Biomedical subjects

D Araújo

Publications and source records attributed to D Araújo.

At least 19 recordsLinked to original sources

PubMed2006

Calcified cysticercotic lesions and intractable epilepsy: a cross sectional study of 512 patients.

BACKGROUND: Neurocysticercosis is a major cause of epilepsy in developing countries and is endemic in Brazil. To test the hypothesis that the aetiological profile of patients with intractable epilepsy in Brazil includes neurocysticercosis, we conducted a cross sectional study investigating the aetiology of intractable epilepsy. METHODS: A total of 512 patients evaluated at the outpatient clinic for intractable epilepsy at the Ribeirão Preto School of Medicine were included in the survey. Medical intractability was determined on the basis of seizure incidence and severity, and response to appropriate epilepsy management. Neuroimaging included brain CT with non-contrasted and contrasted phases and high resolution MRI. Patients were divided into neurocysticercosis and non-neurocysticercosis groups according to previous diagnostic criteria. RESULTS: The most common epileptogenic lesions were mesial temporal sclerosis (MTS; 56.0%), malformations of cortical development (12.1%), and brain tumours (9.9%). Neuroimaging was normal in 8.7% of patients. Calcifications were found in 27% of patients and were significantly more common in patients with MTS than in those without MTS (p<0.001). Isolated neurocysticercosis was found in only eight patients (1.56%). CONCLUSIONS: These data suggest that neurocysticercosis is an uncommon cause of intractable epilepsy, even in an endemic region such as Brazil, and that it may only represent a coexistent pathology. However, an analysis of our findings reveals that neurocysticercosis was more common in patients with MTS. This finding could suggest either that there is a cause-effect relationship between MTS and neurocysticercosis, or that MTS and neurocysticercosis co-vary with a missing variable, such as socio-economic status.

Adolescent↗

PubMed2005

Suppression of obsessive-compulsive symptoms after epilepsy surgery.

We report two male patients with medically intractable epilepsy and obsessive-compulsive disorder (OCD) symptoms. Both patients experienced remission of obsessive-compulsive symptoms after surgical treatment of epilepsy. Although the surgeries targeted different brain regions, the two patients had in common unilateral anterior cingulate cortex ablation. On the basis of these observations, we discuss the pathophysiology of OCD symptoms, emphasizing the role of corticosubcortical pathways in their genesis. Our data suggest that surgeries that affect neural loops associated with obsessive-compulsive symptoms can lead to an improvement of OCD; however, the structures responsible for this effect cannot be conclusively determined.

Adult↗

PubMed2005

Cognitive performance of patients with mesial temporal lobe epilepsy and incidental calcified neurocysticercosis.

OBJECTIVES: Although chronic calcified neurocysticercosis (NCC) has been considered a major cause of symptomatic epilepsy in developing countries, it can also be an incidental pathological finding in epileptic patients from endemic regions. The mechanisms of brain plasticity occurring in patients with NCC during and after the inflammatory process related to the parasite infection, death, degeneration, and calcification within the host brain might be an independent factor for cognitive impairment in patients with NCC and epilepsy. In order to assess this possibility cognitive performance of patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) with and without NCC was investigated through structured neuropsychological testing. METHODS: Cognitive performance of long term MTLE-HS patients with (HS-NCC group, n = 32) and without NCC (HS only, n = 48) was compared. Imbalances between the two groups with respect to clinical, demographic, neuroimaging, and electrophysiological variables were adjusted by linear multiple regression analysis and Bonferroni correction for multiple tests. RESULTS AND CONCLUSIONS: There were no cognitive performance differences between HS-NCC and HS only patients, leading to the conclusion that chronic calcified NCC per se does not aggravate the cognitive performance of patients with long term MTLE-HS.

Brain Diseases↗

PubMed2005

Cytogenetic analysis of the neotropical spider Nephilengys cruentata (Araneomorphae, Tetragnathidae): standard staining nors, C-bands and base-specific fluorochromes.

