[Hypertensive female patients often undertreated or treated too late. Therapy of hypertension needs women's initiative]. / Hypertonikerinnen oft unzureichend oder zu spät behandelt. Die Hochdrucktherapie braucht eine Frauenbewegung.

Both the cardiovascular risk profile and the incidence of arterial hypertension are known to show gender-specific differences. In postmenopausal women, the cardiovascular risk is clearly elevated. At particular risk are women with diabetes mellitus, overweight and hypertriglyceridemia. In numerous clinical studies on the treatment of arterial hypertension, however, the percentage of women involved is small, and not representative. Furthermore, studies on the confirmation of the diagnosis and treatment show that treatment of hypertension in female patients has often been less effective and less rigorously applied than in men. At the same time, it is known that the success of rigorous risk reduction is independent of gender.

Assessment of left mammary artery grafts (LIMA) to left anterior descending artery (LAD) after off-pump coronary artery bypass grafting by color Doppler.

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) on a beating heart with a LIMA graft to the LAD is established for patients with one vessel disease. The aim of the study was to assess the LIMA patency noninvasive by transcutaneous duplex ultrasound. METHODS: 25 patients (16 male, 9 female, mean age 58+/-13 yr) with LIMA grafts to LAD by OPCAB procedures were studied 7-20 days after surgery. Doppler velocity parameters were measured by use of a 7 MHz transducer placed in left intercostal space. The conventional coronary angiographies performed showed the LIMA graft patent. RESULTS: In all cases a typical biphasic pattern of blood flow was recorded with forward flow in both systole and diastole respectively. Under basal conditions the mean peak velocities in systole were 0.36 m/s and the mean peak velocities in diastole were 0.27 m/s with a mean systolic/diastolic ratio of 1.33. CONCLUSION: Transcutaneous Doppler ultrasound is useful in the detection of the LIMA graft flow. This non-invasive technique may find applications for routine postoperative follow-up of patients with LIMA grafts.

Changes in antihypertensive therapy--the role of adverse effects and compliance.

In a German multicentre study (1603 patients, 320 private practices), adverse effects and patient compliance during antihypertensive therapy were investigated using standardized questionnaires for both patient and physician. Patients with a change in antihypertensive therapy during the last six months were included in this study. The single most important reason for the change in therapy was inadequate blood pressure control (48.4%), followed by adverse effects (30.1%), patient dissatisfaction (20.0%), non-compliance (16.8%) and cost (4.9%). The most frequent adverse effects noted by the doctors were cough (51.9%), oedema (36.9%), flush (36.6) and dizziness (27.8%). In comparing the answers of the physicians and patients, it becomes obvious that compliance may be overestimated by the doctors (good: 41.7%; medium: 57.3%; bad: 1.0%), since only 32.3% of the patients stated that they never missed a dose, 54.8% were occasionally non-compliant and 12.9% admitted missing a dose frequently. The predominant reasons for non-compliance (assessed by the patients) were forgetfulness (40.4%), followed by adverse effects (9.6%) and irregular lifestyle (6.5%). Thus, lack of effectiveness and adverse effects/patient dissatisfaction/non-compliance contributed roughly equally to the decision to change therapy. In addition, forgetfulness was shown to be an important contributor to suboptimal compliance. Lastly, physicians may still underestimate the extent of non-compliance.

[Advantages of 24-hour ambulatory blood pressure monitoring for the assessment of dose-effect relations and dose-equivalency]. / Vorteile des Einsatzes der ambulanten 24-Std.-Blutdruckmessung zur Ermittlung von Dosis-Wirkungs-Beziehungen und Aquivalenzdosierungen.

Because of the high variability of blood-pressure, clinical studies using casual measurements require rather large numbers of patients for assessment of pharmacologic efficacy. By the use of blood-pressure monitoring over 24 hours this number can be dramatically reduced. Additional benefits are the precise determination of dose-effect relationships and the more accurate estimate of the response-rate. Comparing two retarded galenic forms of Verapamil we show that even dose-equivalence can be studied with this type of blood-pressure recording.

Non-invasive assessment of right and left ventricular volumes 11 to 24 years after corrective surgery on patients with tetralogy of Fallot.

Patients who had corrective surgery for tetralogy of Fallot using a transannular right ventricular outflow tract (TRVOT) patch showed a higher risk of post-operative mortality and reoperation in the long-term follow-up. A total of 642 patients were operated upon for tetralogy of Fallot between 1952 and 1982. Twenty-six patients who survived for more than 10 years were selected for this study. Fifteen randomly selected patients (group 1) without outflow tract patch were compared with 11 patients (group 2) where a transannular right ventricular outflow patch had been used. Right and left ventricular volumes were assessed using combined first-pass and equilibrium radionuclide ventriculography. After administration of 25 mCi of 99mTc-pertechnetate, data were acquired with a gamma camera with a large viewing field and the patient at rest and during exercise. The patients in group 1 were able to manage a workload of 65 +/- 24 W on the bicycle ergometer while the patients in group 2 could only reach a mean maximum of 34 +/- 12 W. Right ventricular end-diastolic volume (RV-EDV) at rest was 198 +/- 67 ml in group 1 and 224 +/- 69 ml in group 2. During exercise, RV-EDV was increased to 218 +/- 75 ml in group 1 (P less than 0.01) and to 246 +/- 79 ml in group 2. Right ventricular end-systolic volumes did not change significantly during exercise. In group 1, the left ventricular (LV) volumes were comparable to the normal; in group 2, LV-EDV was diminished at rest and during the stress test.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of intracellular sodium and calcium in essential hypertension during diuretic treatment.

