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Biomedical subjects

J Widimský

Publications and source records attributed to J Widimský.

At least 19 recordsLinked to original sources
PubMed2006

Biochemical markers of endothelial dysfunction in patients with endocrine and essential hypertension.

The aim of our study was to evaluate potential differences in the concentration of biochemical markers of endothelial dysfunction between essential hypertension, endocrine hypertension (pheochromocytoma, primary hyperaldosteronism) and control healthy group and to assess a potential relationship between these markers of endothelial dysfunction and vasopressor substances overproduced in endocrine hypertension. We have investigated 21 patients with moderate essential hypertension, 29 patients with primary hyperaldosteronism, 24 subjects with pheochromocytoma and 26 healthy volunteers. Following parameters of endothelial dysfunction were measured, von Willebrand factor (vWf), plasminogen activator (t-PA) and E-selectin (E-sel). Clinical blood pressure was measured according to the European Society of Hypertension recommendations. We found significantly higher levels of the von Willebrand factor in patients with essential hypertension in comparison with a control group (114+/-20 IU/dl vs 90+/-47 IU/dl; P=0.04) and patients with primary hyperaldosteronism (114+/-20 IU/dl vs 99+/-11 IU/dl; P=0.01). Patients with endocrine hypertension revealed increased levels of vWF compared to the control group, but these differences did not reach statistical significance. Levels of t-PA were increased in patients with pheochromocytoma in comparison with the control group (4.6+/-1.9 ng/ml vs 3.4+/-0.9 ng/ml; P=0.01) and with primary hyperaldosteronism (4.6+/-1.9 ng/ml vs 3.4+/-1.1 ng/ml; P<0.01). In case of E-selectin we found lower levels in patients with pheochromocytoma in comparison with other groups, but they differed significantly only with primary hyperaldosteronism (40.2+/-15.0 ng/ml vs 51.3+/-23.0 ng/ml; P=0.05). Our study did not reveal any convincing evidence of differences in the levels of biochemical markers of endothelial dysfunction between essential and endocrine hypertension. No correlation between the biochemical markers of endothelial dysfunction and vasopressor substances activated in endocrine hypertension was found.

Adrenal Gland Neoplasms↗
PubMed2006

[The FIELD study presented and published. Unconvincing results of fenofibrates in diabetic patients].

The prognosis of the patients with the Type II diabetes mellitus without myocardial infarction is as serious as the prognosis of the patients who had experienced myocardial infarction without diabetes mellitus. Consequently there is a big interest of IHD prevention options in diabetic patients, not only by hypertension therapy, but also by hypolipidemic treatment. That is why the results of FIELD study were expected with a great interest. FIELD study randomized 9 795 patients with the Type II diabetes mellitus and initial values of total cholesterol 3.0 to 6.5 mmol/l and in addition with total cholesterol/HDL-cholesterol rate > or = 4.0 or with the values of plasmatic triglycerides between 1.0 and 5.0 mmol/l for treatment with 200 mg of micronized phenophibrate or placebo. As phenophibrate positively influences the typical lipid disorder at diabetic patients, the throughout positive results of phenophibrate had been expected. Study did not fulfil the primary objective of the study of coronary deaths/ non fatal myocardial infarctions (insignificant decrease by 11%). Although phenophibrate significantly decreased non fatal myocardial infarctions and myocardial revascularizations, total mortality and cardiovascular mortality were not positively influenced and they even show non significant aggravating trend. Moreover, the positive effect of phenophibrate on non fatal myocardial infarctions and revascularizations was present only at the persons who had not experienced a cardiovascular disease and only at the persons under 65 years. Phenophibrate positively influenced some diabetic micro vascular complications (nephropathy and retinopathy). Thus, the results of FIELD study present a disappointment and that is why the recommendations of the statin therapy as a priority therapy of dislipidemia stay unchanged also for the patients with Type II diabetes mellitus.

Cardiovascular Diseases↗
PubMed2005

Second derivative of the finger arterial pressure waveform: an insight into dynamics of the peripheral arterial pressure pulse.

