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Biomedical subjects

W F Graettinger

Publications and source records attributed to W F Graettinger.

28 records · Page 2Linked to original sources
PubMed1989

Comparison of antihypertensive therapies by noninvasive techniques.

We compared the antihypertensive effects of the beta-blocker atenolol and the converting enzyme inhibitor lisinopril during 12 weeks of treatment in patients with mild to moderate essential hypertension. Atenolol (n = 10) significantly decreased conventionally measured blood pressure from 144/103 to 135/93 mm Hg and lisinopril (n = 9) from 150/104 to 130/92 mm Hg. Based on data derived from automated 24-h ambulatory blood pressure monitoring, atenolol decreased the average whole-day systolic pressure by 18 +/- 6 mm Hg (p less than 0.02) and the diastolic pressure by 11 +/- 2 mm Hg (p less than 0.01). Lisinopril produced decreases of 27 +/- 5 mm Hg (p less than 0.01) and 13 +/- 2 mm Hg (p less than 0.001). Examination of the 24-h blood pressure patterns showed that the efficacies of the two drugs were similar. Each appeared to be effective throughout the whole-day monitoring period, although only lisinopril significantly decreased blood pressure during the final four-h period (4 AM to 8 AM) preceding the next day's dose. Neither drug produced significant echocardiographic changes in left ventricular wall thickness or muscle mass during the short-term treatment. Lisinopril and atenolol effectively decrease blood pressure during a 24-h period. Moreover, we found that automated whole-day blood pressure monitoring is a useful tool for comparing the efficacy and duration of action of differing antihypertensive agents.

Adult↗
PubMed1988

Characterization of antihypertensive therapy by whole-day blood pressure monitoring.

Whole-day ambulatory monitoring is used for diagnosing hypertension and for judging response to treatment. We evaluated both of these properties in an antihypertensive trial with the calcium channel blocker diltiazem hydrochloride. Measured by a conventional sphygmomanometer, systolic and diastolic blood pressures fell significantly in patients who received diltiazem, whereas no consistent changes occurred in those who received placebo. Administration of the drug also decreased systolic and diastolic blood pressures evenly throughout the day, as determined by automated monitoring. The 15 diltiazem-treated patients were subdivided into those whose clinically diagnosed hypertension was confirmed by pretreatment blood pressure monitoring (24-hour average diastolic blood pressure, greater than or equal to 90 mm Hg; n = 9) and those whose 24-hour blood pressures failed to meet this criterion (n = 6). Diltiazem therapy decreased average whole-day blood pressures by 18/13 mm Hg in the hypertensives but by only 0/1 mm Hg in the others. Thus, whole-day blood pressure monitoring strengthens antihypertensive trials by documenting efficacy and duration of treatment. In addition, it enhances the diagnosis of hypertension, thereby identifying those patients in whom treatment seems justified.

Adult↗
PubMed1988

Validation of portable noninvasive blood pressure monitoring devices: comparisons with intra-arterial and sphygmomanometer measurements.

We have evaluated the accuracy of measurements provided by different types of portable automatic blood pressure monitoring devices by comparing them with intra-arterial and mercury sphygmomanometer measurements in 25 hospitalized patients. Systolic blood pressure values with portable devices that use auscultatory or oscillometric methods of measurement correlated significantly with intra-arterial values (r = 0.74 and 0.89; p less than 0.001 for both); similarly, diastolic values correlated significantly (r = 0.86 and 0.81; p less than 0.001 for both). Compared with intra-arterial measurements, there was a slight tendency for the portable devices to underestimate systolic blood pressure and overestimate diastolic blood pressure. Correlations between auscultatory or oscillometric measurements and sphygmomanometer measurements in these patients were also significant; moreover, the absolute blood pressure values obtained with the portable devices were almost identical to those with the sphymomanometer. In a further group of 12 volunteers, auscultatory and oscillometric values correlated very closely with simultaneously measured sphygmomanometer values for both systolic (r = 0.99 and 0.98) and diastolic (r = 0.96 and 0.94) blood pressures. An auscultatory device that uses continuous ECG R wave gating for Korotkoff sounds was also found to be highly accurate. Thus we have found that automated portable devices that use either auscultatory or oscillometric methods of measurement provide reliable blood pressure values.

Auscultation↗
PubMed1988

Correlates of cardiac structure and function in normotensive adolescents.

To evaluate body weight as a determinant of cardiac structure and function in adolescents, 47 normotensive 13-year-old subjects were studied with M-mode echo duplex Doppler echocardiography (DE). They were separated by body weight into standard (greater than 55 kg) and lighter (less than 55 kg) groups. No subject had a blood pressure greater than 140/90. The differences between the groups in systolic (SBP) and diastolic (DBP) blood pressures, LV mass, left atrial size (LA), and peak aortic flow velocity (PAoV) were measured. (Formula: see text). Body weight strongly correlated with SBP in the entire study group (r = 0.66, P less than 0.001) but slightly less strongly with DBP (r = 0.48, P less than 0.001). Left ventricular filling indices such as peak early diastolic flow velocity, early diastolic filling integral, peak atrial flow velocity, and atrial filling integral were not significantly different between the groups. No significant differences in blood pressure, LV mass, LA size, or peak aortic flow velocity could be demonstrated when the subjects were subdivided on the basis of gender or presence or absence of family history of hypertension. Body weight appeared to be not only a strong predictor of blood pressure but also of cardiac structural and functional characteristics in adolescents.

Adolescent↗
PubMed1988

Diastolic blood pressure and left ventricular filling.

