[Primary hypertension, positive family history and pregnancy]. / Nadcisnienie tetnicze pierwotne, obciazenie rodzinne nadcisnieniem--a ciaza.

The greatest belief that the group of patients with primary hypertension is heterogeneous and the progress which took place in the last few years in the research study concerning primary hypertension induced to recapitulation of the given data to asses the influence of the primary hypertension on the pregnant woman and the fetus. The study presented with clinical data claims that 50% of women with mild and moderate primary hypertension showed spontaneous reduction of blood pressure levels in the first months of pregnancy. The results should be taken under consideration when treating the hypertension. Simultaneously, at present the medicine does not posses the ability to indicate the type of hypertension which manifests itself in the second half of pregnancy, it is being proposed to monitor the evaluation of the renin-angiotensin-aldosterone system during pregnancy, as being helpful to the physician. All the study concerning the activity of the RAA system during pregnancy with the pregnancy induced hypertension showed remarkably lower growth levels with the gestational age unlike the pregnancy with the primary hypertension. The mild as well as moderate primary hypertension does not implicate any danger to the woman nor the fetus. But the simultaneous incidence of the pregnancy induced hypertension deteriorates the prognosis for both the woman and the fetus. The most sensitive prognostic factor for the pregnant woman with primary hypertension is the evaluation of the blood pressure levels in the first half of pregnancy. The study also covers the importance of the arterial hypertension family history among both healthy and those with primary hypertension pregnant women.

The efficacy and tolerability of losartan versus atenolol in patients with isolated systolic hypertension. Losartan ISH Investigators Group.

OBJECTIVE: To compare the efficacy and tolerability of angiotensin II (Ang II) antagonist losartan and the beta-blocker atenolol in the treatment of patients with isolated systolic hypertension (ISH) after 16 weeks of treatment. METHODS: A double-blind, randomized, multi-country study was carried out in 273 patients with ISH. Patients with a sitting systolic blood pressure (SiSBP) of 160-205 mmHg, and a sitting diastolic blood pressure (SiDBP) < 90 mmHg at screening and at placebo baseline were subjected to a 4-week placebo period and then randomly grouped to receive 50 mg losartan or 50 mg atenolol once daily for 16 weeks. At 8 and 12 weeks, patients not controlled (SiDBP > or = 160 mmHg) were given additional treatment of 12.5 mg hydrochlorothiazide (HCTZ) once daily. RESULTS: Similar significant reductions in SiSBPs (mean +/- SD) were obtained with 50 mg losartan and 50 mg atenolol, from 173.7 +/- 10.3 and 173.5 +/- 10.7 mmHg at baseline to 149.0 +/- 15.5 and 148.2 +/- 15.3 mmHg after 16 weeks of losartan or atenolol treatment respectively. Sixty-seven percent of the losartan-treated and 64% of the atenolol-treated patients remained on monotherapy throughout the study. Only 1.5% of the losartan-treated patients withdrew because of a clinical adverse event (CAE) compared with 7.2% in the atenolol-treatment group (P= 0.035). Drug-related CAEs were observed significantly more frequently with atenolol than with losartan treatment (20.3 versus 10.4%; P = 0.029). CONCLUSION: It is concluded that 50 mg losartan and 50 mg atenolol produced comparable reductions in SiSBP in patients with ISH but losartan was better tolerated. This is the first demonstration of the therapeutic value of selective Ang II receptor blockade with losartan in the treatment of ISH.

[Controlled release diltiazem in monotherapy of hypertension--time of drug administration and circadian blood pressure pattern]. / Diltiazem o kontrolowanym uwalnianiu w monoterapii pierwotnego nadcisnienia tetniczego--pora dnia zazycia leku a rozklad dobowy wartosci cisnienia tetniczego.

30 patients with primary mild to moderate hypertension (DBP 95-110 mm Hg) were treated with long acting diltiazem (120 or 240 mg) once daily in the morning (7.00-8.00 a.m.) for at least 3 weeks and after that the administration time was changed to evening dose (19.00-20.00 p.m.) for next 3 weeks. 24-hours ABPM was performed in all patients on the last day of each period. Obtained recordings were compared in different periods of time: total 24 hours, 6.00-23.00, 23.00-6.00, 4.30-8.00, 5.00-11.00, 20.00-2.00. Mean values of systolic and diastolic blood pressure, heart rate and pressure load (defined as percentage of records above 140/90 mm Hg in day and above 120/80 mm Hg at night) did not differ significantly between investigated dosage regimens. The evening administration of diltiazem did not produce greater decrease of BP at night than the morning dose. For this reason slow release formulation of diltiazem (oxycardil in doses of 120 to 240 mg) can be safely administered in the evening if needed.

