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  • Hypertension  (61)
  • Springer  (61)
  • 1990-1994  (58)
  • 1985-1989
  • 1970-1974  (3)
  • 1992  (58)
  • 1972  (3)
Collection
Publisher
  • Springer  (61)
Years
  • 1990-1994  (58)
  • 1985-1989
  • 1970-1974  (3)
Year
  • 1
    ISSN: 1432-1041
    Keywords: Felodipine ; Hypertension ; dosage regimen ; extended release tablet ; adverse effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The blood pressure lowering capacity of felodipine administered either as extended release tablets once or twice daily or as plain tablets twice daily has been compared in a double-blind, three-way cross-over study in 16 hypertensive patients. All the patients were on long-term treatment with 10 or 20 mg felodipine daily and other antihypertensive therapy (mainly beta-blockers) was allowed if it was kept unchanged. Non-invasive blood pressure and heart rate recordings were obtained throughout 24 hour periods using an Accutracker ambulatory system. The 24 h mean systolic and diastolic blood pressures after extended release tablets o.m. did not differ significantly from those after extended release tablets b.d. or plain tablets b.d. There was a tendency for the extended release tablets given o.m. to reduce blood pressure somewhat more in the morning, and for the extended release tablets b.d. to reduce blood pressure more during the night than the other treatments. Mean 24 h heart rate after all treatments was comparable. Manual recordings confirmed these results. Blood pressure was well-controlled throughout the 24 h period by all three treatments. The extended release tablets tended to give less extreme plasma concentrations of felodipine. This may be of value for patients with adverse vasodilator effects. For a majority of hypertensive patients the adequacy of blood pressure control and the simplicity of once daily dosing will favour the extended release tablet given once daily.
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  • 2
    ISSN: 1432-1041
    Keywords: Carteolol ; Dilevalol ; Hypertension ; β-adrenoceptor blocker ; intrinsic sympathomimetic activity ; lipids ; creatine phosphokinase ; glycosylated haemoglobin A1c ; uric acid
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
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  • 3
    ISSN: 1432-1041
    Keywords: Nicardipine ; Hypertension ; ambulatory blood pressure ; adverse effects ; hydrochlorothiazide ; captopril
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The antihypertensive efficacy of sustained-release nicardipine compared to placebo as third-line therapy has been assessed by ambulatory blood pressure monitoring in severly hypertensive patients with clinically unsatisfactory blood pressure control on 50 mg hydrochlorothiazide o.d. and 75 mg captopril b.d. Forty-two patients, 31 m and 11 f, with supine diastolic blood pressure 95–115 mm Hg after a 4 week run-in period on open hydrochlorothiazide and captopril, were randomly allocated to sustained-release nicardipine 45–60 mg/d or placebo. At a visit to the clinic blood pressure and heart rate were measured 12 h after the evening dose by a trained observer unaware of the treatment. Twenty-four hour ambulatory monitoring was performed at the end of baseline and after 8 weeks of blinded medication. There was no significant change in BD at the visit or on ambulatory monitoring in the placebo treated patients. In contrast, nicardipine produced a significant reduction in both blood pressures without affecting heart rate. Nicardipine also decreased the mean 24-h blood pressure by 14/10 mm Hg in patients whose clinical hypertension had been confirmed by ambulatory blood pressure monitoring but by only 3/2 mm Hg in ambulant patients who were normotensive on two-drug therapy. One patient experienced an episode of severe symptomatic hypotension while on nicardipine. Otherwise, the numbers and percentages of patients from each group reporting adverse experiences were similar. It is concluded that nicardipine appears to be an effective antihypertensive agent when used as third line therapy with diuretics and angiotensin converting enzyme inhibitors in patients with severe hypertension. In addition, since 40% of such patients already on two drug therapy were found to have a normal ambulatory blood pressure, the results reinforce the value of ambulatory monitoring in distinguishing hypertensives in whom more aggressive treatment may not by justified.
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  • 4
    ISSN: 1432-1041
    Keywords: Doxazosin ; Hypertension ; Diabetes mellitus ; non-insulin dependent diabetes mellitus ; insulin sensitivity ; serum lipids ; adverse drug effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The effect of doxazosin, an a,-adrenoceptor blocking drug, on blood pressure, sensitivity to insulin and serum lipids has been evaluated in 14 hypertensive, non-insulin dependent diabetic patients. The dose was titrated individually upwards from 1 mg until the diastolic blood pressure was below 90 mm Hg, side-effects precluded further dosage increase or the maximum daily dose of 16 mg was achieved. After 12 weeks of treatment (mean doxazosin dose 5.6 ± 5.1 mg daily), the supine and standing diastolic blood pressure of the patients had declined by about 7 mmHg, whereas their systolic blood pressure and heart rate were not significantly changed. The metabolic clearance rate of glucose increased from 2.35 to 3.37 ml - min−1 - kg−1 during treatment, suggesting improved sensitivity to insulin. Fasting plasma glucose was 11.9 mmol·1−1 before and 10.9 mmol·l−1 after doxazosin therapy (NS). Serum electrolytes and lipids did not change significantly but serum uric acid decreased from 305 to 281 μmol · 1−1 Doxazosin may be a useful alternative for the treatment of hypertension in NIDDM patients.
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  • 5
    ISSN: 1432-1041
    Keywords: Nitrendipine ; Bisoprolol ; Hypertension ; self-measured blood pressure ; diurnal variation ; adverse effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary In a double-blind, placebo-controlled study the antihypertensive efficacy and tolerability of a single morning dose of either 10 mg bisoprolol (n=26) or 20 mg nitrendipine (n=27) were investigated. Blood pressure was measured by three techniques: (1) Casual blood pressure 24 h after the dose; (2) ambulatory 24-h whole-day monitoring; and (3) self-recorded blood pressure in the morning 24 h after the dose (6–8 a.m.) and in the evening (6–8 p.m.). After 4 weeks of therapy bisoprolol had produced a highly significant reduction in blood pressure as assessed by casual, ambulatory day- and night-time monitoring, and self-measured morning and evening readings. Bisoprolol was significantly more effective than nitrendipine, which did not induce a significant reduction in the ambulatory night-time recordings. Whole-day ambulatory blood pressure profiles showed an antihypertensive effect of bisoprolol throughout the entire 24-h period. 24-h blood pressure curves after nitrendipine demonstrated a markedly shorter duration of action, with no reduction in early morning blood pressure. Adverse effects and tolerability of the two drugs were comparable. The average changes in systolic and diastolic blood pressure after bisoprolol and nitrendipine in 2-h periods of ambulatory monitoring (6–8 a.m. and 6–8 p.m.) and self-measured blood pressure (6–8 a.m. and 6–8 p.m.) showed a good agreement between ambulatory and self-measured blood pressure determinations with no significant difference between the methods. The results show that 24 h antihypertensive efficacy was more pronounced for bisoprolol than for nitrendipine at the doses studied. Further, self-measured blood pressures at home were suitable for accurate estimation of the 12-h and 24-h antihypertensive efficacy of the two drugs. The methodological findings of this study have important implications for further pharmacological trials investigating the duration of action of antihypertensive drugs.
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  • 6
    ISSN: 1432-1041
    Keywords: Dexfenfluramine ; Hypertension ; obesity ; norepinephrine ; exercise ; catecholamines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The effect of dexfenfluramine (dF) on body weight, blood pressure and noradrenergic activity were studied in 30 obese hypertensive patients randomly divided into two groups and treated for 3 months either with dF (30 mg daily; 16 subjects) or placebo (Pl; 14 subjects). 11 patients from the dF group and 9 patients given Pl completed the entire experimental protocol, including monthly visits for metabolic and hormonal measurements, as well as a bicycle exercise test with arterial catheterisation for haemodynamic and catecholamine measurements performed before and after 3 months of treatment. A progressive significant decrease in body weight, averaging 6.0 kg after 3 months was observed in the dF-treated group, whereas loss of weight in the placebo group (1.4 kg) was not significant. While blood pressure and noradrenergic activity, assessed as changes in the plasma levels and urinary excretion of norepinephrine, remained unaffected in the Pl group, a significant drop in the supine systolic and diastolic blood pressures, as well as in the resting venous norepinephrine level and in urinary norepinephrine excretion was found after the first month of dF administration. In addition, the exercise-induced rise in systolic and diastolic blood pressure, as well as in arterial plasma norepinephrine and epinephrine concentrations, was significantly reduced after 3 months of dF administration; there were no such changes in the Pl-treated group. The results of the present study indicate that, in addition to the weight-reducing effect of dexfenfluramine, its hypotensive effect may be mediated by a decrease in noradrenergic activity.
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  • 7
    ISSN: 1432-1041
    Keywords: Antihypertensive drugs ; Hypertension ; arterial compliance ; peripheral resistance ; nicardipine ; enalapril ; atenolol ; urapidil ; essential ; pulse wave velocity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Haemodynamic changes in the carotid and brachial arteries produced by single doses of four antihypertensive drugs (nicardipine, enalapril, atenolol, and urapidil) have been studied in 12 patients with essential hypertension. Measurements were performed noninvasively using a mechanographic method and B-mode pulsed Doppler ultrasonography. Within 7 h all of the drugs had caused a significant reduction in blood pressure, whereas heart rate showed a significant change only after atenolol. All the drugs produced a marked reduction in brachial pulse-wave velocity. Only nicardipine caused a significant reduction in vessel wall tension both in the carotid and brachial arteries, while brachial peripheral resistance was significantly reduced by all the drugs except atenolol. Neither atenolol nor enalapril caused any significant reduction in carotid peripheral resistance. The results show that all four antihypertensive drugs led to a beneficial increase in arterial compliance despite their different effects on peripheral resistance.
