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Biomedical subjects

P Greminger

Publications and source records attributed to P Greminger.

At least 127 records · Page 7Linked to original sources
PubMed1985

Atenolol versus pindolol: side-effects in hypertension.

This randomized crossover out-patient study was designed to compare the antihypertensive effects of atenolol and pindolol. After a wash-out period of two weeks in pretreated cases, 107 patients with essential hypertension were given either atenolol 100 mg once-daily or pindolol 20 mg slow release (SR) once-daily. Both atenolol and pindolol lowered blood pressure over the 24 week period. The diastolic blood pressure reduction was significantly greater (p less than 0.01) with atenolol than with pindolol. Before beta-blocker therapy, many patients had already experienced side-effects such as fatigue, sleep disturbances and dreams. This probably relates to the high sensitivity of the analogue scale used to assess side-effects, and to the high incidence of such symptoms in untreated patients. As the study progressed there was a reduction in the frequency of fatigue (p less than 0.03) and dreams (p less than 0.05) in both groups, whereas sleep disturbances significantly increased under pindolol (p less than 0.05) but decreased under atenolol (p less than 0.05). The only important side-effect difference between the two beta-blockers was the higher incidence of sleep disturbances with pindolol which may be due to the higher lipophilicity of this beta-blocker.

Adolescent↗
PubMed1985

Long-term experience in percutaneous transluminal dilatation of renal artery stenosis.

Percutaneous transluminal dilatation was attempted in 65 patients with renovascular hypertension. In five cases (8 percent), percutaneous transluminal dilatation could not be performed for technical reasons. In the remaining 60 patients (35 with atherosclerotic stenosis and 25 with fibromuscular dysplasia), both mean systolic and diastolic pressure fell immediately after percutaneous transluminal dilatation and remained significantly lower for a period of up to five years. Cure rates after a mean control period of 21.6 months were higher in patients with fibromuscular dysplasia (50 percent) than in those with atherosclerotic stenosis (29 percent). Improvement of blood pressure was observed in 32 percent of patients with fibromuscular dysplasia and in 48 percent of patients with atherosclerotic stenosis. Follow-up angiography in 33 cases showed occlusion of the dilated artery in two patients and recurrence of slight renal artery stenosis in nine patients. Successful redilatation could be performed in five of these cases. Furthermore, renal vein renin determinations were only of limited diagnostic or prognostic value. These results document the good long-term effect of percutaneous transluminal dilatation in patients with renal artery stenosis. Percutaneous transluminal dilatation should, therefore, be the favored procedure in patients with renovascular hypertension.

Adult↗
PubMed1985

Pathogenetic aspects of hypertension in Cushing's syndrome.

Abnormalities of the renin-angiotensin-aldosterone system (RAAS) were observed in hypertensive patients suffering from Cushing's syndrome. In 12 patients with different etiology of Cushing's syndrome renin substrate concentration and urinary-free cortisol, as well as the circadian rhythms of plasma cortisol, aldosterone and plasma renin activity were measured. Plasma renin substrate concentrations were found elevated in all but 1 patient, while plasma renin activity was elevated, normal or lowered. Plasma aldosterone values were found in the lower normal range. A physiological rhythm of cortisol secretion was not observed in any patient with Cushing's syndrome, while plasma aldosterone was secreted episodically mostly within the normal range. We conclude that changes of the RAAS may not be predominantly responsive for hypertension in Cushing's syndrome; other factors like circulating catecholamines are probably of greater importance for the pathogenesis of blood pressure elevation in hypercortisolemic patients.

Adolescent↗
PubMed1985

Adrenalectomy in primary aldosteronism: a long-term follow-up study.

