Effects of Cardioselective Beta Blocker Nebivolol on Different Biochemical Parameters in Essential Hypertensive Patients.

Background : Nebivolol is a third-generation highly selective b1-blocker with additional endothelial nitric oxide (NO) mediated vasodilating activity. This property may potentiate the blood pressure-lowering effect of Nebivolol. Nebivolol is also claimed to have neutral or favourable effect on carbohydrate metabolism and lipid profile. Therefore this study was conducted to evaluate effects of Nebivolol on different biochemical parameters in essential hypertensive patients. Materials and Methods : 21 newly diagnosed patients of either sex with essential hypertension were included in the study. Patients having co-morbidities e.g. Diabetes mellitus, hyperlipidemia, gout, pregnant females were excluded from the study. Baseline readings of lipid profile, serum electrolytes, fasting blood sugar and uric acid were recorded before starting Nebivolol drug therapy. Same biochemical tests were repeated after six months drug treatment. Results and Observation : After comparing the means there is increase in total cholesterol, LDL, Serum electrolytes, blood sugar levels but this increase is within normal limits and is not statistically significant. While there is decrease in TG level but statistically not significant. No significant change in HDL, uric acid levels. Conclusion : Nebivolol is a unique, highly selective b1-blocker due to its neutral metabolic properties and is potentially safe over conventional b-blockers.

Effects of dexamethasone in primary intracerebral hemorrhage in the south west of Iran

Previous study revealed the value of dexamethasone in the treatment of vasogenic edema associated with brain tumor and abscess. However there are poor documented studies about its usefulness in primary intracerebral hemorrhage. In this study we evaluated dexamethasone effects in primary intracerebral hemorrhage. In a double blind randomized placebo-controlled clinical trial we evaluated 200 intracerebral hemorrhage cases between 40 to 80 years old whom were admitted at Golestan Hospital [Ahwaz, IR] between March 2002 And March 2003. They were divided in two groups; dexamethasone [N=100] and placebo [N=100]. Then mortality, GI bleeding, fever, electrolytes disturbances, hypertension and hyperglycemic status were analyzed in two groups. Ethical considerations were employed and subjects were followed by appropriate statistical methods for 21 days to assess the major outcomes. Mortality was much higher in the dexamethasone group; Dexamethasone group [49.3%] and placebo [23.4%] and also fever was higher seen in the dexamethasone group; dexamethasone group [40.2%] and placebo group [24.7%] but there was not any significant statistical difference between two groups as regards other complications. Dexamethasone is widely used for cerebral edema associated conditions but in this study we saw that it's complications in intracerebral hemorrhage such as increasing fever and mortality are significantly higher. Hence it use for treatment of primary intracerebral hemorrhage should be reconsidered

Comparison between the induction of anesthesia using sevoflurane-nitrous oxide, propofol or combination of propofol and sevoflurane-nitrous oxide using laryngeal mask airway [LMA] in hypertensive patients

In a double-blinded trial, 90 patients with stable hypertension were enrolled in this study. Each group consisted of 30 patients. The induction in group S was by sevoflurane 4% + 50% oxygen +50% nitrous oxide by inhalation using the tidal volume technique. The induction in group P was by propofol 2mg/kg IV, and in group PS [combination group] was by propofol 1mg/kg followed by inhalation of 4% sevoflurane.The present study compared hemodynamic changes, laryngeal mask airway [LMA] insertion time and any complications occurred in the induction period between the three groups. LMA insertion time was significantly longer in the sevoflurane group than in the other two groups. Mean arterial blood pressure [MAP] was significantly lower within each group after induction in comparison to before induction. In all the groups, LMA was successfully inserted in all patients. According to patients induction was pleasant in 90% of patients in the propofol group and was 88% in the combination group and 40% in the sevoflurane group. This study concluded that in the combination group there is the advantage of patient satisfaction and rapid induction with no apnea which occurred with propofol and had the advantage of hemodynamic stability encountered with sevoflurane

Evaluation of terazosin action on experimentally-induced hypertension and insulin resistance in rats

Terazosin is an alpha 1 blocker indicated in therapy of mild to moderate hypertension, in peripheral vascular disease and in cases of refractory congestive heart failure. It is also used in benign prostatic hypertrophy. The present study was designed to investigate the effects of terazosin on blood pressure, renal blood flow parameters, insulin resistance, blood glucose, cholesterol and triglycerides in rats. Insulin resistance was induced experimentally by feeding rats l0% fructose in drinking water for 4 weeks. In vitro studies done to investigate terazosin site of action. In-vivo studies, terazosin significantly decreased systolic and mean arterial blood pressure and serum cholesterol but triglycerides showed insignificant change. Terazosin significantly improved insulin sensitivity. Doppler technique showed that Terazosin significantly decreased renal artery systolic pressure and blood flow velocity while it produced insignificant effect on heart rate. In-vitro studies on isolated rat aorta and isolated rat heart, terazosin had a significant cholinomimetic effect beside it's alpha 1 blocking action

