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Biomedical subjects

T Mengden

Publications and source records attributed to T Mengden.

At least 19 recordsLinked to original sources
PubMed2003

[Lowering of blood pressure, blood pressure amplitude and heart rate by treatment with valsartan or valsartan/hydrochlorothiazide. Results of an open observation study of 11,447 hypertensives].

OBJECTIVE: This trial investigated the decrease of blood pressure, safety and tolerability of valsartan, an angiotensin-receptor blocker, alone or combined with the diuretic hydrochlorothiazide. In addition, the effect on pulse pressure, heart rate and mean blood pressure were recorded as independent markers of cardiovascular risk. PATIENTS AND METHODS: 12278 hypertensive patients were treated for 12 weeks with valsartan alone or combined with hydrochlorothiazide in a multi-centre open trial. Previously established antihypertensive treatment was continued. Systolic and diastolic pressure, pulse pressure and resting heart rate were recorded at the start of the trial and at 1, 4 and 12 weeks thereafter. RESULTS: Data on 11447 were complete enough to be evaluated (54% males, 46% females; mean age 60.8 years). 44% of the patients were at the same time receiving other antihypertensive drugs at the start of the trial, but the numbers so treated decreased during the trial period. Systolic pressure was reduced by 27.8 mmHg. diastolic pressure by 14.7 mmHg, with a calculated reduction of pulse pressure from 71.5 to 58.7 mmHg. Heart rate was reduced by 3.4 beats. The treatment had to be stopped prematurely in 2.3% of patients because of side effects. There were no severe or life-threatening side effects. CONCLUSION: Treatment with valsartan alone or combined with hydrochlorothiazide provides effective blood pressure reduction and is well tolerated. This trial suggests that, in addition to the fall in blood pressure, the independent risk factors of cardiovascular disease, pulse pressure and resting heart rate, were also reduced during administration of valsartan.

Angiotensin Receptor Antagonists↗
PubMed2000

[Your patient self-monitors his blood pressure. Other limit values are applicable].

For self-measurement of blood pressure, two points are of great importance: proper patient instruction, and the accuracy of the measuring device. The trend towards the use of wrist-worn devices is associated with increasing numbers of measuring errors. The reason for this is usually incorrect positioning of the pickup point. Since statistics show that measurements made by the patient are clearly lower than those made in the doctor's office, the First International Consensus Conference on Blood Pressure Measurement held in 1999 established the threshold for differentiating between normo- and hypertension to be 135/85 mmHg. Thus, the use of the WHO definition of normotension in the doctor's office (< 140/90) thus represents a methodological error. Indications for self-measurement are, in particular, long-term monitoring of hypertension, monitoring of blood pressure during dose titration, identification of a "white-coat hypertension", and as a means of improving compliance. For diagnostic purposes, a measurement rate of at least 12 per week is mandatory.

Blood Pressure Monitoring, Ambulatory↗
PubMed2000

[Silent myocardial ischemia in hypertensive patients].

Silent myocardial ischemia occurs in hypertensive individuals with a prevalence of approximately 35%. ST-alterations are triggered by a) hypertensive peaks and b) heart rate increase. Like in patients with coronary heart disease most ischemic events occur without angina. They are clinically silent. In daily practice silent myocardial ischemia may be detected by ECG under physical load or with 24 h Holter ECG-monitoring. The latter can detect ischemic events missed by ECG-monitored exercise tolerance. In hypertensive patients the simultaneous, ST-triggered recording of ECG and blood pressure data is more meaningful. Patients with silent ischemia are at higher risk than individuals without. Angor is not as strong a determinant of risk as silent ischemia. Hypertensive patients without coronary artery disease (CAD) who have silent ischemia may even have a worse prognosis than those with known CAD. It is therefore important to substantiate the objective extent of silent ischemia by ST-analysis. If detected it has to be included into therapeutic considerations with the goal to prevent such episodes by antihypertensive treatment.

Adult↗
PubMed2000

Normal values of blood pressure self-measurement in view of the 1999 World Health Organization-International Society of Hypertension guidelines.

