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Biomedical subjects

M Middeke

Publications and source records attributed to M Middeke.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Quality of life of hypertensive physicians with hypertension therapy. Randomized double-blind study of 237 female and male physicians with high blood pressure].

In a group of 237 hypertensive male and female physicians, a placebo-controlled randomized double-blind, cross-over trial was performed to investigate the effects of the ACE inhibitor captopril on blood pressure and well-being. A thoroughly tested standardized measurement of well-being was employed. On the basis of the multivariate linear model, differences in the response to treatment (t-tests for cross-over differences) were investigated in terms of the seven parameters of well-being measured. In comparison with placebo, captopril (50 mg once daily) had a significant effect on five of the seven parameters. Thus, mood, general well-being, work performance, regeneration and quality of sleep all improved under treatment. It was also found that these improvements were not an immediate consequence of blood pressure reduction. The standardized evaluation employed here thus proved to be an informative additional evaluation criterion of antihypertensive therapy.

Captopril↗
PubMed1991

Long time incubation of monocytic U 937 cells with LDL increases specific paf-acether binding and the cellular acetylhydrolase activity.

Besides the well established role of low density lipoproteins (LDL), the phospholipid PAF-acether (paf) seems to be involved in atherogenesis. The effect of LDL (10 micrograms/ml for 24 h, n = 3) on paf binding characteristics of monocyte/macrophage-like U 937 cells was investigated using the radioligand [3H]paf, unlabeled paf and the paf receptor antagonist WEB 2086. The specific [3H]paf binding significantly increased at 1.4 nM (P less than 0.02) and 2.8 nM (P less than 0.01) added [3H]paf with an increased number of paf binding sites in the Scatchard plot analysis of the data. Specific paf binding was functionally active since paf mediated a cellular [Ca2+]i rise. The protein kinase C (PKC) activator PMA (1 nM, 37 degrees C) expressed specific [3H]paf binding already after a 15-min incubation period, indicating a PKC activation as the decisive step of paf receptor expression. LDL also stimulated the paf degrading cellular acetylhydrolase significantly by increasing both Km (9.4 +/- 1.9 vs. 2.0 +/- 0.5 microM, P less than 0.02) and vmax (0.5 +/- 0.2 vs. 0.2 +/- 0.0 nmol/min per mg cell protein, P less than 0.02). The data demonstrate that LDL increases the number of paf receptors on monocyte/macrophage-like U 937 cells and interferes with the dynamics and/or synthesis of the cellular acetyl hydrolase. These effects could be of importance in the pathogenesis of atherosclerosis.

Acetylesterase↗
PubMed1991

Circadian blood pressure rhythm in primary and secondary hypertension.

Circadian blood pressure variability was recorded in patients with primary hypertension and with different forms of secondary hypertension using ambulatory 24-h blood pressure measurement. A group of 20 patients with different forms of secondary hypertension was compared with a matched group of patients with primary hypertension. Although the mean 24-h blood pressure was not different between the two groups, the patients with secondary hypertension had significantly higher systolic blood pressure during sleep and higher systolic and diastolic blood pressure in the early morning, compared with the primary hypertension group. This nocturnal blood pressure fall was then investigated in various groups of patients with different forms of secondary hypertension and compared with normotensives and patients with primary hypertension. Patients with mild primary hypertension (n = 152) and with severe primary hypertension (n = 30) had the same blood pressure fall (14-16 mm Hg systolic and diastolic) during the night (23:00-05:00 h) as normotensives (n = 20). However, in patients with renoparenchymal hypertension (n = 29), renovascular hypertensions (n = 20), hyperaldosteronism (n = 6), and hyperthyroidism (n = 14), the nocturnal blood pressure fall was significantly (p less than 0.01) reduced. One patient with coarctation of the aorta and nine patients with primary hyperparathyroidism and elevated blood pressure had a normal circadian blood pressure profile with a normal nocturnal blood pressure fall. The heart rate decrease during the night was equal in all patient groups. Ambulatory blood pressure measurement allows blood pressure recording under everyday conditions, including nighttime. In primary hypertension the blood pressure variability exhibits the same circadian variation as in normotension, showing a marked nocturnal fall.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Chronopharmacology of captopril plus hydrochlorothiazide in hypertension: morning versus evening dosing.

