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PubMed1997

Twenty-one-year survival of primary hypertensive patients allocated to care in general practice or in specialized hypertension clinic. An observational study of 831 hypertensive patients.

After initial diagnostic and therapeutic assessment at a specialized hypertension clinic, 831 patients with primary hypertension were during a 15-year period allocated to continuing care management either by their general practitioner or by the out-patient department of the hypertension clinic. At a given date survival was assessed in the two groups: general practice (n = 437, 233 males, 214 females) and specialized hypertension clinic (n = 394, 208 males, 186 females). Median observation time for both groups was 11 years, the longest observation time was 21 years, 8 months. There were no significant differences between the groups concerning age at entry, pretreatment clinical status, pretreatment blood pressure or treated blood pressure level before allocation. The patients in the two groups had the same access to hospitalization when needed. Judged by a Cox regression model, no difference in survival between the two groups could be registered. No differences were found between the causes of death in the two treatment groups, the main cause of death in both groups being ischaemic heart disease. Our results indicate that after initial diagnostic assessment and adjustment, the management of treatment care in a specialized hypertension clinic offers no advantage concerning survival compared to management of care in general practice.

Cause of Death↗
PubMed1980

Hypertension in general practice. Part III. Treatment of hypertensive heart failure and hypertensive emergencies.

The therapy of hypertension with heart failure is a classic illustration of the value of agents reducing the afterload, being a specialized example of the general principle of the modern treatment of heart failure by vasodilator therapy. Agents such as diuretics and vasodilators are used in the therapy of heart failure in general and also in the therapy of hypertensive heart failure. However, drugs such as digoxin, which primarily and directly increase the inotropic state of the heart, should not be used without careful consideration, because the basic problem is not the defective inotropic state of the myocardium, but the increased afterload. In hypertensive emergencies, the real danger is over-rapid reduction of the blood pressure with cerebral underperfusion and cerebrovascular accidents. Hence, in acute hypertensive heart failure or hypertensive encephalopathy, smooth reduction of blood pressure is essential and oral agents are often effective. In those unusual patients in whom urgent intravenous therapy is required, monitored infusions are used, but never single intravenous injections which can have effects that cannot be controlled.

Acute Kidney Injury↗
PubMed1982

[The Lyons Group for the Campaign against Hypertension. Evaluation of subjects initially hypertensive. By the Lyons Cooperative Group in the Campaign against Hypertension].

A Community Control Program of Hypertension started in Lyon in 1972, as part of a WHO program. It dealt with two occupational, Study and Reference, populations, each amounting to about 12500 subjects. Its goal was to improve the level of treatment of hypertension in the Study population, by stimulating the usual health care system without modifying it (and so were the treatments decided and chosen by the GP's). The level of treatment was the same in both populations in 1972. 59% of the subjects found hypertensive at the 1972 total screening in both populations could be reexamined in 1977. After standardisation for age and sex, the percentages of treated subjects among those still hypertensive in 1977 were 63,0 and 46,1 respectively in the Study and Reference populations (p. less than 0.001). It is concluded that the level of treatment of hypertension in the population can be appreciably improved by a stimulation of the currently available health care system.

Adolescent↗
PubMed1980

[Renin-angiotensin-aldosterone system in essential hypertension. Inappropriately high plasma aldosterone in young patients with severe hypertension and in older hypertensives].

Both in male (n = 353) and in female patients (n = 211) with essential hypertension supine (basal) plasma renin activity showed an age-dependent significant decrease whereas plasma aldosterone remained almost unchanged in women or was even slightly increased with age in men. In younger hypertensives (15-34 years) a significant inverse correlation between plasma renin activity and mean arterial blood pressure could be observed. On the other hand, middle-aged men (35-50 years) showed a positive relationship between renin and blood pressure whereas in females of the same age group no correlation between these two parameters was found. In older patients (greater than 50 years) of both sexes a positive correlation between renin activity and mean arterial blood pressure was obtained. In all age-groups and in both sexes there was either no correlation, or only a weak (positive) one, between plasma aldosterone and mean arterial blood pressure. These findings suggest that in essential hypertension renin secretion is regulated mainly by blood pressure. The observed sex and age-related differences may be due to changes in the renovascular system. The inappropriately high plasma aldosterone concentrations (compared to the relatively low renin levels) in younger hypertensives with severe hypertension, and in the older population, document disturbed aldosterone secretion which probably contributes to the elevated blood pressure in these patients.

Acute Disease↗
PubMed1998

[Long-term survival of patients with hypertension treated in general practice or at a specialized hypertension clinic. A 21-year observation study of 831 patients with hypertension].

