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To assess the cardiac characteristics and postoperative courses in patients with Cushing's syndrome, electrocardiography and echocardiography were performed to study 12 consecutive, unselected patients, and results were compared with those of essential hypertension and primary aldosteronism. Eleven patients had hypertension and 7 had diabetes mellitus. Before adrenalectomy, common electrocardiographic abnormalities consisted of high-voltage QRS complexes (10 patients) and negative T waves (7 patients). Echocardiograms showed left ventricular hypertrophy in 9 patients, and all the patients had evidence of asymmetric septal hypertrophy. In patients with left ventricular hypertrophy, the thickness of the interventricular septum ranged from 16 to 32 mm, whereas the ratio of the thickness of interventricular septum to that of the posterior wall ranged from 1.33 to 2.67. The interventricular septum in Cushing's syndrome was extremely thicker and asymmetric septal hypertrophy occurred more often than essential hypertension and primary aldosteronism. Nine patients could be followed up after operation. In these patients abnormal electrocardiographic findings had normalized, the thickness of interventricular septum had decreased and asymmetric septal hypertrophy had disappeared except in 1 patient. The reason why left ventricular hypertrophy in Cushing's syndrome is severe is still unknown. Because left ventricular hypertrophy is more severe and the frequency of asymmetric septal hypertrophy much greater in Cushing's syndrome than in essential and other secondary hypertension, it is thought that not only increased aortic pressure but excessive plasma cortisol may be etiologic factors in the progression of left ventricular hypertrophy in Cushing's syndrome.
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PMID:Cardiac characteristics and postoperative courses in Cushing's syndrome. 153 96

The risk for cardiovascular complications is already substantially increased in persons with borderline elevation of arterial pressure (141-159/90-94 mmHg and transiently below). It increases progressively with higher grades of hypertension. The main aim of treatment is thus a significant improvement in survival for the patient. Persons with raised blood pressure (BP) have often additional cardiovascular risk factors such as deranged carbohydrate metabolism, dyslipidemia, left ventricular hypertrophy, smoking and others. Treatment of hypertensive patients should thus not only normalize BP but should at the same time reduce associated risk factors or at least not increase them. Conventional antihypertensive treatment based on thiazides in high doses or beta-blocking agents led to marked reduction of strokes and heart failure, but did not satisfactorily reduce coronary heart disease or sudden cardiac death. It has been suspected that other cardiac risk factors are insufficiently influenced or eventually even deteriorated by conventional therapy, thus counteracting partly a beneficial effect of lowered BP. Beta-blockers however have at least a secondary preventive effect after myocardial infarction. Newer antihypertensive drugs such as ACE-inhibitors, calcium antagonists and alpha 1-blockers reduce left ventricular hypertrophy and are at least neutral with regard to metabolism of lipids and carbohydrates. The non-thiazide diuretic indapamide and the serotonin (S2-) blocker ketanserin likewise are neutral with regard to glucose and lipid metabolism. The efficacy of these new drugs regarding long term survival is as yet undetermined. Persisting borderline or established hypertension should as a rule always be approached with basic non-pharmacologic measures: loss of overweight, reduction of alcohol intake, exercise, avoidance of high salt foods, abstention from smoking and withdrawal of BP-raising drugs. If antihypertensive medication is indicated, potential first line drugs are ACE-inhibitors, calcium antagonists, beta-blockers, thiazides at low dose, indapamide, ketanserin, the alpha 1-blocker prazosin and others; initially as monotherapy, if needed in combinations of 2 or 3. Older patients or those will with additional disturbances such as diabetes, hypercholesterolemia, nephropathy, heart failure, ischemic heart disease, arrhythmias, claudication, asthma and others need problem-adjusted modifications of treatment.
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PMID:[Antihypertensive therapy in the nineties]. 153 54

As shown by large-scale clinical trials, the antihypertensive effectiveness of diuretics has been associated with a dramatic decrease in the incidence of stroke. This decrease, however, has not been accompanied by a similar reduction in atherosclerotic complications of hypertension, perhaps because other risk factors are important contributors to cardiovascular disease. In particular, a pathophysiologic relationship appears to exist between high blood pressure, left ventricular hypertrophy, diabetes and dyslipidemia. Thus, metabolically neutral antihypertensive agents such as calcium antagonists, which have no adverse effects on serum lipids and insulin sensitivity and can reduce left ventricular mass, are particularly suitable for the treatment of hypertension and attendant cardiovascular complications.
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PMID:Calcium antagonists for the treatment of systemic hypertension. 157 72

