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Biomedical subjects

P Vallance

Publications and source records attributed to P Vallance.

At least 127 records · Page 7Linked to original sources
PubMed1993

Effect of stress management on blood pressure in mild primary hypertension.

OBJECTIVE: To establish whether stress management had a larger effect than a control treatment on resting blood pressure, ambulatory blood pressure, and left ventricular mass. DESIGN: A 12 week baseline period of habituation to measurement of blood pressure was followed by randomisation to either stress management or mild exercise for six months and follow up six months later. SETTING: General practice, district general hospital, and medical school. PATIENTS: Of the 184 patients aged under 60 with mild primary hypertension who entered the baseline habituation period, 88 were excluded because they failed to meet the entry criteria or they withdrew from the study. The remaining 46 men and 50 women underwent treatment. INTERVENTIONS: 10 clinical sessions and daily practice at home of either stress management based on relaxation or non-aerobic stretching exercises. Mildly stressful 15 minute interviews before and after treatment. MAIN OUTCOME MEASURES: Diastolic and systolic blood pressure in the clinic and during 12 hours of ambulatory recording, and left ventricular mass measured by echocardiography. RESULTS: The patients' blood pressure fell during habituation (systolic pressure from 152 mmHg to 140 mmHg, diastolic pressure from 98 to 93 mm Hg), but neither resting nor ambulatory blood pressure was changed by the treatments. Left ventricular mass was also unchanged. Blood pressure rose during the stressful interview, but this rise was reduced by stress management (systolic pressure rose by 7.4 mmHg before treatment and by 3.7 mmHg after treatment). CONCLUSION: Stress management of a type advocated for treating mild primary hypertension is ineffective in lowering blood pressure in patients who are well habituated to measuring blood pressure.

Adult↗
PubMed1993

Platelet adhesion to human vascular endothelium is modulated by constitutive and cytokine induced nitric oxide.

OBJECTIVE: The aim was to study whether basal or cytokine stimulated generation of nitric oxide (NO) modulates platelet adhesion to human umbilical vein endothelial cells (HUVEC). METHODS: The adhesion of 111In labelled human platelets to transfected HUVEC (SGHEC-7) was measured either alone or after incubation of SGHEC-7 cells for 18 h with interleukin-1 beta (IL-1 beta) and/or tumour necrosis factor alpha (TNF alpha). The activity of NO synthase in these cells was measured by formation of citrulline. The effects of dexamethasone (0.3 microM) and NG-monomethyl-L-arginine (L-NMMA, 100 microM) on these two variables were determined. RESULTS: Stimulation of SGHEC-7 cells with IL-1 beta or TNF alpha (each at 1-30 ng.ml-1) caused them to express the inducible NO synthase, an effect that was prevented by dexamethasone. Platelet adhesion to unstimulated SGHEC-7 cells was < 0.1% (n = 3) and was increased to 0.7 (SEM 0.2)% by L-NMMA but was not affected by dexamethasone. Stimulation of the cells with IL-1 beta and TNF alpha increased platelet adhesion to a maximum of 2.2(0.4)%. This increase was enhanced by both dexamethasone and L-NMMA. The effect of L-NMMA was prevented by L-arginine. CONCLUSIONS: Inhibition of NO synthesis by L-NMMA potentiates platelet adhesion to unstimulated SGHEC-7 cells, showing that basally released NO regulates platelet adhesion. Stimulation of SGHEC-7 cells by cytokines increases their adhesive properties but at the same time causes them to express the inducible NO synthase. Nitric oxide generated by this enzyme contributes to the modulation of the adhesive properties of the endothelial cells. Thus both constitutive and inducible NO synthases modulate endothelial cell thrombogenicity.

Amino Acid Oxidoreductases↗
PubMed1993

Role of endogenous nitric oxide in septic shock.

Nitric oxide synthesized by a constitutive enzyme is a widespread mediator of cell-cell and intracellular communication. This mediator provides a continuous vasodilator influence in the cardiovascular system, modifies the function of circulating cells, and acts as a neurotransmitter. After exposure to bacterial endotoxin or certain cytokines, expression of a second, inducible nitric oxide synthase occurs in a wide variety of tissues. This enzyme produces large amounts of nitric oxide for long periods and has been implicated in pathophysiologic changes seen in sepsis. In some cells, including macrophages, the nitric oxide synthesized by the inducible enzyme is toxic and appears to be an important mediator in host defense. Studies in animals and in vitro have demonstrated that nitric oxide released from inducible nitric oxide synthase in other tissues may cause profound vasodilation, damage to host cells, and cardiac dysfunction. The hypotension of endotoxin- or cytokine-induced shock can be reversed by inhibitors of nitric oxide synthase and these agents may provide a novel therapeutic approach to the treatment of severe septic shock. Preliminary studies in humans suggest that inhibition of nitric oxide synthase improves BP and stabilizes hemodynamics; effects on mortality rates remain to be determined.