The aim of this work is to characterize Nephilengys cruentata in relation to the diploid number, chromosome morphology, type of sex determination chromosome system, chromosomes bearing the Nucleolar Organizer Regions (NORs), C-banding pattern, and AT or GC repetitive sequences. The chromosome preparations were submitted to standard staining (Giemsa), NOR silver impregnation, C-banding technique, and base-specific fluorochrome staining. The analysis of the cells showed 2n = 24 and 2n = 26 chromosomes in the embryos, and 2n = 26 in the ovarian cells, being all the chromosomes acrocentric. The long arm of the pairs 1, 2 and 3 showed an extensive negative heteropycnotic area when the mitotic metaphases were stained with Giemsa. The sexual chromosomes did not show differential characteristics that allowed to distinguish them from the other chromosomes of the complement. Considering the diploid numbers found in N. cruentata and the prevalence of X1X2 sex determination chromosome system in Tetragnathidae, N. cruentata seems to possess 2n = 24 = 22 + X1X2 in the males, and 2n = 26 = 22 + X1X1X2X2 in the females. The pairs 1, 2 and 3 showed NORs which are coincident with the negative heteropycnotic patterns. Using the C-banding technique, the pericentromeric region of the chromosomes revealed small quantity or even absence of constitutive heterochromatin, differing of the C-banding pattern described in other species of spiders. In N. cruentata the fluorochromes DAPI/DA, DAPI/MM and CMA3/DA revealed that the constitutive heterochromatin is rich in AT bases and the NORs possess repetitive sequences of GC bases.

Animals↗

PubMed2004

In vivo tissue characterization using magnetic techniques.

Among the few non-invasive methods to quantify liver iron deposits, magnetic resonance imaging (MRI) and biomagnetic liver susceptometry (BLS) have been considered the best to evaluate iron overload in the body. This diagnosis is necessary for patients who regularly receive red blood cells transfusion and that have a genetic disorder known as hemochromatosis. In this work, we present the evaluation of the clinical usefulness of MRI and BLS of hepatic tissue to quantify iron deposits in non-transfused and transfused patients. Liver iron evaluation by MRI and BLS were performed in a group of 48 patients. The MRI images weighted in T2 were acquired using multi-slice single-spin-echo (SSE) and single-slice multi-spin-echo (MSE), conducted on a 1.5 T whole body scanner. BLS measurements were performed using an ac superconducting susceptometer based on SQUID. Typically MRI is able to evaluate iron overload in liver as high as 30 mg/g(dry tissue) when using MRI scanners provided with specially designed pulse sequences. For higher iron concentrations susceptibility measurement works better than MRI to evaluate higher iron overloads in the liver, because in this case there is saturation of MRI signal.

Adolescent↗

PubMed2004

Cortical malformations are associated with a rare polymorphism of cellular prion protein.

Studies in animals lacking the cellular prion protein (PrP(c)) gene (Prnp) showed higher neuronal excitability in vitro and increased sensitivity to seizures in vivo. The authors previously reported a rare polymorphism at codon 171 (Asn-->Ser) of human Prnp to be associated with mesial temporal lobe epilepsy related to hippocampal sclerosis. They demonstrated that the same variant allele is also associated with symptomatic epilepsies related to different forms of malformations of cortical development.

Adolescent↗

PubMed2004

The size and prevalence of the cavum septum pellucidum are normal in subjects with panic disorder.

