Mortalidad por enfermedad cerebro-vascular en Argentina:1962-1985 / Stroke mortality in Argentina: 1962-1985

Se analizó la tasa de mortalidad por enfermedad cerebro-vascular(ECV)en Argentina de 1962 a 1985. El porcentaje de mortalidad por ECV representó en 1985, el 9.9% del total de las muertes del país. El porcentaje de mortalidad aumentó 10% de 1970 a 1985. La mortalidad por ECV fue mayor en el varón que en la mujer. Desde 1977 se observó una tendencia declinante de la mortalidad en mayores de 45 años de edad en ambos sexos. En contraste, se demostró un aumento de la mortalidad(+27.7% ) entre las mujeres jóvenes. La Argentina presenta la tasa más elevada de mortalidad por ECV de los países de las Americas. Es posible que la alta mortalidad por ECV ocurra como consecuencia del inadecuado control de la hipertensión arterial demostrado en el país, así como por el efecto de la alta prevalencia de otros factores de riesgo entre las mujeres jóvenes(tabaquismo y toma de anovulatorios). Estos resultados indican que se deberán implementar programas educacionales para lograr el adecuado control de la hipertensión arterial y de otros factores de riesgo cardiovascular, con el fin de lograr la disminución de la mortalidad por ECV

Mortalidad por enfermedad cerebro-vascular en Argentina:1962-1985 / Stroke mortality in Argentina: 1962-1985

Se analizó la tasa de mortalidad por enfermedad cerebro-vascular(ECV)en Argentina de 1962 a 1985. El porcentaje de mortalidad por ECV representó en 1985, el 9.9% del total de las muertes del país. El porcentaje de mortalidad aumentó 10% de 1970 a 1985. La mortalidad por ECV fue mayor en el varón que en la mujer. Desde 1977 se observó una tendencia declinante de la mortalidad en mayores de 45 años de edad en ambos sexos. En contraste, se demostró un aumento de la mortalidad(+27.7% ) entre las mujeres jóvenes. La Argentina presenta la tasa más elevada de mortalidad por ECV de los países de las Americas. Es posible que la alta mortalidad por ECV ocurra como consecuencia del inadecuado control de la hipertensión arterial demostrado en el país, así como por el efecto de la alta prevalencia de otros factores de riesgo entre las mujeres jóvenes(tabaquismo y toma de anovulatorios). Estos resultados indican que se deberán implementar programas educacionales para lograr el adecuado control de la hipertensión arterial y de otros factores de riesgo cardiovascular, con el fin de lograr la disminución de la mortalidad por ECV

Liver cirrhosis mortality in Argentina: its relationship to alcohol intake.

In Argentina, rates of liver cirrhosis mortality increased significantly in both sexes (men 81.3% and women 79.8%) between 1962 and 1970. A tendency towards a decrease in mortality rates for liver cirrhosis was observed in all groups, except for men aged 35-44 years, between 1970 and 1978, but the age-adjusted mortality rate persisted in 1978 at a level significantly higher than in 1962. The high mortality rate caused by liver cirrhosis may be the consequence of high alcohol intake in Argentina. In 1975, the average per capita consumption of alcoholic beverages, per year was 80 l of wine, 16.75 l of beer and 7.5 l of distilled liquors. These results indicate that important educational and legislative measures should be undertaken to try to correct life styles in an attempt to decrease the incidence of alcohol-related diseases and accidents in Argentina.

Coronary heart disease mortality and coronary risk factors in Argentina.

A marked increase in the coronary heart disease (CHD) mortality of working-age (35-64 years) men and women occurred in Argentina in the 1960s and 1970s. CHD is the leading cause of death in men. In 1978, Argentine men had also one of the highest CHD mortality rates (603.9/100,000) in international mortality statistics and Argentine women (155.2/100,000) were also at the top of these statistics. Stroke mortality has also increased in the younger age-group of men and women over the last decade. The high CHD and stroke mortality rates are compatible with a high prevalence of cardiovascular risk factors. Several surveys have demonstrated that mean serum total cholesterol levels are high, the prevalence of smokers is increasing and the proportion of adequately treated hypertensive patients is low. These results suggest that measures should be introduced to change the Argentine way of life to try to initiate a decline in cardiovascular mortality.