Blood pressure follows a strong circadian rhythm in normotensive people and in patients with primary hypertension. This may have several implications for antihypertensive therapy, including the time of dosing. For this reason we studied the influence of different dosing times on the antihypertensive effect over 24 h using ambulatory blood pressure monitoring (ABPM). We studied 13 male patients with moderate hypertension with controlled blood pressure over 12 months under a fixed combination of captopril and hydrochlorothiazide. The dosage of the combination therapy was then halved and given as one evening and then as one morning dose, each for 3 weeks. The combination therapy given twice daily showed a good 24-h antihypertensive effect after 12 months of treatment. During the following 6 weeks the mean 24-h blood pressure did not increase under half dosage, irrespective of whether under evening or morning dosing. However, mean daytime values (systolic and diastolic) of ABPM were significantly higher with evening dosing when compared both with full dosage and with half dosage given in the morning. The mean arterial blood pressure over 24 h showed the same differences as systolic and diastolic blood pressure, whereas heart rate was not significantly different between the three therapeutic regimens. ABPM seems to be an ideal method for chronopharmacological investigations under everyday conditions. Our study demonstrated significant differences in daytime blood pressure but not in 24-h blood pressure between morning and evening dosing of a fixed antihypertensive combination therapy.

Blood Pressure↗
PubMed1991

[Value of ambulatory 24-hour blood pressure monitoring in diagnosis of mild hypertension].

Ambulatory blood-pressure monitoring (ABPM) is the best method to identify causal blood-pressure increases, and for differentiating between white-coat (office) blood pressure and sustained hypertension. This differentiation is necessary because 20% of patients with mild hypertension (90-104 mmHg diastolic, without end-organ damage) have white-coat hypertension. Thus, using conventional blood-pressure measurements (repeated measurements on at least two different occasions) for diagnosing mild hypertension (85% of all hypertensives!) many persons will be overtreated. The results of intervention in mild hypertension will improve through a better identification of patients at risk. ABPM correlates best with end-organ damage. The introduction of ABPM for diagnosing mild hypertension seems to be the best way to differentiate between white-coat hypertension without increased cardiovascular risk and sustained hypertension with increased cardiovascular risk. This procedure allows a better treatment of patients at risk and it avoids overtreatment. The ABPM diastolic blood-pressure range for mild hypertension is 85-92 mmHg (mean values during the active phase).

Antihypertensive Agents↗
PubMed1990

[Successful drug therapy in Aspergillus endocarditis].

A 74-year-old man who had a weight loss of 7 kg in three months, with fever up to 38 degrees C and anaemia (Hb 9.4 g/dl) began to have pain and blue discoloration of fingers II-V of the right hand. Echocardiography demonstrated vegetation on the aortic valve cusps and blood culture grew Aspergillus fumigatus, indicating Aspergillus endocarditis. There were no predisposing factors. Valve replacement was contraindicated because of the age of the patient, the presence of peripheral arterial disease, and previous myocardial infarction. Treatment was started with amphotericin B i.v. (dosage increasing to 50 mg daily) and 1.5 g daily of flucytosine by mouth, to a total of 1.1 g amphotericin B and 41.5 g flucytosine in five weeks. During this time there was a gradual decrease in symptoms and the valve vegetations. Nine months later there has been no recurrence.

Aged↗
PubMed1990

[Reversible space-occupying lesions of the kidney in HIV infection].

In January 1990 a 32 year old nurse was admitted with fever, weight loss of 9 kilogramms and pain of her right flank. HIV infection due to intravenous drug abuse had been diagnosed in 1986. Ultrasonic imaging revealed a solid tumor of low echogenicity in the cranial part of the right kidney. This finding could be confirmed with computed tomography and magnetic resonance imaging. Angiographic study showed a missing of blood vessels in the same area. A transcutaneous puncture with a thin needle resulted histologically in unspecific findings like detritus, lymphoid cells and neutrophils. Antibiotic treatment with amoxicilline and cefuroxim was without success. Symptoms as well as ultrasonic findings completely disappeared following oral administration of ofloxazine. The clinical course and the successful treatment support the diagnosis of an atypical renal abscess. As a second diagnosis a histologically proven cirrhosis of the liver could be established. Hepatitis C serology proved to be positive.

Abscess↗
PubMed1990

Duplex sonography in the diagnosis of renovascular hypertension.

