Effects of the correction of renal artery stenosis on blood pressure, renal function and left ventricular morphology.

The aim of this study was to evaluate the effect of renal artery stenosis (RAS) correction in hypertensive patients on 24 h SBP, 24 h DBP, creatinine clearance (GFR), urinary albumin excretion (UAE) and LV morphology and mass (LVMI). A total of 61 hypertensive patients with RAS undergoing PTRA and/or surgical treatment entered the prospective study. The final analysis was done in 44 patients (age range 45.8 +/- 16.2 years) with RAS (atherosclerosis (ASC) 31 patients, fibromuscular dysplasia (FMD) 12 patients, arteritis 1 patient) who underwent PTRA (34 patients) or surgical treatment (10 patients) and presented no Doppler signs of restenosis (or a new stenosis) during 1-year observation. The pre-interventional assessment repeated after 6 and 12 months included ABPM, GFR, UAE and echocardiography. The results were analysed in the combined group (CG) and in according aetiology. 24 h SBP and 24 h DBP decreased in all groups 6 months post-intervention and did not change further. Cure of HT was observed in 35% and 29% of ASC patients at 6 and 12 months respectively; and in 58% of FMD patients. Failure rate at 12 months was 48% in ASC against 25% in FMD. The mean GFR in CG was higher 12 months after intervention. The increase in GFR was noted in 45% of patients, the decrease in 25% of patients at 12 months. Normal values of UAE were found in 71% of patients, pre- and post-intervention alike. Mean LVMI and number of patients with LVH in CG decreased already during the initial 6 months post-intervention and did not change further. In conclusion, correction of RAS leads to cure of or improved control of hypertension in the majority of the patients with FMD, but in the ASC group in about half of cases no BP cure or improvement was seen. The renal function was improved or stable in two-thirds of patients after revascularization. Successful renal revascularization was followed by regression of LVH, which was evident within 6 months post-intervention.

Plasma fibrinogen as a risk factor for restenosis after percutaneous transluminal renal angioplasty in patients with atherosclerotic renal artery stenosis.

BACKGROUND: In contrast to those for coronary restenosis, the data regarding the risk factors for renal restenosis are limited. OBJECTIVE: To evaluate potential humoral risk factors for restenosis after percutaneous transluminal renal angioplasty (PTRA). METHODS: We studied 27 patients aged 54+/-10 years with atherosclerotic renal artery stenosis in a 1-year prospective follow-up. Restenosis (confirmed by angiography) occurred in eight patients 1-6 months after PTRA. We detected no Doppler ultrasound evidence of restenosis in 19 patients throughout 1 year. Blood studies were done before PTRA for all patients, at the time of diagnosis of restenosis and, for those without restenosis, after 1 year. including determinations of fibrinogen, lipids, platelets and leukocytes. RESULTS: The mean level of fibrinogen in patients who experienced restenosis was higher than that in those who did not (450+/-150 mg% versus 337+/-57 mg%, P < 0.01) and remained unchanged for both groups during follow-up. The other parameters did not differ between the groups before PTRA and did not change over time, with the exception of platelet count in patients who did not experience restenosis, which had decreased from 253+/-93G/l to 200+/-63G/l (P < 0.01) 1 year after PTRA. The logistic multiple regression analysis disclosed that an increment of fibrinogen level by 100 mg% was linked with an odds ratio for restenosis of 3.2 (95% confidence interval 1.1-9.8). CONCLUSIONS: Restenosis was associated with higher than normal levels of fibrinogen before PTRA. A high plasma fibrinogen level might play a role in the development of restenosis after PTRA.

Blood pressure, plasma NPY and catecholamines during physical exercise in relation to menstrual cycle, ovariectomy, and estrogen replacement.

Some evidences indicate that the female sex hormones protect against the development of cardiovascular diseases. Modulation of sympathetic activity may be one of the possibilities. We investigated the influence of treadmill stress on blood pressure (BP) and plasma neuropeptide Y (NPY), norepinephrine (NE) and epinephrine (E) concentrations in 11 normotensive, menstruating women in the follicular (HWf) and luteal (HWl) phases and in eight ovariectomized women, before (OVX) and after estrogen supplementation (OVXe). Both at rest and during exercise there were no differences in BP between HWf and HWl and between OVX and OVXe. During stress BP was significantly lower in HWf and HWl than in OVX but not in OVXe. NPY did not differ significantly between the groups of women either at rest or during activity. We did not observe differences in resting and stimulated NE and E between HWf and HWl and between OVX and OVXe. Neither resting nor activated NE and E differed between the groups, except higher stimulated NE in OVX than in HWf. These results suggest that the female sex hormones may modulate the BP response to dynamic exercise. Our data support evidence that this influence may be exerted by circulating catecholamines and not by NPY.

