Cardiovascular indices of peripheral and central sympathetic activation.

OBJECTIVE: A number of sympathetic nervous system (SNS) parameters have been used in cardiovascular psychophysiology. This study aimed to describe the pattern and redundancy of a set of SNS parameters during peripherally induced changes of cardiac sympathetic activation and reflex modulation of central SNS control. Preejection period (PEP) was assessed as a marker of peripheral sympathetic activation. Low-frequency blood pressure variability (BPV) was assessed as an estimate of central SNS control. METHODS: Peripheral beta-sympathetic stimulation and blockade were achieved with epinephrine and esmolol hydrochloride (beta1-blockade), respectively. Changes in central SNS output were induced by loading and unloading arterial baroreceptors with norepinephrine and nitroprusside sodium, respectively. This single-blinded, crossover study in 24 healthy men also included two placebo control periods. PEP was derived from impedance cardiography and adjusted individually for heart rate. BPV was calculated by power spectral analyses of beat-to-beat heart rate and systolic blood pressure (Finapres system) data. RESULTS: PEP decreased during epinephrine infusion (-40.1 +/- 3.8 ms, p <.0001) and increased during esmolol infusion (+6.6 +/- 3.5 ms, p =.05). PEP was shortened after central SNS activation by nitroprusside (-16.8 +/- 2.9 ms, p < 0.0001). Systolic BPV in the low-frequency range (0.07-0.14 Hz, Mayer waves) increased during nitroprusside infusion (+0.44 +/- 0.19 ln mm Hg(2), p =.03) and decreased during norepinephrine infusion (-0.67 +/- 0.13 ln mm Hg(2), p < 0.0001). Low-frequency BPV did not change significantly during epinephrine or esmolol infusion. CONCLUSIONS: Our data provide empirical evidence of separable peripheral and central sympathetic response components. The combined report of low-frequency BPV and PEP gives distinct information on both central SNS control and the level of sympathetic cardiac activation achieved.

Chest pain early after percutaneous coronary intervention: incidence and relation to ECG changes, cardiac enzymes and follow-up events.

To investigate the incidence of chest pain early after percutaneous coronary interventions and its correlation with ECG changes, cardiac enzymes, clinical and procedural variables and follow-up events, we prospectively studied 199 patients (84% male; mean age, 60.1 +/- 9.4 years) after primary successful percutaneous coronary interventions (21% PTCA; 79% additional stent implantation). During the first 16 hours following the intervention, the occurrence of chest pain was noted, ECGs were recorded and serial measurements of cardiac enzymes were performed. Seventy-six patients (38%) with elevated enzyme levels at time 0 were excluded. A clinical follow-up was obtained at 6 months. Forty patients (32.5%) experienced chest pain; new ECG changes were detected in 3 (2.5%). The mean levels of all enzymes were significantly higher in patients with chest pain 16 hours after the intervention. In patients with chest pain versus those without, CK-MB mass and troponin I levels higher than twice the upper normal limit were seen in 43.6% versus 11.0% (p < 0.0001) and 45.0% versus 17.3% (p < 0.002), respectively. Elevated troponin I (< 0.004) and CK-MB mass (< 0.04) as well as presumed ischemic chest pain (< 0.03) could be identified as risk factors for recurrent chest pain during follow-up. In conclusion, chest pain was common early after percutaneous coronary interventions and correlated with elevated cardiac enzymes, suggesting peri-interventional myocardial necrosis. Elevated levels of CK-MB mass and troponin I, as well as presumed ischemic chest pain, were associated with recurrent chest pain during follow-up.

Effects of losartan titrated to Losartan/Hydrochlorothiazide and amlodipine on left ventricular mass in patients with mild-to-moderate hypertension. A double-blind randomized controlled study.

