ABSTRACT
Los inhibidores de la enzima convertidora de la angiotensina (IECA) han demostrado ser eficases en el tratamiento de la hipertensión arterial. Sin embargo, una importante proporción de hipertensos recibe además antiagregación plaquetaria con ácido acetil salicílico (AAS), y la consecuente inhibición de la síntesis de prostaglandinas con AAS atenuaría el efecto vasodilatador y la mayor excreción urinaria de sodio (Na(u)) atribuidas al IECA. Nuestro objetivo fue evaluar la interacción de dos dosis de AAS (81 y 325 mg/día) sobre el efecto hipotensor del enalapril y el impacto sobre la excreción de (Na(u)) en pacientes hipertensos. Se incluyeron 22 pacientes de ambos os sexos, entre 35 y 65 años. Todos reciberon enalapril, dieta hiposódica y, secuencialmente separadas por período de (wash out), las dos dois de AAS durante los setenta días del estudio. Se evaluó: presdión arterial sistólica (PAS), diastólica (PAD), media (PAM) y (Na(u)) en un período basal (PB), con 325 y 81 mg de AAS (P1 y P2 respectivamente). Comparando el PB con P1 y P2, se observó una reduccíon significativa de la PAS, PAD, PAM (p<0.01). Al comparar la PAS, PAD, PAM entre P1 y P2, no hubo diferencias significativas. La (Na(u)) en el PB fue mayor (p<0.01)con respecto al P1 y P2, y también P2 con respecto a P1. Estos resultados sugieren que en una población de pacientes hipertensos esenciales tratados con elapril y diferentes dosis de AAS, el tratamiento con dosis bajas de AAS está asociado a mejor control de la PA y mayor eliminación de sodio urinario.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Antihypertensive Agents/therapeutic use , Aspirin/administration & dosage , Enalapril/therapeutic use , Hypertension/drug therapy , Natriuresis/drug effects , Platelet Aggregation Inhibitors/administration & dosage , Antihypertensive Agents/antagonists & inhibitors , Aspirin/pharmacology , Cross-Over Studies , Double-Blind Method , Enalapril/antagonists & inhibitors , Prospective Studies , Platelet Aggregation Inhibitors/pharmacologySubject(s)
Humans , Male , Female , Albumins , Alkaline Phosphatase , Liver/enzymology , Liver/physiopathology , Liver Diseases , Liver Function Tests , Transaminases , Transglutaminases , Diagnosis, DifferentialSubject(s)
Humans , Male , Female , Liver Diseases , Biomarkers/blood , Kidney Function Tests , Bilirubin , Diagnosis, Differential , Liver/enzymology , Liver/physiopathologyABSTRACT
The audiovestibular system can be affected by an immunologic etiology. The immune-mediated inner ear disease (IMIED) is a syndrome that includes rapidly progressive sensorineural hearing loss, vertigo and tinnitus, which occurs as a primary disorder or complicates certain autoimmune systemic conditions. However, if treated promptly with immunosuppression, the audiological sequel of IMIED may be avoided. We present a 28 year old female patient, who after rhinitis and mioarthralgias developed a vestibular syndrome. A week later she experienced bilateral hearing loss that progressed to deafness in 72 hours. The examination revealed horizontal and torsional nystagmus, a disrupted vestibulo-ocular reflex and vertigo with the positional changes. Laboratory data were normal except for eritrosedimentation rate (75 mm/1 hour). The autoantibodies usually present in rheumatologic autoimmune systemic diseases were negative. The antibodies to the 68-kD antigen found in the inner ear were positive. The chest x-ray and sinus x-ray were normal. The head magnetic resonance imaging with gadolinium and ear computed tomography were normal. Cerebrospinal fluid studies showed normal findings. With the possible diagnosis of IMIED we started early treatment with corticosteroids, with improvement in auditory and vestibular function thereafter. We highlight the early recognition of IMIED as a differential diagnosis in patients with acute bilateral hearing loss, because prompt treatment with immunosuppression might have a positive effect on auditory function recovery.