RESUMEN
Recent epidemiological studies have shown a J-shaped association between the risk of stroke and systolic blood pressure (SBP) levels in people with chronic kidney disease (CKD). The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized, placebo-controlled trial demonstrating that perindopril-based blood pressure (BP) lowering reduced the risk of stroke in 6105 participants with prior cerebrovascular disease. We estimated the effects of therapy on the risk of recurrent stroke in 1757 of these participants with stage 3 or greater CKD according to baseline BP and the relationship between achieved follow-up BP and the risk of stroke. Active therapy produced comparable and significant reductions in the risk of stroke across all baseline SBP levels. The age- and gender-adjusted incidence of stroke increased significantly in a log-linear relationship for achieved SBP levels and strokes per 1000 person-years. This association persisted after adjusting for potential confounding factors. We found that perindopril-based BP lowering effectively prevented recurrent stroke in people with CKD, across a wide range of BP levels, without evidence of an increased risk of stroke in people with low BP levels.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Perindopril/uso terapéutico , Insuficiencia Renal Crónica/complicaciones , Accidente Cerebrovascular/prevención & control , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perindopril/farmacología , Medición de Riesgo , Prevención Secundaria , Accidente Cerebrovascular/complicacionesRESUMEN
Larger variability of office blood pressure (BP) was reportedly associated with a higher risk of stroke or mortality from all causes. In the present study, we focused on the relationship of variability of office BP and occurrence of acute myocardial infarction (MI). We registered 139 patients receiving antihypertensive therapy for more than 1 year who experienced first-ever episode of MI at the age of 60 years or over. At least two sex- and age-matched (+/- 5 years) control patients were registered for every MI patient. Average systolic and diastolic BP during the 12-month period prior to the occurrence of MI, or the time of registration in the case of control patients, was similar in both patient groups. The office BP variability was evaluated by calculating the variation coefficient (VC) of BP. VC of diastolic BP was significantly higher in the MI patients (10.0 +/- 4.0%) compared with the control patients (8.8 +/- 3.4%). VC of systolic BP was not different between the MI and the control patients. Multiple logistic analysis revealed the relationship of the VC for office diastolic BP to the occurrence of MI was significant after adjustment for BP level, age, gender, body mass index, serum total cholesterol concentrations, diabetes mellitus, and current smoking. In conclusion, larger long-term variability of office diastolic BP during antihypertensive therapy is a predictor of MI.
Asunto(s)
Determinación de la Presión Sanguínea/métodos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Hipertensión/diagnóstico , Incidencia , Japón/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Visita a Consultorio Médico , Valor Predictivo de las Pruebas , Valores de Referencia , Medición de Riesgo , Factores de Riesgo , Sensibilidad y Especificidad , Distribución por SexoRESUMEN
Large 24-h blood pressure (BP) variability and an excessive drop in BP during nighttime are associated with a higher risk of cardiovascular events. Data are lacking regarding the prognostic significance of variability in BP measured during office visits. We analyzed the relationship between office BP variability and the risk of brain infarction in elderly patients receiving antihypertensive therapy. Patients who experienced their first-ever stroke at the age of 60 years or over were registered in the study. At least 2 sex- and age-matched control patients were registered for each case patient. Office BP at each clinic visit and known cardiovascular risk factors were recorded. The BP variability was defined as the variation coefficient (VC) of office BP. In this report, we analyze the data of brain infarction patients. The VC of both systolic and diastolic BPs was significantly higher in the brain infarction patients than in the control patients. Higher office BP variability was associated with a higher risk of brain infarction after adjustment for BP level and other confounding factors. Regarding diastolic BP, the association of brain infarction with the maximal value for the difference of office BPs taken at any consecutive two visits (Max-deltaBP) or the difference between the highest and lowest values of office BP (BP-range) recorded during a 1-year period prior to the event was also significant. In conclusion, a retrospective case-control study suggested that office BP variability was an independent predictor of brain infarction. Either the Max-deltaBP or the BP-range may be surrogate indices of diastolic BP variability.
Asunto(s)
Determinación de la Presión Sanguínea/métodos , Presión Sanguínea , Infarto Cerebral/etiología , Hipertensión/complicaciones , Hipertensión/fisiopatología , Anciano , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Femenino , Predicción , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Visita a Consultorio Médico , Factores de RiesgoRESUMEN
An 18-year old female with mental retardation and unexamined complex congenital heart disease received dental care under general anesthesia. Anesthesia was induced and maintained successfully without any significant hemodynamic changes with inhalation of nitrous oxide, oxygen (FIO2 0.25-0.3) and sevoflurane after a heavy premedication (morphine 10 mg, scopolamine 0.3 mg and midazolam 5 mg i.m.). After induction of anesthesia, cardiac anomaly was diagnosed by transesophageal echocardiography as TGA, VSD, PS, and operation was completed without any problem. Two points are considered important in this case; first, to appropriately estimate preoperative cardiac function and second, to adequately manage anesthesia to avoid any hemodynamic fluctuation.
