Showing papers in "Journal of Hypertension in 1996"
TL;DR: Blood pressure is inversely related to birth weight in children and in adults and the positive results in neonates and the inconsistency in adolescence may be related to the unusual growth dynamics during these phases of growth.
Abstract: ObjectiveTo assess the strength of evidence for an inverse relationship between blood pressure and birth weight.DesignA systematic review of the published literature.SettingPublished studies describing the relationship between blood pressure and birth weight since 1956.SubjectsMore than 66 000 subje
730 citations
TL;DR: A single-blind trial was conducted under the direction of the Shanghai Institute of Hypertension to assess the effectiveness of nifedipine treatment in elderly hypertensives.
Abstract: ObjectiveTo assess the effectiveness of nifedipine treatment in elderly hypertensives.MethodsA single-blind trial was conducted under the direction of the Shanghai Institute of Hypertension in 1632 subjects aged 60-79 years alternatively allocated to either nifedipine or placebo after a 4-week place
403 citations
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TL;DR: Pulse wave analysis has been an important part of the medical examination from ancient times as discussed by the authors, and it has been used to detect asymptomatic hypertension and to chart the natural history of essential hypertension and distinguish between this condition and chronic nephritis.
Abstract: PULSE WAVE ANALYSIS IN HISTORICAL TIMES: Interpretation of the arterial pulse has been an important part of the medical examination from ancient times. Graphic methods for clinical pulse wave recording were introduced by Marey in Paris and by Mahomed in London last century. Mahomed showed how such recordings could be used to detect asymptomatic hypertension, and used them to chart the natural history of essential hypertension and to distinguish between this condition and chronic nephritis. Interest in arterial pulse analysis, as applied by Mahomed, lapsed with the introduction of the cuff sphygmomanometer 100 years ago. MODERN PULSE WAVE ANALYSIS: Analysis of the arterial pulse is now regaining favour as limitations of the cuff sphygmomanometer are better recognized (including the ability only to measure extremes of the pulse in the brachial artery). In addition, high-fidelity tonometers have been introduced for very accurate, non-invasive measurement of arterial pulse contour, and there is now a better understanding of arterial hemodynamics, and appreciation of disease and aging effects in humans. It is now possible to record the pulse wave accurately in the radial or carotid artery, to synthesize the ascending aortic pulse waveform, to identify systolic and diastolic periods and to generate indices of ventricular-vascular interaction previously only possible with invasive arterial catheterization. Pressure pulse wave analysis now permits more accurate diagnosis and more logical therapy than was ever possible in the past.
392 citations
TL;DR: Findings suggest a vascular pathogenetic link between obstructive sleep apnoea and systemic hypertension, and endothelium-dependent vascular relaxation in patients with obstructiveSleep apNoea was reduced independently of hypertension.
Abstract: ObjectiveTo evaluate endothelium-dependent vascular function in obstructive sleep apnoea patients.Design and methodsForearm blood flow and vascular resistance were studied in eight normotensives and eight obstructive sleep apnoea patients and also in eight normotensive and eight hypertensive control
272 citations
TL;DR: It is demonstrated that a β-blocker with α1-blocking properties has favorable effects on glucose metabolism, suggesting a potentially important role of peripheral blood flow in regulating glucose uptake.
Abstract: BackgroundHypertensive patients frequently show resistance to insulin-stimulated glucose uptake and hyperinsulinemia. Diuretics and β-adrenoceptor blocking agents have been found to decrease insulin sensitivity, whereas α1-blockers and angiotensin converting enzyme inhibitors seem to improve it.Obje
234 citations
TL;DR: Inhibition of angiotensin converting enzyme with captopril had a significant effect on blood pressure that was not directly accounted for by a suppression of plasma Ang II levels.
Abstract: ObjectiveTo evaluate the contribution of angiotensin-(1-7) [Ang-(1-7)] and prostaglandins to the acute and long-term anti hypertensive actions of captopril in mild-to-moderate essential hypertensive patientsDesign and MethodsBlood pressure, cardiac rate and the plasma concentrations of angiotensin I
218 citations
TL;DR: It is suggested that adrenomedullin inhibits FCS-stimulated proliferation in cultured rat VSMCs, probably through a cyclic AMP-dependent process, and may play a role as an antiproliferative factor forVSMCs in a paracrine fashion.
