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Biomedical subjects

F W Lohmann

Publications and source records attributed to F W Lohmann.

At least 19 recordsLinked to original sources
PubMed1998

[Hypertension-induced organ damage].

Until now, an occasional blood pressure of below 140 mmHg systolic and less than 90 mmHg diastolic at rest has been regarded as normal. However, the most recent recommendations set the range for normotension lower: below 130/85 mmHg. Therapeutic targets will have to be adjusted accordingly. Raised diastolic and/or systolic blood pressure accelerates the process of arteriosclerosis and causes baromechanical effects. These result in disturbances of organ perfusion (brain, heart, kidney, peripheral organs) and left ventricular hypertrophy, cardiac failure, haemorrhagic insult and hypertensive encephalopathy. Echocardiography is particularly well suited for revealing and quantifying the results of hypertension at an early stage. Prompt, adequate antihypertensive therapy prevents or decreases hypertension-induced organ damage. Early diagnosis of hypertension and consistent blood pressure normalisation are, therefore, indispensable. The proportion of undiagnosed and inadequately treated hypertension patients is too high, in fact it is clearly increasing. The author presents specific proposals for improving antihypertensive treatment in order to reduce or prevent avoidable hypertension-induced organ damage. Above all, society must heighten its awareness of health and sharpen its own sense of responsibility.

Antihypertensive Agents↗
PubMed1997

Influence of sleep apnea on 24-hour blood pressure.

OBJECTIVE: To study the influence of obstructive sleep apnea (OSA) on 24-h BP. SETTING: Sleep laboratory of the Medical Department, Neukölln Hospital, Berlin, Germany. METHODS: In 93 subjects, noninvasive 24-h BP monitoring was performed with BP recordings made at 15-min intervals. Apnea severity was evaluated by means of a portable device that allows calculation of an oxygen desaturation index (ODI). A normal 24-h BP profile (dipping) was defined by a night/day BP ratio of 0.9. RESULTS: ODI was related to systolic and diastolic daytime (p<0.001) and nighttime BP (p<0.001) as well as systolic and diastolic BP night/day ratios (p<0.001). Multiple regression analysis showed that age and ODI were independently related to daytime BP. When subjects were grouped according to apnea severity, daytime BP increased as ODI increased: 127/80+/-10/11 mm Hg in habitual snorers (ODI 0 to 5), 135/87+/-15/9 mm Hg in mild OSA (ODI 6 to 30), and 140/90+/-13/10 mm Hg in severe OSA (ODI >30) (p values <0.05 for comparisons of OSA groups with habitual snorers). Compared to subjects with mild OSA or habitual snorers, BP night/day ratios were greater in patients with severe OSA (p values <0.05). Accordingly, hypertension and nondipping increased as ODI increased. CONCLUSION: OSA is associated with hypertension independent of the confounding factors of age and obesity. Nondipping is related to apnea severity. These alterations might contribute to the increased mortality in patients with severe OSA.

Blood Pressure↗
PubMed1997

Comparison of efficacy of spirapril and enalapril in control of mild-to-moderate hypertension.

The efficacy of spirapril, 6 mg once daily, was compared with enalapril, 5-20 mg once daily, in the control of mild-to-moderate hypertension in a placebo-controlled, parallel-group study. A total of 251 patients participated in the study, all of whom underwent a 4-week washout period on placebo. Thereafter, 100 patients were randomized to spirapril, 6 mg once daily, 101 patients to enalapril, 5-20 mg once daily, and 50 patients remained on placebo. Sitting diastolic blood pressure (DBP) and systolic blood pressure (SBP) were measured at 2-weekly clinic visits. Blood pressure profiles during peak and trough plasma drug concentrations (2-4 hours and 24-26 hours postdose, respectively) were determined at baseline and 4 and 8 weeks after starting the double-blind phase. Compared with placebo, treatment with both spirapril and enalapril resulted in significant reductions (p < 0.001) in DBP and SBP. DBP was reduced to a greater extent with spirapril than with enalapril both at peak (-17.4 mmHg vs. -14.8 mmHg) and trough (-14.7 mmHg vs. -12.4 mmHg). Thus, although the trough/peak DBP ratios for spirapril and enalapril were very similar (84% vs. 82%), actual reductions in DBP were different. Spirapril and enalapril treatment resulted in similar reductions in SBP at both peak and trough levels. Both drugs were well tolerated, and there were very few adverse events or changes in hematological or biochemical parameters during the study. In conclusion, spirapril, 6 mg once daily, as the initial and maintenance dose, is at least as effective and well tolerated as enalapril individually titrated.

Administration, Oral↗
PubMed1997

Structured patient education for out-patients with hypertension in general practice: a model project in Germany.