The effect of unilateral adrenalectomy in primary aldosteronism was analyzed in 38 patients with unilateral adenoma, 12 cases with idiopathic bilateral hyperplasia and 1 patient suffering from an aldosterone-producing carcinoma. Responses to surgery differed markedly. In all 38 adenoma cases plasma aldosterone dropped to normal levels and remained within normal range during a mean follow-up period of 75 +/- 12 months. 23 (61%) of these patients became normotensive without medication and thus could be classified as definitely cured. 34% (13 patients) improved (normotensive under medical treatment) and only 2 cases (5%) remained hypertensive despite sufficient medical treatment. In the hyperplasia group, however, the effect of adrenalectomy was disappointing. None of these subjects showed a long-lasting normalization of aldosterone secretion. A temporary remission for no more than 3-4 months was achieved in only 3 patients. In a fourth case with macronodular hyperplasia, primary aldosteronism relapsed after a 6-year period of normal blood pressure and aldosterone values. Therefore, 6 years after adrenalectomy no hyperplasia patient was definitely cured in contrast to 61% of the adenoma cases. The problems in the management of hypertension in adrenal hyperplasia are furthermore documented by a poorer blood pressure control despite antihypertensive medication and a high rate of vascular complications. During the follow-up, 3 of 12 hyperplasia patients experienced a cerebrovascular event and 1 a myocardial infarction.

Adenoma↗
PubMed1985

Primary aldosteronism: treatment with trilostane.

Trilostane, an inhibitor of the 3 beta-hydroxysteroid dehydrogenase enzyme system of steroid biosynthesis, was applied to 18 patients with primary aldosteronism (9 patients with adrenal adenoma, 9 patients with bilateral adrenal hyperplasia) for 12 weeks. A marked decrease in plasma aldosterone was observed during therapy combined with a reduction in blood pressure and a rise in serum potassium levels. Except for slight diarrhea in 4 patients, which did not require cessation of trilostane medication, no further side effects were observed. Trilostane proved to be an effective inhibitor of aldosterone biosynthesis and was found useful in the treatment of primary aldosteronism both in patients with adrenal adenoma and in those with bilateral adrenal hyperplasia.

3-Hydroxysteroid Dehydrogenases↗
PubMed1985

Unilateral parenchymatous kidney disease and hypertension: results of nephrectomy and medical treatment.

In the present study 43 patients with unilateral parenchymatous kidney disease and hypertension were investigated. 20 patients were nephrectomized, 23 treated with antihypertensive drugs. Both therapeutic approaches showed an excellent and sustained blood pressure-(BP)-lowering effect. BP fell from 185 +/- 27/116 +/- 13 to 138 +/- 20/86 +/- 10 mm Hg in the operated and from 194 +/- 32/116 +/- 13 to 149 +/- 22/95 +/- 12 mm Hg in the medically treated patients after 2 and 6 weeks, respectively (p less than 0.001). BP was 142 +/- 16/89 +/- 11 and 136 +/- 16/90 +/- 10 mm Hg at the long-term follow-up in the 2 subgroups. In the operated group 70% (n = 14) were cured, 20% (n = 4) were improved and 10% (n = 2) unimproved. In the medically treated group 65% (n = 15) were normotensive, 26% (n = 6) improved and 9% (n = 2) treatment resistant. No significant correlation between postoperative BP reduction and lateralization of renin secretion (PRA-ratio greater than or equal to 1.5) was found. Although cured patients showed a higher mean PRA-ratio, 4 patients with a PRA-ratio less than 1.5 were cured (n = 2) or improved (n = 2) postoperatively. Our results document an excellent and sustained antihypertensive effect of both nephrectomy and medical treatment in patients with unilateral parenchymatous kidney disease and hypertension. They further limit the predictive value of renal venous renin determination in the preoperative workup.

Adolescent↗
PubMed1985

A simple and effective method to teach patients about high blood pressure and obesity.

It is an open question whether information about hypertension and obesity increases compliance with therapy. Nevertheless, patients increasingly demand precise but simple and comprehensive information. A simple slide programme is described which can be demonstrated in any waiting room. The learning effect was assessed in 1083 subjects, of whom 485 had seen the programme completely; 256 subjects served as controls. The percentage of subjects with good or excellent knowledge about hypertension and obesity rose from 22.8% in the controls to 64.2% in the experimental group. Age was the only factor influencing learning, but this was of no great importance in subjects under 70. In particular, social status did not have any significant effect on learning. This programme may be an ideal tool to inform patients about hypertension and obesity and to study the influence of information on compliance with therapy.

Age Factors↗
PubMed1985

Does self-measurement of blood pressure improve patient compliance in hypertension?