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  • 8
    ISSN: 1432-1041
    Keywords: Hypertension ; Hyperlipidaemia ; Nicardipine ; lipid metabolism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The an tihypertensive and metabolic effects of oral nicardipine SR 40 mg b. i. d. have been studied in 18 (15 m, 3 f; age 52.7 y) hypertensives with mild hypercholesterolaemia, treated for 3 months after a 2 week period on placebo. An iv Fat Tolerance Test (FTT) was also performed in 8 patients following placebo, treatment with acute nicardipine 20 mg and chronic administration of nicardipine SR. There was a significant fall in BP from 160/97 on placebo to 147/87 after 3 months on nicardipine SR with no change in heart rate. Blood lipids did not change significantly. The disappearance rate of the lipid emulsion in the ivFTT showed no significant change (K2 was 1.93% /min after placebo, 1.84 after nicardipine 20 mg and 1.71 after chronic treatment). The results suggest that nicardipine is an effective antihypertensive drug and that it is devoid of untoward effects on lipid metabolism.
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  • 9
    ISSN: 1432-1041
    Keywords: Hypertension ; ACE-inhibition ; Atenolol ; urinary ; albumin excretion ; renal haemodynamics ; lisinopril ; GFR ; renal function ; adverse events
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The presence of slightly increased urinary albumin excretion (UAE), even at levels well below levels detectable by an ordinary dipstick, has been suggested as a predictor of cardiovascular morbidity and as a reflection of the degree of overall vascular permeability. The aim of the present investigation was to study the effects of two different antihypertensive drug regimens, an ACE inhibitor and aβ-adrenoceptor antagonist, on the low UAE rate observed in subjects with uncomplicated, mild to moderate primary hypertension. After a 4-week placebo run-in period, 49 patients (mean age 54 y) were randomly assigned in a double blind manner either to further 4 weeks on placebo (P,n =15), 8 weeks on lisinopril (L,n = 17; 20 mg/40 mg o. d.) or 8 weeks on atenolol (A,n =17; 50 mg/100 mg o. d.). The 24-h UAE was measured every second week. At entry and after 4 weeks the glomerular filtration rate and the renal plasma flow were measured. Both drugs lowered blood pressure (BP) to a similar extent after 4 and 8 weeks of treatment; the blood pressures were 160/106 (P), 159/104 (L) and 154/103 (A) at entry, and 133/83 (L) and 134/87 (A) at the end of the study after 8 weeks. On entry the 24-h UAE in all patients ranged from 4 to 49 mg (mean 14.1 mg), and it did not differ significantly between groups. After 4 weeks the UAE during 24 h was reduced by approximately one third in the lisinopril-treated group, and by 10 % in the atenolol reated group, whereas it remained unaltered in the group on placebo. After 8 weeks the 24-hour UAE was approximately 20 % lower compared to baseline levels in the lisinopril-treated patients. In the atenolol-treated group the UAE was unaltered compared to baseline. However, none of the changes in the UAE was statistically significant, nor were there any statistically significant differences between the two antihypertensive regimens. Moreover, there were no significant effect of the lisinopril or atenolol treatment on renal function or on renal haemodynamics. It is concluded that in patients with uncomplicated, mild to moderate hypertension both an ACE-inhibitor, such as lisinopril, as well as aβ 1-selective adrenoceptor blocking agent, such as ate
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  • 10
    ISSN: 1432-1041
    Keywords: Nicardipine ; Hypertension ; calcium antagonist ; mental arithmetic ; cold pressor test ; exercise test ; haemodynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The effects of the calcium antagonist nicardipine on the pressor response to mental arithmetic, cold pressor and exercise tests have been studied in fifteen patients with established mild to moderate essential hypertension. Nicardipine 20 mg p.o. showed a hypotensive effect within 60 min, associated with a fall in total peripheral resistance and an increase in heart rate. As the pressor response to each stress was not affected by nicardipine, the peak blood pressure reached during each stress was lower. Nicardipine lowers blood pressure at rest as a result of arteriolar dilatation, associated with reflex tachycardia. The pressor responsiveness to various stresses was not affected by nicardipine.
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  • 11
    ISSN: 1432-1041
    Keywords: Hypertension ; Carvedilol ; chronic renal failure ; pharmacokinetics ; adverse effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The pharmacokinetic and acute systemic haemodynamic effects of a single oral dose of 50 mg carvedilol has been studied in 24 hypertensive patients with chronic renal failure. The patients were stratified into 3 groups according to the creatinine clearance: I 51–90 ml · min−1; II 26–50 ml · min−1; III 4–25 ml · min−1. The area under plasma level time curve AUC, the elimination half-life t/12, the maximum plasma concentration Cmax, the time to peak concentration tmax were not significantly different between groups, whereas the amount of unchanged drug or metabolite excreted in urine Ae and the renal clearance CLR of carvedilol and its metabolites M2, M4, M5 were significantly decreased in Group III. Blood pressure and heart rate decreased in all 3 groups of patients after acute administration of 50 mg carvedilol. Mild adverse effects were reported in 6 patients. Despite a decrease in the renal clearance of carvedilol and of its metabolites with decreasing kidney function, its main pharmacokinetic parameters remained unchanged. The present results suggest that the dose of carvedilol need not be reduced in hypertensive patients with chronic renal failure.
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  • 12
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    Electronic Resource
    Springer
    European journal of pediatrics 151 (1992), S. 134-135 
    ISSN: 1432-1076
    Keywords: Hypertension ; Chronic lung disease ; Dexamethosone ; Preterm delivery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The magnitude and duration of the effect of dexamethasone on systolic blood pressure has been examined in 13 very preterm infants (median gestational age 25 weeks). All had chronic lung disease (CLD). To exclude any effect of CLD on blood pressure each infant acted as his or her own control. Systolic blood pressure increased in all infants (P〈0.01) and remained elevated for at least 48h following cessation of therapy. The median maximum increase in blood pressure was 24 mm Hg (range 13–49 mmHg) and occurred on day 4 (median, range 2–10) of treatment. One infant developed hypertensive encephalopathy. These results demonstrate the need to monitor infants with CLD throughout steroid therapy and preferably for some days after it has ceased.
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  • 13
    ISSN: 1432-5233
    Keywords: Hyperlipidaemia ; Hypertension ; Mice ; Obesity ; Rats
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Genetic background has recently been implicated as an important factor in the development of diabetic nephropathy in humans. Little is known about the natural history of renal disease in patients with type 2 (non-insulin-dependent) diabetes mellitus. Because toxins used in chemically induced models of diabetes may be associated with pathological renal changes, investigators have employed well-defined, genetically distinct animal models to study diabetic nephropathy. This review will focus on animal models of spontaneous type 2 diabetic nephropathy. No single animal model of diabetes corresponds exactly to the human disorder, nor develops renal changes identical to those seen in man. Rodents have been the most studied species with diabetic renal disease. The spontaneously hypertensive/NIH-corpulent (SHR/N-cp) rat provides a unique model of obesity, type 2 diabetes and nephropathy. In addition, genetic controls for this rat, including the lean SHR/N-cp rat and the Wistar-Kyoto/NIH-corpulent (WKY/N-cp) rat, allow assessment of the role of hypertension and obesity in the pathogenesis of diabetic nephropathy. SHR/N-cp rats have abnormal glucose tolerance, hypertension, and develop a renal disease reminiscent of human diabetic nephropathy. WKY/N-cp rats are also obese and have hyperlipidaemia, but their glucose control is somewhat worse than that of the SHR/N-cp rat. In contrast, they do not have hypertension, the renal disease is less severe, and is less suggestive of the human pathology. Finally the LA/N-cp rat also carries the gene for obesity, and exhibits hyperlipidaemia. In contrast to the other two spontaneous models of obesity it does not exhibit hypertension or glucose intolerance. There is little evidence of renal disease in this model. The development of genetic models of obesity, hypertension and glucose intolerance provides a unique opportunity to make longitudinal observations on the natural history of diabetic nephropathy, and to test the various proposed mechanisms for the development of diabetic glomerulopathy, and the effects of various treatment modalities. Diversity in manifestations of diabetic renal disease in animals suggests the importance of genetic mechanisms in pathological outcomes.
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  • 14
    ISSN: 1432-5233
    Keywords: Diabetes ; Hypertension ; Insulin ; Red blood cell ; Sodium-lithium countertransport ; Sodium-proton exchange
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The presence in human red blood cells (RBC) of insulin receptors led us to examine the role of insulin in the regulation of Na/Li and Na/H exchanges (EXCs) that we previously reported to have high activity in hypertension and diabetic nephropathy. To this end, red cells of fasted normotensive subjects were incubated for 1 h with insulin (0–100 μU/ml) to study the external Na+ activation at ten Na+ concentrations. We found that insulin increased twofold theK m for Na+ to activate Na/H and Na/Li EXC. Insulin also modulated the activity of Na/Li EXC in vivo because theK m for Na was significantly higher in the fed than in the fasted state. In the fed state the highK m for Na+ caused an incomplete saturation of Li+ efflux between 70 and 150 mM Na+ which led to underestimation of theV max andK m. To correctly determine theV max andK m for the extracellular Na+ of Na/Li EXC it is critical to control the feeding status of cases and controls and to ensure complete saturation of the flux. We have studied the Na+-activation kinetics of Na/Li EXC in fed normoalbuminuric and nephropathic patients, raising Na+ concentrations up to 280 mM under isosmotic conditions to avoid cell shrinkage. Under such conditions, Na/Li EXC shows significantly higherK m andV max values in nephropathic than in normoalbuminuric patients; this finding may explain the different results obtained by others in fed diabetic patients. The kinetic alterations of Na/Li EXC are also shared by patients with insulin-resistant hypertension as well as by red blood cells of fasted control subjects exposed in vitro to insulin action. We propose, therefore, that hyperinsulinaemia and/or a hyper-responsiveness of this Na+ antiporter to insulin are linked to the phenotypic alterations of Na/Li EXC in diabetes and hypertension.
