Biomedical subjects
P Baumgart
Publications and source records attributed to P Baumgart.
The neglected time factor and antihypertensive therapy. A pitfall in evaluating side effects in a cross-over study.
The aim of this study was to examine the influence of a time factor that may lead to inaccurate interpretation of data on the incidence of side effects in a double-blind study with drug cross-over. After a washout period, 58 patients with essential hypertension received either 20 mg of enalapril or 50 mg of atenolol. After two weeks, the dosage was doubled (to 40 mg of enalapril and 100 mg of atenolol) in those patients with diastolic blood pressure higher than 95 mm Hg. After four weeks of active treatment and a second two-week washout period, patients received the alternative antihypertensive agent under the same procedure and time schedule as in the first treatment phase. Four patients dropped out. Side effects were evaluated by questionnaire at weeks 2, 4, 8, and 10. In the 54 patients who completed the study, enalapril and atenolol led to almost identical blood pressure reduction in both treatment phases, indicating that pooling these data is a sound method. However, incidence of side effects was twice as high in phase 1 as in phase 2 and markedly decreased in each treatment phase, with no differences being observed between enalapril and atenolol. These results clearly demonstrate that pooling side effects data from a cross-over study may lead to quite wrong interpretations.
[Forms of adrenal hypertension].
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[Septic fever, joint pains and hepatosplenomegaly].
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[Bone pain, spontaneous fractures, muscle weakness].
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In situ Brillouin scattering from surface-anisotropy-dominated Damon-Eshbach modes in ultrathin epitaxial Fe(110) layers.
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[Diagnostic aspects of 24-hour blood pressure determination].
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[24-hour blood pressure determination: therapeutic and prognostic implications].
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Collective spin waves in Fe-Pd and Fe-W multilayer structures.
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Localized phonon modes in Fe-Pd multilayer structures.
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[Ambulatory 24-hour blood pressure monitoring before and after dilatation of renal artery stenoses].
The time course of blood pressure reduction after transluminal dilatation of renal artery stenoses was investigated by repeated 24 h blood pressure monitoring in 17 patients with renovascular hypertension. The results of treatment were compared for the different types of stenoses. The diurnal and nocturnal variations in blood pressure were not altered. The mean blood pressure in all patients during daytime (0800-2000) was 160 +/- 13/99 +/- 7 mm Hg (mean +/- SD syst./diast.) before dilatation, 151 +/- 10/91 +/- 6 mm Hg on the day of dilatation (p syst. less than 0.01, p diast. less than 0.01) and 151 +/- 9/91 +/- 6 mm Hg 1-4 weeks after. Blood pressure was further reduced to 137 +/- 12/84 +/- 8 mm Hg after 9-11 months despite a reduction in drug treatment (p syst. less than 0.001, p diast. less than 0.001). After 9-11 months the reduction in blood pressure (0800-2000) was 31/21 mm Hg (mean syst./diast. reduction) in the patients with only one kidney and 29/20 mm Hg in subjects with fibromuscular dysplasia. In the patients with arteriosclerotic renal artery stenoses who had two kidneys the blood pressure was reduced by only 18/11 mm Hg. The results of repeated ambulatory blood pressure monitoring indicate that the initial fall in blood pressure after dilatation of renal artery stenoses is followed by a delayed further reduction. Subjects with only one kidney and patients with fibromuscular dysplasia show the most effective reduction in blood pressure after dilatation of renal artery stenoses.
[Hemangiosarcoma of the heart].
The clinical appearance, typical localization, diagnostic procedure and the treatment of hemangiosarcoma--the most frequent malignant tumor of the heart are reported by the case of a 27 years old woman. The patient suffered from dyspnea, congestion of the superior caval vein and paroxysmal tachycardia. X-ray showed cardiac enlargement due to pericardial effusion. Echocardiography revealed a large tumor in the right atrium. Computertomography and angiocardiography showed tumor masses at the orifice of the superior caval vein and a bypass of the blood flow via the azygos vein. Thoracotomy yielded an inoperable hemangiosarcoma. By the combined treatment of irradiation and chemotherapy the cardiac tumor completely disappeared, the patient was temporary symptomless. Later metastases occurred and the patient died 13 months after diagnosis.
