Losartan vs atenolol in prevention of stroke and cardiovascular disease.
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Adrenergic beta-Antagonists↗
Biomedical subjects
Ehud Grossman
Publications and source records attributed to Ehud Grossman.
Impaired nocturnal melatonin secretion in non-dipper hypertensive patients.
BACKGROUND: Melatonin plays a role in the biologic regulation of circadian rhythms, including sleep. Melatonin has also been shown to modulate vascular smooth muscle tone and to induce hemodynamic effects in humans. OBJECTIVE: To evaluate whether melatonin plays a role in the circadian rhythm of blood pressure in hypertensive patients. METHODS: Sixteen elderly patients with essential hypertension were evaluated. Patients were defined as either dippers (DIP, n = 8) or non-dippers (NDIP, n = 8) according to the nocturnal change in the mean arterial pressure (MAP). 6-Sulfatoxymelatonin (6-SMT), the main melatonin metabolite, was determined by enzyme-linked immunosorbent assay (ELISA) in two separate urine collections, one in the daytime and one during the night. RESULTS: Both groups of DIP and NDIP hypertensives were comparable in regard to age and sex. During the night, the mean arterial pressure decreased by 10.3 +/- 2.2% in the DIP and increased by 7.5 +/- 1.7% in the NDIP group (p < 0.01). Daily 6-SMT was comparable in DIP (3.28 +/- 0.87 microg/12 h) and NDIP (2.31 +/- 0.68 microg/12 h) (p = 0.39). However, while the DIP presented the physiological nocturnal increase in urinary 6-SMT (mean 8.19 +/- 1.68 microg/ 12 h), this surge of melatonin production was missing in NDIP in whom nocturnal urinary 6-SMT concentrations were not significantly different from daily levels (mean 2.56 +/- 0.79 microg/12 h). The nocturnal change in urinary 6-SMT excretion was positively correlated to the nocturnal change in MAP (R = 0.54; p = 0.031). CONCLUSIONS: NDIP hypertensive patients differ from DIP hypertensives by having an impaired nocturnal melatonin secretion. Thus, melatonin may play a role in the circadian rhythm of blood pressure in hypertensive patients.
Aged↗
[Standpoint on the use of angiotensin receptor blockers in the treatment of hypertension].
Angiotensin receptor blockers (ARBs) have gained widespread use in clinical medicine during the past decade. Several large, prospective and randomized multi-center trials have led us to reconsider the role of ARBs in the treatment of hypertension. Firstly, in view of the favorable safety and side effect profile of ARBs, we recommend their use in hypertensive subjects in whom ACE inhibitors are indicated but are unable to tolerate agents of this type due to intractable cough. Secondly, in light of the results of the RENAAL and IDNT studies, we consider ARBs as the drug of choice in diabetic subjects with hypertension and proteinuria (> 300 mg/L). Thirdly, we view ACE inhibitors and ARBs as equally adequate for the treatment of diabetic patients with hypertension and microalbuminuria and recommend the use of the maximal allowable doses of these drugs in such patients. Finally, older hypertensive individuals with left ventricular hypertrophy should receive either ACE inhibitors or ARBs, as these drug classes presently appear to provide better overall protection than beta blockers or calcium channel blockers in this particular subgroup of patients.
Angiotensin Receptor Antagonists↗
[Pyogenic liver abscess--an unusual presentation of colonic villous adenoma].
A pyogenic liver abscess is a final common pathway of many pathologic processes, mainly suppurative cholangitis or suppurative pyephlebitis, arising from abdominal or pelvic infection. There are many other etiologies, and some abscesses are idiopathic-namely, cryptogenic abscess. We present a case of a man with a pyogenic liver abscess. This was the clue for the diagnosis of a large but clinically silent villous adenoma of the colon. Colonic tumors, manifested clinically as an hepatic abscess, in the absence of liver metastases, are very uncommon. This is the first description of a villous adenomatous tumor with such a presentation.
Adenoma, Villous↗
Orthostatic hypotension in acute geriatric ward: is it a consistent finding?
BACKGROUND: Orthostatic hypotension (OH) is a common finding among older patients. We designed a study to examine the prevalence and consistency of OH during the day. METHODS: A total of 502 inpatients (241 men and 261 women) with a mean age of 81.6 years were included in the study. Orthostatic tests were performed 3 times during the day, 30 minutes after meals. In 13 patients only 2 sets of measurements were obtained, and they were omitted from some of the calculations. Orthostatic hypotension was defined as a fall of at least 20 mm Hg in systolic blood pressure and/or 10 mm Hg in diastolic blood pressure on assuming an upright posture. RESULTS: Three hundred thirty-two (67.9%) of 489 patients experienced OH at least once during the day. Of these, 170 patients (34.8% of the 489) had OH at least twice (persistent OH) and 162 patients (33.1%) experienced OH only once (variable OH). Diastolic OH was more prevalent than systolic OH (57.3% vs 43.4%; P<.001). The intraindividual consistency of OH was low (kappa = 0.2). Orthostatic hypotension was observed less frequently during the evening than during the morning and afternoon (P<.05 vs morning and P =.003 vs afternoon). The difference between meals' constituents (light vs heavy meals) did not affect the prevalence of OH. CONCLUSIONS: Orthostatic hypotension is very common in the elderly, and diastolic OH is more common than systolic OH. The prevalence of OH is the lowest during the evening, and meals do not increase the prevalence of OH. The intraindividual consistency of OH during the day is poor. Thus, in elderly patients, more attention should be paid to diastolic OH and the diagnosis should be based on repeated measurements.
