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Journal ArticleDOI

Plasma volume and chronic hypertension. Relationship to arterial pressure levels in different hypertensive diseases.

01 May 1970-JAMA Internal Medicine (American Medical Association)-Vol. 125, Iss: 5, pp 835-842
TL;DR: Plasma volume was measured with radioactive iodinated I 131 serum albumin in 80 normal subjects and 135 hypertensive patients without cardiac or renal failure, and results were correlated with weekly diastolic pressure averages.
Abstract: Plasma volume was measured with radioactive iodinated I 131 serum albumin in 80 normal subjects and 135 hypertensive patients without cardiac or renal failure, and results, expressed in milliliters per centimeter of body height, were correlated with weekly diastolic pressure averages (DBP). Plasma volume (PV) was reduced in renovascular hypertensive patients, whereas it correlated directly with DBP in hypertensive patients with renal parenchymal disease (r = 0.853, P P P P
Citations
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Journal ArticleDOI
TL;DR: Measurements of thoracic fluid volume support occult volume expansion as a mediator of antihypertensive drug resistance and use of impedance measurements to guide advancing diuretic dose and adjustment of multidrug anti Hypertensive treatment.
Abstract: Although resistant hypertension affects a minority of all hypertensives, this group continues to experience disproportionately high cardiovascular event rates despite newer antihypertensive agents. Hypertension represents an imbalance of hemodynamic forces within the circulation, usually characterized by elevated systemic vascular resistance. We studied the utility of serial hemodynamic parameters in the selection and titration of antihypertensive medication in resistant hypertensive patients using highly reproducible noninvasive measurements by thoracic bioimpedance. Resistant hypertension patients (n=104) were randomized to drug selection based either on serial hemodynamic (HD) measurements and a predefined algorithm or on drug selection directed by a hypertension specialist (SC) in a 3-month intensive treatment program. Blood pressure was lowered by intensified drug therapy in both treatment groups (169+/-3/87+/-2 to 139+/-2/72+/-1 mm Hg HD versus 173+/-3/91+/-2 to 147+/-2/79+/-1 mm Hg SC, P<0.01 for systolic and diastolic BP), using similar numbers and intensity of antihypertensive medications. Blood pressures were reduced further for those treated according to hemodynamic measurements, resulting in improved control rates (56% HD versus 33% SC controlled to

374 citations

Journal ArticleDOI
TL;DR: A direct correlation between blood pressure and blood viscosity among normotensive and hypertensive subjects is demonstrated, in part, due to the rheologic effects of an elevated fibrinogen level and to an increased hematocrit value.

355 citations

Journal ArticleDOI
TL;DR: Three biochemical tests for the diagnosis of pheochromocytoma were evaluated in 24 patients with proved tumors and 40 patients whose clinical picture was suspect but who had no evidence of the disease, reaffirm the value of plasma catecholamines and indicate that urinarycatecholamine metabolites are less useful.
Abstract: Three biochemical tests for the diagnosis of pheochromocytoma were evaluated in 24 patients with proved tumors and 40 patients whose clinical picture was suspect but who had no evidence of the disease. Measurement of resting, supine plasma catecholamines (by radioenzymatic assay) was more useful than either 24-hour urinary vanillylmandelic acid (VMA) or metanephrines or both. In only one of 23 patients with pheochromocytoma were plasma catecholamines within the range of those in patients without pheochromocytoma, as compared with urinary VMA in 11 of 22, urinary metanephrines in five of 22 and both metabolites in three of 22. These studies reaffirm the value of plasma catecholamines in the diagnosis of pheochromocytoma and indicate that urinary catecholamine metabolites are less useful. The poor correlation between the height of arterial pressure and circulating levels of catecholamines suggests that the regulation of arterial pressure in pheochromocytoma is complex.

316 citations

Journal ArticleDOI
TL;DR: Treatment with vasodilating drugs specifically reverses the major hemodynamic abnormality of primary hypertension and well-tolerated doses of hydralazine (200 mg/day) can normalize the hemodynamics of most hypertensives.
Abstract: Treatment with vasodilating drugs specifically reverses the major hemodynamic abnormality of primary hypertension. Hypotensive effectiveness of vasodilators is limited by three responses of hypertensives to vasodilation-induced blood pressure reduction, including reflex increases in sympathetic activity that raise cardiac output, augmentation of plasma renin activity, and sodium retention with plasma volume expansion. Concomitant administration of propranolol suppresses the first and second responses, and diuretics prevent the third. In treating chronic hypertension, vasodilators should be coadministered with both drugs. Potentiated in this fashion, well-tolerated doses of hydralazine (200 mg/day) can normalize the hemodynamics of most hypertensives. Guancydine and, particularly, minoxidil are promising antihypertensive vasodilators but remain in the investigative stages. Nitroprusside and diazoxide are powerful intravenous vasodilators and are effective for hypertensive emergencies. They differ in time course of action and in effect on cardiac output.

