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  • 1
    ISSN: 1432-1440
    Keywords: Nifedipine gastrointestinal therapeutic system ; Essential hypertension ; Ambulatory blood pressure measurement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The nifedipine gastrointestinal therapeutic system (GITS) is a recently developed controlled-release formulation for once-a-day dosing. We evaluated the influence of morning versus evening administration of the drug in a randomized double-blind cross-over study including 15 essential hypertensives. Five patients had to be excluded from blood pressure analysis because of noncompliance (three cases) or intolerable side effects (two cases). To assess the exact duration of the antihypertensive efficacy noninvasive automatic ambulatory blood pressure monitoring was performed. After a placebo period patients were given 30 mg nifedipine GITS either at 1000 or 2200 hours. Twenty-four-hour systolic and diastolic blood pressure profiles documented a sustained antihypertensive effect of both nifedipine regimens throughout the whole period without affecting the circadian rhythm. Statistical analysis revealed no significant difference between morning and evening administration. Two patients stopped their medication because of intolerable side effects (fatigue and muscle cramps, respectively). Two more cases suffered from mild reversible headache which provoked no discontinuation of the drug. In conclusion our results document a sustained antihypertensive efficacy of 30 mg nifedipine GITS in patients with moderate essential hypertension. Time of administration has no impact on day- and nighttime blood pressure control.
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  • 2
    ISSN: 1432-1440
    Keywords: Bronchial neuroendocrine tumor ; Mitral insufficiency ; Aortic insufficiency ; Carcinoid heart disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A female patient suffering from a bronchial neuroendocrine tumor with unilateral leftsided carcinoid heart disease is reported. Repeated x-ray films of the chest showed a slowly growing lung tumor in the left lower lobe. The patient refused any diagnostic or therapeutic procedure to define the type of the tumor. During the follow-up of 24 years she developed severe mitral and moderate to severe aortic insufficiency, both invasively quantified by thermodilution techniques. During surgery for double valve replacement the patient died from left ventricular heart failure. Necropsy revealed the typical pattern of a bronchial neuroendocrine tumor without metastases. Examination of the heart disclosed the characteristic deposits of fibrous tissue on the cusps of both the mitral and the aortic valves whereas the right heart showed no abnormalities. Review of the literature suggests the unilateral left-sided carcinoid heart disease to be a very rare finding, its pathogenesis remains to be elucidated.
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  • 3
    ISSN: 1432-1440
    Keywords: Cushing's syndrome ; Urinary corticosteroids ; diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We evaluated the usefulness of the basal urinary 24-h excretion rates of free cortisol versus 17-hydroxycorticosteroids in the diagnosis of Cushing's syndrome. On an outpatient basis, both urinary free cortisol and 17-hydroxycorticosteroids levels were determined in 48 patients with Cushing's syndrome, as well as in 95 obese and 94 healthy control persons of normal weight. Determination of the urinary free cortisol content allowed a clear-cut distinction between the patients with hypercortisolism and the controls, resulting in a sensitivity of 100% and specificity of 98% for the diagnosis of Cushing's syndrome. The diagnostic accuracy of urinary free cortisol was distinctly superior to that of 17-hydroxycorticosteroids, which showed a wide overlap of values between the groups, with a sensitivity of 73% and a specificity of 94%. In conclusion, the measurement of basal urinary free cortisol provided an excellent diagnostic sensitivity and specificity in the assessment of adrenocortical function. This simple and accurate test thus seems to be particularly useful in the outpatient evaluation of patients with suspected Cushing's syndrome.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 64 (1986), S. 327-332 
    ISSN: 1432-1440
    Keywords: Severe hypertension ; Minoxidil ; Captopril
