Impact of mental and physical stress on blood pressure and pulse pressure under normobaric versus hypoxic conditions.

Objective: Hypobaric hypoxia, physical and psychosocial stress may influence key cardiovascular parameters including blood pressure (BP) and pulse pressure (PP). We investigated the effects of mild hypobaric hypoxia exposure on BP and PP reactivity to mental and physical stress and to passive elevation by cable car.

Methods: 36 healthy volunteers participated in a defined test procedure consisting of a period of rest 1, mental stress task (KLT-R), period of rest 2, combined mental (KLT-R) and physical task (bicycle ergometry) and a last period of rest both at Graz, Austria (353 m asl) and at the top station Dachstein (2700 m asl).

[Hypertension short message service].

Hypertension Short Message Service is a new tool for disease management aimed at improving the success of the doctor's daily routine in hypertension treatment both in terms of the quality of hypertension assessment and concerning the efficacy of treatment. At present there is a wide and disappointing difference between the results of treatment in routine work [1] and in clinical trials [2, 3] even when the same cohort of patients is treated by the same therapists. The efficacy rate in daily routine is about 20-35% as compared to 70-85% during trials.

Hypertension in women: the role of progesterone and aldosterone.

The age-related course of blood pressure and its gender-related difference, as well as the incidence of hypertension, have been the subject of multiple experimental, clinical and epidemiological studies over the past decades. The role of the sex hormones estradiol and testosterone within this gender dimorphism has been investigated without conclusive results. In this review, we provide background information on the gender difference in blood pressure, describe the impact of progesterone and aldosterone, and discuss the pathophysiology of aldosteronism as well as the potential role of drospirenone as a gender-specific agent for the prevention and treatment of hypertension and for cardiovascular protection.

A new oscillometric method for pulse wave analysis: comparison with a common tonometric method.

In the European Society of Cardiology-European Society of Hypertension guidelines of the year 2007, the consequences of arterial stiffness and wave reflection on cardiovascular mortality have a major role. But the investigators claimed the poor availability of devices/methods providing easy and widely suitable measuring of arterial wall stiffness or their surrogates like augmentation index (AIx) or aortic systolic blood pressure (aSBP). The aim of this study was the validation of a novel method determining AIx and aSBP based on an oscillometric method using a common cuff (ARCSolver) against a validated tonometric system (SphygmoCor).

[Arteriell wall-stiffness: a new important cardiovascular risk factor].

In addition to blood pressure (BP), Augmentation index (AIx) and pulse wave velocity (PWV) are two further parameters to assess arterial function. Even so these functions are partly interdependent, each of them is a strong and independent predictor of vascular risk and end organ damage. In consideration of the high general interest in cardiovascular disease, the diagnostic improvement in assessing abnormal vascular function by these new techniques should be promptly put into practice.

Influence of artificial sweetener on human blood glucose concentration.

Artificial sweeteners, such as saccharin or cyclamic acid are synthetically manufactured sweetenings. Known for their low energetic value they serve especially diabetic and adipose patients as sugar substitutes. It has been hypothesized that the substitution of sugar with artificial sweeteners may induce a decrease of the blood glucose.

The Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) trial: outcomes in patients receiving monotherapy.

In the main Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) report, we investigated outcomes in 15 245 high-risk hypertensive subjects treated with valsartan- or amlodipine-based regimens. In this report, we analyzed outcomes in 7080 patients (46.4%) who, at the end of the initial drug adjustment period (6 months), remained on monotherapy.

[Blood pressure and arterial stiffness. A comparison of two devices for measuring augmentationindex and pulse wave velocity].

Augmentationindex (AIx) and Pulse Wave Velocity (PWV) give much more information on the function of the arterial tree than that obtained by blood pressure recordings. The rediscovered value of arterial stiffness measured by means of AIx or PWV is now proven as an independent cardiovascular risk factor and helps to differentiate patients at risk and their cardiovascular treatment offer. In the last decade, the methods to measure and to calculate AIx and PWV have become increasingly simple.

Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study.

Objective: Few data are available comparing the effects of monotherapy and combination therapy on target organ damage. The PICXEL study compared the efficacy of a strategy based on first-line combination with perindopril/indapamide versus monotherapy with enalapril in reducing left ventricular hypertrophy (LVH) in hypertensive patients.

Methods: In this 1-year multicentre randomized double-blind study, patients received an increasing dosage of perindopril/indapamide (n = 284) or enalapril (n = 272).

Felodipine-metoprolol combination tablet: maintained health-related quality of life in the presence of substantial blood pressure reduction.

Background: Most treated hypertensive patients do not achieve adequate blood pressure (BP) control. Initiating therapy with two drugs has been suggested when BP is >20/10 mm Hg above goal. To ensure patients' compliance, such treatment needs to be well tolerated and must not compromise health-related quality of life (HRQL).

[The theory-practice problem of blood pressure assessment].

The theoretical basis for assessment of blood pressure described in the guidelines of the ISH-ESC and in JNC 7 ignores the variability of blood pressure and is therefore not applicable in general practice. Although the guidelines do not meet the daily requirements, they are not questioned by the physician, and are therefore confusing both physicians and millions of patients taking self-recordings. The unsolved problems are: The confidence interval for the single readings and the mean values are ignored.

Blood pressure characteristics of hypertensive patients in Austria as determined by self-monitoring (SCREEN-II).

This is the first large-scale, countrywide study evaluating blood pressure levels in treated hypertensive patients based on home blood pressure monitoring. The study was conducted all over Austria by 166 physicians enrolling a total of 1303 patients each taking at least 30 home blood pressure readings (a total of 39,000 readings). Stratification of patients into groups with normotension, mild hypertension or severe hypertension followed the recommendations of the Austrian Hypertension League (normotension defined as no more than seven readings higher than 135/85 mmHg, according to a blood pressure load of no more than 25%).

