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Biomedical subjects

L Hansson

Publications and source records attributed to L Hansson.

At least 451 records · Page 25Linked to original sources
PubMed1982

Experience with nitrendipine--a new calcium antagonist--in hypertension.

The antihypertensive effect of 20 mg of nitrendipine (BAY e 5009) was compared with that of 40 mg, administered orally once daily to 12 patients with essential hypertension (WHO I-II). The study was designed as a double-blind, within-patient comparison. The present results indicate that nitrendipine has a significant antihypertensive effect both at 20 and 40 mg as compared to placebo. There was no significant change in heart rate with 20 mg of nitrendipine, whereas there was a significant increase in heart rate after the first dose of 40 mg. Nitrendipine in dosages of 20 mg and 40 mg daily was equally effective as regards the antihypertensive effect. This applies both to the early response (first day) and the late response (3 weeks). Side effects were common in the 40-mg treatment group, but rare in the 20-mg group; only one patient had headache (three times) during the 3-week treatment period. It can be concluded that in mild hypertension, treatment with 20 mg of nitrendipine once daily constitutes an effective antihypertensive therapy. In more severe cases of hypertension, however, combination treatment with beta-blockers, for example, and/or repeated daily administration of nitrendipine ought to be investigated.

Adult↗
PubMed1982

Mode of action of beta-adrenoceptor blocking agents in hypertension. A comparison between metoprolol and pindolol with special reference to peripheral vascular effects.

beta-Adrenoceptor blocking drugs are generally recognized as being effective in the treatment of hypertension. The mechanisms whereby these drugs reduce blood pressure are, however, not fully understood. In a double-blind, randomized study either metoprolol, 100--300 mg/day, or pindolol, 5--15 mg/day, was given for 6 months and the effects on blood pressure, heart rate and vascular resistance in the calf and forearm were investigated. Measurements were made at rest, during and after physical exercise, and during postischaemic hyperaemia. Both drugs reduced blood pressure to the same extent both at rest and during and after exercise. Metoprolol reduced heart rate to a greater extent than pindolol at rest and after exercise, whereas no difference was seen during physical exercise. Pindolol reduced the vascular resistance in the calf at rest by 14% (p less than 0.05), whereas metoprolol tended to increase vascular resistance, the difference in effect being highly significant (p less than 0.005). During and after leg exercise, there was no difference in forearm vascular resistance between the two drugs. It may be concluded that pindolol reduced resting blood pressure partly through peripheral vasodilatation. This was probably an effect of beta 2-adrenoceptor stimulation linked to the pronounced intrinsic sympathomimetic activity (ISA) of pindolol. Metoprolol on the other hand, acted mainly through cardiac mechanisms, as suggested by its pronounced reduction of heart rate.

Adult↗
PubMed1982

A hemodynamic study of arteriolar changes in patients with previous malignant hypertension.

Blood flow resistance was studied in two peripheral vascular beds in 15 patients with previous malignant hypertension and in matched groups of patients with "benign" hypertension and control subjects. Both hypertensive groups had significantly higher resistance in the hands (skin vessel bed) at maximal dilatation (2.5 and 2.5 U, respectively) than the normotensive group (1.9 U) (p less than 0.01). This increase indicates structural changes in the arteriolar wall in both hypertensive groups. It indicates a similar degree of adaptation of the vascular changes to the present blood pressure level in both hypertensive groups, although the initial blood pressure had been much higher in the group with previous malignant hypertension than in the group with "benign" hypertension. Different findings were made in the calves (muscle vessel bed), and the most severe changes were found in patients with previous malignant hypertension. Resistance at maximal dilatation was 2.4 U compared to 1.9 U in the group with "benign" hypertension (p less than 0.05) and 1.6 U in the control group (p less than 0.001 and p less than 0.05, respectively).

Adult↗
PubMed1982

Haemodynamic effects of metoprolol and pindolol: a comparison in hypertensive patients.

1 In a double-blind study, 36 patients with essential hypertension were randomly allocated to treatment with either metoprolol, 100--300 mg/day, or pindolol, 5--15 mg/day for 6 months. Haemodynamic investigations were made on three separate occasions. Blood flow in the calves and in the forearm was determined by venous occlusion plethysmography after 6 weeks of placebo, after 6 weeks and again after 6 months of active therapy. 2 Both drugs reduced blood pressure significantly, by 17.1/11.8 mm Hg with metoprolol and 21.9/10.9 mm Hg with pindolol after 6 weeks (P less than 0.005). No further changes were seen after 6 months. 3 Heart rate after 6 weeks was significantly reduced by metoprolol (10.7 +/- 2.4 beats/min, P less than 0.001) but not by pindolol (4.4 +/- 2.3 beats/min, NS). After 6 months a significant reduction was seen also in the pindolol group (5.2 +/- 2.1 beats/min, P less than 0.05). 4 The vascular resistance in the calves at rest was reduced by pindolol (P less than 0.05), whereas resistance tended to increase with metoprolol. 5 Resting vascular resistance in the forearm after 6 months was significantly reduced in the metoprolol group (P less than 0.001) as well as in the pindolol group (P less than 0.02). The increase in forearm vascular resistance seen during leg exercise was not influenced by either drug. 6 Vascular resistance at maximal vasodilatation was unchanged in the calves, but a significant reduction (-17.4 +/- 5.7%, P less than 0.01) in the forearm vascular bed was seen after 6 months of pindolol. No change was observed with metoprolol. 7 It is concluded that pindolol reduces elevated blood pressure partly through peripheral vascular mechanism. Metoprolol, on the other hand, probably acts mainly via central cardiac mechanisms.

