Biomedical subjects
Publications and source records attributed to B Weisser.
Nowadays, not only endurance training but also power training is recommended for patients with hypertension. In appropriately doses programs (no forced respiration), a number of studies have documented a blood pressure lowering effect. In the elderly hypertensive in particular, positive effects of power training that go beyond the simple lowering of elevated blood pressure may be expected.
The aim of the project promoted by the federal state of North-Rhine/Westphalia was the development of a field stage test focusing on endurance exercises of elderly people which withstand test-theoretical quality criteria, in particular that of economy. The main objectives were therefore the measurement of individual potential by measuring the heart rate, with simultaneous minimization of health risks and a close link to normal, everyday exercises. The test procedure was supposed to estimate the aerobic endurance of elderly people in order to enable us to give individual training recommendations on walking. In a three-phase procedure (laboratory and field ergometry, test development, and evaluation) with a total of 90 test persons, the individual heart rates and lactate levels were measured in 269 single tests. The findings show that an evaluation of the individual performance capability on the basis of heart rate is possible using a three-stage power walking test (PWT), without requiring maximum strain of the subjects. The PWT can therefore be seen as a diagnostic instrument available for the age group of the 60-80 year-olds, supplying a default for an individual strain dosage for walking. The test is accomplished independently of the respective age of the subjects and the result is an individual training plan for walking on the basis of an estimate of personal endurance. Developed as a staged test, the three levels requiring a 400 m walk on each level at different speeds, all the test requires is the measurement of the heart rate at the end of each level. The validity of the common guides for the planning of training by heart rate for systematic endurance training (walking) is thereby improved enabling a more individual training recommendation.
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The circadian pattern of numerous cardiovascular events (myocardial infarction, sudden cardiac death, stroke) reveals a peak in the early hours of the morning. A circadian rhythm peaking in the morning is also found for so-called silent myocardial ischaemia, which occurs in more than 20% of patients with arterial hypertension, and can be regularly detected in combined 24-h-ABPM/EKG examinations. Comparative studies have shown that hypertensives with SMI suffer more cardiac events than those with no SMI. It has further been demonstrated that an elevated blood pressure amplitude, with is considered an independent risk factor for cardiac events, is associated with an increased incidence of SMI in patients with micro- or macro-angiopathy. Accordingly, consideration should be given to SMI when deciding on treatment, also in hypertensives with no angina pectoris symptoms.
OBJECTIVE: This trial investigated the decrease of blood pressure, safety and tolerability of valsartan, an angiotensin-receptor blocker, alone or combined with the diuretic hydrochlorothiazide. In addition, the effect on pulse pressure, heart rate and mean blood pressure were recorded as independent markers of cardiovascular risk. PATIENTS AND METHODS: 12278 hypertensive patients were treated for 12 weeks with valsartan alone or combined with hydrochlorothiazide in a multi-centre open trial. Previously established antihypertensive treatment was continued. Systolic and diastolic pressure, pulse pressure and resting heart rate were recorded at the start of the trial and at 1, 4 and 12 weeks thereafter. RESULTS: Data on 11447 were complete enough to be evaluated (54% males, 46% females; mean age 60.8 years). 44% of the patients were at the same time receiving other antihypertensive drugs at the start of the trial, but the numbers so treated decreased during the trial period. Systolic pressure was reduced by 27.8 mmHg. diastolic pressure by 14.7 mmHg, with a calculated reduction of pulse pressure from 71.5 to 58.7 mmHg. Heart rate was reduced by 3.4 beats. The treatment had to be stopped prematurely in 2.3% of patients because of side effects. There were no severe or life-threatening side effects. CONCLUSION: Treatment with valsartan alone or combined with hydrochlorothiazide provides effective blood pressure reduction and is well tolerated. This trial suggests that, in addition to the fall in blood pressure, the independent risk factors of cardiovascular disease, pulse pressure and resting heart rate, were also reduced during administration of valsartan.
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A musculoskeletal disease frequently entails numerous physical, social and occupational limitations, e.g. reduction of physical capabilities, chronic pain, and loss of employment. A number of patients suffer from comorbid psychological strain or mental disorders, and it frequently remains unclear whether these psychological phenomena are unconnected to, a consequence of or even among the causes for the somatic disease. In order to diagnose, or possibly prevent, comorbid mental disorders, it is necessary to know risk factors which are associated with mental disorders. Studies published during the last twenty years are reviewed which examine sociodemographic, disease specific and psychosocial factors in connection with psychological strain or mental disorders among patients with musculoskeletal diseases. Due to the relatively small number of relevant studies (n = 12), the findings have to be interpreted carefully.
Recently, there have been several reports on the influence of physical activity on immune function. Most of the studies were conducted using maximal exercise in young and middle-aged subjects. Since human immune function undergoes adverse changes with aging, we investigated in the present study whether submaximal, aerobic exercise induces changes in immune function in elderly subjects. Leukocytes, differential blood count, subsets of lymphocytes, CD4/CD8 ratio and immunoglobulins were studied after submaximal aerobic exercise (mean lactate 2.57 + 0.3 mmol/l) in 15 elderly subjects (mean age 68 +/- 5.6 years). These parameters were measured before, immediately after and 4 hours after exercise. Mean hemoglobin was unchanged indicating no hemoconcentration. There was a small increase in mean total lymphocytes (p < 0.05 immediately after exercise), while there was a highly significant increase in leukocyte count both immediately and 4 hours after exercise (p < 0.01). We found a significant correlation between the increase in leukocytes and lactate concentration (p < 0.01, r = 0.784). Lactate levels of all subjects were below 4 mmol/l. These results might indicate that the effect of a single bout of aerobic exercise on immune function depends on the intensity and duration of exercise relative to the level of fitness in elderly subjects. There was a highly significant rise (p < 0.001) in CD4/CD8 ratio 4 hours after exercise. This increase was mainly due to a rise in CD4 cell number whereas T-suppressor cells were almost unchanged. Our data show a possible stimulation of immune function by a submaximal, aerobic exercise in elderly subjects. Further studies are required to clarify whether a stimulation of CD4/CD8 ratio by chronic training gives rise to a reduction of infections in physically active elderly persons.
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New guidelines for the management of hypertension have been published in 1999 by the World Health Organization (WHO) and the International Society of Hypertension (ISH). The WHO/ISH Committee has adopted in principle the definition and classification of hypertension provided by the JNC VI (1997). The new classification defines a blood pressure of 120/80 mm Hg as optimal and of 130/85 mm Hg as the limit between normal and high-normal blood pressure. It is unclear which self-measured home blood pressure values correspond to these office blood pressure limits. In this study we reevaluated data from our Dübendorf study to determine self-measured blood pressure values corresponding to optimal and normal office blood pressure using the percentiles of the (office and home) blood pressure distributions of 503 individuals (age, 20 to 90 years; mean age, 46.5 years; 265 men, 238 women). Self-measured blood pressure values corresponding to office values of 130/85 mm Hg and 120/80 mm Hg were 124.1/79.9 mm Hg and 114.3/75.1 mm Hg. Thus, we propose 125/80 mm Hg as a home blood pressure corresponding to an office blood pressure of 130/85 mm Hg (WHO 1999: normal) and 115/75 mm Hg corresponding to 120/80 mm Hg (optimal).