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Yalçin SS, Erdal İ, Oğuz B, Duzova A. Association of urine phthalate metabolites, bisphenol A levels and serum electrolytes with 24-h blood pressure profile in adolescents. BMC Nephrol 2022; 23:141. [PMID: 35410150 PMCID: PMC9004182 DOI: 10.1186/s12882-022-02774-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/04/2022] [Indexed: 12/19/2022] Open
Abstract
Background Among the possible causes of hypertension in adolescence, electrolyte imbalances and environmental pollutants are drawing increasing attention. We aimed to examine the relationship between bisphenol A (BPA), phthalate metabolites, and serum electrolytes and blood pressure. Methods Eighty-six participants aged 12–15 years were included in the study. Body mass index (BMI), office blood pressure and 24-h ambulatory blood pressure measurements (ABPM), and carotid intima-media thickness were determined. Blood samples were taken for hemogram, renal function tests, and serum electrolytes. Free- and total-BPA and phthalate metabolites were analyzed from urine samples. Results Of the participants, 34 were evaluated as normal blood pressure profile, 33 as white-coat hypertension (WCHT), and 19 as ABPM-hypertension. Adolescents in ABPM- hypertension groups had higher BMI-standard deviation score (SDS), leucocyte, platelet count; but lower serum chloride, compared to the normal blood pressure profile group. The percentage of adolescents with detectable urinary mono-benzyl phthalate (MBzP) was higher in ABPM-hypertension (42.1%) and WCHT groups (33.3%), compared to the normal blood pressure profile group (5.9%, p = 0.004). Associations between MBzP and ABPM- hypertension and WCHT were remained after confounding factor adjustment. Adolescents with detectable MBzP levels had also higher “albumin-corrected calcium” and lower serum phosphate and “albumin-corrected calcium x phosphate product” compared to others. Adolescents with detectable urinary MBzP levels had higher blood pressure profiles in some 24-h (mean arterial pressure-SDS, systolic blood pressure-SDS), daytime (systolic blood pressure-SDS), and night-time (mean arterial pressure-SDS, systolic blood pressure-SDS, and diastolic blood pressure-SDS) measurements, compared to others. WCHT was found to be associated negatively with monomethyl phthalate and the sum of dibutyl phthalate metabolites and ABPM-HT with MCPP. There was no significant association between blood pressure profiles and free- and total-BPA status. Conclusion MBzP was associated with adverse blood pressure profiles in adolescence. Additive follow-up studies are necessary for cause-effect relations. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02774-y.
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Affiliation(s)
- Siddika Songül Yalçin
- Unit of Social Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
| | - İzzet Erdal
- Unit of Social Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Berna Oğuz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Duzova
- Unit of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Kizilgul M, Kan S, Beysel S, Apaydin M, Ozcelik O, Caliskan M, Ozbek M, Ozdemir S, Cakal E. Is fibroblast growth factor 23 a new cardiovascular risk marker in gestational diabetes? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:562-566. [PMID: 28977159 PMCID: PMC10522065 DOI: 10.1590/2359-3997000000287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 04/06/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was designed to compare the serum levels of fibroblast growth factor 23 (FGF23) among patients with gestational diabetes mellitus (GDM) and healthy pregnant women, and to evaluate the association between hormonal and metabolic parameters. SUBJECTS AND METHODS A total of 82 pregnant women were consecutively enrolled in the study. Of these, 46 were diagnosed as having GDM; the remaining 36 healthy pregnant women served as controls in a cross-sectional study design. The womens' ages ranged from 22 to 38 years and gestational ages, from 24 to 28 weeks. Serum samples were analyzed for FGF23 levels using an enzyme-linked immunosorbent assay. RESULTS Serum FGF23 levels were increased in patients with GDM compared with controls (median, 65.3 for patients with GDM vs. 36.6 ng/mL for healthy controls; p = 0.019). Mean fasting glucose (105.6 ± 7.4 vs. 70.2 ± 7.2 mg/dL, p < 0.001), HbA1c (5.6 ± 0.5 vs. 4.9 ± 0.5%, p < 0.001), insulin (median, 11.1 vs. 8.7 µIU/mL, p = 0.006) and HOMA-IR (3.0 (1.8) vs 1.4 (0.6), p < 0.001) levels were significantly higher in patients with GDM than in controls. Serum FGF23 level was positively correlated with body mass index (r2 = 0.346, p < 0.05), FPG (r2 = 0.264, p < 0.05), insulin (r2 = 0.388, p < 0.05), HOMA-IR (r2 = 0.384, p < 0.05). CONCLUSION Serum FGF23 levels were higher in women with GDM compared with controls. The present findings suggest that FGF23 could be a useful marker of cardiovascular disease in GDM.
