Clinical Efficacy and Safety of Gepefrin in the Treatment of Hypotension

BACKGROUND: The proper management of the patients with hypotention remains a difficult clinical problem. This study was designed to evaluate the efficacy and safety of gepefrin in the treament of symptomatic hypotensive patients in outpatient clinic of university hospital. METHODS: Thirty milligrams of Gepefrin was given twice daily for 4 weeks in 30 patients with hypotension(6 males, 24 females ; 23-60 years of age). Blood pressure, heart rate, subjective symptoms and side effects were checked before medication and at the end of 1st, 2nd, 3rd, 4th week of medication. RESULTS: 1) Grpefrin increased sitting systolic blood pressure significantly(p<0.05) by the end of 1st week and thereafter. 2) Hypotensive symptoms were improved in 76% of hypotensive patients and overall rate of usefulness was 70%. 3) Heart rate did not change significantly. 4) One patient complained of loose bowel movement and another one, of anorexia among 30 study patients and all laboratory parameters were within normal limits before and after drug treatment, thus the rate of safety was 93%. CONCLUSION: Results from this study suggests that gepefrin 60mg daily increases the blood pressure mildly and improves the symptoms moderately in symptomatic hypotensive patients.

Effect of the Long-Term Therapy with Felodipine(Munobal(R)) in Patients with Essential Hypertension : With Reference to Persistence of Its Antihypertensive Effect and Safety

BACKGROUND: Hypertension is a major and growing public health problem and it calls for life-long management. The antihypertensive agents are still playing major roles in the management of hypertension. We studied the effect of the long-term therapy with a new calcium channel blocker, felodipine in patients with essential hypertension. METHODS: We recruited 31 patients with mild to moderate essential hypertention and gave them 5mg (1 tablet) of felodipine(Munobal(R)) once daily for 12 months. We measured the blood pressure and the heart rate every month and tried to detect any untoward symptoms and signs during the whole observation period. Baseline work-up for the hypertensive patients were done as usual before and after the study. RESULTS: The average systolic and diastolic blood pressures were 162.7+/-9.7/99.6+/-7.4mmHg respectively before the administration and they came down to the level of 139.7+/-15.0/87.3+/-8.6mmHg respectively at the end of the 1st month (p<0.05). This trend was maintained during the whole observation period, so they were 141.2+/-11.0/85.6+/-8.2mmHg respectively at the end of the study (p<0.05). Untoward drug reactions such as gastrointestinal troubles, facial edema, leg edema, chest pain and headache were present in 11 patients (35%) but they were not serious. There was no case in which the drug was withdrawn. There was one case in which the level of the serum triglyceride increased after the administration of the drug. CONCLUSION: Felodipine has good and persistent hypotensive effect and it is safe and easy to use.

The effect of angiotensin converting enzyme inhibitor(enarlapril) on the capsicin-induced cough reflex / 대한내과학회지

No abstract available.

The Evaluation of Coronary Artery Stenosis by Exercise-Induced Negative U Wave

BACKGROUND: Negative U wave is frequent maker of systemic hypertension, aortic or mitral regurgitation and myocardial ischemia. This study was undertaken to determine the diagnostic significance of exercise-induced negative U wave in coronary artery stenosis. METHOD: 72 patients(46 men and 26 women ; 24~66 years of age) with chest pain were analysed with exercised-induced negative U wave and coronary angiographic finding. RESULT: Exercise-induced negative U wave was seen in 14 patients(19%). Among 14 patients with exercise-induced negative U wave, the predictive value of significant coronary artery stenosis(> or =75% stenosis of major coronary artery) was 71%, Exercise-induced negative U wave is more prevalent in patients with significant coronary artery stenosis(p<0.05). CONCLUSION: Exercise-induced negative U wave is a good marker of significant coronary artery stenosis.

Clinical Effects and Safety of Delapril in Patients with Essential Hypertension

BACKGROUND: To evaluate depressure effect and safety of delapril, a new ACE inhibitor, in Korea. METHOD: Thirty three patients, aged 37-69, with mild to moderate essential hypertension were first observed for 2 weeks with placebo followed by administration of 15mg of delapril twice daily for 2 weeks, then doubled dosage to 30mg b.i.d. and combined with 25mg of dihydrochlorothiazide if optimal BP were not obtained at the end of 4th week, continued the same dose until the end of 10 week's trial period. RESULT: BP dropped 15/9mmHg inaverage at the end of 10th week rewarding 70% of cumulative effectiveness. Most frequent side reaction was dry cough, occurred in 9% of patients followed by chest tightness, headache, constipation and transient elevation of GPT. CONCLUSION: Delapril 15-30mg twice daily as monotheraphy or combined with diuretics is well tolerated and effective in the treatment of mild to moderate essential hypertension.

