摘要:

A cohort of more than 8000 Japanese men living in Hawaii was studied for factors associated with blood pressure levels, with an emphasis on biological and sociocultural variables. Bivariate and multivariate analyses of more than 50 variables indicated that obesity, age, hematocrit, heart rate, forced vital capacity, serum triglyceride, serum uric acid, cigarette consumption, and family history of hypertension were independently associated with both cross-sectional levels and longitudinal changes in blood pressure. Serum glucose and alcohol consumption were associated with cross-sectional levels only. There was little evidence of association for specific dietary items, type of diet, diet changes, or use of salt. Furthermore, there was no support for the psychosocial hypotheses of elevated blood pressure from the stress of migration, acculturation, or status incongruity. (Hypertension 4: 406–414, 1982)

ISSN:0194-911X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Low patient cooperation erodes many of the proven benefits of antihypertensive therapy. Over the last few years, there have been important advances in our understanding of the nature and management of patient compliance in hypertension and other chronic illnesses. In this article we review the theoretical foundation of compliance behavior; methods of measuring compliance; established and promising approaches to managing compliance; ethical considerations in measuring, improving, and researching compliance; the current state of implementation of compliance techniques in practice settings; and the efforts to disseminate information on compliance through undergraduate and continuing health professional education programs. (Hypertension 4: 415–423, 1982)

ISSN:0194-911X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Hormonal and mean arterial pressure (MAP) responses to posture, isometric handgrip, angiotensin II (AH), adrenocorticotrophic hormone (ACTH), and metoclopramide (MCP), a dopamine (DA) antagonist, were examined in nine men with essential hypertension and nine age- and weight-matched normotensive men on a constant 100 mEq sodium and 80 mEq potassium intake before and after 4 days of administration of the DA agonist, bromocriptine (BEC; 2.5 mg three times a day). BEC depressed supine basal MAP in the hypertensives, and decreased MAP response to posture and isometric exercise in both groups. There were similar reductions (p< 0.01) in basal supine norepinephrine (NE) in the two groups. Hypertensives displayed greater (p< 0.01) NE responses to posture and exercise than the normotensives. BEC decreased the NE response to 10 minutes of upright posture and exercise more in hypertensives (p< 0.01) than in normotensives. Hypertensives had greater (p< 0.05) plasma aldosterone (PA) responses to exercise than normotensives, but following BEC, the responses were similar. BEC did not affect basal PRA or PRA responses to posture and exercise in the two groups. PA responses to ACTH and MCP were similar in both groups, but the hypertensives displayed greater (p< 0.01) PA responses to AH. BEC suppressed PA responses to AH (p< 0.01) and to high dose ACTH (p< 0.05) to a similar extent in both groups. The prolactin as well as the PA response to DA antagonism with MCP was similar in the two groups. These results suggest that dopaminergic control of NE secretion may be altered in essential hypertension. Blood pressure lowering effects of BEC in patients with essential hypertension may be related, in part, to depression of sympathetic nervous system activity. (Hypertension 4: 424–430, 1982)

ISSN:0194-911X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This study examines the influence of dopamine on plasma catecholamine, prolactin (PRL), and mean arterial pressure (MAP) responses to upright posture and isometric handgrip exercise and the recumbent circadian PRL and MAP patterns in essential hypertension. Nine men with sustained essential hypertension and nine age- and weight-matched normotensive controls were studied after they had reached metabolic equilibrium on a constant intake of 100 mEq sodium and 80 mEq potassium. The hypertensive group, but not the normotensive group, displayed a PRL response to upright posture and isometric handgrip. Hypertensives and normotensives had similar basal supine catecholamine levels and similar epinephrine and dopamine responses to posture and handgrip. The hypertensives had greater (p< 0.01) norepinephrine (NE) responses to posture and handgrip than did the normotensives. Bromocriptine (BEC) depressed supine basal MAP in the hypertensives but not in the normotensives. BEC markedly decreased the basal PRL levels in both groups. BEC eliminated the PRL response to posture in the hypertensives and depressed the NE response to posture and handgrip to a greater extent (p< 0.01) in the hypertensives than in the normotensives. In the control period, a clear circadian rhythm of PRL and MAP was noted in both groups. In both groups an increase in PRL concentration occurred between 60 to 90 minutes after sleep onset, and was followed by several larger secretory episodes resulting in progressively higher levels during the night with peak values occurring at the end of the sleep period, generally at 0500 to 0600 hours. During the hour after awakening, a fall in PRL concentration began, and lowest levels were reached at approximately 1100 hours in both groups. The mean 24-hour PRL levels in the hypertensive group (12.6 ± 0.5 ng/ml) were higher (p< 0.01) than in the normotensives (10.8 ± 0.4 ng/ml). During the waking hours, there was a correlation (r = 0.57,p< 0.01) between recumbent PRL levels and MAP. BEC therapy lowered MAP levels throughout the 24 hours in the hypertensive group. BEC also eliminated the circadian rhythm of PRL secretion. Thus, circadian variations in PRL secretion and blood pressure appear to be modulated by a central and/or peripheral dopaminergic mechanism. Decreased dopaminergic activity in essential hypertension may account, in part, for aberrances in PRL secretion and elevated blood pressure in this disease state. (Hypertension 4: 431–438, 1982)