Abstract: OBJECTIVE The present study was designed to examine whether adrenomedullin affects fetal calf serum (FCS)-stimulated proliferation in cultured rat vascular smooth muscle cells (VSMCs). METHODS Rat VSMCs were grown from explants of Sprague-Dawley rat aorta and were grown using the standard cell culture method. After incubation for 24 h with various concentrations of adrenomedullin in the presence of 5% FCS, trichloroacetic acid-insoluble tritiated thymidine was measured in a liquid scintillation counter. After incubation for 48 h, cell counts were performed. Cyclic adenosine 3',5'-monophosphate (AMP) levels were determined by radioimmunoassay. RESULTS Rat adrenomedullin exhibited concentration-dependent inhibition of the FCS-stimulated increase in thymidine incorporation between 10(-7) and 10(-9) mol/l and of cell number at 10(-7) mol/l. However, the calcitonin generelated peptide (CGRP) receptor antagonist human CGRP(8-37) abolished these antiproliferative effects of rat adrenomedullin. Inhibition by adrenomedullin of FCS-stimulated cellular proliferation was paralleled by an increase in the cellular level of cyclic AMP. 8-Bromocyclic AMP, a cyclic AMP analogue, and forskolin, an activator of adenylate cyclase, inhibited the FCS-stimulated increase in thymidine incorporation and cell number. CONCLUSIONS These results suggest that adrenomedullin inhibits FCS-stimulated proliferation in cultured rat VSMCs, probably through a cyclic AMP-dependent process. Taken together with the finding that adrenomedullin is synthesized in and secreted from vascular endothelial cells, adrenomedullin may play a role as an antiproliferative factor for VSMCs in a paracrine fashion.
208 citations
TL;DR: MAU increased with age, severity of hypertension and duration of hypertension, was associated with higher plasma creatinine values, and was more common in patients with hyperlipidemia.
Abstract: Objective We tested the hypothesis that qualitative microalbuminuria (MAU) screening in a practice setting would identify non-diabetic hypertensive patients at high risk of developing cardiovascular disease.Design We enrolled general practitioners throughout Germany, who obtained histories, physical
196 citations
TL;DR: HGF can exert stimulating effects on endothelial cell growth, but not on VSMC growth, in an additive manner with bFGF but not with VEGF, demonstrating that HGF may provide the opportunity for a new therapeutic strategy for vascular diseases in which the abnormalities are vasoconstriction and pathological growth.
Abstract: OBJECTIVE To seek an endothelium-specific growth factor by examining the mitogenic effects of hepatocyte growth factor (HGF) on endothelial cells and on vascular smooth muscle cells (VSMC). METHODS Rat and human endothelial cells and VSMC were employed. DNA, RNA and protein synthesis were measured by using [3H]-thymidine, uridine and leucine. Coculture of endothelial cells with VSMC was also performed to study the role of endothelial cells. RESULTS Coculture of endothelial cells with VSMC resulted in a significant decrease in DNA synthesis of VSMC. HGF, as well as basic fibroblast growth factor (bFGF), stimulated DNA, RNA and protein synthesis by endothelial cells in a dose-dependent manner. Interestingly, co-incubation of endothelial cells with HGF and bFGF resulted in an additive stimulation of DNA synthesis. Similarly, HGF and interleukin-1 alpha and -6 stimulated DNA synthesis by coronary endothelial cells, whereas interleukin-1 beta and transforming growth factor-beta (TGF-beta) did not. However, HGF showed markedly different actions from bFGF on VSMC growth. bFGF, TGF-beta, interleukin-1 alpha, -1 beta and -6 stimulated DNA synthesis in VSMC significantly, whereas HGF did not. Finally, we examined the mitogenic effect of HGF on human aortic endothelial cells and VSMC. Incubation with HGF increased DNA synthesis and growth by endothelial cells in a dose-dependent manner, whose degree was significantly greater than those with bFGF, vascular endothelial growth factor (VEGF) and interleukin-6. Addition of HGF and VEGF showed no additive effect on DNA synthesis in endothelial cells, in contrast to those of bFGF and HGF. On the other hand, bFGF, but not HGF and VEGF, stimulated DNA synthesis in VSMC. CONCLUSION These results demonstrate that HGF can exert stimulating effects on endothelial cell growth, but not on VSMC growth, in an additive manner with bFGF but not with VEGF. These characteristics of HGF as an endothelium-specific growth factor may provide the opportunity for a new therapeutic strategy for vascular diseases in which the abnormalities were vasoconstriction and pathological growth.
