Biomedical subjects

T Mengden

Publications and source records attributed to T Mengden.

64 records · Page 4Linked to original sources

PubMed1989

[Self measurement of blood pressure: patient education].

Many patients measure their blood pressure without any instruction due to the availability of modern measuring devices. Although the technique can be mastered by most of the patients, some sources of error have to be eliminated. The aim of such an instruction is to explain these sources of error to the patients and to give them opportunity to practise the self measurement under medical supervision. An instruction sheet is handed out as a pamphlet. The patients are also directed to keep a record of all measurements which is periodically controlled by the physician. It is also advisable to reexamine the measuring technique of the patient from time to time and to check the accuracy of the patients measuring device.

Blood Pressure Determination↗

PubMed1989

[Why are blood pressure values higher in the doctor's office than at home?].

Blood pressure values measured by the patients at home are lower than those measured during medical consultation. To test whether the person measuring the blood pressure is responsible for this difference, the blood pressure of 127 patients was measured first by the doctor and then by the patients themselves during the consultation. There was a good agreement and no significant difference between the two measurements. Values taken at home were however significantly lower. Our results indicate, that difference between clinic and home blood pressure values does not depend on the person performing the measurement.

Blood Pressure↗

PubMed1989

[Diagnostic and prognostic aspects of home blood pressure measurement].

Up to now the diagnosis of hypertension has been based on a few casual blood pressure measurements in the physician's office according to WHO guidelines. Blood pressure measurements at home in the recent years have gained increasing popularity as a supplementary diagnostic tool. The establishment of an everyday blood pressure profile and exclusion of "white coat" hypertension are the main diagnostic indications. In borderline hypertension those patients with elevated home blood pressures can be identified. However world-wide epidemiologic studies are urgently needed to develop definitions of normal and pathological values for self-recorded blood pressure readings. From our experience diastolic home-recorded values higher than 90 mm Hg should be regarded as pathological.

Blood Pressure Determination↗

PubMed1989

[The therapeutic significance of home blood pressure measurement].

Optimization of antihypertensive therapy during the initial dose titration as well as the long term follow-up of chronic therapy constitute the main therapeutic indications of blood pressure measurement at home. Furthermore home blood pressure measurements may be of value in patients with unsatisfactory blood pressure response in whom poor compliance is suspected. Finally patients may adjust their antihypertensive therapy according to the level of self-recorded blood pressure measurements.

Antihypertensive Agents↗

PubMed1989

Vasoconstriction: a novel activity for low density lipoprotein.

Low density lipoprotein plays an important role in the pathogenesis of atherosclerosis. Cumulative addition of 1-30 micrograms/ml of LDL from normolipidemic subjects produced a dose-dependent increase in contractile tension of thoracic aortic rings from rats. The maximal LDL-induced contractile response was approximately 30% of that induced by 1 microM norepinephrine. Similar concentrations of LDL induced a dose-dependent transient increase of the concentration of intracellular free calcium, and a biphasic change of the intracellular pH in cultured rat vascular smooth muscle cells. We conclude that low density lipoprotein occurring for example in the extravascular fluid can mediate vasoconstriction by changes in cytosolic calcium and intracellular pH.

Animals↗

PubMed1989

Effect of low-density lipoprotein on intracellular calcium, intracellular pH and DNA synthesis in cultured vascular smooth muscle cells.

Low-density lipoprotein has proliferative effects on vascular smooth muscle cells and thus may play a role in the pathogenesis of atherosclerosis and hypertension. In order to investigate the underlying mechanisms, we studied the influence of low-density lipoprotein on intracellular free calcium, intracellular pH and the rate of DNA synthesis in cultured vascular smooth muscle cells of the rat aorta. The low-density lipoprotein (1-30 micrograms/ml) caused a dose-dependent increase in intracellular calcium and affected the intracellular pH accordingly. In addition, a marked low-density lipoprotein-induced increase in 3H-thymidine incorporation into DNA was observed. It is concluded that low-density lipoprotein, apart from its classical role as a cholesterol-transporting vehicle, enhances cellular processes leading to cell proliferation.

Animals↗

PubMed1989

Pharmacokinetic and pharmacodynamic properties of ramipril in patients with congestive heart failure (NYHA III-IV).

