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Biomedical subjects

I W Franz

Publications and source records attributed to I W Franz.

At least 19 recordsLinked to original sources
PubMed2002

[Blood coagulation in normotensives and hypertensives in relation to their body mass index].

UNLABELLED: BACKGROUND AND PERSPECTIVE: Various parameters of the coagulation cascade and fibrinolysis are important predictors of myocardial infarction and stroke, for which hypertension is a risk factor. It is unclear whether an elevated blood pressure by itself can produce activated clotting. PATIENTS AND METHODS: Coagulation tests were done on overweight hypertensive (n=40); aged 49 +/- 8 years; group 3), overweight normotensives (n=19; aged 51 +/- 8 years; group 2) and normal-weight normotensives (n=20; aged 51 +/- 8; group 1). RESULTS: Plasminogen-activator-inhibitor 1 (PAI-1), a measure of impaired fibrinolysis, was elevated in group 2 (20.5 +/- 11 U/ml; p < 0.001), compared with group 1 (11.6 +/- 6 U/ml), and was even higher in group 3 (27.5 +/- 9 U/ml; p < 0.05). Fibrinogen and factor VIII, parameters that promote clotting, were elevated in group 2 (360 +/- 61 mg/dl and 143 +/- 15 %, respectively; p < 0.001), and in group 3 (368 +/- 63 mg/dl and 146 +/- 18%; p < 0.001) compared to group 1 (304 +/- 40 mg/dl and 127 +/- 17%). Correspondingly, fibrin monometers, a measure of intravascular coagulation, were elevated in group 3 (p < 0.05) and partial thromboplastin time (PTT) decreased (p < 0.001). Pearson correlation showed a significant (p < 0.001) positive relationship between PAI-1 and body mass index (BMI) (0.539), triglycerides (0.512), blood pressure (0.388 to 0.534), fibrinogen (0.404, and a negative one with HDL-cholesterol (0.625). BMI also correlated with fibrinogen (0.509; p < 0.001) and factor VIII (0.337; p < 0.01). CONCLUSIONS: Fibrinolysis and activated coagulation are reduced in hypertensive subjects: this favours the occurrence of myocardial infarction and stroke. In addition to the level of blood pressure, the extent of the changes are effected especially by BMI and metabolic risk factors.

Adult↗
PubMed2002

[Fish, olive oil, fruit, vegetables and fiber. Therapy of hypertension a la carte].

A healthy diet has a positive impact both on elevated blood pressure and its associated cardiovascular risk. In particular the association between obesity and hypertension is beyond doubt. Accordingly, a calorie-controlled or low-calorie diet resulting in a reduction in weight, lowers raised blood pressure. Blood pressure is also determined by the composition of the diet. A substantial pressure-lowering effect has been shown to be associated with the regular ingestion of fish and olive oil. Evidence also points to a positive effect of a diet high in fruit and vegetables and low in fat. Also recommended for hypertensives is a low-salt and potassium-rich diet, and sparing use of alcohol. The impact of a healthy diet on the cardiovascular risk is particularly favorable when the patient also takes regular physical exercise.

Animals↗
PubMed2002

The effect of amlodipine on exercise-induced pulmonary hypertension and right heart function in patients with chronic obstructive pulmonary disease.

The aim of the study was to investigate the pulmonary vasodilator effect of the dihydropyridine calcium channel blocker amlodipine in patients with clinically stable chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH). Many patients with COPD develop chronic PH and this may predict mortality in this disorder. The treatment with calcium channel blockers is accepted as a therapeutic strategy for primary pulmonary hypertension. In twenty male patients (mean age 57+/-7 years) with clinically stable COPD and PH, we investigated whether amlodipine could effectively decrease pulmonary vascular resistance (PVR) and pulmonary arterial pressure (PAP) and improve right heart function. PAP was recorded by a balloon-tipped thermodilution catheter and cardiac output was determined in triplicate by thermodilution at rest and during exercise. In addition, blood gas values were determined from the capillary blood of the earlobe. All measurements were done under identical conditions before and after 18 days of chronic treatment: with 10 mg amlodipine once daily starting with 5mg in the first week. At a mean maximal achieved workload of 71.3+/-20 Watts, amlodipine achieved a significant reduction in PVR (-13.4%; p<0.01) and PAP (-12.1%; p<0.001) implying an improved right heart function assessed by a significant reduction in mean right atrial pressure (-20.6%; p<0.05). During the action of amlodipine there were no significant changes in pulmonary gas exchange and pulmonary capillary wedge pressure. Amlodipine given as a single daily oral dose of 10mg is a safe and effective pulmonary vasodilator in COPD patients with PH and leads to an improvement in right heart function.

