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Biomedical subjects

W Tenschert

Publications and source records attributed to W Tenschert.

At least 55 records · Page 3Linked to original sources
PubMed1986

Efficacy of low dose captopril once daily in diuretic resistant hypertension.

In 12 essential hypertensive patients insufficiently controlled by treatment with 50 mg hydrochlorothiazide, the blood pressure lowering effect of the addition of 25 mg captopril once daily was examined. Twenty four hour ambulatory blood pressure monitoring was performed using portable automatic recording devices before treatment, after 4 weeks of treatment with hydrochlorothiazide alone, and again after 4 weeks of combined treatment with captopril. The combined treatment yielded a marked additional blood pressure reduction in comparison with the previous medication of the diuretic alone. The additional antihypertensive effect of captopril lasted 24 hours. During the daytime between 08.00 h and 20.00 h the mean blood pressure was 158 +/- 13/100 +/- 8 mmHg before treatment. After treatment with hydrochlorothiazide alone it was 151 +/- 11/93 +/- 8 mmHg and after hydrochlorothiazide and captopril it was 140 +/- 13/88 +/- 9 mmHg. Our results indicate that the addition of only 25 mg captopril once a day to a diuretic may result in a marked additional blood pressure reduction or normalization in cases of insufficient control by the diuretic alone.

Adult↗
PubMed1985

[Diuretic-resistant hypertension. Effect of an additional daily single dose of a ACE inhibitor].

The effect of additional administration of a low dose of an ACE inhibitor when blood pressure is inadequately controlled by a diuretic alone was investigated in 12 essential hypertensive patients. 24 h blood pressure monitorings were performed with portable automatic recording devices before and after treatment with 50 mg hydrochlorothiazide (HCT) and after additional administration of 25 mg captopril. The frequency of blood pressure readings exceeding 160/95 mm Hg within 24 hours was reduced in 11 of the 12 patients after administration of the ACE inhibitor. Mean blood pressure during daytime was 158 +/- 13 / 100 +/- 8 mm Hg without treatment, 151 +/- 11 / 93 +/- 8 mm Hg during HCT alone and 140 +/- 13 / 88 +/- 9 mm Hg during HCT + captopril. The results show that in a large proportion of hypertensives inadequately controlled by a diuretic alone, the addition of a low dose of an ACE inhibitor (captopril, 25 mg once daily) may normalize the blood pressure.

Adult↗
PubMed1985

Treatment of resistant hypertension by phlebotomy.

In 15 essential hypertensives resistant against a standard triple combination of antihypertensive drugs phlebotomy was performed. Mean arterial pressure was lowered from 140.1 +/- 12.2 mm Hg to 123.8 +/- 14.9 mm Hg after 14 days. No serious side effects were observed. The duration of the hypotensive effect of phlebotomy was about 4 weeks. Phlebotomy can be used in addition to drug treatment in resistant essential hypertension.

Adult↗
PubMed1985

Secondary hypertension and neurofibromatosis: bilateral renal artery stenosis and coarctation of the abdominal aorta.

A 34-year-old white man with generalized neurofibromatosis was found to have severe renal vascular hypertension due to a coarctation of the abdominal aorta and bilateral renal artery stenosis with saccular aneurysms. Increased renal venous renin activity showed the active involvement of the renin-angiotensin system in maintaining the hypertension. Because the patient refused surgical treatment, antihypertensive treatment with Captopril, a specific inhibitor of the angiotensin converting enzyme was used, resulting in normal blood pressure being restored over an 18 month observation period.

Adult↗
PubMed1985

Primary aldosteronism: diagnosis and noninvasive lateralization procedures.

In 72 patients with primary aldosteronism who were classified on the basis of adrenal pathology after adrenalectomy, analysis of routine clinical and laboratory data, of supine and upright plasma aldosterone, and of plasma renin activity were of limited value in differentiating patients with aldosterone-producing adenoma(s) (APA, n = 59) from those with idiopathic adrenal hyperplasia (IAH, n = 13). Normokalemic aldosteronism occurred in 6 patients (3 APA, 3 IAH). A correct classification of the adrenal lesion(s) was obtained in 80% of the patients by computed tomography and only in 69% by adrenal scintiscan. In addition, adrenal scintiscan was hampered by a relatively high rate of incorrect results independent of whether dexamethasone was used or not. Small adenomas (less than 1 cm) and more often adrenal hyperplasia may escape visualization by computed tomography.

Adenoma↗
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↗
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

Primary aldosteronism due to adrenal carcinomas.