New guidelines for the management of hypertension have been published in 1999 by the World Health Organization (WHO) and the International Society of Hypertension (ISH). The WHO/ISH Committee has adopted in principle the definition and classification of hypertension provided by the JNC VI (1997). The new classification defines a blood pressure of 120/80 mm Hg as optimal and of 130/85 mm Hg as the limit between normal and high-normal blood pressure. It is unclear which self-measured home blood pressure values correspond to these office blood pressure limits. In this study we reevaluated data from our Dübendorf study to determine self-measured blood pressure values corresponding to optimal and normal office blood pressure using the percentiles of the (office and home) blood pressure distributions of 503 individuals (age, 20 to 90 years; mean age, 46.5 years; 265 men, 238 women). Self-measured blood pressure values corresponding to office values of 130/85 mm Hg and 120/80 mm Hg were 124.1/79.9 mm Hg and 114.3/75.1 mm Hg. Thus, we propose 125/80 mm Hg as a home blood pressure corresponding to an office blood pressure of 130/85 mm Hg (WHO 1999: normal) and 115/75 mm Hg corresponding to 120/80 mm Hg (optimal).

Adult↗
PubMed2000

User procedure for self-measurement of blood pressure. First International Consensus Conference on Self Blood Pressure Measurement.

OBJECTIVE: To review the medical literature regarding the methodology of self-measurement of blood pressure and to provide some practical recommendations regarding protocol and procedure for measurement, documentation and analysis of data, choice and provision of devices and education of patients and physicians. PROCEDURE AND PROTOCOL FOR MEASUREMENTS: Technical recommendations regarding measurement of blood pressure do not differ from usual guidelines. Frequency of measurement remains a matter of discussion. At the beginning of the self-measurements of blood pressure and during the titration phase, there should be a 7-day measurement period with two measurement of blood pressure each morning and two measurements in the evening at pre-stipulated times. For long-term observation, a minimum measurement period of 1 week per quarter is required. The minimum number of measurements performed during each period should be a total of 12 readings recorded within seven working days. Depending on individual needs (e.g. poor compliance) or for pharmacologic studies, a higher frequency of readings could be used. DOCUMENTATION AND ANALYSIS OF DATA: Owing to the lack of reliability of patients' diaries, the use of printer-equipped or memory-equipped devices is advocated. All the recorded data, except those obtained on the first day, must be used for analysis. CHOICE AND PROVISION OF DEVICES: Self-measurement of blood pressure should be performed with validated fully automated devices using a brachial cuff. The preference should be given to apparatus offering the possibility of storing and transmitting measurements. Wrist apparatus should be used with caution due to the risk of measurement errors if it is used inappropriately. A manual device should be considered for patients suffering from irregular cardiac rhythms and patients with large or small arm circumferences, since automated devices have not been validated for use in these situations. Reimbursement of hypertensive patients using validated devices should be considered, so long as they are adequately trained and supervised. EDUCATION OF PATIENTS: In a therapeutic perspective, self-measurement of blood pressure should be performed by trained patients under the supervision of their practitioner. Teaching must be performed by skilled staff in hypertension centers and ultimately in general practice. Self-measurement of blood pressure is to be recommended for any hypertensive patient who is sufficiently motivated to participate in the treatment of his own hypertension. Patients with physical problems or mental disabilities that make them unable to perform or to understand the measuring technique represent the limits of the method. Education of patients must encompass information about hypertension and cardiovascular risk, blood-pressure-measurement procedures, advice on items of equipment and their proper use, protocols, and interpretation of data. A patient's proficiency must be checked before he or she should be considered competent at performing the procedure. Annual reevaluation is required.

Blood Pressure Determination↗
PubMed1999

Cholesterol enhances contractile responses in isolated small mesenteric arteries of normotensive and spontaneously hypertensive rats.

OBJECTIVE: In order to examine possible mechanisms by which hypercholesterolemia may contribute to the development of cardiovascular disease, we investigated the effect of cholesterol enrichment on contractility in isolated small rat mesenteric arteries. DESIGN: Contractile responses of cholesterol-enriched isolated small mesenteric arteries of normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR) were compared with control groups. METHODS: First- to second-order mesenteric arteries (327-349 microm internal lumen diameter) were dissected from the mesenteric bed of 10-20-week-old male WKY rats and SHR, and incubated in cholesterol-free and cholesterol-rich (150 microg/ml) medium. Isolated arteries were mounted on a Mulvany-Halpern myograph for measurement of isometric tension. RESULTS: Cholesterol significantly increased active wall tension and active wall pressure in WKY rat arteries and active wall tension in SHR arteries in response to potassium chloride, norepinephrine and serotonin (P < 0.05). In addition, contractile responses to all agonists were significantly higher in cholesterol-enriched SHR arteries compared with cholesterol-enriched WKY rat vessels (P < 0.05). CONCLUSIONS: These findings suggest that elevated cholesterol content enhances agonist-stimulated contractility in small mesenteric resistance arteries, providing a possible mechanism by which hypercholesterolemia may contribute to the development of hypertension.