194 citations
191 citations
TL;DR: Hypertensive patients with well-controlled blood pressures under treatment for more than 1 year with the once-a-day calcium channel antagonist nifedipine GITS exhibit normal structure and function of gluteal subcutaneous small arteries, whereas similar patients with blood pressure equally well controlled by the β-blocker atenolol present thicker small arteries with abnormal endothelium- dependent relaxation and altered contractility.
Abstract: OBJECTIVE To investigate the effects on resistance artery structure and function of monotherapy with the beta-blocker atenolol or the calcium channel antagonist nifedipine in its once a day form or gastrointestinal therapeutic system (GITS). SUBJECTS Twenty well-controlled essential hypertensive patients matched for age, body mass index, duration and severity of hypertension. Normotensive subjects and untreated hypertensives served as the reference groups. METHODS Resistance-size small arteries (standardized lumen diameter 247 +/- 8 microns) were dissected from a gluteal subcutaneous biopsy, and studied both on a wire myograph as pressurized vessels. RESULTS The media width:lumen diameter ratio of arteries was 5.37 +/- 0.09% in normotensive subjects, 5.38 +/- 0.18% in patients treated with nifedipine GITS, 6.81 +/- 0.18% in patients treated with atenolol and 7.08 +/- 0.12% in untreated hypertensives (for each of the latter two groups P < 0.001, versus each of the two former groups). The media stress developed in response to noradrenaline and the endothelium-dependent relaxation induced by acetylcholine were significantly smaller in small arteries from untreated or atenolol-treated patients than they were in those from normotensive subjects or nifedipine GITS-treated patients. CONCLUSION Hypertensive patients with well-controlled blood pressures under treatment for more than 1 year with the once-a-day calcium channel antagonist nifedipine GITS exhibit normal structure and function of gluteal subcutaneous small arteries, whereas similar patients with blood pressure equally well controlled by the beta-blocker atenolol present thicker small arteries with abnormal endothelium-dependent relaxation and altered contractility. Whether this finding applies also to other vascular beds, and whether it is associated with a better outcome in relation to morbidity and mortality resulting from elevated blood pressure, remain to be established.
TL;DR: In the anaesthetized rat acute increases in heart rate are accompanied by reductions in arterial compliance and distensibility, and the effect is greater in elastic than in muscle arteries.
Abstract: ObjectivesViscous and inertial components contribute to arterial distensibility and compliance in vitro. The purpose of our study was to determine whether this phenomenon is of relevance in vivo, namely, whether arterial compliance is altered by an increase in heart rateDesignArterial diameter was a
TL;DR: Clock time-independent methods, particularly square-wave fitting, can predict the actual awake and asleep blood pressures and the awake-asleep pressure differences with reasonable accuracy and the results are independent of the awake/asleep pattern of the subjects.
Abstract: ObjectiveTo assess the relationships of daytime and night-time blood pressures and the day-night pressure differences, obtained by various analytical methods, with the actual awake and asleep pressures and the awakeasleep pressure difference.MethodsAmbulatory blood pressure was successfully monitore
TL;DR: The data suggest that the beneficial effects of dietary olive oil on the plasma lipids and lipoprotein profile, lipid and fatty acid composition of erythrocyte membrane, and blood pressure in women with untreated essential hypertension are not found equally for the HOSO-rich diet, despite both vegetable oils providing a similar concentration of MUFA.
