Search

Arterial hypertension is a public health problem and patient adherence to treatment is challenging. This study tested whether frequent nurse visits provide additional benefits to antihypertensive treatment. Every 30 days, a pharmacist visited these patients to deliver antihypertensive drugs and perform a pill count. Nurses visited group A (48 patients) every 15 days and group B (52 patients) every 90 days. Ambulatory blood pressure (BP) monitoring was performed 15 and 180 days after randomization. At randomization, groups A and B had the same clinical systolic (191 +/- 5 v 186 +/- 3 mm Hg) and diastolic BP levels (122 +/- 3 v 117 +/- 4 mm Hg), respectively. After 90 days, BP declined more in group A than in group B (35 +/- 5/19 +/- 3 v 27 +/- 5/9 +/- 3 mm Hg). At 180 days, the difference increased because the reduction persisted in group A but decreased in group B (36 +/- 6/21 +/- 4 v 17 +/- 4/10 +/- 2 mm Hg). The mean ambulatory BP monitoring values were similar in both groups at 15 and 180 days. However, the attenuation of the clinic-daytime BP difference was larger in group A than in group B (systolic, -13 +/- 4 v -3 +/- 4 mm Hg; diastolic -11 +/- 3 v -4 +/- 3 mm Hg). The patients with clinic-daytime differences decreased more in group A (systolic, 16 to 10; diastolic, 20 to 14) than in group B (systolic, 19 and 20; diastolic, 22 and 22). These data indicate that frequent nurse visits significantly attenuate the white coat effect (clinic daytime BP difference).

Oxidative stress emerges as a potential factor in the pathogenesis of hypertension and a common signal transduction mechanism by which various risk factors mediate cardiovascular and renal disease. A greater level of oxidative stress could contribute to higher rates of hypertension and related cardiovascular and renal complications in African Americans than in white Americans. The objective of this study was to compare oxidative stress induced by a standardized episode of acute hyperlipidemia in the two groups. Fifteen African Americans (37 +/- 1 years, 9 women/6 men, body mass index 30 +/- 2 kg/m(2)) and 15 whites (38 +/- 2 years, 9 women/6 men, body mass index 27 +/- 1 kg/m(2)) were evaluated. Acute hyperlipidemia was induced by a 4-h long infusion of Intralipid and heparin. Blood samples were drawn at baseline and after 2 and 4 h of acute hyperlipidemia for nonesterified fatty acids, triglycerides, and F2-isoprostanes, a biomarker of oxidative stress. Plasma nonesterified fatty acids and triglycerides increased significantly and similarly in African Americans and whites after 2 and 4 h of the Intralipid and heparin infusion. Although baseline plasma F2-isoprostanes did not differ between groups, F2-isoprostanes increased more in African Americans than in whites at 2 h (12.2 +/- 2.6 v 5.0 +/- 2.9 pg/mL, P

Arterial hypertension is a public health problem and patient adherence to treatment is challenging. This study tested whether frequent nurse visits provide additional benefits to antihypertensive treatment. Every 30 days, a pharmacist visited these patients to deliver antihypertensive drugs and perform a pill count. Nurses visited group A (48 patients) every 15 days and group B (52 patients) every 90 days. Ambulatory blood pressure (BP) monitoring was performed 15 and 180 days after randomization. At randomization, groups A and B had the same clinical systolic (191 +/- 5 v 186 +/- 3 mm Hg) and diastolic BP levels (122 +/- 3 v 117 +/- 4 mm Hg), respectively. After 90 days, BP declined more in group A than in group B (35 +/- 5/19 +/- 3 v 27 +/- 5/9 +/- 3 mm Hg). At 180 days, the difference increased because the reduction persisted in group A but decreased in group B (36 +/- 6/21 +/- 4 v 17 +/- 4/10 +/- 2 mm Hg). The mean ambulatory BP monitoring values were similar in both groups at 15 and 180 days. However, the attenuation of the clinic-daytime BP difference was larger in group A than in group B (systolic, -13 +/- 4 v -3 +/- 4 mm Hg; diastolic -11 +/- 3 v -4 +/- 3 mm Hg). The patients with clinic-daytime differences decreased more in group A (systolic, 16 to 10; diastolic, 20 to 14) than in group B (systolic, 19 and 20; diastolic, 22 and 22). These data indicate that frequent nurse visits significantly attenuate the white coat effect (clinic daytime BP difference).