To study the effects of the angiotensin II receptor antagonist Losartan and Amlodipine on left ventricular mass (LVM), we performed blood pressure measurements and transthoracic echocardiographies at baseline. After a 4-week placebo run-in period, 25 patients with mild-to-moderate essential hypertension were randomly allocated to active treatment with Losartan 50 mg titrated to Losartan 50 mg/hydrochlorothiazide (HCT) 12.5 mg (n = 11) or Amlodipine 5 mg titrated to 10 mg (n = 14) for 16 weeks. After treatment, blood pressure decreased significantly in both groups. LVM and LVM index (mean +/- SD/median) in the Losartan group at baseline were 311 +/- 101/288 g and 163 +/- 55/150 g/m(2) and decreased significantly to 252 +/- 25/255 g and 133 +/- 22/128 g/m(2) (p = 0.003 for LVM; p = 0. 01 for LVM index) after 16 weeks of active treatment. In the Amlodipine group LVM and LVM index decreased from 259 +/- 47/243 g and 136 +/- 25/ 131 g/m(2) to 240 +/- 42/234 g and 126 +/- 24/123 g/m(2) (n.s.). In conclusion, LVM decreased significantly as early as 16 weeks after initiation of antihypertensive treatment with the Angiotensin II antagonist Losartan.

Effects of losartan titrated to losartan/hydrochlorothiazide and amlodipine on blood pressure and peripheral capillary microcirculation in patients with mild-to-moderate hypertension.

OBJECTIVE: To measure the effects of losartan and amlodipine on peripheral capillary microcirculation in hypertension. SETTING: Medical out-patient clinic, Basel, in a university teaching hospital. METHODS: After a 4-week placebo run-in period 20 patients aged 50 +/- 8 (range 36-65) years with mild-to-moderate hypertension were randomly allocated to receive active treatment with losartan 50 mg titrated to losartan 50 mg/hydrochlorothiazide (HCT) 12.5 mg, or amlodipine 5 mg titrated to 10 mg for a 12 week period. Titration was performed if diastolic blood pressure (BP) was > or=90 mm Hg after 6 weeks of treatment. BP measurements as well as video capillary microscopy of the finger nailfold at the end of the placebo period and after 12 weeks of active treatment were compared. Capillary blood cell velocity was measured at rest and immediately, 1 min and 2 min after local finger cooling. RESULTS: After 3 months of treatment with amlodipine (n = 10) and losartan titrated to losartan-HCT (n = 10) sitting BP decreased significantly from 160 +/- 7/103 +/- 4 mm Hg and 147 +/- 7/98 +/- 6 mm Hg to 131 +/- 10/86 +/- 7 mm Hg and 134 +/- 17/89 +/- 9 mm Hg, respectively (P < 0.01). After local finger cooling the area under the curve (AUC) of capillary blood cell velocities was 1.13 +/- 0.58 mm (median +/- s.d.) at baseline and increased to 1.94 +/- 1.15 (P < 0.05) in losartan/losartan-HCT treated patients. In amlodipine treated patients the increase in AUC of capillary blood cell velocity did not reach the level of statistical significance (1.59 +/- 1.36 to 2.14 +/- 1.05 mm). CONCLUSION: This small trial shows that the area under the curve of capillary blood cell velocity increases in hypertensive patients treated with both losartan/losartan-HCT and amlodipine compared with baseline values.

[HIV prevention in Turkish immigrants in a general internal medicine outpatient service]. / HIV-Prävention bei türkischen Immigranten in einer allgemeininternistischen Poliklinik.

This study investigates the level of knowledge about mechanisms of HIV transmission and risk behaviour for HIV infection in Turkish immigrants in Basel, Switzerland. In addition, the effectiveness of physician based HIV counseling in a general internal medicine outpatient clinic was evaluated. Two consecutive samples of 150 and 98 Turkish patients with a first clinic contact, were recruited 6 months apart. The first group was exposed to an interpreter assisted counseling on HIV prevention (intervention group), the control group received no systematic counseling. Knowledge about mechanisms of HIV transmission and risk behaviour for HIV infection was assessed by a 29 item questionnaire at baseline and by interview at follow-up. One year follow-up was possible in 49% of the patients. At baseline, Turkish patients had statistically significant lower global scores on knowledge about HIV than a second control group of 148 Swiss patients. Mean percentage scores of correct answers in the whole Turkish study population improved from 49.3% to 60.0% (p < 0.0001). However, the difference of gained knowledge between intervention and control groups was only of borderline significance (p = 0.059). Study design and low follow-up limit conclusions from this study. From 1992 to 1994 knowledge about HIV infection had improved in Turkish patients, but was still inferior to the knowledge of Swiss patients.