To investigate the pharmacokinetics and pharmacodynamics of a new angiotensin converting enzyme (ACE) inhibitor, ramipril (HOE 498), in patients with cardiac insufficiency (NYHA III-IV), we performed an open trial with a follow-up of 10 days. Twenty-seven patients (18 females, 9 males), mean aged 62 years (46-83) with severe heart failure, were included. After a single oral dose of 5 mg ramipril, the plasma and urine levels of ramipril, ramiprilat, ACE plasma activity, standard laboratory values, blood pressure and pulse rate were evaluated. The maximal plasma level of ramipril was 57.0 +/- 26.8 ng/ml after 1.4 h; t1/2 was 2.4 +/- 1.2 h. The peak level of ramiprilat was 27.9 +/- 24 ng/ml after 4.6 h; t1/2 for the active compound was 6 +/- 4.2 h. The total recovery of ramipril and metabolites in urine was on average 39 +/- 17.5% within 96 h. Ninety-five percent inhibition of ACE activity was observed in all patients and 80% inhibition lasted 24 h. Systolic and diastolic blood pressure decreased without changes in heart rate. Five patients had mild side effects: hypotension, diarrhea, and dizziness. In conclusion, in patients with severe heart failure, plasma levels of drug and active metabolite were higher and remained measurable longer, with more sustained inhibition of ACE activity than reported in healthy volunteers. This indicates that titration should start with lower doses (1.25-2.5 mg) and that doses above 5 mg may rarely be necessary.

Administration, Oral↗

PubMedDate not supplied

Evidence for structural alterations in resistance arteries of patients with severe congestive heart failure.

Congestive heart failure (CHF) is characterized by an increase in total peripheral resistance. It was the specific aim of this study to investigate whether structural factors participate in the increased peripheral resistance that can be observed in severe heart failure. We determined forearm vascular resistance (FVR) at rest and after 10 min ischemia (Rmin; mm Hg/ml/min/100 ml) using venous occlusion plethysmography. Rmin was studied since it is largely dependent on the structural characteristics of resistance arteries. 24 patients with CHF [71.5 +/- 2.3 years; New York Heart Association (NYHA) functional class I-IV] with no history of arterial hypertension and casual arterial blood pressure < 140/90 mm Hg and 24 normotensive healthy control subjects (52.5 +/- 4.1 years) were included in our study. The patients were subdivided into those with 'mild' (NYHA class I and II; n = 10) and 'severe' (NYHA class III and IV; n = 14) heart failure. There were no significant differences between the two groups for echocardiographically determined ejection fraction and mean arterial blood pressure. Resting FVR averaged 40.5 +/- 4.4 mm Hg/ml/min/100 ml in control subjects and was 43.6 +/- 7.9 (nonsignificant vs. control) and 51.0 +/- 5 mm Hg/ml/min/100 ml (p < 0.05 vs. control) in patients with mild and severe CHF, respectively. No significant correlation between age and Rmin could be demonstrated in either the patient or the control group. Furthermore, Rmin did not differ between patients with mild CHF and control subjects. However, Rmin was significantly elevated in patients with severe CHF (5.7 +/- 0.39 mm Hg/ml/min/100 ml) as compared to patients with mild CHF (4.0 +/- 0.39 mm Hg/ml/min/100 ml; p < 0.05) and controls (4.5 +/- 0.26 mm Hg/ml/min/100 ml; p < 0.05). In conclusion, our study supports the concept that structural alterations contribute to the increased peripheral resistance in patients with heart failure. These changes are correlated with the severity of clinical symptoms.

Adult↗

PubMedDate not supplied

[Rational diagnosis of endocrine forms of hypertension].

Primary aldosteronism, Cushing's syndrome and pheochromocytoma are the most frequent endocrine hypertensive disorders. Following biochemical confirmation of the clinical diagnosis, mainly non-invasive imaging techniques are necessary to determine the cause of the hormone excess. Diagnosis of primary aldosteronism is confirmed by analysis of aldosterone and renin in peripheral venous blood. Differentiation between adenoma and idiopathic adrenal hyperplasia usually is achieved by computed tomography and isotope scan. A reliable test for the biochemical confirmation of Cushing's syndrome is the determination of urine-free cortisol. In patients with equivocal results the dexamethasone suppression test is performed. Differential diagnosis between ACTH-dependent Cushing's syndrome (pituitary or ectopic) and primary adrenal disorders can be made by determination of plasma-ACTH and -cortisol. Non-invasive localization procedures include computed tomography of the abdomen, computed tomography or magnetic resonance imaging of the pituitary gland, sonography and isotope scan. Diagnosis of pheochromocytoma is based on elevated catecholamine levels in urine or plasma. The tumor is localized by ultrasound, computed tomography or isotope scan.

Adrenal Gland Neoplasms↗

PubMedDate not supplied

[Nuclear medicine diagnostic localization in primary aldosteronism and Cushing syndrome].

The main indication for 131J-cholesterol scintigraphy is primary aldosteronism. The preoperative localization of aldosterone - producing adenomas may be obtained with the non-invasive NP-59 - scintigraphy in 75-85% of the patients. Idiopathic bilateral adrenal hyperplasia is diagnosed correctly in 90-100% of the cases. In Cushing's syndrome scintigraphy of the adrenal cortex is indicated only in specific cases such as very small adenomas, primary nodular adrenal hyperplasia and/or for the localization of ectopic adrenal cortex tissue. A false diagnosis may be caused by asymmetric uptake of the radioisotope in idiopathic bilateral hyperplasia or by unspecific absorption in non - adenomatous adrenal cortex tissue with symmetric uptake in patients with unilateral adenomas.

Adenoma↗