Circulatory encephalopathy in patients with arterial hypertension

More accurate definition of the leading factors of development of discirculatory encephalopathy (DE) in patients with arterial hypertension was the aim of this investigation. The analysis of correlations between clinical and computer tomographical symptoms of DE on the one hand and the indices of central hemodynamics, head blood circulation and presence of atherosclerosis of head arteria on the other hand was performed. It was found that congestion in head venous system was the main factor in DE development. The conclusion was made that both atherosclerosis of head arteria and arterial hypertension promoted venous congestion in head by means of decreasing the amplitude of arterial pulsation and in turn the development of DE. Meanwhile, the increase of minute blood flow prevents it.     

Left ventricular hypertrophy in patients with nephrogenic arterial hypertension

Incidence and geometric peculiarities of hypertrophy of the left ventricle of the heart (HLVH) were studied on the basis of findings from the echocardiographic investigation done in 86 patients with chronic glomerulonephritis (ChGN) with arterial hypertension (AH), with the renal function being preserved and at the early stages of renal insufficiency. HLVH was detected in 30.2% of the patients, in 80.8% of whom it was concentric, and in 19.2% eccentric, in 76%--symmetric and in 23.1%--asymmetric. Incidence of HLVH did not correlate with sex, clinical variant of ChGN, renal function status, and increased with the degree and duration of AH. There was no difference in geometric peculiarities between sexes, clinical variants of ChGN, and no association with degree and duration of AH as well as with functional state of the kidneys.     

Clinical profile of arterial hypertension in patients with cerebrovascular diseases

The aim this work was to assess retrospectively the history of hypertension in patients admitted for cerebrovascular diseases. Two hundred and forty eight patients were studied (69% with ischemic strokes, 24% with hemorrhagic strokes and 7% with transient ischemic attacks. 76% of cases had a history hypertension with an evolution of ten years or more in 81% of cases. No differences in the prevalence of hypertension was observed among the different types of strokes. Of the 139 patients in whom the severity of hypertension was registered, 37% had mild, 45% moderate, 15% severe and 3% systolic hypertension. Those with severe hypertension had a higher incidence of hemorrhagic stroke. Fundoscopic examination was abnormal in 81% of the 64 patients in whom it was performed, left ventricular hypertrophy was found in 62% of the 146 patients in whom it was investigated. 51% of patients were receiving anti hypertensive treatment and it was effective in 26% of them. Thirty one percent of subjects had old lesions in the CAT scan; these subjects had a similar prevalence of hypertension and effectiveness of treatment than patients without old lesions. It is concluded that a history of more than ten years of hypertension is a risk factor for cerebrovascular disease, that severe hypertension is mostly associated to hemorrhagic strokes and that only 26% of patients with stroke had and adequate anti hypertensive treatment.     

Diastolic function parameters and atrial arrhythmias in patients with arterial hypertension

OBJECTIVE: To investigate in patients with arterial hypertension (HT) the extent of left ventricular (LV) hypertrophy and diastolic function in relation to atrial arrhythmias. PATIENTS AND METHODS: In 112 hypertensive patients (40 women, 72 men; mean age 50 +/- 6.6 years) with a mean systolic blood pressure for the cohort of 170 +/- 5 mmHg, their first invasive coronary angiography was performed between July 1995 and October 1997 because of angina pectoris and/or an abnormal stress electrocardiogram. After excluding coronary heart disease LV dimensions and diastolic function were measured by echocardiography; in 59 of the 112 patients LV hypertrophy was demonstrated. In addition, long-term blood pressure monitoring, exercise and long-term electrocardiography, late-potential analysis and measurement of heart rate variability were undertaken. The control group consisted of 51 patients without arterial hypertension after exclusion of coronary heart disease. RESULTS: Even in the hypertensive patients without LV hypertrophy diastolic LV function and ergometric exercise capacity were reduced. The risk of LV arrhythmias was significantly higher in patients with LV hypertrophy than those without and in the control group, as measured by the complexity of atrial arrhythmias (P < 0.001), the incidence of abnormal late potentials (P < 0.001) and reduction in heart rate variability (29.3 +/- 5.3 ms vs 47.8 +/- 12.1 ms vs 60.7 +/- 6.6 ms; P < 0.001). There were similar results regarding severe complex atrial arrhythmias (38.5 vs 15.0 vs 0%; P < 0.001). The incidence of atrial arrhythmias correlated with the LV diameter (r = 0.68, P < 0.001), LV morphological dimensions and diastolic function (isovolumetric relaxation time r = 0.44, P < 0.001) and the ratio of early to late diastolic inflow (r = 0.46; P < 0.001). CONCLUSIONS: Hypertensive patients have a higher risk of atrial and ventricular arrhythmias, depending on the degree of LV hypertrophy. But atrial arrhythmias, in contrary to ventricular arrhythmias, are also closely related to abnormalities in LV diastolic function.     

