Blood pressure values are characterized by marked fluctuations occurring not only within a 24-hour period, but also on a day-to-day and even visit-to-visit basis. Such blood pressure fluctuation was once considered 'background noise' or a randomly occurring phenomenon; however, recently it is widely accepted that these variations are the result of complex interactions between extrinsic environmental and behavioral factors and intrinsic cardiovascular regulatory mechanisms. Although adverse cardiovascular consequences of hypertension largely depend on absolute blood pressure values, variations in blood pressure also have predictive value for cardiovascular events. Post-hoc analyses of large intervention trials in hypertension have shown that within-patient visit-to-visit blood pressure variation is strongly prognostic for cardiovascular morbidity and mortality, especially in high-risk patients, suggesting that antihypertensive treatment should be targeted not only towards reducing mean blood pressure levels but also to stabilizing blood pressure variability.
Blood Pressure* ; Humans ; Hypertension ; Mortality

BACKGROUND: Primary pulmonary hypertension(PPH) that affects predominantly young and productive people, is a progressive fatal disease of unknown cause. The objectives of this study were to characterize mortality in patients with PPH and to investigate the factors associated with their mortality. METHODS: Thirteen patients with PPH were enrolled between 1988 and 1996 and followed up through July 1999. Measurements at diagnosis included hemodynamic and pulmonary function variables in addition to information on demographic data and medical history. RESULTS: 1) The mean age of the patients with PPH enrolled into the study was 36.1+/-9.3 years with female predominance. 2) The estimated median survival was 3.4+/-0.6 years. 3) Decreased cardiac index was the only significant predictor of mortality(Cox proportional hazards model). CONCLUSION: Patients with PPH have a high mortality. In this limited study with a small number of patients, mortality is largely associated with decreased cardiac index.
Diagnosis ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Mortality ; Prognosis

Recent global hypertension guidelines recommend an early, strict and 24-hour blood pressure (BP) control for the prevention of target organ damage and cardiovascular events. Out-of-office BP measurement such as ambulatory BP monitoring and home BP monitoring is now widely utilized to rule out white-coat hypertension, to detect masked hypertension, to evaluate the effects of antihypertensive medication, to analyze diurnal BP variation, and to increase drug adherence. Nocturnal hypertension has been neglected in the management of hypertension despite of its clinical significance. Nighttime BP and non-dipping patterns of BP are stronger risk predictors for the future cardiovascular mortality and morbidity than clinic or daytime BP. In addition to ambulatory or home daytime BP and 24-hour mean BP, nocturnal BP should be a new therapeutic target for the optimal treatment of hypertension to improve prognosis in hypertensive patients. This review will provide an overview of epidemiology, characteristics, and pathophysiology of nocturnal hypertension and clinical significance, therapeutic implication and future perspectives of nocturnal hypertension will be discussed.
Blood Pressure ; Chronotherapy ; Epidemiology ; Humans ; Hypertension ; Masked Hypertension ; Mortality ; Prognosis

There are so many differences between the elderly patients and the younger patients in the aspects of a causes and the clinical course of spontaneous intracerebral hemorrage (ICH). As the mean life-time of a general population goes longer, the incidence of spontaneous ICH increases but the aggressive support in ICH is withdrawn more commonly and a prognosis of ICH becomes poor. Therefore, a prevention of ICH and a strict control of hypertension is very very important.
Aged ; Cerebral Hemorrhage* ; Humans ; Hypertension ; Incidence ; Mortality ; Prognosis