Secondary hypertension in the elderly.

This paper discusses the most significant aspects of secondary hypertension in older patients against the background of a rising proportion of elderly in the hypertensive population. Renal artery stenosis and pheochromocytoma are singled out as those causes of secondary hypertension which appear to be related to older age. The available data relevant to epidemiology of these conditions and age-dependent clinical characteristics are reviewed. Preservation of renal function in the elderly with renal artery stenosis is underlined as an important goal of therapy with revascularising techniques. It is proposed that screening for renal artery stenosis and pheochromocytoma may be equally important in the elderly as in the younger hypertensive patient.

Evaluation of plasma aldosterone to plasma renin activity ratio in patients with primary aldosteronism.

The plasma aldosterone to renin activity ratio (A/PRA) was assessed retrospectively in 103 patients with primary aldosteronism including 74 patients with surgically proven adrenal cortical adenoma (APA) and 29 patients with idiopathic adrenal cortical hyperplasia (IHA). The results were compared with those obtained in 31 patients with essential hypertension (EH) and 45 healthy normotensive controls. The upper limit of normal A/PRA ratio, as obtained in the controls was 17.8. This value was exceeded in 89% of patients with APA; postoperatively it decreased in 97% of the APA group, and returned to normal in 81%. In the IHA group the A/PRA was elevated in 70% of patients. The normal ratios in patients with primary aldosteronism were associated with unsuppressed plasma renin activity (PRA). Although the mean values of the A/PRA ratio differed significantly between the groups, complete separation was not obtained. The serum potassium level at time of testing did not influence the diagnostic value of the A/PRA ratio, although an inverse correlation between serum potassium and the A/PRA ratio was found in the patients with APA. This study supports the high sensitivity of the A/PRA ratio in diagnosis of primary aldosteronism, however, a single determination with a normal result may not be sufficient for exclusion of the disease.

Pathogenesis of essential hypertension--present views.

The paper reviews the main lines of research pertaining to modern understanding of pathogenesis of essential hypertension. Attention is focused on the role of sympathetic activity, including the neuropeptide Y, as well as on those of atrial natriuretic peptide, endothelins and nitric oxide. The concept of endothelial dysfunction is discussed as a possible factor contributing to the development of hypertension, but also as its sequel. Finally, hyperinsulinemia and insulin resistance are viewed within a scope of interrelated factors of possible pathogenetic significance in essential hypertension. Genetic studies are singled out as the most promising line of further research.

Postural stimulation test in patients with aldosterone producing adenomas.

OBJECTIVE: The purpose of this study was to evaluate the postural stimulation test before and after surgical treatment in patients with aldosterone-producing adenomas. DESIGN: The retrospective study was made on patients with aldosterone producing adenomas. PATIENTS: The postural stimulation test was analysed in 60 patients with surgically proven aldosterone producing adenoma and in 15 healthy volunteers. MEASUREMENTS: The postural stimulation test was based on measurements of plasma aldosterone, cortisol and renin activity (PRA) at 0800 h and at noon after 4 hours ambulation. RESULTS: The patients were divided into two groups according to the individual pattern of plasma aldosterone concentration following the postural test. Plasma aldosterone concentration decreased or did not change after 4 hours of standing in 42 patients (group 1, 70% of total) and increased in 18 patients (group 2, 30% of total). Mean plasma aldosterone was significantly higher in group 1 than in group 2 (1325 +/- 164 pmol/l (mean +/- SE) and 538 +/- 53 pmol/l, respectively). Mean plasma cortisol concentration after 4 hours of upright posture in both groups remained low (242 +/- 35 vs 401 +/- 63 nmol/l (group 1) and 317 +/- 46 vs 367 +/- 43 nmol/l (group 2)). Mean PRA in both groups was suppressed after 4 hours of upright posture (0.2 +/- 0.04 vs 0.2 +/- 0.04 pmol/l/s and 0.3 +/- 0.06 vs 0.1 +/- 0.02 pmol/l/s, respectively). CONCLUSION: Diverse changes in plasma aldosterone and cortisol found in response to the postural test may indicate pathogenetic heterogeneity amongst patients with aldosterone producing adenomas and should be considered during diagnosis of primary aldosteronism.

