Treatment of hypertension in the elderly: effects on blood pressure, heart rate, and physical fitness.

The subjects were 36 hypertensive patients aged 61 to 79 years (mean, 66 years). After a placebo run-in period of one month, each patient was randomly assigned to two months of treatment with 100 mg of metoprolol, 50 mg of captopril, or 25 mg of hydrochlorothiazide plus 2.5 mg of amiloride daily, or placebo. The doses were doubled if diastolic pressure was above 95 mm Hg after one month of treatment. Blood pressure, heart rate, and physical fitness (endurance during a standard cycle ergometer exercise) were measured and side effects assessed after each two-month treatment period. Mean blood pressures were significantly lower after treatment with metoprolol (154/92 mm Hg), captopril (157/92 mm Hg), and hydrochlorothiazide-amiloride (152/91 mm Hg) than after placebo (170/101 mm Hg). Heart rate was significantly lower after treatment with metoprolol (64 beats/minute) than after placebo (77 beats/minute). Exercise endurance was lower after treatment with metoprolol (498 seconds) and hydrochlorothiazide-amiloride (519 seconds) than after placebo (529 seconds) and higher after captopril (541 seconds). More patients reached the target exercise work load after captopril than after the other treatments. No patients withdrew from treatment because of side effects or abnormal laboratory test results. All three active treatments benefited the elderly hypertensive patients and did not lower their physical fitness. Captopril appeared to be more effective than the other two treatments.

Right ventricular wall thickness and function in hypertensive patients with and without left ventricular hypertrophy: echo-Doppler study.

The structure and function of the right ventricle in arterial hypertension have been the subject of only a few reports. The present study evaluated the functional and structural changes in both left and right ventricles. Doppler and standard echocardiography were performed in 58 hypertensive patients (33 without and 25 with left ventricular hypertrophy). We concluded that right ventricular wall thickness is significantly increased in hypertensive patients compared with normotensive subjects, and that there is a significant, direct correlation between right and left ventricular thickness. Abnormalities in right and left ventricular filling, characterized by a reduction in early and an increase in late diastolic flow velocity, occur in hypertensive patients, and there is a direct correlation between late mitral and tricuspidal flow velocities and left and right ventricular thickness.

Antihypertensive efficacy and influence on physical activity of three different treatments in elderly hypertensive patients.

The antihypertensive efficacy and subjective and physical tolerability of three different pharmacological treatments (metoprolol, captopril and the combination of hydrochlorothiazide + amiloride) were compared with placebo in 36 elderly hypertensives (aged 61-79 years), according to a Latin-square double-blind design. The placebo and the active treatments were administered for 2 months. Seated blood pressure was significantly reduced by all the pharmacological treatments compared with placebo, but only metoprolol significantly reduced the heart rate. No haematological or biochemical changes were observed during the study. Physical fitness, evaluated as endurance in a standard cycle ergometer exercise test, was slightly decreased after the treatment with metoprolol and the diuretic combination and slightly improved after treatment with captopril. Subjective tolerability, evaluated by a check-list of symptoms, was better during the active therapies, and in particular during the captopril treatment, than during the placebo treatment. Our results indicate that all three active treatment regimens significantly reduce blood pressure in elderly hypertensives and that captopril appears slightly better tolerated physically and subjectively.

Left ventricular diastolic function in athletes and borderline hypertensives with mild cardiac hypertrophy.

The aim of this study was to evaluate the diastolic function in athletes and in young borderline hypertensives with mild left ventricular hypertrophy. Left ventricular filling was assessed by echo Doppler measurement of transmitral flow velocity in 18 soccer players (age 22 +/- 4 years, left ventricular mass index, LVMI 136 +/- 12 g/m2), in 15 borderline hypertensives (age 21 +/- 3 years, LVMI 137 +/- 9 g/m2), and 20 normotensive subjects (age 22 +/- 4 years, LVMI 93 +/- 10 g/m2) as reference group. We found that left ventricular filling profile was similar in borderline hypertensives, in athletes and in normotensive subjects. These findings suggest that, at least in the early stage, mild cardiac hypertrophy secondary to borderline blood pressure elevation is characterized by indexes of diastolic function not different from those found in athletes with physiological hypertrophy.

Effects of long-term blood pressure control on left and right ventricular structure and function in hypertensive patients.