Animals↗
PubMed1992

Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure.

Nitric oxide (NO), synthesised from L-arginine, contributes to the regulation of blood pressure and to host defence. We describe in-vitro and in-vivo evidence that NO synthesis can be inhibited by an endogenous compound, NG,NG-dimethylarginine (asymmetrical dimethylarginine, ADMA). In man, this inhibitor is found in plasma and more than 10 mg is excreted in urine over 24 h. However, in patients with end-stage chronic renal failure, who have little or no urine output, elimination is blocked and circulating concentrations of the inhibitor rise sufficiently to inhibit NO synthesis. Accumulation of endogenous ADMA, leading to impaired NO synthesis, might contribute to the hypertension and immune dysfunction associated with chronic renal failure.

Adult↗
PubMed1992

The effect of endothelium-derived nitric oxide on ex vivo whole blood platelet aggregation in man.

The effects of changes in endogenous endothelium-derived nitric oxide (NO) on forearm blood flow and ex vivo platelet aggregation have been studied in 7 healthy volunteers. Measurements were made of forearm blood flow and ex vivo collagen-stimulated platelet aggregation during unilateral brachial artery infusions of saline, acetylcholine (ACh), NG monomethyl-L-arginine (L-NMMA), and prostacyclin (PGI2). The uninfused arm acted as a control. Forearm blood flow was increased by ACh, an agent which stimulates NO release, and decreased by L-NMMA, an agent which stereospecifically inhibits NO synthesis. Collagen-stimulated platelet aggregation measured ex vivo in whole blood draining the infused arm was unaltered by either ACh or L-NMMA. Conversely, PGI2, an agent which acts independently of NO, caused an increase in forearm blood flow which was accompanied by significant inhibition of platelet aggregation. The results suggest that release of endothelium-derived NO in quantities sufficient to cause substantial changes in blood vessel tone does not lead to changes in platelet aggregation in the blood flowing through the vessels. It is, however, still possible that endothelium-derived NO modulates platelet activity at the level of the endothelium.

Acetylcholine↗
PubMed1992

Effect of acute plasma volume expansion on peripheral arteriolar tone in healthy subjects.

1. Using venous occlusion plethysmography, we have investigated the forearm blood flow response in healthy subjects to the acute plasma volume expansion caused by a rapid intravenous infusion of saline. The contribution made to this response by nitric oxide has been investigated using local intra-arterial infusions of the nitric oxide synthase inhibitor NG-monomethyl-L-arginine. 2. The infusion of 1000 ml of saline over 25 min caused plasma volume to increase by about 7%, and resulted in a rise in forearm blood flow, with no change in arterial blood pressure. The onset of the blood flow response occurred within 10 min and blood flow remained elevated above baseline 20 min after the end of the saline infusion. 3. Local intra-arterial infusion of NG-monomethyl-L-arginine alone caused a reduction in forearm blood flow which was maximal at the end of the infusion and gradually recovered to baseline levels over 40 min. 4. When local intra-arterial infusion of NG-monomethyl-L-arginine was followed by plasma volume expansion, the calculated effect of NG-monomethyl-L-arginine was such as to abolish the vasodilator response to saline. 5. The effect of local intra-arterial infusion of NG-monomethyl-L-arginine on forearm blood flow was greater when the drug was given after volume expansion had occurred, than when it was given before the administration of saline. However, in control experiments the vasoconstrictor response to noradrenaline was also enhanced after the administration of the volume load in comparison with the response to noradrenaline given alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Arginine↗
PubMed1992

The vascular endothelium in diabetes and hypertension.

PURPOSE: To review recent research into the function of endothelial cells in relation to diabetes and hypertension, and the implications for cardiovascular control. ENDOTHELIAL FUNCTIONS: Endothelial cells extract and inactive circulating hormones, convert inactive precursors into vasoactive products, and synthesize and secrete vasodilator and vasoconstrictor mediators, which also modify platelet function and cell growth. DIABETES: Abnormalities in endothelial cell morphology and function are recognized features of diabetes. Diminished endothelium-dependent relaxation and enhanced endothelium-dependent contraction have been described. HYPERTENSION: Similar defects in endothelial cell function have been demonstrated in animal and human hypertension. These might lead to increased vascular tone, vasospasm, platelet activation and atheroma. THERAPY: Certain drugs modify or mimic endothelium-derived mediators. Endothelial dysfunction may contribute to cardiovascular pathology, but the precise clinical and therapeutic significance of modifying endothelial function remains to be determined.

Blood Platelets↗
PubMed1992

Endogenous dimethylarginine as an inhibitor of nitric oxide synthesis.

Nitric oxide (NO) is a widespread biological mediator with myriad functions. We have demonstrated that methylated arginines capable of inhibiting NO synthesis circulate in the plasma of healthy volunteers and are excreted unchanged in the urine. Up to 10 mg of asymmetric dimethylarginine is excreted in the urine every day, and this compound inhibits NO synthesis in vitro and in vivo, in animals and in humans. This finding raises the possibility that these compounds may act as endogenous regulators of the L-arginine:NO pathway in health and disease.