Asunto(s)
Anomalías Múltiples , Anestesia Dental , Anestesia General , Atención Dental para la Persona con Discapacidad , Cardiopatías Congénitas/complicaciones , Discapacidad Intelectual/complicaciones , Adolescente , Sedación Consciente , Femenino , Humanos , Medicación PreanestésicaRESUMEN
OBJECTIVE: To clarify the role of insulin resistance and hyperinsulinaemia in the pathogenesis of obesity-related hypertension. DESIGN: An open study comparing the effects of weight reduction by low-energy diet and treatment with troglitazone, an insulin-sensitizing agent. SETTING: A tertiary teaching hospital. PATIENTS: Thirty overweight hypertensive patients (15 men and 15 women, mean age 61 years, mean body mass index 29.1 kg/m2). INTERVENTIONS: Fifteen patients were assigned to a weight-reduction programme by low-energy diet (3360 kJ/day) for 3 weeks; the remaining 15 patients were treated with troglitazone (400 mg/day) for 8 weeks. MAIN OUTCOME MEASURES: Casual and ambulatory blood pressures, glucose and lipid metabolism, and insulin sensitivity. RESULTS: The baseline values of body mass index, fasting and post-glucose plasma insulin, and casual and ambulatory blood pressures were comparable between the two groups. Weight reduction (4.1 +/- 0.3 kg, mean +/- SEM) was associated with significant decreases in plasma insulin, blood glucose, homeostasis model assessment (HOMA) insulin resistance index, serum triglyceride, casual blood pressure (7.7 +/- 2.3/ 3.9 +/- 1.4 mmHg) and 24 h blood pressure (8.3 +/- 1.9/ 4.3 +/- 1.1 mmHg). Treatment with troglitazone caused comparable decreases in the metabolic parameters and HOMA index, but did not change casual or 24 h blood pressure (0.8 +/- 3.4/0.8 +/- 2.1 and 1.5 +/- 2.4/ 1.0 +/- 1.9 mmHg, respectively). CONCLUSIONS: Insulin resistance/hyperinsulinaemia may not have an important role in the pathogenesis of obesity-related hypertension. The antihypertensive effect of weight reduction seems to be mediated mainly by other mechanisms.
Asunto(s)
Presión Sanguínea/efectos de los fármacos , Cromanos/farmacología , Dieta Reductora , Hipertensión/terapia , Hipoglucemiantes/farmacología , Obesidad/fisiopatología , Tiazoles/farmacología , Tiazolidinedionas , Adulto , Anciano , Femenino , Humanos , Hipertensión/etiología , Resistencia a la Insulina , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Troglitazona , Pérdida de PesoRESUMEN
BACKGROUND AND PURPOSE: Patients with severe carotid artery stenosis may have more severe ischemic damage after embolic stroke than patients without this abnormality. Unilateral proximal carotid occlusion (UCO) alone typically does not induce infarction in normotensive rats. The aim of this study was to investigate whether UCO increases infarct size after microembolic, experimental stroke. METHODS: Microembolic infarction was induced in 2 groups of Sprague-Dawley rats by injecting 2000 microspheres (50-micrometer diameter) intracranially from the external carotid artery. The common carotid artery (CCA) was either ligated just after the injection (CCA occlusion group, n=8) or left intact (CCA open group, n=8). In the control group (n=4), vehicle without microspheres was injected and the CCA was ligated. Twenty-four hours later, the brains were removed and infarct volumes measured. Perfusion-weighted imaging was used to evaluate the cerebral circulation before and after CCA occlusion with and without microsphere injection in a separate group of animals (n=16). RESULTS: All animals in the microemboli groups survived and had only a slight hemiparesis 24 hours after occlusion. No neurological deficits were observed in the control group. Infarct volumes were 145+/-57 mm(3) in the CCA occlusion group and 45+/-26 mm(3) in the CCA open group (P <0.01). There were no infarctions detected in the control group. Perfusion-weighted imaging showed that cerebral blood flow decreased after the CCA occlusion in both experiments with and without the microsphere injection. CONCLUSIONS: UCO alone does not induce ischemic damage, but it worsens ischemic lesion size after multiple microemboli. This is probably due to the slight cerebral perfusion insufficiency caused by UCO. These results suggest that patients with cerebral hemodynamic insufficiency, such as those with severe carotid stenosis, may have increased ischemic damage after microembolic events.