Adult↗
PubMed1982

Captopril and atenolol combined with hydrochlorothiazide in essential hypertension.

1 Fifty-seven patients with mild or moderate essential hypertension, mean age 50 (range 31-69) were randomised to treatment with either captopril or atenolol. Twenty-six patients in each group completed the study. 2 Captopril (25-50 mg three times daily) and atenolol (50-100 mg once daily) caused a highly significant fall in blood pressure both supine and standing. 3 When hydrochlorothiazide (25-50 mg once daily) was added a further fall in blood pressure was observed in both groups. 4 Captopril as single drug caused no significant change in heart rate, while atenolol significantly reduced heart rate both supine and standing. 5 Two patients were excluded from the captopril group, one because of a reversible loss of taste and the other because of dizziness. Three patients were excluded from the atenolol group, two because of bradyarrhythmias and one because of inadequate blood pressure response. 6 Both captopril and atenolol were found to be effective antihypertensive agents, suitable for the treatment of essential hypertension.

Adult↗
PubMed1982

Renal function as an indicator of prognosis in malignant essential hypertension.

Renal function was evaluated in a group of 24 patients (21 men and 3 women, mean age 47 years) who had survived the malignant phase of hypertension during the period of 1969-1979. Five had grade III retinopathy (haemorrhages and exudates) and 19 had grade IV changes (papilloedema, FH IV) at diagnosis. Highest recorded blood pressure was 248 +/- 4/152 +/- 3 mmHg (mean +/- S.E.M.). Renal function rapidly deteriorated in 7 cases with progression to terminal uraemia. All patients in this group had a marked elevation in serum creatinine at diagnosis (448 +/- 105 mumol/l) and inadequate blood pressure control. Two of these 7 patients died and 5 underwent renal transplantation. The other 17 patients initially had serum creatinine less than or equal to 250 mumol/l (169 +/- 19 mumol/l-glomerular filtration rate (GFR) 51 +/- 7 ml/min). All except one were reinvestigated after a mean time of 6 years (range 6 months-11 years) with evaluation of blood pressure and determination of GFR by 51Cr-EDTA clearance. At follow-up their blood pressure was fairly well controlled (153 +/- 3/99 +/- 2 mmHg). Their GFR was 62 +/- 6 ml/min. Of the 11 patients in whom two GFR determinations were available (one initially and one at follow-up), six patients showed a marked increase in GFR while 5 patients showed only slight or no improvement in spite of fairly good blood pressure control. In malignant hypertension adequate antihypertensive treatment can lead to a pronounced improvement in GFR unless renal function has deteriorated gravely.

Adult↗
PubMed1982

A double-blind comparison of spironolactone and hydrochlorothiazide in hypertensive patients treated with metoprolol.

The antihypertensive effects of hydrochlorothiazide and spironolactone when added to treatment with metoprolol were compared in a double-blind trial comprising 55 previously untreated patients with essential hypertension. Twenty-four patients became normotensive on metoprolol alone, whereas ten patients were randomized to additional therapy with hydrochlorothiazide and ten to spironolactone. Eleven patients dropped out of the trial. Spironolactone was significantly more effective than hydrochlorothiazide as regards reduction of the diastolic blood pressure, Side effects were few and mild during all phases of the study.

Adult↗
PubMed1981

Immunological changes in patients with previous malignant essential hypertension.

Increased T-lymphocyte reactivity against human arterial antigen was significantly more common in a group of 20 patients with previously malignant essential hypertension than in matched control subjects. Serum-levels of IgG and IgM and the prevalence of autoantibodies were also significantly higher in the patients. It is suggested that these changes, whether primary or secondary, may contribute to or aggravate the vascular damage in this condition and are therefore of pathogenetic importance.

Adult↗
PubMed1981

Haemodynamic effects of noise exposure before and after beta 1-selective and non-selective beta-adrenoceptor blockade in patients with essential hypertension.

1. Noise stimulation (100 dBA) for 10 min caused a significant increase in diastolic (7.0%, P less than 0.001) and mean arterial blood pressure (4.3%, P less than 0.01) in patients with essential hypertension. 2. The blood pressure response to noise was due to an increase in total peripheral resistance (4.8%, P less than 0.02); heart rate, stroke volume and cardiac output were unchanged. 3. beta 1-selective adrenoceptor blockade (metoprolol) did not change the haemodynamic reaction pattern induced by noise. 4. Noise exposure during non-selective beta-adrenoceptor blockade (propranolol) caused an accentuated blood pressure response with increments of both systolic and diastolic blood pressure as well as a more pronounced rise in total peripheral resistance. 5. The haemodynamic changes induced by noise stimulation at 100 dBA totally disappeared after 5 min of quiet rest at 40 dBA.