Duplex sonography (DS) has become a well established method for diagnosing peripheral vascular diseases. Technical developments (higher resolution of transducer and deeper penetration) have made also abdominal and retroperitoneal vessels, including renal arteries, accessible for duplex sonography. This method provides the opportunity to recognize renal artery stenoses causing renovascular hypertension without invasive procedures. We therefore examined 86 hypertensive patients with a high likelihood of renovascular hypertension. Due to technical problems (bowel gas, adipositas) we excluded 7 patients. 79 patients (17-79 years) were included in our study. Flow patterns of several renal vascular areas were evaluated while the renal artery was demonstrated on a B-scan. A spectrum analysis included the evaluation of the frequency pattern (widening of the frequency band and loss of a frequency free window below the systolic rise?), the sloping of the diastolic shoulder, and the calculation of different parameters like acceleration index, deceleration index, resistance index, acceleration time, and systolic peak velocity. The accuracy of DS in diagnosing renal artery stenoses was compared with arterial digital subtraction angiography (DSA). Renal artery stenoses was diagnosed in 21 out of 158 renal arteries (13%). Except for the systolic peak velocity no significant correlations could be found of any of the indices from spectrum analysis with hemodynamically significant stenoses (greater than 50%). However, the following 3 criteria proved to be valuable signs of a hemodynamically significant stenoses: 1) Maximal systolic acceleration greater than 3 m/s, 2) Steep sloping diastolic shoulder, and 3) Turbulence of all frequency ranges without a frequency free window below the systolic rise. Compared with DSA the sensitivity of DS was 84.0%, the specificity was 98.5%, and the predictive value 91% in significant stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Diuretic-induced edema].

The diagnosis of "diuretic-induced oedema" was made in 17 women (mean age 42.4 [23-60] years) who had developed generalized oedema after stopping their (chronic) intake of diuretics. Five patients were between 11 and 32% overweight, five of them were unusually old. A further four patients had severe concomitant diseases, such as primary lymphoedema, mitral valve defect and lupus erythematosus. In 10 of the 17 discontinuation was successful: the initial weight gain averaged 3.9 (1.5-7.5) kg. The maximal weight-gain, in a woman in the course of weaning her of the diuretic, was reversed within 20 days. Diuretic withdrawal after more than 20 years in a woman with mitral valve disease caused heart failure. Diuretic abuse caused prerenal failure in one women, but renal function became normal again after stopping of the diuretic and rehydration.

Adult↗
PubMed1990

Concomitant considerations in long-term antihypertensive treatment.

Even with antihypertensive therapy, the risks in hypertensive patients, especially the incidence of coronary events, cannot be lowered to that of the normotensive population. Therefore, the metabolic effects of long-term therapy on lipid metabolism and the efficacy of antihypertensive drugs to lower blood pressure were studied as possible explanations for this partial therapeutic failure. Hypertensive patients who participated in a long-term trial provided a unique opportunity to observe the effects of long-term treatment and of then discontinuing antihypertensive therapy. During treatment, increases in total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides following hydrochlorothiazide, and increases of LDL-C and triglycerides and a decrease of high-density lipoprotein cholesterol (HDL-C) following atenolol were observed up to 42 months. After 5.2 +/- 1.4 years of randomised antihypertensive treatment, cessation of hydrochlorothiazide led to a decrease of total cholesterol from 6.40 to 5.98 mmol/l and of LDL-C from 4.33 to 3.89 mmol/l. After discontinuation of atenolol, LDL-C decreased from 4.20 to 3.89 mmol/l and triglycerides from 2.21 to 1.91 mmol/l, whereas HDL-C increased from 0.96 to 1.17 mmol/l (all differences significant). Thus the adverse effects of both agents persisted for more than five years and were reversible after medication was discontinued. In recent years titration to the lowest possible dose of antihypertensive agents has been suggested to avoid adverse metabolic alterations and subjective side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Beta-adrenergic blood pressure regulation in Shy-Drager syndrome and pheochromocytoma.

Both Shy-Drager syndrome and pheochromocytoma are characterized by an abnormal catecholamine secretion, e.g. a reduced secretion in Shy-Drager syndrome, and an excessive stimulation in pheochromocytoma resulting in adrenergic dysfunction and in adrenergic hyperactivity, respectively. The relationship between extreme variations in circulating catecholamines and beta-adrenergic receptor activity was studied in two patients with severe orthostatic hypotension (Shy-Drager syndrome) and in a patient with pheochromocytoma with excessive spontaneous catecholamine increases using the lymphocyte beta 2-adrenoceptor assay. In both patients with Shy-Drager syndrome, basal plasma concentrations of epinephrine and dopamine were low under resting conditions and could not be stimulated in the upright position. Norepinephrine was low in the first patient, and could not be stimulated; whereas the second patient had a normal basal concentration of norepinephrine, which could be moderately stimulated. There was no beta-adrenoceptor abnormality in the first patient: however, in the second patient, there were no measurable beta-adrenoceptors on membrane fractions, whereas a population of receptors only in the low affinity state could be identified on intact cells. Alpha-adrenoceptor density on thrombocyte membranes was slightly increased in both patients with Shy-Drager syndrome and showed no substantial change during upright posture. Catecholamine increases in the pheochromocytoma patient were accompanied by a rise in blood pressure, bradycardia, and an acute up-regulation of beta-adrenoceptors. Plasma concentrations of cAMP paralleled the increase in receptor density and blood pressure. The findings in pheochromocytoma add support to the theory that an acute catecholamine stimulation gives rise to an acute beta-adrenergic sensitization leading to blood pressure elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Neoplasms↗
PubMed1989

[Ambulatory indirect long-term blood pressure measurement in primary and secondary hypertension].

