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Background/aim: World Health Organization (WHO) studies on the global level have shown that one of the major problems of the public health is hypertension. Blood pressure level greater than 140/90 mmHg is directly and predictively linked to other cardiovascular diseases. The aim of this research was to determine the prevalence of hypertension and the risk groups among the adult population in the Sumadija District, Serbia., Methods: This cross-sectional study included 1.669 elderly population of the Sumadija District, aged 25-74. The study was performed according to the protocol of the Countrywide Integrated Noncommunicable Disease Intervention (CINDI) international program., Results: In the Sumadija District more than a half of the population aged 25-74 suffers from hypertension (53%). In the Sumadija District 9% of population has undiagnosed hypertension. In the group of people familiar with their high blood pressure problems, good disease control is achieved in only 46% of them. Statistically, hypertension occurs more frequently in males aged 45-74, of lower education, and in rural population. This is the target group for implementation of the high risk strategy. Statistically, there is a higher prevalence of hypertension in people suffering from myocardial infarction (p =0.04), angina pectoris (p = 0.00), other cardiac diseases (cardiac insufficiency) (p = 0.00) and cerebrovascular crises (p = 0.04)., Conclusion: A continuous increase of patients with hypertension, coupled with the developed complications and increase in cardiovascular diseases as a cause of death, points to the lack of effective access to prevention and early detection of these diseases in the primary health care among the risk groups in Sumadija.

The frequency of hyperuricemia in 253 patients with essential hypertension (EH) was studied. The level of uric acid in serum and frequency of hyperuricemia were determined in patients divided according to sex and renin plasma activity (RPA). High values of uric acid in serum were found in a total of 69 patients (27.3%), of which there were 40 males (30.1%) and 29 females (24.2%). The highest values of uric acid were found in those with high RPA, but the difference was significant only in males (p < 0.05). No correlation was observed between the values of the uric acid in serum and RPA in none of the renin subgroups. On the basis of our study, it was not possible to explain the high values of uric acid in serum in patients with EH, especially in those with high plasma renin activity, as well as the role of renin-angiotensin-aldosterone system in the pathogenesis of hyperuricemia.

The antihypertensive efficacy and safety of lisinopril (L), a novel ACE inhibitor, were compared to those of captopril (C), the familiar drug of the same class, in a multicentre controlled trial. The study included 91 mild-to-moderate, middle-aged hypertensives of both genders, 46 of which were randomized to C and 45 to L. After a two-week placebo period the examinees were receiving either L o.d. in increasing dosage of 10, 20, or 40 mg per day (amount necessary to achieve normotension), or C b.i.d. in a corresponding daily dose of 25, 50, or 100 mg. During the eight-week formal part of the trial, L decreased the systolic blood pressure from the initial values by an average of 14.9%, and the diastolic pressure by some 15.2%. The same parameters were lowered on C by 11.2%, and 11.7%, respectively. The mean arterial pressure from an initial average of 125.5 mmHg was lowered to 110.9 mmHg on C (11.6% reduction, p < 0.01), and from 125.3 mmHg to 108.2 mmHg on L (13.6% reduction, p < 0.01). Although the L effects were more pronounced, the observed between-group differences did not reach the level of statistical significance, except for the achievement of normotension, which disclosed the superiority of L (p < 0.05). The tolerability of both drugs was good and only one examinee had to be excluded because of side-effects (proteinuria). It is concluded that both ACEIs under study showed comparable efficacy and safety, L being marginally more potent and longer acting.

The antihypertensive efficacy and safety of lisinopril (L), a novel ACE inhibitor, was compared to captopril (C), the known and already approved drug in our country in a multicenter double-blind Yugoslav trial. The study included 91 mild-to-moderate hypertensive patients of both sexes. Forty-six patients were randomized to receive captopril and 45 lisinopril. After a 2 week placebo, the examinees were administered either L in increasing dose of 10, 20, or 40 mg per day (amount necessary to achieve normotension), or C in a dosage of 25, 50, or 100 mg per day. During the 8 week formal trial L decreased the systolic blood pressure by an average of 14.9% from the initial values, and the diastolic pressure by some 15.2%. The same parameters were lowered on C by 11.2%, and 11.7%, respectively. Although the L effects were more pronounced, the observed differences did not reach the level of statistical significance (except for the dose-to-normotension relationship which was significantly better in the L group). It is concluded that both ACEIs under study showed comparable efficacy and tolerability, L being marginally more potent, and longer acting.

The data on plasma renin activity (PRA) obtained by catheterization of renal veins in 272 patients with essential arterial hypertension (EH) are reported. In order to exclude a secondary nature of hypertension, all patients were hospitalized and submitted to the extensive clinical and laboratory examinations (according to the protocol) including renal angiography. The aim of the work was to get evidence whether in the apparently homogeneous group of patients with EH there are differences in renin activity between the renal veins giving the quotient (Q) higher than 1.5, and possibly to recognize the clinical meaning of the differences of Q found. In the examined patients as a whole regardless of PRA, 50 of them (18.3%) showed Q greater than or equal to 1.5 and among them in 16 (5.8%) patients Q greater than or equal to 2 was found. The patients were divided according to PRA into those with low, normal and high PRA. In the hyperreninemic group of patients no Q greater than or equal to 2.0 has been found. In the hyporeninemic group 9 patients (9.9%) exhibited Q greater than or equal to 2.0. Although, one does not expect in EH to find differences in PRA between left and right renal vein, we have found the values of Q greater than or equal to 1.5 in nearly 1/5 of our patients. These differences found could be resulting from the existence of asymmetrical angiosclerotic or other renal pathological changes that can not be examined by the available clinical methods.(ABSTRACT TRUNCATED AT 250 WORDS)

