Obesity is a common health problem in
many Western Industrial countries. It is an important
risk factor for hypertension, coronary and other cardiovascular
disease. Prevalence of obesity and its correlation with
other cardiovascular risk factors was not known in Egypt
and many developing countries. During a cross sectional
survey - the Egyptian National Hypertension Project
- body weight, body mass index (BMI) and waist/hip (W/H)
measurements were made on a random sample of 2292 individuals,
751 normotensives and 1541 hypertensives, age ranged
25-90 years. The survey was conducted in 21 sampling
locations representing all Egyptian geographic regions
and socioeconomic groups. Blood pressure was measured
using a standardized protocol and blood samples were
taken while fasting and 2 hours after 75 gm oral glucose
samples were analyzed for sugar, cholesterol and triglycerides.
Individuals were evaluated clinically for signs of heart
failure, the presence of two or more of the following
was consistent with clinical heart failure; cardiac
dyspnea, ankle oedema, pulmonary congestion, raised
jugular venous pressure and abnormal third heart sound.
Obesity defined as BMI greater than 30 kg/m2 was present
in 26.6% of NT (13.9 in M, 35.6 % in F) and in 46.3%
of hypertensives (26.4 in M 50.7% in F), W/H was 0.87
in NT (0.9 in M, 0.85 in F) and 0.90 in HT (0.93 in
M, 0.88 in F). Systolic and diastolic BP correlated
best and significantly (p0.000 in all). Triglycerides
correlated best with W/H (r0230, p25 kg/m2 ) showed
that obese individuals whether NT or 1-IT have faster
heart rate, more urban distribution, higher levels of
F, PPBS, triglycerides and cholesterol levels. All levels
were higher in HT than in NT. Diabetes mellitus, hypertriglyceridemia,
hypercholesterolemia and clinical heart failure were
more prevalent in the obese group, while cigarette smoking
was more common in the non-obese individuals.
Conclusion:
Obesity is very prevalent in Egyptians, especially
hypertensive women and more common in urban than rural
areas.
DM, HTG, H Cholest.. and HF are more common in obese
than non-obese individuals. BP correlates more with
body fat distribution (W/H) than with BMI or body weight.
M
Mohsen Ibrahim M.D.
Prof & Chairman, Department of Cardiovascular Medicine
-
Cairo University President of The Egyptian Hypertension
Society
THE PRESIDENTS MESSAGE
Obesity is a common health problem in many Western Industrial
countries. It is an important risk factor for hypertension,
coronary and other cardiovascular disease. Prevalence
of obesity and its correlation with other cardiovascular
risk factors was not known in Egypt and many developing
countries. During a cross sectional survey - the Egyptian
National Hypertension Project - body weight, body mass
index (BMI) and waist/hip (W/H) measurements were made
on a random sample of 2292 individuals, 751 normotensives
and 1541 hypertensives, age ranged 25-90 years. The
survey was conducted in 21 sampling locations representing
all Egyptian geographic regions and socioeconomic groups.
Blood pressure was measured using a standardized protocol
and blood samples were taken while fasting and 2 hours
after 75 gm oral glucose samples were analyzed for sugar,
cholesterol and triglycerides. Individuals were evaluated
clinically for signs of heart failure, the presence
of two or more of the following was consistent with
clinical heart failure; cardiac dyspnea, ankle oedema,
pulmonary congestion, raised jugular venous pressure
and abnormal third heart sound. Obesity defined as BMI
greater than 30 kg/m2 was present in 26.6% of NT (13.9
in M, 35.6 % in F) and in 46.3% of hypertensives (26.4
in M 50.7% in F), W/H was 0.87 in NT (0.9 in M, 0.85
in F) and 0.90 in HT (0.93 in M, 0.88 in F). Systolic
and diastolic BP correlated best and significantly (p0.000
in all). Triglycerides correlated best with W/H (r0230,
p25 kg/m2 ) showed that obese individuals whether NT
or 1-IT have faster heart rate, more urban distribution,
higher levels of F, PPBS, triglycerides and cholesterol
levels. All levels were higher in HT than in NT. Diabetes
mellitus, hypertriglyceridemia, hypercholesterolemia
and clinical heart failure were more prevalent in the
obese group, while cigarette smoking was more common
in the non-obese individuals.
Conclusion:
Obesity is very prevalent in Egyptians,
especially hypertensive women and more common in urban
than rural areas.
