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Biomedical subjects

R Kolloch

Publications and source records attributed to R Kolloch.

At least 19 recordsLinked to original sources
PubMed2003

[Malignant hypertension in a single kidney with doubled blood vessel supply].

HISTORY: A 72-year-old male in acute renal failure, intubated and ventilated, was transferred to our hospital. He had a 30-years history of severe hypertension and signs of general atherosclerosis. 25 years ago, the left kidney had been removed because of an ischaemic renal infarction due to a renal artery stenosis. Blood pressure-monitoring showed excessive high systolic (up to 250 mmHg) and diastolic (up to 160 mmHg) blood pressure. INVESTIGATIONS: The MRI-scan revealed a single right kidney with a main artery and an accessory one, both with a severe ostial stenosis. The resistance index (RI) value, measured by duplex ultrasonography was 44. DIAGNOSIS AND TREATMENT: In two interventional procedures both stenosed arteries were dilated a stent was applied. Afterwards blood pressure and renal function improved. CONCLUSIONS: Severe hypertension can be caused by a renal artery stenosis. It can be diagnosed by duplex ultrasonographic studies, which has the advantage of determining the RI and therefore identifying patients with no improvement of blood pressure or renal function after resolving the stenosis. The angioplasty with or without a stent is as successful as an operation but has less complications.

Aged↗
PubMed2003

[Aldosterone receptor antagonists in heart failure. Rightly brought back from retirement].

There is growing evidence that aldosterone plays an important role in the development of endorgan-damage e.g. vascular and cardiac fibrosis, remodeling and endothelial dysfunction. Aldosterone-antagonism has become a novel therapeutic principle beyond its sodium retention properties in the treatment of cardiovascular diseases. In patients with severe left ventricular dysfunction spironolactone could reduce death and hospitalisation. A new selective aldosterone antagonist, eplerenone, was effective in patients with left ventricular dysfunction after myocardial infarction added to optimal medical therapy.

Aldosterone↗
PubMed2002

[When blood pressure control is a problem. Refractory hypertension is rare].

Hypertension is considered refractory when the use of three pharmacologically different antihypertensives (included a diuretic, a sympathetic blocker and a vasodilator) given at maximum dose fails to lower the blood pressure to below 140/90 mmHg. In the event of isolated systolic hypertension, the value should be reduced to below 140 mmHg. A truly refractory form may be assumed in some 2-5% of all hypertensives, and must be differentiated from a pseudo form in which such factors as counter-regulatory mechanisms, inadequate use of general measures, inadequate antihypertensive therapy, interactions with other drugs, or secondary hypertension may play a role. Refractory patients in whom the underlying cause cannot be identified should be referred to an appropriate specialist. Diuretic treatment should first be optimized and antihypertensive doses maximized (with consideration being given to side effects). Further substances such as minoxidil in combination with a beta-blocker and a diuretic may be used.

Antihypertensive Agents↗
PubMed2001

Antihypertensive effects of valsartan/hydrochlorothiazide combination in essential hypertension.

Fixed-dose combination therapy has received increased interest since publication of JNC-VI report and WHO/ISH guidelines 1999. We compared in a randomized, double-blind study the efficacy and tolerability of valsartan 80 mg combined with hydrochlorothiazide (HCTZ) 12.5 mg to monotherapy with either HCTZ 12.5 mg or 25 mg in patients with essential hypertension inadequately controlled by previous HCTZ 12.5 mg monotherapy. Two hundred and seventeen patients whose blood pressure (BP) control remained poor (95 mmHg < or = sitting diastolic BP < 115 mmHg) after a 4-week single-blind period with HCTZ 12.5 mg were randomized to receive either combination therapy with valsartan 80 mg plus HCTZ 12.5 mg (V/HCTZ) or monotherapy with HCTZ 12.5 mg or HCTZ 25 mg for 8 weeks. Reduction of sitting trough diastolic BP between baseline and week 8 as well as tolerability was evaluated. Reduction in trough diastolic BP was most pronounced in the V/HCTZ group (-11.3 mmHg) and significantly greater than in the HCTZ 12.5 mg group (-2.9 mmHg, p < 0.001) and the HCTZ 25 mg group (-5.7 mmHg, p < 0.001). Tolerability of study medication was comparable between all three groups. In conclusion, switching to V/HCTZ combination therapy provides an additional lowering of BP compared to dosage increase of the thiazide in patients with BP insufficiently controlled by HCTZ 12.5 mg monotherapy.

Aged↗
PubMed2001

Effects of individual risk factors on the incidence of cardiovascular events in the treated hypertensive patients of the Hypertension Optimal Treatment Study. HOT Study Group.

