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T Lüscher

Publications and source records attributed to T Lüscher.

At least 55 records · Page 3Linked to original sources
PubMed1983

Problem cases in renovascular hypertension.

The clinical course and response to therapy of 16 patients with various complex forms of renovascular hypertension were investigated. Reconstructive surgery and/or transluminal dilatation was either ineffective (n = 5) or could not be performed for technical reasons (n = 11). The group contained 7 patients with multilocular fibromuscular disease involving both renal arteries, two cases with multiple arteriosclerotic vascular occlusions, 3 patients with branch renal artery aneurysms, 3 with renal artery stenosis in a solitary kidney and one patient with renal artery stenosis and contraction of the contralateral kidney due to a non-vascular cause. With antihypertensive treatment, particularly with the angiotensin converting enzyme inhibitor captopril (n = 7), blood pressure could be reduced from 214 +/- 40/124 +/- 23 mm Hg to 145 +/- 23/88 +/- 9 mm Hg (P less than 0.001). In 11 of the 16 patients (69%) the values decreased to less than 160/95 mm Hg. These results suggest that, in complex forms of renovascular hypertension, antihypertensive treatment may be a potent therapeutic alternative if surgery and/or transluminal dilatation can not be performed or seem to have too high a risk.

Adult↗
PubMed1982

[Renovascular hypertension: comparison between transluminal dilatation and surgical procedures].

Percutaneous transluminal dilatation (PTD; n = 45) was compared with surgical procedures (n = 51) in 96 patients with renovascular hypertension. Since cases with atherosclerotic stenosis (ASS) are known to show a different response to surgery than those with fibromuscular dysplasia (FMD), group-specific analysis was performed. In their two subgroups (ASS and FMD) both surgical and dilated patients showed comparable mean age and sex distribution and serum creatinine. However, differences were observed in mean duration of hypertension and in pretreatment blood pressure values: surgical patients with ASS and FMD showed a lower mean duration of hypertension (operation: ASS 3.2, FMD 1.9 years; PTD: ASS 5.1, FMD 3.4 years) and higher mean blood pressure values (surgery: ASS 207/121, FMD 209/126 mm Hg; PTD: ASS 199/115, FMD 175/108 mm Hg). After a mean observation period of 2.6 years mean blood pressure fell in the surgery group to 147/90 mm Hg in the 26 cases with ASS, and to 139/87 mm Hg in the 25 patients with FMD. In dilated cases respective blood pressure values were 145/90 mm Hg (ASS, n = 17) and 132/84 mm Hg (FMD, n = 11). These results show a comparable blood pressure lowering effect for surgery and dilatation in renovascular hypertension. In cases with lengthy stenosis or involvement of primary branches of the renal artery and in those with aortic or poststenotic renal aneurysm a surgical technique should be performed, whereas in the remaining cases PTD represents a favourable procedure.

Adult↗
PubMed1982

[Compliance].

Explore the source record for details and available documents.

Hospitalization↗
PubMed1982

[Factitious hypoglycemia: clinical aspects, diagnosis and course in a non-diabetic male].

The case of a 37-year-old man without diabetes is reported who began to experience repetitive episodes of loss of consciousness. For 11/2 years the patient suffered from attacks of fatigue associated with sweating, tachycardia, blurred vision and finally unconsciousness. In the presence of low blood sugar and high plasma insulin values, an insulin producing pancreatic adenoma was initially suspected. In view of the negative results of radiological investigations, the different blood sugar reactions during fasting tests with and without supervision, together with low concentrations of C-peptide and high insulin values during various hypoglycemic episodes, factitious hypoglycemia was diagnosed. Finally, an ampoule of insulin was found in a locked suitcase of the patient. Therefore, in patients with fasting hypoglycemia as well as insulin producing adenoma, surreptitious insulin injections as part of a Müncchausen syndrome should be considered.

Adult↗
PubMed1982

[Factors determining compliance in hypertensive patients].