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  • 15
    Electronic Resource
    Electronic Resource
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    Acta diabetologica 29 (1992), S. 196-200 
    ISSN: 1432-5233
    Keywords: Hyperinsulinaemia ; Glucose metabolism ; Hypertension ; Ion pumps-ANP
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Much epidemiological, physiological and biochemical evidence links insulin resistance and hyperinsulinaemia to the pathogenesis of hypertension in some metabolic diseases such as obesity and type 2 (non-insulin-depedent) diabetes mellitus. Insulin resistance per se, by altering the energy needs of the cell, by causing a shift from glucose to lipid metabolism, or by some other incompletely defined mechanisms, could be responsible for the development of hypertension. It is also possible that hyperinsulinaemia, by acting on the vascular tree, leads to an increase in blood pressure. Moreover, insulin has been shown to augment renal sodium reabsorption, to stimulate the sympathetic nervous system, to influence atrial natriuretic peptide release and the renin-angiotensin-aldosterone system and to activate a number of sodium pumps which are present in all cell membranes, including vascular smooth muscle cells. Insulin can also directly stimulate cell growth. All these mechanisms, in various combinations, with the concurrence of some genetic factors, could lead to the development of the association between hypertension and abnormalities in glucose metabolism.
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  • 16
    ISSN: 1432-5233
    Keywords: Abnormal albuminuria ; ACE-inhibition ; Hypertension ; Microalbuminuria ; Diabetic nephropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract There is general agreement that a fall rate in glomerular filtration rate (GFR) is the principal endpoint in diabetics with renal disease, and that abnormal albuminuria (including microalbuminuria) is an important intermediate end-point. The relative roles of blood pressure (BP) elevation and abnormal albuminuria in the prediction and genesis of renal disease are a matter of debate, and are further analysed in this paper. New studies show that neither genetic predisposition to hypertension (parental BP) nor parental abnormal albuminuria can be used to predict renal disease in patients with type 1 (insulin-dependent) diabetes. However, parental predisposition to proteinuria seems to be important to certain types of patients with type 2 (non-insulin-dependent) diabetes. Cross-sectional as well as follow-up studies document that GFR is generally well preserved in microalbuminuria (in both type 1 and type 2 patients), while the transition to clinical proteinuria is associated with a decline in GFR. Thus, prevention of overt proteinuria is important in clinical trials in microalbuminuric patients. In type 1 diabetes clear ultrastructural changes have been documented with microalbuminuria and a good correlation between abnormal albuminuria and structural damage is seen. Structural damage in normo- and microalbuminuric patients correlates poorly with BP. New studies in type 1 diabetes document that microalbuminuria (but not elevated BP) predicts not only clinical diabetic nephropathy but also end-stage renal failure and mortality. In type 2 diabetes microalbuminuria is the strongest predictor of mortality, whereas BP elevation is not a predictor. Several studies now document that antihypertensive treatment, especially with inhibitors of angiotensin converting enzyme, is able to reverse or reduce abnormal albuminuria, even in non-hypertensive type 1 patients, and possibly preserve GFR. Therefore, microalbuminuria may be the main indicator for starting antihypertensive treatment in these patients. With respect to organ damage in the retina, abnormal albuminuria is an important indicator of the risk of severe diabetic retinopathy. BP elevation seems not to be an initiating factor, but rather aggravates established retinopathy. Left ventricular hypertrophy has a stronger correlation with BP elevation than normoalbuminuria, suggesting that left ventricular hypertrophy is at least partially a phenomenon secondary to elevated BP in diabetic patients with abnormal albuminuria. Generally, abnormal albuminuria is a strong indicator of cardiovascular renal damage in diabetic patients and in most organs is a stronger factor than elevated BP.
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  • 17
    ISSN: 1432-5233
    Keywords: Diabetic nephropathy ; Hypertension ; Microalbuminuria ; Na+/Li+ countertransport ; Type 1 diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Elevated erythrocyte sodium-lithium countertransport activity is an intermediate phenotype of essential hypertension among Caucasians, and may also associate with kidney disease in type 1 (insulin-dependent) diabetes mellitus. Evidence supporting the hypothesis that an inherited predisposition to essential hypertension may thus partly identify with the genetic background of susceptibility to diabetic nephropathy is, however, controversial. This review discusses the possible points of controversy, with emphasis upon the need to standardize the manifest heterogeneity in the current techniques of measurement, as well as upon the clinical concomitants and interpretation of elevated sodium-lithium countertransport activity in type 1 diabetes mellitus. Large family studies may be required in order to single out the independent contributions of genes and environment to sodium-lithium countertransport activity in type 1 diabetes mellitus. However, the original hypothesis that genes underlying elevated sodium-lithium countertransport in essential hypertension and in diabetic nephropathy may also reflect in part a predisposition to diabetic kidney disease cannot be rejected on the basis of current evidence.
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  • 18
    ISSN: 1432-5233
    Keywords: Endogenous digoxin-like factor ; Insulin resistance ; Hypertension ; Obesity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hypertensive obese subjects with glucose intolerance have hyperinsulinaemia, insulin resistance and intracellular cation imbalance resulting in increased sodium content. The aim of our study was to assess in these patients plasma levels of endogenous digoxin-like factor (EDLF), an inhibitor of the sodium-pump mechanism. We studied 14 hypertensive and 12 normotensive subjects with obesity and glucose intolerance for fasting blood glucose, and plasma insulin, C-peptide and EDLF levels: the two groups were matched for age and BMI and were studied after a 2-week wash-out period from hypotensive drugs. Compared with normotensives, hypertensive subjects had higher plasma insulin levels, a greater immunoreactive insulin/C-peptide ratio, a lower glucose/insulin ratio and higher plasma EDLF levels. Our results confirm that among obese people with glucose intolerance, hypertensives are more hyperinsulinaemic and insulin-resistant than normotensives and indicate that the intracellular cation imbalance in these patients may be attributable, at least in part, to EDLF.
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  • 19
    ISSN: 1432-5233
    Keywords: Cholesterol ; Hypertension ; Microalbuminuria ; Nephropathy ; Sodium ; lithium countertransport ; Triglycerides-Type 2 (non-insulin-dependent) diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sodium-lithium countertransport (Na+/ Li+ CT) activity in erythrocytes has been shown to be high in a subset of patients with essential but not secondary hypertension and in type 1 (insulin-dependent) diabetic patients with nephropathy. More recently it has been shown that the presence of a major gene for Na+/Li+ CT, or another closely linked gene, rather than the actual level of Na+/Li+ CT, increases the risk of hypertension onset. The aim of the present study was to investigate whether Na+/Li+ CT activity is associated with hypertension and nephropathy in type 2 (non-insulin-dependent) diabetes. We studied 18 type 2 diabetic patients with normal blood pressure levels (systolic ≤140 and diastolic ≤85 mmHg) and albumin excretion rate (≤15 μg/min), 19 type 2 diabetic patients with hypertension (systolic ≥145 and diastolic ≥90 mmHg) and a normal albumin excretion rate (≤15 μg/min) and 19 type 2 diabetic patients with an increased albumin excretion rate (≤20 μg/min), irrespective of blood pressure levels. Eighteen normal subjects, matched for sex and age, served as controls. Na+/Li+ CT activity in erythrocytes was higher in type 2 diabetics with a high albumin excretion rate (486±148 μmol/l erythrocytes per hour,P〈0.01) and in hypertensive diabetics (410±129,P〈0.05), but not in normotensive diabetics (340±141), than in controls (282±96) (mean±SD). Body mass index was higher in diabetics with hypertension and in those with an abnormal albumin excretion rate than in normotensive diabetics and controls. Blood pressure levels were higher in diabetic patients with an increased albumin excretion rate than in normotensive diabetics and controls. Of diabetic patients with a high albumin excretion rate 26% had normal diastolic blood pressure levels. Diabetics with a high albumin excretion rate had higher glycated haemoglobin, cholesterol and triglyceride levels and a longer duration of diabetes than hypertensive diabetics with a normal albumin excretion rate. The association of these clinical features in type 2 diabetes closely resembles that previously reported in type 1 diabetes. A novel finding of the present study is that predisposition to hypertension, as indicated by high Na+/Li+ CT, seems to confer a susceptibility to the development of renal damage in type 2 diabetes, partially independent of blood pressure levels per se, and that diabetic patients with high Na+/Li+ CT and hypertension are, to some extent, protected against the development of nephropathy when the metabolic control is tighter and the duration of the disease shorter.
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  • 20
    ISSN: 1432-2307
    Keywords: Hypertension ; Aging ; Arteriolosclerosis ; Nephrosclerosis ; Atherosclerosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary With increasing age, the thoracic aorta shows progressive fibroplastic intimal thickening, which is thought to be pre-atheromatous. A similar progressive intimal thickening in the renal cortical arteries is the distinguishing feature of the nephrosclerosis which underlies essential hypertension. Therefore, the earliest detectable youthful precursors of atherosclerosis and hypertension show strong morphological resemblances to each other. In this study, close statistical associations have been shown between the two types of arterial intimal fibroplasia. Both conditions show similar sigmoid growth curves from ages 6 to 70 years, thereby generating correlations across age groups ofr=0.99 in New Orleans andr=0.95 in Mexico City. Specimens gathered in New Orleans were found to have about 1.4 times greater arterial intimal thickening than specimens from Mexico City, and this excess was seen at all ages in both the aortas and the renal cortical arteries. It seems likely that intimai fibroplasia of arteries is reflecting similar biological principles at all levels of the vascular tree. Whatever etiological factors vary between New Orleans and Mexico City, those factors appear to act directly at a tissue level to promote the early precursors of atherosclerosis and of the nephrosclerosis that underlies hypertension.