Animals↗
PubMed1998

What is the value of home (self) blood pressure monitoring in patients with hypertensive heart disease?

The acceptable maximal blood pressure values for patients monitoring their own blood pressure at home have not yet been determined. Risk of cardiovascular disease may be increased at lower blood pressure limits than those suggested by the World Health Organization (WHO) for clinic readings. We have investigated 25 patients with proven hypertensive small-vessel disease and compared self-monitored, ambulatory 24-h (ABPM) and clinic blood pressure measurements. The diagnosis of hypertensive small-vessel disease was based on clinical evidence of myocardial ischemia, angiographic exclusion of coronary heart disease, and abnormal single-photon emission computed tomography (SPECT) thallium-201 myocardial scintigraphy. Mean self-monitored values were 143.4 +/- 13.6/84.0 +/- 9.4 mm Hg (95% confidence intervals 137.6-149.0 mm Hg for systolic and 80.1-87.9 mm Hg for diastolic blood pressure). Both home and ambulatory daytime readings (141.2 +/- 11.8/83.9 +/- 10.2 mm Hg) were significantly lower than the clinic readings by the physicians (clinic systolic, 169.2 +/- 16.5 mg; clinic diastolic, 95.0 +/- 11.6 mm Hg; P < .0001 v home and ambulatory readings). There was no significant difference between home and ambulatory readings. Agreement between home and ambulatory values was much closer than for clinic v ABPM readings. The respective correlation coefficients for systolic values were r = 0.702 (home v ABPM; P < .0001) and r = 0.32 (clinic v ABPM; NS). For diastolic values correlation coefficients were r = 0.674 (home v ABPM; P < .0002) and r = 0.574 (clinic v ABPM; P < .003) respectively. In conclusion, the reported results suggest that the WHO suggested definition of hypertension (> or = 140/90 mm Hg) may be set too high when blood pressures are measured by the patient at home. A cutoff value of < 135/85 mm Hg, as in ABPM, may be a more realistic upper limit for self-monitoring.

Aged↗
PubMed1998

Reliability of reporting self-measured blood pressure values by hypertensive patients.

For self-measurement of blood pressure to be useful, patient reporting of test results must be reliable and accurate. Until now no study directly measured the accuracy and reliability of patients' reporting of self-measured blood pressure values. Thirty hypertensive patients (69 +/- 11 years) were instructed to measure blood pressure at home over 14 days with the highly accurate Omron IC monitor and to keep a record of all readings in a patient logbook. To assess the reliability of the records, patients were not informed about the memory capacity of the device. We compared automatically stored blood pressure readings with the respective logbook entries to analyze deletion (under-reporting), addition (over-reporting), and precision of reporting of test results. The prevalent pattern was under-reporting, averaging 36% +/- 24% (3% to 89%), which occurred significantly more than over-reporting (9% +/- 11%; 0% to 38%). The precision of reporting (identical values at corresponding times) was 76% +/- 34% (0% to 100%). This observer error did not affect group comparisons of automatically stored values and logbook entries, although the estimated limits of agreement were wide. Blood pressure control, duration of hypertension, age, or previous use of self-measurement and patterns of logbook entries were not found to be predictive of the patients' reliability. Our results demonstrate a substantial observer error in the reporting of self-measured blood pressure values. This bias may be reduced by memory-equipped blood pressure devices.

Blood Pressure Determination↗
PubMed1998

Changes in antihypertensive therapy--the role of adverse effects and compliance.

In a German multicentre study (1603 patients, 320 private practices), adverse effects and patient compliance during antihypertensive therapy were investigated using standardized questionnaires for both patient and physician. Patients with a change in antihypertensive therapy during the last six months were included in this study. The single most important reason for the change in therapy was inadequate blood pressure control (48.4%), followed by adverse effects (30.1%), patient dissatisfaction (20.0%), non-compliance (16.8%) and cost (4.9%). The most frequent adverse effects noted by the doctors were cough (51.9%), oedema (36.9%), flush (36.6) and dizziness (27.8%). In comparing the answers of the physicians and patients, it becomes obvious that compliance may be overestimated by the doctors (good: 41.7%; medium: 57.3%; bad: 1.0%), since only 32.3% of the patients stated that they never missed a dose, 54.8% were occasionally non-compliant and 12.9% admitted missing a dose frequently. The predominant reasons for non-compliance (assessed by the patients) were forgetfulness (40.4%), followed by adverse effects (9.6%) and irregular lifestyle (6.5%). Thus, lack of effectiveness and adverse effects/patient dissatisfaction/non-compliance contributed roughly equally to the decision to change therapy. In addition, forgetfulness was shown to be an important contributor to suboptimal compliance. Lastly, physicians may still underestimate the extent of non-compliance.