Elevated endothelin-1 plasma concentration in patients with essential hypertension.

BACKGROUND: Endothelin-1 (ET-1) may play an important role in the development and maintenance of hypertensive states. In patients with essential hypertension, ET-1 plasma concentration increases or remains unchanged. The aim of the present study was to investigate ET-1 plasma concentration in patients with mild-to-moderate essential hypertension and its interrelationship with catecholamines, neuropeptide Y and atrial natriuretic peptide (ANP). METHODS: The study included 37 patients (mean age 38.2 +/- 1.6 years) with mild-to-moderate essential hypertension. The control group consisted of 21 healthy volunteers (mean age 35.6 +/- 1.4 years). ET-1, neuropeptide Y and ANP were determined by radioimmunoassay methods and catecholamine plasma concentration was determined radioenzymatically. RESULTS: Our study shows that plasma ET-1 and neuropeptide Y levels are elevated in patients with essential hypertension compared with a control group. No correlation was found in either of the groups between plasma ET-1 level and plasma neuropeptide Y, catecholamine or ANP concentrations. CONCLUSION: Our results suggest that ET-1 is relevant in the development and maintenance of elevated blood pressure.

[Giant cell arteritis--presentation of 3 cases]. / Olbrzymiokomórkowe zapalenie Tetnicy skroniowej--omówienie 3 przypadków.

Three patients with giant cell arteritis (GCA) observed recently in our department are described. One of them demonstrated clinical picture of polymyalgia rheumatica, the other two presented with clinical symptoms of GCA. This presentation seems to be very helpful for correct diagnosis in cases with difficult recognition.

[Blood pressure in young men with a family history of primary hypertension--traditional and 24-hour blood pressure measurements]. / Cisnienie tetnicze u mlodych mezczyzn obarczonych rodzinnym wystepowaniem pierwotnego nadcisnienia tetniczego--pomiary tradycyjne i automatyczne pomiary calodobowe.

Blood pressure was measured in two groups of young males-group S-55 men with positive family history of essential hypertension (EH) and group K-11 men with negative family history of EH (mean age 24.5 +/- 3.3 and 23.5 +/- 4.7 years). Two methods of blood pressure measurement--traditional blood pressure measurement (method A) and automatic ambulatory indirect blood pressure monitoring (method B) were used. Blood pressure was higher in group S than in group K-method A 140 +/- 14/86 +/- 10 vs 122 +/- 10/73 +/- 8 mm Hg; method B: 132 +/- 11/78 +/- 10 vs 123 +/- 8/72 +/- 7 mm Hg. Contrary to group K, in group S discrepancies in the frequency of diagnosis of systolic or diastolic hypertension were found between the two methods of blood pressure measurement. These results indicate that in young males the traditional method of blood pressure measurement may provide a false positive diagnosis of hypertension, but both methods of blood pressure measurement used in this work were effective in the diagnosis of normotension. As a population the young males with positive family history of EH have higher blood pressure then young males with negative family history of EH.

[Isometric exercise and cold pressor test in young men with a family history of essential hypertension]. / Wysilek izometryczny i test oziebienia u mlodych mezczyzn z obciazajacym wywiadem rodzinnym w kierunku pierwotnego nadcisnienia tetniczego.

An exaggerated pressor reaction to the isometric exercise and cold pressor test (CPT) is found to be a predictor or future hypertension. In the two groups of young males: 51 men with positive family history of essential hypertension (EH) (mean age: 24.3 +/- 3.3 years, group S) and 11 men with negative history of EH (mean age: 23.5 +/- 3.7 years, group K) the blood pressure responsiveness to the handgrip test (HG) and CPT were evaluated. Ambulatory systolic (SBP) and diastolic (DBP) blood pressure were higher in S then K (respectively: 136 +/- 11/81 +/- 10 mm Hg vs 126 +/- 4/76 +/- 6 mm Hg, p < 0.05). The elevation of blood pressure after HG (30% of maximal voluntary contraction for 3 min.) was higher in K than S (respectively: delta SBP = 37 +/- 20 vs 21 +/- 17 mm Hg i delta DBP = 27 +/- 20 vs 7 +/- 12 mm Hg, p < 0.05). Similarly, after CPT (by immersing the left hand and forearm in ice-cold water for 2 min.) the elevation of blood pressure was higher in K than S (respectively: delta SBP = 22 +/- 11 vs 12 +/- 12 mm Hg i delta DBP = 17 +/- 12 vs 9 +/- 9 mm Hg, p < 0.05). These results do not confirm an exaggerated blood pressure responsiveness to the HG test or CPT in young males with positive family history of EH, irrespectively to the diagnosis of normotension or borderline hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

[Young men with a positive family history of hypertension have higher values in a circadian blood pressure profile]. / Mlodzi mezczyzni z wywiadem rodzinnego nadcisnienia tetniczego maja wyzsze wartosci dobowego profilu cisnienia.

