Harmful alcohol use among acutely ill hospitalized medical patients in Oslo and Moscow: A cross-sectional study.

BACKGROUND: The aim was to estimate the prevalence of harmful alcohol use in relation to socio-demographic characteristics among acutely ill medical patients, and examine identification measures of alcohol use, including the alcohol biomarker phosphatidylethanol 16:0/18:1 (PEth). METHODS: A cross-sectional study, lasting one year at one hospital in Oslo, Norway and one in Moscow, Russia recruiting acute medically ill patients (≥ 18 years), able to give informed consent. Self-reported data on socio-demographics, mental distress (Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4 (AUDIT-4) and alcohol consumption past 24 h were collected. PEth and alcohol concentration were measured in whole blood. RESULTS: Of 5883 participating patients, 19.2% in Moscow and 21.1% in Oslo were harmful alcohol users, measured by AUDIT-4, while the prevalence of PEth-positive patients was lower: 11.4% in Oslo, 14.3% in Moscow. Men in Moscow were more likely to be harmful users by AUDIT-4 and PEth compared to men in Oslo, except of those being ≥ 71 years. Women in Oslo were more likely to be harmful users compared to those in Moscow by AUDIT-4, but not by PEth for those aged < 61 years. CONCLUSIONS: The prevalence of harmful alcohol use was high at both study sites. The prevalence of harmful alcohol use was lower when assessed by PEth compared to AUDIT-4. Thus, self-reporting was the most sensitive measure in revealing harmful alcohol use among all groups except for women in Moscow. Hence, screening and identification with objective biomarkers and self-reporting might be a method for early intervention.

Autonomic function in hypertensive and normotensive subjects: the importance of gender.

Baroreceptor reflex sensitivity (BRS) has been found lower and heart rate variability (HRV) parasympathetic markers have been found higher in healthy women than in healthy men. Thus, in the present study we hypothesized gender differences in the autonomic function among hypertensive subjects. Forty-one hypertensive patients and 34 normotensive subjects, age 53+/-1 years, were examined. Four weeks after cessation of antihypertensive therapy, HRV was assessed in 24-hour Holter ECGs, and BRS was calculated with the transfer technique. A t test was performed after log transformation of spectral values. Resting blood pressure and heart rate in the hypertensive and the normotensive groups were 150+/-2/100+/-1 (mean+/-SEM) and 121+/-2/81+/-1 mm Hg, respectively, and 68+/-1 and 60+/-1 bpm, respectively (P<0.0005). Compared with normotensive controls, hypertensive patients had lower total power (1224+/-116 versus 1797+/-241 ms(2); P=0.03), lower low frequency power (550+/-57 versus 813+/-115 ms(2); P=0.04), lower high frequency power (141+/-23 versus 215+/-38 ms(2); P=0.06), lower root mean square successive difference (28.7+/-2.7 versus 35.7+/-3.0 ms; P=0.03), and PNN50 (4.9+/-0.6% versus 9.8+/-1.5%; P=0.003). BRS was also lower in the hypertensive subjects (7.6+/-0.6 versus 10.4+/-0.8 ms/mm Hg; P=0.005). When comparing the same parameters between normotensive subjects and hypertensive subjects within the same gender group, we found significant reduction (P<0.05) only within the female group. The difference in BRS within the female group was twice that within the male group. Stepwise multiple regression analysis revealed gender, age, HDL cholesterol, and blood pressure as independent explanatory variables of BRS and HRV. Our results suggest that gender is an important determinant of BRS and HRV. Autonomic function parameters were especially impaired in hypertensive women compared with hypertensive men.

Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics.

