Relationship between microalbuminuria and cardiac structural changes in mild hypertensive patients

The aim of this study was to determine the relationship between urinary albumin excretion (UAE), cardiac structural changes upon echocardiography and 24-h ambulatory blood pressure (ABPM) levels. Twenty mild hypertensive patients (mean age 56.8 ± 9.6 years) were evaluated. After 2 weeks of a washout period of all antihypertensive drugs, all patients underwent an echocardiographic evaluation, a 24-h ABPM and an overnight urine collection. Systolic and diastolic blood pressure during 24-h ABPM was 145 ± 14/91 ± 10 mmHg (daytime) and 130 ± 14/76 ± 8 mmHg (nighttime), respectively. Seven (35 percent) patients presented UAE > or = 15 æg/min, and for the whole group, the geometric mean value for UAE was 10.2 x/÷ 3.86 æg/min. Cardiac measurements showed mean values of interventricular septum thickness (IVS) of 11 ± 2.3 mm, left ventricular posterior wall thickness (PWT) of 10 ± 2.0 mm, left ventricular mass (LVM) of 165 ± 52 g, and left ventricular mass index (LVMI) of 99 ± 31 g/m². A forward stepwise regression model indicated that blood pressure levels did not influence UAE. Significant correlations were observed between UAE and cardiac structural parameters such as IVS (r = 0.71, P<0.001), PWT (r = 0.64, P<0.005), LVM (r = 0.65, P<0.005) and LVMI (r = 0.57, P<0.01). Compared with normoalbuminuric patients, those who had microalbuminuria presented higher values of all cardiac parameters measured. The predictive positive and negative values of UAE > or = 15 æg/min for the presence of geometric cardiac abnormalities were 75 and 91.6 percent. These data indicate that microalbuminuria in essential hypertension represents an early marker of cardiac structural damage

Intima-media thickness evaluation by B-mode ultrasound: Correlation with blood pressure levels and cardiac structures

The aim of this study was to analyze the thickness of the intima-media complex (IMC) using a noninvasive method. The carotid and femoral common arteries were evaluated by noninvasive B-mode ultrasound in 63 normotensive and in 52 hypertensive subjects and the thickness of the IMC was tested for correlation with blood pressure, cardiac structures and several clinical and biological parameters. The IMC was thicker in hypertensive than in normotensive subjects (0.67 ± 0.13 and 0.62 ± 0.16 vs 0.54 ± 0.09 and 0.52 ± 0.11 mm, respectively, P<0.0001). In normotensive patients, the simple linear regression showed significant correlations between IMC and age, body mass index and 24-h systolic blood pressure for both the carotid and femoral arteries. In hypertensives the carotid IMC was correlated with age and 24-h systolic blood pressure while femoral IMC was correlated only with 24-h diastolic blood pressure. Forward stepwise regression showed that age, body mass index and 24-h systolic blood pressure influenced the carotid IMC relationship (r2 = 0.39) in normotensives. On the other hand, the femoral IMC relationship was influenced by 24-h systolic blood pressure and age (r2 = 0.40). In hypertensives, age and 24-h systolic blood pressure were the most important determinants of carotid IMC (r2 = 0.37), while femoral IMC was influenced only by 24-h diastolic blood pressure (r2 = 0.10). There was an association between carotid IMC and echocardiographic findings in normotensives, while in hypertensives only the left posterior wall and interventricular septum were associated with femoral IMC. We conclude that age and blood pressure influence the intima-media thickness, while echocardiographic changes are associated with the IMC

Microalbuminuria, arterial blood pressure and retinopathy in insulin dependent diabetes

In order to evaluate the relationship between urinary albumin excretion, arterial blood pressure and diabetic retinopathy in insulin dependent diabetics we examined 55 patients without clinical proteinuria and whose disease had started before the age of 30. Each patient was asked to collect at least one overnight timed urine sample for albumin analysis by an ELISA method. Normoalbuminuria was defined as urinary albumin excretion (UAE) of < 20 mug/min (n = 32) and microalbuminuria as 21-200 mug/min (n = 23). Patients with microalbuminuria showed higher levels of blood pressure, serum creatinine and glicosylated haemoglobin as compared to normoalbuminuric patients. Significant correlation was observed between diastolic blood pressure and UAE (r = 0.52; p < O.001).Preproliferative and proliferative diabetic retinopathy was detected in 9 patients (l6.4 per cent). All of them had diabetes for more than 10 years, elevated UAE and diastolic blood pressure equal or higher than 85 mmHg. In our population of insulin dependent diabetics we found a high prevalence of microalbuminuria which is considered to be predictive of the latter development of diabetic nephropathy. Microalbuminuria is associated with elevated blood pressure and diabetic retinal lesions. We conclude that urinary albumin excretion should be monitored in patients with insulin dependent diabetes to detect those who should be considered at risk of developing nephropathy and retinopathy.

