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Biomedical subjects

P Greminger

Publications and source records attributed to P Greminger.

At least 109 records · Page 6Linked to original sources
PubMed1986

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.

Adult↗
PubMed1986

Renal venous renin determinations in renovascular hypertension. Diagnostic and prognostic value in unilateral renal artery stenosis treated by surgery or percutaneous transluminal angioplasty.

To assess the diagnostic and prognostic value of renal venous renin levels in renovascular hypertension, 95 patients with severe unilateral renal artery stenosis were studied. Surgery (n = 52) or percutaneous transluminal dilation (n = 43) were done irrespective of renal venous renin levels. Lateralization of renin secretion as assessed by the PRA ratio and the renin secretion index was found in the majority of patients (66% and 88%, respectively). Patients with fibromuscular hyperplasia had more frequently PRA ratios less than 1.5 than those with arteriosclerotic stenosis (p less than 0.05). The renin secretion index proved to have a higher sensitivity (92%) and predictive value (92%) for a successful outcome of both surgery and PTA than the PRA ratio (69% and 89%, respectively), while the specificity was the same with both parameters (42% and 43%, respectively). The contralateral suppression index was most specific in predicting an unfavorable outcome. However, with all ratios used, a considerable number of false-negative and false-positive tests were observed both with surgery and PTA, a finding limiting the value of the method in selecting patients for these interventions. Other factors, such as age of the patient, kidney function and the underlying arterial disease turned out to be equally important prognostic factors. Thus, although cure after both surgery and PTA is more likely in the presence of lateralized renin secretion and contralateral suppression, the method does not allow to exclude patients with severe renal artery stenosis, hypertension and negative renal venous renin tests from these interventions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Surgery, transluminal dilatation and medical therapy in the management of renovascular hypertension.

In the present retrospective study, the effect of various therapeutic procedures (surgery, percutaneous transluminal dilatation and antihypertensive drugs) was analyzed in 202 patients with renovascular hypertension. The results show that each of the three methods effectively lowers blood pressure. However, marked differences were observed in pretreatment clinical and laboratory data among the three groups. These differences were most probably caused by different selection criteria before submitting the patient to a given therapeutic regime. Our findings also demonstrate that on the basis of the present analysis a direct comparison between surgery, dilatation and medical therapy is not possible.

Adult↗
PubMed1986

Captopril and kidney function in renovascular and essential hypertension.

In the present study 25 patients with various forms of severe hypertension (essential hypertension: n = 12; renovascular hypertension: n = 11; unilateral small kidney: n = 2), which were treated with captopril for a mean control period of 34.9 months, were investigated. Reduction of mean blood pressure under captopril was comparable in all subgroups. However, patients with renovascular hypertension showed a significant increase in serum creatinine from 117 to 162 mumol/l (p less than 0.05) after 34.9 months, whereas in essential hypertensives even a slight decrease could be observed (113 vs. 111 mumol/l). Serum creatinine of the 2 patients with unilateral small kidney remained within the normal range. Changes in creatinine were markedly higher in cases with bilateral renal artery stenosis and/or in those with a very high initial plasma renin activity (greater than 15 ng/ml X 3 h). Our findings underline the necessity of cautious application of captopril in patients with renovascular hypertension.

Adult↗
PubMed1986

Fibromuscular hyperplasia: extension of the disease and therapeutic outcome. Results of the University Hospital Zurich Cooperative Study on Fibromuscular Hyperplasia.

92 patients with fibromuscular hyperplasia (FMH) seen at the University Hospital Zurich were studied. Renovascular FMH was the most frequent manifestation of the disease (89%). FMH of the cerebral arteries was seen in 26%. The intestinal and subclavian arteries were involved in 9% each and the iliac arteries in 5% of the patients. In 2 patients each FMH of the abdominal aorta or the coronary arteries, respectively, was found. 26% of the patients had systemic disease with involvement of 2 or more arteries. Half of the patients with bilateral renovascular disease showed additional extrarenal FMH. All patients with renovascular FMH were hypertensive (mean blood pressure 194 +/- 34/119 +/- 18 mm Hg). Surgery, percutaneous transluminal angioplasty (PTA) and medical therapy were equally effective in controlling blood pressure. The cure rates were 52% in patients undergoing surgery and 50% in those treated with PTA. The complication rate, however, was higher with surgery (11%) than with PTA (3%). 62% of the patients treated medically were normotensive. Major side effects occurred in 4.8%. The outcome of curative interventions (surgery or PTA) was influenced by the extension of FMH. In unilateral disease the cure rate was significantly higher (62%) than in systemic FMH (28%; p less than 0.03). Patients with strict bilateral disease were cured in 50%. We conclude: (a) PTA seems to be the treatment of choice in renovascular FMH because of a high cure and a low complication rate and (b) the outcome of curative interventions seems markedly influenced by the extension of FMH in these patients.

