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Biomedical subjects

L Hansson

Publications and source records attributed to L Hansson.

At least 397 records · Page 22Linked to original sources
PubMed1987

The rationale for ketanserin therapy in hypertension.

The rationale for ketanserin therapy in hypertension is reviewed against the background of known physiological and pathophysiological effects of serotonin. The usefulness of the serotonin (5-HT2) antagonist ketanserin in the treatment of hypertension is evaluated with respect to its known antihypertensive property as well as in relation to its effect on hypertension-induced cardiovascular changes, platelet hyperreactivity, and atheroma formation. Based on ketanserin's documented antihypertensive effect and also on its potentially positive effect on cardiovascular mortality via other mechanisms, it would appear that ketanserin could offer a highly rational approach to the treatment of hypertension and its risks in the future.

Animals↗
PubMed1987

Acute and long-term hemodynamic effects of carvedilol, a combined beta-adrenoceptor blocking and precapillary vasodilating agent, in hypertensive patients.

The purpose of these studies was to investigate the hemodynamic effects of carvedilol, a compound with combined properties of nonselective beta-adrenoceptor blockade and precapillary vasodilatation. The acute effects were studied with invasive technique (dye dilution) in 10 patients taking 25 mg orally and noninvasively (forearm plethysmography) in 10 patients taking 25 mg and in 10 patients taking 50 mg orally, all with essential hypertension. Significant reductions of systolic and diastolic blood pressure (p less than 0.05-0.001) were observed in all groups. Total peripheral resistance (TPR) did not change acutely whereas resistance in the forearm was reduced by 16% (p less than 0.05; invasive group). When a comparison with propranolol (80 mg x 2) was made in a randomized double-blind placebo controlled trial in 30 patients, carvedilol acutely reduced blood pressure significantly by 13/6 mg Hg (25 mg) and 17/10 mm Hg (50 mg) in contrast to propranolol. Resistance in the forearm fell significantly with 50 mg carvedilol, whereas propranolol caused a significant rise. After 4 weeks, both compounds had reduced blood pressure significantly. Blood flow was still reduced with propranolol in contrast to the findings with carvedilol. In conclusion, the summary of these studies shows that carvedilol given orally has a useful antihypertensive effect both acutely and during prolonged treatment, and it has an attractive hemodynamic profile, in agreement with the hemodynamic findings in essential hypertension.

Adrenergic beta-Antagonists↗
PubMed1987

Addition of the calcium antagonist PN 200-110 to pindolol markedly augments the antihypertensive effect in essential hypertension.

Several large-scale studies have recently drawn attention to the fact that arterial hypertension frequently is inadequately controlled and that therapeutic alternatives other than the commonly employed stepped-care treatment may be needed in order to obtain normotension. For this reason PN 200-110, a new dihydropyridine calcium antagonist--at two different dose levels (average 3.8 mg b.i.d. or 5.7 mg b.i.d.)--or placebo was added in a double-blind cross-over trial to pindolol, 10 mg per day, in 20 patients with essential hypertension, after an initial 3-week placebo period. Ionized calcium in serum was determined repeatedly during the study. From an initial level of 157/100 mm Hg, PN 200-110 at the first dose level reduced blood pressure by 14/11 mm Hg (p less than 0.01/0.001) and at the second dose level reduced blood pressure by 22/18 mm Hg (p less than 0.001/0.001). The reduction in mean arterial pressure was significantly correlated to age (=0.050, p less than 0.05). There was no significant increase in heart rate, nor were there any significant correlations between ionized calcium and the effect of PN 200-110 nor between the changes in ionized calcium and the changes in blood pressure. Adverse effects were few and mild. One patient had to be withdrawn because of side effects, probably not related to the investigated drugs. Thus, addition of PN 200-110 to hypertensive patients treated with pindolol caused highly significant and clinically relevant further reductions in arterial pressure. The results show that a combination of this kind offers the possibility of good blood pressure control.