Asunto(s)
Isquemia Encefálica/patología , Estenosis Carotídea/complicaciones , Embolia Intracraneal/fisiopatología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Animales , Isquemia Encefálica/etiología , Isquemia Encefálica/fisiopatología , Estenosis Carotídea/fisiopatología , Arterias Cerebrales , Colorantes , Modelos Animales de Enfermedad , Hemodinámica , Masculino , Microesferas , Ratas , Ratas Sprague-Dawley , Accidente Cerebrovascular/patología , Sales de TetrazolioRESUMEN
The aim of this study was to analyze the treatment of elderly hypertensive patients by Japanese physicians specializing in hypertension. We enrolled 939 patients with hypertension who were treated in the outpatient clinics of 11 hospitals in 1995; 793 of these patients (388 men and 405 women; mean age, 66.6+/-9.0 years) received follow-up examinations in 1996, and the data on these patients was used for the present analysis. Blood pressure (BP), body mass index, lifestyle, and laboratory data were analyzed in all patients. The average BP was 143+/-16/81+/-10 mmHg in 1995 and 142+/-15/80+/-10 mmHg in 1996. The patients whose baseline BP was at the level of Grade 2 or 3 in the WHO-ISH classification (n=117) were characterized by a higher women-to-men ratio, higher age, a higher serum total cholesterol concentration, and higher QRS voltage. In these patients, from 1995 to 1996, the average BP significantly decreased, whereas fasting plasma glucose, serum total cholesterol and serum creatinine concentrations showed only negligible changes. In 220 patients (28%), BP was <140/<90 mmHg at both the initial and the follow-up examinations, whereas 351 patients (44%) were hypertensive in both 1995 and 1996. Thirty-three percent of the patients were smokers. More smokers than nonsmokers had had prior cardiovascular events, diabetes mellitus, or overt proteinuria. In conclusion, the average BP level among the patients treated by Japanese physicians specializing in hypertension was somewhat higher than that recommended by WHO-ISH Guidelines (1999). Patient education to control lifestyle-related risk factors, particularly to stop smoking, should be emphasized.
Asunto(s)
Presión Sanguínea , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Estilo de Vida , Práctica Profesional/estadística & datos numéricos , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Antihipertensivos/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Japón/epidemiología , Masculino , Medicina/estadística & datos numéricos , Persona de Mediana Edad , Obesidad/epidemiología , Pacientes Ambulatorios/estadística & datos numéricos , Educación del Paciente como Asunto/estadística & datos numéricos , Factores de Riesgo , Fumar , EspecializaciónRESUMEN
This study was designed to characterize the initial and secondary changes of the apparent diffusion coefficient (ADC) of water with high temporal resolution measurements of ADC values and to correlate ADC changes with functional outcomes. Fourteen rats underwent 30 minutes of temporary middle cerebral artery occlusion (MCAO). Diffusion-, perfusion-, and T2-weighted imaging was performed during MCAO and every 30 minutes for a total of 12 hours after reperfusion (n = 6). Neurological outcomes were evaluated during MCAO, every 30 minutes for a total of 6 hours and at 24 hours after reperfusion (n = 8). The decreased cerebral blood flow during MCAO returned to normal after reperfusion and remained unchanged thereafter. The decreased ADC values during occlusion completely recovered at 1 hour after reperfusion. The renormalized ADC values started to decrease secondarily at 2.5 hours, accompanied by a delayed increase in T2 values. The ADC-defined secondary lesion grew over time and was 52% of the ADC-defined initial lesion at 12 hours. Histological evaluation demonstrated neuronal damage in the regions of secondary ADC decline. Complete resolution of neurological deficits was seen in 1 rat at 1 hour and in 6 rats between 2.5 and 6 hours after reperfusion; no secondary neurological deficits were observed at 24 hours. These data suggest that (1) a secondary ADC reduction occurs as early as 2.5 hours after reperfusion, evolves in a slow fashion, and is associated with neuronal injury; and (2) renormalization and secondary decline in ADC are not associated with neurological recovery and worsening, respectively.