The functional and anatomical abnormalities of the right ventricle may occur in hypertensive patients with left ventricular hypertrophy (LVH). The present study was designed to assess the functional and structural changes in both left and right ventricles induced by chronic antihypertensive therapy. Doppler and standard echocardiography were performed in 10 hypertensive patients with LVH before and after 1 year of treatment with captopril alone (5 patients) or captopril plus nifedipine (5 patients). We found that the left ventricular mass index and right ventricular thickness were significantly reduced in all patients when compared with pretreatment values. Furthermore, the Doppler-derived diastolic filling indexes show a significant improvement of both ventricular chambers. Our data suggest that anatomical and functional changes induced by therapy in hypertensive patients are not limited to the left ventricle but also involve the right ventricle.

Effect on resting blood pressure and blood pressure homeostasis of short-term administration of the alpha 1-adrenergic receptor antagonist, trimazosin, in hypertension.

The effects of trimazosin on blood pressure and cardiovascular homeostasis were studied in 12 subjects with untreated essential hypertension of mild or moderate degree. After a 3-day placebo period, the subjects were given trimazosin at the dose of 50, 100, or 200 mg twice daily (7 am and 7 pm) according to a randomized, double-blind crossover protocol. Each treatment was prolonged for 3 days and separated from the subsequent treatment by a 2-day placebo period. Blood pressure (sphygmomanometry) and heart rate were measured at rest during various laboratory maneuvers on the first and third day of the initial placebo, on the first and third day of the drug periods, and on the second day of the intervening placebo periods. Compared to placebo values, trimazosin caused a reduction in systolic and diastolic blood pressure which was well sustained through the time between the morning and the evening administration of the drug and was accompanied by only a slight tachycardia. the antihypertensive effect was similar in the supine and upright position and in both instances it was greater for the 100 or 200 mg twice daily dose than for the 50-mg twice daily dose. The pressor and tachycardic responses to cold pressor test and to isometric and dynamic exercise were unaffected by the various doses of trimazosin whose antihypertensive effect was therefore similarly evident at rest and during behaviorally occurring blood pressure rises.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlation between arterial pressure at rest and during effort and left ventricular mass in hypertensive patients who were never treated]. / Correlazione tra pressione arteriosa a riposo e sotto sforzo e massa ventricolare sinistra in pazienti ipertsi mai trattati.

A poor correlation has been found between blood pressure at rest and left ventricular mass in the course of several echocardiographic studies on hypertensive patients. The aim of this work was to determine if this finding could be the result of previous antihypertensive therapy, which had been suspended a few weeks previously in most of the studies. In addition, we tested whether blood pressure values during physical exercise correlate with the echocardiographic indices of left ventricular mass better than the values at rest. In our group of 43 patients with mild to moderate essential hypertension who had never been pharmacologically treated, the correlation between both systolic and diastolic blood pressure and left ventricular mass was poor (r = 0.41 and 0.30 respectively). This result suggests that one or more factors other than hypertension may determine the development of left ventricular hypertrophy. However, in 10 patients with left ventricular hypertrophy a more significant correlation was found between cardiac mass and diastolic pressure (r = 0.52), rather than systolic pressure (r = 0.33). This finding supports data indicating that cardiovascular risk is related more to diastolic pressure increments than to systolic pressure. As for blood pressure values during physical exercise, in our study they did not show a better predictivity of ventricular mass than the values at rest.

[Pulsed Doppler evaluation of left ventricular filling in stable and borderline juvenile arterial hypertension]. / Valutazione con Doppler pulsato del riempimento ventricolare sinistro nell'ipertensione arteriosa giovanile stabile e borderline.

Left ventricular hypertrophy in hypertensive patients may be associated with changes in diastolic function. To examine whether or not any alteration in left ventricular function is also present in the early phases of hypertension, left ventricular filling was studied using the echo-Doppler method in 30 young mild hypertensive patients, 40 borderline untreated hypertensives and 30 age-matched normotensive controls. Left ventricular wall thickness, left ventricular mass (Dévereux formula) and shortening fraction were measured using M-mode echocardiogram under 2D control. Trans-mitral flow was measured by pulsed-Doppler and the following parameters were derived: peak early (E) and atrial (A) diastolic flow rate, their ratio E/A, the integral of early (Ei) and atrial (Ai) diastolic flow rates and their ratio (Ei/Ai). Our data show that left ventricular mass is greater in mild hypertensive patients than in borderline and normal controls. No differences in left ventricular systolic function were found in the three groups whereas diastolic function changes were present in the hypertensive group: in particular the peak early/atrial flow rate ratio was significantly reduced compared with the other two groups. Therefore, it appears that changes in diastolic function may also be present even in the early phases of mild hypertension.