The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multi-centre, prospective, randomized, double-blind, parallel-group study. The primary objective of SCOPE is to assess the effect of the angiotensin II type 1 (AT1) receptor blocker, candesartan cilexetil 8-16 mg once daily, on major cardiovascular events in elderly patients (70-89 years of age) with mild hypertension (DBP 90-99 and/or SBP 160-179 mmHg). The secondary objectives of the study are to test the hypothesis that antihypertensive therapy can prevent cognitive decline (as measured by the Mini Mental State Examination, MMSE) and dementia, and to assess the effect of therapy on total mortality, myocardial infarction (MI), stroke, renal function, and hospitalization. A total of 4964 patients from 15 participating countries were recruited during the randomization phase of SCOPE, exceeding the target population of 4000. The mean age of the patients at enrolment was 76 years, the ratio of male to female patients was approximately 1:2, and 52% of patients were already being treated with an antihypertensive agent at enrolment. The majority of patients (88%) were educated to at least primary school level. At randomization, mean sitting blood pressure values were SBP 166 mmHg and DBP 90 mmHg, and the mean MMSE score was 28. Previous cardiovascular disease in the study population included myocardial infarction (4%), stroke (4%) and atrial fibrillation (4%). Men, more often than women, had a history of previous MI, stroke and atrial fibrillation. A greater percentage of men were smokers (13% vs 6% in women) and had attended university (11% vs 3% of women). Of the randomized patients, 21% were 80 years of age. In this age group smoking was less common (4% vs 10% for 70-79-year-olds) and fewer had attended university (4% vs 7% for 70-79-year-olds). The incidence of MI was similar in both age groups. However, stroke and atrial fibrillation had occurred approximately twice as frequently in the older patients. The patients' mean age at baseline was similar in the participating countries, and most countries showed the approximate 1:2 ratio for male to female patients. There was also little inter-country variation in terms of mean SBP, DBP or MMSE score. However, there was considerable regional variation in the percentage of patients on therapy prior to enrolment.

Study on COgnition and Prognosis in the Elderly (SCOPE).

The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multicentre, prospective, randomized, double-blind, parallel-group study designed to compare the effects of candesartan cilexetil and placebo in elderly patients with mild hypertension. The primary objective of the study is to assess the effect of candesartan cilexetil on major cardiovascular events. The secondary objectives of the study are to assess the effect of candesartan cilexetil on cognitive function and on total mortality, cardiovascular mortality, myocardial infarction, stroke, renal function, hospitalization, quality of life and health economics. Male and female patients aged between 70 and 89 years, with a sitting systolic blood pressure (SBP) of 160-179 mmHg and/or diastolic blood pressure (DBP) of 90-99 mmHg, and a Mini-Mental State Examination (MMSE) score of 24 or above, are eligible for the study. The overall target study population is 4000 patients, at least 1000 of whom are also to be assessed for quality of life and health economics data. After an open run-in period lasting 1-3 months, during which patients are assessed for eligibility and those who are already on antihypertensive therapy at enrolment are switched to hydrochlorothiazide 12.5 mg o.d., patients are randomized to receive either candesartan cilexetil 8 mg once daily (o.d.) or matching placebo o.d. At subsequent study visits, if SBP remains >160 mmHg, or has decreased by <10 mmHg since the randomization visit, or DBP is >85 mmHg, study treatment is doubled to candesartan cilexetil 16 mg o.d. or two placebo tablets o.d. Recruitment was completed in January 1999. At that time 4964 patients had been randomized. All randomized patients will be followed for an additional 2 years. If the event rate is lower than anticipated, the follow-up will be prolonged.

Relationship between insulin sensitivity and maximal forearm blood flow in young men.

