C. Dal Palù

Evaluation of Hypertension and Related Target Organ Damage by Average Day-time Blood Pressure

Aim of the present study was to verify whether average blood pressure continuously recorded throughout the day correlates with the degree of target organ damage more closely than casual pressure in hypertensive patients. The study was conducted in 102 subjects with borderline, moderate and severe hypertension. Our results confirm a closer relationship between cardiovascular complications and recorder blood pressure than casual pressure possibly because the latter less perfectly reflects the patients usual pressures which are generally lower. However our results further demonstrate that blood pressure variability also contributes to the degree of target organ damage since for equal average day-time pressures a greater severity of cardiovascular complications was observed in patients with the highest blood pressure variability and the highest peaks of pressure. These findings should be carefully considered when evaluating the effect of antihypertensive drugs.

Blood pressure changes during heavy-resistance exercise.

To study the mechanisms of the blood pressure changes during weight-lifting, three hypertensive and five normotensive body-builders underwent continuous intra-arterial monitoring. In two subjects (one normotensive and one hypertensive), intrathoracic and intra-abdominal pressures were also measured. Extremely high blood pressure elevations of up to 345/245 mmHg were observed during the lifts. Squatting caused the highest pressure rises and single-arm curls the lowest. Both the intrathoracic and the intra-abdominal pressures increased greatly during each lift and closely paralleled the changes in intra-arterial pressure. A close correlation was found between the blood pressure increase during the exercise and during a hand-grip test (r = 0.95, P less than 0.001). These results suggest that a pronounced increase in intra-thoracic and intra-abdominal pressures is a major determinant of the blood pressure elevations occurring during weight-lifting. The pressor reflex which accompanies static contractions and the individual baseline blood pressure levels also seem to affect the height of the pressure peaks.

Hypertension prevalence and age-related changes of blood-pressure in semi-nomadic and urban Oromos of Ethiopia

We evaluated the prevalence of hypertension and the age-related behaviour of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in a wide sample of male and female Ethiopian Oromos living in rural or pre-industrial urbanized settings. Blood pressure (BP) was measured in the sitting position after 5 min rest in 5277 Oromos. In the group, 4928 were semi-nomadic shepherds, while 349 came from a town of 60,000 inhabitants where they were involved in low-technology jobs. The first subgroup was composed of 2482 men and 2446 women. All subjects were divided into 3 age groups: 15–44, 45–64, and ⩾65 years. Body weight (BW) and the Quetelet index (QI) were matched to BP levels using Pearsons method. In semi-nomadic men, SBP was 121.4±8.4 mmHg versus 132.4±10.4 mmHg in urban men (p<0.001). In women, SBP was 120.5±7.9 mmHg versus 128.1±10.1 mmHg (p<0.001). The prevalence of hypertension was 0.40% in the semi-nomadic and 3.15% in the urban population. In the latter, significant increases in BW and QI were found, which were significantly correlated to both SBP and DBP. In semi-nomadic men, a 5.33% increase in SBP and a 5.22% in DBP was found between age groups 1 and 2 (p<0.001 in both). In urban men the increase was 4.77% and 3.41% respectively (p<0.001). In both male populations no difference in SBP and DBP was observed between age groups 2 and 3. In semi-nomadic women however, a progressive rise in SBP (4.84% between age groups 1 and 2,p<0.001; 1.86% between groups 2 and 3,p<0.001) and DBP (4.26% between age groups 1 and 2,p<0.001; 2.72% between groups 2 and 3,p<0.001) was present. Similar differences in SBP and DBP were evident between urban women of age groups 1 and 2. Due to social reasons, women for group 3 were not available in the urban setting. In conclusion, this study shows a very low prevalence of hypertension in a semi-nomadic group and about an 8-fold increase in the urban population. SBP and DBP are significantly higher in the urban setting and in both men and women the increase is related to BW. Moreover, SBP and DBP progressively increase with age in women but not in men.

Ventricular myosin and creatine-kinase isoenzymes in hypertensive rats treated with captopril.

In the myocardium, myosin and creatine kinase isoforms possess different capacities for using O2 and energy-rich phosphates. We studied electrophoretically the distribution of these isoforms in 19 hypertensive rats (two-kidney, one clip model of hypertension) and in age-matched controls. After 6 weeks of hypertension, seven rats were treated with captopril (2 mg/kg daily) for 4 weeks, six were left hypertensive for another 4 weeks, and the remaining rats were killed under ether anesthesia. In the latter, ventricular mass was significantly higher than in controls; V3 isomyosin was 32.3 ±6.8% versus 0%, and both creatine kinase-MB and -BB were increased at the expense of creatine kinase-MM (creatine kinase-MB=29±2.8% vs. 14.7±1.8%, p < 0.001; creatine kinase-BB=3.1±0.6% vs. 1.7±0.8%, p < 0.001). After 10 weeks of hypertension, ventricular mass, V3 isomyosin, and both creatine kinase-MB and -BB isoforms were found to be persistently higher than in controls. At the same time, captopril-treated rats showed reduced but not normalized blood pressure levels, normalized ventricular mass, and prevalence of the V1 isomyosin (56.9±22% vs. 47.9±23.8% in normotensive controls, p < =NS). However, higher levels of creatine kinase-MB and -BB were still found in these rats in comparison with the normotensive controls (creatine kinase-MB=22.4±5.4% vs. 15.8±2.8%, p < 0.025; creatine kinase-BB=2.3±0.1% vs. 1.8±0.3%, p < 0.02). Therefore, despite the normalization in ventricular mass and isomyosin pattern, captopril-treated rats partly maintain the adaptive changes in creatine kinase isoenzymes that lead to a better use of energy-rich phosphates.

