Management of essential hypertension in patients with different degrees of left ventricular hypertrophy. Multicenter trial.

Three hundred and four hypertensive patients with different degrees of left ventricular hypertrophy (LVH) were recruited and followed for 4 years. The patients were randomized into two groups: Group I (150 patients) was treated with a combination of hypotensive drugs including beta-blockers, and group II (154 patients) was treated with the same combination of drugs including diuretics instead of beta-blockers. By the end of the fourth year, 60 endpoints were recorded: 17 strokes, 13 myocardial infarctions, and 30 cases of chronic coronary insufficiency.

[Color-coded duplex sonography of liver tumors. Does the blood supply permit a conclusion on staging?].

Real-time ultrasonography is a sensitive screening method in patients with suspected liver tumors. However, sonomorphology does not differentiate between benign and malignant tumors. In a prospective study we examined patients with liver tumors with color-coded duplex ultrasonography to find out whether the perfusion status of the liver tumor permits a differential diagnosis.

[Combined echo- and Doppler echocardiography determination of diastolic function parameters of the left ventricle].

In patients with arterial hypertension with and without LVH and in hypertrophic non-obstructive cardiomyopathy diastolic parameters were analyzed with M-mode and Doppler-Echocardiography. In hypertrophied hearts we could demonstrate, that Doppler estimated transmitral flow during rapid filling phase was significantly reduced. The lower early diastolic flow is compensated by an augmentation of atrial systole (higher A/R quotient).

Combined Doppler and M-mode analysis of diastolic filling behaviour in arterial hypertension with and without left ventricular hypertrophy.

The authors analysed Doppler and M-mode derived diastolic parameters of left ventricular filling in patients with arterial hypertension with and without left ventricular hypertrophy (LVH) and with hypertrophic nonobstructive cardiomyopathy (HNCM). In hypertrophied hearts they demonstrated that the transmitral flow during rapid filling phase was significantly reduced. The lower early diastolic flow is compensated by an augmentation of atrial systole.

Determinants of left ventricular hypertrophy in arterial hypertension.

A long term study (2-7 years, mean 3.6 years) monitoring 112 clinical and echocardiographic pattern in 593 hypertensives and 156 normotensives was performed in order to find associations to left ventricular hypertrophy (LVH) developing later. 49% of the hypertensives developed echocardiographic signs of LVH (wall thickness of 12 mm and more), in contrast to 5.

[Stress hemodynamics in hypertensive patients treated with nifedipine].

In 10 male juvenile hypertensives WHO stage I who are active in sports echocardiographic investigations were performed at rest and on exertion (up to 2 Watt/kg body-weight) without therapy as well as 1 hour after sublingual administration of 20 mg nifedipine and after a six-week treatment with 3 times 20 mg nifedipine a day. 51 normotensives of the same age served as reference test persons. The antihypertensive effect was distinct, but not so expressive as under the beta-blockade.

[Effects of propranolol on central hemodynamics in hypertensive patients at rest and during stress].

In 10 male hypertensives without therapy who were active in sports echocardiographic examinations at rest, during and after a dynamic exercise were performed 1 hour after oral administration of 100 mg of propranolol and 6 weeks after a daily administration of 3 X 25 mg of propranolol. For comparison the results of 51 normotensive males of the same age were at disposal. The effects of propranolol in the acute experiment and under a permanent therapy are demonstrated at the parameters heart rate, systolic blood pressure, mean arterial pressure, end-diastolic volume index, stroke-volume index, ejection fraction, frequence-normed mean circumferential speed of shortening of fibres and peripheral resistance.

[Diagnosis of heart tumors--contribution of 2-dimensional and Doppler echocardiography].

The advantages of the modern two-dimensional echocardiography in comparison to the M-mode one are investigated on the basis of findings in 7 patients with heart tumors. Also the possibilities of Doppler echocardiography for comprehensive information about the cardiac situation in these patients are demonstrated. It will be shown that in some patients operation can be performed entirely on the basis of echocardiographic findings.

Bilateral atrial myxomas. Surgical correction after echocardiographic diagnosis.