Reference Values for the Ambulatory Blood Pressure in Normotensive Korean Young Men

BACKGROUND: To obtain reference values for the ambulatory blood pressure, 30 normotensive Korean young males, aged 22-28 years(mean age: 25 years) were investigated. METHODS: The ambulatory blood pressure was recorded with SpaceLabs Model 90207 monitor over 24 hours at 20 minutes intervals during day-time(6 am-10pm) and at 30 minutes intervals during night-time (10 pm-6 am). RESULTS: The ambulatory blood pressure of the 30 subjects averaged 119/74mmHg over 24 hours, 122/78 mmHg during day-time and 112/68 mmHg during night-time. The upper limit of normal ambulatory blood pressure was suggested as the value of mean+/-2SD which revealed 131/84mmHg for 24 hours, 134/90 mmHg for day-time and 126/80 mmHg for night-time. CONCLUSION: Reference values for the ambulatory blood pressure, in normotensive Korean young men, were obtained by SpaceLab model 90207 monitor.

Efficacy and Safety of Nifedipine Gastrointestinal Therapeutic System(Adalat OROS) in Patients with Mild to Moderate Essential Hypertension

BACKGROUND: This study was designed to evaluate the antihypertensive efficacy and safety of nifedipine gastrointestinal system push-pull osmotic pump formulation in patients with mild to moderate essential hypertension. METHODS: After 2 weeks placebo run-in period, nifedipine 60 mg was administered once daily for 8 weeks in thirty-two patients with mild to moderate essential hypertension. RESULTS: At the end point of treatment, sitting blood pressure decreased as much as 33/16mmHg in average and rewarded 88% of efficacy and 69% of normalization. The ambulatoy blood pressure monitoring in 10 patients also revealed 11% decrease in 24 hr mean diastolic blood pressure and 32% decrease in % elevated blood pressure. The most frequent side reactions were constipation in 7 patients and polyuria in 6 patients which were tolerated during entire trial period. There were no significant changes in biochemical parameters and hematologic data, thus making the rate of safety 91% and overall rating of usefulness was 84%. CONCLUSION: Nifedipine GITS 60 mg once daily regimen is well tolerated and effective in the treatment of mild to moderate essential hypertension.

Effect of Nitrendipine on the Blood Pressure of Mild Hypertensives

Fifty patients with mild essential hypertension were studied to evaluate the efficacy of once-daily regimen of nitrendipine, 10~20mg daily for 12 weeks. 1) Thirty-Seven patients completed the study and showed -9% change in mean arterial headache etc. 2) Eight patients were dropped out because of side reaction, namely flushing, palpitation, headache etc. 3) Ambulatory blood pressure monitoring before and after treatment in 3 patients confirmed the drug efficacy revealing 9% decrement in mean blood pressure and 46% decrease in % elevated BP. 4) Twenty patients who were controlled with other hypotensive drugs were well controlled & maintained the blood pressure in normal range after switching to nitrendpine 10~20mg daily. In conclusion, citrendipine is a safe and good antihypertensive calcium antagonist in the treatment of mild hypertensives with 10~20mg of once-daily dosage.

Hypotensive Efficacy and Safety of Ramipril on the Patients with Essential Hypertension

Thirty three patients with mild to moderate essential hypertension were administered ramipril, a new ACe inhibitor, 2.5-5mg once daily for 6 weeks to evaluate the hypotensive efficacy and safety. The results were as follows : 1) The patients consisted of 18 males, 15 females, aged 54 on average and classified as mild in 19 and moderate in 14 patients. 2) At the end of 6 weeks trial, blood pressure dropped 13/6mmHg on average, rewarding 70% effectiveness and normalized below 150/90mmHg in 39%. 3) The most frequent side reaction was dry cough in 5 patients(15%) followed by asthenia, GI trouble, dizziness, edema, eye injection and one case of GPT elevation which normalized after completion of trial. 4) The rating of safety of safety was 79% and of overall usefulness was 73%. In conclusion, ramipril 5mg once daily regimen is well tolerated and effective in the treatment of mild to moderated essential hypertension.

Hypotensive Efficacy and Safety of Manidipine on the Patient with Essential Hypertension

Thirty patient with essential hypertension were administered Manidipine, a new calcium antagonist, 10~20mg once daily to evaluate the hypotensive efficacy and safety for 8 weeks. And the followings were the result. 1) Patients were consists of 14 male, 16 female, aged 53 in average and classified as mild in 21 and moderate in 9 patients. 2) Optimum intial dose was 10mg and 10 to 20mg were the doses recommended. 3) Blood pressure dropped after 8 weeks 24/13mmHg in average, rewarding 80% effectiveness and normalized in 87%. 4) Most frequent side reaction was facial flushing in 5 patiens followed by palpitation and dizziness, all of which did not disturb the continuation of medication. 5) Most of routine laboratory parameter were normal and unchanged between before and after the trial. 6) Overall rating of usefulness was 77%. In conclusion, Manidipine 10 to 20mg once daily regimen is well tolerated and effective in the treatment of mild to moderate essential hypertension.