The role of arterial hypertension in the occurrence of strokes at a young age

The analysis of insult occurrence in patients at the age under 45 years, caused by blood hypertension, shows, that they make 30.1% from common number of insult in 166 young people, treated in the neurological and other departments of Burdenko Main Military Clinical Hospital in 1989-1996. On occasion of ischemic insult were treated 37 patients, hemorrhagic--13. The reason of insults was "soft" blood hypertension: in 51.4%--at ischemic insult and in 30.1%--hemorrhagic. The authors consider, that the main direction of prophylaxis of insult is active revealing and adequate treatment of the patients with blood, including "soft" hypertension, use of hypotensive preparations and some non-medicative methods of treatment.     

Serum angiotensin converting enzyme activity in patients with untreated essential arterial hypertension

The serum angiotensin converting enzyme (ACE) in 30 patients with untreated essential arterial hypertension, 30 patients with chronic renal failure accompanied with arterial hypertension and 30 healthy individuals was measured. The subjects of both sexes have been old 35-60 years. The serum ACE activity was determined by the spectrophotometric method, using Hip-Gly-Gly as a substrate. The serum ACE activity significantly increased in patients with arterial hypertension (32.48 +/- 2.02; X +/- SEM) and patients with chronical renal failure accompanied with arterial hypertension (37.10 +/- 1.45) when compared to the healthy individuals (20.83 +/- 1.33). Possible mechanisms of increasing ACE activity with the patients suffering of arterial hypertension are discussed.     

Time of occurrence of paroxysmal atrial fibrillation in Holter monitoring in patients with coronary heart disease and in patients with hypertension

Paroxysmal atrial fibrillation (PAF) often accompany coronary heart disease (CHD), and primary hypertension (PH). The aim of the study was to evaluate the time of occurrence and duration of paroxysmal atrial fibrillation (PAF) identified from Holter recordings in 63 patients (27 women and 36 men) with CHD (n = 45) and PH (n = 18). No pharmacological treatment was applied before and during the examination. All patients were in sinus rhythm at the start and the end of the recording which lasted for 24 hours. PAF were defined as the occurrence of at least four beats of supraventricular origin, with no visible P or flutter waves. The time of onset, duration, ventricular rate and symptoms of each PAF were noted. There were 219 paroxysms recorded in 63 patients which occurred more often by day than by night, the time of duration was 0.9-240 s. Of the total, 16.3% of episodes with CHD and 9.5% episodes in patients with PH occurred between the hours 8:00-10:00 and between 16:00 and 18:00; 9.1% and 21% respectively. We concluded that in patients with CHD and with H most of the episodes (95%) are silent, they occurred more often during the day activity (particularly between the hours of 8:00 and 10:00 and 16:00-18:00 in both groups). In patients with CHD we observed the third peak of occurrence of PAF between the hours 22:00-0:00.     

Structural and functional alterations of the intramyocardial coronary arterioles in patients with arterial hypertension

BACKGROUND: In hypertensive patients with angina pectoris, the coronary vasodilator reserve is frequently impaired despite a normal coronary angiogram. Experimental data indicate that structural alterations of the intramyocardial coronary vasculature contribute to an increased minimal coronary resistance and a diminished coronary flow reserve. METHODS AND RESULTS: In 14 patients (10 men and 4 women) with arterial hypertension and 8 normotensive subjects, minimal coronary resistance and vasodilator reserve (dipyridamole: 0.5 mg/kg body wt, gas chromatographic argon method) were determined after the angiographic exclusion of relevant coronary artery disease. Coronary reserve was depressed in hypertensive patients (2.7 +/- 2.3 vs 4.6 +/- 1.3, P < or = .05) due to increased minimal coronary resistance (0.64 +/- 30 vs 0.24 +/- 0.055 mm Hg.min.100 g.mL-1, p < or = 0.002). In right septal biopsies, mean external arteriolar diameter (21.6 +/- 2.3 vs 17.2 +/- 2.5 microns, P < or = .001), mean arteriolar wall area (271 +/- 61 vs 172 +/- 62 microns 2, P < or = .01), percent medial wall area (69.9 +/- 4.0 vs 66.0 +/- 3.2%W, P < or = .05), mean periarteriolar fibrosis area (216 +/- 122 vs 104 +/- 68 microns 2, P < or = .05), and volume density of total interstitial fibrosis (3.6 +/- 1.8 vs 1.9 +/- 0.5Vv% fibrosis, P < or = .05) were increased in hypertensive patients compared with normotensive subjects. Minimal coronary resistance correlated with %W (r = .6, P < or = .003) and Vv% fibrosis (r = .62, P < or = .002). Left ventricular mass index (111 +/- 21 vs 97 +/- 17 g/m2, P = NS) and left ventricular end-diastolic pressure (12 +/- 6 vs 8 +/- 3 mm Hg, P = NS) did not correlate significantly with minimal coronary resistance. In multivariate analysis, both %W and Vv% fibrosis explained half of the variability of minimal coronary resistance (r2 = .5, P < or = .002). CONCLUSIONS: Structural remodeling of the intramyocardial coronary arterioles and the accumulation of fibrillar collagen are decisive factors for a reduced coronary dilatory capacity in patients with arterial hypertension and angina pectoris in the absence of relevant coronary artery stenoses.     