Safety and effectiveness of umbilical vein oxytocics injection in hypertensive and cardiac parturient

Systemic injection of ergometrine and oxytocics for hypertensive and cardiac patients constitutes a real risk. 100 patients were included in this study, all were hypertensive except 5 cardiac patients. Different oxytocics were injected in the umbilical vein in the 3rd stage of labor in 55 hypertensive and 5 cardiac patients compared with distilled water in 20 parturient and another 20 patients received nothing. Those who received intraumbilical [IU] vein prostaglandin E2 had significantly shorter mean placental separation time followed by oxytocin and lastly ergometrine and distilled water. There is a decreased incidence of postpartum hemorrhage and retension of the placenta and increase in the mean hemoglobin on the second postpartum day. There is no significant difference of the mean arterial blood pressure and pulse rate before and after injection of umbilical vein by these oxytocics. Oxytocin and ergometrine IU vein injection appeared to be safer and effective compared to prostaglandin E2 and nothing. So, IU vein injection of oxytocin and ergometrine is recommended in hypertensive and cardiac patients as a preventive approach for postpartum hemorrhage in those high risk group rather than systemic injection

Isradipine in Pakistani hypertensive patients

Isradipine, a calcium channel blocker, was given to 124 [29 females and 32 males] hypertensive patients for eight weeks after three weeks on placebo treatment. Mean age was 46.5 +/- 0.86 years, mean weight before treatment was 70.04+1-1.2 kg, after treatment it was 69.7 +/- 1.3 Kg, mean height was 154.5 +/- 0.8 cm and mean duration of hypertension was 4.2 +/- 0.31 years. Mean sitting systolic pressure decreased from 164 +/- 1.5 mmHg to 146 +/- 2.19 mmHg [p<.001] while mean sitting diastolic pressure dropped from 106.5 +/- 0.62 mmHg to 93.1 +/- 0.8 mmHg [p<.001]. Mean standing systolic pressure fell from 166 +/- 1.08 mmHg to 147 +/- 1.8 mmHg [p<.01] while erect diastolic pressure fell from 108 +/- 0.6 mmHg to 96.9 +/- 1.7 mmHg [p<.001]. Mean sitting arterial pressure decreased from 125 mmHg to 110 mmHg while standing mean arterial pressure decreased from 127 mmHg to 119 mmHg. No statistically significant fall in heart rate both in supine and standing position was observed. Laboratory results did not show any variation. After eight weeks on active treatment 34% of the patients were taking 1.25 mg B.D while 66% of the patients were on 2.5 mg B.D. Isradipine was found effective and safe in patients with mild to moderate hypertension who tolerated the drug

Detection of feto-placental hemodynamic changes using doppler ultrasound during short term treatment with dipyridamole in cases of mild hypertension with pregnancy

The present study included 25 pregnant women having mild hypertension. Doppler ultrasound was done for each case included in the study before and after treatment with dipyridamole [75 mg tablet, three times daily] for one week with the objective of finding the effect of dipyridamole on fetal hemodynamic. The study consists of two subgroups. The first subgroup included 15 cases of mild pregnancy induced hypertension, their mean arterial blood pressure was 110.44 +/- 3.91 mmHg. It dropped to 105 +/- 4.34 mmHg after dipyridamole treatment. The second subgroup included 10 cases of controlled essential hypertension with pregnancy who were under treatment with alpha-methyl dopa [Aldomet] 250 mg tablets, three times daily from before pregnancy, their mean arterial blood pressure was 115.67 +/- 36.86 mmHg which dropped to 109.4 +/- 4.83 mmHg after dipyridamole treatment for one week. The mean A/B ratio in the fetal aorta, and umbilical artery of the total study group was found to drop from 6.77 +/- 3.91, and 2.92 +/- 0.63 before dipyridamole treatment to 4.49 +/- 1.32, and 2.26 +/- 0.38 after treatment in the two blood vessels respectively. Regarding the mean [RI] in the fetal aorta, and the umbilical artery of the total study group, it was found that it dropped from 0.82 +/- 0.71, and 0.64 +/- 0.29 before dipyridamole treatment to 0.75 +/- 0.09, and 0.25 +/- 0.08 after treatment in the two blood vessels respectively. The improvement in the Doppler parameters was observed to occur more among the PIH subgroup of patients when compared to the Ess. H. group. In conclusion, dipyridamole was found to have an effect on the fetal hemodynamics as it improve the A/B ratio, and it decreased the RI and PI in cases having hypertensive disease with pregnancy