Adult↗
PubMed1987

Aims of treatment of hypertension.

The major aim of treatment of arterial hypertension is to reduce the increased risks of cardio-cerebrovascular morbidity and mortality that are associated with elevated blood pressure (BP). A direct relationship can be found between the level of BP and risk, even down to what is normally considered to be the "normotensive range", i.e., diastolic BPs of 80 mm Hg. Moreover, when considering that the risk in treated hypertensive patients is more closely linked to the BP level achieved during treatment than to the initial untreated level, it becomes obvious that the aim should be to lower elevated arterial pressure to strictly "normotensive" levels. Recently, the results of several large-scale trials have shown that treated hypertensive patients still have an increased risk for morbidity and mortality, compared with normotensive subjects recruited from the same population and of the same sex and age. The main reason for this appears to be inadequate control of BP. Since mortality and morbidity from coronary heart disease (CHD) still constitute the major risk in hypertension, special efforts should be directed towards this problem. In addition to the obvious need for better control of BP, there appears to be a need also for direct measures against CHD. The beta-blockers are therefore of particular interest. Despite the fact that the large-scale Medical Research Council (MRC) and the International Prospective Primary Prevention Study in Hypertension (IPPPSH) studies only indicated that beta-blockers could have a primary preventive effect against CHD in nonsmoking male patients, the possibility that beta-blockers may in fact have a primary preventive effect against CHD in hypertension is still logical.

Antihypertensive Agents↗
PubMed1987

Beta-blockers in hypertension.

Following the early and important observations more than two decades ago, by Prichard and Gillam that beta-blockers had a useful antihypertensive effect, this class of compounds has become widely accepted in the treatment of elevated arterial pressure. Today there are numerous different compounds available within the beta-blocker class, with marked differences in their ancillary properties. Undoubtedly, the blockade of beta 1-adrenoceptors is the effect needed to achieve the reduction in blood pressure, and this selectivity also offers some advantages from a safety point of view. However, in some circumstances, ancillary properties such as beta 2-blockade may offer advantages, as can intrinsic sympathomimetic activity. The fact that beta-blockers have become first-line treatment for hypertension in many countries and that memoranda produced by the World Health Organization and the International Society of Hypertension jointly advocate beta-blockers as one alternative for basic therapy reflects the positive balance between efficacy and side effects seen with these agents. It is also an indication that positive long-term clinical experience has been accumulated with beta-blockers. Finally, secondary prevention against coronary heart disease is well documented for beta-blockers. For this reason there have been great hopes for many years that beta-blockers would also have a primary preventive effect against coronary heart disease when used in the treatment of hypertension. Indications are now accumulating that, at least in some subgroups of patients, beta-blockers may have such an effect. Thus, although newer classes of compounds appear to be extremely competitive, beta-blockers are likely to play an important role in the treatment of hypertension for many years to come.

Adrenergic beta-Antagonists↗
PubMed1987

STOP-Hypertension--preliminary communication from the pilot study of the Swedish Trial in Old Patients with Hypertension.

The Swedish trial in old patients with hypertension (STOP-Hypertension) is a multicentre, randomized, double-blind study of beta-blockers/diuretics versus placebo in old hypertensives. Primary end-points are stroke and myocardial infarction (fatal and non-fatal) as well as other cardiovascular mortality. To evaluate the logistics of STOP-Hypertension, a pilot study was carried out. All patients aged 70-84 years in 31 centres were consecutively registered in a log-book. Altogether 4668 patients were screened: 41.5% had previously been treated for hypertension and 13.5% had blood pressures greater than or equal to 180/105 mmHg. Thus, 55% were 'hypertensive'. In all, 465 patients (18% of the 'hypertensive' patients) started a 3-month washout period (previously treated, n = 396) or a 4-week run-in period (previously untreated, n = 69) period. The most frequent reasons for not starting the run-in/washout were other indications for treatment with beta-blockers/diuretics (13%), unwillingness to participate (8%) or isolated systolic hypertension (4%). The pilot study was evaluated after 1 year: 89 patients (1.9%) had been randomized, 66 patients (1.4%) were still in the run-in/washout period and the majority of the remaining patients were not randomized because they had not reached the inclusion blood pressure (greater than or equal to 180 mmHg systolic and/or greater than or equal to 105 mmHg diastolic) following withdrawal of their antihypertensive medication. During the run-in/washout period there were few serious clinical events: one case of myocardial infarction, three patients had strokes (two fatal), 10 developed congestive heart failure, three tachyarrhythmia and two pneumonia (one fatal).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1987