In a model project, office-based physicians in two regions of Germany provided a structured treatment and teaching programme for out-patients with hypertension. The project was carried out in co-operation with the German Hypertension League and designed to evaluate the practicability and efficacy of the implementation in routine primary health care. A total of 111 primary health care practices in two German districts who had participated in a training course were interviewed. In 43 of these offices documented data of all patients who had received the standardised treatment and teaching were evaluated. The programme was well received by the physicians of which 81% rated the training course and 93% the teaching material as 'very good' or 'good'. A total of 466 patients were trained. Data collected on 272 patients (22 weeks after the intervention) demonstrated the efficacy of the programme at treatment level: reduction of body weight (2 kg, P < 0.001) and blood pressure (from systolic 158+/-18 to 148+/-17 mm Hg, P < 0.001; diastolic 91 +/-9 to 86+/-9, P < 0.001). Sixty-five per cent of patients learned for the first time how to perform blood pressure self-monitoring during the programme. The number of blood pressure readings by the patients' increased significantly from 1+/-3 measurements per week before, to 8+/-7 measurements per week after the programme (P < 0.001). The results of the study demonstrate the practicability and efficacy of the implementation of the programme for patients with hypertension into routine primary health care.

Adult↗
PubMed1996

Monitoring antihypertensive therapy through blood pressure measurements taken casually, at rest, during exercise, and under outpatient conditions.

To ensure a high degree of patient compliance, and thus, therapeutic safety also, an antihypertensive agent should lower blood pressure for 24 h when taken once a day. A placebo-controlled investigation was carried out in 22 patients with essential arterial hypertension, to ascertain whether this was the case with once daily administration of ramipril. Blood pressure was measured at rest, during exercise, and under outpatient conditions (ambulant blood pressure measurement-ABPM). In our study, ramipril had an excellent 24-h effect and was found to be suitable for administration once a day. ABPM represents the most comprehensive and reliable means of monitoring antihypertensive treatment, particularly since it also provides data about nocturnal blood pressure behavior and additionally enables the most distinctive determination of the trough to peak-ratio.

Adult↗
PubMed1996

Hypertension and obstructive sleep apnea. Ambulatory blood pressure monitoring before and with nCPAP-therapy.

We studied 24-h blood pressure (BP) in 17 hypertensive patients with polysomnographic verified moderate to severe obstructive sleep apnea (OSA) before, after 1-3 days and after 4-6 months of treatment with nasal continuous positive airway pressure (nCPAP). BP was recorded using an ambulatory blood pressure monitoring (ABPM) device with oscillometric measurement method (SpaceLabs 90207) over a period of 24 h with intervals of 15 min in daytime and nighttime. Hypertension was defined as mean BP in the daytime period > 135/85 mm Hg; OSA was diagnosed when a full night polysomnography indicated an apnea hypopnea index (AHI) > 10/h. Hypertensive systolic/diastolic daytime BP values decreased significantly from 144.8/94.4 mm Hg at baseline to 138.9/89.4 mm Hg after short-term, and to 136.4/86.9 mm Hg after long-term nCPAP-therapy. Nighttime BP values, too, were reduced significantly from 137.6/87.1 mm Hg at baseline to 129.9/82.3 mm Hg after short-term, and to 128.6/ 79.8 mm Hg after long-term therapy. In addition to these data the heart rate fell significantly from 82.5 b/min to 74.8 b/min after 4-6 months in daytime, and from 70.9 b/min to 63.6 b/min in nighttime. The beneficial effect on diurnal and nocturnal hypertension in patients with nCPAP-therapy of OSA suggests a causal relationship between systemic hypertension and obstructive sleep apnea.

Adult↗
PubMed1994

[Therapy of arterial hypertension in the elderly. Characteristics of hypertension in aging--use of calcium antagonists].

In the elderly patient (from 60-65 years) elevated blood pressure (160/99 mmHg or more under conditions of rest) is a risk factor that requires treatment. This also applies to isolated systolic hypertension (systolic BP > or = 160 mmHg at a diastolic pressure < 90 mmHg). Individually tailored antihypertensive treatment can clearly improve the quality of life and prognosis of the elderly hypertensive. In view of the importance of increased peripheralvascular resistance, in the elderly patient, the anti-hypertensive concept should always include a vasodilator. This requirement makes calcium antagonists, in particular those of the dihydropyridine type, when they are well tolerated, highly suitable for treating hypertension in the elderly. An added advantage is the fact that there are virtually no major contraindications. In this connection, substances that exert a uniform effect over 24 hours should be given preference (advantages: single dosage, better tolerability). In addition, the dihydropyridines (calcium antagonists of the nifedipine type) can readily be together with other agents when combination treatment necessary.

Aged↗
PubMed1993

[Circadian antihypertensive action and tolerability of a sustained-release form of isradipine in an intra-individual comparison with nitrendipine].