In the present study two patients with aldosterone-producing adrenal carcinomas are reported. The clinical features were characterized by hypertension and severe hypokalemia with muscular weakness, flaccid paralysis of arms and legs, diarrhea and polyuria. In both cases excessively high plasma aldosterone levels and suppressed plasma renin activity were found. In contrast to most other cases with aldosterone-secreting tumours plasma cortisol, urinary free cortisol excretion, 17-hydroxy- and 17-ketosteroids were in the normal range. There was no clinical evidence of oversecretion of sex hormones. After adrenalectomy blood pressure and serum potassium normalized and the clinical symptoms disappeared. Plasma aldosterone and urinary aldosterone secretion returned to normal, while plasma renin activity remained low. Three and a half and 6 months later primary aldosteronism and the associated clinical symptoms reappeared due to hormonally active metastases. After introducing the antitumour drug o,p'-DDD in patient 1 aldosterone secretion normalized and the clinical status of the patient markedly improved. However, 10 months after diagnosis the patient died due to a haemorrhage from a liver metastasis. In patient 2 tumour-invaded regional lymph nodes were surgically removed with only minor changes in the hormone pattern.

Adrenal Cortex Neoplasms↗
PubMed1984

[Rare forms of hypertension (neurofibromatosis and cholesterol embolization].

In the past year 5 patients with uncommon secondary hypertension have been observed at the Medical Clinic, Cantonal Hospital of St Gall, Switzerland. Two patients had generalized neurofibromatosis with specific vascular lesions of the renal arteries, while 3 older patients showed clinical and morphologic signs of repeated renal cholesterol embolization. Experience with these 5 patients shows that angiography should chiefly be used in young patients with suspected secondary hypertension. Older patients with common vascular sclerosis should undergo angiography only where the indication is urgent, in view of the risk of renal cholesterol embolization. In 3 of 5 patients a lasting improvement in hypertension was achieved by antihypertensive drug therapy. Two older patients with cholesterol embolization died from complications such as uremia and therapy-resistant hypertension.

Adult↗
PubMed1984

Angiotensin II binding to human mononuclear cells: receptor or free fluid endocytosis?

It has recently been claimed that there are angiotensin II (ANG II) receptors on human mononuclear cells and on platelets and this has been used for investigating the regulation of the renin-angiotensin system in hypertension. We here show the following. Binding kinetics of 125I-labelled ANG II and [3H]ANG II to mononuclear cells were slow (maximum at 90 min) and the same as for [3H]-inulin. As with [3H]inulin there was no binding at 4 degrees C. Release from the cells was slow and incomplete (about 30% after 15 min, 60% after 60 min). Binding was not saturable over a range from 10(-12) to 10(-6) mol of ANG II/l, about 8% of offered peptide being bound at all concentrations. Various inhibitors of free fluid endocytosis exhibited the same inhibition pattern of ANG II binding to mononuclear cells. Therefore uptake of ANG II into mononuclear cells displayed all the features of free fluid endocytosis. ANG II was degraded by carboxypeptidase A. When this degradation was prevented by D-phenylalanine, no binding occurred. In platelet preparations contaminated by 0.3-5% of mononuclear cells, 125I-labelled ANG II was degraded as well. Free fluid endocytosis of the degradation product strongly depended on the percentage of contaminating mononuclear cells. We conclude that there are no ANG II receptors on human mononuclear cells and that their presence on human platelets is doubtful.

Angiotensin II↗
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↗
PubMed1982

[Blood pressure, renin angiotensin aldosterone system and other cardiovascular risk factors in children of essential hypertensives (author's transl)].

In the present study, blood pressure, the renin angiotensin aldosterone system, and other cardiovascular risk factors, such as glucose, cholesterine, and triglycerides, were investigated in 294 offspring of essential hypertensives (5-34 years) and in 122 children of normotensive parents (5-34 years). Offspring of essential hypertensives showed statistically significant higher systolic and diastolic blood pressure values than those of normotensive parents (p less than 0.003, less than 0.005, respectively). Furthermore, in children of hypertensive parents a statistically significant higher body weight and body mass index than in controls could be observed (p less than 0.006, less than 0.001, respectively). With the exception of statistically significant, lower mean supine plasma aldosterone values (p less than 0.02) in children of hypertensive parents, no major differences between the two groups were seen in stimulated aldosterone, supine and stimulated plasma renin activity, and plasma cortisol. Furthermore, in the present study, 41 hypertensive parents, 65 (normotensive) spouses of hypertensives, and 47 (normotensive) parents of control children were investigated. As expected, hypertensive parents showed statistically significant higher blood pressure values than parents of control children and their spouses (p less than 0.001). Interestingly, hypertensive parents had not only a higher body mass index than control parents but also than their spouses (p less than 0.01 and less than 0.02, respectively). These findings support a genetic disposition as being the underlying cause of higher body weight in hypertensives and make it less probable that a higher food intake in hypertensive families is responsible for this phenomenon. The results of the present study indicate that early body weight control in children of hypertensive parents may be an important contribution to the prevention of hypertension.