In order to elucidate the clinical effectiveness of nimodipine treatment, we analyzed 322 consecutive patients with the aneurysmal subarachnoid hemorrhage operated between September, 1987 and December, 1991. The nimodipine treatment group of one hundred and forty-two patients(44.1%) was compared with the control group of one hundred and eighty patients(55.9%) treated without nimodipine during this period. The patients were randomly allocated to either group. The nimodipine was infused intravenously at 30 microgram/Kg/hr for the first week beginning on the day of admission and then given orally at 360 mg/day for the following two weeks. Statistical anayses were done using the Student's t-test and clinical variables were compared using the chi-square, Mantel-Haenszel chi-square, two-tailed Fisher's exact test. There was no difference in clinical and radiological variables known to influence the outcome of the disease, such as age, sex, presence of hypertension, history of previous subarachnoid hemorrhage, preoperative categorization by Hunt and Hess grade and Fisher's classification, presence of hydrocephalus, location of aneurysm, multiplicity and vasospasm on preoperative angiography(p>0.05). The only difference was in the timing of surgery(p<0.05). The functional outcome, mortality and morbidity, and mortality due to delayed ischemic deficits were not significantly different (p>0.05, respectively). The number of patients with good functional recovery and the number of who developed delayed ischemic deficit(DID) were not significantly different between the group (P>0.05), respectively. Nimodipine treatment did not improve the rate of good outcome in the aneurysmal subarachnoid hemorrhage in our study.
Aneurysm* ; Classification ; Humans ; Hydrocephalus ; Hypertension ; Mortality ; Nimodipine* ; Subarachnoid Hemorrhage*

BACKGROUND: Hypertension is the major risk factor for cardiovascular disease. The increased left ventricular mass has been recognized as an independent predictor of morbidity and mortality in hypertensive patients. The assessment of the regression of left ventricular(LV) mass after antihypertensive therapy offers prognostic information. 2D echocardiography has proved a sensitive tool for the detection of the change of LV mass. METHOD: LV mass and LV mass index were measured by area-length method of 2D echocardiography in 26 hypertensive patients and 10 normal control to evaluate the effect of betablocker(group I, n=16) and angiotensin converting enzyme(ACE) inhibitor(group II, n=10) on the regression of LV mass. RESULT: There was a significant increase of LV mass and LV mass index in the hypertensive patients(199.0+/-37.7gm, 119.2+/-21.2gm/m2) compaired to the control(129.7+/-11.7gm, 87.4+/-8.8gm/m2)(p<0.01, p<0.01). After 13.1 week treatment, LV mass was significantly decreased in group I(200.9+/-35.3gm vs 164.7+/-25.4gm)(p<0.01) and group II(195.9+/-43.3gm vs 152.4+/-27.1gm)(p<0.01). The LV mass index was also significantly decreased in group I(120.3+/-20.7gm/m2 vs 98.8+/-15.5gm/m2)(p<0.01) and group II(117.5+/-22.9gm/m2 vs 91.5+/-13.6gm/m2)(p<0.01). CONCLUSION: This results showed that LV mass can be reduced in hypertensive patients who receive beta blocker and ACE inhibitor. The effect of antihypertensive therapy on LV mass should be considered in treatment of the hypertensive patients who had hypertrophied LV.
Angiotensins ; Cardiovascular Diseases ; Echocardiography ; Humans ; Hypertension ; Mortality ; Risk Factors

To evaluate whether the perioperative myocardiac infarction or cardiac mortality can be predicted in non-cardiac surgery, a computer program for the prediction value was applicated 70 normotensive and 93 hypertensive patients. The eight questions which are required a answer either "yes" or "no" for emergency surgery, experience of anginal attacks, ischemia on electrocardiography, history of myocardiac infarction, age over 70 years, laparotomy and/or thoracotomy, surgery involving great vessels and serum potassium less than 3.5 mEq/L are employed in this program. The prediction values were higher in the normotensive group(10.2+/-15.3%) than the hypertensive group(7.9+/-6.9%), and two cases of perioperative myocardiac infarction occurred in the normotensive group. Histories of myocardiac infarction in the normotensive patients(14.3%) were significantly more frequent than in the hypertensive group(3.3%). The authors suggested that the patients history of hypertension seems not to be directily related to the prediction value of perioperative myocardiac infarction and cardiac mortality.
Electrocardiography ; Emergencies ; Humans ; Hypertension* ; Infarction* ; Ischemia ; Laparotomy ; Mortality* ; Potassium ; Thoracotomy

