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Biomedical subjects

A Zeller

Publications and source records attributed to A Zeller.

At least 19 recordsLinked to original sources
PubMed2006

C-reactive protein and echocardiography have little impact on risk stratification in never-treated hypertensive patients.

The aim of this study was to assess the contribution of increased concentrations of high-sensitivity C-reactive protein (hsCRP) and echocardiography to risk stratification according to the 2003 European guidelines for the management of arterial hypertension in patients with untreated hypertension. A total of 207 consecutive medical outpatients with untreated hypertension were included. History and clinical examination, electrocardiography, laboratory analyses including the measurement of hsCRP and echocardiography were performed in all patients. Patients were classified into four risk groups with and without using echocardiography and hsCRP concentrations of at least 10 mg/l according to the 2003 guidelines for the management of hypertension. The majority of the 207 patients (81%) were at moderate or high cardiovascular risk before adding echocardiography and/or hsCRP to the risk stratification process. When echocardiography was included, only three patients were reclassified from the moderate added risk to the high added risk group. Adding hsCRP concentrations of at least 10 mg/l had no impact on risk stratification. Using an hsCRP cutoff level of 3 mg/l, one patient was at moderate instead of low added risk, eight patients were at high instead of moderate added risk and one patient was at very high instead of high added risk. We conclude that hsCRP at the proposed cutoff level of 10 mg/l has no impact on risk stratification in outpatients with untreated hypertension. An hsCRP cutoff level of 3 mg/l may be more suitable for risk stratification. Finally, our data suggest that depending on the population studied, there is minimal impact of echocardiography on risk stratification.

C-Reactive Protein↗
PubMed2005

[Angiotensin II receptor blockers--evidence along the cardiovascular continuum].

The introduction of Angiotensin II receptor blockers (ARB) in 1995 was another milestone in the pharmacological management of hypertension. Due to the manifold effects on several target organs Angiotensin II is one of the most important mediator in the pathogenesis of hypertension. The blockade of the Angiotensin II receptor type 1 is a crucial cornerstone in interrupting the pathophysiological pathways in hypertension. Furthermore ARB have an excellent tolerability comparable with placebo. In the last decade large placebo-controlled trials could prove the efficiency of ARB in terms of morbidity and mortality. Patients after acute myocardial infarction and patients with chronic heart failure benefit from treatment with ARB equally compared to treatment with ACE inhibitors. Combining ARB and ACE inhibitors in patient after myocardial infarction increases the rate of adverse events without improving survival. Increase of microalbuminuria and worsening of diabetic nephropathy is reduced by ARB in patients with diabetes type 2, but an advantage over ACE inhibitors could not be documented. Hypertensive patients with electrocardiographically left ventricular hypertrophy treated with ARB seem to have an additional benefit in terms of morbidity and mortality compared to treatment with beta-blockers. In the early treatment of stroke patients treated with ARB have a lower 12-mounth mortality than patients receiving placebo. In conclusion, Angiotensin II receptor blockers are due to their well proved efficiency, the cardio- and renoprotective qualities and the excellent tolerability profile a useful therapeutic option in the management of patients with hypertension.

Adrenergic beta-Antagonists↗
PubMed2005

[Salt, hypertension and cardiovascular risk].

For more than a century salt and blood pressure have been linked. Prospective randomized clinical trials and meta-analyses provided evidence that a reduction of daily salt intake of 100 mmol will lower systolic blood pressure by 3-5 mm Hg, whereas diastolic blood pressure can be reduced by 1 mm Hg. The effect of salt restriction depends strongly on individual salt sensitivity. Whether a reduction of salt intake will ultimately result in a decline of cardiovascular morbidity and mortality remains to be determined in future studies.

Causality↗
PubMed2005

Diagnostic significance of transferrinuria and albumin-specific dipstick testing in primary care patients with elevated office blood pressure.