The influence of various demographic, disease-related and therapeutic factors on compliance has been investigated in 110 patients with hypertension, heart failure or edema. While demographic factors such as age, sex, socioeconomic status, marital status and smoking habits, scarcely influenced drug adherence, duration of therapy showed the greatest compliance-lowering effect. In the 27 hospitalized patients compliance decreased in 3.2 weeks from 92.6% to 75% and in 83 outpatients from 83% to 56% in 17.8 weeks. Totally mean compliance of hospitalized patients was higher (86.9%) than in outpatients (79.7%). The percentage of fully compliant patients was also greater (74%) in hospitalized patients than in outpatients (54.2%). Patients with symptomatic diagnoses complied better than asymptomatic patients: Mean compliance rate was 87% (n = 17) in outpatients with heart failure or edema and 77.3% (n = 66) in hypertensive outpatients. Hypertensives with symptoms due to other diseases also showed a higher compliance (80%) than those with asymptomatic diagnoses (71.1%). New symptoms during therapy and side effects of the antihypertensive treatment decreased the percentage of compliers to 64% and 59% respectively. On the other hand, the severity of hypertension had no effect on drug adherence. Patients with systolic blood pressure values between 140 and less than 180 mm Hg showed an identical compliance (79.8%; n = 47) to those with systolic values greater than 180 mm Hg (79.9% n = 60).

Age Factors↗
PubMed1982

[Weight reduction and blood pressure].

112 patients (78 hypertensives and 34 normotensives) received guidance from a specially trained dietitian on a low-calorie diet. During a mean control period of 10.8 months with a comparable number of visits in each group, the following results were observed: 51% (n = 40) of hypertensive patients achieved a significant weight reduction. In 28% (n = 22) antihypertensive medication was constant and in 23% (n = 18) this medication was reduced or withdrawn. 37% (n = 29) showed no significant changes in body weight or blood pressure and 12% (n = 9) dropped out. In 22 patients a weight reduction of 8.5 kg with a significant fall in blood pressure from 156/99 to 137/90 mm Hg was observed. In 18 hypertensives a weight reduction of 8.5 kg allowed reduction or withdrawal of antihypertensive medication with blood pressure remaining unchanged (139/91 vs. 135/90 mm Hg). Similar results were achieved in 34 normotensive obese patients: 59% (n = 20) had significant weight reduction, 32% (n = 11) no significant reduction in weight or blood pressure, and 9% (n = 3) dropped out. 20 patients with a reduction of 9 kg showed a significant fall in blood pressure from 132/84 to 123/80 mm Hg. The results demonstrate the favourable effect of weight reduction on blood pressure. The time-consuming nature of the frequent and intensive checks should, however, be borne in mind.

Adult↗
PubMed1982

Prizidilol (SK & F 92657), a new vasodilator with beta-blocking properties in the treatment of essential hypertension.

The antihypertensive effect of a new vasodilator with betablocking properties (SK & F 92657) was investigated in 10 patients with mild to moderate essential hypertension. After a mean treatment period of 26,5 weeks (6,5-49 weeks) blood pressure was significantly reduced, from 168 +/- 22/106 +/- 6 mmHg to 144 +/- 19/94 +/- 12 mmHg (p less than 0.05 and 0.025). The mean dose was 410 mg (100-700 mg). Heart rate decreased slightly from 77 +/- 12 to 70 +/- 8 beats/min. Plasma renin activity and plasma aldosterone showed only minor changes. Nausea, heavy dreams, facial and hand flushing and mild depression were reported as side effects. In most patients the symptoms disappeared without reduction in the dose. In one patient anaemia developed after 7 weeks and treatment with prizidilol was stopped. A slight but statistically significant decrease in haemoglobin concentration of 1.1 +/- 0.6 g/dl was observed in 5 of the 10 patients (p less than 0.02). Thus, a mean dose of prizidilol of 410 +/- 242 mg/day had a mean blood pressure lowering effect of 24/12 mmHg. In 7 of the 10 patients (70%) diastolic blood pressure could be reduced to 95 mmHg or less. However, the observed haematological side-effects should be carefully monitored in further studies and may limit the clinical use of prizidilol.

