Stephan Lüders | Georg-August-Universität Göttingen (original) (raw)
Papers by Stephan Lüders
Deutsche medizinische Wochenschrift, 2016
Clinical Research in Cardiology, 2019
Objective Activation of the sympathetic nervous system increases sodium retention in resistant hy... more Objective Activation of the sympathetic nervous system increases sodium retention in resistant hypertension. Baroreflex activation therapy (BAT) is an interventional method to reduce sympathetic overactivity in patients with resistant hypertension. This study aimed to assess the effect of BAT on urinary sodium excretion. Methods From 2012 to 2015, consecutive patients with resistant hypertension and blood pressure (BP) above target despite polypharmacy strategies were consecutively included in this observational study. BAT was provided with the individual adaption of programmed parameters over the first months. 24-h urinary sodium excretion (UNa) was estimated at baseline and after 6 months using the Kawasaki formula in patients undergoing BAT. Additionally, the fractional sodium excretion, plasma renin activity, and aldosterone levels were assessed. Results Forty-two patients completed the 6-month follow-up period. Office systolic and ambulatory 24-h systolic BP at baseline were 169 ± 27 mmHg and 148 ± 16 mmHg despite a median intake of 7(3-9) antihypertensive drugs. After 6 months of BAT, systolic office BP decreased to 150 ± 29 mmHg (p < 0.01), 24-h systolic BP to 142 ± 22 mmHg (p = 0.04) and 24-h UNa increased by 37% compared to baseline (128 ± 66 vs. 155 ± 83 mmol/day, p < 0.01). These findings were accompanied by a significant increase in fractional sodium excretion (0.74% [0.43-1.47] to 0.92% [0.61-1.92]; p = 0.02). However, in contrast to the significant BP reduction, eGFR, plasma sodium, renin activity and aldosterone levels did not change during BAT. The increase in sodium excretion was correlated with the change in eGFR (r = 0.371; p = 0.015). Conclusion The present study revealed a significant increase of estimated 24-h UNa which may contribute to the long-term BP-lowering effects of this interventional method.
MMW Fortschritte der Medizin, Jan 26, 2001
Kidney International, 1995
Effects of endothelin on hemodynamics, prostaglandins, blood coagulation and renal function. The ... more Effects of endothelin on hemodynamics, prostaglandins, blood coagulation and renal function. The interaction of the endogenous vasoconstrictors endothelin (ET), angiotensin II (Ang II) and catecholamines with the kallikrein-kinin-, prostaglandin and renin-aldosterone systems in the pathogenesis of acute renal failure (ARF) is still to be defined. In 18 anesthesized pigs the influence of i.v. bolus applications of ET (2 pg/kg), Ang 11(10 igfkg) and norepinephrine (NE; 20 jig/kg) on hemodynamics, plasmatic coagulation and fibrinolysis system, prostaglandins and renal function was studied. ET induced a biphasic change in blood pressure, starting with an initial short-lasting reduction followed by a long-lasting elevation of systolic and diastolic blood pressure. Endothelin bolus resulted in a significant increase of 6-keto-PGF1a, PGEZ and TXB2 plasma levels (P < 0.05 against preinjection values), whereas prostaglandins remained unchanged in the Ang II and NE groups. There was a distinct correlation between the plasma ET and 6-keto-PGF1a levels (r = 0.82). In contrast to Ang II or NE, ET induced a shortening of the activated partial thromboplastin time (aPTI) and increase of antithrombin III levels (ATIII), fibrin monomers (FM), prekallikrein (PKK) and factor VIII activity at the beginning. Finally a pronounced decrease of ATIII, FM and PKK occurred, indicating a consumptive coagulopathy. At the end of the experiment, elevated plasma renin activity and pCO2, significantly decreased creatinine clearance, blood pH, P°2, base excess, HC03, oxygen saturation (P < 0.01), a distinct glomerular proteinuria, and a final anuria were observated. These results reveal that ET activates the plasmatic coagulation system and induces an ARF accompanied by impairment of pulmonary function. Its coagulation activating and renal vasoconstrictive effects may be important pathophysiological factors, especially when the counteractive release of vasodilatatory and antiaggregatory prostacyclin or NO is impaired. There is evidence that the endothelium is a highly active endocrine organ system playing an important role in the pathogenesis of renal disease because of its strategic anatomical position between the circulating blood and vascular smooth muscle, juxtaglomerular and mesangial cells. In addition to the relaxing factors prostacyclin and NO (nitric oxide), the endothelium synthesizes and releases vasoconstrictive substances, including products derived from arachidonic acid metabolism and the recently discovered peptide endothelin. The endothelin (ET) family consists of three structurally and pharmacologically separate isopeptides [1]. Endothelin-1 is a 21-amino acid peptide arising by proteolytic processing of specific prohor
Journal of the American College of Cardiology, 1993
O~jeetives. The present study was designed to test the hypothesis that the direct thmmbin inhibit... more O~jeetives. The present study was designed to test the hypothesis that the direct thmmbin inhibitor hbxdin is mc~re efficient than beparln in reducing tkrmnhus Formation r&r coronary stenting. Background. Despite aggressive anticoagulatirr~. r&ztl;:e thrombosis of coronary stents is a major mmpticatton associated with these new devices. M&hods. In 19 minipigs indium-lll-tabeled thmmhwyies and ioditw1254abeled Ilbrinogen were injected 14 tn 19 It before commwy implantation of tantalum h&on-expnndable sttents. In group 1 (n = 6, seven rtents), a b&s of hsparin (100 U/kg body wefght) was given before stenting. Group 2 (II = 6. 11 stenls) nnived holh d&ran (500 ml) and hsparin ta 1MUikg bolus followed by P continuous infusion of SO U/kg per h). Ia group 3 [n = 7,J3 statts), birudln (remmbinant desalphatoldrudin HV 1 [CGP 393931 [I mgikg]) was given before stat Implantation, followed by cm lnfuslon of 1 m#kg per h. AU animals were txetreated with aspirin (250 mg intravenmtsly). rtonts in group 3. The aumber of pl*telets on 1 s&e& averz@ 116.2 (range 22 to 5221 x lo" iagrmtp 1,643 (e I1 tn 169) x lo6 in group 2 and 19.7 (range 9 to 38) X l@ in group 3 (p < LX@% vs. grouy 1 and KS. group 2). T&e increase in #&et awxiat?d with medial tear in all gmups, WPS Law& ia group. Simttarty, &&I depositiw was twvst en steats treated animals. reduction achieved with cmnblwd kelrzxin, dext%%n & (J Aa Cdl Canlid 1993,21:2&54) Percutaneous transluminal coronary angioplasty is increasingly applied as the primary revascttlarization procedure in patients with obstructive coronary artery disease (I,Z). However. two major problems limit its immediate and longterm success. Abnrpt coronary occlusion occurs in 2% to II% of patients (3.4) and restenosis of successfully dilated lesions is observed in 20% to 40% of patients (5.61. lntracoronary stents have been suggested as a means to manage both acute occlusion, by pressing obstructive intimal tears to the vessel wall (7). and restenosis, by creating a large smooth-eontourcd lumen, preventing elastic recoil and providing enough space for a reparative vessel response nor restthing in significant lumen obstruction (8.9). Fmm the Departments 01 Cardiology, Nuclear Medicine. Exprrimtnlti AniaUl Research and Nephrology. University Clmic. Cirningen. Germany. This work was supperred by a &znt rrflron Deursche Forschun~~semeinrchaR. SFB 3343. GWngcn. Germany. This work ccmtains part of the Habiiitalian-s_xhrift of Dr. Buchwald. Manuwipl r&vcdJaruary 13. 19% revised manuscript received June 22, 1992. acceplcd June 23. 1592.-[or Amd B. Buchwald. MD, Department of Cardiolagy~Universily Clinic. RoberiXochSkasse 40. WI Gallingen. Gcr.