Abstract: Objective To study the effect of a diet rich in monounsaturated fatty acids (MUFA), from high-oleic sunflower oil (HOSO) and olive oil, on plasma lipids, erythrocyte membrane lipids (including fatty acid composition) and blood pressure of hypertensive (normocholesterolaemic or hypercholesterolaemic) women. Methods There were 16 participants who were hypertensive women aged 56.2 ± 5A years. The participants ate a diet enriched with HOSO or olive oil for two 4-week periods with a 4-week washout period before starting the second type of MUFA diet At entry and during study of each diet, plasma lipids and apolipoproteins were measured by conventional enzymatic methods. Erythrocyte membrane lipid and fatty acid compositions were analysed by means of the latroscan thin-layer chromatography/flame ionization detection technique and by gas chromatography, respectively. Blood pressure was also measured. The statistical analysis was conducted by using Student's two-tailed paired t-test Results In both groups of hypertensive patients, there was a significant increase in plasma high-density lipoprotein (HDL) cholesterol concentration after the HOSO or olive oil diets, with regard to baseline. Additionally, a significant decrease in plasma HDL 2 cholesterol concentration and an increase in plasma HDL 3 cholesterol concentration were evident The membrane free-cholesterol concentration increased significantly and the phospholipid concentration decreased significantly in erythrocytes after the olive oil diet, though both MUFA diets produced a significant decrease in the concentration of membrane esterified cholesterol. Therefore, the molar ratio of cholesterol to phospholipids was raised significantly in the erythrocyte membrane of hypertensive women after the dietary olive oil, but not after the HOSO diet In the hypertensive and normocholesterolaemic group the HOSO diet significantly increased the content in the erythrocyte membrane of oleic, eicosenoic, arachidonic and docosapentaenoic acids, whereas the olive oil diet increased the content of palmitoleic acid and long-chain polyunsaturated fatty acids of the n-3 family besides, compared with baseline. A significant decrease in linoleic acid was also evident In the hypertensive and hypercholesterolaemic group, the HOSO diet resulted in significant increases in palmitoleic, oleic, eicosenoic and behenic acids, whereas the olive oil diet enhanced the content of arachidonic, docosapentaenoic and docosahexaenoic acids besides, with respect to baseline. In addition, there was a significant decrease in stearic acid, but only after dietary olive oil was there a decrease in linoleic acid. The most important differences between the two MUFA diets were the increase in n-3 fatty acids and the decrease in the n-6:n-3 fatty acids ratio after dietary olive oil in the erythrocyte membranes of hypertensive patients. Interestingly, a significant reduction in systolic and diastolic blood pressures was only evident after the ingestion of olive oil. Conclusion These data suggest that the beneficial effects of dietary olive oil on the plasma lipids and lipoprotein profile, lipid and fatty acid composition of erythrocyte membrane, and blood pressure in women with untreated essential hypertension are not found equally for the HOSO-rich diet, despite both vegetable oils providing a similar concentration of MUFA.
TL;DR: Investigations of the efferent pressor mechanisms and the renal handling of endogenous ouabain are novel approaches to the etiology and therapy of several common cardiovascular disorders.
Abstract: Objective To assess possible relationships between endogenous ouabain, sodium balance and blood pressure.Content This review concerns the structure of endogenous ouabain, circulating levels of this steroid in various disorders of fluid and electrolyte balance, recent evidence for the association of
TL;DR: The consistent relationship between baseline LVH and subsequent morbid events and the initial evidence of a parallelism between LVH change and prognosis need to be supplemented by additional studies that examine the latter relationship in diverse populations under varied treatments.
Abstract: Objective To assess whether regression of left ventricular hypertrophy (LVH) can be used as a surrogate end-point for morbid events in hypertension treatment trials. Design and methods Statistical, epidemiologic and treatment trial literature was reviewed to identify the criteria that should be met by a surrogate end-point and to determine whether these criteria are met by existing data on the regression of LVH. Results Relevant criteria include: (1) a consistent relationship between LVH and subsequent morbid events; (2) prediction of lower or higher complication rates by LVH regression or progression; (3) evidence that the relationship between LVH regression/progression and morbidity/mortality is consistent in different populations and with different treatments; and (4) demonstration of a quantitative relationship that allows prediction of a change in clinical risk from a measured change in LVH. The results of seven electrocardiographic and 10 echocardiographic studies with a total of about 20 000 subjects have shown consistently higher risks of morbid events in subjects with than without LVH (odds ratios 1.4- 5.4). The available data (four studies, 1145 subjects) suggest that morbid events will occur in a higher proportion of subjects in whom LVH progresses (13-59%) rather than regresses (7-12%). However, the latter data are derived almost entirely from white subjects, predominantly male, with incomplete knowledge of interim treatment and blood pressure in most instances; no information on the mathematical relationship between change in LVH and subsequent morbidity and mortality is yet available. Conclusions A strict definition of the information required to establish a fully adequate surrogate end-point for morbid events in antihypertensive has been partially but not completely satisfied. The consistent relationship between baseline LVH and subsequent morbid events and the initial evidence of a parallelism between LVH change and prognosis need to be supplemented by additional studies that examine the latter relationship in diverse populations under varied treatments, and which examine the quantitative relationship between measured change in LVH and the subsequent rates of morbid events. Additional data will come from ongoing treatment trials (approximately 12 000 subjects) and observational studies (approximately 8000 subjects) with serial assessments of LVH.