DM, HTG, H Cholest.. and HF are more common in obese
than non-obese individuals. BP correlates more with
body fat distribution (W/H) than with BMI or body weight.
M Mohsen Ibrahim M.D.
Prof & Chairman, Department of Cardiovascular Medicine
—
Cairo University President of The Egyptian Hypertension
Society.
SCIENTIFIC NEWS
- A Three-dimensional helical CT angiography
of renal transplant recipients presenting with hypertension,
graft dysfunction or both, is now available and can
provide valuable information that might be used to
guide their further therapy.
- For perioperative hypertension &
in hypertensive emergencies & crises a new parenteral
antihypertensive; Fenoldopam: [a dopamine receptor
(DA I selective) agonist] has recently been approved
by the (FDA).
Pharmacoeconomics of therapy, is a hot
issue in all cardiology meetings in trial to solve the
challenge with balancing healthcare costs & quality
of life.
As &1—adrenergic hypothesis is now linked
to the pathophysiology of pulmonary hypertension,
so the use of &1agonists for appetite suppression
and other disease should be avoided.
CONTENTS
- The president message.
- Scientific news.
- Molecules in focus; An innovative
antihypertensive concept for the new millennium.
- Abstracts of world literature.
- Abstract of local literature.
- Challenge yourself.
- Therapeutic considerations: Diabetic
Hypertensives
- Environmental hazardous: Noise pollution
- Bed-side tips
- Cardiology pearls
- EHS news
- Calendar
MOLECULES IN FOCUS
“AN INNOVATIVE ANTIHYPERTENSIVE CONCEPT FOR THE
NEW MILLENNIUM”
Omnia Nayel
Prof. of Pharmacology, Faculty of Medicine,
University of Alexandria.
Despite five decays have lapsed in the
progress of management of hypertension; the disease
still commonly worldwide prevails. This necessitates
an endless need for emergence of new therapeutic trends
that could be preferentially tailored reasonably well
to patients needs; whether to dosage requirement, metabolic
profile neutrality, safety to concomitantly associated
diseases or other cardiovascular risks etc. Furthermore,
the patient’s compliance to a seemingly symptomless
yet progressive disease adds a third dimensional depth
that weighs to blood pressure control; whereby tolerance
will mean compliance and compliance will mean efficacy
of the antihypertensive that is meant to be addressed
in this new millennium.
In such a domain the concept of striking
with a drug on higher central controls initiating and
maintaining high blood pressure is now being revived
but with a newer insight. This renewed interest resides
on a global trend to perceive the increase in pressure
as a malfunction [loss of receptor sensitivity] of the
adaptive emergency response that pertains cerebral and
coronary supply sufficient enough to cope with body
demands. The logic then would be to intervene with an
antihypertensive that deals with such complex regulation
in a rational, physiological mode rather than to fight
against it.
The concept set to achieve this was
through the use of a substance with an imidazoline-like
structure as rilmenidine, that can bind selectively
to I1 [imidazoline] receptors, located in the rostro-ventrolateral
medulla of the brain stem, resulting in a decrease in
the sympathetic outflow. However, it still remains debatable
how rilmenidine provokes this genuine agonistic action
but it has been hypothesized that it acts there as an
inverse agonist.
Through this, rilmenidine will reinitialize
such maladaptive responses, resetting the set point
of baroreflex back, so as to normalize blood pressure.
The consequence of such sympathetic inhibition will
be, a reduction in peripheral vascular resistance, yet
fortunately without interfering with adaptation to standing
or sitting upright [particularly in elderly] nor to
exercise ... etc.
The drug thus controls the sympathetic
overdrive to the heart and reduces the left ventricular
end-diastolic and end-systolic volumes, whereas the
stroke volume, cardiac output, and pulmonary artery
pressures remain largely unchanged. Moreover such decrease
in sympathetic outflow, is apt to reduce the renin,
secretion
Beyond this, by selective binding of
rilmenidine to b receptors in the kidney, it can simultaneously
inhibit H+/ Na+ exchanger situated at the basolateral
membrane of the proximal convoluted tubules which is
responsible for Na+ absorption. Through this the drug
can excrete natiuresis directly by decreasing water
and sodium overload and indirectly by changing neural
and hormonal influences on the kidney. In humans the
drug was also reported to decrease glomerular filtration
rate and infiltration fraction.
From aforementioned, it is clear that
rilmenidine encompasses two key organs involved in pressure
regulation whereby it controls the immediate [nervous]
and delayed [renal] setup in a comprehensive physiological
way without neglecting the body’s abilities to
adapt.