Adult↗
PubMed1994

Primary aldosteronism: difference in clinical presentation and long-term follow-up between adenoma and bilateral hyperplasia of the adrenal glands.

Since 1974 primary aldosteronism has been diagnosed in 71 patients in our outpatient clinic. Thirty-four patients had a unilateral aldosterone-producing adenoma, whereas bilateral adrenal hyperplasia was diagnosed in 37 patients. Although at the time of diagnosis the mean potassium values were lower and mean aldosterone levels were higher in patients with an adenoma, as compared to those with bilateral hyperplasia, these laboratory data did not allow us to differentiate between the two leading causes of primary aldosteronism in the individual patient due to pronounced overlap of laboratory values between the two groups. During the first few years, a successful differential diagnosis was made by adrenal phlebography and separate sampling of plasma aldosterone in both adrenal veins; later non-invasive imaging techniques such as computed tomography and radionuclide scanning were used. The best results were obtained in patients with adenoma who underwent adrenalectomy. Fifty-six percent of these patients were clinically and biochemically cured; 28% were improved and had normal blood pressure values during drug treatment. In contrast, patients with bilateral hyperplasia were treated pharmacologically, but only in half of the patients could normal blood pressure values be achieved. Two thirds of the male patients developed gynecomastia during spironolactone treatment. As expected, unilateral adrenalectomy was unsuccessful in the 7 patients with bilateral hyperplasia who underwent surgery. Our results confirm that surgical treatment of adrenal adenomas and drug treatment of bilateral hyperplasias are the appropriate therapy in primary aldosteronism. A differential diagnosis cannot be made on the basis of clinical and non-invasive laboratory data alone; imaging techniques have to be included in the diagnostic process.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1994

Ambulatory 24-hour blood pressure versus self-measured blood pressure in pharmacologic trials.

In recent years, indirect ambulatory 24-h blood pressure monitoring and self-measurement at home have gained increasing importance in pharmacologic studies. Both methods have important advantages over conventional casual blood pressure determinations in the clinic. The better reproducibility of blood pressure recordings by either ambulatory monitoring or home readings suggests that both techniques are superior to office readings for evaluating the effect of antihypertensive therapy. The multiple readings obtained during ambulatory 24-h monitoring or by self-measurement at home reduce the variability of blood pressure estimates and substantially decrease the number of patients needed to detect clinically relevant blood pressure differences. Furthermore, dose-response relationships of new and established antihypertensive drugs are improved, as the random effect of blood pressure measurements falls below the expected treatment effect. Although there is some overlap between the information obtained with home and ambulatory monitoring, there are also important differences. Ambulatory monitoring provides information about the diurnal profile of blood pressure and has great advantages for trials investigating the time course of a particular drug. Self-measurement can provide repeated measurements in the same situation over prolonged periods of time, and therefore is ideally suited for monitoring changes in blood pressure induced by treatment or progression of the disease. In pharmacologic studies both techniques are thus complementary.

Adrenergic beta-Antagonists↗
PubMed1993

[Are home blood pressure measurements and 24-hour ambulatory recordings superior to office measurements? Comparison of 3 blood pressure recording methods in a study of cilazapril versus atenolol].

Self-assessment of blood pressure and ambulatory blood pressure monitoring (ABPM) are being more widely used in the diagnosis and therapy of hypertension, in addition to office blood pressure measurement. The present multicenter double-blind study compared cilazapril 2.5 to 5 mg (n = 26) to atenolol 50 to 100 mg (n = 27) over a period course of eight weeks. Office blood pressures in the morning before medication, ABPM over 24 h and self assessment of the blood pressure in the morning and evening were taken. The aim of the study was to find out if the results of ABPM and self assessment of blood pressure are similar when compared to office blood pressure measurement. After four weeks of therapy both cilazapril and atenolol achieved a significant and comparable reduction of blood pressure, which did not change significantly afterwards. Both medications showed a comparable blood pressure control over 24 h. with a once-a-day regimen. The comparison of the three techniques of blood pressure measurement demonstrates that ABPM results in significantly lower average daily values than office blood pressure measurement and that the self-assessed blood pressure values in most cases lie in-between. Although the diastolic ambulatory daily values were on the average 9 mmHg lower than the corresponding office values, it was not possible for an individual patient to accurately predict the ambulatory value obtained by to his office blood pressure value. Similar results were found for the values according to self assessment of blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