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TL;DR: There is increasing evidence that the sympathetic nervous system may play a primary role in the pathogenesis of essential hypertension and the long-term regulation of arterial pressure.
Abstract: UNLABELLED INCREASED SYMPATHETIC NERVE ACTIVITY IN HYPERTENSION: Two techniques (the microneurographic method for intraneural recordings of sympathetic nerve activity and radiotracer techniques for study of norepinephrine kinetics) have been used recently to obtain sophisticated insight into regional sympathetic function in humans. Persuasive evidence now indicates that young mildly hypertensive humans have increased sympathetic neural activity. LONG-TERM REGULATION OF ARTERIAL PRESSURE: Three credible mechanisms have been proposed to sustain long-term sympathetic nervous influences in hypertension: antinatriuretic and renin stimulating effects of the renal sympathetic nerves, sympathetic influences on the development of vascular membrane properties and trophic effects of the sympathetic nerves on vascular and cardiac muscle. CONCLUSION There is increasing evidence that the sympathetic nervous system may play a primary role in the pathogenesis of essential hypertension and the long-term regulation of arterial pressure.
TL;DR: Expected renovascular response to infused Ang II was blunted in persons with the AGT TT genotype, the first report of an association between a specific gene variant and altered renal physiology in humans with particular relevance to essential hypertension.
Abstract: OBJECTIVE Recently, we reported evidence for genetic linkage between human essential hypertension and the angiotensinogen gene (AGT) and an association with a common molecular variant of this gene (methionine 235 --> threonine or T235). Other studies had led us to hypothesize that blunted renal plasma flow responses to infused angiotensin II (Ang II) when in high salt balance may reflect increased intrarenal formation of Ang II, a condition that might promote hypertension. Here we examine the relationship between AGT genotype and renal vascular response to infused Ang II. METHODS Hypertensive (n = 34, all off medication) and normotensive (n = 57) members of families with a history of hypertension (age 18-60 years) as well as 29 normotensive volunteers without a family history of hypertension were studied after controlled diets with 200 mequiv./day sodium. Ang II was infused at a mildly pressor dose (3 ng/kg/min) and renal plasma flow was determined by steady-state plasma para-aminohippurate concentration. RESULTS After correction for covariates in multivariate analyses, participants homozygous for the T235 variant had significantly diminished renal plasma flow responses to the Ang II infusion (P = 0.005). Changes in renal arterial resistance were also blunted in the T235 homozygotes. Similar results were found when analysis was restricted to normotensive participants or subdivided based on family history of hypertension. No confounding factors associated with AGT genotype that could explain these differences were found. Furthermore, obesity, which also suppressed renovascular response to Ang II, was found to interact significantly (P = 0.017) with genotype such that, among T235 homozygotes, obesity had a greater blunting effect on renal vascular response. CONCLUSIONS Expected renovascular response to infused Ang II was blunted in persons with the AGT TT genotype. This is the first report of an association between a specific gene variant and altered renal physiology in humans with particular relevance to essential hypertension.
TL;DR: The results of this study suggest that patients with isolated office hypertension should not be considered as truly normotensive individuals and hence, these patients require a careful medical follow-up.
Abstract: Objective and method Isolated office hypertension, defined as hypertensive blood pressure values in a medical setting but normal self-measured or ambulatory-recorded blood pressures, is frequently encountered in clinical practice Yet, whether this condition represents a transient state in the development of a sustained ambulatory hypertension is still unknown as no long-term analysis of the evolution of ambulatory blood pressure has been carried out in patients with isolated office hypertension To evaluate whether such patients should be considered as truly normotensive or hypertensive, we have studied the long-term changes in office and ambulatory blood pressures in 81 patients in whom isolated office hypertension was observed between 1982 and 1988 Results After a 5-6 year follow-up, 60 of the 81 patients had a mean 12 h daytime ambulatory blood pressure greater than 140/90 mmHg, suggesting an evolution towards ambulatory hypertension The development of hypertension could not be predicted on the basis of the follow-up office blood pressures as these tended to decrease during the follow-up period Conclusions The results of this study suggest that patients with isolated office hypertension should not be considered as truly normotensive individuals Hence, these patients require a careful medical follow-up Office blood pressure readings alone, however, do not appear to provide a good indicator of the long-term outcome of isolated office hypertension
TL;DR: Office, home and daytime ambulatory blood pressure levels were higher in winter than they were in summer in patients with essential hypertension, however, the seasonal variations in average 24 h blood pressure may be small because of the lack of changes in night-time blood pressure.