Asunto(s)
Encéfalo/fisiopatología , Circulación Cerebrovascular/fisiología , Hipoxia-Isquemia Encefálica/fisiopatología , Daño por Reperfusión/fisiopatología , Animales , Encéfalo/irrigación sanguínea , Encéfalo/patología , Hipoxia-Isquemia Encefálica/patología , Infarto de la Arteria Cerebral Media/patología , Infarto de la Arteria Cerebral Media/fisiopatología , Imagen por Resonancia Magnética , Masculino , Ratas , Ratas Sprague-Dawley , Daño por Reperfusión/patología , Factores de TiempoRESUMEN
BACKGROUND: Dihydropyridine calcium antagonists increase heart rate due to reflex activation of the sympathetic nervous system, although these effects are less obvious for long-acting agents. OBJECTIVE: To study the effects of diltiazem retard, a long-acting nondihydropyridine calcium antagonist, on 24h blood pressure, heart rate and autonomic nerve activity in patients with essential hypertension. DESIGN: Randomized crossover design. METHODS: Thirteen patients [five men and eight women, aged 64+/-2 years (mean+/-SEM)] were administered placebo or diltiazem retard (100-200mg once daily) for 4 weeks each. Ambulatory monitoring of blood pressure and heart rate, and electrocardiography were carried out at the end of each period using a multibiomedical recorder (TM-2425). Autonomic nerve activity was evaluated by power spectral analysis of variability of heart rate using the high-frequency component as an index of parasympathetic nerve activity and the ratio of the low-frequency component and the high-frequency component as an index of sympathovagal balance. RESULTS: Treatment with diltiazem retard significantly decreased 24h average blood pressure and heart rate by 11.6+/-3.6/5.7+/-1.8mmHg and 5.0+/-1.1 beats/min, respectively. The changes in daytime and night-time values were comparable. Diltiazem retard also significantly decreased daytime and 24h low:high-frequency-component ratio (2.0+/-0.2 versus 1.7+/-0.2 and 1. 8+/-0.2 versus 1.6+/-0.2, respectively). CONCLUSIONS: These results indicate that diltiazem retard is effective as a once-daily antihypertensive agent and has favorable effects on heart rate and the autonomic nervous system.
Asunto(s)
Antihipertensivos/farmacología , Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/farmacología , Diltiazem/farmacología , Frecuencia Cardíaca/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Anciano , Antihipertensivos/administración & dosificación , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/uso terapéutico , Preparaciones de Acción Retardada , Diltiazem/administración & dosificación , Diltiazem/uso terapéutico , Esquema de Medicación , Monitoreo de Drogas , Electrocardiografía , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Sistema Nervioso Parasimpático/efectos de los fármacos , Sistema Nervioso Parasimpático/fisiopatología , Sistema Nervioso Simpático/efectos de los fármacos , Sistema Nervioso Simpático/fisiopatología , Nervio Vago/efectos de los fármacos , Nervio Vago/fisiopatologíaRESUMEN
Ingestion of alcohol acutely decreases vascular resistance and blood pressure (BP) with activation of the sympathetic nervous system in Orientals. Although alpha1-blockers are widely used in the treatment of hypertension, the possible interaction between alcohol and alpha1-blockers has not been clarified. We examined the effects of prazosin on the alcohol-induced BP changes in Japanese men with mild hypertension. Ten hypertensive patients (54 +/- 3 years, mean +/- SE) were given 1 mL/kg of alcohol or isocaloric control drink with a light meal in the evening before and 5 to 7 days after treatment with prazosin (1 mg three times daily). Ambulatory BP monitoring was carried out every 30 min for 24 h in each period using Colin ABPM-630. Blood samples were obtained before and 2 h after intake of alcohol or control drink. Before prazosin treatment, alcohol ingestion decreased BP for several hours with a significant reduction in average 24-h BP, whereas it increased heart rate, plasma norepinephrine, and plasma renin activity. Treatment with prazosin caused a significant decrease in 24-h BP (136.3 +/- 4.0/82.8 +/- 2.5 v 131.6 +/- 3.2/80.0 +/- 2.3 mm Hg). The alcohol-induced hypotension at 2-4 h after ingestion was enhanced by prazosin (-18.0 +/- 3.7/-11.8 +/- 2.7 v -24.4 +/- 4.9/-17.8 +/- 2.8 mm Hg, P < .05 for diastolic BP). These results suggested that inhibition of the sympathetic nervous system with alpha1-blockers accentuates alcohol-induced hypotension. Ingestion of alcohol may cause a marked BP reduction in hypertensive Orientals treated with alpha1-blockers.