Complex arrhythmia is frequent in hemodialysis patients but it is not clear if this is a consequence of dialysis or uremia or is secondary to the hemodynamic and cardiovascular alterations often associated with chronic renal failure. The incidence of complex ventricular arrhythmia (frequent multiform premature beats, couplets, and runs) in 31 subjects who had their uremic status recently corrected by renal transplant (Group 1) and in 23 predialysis (Group 2) and 73 hemodialysis (Group 3) chronic renal failure patients were studied with 24-h Holter monitoring. Patients were not receiving antiarrhythmic drugs or digitalis and significant coronary artery disease was excluded by clinical and noninvasive methods. Complex arrhythmia was two times more frequent in dialysis patients but the difference did not reach statistical significance (Group 1: 16%; Group 2: 17%; Group 3: 34%; chi2 4.9, P = .086). The stepwise model of logistic regression analysis identified systolic blood pressure (odds ratio 1.015, 95% confidence interval [CI] 1.001-1.027, P = .03) and left ventricular systolic dysfunction (odds ratio 7.04, 95% CI 1.3-36.7, P = .02) as the only factors that independently influenced the probability of complex arrhythmia. Age, gender, race, diabetes, smoking status, body mass index, diastolic blood pressure, serum creatinine, hematocrit, left ventricular mass index, and use of diuretics, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, sympatolytics, and calcium channel blockers did not influence the occurrence of complex arrhythmia. The data indicate that blood pressure and myocardial dysfunction are more important determinants of complex arrhythmia than dialysis or uremia in chronic renal disease patients.

The acute hemodynamic effect of cyclosporine in man is controversial. A randomized, double blind, placebo-controlled, cross-over study was undertaken to evaluate the effect of a single oral dose of cyclosporine (20 mg/kg body weight) on mean blood pressure (MBP), heart rate (HR), forearm blood flow (FBF), and vascular resistance (FVR) in 16 healthy adult subjects. Subjects were studied twice, with an intervening period of 2 weeks, before and after the administration of either cyclosporine or the vehicle olive oil. Blood pressure was measured on brachial and digital arteries. After 30 min of rest, basal measurements were obtained and individuals were randomly assigned to receive either cyclosporine or the vehicle, and the same measurements were repeated 2 h later. Mean whole blood levels of cyclosporine were 1542 ± 387 ng/mL (range 1000 to 2550) 2 h after the administration of a single oral dose of cyclosporine. Cyclosporine did not cause any significant change in the hemodynamic parameters when compared with vehicle. Pre- and post–cyclosporine data were as follows (means ± SD): MBP (determined by Finapres on the digital artery), 92 ± 10 v 95 ± 11 mm Hg; HR, 66 ± 10 v 68 ± 11 beats/min; FBF, 3.9 ± 1.3 v 3.8 ± 1.8 mL/100 mL/min; and FVR, 28 ± 9 v 33 ± 18 units, respectively. For the vehicle the results were: MBP, 94 ± 9 v 94 ± 9; HR, 67 ± 9 v 67 ± 11; FBF, 3.3 ± 1.6 v 3.2 ± 2.0; FVR, 35 ± 14 v 37 ± 15, respectively. These figures did not differ from those obtained with the auscultatory method applied to the brachial artery among 10 selected subjects studied with Finapres. In conclusion, we found no evidence that at supratherapeutic doses cyclosporine causes acute increase in blood pressure or peripheral vasoconstriction in humans.