Reproducibility of Ambulatory Electrocardiography

To evaluate the reproducibility of the Ambulatory Electrocardiography (AECG), we examined the consistency rates of premature beats between the baseline AECG's and the repeat AECG's in 23 patients who underwent AECG's times within 1 year. 12 patients were male and 11 patients were female. Their mean age was 48 years. (Range ; 20 years-75 years) The time interval between both AECG's was 1 month 20 days. (Range ; 1 day-9months) They did not take any antiarrhythmic druge during the observation period except 4 patients who were taking calcium channel blockers or beta receptor blockers for hypertensive heart disease or ischemic heart disease. The consistency rate of both frequency and complexity of ventricular premature beats was 52%. The consisency rate of both frequency and complexity of supraventicular premature beats was 35%. These consistency rates seemed to vary as the time interval between both AECG's differed. In the case of ventricular premature beats, the consistency rates of 1 day, 8 days and 5 months as the time interval were 100%, 38% and 14% respectively. In the case of supraventricular premature beats, the consistency rates were 50%, 25% and 29%. We concluded that the reproducility of the AECG was low and this reproducibility became lower as the time interval between both AECG's became longer and that hese facts had to be considered when the effect of the antiarrhythmic drugs was evaluated.

Diurnal Variation of Blood Pressure; the Difference between before and after Removal of Pheochromocytoma: Evaluation by Ambulatory Blood Pressure Monitoring

Ambulatory BP monitoring was performed in a patients with pheochromocytoma before and after removal of the tumor. Before surgery, it did not show any significant diurnal variation. But, after surgery the diurnal variation was restored.

The Experience of Percutaneous Transluminal Coronary Angioplasty (PTCA) on the 25 Patients with Coronary Artery Disease

PTCA has been widely applied in patients with symptomatic coronary artery disease since 1977. The PTCA was performed on a total of 25 patients (19 men and 6 women) from Feburary 1988 to January 1990 at Inje University Baik Hospital. Their mean age was 51.4+/-10.1 years. The 20 patients had unstable angina, and 5 patients had stable angina. The 6 patients had a previous myocardial infarction. The 17 patients had one vessel disease, 6 patients had two vessel disease and 2 patients had three vessel disease. Primary success was achieved in 24 of 25 patients. The mean degree of stenosis was reduced from 80.7+/-2.9% to 16.2+/-3.3% (p<0.01). After PTCA, pain was relieved or subsided in all patients. In 6 patients, mild chest pain has reccured during the short term follow up. Repeat PTCA was performed in 2 of 6 patients successfully. Complications occurred in 3 patients ; coronary artery spasm, ventricular fibrillation and femoral artery hematoma in each patients.

Effect of Pravastatin on Serum Lipids of Patient with Primary Hyperlipidemia

A new hypolipidemic drug, pravastatin, hydroxymethylglutaryl coenzyme A reductase inhibitor was administered to 33 patients with primary hyperlipidemia, 10mg daily for 8 weeks and sequential changes of lipid profile were analysed as follows. 1) Mean value at baseline period of total cholesterol, triglyceride, high and low density lipoprotein cholesterol were 260, 220, 51 and 163mg/dl respectively. 2) Total cholesterol showed 21% decrease at the end of 8 weeks and that of LDL-cholesterol were 30%. 3) Triglyceride decreased 16% at the end of 8 weeks and increment of HDL-cholesterol was 8% at the end of 8 weeks. 4) No serious side reactions were observed except one patient, who showed generalized skin rash which last 3 days and did not prevent further medication. In conclusion, pravastatin is a safe and useful hypolipidemic agent for the patient with primary hyperlipidemia.

Effect of Lovastatin(Mevacor(R)) on Serum Lipids of Patients with Primary Hyperlipidemia

A new hypolipidemic agent, lovastatin, hydroxy-methyl-gultaryl coenzyme A reductase inhibitor was administred to 25 patients with primary hyperlipidemia 20 to 40 mg daily for 12 weeks and sequential changes of serum lipid profile were analysed as follow. 1) Mean average at baseline period of serum total cholesterol, triglyceride, HDL and low desity lipoprotein cholesterol were 271, 179, 51 and 185 mg/dl respectively. 2) Total cholesterol showed 20% decrease at 4th week and 23% decrease at the end of 12th week while low density lipoprotein cholesterol decreased 31% and 33% respectively. 3) Triglyceride dropped 7% at 8th week and 3% at 12th week. High density lipoprotein cholesterol increased 4% at 4th week and showed 2% decrease at the end of study. 4) Only one patient complained of moderate abdominal pain, which subsided after 2 weeks drug withdrawal. In conclusion, lovastatin was well tolerated and effective, in the treatment of primary hyperlipidemia.

