W Lissens

Calcium, vitamin D-endocrine system, and parathyroid hormone in black and white males.

SummaryThe serum and urinary calcium, 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), and parathyroid hormone (PTH) were studied in healthy black and white males living in Belgium, and the results were compared to data in blacks of similar age living in Zaïre. Dietary calcium and vitamin D were estimated in a subsample of blacks and whites examined in Belgium. Compared to whites (9.51±0.28 mg%) serum calcium was somewhat lower in blacks (9.26±0.27 mg% in Belgium; 9.19±0.48 mg% in Zaïre). The 24 hour urinary calcium excretion averaged 215.0±16.7 mg% in whites and was higher (P<0.05 or less) than in blacks (115±71 mg% in Belgium; 36±33 mg% in Zaïre). The serum 25OHD levels were similar in whites and blacks evaluated in Zaïre, both being higher (P<0.05 or less) than in blacks living in Belgium. In the latter blacks, an inverse correlation was observed between the 25OHD level and the duration of the stay in a temperate climate. Parathyroid hormone levels were slightly higher in blacks living in Belgium than in the other two groups of subjects. The serum levels of 1,25(OH)2D3 and human vitamin D-binding protein were similar in the three groups of subjects. Dietary calcium averaged 541±152 mg/day in blacks and was significantly (P<0.001) less than in whites (1,203±508 mg/day), whereas no significant difference was observed in dietary vitamin D intake between blacks and whites. It is concluded that calcium intake is low in blacks but stimulation of parathyroid hormone and 1,25(OH)2D3 required to achieve normocalcemia does not occur.

Calcium entry blockade or beta‐blockade in long‐term management of hypertension in blacks

The long‐term efficacy of nitrendipine and acebutolol was assessed during a 40‐week double‐blind randomized trial in 60 hypertensive blacks. Nitrendipine (mean dose 32 mg/day) and acebutolol (414 mg/day) were administered in monotherapy in increasing dosage and mefruside was added in patients not controlled by monotherapy. The recumbent and standing blood pressures were reduced (P < 0.01 or less) during monotherapy with nitrendipine and acebutolol, but the magnitude of blood pressure reduction was greater (P < 0.05 or less) during nitrendipine dosing. Pulse rate decreased (P < 0.01) during acebutolol whereas nitrendipine induced a nonsignificant increase. Both treatments induced no changes in serum electrolytes, creatinine, urea, uric acid, lipids, plasma renin activity, and plasma and urinary aldosterone. The overall incidence of side effects was similar with both treatments but four patients discontinued nitrendipine because of headache. The addition of mefruside to nitrendipine or acebutolol produced a further fall of blood pressure in patients not controlled with monotherapy. Monotherapy with nitrendipine or acebutolol offers an effective, safe first‐line antihypertensive treatment in blacks entered in this study; with the described dosages and therapeutic schedule, nitrendipine was somewhat more effective than acebutolol.

Changes in erythrocyte sodium and plasma lipids associated with physical training

The intracellular concentrations and transmembrane fluxes of Na+ and K+ in erythrocytes, and plasma lipids were investigated in 30 middle-aged volunteers, before and after physical training. During the first 4 months of the study, half of the subjects (group A) were subjected to a training programme (3 h/week), while the others (group B) served as controls. At the end of the control period the group B subjects also underwent a period of training. At the end of the training, in both experimental groups, the intra-erythrocyte Na+ concentration was decreased (P less than 0.001); the magnitude of this decrease was related to the increase achieved in physical working capacity (r = -0.44; P less than 0.05). After training the activity of the erythrocyte Na+-Li+ counter-transport system was decreased (P less than 0.001) in both groups, whereas Na+,K+ cotransport activity was increased (P less than 0.001). The training intervention did not affect erythrocyte ouabain-sensitive 86Rb uptake, or the calculated rate constant for ouabain-sensitive Na+ efflux. Furthermore, the plasma concentrations of high density lipoproteins (HDL)2- and HDL3-cholesterol (P less than 0.001) markedly increased in both groups during the training period. However, these changes were not significantly correlated with the observed training-induced changes in erythrocyte transmembrane cationic fluxes. It is concluded that physical training decreases intra-erythrocyte Na+ concentration. No significant associations between training-induced changes in plasma lipids and erythrocyte sodium balance could be demonstrated.

Racial differences in intracellular concentration and transmembrane fluxes of sodium and potassium in erythrocytes of normal male subjects

Erythrocyte concentrations and fluxes of sodium and potassium were investigated in normal black and white male subjects. Erythrocyte sodium concentration was significantly elevated in blacks compared to whites. In single regression analysis erythrocyte sodium concentration was inversely related to the ouabain-sensitive 86Rb-uptake and to the frusemide-sensitive sodium efflux. After adjusting for race, only the relationship between the erythrocyte sodium concentration and the Na+, K+-ATpase pump activity persisted. The sodium-lithium countertransport system was also depressed in the black subjects. No significant difference was observed in erythrocyte potassium concentration between blacks and white. It is probable that, in blacks the decreased active influx of potassium through the sodium-potassium pump was to some extent counter balanced by a reduced efflux of this cationic mediated by the depressed cotransport system. There was no difference in cationic concentrations and fluxes of sodium and potassium between blacks bearing and not bearing haemoglobin S.

Free Ionised Calcium—A Critical Survey

It is our aim to summarise and discuss procedures for the evaluation of the concentration of free ionised calcium in serum or plasma. Stress is laid upon the interrelations and relative validity of the most common algebraic expressions to appraise the calcium status. The multitude of formulae proposed in the literature are, by mathematical discussion, reduced to variations on a single theme. A second topic is the direct potentiometric measurement of free ionised calcium concentration. Finally we review the literature on the clinical utility of measuring or calculating the free ionised calcium concentration.

