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 Summary


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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...


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....

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 decided to...

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

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 6.1, but non-diabetic 130 85 or treated for hypertension Triglycerides 1.7 HDL-cholesterol 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...

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...

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.

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...

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.

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...

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...

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...

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,...

Differential Diagnosis

Of great concern are the symptoms that accompany the headaches in this patient anxiety, palpitations, and sweating. While these symptoms could be explained by a psychiatric illness, such as an anxiety disorder, the extremely elevated blood pressure observed in the emergency department would not be consistent with a psychiatric cause. In children, hypertension is unusual, and almost always secondary to underlying disease or congenital malformation. The signs and symptoms coincident with headache in this patient are classically associated with pheochromocytoma.

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.

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)

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.

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...

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.

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.

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.

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...

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.

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

The Benefits and Risks of Exercise

Sedentary living, on the other hand, is the fifth major cardiac risk factor. Because it increases the risk for coronary artery disease by almost two times, a lack of exercise is nearly as dangerous as smoking, abnormal cholesterol levels, or hypertension. Regular exercise does raise your risk for minor injuries, such as shin splints or sprains and strains. But if you talk to your doctor before you start a program, choose a low-impact activity, take it slowly at first, and very gradually increase the intensity of your program, the benefits lower total cholesterol, lower triglycerides, higher HDL, lower blood pressure, better control of blood sugar, a stronger heart that pumps blood more efficiently, even a better mood far outweigh the risks.

Treatment and Outcome

Hypertension and other factors that might promote atherosclerosis (the common age-related arterial narrowing) must be extremely well controlled in these patients who have suffered widespread damage to their arteries. Antiplatelet therapy should probably be continued for life. Anti-OSTEOPOROSIS treatment may be used to protect against the effects of the corticosteroids, especially in postmenopausal women. Infection is a concern in patients receiving powerful immuno-suppression drugs as described above and should be promptly treated. With modern treatment approximately 70-80 percent of patients can be expected to be alive five years after diagnosis.

Man with a Tender Toe and Anemia

He was employed and smoked one pack of cigarettes and drank one pint of liquor each day. Preexisting medical problems included hypertension, hypercholesterolemia, and type 2 diabetes, but he did not consistently see a physician or take prescribed medications. Laboratory data from 3 years earlier were notable for hemoglobin 13.9 g dL and creatinine 1.3 mg dL. Abdominal ultrasound showed a liver that was normal in size and echogenicity and bilateral small kidneys with increased echotexture consistent with renal parenchymal disease. A renal biopsy showed arterial thickening and diffuse glomerulosclerosis, consistent with chronic hypertension. The gout was treated with an intraarticular steroid injection, hemodialysis was initiated, and hypertension, diabetes, and alcohol and smoking cessation were managed medically. Recombinant human erythropoietin (Epogen) injections were begun for treatment of anemia. He did not require red blood cell transfusion.

Cardiometabolic risk syndrome

IR is thought to play a central role in the development of a cluster of interrelated metabolic abnormalities that predispose to the development of coronary heart disease (CHD) and occur together more often than would be predicted by chance. Over the years, this clustering of risk factors has been referred to by such terms as the Insulin Resistance Syndrome, Syndrome X, Metabolic Syndrome, and the Cardiometabolic Risk Syndrome. The commonly acknowledged features include increased adiposity, dyslipidemia, glucose intolerance, and hypertension, although more recent evidence indicates that other abnormalities are also associated with this syndrome, including hyperuricemia, low-grade inflammation, and a prothrombotic state (6). The focus of this chapter will be the pathogenesis and management of the characteristic dyslipidemia associated with insulin-resistant states.

Clinical studies of renin angiotensin aldosterone system inhibition and outcomes of insulin resistance

Definitions ALPINE, Antihypertensive treatment and Lipid Profile in a North of Sweden Efficacy SCOPE, Study of Cognition and Prognosis in the Elderly. Definitions ALPINE, Antihypertensive treatment and Lipid Profile in a North of Sweden Efficacy SCOPE, Study of Cognition and Prognosis in the Elderly. with hypertension and Main trials examining the effect of long-term therapy with angiotensin II type 1 receptor antagonists on insulin sensitivity in patients with hypertension and or insulin resistance and or impaired glucose tolerance Main trials examining the effect of long-term therapy with angiotensin II type 1 receptor antagonists on insulin sensitivity in patients with hypertension and or insulin resistance and or impaired glucose tolerance