When this was translated to long term
antihypertensive monotherapeutic efficacy assessment,
over a year, in an open study conducted on mild to moderate
hypertensives or in a multicenter pharmacoepidemiological
open trial involving 2072 general physicians and 18,257
hypertensive patients many of which were suffering from
concomitant conditions [diabetes, dyslipidemia, heart
failure, renal failure, dysrrhythmias, ... etc] all
results came up with a solid statement” rilmenidine
remains effective in long —term without any fading
of effect.”
And since selective b receptor antihypertensives
do not bind to any other receptors in the therapeutic
range specified, it is not surprising that their adverse
effects on other bodily functions is down to minimal.
This adds to their safety utility to be used in patients
whatever their comorbid disease and/or age is. Also
a rebound (withdrawal) phenomenon has not been reported
for such I~ receptor stimulants.
Thus striking on imidazoline receptors
proved to be an innovative acceptable modality of an
effective antihypertensive, that has come in to focus
in this new millennium.
BIBLIOGRAPHY:
- Ostermann G, Brisgand B, Schmitt
J, Fillastre JP. Efficacy and acceptability of rilmenidine
for mild-to-moderate systemic hypertension. Am J Cardiol.
l988;76D-80D.
- Beau B, Mahieux F, Paraire M, Laurin
5, Brisgand B, Vitou P. Efficacy and safety of rilmenidine
for arterial hypertension. Am J Cardiol. 1988;61 :95D-102D
- Bricca G, Dontenwill MA, Feldman
J, Tibirica E, Belcourt A, Bousquet P. Rilmenidine
selectivity for imidazoline receptors in human brain.
Fur J pharmacol. 1989;163:373-377.
- Harron DWG. Antithypertensive drugs
and baroreflex sensitivity: effects of rilmenidine.
Fur .1 pharmacol. 1990; 181:235-240.
- Gomez R.E, Emsberger P, Feinland
G,et at. Rilmenidine lowers arterial pressure via
imidazole receptors in brain stem C area. Eur J Pharmacol.
1991;195:181-191..
- Tibirica E, Feldman J, Mermet CI,
Monassier L, Gonon F, Bousquet P. Selectivity of rilmenidine
for the nucleus reticularis lateralis, a ventrolateral
medullary structure containing imidazolinepreferring
receptors. Eur J Pharmacol. 1991;209:213-221.
- Hamilton CA. The role of imidazoline
receptors in blood pressure regulation. Pharmacol
Ther. 1992; 54:23 1-248
- Heda GA, Godwin SJ, Sannajust F.
Differential receptors involved in the cardiovascular
effects of clonidine and rilmenidine in conscious
rabbits. Hypertens. 1993; II (suppl 5):5322-S323.
- Sannajust F, Heda GA. Effect of rilmenidine
on baroreflex control of renal sympathetic nerve activity.
I Hypertens. I 993;:II (suppl 5):S328-S329)
- Sannajust F, Heda GA. Involvement
of imidazoline-preferring receptors in regulation
of sympathetic tone. Am J Cardiol. 1994;7A-19A.
- Gargalidis-Moudanos C, Parini A,
Selectivity of rilmenidine for 1 imidazoline receptors
in rabbit proximal tubule cells. J Cardiovasc Pharmacol.
1995;26(suppl 2):559-S62.
- Luccioni R. Evaluation pharmacoepidemio
logique de Ia rilmenidine chez 18335 hypertendus.
Presse Med. 1995;24,:1857-1864.
- Pillion G, fevrier B, Codis P, Schutz
D. Long-term control of blood pressure by rilmenidine
in high-risk populations. Am J Cardiol. 1994;74:58A-65A.
- Esler M. Sympathetic nervous system:
contribution to human hypertension and related cardiovascular
disease. J Card iovasc Pharmeol. 1995;26 (suppl 2):S24-S28.
- Smyth DD, Penner SB. Imidazoline
receptor mediated natriuresis: central and/or peripheral
effect? J Auton Nerv Syst 1998;72(2-3): 155-62.
- Head GA, Burke SL, Chan CK. Site
and receptors involved in the sympathoinhibitory actions
of rilmenidine. J Hypertens Suppl 1998; 1 6(3):S7-l
2.