Non-invasive automatic 24-h indirect monitoring of blood pressure was performed in two groups of young males - group S - 55 men with positive family history of essential hypertension (EH) (mean age 24.6 +/- 3.6 years) and group K - 11 men with negative family history of EH (23.5 +/- 3.7 years). Circadian blood pressure variations were studied in two-hour periods throughout 24 hours. The curves of the blood pressure profiles in groups S and K had similar shape. The mean systolic blood pressure estimated for each of the two-hour periods was higher in group S than in group K in the corresponding period. Mean diastolic blood pressure estimated for each of the two-hour periods was higher in group S than in group K in almost all periods of the daily activity. These results indicate that young males with positive family history of EH have higher blood pressure than young males with negative family history of EH. This stable disregulation of blood pressure is present not only during day-time activity but also during sleep.

[Augmented activity of the adrenal medulla in young men with positive family history of essential hypertension]. / Zwiekszona aktywnosc rdzenia nadnerczy u mlodych mezczyzn z rodzinnym ryzykiem pierwotnego nadcisnienia tetniczego.

Serum adrenaline (AD) and noradrenaline (NA) were measured by RIA method in two groups of young males: group S (n = 54) with positive family history of essential hypertension (EH) and group K (n = 9) with negative family history of EH (mean age: 24.6 +/- 3.3 i 23.6 +/- 3.6 years respectively). AD and NA concentrations were estimated in basic conditions (AD1, NA1) and after 10 min of passive vertical posture(AD2, NA2). In group S AD1 concentration was higher than in group K (54.4 +/- 24.4 i 37.8 +/- 15.6 pg/ml respectively, p < 0.05). In group S a positive correlation was found between mean systolic blood pressure (SBP) and mean heart rate (HR) estimated during 5-hours monitoring by Spacelab IGR 5300 ambulatory blood pressure and heart rate monitoring system (r = 0.5, p < or = 0.01). Pearson's correlation coefficient (Pcc). In this same group positive correlations were also found between AD2 and SBP - r = 0.31, p < 0.05 (Pcc) and between AD2 and HR: r = 0.33, p < 0.05 (Pcc). Results of 5-hours blood pressure monitoring showed that 15 of 54 males from group S had SBP > 139 mmHg (group S1). In group S1, AD1 and AD2 concentrations were higher than in group K (AD1: 366 +/- 144; 206 +/- 85, p < 0.01 and AD2: 626 +/- 266; 369 +/- 156 fmol/ml, p < 0.05 respectively). No differences were found in AD1, AD2, NA1 and NA2 concentration between group K and normotensive (SBB < 140 mmHg) males with positive family history of EH: group S2. In young males with positive family history of EH, the elevation of blood pressure might be caused by an augmented activity of the adrenal medulla.

Plasma atrial natriuretic peptide (ANP) concentration in patients with pheochromocytoma.

The interaction between catecholamines (CA) and ANP is not clearly established. The effects of excess endogenous CA on ANP secretion can be investigated in patients with pheochromocytoma. We studied 27 patients with surgically and histologically proven pheochromocytoma (P) aged 19-70 years. In 16 of these patients plasma ANP study was repeated after surgical removal of the tumour. The control group (C) consisted of 20 healthy volunteers aged 21-48 years. Moreover, 42 patients with uncomplicated mild to moderate essential hypertension (EH) aged 18-48 years were also studied. In P higher plasma ANP concentration versus C, EH was found (51.9 +/- 8.1; 25.5 +/- 1.5; 19.3 +/- 1.5 fmol/ml, respectively). In 16 patients with P, increased plasma ANP level (mean 63.3 +/- 12.6 fmol/ml) declined after surgical removal of the tumour (mean 22.4 +/- 2.9 fmol/ml). In the P patients no relationship was found between plasma ANP and hormonal patterns of the tumour or between plasma ANP and plasma catecholamines, whereas significant positive correlations between plasma ANP and both systolic and diastolic blood pressure and heart rate were demonstrated. These results suggest that excess CA produced by the chromaffin tumour induce ANP secretion via stimulation of adrenergic receptors. However, influence of the haemodynamic changes evoked by CA cannot be excluded. It is suggested that increased secretion of ANP may be of some importance in maintaining blood pressure homeostasis in patients with pheochromocytoma.