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Affiliation(s)
- Muhammed Kizilgul
- Department of Endocrinology and MetabolismDiskapi Teaching and Research HospitalAnkaraTurkeyDepartment of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Ankara, Turkey
- Schulze Diabetes InstituteDepartment of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSASchulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Seyfullah Kan
- Department of Endocrinology and MetabolismDiskapi Teaching and Research HospitalAnkaraTurkeyDepartment of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Selvihan Beysel
- Department of Endocrinology and MetabolismDiskapi Teaching and Research HospitalAnkaraTurkeyDepartment of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Mahmut Apaydin
- Department of Endocrinology and MetabolismDiskapi Teaching and Research HospitalAnkaraTurkeyDepartment of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Ozgur Ozcelik
- Department of Endocrinology and MetabolismDiskapi Teaching and Research HospitalAnkaraTurkeyDepartment of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Mustafa Caliskan
- Department of Endocrinology and MetabolismDiskapi Teaching and Research HospitalAnkaraTurkeyDepartment of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Mustafa Ozbek
- Department of Endocrinology and MetabolismDiskapi Teaching and Research HospitalAnkaraTurkeyDepartment of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Seyda Ozdemir
- Department of BiochemistryDiskapi Teaching and Research HospitalAnkaraTurkeyDepartment of Biochemistry, Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and MetabolismDiskapi Teaching and Research HospitalAnkaraTurkeyDepartment of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Ankara, Turkey
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Junttila E, Koskenkari J, Ala-Kokko T. Hypophosphatemia after nontraumatic intracranial hemorrhage. Acta Anaesthesiol Scand 2017; 61:641-649. [PMID: 28497591 DOI: 10.1111/aas.12903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/06/2017] [Accepted: 04/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this study was to assess the incidence and contributing factors of hypophosphatemia and the association with poor long-term outcome after nontraumatic intracranial hemorrhage. METHODS This was a prospective, observational study of patients with nontraumatic intracranial hemorrhage (i.e., aneurysmal or perimesencephalic subarachnoid hemorrhage, or spontaneous intracerebral or intraventricular hemorrhage) treated in the intensive care unit (ICU) at our university hospital. Plasma phosphate concentrations were measured serially in 2-day sections during the 6 day study period. The ICU mortality was recorded, 3-month and 1-year outcomes were assessed using the Glasgow Outcome Scale. RESULTS One hundred patients were enrolled. The frequency of hypophosphatemia (Pi ≤ 0.65 mmol/l) was 70%. Chronic hypertension, acute hydrocephalus, and diffuse brain edema were more common in patients with hypophosphatemia compared with normophosphatemics (44% vs. 21%, P = 0.021; 59% vs. 33%, P = 0.021; and 43% vs. 13%, P = 0.004, respectively). Hypophosphatemic patients had higher maximum SOFA scores [10 (7-11) vs. 7.5 (5.75-10), P = 0.024]. Initial phosphate concentration correlated inversely with APACHE II score on admission (ρ = -0.304, P = 0.002) and SOFA score on the first ICU day (ρ = -0.269, P = 0.008). There was no difference in outcome between hypophosphatemic and normophosphatemic patients. In all five patients with severe hypophosphatemia (Pi < 0.32 mmol/l) the functional outcome was good. CONCLUSION Hypophosphatemia was common in this patient population. The outcome was similar between hypophosphatemic and normophosphatemic patients. Chronic hypertension, acute hydrocephalus, diffuse brain edema and higher SOFA scores were more common in patients with hypophosphatemia.
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Affiliation(s)
- E. Junttila
- Department Anesthesiology; Tampere University Hospital; Tampere Finland
- Department Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; Medical Research Center Oulu; Research Group of Surgery, Anesthesia and Intensive Care; Medical Faculty; University of Oulu; Oulu Finland
| | - J. Koskenkari
- Department Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; Medical Research Center Oulu; Research Group of Surgery, Anesthesia and Intensive Care; Medical Faculty; University of Oulu; Oulu Finland
| | - T. Ala-Kokko
- Department Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; Medical Research Center Oulu; Research Group of Surgery, Anesthesia and Intensive Care; Medical Faculty; University of Oulu; Oulu Finland
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McCarty MF, DiNicolantonio JJ. Bioavailable dietary phosphate, a mediator of cardiovascular disease, may be decreased with plant-based diets, phosphate binders, niacin, and avoidance of phosphate additives. Nutrition 2014; 30:739-47. [DOI: 10.1016/j.nut.2013.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 12/17/2022]
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Obeid OA, Hachem DH, Ayoub JJ. Refeeding and metabolic syndromes: two sides of the same coin. Nutr Diabetes 2014; 4:e120. [PMID: 24979149 PMCID: PMC4079929 DOI: 10.1038/nutd.2014.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/09/2014] [Accepted: 05/28/2014] [Indexed: 12/13/2022] Open
Abstract
Refeeding syndrome describes the metabolic and clinical changes attributed to aggressive rehabilitation of malnourished subjects. The metabolic changes of refeeding are related to hypophosphatemia, hypokalemia, hypomagnesemia, sodium retention and hyperglycemia, and these are believed to be mainly the result of increased insulin secretion following high carbohydrate intake. In the past few decades, increased consumption of processed food (refined cereals, oils, sugar and sweeteners, and so on) lowered the intake of several macrominerals (mainly phosphorus, potassium and magnesium). This seems to have compromised the postprandial status of these macrominerals, in a manner that mimics low grade refeeding syndrome status. At the pathophysiological level, this condition favored the development of the different components of the metabolic syndrome. Thus, it is reasonable to postulate that metabolic syndrome is the result of long term exposure to a mild refeeding syndrome.
