Clinical evaluation of 24 h ambulatory monitoring of blood pressure under various environmental conditions (home and work versus hospital).

OBJECTIVE: To assess the effects of activity and environment on the spontaneous changes in 24 h blood pressure monitoring (BPM) and how these factors influenced the diagnosis of white-coat hypertension in the hypertensive subjects. PATIENTS AND METHODS: We examined 44 white-collar workers with untreated, uncomplicated mild hypertension, mean age 35 years, twice using 24 h BPM: on the day of natural activity, at home and at work (work-day 24 h BPM); and on the fourth day of hospitalization (hospital-day 24 h BPM). RESULTS: The mean value of blood pressure during activity period in hospital (hospital-day blood pressure) wqas significantly lower than that for ambulatory monitoring day (work-day blood pressure; 132/82 versus 138/85 mmHg). For work-day 24 h BPM the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) from the period 0800-1600 h were substantially higher than the values from 1600-2300 h; for hospital-day 24 h BPM the mean SBP and DBP from two parallel activity periods did not differ significantly. The average office blood pressure of outpatients was 147.9 mmHg for SBP and 92.4 mmHg for DBP. Using the same threshold value of work-day and hospital-day blood pressures < 135/85 mmHg, the prevalence of white-coat hypertension was higher during a hospital day than it was on the work day. Basing our analysis of work-day 24 h BPM, white-coat hypertension was diagnosed in 28% of patients; basing our analysis on hospital-day 24 h BPM it was diagnosed in 49% of patients. mean night SBP and DBP at home and at hospital did not differ significantly. The correlation coefficients for relationship between home-night and hospital-night blood pressures were higher than those for work-day and hospital-day blood pressures (0.6 versus 0.44 for SBP; 0.63 versus 0.56 for DBP).CONCLUSIONS: Modification of the environmental conditions during activity period of men with mild hypertension causes an essential change in values and rhythm of blood pressure during this period, but does not influence the mean night blood pressure. Disregarding this fact during clinical interpretation of the results of 24 h BPM, especially with this group of patients, might be the main cause of a significant mistake in diagnosing white-coat hypertension.

[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.

[Plasma renin activity, aldosterone and adrenergic activity in patients with hypertension and in normotensives with a family history of hypertension]. / Aktywnosc reninowa osocza, aldosteron i aktywnosc adrenegiczna u pacjentów z nadcisnieniem tetniczym i zdrowych osób z obciazeniem genetycznym w tym kierunku.

UNLABELLED: The aim of the study was to analyse plasma renin activity (PRA), aldosterone (Ald) and catecholamines at rest, after psychological stress and physical exercise in patients with essential hypertension (EH) and normotensive persons with (FH +) and without (FH-) family history of hypertension. MATERIALS AND METHODS: 100 men, aged 18-35 years, were investigated: 36 in EH, 32 in FH + and 32 in FH- groups. PRA, Ald and plasma level of adrenaline (A), noradrenaline (NA) and dopamine (D) were estimated at rest, after 30' of stress (Kraepelins test) and at the end and 30, after submaximal ergometric exercise. RESULTS: The groups did not differ in respect to PRA and Ald in all periods of study as well as to A and NA at rest and during stress. A in EH and FH + as well as NA in FH + were significantly higher than FH- at the end and 30 after exercise. D in EH was higher (p < 0.05) than in both normotensive groups and at rest and stress than FH- during exercise and recovery. There were also some correlations between PRA, Ald and catecholamines. In FH + and FH- but not in EH group PRA and Ald positively correlated at rest (r = 0.588 and 0.612) and during stress (r = 0.626 and 0.477). On the contrary in EH as well as FH + groups PRA positively correlated with A (r = 0.385 and 0.368) and NA (r = 0.370 and 0.386) at rest. In addition PRA correlated positively with A during stress (r = 0.368) as well as with NA during recovery (r = 0.313) in FH + groups. Ald correlated with D positively in FH + (r + 0.380) and negatively (r = 0.304) in FH- at rest, whereas Ald was positively correlated with A in EH (r = 0.511) as well as in FH + (r = 0.354) during exercise. CONCLUSIONS: Hypertension and family history of it changes adrenergic reactivity and influences the relationship between plasma renin activity, aldosterone, and catecholamines.

Hypertension and lipids.

