Hypertension screening in a salami factory: a worksite hypertension study

The prevalence, awareness and control of hypertension are important epidemiological research topics worldwide. The screening of hypertension in a workplace has some special aspects. We have screened the employees in a Hungarian salami factory (Pick Salami Factory, Szeged, Hungary) for hypertensives. In a cross-sectional survey, the blood pressure (BP) was measured with an instrument meeting accepted measuring principles (BP-TRU BP) and a questionnaire was filled. In all, 1012 factory workers were screened (600 male and 412 female) and 25.7% of the workers proved to be hypertensives. Of these, 61.5% of the hypertensive employees were aware that their BP is high. Among the treated hypertensives, 21.9% were controlled. These results suggest that the efficacy of the management of hypertension in Hungary cannot be solely responsible for the high cardiovascular morbidity and mortality. The improvement of the management of hypertension should decrease the cardiovascular risk in the hypertensive population. The worksite screening and follow-up of hypertension seem to be logical health service solutions. This has been proven to be cost-effective.

[Treatment of renal artery stenoses with stent implantation]

The authors report on their experience with the treatment of renovascular hypertension by stent implantation. In the past 4 years different types of stents (Palmaz [9], Palmaz-Corinthian [4], Memotherm [1] and AVE [1]) were implanted into 15 renal arteries of 11 patients. The indication was primary in 8 cases, and secondary in 3 patients, because of restenosis of a previously dilated renal artery. 14 stents were implanted into narrowed renal arteries, and in the remaining one case a stent was placed in an occluded renal artery immediately after recanalization. The technical success was 100%. In all but the recanalized case in which the renal artery was occluded, stents are still open. On the basis of this experience and the literature, the authors suggest the more extensive usage of this less invasive method.

New non competitive AMPA antagonists

New halogen atom substituted 2,3-benzodiazepine derivatives condensed with an azole ring on the seven membered part of the ring system of type 3 and 4 as well as 5 and 6 were synthesized. It was found that chloro-, dichloro- and bromo-substitutions in the benzene ring and additionally imidazole ring condensation on the diazepine ring can successfully substitute the methylenedioxy group in the well known molecules GYKI 52466 (1) and GYKI 53773 (2) and the 3-acetyl-4-methyl structural feature in 2, respectively, preserving the highly active AMPA antagonist characteristic of the original molecules. From the most active compounds (3b,i) 3b (GYKI 47261) was chosen for detailed investigations. 3b revealed an excellent, broad spectrum anticonvulsant activity against seizures evoked by electroshock and different chemoconvulsive agents indicating a possible antiepileptic efficacy. 3b was found to be highly active in a transient model of focal ischemia predictive of a therapeutic value in human stroke. 3b also reversed the dopamine depleting effect of MPTP and antagonized the oxotremorine induced tremor in mice indicating a potential antiparkinson activity.

Platelet eicosanoids and the effect of captopril in blood pressure regulation

We investigated the eicosanoid synthesis of platelets of Wistar and of Okamoto spontaneously hypertensive rats (SHR), and the effect of captopril in vitro, using [14C]arachidonic acid as a tracer substrate and chromatographic determination. Lipoxygenase activity was elevated, while the formation of cyclooxygenase products was reduced in SHR platelets, compared to those of Wistar rats. This difference might play a role in the pathomechanism of hypertension in SHR. In SHR with lower blood pressure, captopril reduced thromboxane synthesis, while in SHR with higher blood pressure thromboxane synthesis was unchanged, but the synthesis of prostaglandin D2, a potent vasodilator, and of 12-L-hydroxy-5,8,10-heptadecatrienoic acid, a stimulator of endothelial prostacyclin formation, was increased. We may conclude that, in spite of the missing angiotensin converting enzyme in platelets, a direct effect on platelet eicosanoid synthesis could contribute to the blood pressure decreasing effect of captopril.

[Comparative analysis of diagnoses by the referring family physician and the hospital admission committee in ambulatory patients at an internal medicine department]

The objectives of the present study were, as follows: 1. To what rate do the primary care doctors refer their patients to the regional internal medicine emergency department? 2. What sort of problems are the reasons of the referring? 3. To what extent are the opinions of the referring doctors confirmed or reviewed by the specialists? 4. What rate of the referred patients are admitted or discharged after the urgent consultations and-or interventions. 5. What kind of additional tests were used by the institutional caregivers in order to make accurate diagnoses? 6. What was the fate of the unaccepted patients? Data were collected in the patient document archive of the First Dept. of Medicine of the Albert Szent-Györgyi Medical University, Szeged, Hungary. Each patients' referring notes and inpatient charts between September 15th, 1995 and January 15th, 1996 were studied in a retrospective way. Upon the results of the study, it was concluded, as follows: The primary care doctors referred their patients with right orientation diagnosis to the emergency department in 70% of the cases. 45.8% of the referred pts. were admitted to the internal inpatient ward. The agreement of the referring and discharge diagnoses was greater (85.7%) among the admitted patients as compared to the unaccepted ones (56.8%). 14% of the referred pts. were referred to other specialists by the internists. On the basis of the results the actual messages of the study for an under- and postgraduate medical teaching group, and for the health care politicians are discussed in the paper.