Insulin resistance is a part of the metabolic cardiovascular syndrome. We aimed to test the hemodynamic hypothesis of insulin resistance, which suggests that a decreased skeletal muscle blood supply with subsequent reduced nutritional flow causes insulin resistance in skeletal muscle. We assessed determinants of peripheral blood flow such as maximal forearm blood flow (MFBF), minimal forearm vascular resistance (MFVR), and whole blood viscosity (WBV) in 27 young men with borderline elevation of blood pressure. Insulin sensitivity measured as glucose disposal rate (GDR) correlated with MFBF (r=0.55, P=0.003), MFVR (r=-0.58, P=0. 002), and WBV (r=-0.39, P=0.046 at shear rate 201 s-1). There was no correlation between GDR and myocardial thickness or left ventricular mass. In a stepwise multiple regression analysis, MFVR and WBV explained 54% of the variation in GDR. The relative increase in mean arterial blood pressure during a mental stress test, as a marker of reactivity or an alert reaction, was correlated with MFVR (r=0.56, P=0.002) and inversely with GDR (r=-0.45, P=0.018) and MFBF (r=-0.49, P=0.01) but not with cardiac dimensions. In a stepwise multiple regression analysis, 48% of the increase in blood pressure during a mental stress test was explained by MFVR and WBV. Fasting insulin correlated with MFVR (r=0.41, P=0.036) and GDR (r=-0.62, P=0.001). These data show a positive association between the appearance of peripheral structural vascular changes as quantified through a hemodynamic technique and insulin resistance in young men with borderline elevation of blood pressure. The cause-effect relationship of this finding needs further evaluations.

[Gamma-hydroxybutyrate--an endogenous substance and an intoxicant]. / Gammahydroksybutyrat--endogen substans og rusmiddel.

Gamma-hydroxybutyrate (GHB), a compound found in the mammalian brain, meets many criteria of a neurotransmitter. Experimentally, GHB has been used as a model for petit mal epilepsy; clinically it has been used as a general anaesthetic, to treat certain sleep disorders and alcoholism. Lately GHB has been abused for its euphoric, sedative and anabolic effects. Coma and seizures following abuse of GHB have been reported, but dependency has received little attention. Adverse effects of GHB include seizure activity and a withdrawal syndrome characterised by insomnia, anxiety and tremor. The present paper reviews the neuropharmacology, potential therapeutic uses and acute adverse effects of GHB, together with a presentation of three cases.

[Ecstasy--cool dope with long-lasting effects?]. / Ecstasy--kult dop med senfølger?

The amphetamine derivative MDMA (3,4-methylenedioxymethamphetamine) was first synthesised in 1914 as an appetite suppressant, but was never used as such. MDMA is commonly known as "ecstasy" and has become a popular recreational drug of abuse at dance-clubs and rave parties, where it is combined with all-night dancing, crowded conditions, poor hydration and loud sound. This combination is probably the main reason why we have seen an upsurge in toxicity problems at rave parties, since all these factors are thought to promote or increase the toxicity of MDMA. The desired effects of MDMA are euphoria, increased energy and enhanced communication with others. Adverse effects are hyperthermia, rhabdomyolysis, acute renal failure, hepatotoxicity, depression and psychosis.

Whole blood viscosity, blood pressure and cardiovascular risk factors in healthy blood donors.

Whole blood viscosity contributes to the total peripheral resistance and has been suggested to be a risk factor for cardiovascular disease. Whole blood viscosity was measured using a direct technique in 105 healthy blood donors and in addition to establishing our reference values, the relationship to blood pressure and other cardiovascular risk factors was assessed. Whole blood viscosity correlated with systolic blood pressure (r = 0.29, p = 0.003), cholesterol (r = 0.21, p = 0.034), cholesterol/HDL cholesterol ratio (r = 0.33, p = 0.01), triglycerides (r = 0.37, p < 0.0005), body mass index (r = 0.29, p = 0.003) and waist-hip ratio (r = 0.30, p = 0.002). Subjects with systolic blood pressure > 130 mmHg (n = 16) had higher whole blood viscosity (p = 0.017) than those with lower blood pressure. Whole blood viscosity was significantly lower in women (n = 52) than in men at all shear rates (0.045 > p > 0.001). These results suggest that even in a population of healthy normotensive blood donors of a wide age range and either gender, there are positive correlations between directly assessed whole blood viscosity and a number of the components of the metabolic cardiovascular syndrome including systolic blood pressure, weight and blood lipids.

