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Haemodynamic studies were undertaken at rest and during supine exercise in 43 juvenile hypertensives. A hyperkinetic circulation was found in 51% of juvenile hypertensives at rest in the supine position. An elevated cardiac output was associated with a higher oxygen consumption in only 24% of the juvenile hypertensives. Systolic hypertension was present during the study in half the juvenile hypertensives; they did not have a significantly higher percentage with an elevated cardiac output. Juvenile hypertensives did not show an excessive pressure response to an exercise test. Thus, exercise is not a suitable way of inducing manifest hypertension in juvenile hypertensives with a normal pressure at the time of testing. Juvenile hypertensives have a relatively elevated peripheral resistance at rest. Peripheral resistance during exercise at cardiac output values more than 15 l/min normalizes. Since high flow rates have been observed to induce maximum vasodilatation in juvenile hypertension, we can assume that their peripheral vascular bed has as yet not developed anatomical structural changes. [ABSTRACT FROM PUBLISHER]

Objectives: To study the association of systemic and local interleukin-35 (IL-35) levels in rheumatoid arthritis., Methods: 37 patients with treatment naïve early RA, 49 with established RA and 29 control patients with osteoarthritis (OA) were studied. Serum and paired synovial fluid samples were analysed for IL-35. Disease activity of RA patients was assessed according to the 28-Joint Count Disease Activity Score (DAS28)., Results: The levels of serum IL-35 were significantly higher in patients with treatment naïve early RA compared to those with established disease and control OA subjects. In addition, serum levels of IL-35 significantly decreased 12 weeks after initiation of glucocorticoids and conventional synthetic disease modifying antirheumatic drugs in patients with treatment naïve early RA. Synovial fluid IL-35 levels were significantly higher in RA compared to OA patients, were significantly elevated compared to serum counterparts and correlated with synovial fluid leukocyte count (r=0.412; p<0.01), serum CRP levels (r=0.362; p<0.05) and DAS28 (r=0.430, p<0.01)., Conclusion: This is the first study showing elevated circulating levels of IL-35 in treatment naïve early RA, its significant decrease after treatment initiation and positive association between increased synovial fluid IL-35 and disease activity in patients with long-lasting RA.

Objectives: The purpose of this study was to evaluate the prevalence and prognostic importance of lower extremity arterial disease (LEAD) in patients with multivessel coronary artery disease., Background: The presence of clinically evident LEAD increases the risk of death in patients with known coronary artery disease. Because studies have lacked noninvasive measures of subclinical LEAD, the true prognostic importance of lower extremity atherosclerosis in this population has probably been underestimated., Methods: Ankle blood pressures were measured in 405 consecutive patients with angiographically documented multivessel coronary disease from seven Bypass Angioplasty Revascularization Investigation (BARI) sites and a parallel study site within 3 years of enrollment. Lower extremity arterial disease was defined as an ankle/arm systolic blood pressure ratio of 0.90 or less., Results: Among patients studied, 69 (17%) had LEAD. These patients were more likely to be current smokers, treated for diabetes, older and present with unstable angina compared with patients without LEAD. Among patients who underwent coronary arterial bypass grafting, major complications occurred in 2.8% of those without LEAD compared with 20.7% of those with LEAD (p = 0.002). Five-year mortality rates were similar for symptomatic LEAD (14%) and asymptomatic LEAD (14%). Patients without LEAD had a 3% mortality. After adjusting for baseline differences, the relative risk of death was 4.9 times greater for patients with LEAD compared with those without (95% confidence interval [CI]: 1.8, 13.4, p < 0.01)., Conclusions: Patients with LEAD have a significantly higher risk of death than patients without LEAD, regardless of the presence of symptoms. An abnormal ankle/arm index is a strong predictor of mortality and can be used to further stratify risk among patients with multivessel coronary artery disease.

In the general population, peripheral atherosclerosis is a strong predictor of cardiovascular disease and death. In patients with known coronary artery disease, it is unclear whether the presence of additional noncoronary atherosclerosis is of further prognostic value. In the Bypass Angioplasty Revascularization Investigation, 5-year outcome was compared between patients with and without clinically evident noncoronary atherosclerosis. Within the subgroup with noncoronary atherosclerosis, surgery, and angioplasty treatment strategies were compared. Noncoronary atherosclerosis was defined as claudication, peripheral vascular surgery, abdominal aortic aneurysm, history of cerebral ischemia, or carotid disease. Among 1,816 patients, 303 (17%) had noncoronary atherosclerosis. These patients were more likely to have a history of congestive heart failure, diabetes, and hypertension, and were more likely to smoke. Coronary angiographic variables were similar between the 2 groups. Five-year survival was 75.8% for patients with noncoronary atherosclerosis and 90.2% for those without (p < 0.001). The adjusted relative risk of death was 1.7 for any noncoronary atherosclerosis, 1.5 for lower extremity disease alone, 1.7 for cerebral disease alone, and 2.3 for both conditions. Among the 303 patients with noncoronary atherosclerosis, the adjusted relative risk of death for surgery versus angioplasty was 0.87 (p = 0.40). However, the study has limited power to detect a treatment effect in this small subgroup. Thus, patients with combined coronary and clinically evident noncoronary atherosclerosis are a high-risk group with significantly worse long-term outcome compared patients with isolated coronary disease.

