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The expert opinion on chronic arterial hypertension contains several problems, such as influence on choice of the profession and change of the profession, judgement of the traffic ability, judgment of the ability for military service, judgment of connective questions and judgment of capability of earning a living. Of particular importance is the expert opinion the following criteria shall be submitted to a complex valuation: etiology and degree of severity, therapeutic influencibility, physical efficiency, use of rehabilitation measures, side-effects of medicaments, prognosis of hypertension, taking into consideration the natural course and the complications after sufficiently long time fo observation and under optimum use of therapeutic and rehabilitative measures.

For the purpose of the valuation of a questionnaire developed by us for the anamnestic recognition of angiocardiopathies, which consists of 63 questions, a repeated interrogation was performed with 220 patients of different age and sex during 14 days. The average reproducibility of the yes/no-decisions was good and varied only slightly in the 8 groups of diseases (86.3--99.4%). The average degree of reproducibility referred to the sexes is nearly the same (94.7% and 95.5%, respectively). Referred to the age groups the highest reproducibility was established in the patients older than 60 years (95.7%) and the lowest in patients between 50 and 60 years (93.3%).

In general the anamnesis meets all requirements which are put to a screening method; however, special problems arise when the anamnesis is made by means of a questionnaire. The team which gives the report had projected a questionnaire for 8 cardiovascular groups of diagnosis (ischaemic heart disease, hypertension, functional, inflammatory and pulmonary heart disease, disturbances of the peripheral arterial blood supply, cerebrovascular insufficiency and venous diseases). This questionnaire was reduced and qualified and tested on test persons of a Berlin enterprise. A final judgment concerning the use of the anamnesis as screening method cannot be given at present. However, it limns oneself already that it is possible with its help to establish many endangered persons and patients and to subject them to the primary and secondary prevention.

The projecting of an anamnestic questionnaire concerning angiocardiopathies for purposes of screening for the 8 most important groups of angiocardiopathies was performed in two simultaneous stages--model experiments and population experiment. In the model stage, which is the topic of this paper, apart from investigations of reproducibility and controls of voluntary falsifications of answers above all an examination concerning the significance of the data was carried out. The methods used for this--analysis of the complaints of typical groups of patients (analysis of discriminancy) and analysis of experiences of recognized experts of angiocardiopathies (scale graduation of symptoms)--were discussed and first results described.

The acute effects of 1.6 mg glycerol trinitrate (2 x 0.8 mg) on the hemodynamic function were compared in 11 healthy subjects and 25 hypertensive patients (WHO stages I and II), at rest and during exercise. The nitrate testing was performed before the beginning of antihypertensive treatment, during nonmedical therapy, as well as under additional oral therapy with diisopropylamin. Right-heart-catheterization, echocardiography, radionuclide-ventriculography and venous occlusion plethysmography were performed. Nitroglycerin consistently led to a reduction of blood pressure in the systemic and pulmonary circulation both at rest and during exercise. There was a small decrease of peripheral arterial resistance (TPR) at rest and a more pronounced decrease of pulmonary arteriolar resistance (PAR) at rest and during exercise. The documented effects may be important with regard to combined antihypertensive treatment. In addition, the application of nitrates in hypertensive crises may be useful.

This review focuses on the following aspects of nonpharmacological management concerning elevation of blood pressure: historical development, highlights and theses, possibilities of intervention, as well as favorable observations, advantages (in early diagnosis), disadvantages, fields of application, and integration of this form of treatment into a comprehensive strategy of hypertension control at a population level. A selection of detailed results is elaborated including: possible failure in primary classification of elevated blood pressure and its consequences, the reducibility of the hypertension problem if nonpharmacological measures are generally used, risk factor prevalences in medical and non-medical university cadres, blood pressure reduction in a spa, and hemodynamic changes induced by nonpharmacological or combined antihypertensive treatment simultaneously with drugs. Finally, reference is made to international results, as well as to the importance of the relation between diagnosing and treating blood pressure elevation concomitantly with a simultaneous management of other main risk factors that must be influenced in order to reduce the cardiac risk in hypertensives.