Adolescent↗
PubMed1982

Long-term experience with captopril in severe hypertension.

1 The long-term effect of the converting-enzyme inhibitor captopril was investigated in 76 patients with various forms of severe hypertension, most cases being resistant to a standardised triple therapy (100 mg hydrochlorothiazide or 80-500 mg frusemide; 320 mg propranolol; and 200 mg hydralazine). 2 In each of the three groups examined (essential, renovascular, and renal parenchymatous hypertension) captopril led to a prompt and sustained reduction in systolic and diastolic blood pressure. Up to an observation time of 2 1/2 years patients with renovascular hypertension showed a more pronounced fall in mean diastolic blood pressures than those with essential hypertension. About 90% of all patients required a diuretic and a substantial percentage of patients needed propranolol as a third drug. 3 The most frequent side effects were skin manifestations, taste disturbances, dizziness, and non-productive cough. Serious adverse effects were rare and included one case of leucopenia and one of the nephrotic syndrome, both of them reversed after withdrawal of captopril. Further analysis showed that side effects occurred mainly in patients with impaired kidney function receiving relatively high dosages of captopril (greater than 200 mg/day). 4 Our results show that captopril is a very potent blood-pressure-lowering agent in severe hypertension, especially in cases with renovascular hypertension.

Adult↗
PubMed1981

[Compliance in hypertensive patients and patients with cardiac insufficiency].

In the present study the compliance or drug-adherence of 83 patients with hypertension (n = 66), heart failure (n = 14) or edema of non-cardiac origin (n = 3) was investigated by the urine fluorescence method over an observation period of 17.8 +/- 15.1 weeks. Mean compliance rate of all patients was 79.7%. Individual drug-adherence ranged from 0 to 100%. Half of the patients (54.2%; n = 45) had positive urine samples in all investigations performed. A quarter (25.3%; n = 21) were compliant in over 50%, whereas in 14.5% (n = 12) the drug could be detected in the urine in only 10 to 50% of the tests and in 6% (n = 5) in less than 10%. The 17 symptomatic patients (patients with heart failure and/or edemas) showed a slightly better compliance (87.0%) than patients with hypertension, who had positive urine samples in 77.3 +/- 30.1% of tests. However, the difference observed was not statistically significant. During treatment a decrease in compliance from 82% at the first visit to 73% and 75% respectively at the second and third could be observed. Finally, at the fourth and fifth consultation only 62.2% and 56% respectively of the patients had positive urine samples. Our results show a good compliance rate in our patients as compared to American studies. During treatment a continuous decrease in compliance could be observed. Our results indicate that the duration of treatment seems to be an important determinant for the patient's drug-adherence. Therefore, it appears necessary to perform compliance-improving strategies as early as after the first follow-up visits.

Adult↗
PubMed1981

[Computerized tomography in adrenal diseases with excessive production of hormones].

In 41 patients with adrenal diseases and hormonal excess (pheochromocytoma n = 9, Cushing's syndrome n = 6, primary aldosteronism n = 26) computer tomography was performed for localization and classification of the adrenal lesion(s). In all patients diagnosis was confirmed by surgery. In all patients with pheochromocytoma a tumor was detected. 8 patients had unilateral adrenal pheochromocytoma, whereas in one female patient the pheochromocytoma was multilocular. 4 of the 6 patients with hypothalamic-pituitary Cushing's syndrome had enlargement of the adrenals. In the 26 patients with primary aldosteronism, computed tomography showed normal adrenal glands in 2 of the 17 patients with unilateral adenoma (with a diameter of 8 mm in both of the 2 patients) and in 6 of the 9 patients with bilateral hyperplasia. In the remaining patients adenoma or hyperplasia was detected. The results document that in patients with pheochromocytoma, with Cushing's syndrome, and in those with primary aldosteronism, computed tomography is a simple and valid method for localization and classification of the adrenal lesion(s). In primary aldosteronism with a normal adrenal computed tomography, however, differentiation between a small unilateral adrenal adenoma and bilateral adrenal hyperplasia remains problematic.

Adrenal Gland Neoplasms↗