How can we block sympathetic overactivity? Effects of rilmenidine and atenolol in overweight hypertensive patients.

The aim of the present study was to evaluate effects of long-term treatment with rilmenidine compared with atenolol on lipid and glucose metabolism and cardiovascular remodelling in hypertension. In total, 37 patients with hypertension were randomised to rilmenidine 1-2 mg/day or atenolol 50-100 mg/day for 26 weeks. Standard oral glucose tolerance test with a parallel measurement of insulin and glucose levels was performed. The 'areas under the curve' (AUC) for insulin and glucose were calculated. Plasma lipids, left ventricular mass index (LVMI), and intima-media thickness (IMT) were measured. Brachial artery diameter during reactive hyperaemia was used to test endothelium-dependent vasodilatation (EDVD). Blood pressure reduction was equally achieved in both treatment arms. The fasting glucose level increased in the atenolol group from 4.8+/-0.6 to 5.2+/-0.7 mmol/l (P<0.01). The AUC of glucose in rilmenidine group decreased from 860+/-93 to 737+/-66 mmol/min/l (P<0.05), and in the atenolol group it increased from 937+/-86 to 989+/-88 mmol/min/l (P<0.05). Rilmenidine showed a positive effect on lipid levels, whereas in the atenolol group a significant decrease of high-density lipoprotein cholesterol was observed. Left ventricular mass index decreased with rilmenidine by 9.6% and by 6.9% with atenolol (P<0.05). Intima-media thickness significantly decreased in the rilmenidine group. Endothelium-dependent vasodilatation slightly increased on in the rilmenidine group, while on in the atenolol group it remained unchanged. Our data suggest that in hypertensive patients central inhibition of sympathetic drive can produce favourable effects on glucose and lipid metabolism compared with standard beta-blockade with a similar antihypertensive efficacy. Rilmenidine also provides beneficial effects on cardiovascular remodelling and altered endothelial function in hypertension.

Benefits of the implementation of structured educational program in hypertension management.

BACKGROUND: The aim of the study was to evaluate the effect of patients' education on treatment compliance and blood pressure (BP) control, as well as lifestyle in hypertension. MATERIAL AND METHODS: Education with the structured program was performed in 89 patients with essential hypertension. The patients knowledge level was determined using a special questionnaire with 26 questions. The regularity of BP self-control and drug treatment were assessed before and after the educational course as well as after 6-months of follow-up. RESULTS: The knowledge level increased after education from 58 +/- 12% up to 92 +/- 11% (p < 0.05), the proportion of patients on regular medication from 34.4% to 74.2% (p < 0.05). Sixty (67.4%) of patients started to perform regular BP self-control. The improvement of knowledge level and treatment compliance was not accompanied by significant changes in lifestyle such as smoking cessation and body weight loss. CONCLUSIONS: The structured patients' education resulted in the increase of patients' knowledge, improvement of drug compliance and self-monitoring of BP. Modification of lifestyle appears to be more problematic point as it did not show any significant improvement.

Power spectral components of heart rate variability in different types of cardiac remodelling in hypertensive patients.

BACKGROUND: The aim of the study was to evaluate whether there are any significant differences in cardiac autonomic regulation in distinct types of hypertensive cardiac remodelling. MATERIAL AND METHODS: We examined 86 patients with mild to moderate essential hypertension (EH). The parameters of left ventricle (LV) were measured by echocardiography: the diastolic mass normalized for body surface area (LVMI) and relative wall thickness (RWT). All patients were divided into three groups: normal LV geometry (23), concentric left ventricular hypertrophy (LVH) (29) and eccentric LVH (34). The control group included 30 age and sex-matched healthy volunteers. For calculation of heart rate variability (HRV) 512 RR intervals in supine rest and passive tilt were measured. Power spectral analysis with fast Furrier transform was used to obtain the total power, low frequency (LF) power (from 0.003 to 0.14 Hz), high frequency (HF) power (from 0.15 to 0.40 Hz) and sympathovagal index (SVI) as LF:HF ratio. RESULTS: The parameters of HRV did not differ significantly among the groups studied. In the group with normal LV geometry there was observed a good response to tilt test resulting in an increase of SVI in three times (from 2.4 +/- 0.3 to 7.2 +/- 0.4), while in patients with both types of LVH there were no significant changes in SVI or even an inverse reaction to passive tilt. In the group with normal geometry patients with higher meanings of RWT had higher LF power (r = 0.52, p < 0.01), while in patients with LVH the increasement of LVMI and RWT was associated with reduction of HRV (rr = -0.43, -0.36, p < 0.05, respectively). CONCLUSIONS: Heart rate variability is significantly reduced in essential hypertension and is also closely connected with cardiac structure and function. Patients with normal LV geometry are characterized by a preserved response to tilt test. LVH produce significant disturbances of autonomic regulation possibly due to lower sensitivity of cardiac adrenoreceptors independently of the LVH pattern.

[T3-thyrotoxicosis: incidence, significance and correlation with iodine intake]. / T3-hyperthyreosis: elófordulása, jelentósége és összefüggése a jódellátottsággal.