- Van Zwieten PA, Peters SL. Central
‘r imidazoline receptors as targets of centrally acting
antihypertensive drugs. Clinical pharmacology of moxonidine
and rilmenidine. Ann N Y Acad Sd 1 999;88 1:420-9
- Fauvel JP; Najem R; Ryon B; Ducher
M; Laville M. Effects of rilmenidine on stress-induced
peak blood pressure and renal function. J Cardiovasc
Pharmacol, 1999, 34:1, 41-5
- Bruban V, Feldman J, Dontenwill M,
Greney H, Pigini M, Giannella M, Brasil L, Bousquet
P. Unusual cardiovascular effects of imidazoline compound,
benazoline. European Society of Hypertension, 1999;
P2.159.
- van Zwieten PA. The renaissance of
centrally acting antihypertensive drugs. J Hypertens
1999;17: Suppl 3:S15-21.
ABSTRACTS OF WORLD LITERATURE
CLINICAL VALUE OF AMBULATORY BLOOD PRESSURE MONITORING
Mallion J7M, Baguet JP, Jean-Philippe Tremel SF, De
Gaudemaris R
Medecine Interne et Cardiologie, CHU de Grenoble, France.
Ambulatory blood pressure monitoring
(ABPM) has now become an established clinical tool.
It is appropriate to take stock and assess the situation
of this technique. Update on equipment: Important improvements
in equipment have occurred, with reductions in weight,
in awkwardness and in noisiness of the machines, better
acceptability and tolerance by the patients, and better
reliability. Validation programs have been proposed
and should be referred to. Limitations of the technique
persist with intermittent recording in current practice.
The reproducibility is limited in the short-term while
recording over 24 h is acceptable. Diagnosis and prognosis:
White-coat effect (WCE) is manifested as a transient
elevation in blood pressure during the medical visit.
The frequency of this phenomenon, the size of the effect,
age, sex and level of blood pressure (BP) or the situation
of occurrence (general practitioner, specialist or nurse)
have been interpreted differently. It does not seem
that WCE predicts cardiovascular morbidity or mortality.
White-coat hypertension (WCH) is diagnosed on the evidence
of abnormal clinical measures of BP and normal ABPM.
The latest upper limits of normality by ABPM recommended
by the JNCVI are 135/85 mmHg
while patients are awake 120/75 mmHg
while patients are asleep. If we accept these upper
limits of normality in ABPM, WCH does not appear to
be a real problem as regards risk factors or end-organ
effects. In terms of prognosis, data are limited. Cardiovascular
morbidity seems low in WCH but identical to that of
hypertensive subjects in these studies. However, further
studies are needed to confirm these results. WCH does
not appear to benefit from anti-hypertensive treatment.
It is obvious that the lower the BP regarded as the
limit of normality, the less likely the occurrence of
secondary effects of metabolism, or end-organ effects
or complications in those classified as hypertensive.
24 hour cycle: One of the most specific characteristics
of ABPM is the possibility of being able to discover
modification or alteration of the 24 h cycle of BP.
Non-dippers are classically defined as those who show
a reduction in BP of less than 10/5 mmHg or 1000 between
the day (06.00--22.00 h) and the night, or an elevation
in BP. In contrast, extreme dippers are those in whom
the BP reduction is greater than 20%.
Cardiovascular system: The data remain inconclusive
with regard to the existence of a consistent relationship
between the lack of a nocturnal dip in blood pressure
and target organ damage. As regards prognosis, it seems
that an inversion of the day--night cycle is of pejorative
significance. Cerebrovascular system: Almost all studies
have shown that non-dippers had a significantly higher
frequency of stroke than dippers. In contrast, too great
a fall in nocturnal BP may be responsible for more marked
cerebral ischaemia.
Renal system: Non-dippers have a significantly elevated
median urinary excretion of albumin. There is a significant
correlation between the systolic BP and nocturnal diastolic
BP, and urinary excretion of albumin, Various studies
have confirmed the increased frequency of change in
the 24 h cycle in hypertensive subjects at the stage
of renal failure.
Diabetes: BP abnormalities should be considered as markers
of an elevated risk in diabetic subjects but cannot
be considered at present as predictive of the appearance
of micro-albuminuria or other abnormalities. ABPM is
thus of interest in type I or type II diabetes both
in the initial assessment and in the follow-up and adaptation
of treatment. Pliarmacotherapeutic uses: The introduction
of ABPM has truly changed the means and possibilities
of approach to the study of the effects of anti-hypertensive
medications, with new possibilities of analysis such
as trough--peak ratio smoothness index, etc.