Asunto(s)
Antagonistas Adrenérgicos alfa/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Depresores del Sistema Nervioso Central/farmacología , Etanol/farmacología , Hipertensión/tratamiento farmacológico , Prazosina/uso terapéutico , Adulto , Anciano , Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Ritmo Circadiano , Diástole , Interacciones Farmacológicas , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipertensión/sangre , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Potasio/sangre , Renina/sangre , SístoleRESUMEN
BACKGROUND AND PURPOSE: The early ischemic lesions demonstrated by diffusion-weighted imaging (DWI) are potentially reversible. The purposes of this study were to determine whether resolution of initial DWI lesions is transient or permanent after different brief periods of focal brain ischemia and to evaluate histological outcomes. METHODS: Sixteen rats were subjected to 10 minutes (n=7) or 30 minutes (n=7) of temporary middle cerebral artery occlusion or sham operation (n=2). DWI, perfusion-weighted imaging (PWI), and T(2)-weighted imaging (T(2)WI) were performed during occlusion; immediately after reperfusion; and at 0.5, 1.0, 1.5, 12, 24, 48, and 72 hours after reperfusion. After the last MRI study, the brains were fixed, sectioned, stained with hematoxylin and eosin, and evaluated for neuronal necrosis. RESULTS: No MRI or histological abnormalities were observed in the sham-operated rats. In both the 10-minute and 30-minute groups, the perfusion deficits and DWI hyperintensities that occurred during occlusion disappeared shortly after reperfusion. The DWI, PWI, and T(2)WI results remained normal thereafter in the 10-minute group, whereas secondary DWI hyperintensity and T(2)WI abnormalities developed at the 12-hour observation point in the 30-minute group. Histological examinations demonstrated neuronal necrosis in both groups, but the number of necrotic neurons was significantly higher in the 30-minute group (95+/-4%) than in the 10-minute group (17+/-10%, P<0.0001). CONCLUSIONS: Transient or permanent resolution of initial DWI lesions depends on the duration of ischemia. Transient resolution of DWI lesions is associated with widespread neuronal necrosis; moreover, permanent resolution of DWI lesions does not necessarily indicate complete salvage of brain tissue from ischemic injury.
Asunto(s)
Ataque Isquémico Transitorio/diagnóstico , Imagen por Resonancia Magnética , Animales , Encéfalo/patología , Ataque Isquémico Transitorio/patología , Masculino , Necrosis , Ratas , Ratas Sprague-Dawley , Reperfusión , Factores de TiempoRESUMEN
Orthostatic hypotension is a serious problem in patients with diabetes mellitus (DM) undergoing hemodialysis (HD). To evaluate cerebral circulation during orthostasis in patients with DM, we examined changes in mean blood flow velocity in the middle cerebral artery (VMCA) during 60 degrees head-up tilt for 5 minutes in patients with DM (six men, two women; age, 57 +/- 3 years [mean +/- SEM]; HD duration, 47 +/- 27 months) before and after bicarbonate HD by using transcranial Doppler sonography. The findings were compared with those in HD patients without diabetes (non-DM; 12 men, 5 women; age, 47 +/- 3 years; HD duration, 82 +/- 23 months). Mean blood pressure (MBP) in the supine position, hematocrit (Hct), plasma fibrinogen, and volume of fluid removed by HD were not significantly different between the two groups (MBP, 106 +/- 6 versus 103 +/- 4 mm Hg; Hct, 26% +/- 1% versus 28% +/- 1%; fibrinogen, 355 +/- 37 versus 357 +/- 27 mg/dL; fluid, 2.5 +/- 0.2 versus 2.3 +/- 0.2 L). Percentage of change in VMCA (% VMCA) during tilt was compared between the groups before and after HD. Before HD, MBP decreased significantly to 93 +/- 5 mm Hg during tilt only in patients with DM. The degree of MBP reduction was -13 +/- 2 mm Hg in DM and -2 +/- 2 mm Hg in non-DM patients (P < 0.01). % VMCA equally decreased during tilt; DM, -12% +/- 3%, and non-DM, -12% +/- 2%. After HD; MBP decreased by 36 +/- 7 mm Hg in patients with DM, which was significantly greater than before HD. VMCA also decreased in both groups after HD, and % VMCA in DM (-32% +/- 5%) was significantly greater than before HD (P < 0.01) and in non-DM patients (-13% +/- 2%; P < 0.01). % VMCA positively correlated with the percentage of change ratio of MBP during tilt in both groups after HD (DM, r = 0. 87, P < 0.01; non-DM, r = 0.61, P < 0.01). Our results showed a significant decrease in cerebral blood flow velocity during tilt of equal magnitude in both groups before HD despite differences in the level of hypotension, whereas reduction in cerebral blood flow velocity and decrease in MBP were more marked in DM after HD. Orthostasis could thus cause hemodynamically mediated brain damage after HD, especially in patients with DM.
