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Yassıbaş E, Samur G, Toka O. SUN-P092: Are Serum Vitamin D Levels Related with Colorectal Cancer Risk? Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rüffer A, Blumauer R, Purbojo A, Glöckler M, Toka O, Cesnjevar R. Innominization of Left Brachiocephalic Vein for Left Superior Vena Cava–Related Obstruction of Cardiac Structures. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Rüffer
- Kinderherzchirurgische Abteilung, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - R. Blumauer
- Kinderherzchirurgische Abteilung, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - A. Purbojo
- Kinderherzchirurgische Abteilung, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - M. Glöckler
- Kinderkardiologische Abteilung, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - O. Toka
- Kinderkardiologische Abteilung, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - R. Cesnjevar
- Kinderherzchirurgische Abteilung, Universität Erlangen-Nürnberg, Erlangen, Germany
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Halbfass J, Toka O, Doll U, Glöckler M, Weyand M, Kondruweit M, Cesnjevar R, Hartmann A, Dittrich S. Endomyocardial Biopsy following Heart Transplantation in Children: A Single-Center Experience. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1599035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J. Halbfass
- Department of Pediatric Cardiology, University Clinic Erlangen, Erlangen, Germany
| | - O. Toka
- Department of Pediatric Cardiology, University Clinic Erlangen, Erlangen, Germany
| | - U. Doll
- Department of Pediatric Cardiology, University Clinic Erlangen, Erlangen, Germany
| | - M. Glöckler
- Department of Pediatric Cardiology, University Clinic Erlangen, Erlangen, Germany
| | - M. Weyand
- Department of Cardiac Surgery, University Clinic Erlangen, Erlangen, Germany
| | - M. Kondruweit
- Department of Cardiac Surgery, University Clinic Erlangen, Erlangen, Germany
| | - R. Cesnjevar
- Department of Pediatric Cardiac Surgery, University Clinic Erlangen, Erlangen, Germany
| | - A. Hartmann
- Department of Pathology, University Clinic Erlangen, Erlangen, Germany
| | - S. Dittrich
- Department of Pediatric Cardiology, University Clinic Erlangen, Erlangen, Germany
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Moosmann J, Kerling A, Glöckler M, Rüffer A, Toka O, Dittrich S. Tolvaptan as an Additive Diuretic in Infants with Capillary Leak after Cardiac Surgery. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1599011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J. Moosmann
- Department of Pediatric Cardiology, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - A. Kerling
- Department of Pediatric Cardiology, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - M. Glöckler
- Department of Pediatric Cardiology, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - A. Rüffer
- Department of Pediatric Cardiac Surgery, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - O. Toka
- Department of Pediatric Cardiology, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S. Dittrich
- Department of Pediatric Cardiology, Universität Erlangen-Nürnberg, Erlangen, Germany
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Moosmann J, Werner R, Cesnjevar R, Toka O, Roppenecker G, Rüffer A. Simulation of an Atrial Assist Device in Fontan Circulation. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rüffer A, Tischer P, Toka O, Glöckler M, Dittrich S, Cesnjevar R, Jüngert J. Cerebral Blood-Flow Velocities during Regional Cerebral Perfusion in Infant Aortic Arch Surgery. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1556033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moosmann J, Ekici A, Cesnjevar R, Dittrich S, Uebe S, Toka O. X-chromosomal copy number variants in patients with coarctation of the aorta. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rüffer A, Münch F, Purbojo A, Glöckler M, Toka O, Dittrich S, Cesnjevar R. Improving outcomes of pediatric postcardiotomy extracorporeal membrane oxygenation. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1393990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Moosmann J, Völkl S, Cesnjevar R, Hartmann A, Dittrich S, Toka O. Zelluläre Immunmodulation bei Patienten mit Failing Fontan. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Moosmann J, Doll U, Rüffer A, Cesnjevar R, Dittrich S, Toka O. Erste Erfahrungen mit dem Vasopressin-Rezeptor Antagonisten (Tolvaptan) als Rescue Diuretikum im Postoperativen Management bei Säuglingen mit HLHS. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hoff K, Ammerpohl O, Kolarova J, Arndt AK, Pfeffer K, Toka O, Siebert R, Kramer HH. Determination of DNA Methylation Patterns in Cardiac Tissue from Hypoplastic Left Heart Syndrome. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rüffer A, Münch F, Purbojo A, Glöckler M, Toka O, Koch AM, Dittrich S, Cesnjevar R. Ventricular Assist Device for Myocarditis or Cardiomyopathy in Pediatric Patients: A Single-Center Series with no Mortality and the Longest Reported Duration of Support, So Far. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Moosmann J, Kopp C, Cavallaro A, Weyand M, Uder M, Cesnjevar R, Dittrich S, Titze J, Toka O. Body-Overload an interstitiellem Natrium als Ursache für therapierefraktäre Ödeme in Failing Fontan Patienten. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Arndt AK, Musso G, Gellert P, Hoff K, Uchida S, Toka O, Siebert R, MacRae CA, Klaassen S, Kramer HH. Transcriptome Sequencing in Hypoplastic Left Heart Syndrome Myocardium Reveals Dysregulated Cell Cycle Genes. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rüffer A, Münch F, Purbojo A, Toka O, Glöckler M, Koch AM, Dittrich S, Cesnjevar R. Single-Center Outcome of Pediatric Extracorporeal Membrane Oxygenation. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Moosmann J, Wiebensohn T, Cesnjevar R, Rüffer A, Glöckler M, Toka O, Dittrich S. Analysen zur Prädisposition und Manifestation der Failing Fontan Zirkulation. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Moosmann J, Toka O, Rompel O, Koch AM, Dittrich S, Glöckler M. Generalized Vessel Malformation with Giant Aortic Dilatation and Arterial Tortuosity: an Exceptional Case. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rüffer A, Kellermann S, Janssen C, Münch F, Demuth M, Toka O, Cesnjevar RA. Evaluation of myocardial ischemia during beating-heart aortic arch repair in a piglet model. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tagariello A, Breuer C, Birkner Y, Schmidt S, Koch A, Cesnjevar R, Ruffer A, Dittrich S, Schneider H, Winterpacht A, Sticht H, Dotsch J, Toka O. Functional Null Mutations in the Gonosomal Homologue Gene TBL1Y are Associated with Non-Syndromic Coarctation of the Aorta. Curr Mol Med 2012; 12:199-205. [DOI: 10.2174/156652412798889027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 10/24/2011] [Accepted: 11/18/2011] [Indexed: 11/22/2022]
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Rüffer A, Arndt F, Ihlenburg S, Purbojo A, Toka O, Weil J, Dittrich S, Cesnjevar R. Intra-pulmonary artery banding - our procedure of choice for rare indications. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tank J, Toka O, Toka HR, Jordan J, Diedrich A, Busjahn A, Luft FC. Autonomic nervous system function in patients with monogenic hypertension and brachydactyly: a field study in north-eastern Turkey. J Hum Hypertens 2001; 15:787-92. [PMID: 11687923 DOI: 10.1038/sj.jhh.1001271] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2000] [Revised: 06/05/2001] [Accepted: 06/13/2001] [Indexed: 11/09/2022]
Abstract
Laboratory studies in patients with autosomal-dominant hypertension and brachydactyly showed increased sensitivity to sympathetic stimuli and severe abnormalities in baroreflex buffering. To further elucidate the mechanisms by which impaired baroreflex sensitivity could influence blood pressure (BP), we conducted autonomic testing under field conditions. We studied 17 hypertensive affected (13 to 48 years, BMI 22.7 +/- 6.5 kg/m(2), 160 +/- 23/98 +/- 15 mm Hg) and 12 normotensive non-affected (9 to 60 years, BMI 24.0 +/- 4.7 kg/m(2), 120 +/- 16/70 +/- 10 mm Hg) family members. Pulse intervals and finger BP were measured using the Portapres device. Valsalva ratio, the blood pressure overshoot during phase IV of the Valsalva manoeuver, the Ewing coefficient (RR30/15 ratio), and heart rate and BP variability were similar in affected and non-affected family members. Overall, baroreflex sensitivity calculated using the cross-spectral (BRSLF, BRSHF) and sequence techniques (BRS+, BRS-) was not different between the groups. However, in younger family members, BRS+ was 12 +/- 3.7 and 22 +/- 13 msec/mm Hg in affected and in non-affected family members, respectively. The decline in BRS with age and with increasing blood pressure was absent in affected family members. We conclude that autonomic reflex testing conducted under field conditions is not impaired in patients with monogenic hypertension and brachydactyly. However, noninvasive testing showed impaired baroreflex control of heart rate at a young age. The reduced BRS in young family members with moderate arterial hypertension may suggest that the impaired baroreflex function is not secondary to the hypertension but rather a primary abnormality, which aggravates the progression of hypertension.