A case is reported of bilateral atrial myxomas diagnosed noninvasively by echocardiography and successfully removed. The excised tumor mass consisted of a mobile right atrial myxoma prolapsing into the right ventricle and a less mobile, not prolapsing myxoma in the left atrium. The operation was performed entirely on the basis of echocardiographic findings, which correlated well with the operative results.

[Regional ventricular wall kinetics in cardiomyopathies as an expression of disordered function of the left ventricle].

Regional wall motion of the left ventricle was estimated in different types of cardiomyopathy CMP (hypertrophic obstructive CMP = HOCM, hypertrophic nonobstructive CMP = HNCM, apical hypertrophic CMP = AHCM and dilatative CMP = DCM) using computer-assisted analysis of two-dimensional echocardiographic images. Different kinetic pattern depending on distribution of hypertrophy were shown in the hypertrophic CMP. The degree and the type of the disturbances of left ventricular wall motion in DCM is useful as a prognostic criteria of the disease.

[Cortical and medullary circulation of the kidneys in pressor and depressor sinocarotid reflexes].

An experimental study in 12 anesthesized rabbits has demonstrated, by means of the hydrogen clearance test, that carotid sinus baroreceptors participate in the control of both the cortical (CF) and the medullary (MF) renal flow. The direction and magnitude of CF and MF changes in case of sinocarotid reflexes are determined by the relationships between extrarenal nervous effects, systemic blood pressure (BP) and self-regulative response of the cortex and the medulla. Arterial hypotension during depressor sinocarotid reflexes is accompanied by decreased CF and MF, while blood pressure stabilization increases CF and MF in these conditions.

[The effect of sinocarotid circulatory reflexes on the microcirculation of the kidney].

Sinocarotid baroreceptor control of renocortical and medullary blood flow was examined by hydrogen washout technique in unconscious rabbits. Direction and size of the local renal blood flow depend on the interaction of extravenal nerval influence, the actual blood pressure and the renal autoregulation. The data reveal an important neuroreflectory control of the renal blood flow.

[Mineralocorticoid-induced changes of vascular reactivity to noradrenaline and angiotensin II in baboons].

In experiments on normotensive baboons of both sex the vascular reactivity on angiotensin II and noradrenaline was studied after an 18-week administration of DOCA (2 mg/b.w./week i.

[Arterial hypertensive dysregulations on the basis of a cerebro-visceral stimulus constellation in baboons].

Basing on the hypothesis that disturbances of cerebral information processing on the basis of acute or chronic stress situations or profound neurotic alterations are being directed to the cardiovascular system only by predisposition to hyperreactivity, the influence of a psycho-nervous-humoral-hormonal stepped load schedule upon central nervous and vegetative functions was studied in baboons. Stochastic interventions into the natural day-night rhythm and application of NaCl and DOCA doses not per se causing a blood pressure rise, either single or in combination for altogether 3 years were used as disturbing factors. It has been revealed that experimental disturbance of the light-dark phases led to lasting deviations of the conditional-reflectory activity in the sense of a predominance of irritation processes.

[Changes in noradrenaline-induced vasoconstriction through ouabain blockade of the transmembranal electrolyte distribution].

In continuation of their studies concerning changes in the reactivity of vascular segments under isolated perfusion in vivo with simultaneous experimental disturbance of transmembranous distribution of electrolytes, the authors investigated in ten rabbits the effect of noradrenaline in the ear with isolated circulation. After perfusion of an ouabain solution (total concentration: 0.4 X 10(-5) M), in dependence on the duration of the effect of glycoside the vasoconstrictor response to 0.

[Changes in blood pressure, heart rate, respiration frequency and ECG in rhesus monkeys exposed to socio-emotional stress].

Blood pressure, heart rate, respiration frequency and ECG parameters were measured in 3 juvenile male rhesus monkeys under acute and chronic influence of a stepped load schedule including positive (nutritional), negative (pain-related) and socially operant conditioning and phases of a pharmacological sensibilization (angiotensin-II) of the cardiovascular system. The results suggest a general adaptation to the positively operant conditioning, while the latter stressing influences (either single or in combination) produced blood pressure and heart rate elevations, which had the character of dysregulatory functional changes (borderline hypertension model) and were reached by other authors, if at all, only through stronger stress influences.