Acute Disease↗
Beta-blocker therapy and depression.
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Adrenergic beta-Antagonists↗
Is there an association between hypertension and cancer mortality?
BACKGROUND: Because of suggestions that hypertension may increase the long-term risk of cancer, we assessed the relation between hypertension and malignancy. METHODS: We conducted a MEDLINE search of English-language articles published between January 1966 and January 2000 using the terms hypertension or blood pressure, and neoplasm or cancer or malignancy. We reviewed prospective studies that reported cancer incidence or mortality in hypertensive and nonhypertensive patients, case-control studies that reported the prevalence of hypertension in cancer patients and controls, and references from identified articles. RESULTS: We identified 10 longitudinal studies that evaluated the association between blood pressure and cancer mortality in 47 119 subjects. Subjects with hypertension experienced an increased rate of cancer mortality during durations of follow-up ranging 9 to 20 years, with an age- and smoking-adjusted pooled odds ratio of 1.23 (95% confidence interval [CI]: 1.11 to 1.36). In 13 case-control studies, including 6964 cases of renal cell cancer and 9181 controls, the adjusted odds ratio for renal cell cancer among hypertensive patients, relative to normotensive counterparts, was 1.75 (95% CI: 1.61 to 1.90). No clear association was found between hypertension and cancer of other sites. CONCLUSION: Hypertension was associated with an increased risk of mortality from cancer, particularly renal cell carcinoma.
Carcinoma, Renal Cell↗
Why beta-blockers are not cardioprotective in elderly patients with hypertension.
Despite the fact that beta-blockers have been used for the treatment of hypertension for more than 30 years, no study has shown that their use reduces morbidity and mortality in the elderly. To the contrary, the British Medical Research Council trial in the elderly documented that although blood pressure was lowered effectively and significantly by atenolol, morbidity and mortality in the beta-blocker group did not differ from that of the placebo group. Not only was beta-blocker monotherapy not effective, but patients who received the combination of beta-blockers and diuretics fared consistently worse than those on diuretics alone. beta-blockers are less effective than diuretics in lowering blood pressure, and are poorly tolerated in the elderly. The reason for their inefficacy in the elderly may be related to their inherent unfavorable effect on systemic hemodynamics and pathophysiologic findings in the arterial tree, heart, kidneys, brain, and on the metabolism of lipids and carbohydrates. Decreased beta-adrenergic responsiveness with age and comorbid conditions makes beta-blockers unattractive. Thus, they should not be considered appropriate for first-line therapy of uncomplicated hypertension in the geriatric population.
Adrenergic beta-Antagonists↗
Carcinogenicity of antihypertensive therapy.
Several studies have suggested that antihypertensive treatment may promote cancer through unknown mechanisms. Early retrospective studies implicated reserpine in breast cancer, but data from prospective studies and meta-analysis of several case-controlled studies showed only a weak association between reserpine and breast cancer which, although statistically significant, is of little clinical concern. Data from case-controlled studies and several cohort studies suggested an association between the use of a diuretic and the occurrence of renal cell cancer, particularly in women. A recent study showed an association between the use of a diuretic and the occurrence of colon cancer. Several prospective studies showed that treatment with atenolol may increase mortality from malignancy. However, other studies that analyzed data from several thousand patients could not confirm this association. In three prospective and a few case-controlled studies, angiotensin converting enzyme inhibitors were not associated with increased mortality from malignancy. In addition, a recent retrospective study showed that long-term use of angiotensin converting enzyme inhibitors had a protective effect against malignancy. Data from three large case-controlled studies and the combined data from eight randomized controlled studies and seven longitudinal studies showed a similar risk for malignancy among users and nonusers of calcium antagonists. Until further data from prospective clinical trials are available, we advise caution about long-term diuretic therapy in women. With regard to other antihypertensive drug classes, we suggest continuing the management of hypertension according to current treatment guidelines with little fear of any substantial cancer risk.
Animals↗
Pedal edema--not all dihydropyridine calcium antagonists are created equal.
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Amlodipine↗
A comparison of management and short-term outcomes of acute myocardial infarction patients admitted to coronary care units and medical wards: the importance of case mix.
BACKGROUND: Variation in case mix of patients can significantly influence outcome. In this study, the management and outcomes of patients with acute myocardial infarction who were admitted either to coronary care units or to internal medicine wards were examined. METHODS: A nationwide prospective study was performed during a 2-month period in all 26 coronary care units and in 82 of 96 internal medicine wards in Israel. All patients with a discharge diagnosis of acute myocardial infarction were included. Comorbidity was coded using the Index of Coexistent Diseases. RESULTS: A total of 1648 consecutive patients with acute myocardial infarction were identified. One thousand and eighty eight (66%) were admitted to coronary care units and 560 (34%) to internal medicine wards. The 30-day mortality for the coronary care unit group was 9.2% compared to 15.5% for patients in the internal medicine ward group. Using logistic regression, independent factors determining 30-day mortality were (odds ratio and 95% confidence interval): age (1.06 per year, 1.03-1.08), Killip score (2.09, 1.64-2.67), Q wave acute myocardial infarction (2.12, 1.31-3.43), and Index of Coexistent Diseases score (1.42, 1.12-1.80). After controlling for age, infarct type and severity, and coexisting medical conditions, no excess mortality was detected among patients admitted to internal medicine wards. CONCLUSIONS: Variance in the case mix has a great influence on the interpretation of mortality in studies of acute myocardial infarction.
Journal Article↗