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Affiliation(s)
- J Tank
- Clinical Research Center, Franz Volhard Clinic, Helios Kliniken-Berlin Medical Faculty of the Charité Humboldt-University, Berlin, Germany
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Jordan J, Toka HR, Heusser K, Toka O, Shannon JR, Tank J, Diedrich A, Stabroth C, Stoffels M, Naraghi R, Oelkers W, Schuster H, Schobel HP, Haller H, Luft FC. Severely impaired baroreflex-buffering in patients with monogenic hypertension and neurovascular contact. Circulation 2000; 102:2611-8. [PMID: 11085965 DOI: 10.1161/01.cir.102.21.2611] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We identified a family with a monogenic syndrome of hypertension, brachydactyly, and neurovascular contact of the brain stem. Neurovascular contact of the ventrolateral medulla may lead to arterial hypertension by interfering with baroreflex function. METHODS AND RESULTS In 5 patients with monogenic hypertension (18 to 34 years old), we conducted detailed autonomic function tests. Blood pressure during complete ganglionic blockade was 134+/-4.9/82+/-4.1 mm Hg and 90+/-6/49+/-2.4 mm Hg in patients and in control subjects, respectively. During ganglionic blockade, plasma vasopressin concentration increased 24-fold in control subjects and <2-fold in patients. In patients, cold pressor testing, hand-grip testing, and upright posture all increased blood pressure excessively. In contrast, muscle sympathetic nerve activity was not increased at rest or during cold pressor testing. The phenylephrine dose that increased systolic blood pressure 12.5 mm Hg was 8.0+/-2.0 microg in patients and 135+/-35 microg in control subjects before ganglionic blockade and 5.4+/-0.4 microg in patients and 13+/-4.8 microg in control subjects during ganglionic blockade. CONCLUSIONS In patients with monogenic hypertension and neurovascular contact, basal blood pressure was increased even during sympathetic and parasympathetic nerve traffic interruption. However, sympathetic stimuli caused an excessive increase in blood pressure. This excessive response cannot be explained by increased sympathetic nerve traffic or increased vascular sensitivity. Instead, we suggest that baroreflex buffering and baroreflex-mediated vasopressin release are severely impaired.
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Affiliation(s)
- J Jordan
- Clinical Research Center, Franz Volhard Clinic, Medical Faculty of the Charité, Humboldt-University, Berlin, Germany.
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Hattenbach LO, Toka HR, Toka O, Schuster H, Luft FC. Absence of hypertensive retinopathy in a Turkish kindred with autosomal dominant hypertension and brachydactyly. Br J Ophthalmol 1998; 82:1363-5. [PMID: 9930264 PMCID: PMC1722453 DOI: 10.1136/bjo.82.12.1363] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A 60 member Turkish kindred with autosomal dominant hypertension, which cosegregates completely with brachydactyly and short stature, was studied. Affected people have severe hypertension and generally die of stroke by the age of 50. The hypertension closely resembles essential hypertension and, accordingly, the mechanisms of blood pressure elevation are unknown. The gene responsible was mapped to chromosome 12p. METHODS All 29 affected family members underwent a basic physical examination and funduscopy. Other than markedly elevated blood pressures and the residua of stroke in a few subjects, the apparent lack of end organ damage was striking, including the normal appearing fundi. Five affected individuals were studied in a clinical research unit study. All underwent a complete ophthalmological examination. Fluorescein angiograms were obtained in three subjects. RESULTS Systolic blood pressures ranged from 170 to 250 mm Hg, while diastolic blood pressures ranged from 100 to 150 mm Hg in affected individuals. In all affected subjects, the fundi were only minimally altered or clinically normal. All three fluorescein angiograms were normal. Despite severe hypertension since childhood the patients showed no signs of hypertensive retinopathy. CONCLUSIONS The absence of hypertensive retinopathy in this novel form of inherited hypertension is due to an altered structure of retinal arteriolar walls or some other protective mechanism. Since evidence of end organ damage is scarce in other organs as well, the protective mechanism appears to be generalised.