Physiopathology and Risk Factors

The principal risk factor of Salmonella aortitis is atherosclerosis. Diabetes mellitus, hypertension and dyslipidemia are thus associated with a risk of endovas-cular infection in the event of Salmonella bacteremia. Diabetes mellitus has particular importance in the occurrence of these infections. Indeed, it seems to be the most frequently underlying pathology involved (in 25 of cases) 76-78, 80 . Other elements seem to represent risk factors of bacteremia if gastroenteritis from salmo-

Dietary CrIii And Free Radical Scavenging Ability

Chromium(III) has been postulated to be an antioxidant, beneficial in the treatment of hypertension. Chromium(III) therapies influencing the glucose insulin system and age-related hypertension have been shown to also lower free radical formation 45 . In spontaneously hypertensive rats, niacin-bound chromium supplementation decreased lipid peroxidation by altering free-radical formation measured, determined by thiobarbi-turic acid reactive substances (TBARS) 45, 46 . Preuss et al in 1997 examined several chromium compounds to determine their efficacy in regulating blood pressure of spontaneously hypertensive rats. The control group ingested a diet low in chromium, and five other groups were fed the same diet with various chromium compounds added at 5 ppm chloride, acetate, nicotinic acid-glycine-cysteine-glutamic acid (NA-AA), picolinate, and niacin-bound chromium. Following this, the rats were challenged with drinking water containing 5 and 10 w v sucrose. Only chromium acetate and...

The Antiphospholipid Syndrome

Primary antiphospholipid syndrome refers to patients with the syndrome who do not have any other rheumatological or autoimmune conditions such as lupus erythematosus. Associated (but not defining) conditions include thrombocytopenia, vasculitic rashes, arthralgias, dermal necrosis of digits, livedo reticularis, and pulmonary hypertension. A thrombotic cause of these additional manifestations is unlikely since anticoagulant treatment does not result in a remission of these complaints.

Proinflammatory markers and adipocytokines

Insulin resistance is associated with a wide array of defects beyond dyslipidaemia, hypertension and obesity. There is plentiful evidence that C-reactive protein (CRP), an inflammatory marker, is strongly associated with metabolic syndrome and with CVD, and this subject has been reviewed in depth in Chapter 8. Furthermore, studies that include participants of different ethnic groups have confirmed recently that CRP is independently associated with the metabolic syndrome (Festa etal., 2000 Heald etal., 2003). There is emerging evidence that CRP concentrations vary between ethnic groups, and a suggestion has been made that CRP might even be used as a screening test for CVD risk in different ethnic groups (Anand etal., 2004). In this respect, we and others have shown elevated CRP in South Asians compared with Europeans (Chambers etal., 2001 Forouhi, Sattar and McKeigue, 2001 Chandalia etal., 2003). In a comparative study of 137 young healthy Asian Indian and European White men in USA...

Religion Prayer and Health

A meta-analytic study by Michael McCullough and associates (McCullough, Hoyt, Larson, Koenig, & Thoresen, 2000) found religious involvement to be related to lower rates of hypertension, heart disease, stroke, and cancer. Such a relationship, of course, does not establish a causal relationship between religious involvement and health. Better health could just as well be due to psychosocial resources provided by religious involvement. For example, religious involvement is likely to expand ones circle of friends and thus increase the social support these friends provide. However, when McCullough et al. controlled for social support, their item analysis revealed a small but significant relationship between religious involvement and death rate that is, people high in religious involvement were somewhat more likely to be alive at follow-up than were people low hi religious involvement. These findings hidicate that religious activity independent of social support is associated with a slight...

Psychosocial stress and socioeconomic differences

Although socio-economic factors are unequivocally associated with coronary risk within ethnic groups, their role in the pathobiology of ethnic differences in the metabolic syndrome or coronary risk are not clear. In the Whitehall Study of civil servants of three ethnic groups (European, South Asian, African-Caribbean) in the UK, socio-economic status was an important confounder of the association of ethnicity and metabolic risk, but adjustment for socio-economic status did not abolish the ethnic differences in adverse metabolic outcomes (diabetes, hypertension, dyslipidaemia) (Whitty etal., 1999). The associations of socio-economic factors with disease risk are complex because they can affect not only disease prevalence but also disease presentation, access to healthcare and management within healthcare systems. No conclusive evidence on these associations with ethnicity and migration yet exists and is an area for future study.

