摘要:

SUMMARY1. Early diagnosis of Familial Hyperaldosteronism Qpe I (FH‐I, glucocorticoid‐suppressible hyperaldosteronism) in asymptomatic, affected individuals is essential if death from stroke is to be prevented.2. In 21 patients with FH‐I (presence of the causative hybrid 11β‐hydroxylase/aldosterone synthase gene confirmed by Southern blot testing), various biochemical parameters were compared as possible screening tests. Hypokalaemia and elevated plasma aldosterone each detected only two (10%) of the affected individuals.3. Plasma renin activity 19 (90%) and aldosterone/renin ratio 18 (86%) were more reliable but not free from false negatives.4. Levels of the urinary ‘hybrid’ steroid, 18‐oxocortisol, were elevated (P<0.01) in all 15 patients tested (138.2 ± 17.4 μg/g creatinine, range 41.6–281.0 μg/g) with no overlap when compared with 11 normals (9.7 ± 1.3μg/g, range 2.8–17.4 μg/g).5. We conclude that measurement of urinary ‘hybrid’ steroids is probably the most rapid and reliable biochemical screening test currently available for FH‐I, with confirmation dependent on demonstration of the hyb

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02038.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. We have conducted a survey of 75 rural and 75 urban randomly selected general practitioners (GPs) in Western Australia to ascertain how closely current practice mirrors published Australian guidelines for the management of hypertension.2. Fifty‐one rural and 49 urban GPs completed the 19 item questionnaire. The two groups were well matched in terms of age and years in general practice. An assessment of the criteria utilized to diagnose hypertension revealed a tendency for much greater scatter in the cut points used to define systolic compared to diastolic hypertension, but no systematic difference between urban and rural GPs.3. After an initial finding of mild hypertension the follow‐up time to the next check‐up was significantly longer for rural patients compared to urban patients (72 ± 13 and 36 ± 5 days respectively,P<0.01). Urban GPs reviewed established hypertensive patients more commonly at 1–3 monthly intervals (89%) while rural GPs reviewed more commonly at 3–6 monthly intervals (86%).4. In terms of target blood pressure (BP) for BP reduction, 67% rural compared to 83% urban GPs aimed for a systolic BP of<140mmHg (P= 0.06), while 95% of both groups aimed for diastolic BP<90mmHg.5. The profile of first line antihypertensive agents most commonly used was also similar in both groups with 46% preferring angiotensin converting enzyme inhibitors, 18.5% diuretics, 18.5% beta blockers, 16% calcium entry blockers and 1% prazosin.6. This study demonstrates a clear preference for the newer anti‐hypertensive agents. Otherwise there was self‐reported broad compliance with Australian guidelines for hypertension management in this randomly selected GP population. Urban and rural practices were more notable for their consistency rather than any systematic differen

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02039.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Four single base mutations unique to the spontaneously hypertensive rat (SHR) were identified in the first 1100 base pairs of its renin gene first intron when compared to that of Wistar‐Kyoto and Sprague‐Dawley normotensive rats.2. These mutations were found to fall within the consensus sequences for a number of transcription factors and thus may alter the affinity of these putative transcription factor binding sites.3. The reported overexpression of the renin gene in the SHR may therefore result from these structural abnormalities and, in turn, result in a tissue angiotensin‐dependent hypertension in this s

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02040.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Nitric oxide (NO) synthase inhibitors and Paf antagonists abrogate hypotension in septic shock. The latter may act by blocking intracellular transduction mechanisms in vascular smooth muscle cells and inflammatory cells. We examined the effect of Paf antagonists on expression of inducible NO synthase.2. A murine macrophage cell line (J774.2) and rat vascular smooth muscle cells (VSMC) were stimulated with lipopoly‐saccharide (LPS), either alone or in combination with Paf or Paf antagonists, BN 50739 or E‐6123.3. NO synthase activity in 5774.2 was measured by the conversion of [3H]l‐arginine to [3H]l‐citrulline. Nitrite accumulation was measured in the culture medium of J774.2 and VSM.4. BN 50739 (10 μmol/L) and E‐6123 (1 μmol/L) both reduced the expression of calcium‐independent NO synthase activity and nitrite accumulation, while Paf alone had no effect.5. Inhibition of NO synthase induction by Paf antagonists might afford therapeutic benefits in the management of septic shock and possibly other cardiovascu

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02041.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. A gastric sodium monitor has been proposed, based upon greater urinary sodium excretion after gastric, compared with intravenous, sodium loading. However, this difference has only been demonstrated in animals and humans on a low sodium diet prior to study. This suggests involvement of a system activated by decreased sodium intake. As the renin‐angiotensin system is the most active of these, this study sought to determine whether angiotensin II (AII) might act as a humoral mediator for this gastric sodium monitor.2. Male New Zealand white rabbits with a gastrostomy tubein situwere placed on a low sodium diet (0.008% NaCl) for 7 days. To determine if differences in plasma AII might explain the different natriuretic responses AII was measured 0, 5,10, 30, 60 and 120 min after a 1.5mmol/kg sodium load given gastrically or intravenously. To determine whether the AII response was specific to low salt diets the gastric salt load was given after equilibration on normal (2.2% NaCl) and high (4.4% NaCl) sodium diets.3. In rabbits on the low sodium diet plasma AII decreased significantly at 5 min after both gastric (P<0.025) and intravenous (P<0.05) sodium and returned to baseline by 10 min in the latter. In contrast after gastric sodium AII remained less than in controls throughout (120 min,P<0.05). In the rabbits on the normal and high sodium diets plasma AII concentration increased non‐significantly after gastric sodium administration.4. We conclude that circulating AII may participate as a mediator of the gastric sodium monitor. Its concentration was reduced and remained persistently lower after gastric but not intravenous sodium. Further, this change was not apparent on sodium diets in which differences in sodium excretion have not been demonstrated previou