In a part of patients with thyrotoxicosis the serum triiodothyronine concentration increases only while free thyroxin level remains in the normal range (T3-thyrotoxicosis). This condition occurs in patients with untreated or treated thyrotoxicosis and in some other but rare thyroid disease, respectively. In this study occurrence and importance of T3-thyrotoxicosis were discussed. This form occurred in 11% of untreated thyrotoxicosis (53/480). The majority of patients suffering from T3-thyrotoxicosis have autonomous thyroid function (i.e. toxic uninodular and multinodular goiter: 45/53, 85%). In case of suppressed TSH and normal free thyroxin T3-thyrotoxicosis can be expected in 40% (53/140). The rate of free-triiodothyronin elevation is highest in Graves' disease with autoimmune origin. We consider the possibilities of development of triidothyronine increasing and the importance of iodine deficiency. Our patients are living in an area where mild iodine deficiency can be proved on the basis of decreased iodine excretion in urine. The results show the diagnostic importance of free-T3 determination.

Correction of hypertensive cardiac remodelling: comparison of different antihypertensive therapies.

The aim of the study was to compare the effects of long-term treatment with different types of antihypertensive drugs on left ventricular hypertrophy (LVH) and diastolic function in patients with essential hypertension. We examined 60 patients with mild to moderate hypertension from 35 to 55 years old (middle age 44.3 +/- 2.3 yrs) having no concomitant diseases. Patients were treated for six months with different types of antihypertensive drugs: 21 patient received nifedipine-retard 40 mg/day, 20--atenolol 100 mg/day, 10--losartan potassium 100 mg/day, 9--perindopril 4 mg/day. Cardiac structure and function was studied by echocardiography. For the left ventricle (LV) the diastolic mass normalised for body surface area (LVMI), the ratio of the early and atrial mitral inflow velocities (E/A), isovolumetric relaxation time (IVRT), relative wall thickness (RWT) were measured. After six months of treatment LVMI decreased by 9% in nifedipine group (P < 0.01), by 10.5% in atenolol group (P < 0.01), by 12% in losartan group (P < 0.01) and by 8.2% in perindopril group (NS). RWT decreased in all groups, while diastolic dimension index remained unchanged. The reversal of LVH was not related to blood pressure reduction. It was more significant in patients with initially higher values of LVMI. Antihypertensive effects of the drugs were comparable. Long-term treatment with all types of selected drugs improves cardiac structure and function independently of their antihypertensive action. Our data suggest that on the basis of the influence on cardiac remodelling no preference for any studied drug can be discerned. The work had the following source of support: the atenolol (Falitonsin) and nifedipine-retard (Corinfar-retard) were provided by the AWD Company (Germany), losartan potassium has been provided by Merck Sharp & Dohme Company and perindopril (Prestarium) by the Servier Group.

[Treatment of Basedow-Graves disease in pregnancy]. / Basedow--Graves-kór kezelése terhességben.

UNLABELLED: Thyrostatic treatment of pregnant women with Graves' disease is a special problem. Observation of 46 pregnancies of 35 women suffering from Graves' disease has been summarized. The outcome was successful in 45 cases. Methimazole and propylthiouracil was administered to the patients without thyroxine. Therapy was needed for the two thirds of the mothers. At the end of the second trimester the thyrostatic agent could have been withdrawn in the 77% of the cases. Antithyroid treatment administered in low dose at the time of conception did not affect the outcome. Premature delivery rate and the number of neonates with low weight did not increased. Transient hyperthyrotropinaemia was observed in one case. Likewise, one infant suffered from neonatal thyrotoxicosis. 37% of the mothers had postpartal recurrence of hyperthyroidism. CONCLUSIONS: the free thyroxin level monitoring is essential during thyrostatic treatment. Thyrotropin receptor antibody investigation, having predictive value for neonatal thyrotoxicosis, should be done, too. Postpartal thyroid control is necessary for elucidate a hyperthyroid relapse, the rate of which was almost 40%.

[Primary hypothyroidism followed by Basedow-Graves disease]. / Primer hypothyreosist követö Basedow--Graves-betegség.

Author describes the history of a patient having primary hypothyroidism. After 7 year replacement therapy Graves' disease has been diagnosed. Author tries to give an explanation for this phenomenon by the changes occurred in thyroid directed immune response. As far as he knows this is the first reported case in the national literature.

[Incidence of the most frequently occurring diseases causing hyperthyroidism syndrome]. / Hyperthyreosis syndromát okozó leggyakoribb kórképek elöfordulása.

Thyrotoxicosis most frequently is caused by Graves' disease and toxic adenoma. Author considers the difficulties of the diagnosis of these disorders. He established the prevalence and incidence of Graves' disease and toxic adenoma: 7.64% and 16.3/10(5)/year in the former and 2.34% and 4.1/10(5)/year in the later. The rate of the prevalence of these disorders in similar to that of iodine deficiency areas thus it refers indirectly to the deficiency of iodine in Hungary. The author suggests to determine correctly the nature of toxic multinodular goiter (autoimmune phenomenon or a variety of autonomous function) because it may have some importance in respect of therapy.