Frequency of delta+ 27-thalassaemia in Sardinians.

To determine the incidence of delta+ 27 thalassaemia in Northern Sardinia we examined blood samples from 750 Sardinian schoolboys by PCR-based molecular analysis. The incidence of delta+ 27 mutation was 1.2% in this study, i.e. twice as high as previously described on the basis of phenotypical studies; the frequency of the beta-thalassaemia is 10.5% and their interaction has been calculated at 0.0003. The majority of delta+ 27 carriers are characterized by a HbA2 level lower than 1.9% and the mean HbA2 level is significantly lower than in normal subjects. All compound heterozygotes for delta+ 27 and beta-thalassaemia show a silent beta-thalassaemic phenotype related to normalization of their HbA2 levels. This study suggests that delta+ 27 thalassaemia should be borne in mind in counselling at-risk couples in which one member has the typical high HbA2 beta-thal trait while the other shows normal or borderline HbA2 level. In these subjects, PCR-based ECO O 109 I digestion of the delta globin gene allows rapid detection of the delta+ 27 mutation.

[Morphofunctional characteristics of the left ventricle in arterial hypertension: echocardiographic and Doppler study]. / Caratteristiche morfofunzionali del ventricolo destro nell'ipertensione arteriosa: studio ecocardiografico e Doppler.

The role of arterial hypertension in the development of left ventricular hypertrophy is well documented; in contrast, the characteristics of the right ventricle in this condition are poorly defined. To investigate whether structural and functional changes of the right ventricle are associated with systemic hypertension, we studied a total of 105 patients using M-mode, 2D and pulsed-Doppler echocardiography. Of these, 31 were hypertensive patients with left ventricular hypertrophy (III), 42 were hypertensives without left ventricular hypertrophy (II) and 32 were normotensive controls (I). Right ventricular anterior wall thickness was measured from the parasternal window, in long axis. The following left and right ventricular filling parameters were evaluated using Doppler mitral and tricuspid flow analysis: the early (E) and late (A) peak velocity, the ratio E/A. Our results show that: right ventricular anterior thickness was 5.7 +/- 0.9 mm in III, 4.3 +/- 0.8 in II and 3.7 +/- 0.8 in I (p less than 0.05 II vs I, p less than 0.01 III vs II and I). There is a significant correlation between right and left ventricular wall thickness in the hypertensive population (r = 0.75, p less than 0.01). Left ventricular filling shows a progressive reduction in E and an increase in A with a progressive reduction in the E/A ratio from 1.47 in I to 1.31 in II and 0.78 in III. Similarly E/A ratio for right ventricular filling decreases from 1.70 in I, 1.32 in II and 0.92 in III.(ABSTRACT TRUNCATED AT 250 WORDS)

Substance use among high-school students: relationships with temperament, personality traits, and parental care perception.

Alcohol use, "alcohol abuse," and illicit drug use were investigated in a representative sample of 1076 urban, northern Italian high school students aged 14 to 19 years in 2001. In addition to questions on substance use, the participants were asked about school achievements and perceived substance use among friends. All the students were submitted to Zuckerman Sensation Seeking Scale (SSS) scale, Eysenck Personality Questionnaire (EPQ), Buss-Durkee Hostility Inventory (BDHI), and Parental Bonding Instrument (PBI). Lifetime alcohol use was found in 80.5%, "alcohol abuse" in 37.7%, cannabis use in 26.2%, ecstasy in 2.8%, heroin in 3.8%, and cocaine in 8.3% of the students: gender differences were significant for alcohol use, "alcohol abuse" and ecstasy use, with male subjects outnumbering females, but not for reported cannabis, heroin, and cocaine use. Early substance use onset among adolescents aged 14-16 years was detected. Higher sensation seeking on SSS, social coping impairment on EPQ, direct aggressiveness on BDHI, poor school achievements, and lower parental care on PBI were found associated with illicit drug use and "alcohol abuse" (multiple drugs users). Increased levels of aggressiveness and sensation seeking were evidenced both in minimal experimenters (ME) and habitual users (HU), without any significant difference, in comparison with abstinent students. Similarly, ME scored higher than abstinent subjects on EPQ for social coping impairment, but lower than HU. Parental care perception was lower in HU, but not in ME with, respect to abstinent subjects. Pearson inverse correlation was demonstrated between PBI scores and EPQ maladaptation and BDHI aggressiveness. Data from this preliminary pilot study suggest that temperamental traits and personality changes may be associated to early substance use "proneness" and reduced perception of parental care.