Lessons and challenges of study of ethnicity in terms of disease risk

The marked differences across racial and ethnic groups in disease risk are likely to be due in part to each of genetic, host susceptibility and environmental factors. The latter are influenced by a multitude of factors, including cultural, religious and socio-economically determined lifestyle and health behaviours affecting type of diet, smoking habit and physical activity. The ethnic differences in cardiovascular risk can provide valuable aetiological clues to differences in patterns of disease presentation, therapeutic needs and response to treatment. One example of this is provided by the dissociation of high rates of diabetes, hypertension and stroke, but lower rates of CHD, in people of Black African-Caribbean descent relative to European Whites. Thus the effects of ethnicity on disease are complex. Two points are of particular note in studying the effect of ethnicity

Clinical implications

There is good evidence that a healthy lifestyle can reduce the incidence of diabetes (Hu etal., 2001), as can treating impaired glucose tolerance with lifestyle modification (Tuomilehto etal., 2001). The Finnish Diabetes Prevention Study assigned 522 middle-aged overweight men and women (mean BMI 31 kgm-2) with impaired glucose tolerance into intervention (individual counselling on diet and physical activity) and control groups. At 3.2 years of follow-up the intervention group had a 58 per cent lower incidence of diabetes, significantly greater reductions in weight and dietary fat intake and greater increases in dietary fibre and exercise ( 4h per week) reversing the changes of insulin resistance and metabolic syndrome (Tuomilehto etal., 2001). Reports of specific interventions to reverse impaired glucose tolerance in people from ethnic groups are currently lacking and are an area for future study. There is, however, good rationale to manage the presence of the metabolic syndrome with...

Put Out the Cigarettes

A large European study reported similar findings in an elderly sample. Smokers exhibited a steeper rate of decline on a measure of global cognitive function than did nonsmokers. The researchers speculated that smoking might affect cognitive function by promoting cerebrovascular injury from atherosclerosis and hypertension.

When to Refer Headache Patients

Several specific headache disorders or illnesses associated with headaches or facial pain, such as cluster headache, giant cell (temporal) arteritis, idio-pathic intracranial hypertension (pseudotumor cerebri), and trigeminal neuralgia, can be recognized clinically, as discussed below. Unless clinicians are comfortable with these entities, it is reasonable to refer patients suspected of having these diagnoses to a neurologist or some other appropriate consultant for further evaluation and management.

FDA Perspective on Genotyping and Clinical Efficacy Safety Trials

Although genomic-based technology may be at an early stage, the issues and questions surrounding pharmacogenetics and pharmacogenomics are not necessarily new. For example, genotyping in clinical trials represents a form of mechanistic or empirical enrichment (i.e., a process for selecting or excluding individual patients or groups of patients for clinical trials). Regulatory agencies are quite familiar with criteria that have been used in the past for routinely enriching clinical efficacy or safety trials for drugs such as inotropic agents, topical nitrates, antiviral drugs, and antibacterials and in diseases such as hypertension, stroke, and sepsis. A well-known example of enrichment is the enrollment of women with breast cancer who overexpress the HER-2 protein in clinical trials of trastuzumab (Herceptin).

Simon Cunningham and Mark Hanson

Chronic diseases have been shown to have their origins early in the lifecourse of an individual. A person's prenatal and subsequent development, eventual adult body mass index and lifestyle all affect the incidence of chronic disease during life. Such risk originates from a combination of adaptive responses made by the foetus to maintain homeostasis in the intra-uterine environment and to 'predict' its future postnatal environment. The biology of such processes, coupled with the rapidity and degree of the transitions in diet occurring in many societies, are thought to contribute to the rapidly rising incidence of type 2 diabetes, hypertension, obesity, dyslipidaemia and endothelial dysfunction, collectively known as the metabolic syndrome. The human environment has changed much faster than our evolutionary biology, and our development leaves us unprepared to live healthily in that environment. Taking a lifecourse view of the aetiology of disease is likely to be more effective than...

Comprehensive Risk Reduction of Cardiovascular Risk Factors in the Diabetic Patient An Integrated Approach

Sensitivity to insulin is variable in the population at large. Cellular insulin resistance develops as the result of a complex interplay of genetic and environmental factors. Hyperinsulinemia occurs as an adaptive response to the increasing insulin resistance. Type 2 diabetes develops when insulin-resistant individuals cannot maintain the degree of excess insulin secretion needed to overcome insulin resistance. There are two aspects to the type 2 diabetic state hyperglycemia and hyper-insulinemia. Insulin resistance and hyperglycemia seem to set the stage for the development of the metabolic syndrome, characterized by dyslipide-mia, hypercoagulability, hypertension, and trun-cal obesity (Table 1). Several of the metabolic derangements seen with the metabolic syndrome are well-established risk factors for CV disease

Subarachnoid hemorrhage 299

Scientists do not yet understand why, but African Americans and Hispanics have a higher incidence of stroke one reason could be that African Americans are more prone to high blood pressure. Pregnancy is yet another risk factor stroke is 13 times more common during the nine months of pregnancy because of changes in blood consistency. Pregnancy-related high blood pressure may predispose a woman to stroke.