Adult↗
PubMed1986

Enalapril as a first-step agent in essential hypertension: a comparative study with atenolol.

The aim of the present double-blind crossover study was to compare the antihypertensive efficacy and tolerability of enalapril and atenolol in 48 patients with mild to moderate essential hypertension. After a 2-week wash-out period, treatment was started with either enalapril 20 mg or atenolol 50 mg daily. In patients with a diastolic blood pressure value of more than 90 mmHg after 2 weeks of therapy, doses were doubled. After 4 weeks of therapy, cases were classified as responders (diastolic blood pressure less than or equal to 95 mmHg) or non-responders (diastolic blood pressure greater than 95 mmHg) and after a 2-week wash-out phase switched over to the alternative drug for another 4-week therapy period. Both substances significantly lowered mean systolic and diastolic blood pressure to a comparable degree. After 2 weeks, 57% of patients under enalapril and 59% under atenolol shared a satisfactory response, which did not change at the higher dose levels. After 4 weeks of therapy the incidence of side effects was slightly, but insignificantly, higher on atenolol than on enalapril. Thus, our results show that both agents seem equally qualified as first-step drugs in the treatment of mild to moderate essential hypertension.

Adult↗
PubMed1985

[Mefenamic acid (Ponstan)-induced acute interstitial nephritis with reversible, severe, non-oliguric renal failure].

Acute interstitial nephritis is a rare complication of treatment with non-steroidal antiinflammatory drugs. A case is reported with severe, reversible, non-oliguric renal failure caused by biopsy-proven acute interstitial nephritis after therapy with mefenamic acid (Ponstan). Prednisone treatment resulted in normalization of renal function within 4 weeks.

Acute Kidney Injury↗
PubMed1985

[Rest and effort hemodynamics during long-term treatment of dilated and ischemic cardiomyopathy with captopril].

In the present study 13 patients with severe chronic heart failure were investigated by right heart catheterization at rest and during handgrip before and 6 months after treatment with captopril (mean dose 2 X 37.5 mg per day). Before initiating captopril therapy all patients were clinically stable on digitalis and diuretics. During the observation period 3 patients died suddenly. Of the remaining cases, 5 had dilated cardiomyopathy and 5 ischemic heart disease. After 6 months, resting hemodynamic measurements changed as follows: systemic vascular resistance decreased from 1594 to 1284 dyn X sec X cm-5 (p less than 0.005), left ventricular end-diastolic pressure decreased from 17 to 10 mm Hg (p less than 0.01) and stroke volume index increased from 32 to 40 ml/m2 (p less than 0.05). Before captopril, 9 patients showed no increase or even a decrease of stroke work index during isometric exercise, whereas after captopril 5 out of the 10 patients showed an increase in stroke work index. The results demonstrate that, in patients with severe chronic heart failure, long-term afterload reduction with captopril is accompanied by a significant improvement in left ventricular performance at rest. Furthermore, during isometric exercise after captopril an improvement in left ventricular function was found in 5 out of 10 patients.

Captopril↗
PubMed1985

[Long-term follow-up and prognosis of dilated cardiomyopathy].

Between 1969 and 1984, 68 patients with dilated cardiomyopathy (mean age 44 years) were observed for an average period of 45 months. 46 patients (68%) died (17 sudden death, 13 congestive heart failure, 5 other causes and 11 unknown causes) during the observation period according to a cumulative 5-year survival rate of 40%. All patients underwent diagnostic cardiac catheterization. Left ventricular ejection fraction was 32%, left ventricular end-diastolic volume index 195 ml/m2, left ventricular end-diastolic pressure 17 mm Hg and cardiac index 2.7 l/min/m2. The initial hemodynamic findings in the non-survivors and the survivors were statistically not significantly different. The prognostic significance of 12 clinical and hemodynamic parameters was evaluated by multivariate regression analysis (Cox model). Only 3 hemodynamic parameters, namely left ventricular end-diastolic volume, left ventricular end-diastolic pressure and cardiac index, showed prognostic significance in regard to survival. Prognostic evaluation of medical therapy (antiarrhythmic drugs n = 14, vasodilators n = 17, anticoagulation n = 37) revealed an improved cumulative 3-year survival rate (87% versus 46%) only for vasodilators.