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  • 21
    ISSN: 1432-0533
    Keywords: Traumatic brain injury ; Hypothermia ; Blood-brain barrier ; Hypertension ; Rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effects of moderate hypothermia on blood-brain barrier (BBB) permeability and the acute hypertensive response after moderate traumatic brain injury (TBI) in rats were examined. TBI produced increased vascular permeability to endogenous serum albumin (IgG) in normothermic rats (37.5°C) throughout the dorsal cortical gray and white matter as well as in the underlying hippocampi as visualized by immunocytochemical techniques. Vascular permeability was greatly reduced in hypothermic rats cooled to 30°C (brain temperature) prior to injury. In hypothermic rats, albumin immunoreactivity was confined to the gray-white interface between cortex and hippocampi with no involvement of the overlying cortices and greatly reduced involvement of the underlying hippocampi. The acute hypertensive response in normothermic rats peaked at 10 s after TBI (187.3 mm Hg) and returned to baseline within 50 s. In contrast, the peak acute hypertensive response was significantly (P〈0.05) reduced in hypothermic rats (154.8 mm Hg, 10 s after TBI) and returned to baseline at 30 s after injury. These results demonstrate that moderate hypothermia greatly reduces endogenous vascular protein-tracer passage into and perhaps through the brain. This reduction may, in part, be related to hypothermia-induced modulation of the systemic blood pressure response to TBI.
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  • 22
    ISSN: 1420-9071
    Keywords: Hypertension ; infancy ; genetic strains ; environmental contributions
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract Cardiovascular responses of adult organisms to feeding are well characterized and, in general, are understood as acute adaptations required for processing and distributing nutrients. Research over the past several years has shown that infants also have important cardiovascular responses to nutrient intake and that these are regulated by changes in autonomic activity to the heart and vasculature. Recent studies have provided results that suggest these responses in infancy may make an important contribution to the long-term development of cardiovascular function, in particular, adult blood pressure (BP). The purpose of this presentation will be to review the evidence that has led to this conclusion, offer ideas about how this potential early-life shaping of subsequent cardiovascular function may come about, and suggest further studies that will be required in order to characterize the mechanisms responsible for these effects.
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  • 23
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    Cellular and molecular life sciences 48 (1992), S. 311-314 
    ISSN: 1420-9071
    Keywords: Hypertension ; SHR ; SS/Jr ; maternal environment ; nutrition ; early experience ; pathophysiology ; genetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract Four reviews on the the role of developmental factors in hypertension are introduced and set in historical context. Recent research in the laboratory rat has shown that the preweaning environment makes an important contribution to the level of blod-pressure reached in adult life in genetic models of hypertension. Both of the most commonly used models of hypertension, the SHR and SS/Jr rat strains, exhibit lower BP in adult life, if they are fostered shortly after birth to mothers from their normotensive control strains. It has been suggested that it is the idiosyncratic maternal behavior of the hypertensive mothers which contributes to the elevated BP of their offspring, and it has been amply demonstrated that there is an association between a constellation of behaviors emitted by rat mothers and the adult BP of their offspring in a wide variety of genetic groups (inbred hypertensive animals, F1's and F2's). In addition to the above, maternal environment has been demonstrated to have a significant impact on the pathophysiological response of hypertensive animals to a high salt diet. Being raised by an SHR mother, versus an SS/Jr mother, increases the magnitude of BP increases to a high salt diet, susceptibility to hemorrhagic stroke, body weight loss and the risk of mortality. A variety of physiological systems are undergoing rapid change during the preweaning period and may mediate the effects of differences in the maternal environment. These include the renin-angiotensin system and the peripheral sympathetic nervous system. Nutritional factors may be involved in all of the phenomena referred to above. Thus, any physiological mechanisms that are proposed to link maternal behavior to its effects on the physiology of adult animals should recognize the involvement of nutritional factors. Research on the role of developmental factors such as maternal behavior in genetic models of hypertension is at the interface of two growing disciplines: behavior genetics and developmental psychobiology. The methodological and conceptual contributions of these fields to advancing our understanding of these phenomena is emphasized.
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  • 24
    ISSN: 1432-0428
    Keywords: Hypertension ; hyperinsulinaemia ; insulinoma ; insulin resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have investigated the hypothesis that insulin is a causal and independent risk factor for blood pressure elevation in humans by comparing pre- and post-operative blood pressure values of 34 consecutive patients with histologically-confirmed diagnosis of insulinoma and 34 age- and sex-matched control patients. In patients with insulinoma hypoglycaemic symptoms were present for 18 (9–36) months. (Values are given as median and 95% confidence interval or mean and SD). After removal of insulinoma fasting plasma insulin levels decreased from 22 (16–28) mU/l to 11 (6–20) mU/l (p〈0.003) and minimal fasting plasma glucose concentrations increased from 2.5 (2.0–3.0) to 4.4 (4.2–5.7) mmol/l (p〈0.002) while blood pressure values remained unchanged. Body mass index before operation was comparable between the groups: 25.5 (5.4) kg/m2 in insulinoma patients and 24.8 (4.7) kg/m2 in control subjects. Pre-operative and post-operative blood pressure values did not differ between the groups, being (systolic/diastolic) 133 (18)/82 (9) mm Hg in insulinoma patients and 128 (15)/78 (10) mm Hg in control subjects before and 129 (19)/80 (10) mm Hg and 125 (11)/76 (7) after surgery. Chronic hyperinsulinaemia in patients with insulinoma is not associated with a detectable elevation of blood pressure values. Correction of hyperinsulinaemia after surgery for insulinoma does not result in blood pressure changes. These results argue against the hypothesis that insulin is an independent causal factor in the development of essential hypertension in humans.
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  • 25
    ISSN: 1434-0879
    Keywords: Renal cell carcinoma ; Renin ; Endothelial cells ; Hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The pathogenetic relationship between tumour and hypertension was investigated in 129 patients with renal cell carcinoma, of whom 41 (31.8%) were hypertensive. Of these 41 patients with renal tumours and hypertension, 6 (14.6%) were found to have primary reninism. In these patients the plasma renin activity in blood from the renal veins showed a tumour kidney to contralateral kidney ratio of between 4 and 7, and 2 patients also had secondary hyperaldosteronism. In the same 6 cases the renin content in the renal tumour tissue was significantly higher than that in tissue from the adjacent tumour-free renal cortex of the ipsilateral kidney. Immunohistochemical demonstration of renin in the tumour was only possible in these 6 cases. In 5 of these patients blood pressure returned to normal following nephrectomy; in the 6th case there was a drop in blood pressure after nephrectomy. In 3 renin-positive tumours examined, autonomous renin production was demonstrated in cell culture. Renin-producing renal cell carcinomas are an uncommon cause of renal hypertension. The differential diagnosis of hypertension should therefore also include renal tumour.
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  • 26
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    Heart and vessels 7 (1992), S. 37-43 
    ISSN: 1615-2573
    Keywords: Takayasu Arteritis ; Hypertension ; Retinopathy ; Renal artery stenosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Takayasu arteritis is the commonest cause of renovascular hypertension in India. The clinical and radiological features, complications and course of 83 patients (51 females, 32 males) seen during the period from 1972–1990 are described in this study. The age of the patients ranged from 5 to 53 years with the mean ±SD of 26.9 ± 9.7. Hypertension (n = 50) and the related symptom of headache (n = 40), dyspnea (n = 24), and giddiness (n = 20) were common at presentation. Twelve patients were in congestive cardiac failure. The symptoms of activitly with fever and arthralgia were present in only 16% contrary to reports from Japan and Mexico. Abnormal arterial pulses and bruit over abdominal (37%) or extra abdominal great arteries (25%) were useful clinical clues to suspect Takayasu arteritis. Rapid sequence intravenous urography was a sensitive screening procedure and predicted correctly the presence of renovascular disease in 80% of the patients. The diagnosis was confirmed on aortography in 72. In the rest, the clinical features and autopsy findings confirmed the same. The four patterns of the disease based on the anatomical extent of involvement were recognised. These were: type I (n = 8) with involvement of aortic arch and its branches, type II (n = 25) descending thoracic and abdominal aorta type III (n = 46) combination of I and II and type IV (n = 4) pulmonary artery in addition to any of the above. Antihypertensive drug therapy was the mainstay of treatment, but surgery in carefully selected patients was rewarding. Eleven patients died during 6 years after the initial diagnosis mainly due to cardiac, renal and cerebro-vascular complications. The course of the disease seems to be slowly progressive and in many patients becomes static for long periods.
