Hypertensions, diastolic

Intoxication results in a characteristic intense, throbbing headache, presumably due to cerebral vasodilation, often associated with dizziness and nausea and occasionally with vomiting and abdominal pain. More severe exposure also causes hypotension, flushing, palpitation, low levels of methemoglobinemia, delirium, and depression of the central nervous system. Aggravation of these symptoms after alcohol ingestion has been observed. On repeated exposure, a tolerance to headache develops but is usually lost after a few days without exposure. At times, persistent tachycardia, diastolic hypertension, and reduced pulse pressure have been observed. On rare occasions, a worker may have an attack of angina pectoris a few days after cessation of repeated exposures, a manifestation of cardiac ischemia. Sudden death due to unheralded cardiac arrest has also been reported under these circumstances. ... 

The most extreme manifestation of untreated hypothyroidism is myxedema coma, which even if detected early and appropriately treated, carries a mortality rate of 30 to 60%. Myxedema coma is a misnomer. Most patients exhibit neither the myxedema nor coma. Patients with myxedema coma usually have longstanding hypothyroidism with the classic symptoms of hypothyroidism. Decompensation into myxedema coma may occur when the homeostatic mechanisms of the severely hypothyroid patient are subject to a stressful precipitating event (e.g., infection, trauma, some medications, stroke, surgery). The principal manifestation of myxedema coma is a deterioration of mental status (apathy, confusion, psychosis, but rarely coma). Other common clinical features include hypothermia, diastolic hypertension (early), hypotension (late), hypoventilation, hypoglycemia, and hyponatremia. If myxedema coma is suspected, the patient is usually admitted to an intensive care unit for pulmonary and cardiovascular support... 

Dose-dependent sustained diastolic hypertension Nausea, dry mouth, dizziness, constipation orthostatic hypotension sedation priapism (trazodone only) mCPP, an anxiogenic metabolite of nefazodone, can accumulate during CYP2D6 inhibition Drowsiness (greater at low doses ) Appetite/weight gain... 

In a placebo-controlled trial of propranolol in 312 patients with diastolic hypertension, 13 tests of cognitive function were assessed at baseline, 3 months, and 12 months (94). Propranolol had no significant effects on 11 of the 13 tests. Compared with placebo, patients taking propranolol had fewer correct responses at 3 months and made more errors of commission. 

Perez-Stable EJ, Halliday R, Gardiner PS, Baron RB, Hauck WW, Acree M, Coates TJ. The effects of propranolol on cognitive function and quality of life a randomized trial among patients with diastolic hypertension. Am J Med 2000 108(5) 359-65. 

Hypokalemia is the key clinical finding that primary aldosteronism may be present in a patient with diastolic hypertension. To confirm the diagnosis, it is necessary to... 

Thiazide diuretics or -blockers have been compared with either ACE inhibitors or CCBs in elderly patients with either systolic or diastolic hypertension or both. In a Swedish trial, no significant differences were seen between conventional drugs and either ACE inhibitors or CCBs. However, there were significantly fewer myocardial infarctions and cases of heart failure in the ACE inhibitor group compared with the CCB group. These data suggest that overall treatment may be more important than specific antihypertensive agents in this population. 

Figure 12.4 shows the control of an experimental oscillation amplitude curve for parameter c. The blood pressure determination errors resulting from c parameter included pseudo-systolic hypotension and pseudo-diastolic hypertension. These errors are evident from Figure 12.4 as a shift of the parameter curve c toward higher cuff pressure in both the systolic and diastolic ranges. 

Introduced by Komfeld and coworkers in 1979 as a dopaminergic agonist that also decreases plasma prolactin concentration, this compound, 230, shows activity in the treatment of acute myocardial infarction with diastolic hypertension. It is also effective in the treatment of pituitary tumors secreting prolactin or growth hormone 102). Its clinicai study revealed its effectiveness in Parkinson s disease, and it is now used clinically. This compound, 230,... 

As a result of such studies hypertension has been operationally defined as the blood pressure level above which therapeutic intervention has clinical benefit. As increasingly aggressive intervention has continued to demonstrate benefits, this level has gradually reduced over time and is commonly defined as systolic blood pressure>l40 mmHg and/or diastolic blood pressure >90 mmHg (Table 1). Isolated systolic hypertension is defined as systolic blood pressure >140 mmHg and diastolic blood pressure <90 mmHg. 

Once essential hypertension develops, management of this disorder becomes a lifetime task. When a direct cause of the hypertension can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks first, with tumors or other abnormalities of the adrenal glands following. In malignant hypertension the diastolic pressure usually exceeds 130 mm Hg. In secondary hypertension,... 

In most individuals, the systolic pressure increases sharply with age, whereas the diastolic pressure increases until about age 55 years and then declines. Older individuals with an elevated systolic pressure have a condition known as isolated systolic hypertension (ISH). When the systolic pressure is high, blood vessels become less flexible and stiffen, leading to cardiovascular disease and kidney damage. Research indicates that treating ISH saves lives and reduces illness. The treatment is the same for ISH as for other forms of hypertension. 

Notify the primary care provider if the diastolic pressure suddenly increases to 130 mm Hg or higher you may have malignant hypertension. 

Essential hypertension, whose prevalence is increased nearly two-fold in the diabetic population, may be another source of free-radical activity. The vascular lesions of hypertension can be produced by free-radical reactions (Selwign, 1983). In the recent Kuopio Ischaemic Heart Risk Factor Study in Finnish men, a marked elevation of blood pressure was associated with low levels of both plasma ascorbate and serum selenium (Salonen etal., 1988). A few studies report a hypotensive effect of supplementary ascorbate in patients with hypertension, but the actual changes in both systolic and diastolic pressure after ascorbate were not statistically significant in comparison with placebo (Trout, 1991). 

Reduce mean arterial pressure (MAP) by 20-25% or to a diastolic blood pressure of 110 mmHg in hypertensive emergencies... 

BP, blood pressure CCB, calcium channel blocker agent DBP, diastolic blood pressure SBP, systolic blood pressure. (Adapted from JNC 7 Modified from Saseen JJ, Carter BL. Hypertension. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 194, with permission.)... 

The treatment of elderly patients with hypertension, as well as those with isolated systolic hypertension, should follow the same approach as with other populations with the exception that lower starting doses may be warranted to avoid symptoms and with special attention paid to postural hypotension. This should include a careful assessment of orthostatic symptoms, measurement of blood pressure in the upright position, and caution to avoid volume depletion and rapid titration of antihypertensive therapy.2 In individuals with isolated systolic hypertension, the optimal level of diastolic pressure is not known, and although treated patients who achieve diastolic pressures less than 60 to 70 mm Hg had poorer outcomes in a landmark trial, their cardiovascular event rate was still lower than those receiving placebo.69... 

Hypertension (systolic blood pressure greater than or equal to 140 mm Hg or diastolic blood pressure greater than or equal to 90 mm Hg) or current use of blood-pressure-lowering medication(s)... 

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