Antihypertensive efficacy and tolerability of a 4-week treatment each with the modified release formulation of the calcium antagonist isradipine (5 mg; Lomir SRO, CAS 75695-93-1) were compared with those of nitrendipine (20 mg) (both with morning intake) in 51 patients with mild to moderate hypertension using a double-blind, intraindividual crossover study. Blood pressure was measured over 24 h at the end of a 2-week placebo phase and after both treatment phases by means of a continuous ambulatory recording device. Upon statistical evaluation of all patients with 3 complete 24-h profiles (n = 44) and combined analysis of data from same treatments the following 24-h mean values were obtained: blood pressure (syst./diast.) was lowered from 151/98 mmHg to 141/91 mmHg by isradipine retard (IS) and to 141/92 mmHg by nitrendipine (NI), whereas heart rate remained nearly unchanged (78 vs 79 beats/min on both therapies). The 24-h profiles differed significantly between placebo and both therapies, the profile as a whole was more even on IS. Starting from a day-time mean value (6:00 a.m.-10:00 p.m.) on placebo of 155/102 mmHg blood pressure was reduced by IS to 143/94 mmHg and by NI to 144/95 mmHg; the corresponding night-time mean values were; placebo 138/85 mmHg, IS 132/82 mmHg, NI 134/83 mmHg. If one compares the area under the blood pressure curves during the hours from 6 p.m. to 12 p.m. significant differences (2p = 0.0128) were found for systolic pressure and borderline significance (2p = 0.0668) for diastolic differences in favour of IS.

Adolescent↗
PubMed1990

[Sympathetic activity in patients with heart failure due to idiopathic dilated cardiomyopathy: modification by beta receptor blockers--a therapeutic approach?].

Increased sympatho-adrenergic activity is a compensatory mechanism in cardiac failure. Accordingly, beta-receptor blockers are generally regarded as contraindicated for use in heart failure. In 1975, Waagstein reported the first successful use of beta-receptor blockers in patients with idiopathic dilated cardiomyopathy. It was shown that the prognosis of patients with dilated cardiomyopathy could be improved by beta-receptor blockade. In this regard, most experience is associated with metoprolol. It should be stressed that the initial, and long-term dosage, as well, was maintained at a very low level (beginning, for example, with 6.25 mg metoprolol daily). An on-going, international, multicenter study is intended to clarify which patients with dilated cardiomyopathy may benefit from treatment with beta-receptor blockers. Additionally, further information is anticipated with respect to the complex mechanism of action. Beside the direct cardiac action with blockade of the cardiotoxic effect of the extremely high levels of plasma catecholamines, induction of an upregulation of the down-regulated beta-1-receptors there is attenuation of the activity of the renin-angiotensin-aldosterone system. Overall, this leads to interruption of the vicious cycle of maladaption associated with chronic heart failure and its attendant unfavorable vasoconstriction and sodium and water retention. This positive aspect of beta-1-receptor blockade in dilated cardiomyopathy carries with its initially and unavoidable negative inotropic effect and thus, in the individual patient, the net effect is difficult to predict. Consequently, the indication must be established on an individual basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1985

Oxygen uptake and plasma catecholamines during submaximal and maximal exercise after long-term beta-receptor blockade.

Beta-receptor antagonists lower exercise heart rate and cardiac output, and can thus be expected to interfere with oxygen transport, and hence physical performance, particularly at higher levels of activity. Therefore, the effects of a 4-week and 15-month treatment period with the beta 1-selective receptor blocker acebutolol (500 mg daily) on oxygen uptake and plasma catecholamines during submaximal steady-state and maximal exercise and on maximal work load were studied in eight WHO stage 1 hypertensive men (mean age 36.4 years). Oxygen uptake, ventilation, and plasma noradrenaline, adrenaline, and dopamine concentrations during steady-state exercise were not significantly different from control conditions either after 4 weeks or after 15 months of receptor blockade, although heart rates were significantly (27% and 25%, respectively; P less than 0.01) reduced. After the 4-week treatment period, maximal oxygen uptake (3.9% reduction, NS) and maximal work load (2.4% reduction, NS) tended to be slightly lower after acebutolol compared with control values; maximal oxygen pulse was significantly (P less than 0.05) increased. However, after long-term treatment of 15 months, maximal oxygen uptake was virtually identical compared with pretreatment values, and maximal work load tended to be higher (5.2%, NS); plasma noradrenaline and adrenaline concentrations were significantly (P less than 0.05) enhanced. Since beta 1-selective receptor blockers do not affect maximal oxygen uptake and maximal work capacity after long-term treatment, they appear preferable for patients taking part in preventive and rehabilitative training programs.

Acebutolol↗
PubMed1983

Aspects of hormonal regulation of lipolysis during exercise: effects of chronic beta-receptor blockade.