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  • 27
    ISSN: 1619-1560
    Keywords: Atrial natriuretic peptide ; Adrenaline ; Hypertension ; Normal subjects ; Renin ; Aldosterone ; Human
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The levels of plasma atrial natriuretic peptide in response to graded adrenaline infusion were determined in six patients with essential hypertension and six healthy normotensive subjects (controls). Basal plasma adrenaline concentration was similar in both groups and rose progressively and to a similar level during adrenaline infusion. Plasma noradrenaline rose in both groups and to the same extent during the 26 and 39 ng/kg/min adrenaline infusion rates. Basal plasma atrial natriuretic peptide levels were higher in the hypertensives than in the controls. Graded adrenaline infusion had no effect on atrial natriuretic peptide levels in the controls but significantly raised atrial natriuretic peptide levels in the hypertensives. Systolic blood pressure rose progressively during adrenaline infusion at a lower infusion rate in the hypertensives than in the controls. Similarly, while heart rate rose during adrenaline infusion in both groups, there was a greater rise in the hypertensives. The increased cardiovascular. responsiveness to adrenaline infusion in patients with essential hypertension may explain why plasma atrial natriuretic peptide levels rose only in this group and not the normotensive subjects.
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  • 28
    ISSN: 1619-1560
    Keywords: Sympathetic nerve activity ; Hypoxia ; Sleep apnoea ; Bradycardia ; Hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Voluntary end-expiratory apnoea in a 23-year-old asymptomatic mild hypertensive patient consistently elicited bradyarrhythmias (complete heart block and sinus pause) and sympathetic activation to muscle blood vessels, indicating simultaneous sympathetic and parasympathetic activation during apnoea. The sympathetic bradyarrhythmic response to apnoea was potentiated by hypoxia and eliminated by atropine. Baroreflex activation also attenuated the bradycardic response to apnoea. A 43-year-old hypertensive patient with sleep apnoea also exhibited bradyarrhythmias (sinus arrest for up to 10 s) and a fall in perfusion pressure to 〈50 mmHg during episodes of sleep apnoea. These cardiovascular changes were associated with a reduction in oxygen saturation to levels as low as 35%. Neither patient was on any medication. Simultaneous sympathetic and parasympathetic activation during episodes of apnoea may predispose to cardiovascular catastrophe. These chemoreflex mediated autonomic changes are inhibited by baroreflex activation. We propose that patients with impaired baroreflexes (patients with hypertension or heart failure and premature infants) may be especially susceptible to excessive autonomic responses to chemoreflex stimulation during periods of apnoea. In these patient groups, brady-arrhythmias, hypoxia, hypoperfusion and sympathetic activation during apnoea may predispose to sudden death.
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  • 29
    ISSN: 1619-1560
    Keywords: Hypertension ; Diastole ; Haemodynamics ; Lower body negative pressure ; Systemic resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Physiological consequences of altered peak left ventricular diastolic filling rate in hypertension have not yet been fully assessed. The hypothesis that altered left ventricular diastolic filling rate interferes with inhibitory cardiopulmonary reflexes was tested. Normalized peak left ventricular diastolic filling rate was calculated from radionuclide ventriculography. Haemodynamic changes during lower body negative pressure (−5 to −40 mmHg) in nine hypertensive patients with slow normalized left ventricular filling rate (Group A) were compared with 16 hypertensive patients with normal normalized peak left ventricular diastolic filling rate and ten normal volunteers of the same age group. Baseline total peripheral resistance was higher in essential hypertension compared to normals but did not differ significantly between the two hypertensive groups. For data analysis, the levels of lower body negative pressure were grouped as low levels of −5 to −10, and −15 to −20 mmHg, an intermediate level of −25 mmHg, and high levels of −30 to −40 mmHg; the change in total peripheral resistance (from baseline) was less prominent in Group A compared to Group B and to normals (−1.4 ± 1.7 [SE], −0.06 ± 1.4, 1.1 ± 1.2 and 4.5 ± 2 u·M2 in Group A at the four consecutive levels of lower body negative pressure vs. 0.9 ± 0.7, 3.8 ± 0.9, 7.2 ± 1.6, and 8.2 ± 1.4 in Group B, and 2.0 ± 0.7, 3.3 ± 0.8, 4.9 ± 0.8, and 5.6 ± 1.0 in normals). The reductions in central venous pressure and in pulmonary wedge pressure were not significantly different among the three groups at the different levels of lower body negative pressure, but the reduction in cardiac output was smaller in patients with reduced dv/dt ratio than in the other two groups. The responses to the cold pressor test were similar in all subjects. We conclude that patients with essential hypertension and diastolic dysfunction have impaired total peripheral resistance responses to lower body negative pressure. This abnormality may reflect an alteration in cardiac baroreflexes secondary to left ventricular diastolic dysfunction, an influence of baseline sympathetic activity on the observed vascular responsiveness to lower body negative pressure, or primary differences among groups in the changes in cardiac output induced by similar levels of lower body negative pressure.
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  • 30
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    Heart and vessels 7 (1992), S. 133-137 
    ISSN: 1615-2573
    Keywords: Takayasu arteritis ; Aortitis syndrome ; Hypertension ; Adrenocorticosteroids ; Immunosuppressives
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The guidelines for medical treatment of Takayasu arteritis established in 1987 by the Systemic Vascular Disorders Research Committee, Ministry of Health and Welfare of Japan are presented. The first part of the guidelines concerns treatment with adreno-corticosteroids and the second part concerns other medical treatment. A review of the literature referring to steroid therapy and other medical treatment of Takayasu arteritis is also included.
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  • 31
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    Heart and vessels 7 (1992), S. 146-153 
    ISSN: 1615-2573
    Keywords: Aorta, diseases ; Aorta, stenosis ; Hypertension ; Percutaneous transluminal angioplasty ; Renal artery, stenosis ; Subclavian artery, stenosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Percutaneous transluminal balloon angioplasty (PTBA) was performed in 87 patients for 111 stenotic lesions due to Takayasu arteritis. Of the lesions attempted for dilatation, 35 were in the aorta, 64 in renal arteries, 9 in subclavian, and 3 in common iliac arteries. The stenosis of aorta could be successfully dilated in 33 of 35 (94.3%) patients with fall in peak systolic pressure gradient (PSG) from 77.7 ± 28.4 mmHg to 26.4 ± 20.6 mmHg (P 〈 0.001) and increase in luminal diameter from 4.7 ± 2.4 mm to 10.1 ± 4.1 mm (P 〈 0.001). On hemodynamic and angiographic restudy in 20 patients at 3–24 months (mean 7.7 ± 4.1 months) further fall in PSG (⩾15 mmHg) was observed in 7 patients, no significant change in 12 patients and restenosis with increase in PSG in one patient which could be successfully redilated. Late restudy at 36–60 months (mean 43 ± 9.4) in six patients showed continued relief of stenosis (mean PSG 8.8 ± 7.8 mmHg). Of the 64 stenotic lesions of the renal arteries, 58 (90.6%) could be successfully dilated with decrease in stenosis from 89.1 ± 10.1% to 29.9 ± 14.9% (P 〈 0.001). Follow-up intra-arterial digital subtraction angiography in 25 patients at a mean follow-up period of 13.1 months (range 3–29 months) showed restenosis in 5/36 (13.9%) lesions which could be successfully redilated. Angioplasty was also successful in dilating 8/9 (88.9%) subclavian and all 3 common iliac artery stenosis. There was marked improvement in symptoms after successful angioplasty. Blood pressure was reduced to normal or improved in all successfully dilated aortic stenosis and in 84.6% of renal artery stenosis. In conclusion, PTBA is safe, highly effective, and therefore should be considered as the treatment of choice particularly for discrete stenotic lesions due to Takayasu arteritis.
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  • 32
    ISSN: 1573-7284
    Keywords: Hypertension ; Job absenteeism ; Spain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study reports the findings of one of the stages of a programme for the detection and control of arterial hypertension, started in I980 in an automobile company with a workforce of 9,782. In the initial screening, 522 hypertensive males were found using epidemiological criteria and 206 of these fulfilled the criteria of definite hypertension. The objective of this study consisted of evaluating, 9 years after the start of the program, the indirect cost in terms of the reduction in the morbidity indicator-temporary work incapacity (TWI). Analysis is based on a comparison of the prevalence of hypertension in the population when the program was begun (6%) and in 1989 (9.8%). It can be observed that the TWI rate of the hypertensive population was significantly higher than that of the rest of the workforce, and that this remained true for the reference group (RG) hypertensives a year after the study was initiated. In contrast, the intervention group (IG) showed significantly lower TWI levels, not only in comparison with the RG but also with the rest of the workers. The estimated reduction in TWI for 1989 was 4.500 days/year, which corresponds to an estimated saving of 76.500.000 pesetas/year.
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  • 33
    ISSN: 1573-7284
    Keywords: Coronary risk ; Hyperlipidemia ; Hypertension ; Hyperglycemia ; Overweight ; WHO-CINDI ; Epidemiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We investigated mean levels and prevalences of total cholesterol, HDL cholesterol, triglycerides, fasting blood glucose, systolic blood pressure and body mass index in adults aged 25 to 64 years participating in the WHO Country-wide Integrated Noncommunicable. Diseases Intervention (CINDI) Programme in Vorarlberg, western Austria. According to the Austrian expert panel and based upon the above age standardized risk factors 50.9% of the male and 29.3% of the female population were at high risk for developing coronary heart disease. Risk factor levels were further compared between euglycemic and hyperglycemic participants. After adjusting for age hyperglycemia was associated with higher body mass index in men (p=0.026) and women (p〈0.001), higher systolic blood pressure in men (p〈0.001) and women (p=0.003), and higher levels of triglycerides in women (p=0.008). No significant differences were observed in total and HDL cholesterol in either sex. When controlling for age and body mass index, fasting blood glucose levels had significant associations only with systolic blood pressure in men (p=0.001). But, with respect to all risk factors, hyperglycemic participants had an age-adjusted adverse coronary risk profile both in men (p=0.002) and in women (p〈0.001).