The study investigated second derivative of the finger arterial pressure waveform (SDFAP) in 120 healthy middle-aged subjects and in 24 subjects with essential hypertension. SDFAP consists of 5 sequential waves 'a'-'e'. Their normalized magnitudes (B/A, C/A, D/A, and E/A) were calculated. In multivariate regression analysis, B/A and C/A correlated only with age. D/A independently correlated with age, heart period, mean blood pressure (MBP), body height, and gender. E/A independently correlated with age and MBP. D/A and E/A were higher (0.42+/-0.16 vs. 0.33+/-0.14, p = 0.05 and 0.63+/-0.15 vs. 0.45+/-0.14, p < 0.001), while B/A and C/A were lower (1.04+/-0.16 vs. 1.20+/-0.17, p = 0.002 and 0.09+/-0.15 vs. 0.26+/-0.20, p = 0.001) in hypertensives compared to sex- and age-matched controls. After the adjustment for MBP, heart period, and body mass index (ANCOVA), independent discriminative power was preserved only for indices B/A and C/A (p = 0.001 and 0.021, respectively). Therefore, B/A and C/A provide additional information about simple clinical characteristics and might reflect the structural alteration of the arterial wall in hypertensive subjects.

Adult↗
PubMed2005

[Recommendations for the treatment of tobacco dependence].

This first Czech version of guidelines formulated by the working group of mentioned medical associations is based on current literature and international guidelines. They are aimed mainly on clinical medicine and on incorporation of this treatment into the health care system according to WHO recommendations. They should serve to the treatment of tobacco dependence at any level: during any contact with the smoking patient (short intervention), in specialised centres or for the health care providers or health system itself.

Humans↗
PubMed2005

[Prevention of cardiovascular events by the antihypertensive treatment using amlodipine and perindopril in comparison with the use of atenolol and bendroflumethiazide. The ASCOT (Anglo-Scandinavian Outcomes Trail: blood pressure lowering arm) study results--multicentre, randomised, controlled trial. Landmark in the development of opinions on combination therapy in hypertension? (comment)].

It is a multicentre, prospective, randomised controlled trial in 19 257 patients with hypertension aged 40-79 years with at least three cardiovascular risk factors. After 5,5 years median follow-up fewer individuals on amlodipine + perindopril had a primary endpoint (429 vs 474, HR 0.90, p = 0.1052), fatal and non-fatal stoke (327 vs 422, HR 0.77, p = 0.0003), total cardiovascular events and procedures 1362 vs 1602, 0.84, p = 0.0001) and all cause mortality (738 vs. 820, HR 0.89, p = 0.025). The incidence of developing diabetes was also less on the amlodipine + perindopril based regimen (567 vs 799, HR 0,70, p = 0.0001). The amlodipine-perindopril based regiment prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen. These results may have in implications with respect to optimum combinations of antihypertensive drugs.

Adult↗
PubMed2004

Diurnal blood pressure variation in pheochromocytoma, primary aldosteronism and Cushing's syndrome.

We examined circadian blood pressure (BP) variation (expressed as a relative night-time BP decline) in subjects with primary aldosteronism (78 patients), pheochromocytoma (n=45) and Cushing's syndrome (n=18). Subjects with aldosterone-producing adenoma (n=21) and pheochromocytoma (n=27) were also investigated after the tumour removal. In all, 65 patients with essential hypertension served as a control group. The night-time BP decline was significantly attenuated in all three forms of endocrine hypertension compared to the control group (primary aldosteronism P<0.0001, pheochromocytoma P<0.0001 for systolic and diastolic BP and Cushing's syndrome P<0.0001/<0.001 vs essential hypertension). In the case of pheochromocytoma, the absence of the night-time BP decrease was more prominent compared to the primary aldosteronism group (P=0.003/0.001) and for the diastolic BP also in comparison with the Cushing's syndrome group (P=0.03). Tumour removal led in both groups to the restoration of the previously altered circadian rhythm (aldosterone-producing adenoma: P=0.0005/0.0009; pheochromocytoma: P=0.001/0.0007). Our study demonstrates a blunted circadian BP variation in all forms of adrenal hypertension in comparison with essential hypertension. This reduction of the night-time BP decrease was more prominent in pheochromocytoma than in primary aldosteronism or Cushing's syndrome.

Adrenal Gland Neoplasms↗
PubMed2004

[Evaluation of the antihypertensive efficacy and tolerability of fixed very low-dose perindopril/indapamid combination in patients with mild to moderate hypertension. Results of a Czech and Slovak multicentric study].

