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Biomedical subjects

A Amery

Publications and source records attributed to A Amery.

At least 73 records · Page 4Linked to original sources
PubMed1993

APTH--a trial on ambulatory blood pressure monitoring and treatment of hypertension: objectives and protocol.

Study is to test the hypothesis that antihypertensive treatment based on ambulatory monitoring may be more beneficial than treatment guided by conventional sphygmomanometry. After a 2 month run-in period on placebo, eligible hypertensive patients (sitting diastolic pressure > 95 mm Hg on conventional measurement) will be randomized into 2 groups, one in which the target pressure is a sitting diastolic pressure from 80 through 89 mm Hg on conventional sphygmomanometry, and one in which a daytime (from 10 to 20 h) ambulatory diastolic pressure from 80 through 89 mm Hg should be achieved. For 6 months following randomization, treatment consisting of lisinopril 10-20 mg per day, associated with 12.5 mg hydrochlorothiazide and 5 mg amlodipine, as necessary, will be stepwise adjusted in order to reach the goal pressure. During this period of the trial the doctor making the therapeutic decisions at the Coordinating Office will be kept blinded with respect to the type of measurement guiding therapy. A final period of 4 months, during which treatment will be adjusted by the patient's personal physician according to the current recommendations, concludes the trial. The outcome measures include the blood pressure level on conventional and ambulatory measurement, the amount of drugs required to achieve the goal blood pressure, side-effects evaluated by a self-administered questionnaire and left ventricular mass as assessed by electrocardiography and echocardiography.

Amlodipine↗
PubMed1993

Biopsy of mammographically-detected breast lesions in a district hospital.

Seventy-nine consecutive needle localization biopsies were performed for non-palpable breast lesions discovered on screening mammography over a two-and-a-half-year period in a district hospital by 15 surgeons. Malignant disease was found in 24 biopsies (30%). Eight were in situ and 16 were infiltrative carcinomas. Half the cancers met the criteria of 'minimal' carcinoma as described by Gallagher and Martin. Forty percent of women 50 years and older (20 of 50) but only 13% of women less than 50 years (4 of 29) had a carcinoma. Of thirty-two mammograms read as 'probably' benign, two (6%) were malignant pathologically. Of forty-seven mammograms considered 'probably' malignant, 22 (47%) were malignant pathologically. Abnormal calcification (38%), density (34%) or both (28%) were suspicious mammographic features. All 'minimal' invasive carcinomas were associated with calcification. Complete removal of the lesion was not achieved in three cases (3.7%) of which none showed invasive malignancy. Of the seven complications, two required treatment. Localization biopsy of non-palpable breast lesions, detected by screening mammography in a district hospital, performed by general surgeons, has produced a yield of malignancies similar to that seen in more specialized units.

Adult↗
PubMed1993

Cardiac variables and blood pressure as determinants of left ventricular inflow velocities.

The determinants of the left ventricular diastolic transmitral flow pattern, measured by use of Doppler velocimetry, were assessed in 40 patients referred for hypertension. The ratio of the atrial to early filling peak velocity (A/E ratio) averaged 0.82 +/- 0.23, BP 156 +/- 19/100 +/- 13 mmHg and left ventricular mass 220 +/- 57. In multiple regression analysis the A/E ratio was independently and positively related to age (P < 0.001) and BP (P < 0.001) and inversely to the fractional shortening of the left ventricular internal diameter (P < 0.01) and left atrial size at end-systole (P < 0.05); these variables accounted for 71% of the variance of the A/E ratio. The peak flow velocity during atrial contraction was positively and independently related to age (P < 0.001), BP (P < 0.05) and heart rate (P < 0.05); early filling velocity decreased with age (P < 0.001) and was positively related to heart rate (P < 0.01), left atrial diameter (P < 0.01) and fractional shortening (P < 0.001). The weak positive associations of the A/E ratio with left ventricular mass (r = 0.32; P < 0.05) and wall thickness (r = 0.38; P < 0.05) did not persist in multiple regression analysis. In conclusion, the left ventricular diastolic filling indexes are related to age, BP, left atrial size and to systolic left ventricular function but left ventricular structural variables, as measured by echocardiography, are not significantly involved.

Adult↗
PubMed1993

[Quality of induction and adrenocortical function. A clinical comparison of Etomidate-Lipuro and Hypnomidate].