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Affiliation(s)
- O A Obeid
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences. American University of Beirut, Beirut, Lebanon
| | - D H Hachem
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences. American University of Beirut, Beirut, Lebanon
| | - J J Ayoub
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences. American University of Beirut, Beirut, Lebanon
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Ditzel J, Lervang HH. Lifestyle diseases and cardiovascular risk factors are interrelated to deficiencies of major substrates in ATP synthesis. Vasc Health Risk Manag 2010; 6:829-36. [PMID: 20957128 PMCID: PMC2952451 DOI: 10.2147/vhrm.s13368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Recent studies on diabetes and metabolic syndrome indicate a common disturbance of inorganic phosphate (Pi) metabolism. Pi is an important substrate in the formation of adenosine triphosphate (ATP), and many lifestyle diseases and cardiovascular risk factors similarly show deficiencies in either 1 or 2 major components of ATP synthesis. Age, male gender, hypertension, obesity, hypertriglyceridemia, metabolic syndrome, and diabetes mellitus are all associated with hypophosphatemia. In addition, tobacco smoking, hyperchylomicronemia, hypertension, and diabetes may involve defects in tissue oxygen delivery. Hypophosphatemia may lead to a critical decrease in intracellular Pi and to mitochondrial dysfunction, which might be counter-acted by the pharmacological use of fructose 1,6-diphosphate.
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Affiliation(s)
- Jørn Ditzel
- Department of Endocrinology, Center for Prevention of Struma and Metabolic Diseases, Aalborg University Hospital, Aarhus University, Aalborg, Denmark
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Serum phosphate in white-coat hypertensive patients: focus on dipping status and metabolic syndrome. Hypertens Res 2010; 33:825-30. [PMID: 20505672 DOI: 10.1038/hr.2010.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent studies indicate an association between serum phosphate levels and blood pressure in hypertensive patients. A growing body of evidence suggests that white-coat hypertension (WCH) is associated with target organ damage. Furthermore, metabolic syndrome (MS) and a non-dipping pattern are associated with increased cardiovascular risk. The purpose of this study was to explore the nocturnal blood pressure fall in patients with WCH according to their serum phosphate levels and number of MS components fulfilled. The study included 2600 patients with WCH who attended our outpatient clinics. All patients underwent repeated office blood pressure measurements, 24-h ambulatory blood pressure monitoring and full clinical and laboratory evaluation. The diagnosis of MS was made according to the Adult Treatment Panel III criteria. Dipping pattern was defined as follows: 'dippers' had a nocturnal systolic blood pressure (NSBP) fall > or =10% but <20%; 'non-dippers' had an NSBP fall <10%; 'extreme dippers' had an NSBP fall > or =20% and 'reverse dippers' had an NSBP increase. There were 314 extreme dippers, 1337 dippers, 734 non-dippers and 116 reverse dippers. Reverse dippers presented with significantly lower levels of serum phosphate, whereas extreme dippers had significantly higher levels (3.39+/-3.29 vs. 3.58+/-3.52 mg per 100 ml, P<0.0001). The patients were classified according to the number of MS components and the main observation was the inverse relationship of serum phosphate with MS components (3.53+/-0.36, 3.50+/-0.38, 3.49+/-0.38, 3.44+/-0.36 and 3.35+/-0.31 mg per 100 ml, respectively, P=0.003). Patients with WCH and low serum phosphate levels appear to have a higher incidence of a non-dipping NSBP profile and an impaired metabolic profile. This observation may be important for the stratification of the cardiovascular risk in WCH patients.
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Gudmundsdottir H, Strand AH, Kjeldsen SE, Høieggen A, Os I. Serum phosphate, blood pressure, and the metabolic syndrome--20-year follow-up of middle-aged men. J Clin Hypertens (Greenwich) 2009; 10:814-21. [PMID: 19128269 DOI: 10.1111/j.1751-7176.2008.00032.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The authors investigated the relationship between serum phosphate (S-phosphate) and the metabolic syndrome in a group of middle-aged hypertensive and normotensive men during 20-year follow-up. Fifty-six men participated. Of the original 34 normotensive men, hypertension developed in 17. In the group as a whole and in those in whom hypertension developed, there was a significant negative relationship between S-phosphate at baseline and mean blood pressure (MBP) at follow-up. A significant relationship was observed between S-phosphate at baseline and components of the metabolic syndrome in the group as a whole, in individuals with hypertension, and in individuals with the lowest S-phosphate levels at follow-up. S-phosphate at baseline predicted MBP 20 years later in a group of hypertensive and normotensive men. When grouped according to the number of components of the metabolic syndrome, individuals with the lowest serum phosphate levels had the highest number of risk factors. These findings may suggest a role of low S-phosphate in the development of hypertension and the metabolic syndrome.