[Effect of cilazapril in patients with essential hypertension: effect on cardiac hypertrophy]

Numerous antihypertensive drugs exist with different modes of action, which have a really effective impact on hypertension. The life expectancy of hypertensive patients is known to depend on the degree of damage caused to their target organs by the hypertension itself. Cardiovascular hypertrophy and its complications are considered to be among the major elements of this process. This work evaluates the effectiveness of the long-term treatment of essential hypertensive subjects (n = 10) with a long-acting ACE-inhibitor, cilazapril, as concerns their blood pressure and cardiac hypertrophy. Cilazapril given orally in a daily dose of 2.5 mg effectively lowered both the systolic (delta 30 mm Hg) and the diastolic (delta 19 mm Hg) blood pressure. No changes were found in body weight or heart rate, and only one side-effects (skin rash) was reported. Cilazapril considerably decreased the left ventricular mass and hence the hypertrophic index of hypertensive patients with cardiac hypertrophy, suggesting that ACE inhibitors are effective not only in lowering blood pressure and decreasing hypertrophy, but also in lowering the cardiac morbidity and mortality.

Proteinuria in the bovine serum albumin loaded rats is aggravated by genetically determined hypertension

The effects of bovine serum albumin (BSA) loading on urinary protein excretion rate (PU) were investigated in spontaneously hypertensive (Okamoto) and normotensive Wistar-Kyoto and Wistar rats. Baseline PU was greater in spontaneously hypertensive rats of both sexes than in the corresponding normotensive groups. Male rats excreted more protein than females. A significant direct correlation could be demonstrated between blood pressure and PU induced by BSA. Glomerular epithelial cell foot process fusion rate was significantly greater in female spontaneously hypertensive rats than in all other groups and correlated with PU increase, especially in female spontaneously hypertensive rats. This study therefore indicates that hypertension which is acquired independently of the glomerular lesion induced by BSA administration accentuates proteinuria in this model of disease.

[Secondary membranous glomerulonephritis]

Following 689 percutaneous renal biopsies, membranous glomerulonephritis was proved in 68 patients. In 16 (23.5%) an underlying primary disease was verified, and thus the glomerulonephritis the secondary form. The primary disease was SLE in 5 cases, diabetes mellitus in 5 cases, rheumatoid arthritis in 3 cases, chronic active hepatitis in 2 cases, an ulcerative colitis and eosinophilic angiolymphoid hyperplasia in 1 patient. As initial sign, nephrotic syndrome emerged in 87.5% of the 16 cases. Microscopic haematuria was observed in half of the patients, as was hypertension, while acute renal failure presented in only 1 case. Histologically, in 13 cases the predominance of early glomerular alterations was characteristic, while in 9 cases the picture proved to be equivocal and accompanied by some degree of interstitial alterations. During combined treatment, remission was achieved in 75%. Two patients with SLE died, but not as a consequence of renal failure. Transient side-effects of the treatment were registered in 5 cases. The principal pathogenetic and clinical differences between the individual secondary nephritis forms, and the difficulty of their differentiation from the idiopathic cases, even on repeated examination, are emphasized. In 3 patients the possibility of secondary renal processes was suggested by the histological picture, and this was proved by the detailed clinical findings.

[The effect of chronic alcohol consumption on blood pressure]

In 1984, a hypertension screening programme was carried out on 13,772 adult subjects in conjunction with a radiological tuberculosis project in the Hungarian town of Csongrád. Among other factors, the effects of a long-lasting and heavy alcohol intake on blood pressure levels were investigated. 21.4% of the men and 2.3% of women admitted to being regular alcohol consumers. Direct and significant relationships were found between the quantity of alcohol consumed and both the systolic (p less than 0.001) and diastolic (p less than 0.05) blood pressures. The prevalence of hypertension (WHO criteria) was higher in heavy drinkers (29.9%) than in abstinent subjects (20.5%, p less than 0.001). When participants were subgrouped according to age groups only the men provided sufficient data. The systolic blood pressure of heavy drinkers was elevated as compared with that of non-drinkers.

Effects of nephrectomy on hypertension, renin activity and total renal function in patients with chronic renal artery occlusion

Eight hypertensive patients (5 men and 3 women, aged between 31 and 64 years) with chronic total occlusion of one renal artery were observed for the past ten years. The peripheral plasma renin activity (PRA) and the renal vein PRA ratio (mean 3.18) were abnormally high in all cases. Because of the small size of the affected kidney (less than 9 cm in length), nephrectomy was the chosen treatment. Postoperative investigations revealed decreases in blood pressure (from 202/118 to 147/93 mmHg), peripheral PRA (from 6.05 to 1.05 ng/ml/h; P less than 0.001), serum creatinine (from 188.8 to 145.1 mumol/100 ml) urine volume (from 1937.5 to 1214.3 ml) and increases in endogenous creatinine clearance (from 36.57 to 53.0 ml/min). The results suggest that, apart from the decrease in blood pressure, the nephrectomy led to the disappearance of a factor which depresses the renal function in cases of chronic renal artery occlusion and which may be related to the renin-angiotensin system.

[Pheochromocytoma in Recklinghausen neurofibromatosis]

The authors describe the case of a 38-year-old hypertensive woman who suffered from neurofibromatosis, pheochromocytoma, scoliosis and diabetes mellitus. Because of the residual pheochromocytoma surgical intervention was repeated. According to the available literature this is the first case in Hungary where pheochromocytoma was associated with neurofibromatosis.

Hypertension screening in a Hungarian town

In conjunction with a radiological tuberculosis project, a hypertension screening programme was carried out in 1984 on 13,772 people (74% of the eligible adult population) in the Hungarian town of Csongrád. In the younger age groups the blood pressure was found to be higher amongst men, whilst in older groups the women had higher blood pressures. By the WHO criteria, systolic hypertension was detected in one-third of the population and diastolic hypertension in one-sixth. Of the hypertensive patients detected, 34% were previously unaware of their diagnosis. The prevalence of hypertension was elevated particularly amongst obese persons and in the sub-group of physical (blue collar) workers aged over 60 years. There was a significant correlation between alcohol consumption and both systolic and diastolic blood pressures. Hypertension was found in 29.9% of heavy drinkers but in only 20.5% of moderate drinkers or total abstainers.