The effect of different factors on cardiac rhythm variability in patients with arterial hypertension

The purpose of this study was to evaluate the influence of different factors, among them left ventricular hypertrophy (LVH) on long-term heart rate variability (HRV) in patients with hypertension. 38 patients with arterial hypertension of different genesis were included in the study. Ischemia was excluded in all the patients by the data of clinical and instrumental methods of investigation. LVH data obtained from HRV of 20 healthy subjects was used as control. HRV was evaluated by estimating variations for short intervals of a rhythmogram (VSI). A HRV decrease did not depend on sex, but essentially depended on patients'a age, disease duration and the form of hypertension. A marked tendency leading to the rate variability decrease was observed only in moderate LVH. In cases of original LVH variability data did not differ from those in patients without signs of LVH. Low or marginal HRV was more often observed in patients with essential hypertension and in those with hypertension of endocrine genesis. As far as renal hypertension is concerned low variability was less frequent. There were a lot of factors which affect the change of HRV. The more significant of them were the patients' age, hypertension genesis and form of hypertension. Factors leading to the rate variability decrease were the following age above 40, endocrine or essential hypertension and moderate form of hypertension.     

Correlation between echocardiographic changes and parameters of pulmonary function in patients with arterial hypertension

This study comprised 30 patients with mild or moderate arterial hypertension (according to classification of the World Health Organization) in whom some echocardiogram and parameters of the lung function were studied in order to establish correlation between them. A good correlation exists between LV (left ventricle) mass index and vital capacity (r = 0.562, p < 0.01), ejection fraction and forced mid expiratory flow (r = 0.717, p < 0.01), LV mass index and Tiffenau index (r = 0.620, p < 0.01), shortening fraction and forced mid expiratory flow (r = 0.591, p < 0.01), airways resistance and posterior wall thickness (r = 0.591), p < 0.01) and between LV mass index and total lung capacity (r = 0.821, p < 0.01). There was not a good correlation or it was not significant (p > 0.05) between other echocardiographic changes and lung function tests.     

Microalbuminuria in arterial hypertension

Microalbuminuria is a considerable good indicator of atherogenic disease and cardiovascular risk. In the arterial hypertension, the main centre organ is the kidney. Structural and functional changes that happen in the hypertensive nephropathy are going to cause alterations m the albumin urinary excretion. The authors have done a revision of the main factors which can origin the existence of microalbuminuria in patients with arterial hypertension, and they conclude that this is an useful biochemist indicator in order to evaluate the degree of renal disease in these patients.     

Effect of oral pyridoxine hydrochloride supplementation on arterial blood pressure in patients with essential hypertension

The purpose of this study was to test the effect of vitamin B6 (pyridoxine-HCl, CAS 58-56-0) supplementation on arterial blood pressure in essential hypertension. The trial comprised 9 normotensive subjects (7 men and 2 women, aged between 32-58 years; mean +/- SD, 48 +/- 11) and 20 patients with essential hypertension (16 men and 4 women, aged between 32-69 years; mean +/- SD, 56 +/- 12). The patients were treated during 4 weeks with a single oral dose of pyridoxine (5 mg/kg body weight/day). After a 5-min rest, measurements were made in the supine position. When compared with the normotensive subjects, the hypertensive subject group had a significantly higher systolic and diastolic blood pressure (p < 0.001) and higher level of plasma norepinephrine (NE) (p < 0.01) before pyridoxine treatment. On the other hand, there were no significant differences in plasma epinephrine (E) and heart rates. Treatment of hypertensive patients with pyridoxine significantly reduced systolic (p < 0.01) and diastolic blood pressure (p < 0.005), plasma NE (p < 0.005) and E (p < 0.05) within 4 weeks. However, there was no significant difference in heart rate at the end of pyridoxine treatment. These results indicate a relationship between pyridoxine status and arterial blood pressure in the essential hypertensive patients.     