Fifty-four patients hospitalized in Niger for complications from hypertension between September 1988 and October 1989 were studied. The following complications were observed: left ventricular hypertrophy (56%), coronary vascular defect (35%), left heart deficiency (26%), cardiac failure (32%), retinopathy (56%), renal insufficiency (35%), and stroke (24%). The most frequent risk factor was Type A personality (76%), followed by stress (48%), excess weight (37%), tobacco use (35%), hyperuricemia (35%), hypercholesteremia (17%), and diabetes (15%). Complications from hypertension may well become a major problem for African countries as they develop.
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PMID:Hospitalizations in Niger (West Africa) for complications from arterial hypertension. 158 Oct 14

Diagnosis of hypertension is based on a classification of blood-pressure values, determined by multiple blood-pressure measurements over a period of several weeks or months. However, possibility of a so-called 'white coat effect' has to be considered, i.e. a marked increase of blood-pressure values in the presence of medical persons. Multiple control-measurements by the patient himself or an ambulatory day profile may clarify the situation in suspicious cases. In the case of pure 'white coat' hypertension, no further investigation is necessary, since cardiovascular complications only correlate with the 'usual' ambulatory blood pressure. Persons with borderline (141-159/91-94 mmHg and intermittently lower, according to the WHO) or established hypertension usually present with further cardiovascular risk factors, like lack of physical exercise, smoking, hypercholesterolemia (elevated total cholesterol/HDL-cholesterol), alone or accompanied by hypertriglyceridemia, disturbed tolerance of glucose or diabetes mellitus, or hypertrophy of the left ventricle. Therefore, in borderline as well as in established hypertension these additional risk factors have to be evaluated. Considering left ventricular hypertrophy electrocardiogram and chest X-ray are insensitive with regard to diagnosis and prognosis of this important and serious risk factor. Echocardiography that can meet both these criteria is for capacity reasons still limited to selected cases. In contrast to the investigation of the risk profile, only few patients will profit from an investigation of etiology of hypertension. It should be tailored to individual features and after thorough evaluation of all consequences, such as costs for the patient, chances for a positive result and possible therapeutical consequences. Usually, careful history taking, clinical investigation and routine laboratory provide an appropriate basis for further rational investigative procedures. Hypertension is a common and important risk factor. The challenge for the public health is great because prognosis can markedly be influenced by early diagnosis and therapy. Insufficient distinction between efficient diagnostic and therapeutical efforts and those that may be superfluous may not only influence psyche and somatic well-being of the patient but also socio-economic balance.
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PMID:[Rational assessment procedure in hypertension]. 160 89

In a retrospective study the frequency of hypokalemia was investigated in a large group of hospitalized patients. In a period of 1 year 33,426 patients were hospitalized, of these 1,177 (3.52%) revealed serum potassium level of less than or equal to 3.0 mmol/l. On admission to the hospital 592 (50.3%) showed serum potassium levels within normal range and developed their hypokalemia in the hospital. A severe hypokalemia equal or lower 2.5 mmol/l was observed only in 0.54% of the patients. Hypokalemia was frequently associated with cardiovascular, gastrointestinal and urogenital diseases following by diabetes mellitus and polytraumas. The main causes of hypokalemia were diuretics and gastrointestinal potassium loss. Severe hypokalemia (less than or equal to 2.5 mmol/l) is a predisposing factor for the occurrence of ectopic ventricular activity in patients with preexisting myocardial lesions like left ventricular hypertrophy or after myocardial infarction. Therefore in patients with preexisting myocardial lesions and severe hypokalemia potassium replacement therapy may be needed.
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PMID:[Hypokalemia--incidence and severity in a general hospital]. 160 81