Minoxidil and captopril in severe hypertension.
The antihypertensive efficacy of minoxidil and captopril was compared in 23 males with essential or renal parenchymatous hypertension refractory to conventional antihypertensive drug therapy. Following a pretreatment period the patients were randomly assigned to receive either minoxidil, 2.5 mg twice daily (n = 12), or captopril, 25 mg twice daily (n = 11). In patients with diastolic blood pressure greater than 95 mmHg, doses of minoxidil and captopril were increased in 2-week intervals. Patients who maintained diastolic pressure greater than 95 mmHg and/or those with intolerable side effects were switched over to the alternative substance. After a mean observation period of 12 weeks a significant decrease in systolic and diastolic blood pressure was observed (179/114 vs 148/92 mmHg in the minoxidil group; 176/111 vs 158/97 mmHg in the captopril group). The primary response rate was 75% in patients treated with minoxidil and 55% in those with captopril (not significant). After the change to the alternative substance two of the four non-responders on captopril and one of the two non-responders on minoxidil became responders. Side effects occurred significantly more often during minoxidil than captopril (p less than 0.05). The high efficacy of minoxidil and captopril in the treatment of severe hypertension refractory to conventional drugs was confirmed. Minoxidil lowered blood pressure slightly more than captopril, but it had a higher incidence of side effects than captopril.
Intracellular calcium during beta-adrenoreceptor blockade in essential hypertension.
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Efficacy of low dose captopril once daily in diuretic resistant hypertension.
In 12 essential hypertensive patients insufficiently controlled by treatment with 50 mg hydrochlorothiazide, the blood pressure lowering effect of the addition of 25 mg captopril once daily was examined. Twenty four hour ambulatory blood pressure monitoring was performed using portable automatic recording devices before treatment, after 4 weeks of treatment with hydrochlorothiazide alone, and again after 4 weeks of combined treatment with captopril. The combined treatment yielded a marked additional blood pressure reduction in comparison with the previous medication of the diuretic alone. The additional antihypertensive effect of captopril lasted 24 hours. During the daytime between 08.00 h and 20.00 h the mean blood pressure was 158 +/- 13/100 +/- 8 mmHg before treatment. After treatment with hydrochlorothiazide alone it was 151 +/- 11/93 +/- 8 mmHg and after hydrochlorothiazide and captopril it was 140 +/- 13/88 +/- 9 mmHg. Our results indicate that the addition of only 25 mg captopril once a day to a diuretic may result in a marked additional blood pressure reduction or normalization in cases of insufficient control by the diuretic alone.
[Diuretic-resistant hypertension. Effect of an additional daily single dose of a ACE inhibitor].
The effect of additional administration of a low dose of an ACE inhibitor when blood pressure is inadequately controlled by a diuretic alone was investigated in 12 essential hypertensive patients. 24 h blood pressure monitorings were performed with portable automatic recording devices before and after treatment with 50 mg hydrochlorothiazide (HCT) and after additional administration of 25 mg captopril. The frequency of blood pressure readings exceeding 160/95 mm Hg within 24 hours was reduced in 11 of the 12 patients after administration of the ACE inhibitor. Mean blood pressure during daytime was 158 +/- 13 / 100 +/- 8 mm Hg without treatment, 151 +/- 11 / 93 +/- 8 mm Hg during HCT alone and 140 +/- 13 / 88 +/- 9 mm Hg during HCT + captopril. The results show that in a large proportion of hypertensives inadequately controlled by a diuretic alone, the addition of a low dose of an ACE inhibitor (captopril, 25 mg once daily) may normalize the blood pressure.