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Park W, Kim BS, Lee JE, Huh JK, Kim BJ, Sung KC, Kang JH, Lee MH, Park JR, Rhee EJ, Oh KW, Lee WY, Park CY, Park SW, Kim SW. Serum phosphate levels and the risk of cardiovascular disease and metabolic syndrome: a double-edged sword. Diabetes Res Clin Pract 2009; 83:119-25. [PMID: 19101054 DOI: 10.1016/j.diabres.2008.08.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 08/18/2008] [Accepted: 08/26/2008] [Indexed: 11/16/2022]
Abstract
This study was performed to evaluate the relationship between serum phosphate levels and cardiovascular risk factors and metabolic syndrome components in a cross-sectional survey. Plasma phosphate was measured by immunoturbidimetry in 46,798 subjects over 20 years of age with an estimated GFR>or=60 mL/(min 1.73 m(2)) who participated in a health-check survey at the Kangbuk Samsung Hospital in South Korea. The median plasma phosphate level was 3.49+/-0.44 mg/dL and the mean estimated GFR was 77.46+/-8.51 mL/(min 1.73 m(2)). We found that serum phosphate levels had a positive correlation with total cholesterol, HDL-C, lipoprotein a, apolipoprotein A1, calcium, and albumin. In addition, serum phosphate levels had a negative correlation with age, body mass index, uric acid, fasting glucose, insulin, HOMA-IR, HS-CRP, triglyceride levels, systolic blood pressure, diastolic blood pressure, and waist circumference (P<0.001). In conclusion, we found that a high phosphate level is correlated with cardiovascular disease while a lower phosphate level is correlated with metabolic syndrome. Serum phosphate levels that were too high or too low correlated with cardiovascular risk factors and elements of metabolic syndrome, respectively, showing that it may be important to maintain an appropriate level of phosphate for the prevention of cardiovascular events and metabolic syndrome.
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Affiliation(s)
- Wan Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Kalaitzidis R, Tsimihodimos V, Bairaktari E, Siamopoulos KC, Elisaf M. Disturbances of phosphate metabolism: another feature of metabolic syndrome. Am J Kidney Dis 2005; 45:851-8. [PMID: 15861350 DOI: 10.1053/j.ajkd.2005.01.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite important recent advances in the understanding of the consequences of metabolic syndrome, its pathophysiological characteristics remain unclear. It has been proposed that disturbances in phosphate metabolism may contribute to the development of this constellation of cardiovascular risk factors. However, there have been insufficient clinical data supporting this hypothesis to date. The aim of our study is to confirm the presence of hypophosphatemia in patients with metabolic syndrome, as well as investigate mechanisms that may underlie the disturbances in phosphate metabolism in this patient group. METHODS Two hundred fifty-five individuals were enrolled. The diagnosis of metabolic syndrome was based on Adult Treatment Panel III guidelines. Subjects with fewer than 3 criteria served as controls. RESULTS Patients with metabolic syndrome showed significantly lower phosphate and magnesium levels compared with controls. Because fractional excretion of phosphate was similar in both groups, we assume that hypophosphatemia in patients with metabolic syndrome can be attributed to decreased dietary intake, as well as internal redistribution of this element. Lower magnesium values in the patient group may result from the same mechanisms as lower phosphate levels. In addition, hyperinsulinemia-induced renal magnesium wasting also may be a contributory factor. CONCLUSION Patients with metabolic syndrome show significantly lower phosphate and magnesium levels compared with healthy individuals. The clinical significance of these disturbances, as well as their importance as targets for preventive or therapeutic interventions, remains to be established.