Eficácia do captopril nos tratamentos agudos e prolongados de pacientes com crise hipertensiva / Effectiveness of captopril in acute and prolonged treatment of patients with hypertensive crisis

A eficacia do captopril no tratamento agudo de emergencias hipertensivas foi estudada em 25 pacientes, bem como a manutencao do efeito anti-hipertensivo por 20 horas adicionais, usando-se doses suplementares (50 mg de 8/8h, via oral). O estudo agudo revelou que 40% dos pacientes responderam com normalizacao da pressao arterial media (PAM), 90 minutos apos a dose oral de 50mg; 40% responderam 90 minutos apos uma segunda dose (100mg) VO e 20% necessitaram de terceira dose (150mg) para a normalizacao da PAM. O estudo prolongado revelou que 64% dos pacientes mantiveram PAM normal durante 20 horas com a administracao de 50mg de captopril a cada 8 horas e 36% dos pacientes tiveram controle adequado da pressao arterial por 10 horas adicionais. Estes dados revelam que o captopril e um grande agente terapeutico util na crise hipertensiva, nao so pelo efeito agudo potente e gradual, mas tambem por manter efeito anti-hipertensivo durante o periodo critico do tratamento, ou seja, nas primeiras 24 horas. Estas caracteristicas reforcam a ideia de que o captopril possa ser uma opcao terapeutica vantajosa nos quadros de crise hipertensiva, em comparacao as drogas vasodilatadoras mais potentes que requerem atencao de pessoal e equipamento de monitorizacao, nem sempre facilmente disponiveis em hospitais gerais

Efeitos imediatos e a médio prazo da administração de verapamil em ratos com hipertensão renal experimental / Immediate and midterm effects of the administration of verapamil in rats with experimental renal hypertension

Os efeitos imediatos e a medio prazo do verapamil sobre a pressao arterial de ratos foram estudados em dois modelos distintos de hipertensao arterial experimental por estenose de arteria renal: l Clip2 rins (modelo GII) e 1 clip 1 rim (modelo GI). Houve reducao significante da pressao arterial em ambos os grupos: maior grau de reducao foi observado no modelo GII (27%) comparado ao modelo GI (l7%). Entretanto, ao final do tratamento a medio prazo, nao mais se observaram diferencas entre os dois grupos. Tambem, o efeito imediato nao foi diferente entre os dois grupos, quer quanto a resposta maxima (GI = 22,6% vs GII = 26,2%), quer quanto a duracao do efeito avaliada pelo T l/2 (GI = 120 min vs GII = 150 min). Estes dados sugerem que o verapamil e igualmente eficaz em reduzir os niveis hipertensivos nestes dois modelos. Portanto, o mecanismo de acao parece ser inespecifico, atraves do antagonismo de calcio, podendo estar envolvidas reducoes do debito cardiaco e/ou vasodilatacao periferica. Por isto, estudos hemodinamicos detalhados dos mecanismos de resposta pressorica a esta droga sao necessarios antes da aplicacao indiscriminada em hipertensao humana

Crise hipertensiva. Tratamento com captopril após insucesso com diurético. Estudo multicêntrico / Hypertensive crisis. Treatment with captopril after failure with diuretics. Multicentric study

A eficacia do captopril, substancia inibidora da enzima conversora da angiotensina I, foi avaliada no tratamento de 116 pacientes em crise hipertensiva. O captopril foi empregado como unica droga anti-hipertensiva, ou apos a insucesso no controle da pressao arterial e da sintomatologia com diuretico via endovenosa (EV) mais tranquilizante via intra-muscular (IM). Um grupo de 99 pacientes recebeu a associacao de diuretico EV e tranquilizante IM, dos quais 10 responderam satisfatoriamente a esta associacao. Nos 89 pacientes restantes, com a administracao de doses variadas de captopril, observou-se reducao da pressao arterial ao nivel estabelecido (PA diastolica < ou igual ll0 mm Hg) em 77,5% dos casos. Em 53% dos pacientes, uma unica dose oral de 50 mg de captopril foi suficiente para a obtencao da resposta antihipertensiva, na dose de l00 mg, via oral.Em 13 casos (76,4%) o resultado foi satisfatorio. Os 4 pacientes restantes receberam uma segunda dose de l00 mg do farmaco, com resultados satisfatorios em 2 (ll,7%) e insucesso em outros 2 (ll,7%). A eficacia do captopril no tratamento de crises hipertensivas, conforme observada no presente trabalho, favorece seu uso no tratamento desta situacao clinica. Outrossim, o fato do captopril ser ativo por via oral, facilita seu emprego no lugar dos vasodilatadores parenterais, na maioria dos pacientes com esta emergencia clinica

Tratamento da crise hipertensiva com captopril. / Treatment of hypertensive crisis with captopril

Avaliou-se a eficiencia do captopril, um inibidor da enzima conversora, no tratamento de 28 pacientes em crise hipertensiva de variadas etiologias: 12 com hipertensao arterial maligna, 6 com hipertensao acelerada, 4 com hipertensao renovascular e 6 com hipertensao renovascular arterial refrataria. A resposta imediata ao captopril foi mais intensa nos pacientes portadores de hipertensao arterial acelerada e maligna e hipertensao renovascular. Assim, em 14 dos 18 pacientes com hipertensao acelerada e maligna, doses entre 150 e 300 mg de captopril foram suficientes para reduzir a pressao arterial a niveis proximos da normalidade. Nos outros 4 pacientes deste grupo, necessitou-se de um diuretico para controlar a pressao arterial. Os 4 pacientes com hipertensao renovascular apresentaram reducoes similares na pressao arterial, porem com doses menores de captopril. Os 6 pacientes portadores de hipertensao arterial refrataria apresentaram menores reducoes pressoricas com doses de captopril entre 50 e 150 mg.Concluiu-se que captopril foi eficaz para o tratamento inicial de crises hipertensivas de diversas etiologias