In twenty-eight patients with juvenile hypertension haemodynamic examinations were made at rest and during exercise (600 kpm/min). The cardiac output was determined by the Fick method; venous blood was sampled from a floating catheter introduced into the pulmonary artery; the systemic pressure was measured directly in the brachial artery. In 57% of the juvenile hypertensives the resting cardiac index was higher than 4.5 l/min/m2. The increase was due to an increase in the stroke volume rather than in the heart rate. Of the patients 37.5% had increased cardiac output relatively to the oxygen uptake also during exercise; most of them were hyperkinetic already at rest. The resting systemic resistance was significantly elevated in patients whose resting systolic pressure was greater than 150 mmHg and/or diastolic pressure was greater than 90 mmHg, compared to controls; during exercise the values of systemic resistance lay within normal limits. The systemic pressure responded to the exercise by either a hypertonic or a normotonic reaction. In only 23% of subjects normotensive at rest a hypertonic response to exercise was found.

Twelve patients with ischemic heart disease were investigated by right and left heart catheterisation. All patients were studied at rest and during exercise, both before and after administration of beta-blocker propranolol, Inderal (ICI). Left ventricular function decreased after administration of propranolol, but these changes were significant only during exercise. Contractility was depressed after administration of propranolol already at rest. On the other hand, left ventricular filling pressure decreased after administration of propranolol. Our results show the poor reliability of the evaluation of the left ventricular function based solely on the left ventricular filling pressure.

To ascertain the effect of elevated blood pressure in adolescence and its 28-year persistence on the arterial haemodynamics in the legs, calf blood flow during dilatation was determined plethysmographically in 52 middle-aged subjects. Blood pressure was measured by auscultation on the arm at rest and during peak hyperaemia. Local vascular resistance during dilatation was calculated from the men blood pressure and maximal flow and was expressed in resistance units. The subjects were divided into 3 groups according to the magnitude of blood pressure (hypertension, borderline hypertension and normotension). Controls comprised 36 normotensive subjects of the same age. The results showed identical values of calf resistance at maximal dilatation in all three groups (hypertension: 2.65 +/- 0.86, borderline hypertension: 2.76 +/- 0.73, normotension: 2.43 +/- 0.33), which did not differ from the control value (2.41 +/- 0.50). The individual values of resistance during dilatation exceeded the upper limit of normality only in 7 of all investigated subjects. It is therefore supposed that in addition to elevated blood pressure other factors inducing the development of structural auto-regulation in the skeletal muscle vascular bed of the lower extremities must be involved.

In 28 juvenile hypertensives (mean age 24 years) central haemodynamics was investigated at rest and during exercise. Hypertensives had significantly higher diastolic pulmonary artery pressure at rest than controls. Pulmonary diastolic pressure increased in parallel with cardiac output during exercise in hypertensives, in controls there was no relationship of pulmonary wedge pressure to cardiac output. Patients with diastolic pulmonary artery pressure higher than 12 mmHg at rest, or higher than controls during exercise, showed also signs of left ventricular hypertrophy on the ECG and/or X-ray. Those who were hyperkinetic and had systemic blood pressure greater than or equal to 150/90 at rest, had also significantly higher mean pulmonary artery pressure at rest. A correlation between total pulmonary, as well as pulmonary vascular and systemic resistances has been found at rest and during exercise in hypertensives; in controls, there was a correlation between the total pulmonary, as well as pulmonary vascular, and systemic resistances at rest; during exercise there was a correlation between total pulmonary, as well as postcapillary pulmonary and systemic resistances.

The haemodynamic effects of four weeks of daily intensive training on bicycle ergometer were studied in 10 men with essential hypertension of grade II (WHO). Three weeks before training all medication was replaced by placebo. Five days before onset of training all patients underwent a haemodynamic examination using floating catheter and direct brachial arterial pressure at rest and during effort. The same examination was repeated within five days after the completion of the training. Resting measurements did not demonstrate any effect of the training on systemic pressure or central haemodynamics. At the given load, however, a significant decrease for the pressor response occurred, i.e. lowering of systolic, mean and diastolic arterial pressure. Peripheral vascular resistance was not affected. Cardiac output (Fick) decreased insignificantly both at rest and during effort after training. Heart rate decreased significantly only during exercise. The training lowered significantly both tension time index and left ventricular stroke work index. No adverse clinical or haemodynamic effects of short intensive training were detected in hypertensive patients. There was no evidence of changes in pulmonary artery diastolic pressure considered as an indicator of the left ventricular filling pressure. The heart volume remained unchanged after training.