This article is based on a study first published in Blood Pressure. After an initial diagnostic and therapeutic assessment at a specialized hypertension clinic, 831 patients with primary hypertension were during a 15-year period allocated to continuing managing care either by their general practitioner or by the hypertension clinic. Survival was assessed in the two groups: general practice (n = 437, 223 males, 214 females) and specialized hypertension clinic (n = 394, 208 males, 186 females). Median observation times for both groups were 11 years. There were no significant differences between the groups concerning age at entry, pretreatment clinical status, pretreatment blood pressure or treated blood pressure level before allocation. Judged by a Cox' regression model, no difference in survival between the two groups could be registered. The leading cause of death in both groups was ischemic heart disease. Our results indicate that after the initial diagnostic assessment and adjustment of treatment, managing care in a specialized hypertension clinic offers no advantage concerning survival compared to managing care in general practice.

Adult↗
PubMed1990

Genetically altered brain amino acid metabolism in spontaneously hypertensive rats: a study by using young spontaneously hypertensive rats and renal hypertensive rats.

Previously we demonstrated altered amino acid levels in brainstem regions of adult spontaneously hypertensive rats (SHR). For comparison, in this study, we determined amino acid concentrations in discrete brainstem regions in young prehypertensive SHR and renal hypertensive rats. In prehypertensive SHR, the content of glutamate was increased in the rostral ventrolateral medulla and the caudal ventrolateral medulla, and the content of beta-alanine was decreased in the nucleus tractus solitarii. In renal hypertensive rats, there was no change in glutamate and beta-alanine contents in all the regions. The profiles of contents of glutamate and beta-alanine in the brainstem regions in young SHR but not in renal hypertensive rats are the same as those found previously in adult SHR. Thus, the results of the present study suggest that the altered amino acid metabolism in the brainstem of SHR may be genetically inherent.

Amino Acids↗
PubMed1994

Effect of dietary calcium on the development of hypertension and hypertensive vascular lesions in DOCA-salt and two-kidney, one clip hypertensive rats.

OBJECTIVE: To examine the effect of modest changes in dietary calcium on systolic blood pressure (SBP) and myocardial and renal vascular lesions in Sprague-Dawley rats. DESIGN: Regular- (0.4%, by weight), high- (0.8%) or low-calcium (0.24%) diets were fed to normotensive control, deoxycorticosterone acetate (DOCA)-salt and two-kidney, one clip (2-K, 1C) hypertensive rats for 8 weeks. METHODS: Tail-cuff SBP and metabolic balance were measured once a week. At the end of the study the kidneys and hearts were collected for histological study. RESULTS: Dietary calcium had no effect on SBP in the DOCA-salt rats, but loading with calcium accelerated the rise in SBP in 2-K,1C rats (P < 0.01, high- versus regular-calcium diet). The high-calcium diet reduced the percentage medial area of intramyocardial arteries in the DOCA-salt and 2-K,1C hypertensive rats. The DOCA-salt rats on the low-calcium diet had a higher renal vascular lesions score than those on the regular- or high-calcium diet (P < 0.05). CONCLUSIONS: A high-calcium diet appears to prevent intramyocardial vascular wall thickening in DOCA-salt and 2-K,1C hypertensive rats, and a low-calcium diet aggravates renal vascular lesions in DOCA-salt hypertensive rats. These effects are not related simply to changes in blood pressure.

Animals↗
PubMed1989

Alpha- and beta-adrenoceptors in hypertension. II. Platelet alpha 2- and lymphocyte beta 2-adrenoceptors in children of parents with essential hypertension. A model for the pathogenesis of the genetically determined hypertension.

To study whether changes in alpha- and beta-adrenoceptors in human essential hypertension (EHT) might be genetically determined, we assessed platelet alpha 2- and lymphocyte beta 2-adrenoceptor density in 48 normotensive children of normotensive parents (NT) and in 41 normotensive children with one EHT-parent. Both groups did not differ in age, body weight and height, blood pressure, heart rate, plasma catecholamine levels, plasma renin activity (PRA), and lymphocyte beta 2-adrenoceptor density. Platelet alpha 2-adrenoceptor density, however, was in EHT-children significantly higher than in NT-children. In NT-children, platelet alpha 2-adrenoceptors were significantly, inversely correlated with PRA, indicating that they might mirror renal alpha 2-adrenoceptors which inhibitorily regulate renin release. In contrast, in EHT-children PRA was not at all related to platelet alpha 2-adrenoceptors, suggesting an early (even in the normotensive stage) disturbance of the alpha 2-adrenoceptor-mediated regulation in renin release. From these results and those obtained in the experimental rat models of acquired hypertension, a model for the pathogenesis of the genetically determined hypertension is proposed in which a very early step in the development of hypertension is a genetically determined increase in renal alpha-adrenoceptors that causes enhanced sodium retention. This initiates a chain of events that finally results in increased peripheral vascular resistance and, hence, blood pressure. On the other hand, beta-adrenoceptor changes seem to be secondary phenomena due to the elevation in blood pressure.