In 87 essential hypertensive patients, torasemide (1- isopropyl-3-([4-(3-methyl-phenylalmino)pyridine]-3-sulfonyl)urea), a new long-acting high-ceiling diuretic, was applied for 6 months in order to assess its effects on blood pressure and intracellular electrolytes. In a randomized trial 42 patients received 2.5 mg and 45 patients 5 mg torasemide once daily. In all patients, diastolic blood pressure was greater than 100 mm Hg before treatment. Blood pressure normalisation (diastolic blood pressure greater than or equal to 90 mmHg) was observed in 21 out of 42 patients receiving 2.5 mg torasemide daily and in 26 out of 42 patients with 5 mg torasemide throughout the study. In both groups doubling of the dosage was performed in these patients who had an insufficient blood pressure control after 4 weeks. In the majority of these non-responders blood pressure normalisation was achieved during the higher dosages. In the total group of patients there was an elevation of the intracellular sodium and a decrease of the intracellular calcium, measured with the ion-selective electrode in red blood cells. It could be shown that the decrease in blood pressure induced by torasemide was accompanied by a decrease of intracellular Ca2+, thus supporting the hypothesis that intracellular free Ca2+ is an important regulator of vascular tone in essential hypertension.

[Computer-assisted assessment of the 24-hour blood pressure profile in essential and secondary hypertensive patients]. / Computergestützte Auswertung von 24-Stunden-Blutdruckprofilen bei essentiellen und sekundären Hypertonikern.

In 17 essential hypertensives, 13 secondary hypertensives and 9 normotensives, noninvasive 24 h blood pressure monitoring was performed. By a computer-aided evaluation according to the Cosinor method, circadian periodicity was quantified and expressed as a coefficient of periodicity in %. This coefficient for systolic pressure was higher in essential hypertensives and normotensives than in secondary hypertensives (42.9 +/- 18.0 et 43.0 +/- 16.7 versus 28.2 +/- 17.7; p less than 0.05). The circadian periodicity of diastolic pressure showed no significant differences. Despite the large overlap, coefficients of periodicity below 20% for systolic pressure may suggest secondary hypertension.

Prescription patterns and costs of antihypertensive drugs in two outpatient clinics: Zürich (Switzerland) and Münster (FRG), 1975-1985.

In the present study the prescription patterns and cost of antihypertensive drugs in two outpatient clinics located in two different countries (Zürich, Switzerland, and Münster, FRG), were analyzed from 1975 till 1985 by using representative random samples of hypertensive outpatients. Throughout the observed period the leading positions were held by diuretics and beta-blockers, whereas central sympatholytics and ganglion blockers nearly disappeared. A rapid increase in the use of calcium antagonists occurred within the last 2 analyzed years. Drugs in fixed combination containing reserpin showed a constant decrease during the observed period, whereas beta-blocker-containing combination drugs increased in both clinics. The comparison between the two clinics revealed only minor differences in the prescription pattern of the various known classes of antihypertensive drugs. However, marked differences were observed within given classes between the preferred products. Both in Zürich and Münster the mean annual drug cost per patient doubled from 1975 to 1985. Especially during the last few years these changes took place with a remarkable rapidity, obviously the result of a more intense promotion of new antihypertensive drugs.

Ca2+ metabolism in arteries of spontaneously hypertensive rats: assessment by proton-induced X-ray emission.

Changes of intracellular Ca2+-metabolism have been considered to be of importance for the pathogenesis of essential hypertension. In the present study particle-induced X-ray emission (PIXE) was used to get information on the spatial distribution of Ca2+ in aortas and renal arteries of spontaneously hypertensive (SHR) and normotensive rats. Our findings demonstrate a significant Ca2+ elevation in the aorta and renal artery of SHR versus normotensive Wistar-Kyoto (WKY) rats (3317 +/- 734 micrograms Ca2+/g tissue versus 1623 +/- 569 micrograms Ca2+/g tissue and 3432 +/- 1867 micrograms Ca2+/g tissue versus 1050 +/- 554 micrograms Ca2+/g tissue).

Assessment of magnesium and aluminum in erythrocytes by the laser microprobe mass analyzer (LAMMA).

The erythrocyte magnesium content was determined using two different analytical systems (atomic absorption spectrometry and the laser microprobe mass analyzer) with specimens from 18 patients with normal renal function and from 10 patients with chronic renal insufficiency. There was a good correlation (r = 0.73) between the two analytical systems. Additionally, the laser microprobe mass analyzer was used to determine the aluminum content of plasma and erythrocytes in specimens from patients who ingested moderate quantities of aluminum hydroxide for several months. Results showed a significant elevation of the plasma aluminum concentration, but a normal erythrocyte aluminum content. The laser microprobe mass analyzer may be useful in studies of mineral metabolism in humans.