Antihypertensive effect of nifedipine-retard and acebutolol in patients with hypertension: a randomized double-blind study

A randomized double-blind, comparative study, with a new slow release preparation of nifedipine (nifedipine-retard), was undertaken in patients with mild, moderate and severe essential hypertensión WHO (stage I-II). After a two-week placebo period, patients were divided into three groups: 1) group I received nifedipine-retard 20 mg orally twice daily; 2) group II received acebutolol 200 mg orally twice daily; and 3) group III received nifedipine-retard 20 mg once daily plus acebutolol 200 mg orally once daily. All three dosage regimens were administered for six weeks. Nifedipine-retard (group I) reduced supine blood pressure from 162 ñ 4.2/105 ñ 1.4 mmHg (21.6 ñ 0.5/14.0 ñ 0.2 Pa) to 139 ñ 4.2/92 ñ 2.6 mmHg (18.5 ñ 0.5/12.3 ñ 0.3 kPa) and slighrly increased the heart rate. Acebutolol (group I) reduced supine blood pressure from 163 ñ 5.3/107 ñ 2.8 mmHg (21.7-0.7/14.2 ñ 0.4 kPa) to 144 ñ 5.0/93 ñ 3.7 mmHg (192 ñ 0.7/12.4 ñ 0.5 kPa) and decreased the heart rate. Nifedipine retard plus acebutolol (group III) reduced supine blood presure from 144 ñ 3.0/101 ñ 1.3 mmHg (19.2 ñ 0.4/13.4 ñ 012 kPa) to 123 ñ 3.4/84 ñ 2.8 mmHg (16.4 ñ 0.5/11.2 ñ 0.4 kPa) and did not significantly alter the heart the heart rate. There was a significant correlation (r = 0.65, p < 0.03) betwee baseline blood pressure and diastolic blood pressure after six weeks of therapy nifedipine-retard. There was a no significant trend between the age of patients and decrease of diastolic blood pressure, positive for nifedipine-retard, and negative for acebutolol. There was a low incidence of side effects with all dosage regimens..

Efectos cardiovasculares, renales y hormonales de la bromocriptina en pacientes hipertensos / Cardiovascular, renal and hormonal effect of the bromocriptine in hypertensive patients

El objetivo de este estudio fue el de investigar el efecto de la Bromocriptina sobre los sistemas Cardiovasculares, Renal y sobre el Sistema Renina-Angiotensina-Aldosterona. Los agonistas dopaminérgicos, tales como la dopamina y sus derivados, inducen aumento de la contractibilidad cardíaca, natriuresis y aumento del flujo sanguíneo renal por activación de recptores adrenérgicos y dopaminérgicos. En el presente estudio se definen los efectos cardiovasculares, renales, y sobre el sistema Renina-Angiotensina-Aldosterona de un activador dopaminérgico-bromocriptina en un programa abierto con placebo comparativo cruzado en 9 pacientes con hipertensión leve y moderada. Se midieron los siguientes parámetros durante un período de placebo (de 4 semanas) y durante un período de bromocriptina (de 8 semanas) en dosis de 2,5 mg-5 mg/día: Presión Arterial (PA); Frecuencia Cardíaca (FC); Fracción de Eyección (FE); y Fracción de Acortamiento (FA) por ecocardiografía; respuesta cardiovascular del ejercicio submáximo en una cincha sin fin y utilizando la metodología de Bruce; depuración de Urea (cl U) (por método colorimétrico); depuración de Creatinina (Cl Cr) (por métodos cinéticos); Aldosterona (por radioinmunoensayo); Actividad de renina plasmática (PRA) (por radioinmunoensayo). La Bromocriptina redujo significativamente la presión arterial promedio de 155/105 a 136/92 mmHg. También produjo un descenso importante de la frecuencia cardíaca en posición de pie; pero no así en posición supina. Respecto a la función cardiovascular no se observaron cambios significativos en la fracción de eyección (Fa) y de acortamiento (Fa)..

Doxazosin en hipertensión arterial esencial leve a moderada: estudio ecocardiográfico / Doxazosin in mild to moderate essential hypertension: echocardiographic study

Trece pacientes con Hipertensión Arterial Esencial leve a moderada concluyeron un estudio abierto con Doxazosin en dosis de 1 a 8 mg. La reducción de la presión arterial en las diferentes posiciones fue altamente significativa (p < 0,001), mientras que la frecuencia del pulso y el peso corporal no se modificaron . Los effectos secundarios fueron leves y solamente un paciente fue retirado del estudio. No se presentaron cambios significativos en los exámenes de laboratorio. En el estudio ecocardiográfico Modo M realizado en ocho pacientes se observó una reducción significativa de la Masa Ventricular (p < 0,01), sin modificaciones en la función sistólica del ventrículo izquierdo. Concluimos que el Doxazosin, un nuevo bloqueante alfa 1 postsináptico, es efectivo en el tratamiento de los pacientes con hipertensión arterial esencial leve a moderada como monoterapia, con pocos efectos secundarios, que no modifica el metabolismo lipídico y que exhibe un efecto beneficioso sobre el corazón, al reducir la Masa Ventricular sin cambios en la función sistólica del ventrículo izquierdo