A collective, multicentre (Ljubljana, Split, Zagreb) comparison of the antihypertensive effects between two angiotensin converting enzyme inhibitors (ACEI) captopril and enalapril was made in 69 hypertensives of both sexes, having a diastolic blood pressure (DBP), following two weeks on a placebo, of between 110 and 130 mm Hg (14.7 and 17.3 kPa). There were 35 patients on enalapril (20-40 mg), and 34 on captopril (50-100 mg). Both drugs under study decreased significantly the mean DBP already after the first week of ACEI treatment (p less than 0.001). By the end of the trial (9th week) captopril had decreased the DBP in the supine position from the initial 180.3 +/- 15.3/117.7 +/- 6.4 mm Hg to 151.6 +/- 11.1/96.8 +/- 7.2 mm Hg. Enalapril had lowered the DBP more efficiently: from 182.7 +/- 16.7/118.7 +/- 7.7 to 145.6 +/- 12.8/92.2 +/- 6.4 mm Hg (p less than 0.05). The average reduction in mean DBP was 16.9% on captopril, and 20.9% on enalapril. Low dose ACEI monotherapy (i.e. 50 mg and 20 mg) achieved DBP normalization in 11.8% on captopril and in 26.4% on enalapril (p less than 0.01). There were no significant heart rate changes. The laboratory results did not change appreciably and there were no relevant side-effects, although particular attention was paid to the expected adverse reactions, such as cough, ageusia or proteinuria. It is concluded that the ACEIs under study showed comparable effectiveness within the used dose range, enalapril being more potent, longer acting, and possibly safer.

Ninety-five hypertensive outpatients of both sexes, aged 23 to 65 years with diastolic blood pressures above 105 but below 120 mmHg (greater than 14.0 but less than 16.0 kPa), after one week on a placebo were randomly assigned either to nicardipine plus a placebo (40 mg/day - 48 patients) or nifedipine sustained-release plus a placebo (20 mg/day - 47 patients) for an additional six weeks. The study groups were homogeneous and comparable. After the run-in period the average blood pressure was 181 +/- 17/116 +/- 9 mmHg (24.1 +/- 2.3/15.5 +/- 1.2 kPa) in the nicardipine and 177 +/- 22/116 +/- 9 mmHg (23.6 +/- 2.9/15.5 +/- 1.2 kPa) in the nifedipine group (p greater than 0.10). In the acute oral test (nicardipine 40 mg to all the subjects; blood pressure measured at 30 min intervals during two hours) almost identical hypotensive effects within and between groups were observed (mean arterial pressure decrease of 11%, after 120 min; p less than 0.05). At the end of this trial blood pressure decreased further to 152 +/- 12/94 +/- 11 mgHg (20.3 +/- 1.6/12.5 +/- 1.5 kPa) (mean decrease of 20%; p less than 0.01) on nicardipine and to 145 +/- 12/94 +/- 11 mmHg (19.3 +/- 1.6/12.5 +/- 1.5 kPa) (mean decrease of 20%; p less than 0.01) on nifedipine. There were no significant changes in pulse rate. The observed between-group differences were trivial (p greater than 0.10). The laboratory data did not alter appreciably during this study. Three patients on nicardipine and four on nifedipine reported headache, palpitations and flushing: one patient on nicardipine and two on nifedipine were as a result excluded from the trial. It was concluded that nicardipine and nifedipine sustained-release were comparably effective and well-tolerated drugs suitable as the first-line agents for the management of mild to moderate hypertension.

Background/Aim. Interatrial conduction time is early marker of disturbed impulse propagation in adult with elevated blood pressure. The aim of our study was to evaluate significance of noninvasive echocardiographic marker of slow sinus impulse propagation (atrial conduction time) for the identification of persons with slightly elevated blood pressure and hypertension in adults. Methods. One hundred and forty nine adults with normal and elevated blood pressure were studied: 46 normotensive adults (group 1), 28 adults with elevated blood pressure and hypertension stage 1 (group 2) and 75 adults with hypertension stage 2 (group 3), based on the Joint National Committee 8 (JNC-8) hypertension guidelines. We studied P wave dispersion, reservoir function of the left atrium (LA), total emptying volume of the LA and total emptying fraction of the LA (LATEF). The atrial conduction time (ACT) was evaluated by the pulsed tissue Doppler, and expressed as interatrial and intraatrial conduction time. Results. The LATEF decreased progressively from the group 3 (64.8 ± 4.4%) to the group 2 (59.8 ± 5.2%) and the group 1 (55.6 ± 7.3%) (p < 0.001). The P wave dispersion (55.1 ± 9.8 ms vs. 46.8 ± 3.1 ms vs. 43.1 ± 2.6 ms; p < 0.01) and intra ACT were significantly prolonged only in the group 3 compared to the other groups (22.7 ± 11.0 ms vs. 8.4 ± 4.7ms vs. 5.6 ± 2.4 ms, respectively; p < 0.001). Inter ACT significantly increased from the group 1 to the group 2 and the group 3 (15.6 ± 3.9 ms vs. 24.6 ± 5.7 ms vs. 50.4 ± 20 ms, respectively; p < 0.05). Using a cut-off level of 19.5 ms, inter ACT could separate adults in the group 2 from the group 1 with a sensitivity of 85%, and specificity of 89% [area under receiver operating characteristic (ROC) curve 0.911]. Conclusion. Prolonged ACT estimated with the tissue Doppler may be useful for identification persons with slighty elevated blood pressure, and hypertension stage 1.