[Effect of hemodialysis on the level of serum digoxin-like substance and sodium-potassium pump activity in erythrocytes from patients with chronic renal failure]. / Wplyw hemodializy na stezenie substancji digoksynopodobnej w surowicy krwi i aktywnosc pompy sodowo-potasowej w erytrocytach chorych z przewlekla niewydolnoscia nerek.

Digoxin-like immunoreactivity (DLS) and erythrocyte sodium-potassium pump (PSP) activity were measured in a group of 16 patients with chronic renal failure (CRF) before and just after haemodialysis and in a group of 9 healthy persons. Before haemodialysis DLS was present in the blood of most CRF patients, at the mean concentration of 0,14 +/- 0,13 micrograms/l. After haemodialysis DLS concentration decreased to 0,09 +/- 0,09 microgram/l (p less than 0,01). In the control group blood DLS concentration was nondetectable. In the CRF group PSP activity was higher before than after haemodialysis (p less than 0,01; 12,1 +/- 1,8 and 7,6 +/- 1,4 muMol Pi/h/g Hb. PSP activity in the control groups was 10,3 +/- 1,9 muMol Pi/h/g Hb). In the CRF group PSP activity was higher before haemodialysis (p less than 0,05) and lower after haemodialysis (p less than 0.01) than in the control group. Our results confirmed the presence of DLS in the blood of the majority of CRF patients. DLS concentration decreased after haemodialysis but we did not found any parallel increase in PSP activity in these patients. These results did not confirm the hypothesis that DLS might inhibit PSP activity in red blood cells from CRF patients.

[Primary arterial hypertension. Treatment with captopril and function of the left heart ventricle, concentration of catecholamine in blood and activity of renin]. / Pierwotne nadcsnienie tetnicze. leczenie kaptoprylem a czynnosc lewej komory serca, stezenie katecholamin we krwi i aktywnosc reniny.

We evaluated the effect of captopril treatment on left ventricular mass (LVM) and function in sustained mild-to-moderate primary hypertension. In 16 men aged 34.5 +/- 6.4 yrs. M-mode echo and pulsed wave Doppler recordings were obtained prior to and after 2 months captopril treatment (50-150 mg daily). No significant changes in heart rate, systolic blood pressure, ejection fraction, fractional shortening, cardiac output, LVM and Doppler-derived indices of mitral inflow were observed. Diastolic blood pressure measured during examination fell from 102.2 +/- 13.3 to 90.3 +/- 9 mmHg (p less than 0.026). No consistent correlations between catecholamines and indexes of left ventricular function were found. Two-month captopril therapy in mild-to-moderate hypertension results in diastolic blood pressure lowering with no effect on LVM or left ventricular function.

[Does hormonal activity of pheochromocytoma affect long-term prognosis in surgically treated patients?]. / Czy aktywnosc hormonalna guza wplywa na odlegle rokowanie u chorych z pheochromocytoma leczonych operacyjnie?

89 patients were operated upon for pheochromocytoma. 61 patients (37 women and 24 men) were available for follow-up. Mean age at operation was 39 +/- 12.3 yrs. Before operation paroxysmal and sustained hypertension were observed in 34 (55.7%) and 27 (44.3%) patients, respectively. Postoperatively permanent normalization of blood pressure was achieved in 38 cases (62.3%). All patients were divided into four groups. Group I with increased urine excretion of noradrenaline (NA) and adrenaline (A) consisted of 19 (31.1%) patients. Group II (increased NA excretion) included 27 (44.3%) patients. Group III comprised 3 (4.9%) cases with elevated A excretion. 12 (19.7%) patients with normal urinary excretion of catecholamines and increased excretion of methoxycatecholamines were alloted to group IV. Permanent normalization of blood pressure predominantly was observed in group IV--91.6%, whilst in group I, II and III this hypotensive effect was noted in 57.9%, 51.8% and 2/3, respectively. Permanent normalization of blood pressure can be mainly expected in patients with pheochromocytoma in whom catecholamines are rapidly inactivated within the tumor.