[Reproducibility of fasting serum cholesterol and triglycerides in ambulatory patients with mixed hyperlipidemia]. / Reproduzierbarkeit von Nüchtern-Serumcholesterin und Triglyzeriden bei ambulanten Patienten mit gemischter Hyperlipidämie.

Intraindividual variability of serum lipid concentrations in normal volunteers and in patients with hyperlipidemia is substantial. The aim of this study was to investigate prospectively the reproducibility of fasting serum triglyceride and total cholesterol concentrations in primary health care patients with combined hyperlipidemia, i.e. under conditions of daily medical practice. Secondary forms of hyperlipidemia were excluded. 19 general medical outpatients with primary combined hyperlipidemia were studied. Serum total cholesterol and triglyceride concentrations were measured after an overnight fast at 08.00 h 4 times at weekly intervals. To study the influence of alcohol intake on serum lipid concentrations, total cholesterol and triglycerides were measured without alcohol influence and 12 hours after consumption of a mean of 100 g alcohol in the evening. In 19 patients (10 males, 9 females, mean age 55 years, body mass index 27.9 +/- 4.4 kg/m2), mean +/- SD of serum triglycerides was 3.97 +/- 1.8 mmol/l and of total cholesterol 7.9 +/- 1.8 mmol/l. The combined intraindividual and interassay coefficient of variation was 18.7 +/- 8.2% for triglycerides and 5.1 +/- 2.5% for total cholesterol. Fasting serum triglycerides (3.5 +/- 1.1 vs. 3.7 +/- 1.4 mmol/l) and total cholesterol (7.6 +/- 1.4 vs. 7.8 +/- 1.0 mmol/l) did not significantly change 12 hours after acute alcohol consumption. Patients with primary combined hyperlipidemia in a primary health care setting show small intraindividual variations of overnight fasted serum triglyceride and total cholesterol concentrations. Moderate alcohol consumption 12 hours before blood sampling does not significantly affect triglyceride and cholesterol values.

Influence of method of reporting study results on decision of physicians to prescribe drugs to lower cholesterol concentration.

OBJECTIVE: To determine whether the reporting of study results by using reductions in relative or absolute risk and the number needed to treat affects the views of physicians about the effectiveness of drugs to lower lipid concentrations and decisions about treatment. DESIGN: Random allocation of two questionnaires presenting the results of three end points of the Helsinki heart study as results from separate trials by using reduction in either relative or absolute risk. In both questionnaires one end point was also presented by showing person years of treatment needed to prevent one myocardial infarction. The effectiveness of lipid lowering drugs was assessed for all end points on an 11 point scale. For each study result the likelihood to treat hypercholesterolaemia of 7.5 mmol/l in a healthy man had to be indicated on a seven point scale. SUBJECTS: Random sample of 802 internists and general practitioners representative of providers of primary care in Switzerland. RESULTS: The response rate was 69.6% (558). For the prevention of fatal and non-fatal myocardial infarction the mean ratings of effectiveness of lipid lowering drugs were 0.45 (95% confidence interval 0.21 to 0.69) and 1.39 (1.09 to 1.68) scale points lower when the reduction of absolute risk or number needed to treat were reported instead of the relative risk reduction (both P < 0.001). Physicians receiving trial results for identical end points in form of absolute reduction of risk or number needed to treat were less inclined to treat hypercholesterolaemia (both P < 0.001). CONCLUSIONS: Physicians' views of the effectiveness of lipid lowering drugs and the decision to prescribe such drugs is affected by the predominant use of reduction of relative risk in trial reports and advertisements.

[Compliance of asylum seekers with an expanded border health screening program in the Basel-Stadt canton 1992-1993]. / Compliance von Asylbewerbern mit der erweiterten grenzsanitarischen Untersuchung im Kanton Basel-Stadt 1992-1993.