Hypertension and hyperlipidaemia are closely interrelated. Both belong to the most important risk factors of cardiovascular disease, with special emphasis on the premature development of atherosclerosis and its complications. The prevalence of both hypertension and hyperlidaemia is high; in the Polish adult population, like in many other countries, it amounts to 20-40% and 60-70%, respectively. The prevalence of hyperlipidaemia in patients with essential hypertension is much higher than in the normotensive subjects and both abnormalities markedly increase the risk of cardiovascular disease. In so called Familial Dyslipidaemic Hypertension, the 16 years mortality rates were 4 times higher than in subjects with dyslipidaemia and hypertension as single risk factors. The present data point to essential hypertension as a metabolic disorder, which may have some pathogenetic links with the derangement of lipid metabolism. According to the recent results, only about 15% of all hypertensives do not exhibit metabolic disturbances. One of the most important topics in this respect is the influence of antihypertensive drugs on metabolic factors, with special reference to lipid metabolism. Some of these drugs may have unfavourable action on lipid variables, while other are neutral or even beneficial. These differences may have great impact on the therapeutic approach to hypertensive patients and form the basis for the concept of individualized therapy of hypertension. The goal of antihypertensive therapy is not only to lower the blood pressure but also to influence all other factors which may be significant for the prognosis. Only such an integrated approach may prevent atherosclerotic complications and reduce the risk of cardiovascular morbidity and mortality.

[Renovascular hypertension--clinical observations and long-term follow-up]. / Nadcisnienie naczyniowo-nerkowe--obserwacja kliniczna i odlegle wyniki leczenia.

Renovascular hypertension is one of the most common causes of secondary hypertension. Its early diagnosis is particularly important, firstly because it is one of the few potentially reversible causes of chronic renal failure. In many centers, including our own, renal angioplasty (PTA) or surgery is the treatment of choice for patients with renovascular hypertension. The aim of the study was the evaluation of the early and late results of PTA versus renovascular surgery. The diagnostic procedures and clinical course of renovascular hypertension were also analyzed. Among patients with renovascular hypertension treated in our Department during the 1981-1993 years, 89 patients (46 men, 43 women) were diagnosed and having renovascular hypertension (3% of all hypertensive patients). The average duration of hypertension in this group was 5 years. High incidence of accelerated hypertension (18%) and cardiovascular complications were observed: myocardial infarction in 20.2% of cases and stroke in 4.5%. The presence of renal failure was found in 22.5% of cases, hypokalemia in 11.2%, 38.3% of patients had changes in other arteries. Renal angioscintigraphy and captopril renal scintigraphy were performed in accordance with renal arteriography in 80% of patients. Arteriography showed unilateral renal artery stenosis in 78.7% of patients and bilateral - in 21.3%. The most common cause of renovascular hypertension in our material was atherosclerosis (65.2%). Fibromuscular dysplasia and Takayasu arteritis were diagnosed less frequently (25.8% and 9.0% respectively). Forty four patients were treated with PTA, 15 underwent surgical revascularization and 11 - unilateral nephrectomy. Early beneficial therapeutic effect (normalization or improvement of blood pressure control) was observed in 88.6% for PTA and 66.7% for surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Doxazosin (alpha 1-adrenoreceptor antagonist) used in primary hypertension and it's beneficial effect on lipid metabolism]. / Doksazosyna (bloker alfa 1-receptorów) skuteczny lek w nadcisnieniu pierwotnym o korzystnym wplywie na gospodarke lipidowa.

The aim of the study was to investigate the effect of a new selective alpha 1-adrenoreceptor blocker doxazosin on blood pressure, serum lipids and lipoproteins in patients with essential hypertension. The study was done in 32 out-patients with mild-to-moderate hypertension (22 men and 10 women, mean age 45.6 +/- 10.1). After 2-week placebo period the patients were given doxazosin in increasing doses from 1 to 8 mg daily for 6 to 14 weeks (mean daily dose 2.24 +/- 1.6 mg). Twenty-nine patients completed the study. The active treatment caused highly significant drop in systolic and diastolic blood pressure both in supine and standing positions. No orthostatic hypertension was noted. There was also a statistically significant decrease in serum total cholesterol, VLDL-cholesterol, and triglyceride levels and increase in the positive prognostic lipid indicators. HDL3-cholesterol and apolipoprotein AI levels as well as HDL/total cholesterol ratio. Accordingly, the statistically significant decrease of the so called atherogenic index was noted. The drug was well tolerated and only one patient dropped from the study because of side effects. The authors conclude that doxazosin appears to be an effective and well tolerated antihypertensive drug with a favorable effect on lipid metabolism. It may be particularly useful in hypertensive patients with coexisting lipid abnormalities.

[A difficult diagnostic case of malignant hypertension]. / Trudny diagnostycznie przypadek nadcisnienia zlosliwego.