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The antihypertensive efficacy of minoxidil and captopril was compared in 23 males with essential or renal parenchymatous hypertension refractory to conventional antihypertensive drug therapy. Following a pretreatment period the patients were randomly assigned to receive either minoxidil, 2.5 mg twice daily (n=12), or captopril, 25 mg twice daily (n=11). In patients with diastolic blood pressure 〉95 mmHg, doses of minoxidil and captopril were increased in 2-week intervals. Patients who maintained diastolic pressure 〉95 mmHg and/or those with intolerable side effects were switched over to the alternative substance. After a mean observation period of 12 weeks a significant decrease in systolic and diastolic blood pressure was observed (179/114 vs 148/92 mmHg in the minoxidil group; 176/111 vs 158/97 mmHg in the captopril group). The primary response rate was 75% in patients treated with minoxidil and 55% in those with captopril (not significant). After the change to the alternative substance two of the four non-responders on captopril and one of the two non-responders on minoxidil became responders. Side effects occurred significantly more often during minoxidil than captopril (p〈0.05). The high efficacy of minoxidil and captopril in the treatment of severe hypertension refractory to conventional drugs was confirmed. Minoxidil lowered blood pressure slightly more than captopril, but it had a higher incidence of side effects than captopril.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 62 (1984), S. 855-858 
    ISSN: 1432-1440
    Keywords: Cushing's syndrome ; Pathogenesis of hypertension ; Renin angiotensin system ; Captopril
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To analyse the role of the renin angiotensin system in the pathogenesis of hypertension in Cushing's syndrome ten patients with hypercorticism (five with pituitary hypothalamic dysfunction, three with adrenal adenomas and two with adrenal carcinomas) received a single oral dose of 25 mg captopril. Mean arterial pressure was then determined at short intervals over periods of up to 240 min. Plasma renin activity (PRA) was measured immediately before the administration of captopril. Eleven patients with severe essential hypertension, who showed a comparable distribution of basal PRA values, served as a control. Patients with elevated basal PRA values (〉3 ng/ml·3 h) showed, both in the subgroup of cases with essential hypertension and in that with Cushing's syndrome, a statistically significant fall (P〈0.05−P〈0.001) in mean arterial pressure, the decrease being slightly more pronounced in essential hypertensives. On the other hand patients with normal PRA values (≦3 ng/ml·3 h) exhibited only a minor fall in mean arterial pressure reaching statistical significance (P〈0.05) only after 60 min (essential hypertension) and 180 min (Cushing's syndrome), respectively. Our results document that in patients with Cushing's syndrome the effect of captopril seems to be determined by the activity of the renin angiotensin system. Thus, in a substantial number of patients with hypercorticism, the renin angiotensin system may be an important factor in the pathogenesis of hypertension, whereas in patients with low PRA values other factors like oversecretion of mineralocorticoids may be responsible for the observed blood pressure increases.
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  • 6
    ISSN: 1432-1440
    Keywords: Essential hypertension ; Renin angiotensin aldosterone system ; Bodyweight ; Blood pressure in childhood ; Essentielle Hypertonie ; Renin-Angiotensin-Aldosteron-System ; Körpergewicht ; Blut-druck beim Kind
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In der vorliegenden Untersuchung wurden 294 Nachkommen (5–34 Jahre) essentieller Hypertoniker bezüglich Blutdruck, Renin-Angiotensin-Aldosteron-System and anderer kardiovaskulärer Risikofaktoren wie Glukose, Cholesterin und Triglyzeride untersucht und mit 122 Nachkommen (5–34 Jahre) normotoner Eltern verglichen. Dabei zeigte sich, daß Nachkommen essentieller Hypertoniker im Mittel statistisch signifikant höhere systolische und diastolische Blutdruckwerte zeigten als solche normotoner Eltern (p〈0,003 bzw. 0,005). Weiter ließ sich bei Kindern hypertoner Eltern im Mittel ein signifikant höheres Körpergewicht und ein größerer Body-Mass-Index beobachten als im Kontrollkollektiv (p〈0,006 bzw. 0,001). Mit Ausnahme statistisch signifikant niedrigerer Ruhe-Plasma-Aldosteronwerte (p〈0,002) bei Kindern essentieller Hypertoniker ließen sich zwischen beiden Kollektiven keine Unterschiede im Stimulationsaldosteron, in der Ruhe- und Stimulations-Plasma-Renin-Aktivität und im Plasmacortisol nachweisen. Ebenfalls zeigten die beiden Kollektive bezüglich der anderen untersuchten Parametern wie Kreatinin, Glukose, Cholesterin und Triglyzeride keine wesentlichen Unterschiede. Weiterhin wurden in der vorliegenden Untersuchung 41 hypertone Elternteile, 65 (normotone) Ehepartner von Hypertonikern und 47 (normotone) Eltern von Kontrollkindern untersucht. Erwarungsgemäß zeigten Hypertoniker statistisch signifikant höhere Blutdruckwerte als ihre Ehepartner und die Kontrolleltern (p〈0,001). Interessanterweise zeigten die hypertonen Eltern nicht nur einen höheren Body-Mass-Index als Kontrolleltern sondeern auch als Ehepartner (p〈0,01 bzw. 〈0,02). Diese Befunde stützen eine vorwiegend genetische Disposition als zugrundeliegende Ursache des höheren Körpergewichtsverhaltens und lassen eine vermehrte Nahrungsmittelaufnahme in Hypertonikerfamilien eher als unwahrscheinlich erscheinen. Die Ergebnisse der vorliegenden Studie legen es nahe, daß durch eine möglichst frühzeitige Kontrolle des Körpergewichtsverhaltens bei Nachkommen essentieller Hypertoniker ein Beitrag zur Primärprävention der Hochdruckkrankheit geleistet werden kann.