J Hypertension 1999; 17(5):
585-595.
INSULIN RESISTANCE, EXERCISE
CAPACITY AND BODY COMPOSITION IN SUBJECTS
WITH TWO HYPERTENSIVE PARENTS
Andersen UB, Dige-Petersen H,Ibsen H, Skø P,
Bruun NE, Vestergaard H, Cliristiansen C.
Department of Clinical Physiology and Nuclear Medicine,
Hvidovre Hospital - Department of Clinical Physiology
and Nuclear Medicine & Internal Medicine, Glostrup
Hospital - Medical Department, Rigshospitalet &
Steno Diabetes Centre, Gentofie Centre for Clinical
and Basic Research, Ballerup, Denmark.
OBJECTIVE: To study insulin resistance
in subjects with strong genetic predisposition to essential
hypertension compared with non-disposed subjects.
SUBJECT: Thirty normotensive subjects aged 18--35 years
whose parents both had essential hypertension, and 30
age- and sex matched subjects whose parents were both
normotensive, were studied. Subjects or parents with
diabetes and morbid obesity were excluded.
METHODS: The study comprised (1) a frequent sampling
oral glucose tolerance test; (2) an isoglycemic hyperinsulinemic
clamp study; (3) an analysis of body composition by
dual-energy X-ray absorptiometry; (4) an exercise test
with gas exchange analysis; and (5) investigation of
composition of usual diet by diet registration for 5
days.
RESULTS: The 24-h diastolic blood pressure was higher
in subjects predisposed to hypertension compared with
the controls: 78.1 versus 74.0 mm Hg, but the insulin
sensitivity index was similar: 312 versus 362 . The
two groups were similar in terms of body composition,
exercise capacity and composition of usual diet. Resting
and 24-h diastolic blood pressures were correlated to
abdominal fat mass but not to insulin sensitivity.
CONCLUSION: Subjects with a strong genetic predisposition
to essential hypertension had increased diastolic blood
pressure compared with subjects with normotensive parents,
but they were not insulin resistant. This may be due
to the subjects being highly selected as to confounding
factors. The increased blood pressure in the hypertension
prone subjects could not be attributed to differences
in body composition, exercise capacity or dietary habits.
I Hypertension 1999; 17(9);
1273-1280.
ABSTRACTS OF LOCAL LITERATURE
APOPTOSIS MEDIATOR SOLUBLE FORMS IN PATIENTS WITH ESSENTIAL
HYPERTENSION; COMPARATIVE EFFECTS OF CAPTOPRIL AND FOSINOPRIL
Enas Frafa, Morad Ahmed and Magdy El-Masry
Dept. of Cardiology and Clinical Path. Faculty of Medicine,
Tanta University, Egypt.
Fas receptors are cell-surface proteins
and apoptosissignaling molecules. Apoptosis may
have an important role in the pathogenesis and progression
of cardiovascular disease. Angiotensin-II stimulates
apoptosis in cultured cardiomyocytes. ACE inhibitors
are used for treatment of hypertension. The present
study was designed to determine the relationship among
the soluble Fas, hypertension and ACE inhibitors. We
determined the serum sFas in 40 patients with essential
hypertension before and after 6 weeks of randomly allocated
treatment with Captopril (n=20)and Fosinopril (n=20).The
control group consisted of 15 age-and sex-matched normotensive
subjects. Baseline sFas levels were higher in hypertensive
patients than in normotensive controls (6.72+0.32 versus
5.61±0.21 units/mI,p.05).There was a direct correlation
between baseline sfas and systolic Bp in hypertensive
patients (r= 0.365, P.05).The 2 ACE inhibitors caused
similar reductions in sFas levels and BP after the treatment
period. Conclusion: These results indicated that circulating
sFas levels are increased in essential hypertension
and suggest the ability of ACE inhibitors to normalize
sFas.
Presented in the 26th Annual
Meeting of the Egyptian Society of Cardiology, Cairo,
Egypt. February 1999.
RENOPROTECTIVE EFFECT OF CALCIUM
CHANNEL BLOCKERS (AMLODIPINE AND
NIFEDIPINE) COMPARISON WITH ACE INHIBITOR (CAPTOPRIL)
AND ANGOTENSIN II
RECEPTOR ANTAGONIST (VALSARTAN)
Salah Naga, Salah Marzouk, Eman El-Eetr
Nephrology, Clinical Pathology & Physiology Departments,
Faculty of Medicine, Alexandria University
The renoprotective effect of CCBs :
Amlodipine and Nifedipine were compared with the ACE
inhibitor (Captopril) and AT1 antagonist (Valsartan).