European Journal of Cardiovascular Prevention & Rehabilitation, 2009
We aimed to assess whether hypertension management with a structured physician information progra... more We aimed to assess whether hypertension management with a structured physician information program and a feedback system leads to improved blood pressure (BP) control and cardiovascular outcomes. Cluster randomized (3 : 1), open, monitored, multicenter trial in Germany. Primary care-based physicians in the information group (IG) received detailed training on hypertension guidelines, feedback on target-level attainment, and a reminder to intensify treatment after each patient visit, whereas the observation/control group (CG) did not receive any such measures. A three-level mixed model was developed. Time-independent level differences between groups, group-independent changes, and nonparallel group-specific changes over time were tested. A total of 15 041 (78.1%) hypertensive patients were in the IG and 4213 (21.9%) in the CG. By 1-year follow-up, 82.9% of patients in the IG and 81.5% in the CG remained in the study. The guideline-oriented BP target was attained by 56.8% in the IG and 52.5% in the CG (+4.3%, P = 0.03), whereas the individual BP target was attained by 57.0% in the IG and 51% in the CG (P = NS). BP control in the IG was achieved 2 months earlier on average. Clinical inertia, defined as the absence of medication changes, despite noncontrol of BP, occurred significantly less often in the IG group. One-year cardiovascular outcomes did not differ between groups. The delivery of systematic information in connection with a feedback system reduces clinical inertia and improves guideline adherence. Although compared with earlier studies, the hypertension control rates obtained are higher, there is still considerable room for improvement.
MMW Fortschritte der Medizin, Jan 22, 1999
The Journal of Clinical Hypertension
Central European Journal of Public Health, 2021
OBJECTIVES The ELITE study (German acronym for "Nutrition, lifestyle and individual informat... more OBJECTIVES The ELITE study (German acronym for "Nutrition, lifestyle and individual information for prevention of heart attack, stroke and dementia") prospectively collects data on hypertension, cardiovascular risk factors (RF), dietary habits, physical activity, cognitive function, and quality of life in North-West Germany, which will then be improved through targeted individual information. The aim of the study is to improve the health of the participants in the long term and to identify reasons for a lack of implementation of prevention measures. METHODS Of 4,602 included subjects, 3,868 could be studied so far at one-year follow-up. Blood pressure (BP) was measured according to the guidelines at admission and blood pressure history, premedication, sports behaviour and BMI were recorded by means of questionnaires and compared with the data collected in the follow-up examination after one year. RESULTS The participants were evaluated in 4 groups (G): G1 - normotensive patients (n = 1,558), G2 - controlled hypertensive patients (n = 502), G3 - untreated uncontrolled hypertensive patients (n = 1,080), G4 - treated uncontrolled hypertensive patients (n = 728). In G1 blood pressure (RR) remained unchanged from 126.3/77.8 to 127.8/78.5, in G2 there was a significant (p < 0.001) RR increase from 128.1/77.0 to 134.9/79.8. In G3 and G4 RR decreased significantly (p < 0.001) from 149.9/90.0 to 143.5/86.9 and from 153.1/87.5 to 146.2 84.1 mmHg, respectively. In G3 and G4, RR decreased in 56.1% and 56.3% of subjects and increased in 18% and 21%, respectively. In contrast, RR increase was found more frequently in G1 and G2 (34.3% and 51%, respectively), and RR decrease less frequently (25.4 and 20.7%, respectively). The main reasons for RR decrease were weight loss, more exercise, and more antihypertensives. Frequently, improved compliance and dietary changes were given as reasons. As expected, the opposite often led to RR increase. CONCLUSION 56% of the hypertensive participants succeeded in lowering their blood pressure, whereas there was a significant increase in blood pressure, especially in those who were well controlled with antihypertensives. This underlines the need to further motivate normotensive patients to maintain their normotension. The results show that the combination of individual written education and lifestyle interventions are an effective tool for the public health sector to combat hypertension. In our participants, lifestyle interventions have a significant impact on BP change. It should be noted critically that there are still too many patients who have not been reached.