    Notes: Summary In the present study, blood pressure, the renin angiotensin aldosterone system, and other cardiovascular risk factors, such as glucose, cholesterine, and triglycerides, were investigated in 294 offspring of essential hypertensives (5–34 years) and in 122 children of normotensive parents (5–34 years). Offspring of essential hypertensives showed statistically significant higher systolic and diastolic blood pressure values than those of normotensive parents (p〈0.003, 〈0.005, respectively). Furthermore, in children of hypertensive parents a statistically significant higher body weight and body mass index than in controls could be observed (p〈0.006, 〈0.001, respectively). With the exception of statistically significant, lower mean supine plasma aldosterone values (p〈0.02) in children of hypertensive parents, no major differences between the two groups were seen in stimulated aldosterone, supine and stimulated plasma renin activity, and plasma cortisol. Furthermore, in the present study, 41 hypertensive parents, 65 (normotensive) spouses of hypertensives, and 47 (normotensive) parents of control children were investigated. As expected, hypertensive parents showed statistically significant higher blood pressure values than parents of control children and their spouses (p〈0.001). Interestingly, hypertensive parents had not only a higher body mass index than control parents but also than their spouses (p〈0.01 and 〈0.02, respectively). These findings support a genetic disposition as being the underlying cause of higher body weight in hypertensives and make it less probable that a higher food intake in hypertensive families is responsible for this phenomenon. The results of the present study indicate that early body weight control in children of hypertensive parents may be an important contribution to the prevention of hypertension.
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  • 7
    ISSN: 1432-1440
    Keywords: Captopril ; Kidney function ; Essential hypertension ; Renovascular hypertension ; Renal parenchymatous hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To study long-term effects of captopril on renal function in patients with various forms of severe hypertension, serum creatinine values were monitored in 76 patients under captopril therapy over a period of up to 3 years. Three different groups were formed: (1) patients with essential hypertension (n=37); (2) patients with renovascular hypertension (n=20); (3) patients with renal parenchymatous hypertension (n=19). In each of the three groups reduction in blood pressure was accompanied by increases in serum creatinine. However, both changes were more pronounced in patients with renovascular hypertension. In this group only the rise in creatinine was statistically significant and showed a slight progression with duration of captopril treatment. Group specific analysis revealed that the increase was smaller in patients with unilateral (n=16) renovascular disease than in those with bilateral (n=4) involvement, but in the former it was still significantly higher than in patients with essential or renal parenchymatous hypertension. Separation of patients according to the underlying disease of renovascular hypertension showed that renal function deteriorated less in patients with arteriosclerotic origin (n=10) than in those with fibromuscular dysplasia (n=8). Statistical evaluation of subjects with renovascular and essential hypertension still revealed significant differences in creatinine when the patients with initial plasma renin activity (PRA) below and above 6 ng/ml·3 h were compared separately. A significant correlation (r=0.73;P〈0.05) between blood pressure reduction and creatinine changes was obtained only for patients with renovascular hypertension. Finally, in all three groups of patients creatinine changes were statistically independent from daily dosages of captopril. From these data we conclude that sustained impairment of kidney function by captopril is mainly restricted to patients with renovascular hypertension and possibly results from the combined effects of low renal perfusion pressure and interference with intrarenal regulation of glomerular filtration rate by a postulated angiotensin-II-mediated mechanism.