A case of a 62-year old male with malignant hypertension was described. The clinical picture was dominated by the presence of cachexia, polyuria and polyneuropathy. Laboratory examinations revealed highly elevated sedimentation rate, hyponatremia and hypokalemia. Secondary hypertension as well as other diseases with similar clinical symptoms were excluded basing in diagnostic procedures. The authors discuss pathophysiological mechanisms on the base of abnormally elevated activity of the renin-angiotensin-aldosterone system. Unusual body weight loss (approximately 20 kgs), polyneuropathy and irreversible lesion of renal tubules without renal function impairment are emphasized.

[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.

Decreased plasma dehydroepiandrosterone sulfate and dihydrotestosterone concentrations in young men after myocardial infarction.

Plasma levels of dehydroepiandrosterone sulfate (DHEA-S), testosterone, dihydrotestosterone (DHT) androstenedione, sex hormone-binding globulin (SHBG), lipoproteins, apolipoproteins and high density lipoprotein (HDL) subfraction were measured in 32 men aged 26-40 years after myocardial infarction (MI) suffered at least 3-4 months prior to the study, who were normocholesterolemic and had angiographically demonstrated coronary occlusion. The control group consisted of 76 healthy men aged 25-40 years. Blood samples were obtained in the morning from fasting subjects. A significant decrease in plasma DHEA-S and DHT levels were found in MI patients. Also, a significant decrease in HDL-cholesterol, HDL2-cholesterol (HDL2-C) and apolipoprotein A-I, an increase in apolipoprotein B and LDL-cholesterol (LDL-C) levels were observed in those patients as compared with healthy men. However, there were no differences in testosterone, androstenedione and SHBG concentrations between the groups. Significant correlations between testosterone and HDL2-C (r = 0.46, P less than 0.01), as well as between DHEA-S and HDL3-C (r = 0.39, P less than 0.05) levels in MI patients were observed. These results suggest that decreased levels of plasma DHEA-S and DHT may promote the development of coronary atherosclerosis in men.

[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.

[Minipress in the treatment of arterial hypertension in light of results from a multicenter study. I. 3-month treatment: monotherapy versus combination treatment]. / Minipress w terapii nadcisnienia tetniczego w swietle wyników badan wieloosrodkowych. I. Leczenie 3-miesieczne: monoterapia a leczenie skojarzone.

Multicenter study of the effectiveness and safety of prazosin (Minipress) in patients with arterial hypertension was carried out in 15 medical centers. Of 366 patients who entered the study, 328 persons satisfying all the protocol conditions were included into the final analysis. The treatment lasted 3 months. Highly significant decrease of systolic and diastolic blood pressure was obtained in all periods of observation. In about two-thirds of patients Minipress was effective as a single drug and in the remaining persons the decrease of blood pressure was achieved using prazosin in combination with other antihypertensive drugs. Patients requiring combination therapy were almost 2 years older (however, the difference was not significant), had higher initial blood pressure and greater body mass. Mean daily doses of Minipress in the monotherapy and combination treatment were 5.6 and 10 mg, respectively. Side effects were observed in 27% of patients, but only in 5% they were the cause of drug withdrawal.

[Minipress in the treatment of arterial hypertension in light of results from a multicenter study. II. Results of long-term monotherapy]. / Minipress w terapii nadcisnienia tetniczego w swietle wyników badan wieloosrodkowych. II. Wyniki dlugotrwalej monoterapii.

Of 218 patients with arterial hypertension, who responded to monotherapy with prazosin (Minipress) during the first 3 months, 178 persons completed the 12-month treatment according to the study protocol. In 9 patients (4.1%) treatment was discontinued because of increase of blood pressure and/or side effects. In the remaining cases patients did not apply for the control examination or the obtained records were incomplete. During all periods of treatment the mean values of systolic and diastolic blood pressure were significantly lower than the corresponding initial values. No significant symptoms of drug tolerance were observed. Mean daily dose of Minipress after 12 months was 5.9 in comparison with 5.6 mg after 3-month therapy. Normal systolic and diastolic pressures at the end of treatment were found in 114 (64%) and 153 (86%) patients, respectively. Full normalization of blood pressure (less than or equal to 140/90) was achieved in 105 (59%) patients. It was found that an important factor determining the antihypertensive effectiveness of Minipress is the initial blood pressure. The inverse correlation between the decrease of systolic pressure and age was found, whereas the age did not affect requiring the drug withdrawal occurred in 27 (14.4%) patients; they were usually the efficacy of Minipress in relation to diastolic blood pressure. Side effects not of moderate intensity and transient character.