Adolescent↗
PubMed1978

Evaluation of drug treatment in mild hypertension: VA-NHLBI feasibility trial. Plan and preliminary results of a two-year feasibility trial for a multicenter intervention study to evaluate the benefits versus the disadvantages of treating mild hypertension. Prepared for the Veterans Administration-National Heart, Lung, and Blood Institute Study Group for Evaluating Treatment in Mild Hypertension.

A feasibility trial to investigate the practicality of determining the advantages and disadvantages of prompt pharmacologic treatment for mild hypertension was jointly funded by the Veterans Administration and the National Heart, Lung and Blood Institute. Its clinical phase has been completed, and it demonstrated 1. that the required relatively young asymptomatic population could be enrolled in the study and 2. that it could be persuaded to adhere to the protocol for 2 years; however, it was evident that intensive efforts would be required in both areas. The feasibility trial screened almost 120,000 potential subjects over a period of 16 months to randomize about 1,000 subjects at four clinical centers. These men and women were 21 to 50 years old, had diastolic pressures from 85 to 105 mm Hg as outpatients, and had no evidence of cardiovascular renal abnormalities. They were randomized in double-blind fashion into active drug therapy and placebo groups. Stepped care therapy involved 50 mg chlorthalidone (Step 1), 100 mg chlorthalidone (Step 2) and 100 chlorthalidone plus 0.25 mg reserpine (Step 3). Death, myocardial infarction, stroke, angina pectoris, and congestive heart failure were the "major" morbid events that were looked for; also recorded were "minor" morbid events consisting primarily of electrocardiographic arrhythmias. The development of significant hypertension was considered a treatment failure. Side effects were carefully tabulated in both active drug and placebo groups. The study revealed an average drop in diastolic pressure of almost 12 mm Hg for active drug group and less than half of that for the placebo group; once established 6 months after randomization, the new pressure levels persisted almost without change throughout the study. Although the feasibility trial was not designed to answer the primary question regarding the benefits of treatment, the events were tabulated for each group. A total of 12 placebo-treated subjects developed significant hypertension and were put on active drug. There was not a significant difference between the two groups in the incidence of "major" morbid events; a total of eight active and five placebo patients developed myocardial infarction or died suddenly. There, however, was an excess of arrhythmias among the active drug subjects (17 in the active group versus 8 in the placebo group on the basis of preliminary data). Finally, there were twice as many side effects and 20 times as many chemical abnormalities among the active as among the placebo subjects. A protocol for a full scale study of the benefits of pharmacologic therapy in mild hypertensives has been prepared and is ready for implementation as needed; it involves relatively minor modifications of the protocol tested in the feasibility trial.

Adult↗
PubMed1989

Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group.

The Hypertension Detection and Follow-up Program followed up 10,940 persons for 5 years in a community-based, randomized, controlled trial of treatment for hypertension. Participants were randomized to one of two treatment groups, stepped care and referred care. The primary end point of the study was all-cause mortality, with morbid events involving the heart, brain, and kidney as secondary end points. Loss of renal function, ascertained by a change in serum creatinine, was among these secondary events. Baseline serum creatinine concentration had a significant prognostic value for 8-year mortality. For persons with a serum creatinine concentration greater than or equal to 1.7 mg/dl, 8-year mortality was more than three times that of all other participants. The estimated 5-year incidence of substantial decline in renal function was 21.7/1,000 in the stepped-care group and 24.6/1,000 in the referred-care group. Among persons with a baseline serum creatinine level between 1.5 and 1.7 mg/dl, the 5-year incidence of decline was 113.3/1,000 (stepped care) and 226.6/1,000 (referred care) (p less than 0.01). The incidence of decline in renal function was greater in men, blacks, and older adults, as well as in those with higher entry diastolic blood pressure. Among persons with a baseline serum creatinine level greater than or equal to 1.7 mg/dl, serum creatinine concentration declined by 25% or more in 28.6% of stepped-care and 25.2% of referred-care participants. Although the incidence of clinically significant hypercreatininemia in a hypertensive population is low, an elevated serum creatinine concentration is a very potent independent risk factor for mortality. The slightly lower rate of development of hypercreatininemia and the higher rate of improvement in stepped-care compared with referred-care participants is consistent with the belief that aggressive treatment of hypertension may reduce renal damage and the associated increased risk of death.