Prolactin, renin, growth hormone, lipoproteins and glucose under guanfacine treatment.

The effect of short-term (6 weeks) and long-term (7 years) guanfacine treatment on some metabolic and endocrine parameters was studied in patients with moderate hypertension. Short-term treatment decreased blood pressure and heart rate, and also produced a significant fall in urinary excretion of noradrenalin and prolactin. Long-term treatment, in addition, produced a progressive decrease in prolactin, total cholesterol and triglyceride levels, but did not change growth hormone levels and oral glucose tolerance test. The decreased mortality and morbidity which was observed under guanfacine treatment may depend not only on important antihypertensive activity of guanfacine, but also on its beneficial effect on known cardiovascular risk factors.

Effects of guanfacine on growth hormone, prolactin, renin, lipoproteins and glucose in essential hypertension.

The effect of single-dose, short-term (6 weeks) and long-term (7 years) guanfacine therapy on various endocrine and metabolic parameters was evaluated in patients with moderate essential hypertension (WHO phase I and II). A single oral dose (2 mg) of guanfacine did not affect the secretion of growth hormone but produced a prompt decrease in blood pressure (BP) levels. Short-term treatment decreased BP and heart rate, and also produced a marked (p less than 0.001) fall in urinary excretion of norepinephrine and serum prolactin levels. Short-term therapy did not affect growth hormone or renin levels. A mean daily dose of 2.8 mg of guanfacine maintained normal BP levels in 22 patients during the long-term follow-up study. In addition, treatment produced a progressive decrease in prolactin, renin, total cholesterol and triglyceride levels, but did not change growth hormone values or oral glucose tolerance test results. The cumulative incidence of cardiovascular complications was significantly lower (p less than 0.001) in guanfacine-treated patients than in a matched control group. The most significant difference was the absence of fatal complications in the guanfacine-treated patients. The present results support the theory that decreased morbidity and mortality in patients treated with guanfacine may depend not only on its important antihypertensive activity, but also on its beneficial effect on known cardiovascular risk factors.

A comparative study of endralazine and captopril in essential hypertension: effect on renin levels, pulmonary function studies and lipid profile.

A comparative study of the effects of captopril, an angiotensin converting enzyme inhibitor and endralazine, a new vasodilator drug, were performed in a group of 20 homogeneous patients with moderate hypertension (WHO: phase I and II). Both drugs produced a marked (p less than 0.001) decrease in mean arterial pressure, but the drop in blood pressure levels and the percentage of patients free of side-effects (p less than 0.001) were greater in patients treated with endralazine. Neither drug affected the lipid profile, nor pulmonary function tests and both increased significantly (p less than 0.001) plasma renin activity levels. The results of this study suggest that both drugs may be recommended for the treatment of hypertensive asthmatic patients, but endralazine should be preferred as first-choice drug, due to its lower incidence of side-effects and higher hypotensive effect obtained with the administration of a lower daily dosage.

Improvement of glucose tolerance in hypertensive diabetic patients treated with guanfacine one year.

In the present study the effect of 1 year of antihypertensive treatment with guanfacine (g) has been evaluated in 18 hypertensive patients with adult-onset, non-insulin-dependent diabetes mellitus (WHO Type II). The treatment produced a marked improvement in the oral glucose tolerance test; guanfacine significantly decreased serum glucose levels, and affected only slightly the insulin secretion. It is suggested that the effect of g may be mediated via a reduction in catecholamine and/or growth hormone and ACTH secretion. The present results also suggest that treatment with guanfacine may improve individual coronary risk in hypertensive diabetic patients.

Abnormal prolactin response to thyrotrophic releasing hormone in essential hypertension.