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Affiliation(s)
- Rigas Kalaitzidis
- Department of Nephrology, Medical School, University of Ioannina, Greece
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11
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Abstract
Thyrotoxic periodic paralysis (TPP) and sporadic periodic paralysis (SPP) are the most common causes of hypokalemic periodic paralysis (HPP) in EDs in Asia. Their neuromuscular presentations are almost indistinguishable. We conducted this study to identify clinical clues that can help EPs distinguish between TPP and SPP. Thirty-four patients presenting to the ED with HPP were enrolled during a 3-year period. They did not have known hyperthyroidism before the attack and no family history of paralysis. They all had low K(+) excretion rates. Vital signs and blood biochemistry, including acid-base and electrolytes, were measured. TPP was subsequently established by thyroid function tests. Twenty patients had TPP and 14 patients had SPP. There was no significant difference in age and sex distribution between them. Systolic (SBP) but not diastolic blood pressure (SBP 145 +/- 4 vs 128 +/- 4 mm Hg, P < 0.001) and heart rate (106 +/- 3 vs 73 +/- 3 beats/min, P < 0.001) were significantly higher in those experiencing TPP than SPP. Among the biochemical factors, only plasma phosphate concentration (2.2 +/- 0.2 vs 3.2 +/- 0.2 mg/dL, P < 0.001) was significantly lower in those experiencing TPP than SPP. Systolic hypertension, tachycardia, and hypophosphatemia are clinical clues favoring the diagnosis of TPP.
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Affiliation(s)
- Yuh-Feng Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, No. 325, Section 2 Cheng-Kung Road, Neihu 114, Taipei, Taiwan
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Lin SH, Lin YF. Propranolol rapidly reverses paralysis, hypokalemia, and hypophosphatemia in thyrotoxic periodic paralysis. Am J Kidney Dis 2001. [DOI: 10.1053/ajkd.2001.22090] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ogawa T, Kamikubo K. Hypokalemic periodic paralysis associated with hypophosphatemia in a patient with hyperinsulinemia. Am J Med Sci 1999; 318:69-72. [PMID: 10408765 DOI: 10.1097/00000441-199907000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 34-year-old man was admitted to the hospital because of acute quadriplegia. On admission, serum potassium was 2.1 mEq/L and serum inorganic phosphate was 1.4 mg/dL. Thyroid function was normal. Serum levels of aldosterone, cortisol, and intact parathyroid hormone were normal. Fasting plasma glucose was 109 mg/dL, and fasting serum insulin was 25.0 U/mL. Shortly after intravenous supplementation of potassium, muscle strength was normalized. Oral glucose tolerance test revealed impaired glucose tolerance and hyperresponse of insulin. During the oral glucose tolerance test, serum potassium and phosphate decreased significantly. These findings suggest that hyperinsulinemia and insulin-induced transmembrane shift of extracellular potassium and phosphate may have been involved in the abnormalities of serum electrolytes and development of hypokalemic periodic paralysis in the present patient.
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Affiliation(s)
- T Ogawa
- Department of Internal Medicine, Takayama Red Cross Hospital, Japan
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Ogawa T, Kamikubo K. Hypokalemic Periodic Paralysis Associated with Hypophosphatemia in a Patient with Hyperinsulinemia. Am J Med Sci 1999. [DOI: 10.1016/s0002-9629(15)40576-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Norris KC, Levine B, Ganesan K. Thyrotoxic periodic paralysis associated with hypokalemia and hypophosphatemia. Am J Kidney Dis 1996; 28:270-3. [PMID: 8768924 DOI: 10.1016/s0272-6386(96)90312-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the rare case of a 43-year-old African-American man with thyrotoxic periodic paralysis associated with hypokalemia and hypophosphatemia. Both serum potassium and serum phosphate levels returned to normal after supplementation with only potassium. We consider the unusual condition of hyperthyroid-related hypokalemia and hypophosphatemia to have contributed to the acute paralysis in this patient.
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Affiliation(s)
- K C Norris
- Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Kjeldsen SE, Moan A, Petrin J, Weder AB, Julius S. Effects of increased arterial epinephrine on insulin, glucose and phosphate. Blood Press 1996; 5:27-31. [PMID: 8777469 DOI: 10.3109/08037059609062103] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The relationship between sympathetic nervous system activity and glucose and insulin metabolism is not fully understood. In the present study we therefore investigated the effect of raising arterial plasma epinephrine within the lower pathophysiological concentration range on insulin, glucose and phosphate in blood. Arterial plasma epinephrine was raised over 60 min by a stepwise increasing intravenous infusion in healthy men aged 20-40 years (n = 40). Compared with infusion of saline, epinephrine caused a small but significant rise in serum insulin of 10 +/- 26 pmol/L (p = 0.016), more than 70% increase in serum glucose (p < 0.0001) and a decrease in serum phosphate (p < 0.0001). The changes in serum insulin during epinephrine infusion correlated negatively with the changes in arterial plasma epinephrine (r = -0.46, p = 0.003) and the changes in serum phosphate correlated negatively with the changes in serum glucose (r = -0.42, p = 0.007). Thus, arterial plasma epinephrine raised within the lower pathophysiological concentration range over a rather short period of time (60 min) has pronounced effects on insulin, glucose and phosphate in blood. These results suggest that epinephrine when infused acutely may suppress the insulin response to raised glucose, and that the acute hypophosphatemic effect of epinephrine is related to the glucose production. Thus, when epinephrine is released into the circulation during various forms of daily stress, e.g. mental stress, it may significantly affect insulin and glucose metabolism.