This study assesses the diagnostic accuracy of transferrinuria and an albumin-specific dipstick assay for detection of renal target organ damage (microalbuminuria) in hypertensive patients in a general practice setting. A spot urine sample of 130 nondiabetic patients with elevated office blood pressure readings (>140 and/or 90 mmHg) was investigated by measuring albumin to creatinine ratio (ACR) and transferrin to creatinine ratio (TCR) and by using an albumin-specific dipstick test (Micral). ACR was considered as comparative gold standard. TCR was elevated (>0.19 mg/mmol) in 26 urine samples (20.0% of the test samples). ACR was raised in 29 samples (22.3% of the test samples). Elevated TCR had a sensitivity of 97% and specificity of 91% for detection of microalbuminuria. Positive predicting value for microalbuminuria was 65%; negative predicting value was 99%. Correlation between ACR and TCR was strong (r=0.96). Dipstick testing for albumin was positive in 23 urine samples (17.7% of the test samples), 27 (20.8%) tests were false positive and six (4.6%) false negative. When dipstick was positive, the sensitivity of detecting microalbuminuria was 79%, and specificity 73%. In conclusion, detection of urinary transferrin in nondiabetic patients with hypertension is strongly associated with urinary albumin excretion. However, assessment of TCR does not identify additional patients with microalbuminuria compared to measurement of ACR alone. The semiquantitative Micral test offers a simple and valuable method to screen hypertensive patients for microalbuminuria in a primary care setting.

Albuminuria↗
PubMed2004

3,3'-Dimethyl-1,1'-methylenediimidazolium tetrachlorocobaltate(II).

The title compound, (C9H14N4)[CoCl4], a methylene-bridged bis-imidazolium salt containing a tetrachlorocobaltate anion, is one of the first examples where an alkyl-bridged bis-imidazolium compound could be structurally characterized. Short C-H...Cl contacts between the imidazolium C-H bonds and the Cl atoms of the counter-anion build up a three-dimensional network and indicate that the C-H bonds are strongly polarized.

Journal Article↗
PubMed2002

[Placebo: an unappreciated factor in medicine].

Placebo is a provoking factor in medicine that is discussed controversially and not fully understood so far. From the scientific point of view and according to evidence-based medicine a proved indication to prescribe a placebo does not exist. Therapy of pain may be an exclusion. In our daily work we consciously use the placebo-effect, but on the other hand we are committed to the placebo-phenomenon. This article gives an overview of various aspects of placebo. The currently supported theory about the placebo response, conditioning and expectancy, are discussed. Further, the side effects (nocebo-phenomenon) and the utility of placebo in randomised clinical trials is highlighted.

Controlled Clinical Trials as Topic↗
PubMed2001

[Hypertensive emergency].

Hypertensive emergencies are acute, life-threatening events, characterised by high blood pressure and concomitant acute hypertensive target organ damage. These patients need immediate lowering of blood pressure mostly with parenteral drugs in the range of the autoregulative capacity of organ circulation and in-hospital monitoring of the vital functions. Hypertensive urgencies are not necessarily life-threatening, but persistence of high blood pressure may lead to acute target organ damage. Blood pressure should be lowered within 24 to 48 hours. Oral therapy is normally sufficient and hospitalisation is rarely necessary, but maintenance of antihypertensive therapy outside the hospital has to be ascertained.

Antihypertensive Agents↗
PubMed2001

[The Basel Medical University Polyclinic on the brink of the 21st century: retrospective and prospective view].

At the occasion of its 125th anniversary the outpatient department of internal medicine is being analysed with regard to its history, development and future. Originally it was founded to improve practical patient-oriented teaching of students and to serve the poor population of Basel. While today the Swiss Health Insurance system warrants proper care for every citizen and thus renders the latter purpose unnecessary, new marginal patient groups have evolved that need proper attention such as HIV patients, asylum-seekers, geriatric patients and others. Teaching obligations have even increased, especially with regard to primary care and family medicine. Thus the reasons for running a medical outpatient department have changed considerably, but still include teaching, research and provision of care to special patient groups. Outpatient departments have to be flexible and to adapt to modern trends in health care.

Forecasting↗