Abstract: Objective To study the influence of seasons on blood pressure in ordinary circumstances. Design and methods We examined seasonal variations of home and 24h h ambulatory and office blood pressures in outpatients with essential hypertension. Office, home and ambulatory blood pressures of 50 outpatients with essential hypertension were recorded in 1993. The subjects were 26 women and 24 men, aged 59.3 ± 1.1 years (mean ± SEM). Office blood pressure was measured monthly by physicians. Home blood pressure was measured every day by the patients in the morning and evening. Ambulatory blood pressure was recorded every 30min in summer and in winter. The order of ambulatory blood pressure monitoring was randomized. The daytime and night-time blood pressures were calculated according to the true waking and sleeping times of the individual patients. Results Both office and home blood pressures showed significant seasonal variations. The winter-summer differences in office and home blood pressures were 4.7 ± 1.3/ 3.3 ± 0.9 and 5.9 ± 1.1/2.7 ± 0.6 mmHg, respectively. They were not influenced by the presence of antihypertensive agents. The winter-summer difference was also significant for daytime ambulatory blood pressure (3.5 ± 1.4/ 2.5 ± 0.8 mmHg), but not for night-time ambulatory blood pressure (-2.9 ± 1.7/ -1.2 ± 1.0 mmHg) or average 24 h blood pressure (1.5 ± 1.3/1.2 ± 0.7 mmHg). There were no significant differences in the waking and sleeping times between the two seasons. Conclusions Office, home and daytime ambulatory blood pressure levels were higher in winter than they were in summer in patients with essential hypertension. However, the seasonal variations in average 24 h blood pressure may be small because of the lack of changes in night-time blood pressure.
TL;DR: Heart rate, free fatty acids level and morning plasma cortisol level are elevated in hypertensive subjects at any body mass index level, but particularly in the lean ones with high systolic blood pressure.
Abstract: Objective To investigate the relationships of blood pressure with carbohydrate metabolism, sympathetic activity and cortisol at different levels of body mass index in middle-aged men.Methods Cross-sectional data concerning men studied in the Paris Prospective Study I were analysed. The cohort includ
TL;DR: This study has shown major differences in LVM estimated using methods based on one-dimensional echocardiography compared with three-dimensional MRI data, largely the result of the geometrical assumptions on which M-mode measurements are based.
Abstract: ObjectiveTo compare measurement of left ventricular mass (LVM) by M-mode echocardiography and magnetic resonance imaging (MRI) in hypertensive subjects.DesignA prospective study.SubjectsTwenty-four untreated hypertensive patients [19 men and five women, aged 51 ± 2 (mean ± SEM) years, supine blood p
TL;DR: Results show that the spontaneous baroreflex method provides good BRS reproducibility under various stimuli that affect the neural control of circulation differently and suggest that BRS variability is dependent neither on haemodynamic modifications nor on the degree of barore Flex engagement, but it seems to reflect an inherent feature of the way in which arterial barore flexes modulate the heart period.
Abstract: ObjectiveThe aim of the present study was to examine the reproducibility of arterial baroreflex sensitivity (BRS) provided by the spontaneous baroreflex method at rest and during laboratory tests.MethodsTwenty healthy volunteers were studied 24 h apart, in the same laboratory and under the same envi
TL;DR: On the basis of observational studies and haemodynamic considerations, it seems prudent to leave all but the highest blood pressures in acute stroke to settle spontaneously.