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Affiliation(s)
- S E Kjeldsen
- Department of Internal Medicine, University of Oslo, Ullevaal Hospital, Norway
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Kjeldsen SE, Zweifler AJ, Petrin J, Weder AB, Julius S. Sympathetic nervous system involvement in essential hypertension: increased platelet noradrenaline coincides with decreased beta-adrenoreceptor responsiveness. Blood Press 1994; 3:164-71. [PMID: 8069404 DOI: 10.3109/08037059409102247] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Platelet catecholamine content may reflect integrated plasma catecholamine concentrations over time. The present study aimed at examining sympathetic nervous system (SNS) involvement in essential hypertension by assessing platelet noradrenaline (NA) and typically beta-adrenoreceptor mediated responses to adrenaline (A) infusion as indices of sympathetic tone. Healthy white men were recruited by public advertising and screening (mean +/- SD): Hypertensives (n = 13, sitting blood pressure [BP] 153 +/- 13/106 +/- 7 mmHg, age 34 +/- 5 years, weight 83 +/- 10 kg) were compared to normotensives (n = 13, sitting BP 114 +/- 9/75 +/- 9 mmHg, age 30 +/- 6 years [n.s.], weight 82 +/- 9 kg [n.s.]). Loss of platelet granular contents (including NA) prior to analysis was minimized by studying young subjects (age range 20-40 years, minimal atherosclerosis), using arterial blood sampling, and processing blood immediately. These procedures resulted in plasma beta-thromboglobulin and platelet factor 4 levels which were not significantly different between groups. Sympathetic activation resulting from stress was minimized by not labelling subjects as either hypertensive or normotensive. Mean arterial platelet NA content was significantly higher in hypertensives (64 +/- 31 pg/mg of platelet weight) compared to normotensives (43 +/- 20 pg/mg, p < 0.05) both at baseline and following 35% expansion of the circulating platelet pool by A infusion (p < 0.05) and correlated with arterial NA in the hypertensives (r = 0.79, p < 0.002) but not in the normotensives (r = 0.04, n.s.). Similar increases in platelet and plasma A during infusion in both groups suggest unchanged platelet uptake capacity and plasma clearance in the hypertensive group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S E Kjeldsen
- Department of Internal Medicine, University of Michigan, Ann Arbor
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18
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van Hooft IM, Grobbee DE, Frölich M, Pols HA, Hofman A. Alterations in calcium metabolism in young people at risk for primary hypertension. The Dutch Hypertension and Offspring Study. Hypertension 1993; 21:267-72. [PMID: 8478035 DOI: 10.1161/01.hyp.21.3.267] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Several disturbances in calcium metabolism have been reported in primary hypertensive subjects. It is, however, not clear whether these alterations predate the development of hypertension or occur as a consequence of high blood pressure. We studied indexes of calcium metabolism in three groups of normotensive children with different familial predispositions for hypertension, based on parental blood pressure levels, with two, one, or no hypertensive parents. Plasma intact parathyroid hormone [1-84] was higher in the offspring of hypertensive parents compared with offspring of normotensive parents (difference, 0.58 pmol/L; standard error of the difference [SED], 0.24; p = 0.02). Mean serum calcium levels were slightly reduced in the offspring of two hypertensive parents (-0.019 mmol/L, SED = 0.013, p = 0.17). Plasma magnesium and phosphate levels were lower in the offspring of hypertensive parents (-0.032 mmol/L [SED = 0.016, p = 0.05] and -0.045 mmol/L [SED = 0.024, p = 0.05], respectively). Mean 1.25-dihydroxyvitamin D3 levels were similar among the groups. No differences in dietary intake of calcium, phosphate, or fiber were found. Urinary calcium excretion per 24 hours and the ratio of 24-hour urinary calcium excretion to daily calcium intake were somewhat higher in the offspring of hypertensive parents. Renal fractional excretion of calcium was similar in the offspring of two hypertensive parents, and renal fractional excretion of phosphate was lower in the offspring of two hypertensive parents compared with offspring of two normotensive parents (-1.50%, SED = 0.74, p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- I M van Hooft
- Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands
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19
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Abstract
A group of 41-year-old hypertensive men (n = 35, blood pressure (BP) 149.9 +/- 2.1/98.9 +/- 1.1 mmHg, mean +/- SEM) who had never received treatment for their condition were compared with hypertensive women of the same age (n = 18, BP 155.9 +/- 4.3/98.1 +/- 1.6 mmHg) with comparable body mass index (BMI, 25.9 +/- 0.5 vs. 24.9 +/- 4.5 kg m-2) who, also, had never received treatment. The lipid profile was more atherogenic in the men, with lower HDL cholesterol (1.21 +/- 0.04 vs. 1.38 +/- 0.06 mmol l-1, P = 0.04), higher total cholesterol (6.04 +/- 0.14 vs. 5.54 +/- 0.18 mmol l-1, P = 0.04) and triglycerides (1.80 +/- 0.16 vs. 0.96 +/- 0.10 mmol l-1, P < 0.001). The hypertensive men had higher haemoglobin (P < 0.001) and haematocrit. Plasma catecholamines were inversely related to BMI in the women only (r = -0.52, P < 0.05 for both noradrenaline and adrenaline). Women with BMI above 25 kg m-2 had significantly lower arterial plasma adrenaline and noradrenaline than those with BMI below 25 kg m-2 (28 +/- 5 vs. 78 +/- 16 pg ml-1, P < 0.01 and 101 +/- 17 vs. 206 +/- 33 pg ml-1, P < 0.01 respectively). A negative curvilinear relationship appeared between arterial adrenaline and insulin (r = 0.49, P = 0.05). These results suggest a male propensity for athero-thrombogenic risk factors in otherwise comparable hypertensive subjects. A close relationship between metabolic risk factors within the normal range seems to exist even in hypertensive women. The decreased sympathetic activity at rest in the obese hypertensive women indicates different pathophysiological mechanism for hypertension in lean and obese. Decreased sympathetic activity and thus reduced energy expenditure, promotes a risk for weight gain, and could explain the inverse relationship between insulin and adrenaline.
