Blunted nocturnal fall of blood pressure in isolated clinical hypertension.

OBJECTIVE: The aim of the study is to assess the relation between diurnal blood pressure variations and target organ damage in isolated clinical hypertension (ICH). MATERIAL AND METHODS: Ninety patients with ICH (clinical systolic blood pressure [SBP] superior or equal to [>=] 140 and/or diastolic blood pressure [DBP]> = 90 mm Hg) and ambulatory daytime SBP and DBP <135/85 mm Hg were enrolled in this study. Patients with ICH were classified into two groups as dippers (13 males, 34 females) and nondippers (7 males, 36 females). Nondippers were defined by a reduction in mean blood pressure of less than 10% from day (06:00-24:00) to night (24:00-6:00); and the rest of the patients were classified as dippers. Left ventricular mass index (LVMI) and early diastolic velocity/late diastolic velocity (e/a) were determined by echocardiography; intima-media thickness (IMT) and compliance of the carotid artery (distensibility coefficient [DC] and compliance coefficient [CC]) were measured by ultrasound. Renal function was measured by glomerular filtrate rate (GFR) and urinary albumin excretion (UAE). Retinal changes were determined by fundoscopy. RESULTS: There was no difference between the demographic and biochemical characteristics of the two groups. IMT was significantly higher in nondippers (p <0.005). The nondippers had significantly lower levels of DC (p <0.005) and CC (p <0.0005). LVMI was above normal in both groups with no significant difference. The e/a ratio, although normal in both groups, differed significantly between them (p <0.0005). HTRP, microalbuminuria and GFR <90 mL/min/1.73 m2 were more frequent in nondipper ICH patients. CONCLUSION: The results of the study suggest that in ICH nondipping is associated with a decrease in arterial compliance. The global risk load for target organ.

Immunoprotection in spontaneous remission of type 1 diabetes: long-term follow-up results.

This prospective pilot study was undertaken to test the efficacy of oral methyl-prednisolone (MP) therapy at spontaneous remission phase of type 1 diabetes in intervening the course of the disease. Twenty-five type 1 diabetic patients who were classified as having a spontaneous remission (honeymoon) were divided into treatment and non-treatment groups on voluntary basis. Fifteen patients thus making up the treatment group (13 males and 2 females, mean age 23.8 +/- 6.2 years) received 0.7-1.0 mg/kg/day of MP p.o. for 2 weeks. The dose of the drug was then gradually diminished every week until 5 mg/day (approx. 0.1 mg/kg/day) and discontinued at 10 +/- 2 weeks. In case of hyperglycemia occurring in 12 of 15 patients due to the administration of steroid, insulin was used to normalize blood glucose levels (average 0.47 +/- 0.21 IU/kg/day). The non-treatment group (8 males and 2 females, mean age 21.8 +/- 8.9) did not receive any special medication or placebo except for insulin whenever necessary to regulate glycemia. Upon completion of protocol, all patients in treatment group displayed clinical remission with 10 still in non-insulin requiring remission for follow-up periods ranging between 16 and 91 months. The remaining 5 patients relapsed within 3-15 months of therapy. Other metabolic (including basal and stimulated C-peptide levels) and immunological indices that have spontaneously ameliorated with the occurrence of honeymoon were also maintained within normal range in the NIR patients. Meanwhile, natural remission in the non-MP-treated group terminated at 3.4 +/- 0.6 months with deterioration of all metabolic and immunological markers as well as increasing requirements for insulin. In conclusion, the spontaneous remission of the patients could be prolonged significantly by MP therapy as opposed to no therapy (P < 0.001). These results suggest that the spontaneous remission phase may be a crucial point of intervention in immunotherapy of type 1 diabetes and that randomized trials with MP at this particular phase would be worthwhile.

Gaucher disease and brucella: just a mere coincidence?

Gaucher disease type I and brucellosis are chronic diseases with similar symptoms and physical signs though the former is the most common lysosomal storage disease and the latter is an infectious disease. The similarities between these diseases make differential diagnosis difficult. Immunodeficiency is a feature of Gaucher disease type I and increases the susceptibility towards infections. A Gaucher disease type I patient with brucellosis is presented with improvement after treatment of brucellosis.

The antihypertensive effects of doxazosin on the arterial system: changes in peripheral vascular resistance and wall tension.

Background: Hypertension is characterized by structural and functional abnormalities that affect the entire cardiovascular system, including the large arteries. The antihypertensive efficacy of doxazosin, a selective alpha(1) antagonist, and its effects on the arterial system were investigated. Method: In our double-blind, randomized, placebo-controlled study including 30 hypertensive patients (doxazosin group: nine males, 11 females; mean age 45+/-12 years; placebo group: four males, six females; mean age 47+/-9 years), the systolic, diastolic and mean blood pressure (BP), heart rate, diameter and area of the brachial artery, peak systolic velocity, end-diastolic velocity, pulsatility index (PI), resistance index (RI), S/D (systolic velocity/diastolic velocity), flow volume, local resistance, and wall tension were recorded before and 4 h after the administration of 2 mg doxazosin or placebo. The two groups were statistically compared. Results: In the doxazosin group, systolic, diastolic and mean pressures decreased significantly (P<0.001), while heart rate remained unchanged. Local resistance (P<0.001), RI (P<0.05), PI (P<0.05), and wall tension (P<0.001) all decreased significantly, while flow volume increased significantly (P<0.05). However, no significant changes were observed in arterial diameter, surface area, peak systolic velocity, end-diastolic velocity or S/D ratio. The placebo group did not show a significant difference in any of the parameters listed above. Conclusion: The antihypertensive effect of doxazosin is accompanied by a reduction in brachial arterial wall tension that occurs without any change in arterial diameter. The lack of change in the diameter of the artery leads us to suggest different effects on other vasomotor determinants.