BACKGROUND: The Hypertension Optimal Treatment (HOT) Study has provided information about cardiovascular events in 18790 hypertensives, subjected to pronounced blood pressure (BP) lowering for a mean of 3.8 years. The HOT study data have subsequently been analysed after stratification of the patients according to global cardiovascular risk, and it has been found that, despite intensive blood pressure lowering in all risk strata, morbid event rates increased with increasing risk stratum. OBJECTIVES: Previously analysed global risk strata were based on combinations of risk factors. The analyses presented here were intended to provide information on the relative role that the presence of each individual factor may have in increasing cardiovascular risk, despite good BP control. METHODS: Risk ratios (RR) for patients with and those without a risk factor were calculated with 95% confidence intervals (CI) using a Cox proportional hazard model, and adjusted for all variables except the one under examination. RESULTS: For all risk factors considered and for all types of event, RR were always greater than 1, indicating a greater risk in the presence, compared with that in the absence of each factor. The male gender was a statistically significant risk for cardiovascular (CV) events, CV and total mortality and particularly for myocardial infarction (MI); age > or = 65 years for CV events, stroke, CV and particularly total mortality; smoking for all events analysed, but particularly for total mortality (twice higher in smokers than in non-smokers); high serum cholesterol (> 6.8 mmol/l) for CV events, MI and CV mortality; high serum creatinine (> 155 micromol/l) for CV events, stroke, CV and total mortality; diabetes for CV events, stroke, total mortality and particularly CV mortality; and ischaemic heart disease for all events analysed. Adjusted RR were often close to or greater than 2. CONCLUSIONS: Each of the risk factors considered was found to be an important cause of residual risk, despite good BP control. These findings emphasize the importance of addressing other correctable risk factors, e.g. smoking, hypercholesterolaemia and diabetes, as well as rigorous control of blood pressure, and of initiating antihypertensive therapy before cardiovascular and renal damage becomes manifest.

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PubMed2000

[Isolated systolic hypertension as risk factor. Also in this case lowering blood pressure makes sense].

Elevated diastolic as well as elevated systolic blood pressure substantially contributes to the increase of cardiovascular risk. Conclusive results have proven that lowering diastolic and/or systolic blood pressure can reduce cardiovascular risk. There is evidence that not only the absolute values for diastolic and systolic blood pressure alone but also the pulse pressure as an additional indicator of cardiovascular risk have to be considered. The prevalence of isolated systolic hypertension increases with age. Remodeling of the arterial wall with increase of collagen and decrease of elastic fibers are leading to an impaired compliance. Decreased compliance and acceleration of the pulse wave velocity can elevate systolic and lower diastolic blood pressure. Cardiac stress and pulse pressure in consequence will rise. In elderly patients there is a strong correlation between cardiovascular mortality and morbidity and systolic blood pressure. Antihypertensive therapy is able to lower cardiovascular morbidity and mortality in elderly patients with isolated systolic hypertension with a predominant risk reduction for stroke.

Aged↗
PubMed1999

Compliance with aspirin or placebo in the Hypertension Optimal Treatment (HOT) study.

OBJECTIVE: The Hypertension Optimal Treatment (HOT) study is a large, prospective trial aimed at defining the level of diastolic blood pressure required during anti-hypertensive therapy in order to achieve maximal protection against cardiovascular complications. A further aim is to assess the effects on morbidity and mortality of a 75 mg daily dose of aspirin compared with placebo. SUBJECTS AND METHODS: Compliance with double-blind administration of aspirin or placebo added to anti-hypertensive treatment was evaluated for 1 year in a subset (n = 530) of the study population (n = 18 790) by placing the medication in a container closed with an electronic cap that records precisely the time of each opening. RESULTS: The 1-year compliance rate (percentage of days with one opening per day) could be assessed in 501 patients. It averaged 78.3 +/- 25% in aspirin-treated patients (n = 236, mean +/- SD), compared with 78.5 +/- 25% in patients having received placebo (n = 265), and was not influenced by age, sex or country (Germany, Italy, Switzerland, UK). The compliance rate was also similar irrespective of whether the patients had reached their target blood pressure, but was significantly better during the first than the second 6-month monitoring period (84.1 +/- 22% versus 72.3 +/- 32%, n = 501). CONCLUSIONS: The high rate of compliance with aspirin or placebo observed in the HOT study suggests that the patients were highly motivated and may account for the unusually good blood pressure control achieved in this trial during long-term anti-hypertensive treatment.

Aged↗
PubMed1998

[Treatment concepts in therapy refractory hypertension].

Although inadequate lowering of elevated blood pressure is not unusual in the doctor's office, both physician and patient accept such a situation. One reason for this therapeutic failure may be either a true or an apparent therapy-resistance, with the latter being far the more common of the two, and often associated with a multiplicity of causes. Since cerebral complications in particular correlate directly with the level of blood pressure, a search for the underlying cause is always worthwhile for the patient.

Antihypertensive Agents↗
PubMed1996

[Complicated course of rheumatoid arthritis with pulmonary involvement, myocardial fibrosis and sleep apnea syndrome].