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Affiliation(s)
- L O Hattenbach
- Department of Ophthalmology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
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Toka HR, Bähring S, Chitayat D, Melby JC, Whitehead R, Jeschke E, Wienker TF, Toka O, Schuster H, Luft FC. Families with autosomal dominant brachydactyly type E, short stature, and severe hypertension. Ann Intern Med 1998; 129:204-8. [PMID: 9696728 DOI: 10.7326/0003-4819-129-3-199808010-00008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Rare, monogenic forms of hypertension may give insight into novel mechanisms relevant to essential hypertension. Autosomal dominant hypertension with brachydactyly has been documented in a single Turkish kindred; the gene was mapped to chromosome 12p. OBJECTIVE To describe the molecular genetics of additional families with autosomal dominant hypertension and brachydactyly. DESIGN Case series. SETTING Tertiary care medical centers. PATIENTS An 11-member Canadian family and a 7-member U.S. family, neither of Turkish background, with autosomal dominant hypertension and type E brachydactyly. MEASUREMENTS Clinical evaluation, genotyping, and haplotype analyses. RESULTS The mode of inheritance, the type E brachydactyly, and the propensity for stroke were consistent with autosomal dominant hypertension with brachydactyly. The same markers on chromosome 12p cosegregated with the phenotype in the families. A haplotype analysis strongly supported the conclusion that these families have a molecular defect in the same gene. CONCLUSIONS The syndrome of autosomal dominant hypertension and brachydactyly is not confined to patients of Turkish origin. All persons with brachydactyly should have their blood pressure measured, and the syndrome should be considered if hypertension is found.
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Affiliation(s)
- H R Toka
- The Hospital for Sick Children, University of Toronto, Ontario, Canada
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Schuster H, Toka O, Toka HR, Busjahn A, Oztekin O, Wienker TF, Bilginturan N, Bähring S, Skrabal F, Haller H, Luft FC. A cross-over medication trial for patients with autosomal-dominant hypertension with brachydactyly. Kidney Int 1998; 53:167-72. [PMID: 9453014 DOI: 10.1046/j.1523-1755.1998.00732.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We examined a family with autosomal-dominant hypertension and brachydactyly from northeastern Turkey. The hypertension was defined as severe, resulting in stroke before age 50 years, featuring normal renin, aldosterone, and catecholamine responses, and did not appear to be salt-sensitive. The responsible gene resides on chromosome 12p. To determine which medications were most effective, we performed a prospective clinical trial. We studied 13 affected individuals in a randomized double-blind, cross-over trial including a beta-blocker (BBL), alpha-blocker (ABL), calcium channel blocker (CCB), converting enzyme inhibitor (CEI), and hydrochlorothiazide (HCT) and placebo (PLA). We then added moxonidine (MOX) and continued the trial for an additional period in a single-blind fashion. Each drug was given for four weeks with an option to double the dose after two weeks; each washout period comprised two weeks. Blood, 24-hour urine, and saliva were studied at the outset, and blood and urine samples were obtained at the end of each phase. Blood pressure (BP) and heart rate measurements were with the patient ambulatory at 24 hours. All regimens required doubled doses at two weeks. Beta blocker, CCB, CEI, and ABL lowered BP (6 to 10 mm Hg) and BP load compared to PLA, while HCT and MOX did not. Converting enzyme inhibitor and HCT increased plasma renin activity (PRA), while BBL lowered PRA. The 24-hour urine analysis indicated a high dietary salt intake with a low potassium and calcium intake. The salivary electrolytes showed similar sodium and potassium concentrations, while chloride values were significantly higher in affected than nonaffected subjects. Thus, this monogenic form of hypertension resembles nonsalt-sensitive essential hypertension in that BBL, CCB, CEI, and ABL were effective, while HCT was not. The BP reduction was similar to other single drug trials in essential hypertension. The high salivary chloride values suggest an additional intermediary phenotype that may be related to electrolyte transport. These results raise the possibility that an as yet unknown hypertensive mechanism is operative in these subjects.