Asunto(s)
Velocidad del Flujo Sanguíneo , Circulación Cerebrovascular , Diabetes Mellitus/fisiopatología , Hipotensión Ortostática/etiología , Diálisis Renal/efectos adversos , Anciano , Presión Sanguínea , Gasto Cardíaco , Arteria Carótida Común/diagnóstico por imagen , Diabetes Mellitus/diagnóstico por imagen , Femenino , Humanos , Hipotensión Ortostática/fisiopatología , Masculino , Persona de Mediana Edad , Pulso Arterial , Pruebas de Mesa Inclinada , Ultrasonografía Doppler TranscranealRESUMEN
BACKGROUND AND PURPOSE: The intraluminal suture middle cerebral artery occlusion (MCAO) model is increasingly used in experimental stroke studies. The purposes of this study were to determine whether (1) spontaneous hyperthermia occurs after different periods of MCAO in this model, (2) hypothalamic injury contributes to hyperthermia, and (3) hyperthermia increases infarct volume after permanent MCAO. METHODS: Rats were subjected to 60, 90, and 120 minutes of transient MCAO (n=8 per group), permanent MCAO (n=8 per group, 5 groups), and permanent hypothalamic occlusion, in which an occluder was inserted 15 to 15.5 mm to block only the hypothalamic branch from the internal carotid artery (n=4) with the use of the intraluminal suture MCAO method. In one group undergoing permanent MCAO, the body temperature was maintained at 37 degrees C throughout the experiment. In another group (n=4) undergoing 90 minutes of temporary MCAO, diffusion- and perfusion-weighted imaging were performed to document the in vivo ischemic changes in the hypothalamus. Body temperature was measured hourly for 12 hours. At 24 hours (12 hours in 2 permanent MCAO groups), triphenyltetrazolium chloride staining was used to verify ischemic hypothalamic injury and to calculate corrected infarct volumes. RESULTS: Spontaneous hyperthermia (>39 degrees C) occurred in the 120-minute group, all permanent MCAO groups, and the hypothalamic occlusion group but not in the 60-minute or the 90-minute groups. Hypothalamic infarction was found in 1 rat each in the 60-minute and 90-minute groups, 6 of the 8 rats in the 120-minute group, 37 of the 40 rats in the permanent occlusion groups, and all 4 rats in the hypothalamic occlusion group. After 90 minutes of transient MCAO, the decreased cerebral blood flow and apparent diffusion coefficient values in the hypothalamic region during occlusion recovered fully 2 hours after reperfusion. The corrected infarct volumes were identical in all permanent occlusion groups. CONCLUSIONS: The intraluminal suture MCAO lasting for >/=2 hours induces spontaneous hyperthermia that is associated with hypothalamic injury, and delayed spontaneous hyperthermia does not increase infarct volume after permanent intraluminal suture MCAO.
Asunto(s)
Arteriopatías Oclusivas/complicaciones , Fiebre/etiología , Ataque Isquémico Transitorio/complicaciones , Arteria Cerebral Media/fisiopatología , Análisis de Varianza , Animales , Arteriopatías Oclusivas/fisiopatología , Temperatura Corporal/fisiología , Isquemia Encefálica/etiología , Isquemia Encefálica/fisiopatología , Arteria Carótida Interna/fisiopatología , Circulación Cerebrovascular/fisiología , Colorantes , Modelos Animales de Enfermedad , Hipotálamo/irrigación sanguínea , Hipotálamo/fisiopatología , Infarto de la Arteria Cerebral Media/complicaciones , Infarto de la Arteria Cerebral Media/patología , Infarto de la Arteria Cerebral Media/fisiopatología , Ataque Isquémico Transitorio/fisiopatología , Imagen por Resonancia Magnética , Masculino , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Reperfusión , Accidente Cerebrovascular/etiología , Técnicas de Sutura , Sales de Tetrazolio , Factores de TiempoRESUMEN
To identify factors that influence changes in the activities of daily living (ADL) assessed by a standardized scoring system, ADL-20, and factors affecting the self-estimate of the changes in ADL, we conducted a 1-yr follow-up study of 1,163 outpatients aged 50 yr or older. The follow-up rate was 83.1%. A decrease in the ADL score was associated with advancing age and a lower prescription rate of beta-blockers. Analysis of the modalities of ADL revealed an association between a decreasing mobility score and a lower prescription rate of beta-blockers. In patients with impaired ADL at the time of enrollment, worsening of the ADL score was also associated with a lower baseline ADL score and a history of cardiovascular events. The prescription rate of diuretics was lower in patients who exhibited an improvement in ADL score. There was a considerable dissociation between the self-estimate of changes in ADL and the actual change in ADL-20 score. In more than 60% of patients with impaired baseline ADL, the self-estimate of changes was worse than the actual change in the ADL score. The "worse-than-actual" self-estimate of changes in ADL was associated with a higher prescription rate of beta-blockers. Thus, a history of cardiovascular events accelerates the aging-related deterioration of ADL. The use of a beta-blocker may worsen the self-estimate of the changes in ADL, while the actual ADL is preserved or slightly improved during beta-blocker therapy.