Panic disorder is thought to involve dysfunction in the septohippocampal system, and the presence of a cavum septum pellucidum might indicate the aberrant development of this system. We compared the prevalence and size of cavum septum pellucidum in 21 patients with panic disorder and in 21 healthy controls by magnetic resonance imaging. The length of the cavum septum pellucidum was measured by counting the number of consecutive 1-mm coronal slices in which it appeared. A cavum septum pellucidum of >6 mm in length was rated as large. There was no significant difference in the proportion of patients (16 of 21 or 76.2%) and controls (18 of 21 or 85.7%) with a cavum septum pellucidum (P=0.35, Fisher's exact test, one-tailed), and no members of either group had a large cavum septum pellucidum. The mean cavum septum pellucidum rating in the patient and control groups was 1.81 (SD=1.50) and 2.09 (SD=1.51), respectively. There were also no significant differences between groups when we analyzed cavum septum pellucidum ratings as a continuous variable (U=196.5; P=0.54). Across all subjects there was a trend towards a higher prevalence of cavum septum pellucidum in males (100%, 10 of 10) than females (75%, 24 of 32; P=0.09, Fisher's exact test, one-tailed). Thus, we conclude that, while panic disorder may involve septo-hippocampal dysfunction, it is not associated with an increased prevalence or size of the cavum septum pellucidum.

Adult↗

PubMed2003

Surgical outcome in mesial temporal sclerosis correlates with prion protein gene variant.

BACKGROUND: Mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) is the most common surgically remediable epileptic syndrome. Ablation of the cellular prion protein (PrP(c)) gene (PRNP) enhances neuronal excitability of the hippocampus in vitro and sensitivity to seizure in vivo, indicating that PrP(c) might be related to epilepsy. OBJECTIVE: To evaluate the genetic contribution of PRNP to MTLE-HS. METHODS: The PRNP coding sequence of DNA from peripheral blood cells of 100 consecutive patients with surgically treated MTLE-HS was compared to that from a group of healthy controls adjusted for sex, age, and ethnicity (n = 180). The presence of PRNP variant alleles was correlated with clinical and presurgical parameters as well as surgical outcome. RESULTS: A variant allele at position 171 (Asn-->Ser), absent in controls, was found in heterozygosis (Asn171Ser) in 23% of patients (p < 0.0001). The PRNP genotypes were not correlated with any clinical or presurgical data investigated. However, patients carrying the Asn171Ser variant had a five times higher chance of continuing to have seizures after temporal lobectomy (95% CI 1.65 to 17.33, p = 0.005) than those carrying the normal allele. At 18 months after surgery, 91.8% of patients with the normal allele at codon 171 were seizure free, in comparison to 68.2% of those carrying Asn171Ser (p = 0.005). CONCLUSIONS: The PRNP variant allele Asn171Ser is highly prevalent in patients with medically untreatable MTLE-HS and influences their surgical outcome. The results suggest that the PRNP variant allele at codon 171 (Asn171Ser) is associated with epileptogenesis in MTLE-HS.

Adult↗

PubMed2003

Decreased left temporal lobe volume of panic patients measured by magnetic resonance imaging.

Reported neuroimaging studies have shown functional and morphological changes of temporal lobe structures in panic patients, but only one used a volumetric method. The aim of the present study was to determine the volume of temporal lobe structures in patients with panic disorder, measured by magnetic resonance imaging. Eleven panic patients and eleven controls matched for age, sex, handedness, socioeconomic status and years of education participated in the study. The mean volume of the left temporal lobe of panic patients was 9% smaller than that of controls (t21 = 2.37, P = 0.028). In addition, there was a trend (P values between 0.05 and 0.10) to smaller volumes of the right temporal lobe (7%, t21 = 1.99, P = 0.06), right amygdala (8%, t21 = 1.83, P = 0.08), left amygdala (5%, t21 = 1.78, P = 0.09) and left hippocampus (9%, t21 = 1.93, P = 0.07) in panic patients compared to controls. There was a positive correlation between left hippocampal volume and duration of panic disorder (r = 0.67, P = 0.025), with recent cases showing more reduction than older cases. The present results show that panic patients have a decreased volume of the left temporal lobe and indicate the presence of volumetric abnormalities of temporal lobe structures.