The transcapillary escape rate of albumin was studied in 24 juvenile hypertensives and in 13 controls on the basis of the radioactivities determined in the blood during 60 min after i.v. injection of human 131I-labelled albumin. In addition, the central haemodynamics of all hypertensive subjects was examined at rest and during exercise. The patients were grouped according to their pressure during the investigation at rest. The group whose mean arterial pressure did not exceed 100 mmHg, thus being within the range of normotension, did not exhibit a significant deviation from controls. The group with mean arterial pressure exceeding this limit (corresponding to the range of borderline hypertension) showed a significantly higher escape rate of albumin (9.3 +/- 5.0%/h) than controls (5.2 +/- 1.6%/h). The albumin escape rate was significantly correlated to the mean pulmonary artery pressure during exercise but not to the remaining central haemodynamic parameters at rest or during exercise. No difference was seen in the magnitude of plasma volumes of juvenile hypertensives and controls. The findings suggest that secondary changes of capillary functions are present already in the early stages of hypertension.

A group of 36 juvenile hypertensive patients underwent echocardiographic and electrocardiographic examinations. In 15 of them echocardiography detected increased left ventricular posterior wall and/or septal thickness in the diastole. Asymmetric septal hypertrophy with a septum posterior wall ratio greater than 1.3 was established in 7 cases (19%). The ECG abnormalities included signs of left atrial abnormality and voltage criteria after Sokolow-Lyon and McPhie. The sensitivity of electrocardiography in detecting left ventricular hypertrophy determined by echocardiography was 15% after Sokolow-Lyon, 15% after McPhie ad 31% using all the criteria combined. The specificity of ECG was 100, 87 and 87%, respectively. The ECG is less sensitive in left ventricular hypertrophy in younger individuals than in the adult population. This seems to be due to a lower degree of hypertrophy in the early stages of essential hypertension. No significant correlation of echocardiographically determined left ventricular mass with precordial ECG voltage was found.

Using the method of equilibrium radionuclide ventriculography (RNV), the right ventricular ejection fraction (RVEF) at rest and at a standard workload of 250 kpm per min was determined in 25 control subjects and in 30 patients with pulmonary hypertension (8 patients with chronic obstructive bronchopulmonary disease, 12 with recurrent pulmonary embolism and 10 with pure mitral stenosis). In the same week as RNV, pulmonary artery pressure was registered in patients with pulmonary hypertension at rest and at standard workload. RVEF was significantly higher (45 +/- 5%) in normal subjects than in patients with pulmonary hypertension (33 +/- 5%) and during exercise increased, whereas in patients with pulmonary hypertension it did not markedly change or decreased. The RVEF correlated at rest (r = -0.6293, p less than 0.001) and during exercise (r = 0.6980, p less than 0.05) with the degree of pulmonary hypertension at rest and during exercise. The results show a good correlation between the RVEF and the degree of pulmonary hypertension in patients with pulmonary hypertension at rest and during exercise.

Central and systemic haemodynamics were investigated in 53 juvenile hypertensives (JH) and in 43 older hypertensives aged over 30 (OH). The cardiac index at rest was significantly higher in JH, stage I and II according to the WHO, than in OH, stage I and II. Hyperkinetic circulation was present in systolic as well as in systolic-diastolic hypertension. Peripheral vascular resistance was at rest in JH relatively elevated (in relation to the given cardiac output) and normalized during heavy muscular work. In OH, peripheral vascular resistance was elevated at rest, but did not normalize during exercise. Mean and end-diastolic pulmonary artery pressure are at rest and during exercise higher in OH, regardless of the stage of hypertension, while in JH they are normal. Mean and diastolic pulmonary artery pressure correlate with systolic pressure in systemic circulation at rest and during exercise both in JH and in OH. In OH, left heart filling pressure is during exercise higher in patients with signs of ischaemic heart disease.

The resting and the maximal calf blood flows at reactive hyperaemia and blood pressure were determined in a group of young persons with borderline and juvenile hypertension (stage I) and in older patients with essential (stage I and II according to WHO) and vasorenal hypertension. The findings were compared with those found in healthy controls of the same age span. The resting blood flow was the same in borderline hypertension and in HPT stage I in young persons as in the control group; in older hypertensives it was significantly lower. The maximal blood flow at reactive hyperaemia was significantly higher in the group of borderline HPT, did not differ in HPT stage I in young subjects, and was significantly lower in older subjects in all stages of HPT. A significantly higher vascular resistance was found in all groups of hypertensives except the borderline HPT both at rest and at reactive hyperaemia. The results suggest that in persons with borderline HPT only functional autoregulation takes place, whereas in HPT stage I and II and in vasorenal HPT the high vascular resistance is already an expression of structural adaption of the vascular wall in the form of its hypertrophy.

