Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure/drug effects , Dietary Sucrose/therapeutic use , Hypertension/diet therapy , Polycystic Kidney Diseases/diet therapy , Adult , Blood Glucose/metabolism , Female , Follow-Up Studies , Humans , Hypertension/blood , Hypertension/physiopathology , Insulin/blood , Insulin Resistance , Male , Middle Aged , Polycystic Kidney Diseases/blood , Treatment OutcomeABSTRACT
A 15-year-old girl in whom the diagnosis of infective endocarditis was established was sent to our cardiothoracic centre for mitral valve replacement because of a streptococcal endocarditis resistant to adequate antibiotic therapy. Despite the combination of fever, a 'new' heart murmur, 'positive blood cultures' and 'vegetations' on the mitral valve, the clinical picture gave rise to some doubt about the diagnosis. Finally the diagnosis of systemic lupus erythematosus was made and after treatment with corticosteroids all symptoms disappeared. In our modern era 'simple symptoms' still play a very important part in clinical decision making.
Subject(s)
Endocarditis, Bacterial/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Lupus Nephritis/diagnosis , Adolescent , Adrenal Cortex Hormones/therapeutic use , Diagnosis, Differential , Diagnostic Errors , Female , Humans , Lupus Erythematosus, Systemic/drug therapy , Lupus Nephritis/drug therapyABSTRACT
1. Fructose feeding, as opposed to vegetable starch feeding, has been shown to elevate blood pressure and to decrease insulin sensitivity in normotensive rats. The long-term relevance of this is unclear, and data in hypertensive strains are scarce. 2. We studied the effects of 27 weeks of a fructose-versus a corn-starch-enriched (69.5% w/w) diet in the spontaneously hypertensive rat. 3. In both dietary groups, blood pressure increased with ageing, with no apparent difference between the diets. The fructose-fed rats gained less weight. However, even selecting fructose-fed rats that matched the weight gain in the corn starch group, did not reveal a significant elevation of systolic blood pressure over time. 4. Extracellular fluid volume was comparable in fructose-fed and corn-starch-fed rats. No effects on creatinine clearance, proteinuria or renal histology were found. Fasting values of plasma triacylgycerols and cholesterol were increased mildly after 2 weeks on the fructose diet. However, fasting glucose and insulin measured after 2 weeks, and the response to an intraperitoneal glucose load, were no different. After 23 weeks of the diets, fasting values of plasma glucose, insulin, triacylglycerols and cholesterol did not differ. There were small differences in the response of plasma glucose levels to the intraperitoneal glucose load, but the area under the curve was not different. The baseline insulin resistance present in spontaneously hypertensive rats possibly blunts the metabolic response to dietary fructose. 5. After 27 weeks, the diets were switched in cross-over design, and measurements were continued until 39 weeks. The fructose diet did not elevate systolic blood pressure in this follow-up experiment.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Blood Pressure/physiology , Fructose/administration & dosage , Rats, Inbred SHR/physiology , Starch/administration & dosage , Animals , Blood Glucose/metabolism , Body Weight , Cholesterol/blood , Extracellular Space/physiology , Insulin/blood , Kidney/physiology , Male , Rats , Triglycerides/metabolismABSTRACT
We compared the effects of 4 weeks of calcium channel blockade (amlodipine) or converting enzyme inhibition (lisinopril) on blood pressure and renal hemodynamics in a double-blind crossover trial in a group of 20 hypertensive cyclosporine-treated renal transplant patients. Amlodipine (10 mg) was more effective than the same dose of lisinopril in controlling hypertension (mean 24-hour arterial pressure, 111 +/- 9 and 115 +/- 9 mm Hg, respectively; P < .05). Blood pressure during both treatments was lower than during placebo (124 +/- 12 mm Hg, P < .05). Compared with placebo, amlodipine treatment was associated with a significant increase in glomerular filtration rate (10 +/- 20%, P < .05) and effective renal plasma flow (27 +/- 20%, P < .01) and a decrease in renal vascular resistance (23 +/- 18%, P < .01). Renal hemodynamics did not change during lisinopril. Neither drug had an effect on proteinuria. The data indicate that amlodipine is more effective than lisinopril in controlling hypertension in cyclosporine-treated patients and that treatment with amlodipine but not with lisinopril is accompanied by an increase in glomerular filtration rate and effective renal plasma flow and a decrease in renal vascular resistance. The data suggest that the renin-angiotensin system does not play a main role in determining cyclosporine-associated changes in renal hemodynamics and has a limited role in determining cyclosporine-associated hypertension.