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  • 34
    ISSN: 1573-739X
    Keywords: Arrhythmia ; Calcium ; Calmodulin/antagonists & inhibitors ; Cardiomyopathy, congestive ; Drug therapy ; Gastrointestinal diseases ; Hypertension ; Neoplasms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Calmodulin is the most important intracellular receptor protein for the second messenger calcium. The calcium-calmodulin complex regulates a number of physiological processes. An increasing number of pharmaceutical products is reported to interfere with the calcium-calmodulin complex. Despite the fact that the precise mechanisms of action of these so-called calmodulin antagonists await further clarification, reports accumulate in the literature indicating a broadening spectrum of putative therapeutic applications of calmodulin antagonists. Some of these applications, such as in cell proliferation, hypertension, congestive heart failure, arrhythmia and gastro-intestinal disorders, are discussed in the present review.
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  • 35
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    Journal of molecular medicine 70 (1992), S. S2 
    ISSN: 1432-1440
    Keywords: Antihypertensive drugs ; Blood pressure ; Hypertension ; Therapeutical trials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Information concerning the level of blood pressure at which treatment should be commenced is incomplete, and current guidelines have to be considered of provisional suggestions on which many experts have a consensus. There is general agreement on the need to administer anti-hypertensive therapy when diastolic pressure is 100 mmHg or above. At diastolic values of 90–99 mmHg the risk, albeit increased, is relatively low. The wisest practical solution, which coincides with guidelines from the World Health Organization and the International Society of Hypertension, is to commence treatment if diastolic pressure is between 95 and 100 mmHg, but only after several months of observation with repeated measurements. At values between 90 and 95 mmHg, a decision in favor of treatment will be influenced by concomitant elevation of systolic values and by the occurrence of other risk factors or a strong family history of cardiovascular disease.
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  • 36
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    Journal of molecular medicine 70 (1992), S. S39 
    ISSN: 1432-1440
    Keywords: Carvedilol ; Celiprolol ; Labetalol ; Dual-acting drugs ; Hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary There are now several antihypertensive agents with dual actions. Among these, labetalol has been studied most extensively. The drug has a place in the chronic treatment of hypertension and in the therapy of hypertensive emergencies. Carvedilol, now available in Germany, has been shown to be effective in different forms of hypertension. Celiprolol binds to beta 1- and beta 2-receptors. This drug also binds to alpha 2-receptors. It is not clear, at present, whether or not this binding property contributes to its antihypertensive effect.
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  • 37
    ISSN: 1432-1440
    Keywords: Hypertension ; Hemodynamics ; Cardiac output ; Exercise ; β-Blockers ; Carvedilol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The cardinal hemodynamic disorder in established essential hypertension is increased total peripheral resistance. During exercise, the increase in stroke volume of the heart is abnormal. A 20-year follow-up study of the hemodynamics in essential hypertension demonstrated a progressive increase in total peripheral resistance and deterioration of the heart pump function. Long-term treatment with antihypertensive agents modifies the circulatory system in different ways. Vasodilators (angiotensin converting enzyme inhibitors, α1-blockers, and calcium antagonists) all reduce total peripheral resistance, and in general, cardiac output, heart rate, and stroke volume remain unchanged. Calcium antagonists like verapamil and diltiazem reduce the heart rate approximately 10% during exercise, but since stroke volume increases, cardiac output is unchanged. Chronic treatment with conventional β-blockers induces a permanent reduction in cardiac output and heart rate during exercise. In contrast, carvedilol — a β1,β2-blocker with α1-blocking activity — prevents the immediate increase in total peripheral resistance during acute β-blockade. In 19 patients followed by hemodynamic measurements over 6–9 months, blood pressure was well controlled by carvedilol. During exercise, total peripheral resistance decreased 6% (P〈0.05), and the reductions in heart rate and cardiac index were less than on conventional β-blockade. Echo-Doppler studies showed a significant reduction in the intraventricular septum of 13%.
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  • 38
    ISSN: 1432-1440
    Keywords: Hypertension ; Left ventricular hypertrophy ; Hypertrophy regression ; Magnetic resonance ; Carvedilol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary For more than 20 years hypertrophy regression has been in the focus of hypertension research. Many studies in animals have shown impressive reduction of left ventricular hypertrophy after medical treatment of hypertension. The most important result seems to be that hypertrophy can be almost completely reversed in young animals, whereas in older animals regression of left ventricular hypertrophy appears to be less complete. Hypertrophy regression in man seems much more difficult to prove. The direct correlation between left ventricular muscle mass and ECG changes has been disappointing in many studies. Echocardiography is able to show a comparatively good impression of left ventricular muscle mass and therefore can also demonstrate regression of left ventricular hypertrophy within its methodological limits. There is no doubt that today magnetic resonance imaging has by far the best imaging quality of all the clinical methods and is able to demonstrate both hypertrophy and its regression with incomparable accuracy. In the present clinical study hypertrophy regression has been demonstrated after 6 months of treatment with Carvedilol.
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  • 39
    ISSN: 1432-1440
    Keywords: Hypertension ; Calcium ; Parathyroid hormone ; 1,25-Dihydroxyvitamin D3
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Essential hypertension has been associated with disturbed calcium metabolism, but the available data are controversial. We measured parameters of calcium metabolism in groups of untreated male subjects (n = 78) with elevated diastolic blood pressure (101 ± 6 mmHg, mean ± SD) and age-matched male subjects (n=79) with low diastolic blood pressure (62 ± 4 mmHg). The participants of the study were drawn from a random population sample. Subjects with high diastolic blood pressure had significantly higher carboxy-terminal parathyroid hormone (PTH) plasma concentrations than controls with low diastolic blood pressure (median 114 vs. 43 pmol/l, P 〈 0.01). The 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations were comparable in both groups. Individuals with high diastolic blood pressure had significantly lower total serum calcium (2.41 ± 0.10 vs. 2.47 ± 0.10 mmol/l, mean ± SD; P 〈 0.01). PTH concentrations were correlated with diastolic pressure (r = −0.39, P 〈 0.001). The data are compatible with increased parathyroid activity despite unchanged concentrations of vitamin D metabolites in human hypertension.
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  • 40
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    Journal of molecular medicine 70 (1992), S. S43 
    ISSN: 1432-1440
    Keywords: Carvedilol ; Hypertension ; β-blocker ; α1-blockade ; ABPM ; Prevention
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The spectrum of demands on an antihypertensive agent is constantly increasing. It is not only supposed to reduce blood pressure, but also to have a certain profile with regard to pathophysiology, hemodynamics, pharmacokinetics, safety, and clinical applicability. Carvedilol is a new β-blocking agent without ISA, which causes vasodilation primarily through an α1-blockade. It combines the positive effects of α1- and β-blockade; the negative properties are offset by each other. It not only provides theoretical advantages, but also shows a favourable hemodynamic profile and is effective and safe. Advantages in both primary and secondary prevention can be expected. It can be administered once daily, is well suited to patient needs, and can be combined with other hypertensive drugs. It also exerts a favorable influence on many secondary diseases. The compelling advantages of the drug make it an important addition to our armamentarium for the treatment of arterial hypertension as a first-line drug.
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  • 41
    ISSN: 1432-1440
    Keywords: Carvedilol ; Hybrid drug ; Coronary heart disease ; Hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a randomized, double-blind study oral doses of 50 mg carvedilol (Dilatrend) were compared with 40 mg propranolol in 16 male patients with coronary heart disease, CHD [12 without significant stenoses following percutaneous transluminal coronary angioplasty (PTCA), 4 with multivessel disease]. Bicycle ergometry in the supine position was performed before and 80 min after drug application; measurements were done at rest, during and after exercise. Clinically, the total exercise time and the onset of angina and exhaustion were noted, while the investigated hemodynamic parameters were heart rate, systemic and pulmonary pressures and resistances, cardiac index, and lower limb blood flow. Clinically, carvedilol improved the exercise tolerance more than propranolol as regards angina and exhaustion. Hemodynamically, carvedilol did not lead, as the classic betablocker propranolol does, to an increase in systemic or pulmonary resistance, to a decrease in cardiac output, or to an increase of the pulmonary capillary wedge pressure during exercise, but instead caused opposite changes. In contrast to propranolol, the post exercise lower limb blood flow had increased significantly. The differences in action between the two betablockers can be explained by the vasodilating properties of carvedilol. Due to these acute effects, carvedilol may be preferred to propranolol in the treatment of CHD patients with hypertension, peripheral occlusive artery disease, and/or coronary vasospasm.
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  • 42
    ISSN: 1432-1971
    Keywords: Coarctation of the aorta ; Hypertension ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Coarctation of the aorta is usually caused by a congenital narrowing of the aorta. This report describes two children who developed hypertension secondary to an acquired coarctation of the aorta. In one patient the coarctation was temporally related to umbilical artery catheterization and was associated with thrombosis and aneurysmal dilatation of the aorta. In the second patient, the coarctation occurred after surgical aortotomy during the removal of an intrathoracic neuroblastoma. Patients who have interventional damage to the aorta should be periodically examined for the appearance of a coarctation. Although an acquired coarctation of the aorta is an infrequent complication of invasive or surgical procedures, it should be identified since it represents a remediable cause of hypertension in children.