In 1992, the Swiss Public Health Office introduced an expanded tuberculosis screening program for refugees. In addition to routine chest X-rays, it includes tuberculosis skin testing and prophylactic treatment with isoniazid of skin test positive individuals. In addition, a vaccine program has been established which, besides routine hepatitis B vaccination of anti-HBc negative individuals, includes vaccination of all refugees against tetanus, diphtheria, polio, measles, mumps and rubella. The two-year experience of this expanded program is reported from Canton Basel-Stadt, Switzerland. During the two-year period (1992 to 1993), 289 adults and 53 children were screened. In 3.1% (n = 9) of 289 refugees who were examined by X-ray, smear positive tuberculosis was found. These 9 cases contributed 12% of all tuberculosis cases identified in Canton Basel-Stadt during the observation period. In 4.4% of all refugees prophylactic treatment with isoniazid was initiated, but 7 of the 15 cases (46.6%) did not complete the prophylaxis. In contrast, compliance with the vaccine program was better and complete vaccination was achieved in 90% of all refugees. The prevalence of anti-HBc antibodies was 28.7% and highest among refugees from Turkey (48.6%) and Africa (34.2%). X-ray screening for tuberculosis in high risk populations such as refugees is effective. However, compliance with 6 months' prophylactic treatment with isoniazid for skin test positives was only moderate.

Efficacy and tolerability of 5 mg of cilazapril plus 12.5 mg of hydrochlorothiazide in mild-to-moderate hypertension: results of 24-hour ambulatory blood pressure monitoring.

The efficacy and tolerability of a fixed combination of 5 mg of cilazapril and 12.5 mg of hydrochlorothiazide against hypertension was evaluated in 36 patients (26 men and 10 women) between 33-68 years old. Twenty-two had newly diagnosed hypertension and 14 had previously treated hypertension. Twenty-four-hour noninvasive ambulatory blood pressure monitoring (ABPM) was performed after a 2-week washout period. Measurements were taken at 20-min intervals during the day (from 8 a.m. to 10 p.m.) and at 30-min intervals during the night (from 10 p.m. to 8 a.m.). Patients with a mean diastolic daytime pressure of > or = 90 < 115 mg Hg were then given 5 mg of cilazapril plus 12.5 mg of hydrochlorothiazide once daily between 6 a.m. and 8 a.m. for 6 weeks. After this period, a second 24-h ABPM was performed. Office blood pressure measurements were taken at weeks -2, 0, 2, and 6. Routine laboratory blood samples were taken at weeks 0 and 6. Single blood pressure readings did not change significantly during the washout period (between weeks -2 and 0). The ABPM 24-h mean systolic pressure changed between weeks 0-6 from 143 +/- 13 to 126 +/- 11 mm Hg (p < 0.0001), and the mean diastolic pressure from 100 +/- 9 to 90 +/- 9 mm Hg (p < 0.0001). Twenty-eight patients (80) responded to treatment (response criteria: mean diastolic daytime pressure at week 6 < 90 mm Hg and/or a difference between weeks 0-6 > or = 5 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)

Nail fold capillaroscopy and echocardiography in mild-to-moderate hypertension treated with cilazapril plus hydrochlorothiazide: first results.

Essential hypertension is characterized by parallel and potentially reversible vascular and cardiac adaptations. In our study, capillaroscopy, echocardiography, and 24-h ambulatory blood pressure profiles were performed in 17 patients (aged 33-63 years; mean, 52 years) with mild-to-moderate hypertension. We measured morphological and hemodynamic parameters of capillary microcirculation as well as morphological echocardiographic parameters at baseline and after 6 weeks' treatment with 5 mg of cilazapril plus 12.5 mg of hydrochlorothiazide. Digital capillary blood flow measurements were assessed by nail fold video capillaroscopy. After 6 weeks of treatment with cilazapril plus hydrochlorothiazide, mean diastolic 24-h ambulatory blood pressure decreased from 98 +/- 6 to 85 +/- 7 mm Hg. Capillary blood cell velocity was 0.6 +/- 0.4 mm/s at baseline and increased to 0.6 +/- 0.4 mm/s. There were no significant changes in morphological capillaroscopic and echocardiographic parameters. In conclusion, we observed a trend toward higher capillary blood cell velocity as early as after 6 weeks of treatment with cilazapril plus hydrochlorothiazide in mild-to-moderate hypertension.