Amlodipine↗
PubMed1998

[Significance of a life style change in arterial hypertension].

Changes in lifestyle represent a rational, promising and low side effect means of lowering the blood pressure and reducing the cardiovascular risk in many hypertensives. The first measure in all over-weight hypertensives is weight reduction. Even when the ideal weight is not reached, this measure leads to a lasting decrease in blood pressure. Beyond a threshold of 30 mg alcohol per day in men (approximately three glasses of beer or two glasses of wine) and 20 mg alcohol per day in women, the consumption of alcohol leads to an increase in blood pressure. Although only some hypertensives respond to a restriction of salt, all hypertensives should limit their salt intake to 5 to 6 g daily. Endurance training is an important pillar of lifestyle change. That relaxation techniques lower blood pressure has not been confirmed by the results of relevant studies. What has been confirmed, however, is the benefit of extensive changes in lifestyle, including information on health, daily endurance training, healthy eating habits and reduction of alcohol intake.

Adolescent↗
PubMed1998

Time course of complete normalization of left ventricular hypertrophy during long-term antihypertensive therapy with angiotensin converting enzyme inhibitors.

Metaanalyses have indicated that ACE inhibitors are more effective than other first-line therapies in reducing left ventricular hypertrophy (LVH). The average treatment period, however, was only approximately 6 months. The aim of the present study, therefore, was to clarify the time course and degree of reversal, and primarily to find out in how many patients a complete normalization of LVH can be achieved. Secondly, we sought to determine whether atrial enlargement can be reduced. Previously untreated hypertensive patients (mean age 46.3 +/- 9 years, eight women, 15 men) with echocardiographically confirmed LVH (left ventricular mass index ([LVMI] > 125 g/m2 for men; > 110 g/m2 for women) were prospectively treated over a 3-year treatment period with quinapril. Nine patients received 10 mg quinapril, 12 received 20 mg of quinapril daily, and five patients additionally received 25 mg hydrochlorothiazide. The time course of changes in LVMI, relative wall thickness, left atrial size, fractional shortening, and diastolic function was evaluated and ambulatory blood pressure monitoring (ABPM) and an exercise test were performed every 6 months. After a mean treatment period of only 7.5 months, there was a significant (P < .001), 17.5% decrease in LVMI with a further continuous and significant (P < .001) decrease of 38.6% after 38.3 +/- 3 months of therapy. In 90.5% of the patients a complete reversal of LVH was achieved. Fractional shortening increased significantly, the maximum being 14.6% after 38.3 +/- 3 months. The peak early/atrial velocity (E/A) ratio increased significantly (P < .01) after just 7.5 +/- 3.1 months with no further changes during follow-up. There seemed to be a parallel change with the decrease in left atrial dimension, where the most important decrease occurred after only 7.5 +/- 3.1 months (P < .01), with a further continuous reduction. Our study clearly shows that maximum reversal of LVH is a time-consuming process and that an essential goal of antihypertensive therapy should be not only a reduction in LVH but also a normalization in LV mass, left atrial size, and in diastolic dysfunction.

Adult↗
PubMed1997

[Exercise hemodynamic in hypertension associated with coronary microangiopathy, coronary heart disease and without ischemic syndrome effect of nifedipine].

