RESUMO
A series of 121 consecutive cases with accelerated hypertension is presented. Forty-seven patients had essential hypertension. This diagnosis was confirmed during the follow-up, which lasted from 3 to 255 months (mean 63.1 +/- 58.1). The relationship between the effects of pharmacological treatment on high blood pressure (BP) and disease course were analyzed in accelerated essential hypertensive patients only, to avoid the imponderable influence of basic disease in secondary hypertension. In most cases, therapeutical effect on BP was monitored by multiple daily BP self-measurements. Since 1974, when this study was initiated, plasma creatinine concentration at admission showed a clear-cut decrease, especially after the introduction in the eighties of new hypotensive drugs. A sustained BP decrease assured a long-lasting preservation of renal function, if the initial functional loss was limited (plasma creatinine concentration of 2 mg/dl (176.8 mumol/l) or less). Renal function was preserved even if the BP decrease was not optimal and signs of relapsing malignant retinopathy were observed in the course of disease. Although the whole series showed a 12-year survival rate of about 69%, patients enrolled after 1980 had a 100% survival rate.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Rim/fisiopatologia , Administração Oral , Adulto , Clonidina/uso terapêutico , Creatinina/sangue , Progressão da Doença , Feminino , Humanos , Hipertensão/mortalidade , Rim/efeitos dos fármacos , Nefropatias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Nifedipino/administração & dosagem , Doenças Retinianas/prevenção & controle , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Fenômenos Cronobiológicos , Reforma dos Serviços de Saúde , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Neoplasias/terapia , Educação de Pacientes como Assunto , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/fisiopatologia , Gravidez , Qualidade da Assistência à SaúdeAssuntos
1-Sarcosina-8-Isoleucina Angiotensina II/uso terapêutico , Angiotensina II/análogos & derivados , Hipertensão Maligna/tratamento farmacológico , 1-Sarcosina-8-Isoleucina Angiotensina II/farmacologia , Adulto , Angiotensina II/sangue , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Renina/sangue , Sódio/sangueRESUMO
A long-term study was done by means of interative fluorangiography on microvascular retinal permeability versus the blood pressure control carried out in 11 patients with a diastolic blood pressure of greater than or equal to 130 mm Hg and with retinal exudates, haemorrhages and oedema. No matter what the original disease was (i.e., essential, renovascular, endocrine hypertension or chronic nephropathy with terminal renal failure) the increased permeability appeared to be critically connected with the blood pressure level. Our results confirm that hypertension per se might be the cause of vascular permeability changes.