Eighty patients with mild to moderate hypertension secondary
to mild to moderate renal insufficiency were divided
into four groups (20 for each). Each group received
one drug to control blood pressure for ten weeks. Blood
urea, serum creatinine, GFR, and total urine protein
and &2 microglobulin were measured before and at
the end of the study. Urea and creatinine decreased
by Amlodipine (t=3.95 and 4.87),Captopril (1=0.87 and
2.95) and Valsatran (t=5.75 and 6.20), and increased
by Nifedipine (t3.6 and 3.15). GFR increased by Amlodipine
(t=2.83) and Valsartan (t=3.7). Amlodipine, Captopril
and Valsartan were equally effective in reducing urea
(F15.53), creatinine (F=9.86), B2 microglobulin (F =
8.54) and protenuria. in conclusion, Amlodipine, a calcium
channel blocker was found to have a renoprotective effect
similar to Captopril and Valsartan.
Accepted, in 3rd Conference
of the Pan—Arab Hypertension Society, Abu
Dhabi, due to be held on Feb 2000.
CHALLENGE YOUR SELF !!!
A 60-year old man was admitted to the hospital
3 hours after the onset of sudden, severe interscapular
pain. His pain reached full intensity immediately. A
few hours later he noted that his right hand was cold
. He had hypertension for many years and was a heavy
smoker.
Physical Examination: Vital signs; pulse;
80 bpm & regular, blood pressure on the left arm:
220/140, after receiving nitropruside IV 220/110, on
the right arm:
90/80. General: diaphoretic. Cardiac: faint diastolic
murmur over the left sternal border. Extremities: right
hand cold, right radial pulse absent; pulses present
in the lower extremities; systolic bruit heard over
the femoral arteries.
Laboratory investigation; Hct: 40% . EGG: LVH Chest
X-ray: widening of the Aorta with intimal calcification.
Question: What is the most likely
diagnosis?
Pick up the solution at CARDIOLOGY PEARLS
on p. 1 7 1 of this issue.
THERAPEUTIC CONSIDERATIONS;
DIABETIC HYPERTENSIVES
in such a category of patients wisdom
implies
knowing that;
Thiazide Diuretics: are cheap but can induce metabolic
upset, especially at high doses (eg hyperglycaemia,
hypokalaemia, hyper-uricamia, hypercholesterolaemia)
& may cause impotence.
B-Blockers: are particularly useful
in presence of Ischaemic heart disease but may be poorly
tolerated (eg lethargy, impotence) & may mask symptoms
of hypoglycaemia & delay recovery from it.
ACE inhibitors: are specific renoprotectives
in IDDM with microalbuminuria or overt proteinuria &
can reduce C.V. morbidity & mortality in patients
with heart failure. However they may precipitate renal
failure in those with renovascular disease & can
induce troublesome dry cough.
Calcium Channel Blockers: are particularly
effective in treatment of blacks & non-dihydro-pyridine
prototypes may be useful if patients develop tachyarrhythmias
but in those with renal disease dihydropyridines may
occasionally worsen urinary albumin excretion despite
improvements in BP.
&-Blockers: may improve lipid profile
.& insulin sensitivity but can induce postural hypotension
especially in patients with autonomic neuropathy.
Postgraduate Doctor ME 1999; Diabetic
Supp: 10-13.
ENVIRONMENTAL HAZARDOUS:
NOISE POLLUTION
A broad array of demographic, ergonomic,
nutritional, and environmental factors are critical
determinants of blood pressure.
Due to the current existing noise pollution
that modernization has posed on us, the overall information
processing of humanity has changed and the rate, quality
and behavior at work has deteriorated. In blood pressure
domains, the current hypothesis that exposure to noise
is positively associated with hypertension is now being
raised.
Occupational noise in particular was
specified, where studies revealed that workers subjected
to such stress constrain may recover a significant impairment
in audiogram, a concomitant increase in HR, SBP, DBP
and a decrease in galvanic skin stimulation, auditory
& visual reaction times!!!
In such studies, initial pressure levels
and duration of employment had an overall impact as
evidenced by being more affecting borderline hypertensives.