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  • 43
    ISSN: 1432-198X
    Keywords: Reflux nephropathy ; Urinary tract infections ; Pyelonephritis ; Radiological appearance ; Renal function ; Hypertension ; Follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a previous report the long-term prognosis of 30 patients with renal scarring after pyelonephritis in childhood was described. In this study, we have related the extent of renal scarring present in childhood to the conditions in early adulthood. A radiological progression of searring from childhood to adulthood was seen in one-third of the kidneys. The 7 patients with bilateral scarring in childhood had a smaller renal area, lower glomerular filtration rate and higher plasma vasopressin at follow-up than 13 healthy controls. The 20 patients who had unilateral searring in childhood had a smaller renal area, lower glomerular filtration rate, higher diastolic blood pressure and higher plasma renin at follow-up than controls; 4 had hypertension. The most important finding was that children with unilateral disease are at risk of serious long-term complications. Filtration fraction at follow-up was higher in patients with extensive renal scarring in childhood compared with those with a normal renal area or small scars in childhood (r=−0.43,P〈0.05). This may indicate glomerular hyperfiltration by remnant glomeruli. This paper emphasizes the potential seriousness of childhood urinary tract infections especially when early infantile infections are overlooked. A follow-up of more than 4 decades may be necessary before the ultimate prognosis can be established, especially in patients with unilateral renal disease. It is advised that most patients with post-infectious renal scars are followed as high-risk patients, and that treatment continuity is established between paediatricians, nephrologists and, when required, obstetricians.
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  • 44
    Electronic Resource
    Electronic Resource
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    Pediatric nephrology 6 (1992), S. 287-291 
    ISSN: 1432-198X
    Keywords: Lead intoxication ; Increased lead burden ; Nephropathy ; Mental retardation ; Hypertension ; Gout
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The epidemiology, clinical symptomatology, diagnosis and management of acute and chronic lead intoxication are reviewed. While acute lead intoxication has become rare, the elevated environmental lead burden is thought to play a causal role in hypertension. Lead may also be linked with neuropsychological disorders of children and possibly even chronic renal failure. The epidemiological and experimental evidence for this hypothesis is critically discussed.
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  • 45
    ISSN: 1432-198X
    Keywords: Hyperfiltration ; Hypertension ; Proteinuria ; Renal insufficiency ; Unilateral renal agenesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The clinical course was reviewed in 157 patients with unilateral renal agenesis and a normal contralateral kidney for the purpose of establishing a prognosis. There were 85 males (54%) and 72 females (46%). The mean age at diagnosis of unilateral renal agenesis was 37 years. The mean years at risk was 56. Proteinuria (〉150 mg/24h) was found in 19% of the 37 patients tested (P〈0.001), hypertension developed in 47% of the 47 patients tested (P=0.010), and renal function (adjusted for age and sex) was decreased in 13% of the 32 patients tested (P=0.001). An increased filtration fraction was found in 7 (54%) of 13 patients evaluated. At the completion of this study, 114 patients (73%) were alive, and the survival rate was similar to that of age-, sex-matched United States life tables. Forty-three patients (27%) died; 6 deaths (4%) were caused by renal failure. Our review indicates that patients with unilateral renal agenesis and a normal solitary kidney are at increased risk of proteinuria, hypertension, and renal insufficiency. Therefore, it is essential to have prolonged and careful follow-up and to employ strategies that maximize renal preservation.
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  • 46
    ISSN: 1432-198X
    Keywords: Hypertension ; Renal ultrasound ; Arterial calcification ; Hypercalciuria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Renal ultrasound examination, performed following a urinary tract infection in a 4·5-year-old girl with triple X syndrome, showed multiple echogenic foci at the corticomedullary junction in both kidneys. She was asymptomatic but had hypertension with echocardiographic evidence of left ventricular hypertrophy. Computerised tomographic scan revealed foci of calcification in the kidneys, spleen and pancreas. On biopsy calcification was found in the internal and external elastic laminae of the superficial temporal artery and in the internal elastic lamina of a renal arcuate artery. Intimal fibrosis was mild and focal. No other arterial calcification was demonstrated radiographically or by ultrasound. Biochemical and hormonal profiles revealed no abnormality except hypercalciuria. The aetiology and prognosis of this child's condition are unknown. Although similar ultrasound and histological appearances have been described in pseudoxanthoma elasticum and in idiopathic arterial calcification of infancy, there is no evidence that the child has either of these conditions.
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  • 47
    ISSN: 1438-8359
    Keywords: Caesarean section ; Hypertension ; Pheochromocytoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 48
    ISSN: 1432-1912
    Keywords: Hypertension ; Serotonin ; Veins ; Human ; In vivo
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In vitro and animal experiments suggest that a constitutional increase in vascular responsiveness to serotonin (5-HT) may play a role in the development of essential hypertension. We have studied the potential alterations in vascular responsiveness to the direct and catecholamine-potentiating effects of exogenous 5-HT in patients with essential hypertension, by comparing in vivo responsiveness of superficial hand veins to local infusions of 5-HT or to coinfusions of 5-HT and noradrenaline in unmedicated hypertensive patients and in healthy control subjects. The dorsal hand vein compliance technique was employed. There was no significant difference between patients and control subjects in the maximal 5-HT-induced venoconstriction or in the doses required for half-maximal venoconstriction (ED50) for 5-HT. Coinfusions of a constant dose of 5-HT caused a significant leftward shift in the dose response curve for noradrenaline as compared with noradrenaline alone. This was indicated by a 9.7±13.7 fold and a 10.4±13.8 fold increase in the ED50 for noradrenaline in the patient and control groups, respectively (p = 0.89 between study groups). Our results argue against a generalized increase in responsiveness to the direct or catecholamine-potentiating effect of 5-HT in vivo in vascular smooth muscle, associated with hypertension.
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  • 49
    ISSN: 1432-198X
    Keywords: Hypertension ; Insulin resistance ; 1,25-dihydroxycholecalciferol ; Vitamin D metabolites ; Parathyroid hormone ; Hemodialysis ; Uremia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effects of i.v. 1,25-dihydroxycholecalciferol (DHCC) on blood pressure and insulin sensitivity were studied in 7 patients on maintenance hemodialysis and compared with 7 healthy controls. Three days after discontinuing oral 1,25-DHCC, the dialysis patients were evaluated by glucose clamp studies to quantitate insulin sensitivity, with (+D) and without (−D) a prior single dose of i.v. 1,25-DHCC at 2μg/m2. Blood pressure was measured just before the glucose studies. During −D studies, the patients were hypertensive (mean arterial blood pressure 108±2 mmHg, controls 84±4 mmHg,P〈0.02) and insulin resistant (insulin sensitivity index 7.5±0.4 mg/kg·min per μU per ml, controls 14.2±0.7,P〈0.01) i.v. 1,25-DHCC significantly reduced the mean arterial blood pressure (96±3 mmHg,P〈0.05) and increased insulin sensivity (10.9±0.5 mg/kg·min per μU per ml,P〈0.02) in the dialysis patients. I. V. 1,25-DHCC did not change blood pressure and insulin sensitivity in the control subjects. During −D studies, serum concentrations of 1,25-DHCC were significantly lower in patients than controls (P〈0.02). Serum 1,25-DHCC during the +D studies increased to supraphysiological levels in both patients and controls. Serum concentrations of intact parathyroid hormone, total and ionized calcium, magnesium, potassium, urea nitrogen and creatinine were not different between the +D and −D studies in either the dialysis patients or the controls. These results suggest that pharmacological doses of 1,25-DHCC may have therapeutic value in the treatment of hypertension and insulin resistance in dialysis patients.
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  • 50
    ISSN: 1432-198X
    Keywords: Reflux nephropathy ; Renal scarring ; Captopril test ; Angiotensin converting enzyme inhibitors ; Hypertension ; Blood pressure ; Plasma renin activity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We studied the plasma renin activity (PRA) and blood pressure (BP) responses to a single oral dose of captopril in children with renal scarring due to vesicoureteral reflux. The test was performed on 19 children, of whom 13 were normotensive and 6 hypertensive. Basal PRA was within the normal range for age for all except 1 patient. Mean basal PRA values for normotensive and hypertensive patients were not significantly different. At 90 min post captopril, the mean PRA increase was 3.61 ng/l per second (SD=7.07) in the normotensive group but only 0.77 ng/l per second (SD=0.83) in the hypertensive group. In 11 patients the average systolic BP 60–90 min post captopril was 0.9%–12.4% lower than the basal value. Diastolic BP decreased after captopril administration in 10 patients and increased in 9. The changes in mean arterial pressure and PRA between 0 and 90 min post captopril were inversely correlated (r=0.605,P〈0.01). Because of the PRA responsiveness in the normotensive patients with renal scarring, we suggest that there was activation of the renin-angiotensin axis in this group. However, it is not apparent whether such patients are more at risk of developing hypertension at a later time.
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  • 51
    ISSN: 1432-198X
    Keywords: Gordon's syndrome ; Atrial natriuretic hormone ; Hypertension ; Hyperkalaemia ; Acidosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To test the hypothesis that renal sensitivity to atrial natriuretic peptide (ANP) is impaired in Gordon's syndrome (hypertension and hyperkalaemia with normal glomerular filtration rate) we infused α-hANP into two patients with this syndrome (a sister and a brother, 19 and 18 years of age). For comparison, 11 healthy volunteers were also examined. The infusion of α-hANP increased urinary volume and excretion of sodium similarly in the patients and controls. The excretion of potassium did not change in either the patients or the controls. The infusion of α-hANP had no effect on the serum potassium levels or the plasma CO2 content in the patients. The present results do not confirm the hypothesis of lack of sensitivity to ANP as a pathophysiological concept in Gordon's syndrome.
