[The importance of antihypertensive therapy in subclinical brain damage]. / Význam antihypertenzní lécby u subklinického poskození mozku.

Older patients are often affected by impaired cognitive function and high blood pressure. Damage to microcirculation of the brain is closely related to changes in large vessels. High blood pressure and vascular stiffness might lead to a damage in microcirculation of the brain and, consequently, to worsening of the patient's cognitive function and dementia. We discuss early diagnosis of subclinical brain damage using magnetic resonance and its preventive management with antihypertensive therapy.

[The normalized smoothness index and parametric population RDH index of losartan in patients with newly diagnosed hypertension and metabolic syndrome]. / Normalizovaný smoothness index a parametrický populacní RDH index losartanu u pacientu s cerstve zjistenou hypertenzí a metabolickým syndromem.

INTRODUCTION: Ambulatory blood pressure monitoring provides an opportunity to evaluate 24-hour efficacy of once daily preparations. AIMS OF THE STUDY: To evaluate 24-hour efficacy of losartan in patients with newly diagnosed hypertension and metabolic syndrome using the parametric population RDH index and normalized smoothness index. PATIENT SAMPLE AND METHODOLOGY: Twenty seven patients with newly diagnosed hypertension and with metabolic syndrome, sufficiently responding to blood pressure therapy with losartan, assessed using sphygmomanometer. 18 men, 9 women, mean age of 48 years, body mass index of 32.6 kg.m(-2), before and after 1 year of therapy with losartan in the mean dose of 69 mg once a day. Blood pressure measured with sphygmomanometer and 24-hour ambulatory monitoring (SpaceLabs 90207) according to the European Society of Hypertension criteria. Hypertension was defined as sphygmomanometer-measured blood pressure values of more than or equal to 130 and/or 85 mm Hg. Fulfilment of at least 3 criteria of metabolic syndrome according to the definition by The Adult Treatment Panel III. RESULTS: The population normalized smoothness index of losartan (+/- standard error of the mean) was 1.10 +/- 0.13 for systolic pressure, 0.81 +/- 0.11 for diastolic pressure and 1.00 +/- 0.14 for mean arterial blood pressure. The parametric population RDH index of 24, 24, 0 for systolic pressure and 24, 24, 0 for diastolic pressure. CONCLUSION: Losartan at a mean dose of 69 mg once daily showed an adequate 24-hour efficacy in patients with newly diagnosed hypertension and metabolic syndrome responding to treatment when blood pressure was measured using sphygmomanometer and the effect expressed as the parametric population RDH index for systolic as well as diastolic pressure and when evaluating normalized smoothness index based on systolic blood pressure value and mean arterial pressure.

[The normalized smoothness index and parametric population RDH index of telmisartane in patients with newly diagnosed hypertension and metabolic syndrome]. / Normalizovaný smoothness index a parametrický populacní RDH index telmisartanu u pacientu cerstve zjistenou hypertenzí a metabolickým syndromem.

INTRODUCTION: Ambulatory blood pressure monitoring provides an opportunity to evaluate 24-hour efficacy of once daily preparations. AIMS OF THE STUDY: To evaluate 24-hour efficacy of telmisartane in patients with newly diagnosed hypertension and metabolic syndrome using the parametric population RDH index and normalized smoothness index. PATIENT SAMPLE AND METHODOLOGY: Thirty newly diagnosed hypertonics with metabolic syndrome, sufficiently responding to blood pressure therapy with telmisartane, assessed using sphygmomanometer. Twenty six men, 4 women, mean age of 44 years, body mass index of 31.4 kg. m2, before and after 1 year of therapy. Blood pressure measured with sphygmomanometer and 24-hour ambulatory monitoring (SpaceLabs 90207) according to the criteria of the European Society of Hypertension. Hypertension was defined as sphygmomanometer-measured blood pressure values of more or equal to 130 and/or 85 mm Hg. Fulfilment of at least 3 criteria of metabolic syndrome according to the definition by The Adult Treatment Panel III. RESULTS: The population normalized smoothness index oftelmisartane (+/- standard error of the mean) of 1.00 +/- 0.11 for systolic pressure and 0.84 +/- 0.10 for diastolic pressure. The parametric population RDH index of 24, 24, 0 for systolic pressure and 22, 15, 1 for diastolic pressure. CONCLUSION: Telmisartane at a mean dose of 60 mg once daily showed an adequate 24-hour efficacy in patients with newly diagnosed hypertension and metabolic syndrome responding to treatment, when blood pressure was measured using sphygmomanometer and the effect expressed as the parametric population RDH index and normalized smoothness index based on systolic blood pressure value. We did not prove the full 24-hour efficacy when diastolic blood pressure was used to calculate both indexes.