Compliance with antihypertensive therapy was measured before and after distribution of non-automatic blood pressure devices. After 2 weeks of placebo treatment, 37 patients were treated with an antihypertensive combination drug containing triamterene. Adherence to therapy was assessed over 8 months by measuring urine fluorescence due to triamterene at intervals of 2-4 weeks, unknown to the patients. After 3 months of therapy, all patients, not just those with poor compliance, were given blood pressure devices and were carefully instructed in their use. The results showed that self-recording of blood pressure increased the compliance rate in the total group from 65% at the beginning of the study to 81% at the end. In those who initially showed poor compliance, there was an increase in compliance from 0 to 70% after self-measuring of blood pressure was introduced. We conclude that self-recording of blood pressure may be of value in patients with unsatisfactory blood pressure responses in whom poor compliance is suspected.

Antihypertensive Agents↗
PubMed1985

The scored tablet--a source of error in drug dosing?

To determine the weight deviation of scored tablets after breaking we took 100 tablets of each of 34 brands of commercially available antihypertensive drugs and broke them into two, using the scored line. We graded the weights of the tablet halves according to their deviation from the expected weight (1 = less than or equal to +/- 5%, 11 = +/- 6-10%, 111 = greater than or equal to +/- 10%). The brands were ranked by the proportion of tablet halves (n = 200) in each category. Only seven brands divided very accurately and 11 brands divided reasonably accurately. Despite the scored line the remainder were either moderately (n = 10) or absolutely (n = 6) unsuitable for breaking, by hand or otherwise. A high proportion of these tablet halves showed weight deviations of 6-10% or more than 10% when compared to the expected weight. These findings show that a great number of antihypertensive drugs do not break evenly despite a scored line. This leads to inaccuracy of dosage.

Antihypertensive Agents↗
PubMed1985

The spectrum of renovascular hypertension.

This review briefly summarizes pathological findings that may cause renovascular hypertension. Though atherosclerosis is the most common cause of renovascular hypertension, one third of all renovascular disorders has to be contributed to one of the arterial dysplasias. In contrast to atherosclerotic lesions which occur predominantly in older, male patients, fibrodysplastic alterations occur rather in younger, female patients. In very few cases malformations of the renal arteries or generalized diseases may cause renovascular hypertension.

Adult↗
PubMed1984

Captopril in Cushing's syndrome.

To analyse the role of the renin angiotensin system in the pathogenesis of hypertension in Cushing's syndrome ten patients with hypercorticism (five with pituitary hypothalamic dysfunction, three with adrenal adenomas and two with adrenal carcinomas) received a single oral dose of 25 mg captopril. Mean arterial pressure was then determined at short intervals over periods of up to 240 min. Plasma renin activity (PRA) was measured immediately before the administration of captopril. Eleven patients with severe essential hypertension, who showed a comparable distribution of basal PRA values, served as a control. Patients with elevated basal PRA values (greater than 3 ng/ml X 3 h) showed, both in the subgroup of cases with essential hypertension and in that with Cushing's syndrome, a statistically significant fall (P less than 0.05-P less than 0.001) in mean arterial pressure, the decrease being slightly more pronounced in essential hypertensives. On the other hand patients with normal PRA values (less than or equal to ng/ml X 3 h) exhibited only a minor fall in mean arterial pressure reaching statistical significance (P less than 0.05) only after 60 min (essential hypertension) and 180 min (Cushing's syndrome), respectively. Our results document that in patients with Cushing's syndrome the effect of captopril seems to be determined by the activity of the renin angiotensin system. Thus, in a substantial number of patients with hypercorticism, the renin angiotensin system may be an important factor in the pathogenesis of hypertension, whereas in patients with low PRA values other factors like oversecretion of mineralocorticoids may be responsible for the observed blood pressure increases.

Adult↗
PubMed1984

Long-term effect of captopril on kidney function in various forms of hypertension.

To study long-term effects of captopril on renal function in patients with various forms of severe hypertension, serum creatinine values were monitored in 76 patients under captopril therapy over a period of up to 3 years. Three different groups were formed: patients with essential hypertension (n = 37); patients with renovascular hypertension (n = 20); patients with renal parenchymatous hypertension (n = 19). In each of the three groups reduction in blood pressure was accompanied by increases in serum creatinine. However, both changes were more pronounced in patients with renovascular hypertension. In this group only the rise in creatinine was statistically significant and showed a slight progression with duration of captopril treatment. Group specific analysis revealed that the increase was smaller in patients with unilateral (n = 16) renovascular disease than in those with bilateral (n = 4) involvement, but in the former it was still significantly higher than in patients with essential or renal parenchymatous hypertension. Separation of patients according to the underlying disease of renovascular hypertension showed that renal function deteriorated less in patients with arteriosclerotic origin (n = 10) than in those with fibromuscular dysplasia (n = 8). Statistical evaluation of subjects with renovascular and essential hypertension still revealed significant differences in creatinine when the patients with initial plasma renin activity (PRA) below and above 6 ng/ml X 3 h were compared separately. A significant correlation (r = 0.73; P less than 0.05) between blood pressure reduction and creatinine changes was obtained only for patients with renovascular hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Captopril↗
PubMed1983