Changes in rat ventricular isomyosins with regression of cardiac hypertrophy.

The changes in ventricular isomyosin composition and Ca2+-activated ATPase activity occurring with regression of both hypertension and cardiac hypertrophy were investigated by using polyacrylamide gel electrophoresis under nondenaturing conditions, heavy chain peptide mapping, and an enzymatic assay. Eight control male Wistar rats and 14 two-kidney, one clip (Goldblatt II) hypertensive rats were studied from the fifth week of age. At 10 weeks of age, five Goldblatt II rats and four normotensive controls were killed. Five other Goldblatt II rats underwent nephrectomy of the ischemic kidney, which resulted in subsequent normalization of blood pressure. The remaining four control, four Goldblatt II rats, and five nephrectomized rats were killed at 15 weeks of age. Both the 10- and 15-week-old hypertensive rats had a significantly higher (p less than 0.001) biventricular weight to body weight ratio than the age-matched controls (3.84 +/- 0.76 X 10(-2) vs 2.75 +/- 0.25 X 10(-2); 5.93 +/- 2.26 X 10(-2) vs 2.65 +/- 0.17 X 10(-2]. The 15-week-old nephrectomized rats had a biventricular weight to body weight ratio (2.90 +/- 0.25 X 10(-2] close to that of age-matched controls and significantly lower (p less than 0.05) than that of age-matched hypertensive rats. In both the 10- and 15-week-old hypertensive rats left ventricular myosin Ca2+-activated ATPase activity was significantly lower (p less than 0.001) than in the age-matched controls (0.44 +/- 0.03 vs 0.59 +/- 0.06; 0.24 +/- 0.05 vs 0.48 +/- 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Hypotensive and renal effects of captopril.

Abstract. The effects of Captopril on blood pressure and renal function were evaluated in ten patients with different degrees of hypertension. In seven, blood pressure was reduced after 7 weeks of therapy; in three it remained practically unchanged. No correlation was found between the standing plasma renin activity before treatment and the hypotensive response. Plasma renin activity increased significantly from the median value of 5.4 (range 1–16.7) to 9.5 (range 2.6–19.8)ngml1 h1 (P< 005) and urine aldosterone significantly fell from 13 (range 2–3–52–5) to 7.4 (range 1.6–14) μg 24 h‐1 (P<001) during therapy. Renal plasma flow decreased from 534 (range 300–616) to 471 (range 333–606) ml min‐1, but the difference was not significant, and glomerular filtration rate fell significantly form 122 (range 64–143) to 88 (range 71–116) ml min‐1 (P<0–05). No urinary excretion of alpha2‐macroglobulin was observed during Captopril. 24 h proteinuria, albumin and transferrin clearance, alanine‐amino transferase, gammaglutamyl transfer‐ase and alpha glucosidase excretion rate and malate‐dehydrogenase clearance remained unaltered throughout the treatment. This indicates that neither glomerular permeability nor renal tubular function were affected by the drug.

Prognostic value of nephrography in atherosclerotic occlusion of the renal artery.

artery Prognostic value of nephrography in atherosclerotic occlusion of the renal ISSN: 1524-4563 Copyright

Antihypertensive efficacy of urapidil versus hydrochlorothiazide alone in patients with mild to moderate essential hypertension and of their combination in nonresponders to monotherapy.

I Department of Internal Medicine, University of Brescia, Brescia, Italy 2 Department of Clinical Medicine, University of Padua, Padua, Italy 3 Department of Internal Medicine, University of Bari, Bari, Italy 4 Department of Internal Medicine, University of Trieste, Trieste, Italy 5 Department of Medicine, University of Naples, Naples , Italy 6 Byk Gulden Medical Departments, Konstanz, Federal Republic of Germany, and Milan, Italy

Adaptation to non-invasive continuous blood pressure monitoring

In this study, the Pressurometer III (Del Mar Avionics) was used to monitor blood pressure on two occasions in 17 ambulatory hypertensive patients. In 9 patients a placebo was administered between the first and the second monitoring. In the remaining 8 patients, placebo administration was discontinued prior to the first monitoring period.

Preliminary Clinical Experience with Calcium Antagonists in Atherosclerosis

SummaryAnimal experiments have shown that the administration of calcium antagonists can prevent or slow the progression of atherosclerosis by inhibiting calcium overload and interfering with lipid metabolism and deposition. These encouraging results have prompted clinical trials to evaluate the effects of calcium antagonists (dihydropyridines and diphenylalkylamines) on atherosclerotic plaque formation. In patients with coronary heart disease, several studies have already shown that calcium antagonists can have a positive effect on plaque evolution, while in hypertensive patients no such study has been published to date.The Verapamil in Hypertension Atherosclerosis Study is an ongoing multicentre randomised double-blind parallel group trial comparing the antihypertensive efficacy of verapamil SR 240 mg/day with that of chlorthalidone 25 mg/day in 1464 patients with essential hypertension aged 40 to 65 years. In a randomised subgroup of patients (n = 550), who will be followed up for 3 years, B-mode ultrasonography is being employed to evaluate the effects of the 2 drugs on carotid wall thickness and carotid plaque development. Ultrasonographic evaluations are performed at baseline, after 3 months, and 1, 2 and 3 years after a standardised protocol to determine intimal-medial thickness in 4 segments of the extracranial carotid tree.The most interesting result to date is the high incidence of carotid alterations, with plaques present in 35% and arterial wall thickening in 31.8% of the 311 asymptomatic hypertensive patients processed so far. A preliminary evaluation of the antihypertensive efficacy of the trial medications after 6 months of double-blind treatment indicates a 63.5% response rate to monotherapy and a 7.8% drop-out rate because of drug inefficacy or intolerance.