Insulin sensitivity relates to other cardiovascular risk factors in young men: validation of some modifications of the hyperinsulinaemic, isoglycaemic glucose clamp technique.

Reduced peripheral sensitivity to insulin-stimulated glucose disposal, insulin resistance, is considered to be central in the metabolic cardiovascular syndrome. The hyperinsulinaemic euglycaemic glucose clamp technique was introduced by DeFronzo in 1979 and is regarded as the reference method for quantifying insulin resistance in skeletal muscle tissue. Recently, we used this technique in young men to relate insulin resistance (inverse of insulin sensitivity) to a number of established cardiovascular risk factors. The method has undergone numerous modifications since 1979 which have not been extensively validated. Therefore, we now describe the modified hyperinsulinaemic, isoglycaemic glucose clamp procedure performed in our laboratory and validate some of the modifications. Five young/middle-aged men were examined twice in three weeks and then re-examined after 4 years in the same way. The intrasubject day-to-day variability in insulin sensitivity was 5%. The average reduction in insulin sensitivity after 4 years was 21%. The last 60 min of the clamp offered a better basis for calculating glucose disposal rate (GDR) than the last 20 min. The variation in glucose measurements during clamp was 5%. We thus found that our modified isoglycaemic hyperinsulinaemic glucose clamp technique for assessing insulin sensitivity in skeletal muscle tissue is accurate and reproducible when performed in young/middle-aged men.

The glucose clamp procedure activates the sympathetic nervous system even in the absence of hyperinsulinemia.

There is a well established connection between hyperinsulinemia and hypertension, and activation of the sympathetic nervous system (SNS) by insulin has been proposed as one mechanism. In short term infusion studies, hyperinsulinemia during the euglycemic glucose clamp examination is associated with increased norepinephrine concentration. However, many of the studies lack sufficient control groups. The euglycemic glucose clamp examination could possibly, by discomfort from iv cannulas, the use of heating cuffs, and prolonged immobilization, by itself increase SNS activity. To examine this, we included nine controls, who had saline instead of glucose and insulin infused iv, among other healthy young men (n = 50) who underwent the euglycemic hyperinsulinemic glucose clamp. During hyperinsulinemic clamp, the plasma norepinephrine concentration increased from 0.87 +/- 0.06 to 1.06 +/- 0.05 nmol/L; in the control study, it increased from 0.99 +/- 0.14 to 1.21 +/- 0.11 nmol/L, a significant treatment effect (P < 0.001, by repeated measures analysis of variance), but no group x treatment effect (P = 0.17), i.e. there was no difference between the groups. There were no significant changes in systolic or diastolic blood pressure, heart rate, or plasma epinephrine concentration during the clamps, nor any differences between the groups. We conclude that the increase in plasma norepinephrine concentration observed during an euglycemic glucose clamp examination may be attributed to the procedure itself, and that the inclusion of a control group is mandatory when assessing SNS activity.

Effects of losartan on insulin sensitivity in severe hypertension: connections through sympathetic nervous system activity?