BMJ, 2002
The Heart Outcomes Prevention Evaluation study (HOPE), has shown beneficial effects of the angiot... more The Heart Outcomes Prevention Evaluation study (HOPE), has shown beneficial effects of the angiotensin converting enzyme inhibitor ramipril on cardiovascular events and disease progression.1 In this issue the investigators describe the results of preventing stroke (p 699).2 The findings clearly show that ramipril substantially decreased the risk of stroke and transient ischaemic attacks in 9297 patients with high cardiovascular risk. A 32% relative risk reduction was found, while the reduction in blood pressure was only 3.8 mm Hg (systolic) and 2.8 mm Hg (diastolic). This benefit was greater than expected from prior meta-analyses of epidemiological studies or trials in hypertension studies. The results have important implications for the primary and secondary prevention of stroke. Firstly, it must be emphasised that hypertension is still the most important risk factor for stroke, as shown in all studies on hypertension in recent decades,3 and more recently in the PROGRESS study, in ...
MMW - Fortschritte der Medizin, 2010
In Zusammenarbeit mit der Bayerischen Landesärztekammer Direkt online teilnehmen unter www. cme-p... more In Zusammenarbeit mit der Bayerischen Landesärztekammer Direkt online teilnehmen unter www. cme-punkt. de cme der mmw EKG und Blutdruckmessung sind essenzielle Bausteine der Risikobewertung.
DMW - Deutsche Medizinische Wochenschrift, 2019
ZusammenfassungDer erhöhte Blutdruck (arterielle Hypertonie) ist eine der häufigsten chronischen ... more ZusammenfassungDer erhöhte Blutdruck (arterielle Hypertonie) ist eine der häufigsten chronischen Erkrankungen und der Hauptrisikofaktor für die Entstehung von Herz-Kreislauf-Erkrankungen. Die in der Praxis/Klinik gängige Blutdruckmessung hat unter standardisierten Bedingungen zu erfolgen. Ansonsten ist eine Fehleinschätzung der tatsächlichen Blutdruckhöhe mit konsekutiv sowohl schlechter Blutdruckkontrolle als auch Fehldiagnosen die Folge. Der Umsetzung/Einhaltung dieser Standards in der täglichen Routine durch einen geschulten Untersucher kommt hierbei die entscheidende Rolle für eine akkurate und zuverlässige Blutdruckmessung zu. Neben der rein technischen/standardisierten Durchführung ist jedoch auch zu beachten, dass viele im Handel erhältliche Blutdruckmessgeräte den Blutdruck nicht genau messen. Daher ist weiterhin auf die Verwendung von validierten Blutdruckmessgeräten (z. B. Prüfsiegel der DHL®) zu achten. Neben der Ruheblutdruckmessung in der Praxis und Klinik erlauben ambu...
CardioVasc, 2016
Troponinerhöhung heißt nicht immer Infarkt 9 TAVI-Nachsorge: Worauf man achten sollte 10 "Verdick... more Troponinerhöhung heißt nicht immer Infarkt 9 TAVI-Nachsorge: Worauf man achten sollte 10 "Verdicktes" Herz: Sportler oder Patient? Gründungssymposium des Universitären Herzzentrums Lübeck 12 Genetik und koronare Herzerkrankung-"anfänglich etwas überschätzt"
Public Health, 2006
Cardiovascular disease is the major cause of morbidity and mortality in people with diabetes. The... more Cardiovascular disease is the major cause of morbidity and mortality in people with diabetes. The management of cardiovascular risk factors in people with diabetes in primary care was compared with National Institute of Clinical Excellence guidelines. Design: A cross-sectional study in 26 general practices, with a combined list size of 256,188 patients, participating in the Kent, Surrey and Sussex Primary Care Research Network. Primary outcomes were process of care measures. Methods: Analysis of general practice computer data on the management of 5980 patients with diabetes, of whom 86% were aged 45 years and over. Results: The prevalence of diabetes was 2.0% in women and 2.6% in men, much lower than the estimated expected prevalence of 4.8% for women and 3.3% in men. Blood pressure was well recorded (96% in both sexes), cholesterol levels less well (79% of women, 84% of men). Hypertension (78% of women, 72% of men) was common. Twentyone percent of women and 16% of men had a blood pressure above 160/100 mmHg, suggesting under use of antihypertensive therapy. Cholesterol levels were R5 mmol/l in 46% of women and 38% of men. Lipid-lowering drugs were prescribed in 38% of women and men. Aspirin was prescribed in 38% of women and 40% of men. Conclusions: There is an under-diagnosis of diabetes and an under-treatment of blood pressure and blood cholesterol, more marked in women than in men. There is
Der Kardiologe, 2013
ABSTRACT Die ambulante 24-h-Blutdruckmessung (ABDM) ist ein unverzichtbarer Pfeiler in der Hypert... more ABSTRACT Die ambulante 24-h-Blutdruckmessung (ABDM) ist ein unverzichtbarer Pfeiler in der Hypertoniediagnostik und Therapieüberwachung. Es besteht kein Zweifel, dass die ABDM entscheidend dazu beiträgt, eine Unter- bzw. Überschätzung (Praxisnormotonie/Praxishypertonie) des Blutdruckniveaus zu vermeiden. Dies gilt auch für Kinder und Jugendliche, bei denen bis zu 20% Hypertoniker trotz Selbst- und Praxisblutdruckmessung übersehen werden würden. Mit der ABDM ist auch die Beurteilung des nächtlichen Blutdruckverhaltens möglich. Der diagnostische und prognostische Wert der ABDM als nichtinvasives Verfahren zur Blutdruckmessung ist abgesichert. Voraussetzungen sind neben der Benutzung eines validierten Systems (z. B. International Protocol 2 der European Society of Hypertension [ESH] oder Prüfsiegel der Deutschen Hochdruckliga [DHL]) die richtige Indikationsstellung, eine ordnungsgemäße Programmierung und Durchführung der Messung sowie die korrekte Klassifikation des Blutdruckniveaus nach DHL-Kriterien. Die Einteilung des Blutdruckniveaus erfolgt in die 6 Klassen „optimal“ bis „Hypertonie Schweregrad 3“. Es erscheint sinnvoll, diese Analogwerte für die individuelle kardiovaskuläre Risikostratifizierung zu benutzen, da sich das kardiovaskuläre Risiko mit steigenden ABDM-Werten erhöht und die ABDM das kardiovaskuläre Risiko deutlich besser abbildet als die Praxisblutdruckmessung. Neben der computertechnischen Auswertung ist eine schriftliche Beurteilung der Blutdruckwerte und des Blutdruckprofils mit Feststellung des Schweregrads durch den untersuchenden Arzt obligat. An computergenerierten standardisierten Befundberichten mittels entsprechender Software wird derzeit von mehreren Fachgesellschaften und Herstellern gearbeitet. Wünschenswert wäre die Darstellung aller wichtigen Parameter und einer graphischen Darstellung auf einer Seite.