UNLABELLED: The purpose of this study was to compare etomidate in a lipid emulsion (Etomidat-Lipuro; Braun, Melsungen) and in propylene glycol (Hypnomidate, Janssen Pharmaceutica) in 90 patients in terms of anaesthetic induction characteristics with special reference to injection side effects, haemodynamic changes, and quality of induction. Adrenocortical hormones were determined in 30 patients who received either Etomidat-Lipuro, Hypnomidate, or propofol (Diprivan, ICI Pharma) for induction of anaesthesia. METHODS: One hundred twenty patients gave their informed consent to the study. In the first part, 90 patients were assigned at random to two groups in which induction of anaesthesia was performed either with Etomidat-Lipuro or Hypnomidate. Anaesthesia was started by i.v. injection of 25 micrograms/kg alfentanil (Rapifen, Janssen Pharmaceutica). One minute later, the hypnotic agent was injected into a freely running i.v. line (18 Gcannula) that was used only for the hypnotic and was removed 15 min later. During injection, the patients were asked to inform the anaesthesiologist spontaneously and on request about their sensations at the injection site. The time from the beginning of anaesthesia until the disappearance of the eyelash reflex was measured. The patients were ventilated and vecuronium was administered to allow good intubation conditions 2-3 min later. For the first 10 min, blood pressure and heart rate were measured every minute. Postoperatively, the same investigator made rounds once a day and examined the injection sites. Signs of pain, redness, swelling, induration, thrombophlebitis, or thrombosis were noted. In the second part of the study, 30 patients were investigated for endocrinological changes after induction of anaesthesia with Etomidat-Lipuro, Hypnomidate, or Diprivan. The patients were allocated to the groups at random. A radial artery catheter was inserted in every patient. Sampling took place 30 min before and 1 and 2 h after induction. Additional samples were drawn 30 min and 1, 2, and 22 h after i.v. administration of 0.25 mg ACTH (Synacthen, Ciba-Geigy). The plasma concentrations of cortisol, 17 alpha-OH-progesterone, and aldosterone and the renin activity were determined by high-performance liquid chromatography. RESULTS: The loss of the eyelash reflex occurred 42.9 +/- 8.7 and 42.2 +/- 11.0 s after the administration of Etomidat-Lipuro and Hypnomidate. The haemodynamic changes were minimal in both groups. After administration of alfentanil, local side effects of the hypnotics were scarce, with a tendency to be weaker and more seldom after Etomidat-Lipuro (3/55 versus 8/55). The postoperative vein reactions were generally mild and occurred in 17 out of 55 patients after Etomidat-Lipuro and 15 out of 55 patients after Hypnomidate. In most cases these signs were no longer present on the 2nd day after the procedure. Cortisol levels were depressed initially by all the hypnotic drugs used. While there was spontaneous recovery in the Diprivan group after 2 h combined with a positive overshooting response to ACTH stimulation, in the etomidate groups cortisol could not be stimulated; it normalized slowly during the following 24 h. The 17 alpha-OH-progesterone increase was significant in the etomidate groups after the administration of ACTH. The aldosterone levels decreased after etomidate injection and had not normalized 24 h later, while there was a normal response to ACTH in the propofol group. There was a normal decrease in renin activity in all three groups after the administration of ACTH. CONCLUSION: Local side effects are minimal after the administration of Etomidat-Lipuro and Hypnomidate. Alfentanil reduces the injection pain of etomidate induction agents. Cortisol and aldosterone are depressed by etomidate, but the clinical relevance is minimal after a single bolus injection.

Adolescent↗
PubMed1992

The increase in blood pressure with age and body mass index is overestimated by conventional sphygmomanometry.

This cross-sectional study investigated whether the technique of blood pressure measurement used (conventional sphygmomanometry vs. ambulatory monitoring) affects the relation between blood pressure and both age and body mass index. Two independent data sets were analyzed. The first comprised 328 subjects (48% men) drawn from the population of a small Belgian town, and the second comprised 776 Irish bank employees (51% men). Age ranged from 17 years to 81 years, and body mass index (weight (kg)/height (m)2) ranged from 16.6 to 40.2. Twenty-four-hour ambulatory blood pressure was lower than blood pressure measured by a nurse in both the Belgian population sample (118/71 mmHg vs. 122/73 mmHg) and the Irish employees (118/72 mmHg vs. 119/76 mmHg). When blood pressure was measured by an observer, the well-established relations between systolic and diastolic blood pressure and both age and body mass index were evident. When the analyses were repeated using 24-hour measurements, the increment (cross-sectionally assessed) in blood pressure with age was weaker, especially in young and middle-aged subjects (20-60 years), while the increase in blood pressure with body mass index was also reduced. The within-subject differences between the conventional and ambulatory blood pressure measurements increased with older age and greater body mass index. Several other relations with blood pressure as the response variable may require revision in light of the present findings.