Abstract: UNLABELLED HYPERTENSION AND STROKE: Hypertension is a major risk factor for stroke, and stroke prevention is the most important achievement of modern antihypertensive treatment. In controlled trials, a few years of this treatment can eliminate the entire excess stroke risk associated with hypertension. In observational studies, stroke risk appears to be not always fully reversible when the blood pressure is lowered with drugs. Hypertension is associated with an increased incidence of both haemorrhagic, ischaemic and lacunar stroke. It is likely that antihypertensive treatment prevents all these types of strokes as well as transient ischaemic attacks. ACUTE STROKE In acute stroke, a transient rise in blood pressure is common, in some cases superimposed on chronic hypertension. No major controlled trials have reported findings on whether blood pressure should be lowered acutely in such patients. On the basis of observational studies and haemodynamic considerations, it seems prudent to leave all but the highest blood pressures in acute stroke to settle spontaneously. ISCHAEMIC STROKE: Ischaemic stroke may occasionally be precipitated by overzealous blood pressure reduction. This has been reported in particular in the initial treatment of very severe hypertension, and occasionally in the elderly hypertensive. It may also occur in the rare cases where transient cerebral ischaemia is haemodynamically induced.
TL;DR: The data show 80 mg valsartanonce a day to be as effective as 20 mg enalapril once a day in the treatment of mild-to-moderate hypertension, and both of the treatments were tolerated well.
Abstract: ObjectiveTo compare the antihypertensive efficacy and systemic tolerability of valsartan, a new angiotensin II receptor antagonist, with placebo and with an angiotensin converting enzyme (ACE) inhibitor, enalapril.DesignA total of 348 adult outpatients with mild-to-moderate uncomplicated essential h
TL;DR: The transversal phase of the research confirms the relationship between blood pressure pattern and early glomerular changes in essential hypertensives without overt proteinuria and emphasizes the role of microalbuminuria as a marker of early cardiac, renal and retinal structural and functional changes inessential hypertension.
Abstract: ObjectiveTo evaluate the prevalence of microalbuminuria (albumin excretion rate, AER) in a wide hypertensive population, and to evaluate any relationship with cardiovascular damage and renal dysfunctionDesignA transversal studySubjects and methodsIn 383 hospitalized Caucasian essential hypertensives
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TL;DR: In this paper, the results of animal studies have shown that undernutrition before birth leads to persisting changes in blood pressure and in a range of other physiological, metabolic and structural parameters.
Abstract: UNLABELLED RESULTS OF UNDERNUTRITION BEFORE BIRTH: Animal studies have shown that undernutrition before birth leads to persisting changes in blood pressure and in a range of other physiological, metabolic and structural parameters. Studies in humans have shown that men and women whose birthweights were at the lower end of the normal range, who were thin or short at birth, or small in relation to placental size, have increased rates of hypertension and coronary heart disease. CONCLUSIONS We are beginning to understand something of the mechanisms underlying these associations. Elevation of blood pressure may be a fetal response to undernutrition and may initiate hypertension in adult life.
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TL;DR: Enhanced release of endothelium-derived relaxing factors (NO and EDHF) help to explain the therapeutic effects of inhibitors of converting enzyme.
Abstract: Purpose To summarize how abnormal release of relaxing and contracting factors from endothelial cells contribute to the vascular abnormalities in hypertension. ENDOTHELIUM-DERIVED FACTORS: The endothelium controls the tone of the underlying vascular smooth muscle by releasing relaxing and contracting factors. The former include prostacyclin, nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF), and the latter endoperoxides, thromboxane A2, superoxide anions and endothelin. Hypertension In most types of hypertension, endothelium-dependent relaxations are curtailed, because of a reduced production and/or action of endothelium-derived NO and EDHF. In essential hypertension, endothelium-dependent relaxations are reduced also because of the endothelium-dependent production of vasoconstrictor prostanoids (endoperoxides and, in some cases, thromboxane A2). Cause or consequence The endothelial dysfunction observed in hypertensive blood vessels is likely to be a consequence rather than a cause of the disease process. Therapeutic implications Enhanced release of endothelium-derived relaxing factors (NO and EDHF) help to explain the therapeutic effects of inhibitors of converting enzyme.
TL;DR: Meta-analysis is superior to narrative reports for systematic reviews of the literature, but its quantitative results should be interpreted with caution even when the analysis is performed according to rigorous rules.
Abstract: Advantages of meta-analysisLiterature reviews have traditionally been largely narrative. Meta-analysis now offers the opportunity to critically evaluate and statistically combine results of comparable studies or trials. Its major purposes are to increase the numbers of observations and the statistic