Hypertension in women

VIgeh M,Ghazlzadeh S, Yokayama K, SakaiT, Mazaheri M, Morita Y, Beheshti S, Kitamura F, Araki S. Relationship between increased blood lead and preganacy hypertension in women without occupational lead exposure In Tehran, Iran. Arch Environ Health 2004 59 70-75. 

Magee LA. Treating hypertension in women of child-bearing age and during pregnancy. Drug Saf 2001 24 457-474. 

The Uppsala Adverse Drug Reaetion database has two reports of aggravated hypertension in women taking antihypertensives and orlistat. Hypertension has also been reported in previously normotensive individu s taking orlistat, whieh, in one ease, responded to stopping orlistat3 ... 

Renal Anthracyclines have minimal renal excretion, being mainly eliminated in bile, and although they are nephrotoxic in some animal models, do not induce major renal toxicity in humans [63 ]. However, PLD induces a high incidence of chronic kidney disease (CKD) and hypertension in women treated long term for recurrence of ovarian cancer. Of 56 patients with recurrent ovarian cancer that were treated with PLD for at least six cycles, 13 developed stage three or higher CKD. Prior exposure to platinum compounds appears to be involved in this toxicity [64 ]. 

The prevalence of hypertension differs based on age, sex, and ethnicity. As individuals become older, their risk of high blood pressure increases. Individuals 55 years of age who do not have hypertension are estimated to have a lifetime risk of 90% of eventually developing hypertension. The National Health and Nutrition Examination Survey from 1999 to 2000 indicated that hypertension is slightly more prevalent in men (30.1%) than women (27.1%). However, the prevalence increased by 5.6% in women and has remained unchanged in men from 1988 to 2000.5 Hypertension prevalence is highest in African-Americans when compared to non-Hispanic whites and Mexican-Americans.1... 

Differential diagnoses include diabetes mellitus and metabolic syndrome because patients with these conditions share several similar characteristics with Cushing s syndrome patients (e.g., obesity, hypertension, hyperlipidemia, hyperglycemia, and insulin resistance). In women, the presentations of hirsutism, menstrual abnormalities, and insulin resistance are similar to those of polycystic ovary syndrome. Cushing s syndrome can be differentiated from these conditions by identifying the classic signs and symptoms of truncal obesity, "moon faces" with facial plethora, a "buffalo hump" and supraclavicular fat pads, red-purple skin striae, and proximal muscle weakness. 

CHCs, even those with less than 35 meg estrogen, can cause small increases in blood pressure (6 to 8 mm Hg) in both normotensive and hypertensive women. In women with hypertension, OCs have been associated with an increased risk of MI and stroke. Use of CHCs is acceptable in women younger than 35 years with well-controlled and monitored hypertension. Hypertensive women with end-organ disease or who smoke should not use CHCs. Progestin-only pills and depot medroxyprogesterone acetate (DMPA) are choices for women with hypertension. 

For women at high risk for preeclampsia, low-dose aspirin after 12 weeks gestation reduces the risk for preeclampsia by 19%. Aspirin may reduce the risk of preterm birth by 7% and fetal or neonatal death by 16%. Calcium, 1 g/day, is recommended for all pregnant women, as it may help prevent hypertension in pregnant women and reduce the risk of preeclampsia by 31% to 67%. 

Ml-M risk associated with OC use is increased. This risk is primarily in smokers or women with other underlying risk factors for coronary artery disease such as hypertension, hypercholesterolemia, morbid obesity, and diabetes. The risk is very low in women younger than 30 years of age. Long-term use - Data suggest that the increased risk of Ml persists after discontinuation of long-term OC use the highest risk group includes women 40 to 49 years of age who used OCs for 5 years or more. 

Smoking- Smoking in combination with OC use has been shown to contribute substantially to the incidence of Mis in women in their mid-30s or older, with smoking accounting for the majority of excess cases. Mortality rates associated with circulatory disease have been shown to increase substantially in smokers, especially in those 35 years of age and older who use OCs. Cerebrovascular diseases - OCs increase the risks of cerebrovascular events (thrombotic and hemorrhagic strokes). In general, the risk is greatest in hypertensive women older than 35 years of age who also smoke. 

Age - The risk of cerebrovascular and circulatory disease in OC users is substantially increased in women 35 years of age and older with other risk factors (eg, smoking, uncontrolled hypertension, hypercholesterolemia [LDL 190], obesity, diabetes). 