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Affiliation(s)
- I Os
- Department of Internal Medicine, Ullevål Hospital, University of Oslo, Norway
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20
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Imaoka M, Morimoto S, Kitano S, Fukuo F, Ogihara T. Calcium metabolism in elderly hypertensive patients: possible participation of exaggerated sodium, calcium and phosphate excretion. Clin Exp Pharmacol Physiol 1991; 18:631-41. [PMID: 1835682 DOI: 10.1111/j.1440-1681.1991.tb01637.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
1. Renal handling of electrolytes, including calcium (Ca), in response to physiological saline infusion (20 mL/kg, i.v., for 2 h) as well as basal circulating levels of Ca-regulating hormones were compared in 27 hypertensive elderly females (mean age 80 +/- 9 years), in 44 normotensive elderly females (79 +/- 9 years) and in 19 young normotensive females (23 +/- 4 years). 2. The hypertensive elderly females showed excessive increase in urine volume and urinary excretions of sodium (Na), Ca and inorganic phosphate (P) in response to saline infusion, associated with slight but significant decrease in circulating levels of Na and ionized Ca compared with those in the other groups. These hypertensive elderly patients also showed characteristic features both in circulating blood pressure and Ca regulating factors; they showed significantly low levels of plasma renin activity and aldosterone concentration, significantly high plasma levels of atrial natriuretic peptide and noradrenalin, compared with those in young controls and normotensive elderly females. 3. Moreover they showed significant increase in basal serum levels of parathyroid hormone and 1,25-dihydroxyvitamin D, and significant decrease in basal serum levels of calcitonin, 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D, compared with those in the other groups. 4. These results suggest that the exaggerated natriuresis associated with excessive loss of Ca and P in urine may participate in the abnormality of Ca metabolism in low-renin hypertensive elderly patients.
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Affiliation(s)
- M Imaoka
- Department of Geriatric Medicine, Osaka University Medical School, Japan
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21
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Kjeldsen SE, Rostrup M, Gjesdal K, Eide I. The epinephrine-blood platelet connection with special reference to essential hypertension. Am Heart J 1991; 122:330-6. [PMID: 2053554 DOI: 10.1016/0002-8703(91)90843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
About three decades ago it was shown by an aggregometer that epinephrine activated blood platelets, and it was proposed that platelets could be the link between stress and cardiovascular disease. During the past 10 years this hypothesis has been tested in clinical studies. It has been found that subjects with hypertension consistently have raised plasma catecholamine levels and in particular elevated epinephrine levels. Arterial but not venous epinephrine concentrations correlated with plasma concentrations of the platelet-release reaction marker beta-thromboglobulin (BTG). Plasma BTG is elevated in hypertensive patients, and psychological stress (i.e., hypertension labeling) stimulates plasma epinephrine and BTG. When a physiologic dose of epinephrine is infused into essential hypertensive patients, platelet counts, platelet size, and plasma BTG concentrations increase more than in normotensive subjects. Data suggest that there is a connection between psychological stress, plasma epinephrine levels, and platelet function, especially in patients with essential hypertension.