DMW - Deutsche Medizinische Wochenschrift, 2015
Dementielle Erkrankungen sind eine zunehmende Belastung für das Gesundheitssystem. Da es bislang ... more Dementielle Erkrankungen sind eine zunehmende Belastung für das Gesundheitssystem. Da es bislang keine effektive Therapie gibt, ist die Primärpravention von herausragender Bedeutung. Zu den gesicherten Risikofaktoren für vaskuläre Demenzen, und vermutlich auch für Alzheimer, gehört die arterielle Hypertonie. Eine rechtzeitige medikamentöse antihypertensive Therapie kann kognitive Funktionseinbußen zumindest verlangsamen und eine Demenz hinauszögern. Definitionen Leichte kognitive Störungen (ICD-10 F06.7) [1]| Bei Weitem nicht alle kognitiven Einschränkungen sind mit einer Demenz gleichzusetzen [2]. Im Gegensatz zur Demenz beeinträchtigen leichte kognitive Störungen den Alltag der Patienten nicht oder nur in geringem Maß. Sie können allerdings ein Vorstadium einer Demenzerkrankung sein. Demenz (ICD-10 F00-F03) [1] | Laut ICD-10-GM Version 2015 ist eine Demenz "ein Syndrom als Folge einer meist chronischen oder fortschreitenden Krankheit des Gehirns" [1]. Bei einer Demenz sind viele höhere kortikale Funktionen gestört, das Bewusstsein ist jedoch nicht getrübt. Begleitet werden die kognitiven Beeinträchtigungen gewöhnlich von Veränderungen der emotionalen Kontrolle, des Sozialverhaltens oder der Motivation. Diese Symptome können auch früher eintreten. Der Begriff Demenz beschreibt eine hetero gene Gruppe von Erkrankungen unterschiedli cher pathophysiologischer Mechanismen mit dem Leitsymptom "kognitive Störung" [3].
<b>Copyright information:</b>Taken from "First-line antihypertensive treatment i... more <b>Copyright information:</b>Taken from "First-line antihypertensive treatment in patients with pre-diabetes: Rationale, design and baseline results of the ADaPT investigation"http://www.cardiab.com/content/7/1/22Cardiovascular Diabetology 2008;7():22-22.Published online 24 Jul 2008PMCID:PMC2529270.
Reviews in Cardiovascular Medicine, 2021
A43 was to assess the association of the depression as a risk factor for coronary heart disease (... more A43 was to assess the association of the depression as a risk factor for coronary heart disease (CHD) based on prospective studies included in published systematic reviews. Methods: A systematic review to identify systematic reviews was conducted in MEDLINE, Cochrane library and Embase databases, with no limit on the start date until December 2015, using keywords for depression, coronary events and risk factors. The selection of the reviews that included prospective studies was realized by two researchers independently; primary data from prospective studies analyzing the relationship of depression and CHD were extracted. The Hazard Ratios (HRs) were pooled using random effects model. The subgroup analysis was carried out considering fatal CHD, myocardial infarction, gender, and follow-up duration. Results: It was selected twenty one systematic reviews comprising thirty five prospective studies that were extracted. The number of people included in the studies was 900,226. The main differences among the studies were the age, gender, measurement of depression, length of follow-up and CHD fatality. The meta-analysis found that the depression behavior is a risk factor for CHD, although the heterogeneity is substantial. The analysis by subgroup found low heterogeneity for myocardial infarction and fatal CHD. The analysis suggested that depression increases the risk for fatal CHD AND myocardial infarction (HR 1.13 95%CI: 1.06-1.20 and HR 1.29 95%CI: 1.19-1.39, respectively). In the subgroup analysis by length of follow-up, the HR of CHD was 1.24 (95%CI 1.01-1.47) for the studies with less than 15 years of follow-up and 1.18 (95%CI 1.12-1.24) for those with more than 15 years of followup. ConClusions: The results of meta-analysis suggest that depression increases the risk of CHD significantly, although the evidence has substantial heterogeneity. PCV24 CardioVasCular risks of ExogEnous TEsTosTEronE usE among mEn: a sysTEmaTiC rEViEw and mETa-analysis
American Journal of Hypertension, 2002
The aim of the study was to investigate whether the calcium channel blocker amlodipine (5 mg/d) w... more The aim of the study was to investigate whether the calcium channel blocker amlodipine (5 mg/d) was able to restore the non-dipping 24-hour blood pressure profile in hypertensive patients after morning versus evening dosing. The study was performed in double-blind, placebo-controlled crossover, multinational design in 36 patients (17 study center Cloppenburg; 19 study center Ferrara). Blood pressure (BP) and heart rate (HR) were monitored by ambulatory blood pressure monitoring (ABPM; SpaceLabs SL 90207) before and after each of the 3-weeks treatment periods with placebo/amlodipine dosing randomly at 08:00h or at 20:00h. ABPM data was analyzed by the ABPM-FIT program [Zuther P, et al. Blood Press Monit 1 : 347-354, 1999]. In the Table means ϮSEM of day (07:00-22:59h) and night values in systolic and diastolic BPs (mmHg) are shown before and after amlodipine dosing in the morning or in the evening. Both dosing times equally and significantly (Friedman test, *pϽ0.001) reduced BP (24h-mean, dayand night-mean) and resulted in a nightly fall in BP leaving HR unaffected (not shown). The results of this cross-over demonstrate that a single dose of amlodipine, independently from dosing time, significantly reduced BP in non-dipping hypertensive patients and transformed the non-dipping 24-hour BP profile into a dipping one.