The One-Year Prognostic Value of the Pre-Discharge ECG after the First Acute Myocardial Infarction

To assess the prognostic value of the 14 ECG variables obtained from the pre-discharge ECG, 35 patients were followed up for at least one year among the 80 patients of the acute myocardial infarction admitted at Seoul Paik Hospital from Sep. 1983 to Aug. 1986. The following results were obtained. 1) The overall in-hospital mortality rate was 20% and the mortality rate tended to decline year by year. 2) The one-year mortality and morbidity rate of the followed patients was 31.4%. 3) Among the 14 variables obtained from the pre-discharge ECG, T-negativity was the only statistically significant (p<0.05) one to predict the one-year prognosis in the patients after the first myocardial infarction, and we could not derive any meaningful datd from the analysis of the combined effects of the three ECG variables (PTF, ST depression and ST elevation).

Antihypertensive Effect of Captopril on Essential Hypertension

The antihypertensive effect of captopril was evaluated in 15 patients with mild to moderate essestial hypertension(Mean age : 55, Mean blood pressure : 171/102mmHg). Captopril was administered 25 to 50mg twice daily with or without hydrochlorothiazide by mouth according to our protocol which was presented in the text. All the patients were followed up to 12 weeks. Captopril with or without hydrochlorothiazide significantly lowered the systolic and diastolic pressure in almost all patients. The mean systolic and diastolic pressure were reduced to 134/86mmHg(-37/-16mmHg ; -22/-16%)(p<0.001). Heart rate did not change significantly. No unwanted effects were observed. We conclude captopril has exellent antihypertensive effect in most patients with mild to moderate essential hypertension.

Antiarrhythmic Effect of Amiodarone on Ventricular Arrhythmias

The antiarrhythmic effect of oral amiodarone was evaluated by 24-hr Holter monitoring in 12 patients with frequent and/or complex ventricular ectopy. Amiodarone was administered as following schedule; 600mg a day for the 1st week, 400mg a day for the 2nd week and 200mg a day, 5 days a week from the 3rd week. In 9 patients, the frequency of VPC decreased significantly or the grade of VPC changed to the more benign grade, so we considered them as "Effective Group" (75%). In 7 patients, both the frequency and the grade of VPC improved, so we considered them as "Excellent Group" (58%). No significant side effect was observed during investigation. We concluded that amiodarone is very effective antiarrhythmic drug and has no serious side effect during a short-term observation.

A representative value for 24-hour monitored ambulatory blood pressure

Several shorter-term alternatives for whole-day ambulatory monitoring of blood pressure using Pressurometer III or conventional sphygmomanometer were evaluated in 12 male patients with mild hypertension. Averages of BP reading at 8 AM once, 3 consecutive-readings either with Pressurometer or manually, serial readings for 2-hour intervals from 8-10 AM and 2-4 PM were compared with that of 24-hour ambulatory, non-invasive BP readings by Pressurometer. Both systolic and diastolic 2-hour BP averages in the morning (8 to 10 o'clock) correlated more strongly with 24-hour averages (r = 0.91 and 0.91) than the 3 consecutive (r = 0.88 and 0.66) or single (r = 0.49 and -0.35) reading alternatives did. In conclusion, the average of serial readings obtained during 2-hour monitoring period from 8 to 10 AM is a reliable predictor of 24-hour ambulatory BP and represents it more closely than the conventional single or multiple BP readings.

1000 Cases of Multi-Staged Treadmill Exercise ECG Test: Is It Safe?

We examined 984 objects for exercise stress test, using CASE I(computer assisted system for exercise). They exercised according to Bruce's protocol, Among them, the mal were 613 and the female were 371. (Male:Female;17:1) The 5th and 6th decades occupied 61% of total objects. The purpose of test was evaluation of chest pain in 84% of total cases. The most frequent end point of test was dyspnea(42%) and chest pain was observed in 13% of total cases. Most of all objects above 8-9 METS. Positive results of exercise stress tert were obtained in 23%. As complications, ventricular tachycardia occurred in 7 cases, supraventricular tachycardia; 8, high degree VPB's; 6, sudden cardiovascular collapse;15, The complication rate was 0.36% but morbidity and mortality were 0. All complicated cases recoved spontaneously only by rest.