A series of 531 consecutive cases of subarachnoid hemorrhage(SAH) admitted neurological and neurosurgical departments during past 7 years was reviewed to assess motality, morbidity and its influencing factors. Those factors including age, sex, neurological status, hypertension, vasospasm(angiographic and symptomatic), location of aneurysm, Fisher's SAH grade, operation time, hydrocephalus and multiplicity of aneurysm were evaluated in isolation and in combination. The overall mortality rat4e was 18.1% and operative mortality was 4.3%, 14 cases among 329 surgical cases. The mortality rate of non-operative group was 40.6%. The difference of mortality rate between two groups was mainly due to neurological grade. 1) The main causes of death in operative group were vasospasm(64.3%) and surgical complication(14.3%). Those of non-operative group were rebleeding, vasospasm and initial ictus. 2) In the operative group, influencing factors on the mortality were Hunt and Hess grade at operatiopn, vasospasm, operation time, Hunt and Hess grade on admission and hydrocephalus in the order of importance. In the non-operative group, neurological grade, hydrocephalus, vasospasm and hypertension were important factors. 3) The morbidity rate(poor outcome) of the operative group was 10.0%(33 cases). The main causes of poor outcome were vasospasm(69.7%) and hydrocephalus(24.2%). Influencing factors were Hunt and Hess grade at operation, symptomatic spasm, Fisher's SAH grade, hydrocephalus and hypertension in the order of importance. 4) The symptomatic vasospasm was related to Fisher's SAH grade and Hunt and Hess grade but it was not related to the aneurysmal location, age and hypertension. The vasospasm appeared most commonly in Fisher's grade III and strongly influenced on the outcome.
Aneurysm ; Cause of Death ; Hydrocephalus ; Hypertension ; Mortality* ; Spasm ; Subarachnoid Hemorrhage*

The purpose of this study is to characterize the recurrence and to investigate the risk factors for the recurrence in the 989 patients who had hypertensive intracerebral hemorrhage between 1989-1995. Fifty-three patients(5.4%) had two episodes of hemorrhage with median interval of 22.3+16.3 months(range, 1.7-71.9 months). The probable risk of recurrent hemorrhage was the highest within two years of the first hemorrhage, being 3.6 % in the first year and 3.5 % in the second year. The sites of the recurrent hemorrhage were different from the initial site in all patients. The common patterns of recurrence were "ganglionic(putamen/caudate nucleus)-thalamic" in 26.8% and "ganglionic-ganglionic in 21.4%. The "lobar-lobar" pattern was noted in only 2 patients, The overall mortality was 28.3%. In patients who had ganglionic-ganglionic pattern, the mortality was significantly inc reased (p<0.005). No recurrent hemorrhage occurred during the regular treatment for hypertension. The only significant tactor for recurrent hemorrhage was the antihypertensive therapy of less than 3 months after the initial attack(p<0.005). Considering lifelong treatment for hypertension, long-term regular control for hypertension will be required to prevent the recurrent hemorrhage.
Hemorrhage ; Humans ; Hypertension ; Intracranial Hemorrhage, Hypertensive ; Mortality ; Recurrence ; Risk Factors

OBJECTIVE: To review the POGS statistics on Maternal Mortality Rate and causes of direct and indirect maternal deaths from 2012 to 2014.
BASIC PROCEDURE: Data were retrieved friom the Integrated Statistical Information System, or ISIS, of POGS, and compliance in its use was assessed. Twenty four hospitals were chosen based on completeness of data and highest number of admissions.
RESULTS: Maternal Mortality Rate for the three-year period was 296 per 100,000 livebirths. The top causes of direct maternal deaths were hypertension, hemorrhage and infection. The top three causes of indirect maternal deaths were hypertension, hemorrhage and infection. The top three causes of indirect maternal deaths were cardiac, pulmonary and vascular.
CONCLUSION: Maternal Mortality Rate from 2012 to 2014 was reviewed. The low compliance submitting complete forms from POGS-accredited hospitals made the Committee on Nationwide Statistics strongly recommend an enhancement of the use of the electronic data-based system.