[The diurnal variability of blood pressure in patients with hypertension and rheumatoid arthritis]. / Diurnální variabilita krevního tlaku u pacientu s hypertenzí a revmatoidní artritidou.

BACKGROUND: The patients with rheumatoid arthritis have high prevalence of hypertension and increased risk of cardiovascular morbidity and mortality. OBJECTIVE: To determine the level of clinical blood pressure (BP) and 24h ambulatory BP in patients with rheumatoid arthritis and hypertension. Analyze the diurnal variability of BP depending on chronic treatment with prednisone, nonsteroidal anti-inflammatory drugs and methotrexate. GROUP OF PATIENTS: 60 patients with clinically stable rheumatoid arthritis and treated or newly diagnosed hypertension. 15 male and 45 female, mean age 58 +/- 11.3 years. RESULTS: Mean clinical systolic BP 139.0 +/- 14.7 mm Hg, diastolic BP 85.7 +/- 6.5 mm Hg and heart rate 74.9 +/- 7.3 beat.min(-1). Mean 24h systolic BP 127.7 +/- 12.6 mm Hg, diastolic BP 77.7 +/- 7.4 mm Hg and heart rate 73.9 +/- 8.7 beat.min(-1). Mean clinical pulse pressure 54.7 +/- 15.6 mm Hg, mean 24h pulse pressure 50.1 +/- 11.6 mm Hg. In the whole group of patients the number of systolic dippers was 28 (47%), nondippers 17 (28%), excesive dippers 11 (18%) and risers 4 (7%), diastolic dippers 27 (45%), nondippers 9 (15%), excesive dippers 22 (37%) and risers 2 (3%). The patients treated with prednisone and nonsteroidal anti-inflammatory drugs were nondippers in 34% both for systolic BP, in 19% and 20% respectively for diastolic BP. They were excessive dippers for systolic BP in 22% and 20% respectively, for diastolic BP in 37% and 38% respectively. In the course of the treatment with methotrexate were 22% patients nondippers for systolic BP and 8% for diastolic BP, 28% was excessive dippers for systolic BP, 47% for diastolic BP. CONCLUSION: Patients with rheumatoid arthritis and hypertension have a slightly increased pulse pressure (55 mm Hg for clinical BP and 50 mm Hg for 24h ambulatory BP) in comparison to arbitrary limits in generally population. Patients treated with prednison and nonsteroidal anti-inflammatory drugs were more often nondippers (34%) in systolic BP than hypertensive control. The patients treated with methotrexate (47%), prednisone (37%) and nonsteroidal anti-inflammatory drugs (38%) were more often excessive dippers in diastolic BP than hypertensive control.

[Definition of 24 hour ambulatory blood pressure values corresponding to office blood pressure values of 130/80 mm Hg]. / Stanovení hodnot 24hodinového ambulantního monitorování krevního tlaku odpovídajících kazuálnímu tlaku 130/80 mm Hg.