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Affiliation(s)
- H Schuster
- Franz Volhard Clinic, Virchow Klinikum, Humboldt University of Berlin, Germany
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Toka HR, Toka O, Luft FC. [Genetics in hypertension research. What can we learn from it regarding common essential hypertension?]. Fortschr Med 1997; 115:36-8. [PMID: 9445830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Essential hypertension is a polygenic disease. Various genes responsible for rare monogenic forms of hypertension have been identified in the recent years. These are glucocorticoid remediable aldosteronism (GRA), Liddle's syndrome and apparent mineralocorticoid excess (AME). A fourth form, the Bilginturan syndrome is associated with brachydactyly and resembles essential hypertension. The investigations of the pathomechanisms in these rare diseases can help us to understand common hypertension.
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Affiliation(s)
- H R Toka
- Abt. für Innere Medizin und Nephrologie, Max-Delbrück-Centrum für Molekulare Medizin, Humboldt-Universität zu Berlin
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Naraghi R, Schuster H, Toka HR, Bähring S, Toka O, Oztekin O, Bilginturan N, Knoblauch H, Wienker TF, Busjahn A, Haller H, Fahlbusch R, Luft FC. Neurovascular compression at the ventrolateral medulla in autosomal dominant hypertension and brachydactyly. Stroke 1997; 28:1749-54. [PMID: 9303020 DOI: 10.1161/01.str.28.9.1749] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Autosomal dominant hypertension with brachydactyly features severe hypertension that causes stroke usually before the age of 50 years. We recently characterized the hypertension as featuring normal renin, aldosterone, and catecholamine responses and mapped the gene responsible to chromosome 12p. Since angiography in an affected subject had earlier shown tortuous vessels, we performed magnetic resonance tomography (MRT) angiography to look for possible neurovascular anomalies (NVA), which have been previously associated with hypertension. NVA can be caused by a looping posterior inferior cerebellar or vertebral artery. Experimental and clinical evidence suggests that NVA may cause hypertension by a compression of the ventrolateral medulla. METHODS We performed MRT in 15 hypertensive affected (aged 14 to 57 years) and 12 normotensive nonaffected (aged 12 to 59 years) family members. We then tested for linkage between the hypertension-brachydactyly phenotypes and the presence of NVA. RESULTS All 15 affected persons had MRT evidence for NVA. All had left-sided posterior inferior cerebellar artery or vertebral artery loops, while 6 had bilateral NVA. None of the nonaffected family members had NVA. The phenotypes were linked with an LOD score of 9.2 given a penetrance of 99%. CONCLUSIONS Autosomal dominant hypertension and brachydactyly regularly feature NVA, which is frequently bilateral. The early age at which NVA was identified suggests that the condition is primary. We suggest that NVA may be involved in the pathogenesis of this form of hypertension and perhaps essential hypertension as well. Further studies are necessary to address the question of causation.