[Salt taste perception in women during physiological pregnancy]. / Percepcja smaku slonego u kobiet w okresie ciazy fizjologicznej.

The authors studied a sensory intensity response to sodium chloride (NaCl) and a sensory hedonic response to salt in suprathreshold concentrations in 120 healthy primigravidas (age: 20-40) during three trimesters of physiological pregnancy, and in 22 healthy nonpregnant women of the same age examined on the 7th or 8th day of the menstrual cycle. In all the periods covered by the study, pregnant women have manifested a tendency to a lower intensity response to all concentrations in comparison with nonpregnant women. The weakening of the response has become statistically significant in the second trimester--with respect to low concentrations, and at the final stage of pregnancy--with respect to medium concentrations. The sensory hedonic response in pregnant women has been increasing along with the age of the fetus. In comparison with the response of nonpregnant women, pregnant women have shown a tendency to the intensified response in all the periods covered by the study.

[Dyslipoproteinemia in primary hypertension]. / Dyslipoproteinemia w pierwotnym nadcisnieniu tetniczym.

The aim of the study was the estimation of the lipid profile and prevalence of dyslipoproteinemia in patients with essential hypertension. The study group consisted of 108 outpatients (61 men and 47 women) with mild to moderate hypertension (HT), aged 35-64, who did not receive antihypertensive drugs for at least four weeks. The matched controls (MC) were randomly chosen for each HT patient from population of Warsaw inhabitants, covered by Pol-MONICA II screen. The concentrations of total cholesterol (CH) and triglycerides (TG) in serum and cholesterol in lipoprotein fractions and subfractions (LDL, HDL, HDL3) were measured by enzymatic methods. The levels of apolipoproteins (Apo A-I, Apo B) were estimated by immunoassay. Laboratory was under control of WHO-Lipid Reference Laboratory and CDC-NHLBI Lipid Standardization Program. In HT the concentration of cholesterol in LDL was significantly higher (p < 0.001) than in MC, both in men (by 15%) and in women (by 22%), but the concentrations of cholesterol in HDL and HDL3 and Apo A-I (in men only) were significantly lower (p < 0.001) in HT than in MC in men (by 21% and by 26%) as well in women (by 16% and by 25%). Also in HT group the mean levels of TG, CH and Apo B were higher than in MC, but these differences were significant only in TG level in men. In HT group the prevalence of normolipemia was twice lower than in MC (22% and 42%). Essential hypertension fractions is associated with abnormal levels of some lipoprotein fraction and with higher prevalence of hyperlipoproteinemia. The coexistence of both abnormalities may be particularly detrimental as important factor in the development of atherosclerosis.

[Comparative studies on the effects of propranolol and acebutolol on blood pressure, serum lipids and lipoproteins in patients with primary hypertension]. / Porównawcze badania nad wplywem propranololu i acebutololu na cisnienie tetnicze oraz lipidy i lipoproteiny surowicy w nadcisnieniu tetniczym pierwotnym.

A comparative studies on the effect of propranolol and acebutolol on blood pressure, cardiac function, blood serum lipids and lipoproteins were carried out in 48 patients with the primary hypertension double-blind method was applied. Tested drugs were given for 12 weeks. It was found, that both drugs are potent and comparable hypotensive agents normalizing blood pressure in the majority of treated patients. No significant difference in the effect on heart rate and adverse reactions has been noted. Acebutolol did not change lipid metabolism parameters whereas propranolol slightly but statistically significantly increased serum triglycerides.

[Individual reactions and psychophysiologic reactions in patients with mild primary hypertension]. / Reakcje osobowosci i psychofizjologiczne reakcje u chorych na lagodne nadcisnienie tetnicze pierwotne.

Fourteen male patients with mild hypertension, aged between 20 and 46 years (mean = 32.4 years) measured their arterial blood pressure thrice daily for 6 weeks. Prior to and after this period psychological tests were carried out, including Gough's ACL test and Spielberger's STAI questionnaire. All patients underwent also Kraeplin's test under stress conditions twice during the experiment. It was found that there is significant correlation of personality response syndromes such as: need for acceptance, inferiority complex, need for success, trust to themselves, anger and some values of blood pressure. So-called personality syndrome related to hypertension was established. Psychophysiological picture accompanying emotional stress was discussed and relationship between blood pressure values (prior to and after emotional stress) and personality syndromes were defined.

[Hypotensive effectiveness and metabolic effects of indapamide in patients with primary arterial hypertension]. / Skutecznosc hipotensyjna i wplywy metaboliczne indapamidu u chorych na nadcisnienie tetnicze pierwotne.