We report on a 67 year old man in whom the chest x-ray revealed marked interstitial opacities in both lungs. The diagnosis of Rheumatoid Arthritis (RA) was established by the presence of five criteria of the American College of Rheumatology for diagnosing RA. High resolution computertomography of the chest confirmed the abnormalities seen in the conventional chest x-ray. A biopsy, taken by open lung surgery, showed the typical pattern of pulmonary involvement in RA and confirmed the association of RA and interstitial lung fibrosis. The histologic examination pointed out lymphocytic infiltration of the bronchies, thickened alveolar walls with lymphoplasmarcellular infiltration and an increase in fibrous connective tissue. A congestive heart failure with severe arrhythmias and an obstructive sleep apnea syndrome (OSAS) were diagnosed in addition. The rhythm disturbances were attributed to the participation of the myocardium in RA and/or by the OSAS. By the treatment with prednisolone, methotrexate, mexiletine and continuous positive airway pressure (CPAP) the rhythm disturbances were alleviated and the patient's condition improved.

Aged↗
PubMed1995

[Potassium citrate versus potassium chloride in essential hypertension. Effects on hemodynamic, hormonal and metabolic parameters].

A study was conducted on 25 patients (18 men, seven women; mean age 48 [24-70] years) with essential hypertension (EH) to see whether an increase in potassium supply influences blood pressure as well as metabolic and hormonal parameters, and whether the anion administered together with potassium affects the results. In a randomized, cross-over trial sequence the patients daily received 120 mmol potassium chloride, 120 mmol potassium citrate or a placebo, each for 8 weeks. Between each of the three periods there was a "wash-out" phase of 4 weeks each. After 8 weeks of potassium citrate intake the systolic and diastolic pressures were reduced significantly, by a mean of 6.2/3.8 mm Hg (P < 0.05). But after potassium chloride there was only a small, not significant, reduction. Metabolic and hormonal parameters (fasting glucose concentration, glucose tolerance test, lipid electrophoresis; plasma renin activity, plasma concentration of aldosterone, noradrenaline and insulin) were not significantly changed.--These findings suggest that an increased supply of potassium has a favourable haemodynamic effect, but this varies markedly between different potassium salts. An increase in potassium supply should thus be considered as an additional measure in the treatment of EH. As long as renal function is normal no unfavourable metabolic effect need be feared.

Adult↗
PubMed1995

Age is a major determinant of the divergent blood pressure responses to varying salt intake in essential hypertension.

Blood pressure responses to 1 week of low (20 mmol sodium/day) and high (300 mmol sodium/day) salt intake were investigated in a double-blind, randomized study in 46 white, nonobese subjects with essential hypertension (13 women, 33 men; mean age 45.3 +/- 2.2 years, age range 25 to 80 years). The individuals were classified as salt-sensitive when mean arterial blood pressure rose by at least 5 mm Hg during high salt intake, as salt-resistant when mean arterial blood pressure changed by less than 5 mm Hg, and as "counter-regulators" when mean arterial blood pressure fell by at least 5 mm Hg during the high salt diet. Mean arterial blood pressure of all subjects taken together increased from 101.9 +/- 1.4 mm Hg during salt restriction to 103.7 +/- 1.5 mm Hg (P < .05) during salt loading. Eleven subjects (23.9%) were classified as salt-sensitive, 27 (58.7%) as salt-resistant, and 8 (17.4%) as counter-regulators. Multiple regression analysis revealed that age, but not baseline blood pressure, sex, body mass index, or family history of hypertension contributed significantly to the change in blood pressure following the diets. Ten of the 11 salt-sensitive subjects were older than the median age of 45 years. In salt-sensitive, as compared to salt-resistant, hypertensive subjects, creatinine clearance was lower and plasma renin activity was suppressed at baseline as well as during low and high salt intake. In contrast, plasma concentrations of norepinephrine and atrial natriuretic peptide were elevated in salt-sensitive subjects. These differences between the groups appeared, at least partially, to be age-related.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Primary amyloidosis of the lung].

We report on a female patient of 66 years of age in whom primary nodular amyloidosis of the lung was diagnosed on the basis of a chance radiological finding. Based on this case report we discuss the pathophysiology, diagnosis and clinical findings of pulmonary amyloidosis.

Amyloidosis↗
PubMed1994

Effects of severe and moderate salt restriction on serum lipids in nonobese normotensive adults.

The effects of severe and moderate sodium restriction on blood pressure and serum lipids were studied in nonobese normotensive adults. Subjects (n = 163) were given a low (20 mmol Na/d) and high (300 mmol Na/d) salt diet for 1 week each in random order. Of these subjects, 25 were selected to participate in a second study with moderate salt restriction (85 mmol na/d) or "normal" sodium diet (200 mmol Na/d) given for 4 weeks each in random order. After severe salt restriction, 19% of the 163 subjects had a significant decrease in blood pressure (salt-sensitive), 15% showed a significant rise (counter-regulator), and 66% exhibited no change (salt-resistant). Severe sodium restriction increased serum total and low density lipoprotein (LDL) cholesterol and triglycerides. After correction for hematocrit, the changes in blood lipids remained significant in the counter regulators only. After moderate salt restriction, serum lipid concentrations and blood pressure did not change.

Adult↗