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) provides a profile of blood pressure (BP) away from the medical environment and has been shown to be a stronger predictor of cardiovascular morbidity and mortality than office BP measurement. There are known the normal BP values for ABPM in general population with office BP value 140/90 mm Hg, but don't are known normal values for ABPM of patients with high risk hypertension which needs to have office BP below 130/80 mm Hg. AIM OF STUDY: Definition of normal BP value of ABPM in patients with office BP130 and/or 80 mm Hg. METHODS: BP measurement in 241 healthy subjects by ABPM and mercury sphygmomanometer according to European Hypertension Society criteria. Subject selection with following criteria: mean office systolic blood pressure 128-132 mm Hg or diastolic blood pressure 78-82 mm Hg. Exclusion ABPM curves with white-coat hypertension and masked hypertension. All office and ABPM inclusion criteria fulfill 37 subjects for systolic blood pressure, mean age 44 years and 48 subjects for diastolic blood pressure, mean age 45 years. RESULTS: Mean office systolic BP 129.9 +/- 1.6 mm Hg, diastolic BP 80.2 +/- 1.5 mm Hg. Mean 24hour systolic BP 119.1 +/- 12.3 (95% CI, 119.0-119.3) mm Hg, diastolic BP 71.4 +/- 10.2 (95% CI, 71.3-71.5) mm Hg, day time systolic BP 123.7 +/- 9.0 (95% CI, 123.6-123.8) mm Hg, diastolic BP 75.4 +/- 7.0 (95% CI, 75.3-75.5) mm Hg, night time systolic BP 105.8 +/- 10.4 (95% CI, 105.7-105.9) mm Hg and diastolic BP 59.8 +/- 9.0 (95% CI, 59.7-59.8) mm Hg. CONCLUSION: The normal BP value ofABPM in patients with office BP 130/80 mm Hg is for 24hour BP 119/71 mm Hg, day time BP 124/75 mm Hg and night time BP 106/60 mm Hg.

Dynamic QT/RR coupling in patients with pacemakers.

The dynamic coupling between heart rate intervals (RR) and ventricular repolarization (QT) is analyzed. The analysis is based on measurements of 11 patients with pacemaker. In each measurement, there are at least 4 abrupt changes of RR preset by the pacemaker. With such a protocol, RR changes are important and well defined while disturbing factors and noise sources (such as those related with motion of patient) are minimized. The QT/RR coupling was described by 3 parameters (a1, b2, b3) transfer function (TRF) selected on the basis of a statistical analysis of performances of different TRF models. We found that our model is by far the best in its class: with more parameters (higher order models) the residuals remain almost the same while the extra parameters display variability much larger than that of our parameters. For all measurements, our TRF model describes more than 70% of QT variability. Within the patient set, we found interesting differences concerning dynamic non-linearity (response times longer with decreasing RR intervals than with increasing RR).

Blood pressure dynamics in hypertensive subjects during tilt table test.

Blood pressure dynamicity during tilt table measurement is discussed. We analyzed ECG and BP parameters from 14 normotensive young healthy volunteers, 15 old healthy volunteers, and two groups of hypertensive patients--20 non-medicated hypertensive subjects with no other known complications and 21 hypertensive non-medicated subjects with confirmed obesity (according to waist circumference), hyperlipidemia or diabetes mellitus. The dynamic parameters, such as pulse pressure, maximum of derivative BP, difference between maximum and minimum of derivative BP and SBP peak--DBP depression time were obtained from derivative continuous blood pressure signal recordings. We have found that the age factor plays a more significant role in dynamic parameters change and in inter-group differentiation than additional risk factors of hypertensive subjects.

[Increased activity of the sympathetic nervous system and the possibilities for therapeutic influence]. / Zvýsená aktivita sympatiku a moznosti terapeutického ovlivnení.

Breakdown in the function of the autonomic nervous system (ANS) due to chronic stress is very probably one of the main pathophysiological mechanisms in the onset and development of essential hypertension, especially in younger hypertonic patients. The degree of dysfunction can be assessed by means of simple tests such as measurement of resting heart rate. Betablockers are the most effective group for chronic treatment of excessive activity of the sympathetic nervous system.

[The smoothness index of betaxolol hydrochloride in patients with newly diagnosed hypertension]. / Smoothness index betaxolol hydrochloridu u pacientu s terstve zjitenou hypertenzí.