Hemodynamic interaction of propranolol and digitalis in patients with arterial hypertension (author's transl)

Central hemodynamics at rest and during supine ergometer exercise have been studied in 12 hypertensive subjects and three healthy persons before and 20 min after 5 mg of intravenous propranolol. Cardiac output (CO) decreased by 19% at rest (p less than 0.001) and by 15% during exercise (p less than 0.001). Pulmonary capillary wedge pressure (PCP) during exercise rose after beta-blockade by 56% to 28 mm Hg (p less than 0.001); a similar increase could be observed in pulmonary artery pressure (PAP) and right atrial mean pressure (RAM). Brachial artery mean pressure at rest did not change significantly; during exercise this value was 6% below the pretreatment level (p less than 0.001). In order to evaluate the influence of digitalis on beta-blocker induced hemodynamic changes, measurements were repeated 30 min after administration of 0.6 mg beta-Methyldigoxin intravenously. After addition of digitalis, average PCP during exercise was significantly lower than after beta-blockade alone (22.8 mm Hg, p less than 0.001). Likewise, PAP and RAM after digitalis were lower than after propranolol alone. CO did not change following digitalis administration. These findings indicate that digitalis partially counteracts the elevation of filling pressures induced by beta-blocking agents but leaves CO unchanged.     

Effect of different single agent antihypertensive therapies on peri-foveal microcirculation in patients with arterial hypertension

PURPOSE: Arterial hypertension is known to be an important risk factor for cerebral and cardiovascular disease. Previous studies have demonstrated alterations in the perifoveal microcirculation in patients with essential hypertension. During follow-up a progression of these alterations has been reported. In the present study we quantified the retinal microcirculation of patients with hypertension under different systemic antihypertensive medication. METHODS: The patients were divided into three groups according to their medication. Group 1 was treated with beta-blocker (n = 17), group 2 with ACE inhibitors (n = 10), and group 3 with calcium channel blockers (n = 11). All patients underwent fluorescein angiographic studies with a scanning laser ophthalmoscope. Perifoveal intercapillary areas (PIA) and the mean perifoveal capillary velocity were quantified from the angiograms. RESULTS: Compared with reference values, all three groups of patients with essential hypertension showed significantly increased PIA and significantly decreased capillary velocity. No difference could be detected between the three groups of patients treated with beta-blocker, ACE inhibitor or calcium channel blocker. CONCLUSION: Alterations of the perifoveal network are found in patients with arterial hypertension. These alterations are similar under antihypertensive monotherapy using beta-blocker, ACE inhibitor or calcium channel blocker.     

Relationship between pain sensitivity and resting arterial blood pressure in patients with painful temporomandibular disorders

OBJECTIVE: Patients experiencing temporomandibular disorders (TMD) show greater sensitivity to painful stimuli than age- and gender-matched control subjects. This enhanced pain sensitivity may result, at least in part, from an alteration in pain regulatory systems that are influenced by resting arterial blood pressure. In this study, we examined the relationship between resting systolic blood pressure and pain perception in 64 female TMD and 23 age-matched pain-free female subjects. METHOD: Resting arterial blood pressure and measures of thermal and ischemic pain threshold and tolerance were determined for each participant. Subjective ratings of thermal pain evoked by suprathreshold noxious thermal stimuli (45-49 degrees C) using a magnitude matching procedure were also obtained for both groups. RESULTS: TMD patients had lower thermal and ischemic pain thresholds and tolerances than pain-free subjects (ps < .05). Both groups provided equivalent intensity ratings to suprathreshold noxious thermal stimuli. A median split of each group based on resting systolic blood pressure revealed an influence of blood pressure on both thermal and ischemic pain perception for the Pain-Free group. The Pain-Free high resting blood pressure subgroup had higher thermal pain tolerances, higher ischemic pain thresholds, and provided lower magnitude estimates of the intensity of graded heat pulses compared with the Pain-Free low blood pressure subgroup. A trend toward a significant effect of blood pressure level on ischemic pain tolerance was also observed for the Pain-Free group. In contrast to the Pain-Free group, blood pressure level did not influence ischemic or thermal pain perception for TMD patients. Similar to the lack of effect of resting blood pressure on experimental pain perception in TMD patients, resting blood pressure was not related to measures of clinical orofacial pain in TMD patients. CONCLUSIONS: These findings confirm our previous findings that TMD patients are more sensitive to noxious stimuli and suggest that painful TMD may result, at least in part, from an impairment in central pain regulatory systems that are influenced by resting arterial blood pressure.