Haemodynamics in Essential Hypertension

Lund‐Johansen, Per

doi:10.1042/cs059343s

Cited by 200 publications

(73 citation statements)

References 41 publications

(54 reference statements)

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“…18,19 In actuality, patients with borderline hypertension may have elevated, normal, or reduced cardiac output, and with advancing age, the cardiac output declines in these patients. 20 Recently, a number of studies showed that individuals with borderline hypertension, even in the adolescent age range, may have a relative enlargement of the left ventricle as compared with normotensive patients.…”

Section: Discussionmentioning

confidence: 99%

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

et al. 1999

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Abstract-We recently showed that rarefaction of skin capillaries in the dorsum of the fingers of patients with essential hypertension is due to the structural (anatomic) absence of capillaries rather than functional nonperfusion. It is not known whether this rarefaction is primary (ie, antedates the onset of hypertension) or secondary (ie, as a consequence of sustained and prolonged elevation of blood pressure [BP]). The aim of the present investigation was to study skin capillary density in a group of patients with mild borderline hypertension to assess whether rarefaction antedates the onset of sustained elevation of BP. The study group included 18 patients with mild borderline hypertension (mean supine BP, 136/83 mm Hg), 32 normotensive controls (mean BP, 126/77 mm Hg), and 45 patients with established essential hypertension (mean BP, 156/98 mm Hg). The skin of the dorsum of the fingers was examined by intravital capillary videomicroscopy before and after venous congestion at 60 mm Hg for 2 minutes. Patients with borderline essential hypertension had the lowest resting capillary density when compared with normotensive controls and patients with established hypertension. Maximal capillary density with venous congestion in the borderline group remained the lowest. The study confirmed that patients with borderline essential hypertension have skin capillary densities that are equally low as or even lower than patients with established hypertension. Both groups had significantly lower capillary densities than normal controls. One explanation for the results is that capillary rarefaction may be due to an early structural abnormality in essential hypertension. (Hypertension. 1999;34:655-658.)

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Section: Discussionmentioning

confidence: 99%

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

et al. 1999

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“…The mode of action of calcium antagonist drugs in reducing vascular smooth muscle tone (Massingham, 1973) and thus the raised peripheral resistance which is the consistent haemodynamic abnormality in essential hypertension (Frohlich et al, 1969;Lund-Johansen, 1967), makes these drugs potentially useful in the treatment of this condition. However, they share many of the side effects of other peripheral vasodilators, including reflex tachycardia, orthostatic hypotension and fluid retention.…”

Section: Discussionmentioning

confidence: 99%

24 h blood pressure control with the once daily calcium antagonist, amlodipine.

Heber

Brigden

Al-Khawaja

et al. 1989

Brit J Clinical Pharma

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1 Amlodipine is a novel calcium antagonist which, although pharmacologically similar to other dihydropyridine calcium antagonists, has a long plasma half-life, permitting steady state blood levels to be achieved with a once-daily dose regimen. 2 We have performed a study to examine the effects of this drug on the blood pressure of hypertensive patients over a 24 h period. After a placebo run-in, the drug was administered to 11 patients at a starting dose of 5 mg, and increased to 10 mg after 2 weeks of treatment if the cuff diastolic blood pressure response was unsatisfactory. Cuff measurements were made at entry, after 2 weeks treatment with placebo, after 2 weeks on amlodipine 5 mg once daily, and after a further 4 weeks on amlodipine 5 mg or 10 mg once daily. Intraarterial blood pressure recordings were made at the end of the placebo phase and at completion of the study. 3 Mean supine blood pressure measured sphygmomanometrically was 168/103 (n = 11) mm Hg at entry, 169/104 (n = 11) mm Hg at the end of the placebo phase, 153/95 (n = 11) mm Hg after 2 weeks of treatment and 146/92 (n = 11) mm Hg at the end of the study. Blood pressure curves plotted for each phase of the study revealed an effective 24 h duration of action. Mean daytime blood pressure was reduced from 165/103 to 147/89 mm Hg (P < 0.05, n = 10), and mean night-time blood pressure was reduced from 137/79 to 121/69 mm Hg (P < 0.05, n = 10). There was no change in heart rate. 4 One patient developed ankle swelling which would have required discontinuation of medication had she not already been at the end of the study. The drug was otherwise well tolerated. 5 These results indicate that amlodipine is effective as a once daily antihypertensive agent, and is well tolerated.

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“…It is generally accepted that the acute administration of a f-adrenoceptor blocking drug results in reduced cardiac output and increased total peripheral vascular resistance with little or no change in blood pressure (Tarazi & Dustan, 1972;Hansson et al, 1973, Lund-Johansen, 1980. In contrast, nonselective (pindolol) and PI1-selective (ICI 89.406) adrenoceptor blocking drugs with pronounced ISA do not reduce cardiac output or heart rate at rest (Lysbo-Svendsen et al, 1979), and vascular resistance is not affected.…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic effects of metoprolol and pindolol: a comparison in hypertensive patients.

Svensson¹,

Gudbrandsson²,

Sivertsson³

et al. 1982

Brit J Clinical Pharma

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1 In a double‐blind study, 36 patients with essential hypertension were randomly allocated to treatment with either metoprolol, 100–300 mg/day, or pindolol, 5–15 mg/day for 6 months. Haemodynamic investigations were made on three separate occasions. Blood flow in the calves and in the forearm was determined by venous occlusion plethysmography after 6 weeks of placebo, after 6 weeks and again after 6 months of active therapy. 2 Both drugs reduced blood pressure significantly, by 17.1/11.8 mm Hg with metoprolol and 21.9/10.9 mm Hg with pindolol after 6 weeks (P less than 0.005). No further changes were seen after 6 months. 3 Heart rate after 6 weeks was significantly reduced by metoprolol (10.7 +/‐ 2.4 beats/min, P less than 0.001) but not by pindolol (4.4 +/‐ 2.3 beats/min, NS). After 6 months a significant reduction was seen also in the pindolol group (5.2 +/‐ 2.1 beats/min, P less than 0.05). 4 The vascular resistance in the calves at rest was reduced by pindolol (P less than 0.05), whereas resistance tended to increase with metoprolol. 5 Resting vascular resistance in the forearm after 6 months was significantly reduced in the metoprolol group (P less than 0.001) as well as in the pindolol group (P less than 0.02). The increase in forearm vascular resistance seen during leg exercise was not influenced by either drug. 6 Vascular resistance at maximal vasodilatation was unchanged in the calves, but a significant reduction (‐17.4 +/‐ 5.7%, P less than 0.01) in the forearm vascular bed was seen after 6 months of pindolol. No change was observed with metoprolol. 7 It is concluded that pindolol reduces elevated blood pressure partly through peripheral vascular mechanism. Metoprolol, on the other hand, probably acts mainly via central cardiac mechanisms.

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Haemodynamics in Essential Hypertension

Cited by 200 publications

References 41 publications

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

24 h blood pressure control with the once daily calcium antagonist, amlodipine.

Haemodynamic effects of metoprolol and pindolol: a comparison in hypertensive patients.

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