Hypertension often is associated with concomitant conditions such as chronic obstructive lung disease, diabetes mellitus, ischemic heart disease, and peripheral vascular disease. Moreover, other cardiovascular risk factors, including dyslipidemias and abnormalities of glucose and insulin metabolism, are common in patients with hypertension. Conventional beta-blockers used for antihypertensive therapy can have adverse effects in patients with airway disease, diabetes, and peripheral vascular disease, and can exaggerate the other risk factors. Newer beta-blockers such as celiprolol, which have selective partial agonist activity expressed at beta 2-receptors, appear to avoid these problems. Celiprolol exhibits antianginal and antihypertensive efficacy without adversely effecting left ventricular systolic function or exercise performance. It also may cause regression of left ventricular hypertrophy. The stimulatory action of celiprolol on vascular beta 2-receptors enhances regional flow and may increase walking distance in patients with claudication. The reduction in renal vascular resistance demonstrated by this drug is associated with preservation of renal blood flow and function. Spirometric measurements of airway function are unchanged during celiprolol treatment. Similarly, there are no adverse effects on lipid or glucose concentrations. These new developments in beta-blocker pharmacology indicate that this class of agents could be used in patients with hypertension with concomitant diseases or risk factors other than high blood pressure.
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PMID:Hypertension with concomitant conditions: the changing role of beta-adrenoceptor blockade. 167 Nov 91

Because of limited clinical investigations addressing the effectiveness of intervention to reduce known risk factors, it is difficult for primary care physicians to decide on which coronary heart disease risk factors to continue to screen for among older patients. The recently published report of the United States Preventive Services Task Force, using explicit screening criteria, has recommended that several risk factors be investigated for use among older adults. Recent longitudinal studies have found that a number of risk factors persist with advancing age-hypertension, left ventricular hypertrophy, impaired glucose metabolism, elevated cholesterol levels, obesity, smoking, physical inactivity, decline in vital capacity, and increased heart rate. Screening to identify many of these risks and treatment and counseling to modify them appear to improve survival. Evidence is less clear that diabetes mellitus and elevated cholesterol levels have the same significance for men and women as they age. Left ventricular hypertrophy and diabetes seem particularly important as risk factors for older women, whereas a high heart rate may be a greater risk for men.
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PMID:Screening persons aged 65 and older for coronary heart disease risk factors. 173 97

In nondiabetic populations, there is an approximately 40% increase in stroke risk and a 25% increase in coronary heart disease (CHD) risk with every 6-mmHg increase above 75 mmHg in usual diastolic blood pressure. Diabetes increases the risk of both conditions by two- to threefold, and in diabetic patients, hypertension further increases these risks. The benefits of lowering blood pressure in nondiabetic subjects have been subjected to meta-analysis, which has demonstrated benefits equivalent to 100% reversal of the excess risk for stroke but with only approximately 50% of CHD risk reversible after 2-3 yr of treatment. In these analyses, the benefit of treating diastolic blood pressure is similar at all levels greater than 90 mmHg. If these results are extrapolated to diabetic patients, possible benefits of therapy for mild hypertension could be two to three times greater than in nondiabetic subjects, but this could still correspond to 300 person-yr of treatment to prevent one nonfatal stroke and 2500 person-yr of treatment to prevent one CHD death, with treatment that may deleteriously affect quality of life in 36% of all diabetic patients. There may also be risks in treating patients with mild hypertension who have existing CHD or left ventricular hypertrophy, which are more common in diabetes. Despite the theoretical risk of deleterious changes in several cardiovascular risk factors with thiazides or beta-blockers, most of the newer agents have not yet been demonstrated to produce similar benefits to the large prospective studies in which the aforementioned agents have been used.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes Care 1991 Nov
PMID:Factors influencing threshold and choice of treatment for hypertension in NIDDM. Cardiovascular factors. 174 54

The authors analyzed in 145 patients with Type 2, diabetes, persisting on average for 10 years, influences affecting the blood pressure reading. 1. In patients treated on account of hypertension (40%) the increase of systolic and diastolic pressure persisted and the fasting concentrations of C peptide were elevated. 2. In patients with elevated levels of diastolic blood pressure and C peptide the rate of cerebrovascular attacks in direct relatives was higher. 3. Higher blood pressure readings were associated with a higher C peptide concentration, signs of ischaemia on the ECG tracing and left ventricular hypertrophy respectively. 4. The higher blood pressure levels were associated also with other manifestations of insulin resistance, i.e. elevated triacylglycerols, low HDL cholesterol levels, raised uric acid levels. 5. Also in stepwise regression analysis the fasting concentration of C peptide held one of the important places among variables which contribute towards variations of systolic blood pressure. 6. These findings support the idea on common pathogenic influences of raised insulin concentrations on metabolism, blood pressure and the development of complications of atherosclerosis.
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PMID:[Blood pressure and insulin resistance in type 2 diabetics]. 177 7


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