253 citations

References
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Journal Article
TL;DR: It is suggested that patients with hypertension, increased ASR and low PRA be given a trial of dexamethasone treatment before undergoing adrenal surgery, as well as patients with Conn's syndrome, for a number of reasons.
Abstract: A father and son are described with a condition characterized by benign hypertension, potassium deficiency, increased aldosterone secretion rate (ASR), raised plasma volume and suppressed plasma renin activity (PRA). There were intermittent elevations of urine 17-ketosteroids and 17-hydroxycorticoids (17-OHCS) but no increase in urine THS, normal circadian rhythm of plasma 17-OHCS, and normal urine 17-OHCS response to dexamethasone and intravenous ACTH. Plasma ACTH and corticosterone secretion were not elevated. Pregnanetriol excretion was normal but urine pregnanediol was increased. At operation on the father no adrenal tumour was found; the excised left adrenal weighed 7 g. and showed nodular cortical hyperplasia; juxtaglomerular cells showed only occasional granules. Following operation hypertension persisted and ASR was half the preoperative value. All abnormalities in father and son were relieved by dexamethasone (DM) 2 mg. daily. The condition recurred following cessation of DM but was relieved by a second course of treatment. No such response to DM was seen in a normal subject or in a patient with Conn's syndrome. For a number of reasons it is suggested that patients with hypertension, increased ASR and low PRA be given a trial of dexamethasone treatment before undergoing adrenal surgery.

413 citations

Journal ArticleDOI
TL;DR: Two distinct patterns of response of blood pressure to achievement of dry weight (no clinical evidence of edema and optimal body sodium content and volume of water), antihypertensive drugs and bilateral nephrectomy were documented in 40 unselected patients with end-stage renal disease.
Abstract: Two distinct patterns of response of blood pressure to achievement of dry weight (no clinical evidence of edema and optimal body sodium content and volume of water), antihypertensive drugs and bilateral nephrectomy were documented in 40 unselected patients with end-stage renal disease. Group 1, 35 of 40 patients, was characterized by an excellent response of blood pressure to dry weight and the ability to remain normotensive without antihypertensive drugs as long as dry weight was maintained. Group 2, five of 40 patients, had persistent hypertension in spite of dry weight, a poor response to antihypertensive drugs and a prompt reduction of blood pressure after bilateral nephrectomy. A further important difference between these two groups was seen in the serum renin values obtained at the initiation of therapy. In Group 1 values ranged from 0 to 1.02 Goldblatt units × 10–4 per milliliter of serum (mean, 0.31) whereas those in Group 2 ranged from 1.88 to 4.60 (mean of 3.37 units). Serum renin level...

373 citations

Journal ArticleDOI
TL;DR: Plasma volume was diminished in hypertensive men, contrast with reports of expanded plasma volume in primary aldosteronism and renoprival hypertension, and emphasize the importance of diagnostic grouping in st...
Abstract: Plasma volume (RISA) was measured in 37 men with essential hypertension uncomplicated by cardiac or renal failure, and results compared with values obtained in 20 normal male subjects. Body height was found to be a better reference index than weight for expressing results, but conclusions were identical whatever the frame of reference used. Plasma volume was diminished in hypertensive men. This decrease was greater the higher the diastolic pressure (r equal to -0.434; p less than 0.01), so that it was only evident in the patients with diastolic blood pressures over 105 mm of mercury. Plasma volume measured 19.4 ml per centimeter in normotensive, and 19.6 ml per centimeter in hypertensive men with diastolic pressure less than 105 mm of mercury, and 16.9 ml per centimeter in those with higher blood pressure (p less than 0.02). These findings contrast with reports of expanded plasma volume in primary aldosteronism and renoprival hypertension, and emphasize the importance of diagnostic grouping in st...

220 citations

Journal ArticleDOI
01 May 1969-Blood
TL;DR: Erythrocyte volume, plasma volume, hematocrit, lean body mass, skinfold thickness, arm circumference, height, and weight were measured in 40 normal males, 38 normal females, and 12 obese females to derive equations for estimating erythrocytes and plasma volumes.

210 citations