Asunto(s)
Actividades Cotidianas/psicología , Antagonistas Adrenérgicos beta/efectos adversos , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Cognición/fisiología , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/psicología , Masculino , Procesos Mentales/fisiologíaRESUMEN
OBJECTIVE: We examined the factors related to the impairment of activities of daily living (ADL). METHODS: ADL was evaluated by using ADL-20, which consists of 20 items from 4 major categories of activities; mobility, self-care, instrumental, and communication. The patients' gender, birth date, clinical diagnosis, past history, life styles, physical findings, laboratory data, and details of therapy were also recorded. Patients A total of 1,163 outpatients aged 50 years or older were included. Data from 1,093 patients were analyzed. RESULTS: We divided the subjects into two groups; Group I having full marks of ADL-20 (n=582) and group II exhibiting an impairment of ADL (n=511). Multiple logistic analysis revealed that in both sexes age and stroke were common independent factors related to the impairment of ADL. Other factors associated with impairment of ADL were smoking in men and presence of proteinuria in women. The presence of hyperlipidemia was associated with preservation of the ADL in women. CONCLUSION: The results demonstrated significant associations of smoking in men and the presence of proteinuria in women with the impairment of ADL in elderly Japanese outpatients. There appears to be a sex difference in the risk factors of impairment of ADL.
Asunto(s)
Actividades Cotidianas , Rehabilitación Cardiaca , Evaluación de la Discapacidad , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Femenino , Humanos , Hiperlipidemias/complicaciones , Hiperlipidemias/epidemiología , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Prevalencia , Proteinuria/complicaciones , Proteinuria/epidemiología , Estudios Retrospectivos , Factores Sexuales , Perfil de Impacto de Enfermedad , Fumar/efectos adversos , Encuestas y CuestionariosRESUMEN
Alcohol ingestion acutely lowers blood pressure (BP) with vasodilation and sympathetic activation in Oriental subjects. We examined the effects of beta blockade on cardiovascular and neurohumoral actions of alcohol in Japanese men with mild-to-moderate essential hypertension. Ten hypertensive patients (54+/-5 years, mean+/-SE) were given 1 ml/kg of alcohol or isocaloric control drink with a light meal in the evening before and 5-7 days after treatment with propranolol (20 mg three times daily). BP and heart rate (HR) were measured every 30 min for 24 h in each period. Blood sampling and echocardiographic examination were carried out before (17.00 h) and after (19.00 h) intake of alcohol or control drink, Before treatment, alcohol ingestion caused significant decreases in BP, total peripheral resistance and serum potassium concentration, while it increased heart rate (HR), cardiac output (CO), plasma norepinephrine and plasma renin activity (PRA). Treatment with propranolol significantly decreased BP and HR for 24 h. Propranolol and alcohol showed an additive depressor effect on night-time BP, and the alcohol-induced hypotension was similar before and after propranolol treatment. The alcohol-induced changes in HR, CO, PRA and serum potassium were significantly attenuated by propranolol. These results suggest that activation of the sympathetic nervous system plays a role in alcohol-induced cardiac stimulation, renin release and hypokalemia through beta receptors. Moderate doses of beta-blockers may not modify alcohol-induced BP reduction in Oriental subjects with hypertension.
Asunto(s)
Antagonistas Adrenérgicos beta/farmacología , Consumo de Bebidas Alcohólicas/fisiopatología , Hemodinámica/efectos de los fármacos , Hipertensión/fisiopatología , Propranolol/farmacología , Sistema Nervioso Simpático/efectos de los fármacos , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Anciano , Pueblo Asiatico , Presión Sanguínea/efectos de los fármacos , Gasto Cardíaco/efectos de los fármacos , Ecocardiografía , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipertensión/tratamiento farmacológico , Japón , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Potasio/sangre , Propranolol/uso terapéutico , Renina/sangre , Resistencia Vascular/efectos de los fármacosRESUMEN
Ischemic heart disease has become more important in regard to mortality in hemodialysis (HD) patients. We examined the therapeutic outcome of initial percutaneous transluminal angioplasty (PTCA) in maintenance HD patients with angina pectoris. They consisted of 8 men and 4 women with a mean age of 56.3 +/- 8.6 years and a mean duration of HD of 4.3 +/- 4.0 years. Thirty-six non-HD patients treated with initial PTCA were matched for age, sex and coronary risk factors, and used as a control. Angiographic lesion success was confirmed by angiography in 21 (84%) of the 25 stenotic sites attempted and clinical success was obtained in 9 (75%) of the 12 HD patients, while there were 40 (78%) lesions successfully removed out of the 51 stenotic sites and there were 26 (72%) clinically successful cases out of the 36 non-HD patients, respectively. Angina recurred in 4 (44%) of 9 HD patients, and in 10 (38%) of 26 non-HD patients after successful PTCA, where the follow-up periods were 23 +/- 20 and 28 +/- 25 months, respectively. There was no significant difference in cumulative lesion survival curve between the two groups. In conclusion, PTCA for chronic HD patients is as effective as that for non-HD patients, at least regarding initial PTCA.