Efecto de la combinación pindolol-clopamida en el tratamiento de la hipertensión leve y moderada: un estudio multicéntrico / Effect of combined pindolol-clopamide in essential and moderate hypertension therapy: a multicentric study

En el presente estudio se reporta el efecto antihipertensivo de la combinación Pindolol + Clopamida vs placebo, en grupos paralelos, con distribución al azar, en un grupo de pacientes hipertensos leves y moderados que asistieron a los Servicios de Medicina Vial del Estado Carabobo. El estudio duró ocho semanas, con exámenes clínicos cada dos semanas. La dosis de Pindolol + Clopamida fue de 1 tableta (10 mg y 5 mg respectivamente). El grupo de pacientes seleccionados perteneció mayormente al sexo masculino (19 pacientes de 20 pacientes en las edades de 30 y 49 años en el grupo placebo; y 16 pacientes de 20 pacientes en las edades de 30 y 49 años en el grupo Pindolol + Clopamida). En el grupo que recibió el tratamiento activo, en el 60% de los pacientes los valores tensionales se normalizaron al final del tratamiento y en el 40% hubo reducciones apreciables, pero no alcanzaron la normalidad. En el grupo placebo apenas hubo descenso a la normalidad en el 20% de los pacientes. Nosotros concluimos que la combinación Pindolol + Clopamida es util en la terapia de la Hipertensión leve y moderada y exhibe excelente tolerancia

Efectos hemodinámicos y bioquímicos de la indapamida en pacientes hipertensos estudio multicentrico ecuatoriano / Hemodinamic and biochemical effects of the indapamide in hypertensive patients: multicentry ecuatorial study

Se estudiaron 85 pacientes con hipertensión arterial leve y moderada en dos poblaciones de Ecuador. Los pacientes fueron distribuidos en dos grupos: a) indapamina y b) placebo. Todos los pacientes fueron evaluados desde el punto de vista cardiovascular, haciéndosele también determinaciones de variables bioquímicas, incluyendo el perfil lipídico. También se practicaron electrocardiogramas de reposo y de esfuerzo. Los pacientes fueron seguidos por un lapso de 120 días. El análisis de los resultados finales evidencian que la indapamida, a una dosis de 2,5 mgs, ejerció una buena acción hipotensora sostenida, tanto en la tensión arterial diastólica como en la sistólica y en las tres posiciones. Los efectos secundarios fueron mínimos, mostrando una buena tolerancia. El grupo bajo indapamida mostró alza significativa en la HDL-C al igual que un descenso en el colesterol total y en la LDL, lo cual se tradujo en un descenso en las razones de riesgo aterosclerótico. En conclusión, la indapamida es un buen hipotensor, eficaz y bien tolerado

"Propranolol versus nifedipina para el control transanéstesico del paciente hipertenso": estudio comparativo / \"Propranolol versus nifedipine for the intranesthetic control of the hypertensive patient\": comparative study

Se llevó a cabo un estudio comparativo entre propranolol y nifedipina en un grupo de 60 pacientes con historia de hipertensión arterial esencial moderada programados para cirugía electiva. La edad estuvo entre 47 y 68 años, clasificación de ASAII-III y el peso estuvo entre 51 a 87 Kg. Se consideraron estudios previos como espinometría, electrocardiograma, biometría hemática, gases en sangre arterial, química sanguínea, examen general de orina pruebas de coagulación, presión arterial y patología agregada. Un grupo recibió un beta bloqueador: Propanolol 40 mg. por vía oral y el otro grupo recibió bloqueadores de canales de calcio: nifedipina 10 mg por vía sublingual, antes de la inducción anestésica. La cirugía se llevó a cabo con anestesia analgésica balanceada. Se registraron frecuencia cardiaca, presión arterial media y tensión arterial sistólica y diastólica. Tanto propanolol como nifedipina no mostraron cambios significativos en la frecuencia cardiaca (p>0.05). Ambos fármacos produjeron cambios significativos en la presión arterial durante el periodo trananestésico o (p<0.05), sin embargo en el periodo postanestésico se observó un efecto hipotensor sostenido de nifedipina (p<0.05). Se concluye que la nifedipina mantuvo estabilización en el descenso tensional durante los diferentes periodos de la anestesia mayor que el propanolol