Out of a group of persons who had had mild hypertension (170/100 mmHg) at the age of 14--29 in the years 1952--1954, 72% were re-examined after 20 years. A surprisingly large part of them (36.3%) had a normal blood pressure even without any treatment during last 15 years. In 43.4%, the hypertension is now stabilized, and in 20.3% a progression of hypertension was found. The prognosis of a mild juvenile hypertension is significantly related to the family history of hypertension, the longevity of parents, and to the initial level of blood pressure.

Sixty patients with silicosis were examined by right heart catheterization and lung function tests during 1958-1966. In the 12-20 years follow-up the information was received of 57 patients (95%). 38 patients died (66.6%), 26 of them of the sequelae of silicosis. The death rate and the length of survival are related to mean pulmonary artery pressure, pressure gradient across pulmonary vascular bed, pulmonary vascular bed, pulmonary vascular resistance (PVR), arterial oxygen saturation (SaO2), vital capacity (VC) and forced expiratory volume (FEV). 12-year mortality in patients with pulmonary hypertension at rest was 81.3%, in contrast to 40.2% in the other patients. No patient with PVR higher than 2.55 u. survived. No patients with SaO2 lower than 89% survived 10 years. Patients with VC higher than 4000 ml at the initial examination are still living. By the method of discriminating analysis 2 main factors determining the prognosis were identified: pulmonary artery pressure and FEV 1".

In 1952-1954, 96 out 256 students aged 14-29 years and registered for juvenile hypertension, had systolic BP of 170/100 mmHg or higher. Of this original group, 73% and 74% could be reexamined after 20 and 28 years, resp. After 20 years, a spontaneous regression of hypertension (HPT) without any therapy occurred in 35.5%. In the remaining patients HPT or borderline HPT was still present, but only 17.1% showed evidence of progression, i.e. development of new organic changes. The examination performed after 28 years showed the same distribution of BP as 8 years ago, and no significant progression of HPT. The prognosis of juvenile HPT was significantly related to the initial values of BP and body mass recorded in 1952-1954, to the family history of hypertension and to familial life expectancy. Juvenile HPT has not a poor prognosis and need not continue into middle or higher age.

The left ventricle (LV) was catheterized without X-ray control by a thin teflon catheter introduced through the right brachial artery. Shaping of the catheter allowed entering LV in more than 95% of patients and its safe placements in LV cavity without causing ectopic beats or other complications. Pressures in the pulmonary circulation (PAP, PAPd, PCW) do not reflect left ventricular filling pressure (LVEDP) precisely, particularly when the LVEDP is elevated. The assessment of pathological LV filling pressure from the pulmonary arterial pressures shows, that there was high percentage of false negative results at rest, but during exercise the abnormal values of LVEDP could be predicted from the pulmonary artery pressures. However, PCW or PAPd cannot be considered as identical with LVEDP. For the rough assessment of apparent left ventricular failure it is sufficient to measure pressures in the pulmonary artery. However, for the exact study, the LV should be catheterized. The described bed-side method fulfill all requirements: it is simple, convenient and safe; the pressure is recorded accurately; the procedure can be repeated and is therefore recommended for wider use.

A longitudinal study of juvenile hypertension made possible to investigate after 20 years 73% of a group of young hypertensives (original age 14--29 years, arterial blood pressure 170/100 and higher 20 years ago), which was originally investigated in 1952--1954. The surprising result was that 35.5% had a normal blood pressure without treatment in the interval, 40.2% showed the same level of hypertension, 5.7% showed higher blood pressure levels but without any new organic changes, 1.5% had the same blood pressure as 20 years earlier, but now required drug therapy as opposed to previously. Only 17.1% of the patients showed any convincing evidence of progression of the disease, i.e. the development of new organic changes. The prognosis of moderate hypertension at a young age is significantly correlated with: a) the occurence of hypertension in the parent; b) the life expectancy of the parents; and c) the initial values of blood pressure. There was no correlation between prognosis and over-weight, weight gain in the past 20 years, original or present heart rate, smoking, alcohol intake or physical activity, participation in sports or the living standard of the given individual.

A 38-year-old female patient had bilateral silicone-made prosthesis implantation performed 17 years ago. Three years after surgery, she had a series of spontaneous miscarriages, later she developed recurrent venous and arterial thromboses. Laboratory tests detected antibodies against cardiolipin and the diagnosis of cardiolipin syndrome was established. The authors discuss the possible association between surgery and the patient's current disease.