ABSTRACT
Declining kidney function predicts increasing cardiovascular risk in people with hypertension. Microalbuminuria is a marker for cardiovascular risk and declining kidney function. Agents that block the renin-angiotensin-aldosterone system (RAAS), notably angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), reduce proteinuria and microalbuminuria, lower blood pressure and slow the progression of proteinuric kidney disease. Evidence is accumulating that the combination of an ACE inhibitor and an ARB is the optimal means of RAAS blockade in this setting, slowing the progression of nephropathy independently of blood pressure lowering to a greater degree than can be achieved using maximum approved doses of either agent alone. However, the emerging therapeutic potential of ACE inhibitor/ARB combination therapy in hypertensive kidney disease requires further characterization. The Irbesartan in the Management of PROteinuric patients at high risk for Vascular Events trial aims to determine definitively whether the combination therapy of an ARB, irbesartan and an ACE inhibitor, ramipril, is more effective than ramipril alone in reducing the urinary albumin excretion rate in patients at high cardiovascular risk with hypertension and proteinuria or microalbuminuria.
Subject(s)
Hypertension/blood , Hypertension/drug therapy , Proteinuria/blood , Proteinuria/drug therapy , Angiotensin Receptor Antagonists , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Dose-Response Relationship, Drug , Evaluation Studies as Topic , Female , Humans , Hypertension/physiopathology , Male , Middle Aged , Proteinuria/physiopathology , Risk Factors , Treatment OutcomeABSTRACT
Restless legs syndrome was present in nine members of a family over a span of five generations. In three subjects, the diagnosis was confirmed by all-night sleep recordings and concomitant EMG. Two of these three subjects also had periodic movements in sleep. The frequency of leg movements decreased from wakefulness to stages 1 and 2 non-REM sleep. There was an increase of free dopamine and homovanillic acid in CSF of the propositus. Clonazepam effectively controlled restless legs in the propositus and his mother.