Angiotensin II (Ang II) is one of the most potent vasoconstrictors, and the first specific and orally available Ang II-receptor antagonist, losartan (MK-954, DuP-753), has now come into clinical use. The primary site of insulin resistance, as measured by the glucose clamp technique, is skeletal muscle. Losartan specifically blocks Ang II-induced vasoconstriction, namely causes vasodilation, and may thus increase glucose delivery to skeletal muscle. We used the euglycaemic hyper-insulinaemic glucose clamp technique to assess insulin sensitivity (glucose disposal rate, GDR) or insulin (I) sensitivity index (GDR/I). In 21-year-old men we found negative correlations between GDR/I and blood viscosity (r = -0.69), haematocrit (r = -0.65), fibrinogen (r = -0.50), cholesterol/HDL ratio (r = -0.45), triglycerides (r = -0.46), body mass index (r = -0.64), waist/hip ratio (r = -0.57), resting heart rate (r = -0.46) and diastolic blood pressure (DBP) (r = -0.43), and with DBP (r = -0.62) and plasma adrenaline (r = -0.36) during mental arithmetic stress. In the Losartan Severe Hypertension Study five patients with a record of DBP > or = 115 mm Hg were examined before and on losartan monotherapy for an average of 6 weeks. GDR increased 27% and plasma noradrenaline decreased 40% (P < 0.05 for both) during treatment with losartan. Calculated whole blood viscosity decreased on losartan (P = 0.04) and the changes in GDR correlated with the changes in viscosity (r = 0.89). These results suggest that losartan, possibly by a sympathicolytic effect, lowers blood viscosity, causes vasodilation, and improves insulin sensitivity in essential hypertension.

Mental stress increases glucose uptake during hyperinsulinemia: associations with sympathetic and cardiovascular responsiveness.

Infusion of epinephrine and norepinephrine reduces insulin-mediated glucose disposal, ie, induces insulin resistance. Mental stress increases concentrations of both plasma catecholamines. However, the effect of acute mental stress on insulin-mediated glucose uptake has not been examined. We observed in pilot studies that a mental stress test (MST) during a euglycemic glucose clamp decreased blood glucose concentration. In a prospective study, euglycemic hyperinsulinemia was established during 120 minutes of glucose clamping; the subjects (N = 74) then underwent 5 minutes of intense mental arithmetics with infusion rates of glucose and insulin kept constant. During MST, plasma epinephrine and norepinephrine increased (by 0.23 +/- 0.02 and 0.50 +/- 0.05 nmol/L) together with blood pressure ([BP] by 18 +/- 8/9 +/- 1 mm Hg) and heart rate ([HR] by 21 +/- 1 beats per minute), with P less than .0001 for all changes. During mental stress, blood glucose concentration decreased by 0.4 +/- 0.1 mmol/L (P < .0001), followed by full recovery after another 10 minutes. Serum insulin was unchanged, indicating an acute but transient increase in glucose uptake. This finding was unrelated to age, sex, body mass, and BP status. Fifty-nine subjects with a decrease in glucose concentrations during MST were characterized by accentuated epinephrine response to MST (a change of 0.25 +/- 0.03 v 0.12 +/- 0.02 nmol/L, P = .001), increase in systolic BP (by 20 +/- 2 v 10 +/- 3 mm Hg, P = .008), and increase in HR (by 23 +/- 2 v 15 +/- 2 beats per minute, P = .008) as compared with 15 subjects with unchanged/increased glucose concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Insulin resistance and sympathetic nervous system activity in hypertensive and normotensive premenopausal women.

The aim of the present study was to compare insulin sensitivity and catecholamine responses to insulin in lean, hypertensive (HT) and normotensive (NT) premenopausal women. HT (BP 149 5/99 +/- 2 mmHg, n = 14) and NT (BP 128 +/- 4/81 +/- 2 mmHg, n = 12) were matched for age (46 +/- 1 vs. 47 +/- 1 years) and body mass index. Insulin sensitivity was determined by fasting serum insulin, glucose disposal rate (GDR) and insulin sensitivity index (GDR/I) using euglycemic hyperinsulinemic glucose clamp technique. Sympathetic nervous system activity was assessed by plasma adrenaline and noradrenaline in arterialized venous blood at baseline and during euglycemic hyperinsulinemic glucose clamp. Insulin sensitivity index correlated negatively with total cholesterol in HT (r = -0.57, p < 0.05) and with body mass index (r = -0.42, p < 0.05, n = 26). The response in catecholamines to euglycemic hyperinsulinemia in HT differed from NT with an increase both in noradrenaline and adrenaline. Blood pressure and heart rate responses, however, did not differ between HT and NT. Fasting serum glucose did not differ between the two groups (4.7 +/- 0.1 mmol/l in HT vs. 4.9 +/- 0.1 mmol/l in NT), nor did fasting serum insulin (16 2 mU/l vs. 13 mU/l). Glucose disposal rate (8.8 +/- 0.5 vs. 8.7 +/- 0.7 mg kg-1 body weight min-1) and insulin sensitivity index were similar (7.3 +/- 0.8 vs. 7.6 +/- 0.8 arbitrary units). We conclude that in lean, premenopausal hypertensive women insulin sensitivity is not reduced compared with age- and weight-matched normotensive women, but the hypertensives respond to hyperinsulinemia with increased plasma catecholamines, i.e. sympathetic nervous systemic activity. Also, insulin sensitivity correlates negatively with serum cholesterol. Thus, an insulin-hyperadrenergic interaction may possibly be involved as a pathogenetic factor in lean hypertensive women.