The effect of thyrotrophin releasing hormone (TRH) on prolactin (PRL) levels was studied in 11 patients with moderate essential hypertension (WHO phases I and II) and in 11 sex and age matched normal subjects. In 90.9 per cent of the patients with essential hypertension presenting normal or elevated basal PRL levels, the response to TRH was blunted. The abnormal response of PRL secretion to TRH administration may reflect the dysfunction of dopaminergic and noradrenergic hypothalamic systems in essential hypertension.

Blood pressure and prolactin: effects of guanfacine. Three-year follow-up study.

Serum prolactin was measured in 76 patients with essential hypertension: 47.4% had elevated serum prolactin, and those with organ damage had presented higher prolactin than those with Phase I (WHO) hypertension. The effect of prolonged treatment (3 years) with guanfacine, an alpha-adrenoceptor stimulant drug, on blood pressure levels, heart rate, and prolactin was evaluated in 15 patients with moderate essential hypertension (WHO: Phase II) and hyperprolactinemia. Treatment produced a marked reduction in blood pressure levels and heart rate. Guanfacine decreased serum prolactin significantly (p less than 0.001), and the inhibition persisted during the 3-year follow-up. The daily dosage of guanfacine did not have to be changed during the 3 years of treatment. Side effects of guanfacine were only observed during the first 3-4 months of therapy. The hypotensive effect of guanfacine was increased by the administration of a diuretic, a vasodilator, or a beta-adrenergic blocking drug. The results indicate that guanfacine administered alone or in combination is an effective drug for treatment of patients with essential hypertension. The inhibitory effect of guanfacine on prolactin suggests that hypothalamic or extrahypothalamic adrenergic pathways may participate in the regulation of prolactin secretion.

Renin levels and cardiovascular morbidity: a prospective study of the effect of beta-adrenergic blocking drugs.

A 3-year prospective study was undertaken to evaluate the relationship between plasma renin activity levels and the incidence of cardiovascular complications in white patients with uncomplicated essential hypertension treated with various beta-adrenergic blocking agents (oxprenolol, pindolol, propranolol, sotalol and timolol). During the follow-up study, 4 (5.9%) of 68 treated patients and 10 (41.7%) of 24 non-treated patients (p less than 0.001) developed cardiovascular complications. The cardiovascular events occurred more frequently in patients with low renin activity levels and in patients with severe hypertension (diastolic blood pressure above 120 mmHg). An increase in plasma renin activity levels was observed following cardiovascular complications in both groups of patients. No cases of myocardial infarction occurred among the treated patients, while 5 cases (3 fatal) of proven myocardial infarction occurred among the non-treated patients. The results of this study suggest that low plasma renin activity levels have no "protective effect" on the incidence of cardiovascular complications in patients with essential hypertension. The fact that no cases of myocardial infarction were observed among patients treated with various beta-adrenergic blocking drugs suggests that these drugs may have a "cardioprotective" effect on ischaemic heart disease in patients with essential hypertension. This hypothesis should be confirmed by further trials.

Treatment of severe essential hypertension with labetalol: effect on active and inactive renin.

The effect of labetalol on blood pressure, heart rate and the renin-angiotensin system was evaluated in 12 patients with severe essential hypertension (diastolic blood pressure greater than or equal to 120 mmHg, WHO: Phase I and II) who had been resistant to other therapeutic regimens. In 9 (76%) patients, labetalol produced a marked reduction in systolic and diastolic pressure (p less than 0.001), while the other 3 patients required the combination of high doses of the drug (1600 mg/day) with a diuretic to achieve normal blood pressure levels. The average dose which controlled blood pressure levels was 777 +/- 393 mg/day. Treatment produced a progressive decrease in heart rate. Side-effects were transient. In contrast to other beta-adrenergic blockers, treatment with labetalol did not modify plasma renin activity levels nor the total concentration of renin or inactive renin levels. During the 1-year follow-up none of the patients treated with labetalol developed cardiovascular accidents, while 4 cardiovascular events occurred in a group of 12 age-matched non-treated severely hypertensive patients. The results of this study indicate that labetalol, administered as a single therapy or in combination with a diuretic, can control blood pressure levels in severely hypertensive patients who had been resistant to the administration of other therapies. Its effects on blood pressure are not related to the renin-angiotensin system.