Asunto(s)
Angina de Pecho/terapia , Angioplastia Coronaria con Balón , Fallo Renal Crónico/complicaciones , Isquemia Miocárdica/terapia , Diálisis Renal , Adulto , Anciano , Angina de Pecho/complicaciones , Distribución de Chi-Cuadrado , Puente de Arteria Coronaria , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
OBJECTIVE: To study the effects of a high calcium intake in hypertensive patients by blood pressure monitoring. DESIGN: In a randomized crossover study, patients were assigned to an 8-week calcium supplementation period and an 8-week control period. The subjects were given 25 mmol/day (1 g/day) of calcium as calcium carbonate during the intervention period. SETTING: A hypertension clinic in a tertiary teaching hospital. PATIENTS: Sixty untreated or treated hypertensive patients (35 men and 25 women, mean age 58 years) with office systolic/diastolic blood pressure > or = 140/90 mmHg. MAIN OUTCOME MEASURES: Office blood pressure, home blood pressure (last 7 days), and ambulatory 24 h blood pressure (every 30 min using TM-2421). RESULTS: The serum calcium concentration and urinary calcium excretion increased significantly with calcium supplementation. Office, home and 24 h blood pressure were lower in the calcium period than in the control period, although the differences were small (mean +/- SEM office blood pressure: 1.2+/-1.2/1.1+/-0.7 mmHg; home blood pressure: 1.9+/-0.7/1.3+/-0.6 mmHg; 24 h blood pressure: 1.2+/-0.8/0.9+/-0.5 mmHg,), and significant only for home systolic and diastolic blood pressures. The difference in home systolic blood pressure was inversely correlated with the level of home blood pressure in the control period and with the difference in urinary calcium. The difference in 24 h systolic blood pressure was positively correlated with the control level of urinary calcium. Age, sex, antihypertensive medication, drinking habit, sodium intake or order of treatment did not significantly influence the effects of calcium supplementation. CONCLUSIONS: An increase in calcium intake tends to lower office, home and ambulatory blood pressure in hypertensive patients. However, the antihypertensive effect is too small to support the general application of a high calcium intake in the treatment of hypertension.
Asunto(s)
Calcio/uso terapéutico , Suplementos Dietéticos , Hipertensión/tratamiento farmacológico , Adulto , Anciano , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Determinación de la Presión Sanguínea/métodos , Monitoreo Ambulatorio de la Presión Arterial , Calcio/sangre , Calcio/orina , Estudios Cruzados , Diástole/efectos de los fármacos , Diástole/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sístole/efectos de los fármacos , Sístole/fisiologíaRESUMEN
PURPOSE: Restriction of alcohol intake is widely recommended in the treatment of hypertension. However, we have observed that alcohol may have biphasic effects on blood pressure in Japanese men with hypertension. METHODS: Hypertensive men (n = 34) who habitually drank alcohol were randomly assigned to keep their drinking habits constant for 4 weeks, or to abstain (or reduce alcohol intake to a maximum of 15 mL/day) for 4 weeks in a crossover design. Amount of alcohol intake was recorded by each patient throughout the study. Office and 24-hour ambulatory blood pressure were measured at the end of both periods. RESULTS: After alcohol restriction, mean (+/-SD) ethanol intake decreased from 66+/-26 mL/day to 11+/-10 mL/day. Office systolic blood pressure decreased slightly from 142+/-12 mm Hg to 139+/-11 mm Hg, and diastolic blood pressure decreased significantly from 95+/-7 mm Hg to 93+/-7 mm Hg in the low-alcohol period. Daytime systolic blood pressure fell by 3+/-9 mm Hg (P <0.05), but nighttime systolic blood pressure rose by 4+/-9 mm Hg (P <0.05) with restriction of alcohol intake. Thus, average 24-hour blood pressure did not change, although 24-hour heart rate and day-night difference in blood pressure decreased significantly in the low-alcohol period. CONCLUSION: In Asian men with hypertension, restriction of alcohol intake reduces daytime blood pressure but not night-time or 24-hour blood pressure.