Deutsche medizinische Wochenschrift, 2016
Clinical Research in Cardiology, 2019
Objective Activation of the sympathetic nervous system increases sodium retention in resistant hy... more Objective Activation of the sympathetic nervous system increases sodium retention in resistant hypertension. Baroreflex activation therapy (BAT) is an interventional method to reduce sympathetic overactivity in patients with resistant hypertension. This study aimed to assess the effect of BAT on urinary sodium excretion. Methods From 2012 to 2015, consecutive patients with resistant hypertension and blood pressure (BP) above target despite polypharmacy strategies were consecutively included in this observational study. BAT was provided with the individual adaption of programmed parameters over the first months. 24-h urinary sodium excretion (UNa) was estimated at baseline and after 6 months using the Kawasaki formula in patients undergoing BAT. Additionally, the fractional sodium excretion, plasma renin activity, and aldosterone levels were assessed. Results Forty-two patients completed the 6-month follow-up period. Office systolic and ambulatory 24-h systolic BP at baseline were 169 ± 27 mmHg and 148 ± 16 mmHg despite a median intake of 7(3-9) antihypertensive drugs. After 6 months of BAT, systolic office BP decreased to 150 ± 29 mmHg (p < 0.01), 24-h systolic BP to 142 ± 22 mmHg (p = 0.04) and 24-h UNa increased by 37% compared to baseline (128 ± 66 vs. 155 ± 83 mmol/day, p < 0.01). These findings were accompanied by a significant increase in fractional sodium excretion (0.74% [0.43-1.47] to 0.92% [0.61-1.92]; p = 0.02). However, in contrast to the significant BP reduction, eGFR, plasma sodium, renin activity and aldosterone levels did not change during BAT. The increase in sodium excretion was correlated with the change in eGFR (r = 0.371; p = 0.015). Conclusion The present study revealed a significant increase of estimated 24-h UNa which may contribute to the long-term BP-lowering effects of this interventional method.
MMW Fortschritte der Medizin, Jan 26, 2001
Kidney International, 1995
Effects of endothelin on hemodynamics, prostaglandins, blood coagulation and renal function. The ... more Effects of endothelin on hemodynamics, prostaglandins, blood coagulation and renal function. The interaction of the endogenous vasoconstrictors endothelin (ET), angiotensin II (Ang II) and catecholamines with the kallikrein-kinin-, prostaglandin and renin-aldosterone systems in the pathogenesis of acute renal failure (ARF) is still to be defined. In 18 anesthesized pigs the influence of i.v. bolus applications of ET (2 pg/kg), Ang 11(10 igfkg) and norepinephrine (NE; 20 jig/kg) on hemodynamics, plasmatic coagulation and fibrinolysis system, prostaglandins and renal function was studied. ET induced a biphasic change in blood pressure, starting with an initial short-lasting reduction followed by a long-lasting elevation of systolic and diastolic blood pressure. Endothelin bolus resulted in a significant increase of 6-keto-PGF1a, PGEZ and TXB2 plasma levels (P < 0.05 against preinjection values), whereas prostaglandins remained unchanged in the Ang II and NE groups. There was a distinct correlation between the plasma ET and 6-keto-PGF1a levels (r = 0.82). In contrast to Ang II or NE, ET induced a shortening of the activated partial thromboplastin time (aPTI) and increase of antithrombin III levels (ATIII), fibrin monomers (FM), prekallikrein (PKK) and factor VIII activity at the beginning. Finally a pronounced decrease of ATIII, FM and PKK occurred, indicating a consumptive coagulopathy. At the end of the experiment, elevated plasma renin activity and pCO2, significantly decreased creatinine clearance, blood pH, P°2, base excess, HC03, oxygen saturation (P < 0.01), a distinct glomerular proteinuria, and a final anuria were observated. These results reveal that ET activates the plasmatic coagulation system and induces an ARF accompanied by impairment of pulmonary function. Its coagulation activating and renal vasoconstrictive effects may be important pathophysiological factors, especially when the counteractive release of vasodilatatory and antiaggregatory prostacyclin or NO is impaired. There is evidence that the endothelium is a highly active endocrine organ system playing an important role in the pathogenesis of renal disease because of its strategic anatomical position between the circulating blood and vascular smooth muscle, juxtaglomerular and mesangial cells. In addition to the relaxing factors prostacyclin and NO (nitric oxide), the endothelium synthesizes and releases vasoconstrictive substances, including products derived from arachidonic acid metabolism and the recently discovered peptide endothelin. The endothelin (ET) family consists of three structurally and pharmacologically separate isopeptides [1]. Endothelin-1 is a 21-amino acid peptide arising by proteolytic processing of specific prohor
Journal of the American College of Cardiology, 1993
O~jeetives. The present study was designed to test the hypothesis that the direct thmmbin inhibit... more O~jeetives. The present study was designed to test the hypothesis that the direct thmmbin inhibitor hbxdin is mc~re efficient than beparln in reducing tkrmnhus Formation r&r coronary stenting. Background. Despite aggressive anticoagulatirr~. r&ztl;:e thrombosis of coronary stents is a major mmpticatton associated with these new devices. M&hods. In 19 minipigs indium-lll-tabeled thmmhwyies and ioditw1254abeled Ilbrinogen were injected 14 tn 19 It before commwy implantation of tantalum h&on-expnndable sttents. In group 1 (n = 6, seven rtents), a b&s of hsparin (100 U/kg body wefght) was given before stenting. Group 2 (II = 6. 11 stenls) nnived holh d&ran (500 ml) and hsparin ta 1MUikg bolus followed by P continuous infusion of SO U/kg per h). Ia group 3 [n = 7,J3 statts), birudln (remmbinant desalphatoldrudin HV 1 [CGP 393931 [I mgikg]) was given before stat Implantation, followed by cm lnfuslon of 1 m#kg per h. AU animals were txetreated with aspirin (250 mg intravenmtsly). rtonts in group 3. The aumber of pl*telets on 1 s&e& averz@ 116.2 (range 22 to 5221 x lo" iagrmtp 1,643 (e I1 tn 169) x lo6 in group 2 and 19.7 (range 9 to 38) X l@ in group 3 (p < LX@% vs. grouy 1 and KS. group 2). T&e increase in #&et awxiat?d with medial tear in all gmups, WPS Law& ia group. Simttarty, &&I depositiw was twvst en steats treated animals. reduction achieved with cmnblwd kelrzxin, dext%%n & (J Aa Cdl Canlid 1993,21:2&54) Percutaneous transluminal coronary angioplasty is increasingly applied as the primary revascttlarization procedure in patients with obstructive coronary artery disease (I,Z). However. two major problems limit its immediate and longterm success. Abnrpt coronary occlusion occurs in 2% to II% of patients (3.4) and restenosis of successfully dilated lesions is observed in 20% to 40% of patients (5.61. lntracoronary stents have been suggested as a means to manage both acute occlusion, by pressing obstructive intimal tears to the vessel wall (7). and restenosis, by creating a large smooth-eontourcd lumen, preventing elastic recoil and providing enough space for a reparative vessel response nor restthing in significant lumen obstruction (8.9). Fmm the Departments 01 Cardiology, Nuclear Medicine. Exprrimtnlti AniaUl Research and Nephrology. University Clmic. Cirningen. Germany. This work was supperred by a &znt rrflron Deursche Forschun~~semeinrchaR. SFB 3343. GWngcn. Germany. This work ccmtains part of the Habiiitalian-s_xhrift of Dr. Buchwald. Manuwipl r&vcdJaruary 13. 19% revised manuscript received June 22, 1992. acceplcd June 23. 1592.-[or Amd B. Buchwald. MD, Department of Cardiolagy~Universily Clinic. RoberiXochSkasse 40. WI Gallingen. Gcr.
