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Biomedical subjects

M Middeke

Publications and source records attributed to M Middeke.

At least 37 records · Page 2Linked to original sources
PubMed1994

Effects of perindopril on serum lipids in hypertensive patients with hyperlipidemia.

The effect of the angiotensin-converting enzyme (ACE)-inhibitor perindopril on serum lipids and apolipoprotein concentrations were assessed in a multicenter, randomized, double-blind, placebo-controlled study in 51 hyperlipidemic patients treated for mild hypertension. Perindopril was given as a single morning dose (4 mg) for 6 weeks. During the treatment period, blood pressure (BP) was significantly (p < 0.001) reduced from 159/99 to 148/90 mm Hg by verum treatment and from 158/101 to 151/95 mm Hg (NS) by placebo treatment. Neither total cholesterol and triglycerides nor high-density-lipoprotein and apolipoprotein AI and B levels were significantly altered by drug treatment as compared with placebo. Although perindopril had good antihypertensive effect in patients with mild hypertension and hyperlipidemia, it had no adverse effects on lipid metabolism in these patients. Therefore, perindopril is recommended for antihypertensive treatment, especially in hypertensive patients with concomitant hyperlipidemia.

Adult↗
PubMed1994

Regulation of the beta-adrenoceptor-cAMP-system during dynamic exercise in patients with primary hypertension after acute beta-blockade.

Beta-adrenoceptors on lymphocytes are acutely increased after dynamic exercise in normotensive subjects, but not in hypertensives. It was thus of interest to evaluate the acute regulation of the lymphocyte beta-adrenoceptor-adenylate-cyclase-cAMP-system (BAAS) in patients with primary hypertension during dynamic stress after acute beta-blockade. Density and affinity of beta 2-adrenoceptors, and intracellular cAMP concentrations (baseline and isoprenaline stimulated values) were measured on the peripheral mononuclear cells in 8 male patients with primary hypertension before and immediately after dynamic exercise on a bicycle (50-200 W) at baseline and after acute beta-blockade (2 h following 100 mg atenolol). Dynamic exercise causes no significant changes in receptor density and affinity, nor in basal cAMP values. After acute beta-blockade the dynamic stress-induced rise in mean arterial blood pressure was significantly (p < 0.01) reduced from 33 to 24 mmHg, and beta-adrenoceptor density significantly (p < 0.05) increased from 1320 to 2102 molecules/cell, whereas affinity remained unchanged. Baseline and stimulated cAMP concentrations increased significantly (p < 0.05) from 5.3 to 7.0 and from 2.1 to 3.5 pmol/10(6) cells, respectively. These findings suggest that in primary hypertension the regulation of the beta 2-adrenoceptor-adenylate-cyclase-cAMP-system is impaired on exercise and can be normalised by acute beta-blockade. Since atenolol predominantly blocks beta 1-adrenoceptors, the observed normalisation of the lymphocyte BAAS may reflect only an unspecific effect of antihypertensive therapy per se.

Adrenergic beta-Antagonists↗
PubMed1993

Deposits of paraprotein in small vessels as a cause of skin ulcers in Waldenström's macroglobulinemia.

A 71-year-old man presented with epistaxis and large ulcers on arms and legs. A monoclonal IgM-kappa gammopathy and high levels of cryoglobulins were found. Histology of the affected skin showed deposits of paraprotein in the small vessels, causing luminal obstruction. This in turn caused ischemic skin lesions, which were successfully treated with cortisone (fluocortolone 100 mg/day every second day) and cyclophosphamide (100 mg/day).

Aged↗
PubMed1993

Erythromelalgia unmasked during norephedrine therapy: a case report.

A thirty-eight-year-old woman presented with typical signs of erythromelalgia: burning, redness, and warm congestion of the extremities. These symptoms occurred after cessation of obesity drug therapy with norephedrine (250 mg/day) continuously over six years. The condition was refractory to treatment with acetylsalicylic acid. It is suggested that erythromelalgia in this case was unmasked by the vasoactive properties of norephedrine. Continuous drug therapy with norephedrine may have led to adaptive adrenergic subsensitivity of vascular smooth muscles. The pathomechanism of primary erythromelalgia is still unknown. Their observations suggest that an enhanced vasodilatation due to an abnormal adrenergic sensitivity may play an important role in the pathogenesis of primary erythromelalgia.

Adult↗
PubMed1993

Treatment of hypertension in the elderly.

Since 1967, results from well controlled long term studies have provided convincing evidence of the benefit of antihypertensive therapy in middle-aged patients. However, many physicians have hesitated to apply these findings to patients over 60 years of age. Recently, the results of several prospective randomised long term trials investigating the treatment of hypertension in elderly patients have been published. An analysis of the results of 5 major trials shows that antihypertensive treatment reduces overall mortality by 20%, cardiovascular mortality by 33%, the incidence of fatal and nonfatal cerebrovascular events by 40%, and complications as a result of coronary heart disease (i.e. fatal and nonfatal myocardial infarction and sudden cardiac death) by 15%. On the basis of trials undertaken in elderly patients with either high systolic and diastolic blood pressure or isolated systolic hypertension, antihypertensive therapy was more beneficial, in absolute terms, in elderly patients than in middle-aged patients with mild hypertension. Treatment was withdrawn as a result of adverse effects in about 2% of middle-aged and elderly hypertensive patients per year. Therefore, it is clear that elderly hypertensive patients should be treated.