Adult↗

PubMed2002

Accuracy of ictal SPECT in mesial temporal lobe epilepsy with bilateral interictal spikes.

OBJECTIVE: In mesial temporal lobe epilepsy (MTLE), the rate of correct seizure lateralization of ictal semiology and ictal EEG is better for patients with unilateral interictal spikes (UIS) than for patients with bilateral interictal spikes (BIS), possibly due to rapid seizure propagation patterns associated with bilateral epileptogenesis. In this study, the authors investigated if ictal SPECT is a reliable diagnostic test for both UIS and BIS patients. METHODS: Video-EEG recording was used as the gold standard to examine the accuracy of ictal SPECT and its relationship with interictal and ictal EEG. Ninety-three consecutive patients with MTLE associated with hippocampal sclerosis were included in the analysis. Ictal SPECT was considered accurate if two blinded observers independently lateralized the scan correctly. RESULTS: Ictal SPECT correctly lateralized 75 (80.6%) of 93 scans. The rate of correct seizure lateralization was 87.6% for the UIS group and only 55.0% for the BIS group (p = 0.0027). In the EEG epochs, 66.7% of BIS patients vs 43.4% of UIS patients had nonlateralized ictal EEG (p < 0.001). CONCLUSION: The authors conclude that the accuracy of ictal SPECT is worse for MTLE patients with BIS than for those with UIS. The role of ictal SPECT in presurgical evaluation of patients with BIS must be reviewed.

Acute Disease↗

PubMed2001

[Renal neoplasm with vena cava involvement].

Renal cancer with vena cava tumour thrombus is relatively rare (4 to 10%). Because of the poor results obtained with any kind of alternative therapy (e.g. radiation, hormonal, chemotherapy and immunotherapy) operation with complete removal of the vena cava tumour thrombus continues to be the better method of treatment. The prognostic significance of the cephalic extent of an inferior vena caval tumor thrombus associated with renal cell carcinoma is controversial. Long-term survival after surgical treatment is possible in patients with localized renal cell carcinoma (survival 50% at five years). The authors report a case of vena caval extension of renal cell carcinoma in a 70-years-old man. The patient presented with a history of right lumbar pain and pedal edema. Magnetic Resonance demonstrated the presence and the level of tumoral thrombus. The patient was submitted to a radical nephrectomy and complete removal of tumor thrombus from vena caval.

Aged↗

PubMed2001

Typical and atypical perfusion patterns in periictal SPECT of patients with unilateral temporal lobe epilepsy.

PURPOSE: To characterize perfusion patterns of periictal single-photon emission tomography (SPECT) in patients with unilateral temporal lobe epilepsy (TLE) and to determine their relationship to the epileptogenic zone (EZ). METHODS: We studied periictal SPECT scans of 53 patients after anterior mesial temporal lobectomy who had good seizure outcome after surgery. Ictal SPECT scans were performed during video-EEG monitoring. Typical SPECT patterns consisted of ipsilateral ictal hyperperfusion or ipsilateral postictal hypoperfusion. Atypical ictal patterns included normal scans, bilateral temporal hyperperfusion, or contralateral patterns. These perfusion patterns were retrospectively analyzed searching for concordance rate with the EZ. RESULTS: We obtained 51 ictal and two early postictal scans. In the typical group, 40 (75.4%) patients had ipsilateral ictal temporal lobe hyperperfusion, and one (1.9%) patient had ipsilateral postictal temporal lobe hypoperfusion. Twelve (22.7%) patients exhibited atypical perfusion patterns: seven (13.2%) patients had bitemporal ictal hyperperfusion (four cases showed asymmetric temporal lobe changes), four (7.6%) patients had contralateral hyperperfusion, and one (1.9%) patient had a normal SPECT scan. All four patients with bitemporal asymmetric hyperperfusions showed greater perfusion lateralized to the side of the EZ. Three of the four patients who had contralateral hyperperfusion also had a complex postictal-like pattern in the ipsilateral temporal lobe consisting of anteromesial hyperperfusion with adjacent lateral hypoperfusion. CONCLUSIONS: This study analyzed typical and atypical perfusion patterns in unilateral TLE, and suggested that not only typical, but also some atypical perfusion patterns may contribute to the lateralization of EZ.