After indications to the great epidemiologic importance of hypertensive heart disease and its relationship with the ischaemic heart disease several results are reported collected during the past 10 years by examinations of more than 500 patients for early diagnosis of cardiac insufficiency in hypertension. The methods of microcatheterization of the pulmonary artery and radiography have been used (even under ergometrical exercise) as well as the calibrated apex cardiography and the echocardiography. For the practising physician a classification of hypertensive heart disease with 4 phases or forms is proposed. The paper ends with a demonstration of the close relationship between prevention and treatment of hypertension as well as between hypertensive and ischaemic heart disease at the same time in a sense of the integrative role of heart insufficiency.

In the development of ischemic heart disease (IHD) in women, there are a variety of factors which, possibly, may exert an influence. The recognition of such factors must be considered prerequisite to a preventive approach to the disease. Possible relationships between socio-economic conditions, in particular education level and occupation as well as marital status and number of children, with manifestations of IHD or presence of risk factors have been studied. Recently, results have been published from the Cottbus Prevention Study/GDR (CGPPS), the World Health Organization Project Eberbach-Wiesloch/FRG and US-American analyses (NHANES II). On evaluation of available data and assessment of the coronary risk profile in women, it should be taken into consideration that comparison is encumbered by the facts that the studies did not employ uniform definitions of socio-economic classification, risk factors and IHD and that they were subject to differing historical developments. Similar to that observed in men, arterial hypertension and overweight was seen significantly more frequently in women factory workers and rural women than in their more sophisticated counterparts. As in other studies, the prevalence of hypercholesterolemia in women did not differ among the socio-economic stratifications. The number of smokers was significantly higher in those at the upper levels of education than in women factory workers and rural women or office workers and housewives. There was an inverse relationship between the level of education and mean arterial blood pressure. There was no relationship, however, between income and cholesterol levels. In women working at the lower levels of employment, there was a higher incidence of IHD.(ABSTRACT TRUNCATED AT 250 WORDS)

Exercise investigations were performed in 39 male hypertensives (WHO stage I-III) to assess haemodynamics and cardiac function after intravenous application of 5 mg propranolol for the detection of latent heart failure. Radiocardiography was used to determine volumetric parameters such as LV end-diastolic volume and ejection fraction, and microcatheterization was employed to obtain the LV filling pressure via pressure measurement in the pulmonary artery (PA). The negative inotropic and chronotropic effects of propranolol on pump function and myocardial mechanics at rest were found to be minimal. During 50 watt exercise however, an increase of the diastolic PA pressure has been observed simultaneously with a diminution of cardiac output (stroke volume being constant). Thus, under acutely administered beta blockade, a general disturbance in the flow-pressure relation could be induced, being comparable to heart failure. Only in a few cases was the reduced contractility compensated by the Frank-Starling mechanism, but only if the mechanism did not participate in the regulation of pump function during the previous control investigation. In other cases a remarkable reduction of cardiac output and even stroke volume occurred, results which may be explained as a consequence of a reduced venous return (or pooling) connected with acutely induced vascular effects (beta-2 blockade).

Apexcardiographic examinations were carried out of 86 hypertensive patients without clinically manifest heart failure. The amplitude of the wave a (or the per cent fraction of the wave a of the total amplitude) and the maximal rate of wave rise, df/dta were statistically significantly higher in the hypertensive patients than in normal subjects. The findings are interpreted as a manifestation of an increased left ventricular rigidity and of an increased atrial contractility in hypertensive patients. No correlation was found between the apexcardiographic indicators checked and the indicators of the cardiac pump function. In 46 hypertensive patients, in addition, a dynamic exercise test was performed (50 W for 6 min); 1 minute after cessation of exercise an apexcardiogram was recorded. An increase in the a/T quotient (greater than or equal to 5%) was found in 20; a decrease (=5%), in 10; and no change (less than +/- 5%), in 16 hypertensive patients. The postexercise apexcardiographic changes had no correlations with haemodynamic changes occurring during exercise.