The age, body mass index, cumulative noise exposure,
current use of blood pressure medications, and alcohol
intake were significant predictors for systolic blood
pressure while a threshold effect of cumulative noise
exposure was a significant predictor of diastolic blood
pressure.
On the contrary to occupational exposures,
there is no support to the suggestion that there exists
a simultaneous correlation between impulse noise exposure[as
gun shots], noise-induced hearing loss, and self-reported
elevated blood pressure.
In mothers subjected to repeated noise
exposure and their preterm newborns were already suffering
from chronic intrauterine stress, such as maternal smoking,
maternal hypertension, and intrauterine growth retardation,
the liability to a change in the maturation of the autonomic
nervous system was raised and was thought to reflect
a possibility of developing essential hypertension as
they grow.
It was explained that extra-auditory
effects of noise exposure is mediated by activation
of the autonomic nervous system & hypothalamic-hypophyseal
adrenal axis with a resultant increase in catecholamines
from the adrenal medulla secondary to noise stress.
In this respect a study has elucidated
that with buzzing noise; a parallel increase in plasma
catecholamine, corticosterone, Angiotensin II, glucose
and lipids were found. While electrophysiologically,
the acetylcholine and choline acetyltransferase in rostral
ventrolateral medulla were increased markedly raising
the assumption that stress-induced hypertension was
closely related to the activation of a Colinergic system
in rVLM.
Realizing the world wide prevalence
of such a problem, the hazardous impacts of noise pollution,
on cardiovascular morbidity and mortality deserves further
attention in wide scale community controlled studies.
References :
- Pol Mer Lek 1996; 1(6): 389-93.
- Indian J Physiol Pharmacol 1996 Jan
: 40 (1) : 35 —40.
- Med Tr Prom Ekol, 1998, :4, 17-2
1
- Arch Environ Health 1999 Mar-Apr
54(2) : 7 1-8.
BED-SIDE TIPS:
ASSIST IN PERTAINING
YOUR PATIENT’S COMPLIANCE.
- You should advice patients to keep
on taking the pills an never to cut it down by just
feeling well. “A patient has to know that there
is no way that he can tell~ just by the way he feels,
whether pressure is high or low.
- Even if your patient has his own
blood pressure measuring device, and his blood pressure
seems controlled, he has to know that nobody can ever
tell what would happen if medications are stopped.
So clear to him that; “ Hypertension is a l~/e
long, initially symptomless but progressive disease
with many morbidity outcomes, that one is fighting
to halt. Insure that this is deeply posed in his mind.
- Also stress that; “Pills are
not magic, and that they need his help c/they are
to work as efficiently as they can to reduce pressure
to normal.” Emphasis that his contribution is
worth a lot and could be achieved in part by his ability
to change his lifestyle.
- Help your patient to bypass the major
obstacle hindering his compliance; that is forgetting
to take medication. So; “Raise to him the tools
to combat forgetting by submitting such PILL —
TAKING TIPS “
- For remembering taking the pills;
--
suggest: -Put the pills where they are linked to a
part of your routine daily scenarios; as keeping them
by the toothbrush,
razor, where one eats or watches TV.
-Write a changeable weekly reminder aside them otherwise
one may stop noticing them. This can be stuck on the
refrigerator, kitchen .. .doors - or on the bedroom,
bathroom mirrors
-Set a watch to keep at pill-taking time.
-Ask the help of relatives or friends to remind taking
the medications.
-Sort the drugs in a ” medication organizer”
that can be bought or constructed, if more than one
type of medication are to be taken.
- For not running out of pills;
--
suggest
-Set up a system for renewal of the prescription by
marking the date on the calendar or ask for the pharmacist’s
cooperation by sending reminder cards or phone rings
if his system implies...
- For remembering taking pills while
traveling;
--
suggest
-Put reminders with the baggage; fasten it on the
suitcase or travel kit.
-Travel with a spare prescription, in case pills are
forgotten.
The Blood Pressure
Book,
Bull Publishing Company, 1996
CARDIOLOGY PEARLS
Diagnosis: Type I aortic dissection producing aortic
regurgitation.
- Aortic dissection should be suspected
if the patient has chest, back, or abdominal pain
that reaches maximum intensity immediately. Hypertension
despite a shocky appearance, coupled with a normal
ECG should further increase suspicion.
- Aortic dissection should be suspected
in any patient with chest pain who develops aortic
insufficiency.
- Marfan syndrome is likely if the
dissection occurs under the age 40.