Relationship between hemorheological factors and insulin sensitivity in normotensive and hypertensive premenopausal women.

The present study aimed at testing a possible relationship between hemorheologic factors such as hematocrit and whole blood viscosity, and insulin sensitivity in premenopausal, hypertensive (HT), and normotensive (NT) women. Fourteen HT and 12 NT women were studied with the hyperinsulinemic euglycemic glucose clamp technique. Insulin sensitivity was similar in NT and HT (8.7 +/- 0.8 v 7.6 +/- 0.8 arbitrary units). Whole blood viscosity did not differ between the two groups at any shear rate (shear rate 5.2 sec-1: 7.5 +/- 0.4 in NT and 8.0 +/- 0.3 in HT, P = NS). Statistically significant negative correlations were observed between the insulin sensitivity index and calculated whole blood viscosity at both high (r = -0.49, P < .01) and low shear rates (r = -0.50, P < .01, n = 26). Insulin sensitivity index was also negatively correlated to body mass index in the combined groups (r = -0.40, P = .04), and to both systolic and diastolic blood pressure (r = -0.44, P = .02 and r = -0.38, P = .05, respectively). In multiple regression analysis, whole blood viscosity, body mass index, systolic, and diastolic blood pressure accounted for 39% of the variation in insulin sensitivity index, but only whole blood viscosity was an independent explanatory variable for the insulin sensitivity index. These results suggest hemorheologic, and therefore indirectly hemodynamic factors as correlates to insulin sensitivity.

Insulin sensitivity, sympathetic activity, and cardiovascular reactivity in young men.

The present study was undertaken to examine the relationships between insulin sensitivity, blood pressure (BP), and cardiovascular reactivity, and to assess sympathetic nervous system influence. Insulin sensitivity (GDR/I; euglycemic glucose clamp technique) was related to BP and heart rate (HR) in different situations in 40 healthy young men: in the laboratory, during a mental arithmetic stress test, and during baseline conditions at home. GDR/I correlated with supine diastolic BP in the laboratory and with maximum diastolic BP during mental stress (r = -0.46, P = .003; r = -0.62, P = .0001, respectively), but not so strongly with diastolic BP measured at home (r = -0.29, P = .09). Diastolic BP during stress and body mass index were the only independent explanatory variables of GDR/I in multiple regression analysis (multiple R = 0.71, R2 = 0.50, P < .0001). GDR/I and systolic BP were not significantly correlated at any time. GDR/I correlated negatively with HR in the laboratory and with maximum HR during mental stress, but not with HR at home. Maximum plasma epinephrine during stress correlated with stress BP and HR (r = 0.53, P = .001; r = 0.70, P < .0001, respectively) and negatively with GDR/I (r = -0.36, P < .05). In the present study, GDR/I is related to diastolic but not to systolic BP, and more closely correlated to diastolic BP and HR measured during mental stress than to diastolic BP and HR during baseline conditions at home.(ABSTRACT TRUNCATED AT 250 WORDS)

[Time utilization in the preparation of medical records]. / Tidsbruk ved journalopptak.