Adolescent↗
PubMed1985

[Renovascular hypertension: surgery, dilatation or drugs?].

The effect of various therapeutic procedures (surgery, percutaneous transluminal dilatation and antihypertensive drugs) was analyzed in 161 patients with renovascular hypertension. The results show that each of the three methods effectively lowers blood pressure. However, marked differences in pretreatment clinical and laboratory data among the three groups were observed, which were most probably caused by different selection criteria before submitting the patient to a given therapeutic regime. The findings also demonstrate that, on the basis of the present analysis, a direct comparison between surgery, dilatation and medical therapy is not possible.

Adult↗
PubMed1985

[Therapy and course of dilated cardiomyopathy].

Dilated cardiomyopathy is a primary myocardial disease of unknown origin. The typical findings are severe systolic pump failure and dilatation of all cardiac chambers with severe cardiomegaly. Clinical symptomatology is determined by myocardial dysfunction with congestive heart failure. Cardiomegaly and arrhythmia may precede clinical symptoms of congestive heart failure by years. Medical therapy is based on classical treatment of congestive heart failure with digitalis and diuretics; recently, afterload-reducing agents, such as converting enzyme inhibitors, have become the drug of choice for patients with severe congestive heart failure. Antiarrhythmic therapy is necessary in the presence of severe arrhythmia, and anticoagulation is indicated when a low-output state or atrial fibrillation are present. Clinical course in dilated cardiomyopathy is usually poor and 5-year survival is 38% in our group.

Anti-Arrhythmia Agents↗
PubMed1985

Captopril before and after spironolactone therapy in primary aldosteronism. Pathogenetic and therapeutical aspects.

In three patients with primary aldosteronism, the acute effect of a single dose of captopril on the elevated mean arterial blood pressure (MAP) was studied before and after 4 weeks of treatment with spironolactone. Before spironolactone therapy, captopril did not cause any drop in MAP. Four weeks later, after an oral daily dose of 400 mg spironolactone, MAP was still elevated in all three patients, though electrolyte abnormalities were fully corrected. Since plasma renin activity (PRA) was increased to values above the normal range, the acute effect of captopril on MAP was tested again. A single dose of 25 mg captopril then caused a fall in MAP to normal. These data reveal the conversion from a renin-independent to a renin-dependent kind of hypertension after spironolactone therapy in three patients with primary aldosteronism syndrome. This might be of pathogenetic and therapeutic interest.

Aldosterone↗
PubMed1985

[Fibromuscular renovascular hypertension: comparison of surgery, transluminal dilatation and drug therapy].

82 patients with fibromuscular renovascular hypertension have been studied. 33 patients were treated surgically (group I), 28 underwent transluminal dilation (group II) and 21 received drug treatment (group III). After a follow-up period of 2.5 (0.1-7) years, blood pressure in group I had decreased from 207 +/- 27/128 +/- 17 mm Hg to 135 +/- 15/85 +/- 9 mm Hg after surgery (p less than 0.001). 1.3 (0.1-4) years after dilation, group II showed a decrease of blood pressure from 174 +/- 25/107 +/- 13 mm Hg to 143 +/- 26/88 +/- 12 mm Hg (p less than 0.001). Blood pressure in group III decreased under drug therapy from 203 +/- 41/122 +/- 16 mm Hg to 146 +/- 19/92 +/- 8 mm Hg (p less than 0.001). 52% of the surgical patients and 50% of the dilated patients were cured, whereas 45% and 39% respectively were improved and 3% and 11% respectively did not improve. In group III, under antihypertensive drug therapy, blood pressure normalized in 62% of the patients, 33% showed better values and 5% did not improve. The complication rate was 11% in group I and 3.3% in group II. In two patients dilation was technically impossible. In group III one patient (4.8%) showed a massive but reversible increase of serum creatinine under captopril. In 70% of all patients the renal vein renin ratio was greater than or equal to 1.5. However, this ratio was unreliable as a parameter to predict the blood pressure decrease with curative methods. It is concluded from the above that all three methods offered good to very good results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