- Drug therapy with nitroprusside and
a beta blocker is the initial treatment in almost
all cases of dissection; surgery should be performed
if the ascending aorta is involved
EHS NEWS:
- The EHS has held its Summer Meeting
of the Society in Helnan Palestine Hotel on June 24-25the,1999
in Alexandria. The program covered many hot issues
evolving these days within the etiopathogenic arena
and has also witnessed scientific debates on updated
guidelines.
- The EHS is organizing its fourth
scientific meeting of the society on the 2628th of
January 2000 at Marriot Hotel, Cairo. The Chairman;
Prof Dr. Mokhtar Gomaa has issued the 1st announcement.
He has focused on how pathophysiology and management
of hypertension is escalating in the direction of
molecular biology. He whole heartily advice the necessity
of focusing on such new concepts as we step in this
new millennium. This will be aside the regular topics
that basically should be discussed in such an important
event. Awards will be presented by the society for
young investigators.
- Members of the EHS are collaborating
with Dr Abdulrahim Jaffer the Undersecretary —
Ministry of Health of The U.A.E and the president
of the 3rd Conference of the Pan —Arab Hypertension
Society in finalizing the arrangements of such important
event, due to be held in Abu Dhabi, 5-9 February,
2000.
EHS News & Calendar
EHS NEWS:
The EHS has held its Summer Meeting
of the Society in Helnan Palestine Hotel on June 24-25the,1999
in Alexandria. The program covered many hot issues evolving
these days within the etiopathogenic arena and has also
witnessed scientific debates on updated guidelines.
The EHS is organizing its fourth scientific meeting
of the society on the 2628th of January 2000 at Marriot
Hotel, Cairo. The Chairman; Prof Dr. Mokhtar Gomaa has
issued the 1st announcement. He has focused on how pathophysiology
and management of hypertension is escalating in the
direction of molecular biology. He whole heartily advice
the necessity of focusing on such new concepts as we
step in this new millennium. This will be aside the
regular topics that basically should be discussed in
such an important event. Awards will be presented by
the society for young investigators.
Members of the EHS are collaborating with Dr Abdulrahim
Jaffer the Undersecretary — Ministry of Health
of The U.A.E and the president of the 3rd Conference
of the Pan —Arab Hypertension Society in finalizing
the arrangements of such important event, due to be
held in Abu Dhabi, 5-9 February, 2000.
CALENDAR
| 4 Annual
International & Pan |
Main Conference
Hall
Alexandria |
Prof Dr.
Mohamed Sobhy
Tel / Fax (203) 4203288 |
The fourth Scientific Meeting of
the EHS |
Marriot Hotel, Cairo Egypt
January 28-29th, 2000
|
Prof Dr. Mokhtar Gomma
Tel (202) 3026871 -Fax (202) 3026871
E-mail : mogomaa@idscl.gov.eg
|
4th European Meeting
Calcium Antagonists |
Amsterdam, Netherlands.
October 27-29, 1999. |
Prof P.A. van Zwieten.
Fax + 31206968704. |
5th International Symposium
Multiple Risk Factors in
C.V.Diseases |
Venice, Italy.
October 28-31, 1999. |
1st. M. Gotto, Jr—
Fondazione Giovanni,
Via Appiani, 720121Milan — Italy. |
4th World Congress
of Echo-
cardiography & vascular
Ultrasound |
Mena-House Oberoi,Cairo
Egypt
January 19-2 1, 2000.
|
Prof Dr. Osama Abdel
Aziz
Tel: (202) 3926650,
Telefax: (202) 3602800 / 3958000 |
|
EHS EXECUTIVE BOARD: |
EDITORIAL
COMMITTEE: |
| President |
: M. M. Ibrahim, MD |
| Vice president |
: H. E. Attia, MD |
| Secretary |
: H. H. Rizk, MD |
| Treasurer |
: W. EI-Aroussy, MD |
| Members |
: A. M. Hassaballah, MD |
| |
: M. M. Gomaa, MD |
| |
: F. A. Maklady, MD |
| |
: S. EI-Tobgy, MD |
| |
: 0. EI-Khashaab, MD |
|
| Editor |
: Hassan KhaIiI,
MD |
| Associate editors |
: Ebtihag Hamdi, MD |
| |
: Omnia Nayel, Ph D |
| |
: Zeinab Ashour, MD |
| |
: Fatma Aboul -Enein, MD
|
| |
: Salwa Morkos, MD |
|
