The relationship between body weight and blood pressure

In adults of Western societies the positive relationship between blood pressure and body weight has often been demonstrated, both cross-sectionally and longitudinally. This correlation is even stronger in children and early adulthood. In most studies in children, the association between age and blood pressure disappears after controlling for weight. Association must be differentiated from causation. It has however been shown in several intervention studies that treatment of obesity by weight loss decreases blood pressure substantially both in hypertensive and normotensive subjects. Although combining results from several intervention trials is difficult this is the only practical way to get an overall estimate of the hypotensive response to be expected from weight reduction. In the randomised controlled intervention studies, conducted in obese hypertensive patients and reviewed in the present meta-analysis, a decrease in body weight by 1 kg resulted in a reduction of systolic and diastolic pressure by 1.2 and 1.0 mmHg, respectively. Blood pressure generally decreased before normal weight was achieved and remained reduced as long as there was no marked regain in body weight. Although a decrease in salt intake during dieting may contribute to the blood pressure lowering effect of weight reduction, also other mechanisms, such as a reduction in plasma renin activity and a decrease in sympathetic tone may also be involved.     

Antihypertensive effect of doxazosin and atenolol in short- and long-term double-blind comparison

The antihypertensive effect and safety of doxazosin once daily as well as the effect on serum lipids was compared with that of atenolol once daily in 40 patients with mild to moderate hypertension. During the first 4 weeks, all patients received placebo therapy. During the subsequent 46 weeks, patients were randomized to doxazosin or atenolol treatment. Treatment was initiated with 1 mg doxazosin or 50 mg atenolol once daily. The dose could be doubled biweekly for 10 weeks until a final dose of 16 mg doxazosin or 100 mg atenolol was reached. The patients then entered the maintenance phase for 36 weeks. The average final dose of doxazosin was 9.2 +/- 1.3 (SEM) mg and that of atenolol was 76.5 +/- 6.2 mg. During the 46 weeks of active treatment, the recumbent diastolic blood pressure (DBP) tended to be lower (p less than 0.05) in patients receiving atenolol at 10, 12, and 22 weeks of treatment. Recumbent systolic BP (SBP) and standing SBP and DBP were not different, however, between patients receiving doxazosin and those receiving atenolol. Recumbent and standing heart rate (HR) were lower (p less than 0.01) during atenolol. The decrease in serum total triglycerides, total cholesterol, and low-density lipoprotein (LDL)-cholesterol after 46 weeks of doxazosin was different (p less than 0.05) from the changes observed during atenolol therapy. Our data indicate that the antihypertensive action of doxazosin is accompanied by favorable effects on serum lipids.     

Outcome of peptic ulcer hemorrhage treated according to a defined approach

The short- and long-term bleeding recurrence and mortality of 157 consecutive patients admitted emergently over a period of 2 years with in actively bleeding peptic ulcer were analyzed. They were treated uniformly according to a defined approach where suitable candidates for surgery were operated on early. The data of the 5-year follow-up were analyzed by constructing life tables. There were 94 men and 63 women with a median age of 72.3 years; 83 ulcers were gastric and 74 duodenal. Thirty-one patients underwent an operation. Eleven patients (7%) died within the first month, one in the surgical group. During the follow-up 13 patients rebled and 54 died, two of the deaths related to peptic ulcer disease. The life table for rebleeding and ulcer-related deaths showed a cumulative risk of 11.8% at 5 years, and the cumulative risk was not statistically different between patients according to their age (60 years and older versus younger), sex, the site of their ulcer (gastric versus duodenal), or the type of treatment (conservative versus surgical). With a well defined approach and early selective surgery, the short-term mortality compares favorably with the usual 10% or more reported. The high mortality rate during the follow-up reflects the advanced age of patients with coexisting disease. This long-term follow-up study could be used as a comparison against future studies evaluating new therapies.

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Resumen Se hizo un análisis de la recidiva de sangrado a corto y largo plazo y de la mortalidad de 157 pacientes consecutivos hospitalizados con úlcera péptica sangrante en un período de dos años.Todos fueron tratados de acuerdo a una conducta definida que incluye operación precoz en pacientes debidamente seleccionados. El análisis del seguimiento a cinco años fue realizado mediante la construcción de tablas de vida. El grupo incluyó 94 hombres; la edad promedio fue 72.3 años. Ochenta y tres de las úlceras fueron gástricas y 74 duodenales. Treinta y un pacientes fueron sometidos a operación. Once pacientes (7%) murieron en el curso del primer mes, uno de ellos en el subgrupo quirúrgico. En el período total de seguimiento se registraron 13 pacientes con sangrado recurrente y 54 murieron, dos debido a enfermedad péptica. La tabla de vida para resangrado y muerte relacionada con úlcera señaló un ríesgo acumulativo de 11.8% a 5 años y el riesgo acumulativo no fue estadísticamente diferente entre los pacientes según su edad (mayores o menores de 60 años), sexo, ubicación de la úlcera (gástrica vs. duodenal) o tipo de tratamiento (conservador vs. quirúrgico).Con una conducta de manejo bien definida que incluye cirugía precoz en pacientes seleccionados, la mortalidad a corto plazo se compara favorablemente con la tasa usual de 10% o má que informa la literatura. La elevada tasa de mortalidad observada en el seguimiento a largo plazo refleja la edad avanzada de los pacientes con enfermedad coexistente.El presente estudio de seguimiento a largo plazo puede ser utilizado como punto de comparación para valorar la eficacia de nuevas modalidades terapéuticas en futuros estudios.