ISSN:0194-911X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

In a 10-year period, 7200 of 19,000 black hypertensive adults in the University of Cincinnati Medical Center were referred to the Hypertension Service. In selected patients, intravenous urograms (1038) and renal arteriograms (238) were performed; 47 cases of renovascular hypertension (0.65% of the referred group and 0.25% of the entire sample) were identified. Atherosclerosis (32 patients) and flbromuscular dysplasia (11) were the most common causes of renal artery obstruction. Other lesions included traumatic thrombosis (2), Leriche syndrome (1), and postrenal transplant anastamotic thrombosis (1). Twenty-four patients were operated on (6 cured, 14 improved, 4 dead) and 23 treated medically (18 improved, 2 unimproved, 3 dead). Surgical mortality was 0. Follow-up exceeded 5 years in 25 patients. Extrarenal vascular lesions were found in 30 patients and accounted for six of seven deaths. Renal vein renin ratios S 1.5:1 (affected to unaffected side) predicted successful surgery in 14 patients, but eight of nine operated patients with ratios < 1.5:1 also had favorable results. Factors in addition to renin assay were weighed before surgery was recommended. Since renovascular hypertension is rare in adult blacks, intensive investigation for this entity is justified only in patients with distinct suggestive findings. Treatment results in blacks are similar to those in white cohorts. (Hypertension 4: 438–443, 1982)

ISSN:0194-911X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The present study was conducted to investigate the influence of captopril on cardiohemodynamic responses in 38 normal volunteers (20- to 35-year-old men) to exogenously administered vasopressor substances. Norepinephrine (NE), 0.05, 0.1, and 0.2 μg/kg min−1; angiotensin II (AH), 5, 10, and 20 ng/kg min−1; and pitressin (2 mU/kg min−1) were infused for 10 minutes. Each infusion was repeated twice, and the responses were reproducible. Captopril (50 mg by mouth) significantly attenuated the pressor responses to NE and pitressin, but the decrease in heart rate in response to NE and pitressin was almost the same before and after captopril treatment, suggesting that captopril potentiates reflex slowing of the heart. Captopril significantly potentiated the pressor response to AIL Attenuation of pressor response and potentiation of reflex slowing of the heart, in response to NE and pitressin, disappeared when a subdepressor dose of AH (1 ng/kg min−1) was infused in addition to captopril. Infusion of a subdepressor dose of bradykinin (BK), 0.1 fig/kg min−1, had no influence on the pressor response to NE. In the subjects treated with indomethacin (225 μg/54 hrs), captopril still attenuated the pressor response to NE. These results suggest that captopril attenuates the pressor responses to NE and pitressin primarily by depletion of endogenous AH; decreased AH may desensitize the contraction of arterial smooth muscle and may potentiate the compensatory reflex mechanism. (Hypertension 4: 444–451, 1982)

ISSN:0194-911X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

To elucidate the pathophysiology of elevated blood pressure in hypercalcemic patients, we studied the plasma concentration of catecholamines and their major metabolites (as an index of sympathetic function) and the blood pressure response to norepinephrine infusion (vascular reactivity) in patients with primary hyperparathyroidism, in patients with primary hypertension, and in normal controls. In addition, we evaluated the hemodynamic response to calcium infusion in normotensive and hypertensive subjects. Plasma levels of both norepinephrine and epinephrine and the metabolites normetanephrine and dihydroxyphenylglycol were significantly higher in the hypercalcemic group than in the other two groups. Norepinephrine infusion increased blood pressure by 8.5 ± 1.4 mm Hg in the control group, by 19 ± 2 mm Hg in the hypercalcemic group and by 29 ± 3 mm Hg in the primary hypertensive group. Infusion of calcium produced a significant rise in both systolic and diastolic blood pressures and in peripheral resistance in the hypertensives, whereas in the normotensive group only systolic blood pressure increased, associated with a rise in cardiac output. We conclude that the observed increased activity of the sympathetic nervous system in hypercalcemia could account for the elevation in blood pressure and the enhanced vascular reactivity could explain the hypertension in some patients with primary hyperparathyroidism. (Hypertension 4: 452–458, 1982)

ISSN:0194-911X    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0194-911X    

出版商:OVID    

年代:1982

数据来源: OVID