Adult↗
PubMed1992

Impairment of renal function with increasing blood lead concentrations in the general population. The Cadmibel Study Group.

BACKGROUND: Nephropathy is known to occur in persons with heavy exposure to lead. Whether exposure to lead in the general population leads to impaired renal function is not known. METHODS: We studied renal function and indexes of lead exposure in a random population sample of 965 men and 1016 women (age range, 20 to 88 years). In all the subjects we measured creatinine clearance and blood concentrations of lead and zinc protoporphyrin (an indirect measure of blood lead level). RESULTS: The mean (+/- SD) creatinine clearance rate was 99 +/- 30 ml per minute in the men and 80 +/- 25 ml per minute in the women. In the men the geometric mean blood lead concentration was 114 micrograms per liter (0.55 mumol per liter) (range, 23 to 725 micrograms per liter [0.11 to 3.5 mumol per liter]), and in the women 75 micrograms per liter (0.36 mumol per liter) (range, 17 to 603 micrograms per liter [0.08 to 2.9 mumol per liter]); the zinc protoporphyrin values in blood averaged 1.0 and 1.1 micrograms per gram of hemoglobin, respectively. The creatinine clearance rate was inversely correlated with blood lead and zinc protoporphyrin values in the men and the women both before and after adjustments for age, bodymass index, and diuretic treatment. A 10-fold increase in blood lead concentration was associated with a reduction of 10 to 13 ml per minute in creatinine clearance. We also found a positive correlation between serum beta 2-microglobulin (which is inversely related to the glomerular filtration rate) and blood lead in men, between serum beta 2-microglobulin and zinc protoporphyrin in both sexes, and between serum creatinine and zinc protoporphyrin in men. CONCLUSIONS: Exposure to lead may impair renal function in the general population. The alternative hypothesis that renal impairment may lead to an increase in the blood lead concentration cannot be excluded, however.

Adult↗
PubMed1992

Treatment of the older hypertensive: paradigms, practices, and proofs.

Recent outcome trials in patients above age 60 with systolo-diastolic hypertension are reviewed. The meta-analysis suggests that antihypertensive drug therapy can decrease cardiovascular and coronary mortality in selected patients. Based on these studies it is suggested that antihypertensive drug therapy is indicated in patients between age 60 and 75 when the diastolic pressure remains above 95 mmHg after repeated measurements. A target for systolic b.p. is not definitely established but a pressure of 150 mmHg may serve as a temporary proposal. Whether uncomplicated isolated systolic hypertension in symptomless patients should be treated is still under investigation.

Aged↗
PubMed1992

Effects of baroceptor and cardiopulmonary reflexes on neural control of heart rate in normal man, as assessed by power spectral analysis.

This study was designed to establish the neurally-mediated effects of baroceptor and cardiopulmonary reflexes on heart rate in normal subjects. We therefore studied the effects of various interventions, able to modify the activity of arterial baroreceptors and cardiopulmonary receptors, on the power spectrum of the R-R interval in nine healthy men. To confirm the efficacy of these interventions left ventricular volume was monitored using a portable radionuclide probe. Isosorbide dinitrate (5 mgm sublingually) while sitting unloads both baroreceptors and the cardiopulmonary receptors; it decreased left ventricular end-diastolic volume (p < 0.01) and the mean R-R interval (p < 0.005), increased the power of the low-frequency (LF) component of the R-R interval (p < 0.01), decreased the power of the high-frequency (HF) component (p < 0.005) and increased the LF/HF ratio (p < 0.05). The application of cuffs around the thighs in the supine position, which unloads only cardiopulmonary receptors, decreased left ventricular end-diastolic volume (p < 0.05) but did not affect mean R-R interval, LF component, HF component and LF/HF ratio (p > or = 0.10). Leg raising, which loads only cardiopulmonary receptors, increased left ventricular end-diastolic volume (p < 0.05) and did not affect the mean R-R interval, LF component, HF component and LF/HF ratio (p > or = 0.10). In conclusion, our data suggest that, in normal man, baroreceptor unloading increased sympathetic and decreased parasympathetic neural control of heart rate; cardiopulmonary reflexes do not appear to have a direct neurally mediated effect on heart rate.

Adult↗
PubMed1992

Twenty-four hour blood pressure monitoring in the Syst-Eur trial.