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02042.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. In patients with primary aldosteronism due to angiotensin‐responsive and andotensin‐unresponsive aldosterone‐producing adenomas, no differences in the coding region of the angiotensin II type 1 (AT1) receptor gene were observed compared to normal subjects in peripheral blood leucocyte DNA.2. Furthermore, no differences in the AT1 receptor gene were observed in DNA extracted from tumour tissue of either subgroup.3. Genotypic and allelic frequencies for an RFLP detected in the coding region of the AT1 receptor gene were not significantly different between normal subjects and patients with aldosterone‐producing adenomas as a group, nor between normal subjects and patients of either subgroup when compared with each other.4. In those patients heterozygous in peripheral blood at the RFLP site, tumour DNA showed the same allelic pattern.5. In patients with aldosterone‐producing adenomas either responsive or unresponsive to the renin‐angiotensin system, no differences were detected using SSCP analysis in the coding region of the AT1 receptor gene in peripheral blood or tu

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02043.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Aldosterone responsiveness to ACTH was compared in eleven patients with angiotensin‐unresponsive (AII‐U) aldosterone‐producing adenomas (APA), 16 with AII‐responsive (AII‐R) APA and 19 with bilateral adrenal hyperplasia (BAH).2. After overnight recumbency, aldosterone levels were highest in AII‐U APA and lowest in BAH. Following 2h of upright posture, however, levels were similar among the three groups.3. During ACTH infusion, aldosterone levels in AII‐U and AII‐R APA were similar, and higher than those in BAH. Because of the higher basal level, the percentage rise in aldosterone was lower in AII‐U APA compared with the other groups, as was the ratio of per cent aldosterone rise to per cent cortisol rise.4. Slightly but significantly reduced plasma cortisol levels observed in the AII‐R APA group may reflect secretion by AII‐R APA of a cortisol‐like substance that is capable of suppressing ACTH and thus adrenal cortisol production.5. The tendency of aldosterone to follow the diurnal rhythm of ACTH in AII‐U APA may thus represent an unmasking of the normal ability of ACTH to regulate aldosterone, secondary to the loss of AII responsiveness, rather than an e

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02044.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. The long‐term reduction in blood pressure following ACE inhibitor treatment in young spontaneously hypertensive rats (SHR) appears to depend on both the kidney and brady‐kinin.2. The aim of this experiment was to examine the effects of ACE inhibition and bradykinin on renal morphology and blood pressure in SHR.3. Between 6 and 10 weeks of age male SHR received one of four treatments: water (n =26), ramipril (1 mg/kg per day;n =24), ramipril (1 mg/kg per day) plus Hoe 140 (0.5 mg/kg per day;n =25) or Hoe 140 (0.5 mg/kg per day;n= 25).4. Renal medullary and cortical volumes were determined stereologically at 10 and 20 weeks of age.5. After 4 weeks of treatment, ramipril reduced the size of the renal medulla while Hoe 140 increased medullary volumes compared to control. Ten weeks after treatment was stopped the renal medulla of the ramipril group had returned to normal, however, there was a persistent increase in medullary volume of both Hoe 140 treated groups.6. Our results imply that bradykinin may influence the size of the renal medulla which may have important effects on the development of hypertension in

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02045.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. We assessed whether a lifestyle modification programme implemented by nurse counsellors in a general practice setting would improve blood pressure (BP) control in treated hypertensive patients.2. Patients were randomized into a control group or one of two intervention groups who received either a high or low level of counselling.3. Patients in the intervention groups had appointments every 4th week for 18 weeks. The low intervention group had one practice appointment and five telephone counselling appointments while the high intervention group had six appointments in their general practice. The patients were counselled using a stage of change behavioural model and motivational interviewing to: reduce alcohol consumption, dietary fat and salt intake and weight; cease smoking; and increase leisure time physical activity.4. Compared with controls the low intervention group showed signifcant decreases in alcohol and salt intake while the high intervention resulted in significant decreases in both weight and BP.5. We conclude that nurse counselling targeted to specific aspects of lifestyle can improve BP control and weight in treated hypertensive patients over 18 weeks. Its longer term effectiveness in the management of hypertension warrants further evaluation.

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02046.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. This study was designed to investigate the effects of isotonic saline loading on renal tubular and neurogenic dopamine (DA) in conscious rabbits.2. Isotonic saline loading did not affect mean arterial pressure, heart rate or renal blood flow but markedly increased urine volume, sodium excretion and DA excretion.3. Renal DA spillover was not affected by venous emptying, while renal noradrenaline (NA) spillover tended to decrease during saline loading. The ratio of % renal DA spillover to % renal NA spillover increased to 2.3 ± 0.6 (P<0.05) 3h after saline loading.4. Isotonic saline loading increased renal tubular DA production but had little effect on neurogenic DA release

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb02047.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY