EURAMIC). The EURAMIC was an incident, population-based, case-control study conducted in eight European countries and Israel to determine whether low toenail chromium concentrations are significantly associated with increased risk for MI. The study included 684 case subjects (men with a first diagnosis of MI within 24 hours of admission to the hospital) and 724 control subjects (men with similar demographic characteristics, but without MI). Average toenail chromium was 1.10mg kg in the case subjects versus 1.30mg kg in the control subjects. Additional analysis indicated that the adjusted ORs for MI for chromium quintiles 1-5 were 1.00, 0.82, 0.68, 0.60, and 0.59, respectively 77 . The results of EURAMIC thus indicate that toenail chromium concentration has a clearly inverse relationship...

Role of the renin angiotensin aldosterone system in vascular endothelial function

Angiotensin II and the sequential progression of cardiovascular disease. CAD, coronary artery disease DM, diabetes mellitus HTN, hypertension LVH, left ventricular hypertrophy. Fig. 2. Angiotensin II and the sequential progression of cardiovascular disease. CAD, coronary artery disease DM, diabetes mellitus HTN, hypertension LVH, left ventricular hypertrophy.

Middle Aged Man with Chronic Foot Ulcer

A 60-year-old man presented to the emergency room with complaints of malaise, fatigue, and a nonhealing foot ulcer. Three weeks earlier, he had been diagnosed with pyoderma and prescribed prednisone 80 mg day and cyclosporine 500 mg day. His past medical history was significant for pyoderma gangrenosa, a severe form of pyoderma associated with chronic disease that occurs on the trunk, diagnosed 3 years prior to presentation. He also had a history of steroid-induced hypertension and diabetes.

Maternofetal transmission See transmission

It's chemical name is 3, 4-methylenedioxymethamphetamine. It is an illegal psychoactive drug that has both hallucinogenic and stimulant properties. It is known to interact with several protease inhibitors, causing an increase of MDMA in the body. This increase can quickly cause overdoses, which could lead to death. MDMA is taken orally, usually in tablet or capsule form, and its effects last approximately four to six hours. Users of the drug say that it produces profoundly positive feelings, empathy for others, elimination of anxiety, and extreme relaxation. MDMA is also said to suppress the need to eat, drink, or sleep, enabling users to endure two- to three-day parties. Consequently, MDMA use sometimes results in severe dehydration or exhaustion. MDMA users also report aftereffects of anxiety, paranoia, and depression. An MDMA overdose is characterized by high blood pressure, faintness, panic attacks, and, in more severe cases, loss of consciousness,...

Interaction between angiotensin endothelium and insulin resistance

Insulin resistance is associated with metabolic syndrome, which increases the risk of adverse cardiovascular outcomes. There is definitive evidence that insulin resistance and endothelial dysfunction progress in parallel. As insulin resistance progresses to clinical metabolic syndrome, impaired glucose tolerance, and development of diabetes, there is a parallel track that leads from endothelial dysfunction to inflammation, with increased oxi-dative stress leading to overt atherosclerotic disease. Insulin resistance has been shown to interact with this parallel track of endothelial dysfunction through the accumulation of free fatty acids, proinflammatory adipokines, and TNF alpha 59 . In addition, increased oxidative stress, oxidation of LDL, the reduction of HDL, and the development of hypertension, hyperuricemia, and hy-perglycemia contribute to the mechanisms of underlying endothelial dysfunction in insulin resistance 51 .

Epidemiology of ethnic differences in the risk for cardiovascular disease

An intriguing dichotomy among people of Black African-Caribbean origin has been reported, with a higher prevalence of diabetes, hypertension and stroke but a lower prevalence of CHD compared with European White groups in the UK (Wild and McKeigue, 1992 Cappuccio etal., 1997 Zoratti, 1998). This phenomenon may be due to a more favourable lipid profile among Black African-Caribbeans (Chaturvedi, McKeigue and Marmot, 1994 Zoratti etal., 2000). Figures 2.3 and 2.4 show the differential CHD and stroke mortality experience (standardized mortality ratios) of people resident in the UK by their country of birth.

Classification Of Cardiotoxins

Cardiotoxicity is not amenable to a simple system of classification. Instead, a wide variety of agents may have toxic action on the myocardium. Some of the better known are antidepressants of the tricyclic category antineoplastic agents such as adriamycin, antibiotics, alcohols, anesthetics and heavy metals. Cardiac drugs become cardiotoxins when taken in large doses. Some of the members of this category that have been involved in many cases of toxicity are digoxin (and other digitalis glycosides), quinidine, beta-adrenergic-receptor agonists, beta-adrenergic-receptor antagonists, and some antihypertensive agents. What follows is a discussion of the mechanisms of some cardiac toxins.

Specific Cardiotoxins Catecholamines

Norepinephrine, epinephrine, and a synthetic analog, isoproterenol, can be car-diotoxic (see Figure 9.2). The normal function of the first two members of this category is to activate alpha and beta receptors, leading to a variety of actions, especially elevation of blood pressure and increased cardiac output. Isoproterenol is a relatively selective beta-receptor agonist. The cardiotoxicity of these compounds is believed to be associated with exaggeration of their normal pharmacological actions. It may be manifested in a variety of symptoms such as arrhythmias, tachycardia, ventricular fibrillation, hypertension, and even myocardial necrosis. It seems

Man with Splenic Vein Thrombosis and Polycythemia

A 55-year-old man presented to the emergency room with a 2-day history of frequent black, tarry stools. He also complained of persistent facial flushing and pruritis and occasional epistaxis during the previous 4 months. Past medical history was negative for hypertension, smoking, diabetes, and previous venous or arterial thrombosis. He also noted that he was a frequent blood donor, giving blood approximately 3-4 times per year for the last 30 years. Physical findings were notable for normal vital signs, plethora, a palpable spleen 5 cm below the left costal margin, and a strongly positive fecal occult blood test. An upper endoscopy revealed large gastric varices as the source of the bleeding. An abdominal CT scan demonstrated splenomegaly and possible splenic vein thrombosis. In addition to routine laboratory analytes, testing for inherited and acquired hypercoagulable risk factors was performed

Trivalent Chromium Absorption And Bioavailability

However, no matter the form of chromium used, the ability to absorb or convert inorganic chromium to the active form appears to decrease with advancing age. Studies demonstrated that the normal adult response time to inorganic chromium treatment requires 1-3 months whereas in children response time to inorganic chromium was typically within 24 hours 11 . As the human body ages, tissue chromium levels decrease and urinary excretion of chromium increases, elevating the risk of heart disease, hypertension and diabetes, increased blood cholesterol, and blood pressure 9, 12, 13 .

Reducing Blood Pressure Naturally

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.

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