Adult↗
PubMed1993

Chronic treatment with anti-endothelin antibodies fails to modify the development of hypertension in stroke-prone spontaneously hypertensive rats and DOCA-salt hypertensive rats.

This study was designed to assess whether blocking endogenous endothelin with anti-endothelin antibodies could alter the development of hypertension in stroke-prone spontaneously hypertensive rats (SHR) and DOCA-salt treated rats. Specific anti-endothelin antibodies were produced in rabbits by standard methods. The amount of anti-endothelin antibodies employed in this study blocked the hypertensive effect of endothelin-1, 750 ng/kg, by 55% in conscious rats. Intravenous injection of anti-endothelin antibodies as a bolus twice a week for 3 weeks did not affect the rise in blood pressure of stroke-prone SHR (268 +/- 8 mmHg, n = 8) compared to control stroke-prone SHR (256 +/- 7 mmHg, n = 8) treated with normal rabbit serum. Intravenous administration of anti-endothelin antibodies in a same manner also failed to alter the development of hypertension in DOCA-salt treated rats (160 +/- 6 mmHg in anti-endothelin antibodies-treated group, n = 7 compared to 164 +/- 5 mmHg in normal rabbit serum-treated group, n = 7). The administration of anti-endothelin antibodies did not induce any significant changes in body weight, urine volume and urinary sodium excretion in stroke-prone SHR and DOCA-salt treated rats compared to those treated with normal rabbit serum. These findings suggest that circulating endothelin might not play a major role in the regulation of blood pressure in stroke-prone SHR and DOCA-salt treated rats.

Aging↗
PubMed1991

The Mentakab Hypertension Project. Part IV--Hypertension care: is it adequate? A criterion-based audit of hypertension care in a hospital.

An audit to assess the adequacy of hypertension care was performed by examining the records and interviewing 55 selected hypertensive patients on treatment and follow-up at the outpatient department of a hospital. The patients selected had no previous record of drop out of treatment and had excellent compliance with drug therapy, so that ineffective blood pressure control cannot be attributable to these two reasons. Adequacy of care was measured by the number of patients whose management as indicated in their records complied with pre-defined criteria of adequate care. Only 18% of patients had achieved adequate blood pressure control. Assessment of patients was inadequate. None of the patients had been screened for secondary causes though 16% of patients had some basic investigations (urinalysis, blood urea and serum potassium), 5% had an assessment of target-organ damage, and 2% had been screened for other cardiovascular risk factors. Only 5% had a surveillance of side-effects from drug-therapy, 45% of the patients demonstrate adequate knowledge concerning complications of hypertension. The use of non-drug treatment was non-existent. The results of this study suggest that there were considerable deficiencies in the management of hypertension. Measures needed to overcome this are discussed.

Adult↗
PubMed1990

Home blood pressure recording in mild hypertension: value of distinguishing sustained from clinic hypertension and effect on diagnosis and treatment. Bath Health District Hypertension Study Group.

To identify the prevalence and magnitude of clinic changes in blood pressure and determine their effects on the diagnosis and treatment of hypertension, 268 patients with a BP greater than or equal to 160/95 mmHg on three consecutive occasions (twice in the general practitioner's surgery and once in the hospital clinic) recorded a home BP series with an electronic sphygmomanometer. Of these patients, 114 had never received antihypertensive treatment and 154 were receiving treatment. On return to the hospital clinic (second clinic visit) the BP was measured independently by the patient and doctor using electronic and mercury sphygmomanometers respectively and compared with the mean BP of the home series. In some 80% of both untreated and treated patients the second clinic BP was higher than the mean BP of the home series and in some 40% of patients a clinic rise of greater than 20/10 mmHg was recorded. Clinic falls in BP occurred in some 20% of both untreated and treated patients, but averaged only 4/4 mmHg. Treatment decisions based on a mean diastolic blood pressure of greater than or equal to 95 mmHg in the home series resulted in antihypertensive treatment not being started in 38% of untreated patients and not increased in 31% or reduced in 16% of treated patients when treatment would have been started, increased or continued unchanged on the basis of the second clinic (fourth recorded) diastolic blood pressure of greater than or equal to 95 mmHg. A patient recorded home series provides a representative sample of BP which distinguishes patients with sustained hypertension from those with clinic hypertension and may help reduce the overdiagnosis and overtreatment of mild hypertension.

Antihypertensive Agents↗
PubMed1990

Value of patient-recorded home blood pressure series in distinguishing sustained from office hypertension: effects on diagnosis and treatment of mild hypertension. Bath District Hypertension Study Group.