Adolescent↗

PubMed2001

Percutaneous mechanical mitral commissurotomy performed with a Cribier's metallic valvulotome. Initial results.

OBJECTIVE: To evaluate the immediate results of percutaneous mechanical mitral commissurotomy. METHODS: Thirty patients underwent percutaneous mechanical mitral commissurotomy performed with a Cribier's metallic valvulotome from 8/11/99 to 2/4/00. Mean age was 30.7 years, and 73.3% were women. With regards to functional class, 63.3% were class III, and 36.7% were class IV. The echocardiographic score had a mean value of 7.5+/- 1.8. RESULTS: The mitral valve area increased from 0.97+/-0.15cm2 to 2.16+/-0.50cm2 (p>0.0001). The mean diastolic gradient decreased from 17.9+/-5.0mmHg to 3.2+/-1.4mmHg. The mean left atrial pressure decreased from 23.6+/-5.4mmHg to 8.6+/-3.1mmHg, (p>0.0001). Systolic pressure in the pulmonary artery decreased from 52.7+/-18.3mmHg to 32.2+/-7.4mmHg. Twenty-nine cases were successful. One patient developed severe mitral regurgitation. Interatrial septal defect was observed and one patient. One patient had cardiac tamponade due to left ventricular perforation. No deaths occurred. CONCLUSION: This method has proven to be safe and efficient in the treatment of rheumatic mitral stenosis. The potential advantage is that it can be used multiple times after sterilization, which decreases procedural costs significantly.

Adult↗

PubMed2000

[Clinical correlation of angiographic restenosis, isolated or associated with stress test variables, with a population that had stent implantation].

OBJECTIVE: We analyse the value of the clinical data, isolated or associated with the stress EKG (SEKG) variables, in the detection of angiographic restenosis (AR: lesion > 50%), in a group of patients (pts) submitted to coronary angioplasty (PTCA) with stenting. POPULATION AND METHODS: 105 patients were followed prospectively (male: 87%; age: 56 +/- 10); clinical evaluation was performed in the 1st, 3rd and 6th month, SEKG in the 4th month and recatheterization for angiographic control in the 6th month. The vascular risk factors, cause of admission, medication at discharge, angiographic and procedure characteristics were analysed. RESULTS: The most frequent vascular risk factors were hypertension (42%), smoking (64%), and dyslipidemia (52%); 30% had previous ischemic heart disease. The indication for PTCA was myocardial infarction (direct PTCA or residual ischemia) in 42% and angina in 59%. All patients were discharged with AAS and ticlopidine, 38% with beta-blockers, 59% with calcium channel blockers and 92% with nitrates. Thirty-eight percent had multivessel disease. They were submitted to dilatation with the implantation of 128 stents in 199 vessels. An intraaortic balloon pump was used in 13% and Abciximab in 47% of the procedures. In the recatheterization for angiographic control in the sixth month, 30 patients had angiographic restenosis (AR rate = 25.2%). In the clinical evaluation, 22 patients (20.9%) had angina, and 14 of them had angiographic restenosis (clinical restenosis rate = 13.3%). In the 16 asymptomatic patients with AR, 5 had positive SEKG. CONCLUSION: The presence of angina in a group of patients submitted to coronary angioplasty with stenting has a low sensitivity (54%), a good specificity (88%), a positive predictive value of 64% and negative of 83% in the detection of angiographic restenosis. The association with clinical data improves sensitivity (83%), with a decrease in specificity (61%).

Aged↗

PubMed2000

Primary angioplasty for acute myocardial infarction complicated by cardiogenic shock on admission.

