Clinical and experimental hypertension : CHE
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Clin. Exp. Hypertens. · May 1999
ReviewThe consequences of traumatic brain injury on cerebral blood flow and autoregulation: a review.
In this decade, the brain argueably stands as one of the most exciting and challenging organs to study. Exciting in as far as that it remains an area of research vastly unknown and challenging due to the very nature of its anatomical design: the skull provides a formidable barrier and direct observations of intraparenchymal function in vivo are impractical. ⋯ The present review will focus on alterations in the cerebrovasculature following TBI, and more specifically on changes in cerebral blood flow (CBF), mediators of CBF including local chemical mediators such as K+, pH and adenosine, endothelial mediators such as nitric oxide and neurogenic mediators such as catecholamines, as well as pressure autoregulation. It is emphasized that further research into these mechanisms may help attenuate the prevalence of secondary insults and therefore improve outcome following TBI.
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Dopamine is frequently administered in the ICU to critically-ill patients. The widespread use of dopamine does not only involve states of distributive and cardiogenic (imminent) shock, but also prophylaxis for deterioration and/or improvement of kidney- and bowel perfusion. ⋯ Furthermore, evidence exists that norepinephrine is more efficacious in fluid resuscitated septic shock patients to restore blood pressure than dopamine, without jeopardizing the renal function. It is concluded that the widespread use of dopamine in the ICU should be reassessed.
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Several large intervention trials in hypertension have shown that treated hypertensive patients are at increased risk of cardiovascular morbidity and mortality in spite of being treated. One possible explanation for this is the fact that the treated blood pressure rarely if ever is brought down to strictly normotensive levels. ⋯ Two prospective intervention trials have addressed this problem, the BBB Study, which has been published, and the much larger HOT Study which is still ongoing. Some of the findings in these two trials will be discussed with an emphasis on giving an up-date of the HOT Study.
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Clin. Exp. Hypertens. · Apr 1996
ReviewAmbulatory blood pressure, blood pressure variability and antihypertensive treatment.
Ambulatory blood pressure monitoring is frequently employed in the clinical practice to improve the diagnosis of hypertension and the appropriateness of the decision regarding initiation of antihypertensive treatment. It is also frequently employed to check the efficacy of this treatment in conditions resembling daily life. ⋯ It will then discuss the advantages of ambulatory blood pressure in studies of efficacy of antihypertensive drugs and the importance of this approach for definition of the trough-to-peak ratio of the antihypertensive effect. Some technical and clinical problems inherent to the ambulatory blood pressure monitoring approach will also be discussed.
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Clin. Exp. Hypertens. · Nov 1993
ReviewEarly detection of subclinical atherosclerosis in asymptomatic subjects at high risk for cardiovascular disease.
Subclinical atherosclerosis can be non-invasively detected via calcifications, thickening and stiffening of arteries. Coronary calcifications seen with ultrafast computed tomography are frequent in hypertension or hypercholesterolemia and synonymous of coronary atherosis but not of coronary stenosis. Wall thickening detectable by extracoronary ultrasonography may be characterized by an intimamedia thickening shown in hypertension or by a focalized plaque whose the presence in the aortic or femoral level seem influenced by systolic pressure. ⋯ Wall stiffening, which reflects sclerosis, is detected by pulse wave velocity. Its increase in hypertension may be an indicator of atherosclerosis and can be reversed by certain antihypertensive agents. Clinical care of at risk individuals might profit from subclinical atherosclerosis which adds objectivity and sensitivity in the individualization of risk and the decision to treat.