ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although it has been recognized for almost 70 years that there is a substantial genetic component to the pathogenesis of hypertension, only recently have systematic efforts been made to identify the responsible genetically determined mechanisms. In the case of several rare syndromes, spectacular progress has been made in identifying the underlying molecular mechanisms responsible for the clinical expression. Glucocorticoidsuppressible aldosteronism and Liddle's syndrome, each inherited as an autosomal-dominant condition, complete the list. In the case of randomly selected patients and families with essential hypertension, inheritance involves many genes and progress has been far more modest. Probably the most promising lead has involved the genes governing the structure of angiotensinogen, the substrate in the renin reaction. Linkage has been established and confirmed. At the moment, however, neither the relation of the genetic abnormality to the underlying mechanisms, nor the contribution of this abnormality to hypertension in the individual patient, has been defined. We know less about other candidate genes, with the exception of studies that rigorously ruled out a contribution. The development of the concept of the “intermediate phenotype,” a physiological feature that makes it possible to identify a homogeneous subpopulation, should help to sort out many of these issues. Unfortunately, the identification and characterization of intermediate phenotypes is substantially more difficult at the moment than are the genetic studies, and so progress is likely to be slow. The field is complicated by the reporting of claims made on the basis of small patient samples. In the case of polymorphisms in the angiotensin-converting enzyme gene as a risk factor for tissue injury, for example, substantial follow-up studies have systematically failed to confirm the original report, which was based on a small patient sample. The fact that the same DNA collection is likely to be examined many times for multiple gene candidates creates a setting in which type I errors are likely, and so we are likely to see many more examples. Caveat lector. Again, the development of relevant intermediate phenotypes will make the spurious association less likely.

ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Both left ventricular mass and left ventricular geometry have been identified as predictors of cardiovascular morbid events. Several studies have suggested that they represent independent risk factors. Studies reported in the past 1 to 2 years have challenged this concept, ie, left ventricular mass may not be a risk factor independent of actual blood pressure load, and left ventricular geometry may not be independent from left ventricular mass and other risk factors. Because of the variability in echocardiographic measurements, echocardiography provides a limited assessment of the actual left ventricular mass in an individual, and therefore of this individual's prognosis, particularly in subjects with mild to moderate hypertension. At present, careful assessment of blood pressure load remains the mainstay for assessment of prognosis of hypertensive subjects.

ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although we have seen a decreased incidence of some of the complications of hypertension, such as myocardial infarction and stroke, the same cannot be said for end-stage renal disease (ESRD). The disparity brings up the question of why improvements in hypertension control apparently do not bring improvement in the incidence of ESRD. Some of the factors likely at play include variation in the mechanisms at work in hypertensive patients of different races and variation in the degree to which antihypertensive agents affect systemic blood pressure and glomerular capillary pressure. These and other factors relating to hypertension and ESRD are the focus of this review.

ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This review covers the role of the sarco(endo)plasmic reticulum in regulating Ca2+influx across the plasma membrane, the role of cytosolic free Ca2+in modulating mitochondrial function, and the role of the plasma membrane in regulating sarco(endo)plasmic reticulum Ca2+, focusing on recent findings that shed a new light on cellular Ca2+regulation. Mechanisms of interactions among the sarco(endo)plasmic reticulum, mitochondria, and the plasma membrane are discussed with a view to explain the lack of consensus regarding the relationship between the cytosolic free Ca2+and blood pressure, and the enigmatic behavior of the Na+-H+exchanger in blood cells (primarily platelets and lymphocytes) from patients with essential hypertension.

ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Resistance to insulin-stimulated glucose uptake is associated with several cardiovascular disease risk factors, including hypertension, dyslipidemia, and alterations of the blood clotting cascade that accentuate thrombosis. This constellation of risk factors may be recognized at young ages and is at least in part heritable. Recognition of this syndrome dictates that preventive and therapeutic strategies should address overall cardiovascular disease risk. In patients with hypertension or diabetes, additional clinical trials are required to identify those interventions that will most effectively reduce not only overall risk but also definitive cardiovascular disease endpoints.

ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Obesity is strongly associated with cardiac risk factors including elevated blood pressure, glucose intolerance, and dyslipidemia. Clinical trials have indicated that weight loss significantly improves these risk profiles. Epidemiologic studies consistently have shown that obesity is a strong risk factor for coronary heart disease in both men and women. In addition, abdominal adiposity may confer added risk for coronary heart disease. Although obesity is a modifiable and preventable cardiac risk factor, management of this disorder remains both challenging and vexing to clinicians. To prevent cardiovascular disease we must find ways to decrease the rising prevalence of obesity and to help overweight individuals achieve and sustain weight loss.

ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Seven new classes of antihypertensive agents that are currently under development are outlined. Clinical studies of neutral endopeptidase inhibitors and angiotensin II receptor blockers are described. Experimental studies are described involving endothelin inhibitors, and clinical and experimental studies of a new multiple action antihypertensive agent, carvedilol, are presented. Studies demonstrating the efficacy of very low doses of thiazide diuretics added to other antihypertensive agents are described. A meta-analysis that found increased risk of sudden death in hypertensive patients treated with non-potassium-sparing diuretics is reported. The controversy over the use of calcium-channel blockers is reviewed, and current recommendations regarding the use of rapidlyacting nifedipine are given.

ISSN:0268-4705    

出版商:OVID    

年代:1996

数据来源: OVID