Chan, LY

Cheung, BMY

Kumana, CR

Leung, RYH

Tsang, KWT

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Title Plasma adrenomedullin level is markedly elevated inbronchiectasisAuthor(s) Cheung, BMY; Tsang, KWT; Leung, RYH; Chan, LY; Kumana, CRCitation The 5th Medical Research Conference, Hong Kong, China,January 2000, v. 22 n. Supp 2, p. 4Issued Date 2000URL http://hdl.handle.net/10722/46869Rights Creative Commons: Attribution 3.0 Hong Kong LicenseG-CH-4DRUG UTILISATION IN A HYPERTENSION OUTPATIENT CLINIC 1996-1999Cheung BMY. Cheung AHK, Ho SPC, Lau CP, Kumana CR. Department of Medicine, University of HongKong, Hong KongObjectives: We previously studied drug utilisation in 246 hypertensive patients in a Hypertension Clinic in1996, before the publication of JNC VI guidelines, Syst-Eur and HOT studies. We repeated the study in 1998to detect changes in drug usage.Methods: 452 hypertensive outpatients (238M, 214F; 54± 13 yrs) were seen in Oct 98-Mar 99. Case noteswere reviewed. Current medications and blood pressure were recorded.Results: In 1998-9, 54% received calcium channel blockers (CCB); 52%, beta-blockers (BB); 25%, angiotensin-converting enzyme inhibitors (ACEI); 21%, thiazide diuretics (D) and 3%, alpha-blockers (a). In 1996, therespective figures were 51 % CCB, 47% BB, 32% ACEI, 15% D and 5% a. The percentage of patients prescribedno drugs (life-style modification), 1 drug (monotherapy), 2, 3 and >3 drugs were 10%, 36%, 41%, 11% and 2%respectively (7%, 48%, 35%, 7% and 2% respectively in 1996). The leading regimes were, in decreasingorder, CCB+BB, CCB, BB and ACEI monotherapy (CCB, CCB+BB, BB, ACEI in 1996). Compared to 1996,fewer patients were on monotherapy, but CCB and BB remained the most popular drugs. The blood pressureon treatment for all patients was 144.5±0.9 / 83.1±0.5 mmHg. Patients treated with a CCB had lower diastolicpressures than those without CCB (81.7±0.7 mmHg vs. 84.7+0.8 mmHg, p<0.01). Only 7% were takingaspirin.Conclusions: Currently, combination therapy is often used to control blood pressure. Many patients achievethe ideal blood pressures suggested in HOT. The popularity of calcium channel blockers is justified by itsblood pressure-lowering efficacy and new data from clinical trials (Syst-Eur, Syst-China, STOP-hypertension-2).However, aspirin (shown to be beneficial in HOT), ACEIs (beneficial in HOPE) and diuretics (as good asACEIs or CCBs in STOP-hypertension-2 but inexpensive) are underused.G-CH-5PLASMA ADRENOMEDLLIN LEVEL IS MARKEDLY ELEVATED IN BRONCHIECTASISCheung BMY, Tsang KWT, Leung RYH, Chan LY, Kumana CR. Department of Medicine, University ofHong Kong.Objectives: Adrenomedullin (AM) is a peptide hormone first isolated from phaeochromocytoma and theadrenal medulla. In the lungs, AM is expressed in many cell types, including bronchial epithelium, bronchialsmooth muscles, pulmonary vasculature and macrophages. We previously reported elevation in the plasmalevels of AM in asthma and in chronic obstructive airway disease. Since cytokines including TNF-a and IL-lpstimulate AM secretion, we studied patients with bronchiectasis, a disease characterised by inflammation andinfection which interact to cause cytokine-mediated progressive destruction of the airway.Methods: 87 bronchiectasis patients (27 M, 60 F; age 62± 14 yrs) and 24 normal healthy subjects werestudied. The immunoreactivity of human AM in the plasma was measured using a specific radioimmunoassay(lower limit of detection 1 pg/tube, coefficient of variation 12%).Results: The mean ± SE plasma AM level in normal subjects was 11.9+ 18.4pmol/l and was 133.2± 19.0pmol/lin bronchiectasis patients (p< 0.001). The increase in plasma AM level was not explained by known factorsincluding hypertension, renal dysfunction and liver disease. AM levels were not related to age or gender. In asubgroup of 43 patients in whom baseline measurements before treatment were available, AM level correlatedwith ESR (r = 0.38, p = 0.01) and ttl-antitrypsin (r = 0.41, p<0.01).Conclusions: The AM levels in bronchiectasis are among the highest we have observed in man, and considerablyhigher than the AM levels encountered in heart failure, liver cirrhosis or renal failure. Elevated plasma AMlevel in patients with bronchiectasis and the positive correlation with disease activity suggest that AM may beinvolved in the pathophysiology of bronchiectasis.- 4 -

Plasma adrenomedullin level is markedly elevated in bronchiectasis

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Plasma adrenomedullin level is markedly elevated in bronchiectasis

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