Nitric oxide and its relation to blood pressure control and target organ damage in hypertensive patients

Patient with essential hypertension have reduced endothelium dependent vasodilatation, this abnormality has been related to decreased activity of endothelium nitric oxide. To estimate nitric oxide level in hypertensive patients to verify its role in relation to blood pressure control and target organ damage in hypertensive patients. Sixty hypertensive patients participated in this study, 40 of whom without clinical evidence of target organ damage of whom 20 had uncontrolled blood pressure and the other 20 were controlled with antihypertensive therapy. Study also included 20 hypertensives with evidence of target organ damage. Ten normal non-hypertensive subjects volunteered as controls. They were all subjected to full clinical assessment and estimation of nitric oxide levels. Each of the hypertensive groups including controlled hypertensives, uncontrolled hypertensives and hypertensives with evidence of target organ damage had statistically significant lower nitric oxide levels compared to normotensive control subjects [p<0.000]. Controlled hypertensive group when compared to the uncontrolled hypertensive group still had a statistically significant difference of nitric oxide [p value 0.000] While hypertensive patients with evidence of target organ damage had a statistically significant low nitric oxide levels compared the controlled hypertensive group [p value < 0.001], they did not have a statistically significant difference in NO levels when compared to the uncontrolled hypertensive group [p value 0.5]. Hypertensive patients whether controlled or not; whether with target organ damage or not have low NO denoting an underlying endothelial dysfunction. Controlled hypertensives with acceptable blood pressure measurements still have evidence of endothelial dysfunction with low NO. Current antihypertensive therapy, though attaining acceptable blood pressure levels does not seem to tackle endothelial dysfunction in hypertensive patients. NO seems to be playing a crucial role in target organ damage in hypertensive patients

Comparative study between st and ard epidural and combined spinal epidural either with fentanyl or fentanyl and bupivacaine for labour analgesia

We carried out an observational study to assess maternal satisfaction with st and ard epidural and combined spinal epidural [CSE]. We selected 60 nulliparous fullterm parturients who were in active labour and requested analgesia. They were divided into 3 groups For [group 1] st and ard epidural analgesia [10 ml of 0.25%] bupivacaine was injected into the epidural space followed by top-up of 10 ml of 0.125% bupivacaine as required. [Group 2], combined spinal-epidural fentanyl [CSEF] the initial dose was 25 micro g fentanyl in 2 ml normal saline followed by top - up of 25 micro g fentanyl in 5 ml in epidural catheter as required. [Group 3] combined spinal-epidural bupivacaine and fentanyl [mixed CSE], the initial intrathecal dose was 2.5 mg bupivacaine and fentanyl 25 micro g in 2ml normal saline, followed by top-up of 20 micro g fentanyl with 0.125% bupivacaine in 10 ml in epidural space as required. We found that the overall satisfaction was geater in the combined spinal-epidural groups than the st and ard epidural group. Good analgesia was achieved in all groups, but the combined spinal-epidural bupivacaine and fentanyl had faster onset and prolonged duration followed by combined spinal-epidural fentanyl and then st and ard epidural group, The leg weakness was more in st and ard epidural group and very mild in group 3 but absent in group 2. Overall, women seem to be satisfied with low dose combined spinal-epidural fentanyl and bupivacaine perhaps because of the faster onset, less motor blockade and feelings of greater self control