[A slide program on hypertension and obesity: a simple method of patient information].

It is well established that information on their disease is one of the prerequisites for improvement of patients' compliance with therapy. The authors have therefore developed a simple slide program presenting information on hypertension and obesity. Consisting of 52 slides, it was shown in the central waiting room of the medical outpatient department at the University Hospital, Zurich. In order to assess learning, 841 patients were asked to fill in a questionnaire. 485 had seen the program and 356 served as controls with the program switched off. Four main results emerged: 1. The percentage of subjects scoring greater than or equal to 4 correct answers (of a maximum of 5) rose significantly from 22.6% to 64.2%. 2. The number of incorrect answers (maximum 3) remained unchanged. 3. Learning decreased with age. 4. Occupation did not have a significant effect on learning. The results clearly show that the program represents an effective method of teaching patients and may therefore serve to improve compliance with therapy.

Adult↗
PubMed1983

[Asymmetric septal hypertrophy in patients with arterial hypertension].

Asymmetric septal hypertrophy (ASH) is the characteristic finding in patients with hypertrophic cardiomyopathy. The purpose of the present study was to examine the effect of chronic pressure overload on left ventricular hypertrophy and ASH in 34 patients with arterial hypertension. 15 patients (Group 1) showed normal blood pressure values (less than 140/90 mm Hg) under antihypertensive treatment but blood pressure remained elevated in 19 patients (Group 2) despite antihypertensive therapy. Left ventricular septal and posterior wall thickness, left ventricular internal diameter and systolic shortening of the internal diameter were measured in all patients by our standard technique. Systolic and diastolic blood pressure were significantly (p less than 0.001) elevated in Group 2 (164/98 mm Hg) as compared to Group 1 (128/84 mm Hg). Septal (1.7 versus 1.1 cm; p less than 0.01) and posterior wall thickness (1.2 versus 1.0 cm; p less than 0.01) as well as the septal/posterior wall ratio (1.4 versus 1.1; p less than 0.001) were significantly increased in Group 2 as compared to Group 1. Left ventricular internal diameter and systolic shortening of the internal diameter did not significantly differ between the two groups. ASH (septal/posterior wall ration greater than or equal to 1.3) was found in 10 patients of Group 2 (55%) and 1 patient of Group 1 (7%). It is concluded that asymmetric septal hypertrophy can be observed in one third of all patients with severe arterial hypertension. Asymmetric septal hypertrophy seems to be dependent on the duration and severity of hypertension and does not appear to be related to hypertrophic cardiomyopathy.

Adrenergic beta-Antagonists↗
PubMed1983

Problem cases in renovascular hypertension.

The clinical course and response to therapy of 16 patients with various complex forms of renovascular hypertension were investigated. Reconstructive surgery and/or transluminal dilatation was either ineffective (n = 5) or could not be performed for technical reasons (n = 11). The group contained 7 patients with multilocular fibromuscular disease involving both renal arteries, two cases with multiple arteriosclerotic vascular occlusions, 3 patients with branch renal artery aneurysms, 3 with renal artery stenosis in a solitary kidney and one patient with renal artery stenosis and contraction of the contralateral kidney due to a non-vascular cause. With antihypertensive treatment, particularly with the angiotensin converting enzyme inhibitor captopril (n = 7), blood pressure could be reduced from 214 +/- 40/124 +/- 23 mm Hg to 145 +/- 23/88 +/- 9 mm Hg (P less than 0.001). In 11 of the 16 patients (69%) the values decreased to less than 160/95 mm Hg. These results suggest that, in complex forms of renovascular hypertension, antihypertensive treatment may be a potent therapeutic alternative if surgery and/or transluminal dilatation can not be performed or seem to have too high a risk.

Adult↗