Exercise-induced lipolysis and hormones possibly involved in the regulation of lipid metabolism in association with exercise (plasma catecholamines, ACTH, HGH, TSH, insulin) were studied in 11 WHO stage 1 to 2 hypertensive men (mean age 37 years) during a 30-min steady-state submaximal (65% of VO2 max) and near-maximal exercise seated on a bicycle ergometer. To assess the contribution of the sympathetic system to the regulation of lipolysis and to define the type of beta-receptors mediating the catecholamine effects on lipolysis, all patients were again studied under identical conditions after a 4-week treatment with the beta-1-beta-2-receptor antagonist pindolol (15 mg daily) and with the beta-1-receptor blocker acebutolol (500 mg daily). Eight patients were even restudied after a 16-month treatment with acebutolol. Plasma glycerol levels increased progressively (P less than 0.001) during exercise reflecting increased exercise-induced lipolysis. The concomitant significant rise of noradrenaline, adrenaline, ACTH, and HGH and the parallel fall in plasma insulin suggest that all these hormones are involved in the adjustment of exercise-induced lipolysis. However, the impaired catecholamine-induced lipolysis under beta-receptor blockade was not accompanied by significant compensatory increases of ACTH, HGH, or TSH or a fall in insulin during exercise. Both beta-receptor antagonists resulted in a similar 27% inhibition of lipolysis confirming that the catecholamine-induced increase of lipolysis is mainly mediated via beta-1-adrenoceptors. After 16 months of treatment with acebutolol, the degree of inhibition of the exercise-induced lipolysis was unchanged. However, FFA were significantly reduced (28%, P less than 0.05) and HGH significantly (100%, P less than 0.05) increased.

Acebutolol↗
PubMed1983

beta-adrenoceptor blockade and physical activity: cardiovascular and metabolic aspects.

This paper assesses mechanisms that may contribute to the higher incidence of increased muscle fatigue during exercise and reduced exercise performance as observed with selective compared with non-selective beta-adrenoceptor antagonists. Published data and the results obtained in 8 healthy subjects (mean age 23 years) studied before and after acute beta-adrenoceptor blockade with pindolol (nonselective, 10 mg) and metoprolol (beta 1-receptor selective, 100 mg) suggest that the differences in the cardiovascular and respiratory effects between the 2 types of antagonists are marginal and cannot explain the discrepancies concerning exercise perception and performance. Conversely, basic differences between the 2 types of antagonists were shown in different groups of hypertensive men (mean age 32 years) studied before and after 4 weeks of treatment with pindolol (15 mg), and with metoprolol (200 mg) and acebutolol (cardioselective, 500 mg), by single crossover technique. Whereas lipolysis was similarly inhibited by both selective and non-selective antagonists, hypoglycaemia occurred only under non-selective blockade. It apparently reflects the inhibition of glycogen breakdown; concomitant rises in plasma adrenaline and ACTH probably reflect counter-regulatory mechanisms.

Acebutolol↗
PubMed1982

[Reproducibility of blood pressure measurements in hypertensives during and after ergometry].

On repeated measurement hypertensives have greater swings in resting blood pressure than those with normal pressures. In 20 untreated hypertensives (WHO stage I), average age 35.8 years, blood pressures were measured during and after ergometry (50-100 Watt) to see whether there were any variations during the day and whether repeat measurements were affected by adaptation. Blood pressure measurements repeated three times during ergometry, gave good agreement above 1 Watt/kg body weight, with a mean of 203/116 mm Hg at 8 a.m., 200/114 mm Hg at 10 a.m. and 203/113 mm Hg at 4 p.m., although resting blood pressures at times differed significantly. Even in patients with labile or borderline hypertension, blood pressure measurement during and after ergometry without exception made it possible to assign them to the hypertensive range, which would not have been possible or only to a limited extent at rest. Measurement of blood pressure during and after standardised ergometry is thus superior to resting blood pressure measurements in the identification of hypertensives.

Adaptation, Physiological↗
PubMed1981

[Beta-receptor blockers: metabolic actions and therapeutic consequences (author's transl)].

Whereas the control of cardiac function occurs through the sympathetic nervous system via the beta 1-receptors, metabolic processes are controlled via beta 1- and/or beta 2-receptors accordingly. The inhibition occurring during the use of non-selective beta-receptor blockade of the beta 2-receptors also consequently leads undesirably to possible impairment of insulin secretion and especially to glycogenolysis in the skeletal musculature. The initially more intensely inhibited lipolysis under mixed beta-receptor blockade lead among other things to more severe changes in the lipoproteins than a predominantly beta 1-selective receptor blockade through reactive compensation procedures. Generally in the treatment of arterial hypertension, as also of cardiovascular disease with beta-receptor blocker, a beta 1-receptor blocker is preferred in order to avoid as far as possible disadvantageous metabolic actions of such treatment.

Adrenergic beta-Antagonists↗