Insulin-like growth factor I in essential hypertension.

mmol/liter; serum cholesterol, 5.95 mmol/liter; serum triglycerides, 1.40 mmol/liter; serum potassium, 4 mmol/liter; serum creatinine, 95 mmol/liter (1.1 mg/dl); creatinine clearance, 112 ml/min/1.73 m body surface; and 24-hour urine albumin excretion, 245 mg. Urinalysis revealed no other abnormalities. An electrocardiogram showed a Sokolow-Lyon voltage of 3.9 mV. Doppler ultrasonographic examination of the heart disclosed increased left-ventricular mass index (LVMI 5 141 g/m) and increased left-ventricular relative wall thickness (RWT 5 0.47); parameters of diastolic and systolic function were within normal limits. Renal ultrasonography revealed normal-sized kidneys with no parenchymal abnormality. No other medical problems were identified. The patient was asked to seek dietary counseling to reduce his sodium chloride intake, and lisinopril (10 mg once daily) was prescribed. Over the next three months, his blood pressure CASE PRESENTATIONS remained about 150/100 mm Hg, and the urinary sodium excrePatient 1. A 42-year-old white man was referred to the Unition ranged between 80 and 100 mmol/day. The lisinopril dose versity Clinic of the University of Navarra for evaluation of was increased to 20 mg daily. Under this therapeutic regimen, arterial hypertension. Three years earlier, the patient had been blood pressure fell to below 140/90 mm Hg during the next told he had elevated blood pressure during an insurance medinine months. One year after the initial medical examination, cal examination. No antihypertensive therapy was prescribed a cardiac echocardiogram revealed diminution of the left-venduring the intervening period. tricular mass index (133 g/m) and the RWT (0.43), and nepheHis father had had hypertension and had died of a noncarlometric analysis of the urine revealed a 24-hour albumin excrediovascular cause at age 70. The patient had had two episodes tion of 80 mg. of urinary tract infection, but a rapid-sequence pyelogram did Patient 2. A 52-year-old white woman was referred to the not reveal any abnormalities. He suffered often from headUniversity Clinic of the University of Navarra for the evaluaaches, but he had no palpitations, sweating, or orthostatic falls tion of recent-onset hypertension. She had been normotensive in blood pressure. He had no additional cardiovascular risk one year earlier. She had a strong family history of cardiovascufactors: he had never smoked; glucose tolerance was normal; lar disease: Her father died at age 55 with hypertension and and plasma cholesterol concentration was below 6.35 mmol/ a myocardial infarction, and her mother died at age 60 of liter. hypertension and a cerebrovascular accident. The patient did On presentation at the outpatient clinic, his blood pressure not smoke and drank alcohol only occasionally. was 168/110 mm Hg, and the pulse rate was 74 beats/min and The patient described herself as a healthy, active individual regular. The body mass index was 24 kg/m. Physical examinawithout medical complaints. She had never used oral contration showed evidence of an enlarged left ventricle and a grade ceptives or cardiovascular drugs. Hypercholesterolemia had 2/6 mid-systolic ejection murmur. No carotid or abdominal been detected during a routine medical examination; only dibruits were heard. Pulses in the extremities were normal. No etary treatment had been recommended. edema was present. Neurologic examination was normal. FunPhysical examination revealed a thin, well-developed, wellduscopic examination revealed mild arteriolar narrowing and nourished female. The body mass index was 26 kg/m. The arteriovenous crossing changes. blood pressure was 159/100 mm Hg. Cardiac examination disclosed a normal PMI, and normal sounds were noted. The abdoLaboratory evaluation revealed: fasting plasma glucose, 5.0 men was not remarkable; no abdominal bruit was audible. No edema was evident in the extremities. Musculoskeletal and neurologic examinations were within normal limits. Funduscopy Presentation of this Forum is made possible by grants from Astra revealed normal eye grounds, except for some mild arteriolar Pharmaceuticals; Merck & Co., Incorporated; Hoechst Marion Rousnarrowing. sel, Incorporated; Dialysis Clinic, Incorporated; and R & D Laboratories, Incorporated. Laboratory studies revealed: fasting plasma glucose, 6.10 mmol/liter; serum cholesterol, 7.12 mmol/liter; high-density lipo