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Résumé Les taux de récidives et de mortalité ont été analysés pendant une période d'observation de deux ans chez 157 patients consécutifs opérés en urgence pour un ulcère saignant activement. Ces patients ont été traités de façon homogène selon un protocole dans lequel l'intervention était précoce. La survie a été analysée selon la méthode actuarielle. Il y avait 94 hommes, la médiane d'âge a été de 72.3 ans. Quatre-vingt trois ulcères étaient gastriques, 74 duodénaux. Trente et un patients ont été opérés. Onze des 157 patients (7%) sont décédés pendant le premier mois. Pendant le suivi, 13 patients ont resaigné, 54 sont décédés, deux en rapport avec leur ulcère. Le risque cumulé de récidive hémorragiqueà 5 ans a été de 11.8% et ne différait pas selon l'âge (<60 ans vs>60 ans), le sexe, la localisation de l'ulcère (gastrique vs duodénal) ou le type de traitement (conservateur vs chirurgical). Selon une approche bien définie, et avec une intervention précoce, la mortalité à court terme dans cette série se compare favorablement avec celle de la littérature, qui est de 10% ou plus. La mortalité élevée dans le suivi est un reflet seulement de l'âge avancé des patients ayant des maladies concommitantes. Le suivi rapporté ici peut éventuellement servir de standard auquel peuvent être comparées de nouvelles stratégies thérapeutiques.

     

In vitro effect of xipamide on sodium-potassium transport systems in human erythrocytes

The in vitro effects of xipamide in a concentration range of 10(-8) to 10(-2) M were investigated on various Na+ and K+ transport systems in human red blood cells. Xipamide inhibited the anion carrier or DIDS-sensitive LiCO3- -influx starting from a concentration of 10(-5) M. However, a decrease in the Na+, K+-pump and the Na+, K+-cotransport activity and a rise in the passive permeability of the cell membrane was only observed starting from a concentration of 10(-4) M xipamide.     

Urinary excretion of electrolytes during prolonged physical activity in normal man

Summary Nine normal young male students were studied during 2 days of relative rest, during 2 days of physical training and again during the succeeding 2 days of relative rest.Twenty-four hour urine collections showed that sodium and potassium excretion were lower during the exercise days, while urinary aldosterone excretion was increased. No differences in the 24-h urinary excretion of creatinine, calcium, and magnesium were found between the resting and exercise days.Hemoglobin concentration, hematocrit and red cell counts were decreased at 14 h and 42 h after exercise; these findings together with the increased serum bilirubin concentration could result from hemolysis.Plasma renin activity, angiotensin II and aldosterone concentration were increased 14 h after exercise but returned to baseline 42 h after exercise.Our data shows that one should take into account previous exercise when interpreting results of certain of these tests.     

Flunarizine in the treatment of vertigo

Experience with flunarizine, a selective calcium-entry blocker, in the treatment of dizziness is reviewed. Clinical efficacy was predicted in pharmacological studies both in rabbits and humans: torsion swing or caloric induced nystagmus were significantly suppressed by flunarizine. Open therapeutic findings, using clinical and electronystagmographic or audiographic assessments as well, showed that flunarizine is of benefit to patients with vertigo of labyrinthine as well as of cerebrovascular origin. These results were confirmed in double-blind controlled trials. Flunarizine, either started with a loading dose gradually decreased thereafter, or given at a fixed 10 mg. dose schedule was proven to produce rapid improvement of dizziness and unsteadiness and to be tolerated very well.     

Intracellular concentration and transmembrane fluxes of sodium and potassium in erythrocytes of white normal male subjects with and without a family history of hypertension

Compared with white normal males without a family history of hypertension (n = 43), red blood cells of white normal males with such a family history (n = 17) had a higher (P less than 0.01) intracellular sodium concentration (8.07 +/- 0.30 versus 7.33 +/- 0.17 mmol/l cells). This could be at least partly due to their lower (P less than 0.001) frusemide-sensitive sodium efflux rate (250 +/- 19 versus 424 +/- 23 mumol/l cells/h). Also their ouabain-resistant 86Rb-uptake (0.81 +/- 0.06 versus 0.97 +/- 0.03 mumol/l cells/h) was lower (P less than 0.05). Potassium concentration in the red blood cells was similar in both groups.     

EFFECTS OF 1-SAR-8-ALA-ANGIOTENSIN II ON SYSTEMIC AND PULMONARY HAEMODYNAMICS IN HYPERTENSIVE PATIENTS

1.The angiotensin II antagonist, 1-Sar-8-Ala-angiotensin II (saralasin), was infused intravenously at a rate of 10 μg/kg per min in thirty-three hypertensive patients, on a normal sodium diet (130 mmol per day) and/or during sodium depletion by low sodium diet (20 mmol per day) and chlorthalidone. 2. In both series, saralasin induced a transient rise in intra-arterial pressure (P < 0.01), accompanied by a slight decrease in heart rate (P < 0.01). The elevation of systolic arterial pressure reached its maximum after 4 min and was more pronounced in sodium-replete patients. Plasma noradrenaline was significantly elevated by 29.7% (P<0.01), but the rise in pressure was not related to concomitant changes in plasma noradrenaline. 3. After the initial pressor effect, arterial pressure, heart rate, cardiac output and total peripheral resistance remained unchanged in the sodium-replete patients, while in the sodium-depleted conditions mean arterial pressure and peripheral resistance were reduced, by 17.8% and 18.6% (P< 0.001) respectively, within 60min. Reflex increases in heart rate (+3.8%) and cardiac output (+ 11.1%) occurred after 10 min (P<0.05), but were not sustained thereafter. 4. Pulmonary vascular resistance was not affected by saralasin. In sodium-depleted patients, pulmonary capillary wedge pressure decreased by 1.2mmHg (P<0.01), with parallel changes of pulmonary artery pressure (P< 0.01).