To identify the incidence and magnitude of office hypertension and determine its effect on diagnosis and treatment, 104 patients with a systolic blood pressure greater than or equal to 160 mmHg and a diastolic blood pressure greater than or equal to 95 mmHg on three consecutive office visits recorded a home BP series with an electronic sphygmomanometer. At the fourth office visit the blood pressure was measured independently by the patient and doctor using electronic and mercury sphygmomanometers, respectively, and compared with the mean blood pressure of the home series. In 80% of patients, the fourth office blood pressure was higher than the mean blood pressure of the home series. An office rise greater than or equal to 10/5 mmHg occurred in some 60% of patients, greater than or equal to 20/10 mmHg in 36% and 30/15 mmHg in 19% of patients. Office falls in blood pressure occurred in 20% of patients but averaged 3/2 mmHg. Treatment decisions based on the mean blood pressure of the home series resulted in treatment not being started in 25 patients (24%) who would have received treatment on their fourth office blood pressures. A patient-recorded home series provides a representative sample of blood pressure distinguishing patients with sustained hypertension from those with office hypertension and reducing the over diagnosis and over treatment of mild hypertension.

Adult↗
PubMed1994

Mutation of low affinity nerve growth factor receptor gene in spontaneously hypertensive and stroke-prone spontaneously hypertensive rats: one of the promising candidate genes for hypertension.

There is evidence that abnormal formation of the sympathetic nervous system might be important for pathogenesis of hypertension. In the present study we analyzed nucleotide sequences of low affinity nerve growth factor receptor (LNGFR) genes in the spontaneously hypertensive rat and its stroke-prone substrain. There was a point mutation generating an amino acid substitution in signal peptide of these LNGFRs. This result suggested that the mutated LNGFR gene is one of the promising candidate genes for hypertension.

Amino Acid Sequence↗
PubMed1993

Summary of 1993 World Health Organisation-International Society of Hypertension guidelines for the management of mild hypertension. Subcommittee of WHO/ISH Mild Hypertension Liaison committee.

As part of the ongoing process of issuing guidelines for managing hypertension the World Health Organisation and International Society of Hypertension present a summary of the latest guidelines for the management of mild hypertension. In both young and elderly people this condition is a risk factor for cardiovascular disease and should be treated. Information is presented on methods of diagnostic evaluation and assessment of risk. Methods of treatment, including changes in lifestyle, are covered.

Adult↗
PubMed1992

The stroke preventive effect in elderly hypertensives cannot fully be explained by the reduction in office blood pressure--insights from the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension).

OBJECTIVE: To study whether the cardiovascular preventive effect of antihypertensive therapy can be explained solely by the reduction in office blood pressure, and to what extent the risk of stroke and cardiac events is associated with in-study diastolic blood pressure (DBP) and systolic blood pressure (SBP). DESIGN: The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomized, double-blind, multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70-84 years. The study group comprised 1,627 elderly patients (mean blood pressure 195/102 mm Hg; mean age 75.7, SD 3.7; 63% females). The average follow-up was 25 months (range 6-65 months). No patient was lost to follow-up. METHOD: We applied a Poisson model taking current age, sex, treatment, DBP and SBP into account for all patients in the study. The constants of the model were estimated by the maximum likelihood method. RESULTS: The risk of stroke was significantly lower (42%, p = 0.0402) for a patient on active therapy than for a patient on placebo having the same blood pressure level, age, and sex. There was a corresponding, non-significant, reduction in cardiac events of 21%. In the whole study group the risk of stroke increased by 3% per mmHg (p = 0.0247) with increasing diastolic blood pressure for a given systolic pressure. The corresponding value for cardiac events was 2% per mmHg (p = 0.0376). CONCLUSION: In STOP-Hypertension we found a substantial risk reduction in stroke in actively treated patients, which was not solely explained by the blood pressure reduction obtained by treatment with beta-blockers and a potassium-sparing diuretic combination.

Aged↗
PubMed1990

Groningen Hypertension Service: ten years experience in detecting and treating hypertension in a population of 23,340 persons in rural and urban districts in Holland with a special hypertension service.

The Groningen Hypertension Service (GHS) has demonstrated that provision of training for volunteers, technical assistance and the services of the General Practitioner Laboratory (a private foundation offering laboratory and diagnostic facilities) have enabled large rural and urban districts to be screened for hypertension within a short period of time at low cost. The GHS trained volunteers and paramedics, who assisted with the treatment for six months. The General Practitioner Laboratory evaluated treatment in nearly 600 hypertensive patients, leading to the institution of low-dose therapy and careful investigation of side-effects.

Adult↗