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 60 (1982), S. 161-170 
    ISSN: 1432-1440
    Keywords: Patient compliance ; Methods of measurement ; Determinants of compliance ; Compliance improving strategies ; Patientencompliance ; Bestimmungsmethoden ; compliancevermindernde Faktoren ; compliancefördernde Maßnahmen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Verschiedene Untersuchungen über die Compliance oder Therapiedisziplin von Patienten haben gezeigt, daß zwischen 20 bis 50% der Patienten vor allem in der Langzeittherapie die ärztlichen Verordnungen nicht oder nur ungenügend befolgen. Die Non-Compliance ist damit seit der Einführung wirksamer Medikamente insbesondere in der Behandlung der essentiellen Hypertonie, bei Fettstoffwechselstörungen, sowie bei Patienten unter tuberkulostatischer Therapie oder prophylaktischer Chemotherapie zu einem der wichtigsten therapielimitierenden Faktoren geworden. Die Einnahmedisziplin verschlechtert sich im Laufe der Behandlung zusehends. In den ersten vier Monaten ist mit einem Abfall der Compliancerate um 30% zu rechnen, nach 5 Jahren ist nur noch ein Fünftel bis ein Viertel der Patienten therapietreu. Die Zuverlässigkeit der Patienten läßt sich mit indirekten Bestimmungsmethoden wie Patientenbefragung, Pillenzählen oder aufgrund der Therapiewirkungen abschätzen. Eine genaue Ermittlung der Compliancerate erfordert die Bestimmung der Medikamente oder Markersubstanzen im Serum oder Urin. Die Ergebnisse von Untersuchungen über compliancebestimmende Faktoren sind zum Teil widersprüchlich. Als gesichert kann hingegen gelten, daß psychische Erkrankungen insbesondere Schizophrenie, ein komplexes Therapieschema mit hoher täglicher Tablettenzahl, Therapien, welche eine Änderung von Lebensgewohnheiten erfordern, eine langdauernde Behandlung und ungenügende, schlecht organisierte Nachkontrollen mit langen Wartezeiten für den Patienten eine schlechte Therapiedisziplin zeigen. Im weiteren beeinflussen das Krankheitsbewußtsein sowie die Einstellung der Familie das Einnahmeverhalten der Patienten. Compliancefördernde Maßnahmen richten sich nach den Faktoren, welche die Therapietreue der Patienten negativ beeinflussen. Entsprechend sollte durch eine Verwendung von „Slow-Release“-Präparaten die tägliche Tablettenzahl möglichst klein gehalten werden. Bei mehreren Tabletteneinnahmen pro Tag ist ein schriftlicher Verordnungszettel („aide-memoire“) von Nutzen. Durch regelmäßige engmaschige Nachkontrollen mit festen Terminen und kurzen Wartezeiten sollte in der Langzeittherapie die „drop-out“-Rate reduziert werden. Eine zusätzliche Betreuung durch paramedizinisches Personal zeigt ebenso wie der Einsatz von Therapiegruppen vor allem in der Betreuung von übergewichtigen Patienten und Hypertonikern einen günstigen Effekt auf die Compliance. Die Beteiligung des Patienten an der Behandlung und Überwachung seiner Erkrankung z.B. durch Blutdruckselbstmessung bei den wenig symptomatischen Hypertonikern führt zu einer deutlichen Verbesserung der Einnahmedisziplin. Bei Therapien, welche eine Änderung von Lebensgewohnheiten erfordern (Diät, Alkoholabstinenz, Nikotinabstinenz u.a.), sollte die Familie (Ehefrau) in den Therapieplan miteinbezogen werden. Die Patientencompliance verdient aufgrund ihrer praktischen Bedeutung (Nichterreichen des Therapieziels, Beeinflussung von Ergebnissen der Arzneimittelforschung, unnötige Kosten) eine vermehrte Beachtung im Rahmen der Patientenbetreuung. Compliancevermindernde Faktoren sollten möglichst eliminiert und Maßnahmen zur Verbesserung der Therapiedisziplin ergriffen werden.
