The Antihypertensive Efficacy, Safety, and Tolerability of Losartan Versus Fosinopril in Patients with Hypertension

BACKGROUND: Losartan potassium, an orally active, highly selective AT (1) angiotensin II receptor inhibitor, effectively reduces blood pressure by directly blocking receptors. The purpose of this study is to compare the antihypertensive efficacy, safety and tolerability of losartan potassium and fosinopril in patients with stage 1 to 3 hypertnesion. METHODS: In this comparative, open labelled, randomized, parallel study, the efficacy, safety and tolerability of once-daily losartan (50mg) versus once-daily fosinopril (10mg) were evaluated over twelve weeks in 96 patients with stage 1-3 hypertension. If trough sitting diastolic blood pressure was equal to or greater than 90mmHg after a 6 week treatment period, the dosage for both study drugs was doubled until the end of the study (week 12). RESULTS: After 6 weeks of treatment, mean reductions in trough sitting diastolic blood pressure were 7.4mmHg (95% confidence interval 5.0-9.9) with 50mg losartan and 6.7mmHg (95% confidence interval 4.4-9.2)with 10mg fosinopril. After 12 weeks of treatment (after dose titration), mean reductions in trough sitting diastolic blood pressure were 9.4mmHg (95% confidence interval 6.7-12.1) with losartan and 10.3mmHg (95% confidence interval 7.6-12.9) with fosinopril. At weeks 6 and 12, there were no dignificant difference in the mean reduction of through ditting diastolic blood pressure between the losartan group and the fosinopril group. Losartan and fosinopril were well tolerated without significant clinical and laboratory adverse reactions. The incidence of dry cough was lower in the losartan group than in the fosinopril group but not statistically significant. CONCLUSIONS: The antihypertensive effect of once-daily administration of losartan is similar to that of once-daily administration of fosinopril in patients with hypertension. Both losartan and fosinopril are well tolerated without significant adverse reaction.

Clinical Efficacy of Lovastatin in Patients with Hypercholesterolemia

BACKGROUND: This study was designed to evaluate the clinical efficasy of lovastatin, HMG-CoA reductase inhibitor, in patients with hypercholesterolemia. METHODS AND RESULTS: Lovastatin 20 to 80 mg were administered once daily for 12 weeks in twenty five patients(11 male, 14 famale ; nine patients with familial hypercholesterolemia) with hypercholesterolemia(>240mg/dl). Compared with pretreatment levels, lovastatin significantly decreased levels of total cholesterol(309+/-46mg/dl versus 201+/-37mg/dl) by 35%, LDL-cholesterol(230+/-48mg/dl versus 125+/-40mg/dl) by 46% and triglyceride(170+/-76 versus 142+/-66mg/dl) by 11% (p<0.05) with significantly decreased levels of total-cholesterol/HDL-cholesterol ratio(7.4+/-2.1 versue 4.6+/-1.5) and LDL-cholesterol/HDL-cholesterol ratio(5.6+/-1.9 versue 2.9+/-1.4) (p<0.005 except triglyceride, respectively). The level of Apo B(183+/-32mg/dl versus 114+/-26mg/dl) was decreased significantly by 37%(p<0.005) with significantly decreased level of Apo A-1(115+/-22 to 122+/-26mg/dl) was increased significantly by 6%(p<0.05). No serious side effects were found. CONCLUSIONS: Results from the present study show that lovastatin is an effective and well-tolerated cholesterol-lowering agent.

The Relationship between Ventricular Arrhythmia in Patients with Myocardial Infarction and Ventricular Late Potential

Ventricular arrhythmia is known as a major cause of sudden death in patients with heart disease, especially in patients with myocardial infarct. Programmed electrical stimulation (PES) is used in order to identify patients with high risk of ventricular arrhythmia, but it is invasive. So ventricular late potential is studied, which can be performed safely. Ventricular late potential was measured in the 65 normal subjects, 17 patients with in-hospital period acute myocardial infarction and 29 patients with old myocardial infarction using signal-averaged high resolution EKG, Mac-15. The positive criteria of ventricular late potential was one of the following : The duration of TQRS is more than 120 msec, or the amplitude of RMS is less than 25microV, or the duration of LP 40 is more than 40 msec. The results are as follows : 1) Among 65 normal subjects(male ; 33, female ; 32), total QRS duration(TQRS)was 103.9+/-8.3msec(mean S.D), terminal 40msec root mean square amplitude(RMS) 47.8+/-24.3uV and terminal 40msec mean amplitude was 32.5+/-15.4uV. Variables of ventricular late potential showed no significant difference by age. 10 subjects showed positive ventricular late potential. 2) Among 17 patients with in-hospital period myocardial infarction, there was no significant difference in variables of ventricular late potential between patients with ventricular arrhythmia(3 subject) and patients without ventricular arrhythmia(14 subjects). 3) Among 29 subjects with old myocardial infarction, TQRS showed significant differrence between patients with ventricular arrhythmia(3 subjects) and patients without ventricular arrhythmias(26 subjects). All of the patients with ventricular arrhythmia(100%) and 6 subjects(24%) of the patients without ventricular arrhythmia showed positive ventricular late potential, and the difference was significant statistically between groups(p value<0.05). This showed that ventricular late potential is helpful in predicting the risk of ventricular arrhythmia among patients with old myocardial infarction.

Double Chambered Right Ventricle(DCRV) in Adult and Adolescence

DCRV is a rare cause of right ventricular outflow obstruction by anomalous muscle bundle at the level of sinus portion. The symptoms due to DCRV itself were mild inspite of significant pressure gradient over 90mmHg between proximal and distal chamber, and became severe by associated complication of bacterial endocarditis or aortic regurgitation in ventricular septal defect. In 12 cases(40%), right ventricular hypertrophy configuration in electrocardiogram was characteristic. Although R wave in V1 was tall, S wave in V6 and R wave in aVR were indistinctive. Those were very useful findings for diagnosis of DCRV which was thought to be possible only invasively. With operation prior to overt right ventricular faliure, the prognosis was good with only minor complication.