European Journal of Cardiovascular Prevention & Rehabilitation, 2009
We aimed to assess whether hypertension management with a structured physician information progra... more We aimed to assess whether hypertension management with a structured physician information program and a feedback system leads to improved blood pressure (BP) control and cardiovascular outcomes. Cluster randomized (3 : 1), open, monitored, multicenter trial in Germany. Primary care-based physicians in the information group (IG) received detailed training on hypertension guidelines, feedback on target-level attainment, and a reminder to intensify treatment after each patient visit, whereas the observation/control group (CG) did not receive any such measures. A three-level mixed model was developed. Time-independent level differences between groups, group-independent changes, and nonparallel group-specific changes over time were tested. A total of 15 041 (78.1%) hypertensive patients were in the IG and 4213 (21.9%) in the CG. By 1-year follow-up, 82.9% of patients in the IG and 81.5% in the CG remained in the study. The guideline-oriented BP target was attained by 56.8% in the IG and 52.5% in the CG (+4.3%, P = 0.03), whereas the individual BP target was attained by 57.0% in the IG and 51% in the CG (P = NS). BP control in the IG was achieved 2 months earlier on average. Clinical inertia, defined as the absence of medication changes, despite noncontrol of BP, occurred significantly less often in the IG group. One-year cardiovascular outcomes did not differ between groups. The delivery of systematic information in connection with a feedback system reduces clinical inertia and improves guideline adherence. Although compared with earlier studies, the hypertension control rates obtained are higher, there is still considerable room for improvement.
MMW Fortschritte der Medizin, Jan 22, 1999
The Journal of Clinical Hypertension
Central European Journal of Public Health, 2021
OBJECTIVES The ELITE study (German acronym for "Nutrition, lifestyle and individual informat... more OBJECTIVES The ELITE study (German acronym for "Nutrition, lifestyle and individual information for prevention of heart attack, stroke and dementia") prospectively collects data on hypertension, cardiovascular risk factors (RF), dietary habits, physical activity, cognitive function, and quality of life in North-West Germany, which will then be improved through targeted individual information. The aim of the study is to improve the health of the participants in the long term and to identify reasons for a lack of implementation of prevention measures. METHODS Of 4,602 included subjects, 3,868 could be studied so far at one-year follow-up. Blood pressure (BP) was measured according to the guidelines at admission and blood pressure history, premedication, sports behaviour and BMI were recorded by means of questionnaires and compared with the data collected in the follow-up examination after one year. RESULTS The participants were evaluated in 4 groups (G): G1 - normotensive patients (n = 1,558), G2 - controlled hypertensive patients (n = 502), G3 - untreated uncontrolled hypertensive patients (n = 1,080), G4 - treated uncontrolled hypertensive patients (n = 728). In G1 blood pressure (RR) remained unchanged from 126.3/77.8 to 127.8/78.5, in G2 there was a significant (p < 0.001) RR increase from 128.1/77.0 to 134.9/79.8. In G3 and G4 RR decreased significantly (p < 0.001) from 149.9/90.0 to 143.5/86.9 and from 153.1/87.5 to 146.2 84.1 mmHg, respectively. In G3 and G4, RR decreased in 56.1% and 56.3% of subjects and increased in 18% and 21%, respectively. In contrast, RR increase was found more frequently in G1 and G2 (34.3% and 51%, respectively), and RR decrease less frequently (25.4 and 20.7%, respectively). The main reasons for RR decrease were weight loss, more exercise, and more antihypertensives. Frequently, improved compliance and dietary changes were given as reasons. As expected, the opposite often led to RR increase. CONCLUSION 56% of the hypertensive participants succeeded in lowering their blood pressure, whereas there was a significant increase in blood pressure, especially in those who were well controlled with antihypertensives. This underlines the need to further motivate normotensive patients to maintain their normotension. The results show that the combination of individual written education and lifestyle interventions are an effective tool for the public health sector to combat hypertension. In our participants, lifestyle interventions have a significant impact on BP change. It should be noted critically that there are still too many patients who have not been reached.