AIM OF THE STUDY: To evaluate the efficacy and tolerability of fixed, low-dose perindopril (2 mg) and indapamide (0.625 mg) combination in patients with mild to moderate hypertension. Secondary aim of the study was to assess the influence of this combination on basic echocardiographic parameters. GROUP OF PATIENTS AND METHODS: 112 patients (57% men, 43 women, mean age 52 +/- 13 years) with newly diagnosed mild to moderate hypertension, without left ventricular dysfunction. 55% of patients had at least one risk factor for coronary artery disease. The following parameters were studied: BMI, sitting and upright casual blood pressure, heart rate, main echocardiographic parameters and basal laboratory tests. RESULTS: Perindopril/indapamide treatment led already after 4 weeks to a significant blood (BP) reduction with most prominent BP differences at the end of the study (sitting BP 130 +/- 10/84 +/- 6 mm Hg vs. 153 +/- 10/97 +/- 5 mm Hg before the treatment). Normalisation of the BP was achieved in 76% of the hypertensives. Good response to treatment (decrease in systolic BP > or = 20 mm Hg and/or decrease in diastolic BP > or = 10 mm Hg) was reported in another 13% patients. Perindopril/indapamid treatment led to a significant decrease in interventricular thickness (10.7 vs. 10.2, P < 0.01) and to the improvement in the left ventricle diastolic function (E/A 1.06 vs. 1,14, P < 0.04). No significant changes in basal laboratory tests were reported during the study. Mild side effects were observed in a few patients. CONCLUSION: Fixed, low-dose perindopril/indapamide combination is a new and potent antihypertensive compound with very good tolerability without a negative influence on metabolic parameters. Perindopril/indapamide treatment resulted in the improvement of diastolic function and in the regression of the left ventricle mass.

Antihypertensive Agents↗
PubMed2004

[Treatment in the primary prevention of stroke--still not fully used option].

Several studies have shown that pharmacological treatment of systolic-diastolic hypertension or isolated systolic hypertension in elderly persons would result in several years in a significant decrease (more than 40%) of stroke. Occurrence of strokes decreased in the Czech Republic in years 1985 till 2002 by more than 40%, which represents about two thirds of the decrease observed in the USA. Nevertheless, we cannot be satisfied with the treatment of hypertension in the Czech Republic because only 18% of patients are effectively treated for the hypertension, with BP < 140/90 mm Hg. Not well controlled hypertension results namely from the minimal use of the combination treatment. From the point of prognosis for the hypertensive patients older than 50 years, the level of systolic pressure is more important than the diastolic pressure. The risk of development of the stroke rises from the level of systolic blood pressure 115 mmHg almost linearly. Calcium channel blockers or diuretics represent the most appropriate therapy of the isolated systolic hypertension of elderly patients. The risk of stroke is higher also in persons with elevated blood pressure in the morning. That is why in elderly patients the use of drugs effectively controlling blood pressure during 24 hours is necessary. Recent studies (HOPE study, PROGRESS study) have demonstrated that the reduction of blood pressure decreases the occurrence of stroke not only in hypertensive patients, but also in the normotensive persons during the primary and secondary prevention. Review data show that 27% of ischemic strokes and 57% of hemorhagic strokes, which happened in the "treated" hypertensive patients, are due to not well controlled hypertension. Missing treatment of hypertension is responsible for 22.8% of strokes in men and 25.4% in women. The given data show a big reserve for the possibility to decrease further the stroke incidence in the population.

Antihypertensive Agents↗
PubMed2003

[The most common forms of endocrine-based hypertension].

Endocrine (adrenal) hypertension (primary aldosteronism, hypercortisolism and pheochromocytoma) had been considered for a long time as a rare cause of arterial hypertension. However, recent studies have shown a frequent incidence of primary aldosteronism among hypertensive subjects and therefore it is necessary to exclude primary aldosteronism in all subjects with severe hypertension. On the contrary, pheochromocytoma and hypercortisolism may be often overlooked in patients with incidentally found adrenal tumor and thus they can cause unexpected per- and postoperative complications.

Adrenal Gland Diseases↗
PubMed2003

Does the treatment of primary hyperaldosteronism influence glucose tolerance?