This article describes the objectives and protocol of a study on ambulatory blood pressure in elderly patients with isolated systolic hypertension. This study constitutes an optional side-project to the Syst-Eur trial. The multicentre Syst-Eur trial investigates whether antihypertensive treatment of elderly patients with isolated systolic hypertension will influence the incidence of stroke. Secondary endpoints include cardiovascular events, such as myocardial infarction. The main objective of the side-project is to investigate whether ambulatory blood pressure monitoring will improve the prediction of cardiovascular complications based on blood pressure measurement in the clinic. The side-project also provides the opportunity to evaluate the diurnal profile of blood pressure in elderly patients with isolated systolic hypertension randomized to placebo or active antihypertensive treatment.

Aged↗
PubMed1992

Effect of physical training on systemic and brachial artery haemodynamics in normal men.

The effect of endurance training on resting systemic and brachial haemodynamics was studied in 27 normal sedentary volunteers using a randomized cross-over design. After four months of physical training, peak oxygen uptake and physical working capacity at a heart rate of 130 beats/min (PW130) were increased by 16% (p less than 0.01) and 29% (p less than 0.001), respectively. At end-diastole left ventricular wall thickness was increased (p less than 0.01), whereas internal diameter was not changed. However, the change in internal diameter was positively related (r = 0.44, p less than 0.036) to the change in PWC130, indicating that the internal diameter increased, particularly in those subjects with the greatest increase in exercise capacity. The systemic haemodynamic adaptation to training was characterized by an increased stroke volume and concomitant reduction in heart rate so that cardiac output was not changed. On the other hand, brachial blood flow decreased by 36% on average. The change in blood flow was negatively related (r = -0.43, p = 0.03) to the change in PWC130 after training. Half the number of subjects were restudied after a four-month detraining period. The echocardiographic and Doppler variables tended to return to the pretraining level.

Adult↗
PubMed1992

The diurnal blood pressure profile. A population study.

This population study included 399 subjects, of whom 370 (93%) showed a significant diurnal blood pressure (BP) rhythm. The nocturnal BP fall was normally distributed and averaged 16 +/- 9 mm Hg systolic and 14 +/- 7 mm Hg diastolic (mean +/- SD). The amplitude of the diurnal BP curve followed a positively skewed distribution, with a mean of 16 +/- 5 mm Hg for systolic BP and 14 +/- 4 mm Hg for diastolic BP. The daily BP maximum occurred at 15:54 +/- 4:47 for systolic BP and at 15:11 +/- 4:20 for diastolic BP. Thirty-four subjects were reexamined after a median interval of 350 days. The test for the presence of a significant diurnal rhythm was discordant in only two subjects. Repeatability (twice the standard deviation of the differences between paired recordings expressed as a percentage of the mean) varied from 11 to 25% for the 24 h, daytime, and overnight BP, and from 76 to 138% for the parameters describing the diurnal BP rhythm. In nine subjects with an initial night/day ratio of mean BP less than 0.78, the nighttime BP was significantly increased at the repeat examination, whereas the opposite tendency was observed in nine subjects with an initial ratio greater than 0.87. In conclusion, the distribution of the nocturnal BP fall is unimodal. The reproducibility of the ambulatory BP is satisfactory for the level of BP and for the presence of a diurnal BP rhythm, but not for the parameters of the diurnal BP curve. Thus, one 24 h recording is insufficient to fully characterize an individual's diurnal BP profile.

Adult↗
PubMed1992

Automated versus observer blood pressure as determinants of left ventricular structure.

We studied the contribution of automated blood pressure measurements to the variation in left ventricular structural characteristics, independent of pressure measured by an observer. Thirty eight patients referred for hypertension underwent 24 h blood pressure monitoring. Echocardiography and repeated blood pressure measurements were taken on 2 different days by an observer and by the use of the Dinamap 845 device. Blood pressure by the observer averaged 157/101 mmHg, Dinamap pressure 152/94 mmHg, 24 h pressure 137/92 mmHg, left ventricular mass 218 g and mean wall thickness 12.7 mm. Left ventricular mass and wall thickness were related (P < 0.05) to systolic observer (r = +0.46; r = +0.47), Dinamap (r = +0.42; r = +0.41) and 24 h blood pressure (r = +0.46; r = +0.53); the correlation coefficients were lower (r = +0.35 to +0.51; P < 0.05) for diastolic pressure. These relations were independent of age, gender, height, weight and heart rate. The Dinamap pressure did not contribute to the difference in the left ventricular structural characteristics, independent of the observer pressure. The 24 h ambulatory pressure explained a small but significant (P < 0.05) fraction of the variation in mean wall thickness in addition to the observer pressure. Left ventricular mass and mean wall thickness were not related to the day-night difference in blood pressure (P > 0.25). In conclusion, observer, Dinamap and ambulatory pressures are significantly related to cardiac structural variables. Ambulatory pressure, but not Dinamap pressure, explains a small part of wall thickness variance in addition to well-standardized pressure measured by an observer.