Amino Acid Oxidoreductases↗
PubMed1992

The role of induction of nitric oxide synthesis in the altered responses of jugular veins from endotoxaemic rabbits.

1. Endotoxaemia is characterized by hypotension, peripheral vasodilatation and a reduced response to vasoconstrictors. Clinical studies have indicated that venodilatation contributes to the haemodynamic changes, although there is no direct evidence for abnormal venous reactivity. In the present study, the role of nitric oxide (NO) in modifying the responses of rabbit isolated jugular veins was examined in vitro, 4 h after intravenous injection of endotoxin. 2. Treatment with endotoxin reduced the contractile response to the thromboxane-mimetic, 9,11-dideoxy-11 alpha, 9 alpha-epoxymethano-prostaglandin F2 alpha (U-46619). This affect was endothelium-independent. The response was partially restored by the NO synthase inhibitor. NG-monomethyl-L-arginine (L-NMMA 300 microM). 3. Jugular veins from control animals did not contract to L-NMMA whereas those from endotoxin-treated animals showed concentration-dependent contractions to L-NMMA. The contractions produced by L-NMMA were reversed by L-arginine but not by D-arginine. Treatment of the animals with dexamethasone (4 mg kg-1) 1 h prior to administration of endotoxin significantly attenuated the response to L-NMMA. 4. The response to sodium nitroprusside did not differ significantly between veins from control and endotoxin-treated animals. Endothelial denudation did not alter the sensitivity of the veins to sodium nitroprusside. Acetylcholine produced endothelium-dependent relaxations which were similar in veins from control and endotoxin-treated animals. 5. The results of this study demonstrate that intravenous administration of endotoxin induces hyporesponsiveness to U-46619 in jugular veins. This effect is mediated, at least in part, by the induction of NO synthesis in smooth muscle. The induction is prevented by prior treatment with dexamethasone.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed1992

Inhibition and stimulation of nitric oxide synthesis in the human forearm arterial bed of patients with insulin-dependent diabetes.

Patients with insulin-dependent diabetes mellitus have an increased mortality and morbidity due to vascular complications. Nitric oxide from the vascular endothelium contributes to the control of normal vascular tone, and endothelial dysfunction has been implicated in the pathogenesis of diabetic vascular disease. In this study we have examined basal and stimulated nitric oxide-mediated vasodilatation in insulin-dependent diabetics and age- and sex-matched healthy controls. Drugs were infused locally into the brachial artery and forearm blood flow measured using venous occlusion plethysmography. Noradrenaline and NG-monomethyl-L-arginine produced similar reductions in resting forearm blood flow in healthy controls. However, in the diabetics, NG-monomethyl-L-arginine was significantly less effective than noradrenaline. Comparing between groups, the response to NG-monomethyl-L-arginine was also significantly less in the diabetics compared with the healthy controls. The response to sodium nitroprusside was significantly less in the diabetics compared with the healthy controls, whereas the responses to both acetylcholine and verapamil were the same in the two groups. The results provide evidence for an abnormality of basal nitric oxide-mediated dilatation in the forearm arterial bed of patients with insulin-dependent diabetes mellitus, and suggest that the vascular smooth muscle is less sensitive to nitric oxide.

Acetylcholine↗
PubMed1992

Effect of local intra-arterial NG-monomethyl-L-arginine in patients with hypertension: the nitric oxide dilator mechanism appears abnormal.

OBJECTIVE: There is indirect evidence that the nitric oxide system may be impaired in hypertensive patients. The objective of this study was to examine basal nitric oxide-mediated dilation in hypertensive patients. DESIGN: The forearm blood flow (FBF) response to noradrenaline and NG-monomethyl-L-arginine (L-NMMA), a stereospecific inhibitor of nitric oxide synthesis, was compared in seven untreated hypertensive patients and 17 normotensive controls. METHODS: Drugs were infused locally into the brachial artery and FBF measured using venous occlusion plethysmography. RESULTS: In normotensives noradrenaline (60, 120 and 240 pmol/min) and L-NMMA (1,2 and 4 mumol/min) produced similar reductions in resting FBF. In the hypertensives L-NMMA was significantly less effective than noradrenaline, such that the threshold dose for L-NMMA vasoconstriction was increased and the overall response to L-NMMA reduced. Furthermore, when noradrenaline was used as an internal control there was a significant negative relationship between the response to L-NMMA and blood pressure. When the responses to L-NMMA and noradrenaline were compared between groups, the response to L-NMMA was significantly less in hypertensives compared with normotensives, whereas there was no statistical difference in the response to noradrenaline between the two groups. CONCLUSIONS: The results suggest an abnormality of basal nitric oxide-mediated dilation in the forearm arteriolar bed of patients with untreated essential hypertension.

Adult↗