Hydralazine and dihydralazine are predominantly arterial vasodilators which cause a reduction in peripheral vascular resistance but also reflex tachycardia and fluid retention. They were used in the treatment of hypertension, in combination with a -blocker and a diuretic. Long-term use of these compounds may cause a condition resembling lupus erythematodes with arthrosis, dermatitis and LE-cells in the blood. This risk is enhanced in women and in patients with a slow acetylator pattern. When combined with the venous vasodilator isosorbide (an organic nitrate) hydralazine was shown to be mildly beneficial in patients with congestive heart failure (V-HEFT I Study). Hydralazine and dihydralazine have been replaced by other therapeutics, both in hypertension treatment and in the management of heart failure. 

In the study populations, 108 MI cases and 387 controls had hypertension. Among women with hypertension, the prothrombin variant was a risk factor for MI (odds ratio 4.32). Compared with nonusers of HRT with wild-type genotype, women who were current users and who had the prothrombin variant had a nearly 11-fold increase in risk of a nonfatal MI. The interaction was absent among normo-tensive women. No interaction was found for factor V Leiden in either hypertensive or normotensive women. 

Epidemiologic, experimental, and in vitro mechanistic data indicate that lead exposure elevates blood pressure in susceptible individuals. In populations with environmental or occupational lead exposure, blood lead concentration is linked with increases in systolic and diastolic blood pressure. Studies of middle-aged and elderly men and women have identified relatively low levels of lead exposure sustained by the general population to be an independent risk factor for hypertension. In addition, epidemiologic studies suggest that low to moderate levels of lead exposure are risk factors for increased cardiovascular mortality. Lead can also elevate blood pressure in experimental animals. The pressor effect of lead may be mediated by an interaction with calcium mediated contraction of vascular smooth muscle, as well as generation of oxidative stress and an associated interference in nitric oxide signaling pathways. 

Blood pressure, especially systolic pressure, increases with age in Western countries and in most cultures in which salt intake is high. In women, the increase is more marked after age 50. Although treated conservatively in the past, most clinicians now believe that hypertension should be treated vigorously in the elderly. 

It is not clear why many women remain normotensive while others have a rise in blood pressure. No confirmation has been obtained of early beliefs that hypertension during oral contraception was more likely to occur in black American women, or in women with a history of hypertension during pregnancy (58,136). However, there is clinical evidence that this can occur and that the women involved... 

The issues of whether hyperuricemia is an independent risk factor for cardiovascular disease and the clinical relevance of the rise in serum uric acid caused by diuretic treatment are controversial (SED-14, 660 351). In the Systolic Hypertension in the Elderly Program (SHEP), diuretic-based treatment in 4327 men and women, aged 60 years or more, with isolated systolic hypertension was associated with significant reduction in cardiovascular events (SED-14, 657). Serum uric acid independently... 

In women reserpine causes a small increase in circulating concentrations of prolactin (1006), which could be related to the small increase in the risk of breast cancer. In 27 hypertensive men reserpine 0.25 mg/day for 3 months had no effect on testosterone, dihydrotestosterone, estradiol, luteinizing hormone, or prolactin (1007). 

The use of oral contraceptives is associated with a slightly higher risk of myocardial infarction in women who are obese, have a history of preeclampsia or hypertension, or have hyperlipoproteinemia or diabetes. There is a much higher risk in women who smoke. The risk attributable to oral contraceptives in women 30-40 years of age who do not smoke is about 4 cases... 

Progressive inactivity, dissatisfaction with social life, and presence of medical and psychiatric illness can be most predictive of insomnia in old age [6, 7], In modern societies higher rates of insomnia are present in women, people who are less educated or unemployed, separated or divorced, the medically ill, and those with depression, anxiety, or substance abuse [8], In a number of studies, insomnia has been found to be correlated with frequent use of medical facilities [9-13], chronic health problems [13-18], perceived poor health [17], increased use of drugs [10,14], and specific medical conditions including respiratory diseases [19-21], hypertension [21], musculoskeletal and other painful disorders [19-24], heart diseases [19, 23], and prostate problems [19], On the other hand, chronic insomnia predisposes to the development of psychiatric disorders [25-27], Therefore, it is important to clearly establish whether co-morbidities are causative for, or simply co-exist with insomnia, in order to recommend the most appropriate treatment. This is why it is better to categorize insomnia as a disease rather than as a symptom [28],... 

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