Erythrocyte concentrations and transmembrane fluxes of sodium and potassium and biochemical measurements during the menstrual cycle in normal women.

The erythrocyte concentrations and the transmembrane fluxes of sodium and potassium were investigated in 20 normal women during the two stages of the menstrual cycle. Half of the women were using oral contraceptives and the other half were not. In women with a normal menstrual cycle the erythrocyte sodium concentration and the ouabain-insensitive total potassium efflux were lower in the luteal than in the follicular phase. Intracellular potassium concentration, ouabain-sensitive rubidium 86 uptake and the furosemide-sensitive sodium and potassium efflux did not differ significantly between the two periods of the cycle. No cycle-related variation in sodium or potassium intracellular concentration was observed in women using oral contraceptives. In these women, however, the ouabain-sensitive 86Rb uptake was increased in the second part of the menstrual cycle. In each woman with a normal menstrual cycle the plasma progesterone, renin activity, angiotensin II, plasma aldosterone concentration, and urinary aldosterone excretion increased during the luteal phase. The increment in the plasma renin activity, plasma angiotensin II, and plasma and urinary aldosterone indicate a stimulation of the renin-aldosterone axis in this menstrual period. During the same phase, serum cholesterol was decreased significantly. When the women using oral contraceptives were compared to those not using them, the renin-aldosterone axis was already stimulated during the first part of the cycle; no further stimulation occurred during the second part.

Comparison of Some Recent Methods for the Differentiation of Elevated Serum Amylase and the Detection of Macroamylasaemia

A pancreatic isoamylase method (Pancreatic Alpha-Amylase EPS, Boehringer) that uses monoclonal antibodies showed almost complete immunoinhibition of salivary (S) amylase activity with only a minor decrease of pancreatic (P) amylase activity. The method displayed good sensitivity and linearity. The correlations of P-amylase activities determined by this technique with a wheat-germ inhibition method and with agarose electrophoresis followed by densitometric scanning were excellent. However, both the wheat-germ and monoclonal inhibition methods failed to detect macroamylasaemia. To recognise macroamylases we used the PEG precipitation method and confirmed the results with agarose electrophoresis. Of 161 serum samples with elevated amylase activities, only four out of five with macroamylasaemia were detected by the PEG precipitation method. No false positives were demonstrated. After PEG precipitation of 28 samples, P-amylase determinations were performed on the supernatants. Again, four out of five with macroamylasaemia were recognised. We consider P-amylase measurement and, when macroamylasaemia is suspected, the combined use of the PEG precipitation method and P-amylase or total amylase determination to be the most practical way to differentiate between elevated serum amylase levels.

Plasma atrial natriuretic peptide and the renin-aldosterone system during long-term administration of the diuretic xipamide in man.

SummaryWe have studied the effect of xipamide on plasma α-atrial natriuretic peptide and the reninaldosterone-kallikrein system in twelve healthy men, using a double-blind cross-over design. After a run-in period on placebo for 1 week the subjects were treated with either placebo (n=6) or xipamide 20 mg once daily (n=6) for 16 weeks and were then switched to the alternative medication for another 16 weeks.The plasma concentration of α-atrial natriuretic peptide fell after 1 week of xipamide administration and increased during prolonged xipamide administration but remained suppressed. The changes in plasma α-ANP observed after 1 week of xipamide were negatively correlated with the changes in haematocrit and haemoglobin. Plasma renin activity (PRA), aldosterone concentration (PAC), and urinary excretion of aldosterone and kallikrein increased after 1 week of xipamide administration, levelled off during the second and fourth weeks, but remained elevated during further prolonged xipamide administration for 16 weeks. The xipamide-induced changes in PRA and PAC were positively correlated with the changes in the haematocrit and haemoglobin.Our data suggest that the changes in plasma renin, aldosterone, and α-atrial natriuretic peptide during xipamide administration may be related to diuretic-induced volume contraction.

Long-term double-blind comparison of doxazosin and atenolol in patients with mild to moderate hypertension

The antihypertensive effect and safety of doxazosin once daily as well as the effect on serum lipids was compared with that of atenolol once daily in 40 patients with mild to moderate hypertension. During the first 4 weeks, all patients received placebo therapy. During the subsequent 46 weeks, patients were randomized to doxazosin or atenolol treatment. Treatment was initiated with 1 mg doxazosin or 50 mg atenolol once daily. The dose could be doubled biweekly for 10 weeks until a final dose of 16 mg doxazosin or 100 mg atenolol was reached. The patients then entered the maintenance phase for 36 weeks. The average final dose of doxazosin was 9.2 ± 1.3 (SEM) mg and that of atenolol was 76.5 ± 6.2 mg. During the 46 weeks of active treatment, the recumbent diastolic blood pressure (DBP) tended to be lower (p < 0.05) in patients receiving atenolol at 10, 12, and 22 weeks of treatment. Recumbent systolic BP (SBP) and standing SBP and DBP were not different, however, between patients receiving doxazosin and those receiving atenolol. Recumbent and standing heart rate (HR) were lower (p < 0.01) during atenolol. The decrease in serum total triglycerides, total cholesterol, and low-density lipoprotein (LDL)-cholesterol after 46 weeks of doxazosin was different (p < 0.05) from the changes observed during atenolol therapy. Our data indicate that the antihypertensive action of doxazosin is accompanied by favorable effects on serum lipids.