OBJECTIVE: Is heart function during exercise impaired in hypertensive patients with effort angina and ST-segment depression but normal coronary angiograms? METHODS AND RESULTS: In 12 hypertensive patients (group 1; aged 53 +/- 4 yrs), who had ST-segment depression during exercise, concomitant angina pectoris but normal coronary angiograms, and no LVH, left ventricular function at rest and during exercise was studied by cardiac catheterization and compared with 12 hypertensives with CAD (group 2; aged 56 +/- 5 yrs) and 12 hypertensives without ST-segment depression (group 3; aged 56 +/- 7 yrs) after discontinuation of all cardiac medications. PCWP was normal at rest and pathologically increased at 79.2 +/- 17.9 watts only in group 1 and 2 (30.2 +/- 6 mm Hg; 31.5 +/- 5 mm Hg, respectively) but not in group 3 (18.5 +/- 3 mm Hg; p < 0.001). Repeated measurements during exercise and 30 min after 10 mg nifedipine orally, showed a significant (p < 0.001) and nearly identical fall in MAP, an increase in CI (p < 0.01), and an unchanged HR x SBP in all groups. However there were significant differences in decrease of PCWP (group 1: -41.4%; group 2: -22.9%, p < 0.01; group 3: -25.4%, p < 0.01) with concomitant reduction in ST-segment depression (p < 0.01) in group 1 and 2 (-43.7% and -36% respectively). CONCLUSIONS: ST-segment depression during exercise ECG with concomitant angina pectoris is not a false-positive finding in hypertensive patients with normal angiograms and without LVH but demonstrates myocardial ischemia, resulting in an impaired left ventricular heart function. This seems to be mainly caused by a functional changeable disorder of the coronary vascular bed as heart function is improved after nifedipine.

Coronary Disease↗
PubMed1997

Efficacy and position of endurance training as a non-drug therapy in the treatment of arterial hypertension.

Regular conditioning has been well documented to exert a beneficial effect on cardiovascular risk factors and to improve overall cardiovascular health and to reduce the incidence of coronary disease. There are conflicting results concerning the effect of physical exercise on blood pressure (BP) in hypertensive patients and its importance in the treatment of hypertension. Therefore 10 male patients with mild arterial hypertension were studied in order to define the BP response to long-term aerobic training (60 min twice a week) under resting conditions, during standardised ergometric workload, during isometric exercise, during cold pressor testing and during 24-h BP monitoring. After 18 months of regular training there were significant reductions in arterial pressures at rest, during and after standardised ergometry and during isometric and cold pressor testing when compared with pre-training. The heart rate also decreased significantly during exercise testing thus implying a decrease in myocardial oxygen consumption. After long-term training, a reduction in systolic and diastolic BP could also be shown during 24-h ambulatory BP monitoring. These results demonstrate that long-term aerobic training leads to a decrease in systolic and diastolic BP at rest, during exercise and during 24-h BP monitoring and imply a beneficial effect in the management of hypertension that is nearly comparable to that of drug therapy.

Adult↗
PubMed1996

[Prognostic significance of blood pressure during ergometry].

Evaluation of high blood pressure would be greatly facilitated by a standardized test procedure that could enable comparable and reproducible blood pressure determinations to be made. It would also be useful to have a standardized method for monitoring sympathetic activity, so that the occurrence and magnitude of inordinate stress responses could be assessed more accurately. One way to meet these requirements is through standardized ergometric testing at workloads of 50 to 100 watts using increments of 10 watts/min. or 25 watts/2 min. (cuff blood pressure measurements). Between the ages of 20 and 50 years the criteria for a hypertensive response during exercise are blood pressure values of more than 200/100 mmHg (mean + 1 SD of the normotensives) at a workload of 100 watts. In the recovery phase, blood pressure is considered as being hypertensive if a value of 140/90 mmHg ist exceeded in the fifth minute. There are several studies showing that the blood pressure response to ergometry predicts future hypertension in patients with normal resting blood pressure. Patients suffering from mild hypertension showed significantly higher blood pressures at 100 watts and after exercise than age-matched normotensives but significantly lower values than hypertensives with stable hypertension. Ergometric studies also assume a prognostic importance, with respect to prevention of acute and chronic complications of hypertension. Therefore we must require that antihypertensive drugs not only normalize the resting blood pressure, but also lower the blood pressure adequately in stressful situations.