BMJ, 2002
The Heart Outcomes Prevention Evaluation study (HOPE), has shown beneficial effects of the angiot... more The Heart Outcomes Prevention Evaluation study (HOPE), has shown beneficial effects of the angiotensin converting enzyme inhibitor ramipril on cardiovascular events and disease progression.1 In this issue the investigators describe the results of preventing stroke (p 699).2 The findings clearly show that ramipril substantially decreased the risk of stroke and transient ischaemic attacks in 9297 patients with high cardiovascular risk. A 32% relative risk reduction was found, while the reduction in blood pressure was only 3.8 mm Hg (systolic) and 2.8 mm Hg (diastolic). This benefit was greater than expected from prior meta-analyses of epidemiological studies or trials in hypertension studies. The results have important implications for the primary and secondary prevention of stroke. Firstly, it must be emphasised that hypertension is still the most important risk factor for stroke, as shown in all studies on hypertension in recent decades,3 and more recently in the PROGRESS study, in ...
MMW - Fortschritte der Medizin, 2010
In Zusammenarbeit mit der Bayerischen Landesärztekammer Direkt online teilnehmen unter www. cme-p... more In Zusammenarbeit mit der Bayerischen Landesärztekammer Direkt online teilnehmen unter www. cme-punkt. de cme der mmw EKG und Blutdruckmessung sind essenzielle Bausteine der Risikobewertung.
DMW - Deutsche Medizinische Wochenschrift, 2019
ZusammenfassungDer erhöhte Blutdruck (arterielle Hypertonie) ist eine der häufigsten chronischen ... more ZusammenfassungDer erhöhte Blutdruck (arterielle Hypertonie) ist eine der häufigsten chronischen Erkrankungen und der Hauptrisikofaktor für die Entstehung von Herz-Kreislauf-Erkrankungen. Die in der Praxis/Klinik gängige Blutdruckmessung hat unter standardisierten Bedingungen zu erfolgen. Ansonsten ist eine Fehleinschätzung der tatsächlichen Blutdruckhöhe mit konsekutiv sowohl schlechter Blutdruckkontrolle als auch Fehldiagnosen die Folge. Der Umsetzung/Einhaltung dieser Standards in der täglichen Routine durch einen geschulten Untersucher kommt hierbei die entscheidende Rolle für eine akkurate und zuverlässige Blutdruckmessung zu. Neben der rein technischen/standardisierten Durchführung ist jedoch auch zu beachten, dass viele im Handel erhältliche Blutdruckmessgeräte den Blutdruck nicht genau messen. Daher ist weiterhin auf die Verwendung von validierten Blutdruckmessgeräten (z. B. Prüfsiegel der DHL®) zu achten. Neben der Ruheblutdruckmessung in der Praxis und Klinik erlauben ambu...
CardioVasc, 2016
Troponinerhöhung heißt nicht immer Infarkt 9 TAVI-Nachsorge: Worauf man achten sollte 10 "Verdick... more Troponinerhöhung heißt nicht immer Infarkt 9 TAVI-Nachsorge: Worauf man achten sollte 10 "Verdicktes" Herz: Sportler oder Patient? Gründungssymposium des Universitären Herzzentrums Lübeck 12 Genetik und koronare Herzerkrankung-"anfänglich etwas überschätzt"
Public Health, 2006
Cardiovascular disease is the major cause of morbidity and mortality in people with diabetes. The... more Cardiovascular disease is the major cause of morbidity and mortality in people with diabetes. The management of cardiovascular risk factors in people with diabetes in primary care was compared with National Institute of Clinical Excellence guidelines. Design: A cross-sectional study in 26 general practices, with a combined list size of 256,188 patients, participating in the Kent, Surrey and Sussex Primary Care Research Network. Primary outcomes were process of care measures. Methods: Analysis of general practice computer data on the management of 5980 patients with diabetes, of whom 86% were aged 45 years and over. Results: The prevalence of diabetes was 2.0% in women and 2.6% in men, much lower than the estimated expected prevalence of 4.8% for women and 3.3% in men. Blood pressure was well recorded (96% in both sexes), cholesterol levels less well (79% of women, 84% of men). Hypertension (78% of women, 72% of men) was common. Twentyone percent of women and 16% of men had a blood pressure above 160/100 mmHg, suggesting under use of antihypertensive therapy. Cholesterol levels were R5 mmol/l in 46% of women and 38% of men. Lipid-lowering drugs were prescribed in 38% of women and men. Aspirin was prescribed in 38% of women and 40% of men. Conclusions: There is an under-diagnosis of diabetes and an under-treatment of blood pressure and blood cholesterol, more marked in women than in men. There is
Der Kardiologe, 2013
ABSTRACT Die ambulante 24-h-Blutdruckmessung (ABDM) ist ein unverzichtbarer Pfeiler in der Hypert... more ABSTRACT Die ambulante 24-h-Blutdruckmessung (ABDM) ist ein unverzichtbarer Pfeiler in der Hypertoniediagnostik und Therapieüberwachung. Es besteht kein Zweifel, dass die ABDM entscheidend dazu beiträgt, eine Unter- bzw. Überschätzung (Praxisnormotonie/Praxishypertonie) des Blutdruckniveaus zu vermeiden. Dies gilt auch für Kinder und Jugendliche, bei denen bis zu 20% Hypertoniker trotz Selbst- und Praxisblutdruckmessung übersehen werden würden. Mit der ABDM ist auch die Beurteilung des nächtlichen Blutdruckverhaltens möglich. Der diagnostische und prognostische Wert der ABDM als nichtinvasives Verfahren zur Blutdruckmessung ist abgesichert. Voraussetzungen sind neben der Benutzung eines validierten Systems (z. B. International Protocol 2 der European Society of Hypertension [ESH] oder Prüfsiegel der Deutschen Hochdruckliga [DHL]) die richtige Indikationsstellung, eine ordnungsgemäße Programmierung und Durchführung der Messung sowie die korrekte Klassifikation des Blutdruckniveaus nach DHL-Kriterien. Die Einteilung des Blutdruckniveaus erfolgt in die 6 Klassen „optimal“ bis „Hypertonie Schweregrad 3“. Es erscheint sinnvoll, diese Analogwerte für die individuelle kardiovaskuläre Risikostratifizierung zu benutzen, da sich das kardiovaskuläre Risiko mit steigenden ABDM-Werten erhöht und die ABDM das kardiovaskuläre Risiko deutlich besser abbildet als die Praxisblutdruckmessung. Neben der computertechnischen Auswertung ist eine schriftliche Beurteilung der Blutdruckwerte und des Blutdruckprofils mit Feststellung des Schweregrads durch den untersuchenden Arzt obligat. An computergenerierten standardisierten Befundberichten mittels entsprechender Software wird derzeit von mehreren Fachgesellschaften und Herstellern gearbeitet. Wünschenswert wäre die Darstellung aller wichtigen Parameter und einer graphischen Darstellung auf einer Seite.