Clinical Immunosuppressive Protocols

Sive agents are still associated with significant side effects including organ toxicity, lifethreat-ening viral and fungal infections, and malignancies.64,65 Commonly used calcineurin inhibitors in induction and maintenance therapy have similar side effects on renal and hepatic function. Neurotoxic effects and post-transplant diabetes mellitus are higher under tacrolimus protocols, whereas the risks of hypercholesterolemia and hypertension are lower compared to those with CsA. Tacrolimus promotes nerve regeneration,66 so this agent will be preferred in CTA transplantations because nerve regeneration will be one of the goals after transplantation. Immunosuppression-related complications can be prevented by close monitoring of the patients and by early medical intervention. The immunologic side effects can be managed by switching the type of immunosuppressant, which was the case after larynx transplantation, where CsA was exchanged with tacrolimus to control hypertension associated with...

The Typical Day Of A Physiatrist

In an inpatient rehabilitation setting, there are three areas crucial to a patient's health. A PM&R specialist is first responsible for managing any acute medical issues, such as hypertension, diabetes, and infectious disease. Second, you address medical concerns uniquely related to rehabilitation. These include pressure ulcers and problems related to proper bowel and bladder function. You may find yourself placing urinary catheters, measuring urinary bladder volume, dis-impacting bowels, or debriding ulcers at the bedside. Third, there are functional rehabilitation issues to consider. In an acute rehabilitation setting, patients stay in rooms with beds much like other hospitals, but there are also physical therapy gyms and other therapy spaces where small miracles take place daily. A PM&R physician might also want to evaluate patients during their therapy sessions. For instance, a physical therapist might demonstrate a patient's limited flexibility for the physiatrist so that he...

If Your Child Has High Cholesterol

Most people don't need to get a fasting lipid profile until they hit twenty. However, the Committee on Nutrition of the American Academy of Pediatrics recommends checking the cholesterol levels of children older than two who have risk factors like a family history of early heart disease or high cholesterol. The committee recommends that doctors and parents talk about screening kids and teens who are obese, are inactive, smoke, have high blood pressure, or have diabetes. Although it's important for adults to have repeat cholesterol tests if levels are found to be high, this is even more important in children, whose levels can vary more than adults'. Table 10.1 gives the cholesterol guidelines for children.

Altered calcium and magnesium homeostasis

Multiple biochemical and functional abnormalities in the platelet function have been documented in type 1 and type 2 diabetes and are noted in Box 1. Together these abnormalities lead to increased platelet aggregability and adhesiveness. The correction of this increased platelet aggregability and adhesiveness with antiplatelet agents such as aspirin should logically reduce CV events in diabetics. Although there are no prospective studies designed for investigating the therapeutic role of aspirin in the diabetic cohort, several lines of evidence support its use in reducing CV risk in diabetic patients. In the recently completed Primary Prevention Project study, efficacy of low-dose aspirin (100 mg d) in primary prevention of CV events was studied in individuals with one or more of the following risk factors hypertension, hypercholes-terolemia, diabetes, obesity, family history of premature myocardial infarction, or advanced age. After a mean follow-up of 3.6 years, there was...

Smallmolecule Antagonists

The first HcrtRl antagonist reported was urea hydrochloride (SB-334867) (18,19) (Fig. 2). It has 50-fold selectivity for HcrtR1 over HcrtR2 and at least 100-fold selectivity over a range of 50 other GPCRs and ion channels on which it was tested. SB-334867 inhibits hypocretin-1 and hypocretin-2 induced calcium responses in cells expressing HcrtR1 with apparent pKb values of 7.27 and 7.23, respectively. In rat brain slices, SB-334867 inhibits hypocretin-1 excitation of locus coeruleus neuronal activity (20). Following ip dosing of rats, SB-334867 is found in the brain but has a relatively short half-life of 0.4 h (18). Even so, SB-334867 inhibits both natural food intake and feeding induced by central administration of hypocretin-1 (21-23), accelerates the transition between feeding and resting, and reduces the occurrence of several activity-related behaviors (22-24). Intracerebroventricular administration of SB-334867 to rats also increases barbiturate-induced anesthesia times and...

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