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Affiliation(s)
- R Naraghi
- Franz Volhard Clinic, Virchow Klinikum, Humboldt University of Berlin, Germany
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Bähring S, Nagai T, Toka HR, Nitz I, Toka O, Aydin A, Mühl A, Wienker TF, Schuster H, Luft FC. Deletion at 12p in a Japanese child with brachydactyly overlaps the assigned locus of brachydactyly with hypertension in a Turkish family. Am J Hum Genet 1997; 60:732-5. [PMID: 9042935 PMCID: PMC1712511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Schuster H, Wienker TF, Toka HR, Bähring S, Jeschke E, Toka O, Busjahn A, Hempel A, Tahlhammer C, Oelkers W, Kunze J, Bilginturan N, Haller H, Luft FC. Autosomal dominant hypertension and brachydactyly in a Turkish kindred resembles essential hypertension. Hypertension 1996; 28:1085-92. [PMID: 8952601 DOI: 10.1161/01.hyp.28.6.1085] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We examined a Turkish kindred with a unique form of autosomal dominant hypertension that cosegregates 100% with brachydactyly and maps to chromosome 12p. Affected adults were 10 to 15 cm shorter than unaffected people; however, their body mass index (27 kg/m2) was not different. Blood pressure increased steeply with age in the affected people so that by age 40 years, they had a mean blood pressure of 140 mm Hg, compared with 92 mm Hg in unaffected individuals. Complete clinical, roentgenographic, and laboratory evaluation was performed in 6 subjects, including 24-hour blood pressure measurements and humoral determinations before and after volume expansion with 2 L normal saline over 4 hours followed by volume contraction on the following day with a 20-mmol sodium diet and 40 mg furosemide at 8 AM, noon, and 4 PM. Two affected men aged 46 and 31 years; 3 affected women aged 40, 31, and 30 years; and 1 unaffected man aged 29 years were studied. Systolic pressures ranged from 170 to 250 mm Hg, and diastolic pressures ranged from 100 to 150 mm Hg in affected people; the unaffected man had a blood pressure of 120/70 mm Hg. Thyroid, adrenal, and renal functions were normal; electrolyte and acid-base statuses were normal. Calcium and phosphate homeostasis was normal. Day-night circadian blood pressure rhythm was preserved. The subjects were not salt sensitive; renin, aldosterone, and catecholamine values reacted appropriately to volume expansion and contraction. Affected people had mild cardiac hypertrophy and increased radial artery wall thickness. Fibroblasts from affected people grew more rapidly in culture than from unaffected people. We conclude that this novel form of inherited hypertension resembles essential hypertension.
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Affiliation(s)
- H Schuster
- Clinical Research Unit, Max Delbrück Center for Molecular Medicine, Franz Volhard Clinic, Virchow Klinikum, Humboldt University of Berlin, Germany
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Schuster H, Wienker TE, Bähring S, Bilginturan N, Toka HR, Neitzel H, Jeschke E, Toka O, Gilbert D, Lowe A, Ott J, Haller H, Luft FC. Severe autosomal dominant hypertension and brachydactyly in a unique Turkish kindred maps to human chromosome 12. Nat Genet 1996; 13:98-100. [PMID: 8673114 DOI: 10.1038/ng0596-98] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Finding genes that cause human hypertension is not straightforward, since the determinants of blood pressure in primary hypertension are multifactorial. One approach to identifying relevant genes is to elucidate rare forms of monogenic hypertension. A relevant mutation may provide a rational starting point from which to analyse the pathophysiology of a condition affecting 20% of the world's population. In 1973 a family with autosomal dominantly inherited brachydactyly and severe hypertension, where the two traits cosegregated completely, was described. We have now re-examined this kindred, and localized the hypertension and brachydactyly locus to chromosome 12p in a region defined by markers D12S364 and D12S87. As the renin-angiotensin-system and sympathetic nervous system respond normally in this form of hypertension, the condition resembles essential hypertension. This feature distinguishes this form of hypertension from glucocorticoid remediable aldosteronism and Liddle's syndrome, which are salt-sensitive forms of monogenic hypertension with very low plasma renin activity. We suggest that identification of the gene involved in hypertension and brachydactyly and its mutation will be of great relevance in elucidating new mechanisms leading to blood pressure elevation.
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Affiliation(s)
- H Schuster
- The Clinical Research Unit, Max Delbrück Center for Molecular Medicine, Franz Volhard Clinic, Rudolf Virchow University Hospitals, Humboldt University, Berlin, Germany
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