AIM: To evaluate primary angioplasty results for the treatment of acute myocardial infarction complicated by cardiogenic shock on admission. POPULATION AND METHODS: Retrospective analysis of 11 consecutive patients with acute myocardial infarction complicated by cardiogenic shock (defined as systolic blood pressure below 80 mmHg and signs of hypoperfusion, despite volume expanders and/or vasopressors infusion) treated with primary angioplasty. Clinical characteristics, angiographic data, hospital outcome and follow-up were analysed. RESULTS: There were ten males (90.9%) with a mean age of 66 years. Eight patients had anterior wall myocardial infarction and three patients had inferior wall myocardial infarction, two of which with extension to the right ventricle. The mean time between symptom onset and angioplasty was 3.5 hours. Three patients had left main coronary artery occlusion; three patients had single vessel disease and five patients had multivessel disease. The angiographic success rate (open infarct-related artery and TIMI III flow) was 90.9% (ten patients). Stent implantation was performed in five patients. Abciximab was given in five patients. In-hospital mortality rate was 36.4% (four patients). The surviving patients had a mean ejection fraction of 43.1% on discharge. In a mean follow-up of 16.2 months, one patient had coronary artery bypass graft and one had stroke. CONCLUSION: Based on published data, our experience with this short series of cases shows that primary angiography should be regarded as a positive option for the treatment of acute myocardial infarction complicated by cardiogenic shock.

Aged↗

PubMed1999

[Angioplasty with stenting in single vessel disease: non invasive methods for detecting restenosis].

OBJECTIVE: To compare the value of the myocardial perfusion imaging with 99Tc sestamibi (MIBI) with clinical data and stress EKG (SEKG) variables, in the detection of angiographic restenosis (AR: lesion > 50%), in a group of patients (pts) with single vessel disease (angiographic lesion above 70% in one epicardial artery), submitted to coronary angioplasty (PTCA) with stenting. POPULATION AND METHODS: Fifty-nine pts, followed prospectively, (49 males and 10 females aged 57 +/- 10) were submitted to 61 angioplasties, with dilatation of 59 vessels, and with stenting in 63 (1.07 stent/vessel). Clinical evaluation was performed in the first, third and sixth month, SEKG with MIBI in the fourth month and recatheterization for angiographic control in the sixth month. The pts were divided in two groups: R-positive angiographic restenosis (AR)--14 pts: NR--without AR--45 pts; the angiographic restenosis rate was 23.7%. The patients' history, cause of admission, procedure characteristics, medication at discharge, clinical events during follow-up, variables of stress EKG associated with myocardial perfusion and angiographic control were analyzed. RESULTS: The cause of admission was the same in both groups (MI in R group: 28.6%; NR: 46.7%; p = ns). There was no difference in the discharge medication. The R group was more symptomatic (Angina: R = 50.0% vs NR = 11.1%; p < 0.001 clinical restenosis rate = 11.8%), and had more revascularization procedures (PTCA: R = 57.1% vs NR = 2.8%; p < 0.001/Bypass surgery: R = 14.3% vs NR = 0%; p = 0.01). This group had abnormal stress EKG more frequently (42.9 vs 20.0%, p = ns) and ischemia in the myocardial perfusion scintigraphy (57.1 vs 6.7% p < 0.001). [table: see text] CONCLUSION: The clinical and diagnostic tests evaluated in this study showed a limited sensitivity in the detection of angiographic restenosis in a group of patients with single vessel disease submitted to coronary angioplasty and stenting. Myocardial scintigraphy was the best method for the detection of angiographic restenosis, showing a high specificity and a reasonable sensitivity.

Angioplasty↗

PubMed1999

[Evaluation of the prognostic value of cardiac troponin i in patients with unstable angina].