Many factors appear to influence diastolic left ventricular (LV) filling, including age, hypertension, and myocardial and coronary disease. Doppler-echocardiography was used to asses the influences of blood pressure (BP) on LV filling in 43 normotensive volunteers aged 12 +/- 0.98 years with heart rates less than or equal to 90 beats/min. Doppler peak diastolic transmitral flow velocities, diastolic flow integrals, and early diastolic deceleration were measured. An interesting difference was noted between the influence of systolic and diastolic BP. Systolic BP was related to LV mass (r = 0.43; P less than 0.005), but was unrelated to any of the Doppler filling indices. Diastolic BP was unrelated to LV mass, but was inversely related to peak early diastolic flow velocity (r = -0.37; P less than 0.05), early diastolic flow velocity integral (r = -0.34; P less than 0.05). The ratio of late-to-early filling (A/E) was directly related to diastolic BP (r = 0.42; P less than 0.005). The relationship between A/E and diastolic BP was strong in subjects (n = 21) with bimodal P waves in electrocardiogram (ECG) lead V1 (r = 0.61; P less than 0.005), but absent in those (n = 15) with unimodal P waves (r = 0.18; P = NS). Thus, the pattern of LV filling is related to the level of diastolic BP in normal adolescents, especially in those with bimodal P waves on ECG. These diastolic BP related changes are independent of heart rate and LV hypertrophy and may represent very early pre-hypertensive alterations in LV diastolic function.

Adolescent↗
PubMed1987

Doppler predictions of pulmonary artery pressure, flow, and resistance in adults.

We examined the accuracy of noninvasive predictions of pulmonary artery pressure (P), flow (Q), and resistance (R) by means of main pulmonary artery blood velocities and diameters measured with Doppler echocardiography (DE). The ratio of noninvasive acceleration time to ejection time (An) was correlated to invasively determined mean pulmonary artery pressure (Pl) and resistance (Rl). Noninvasive flows were correlated to thermodilution flows (Ql). Simultaneous invasive and noninvasive measurements were made in nine adult patients (ages = 22 to 73 years). The results were: Pl = 87 - 152An, r = 0.90, SEE = 7 mm Hg, p less than 0.05; Rl = 899 - 1722An, r = 0.79, SEE = 121 dynes X sec X cm-5, p less than 0.05; and Ql = -0.3 + 1.21Qn, r = 0.95, SEE = 0.81 L X min-1, p less than 0.05. We then used these equations prospectively to predict Pl, Rl, and Ql in 21 of 25 (83% technically adequate) consecutive patients. Pl, Rl, and Ql ranged from 10 to 35 mm Hg, 39 to 456 dynes X sec X cm-5, and 3.51 to 8.39 L X min-1, respectively. Results were: Pl = 0.80P + 3, r = 0.72, SEE = 6 mm Hg, p less than 0.05; Rl = 0.75R - 12, r = 0.64, SEE = 77 dynes X sec X cm-5, p less than 0.005; and Ql = 0.87Q + 0.38, r = 0.83, SEE = 0.86 L X min-1, p less than 0.05. These results suggest that DE predictions of pulmonary artery pressure, flow, and resistance correlate significantly with values subsequently obtained at catheterization.

Adult↗
PubMed1987

The adrenergic inhibitors.

Although most of the centrally and peripherally-acting adrenergic inhibitors have been available for several years, they continue to contribute importantly to antihypertensive therapy. There are remarkably few contraindications to their use. They are useful in hypertension of all grades of severity, and are also valuable in complicated forms of hypertension, such as those associated with renal insufficiency, diabetes mellitus, and chronic obstructive lung disease. They can produce some fairly predictable side effects in patients, but generally do not cause significant metabolic changes. These drugs also seem to be tolerated well by physically active patients. They appear to have desirable effects on cardiac structure. In general, the adrenergic inhibitors cause regression of a left ventricular hypertrophy, which may well be a valuable property, especially in older hypertensive patients.

Adrenergic alpha-Antagonists↗
PubMed1987

Diastolic blood pressure as a determinant of Doppler left ventricular filling indexes in normotensive adolescents.

Alterations in left ventricular filling can occur with aging and in patients with hypertension, ischemic heart disease, congestive and hypertrophic cardiomyopathy and congenital heart disease. This study examines the effects of blood pressure on left ventricular diastolic filling indexes measured by Doppler ultrasound technique in 47 young normotensive adolescents (mean age 13 years). Left ventricular filling was assessed by Doppler peak early and late diastolic transmitral flow velocities, early and late diastolic flow velocity integrals and early diastolic deceleration. Systolic blood pressure did not correlate with any of the Doppler filling indexes, although it was related to echocardiographic left ventricular mass (r = 0.44, p less than 0.005). Diastolic blood pressure did not correlate with left ventricular mass; however, it was inversely related to peak early diastolic flow velocity (r = -0.44, p less than 0.005), early diastolic flow velocity integral (r = -0.40, p less than 0.01) and early diastolic deceleration (r = -0.32, p less than 0.05). The ratio of late to early peak filling (A/E) was directly related to diastolic blood pressure (r = 0.48, p less than 0.001). Examination of electrocardiograms showed that there was a stronger correlation between A/E ratio and diastolic blood pressure (r = 0.63) in 22 subjects with bimodal P waves in lead V1 than in subjects with unimodal P waves (r = 0.45).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Painless myocardial infarction with interventricular septal rupture presenting as the acute onset of congestive heart failure.

Two cases of ventricular septal rupture complicating infero-posterior myocardial infarction which are atypical in presentation, clinical course, and outcome are presented and the relevant literature is reviewed. The patients presented late after the acute onset of congestive heart failure, without a history of chest pain, were diagnosed noninvasively, survived with medical therapy for 2 and 4 months, and went on to successful surgical repair.

Aged↗