The long-term effect of isradipine in pindolol-treated patients.

The long-term efficacy of isradipine, a new dihydropyridine calcium antagonist with marked vascular selectivity, was evaluated in 17 patients with essential hypertension. All had a supine diastolic blood pressure of greater than 95 mmHg with 10 mg pindolol once daily. After a short-term, double-blind, dose-finding, crossover comparison with addition of isradipine or placebo twice daily, they continued on pindolol and their optimal dose of isradipine in a single-blind, long-term follow-up study. Eighteen patients were recruited but one male patient discontinued treatment after 2 weeks due to ankle oedema and will not be accounted for in the overall evaluation. There were 11 males and six females with a mean age of 56 +/- 10 years. In the short-term study on the optimal dose of isradipine (5.1 mg twice daily) blood pressure was lowered by 24/18 mmHg (P less than 0.001). No change in heart rate was seen despite the substantial drop in blood pressure. In the long-term study the patients were seen for a mean follow-up time of 12.5 months (range 4-17 months). After the longest follow-up time mean arterial pressure was 107.0 +/- 7.4 compared with 120.1 +/- 8.2 mmHg after placebo baseline [delta = 13 mmHg (11%), P less than 0.001, n = 17]. The heart rate was unchanged (delta = 0.2 beats/min, 95% confidence limits -3, +3), and so was ankle circumference (delta = 0.12 cm, 95% confidence interval, -1, +1). On the other hand, mean weight was reduced by 2 kg from 90 kg (P less than 0.05, n = 17).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Changes in transcutaneous PCO2 with sleep in normal subjects and in patients with chronic respiratory diseases.

In order to establish the normal range for increase in transcutaneous PCO2 (PtcCO2) during sleep, 33 healthy volunteers were investigated with the Hewlett Packard capnometer 47210A option A10. PtcCO2 was on average 46 mmHg (6.1 kPa) when the subjects were awake. The highest recorded level during sleep was, on average, 52 mmHg (6.9 kPa). The mean maximal increase was thus 6 mm Hg (0.8 kPa) or 13% of awake PtcCO2. Measurements were also performed in 15 patients with interstitial lung disease, 23 patients with chronic obstructive pulmonary disease, 10 patients with scoliosis and in 21 patients with obstructive sleep apnoea syndrome. The mean maximal increase in PtcCO2 with sleep was essentially the same in all groups, except in the scoliosis patients who showed an increase of 11 mmHg (1.5 kPa) (21% of awake PtcCO2); this was significantly more than in any other group. There was a positive relationship (r = 0.67, p less than 0.05) between arterial PCO2 and the increase in PtcCO2 in the scoliotics but not in the other groups.

Adolescent↗
PubMed1986

Hemodynamics of metoprolol and pindolol in systemic hypertension with particular reference to reversal of structural vascular changes.