Ambulatory 24 hour blood pressure measurements were performed in 21 patients with various forms of secondary hypertension and were compared with the blood pressure profile of a matched group of patients with primary hypertension. Patients with renovascular (n = 8) and renoparechymal hypertension (n = 8), and with primary hyperaldosteronism (n = 4) showed no significant fall in systolic blood pressure during the sleeping period (00-03 a.m.) and in systolic and diastolic blood pressure in the early morning (06 a.m.) as compared with essential hypertensives. However, in a single case of hypertension due to coarctation of the aorta the 24 hour blood pressure profile is not different from essential hypertension. Thus, ambulatory 24 hour blood pressure recording is a good method for screening secondary forms of hypertension.

Ambulatory Care↗
PubMed1989

[Clinical significance of intrinsic sympathomimetic activity of the beta blocker carteolol. II: Comparative studies of carteolol and pindolol in patients with bradycardia].

Completing previous studies in patients with sinus bradycardia (Med. Klin. 82 [1987], 647-650) we compared metoprolol with carteolol and pindolol, pindolol with carteolol, no treatment with carteolol (in two groups) in five series of the paired comparisons of Holter-ECG each. With change from metoprolol to carteolol or pindolol (dose ratio 10:1) lowest heart rate on Holter-ECG increased by 28 or 29% without change of exercise heart rate. Direct comparison of pindolol and carteolol revealed a very similar heart rate profile, indicating equipotent beta blockade and ISA. In patients with previous beta blocker induced bradycardia, carteolol did not change a normal resting heart rate off treatment. However, in patients with spontaneous sinus bradycardia carteolol increased lowest heart rate (+14%, due to overriding ISA) and lowered exercise heart rate (-15%, due to overriding beta blockade). A beta blocker induced sinus bradycardia consistently improved with change of treatment to carteolol and pindolol. With caution carteolol and pindolol may also be used despite spontaneous sinus bradycardia.

Adult↗
PubMed1989

[Adrenergic receptors and hypertension in pregnancy].

During the last 10 years, radioligand binding studies have greatly advanced our knowledge about adrenoceptors in circulating lymphocytes. In essential hypertension the activity of the sympathetic system seems to be altered. Stimulation of the sympathetic system leads to rapid increase of lymphocyte beta-2-adrenoceptor density. In contrast, gestational hypertension is characterized by a decrease in cardiac output and enhanced arteriolar and venolar resistance. Peripheral resistance is modulated by alpha- and beta adrenoceptors and further studies are needed to characterize and quantify adrenoceptor density in gestational hypertension.

Arousal↗
PubMed1989

Correlations between ST-segment depressions in patients with arterial hypertension and changes in arterial blood pressure and the heart rate.

In 10 treated hypertensives without coronary heart disease we carried out 24-h monitoring of the ST-segment and blood pressure. Twenty-four periods with ST-segment depressions of greater than 0.1 mV were recorded in nine of 10 patients. In nine of 24 periods with ST-segment depressions blood pressure was elevated. The heart rate was increased in 20 of 24 ST-segment depressions. During nine periods with ST-segment depressions angina pectoris was reported, and 27 anginal attacks without ST-segment depressions were observed. These results indicate that only 38% of ST-segment depressions in hypertensive heart disease are paralleled by increases in blood pressure, but 83% are paralleled by increases in the heart rate (P less than 0.001), which shows a better correlation with ST-segment depressions than blood pressure.

Angina Pectoris↗
PubMed1988

Acute regulation of lymphocyte beta-adrenoceptor activity in pheochromocytoma.

The effect of an acute endogeneous catecholamine stimulation on the regulation of lymphocyte beta-adrenoceptor activity was studied in a patient with pheochromocytoma. Baseline blood pressure, heart rate, adrenoceptor density, and plasma concentrations of epinephrine, norepinephrine, and cyclic adenosine monophosphate were normal. Excessive spontaneous increases of catecholamine concentrations were accompanied by a rise in blood pressure, bradycardia, and an acute up-regulation of beta-adrenoceptors. Plasma concentrations of cyclic adenosine monophosphate paralleled the increase in receptor density and blood pressure. After normalization of catecholamine plasma levels, blood pressure, and beta-adrenoceptor density returned to baseline values. This observation adds support to the theory that an acute catecholamine stimulation leads to an acute sensitization of the beta-adrenoceptor-adenylatecyclase-cyclic-adenosine-monophosphate system leading to blood pressure elevation.

Adrenal Gland Neoplasms↗