DMW - Deutsche Medizinische Wochenschrift, 2015
Dementielle Erkrankungen sind eine zunehmende Belastung für das Gesundheitssystem. Da es bislang ... more Dementielle Erkrankungen sind eine zunehmende Belastung für das Gesundheitssystem. Da es bislang keine effektive Therapie gibt, ist die Primärpravention von herausragender Bedeutung. Zu den gesicherten Risikofaktoren für vaskuläre Demenzen, und vermutlich auch für Alzheimer, gehört die arterielle Hypertonie. Eine rechtzeitige medikamentöse antihypertensive Therapie kann kognitive Funktionseinbußen zumindest verlangsamen und eine Demenz hinauszögern. Definitionen Leichte kognitive Störungen (ICD-10 F06.7) [1]| Bei Weitem nicht alle kognitiven Einschränkungen sind mit einer Demenz gleichzusetzen [2]. Im Gegensatz zur Demenz beeinträchtigen leichte kognitive Störungen den Alltag der Patienten nicht oder nur in geringem Maß. Sie können allerdings ein Vorstadium einer Demenzerkrankung sein. Demenz (ICD-10 F00-F03) [1] | Laut ICD-10-GM Version 2015 ist eine Demenz "ein Syndrom als Folge einer meist chronischen oder fortschreitenden Krankheit des Gehirns" [1]. Bei einer Demenz sind viele höhere kortikale Funktionen gestört, das Bewusstsein ist jedoch nicht getrübt. Begleitet werden die kognitiven Beeinträchtigungen gewöhnlich von Veränderungen der emotionalen Kontrolle, des Sozialverhaltens oder der Motivation. Diese Symptome können auch früher eintreten. Der Begriff Demenz beschreibt eine hetero gene Gruppe von Erkrankungen unterschiedli cher pathophysiologischer Mechanismen mit dem Leitsymptom "kognitive Störung" [3].
<b>Copyright information:</b>Taken from "First-line antihypertensive treatment i... more <b>Copyright information:</b>Taken from "First-line antihypertensive treatment in patients with pre-diabetes: Rationale, design and baseline results of the ADaPT investigation"http://www.cardiab.com/content/7/1/22Cardiovascular Diabetology 2008;7():22-22.Published online 24 Jul 2008PMCID:PMC2529270.
Reviews in Cardiovascular Medicine, 2021
A43 was to assess the association of the depression as a risk factor for coronary heart disease (... more A43 was to assess the association of the depression as a risk factor for coronary heart disease (CHD) based on prospective studies included in published systematic reviews. Methods: A systematic review to identify systematic reviews was conducted in MEDLINE, Cochrane library and Embase databases, with no limit on the start date until December 2015, using keywords for depression, coronary events and risk factors. The selection of the reviews that included prospective studies was realized by two researchers independently; primary data from prospective studies analyzing the relationship of depression and CHD were extracted. The Hazard Ratios (HRs) were pooled using random effects model. The subgroup analysis was carried out considering fatal CHD, myocardial infarction, gender, and follow-up duration. Results: It was selected twenty one systematic reviews comprising thirty five prospective studies that were extracted. The number of people included in the studies was 900,226. The main differences among the studies were the age, gender, measurement of depression, length of follow-up and CHD fatality. The meta-analysis found that the depression behavior is a risk factor for CHD, although the heterogeneity is substantial. The analysis by subgroup found low heterogeneity for myocardial infarction and fatal CHD. The analysis suggested that depression increases the risk for fatal CHD AND myocardial infarction (HR 1.13 95%CI: 1.06-1.20 and HR 1.29 95%CI: 1.19-1.39, respectively). In the subgroup analysis by length of follow-up, the HR of CHD was 1.24 (95%CI 1.01-1.47) for the studies with less than 15 years of follow-up and 1.18 (95%CI 1.12-1.24) for those with more than 15 years of followup. ConClusions: The results of meta-analysis suggest that depression increases the risk of CHD significantly, although the evidence has substantial heterogeneity. PCV24 CardioVasCular risks of ExogEnous TEsTosTEronE usE among mEn: a sysTEmaTiC rEViEw and mETa-analysis
American Journal of Hypertension, 2002
The aim of the study was to investigate whether the calcium channel blocker amlodipine (5 mg/d) w... more The aim of the study was to investigate whether the calcium channel blocker amlodipine (5 mg/d) was able to restore the non-dipping 24-hour blood pressure profile in hypertensive patients after morning versus evening dosing. The study was performed in double-blind, placebo-controlled crossover, multinational design in 36 patients (17 study center Cloppenburg; 19 study center Ferrara). Blood pressure (BP) and heart rate (HR) were monitored by ambulatory blood pressure monitoring (ABPM; SpaceLabs SL 90207) before and after each of the 3-weeks treatment periods with placebo/amlodipine dosing randomly at 08:00h or at 20:00h. ABPM data was analyzed by the ABPM-FIT program [Zuther P, et al. Blood Press Monit 1 : 347-354, 1999]. In the Table means ϮSEM of day (07:00-22:59h) and night values in systolic and diastolic BPs (mmHg) are shown before and after amlodipine dosing in the morning or in the evening. Both dosing times equally and significantly (Friedman test, *pϽ0.001) reduced BP (24h-mean, dayand night-mean) and resulted in a nightly fall in BP leaving HR unaffected (not shown). The results of this cross-over demonstrate that a single dose of amlodipine, independently from dosing time, significantly reduced BP in non-dipping hypertensive patients and transformed the non-dipping 24-hour BP profile into a dipping one.