INTRODUCTION: 24-hour ambulatory blood pressure monitoring (ABPM) has a higher predictive value for cardiovascular diseases than occasional blood pressure (BP) measurement with sphygmomanometer. ABPM allows for the assessment of 24-hour effect of drugs administered once a day using the smoothness index (SI) method. OBJECTIVE OF WORK: Find out the 24-hour effect of betaxolol hydrochloride administered once a day by determining the smoothness index. Cohort and methodology: Examination of 30 newly diagnosed hypertonics prior to and after 3-month treatment with betaxolol hydrochloride at an average dose of 15 mg once a day. BP measurement using sphygmomanometer and ABPM (SpaceLabs 90207) according to European Society for Hypertension criteria. Determining the smoothness index from individual average hourly changes in BP after treatment by dividing the hourly values average by standard deviation. Calculation of average SI from individual patient data with standard deviation and 95% confidence interval (95% CI). RESULT: The calculated SI value of betaxolol hydrochloride was 1.03 +/- 0.65 (95% CI, 0.80 to 1.26) and 1.27 +/- 0.89 (95% CI, 0.95 to 1.59) for systolic and diastolic BP, respectively. CONCLUSION: Average SI of betaxolol hydrochloride is higher than 1 when both systolic and diastolic BP is measured. Based on the above parameter, the monitored drug has a sufficient 24-hour effect and can be administered once a day.

[Morin in the therapy of the ischemia-reperfusion damage model of the rat kidney]. / Morin v terapii ischemicko-reperfuzního poskození ledvinné tkáne laboratorního potkana.

The aim of this study was to analyze the protective effects of morin administered during the therapy of reperfusion injury of the laboratory rat kidney. Animals were randomly divided into five groups (n= 10). One group was left intact. Three medicated groups and one placebo group were subjected to ischemia (60 min) and reperfusion of the left kidney. Morin was suspended in a 2 ml of 0.5% Avicel solution and administered orally by a gastric probe at doses of 5, 10, and 20 mg.kg(-1) once a day for 15 days. The placebo group was given only 2 ml of 0.5% Avicel in the same way. On the 15th day, all the animals were exsanguinated and the reperfused kidneys were recovered. Selected biochemical markers in blood were assessed: superoxide dismutase, glutathion peroxidase, total antioxidative capacity, malondialdehyde, creatinine, urea, and uric acid. Creatinine, urea, and total protein were analyzed in urine, and a 24-hour diuresis was recorded. The kidney tissue samples were used for histopathological examination. Morin supported the organism's own defensive reactions against free radicals and decreased lipid peroxidation in the cell membranes and contributed to the recovery of kidney functions. The histopathological results confirm 20 mg x kg(-1) as the most effective dose.

[Prophylactic administration of homoisoflavonoid in ischemic-reperfusion damage of the renal tissue in the laboratory rat]. / Profylaktické podávání homoizoflavonoidu u ischemicko- reperfuzního poskození ledvinné tkáne laboratorního potkana.

The study aimed to examine the antioxidizing effect of homoisoflavonoid in prophylactic administration under the conditions of renal ischemia-reperfusion in the laboratory rat. The pathological model for the in vivo experiment was unilateral renal ischemia-reperfusion of the laboratory rat. The animals were randomized into 5 groups. Homoisoflavonoid was administered to treated groups orally in doses of 5, 10 and 20 mg/kg once a day in 0.5% Avicel solution. The placebo group received Avicel only, and the intact group was without medication and intervention. On day 15 of the experiment, renal tissue ischemia/reperfusion (60/10 mins) was induced in the treated and placebo groups. Then the animals were exsanguinated, biochemical parameters in the blood (superoxidismutase, glutathionperoxidase, total antioxidizing capacity and malondialdehyde) were assayed, and renal samples were withdrawn for histopathological examination. A biochemical examination demonstrated a dependence of the effect of homoisoflavonoid on the dose administered. An obvious effect was demonstrated in the values of GSHPx, AOC, and MDA. On the other hand, a negative dependence was found between the dose of administered homoisoflavonoid and SOD and GSHPx values. The results of biochemical examination correlate with the histopathological pictures of the renal tissue and support the assumption about a protective effect of homoisoflavonoid under the conditions of artificially induced pathological state--renal tissue ischemia-reperfusion.