Aged↗
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

Risk-benefit aspects of antihypertensive drugs.

Several long term trials using traditional antihypertensive therapy with diuretics and beta-blockers have shown that antihypertensive therapy reduces the overall risk of cardiovascular complications. However, even after several years of therapy the cardiovascular risk in hypertensive patients cannot be lowered to that in the normotensive population. Antihypertensive therapy can reduce the incidence of cerebrovascular complications in patients with hypertension by about 65%. However, the effect of such therapy in preventing coronary events has been disappointing, as these events are 3 to 4 times more common than cerebrovascular complications in hypertensive patients. It is now apparent that adverse pharmacological effects of diuretics and beta-blockers on lipid metabolism persist for many years. Thus, treatment with these agents constitutes a new risk factor for coronary heart disease and may, at least in part, explain the failure of traditional antihypertensive therapy to reduce the incidence of myocardial infarction and sudden death as effectively as that of cerebrovascular accidents. On the other hand, titration of these antihypertensive agents to the lowest possible dose in order to avoid metabolic alterations and subjective adverse effects has frequently resulted in the administration of subtherapeutic doses, particularly for hydrochlorothiazide. Until comparative long term clinical trials with older and newer antihypertensive agents and morbidity and mortality as end-points are completed, the debate on first-line drugs for antihypertensive treatment will not be satisfactorily resolved.

Antihypertensive Agents↗
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

[Synchronized circadian blood pressure rhythm and sympatho-adrenergic activity].

Circadian blood pressure rhythm exhibits a typical biphasic pattern in normotensives and in patients with primary hypertension. It is, however, disturbed in patients with secondary hypertension. There is ample evidence suggesting a major role for the sympatho-adrenergic system in regulating this rhythm. In order to investigate this relationship more accurately, the sympatho-adrenergic activity was studied in 20 patients with normal blood pressure, 20 patients with primary hypertension, and in patients with several diseases characterized by an abnormal catecholamine secretion, e.g. two pheochromocytomas, one adrenomedullary hyperplasia, and two Shy-Drager syndromes. Catecholamine concentrations were measured in plasma and urine, cAMP concentrations in plasma or in lymphocytes, and beta-adrenoceptor density and affinity on lymphocytes, and 24-h blood pressure monitoring was conducted. The data shows synchronicity of the circadian blood pressure rhythm and the sympatho-adrenergic activity both in normotensives and in patients with primary hypertension with normal circadian rhythm, and in abnormal catecholamine secretion with an abnormal circadian blood pressure curve. It is concluded that sympatho-adrenergic mechanisms play an important role in controlling and regulating circadian blood pressure.

Adrenal Gland Neoplasms↗
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

[Quality of life of hypertensive physicians with hypertension therapy. Randomized double-blind study of 237 female and male physicians with high blood pressure].

In a group of 237 hypertensive male and female physicians, a placebo-controlled randomized double-blind, cross-over trial was performed to investigate the effects of the ACE inhibitor captopril on blood pressure and well-being. A thoroughly tested standardized measurement of well-being was employed. On the basis of the multivariate linear model, differences in the response to treatment (t-tests for cross-over differences) were investigated in terms of the seven parameters of well-being measured. In comparison with placebo, captopril (50 mg once daily) had a significant effect on five of the seven parameters. Thus, mood, general well-being, work performance, regeneration and quality of sleep all improved under treatment. It was also found that these improvements were not an immediate consequence of blood pressure reduction. The standardized evaluation employed here thus proved to be an informative additional evaluation criterion of antihypertensive therapy.

Captopril↗
PubMed1991

Long time incubation of monocytic U 937 cells with LDL increases specific paf-acether binding and the cellular acetylhydrolase activity.

Besides the well established role of low density lipoproteins (LDL), the phospholipid PAF-acether (paf) seems to be involved in atherogenesis. The effect of LDL (10 micrograms/ml for 24 h, n = 3) on paf binding characteristics of monocyte/macrophage-like U 937 cells was investigated using the radioligand [3H]paf, unlabeled paf and the paf receptor antagonist WEB 2086. The specific [3H]paf binding significantly increased at 1.4 nM (P less than 0.02) and 2.8 nM (P less than 0.01) added [3H]paf with an increased number of paf binding sites in the Scatchard plot analysis of the data. Specific paf binding was functionally active since paf mediated a cellular [Ca2+]i rise. The protein kinase C (PKC) activator PMA (1 nM, 37 degrees C) expressed specific [3H]paf binding already after a 15-min incubation period, indicating a PKC activation as the decisive step of paf receptor expression. LDL also stimulated the paf degrading cellular acetylhydrolase significantly by increasing both Km (9.4 +/- 1.9 vs. 2.0 +/- 0.5 microM, P less than 0.02) and vmax (0.5 +/- 0.2 vs. 0.2 +/- 0.0 nmol/min per mg cell protein, P less than 0.02). The data demonstrate that LDL increases the number of paf receptors on monocyte/macrophage-like U 937 cells and interferes with the dynamics and/or synthesis of the cellular acetyl hydrolase. These effects could be of importance in the pathogenesis of atherosclerosis.

Acetylesterase↗
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↗