Primary hyperaldosteronism (PH) is frequently considered to be a secondary form of diabetes mellitus (DM). In our previous study we attempted to evaluate the prevalence of DM among patients with PH compared to control subjects with essential hypertension (EH). We have noted a relatively high prevalence of DM and impaired glucose tolerance in PH, but the differences between the PH and EH groups did not reach statistical significance. We performed this study to assess whether the effective treatment of PH (surgical and conservative) would improve the glucose tolerance. We have studied 24 patients with PH of the following two subtypes: aldosterone-producing adenoma (APA) treated with adrenalectomy and idiopathic hyperaldosteronism (IHA) treated with spironolactone. No significant changes of glucose levels were found in the 60th and 120th min of the oral glucose tolerance test (OGTT) in the APA group. On the other hand, fasting glucose levels were decreased significantly after adrenalectomy. Plasma glucose levels were significantly increased in the 60th min, but no differences were found in fasting values and in the 120th min in the IHA group. There was a significantly higher incidence of impaired glucose tolerance (36 per cent before, 45 per cent after treatment) and DM (9 per cent, 18 per cent) in the IHA group compared to the APA group (8 per cent, 32 per cent; DM 0 per cent, 0 per cent). In conclusion, the treatment of PH does not improve glucose tolerance. Mild worsening of glucose tolerance after treatment could be explained by an increase of the body mass index. These data, in accordance with our previous study, do not support the idea that PH is a secondary form of diabetes mellitus.

Adrenalectomy↗
PubMed2002

Serum leptin levels in patients with primary hyperaldosteronism before and after treatment: relationships to insulin sensitivity.

BACKGROUND: Leptin is a protein hormone produced predominantly by adipocytes that plays a role in food intake regulation and a series of other physiological processes including blood pressure regulation. OBJECTIVES: The aim of our study was to compare serum leptin levels in patients with primary hyperaldosteronism (PA) with those of healthy subjects and to explore the relationship of serum leptin levels and the parameters of insulin action in these patients before and after surgical or pharmacological treatment. METHODS: Serum potassium, leptin, aldosterone, insulin levels and plasma renin activity were measured and hyperinsulinaemic euglycaemic clamp was performed in 11 patients with PA and 11 healthy age-, gender- and body mass index (BMI)-matched subjects. In eight of 11 patients the same measurements were repeated at least 6 months after surgical or pharmacological treatment. RESULTS: The basal serum leptin levels in PA patients did not significantly differ from those of healthy subjects (mean+/-s.e.m. 8.4+/-1.9 vs 11.2+/-1.8 ng/ml, P=0.30), although their insulin sensitivity was significantly impaired (PA patients vs control subjects: glucose disposal rate in the last 20 min of clamp (M) 18.7+/-1.8 vs 30.6+/-3.3 micromol/kg/min, metabolic clearance rate of glucose (MCR(g)) 3.9+/-0.5 vs 7.2+/-1.1 ml/kg/min, P<0.05). The surgical or pharmacological treatment of PA patients increased significantly their serum leptin levels (10.9+/-3.7 vs 8.4+/-1.9 ng/ml, P<0.05) and simultaneously improved their insulin sensitivity. Basal serum leptin levels in both groups correlated positively with BMI and serum insulin levels. The inverse relationship between serum leptin levels and the insulin sensitivity parameters was found in both PA patients before treatment and healthy subjects. These relationships disappeared after treatment of PA patients except for those between serum leptin levels and MCR(g). CONCLUSION: Basal serum leptin levels in untreated patients with PA do not significantly differ from those of healthy subjects, but increase significantly after surgical or pharmacological treatment. The increase in serum leptin levels is paradoxically accompanied by the improvement of insulin sensitivity in these patients.

Adrenal Glands↗
PubMed2002

[Laparoscopic transperitoneal adrenalectomy in hormonally-active adrenal tumors].

Laparoscopic adrenalectomy is considered the "gold standard" in adrenal surgery for benign functioning (and non-functioning) tumors. Laparoscopy meets criteria of miniinvasive surgery with minimal postoperative pain, short hospital stay and an outstanding cosmetic effect, the radicality of the procedure, open surgery and laparoscopy are equally effective. In cooperation with endocrinological department focused on detection of functioning adrenal tumors, the diagnostic and therapeutic procedure seems to be very efficient, so that the primary goal of rapid cure could be achieved. Patients after laparoscopic adrenalectomy mostly do not need chronic antihypertensive medication and only those after bilateral adrenalectomy (Cushing's disease) require life-long low dose hydrocortisone therapy. In pheochromocytomas, total excision of the tumor is considered to be a life-saving procedure, although up to 20% may recur as hereditary or as a part of von Hippel-Lindau's disease.

Adrenal Cortex Hormones↗