    Notes: Summary Several studies concerning compliance or drug adherence of patients have shown, that between 20–50% of the patients in particular during long term therapy do not or only insufficiently follow doctor's advice. Thus, since the introduction of potent drugs, non-compliance has become one of the most important therapy limiting factors in particular in the management of essential hypertension, disorders of lipid metabolism, tuberculosis and chemo-prophylaxis. Compliance decreases during treatment. During the first four months a decline of compliance rate of 30% must be expected, after five years only 20–25% of the patients are still compliant. Patients' cooperation may be estimated by indirect methods such as patient interview, pill-counting or therapeutic outcome. An exact determination of compliance requires measurements of blood levels or urinary excretion of the medicaments or marker. The results of studies about the determinants of compliance are conflicting. However, it seems to be proved, that a psychiatric diagnosis in particular schizophrenia, a complex therapeutic regimen with a high number of daily tablets, therapies which include a behavioral change, longterm therapy and a inefficient follow-up system with long waiting time for the patient are associated with non-compliance. In addition, patients perception of the disease and family support are influencing drug adherence. Compliance improving strategies were derived from the determinants which diminish patients' drug adherence. By using slow release medicaments the number of daily tablets should be minimalized. If several tablets must be taken daily an “aide-memoire” may be useful. The drop-out rate should be reduced by regular scheduled follow-up visits with short waiting time. In addition, follow-up care by a nurse or a diet adviser as well as therapy groups show a compliance improving effect in particular in patients with overweight or hypertension. The participation of the patient in therapy and follow-up for instance by blood pressure selfmeasurement in the mostly symptomless hypertensives increases markedly drug adherence. In therapies which necessitate behavioral changes (diet, alcohol abstinence, stop of smoking) the family should be integrated in the therapeutical procedure. Because of its practical importance (unsatisfactory therapeutical outcome, influence on results of pharmacological studies, costs) compliance should be taken into account in patient's care. Compliance decreasing factors should be eliminated and strategies for improving drug adherence should be performed.
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 63 (1985), S. 361-363 
    ISSN: 1432-1440
    Keywords: Primary aldosteronism ; Captopril ; Spironolactone ; Renin-angiotensin ; Converting-enzyme ; Secondary hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In three patients with primary aldosteronism, the acute effect of a single dose of captopril on the elevated mean arterial blood pressure (MAP) was studied before and after 4 weeks of treatment with spironolactone. Before spironolactone therapy, captopril did not cause any drop in MAP. Four weeks later, after an oral daily dose of 400 mg spironolactone, MAP was still elevated in all three patients, though electrolyte abnormalities were fully corrected. Since plasma renin activity (PRA) was increased to values above the normal range, the acute effect of captopril on MAP was tested again. A single dose of 25 mg captopril then caused a fall in MAP to normal. These data reveal the conversion from a renin-independent to a renindependent kind of hypertension after spironolactone therapy in three patients with primary aldosteronism syndrome. This might be of pathogenetic and therapeutic interest.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    European journal of clinical pharmacology 28 (1985), S. 89-91 
    ISSN: 1432-1041
    Keywords: atenolol ; pindolol ; sleep disturbance ; β-blockers ; dreaming ; fatigue ; hypertension ; lipophilicity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary This randomized crossover out-patient study was designed to compare the antihypertensive effects of atenolol and pindolol. After a wash-out period of two weeks in pretreated cases, 107 patients with essential hypertension were given either atenolol 100 mg once-daily or pindolol 20 mg slow release (SR) once-daily. Both atenolol and pindolol lowered blood pressure over the 24 week period. The diastolic blood pressure reduction was significantly greater (p〈0.01) with atenolol than with pindolol. Before β-blocker therapy, many patients had already experienced side-effects such as fatigue, sleep disturbances and dreams. This probably relates to the high sensitivity of the analogue scale used to assess side-effects, and to the high incidence of such symptoms in untreated patients. As the study progressed there was a reduction in the frequency of fatigue (p〈0.03) and dreams (p〈0.05) in both groups, whereas sleep disturbances significantly increased under pindolol (p〈0.05) but decreased under atenolol (p〈0.05). The only important side-effect difference between the two β-blockers was the higher incidence of sleep disturbances with pindolol which may be due to the higher lipophilicity of this β-blocker.
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