Adrenergic beta-Antagonists↗
PubMed1982

[Blood pressure, renin angiotensin aldosterone system and other cardiovascular risk factors in children of essential hypertensives (author's transl)].

In the present study, blood pressure, the renin angiotensin aldosterone system, and other cardiovascular risk factors, such as glucose, cholesterine, and triglycerides, were investigated in 294 offspring of essential hypertensives (5-34 years) and in 122 children of normotensive parents (5-34 years). Offspring of essential hypertensives showed statistically significant higher systolic and diastolic blood pressure values than those of normotensive parents (p less than 0.003, less than 0.005, respectively). Furthermore, in children of hypertensive parents a statistically significant higher body weight and body mass index than in controls could be observed (p less than 0.006, less than 0.001, respectively). With the exception of statistically significant, lower mean supine plasma aldosterone values (p less than 0.02) in children of hypertensive parents, no major differences between the two groups were seen in stimulated aldosterone, supine and stimulated plasma renin activity, and plasma cortisol. Furthermore, in the present study, 41 hypertensive parents, 65 (normotensive) spouses of hypertensives, and 47 (normotensive) parents of control children were investigated. As expected, hypertensive parents showed statistically significant higher blood pressure values than parents of control children and their spouses (p less than 0.001). Interestingly, hypertensive parents had not only a higher body mass index than control parents but also than their spouses (p less than 0.01 and less than 0.02, respectively). These findings support a genetic disposition as being the underlying cause of higher body weight in hypertensives and make it less probable that a higher food intake in hypertensive families is responsible for this phenomenon. The results of the present study indicate that early body weight control in children of hypertensive parents may be an important contribution to the prevention of hypertension.

Adolescent↗
PubMed1981

[Compliance in hypertensive patients and patients with cardiac insufficiency].

In the present study the compliance or drug-adherence of 83 patients with hypertension (n = 66), heart failure (n = 14) or edema of non-cardiac origin (n = 3) was investigated by the urine fluorescence method over an observation period of 17.8 +/- 15.1 weeks. Mean compliance rate of all patients was 79.7%. Individual drug-adherence ranged from 0 to 100%. Half of the patients (54.2%; n = 45) had positive urine samples in all investigations performed. A quarter (25.3%; n = 21) were compliant in over 50%, whereas in 14.5% (n = 12) the drug could be detected in the urine in only 10 to 50% of the tests and in 6% (n = 5) in less than 10%. The 17 symptomatic patients (patients with heart failure and/or edemas) showed a slightly better compliance (87.0%) than patients with hypertension, who had positive urine samples in 77.3 +/- 30.1% of tests. However, the difference observed was not statistically significant. During treatment a decrease in compliance from 82% at the first visit to 73% and 75% respectively at the second and third could be observed. Finally, at the fourth and fifth consultation only 62.2% and 56% respectively of the patients had positive urine samples. Our results show a good compliance rate in our patients as compared to American studies. During treatment a continuous decrease in compliance could be observed. Our results indicate that the duration of treatment seems to be an important determinant for the patient's drug-adherence. Therefore, it appears necessary to perform compliance-improving strategies as early as after the first follow-up visits.

Adult↗
PubMed1981

[Ultrasonic findings in renal diseases with hypertension (author's transl)].

Ultrasound investigations of the kidney were performed in a prospective study in 51 patients with hypertension. It was shown by means of characteristic changes that renovascular and renal parenchymatous diseases can be differentiated. The case of renal atrophy could be demonstrated in 14 out of 20 cases with renovascular changes and in 15 out of 18 cases wtih primary renal parenchymatous disease. There were false positive results in two out of 13 cases of essential hypertension. The importance of intrarenal cysts in the aetiology of hypertension requires further investigation.

False Positive Reactions↗