In a double-blind, comparative study metoprolol (100 to 300 mg/day) or pindolol (5 to 15 mg/day) was given in randomized order to 39 patients with uncomplicated essential hypertension. Peripheral hemodynamics were studied by noninvasive means after an initial 6-week placebo period and again after 6 weeks and 6 months of active treatment. Three patients withdrew from the trial during the 6-week period of active treatment. Heart rate during exercise on an ergometric bicycle to a predetermined workload indicated that the degree of beta-adrenoceptor blockade was identical during treatment with either metoprolol or pindolol. Both agents also reduced resting blood pressure to the same extent. Heart rate at rest fell considerably more during metoprolol than pindolol therapy, while vascular resistance was reduced by pindolol but not by metoprolol. This indicates that the antihypertensive effect of metoprolol can be ascribed mainly to cardiac mechanisms; in contrast, pindolol appears to lower blood pressure primarily through vascular effects. Studies at maximal dilatation showed that pindolol, but not metoprolol, reduced resistance at maximal dilatation after 6 months of treatment, indicating that a reversal of the structural vascular changes had occurred. The hemodynamic differences between the 2 agents can probably be explained by the fact that pindolol with its intrinsic sympathomimetic activity acts as a partial agonist causing active stimulation of vascular beta 2 adrenoceptors and relaxation of resistance vessels.

Adult↗
PubMed1986

Stability of treatment outcome in short-term psychiatric care. A six-month follow-up of a controlled study of patient involvement.

The general trend of avoiding and shortening in-patient treatment raises the question of the stability of treatment gains made during hospitalization. A 6-month follow-up was made for patients treated on a short-term psychiatric ward. The origin was a controlled study of two models of patient involvement in treatment planning. Patients benefiting most from a cooperation procedure during hospitalization were those with socio-psychological treatment objectives and those treated in a Basic Activation Group on the ward. The superior outcome for these patients was not stable during the period of follow-up, resulting in an incongruence between in-hospital and post-hospital adjustment. Furthermore, these patients at time of follow-up showed an increased confidence in the staff of the ward and a decrease in the rated importance of their social network. It is suggested that this is the result of dependency reactions and a separation process from the therapeutic milieu of the ward which were not resolved at time of discharge. Greater concern should be invested in formulating the treatment contract in an out-patient context in order to place the emphasis on the real life situation of the patient.

Adult↗
PubMed1986

Swedish trial in old patients with hypertension. A prospective multicentre study in Swedish primary health care.

The Swedish trial in old patients with hypertension was initiated by the Swedish League against Hypertension. It will be conducted as a prospective multicentre study in Swedish primary health care, and will comprise approximately 2 000 patients on active treatment and 2 000 on placebo to be studied for three years. The primary goal with this study is to investigate whether pharmacological treatment of hypertension in men and women aged 70-84 years will reduce the incidence of fatal and nonfatal cardiac and cerebrovascular disease. Before starting the main trial a pilot study comprising 400 patients will be carried out during one year to evaluate all logistical aspects of the study. This pilot study commenced in October 1985.

Adrenergic beta-Antagonists↗
PubMed1985

Alterations in trace element and plasma amino-acid profile in experimental gram-negative septicaemia.

Infection can produce changes in the levels of trace metals such as copper, iron and zinc and several amino acids. These trace metals are involved in many metabolic reactions as well as in the host defence response. In the present study we have induced septicaemia in male Sprague-Dawley rats. The rats were made septic by surgical insertion of a gelatine capsule containing known amounts of E. coli (1.25 x 10(7) bact/ml) and Bacteroides fragiles (2.5 x 10(7) bact/ml) along with sterile rat faeces as an adjuvant (50% vol/vol), and barium sulphate (10% weight/weight) as an irritant into the abdomen. Blood samples were collected at 36, 60 and 72 h to study alterations in the pattern of copper, zinc, calcium and magnesium and plasma amino acids. Liver samples were taken after sacrifice at 72 h for inorganic element analysis. Sepsis produced a significant increase in copper and magnesium and a significant decrease in zinc and calcium levels of plasma. Trace element content of the livers the septic rats did not differ appreciably from control rats. Septic rats also had a lowered concentration of branched chain amino acids. These changes especially those of copper and zinc could be expected to have a role in the progress of the disease. The changes observed in the present study might be caused through the release of Interleukin-I or related substances from the phagocytic cells.

Journal Article↗