This research reports level of blood pressure control and ability to maintain newly discovered hypertensives in a municipal hospital setting by use of family-and self-monitored home blood pressure units. Three hundred ninety-six patients were randomized into family-and self-monitored blood pressure groups and a control group. Findings indicate that the use of either self-or family-read cuffs is effective in the first six months of treatment in lowering blood pressures. The data are suggestive of a beneficial effect of the IntrodiuctionThe exponential growth in research on hypertension during the last decade results primarily from the recognition that standard medical regimens are effective in reducing the undesirable sequelae of uncontrolled hypertension. 1-3 Two of the major areas of research involve screening programs,4-9 and the problem of maintaining patients on antihypertensive therapy which is part of a broader area regarding the maintenance of behavioral change. [10][11][12] To facilitate compliance and its correlate, blood pressure control, a number of intervention strategies have been tested including locating a hypertension specialty clinic in the community,3 6'320 locating a hypertension treatment clinic in or near the work site, 8,21-23 establishing specialty clinics within university medical clinics,2425 providing intense follow-up for hypertension patients to assure appointment keeping,2627 providing various forms of social support and education,28-32 and providing patients with self-monitoring blood pressure cuffs.33-37 These interventions for improving the control of blood pressure have met with varying levels of success.There is effective in maintaining controlled BP for a time period greater than that required for an initial BP reduction.Three specific hypotheses were tested: I) the use of a home blood pressure cuff administered by a patient-selected significant other (usually a family member identified by the patient) will enhance BP reduction over either a self-administered blood pressure cuff group or a "standard treatment" group; 2) the use of a self-administered blood pressure cuff will enhance blood pressure reduction over a "standard treatment" group; and 3) fewer patients will drop out of treatment from the significant other administered group than from either the self-administered or "standard treatment" groups. MethodsPatients in this project lived in inner-city Indianapolis and were predominantly low income and Black. The study was conducted in the Medicine Clinic of a large, urban, university affilitated municipal hospital. The hospital serves a broad spectrum of the community and also has responsibility for the medical care of the county's indigent population.Patients entered into this study were either newly discovered hypertensive patients or previously treated patients who had been untreated for at least one year. Study patients were identified from screening and referral from a community screening effort9 and from programs both in the community and the hospital outpat...
To investigate possible dopaminergic effects on aldosterone production, we administered the dopamine antagonist metoclopramide to 11 normal subjects, 8 patients with primary aldosteronism due to adenoma or hyperplasia, and 5 other patients with the glucocorticoid-suppressible form of hyperaldosteronism (GSH). All subjects except for those with GSH responded to metoclopramide with an increase in plasma aldosterone concentration even when endogenous ACTH was suppressed by dexamethasone pretreatment. This increase occurred without apparent mediation of other recognized stimuli for aldosterone secretion. In contrast, the patients with GSH failed to show any aldosterone response while receiving dexamethasone, but demonstrated a rise in plasma aldosterone concentration when dexamethasone was withheld. The responses in the patients with both forms of primary aldosteronism were greater in magnitude than in the normal subjects or in the subjects with GSH when not receiving dexamethasone. These studies, while demonstrating differences between the subtypes of hyperaldosteronism in their responsiveness to metoclopramide, indicate that ACTH or some other factor may exert a permissive effect in GSH for the aldosterone response to metoclopramide. A graded infusion of ACTH revealed a greater aldosterone response in GSH compared to that in the other groups, further suggesting the importance of ACTH in this disorder.
SUMMARY To assess the influence of heredity on factors that help regulate the arterial blood pressure in man, we conducted sodium-loading and depletion studies in monozygotic and dizygotic twins, normotensive first-degree relatives of essential hypertensives, and in nonnotenslve control subjects matched for age, sex, and race. Following sodium-loading, we found evidence for the influence of genetic variance on the natriuretic responses, plasma renin activity (PRA), plasma aldosterone concentrations (PA), and plasma and urinary norepinephrine. Relatives of hypertensives differed from controls in that they had higher blood pressures, greater renin values, and relatively sluggish natriuretic responses. Since renin and fractional sodium excretion values were inversely correlated in all subject groups, it is possible that the heritable influences we observed on sodium excretion were mediated by the renin-angiotensin-aldosterone system. 79 the nature of these influences has not been defined clearly. To examine inherited mechanisms that may contribute to the development of essential hypertension in some individuals, or the resistance to hypertension in others, we conducted detailed studies of monozygotic and dizygotic normotensive twins, normotensive firstdegree relatives of essential hypertensives, and large numbers of normotensive white and black subjects by means of a standardized protocol incorporating both sodium-loading and depletion. "14 In these studies we examined electrolyte balance, components of the renin-angiotensin-aldosterone system, and humoral indicators of sympathetic nervous system activity. The studies in twins 1-34fluences in each of these areas. The studies in normotensive, first-degree relatives of essential hypertensives indicated the existence of important differences in electrolyte excretion and peripheral renin values that may contribute to the susceptibility to hypertension of this high-risk group." We present these findings in light of their bearing on the importance of heredity in regulating blood pressure in man. Methods Studies in TwinsData from monozygotic (MZ) and dizygotic (DZ) twins provide a unique opportunity to test for the existence of genetic variation in traits. Since MZ twins are genetically identical and DZ twins are related as full siblings, a given trait would be expected to exhibit smaller twin-pair differences for MZ than DZ twins if genetic influences are present. On the other hand, if the trait is only influenced by environmental variability, the MZ and DZ twin-pair differences should be approximately equal.The statistical methods involved in the analysis of MZ and DZ twin data have been recently reviewed by Christian. 16 We chose the comparison of MZ and DZ twins as the most efficient method for the initial investigation of heritable components in quantitative by guest on May 11, 2018 http://hyper.ahajournals.org/ Downloaded from
SUMMARY We examined tbe responses to volume expansion and contraction in normals, essential hypertensives, and patients with secondary hypertension, in order to formulate a more precise method of categorizing essential hypertensives with respect to plasma renin and aldosterone responses. We studied 379 normal and 464 hypertensive patients during and after a 4 hour 2 liter intravenous saline infusion, and after 120 mg oral furosemide. The large number of normal white and black subjects permitted renin profiling according to race and age. Of 395 essential hypertensives, 12% were categorized as having low-renln, 72% normal-renln, and 16% high-renln hypertension. Our results show, when tbe renin values are adjusted for age and race, lowrenin hypertension in blacks and the elderly is less common than previously described. The most useful clinical information obtained was from measurements of plasma renin activity and aldosterone concentration following saline infusion, since that maneuver identified all patients with high-renin hypertension and also the 25 patients with primary aldosteronism.
The blood pressure response to surgery or percutaneous transluminal angioplasty (PTA) was determined an average of 3 years after treatment. In atherosclerotic disease, 85% of patients benefited. Furthermore, the extremely low overall cure rate of 6% (4/67) suggests that renal artery stenosis due to atherosclerosis is rarely a sole cause of hypertension, but more likely is an atherosclerotic complication of essential hypertension that develops in patients who are cigarette smokers. In fibrodysplastic disease both treatments were likely to improve the blood pressure. However, surgery resulted in a 41% rate of loss of the operated kidney. The response to PTA or surgery is strongly influenced by the etiology of the lesion being treated.
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