[Therapy-refractory arterial hypertension in a young patient]. / Therapierefraktäre arterielle Hypertonie bei einem jungen Patienten.

We report on a 41-year-old patient admitted for refractory arterial hypertension that had developed after a curative chemotherapy regimen due to seminoma stadium IIb four years ago. After exclusion of secondary forms of arterial hypertension (actually unsuccessfully treated with 5 different antihypertensive drugs) we performed a controlled medication intake-trial in our outpatient clinic. 90 minutes after taking the pills the patient complained of dizziness and perspiration while hypotension and bradycardia were measured simultaneously. Due to the difficult psychosocial situation (conflicts with the insurance and in the family, financial problems) and the suspected narcisstic personality disorder the issue of the proven malcompliance was not openly discussed in order to preserve the patient-doctor alliance. The antihypertensive regimen was then reduced to a double regimen. In the second part of the article the most common reasons for refractory arterial hypertension, especially the problem of treatment malcompliance, are summarized.

Influence of different racing positions on metabolic cost in elite cyclists.

The spectacular improvements of the 1-h world record in cycling in the last four years have highlighted the importance of aerodynamics in modern bicycle racing. We have investigated the metabolic consequences of the low-crouched aero-positions necessary to reduce air drag. In this study, 14 elite male bicycle racers (24.0 +/- 1.0 yr, VO2max 69.4 +/- 0.5 mL.kg-1.min-1) were tested for oxygen consumption (VO2) and heart rate (HR) at 70% (302.6 +/- 5.3 W) of their individual VO2max in three different riding positions during a single test run. The subjects rode their racing bicycles on a wind braked roller; the sequence of the three following positions was randomized: 1) upright cycling (UP), cadence 90 rpm; 2) hands on drops (DP), 90 rpm; and 3) hands on clip-on aero-handlebars (AP), 90 rpm. VO2 and HR values in AP were significantly higher by 1.5 mL.kg-1.min-1 and 5 beats.min-1, respectively, compared with UP. We concluded that riding a bicycle in an extreme aero-position increases the metabolic cost of cycling when wind resistance is not taken into account. However, when the mechanical power losses of 9 W (estimated by the VO2 increase) are compared with the expected aerodynamic power savings of approximately 100 W, it appears that aerodynamic advantages by far outweight their metabolic cost.