As a noninvasive method of examination, conventional computer tomography (CT) has assumed an important role in assessment of pathologic anatomy of the heart. In contrast, previously, CT has not been applied for routine investigations of myocardial perfusion. In this study, a new method is described which, with intravenous injection of contrast medium, enables delineation of perfusion differences in the myocardium. Studies were performed in ten healthy male subjects and 71 patients with angiographically-documented coronary artery disease with a Somatom SF (Siemens) with a scanning time of five seconds. Prior to contrast injection, a native scan was obtained in the short axis view of the left ventricle as well as in apical and central view. After injection of 30 ml of contrast medium through a 7F ring catheter positioned in the inferior vena cava, imaging was again performed and then repeated subsequent to administration of 0.5 mg/kg dipyridamole. Quantitative evaluation of the CT images was carried out through circumferential analysis of the apical and central segments. The circumference was divided into 60 segments of six degrees each and for each segment ten density measurements were performed to obtain average values subendocardially, intramurally and subepicardially. After correction for the density value of the ascending aorta in healthy subjects, the density profile was constructed. The density profile of the healthy subjects was designated as the mean value curve. The circumferential profile of patients with coronary artery disease was tested against the mean value curve from which two indexes for description of perfusion disturbances were defined.(ABSTRACT TRUNCATED AT 250 WORDS)

To investigate still uncertain aspects of the diagnosis of ischemic heart disease (IHD) in women, between 1969 and 1984, repeated exercise studies were performed in 706 asymptomatic women (between the ages of 17 and 63 years). On observation of pathologic ST-segment depression of more than 0.1 mV, the exercise study was repeated after administration of 0.8 mg nitroglycerin. Pathologic ST-segment depression was seen in 310 women (44%). In 217 patients (31%), nitroglycerin had no effect (NTG negative); in 93 women (13%), there was normalization of the ST-segment changes (NTG positive). Additionally, in selected subgroups of patients, pulmonary artery pressure was measured at rest and during exercise and ECG mapping performed (n = 114); radionuclide ventriculograms (n = 64) and 201-thallium scintigrams (n = 99) were obtained and coronary angiography (n = 85) was performed. In the NTG-negative women, ejection fraction, myocardial perfusion and coronary arteries were normal. NTG-positive women had lower mean ejection fractions but still within normal limits and indications of impaired myocardial perfusion. High-grade coronary stenoses were found in 25%. No patient with pathologic ST-segment depression had mitral valve prolapse. NTG-positive women had significantly more risk factors than NTG-negative women. In the former group, pulmonary artery pressure measurements showed pathologic exercise hemodynamics, only in 25% of whom IHD with significant stenosis was found to be the cause. For this condition, differential diagnostic considerations include cardiomyopathy or small vessel disease.

Peripheral perfusion abnormalities are considered a possible reason for myocardial ischemia in the absence of visible coronary artery stenoses. In 85 women (age: 41-58 years, mean age: 46 +/- 8) with pathological exercise ECG (precordial mapping: 50 leads), hemodynamic studies were performed without medication, after sublingual nitroglycerin (NTG, 0.8 mg), sublingual Nifedipin (N, 30 mg), and intravenous Dipyridamol (D, 0.5 mg/kg). Eighteen women showed normal coronary arteries and a normal myocardial perfusion (group I), 21 an impaired perfusion due to coronary stenoses (Group II), and 46 women a reduced perfusion without visible changes (Group III). Reference methods were measurement of pulmonary artery pressure, 201-TI-scintigraphy, and coronary angiography. In group II, enddiastolic and endsystolic left ventricular volume (EDV, ESV) as well as enddiastolic pulmonary artery pressure (pAd) were increased, the ejection fraction (EF) was reduced, and cardiac output (CO) was normal. In group III, ESV, EDV, EF, and CO were significantly reduced, while pAd increased. In group II, N led to a normalization of ESV, EDV, EF, and pAd. In group III, NTG led to a reduction of pAd and EDV, and concomitantly to a further reduction of the already low CO. In both groups the reduction of ST-segment depressions after NTG was significant. N led to a moderate reduction of pAd and ST-segment depression, but to an increase of CO in both groups. D exhibited a comparable effect in group III. In group II an increase of ST-segment changes and of pAd with unchanged CO was observed. With regard to longterm treatment of women in group III, N and D seemed to be more efficacious than nitrates due to a beneficial effect on cardiac output.

Recently in patients with hypertension in one third of the cases by haemodynamic investigations in rest a latent heart insufficiency could be proved. It was the aim of the at present performed examinations to test, whether or in which degree the proportion of latent heart insufficiency increases in patients with hypertension affected. In 30 patients with essential hypertension a complex haemodynamic examination program consisting of catheterisation of the right heart, radiocardiography and ergometry was carried out. It could be demonstrated that complex examinations of such a kind are possible also under physical stress and may be used in the judgment of the cardiac function in patients with hypertension.