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  • 52
    ISSN: 1432-198X
    Keywords: Acute poststreptococcal glomerulonephritis ; Atrial natriuretic peptide ; Endothelin ; Sodium retention ; Hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Plasma levels of atrial natriuretic peptide (ANP) and of endothelin (ET) were significantly elevated (87.7±13.9 pg/ml and 79.7±10.8pg/ml, respectively) during the acute phase of acute poststreptococcal glomerulonephritis (APSGN). Plasma renin levels were normal, fractional excretion of sodium (FENa) was 0.5±0.1% and creatinine clearance (C Cr) averaged 82.2±18.3 ml/min per 1.73 m2. In the recovery phase of the disease (n=12), levels of ANP (23.6±6.7 pg/ml) and ET (43.1±2.4 pg/ml) fell and were not significantly different from those measured in 11 control subjects. FENa increased to 1.3±0.1% andC Cr to 113.5±12.1 ml/min per 1.73 m2 (all values mean ± standard error). ANP did not correlate with PRA, blood pressure,C Cr or FENa. There was an inverse relationship between the ET level and FENa in the acute phase of the disease (r=0.489,P〈0.05), but no significant correlation between ET and blood pressure, PRA,C Cr or ANP was found. We suggest that, despite the sodium retention, the increased ANP level in APSGN indicates unresponsiveness of the kidneys to ANP; the increased ET levels may contribute to this.
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  • 53
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    Journal of molecular medicine 70 (1992), S. 392-395 
    ISSN: 1432-1440
    Keywords: Adrenal gland ; Aldosterone ; Hypertension ; Mineralocorticoid ; Renin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the 1950s, after years of suspicion and work by many investigators regarding a potent mineralocorticoid hormone from the adrenal cortex, aldosterone was at last isolated and chemically identified [40, 41]. Soon after, Jerome Conn was the first to report [11] the clinical correlate of excessive secretion of aldosterone from a benign adrenocortical tumor manifested by hypertension and hypokalemia with the increased urinary excretion of aldosterone. This tumor is often called as aldosteronoma, and the disorder produced by it has been called primary aldosteronism by Conn. In the vast majority of patients harboring such tumors, the hypertension is cured by the resection of the tumor [12, 51], although some suggest that the hypertension may recur in a proportion of apparently cured patients [3, 36]. Thus, primary aldosteronism represents one of a few potentially curable forms of hypertension. Since aldosterone is elaborated normally by the zona glomerulosa cells of the adrenal, it has been assumed that all aldosteronomas originate from the cells of the glomerulosa zone. A clonal origin of aldosteronomas has also been suggested [28]. Some earlier and recent developments, however, indicate that functionally there may be more than one type of aldosteronomas and that their cellular origins might be different.
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  • 54
    ISSN: 1432-1440
    Keywords: Hypertension ; α-Ad-renoceptor antagonists ; β-Adrenoceptor antagonists (β-blockers) ; Carvedilol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The α and β-adrenoceptors are at present subdivided into α1/α2 and β1/β2 (probably also β3) subtypes. This subdivision, based on functional pharmacological studies, has been largely confirmed by molecular biological techniques. At presynaptic sites α2- and β2-adrenoceptors are known to predominate, whereas both α1/α2- and β1/β2-receptors may be found at postsynaptic sites. This subdivision and classification of adrenoceptors, receptor changes in disease, and the availability of agonists and antagonists for the various receptor subtypes are discussed as the basis for antihypertensive drug therapy. α-Adrenoceptor antagonists are vasodilators, which owe their antihypertensive activity to arterial vasodilatation, while venous dilatation occurs simultaneously. Selective α1-antagonists (prazosin, doxazosin) are preferable to the older nonselective compounds like phentolamine. β-Blockers are useful antihypertensive agents used on a very large scale, but their mode of action remains unknown in detail. The combination of α- and β-adrenoceptor blockade would be attractive, particularly for hemodynamic reasons. α-Adrenoceptor blockade reduces peripheral vascular resistance but also counteracts the vasoconstrictor effect of β-blockers in the extremities, underlying the well-known side-effect of cold hands and feet. β-Adrenoceptor blockade will not only contribute to the hypotensive effect but also suppress reflex tachycardia induced by α-adrenoceptor blockade.
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  • 55
    ISSN: 1432-1440
    Keywords: β-Blockers ; Hypertension ; Vasodilation ; Ergometric exercise
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The present study was conducted to assess the efficacy and safety of carvedilol 50 mg as compared to metoprolol 200 mg at rest and during and after a standardized bicycle ergometric exercise test. Carvedilol is a novel non-selective β-blocker without intrinsic sympathomimetic activity possessing vasodilatory properties primarily due to an α1-antagonism in the same dose range. Both drugs were effective in reducing systolic and diastolic blood pressure at rest and during and after exercise. The reduction of diastolic blood pressure was much stronger under carvedilol treatment than under metoprolol treatment at all measurement points. Carvedilol was even effective in the treatment of patients whose blood pressure was unsatisfactorily controlled by metoprolol. This shows the importance of the vasodilation component of carvedilol. No serious adverse events were observed. Carvedilol therefore promises very well as a powerful and safe drug for the treatment of essential arterial hypertension.
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  • 56
    ISSN: 1432-1440
    Keywords: Left ventricular hypertrophy ; Hypertension ; Coronary heart disease ; Antihypertensive treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Left ventricular hypertrophy (LVH) constitutes a powerful independent risk factor in hypertensive heart disease. Although initially the wall stress, i.e., left ventricular afterload, remains normal, the coronary reserve is diminished due to disturbances in the microcirculation. This is also shown in the commonly present silent ischemia episodes in Holter monitoring. LVH also causes ventricular dilation and heart failure. Apart from systolic wall stress LVH is modulated by the trophic effects of the sympathetic nervous system and angiotensin II and genetic factors. Long-term antihypertensive treatment must therefore focus on regression of both LVH and the microvascular abnormalities. A step approach for the treatment of the LVH has been recommended on the basis of the experience of this working group with calcium antagonists and ACE inhibitors, whereas the place of β-blockers is as yet unclear. Preliminary data indicate that coronary flow rescue can also be improved after chronic antihypertensive treatment.
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  • 57
    ISSN: 1432-1440
    Keywords: Hypertension ; Kidney ; Antihypertensive drugs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Antihypertensive therapy influences kidney function by different mechanisms depending on the mode of action of the drug used. The GFR is improved by calcium entry blockers and ACE inhibitors, unaffected by vasodilators, α-blockers and centrally acting sympatholytics and impaired by β-blockers. The same is true for renal blood flow and is due to changes of renal vascular resistance. Renal sodium excretion is impaired mostly by vasodilators, by α-blockers, sympatholytics and β-blockers; in contrast, calcium entry blockers and ACE inhibitors acutely induce natriuresis. The RAAS is stimulated by vasodilators, unaffected by α-blockers and sympatholytics and suppressed by β-blockers. Plasma catecholamines are stimulated by vasodilators and suppressed by centrally acting sympatholytics and unaffected by the others. Induction of acute renal functional impairment is reported for ACE inhibitors under conditions of compromised renal perfusion pressure such as in renal artery stenosis. These data from the literature reviewed are supported by our own experimental data on sodium balance under different drugs and micropuncture data in experimental renal artery stenosis. To achieve effective antihypertensive treatment with a low profile of side effects, careful monitoring of renal function seems to be mandatory.
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  • 58
    Electronic Resource
    Electronic Resource
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    Journal of molecular medicine 70 (1992), S. S127 
    ISSN: 1432-1440
    Keywords: Carvedilol ; Kidney ; Hypertension ; Renal hemodynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Antihypertensive drugs have differing effects on renal hemodynamics, tubular function, plasma electrolytes, and hormonal responses. Nonselective β-blockers without intrinsic sympathomimetic activites, such as propranolol, have been reported to reduce renal blood flow and to cause a modest decrease in glomerular filtration rate. Carvedilol is a new multiple action agent displaying nonselective β-blockade without intrinsic sympathicomimetic activity, α1-adrenoceptor blockade (probably responsible for its vasodilator activity), and possibly also calcium antagonist properties. The presence of these different pharmacodynamic properties results in a different effect on the kidney as compared with, e.g., propranolol. In the dog, intrarenal infusion of carvedilol resulted in a renal vasodilator response with preservation of renal blood flow and without inducing sodium retention; in contrast, propranolol induced a renal vasoconstrictor response and sodium retention in this model. A renal vasodilator response to carvedilol was also reported in spontaneously hypertensive rats (SHR) and in DOCA-salt SHR. In contrast to labetalol, i.v. infusion of hypotensive doses of carvedilol in conscious SHR did not cause sodium retention. Carvedilol was effective in controlling hypertension and preserving renal function in a rat model of progressive hypertensive renal disease. In patients with essential hypertension, carvedilol was reported to reduce renal vascular resistance in the presence of reduced perfusion pressure, allowing for normal renal autoregulation of renal blood flow. Although a small reduction in glomerular filtration rate was seen after acute administration, renal function was preserved during chronic treatment. It is concluded from these studies that renal perfusion and renal function are well maintained during acute and chronic treatment with carvedilol. The compound does not appear to cause sodium retention, and preliminary animal test data suggest the possibility of a renoprotective effect.
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  • 59
    ISSN: 1432-1041
    Keywords: Hypertension ; treatment with Nepresol ; Trasicor and combination of both
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary In a single-blind trial the antihypertensive effects of Nepresol, Nepresol and Trasicor and Trasicor alone were tested in 18 patients with mild to moderate hypertension. After a control period of 2 weeks during which a placebo was administered, each active compound was given for 3 weeks. Two patients failed to complete the trial and three of the remaining 16 did not respond satisfactorily to any of the treatments. The other 13 patients showed statistically significant reductions in systolic and diastolic blood pressures (systolic 8.6–13.2%; diastolic 7.4–8.2%) in response to each of the three treatments. Trasicor counteracted the increase in heart rate caused by Nepresol without impairing its hypotensive effect; the reduction in blood pressure was slightly greater, although not by a statistically sign