Adult↗
PubMed1996

[Decreasing the antihypertensive dosage during longterm treatment and complete regression of left ventricular hypertrophy].

AIM OF STUDY: To discover whether in hypertensives with left ventricular hypertrophy (LVH) the increased muscle mass will completely regress under antihypertensive treatment and drug dosage can in consequence be reduced. PATIENTS AND METHOD: Prospectively 22 previously untreated hypertensives (20 men, 2 women; mean age 43.6 +/- 9 years) with echocardiographically confirmed LVH were investigated. The observation period was 102 +/- 5 months. All patients initially received metoprolol, 100 mg daily, after 14 days 200 mg daily (additionally hydrochlorothiazide in five patients). In all patients the blood pressure became normal at rest and on exercise within 6 weeks. RESULTS: After one year the mean left ventricular muscle mass index (LVMI) had fallen from 151 +/- 29 to 117 +/- 26 g/m2 (P < 0.001), and after 7 years to 82 +/- 14 g/m2 (P < 0.001; - 45.7%). Complete remission of LVH was demonstrated in 21 Patients. The drug dosage could either be reduced or the drug completely discontinued in 11 patients (group 1): after 102 +/- 5 months four patients took no drug, while seven were on 100 mg metoprolol. This was not possible in the other 11 patients (group 2), five of whom had been on both metoprolol and hydrochlorothiazide. The two groups differed with respect to loss of body weight (group 1: from 81.+/- 12 to 79.1 +/- 13 kg; P < 0.05; group 2: 85.7 +/- 8 to 88.1 +/- 10 kg; P < 0.05), but not regarding reduction of LVMI and blood pressure. CONCLUSION: Antihypertensive treatment for several years leads to regression in LVH in nearly all patients. In half of them the drug dosage can be reduced or the drug even discontinued. Weight loss may play an important part in this development.

Adult↗
PubMed1996

Blood pressure measurement during ergometric stress testing.

Evaluation of high blood pressure would be greatly facilitated by a standardized test procedure that could enable comparable and reproducible blood pressure determinations to be made. It would also be useful to have a standardized method for monitoring sympathetic activity, so that the occurrence and magnitude of inordinate stress responses could be assessed more accurately. One way to meet these requirements is through standardized ergometric testing at workloads of 50 to 100 watts using increments of 10 watts/ min or 25 watts/2 min (cuff blood pressure measurements). Between the ages of 20 and 50 years the criteria for a hypertensive response during exercise are blood pressure values of more than 200/100 mg Hg (mean + 1 SD of the normotensives) at a workload of 100 W. In the recovery phase, blood pressure is considered as being hypertensive if a value of 140/90 mm Hg is exceeded in the fifth minute. There are several studies showing that the blood pressure response to ergometry predicts future hypertension in patients with normal resting blood pressure. Patients suffering from mild hypertension showed significantly (p < 0.001) higher blood pressures (213 +/- 22/116 +/- 11 mm Hg) at 100 W and after exercise than age-matched normotensives (188 +/- 14/92 +/- 9 mm Hg) but significantly (p < 0.001) lower values than hypertensives with stable hypertension (225 +/- 22/126 +/- 11 mm Hg). Using the normal upper limits for blood pressure during and after ergometry, the ergometric procedure revealed that 50% of the patients with borderline hypertension at rest could be classified as hypertensives. Follow-up examinations several years (average 3.8 years) later subsequently showed that 97% of the ergometric-positive borderline hypertensives developed established hypertension. Ergometric studies also assume a prognostic importance, with respect to prevention of acute and chronic complications of hypertension. Therefore, we must require that antihypertensive drugs not only normalize the resting blood pressure, but also lower the blood pressure adequately in stressful situations. This requirement is by no means satisfied by all hypertensive drugs that are effective at rest.

Adult↗