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Affiliation(s)
- S E Kjeldsen
- Department of Internal Medicine, Ullevaal University Hospital, Oslo, Norway
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22
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Brickman AS, Nyby MD, von Hungen K, Eggena P, Tuck ML. Calcitropic hormones, platelet calcium, and blood pressure in essential hypertension. Hypertension 1990; 16:515-22. [PMID: 2228152 DOI: 10.1161/01.hyp.16.5.515] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Plasma ionized calcium, platelet cytosolic calcium (using the fura-2 method in gel-filtered platelets), parathyroid hormone (both the intact hormone and a midmolecule portion), calcitriol, and calcidiol were measured in 19 untreated male patients with essential hypertension and 19 age-matched normotensive male research subjects. Mean levels of platelet cytosolic calcium, parathyroid hormone, calcitriol, and calcidiol were all significantly higher, whereas plasma ionized calcium was significantly lower, in the hypertensive group compared with the normotensive group. Both platelet cytosolic calcium and intact parathyroid hormone were positively correlated with mean arterial pressure (r = 0.58, p less than 0.001; r = 0.54, p less than 0.001, respectively), whereas plasma ionized calcium was inversely correlated with mean arterial pressure (r = -0.60, p less than 0.001) in the combined group of all study subjects. All three of these correlations were significant in the hypertensive group alone but not in the normotensive group alone. When analyzed with plasma ionized calcium, body mass index, serum calcitriol, and calcidiol in a multivariable regression model, the significance of the partial regressions of platelet cytosolic calcium and parathyroid hormone with mean arterial pressure persisted. Intact parathyroid hormone was positively correlated to platelet cytosolic calcium (r = 0.43, p less than 0.01) and plasma ionized calcium was inversely correlated to platelet cytosolic calcium (r = -0.44, p less than 0.01). These results confirm previous reports of disturbances of calcium metabolism in essential hypertension and suggest that the elevated platelet cytosolic calcium observed in essential hypertension may be linked to one or more of these alterations of calcium metabolism.
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Affiliation(s)
- A S Brickman
- Division of Endocrinology, Sepulveda Veterans Administration Medical Center, Calif
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Kjeldsen SE, Sejersted OM, Frederichsen P, Leren P, Eide IK. Increased erythrocyte magnesium content in essential hypertension. Scand J Clin Lab Invest 1990; 50:395-400. [PMID: 2392652 DOI: 10.3109/00365519009091597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The present study aimed at testing the hypothesis of decreased erythrocyte magnesium content and magnesium deficiency in essential hypertension. Atomic absorption was used to measure the erythrocyte content of total magnesium in 50-year-old otherwise healthy white males with essential hypertension (n = 12, blood pressure (mean +/- SE) 155 +/- 4/109 +/- 2 mmHg) that had never been treated and in normotensive control subjects (n = 12, blood pressure 128 +/- 2/88 +/- 1 mmHg) matched for age, sex, race, height, weight and smoking habits. The erythrocyte magnesium content was significantly increased in the hypertensive group (2.266 +/- 0.063 vs 1.903 +/- 0.069 mmol/l erythrocytes, p less than 0.001). No significant difference between the groups was detected for serum concentration or the 24-h urinary excretion of magnesium. In conclusion, the present study indicates increased rather than decreased erythrocyte content of magnesium in 50-year-old white males with 'never-treated', essential hypertension. Magnesium deficiency is, therefore, unlikely in this subset of critically selected and matched hypertensive patients.
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Affiliation(s)
- S E Kjeldsen
- Department of Internal Medicine, Ullevaal University Hospital, Norway
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Kjeldsen SE, Schork NJ, Leren P, Eide IK. Arterial plasma norepinephrine correlates to blood pressure in middle-aged men with sustained essential hypertension. Am Heart J 1989; 118:775-81. [PMID: 2801485 DOI: 10.1016/0002-8703(89)90592-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Increased plasma catecholamine levels assessed from the venous blood have been found in a number of studies of younger patients with essential hypertension, but hypertensive-normotensive differences could not easily be demonstrated in subjects above 40 years of age. For several reasons, measurement of arterial plasma catecholamines may be a more sensitive tool for the detection of hypertensive-normotensive differences. The present study therefore aimed at examining both venous and arterial plasma catecholamines in a group of white men, all 50 years of age, with never-treated, established essential hypertension (n = 61, blood pressure 165 +/- 2/112 +/- 1 mm Hg, means +/- SE) and comparing them with a similar group of normotensive men (n = 51, blood pressure 128 +/- 1/85 +/- 1 mm Hg). Arterial and venous plasma epinephrine, heart rate, and body weight were significantly elevated in the hypertensive group. Plasma norepinephrine was similar between the groups in the venous blood, whereas in the arterial blood the values in hypertensive subjects were moderately, but significantly increased (p less than 0.03). However, stepwise multiple regression analysis suggested arterial plasma norepinephrine was the only significant independent explanatory variable of raised blood pressure in the hypertensive group (r = 0.51, t = 4.05, p = 0.0002). Such a relationship was not found in the normotensive group. Thus based on measurements in arterial blood, we conclude that plasma norepinephrine, representing sympathetic tone, may be an important pathogenetic factor for high blood pressure in middle-aged men with established hypertension.
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Affiliation(s)
- S E Kjeldsen
- Department of Internal Medicine, Ullevaal University Hospital, Oslo, Norway
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