Indapamide--a non-thiazide diuretic agent--was given to 28 patients with mild and moderate hypertension in a daily dose of 2.5 mg for 12 weeks. Statistically significant decrease in both systolic and diastolic blood pressure and complete normalization of the arterial blood pressure were achieved in 82% of the treated patients. Adverse reactions were mild and transient. However, low but statistically significant decrease in blood serum potassium and changes in the carbohydrate metabolism were seen. No significant effect of the-drug on lipid metabolism was found except the low but statistically significant increase in total cholesterol. Indapamide is an efficient and well tolerated hypotensive agent. However, biochemical indices should be checked up during the treatment due to the potential adverse reactions.

[Ambulatory 24-hour blood pressure monitoring in patients with resistant hypertension]. / Rejestracja 24-godzinna cisnienia tetniczego krwi u chorych z tzw. Opornym nadcisnieniem tetniczym.

The aim of the study was to assess the usefulness of 24-hour blood pressure (BP) and heart rate (HR) monitoring in patients with "resistant" hypertension. 30 patients (44.1 +/- 9.9 years) with diastolic BP 100 mm Hg or more in spite of treatment with three or more antihypertensive drugs were studied. Ambulatory recording of BP and HR was performed by means of Del Mar Avionics monitoring system 9000. Mean recording time was 21.5 hours and mean number of measurements during one recording--56.7. Mean ambulatory systolic and diastolic BP values were significantly lower than mean value of three casual measurements (146.0 +/- 24.6 vs 171.5 +/- 21.2 mm Hg for systolic and 97.2 +/- 11.3 vs 110.4 +/- 7.5 mm Hg for diastolic BP p less than 0.01) In 14 (46.6%) systolic BP and in 10 patients (33.3%) diastolic BP were normal. The patients with normal and abnormal ambulatory BP recordings did not differ in regard to age and mean clinic BP levels. However, patients with abnormal ambulatory BP recordings were more often overweight and showed a greater frequency of left ventricular hypertrophy and family history of hypertension and its complications. The results of the study show that ambulatory BP monitoring may be of value in assessing the response to antihypertensive treatment in patients with so called resistant hypertension as judged on the basis of clinic pressure.

[Twenty-four hour automatic recording of blood pressure and cardiac rhythm in patients with borderline hypertension]. / Calodobowa automatyczna rejestracja cisnienia tetniczego krwi i rytmu serca u chorych z granicznym nadcisnieniem tetniczym.

The aim of the study was to evaluate the usefulness of 24-hour automatic recording of blood pressure and cardiac rhythm in patients with borderline hypertension. The study was performed in 50 patients aged 38.8 +/- 13.1 using the Del Mar Avionics device. Mean time of recordings was 21.3 hours, and the mean number of blood pressure measurements per one patient was 52.4. Great fluctuations of systolic blood pressure (from 92.1 +/- 12.6 to 191 +/- 37.0 mm Hg) and diastolic one (from 57.3 +/- 11.4 to 118.9 +/- 13.8 mm Hg) were observed. Mean systolic blood pressure (125.6 +/- 10.6 mm Hg) was significantly lower than the mean value of last three ambulatory measurements (141.9 +/- 9.8; p less than 0.001). Also mean diastolic pressure was lower than that obtained in the out patient clinic (84.7 +/- 9.7 vs 91.9 +/- 3.2 mm Hg; p less than 0.001). Mean heart rate during the day was 86.2 +/- 10.7 and at night 69.7 +/- 10.5 beats per minute. Ventricular and/or supraventricular cardiac arrhythmias were observed in 14 (28%) of examined patients. Results of the study indicate, that 24-hour automatic blood pressure recording is the valuable method, affording possibilities for more precise estimation of blood pressure and its 24-hour fluctuations in patients with borderline hypertension.

Taste perception of sodium chloride in suprathreshold concentration related to essential hypertension.

The object of this study was to test taste responsiveness and taste preferences for NaCl in suprathreshold concentrations in hypertensive individuals. The investigations were carried out in 52 patients with essential hypertension (HT) and 46 normotensive (NT) control subjects. Two types of taste response were tested: (a) an intensity response, and (b) a hedonic (pleasantness) response to NaCl stimuli of 0.08-0.96% concentration. Intensity and hedonic responses were collected using an unstructured linear scale and a nine-point interval scale, respectively. The intensity slope for HT tended to be consistently flatter than the slope for NT. Lower intensity response was more pronounced in HT males. The hedonic responses of HT and NT subjects were split into three subgroups: 'up' (concentration increases, pleasantness increases), 'down' (concentration increases, pleasantness decreases), and 'up-and-down' (concentration increases, pleasantness--). Diversity of response was also observed in the control NT group. The conclusion was that essential hypertension seems to depress the intensity response to NaCl, especially in men, but the pattern of hedonic response to a growing concentration of NaCl is influenced by factors other than hypertension.