Noninvasive detection of vessel stiffness from continuous blood pressure recordings in hypertensive subjects.

This paper presents results of blood pressure dynamicity analysis aimed at vessel stiffness detection and subsequent cardiac risk stratification. We analyzed ECG and BP parameters from 12 normotensive young healthy volunteers, 10 old healthy volunteers, and two groups of hypertensive patients -- 12 young non-medicated hypertensive subjects with no other known complications and 16 hypertensive non-medicated subjects with confirmed obesity (according to waist circumference), hyperlipidemia or diabetes mellitus. The dynamic parameters obtained from a derivative continuous blood pressure signal provide additional information about vessel compliance. They can differentiate hypertensive subjects according to the level of cardiovascular risk.

[Primary pulmonary hypertension--aspects of diagnosis and therapy]. / Primární plicní hypertenze--aktuální pohled na diagnostiku a lécbu.

Primary Lung Hypertension is a serious disease of unknown cause. Various genetic, vasoconstriction, proliferation and procoagulation factor participate in etiology and pathogenesis. In establishing the diagnosis it is necessary to exclude secondary, particularly embolic cause of pulmonary hypertension. There are diseases with associated primary pulmonary hypertension. Present therapy improves symptoms of the disease, three years after the diagnosis is established, 75% of patients survive. In the therapy of primary pulmonary hypertension, the recommended drugs are calcium channel blockers, epoprostenol, oxygen therapy and anticoagulant drugs. The new, clinically tested drugs include inhalation and oral analogs of prostacyclins, endothelin receptor antagonists and phosphodiesterase blockers.

Heart rate and increased intravascular volume.

The objective was to establish whether an intravascular volume increase leads to a heart rate (HR) increase without increased sympathetic tonus. HR changes at rest and at deep breathing (6/min - simulated increase of atrial filling pressure) were measured in patients after heart transplantation. Evaluation of dependency of HR changes on breathing depth was done through a new time series methodology. The data was evaluated through graphs displaying a significant increase in the graph area at deep breathing, when compared with breathing at rest (p<0.01). We presume that an increase in HR corresponds to increased intravascular volume and malfunctioning kidneys.

[Prednicarbate and cetirizin dihydrochloride in the treatment of atopic eczema in the acute phase in children]. / Prednikarbat a cetirizin dihydrochlorid v terapii akutní fáze atopického ekzému u detí.

The aim of the study was to monitor the impact of local application of prednicarbat (Dermatop, Hoechst-Biotika) and oral administration of cetirizin (Zyrtec, UCB) on the development of the acute stage of atopic eczema (AE) or acute exacerbation of the chronic form of AE in two groups of patients. Effectiveness and safety of both preparations were being evaluated in 80 children undergoing an outpatient treatment. In the first group, only prednicarbat cream was applied to affected places twice a day for a maximum of 10 days, while in the other group also cetirizin was administered once a day in a dosage according to the patient's age. On the treated places, erythema, infiltrate and excoriation were evaluated with respect to the intensity of manifestation. The results of the study show favourable effects of both preparations on AE development, already during the first days of the therapy. In both groups there was a complete remission of the monitored symptoms in more than 80 per cent of the patients. There was no deterioration of the disease in any patient, and no cases of adverse reactions were registered.

[Effects of carvedilol, a sympatholytic, in experimental alloxan diabetes in laboratory rats]. / Studium úcinku sympatolytika carvedilolu v podmínkách experimentálního alloxanového diabetu u laboratorního potkana.

A possible effect of the sympatholytic carvedilol on alloxan-induced diabetes mellitus in the laboratory rat was examined in experiments. The animals were divided into a group treated with carvedilol in a single daily dose of 10mg/kg in 1 ml of diluting solution i.p and the control group which received only diluting solution in the pertinent amount. The values of malondialdehyde and glucose in the serum, diuresis and total losses of sugar in the urine within 24 hours were estimated and histopathological examination of the kidneys of the treated and control groups was performed. The results show an effect of the tested dose of the drug, primarily in the region the proximal renal tubule.