Adult↗
PubMed1981

Possible relationship between psycho-emotional factors and haemodynamic patterns in the pathogenesis of mild blood pressure elevation.

1. Psycho-emotional profiles were compared with invasive haemodynamic findings in a population sample of 37 young men (mean age 27 years) with mild blood pressure elevation and in 21 matched normotensive controls. 2. In comparison with normotensive controls, subjects with hyperkinetic blood pressure elevation had higher irritability levels, more guilt feelings and more psychic distressful symptoms. 3. In subjects with blood pressure elevation and normokinetic circulation structural vascular changes were found, and their psycho-emotional profiles showed high irritability levels but not significantly increased guilt or anxiety. 4. These results indicate a relationship between psychological factors and haemodynamic patterns in mild blood pressure elevation. A psychosomatic aetiology in hyperkinetic blood pressure elevation is suggested, and the psychological findings are compatible with a gradual development from hyperkinetic to normokinetic blood pressure elevation.

Adult↗
PubMed1981

Metoprolol and pindolol in hypertension: different effects on peripheral haemodynamics.

1. Thirty-six patients with essential hypertension, were randomly allocated to double-blind treatment with either metoprolol (100--200 mg/day) or pindolol (5--10 mg/day). The effects upon blood pressure and peripheral blood flow were determined. Both drugs reduced blood pressure significantly. 2. Heart rate was significantly reduced by metoprolol but not by pindolol. 3. Vascular resistance at maximal dilatation was not changed by either pindolol. 4. At rest, pindolol reduced vascular resistance in the calf by 14% (P less than 0.05) but metoprolol tended to increase the resistance slightly. The difference in effect was also significant (P less than 0.005). 5. During leg muscle work there were no changes in vascular resistance in the forearm with either compound. 6. We conclude that pindolol appears to reduce blood pressure at least partly through vascular mechanisms, in contrast to metoprolol. The response to sympathetic stimulation induced by physical exercise does not differ between metoprolol- and pindolol-treated patients.

Double-Blind Method↗
PubMed1981

Circulatory effects of stress in essential hypertension.

Hemodynamics and plasma catecholamines were studied during mental arithmetics and cold pressor test in thirteen patients with essential hypertension. Blood pressure was significantly increased by both forms of "stress". Cold pressor test caused a significant increase in total peripheral resistance, while mental arithmetics increased heart rate and cardiac output significantly. Thus, different forms of "stress" can increase blood pressure by totally different hemodynamic mechanisms. Acute cardioselective and non-selective beta-receptor blockade did not affect the hemodynamic reaction pattern during cold pressor test. The increase in heart rate and cardiac output during mental arithmetics was blocked by non-selective but not with cardioselective beta-blockade. Both beta-blockers were, however, inefficient in preventing the blood pressure elevation induced by mental arithmetics. Plasma noradrenalin was significantly increased during mental arithmetics after both cardioselective and non-selective beta-blockade compared to placebo. During cold pressor test there was a significant increase in noradrenalin only after non-selective beta-blockade. Adrenalin in plasma was significantly increased only during mental arithmetics after cardioselective beta-blockade. The pathogenesis of essential hypertension is complex and still not fully understood. Both hereditary (1) and environmental factors such as salt intake (2) and stress (3,4,5) are probably of importance as risk factors for essential hypertension. Animal studies have shown that different forms of stress can produce permanent hypertension due to structural changes in the resistance vessels (6). Against this background we decided to investigate acute hemodynamic effects of two well-defined types of "stress", e.g. mental arithmetics and cold pressor test in patients with essential hypertension and to study if the hemodynamic reactions could be modified by cardioselective and non-selective beta-receptor blockade. Catecholamines in plasma were studied before, during and after "stress".

Adult↗
PubMed1981

Hypertension in the elderly. Hypertension seminars at Ostra Hospital, Göteborg, Sweden.

A review on the effects of ageing on cardiovascular function, with special reference to high blood pressure (BP), is given in this seminar. In most western populations the diastolic and especially the systolic BP increases with age in both sexes and this has been observed both in cross-sectional and longitudinal studies. Over the age of 60 the diastolic BP decreases. Of the different risk factors for cardiovascular diseases, only BP has been shown consistently to be an independent risk indicator in subjects 70 years or older. Hypotensive drugs used in the treatment of middle-aged hypertensive patients can also reduce the BP in elderly hypertensive patients can also reduce the BP in elderly hypertensive patients but are likely to produce more adverse reactions such as electrolyte disturbances and glucose intolerance by thiazides, depression by reserpine, orthostatic hypotension by methyldopa and excessive bradycardia by beta-blockers. A prolongation of life expectancy in hypertensive patients 60 years or older by hypotensive drug therapy has not been shown conclusively in controlled trials.

Adult↗