Adult↗
PubMed1992

Erythrocyte membrane lipids and cationic transport systems in men.

OBJECTIVE: The relationship between erythrocyte membrane and plasma lipids and various transmembrane erythrocyte cationic fluxes was examined in 53 normal men. DESIGN: Different measurements of erythrocyte transport systems were obtained: Na(+)-Li+ countertransport activity; Na+, K+ cotransport activity; Na+, K(+)-ATPase pump activity and the ground membrane permeability for Na+ and K+ as well as the intra-erythrocyte Na+, K+ and Mg2+ concentrations. Plasma cholesterol, triglycerides, phospholipids, free fatty acids, low- and high-density lipoprotein cholesterol levels and the erythrocyte membrane contents of cholesterol, phospholipids and free fatty acids were obtained from fasting subjects. RESULTS: In single regression analysis the erythrocyte Na(+)-Li+ countertransport and Na+, K+ cotransport activities were negatively related to the erythrocyte membrane cholesterol, phospholipids and free fatty acids contents. The Na+, K(+)-ATPase pump activity as assessed by the ouabain-sensitive Na+ efflux was also inversely related to the membrane cholesterol and phospholipids contents. In multiple regression analysis the red blood cell Na(+)-Li+ countertransport activity was independently and negatively related to the membrane cholesterol and free fatty acids contents. CONCLUSION: Our data show that an elevated level of erythrocyte membrane lipids in normal men is accompanied by lower Na(+)-Li+ countertransport, Na+, K+ cotransport and Na+, K(+)-ATPase pump activities.

Adult↗
PubMed1992

Syst-Eur--a multicenter trial on the treatment of isolated systolic hypertension in the elderly: first interim report.

Syst-Eur is a multicenter placebo-controlled outcome trial designed by the European Working Party on High Blood Pressure in the Elderly to investigate the effect of antihypertensive treatment on the incidence of stroke in elderly patients with isolated systolic hypertension (ISH). Eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160-219 mm Hg with a diastolic blood pressure less than 95 mm Hg. The present paper is an interim report on the first 316 patients randomized into this trial. The placebo (n = 170) and active treatment (n = 146) groups were similar at randomization with respect to age (73 +/- 8 years; mean +/- SD), sitting blood pressure (178 +/- 12 mm Hg systolic; 85 +/- 7 mm Hg diastolic), percentage of men (34%), and percentage of patients with cardiovascular complications (29%). After randomization blood pressure fell more (p less than 0.001) in patients on active treatment than in those in the placebo group (19 +/- 20 mm Hg systolic; 6 +/- 10 mm Hg diastolic vs. 7 +/- 19 and 1 +/- 10 mm Hg for sitting blood pressure). This first interim report on the Syst-Eur trial demonstrates that a multinational trial in elderly patients with ISH is feasible and that a significant blood pressure difference between the two treatment groups can be achieved and maintained. New centers are being recruited in order to randomize a total of 3,000 patients.

Aged↗
PubMed1992

Comparison of the effect of celiprolol and nifedipine on blood pressure and plasma lipids.

During a double-blind, randomized study in hypertensive patients, changes in blood pressure (BP) and in plasma lipid and lipoprotein levels during treatment with celiprolol were compared with those occurring during nifedipine treatment. Fifty-three patients (28 men and 25 women) with mild-to-moderate hypertension, aged 20-64 years, were studied. After a 1-month placebo run-in period, patients were randomly assigned to receive either nifedipine (40 mg daily) or celiprolol (200 mg daily) each time using a double dummy technique. After 6 weeks, dosages of each drug could be doubled. Both drugs caused similar reductions in blood pressure but after 12 weeks treatment, the percentage of decrease in diastolic BP (DBP) was more pronounced (p less than 0.01) in the nifedipine group (-18%) than in the celiprolol group (-12%). After 6 weeks, there were no differences in plasma lipids between the two treatment groups. However, the changes after 12 weeks treatment were different (p less than 0.05) between the groups, leading to lower levels of plasma esterified cholesterol, low-density lipoprotein (LDL) cholesterol and apoprotein AI, AII, and B in the celiprolol group. Plasma lecithin cholesterol acyltransferase activity (LCAT) was not modified, suggesting that reverse cholesterol transport was not affected by the drugs. In both treatment groups, a significant positive relationship was observed between changes in LDL cholesterol and apoprotein B. As compared with nifedipine, celiprolol after 12-week therapy had a rather favorable plasma lipid profile. The clinical relevance of such findings, in terms of prevention of cardiovascular complications, has yet to be established.

Acyltransferases↗