Biomedical subjects

M Klüglich

Publications and source records attributed to M Klüglich.

6 recordsLinked to original sources

PubMed1993

[Ultrasound of incidental tumors of the adrenal gland and endocrine hypertension].

We report on a retrospective analysis of 1,500 hypertensive patients who underwent a sonographic examination of the abdomen. 8 'incidentalomas' of the adrenal gland (0.6%) were thereby found. Endocrinological analysis showed that only 1 of the incidentalomas was active (pheochromocytoma). The other tumors had no endocrine activity. On the other side, 7 patients without any sonographic abnormality had hyperaldosteronism, 1 patient suffered from an adrenomedullary hyperplasia. Those patients had been thought to have endocrine hypertension from clinical suspicion. We conclude that a thorough sonographic examination of the adrenal area is an important part of the diagnostic workup in hypertensive patients, although most of the incidentally discovered tumors are endocrinologically inactive. Adrenocortical and adrenomedullary hyperplasias and adrenocortical adenomas are detected clinically while they are still not visible by ultrasound.

Adrenal Gland Neoplasms↗

PubMed1992

[What does general practice hypertension mean?].

White coat hypertension means an isolated blood pressure elevation during conventional measurement in the doctor's office, while blood pressure is in the normal range outside the office over 24 hrs. The incidence is about 20-25% of all "hypertensives" identified in the office. Patients with white coat hypertension show no increased blood pressure variability outside the office, and they do not seem to be more anxious regarding psychological testing as compared with hypertensives. The white coat effect is very specific for the situation in the doctors office. The effect is more pronounced in younger and female patients. However, also in isolated systolic hypertension in the elderly the white coat effect is present to a substantial amount. Under dynamic exercise there is no different hemodynamic response in patients with white coat hypertension as compared with normotensives. Differences are however observed with regard to posture and under isometric exercise. So far, white coat hypertension seems to be a benign and harmless condition not related to an increased cardiovascular risk, which must not be treated.

Arousal↗

PubMed1992

[Circadian blood pressure rhythm in hyperthyroidism and primary hyperparathyroidism].

Some secondary forms of hypertension are characterized by an abnormal circadian blood-pressure rhythm. Therefore, the circadian blood-pressure variability was investigated in a prospective study using ambulatory blood-pressure monitoring in patients with hyperthyroidism and in patients with primary hyperparathyroidism. Both endocrine disorders are often associated with hypertension. Out of 17 patients with hyperthyroidism 73% were hypertensive, and out of 15 patients with hyperparathyroidism 80% were hypertensive. The blood-pressure profiles were compared to profiles from controls comprising normotensive subjects and patients with essential hypertension. The patients with hyperthyroidism and hypertension had a blunted circadian blood-pressure curve with only a small nocturnal reduction of systolic and diastolic blood pressure as compared to control patients. In patients with hyperthyroidism and normal blood pressure, the circadian blood-pressure rhythm was normal; however, in these patients the circadian heart-rate curve was blunted. All patients with hyperparathyroidism (with and without hypertension) had a normal circadian blood pressure and heart-rate rhythm. From these observations we conclude that in hyperthyroidism the circadian regulation of blood pressure or heart rate is significantly blunted. The circadian blood pressure and heart-rate curve is normal in primary hyperparathyroidism.

Adult↗

PubMed1991

Circadian blood pressure rhythm in primary and secondary hypertension.

Circadian blood pressure variability was recorded in patients with primary hypertension and with different forms of secondary hypertension using ambulatory 24-h blood pressure measurement. A group of 20 patients with different forms of secondary hypertension was compared with a matched group of patients with primary hypertension. Although the mean 24-h blood pressure was not different between the two groups, the patients with secondary hypertension had significantly higher systolic blood pressure during sleep and higher systolic and diastolic blood pressure in the early morning, compared with the primary hypertension group. This nocturnal blood pressure fall was then investigated in various groups of patients with different forms of secondary hypertension and compared with normotensives and patients with primary hypertension. Patients with mild primary hypertension (n = 152) and with severe primary hypertension (n = 30) had the same blood pressure fall (14-16 mm Hg systolic and diastolic) during the night (23:00-05:00 h) as normotensives (n = 20). However, in patients with renoparenchymal hypertension (n = 29), renovascular hypertensions (n = 20), hyperaldosteronism (n = 6), and hyperthyroidism (n = 14), the nocturnal blood pressure fall was significantly (p less than 0.01) reduced. One patient with coarctation of the aorta and nine patients with primary hyperparathyroidism and elevated blood pressure had a normal circadian blood pressure profile with a normal nocturnal blood pressure fall. The heart rate decrease during the night was equal in all patient groups. Ambulatory blood pressure measurement allows blood pressure recording under everyday conditions, including nighttime. In primary hypertension the blood pressure variability exhibits the same circadian variation as in normotension, showing a marked nocturnal fall.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1991

Chronopharmacology of captopril plus hydrochlorothiazide in hypertension: morning versus evening dosing.

Blood pressure follows a strong circadian rhythm in normotensive people and in patients with primary hypertension. This may have several implications for antihypertensive therapy, including the time of dosing. For this reason we studied the influence of different dosing times on the antihypertensive effect over 24 h using ambulatory blood pressure monitoring (ABPM). We studied 13 male patients with moderate hypertension with controlled blood pressure over 12 months under a fixed combination of captopril and hydrochlorothiazide. The dosage of the combination therapy was then halved and given as one evening and then as one morning dose, each for 3 weeks. The combination therapy given twice daily showed a good 24-h antihypertensive effect after 12 months of treatment. During the following 6 weeks the mean 24-h blood pressure did not increase under half dosage, irrespective of whether under evening or morning dosing. However, mean daytime values (systolic and diastolic) of ABPM were significantly higher with evening dosing when compared both with full dosage and with half dosage given in the morning. The mean arterial blood pressure over 24 h showed the same differences as systolic and diastolic blood pressure, whereas heart rate was not significantly different between the three therapeutic regimens. ABPM seems to be an ideal method for chronopharmacological investigations under everyday conditions. Our study demonstrated significant differences in daytime blood pressure but not in 24-h blood pressure between morning and evening dosing of a fixed antihypertensive combination therapy.

Blood Pressure↗

PubMed1991

[Value of ambulatory 24-hour blood pressure monitoring in diagnosis of mild hypertension].

Ambulatory blood-pressure monitoring (ABPM) is the best method to identify causal blood-pressure increases, and for differentiating between white-coat (office) blood pressure and sustained hypertension. This differentiation is necessary because 20% of patients with mild hypertension (90-104 mmHg diastolic, without end-organ damage) have white-coat hypertension. Thus, using conventional blood-pressure measurements (repeated measurements on at least two different occasions) for diagnosing mild hypertension (85% of all hypertensives!) many persons will be overtreated. The results of intervention in mild hypertension will improve through a better identification of patients at risk. ABPM correlates best with end-organ damage. The introduction of ABPM for diagnosing mild hypertension seems to be the best way to differentiate between white-coat hypertension without increased cardiovascular risk and sustained hypertension with increased cardiovascular risk. This procedure allows a better treatment of patients at risk and it avoids overtreatment. The ABPM diastolic blood-pressure range for mild hypertension is 85-92 mmHg (mean values during the active phase).

Antihypertensive Agents↗