OBJECTIVE: The purpose of this study was to evaluate the in-hospital and follow-up prognostic value of cardiac troponin I in patients admitted in the Coronary Care Unit and discharged with the diagnosis of unstable angina. POPULATION AND METHODS: 118 patients were admitted in the Coronary Care Unit, discharged with the diagnosis of unstable angina with a follow-up of 13.5 months. Cardiac Troponin I (cTnI) was measured on admission, 4 and 12 hours later. For the purposes of the study, we chose a cut-off value of 0.4 ng/mL as the minimal acceptable concentration of cTnI. The patients were divided in two groups: Group A (n = 82) if all measurements with cTnI < or = 0.4 ng/mL and Group B (n = 36) if any measurement with cTnI > 0.4 ng/mL. In both groups, multiple coronary events during hospitalisation and follow-up were evaluated: death; acute myocardial infarction; angina; hospitalisation; coronary surgery or angioplasty; and also the severity of coronary artery disease and the number of patients without coronary events. The results were compared by the Student's unpaired t-test and by chi-square test. RESULTS: Age, sex and vascular risk factors were similar in both groups. There was a statistically significant increase in angina and coronary surgery with increasing levels of cardiac troponin I (Group B) (13 vs 5, p < 0.0001), multiple vessel disease (16 vs 18, p < 0.0008) and myocardial infarction (12% vs 0%, p < 0.03). Sixty patients had no coronary events in Group A compared to thirteen in Group B (p < 0.0001). There were no significant differences between the groups with respect to hospitalisation and angioplasty (17% in Group B vs 7% in Group A) and death (3% vs 0%). CONCLUSIONS: In this population with unstable angina, cardiac troponin I level greater than 0.4 ng/mL measured in the 12 hours after admission provides useful prognostic information. It permits the early identification of patients with an increased risk of in-hospital and follow-up cardiac events and could be correlated with the severity of coronary artery disease.

Angina, Unstable↗

PubMed1997

Insulin sensitivity, glucose effectiveness, and beta-cell function in obese males with essential hypertension: investigation of the effects of treatment with a calcium channel blocker (diltiazem) or an angiotensin-converting enzyme inhibitor (quinapril).

It has been suggested that hyperinsulinemia secondary to insulin resistance may be a pathogenetic factor common to obesity, non-insulin-dependent diabetes mellitus (NIDDM), and hypertension. Furthermore, beta-blockers and thiazide diuretics have been shown to be capable of increasing insulin resistance and thus of inducing NIDDM in predisposed individuals. We used the minimal model approach (MMA) to glucose metabolism and insulin kinetics to compare peripheral insulin sensitivity and beta-cell function in hypertensive and normotensive obese men. The hypertensive group consisted of 37 obese men with mild to moderate hypertension; following a drug-free period of 4 weeks, 20 of these subjects received diltiazem and 17 quinapril over the 12-week study period. The normotensive (control) group contained 17 obese men without microalbuminuria, dyslipidemia, or a family history of essential hypertension or NIDDM. Before and at the end of the 12-week study period, subjects underwent frequently sampled intravenous glucose tolerance (FSIGT) tests. The results were used to estimate an insulin sensitivity index (S(I)), a glucose effectiveness index (S(G)), and beta-cell sensitivity to glucose indices during first- and second-phase insulin secretion (phi1 and phi2) using the minimal models of glucose metabolism and insulin kinetics. No significant differences in S(I) or S(G) were detected between the hypertensive and control groups. Twelve weeks' treatment with diltiazem led to a slight but significant increase in phi1; however, neither diltiazem nor quinapril had significant effects on S(I) or S(G). We conclude that men with obesity and hypertension have no greater insulin resistance than those with obesity alone, suggesting that hypertension is not generally associated with any significant increase in insulin resistance. Treatment with diltiazem or quinapril does not have undesirable effects on glucose metabolism. However, treatment with diltiazem led to a significant increase in beta-cell sensitivity to glucose; this is of particular interest, given the importance of phi1 for peripheral glucose uptake.

Adolescent↗