The time available for preparing a medical record may be of importance for the resulting quality. We studied the records of 166 patients admitted to a medical department during a fortnight. 24 doctors registered the time spent on history taking, clinical examination and emergency treatment, paper work and other patient-associated tasks. The doctors received a mean of seven patients each, spending a mean of 53 (range 20-120) minutes in all. The mean time spent on clinical examination was 27 minutes, on paper work 18 minutes and on other tasks 11 minutes. Time of the day or age of the patient did not influence the time spent on the tasks. Only rarely (7%) did the doctor experience shortage of time.

[The medical record--content, interpretation and quality. Study of 100 medical records from a department of internal medicine]. / Journalen--innhold, forventning og kvalitet. En studie av 100 indremedisinske innkomstjournaler.

An evaluation of the primary medical records of 100 patients admitted to a medical department showed that several elements in the journal often had been left out. Therefore all doctors working in the department were asked for their opinion of the necessity for each of the elements in a journal. A comparison of these doctors' opinions with our registrations indicated that the actual "shortening" of the journals was probably a result of choice rather than mere chance. Despite a considerable amount of work trying to establish relevant criteria, we did not succeed in developing a reliable method for measuring the quality of the medical record. The journals recorded at night were significantly shorter than those recorded during the day. A follow-up note (or discharge of the patient within one day), was found in 80% of the journals. Quality standards of the medical record are lacking and should be developed.

A double-blind study of psychosocial factors in 40-year-old women with essential hypertension.

Most studies on essential hypertension have been performed in men. The aim of the present study was to describe psychosocial characteristics of 40-year-old women with never-treated essential hypertension. Psychosocial factors like childhood traumas, economy and education were studied, and psychological assessments of irritability, hostility, 'John Henryism' and type A behavior pattern carried out. Hypertensive premenopausal women (n = 29) were compared with healthy, age-matched, normotensive women (n = 18). Neither the women nor the examining physicians were aware of the subjects' blood pressure status, and the setting, thus, was double-blind. All women were investigated in the same phase of the menstrual cycle, and in a random order. The hypertensives' parents more often had hypotension than the normotensives'. The psychiatrist who conducted the interviews correctly classified the majority of subjects as either hypertensive or normotensive. Alexithymia and difficulties in coping with aggression were more prevalent among the hypertensives. Hypertensive and normotensive women did not differ in most of the psychosocial factors previously found to differ between hypertensive and normotensive men. Our data may imply that psychosocial as well as genetic factors may contribute differently to the etiology of essential hypertension in women than in men.

Relationship between hemorrheologic factors and insulin sensitivity in healthy young men.

The present study aimed at testing a possible relationship between hemorrheologic factors, such as hematocrit, fibrinogen, and whole-blood viscosity, and insulin sensitivity in healthy humans. Twenty-one 21-year-old men were studied with the hyperinsulinemic euglycemic glucose clamp technique. We found statistically significant negative correlations between the glucose disposal rate (GDR) and calculated whole-blood viscosity at both high (r = -.55, P = .01) and low (r = -.51, P = .01) shear rates. We observed negative associations between GDR and fibrinogen (r = -.66, P = .002), GDR and hematocrit (r = -.63, P = .002), GDR and body mass index (r = -.51, P = .007), and GDR and resting heart rate (r = -.46, P = .04). Using stepwise multiple regression considering whole-blood viscosity, body mass index, mean arterial blood pressure, and heart rate as independent variables, we found that only whole-blood viscosity and body mass index were independent explanatory variables of the GDR. Together they accounted for 63% of the variability in the GDR in our subjects. These results suggest hemorrheologic, and therefore indirectly hemodynamic, factors as correlates to insulin sensitivity.