Efficacy of very low dose perindopril 2 mg/indapamide 0.625 mg combination on left ventricular hypertrophy in hypertensive patients: the P.I.C.X.E.L. study rationale and design.

The PICXEL study is designed to evaluate the effects of long-term administration of very low-dose combination perindopril 2 mg/indapamide 0.625 mg (Per/Ind) vs enalapril in reducing left ventricular hypertrophy (LVH) in hypertensive patients. This multicentre, controlled, randomised, double-blind, parallel group study is carried-out to assess the variation of left ventricular mass index (LVMI) after treatment, using a centralised control of M-mode echocardiography determinations, and a dedicated software for semi-automatic measurement.

[Angiotensin receptor blockers--significance for the therapy of hypertension].

Angiotensin receptor antagonists (ARB) are equally effective but better tolerated than all the other blood pressure lowering agents. The reason, why they are not subscribed as first line drugs for uncomplicated hypertension, is the higher price for these products. What the real difference in costs is, remains unclear because calculations are missing to what extent lesser controls of therapy would shift the balance in favour of the ARBs.

Intestinal elimination of hydroxyethyl starch?

Objective: Hydroxyethyl starch (HES) is mainly eliminated via the kidneys. Any information about extrarenal elimination obtained so far has been either incomplete or contradictory. The objective of this study was to quantify the intestinal excretion of infused HES with a mean molecular weight of 200,000 and a molar substitution of 0.

[How reproducible is blood pressure measurement? Intra- and interindividual blood pressure variability in routine practice].

Considering the reproducibility of blood pressure readings the epidemiologist and the physician in his clinical work take two different points of view. Studying drug effects the epidemiologist is interested in significant differences of blood pressures in a study population. The physician however, who estimates the effect of his prescription given to an individual patient has to compare single blood pressure readings in single individuals.

Felodipine-metoprolol combination tablet: a valuable option to initiate antihypertensive therapy?

The aim of the present study was to assess the efficacy and tolerability of a calcium antagonist/beta-blocker fixed combination tablet used as first-line antihypertesnive therapy in comparison with an angiotensin converting enzyme inhibitor and placebo. Patients with uncomplicated essential hypertension (diastolic blood pressure between 95 and 110 mm Hg at the end of a 4-week run-in period) were randomly allocated to a double-blind, 12-week treatment with either a combination tablet of felodipine and metoprolol (Logimax), 5/50 mg daily (n = 321), enalapril, 10 mg daily (n = 321), or placebo (n = 304), with the possibility of doubling the dose after 4 or 8 weeks of treatment if needed (diastolic blood pressure remaining >90 mm Hg). The combined felodipine-metoprolol treatment controlled blood pressure (diastolic < or =90 mm Hg 24 h after dose) in 72% of patients after 12 weeks, as compared with 49% for enalapril and 30% for placebo.

Treatment of left ventricular hypertrophy in hypertensive patients with a combination of verapamil and captopril--a multicenter study.

Unlabelled: The regression of left ventricular hypertrophy in hypertensive patients was evaluated in a multicenter study with a combination therapy of verapamil 120 mg and captopril 25 mg given once or twice daily. The degree of left ventricular hypertrophy was assessed using echocardiography, while hypertension was evaluated by means of twice daily blood pressure self-measurements and ambulatory blood pressure monitoring.

Results: An overall of 61 patients was evaluated.

[Compliance of the hypertensive patient in medical practice--analysis of an observation study. 2].

In a subgroup of 301 hypertensive patients out of the user--observation study ("Anwendungsbeobachtung") with Renitec und CO-Renitec we studied which compliance-improving methods are effective. We tested the effects of blood pressure self-measurement and of an exclusive conversation with the patients. It could be shown, at least in our approach, that the conversation with the patient resulted in a lighter efficacy than blood pressure self-measurement: > 80% compliance was found in 80% of the patients, compared with only 40% of the patients with standard care.

[Therapy of hypertension in general practice with Renitec and Co-Renitec--analysis of an administration study].

In a user-observation study ("Anwendungsbeobachtung") it could be demonstrated that Renitec and Co-Renitec lowered elevated blood pressure but not sufficiently according to the WHO-criteria. It seems that the necessary dose titrations are not carried out in a daily routine. Furthermore it has to be stated that even widespread observation studies are not able to differentiate the properties of a drug.

A comparative bioavailability study on two new sustained-release formulations of disodiummonofluorophosphate versus a nonsustained-release formulation in healthy volunteers.

In 12 healthy volunteers the pharmacokinetic parameters of two new sustained-release formulations of disodiummonofluorophosphate (MFP) (B and C) were compared with those of a nonsustained-release reference preparation (A). This randomized study had a single-dose, triple-cross over design and consisted of 3 trial days separated by a 1-week washout period. Serial blood samples were obtained over a period of 24 hours and 24-hour urine was collected.

[New aspects in evaluating the hypertensive patient: measuring blood pressure in the physician's office--ambulatory blood pressure monitoring--blood pressure self-measurement].

The "average" blood pressure of hypertensives, which is held responsible for the adverse effects of hypertension is poorly reflected by causal readings (CR), which are taken as a surrogate. CR do not only differ from average blood pressures, but also fail to give information on blood pressure variability. According to white coat effect and blood pressure variability a satisfying classification of severity and consecutively of prognosis cannot be done in an individual.

[Patient compliance of hypertensive patients in the physician's practice].

Compliance of hypertensive patients is primarily estimated in participating patients in clinical trials. Although compliance is overestimated by pill-counting, this technique is most frequently used. 389 Austrian general practitioners studied compliance in 945 hypertensives, using the Medication Event Monitoring System.