ABSTRACT
The efficacy of isradipine, a new antihypertensive dihydropyridine calcium antagonist, was prospectively studied in Ethiopian patients with uncontrolled severe hypertension on multiple antihypertensive agents. Enrolled were 13 patients based on inclusion and exclusion criteria and 12 patients completed the study. The study design included a three-week wash-out period followed by eight weeks of active treatment. Eleven patients (92%) took diuretics in addition to isradipine. Patients were started on 2.5mg of isradipine twice daily and the dose was increased to 5mg twice daily in eight (67%) patients since the diastolic blood pressure (DBP) remained above 90mmHg four weeks after the initiation of therapy. The treatment resulted in a mean decrease of 42mmHg in systolic blood pressure (SBP) (p < 0.0001) and 34mmHg in DBP (p < 0.0001). Seven patients (58%) achieved normalization of DBP and in the remaining 5 (42%) the DBP became less than 105mmHg. Almost all patients experienced mild and transient side effects resulting from vasodilation but all tolerated these except one who dropped out from the study. In conclusion, these results indicate that isradipine combined with a diuretic is a safe and effective antihypertensive agent in Ethiopian patients with uncontrolled hypertension.
Subject(s)
Hypertension/drug therapy , Isradipine/therapeutic use , Adult , Blood Pressure/drug effects , Diuretics/therapeutic use , Drug Therapy, Combination , Ethiopia , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
A double-blind trial of hydrochlorothiazide, timolol and enalapril was carried out in Ethiopians with essential hypertension at the Tikur Anbessa Hospital, Addis Abeba, between 1987 and 1990. Patients with a supine diastolic blood pleasure of 95-120 mmHg after a washout period of 2 weeks were randomized to receive hydrochlorothiazide 25 mg daily, timolol 10 mg daily or enalapril 10 mg daily. Doses were doubled at 4 weeks if the diastolic blood pressure remained above 95 mmHg. At the end of 8 weeks of treatment, there were 9 patients taking hydrochlorothiazide, 10 patients taking timolol and 7 patients taking enalapril. Hydrochlorothiazide significantly lowered both systolic and diastolic blood pressure at 4 and 8 weeks compared with pre-treatment levels. Timolol and enalapril did not significantly lower the systolic blood pressure, but each lowered the diastolic blood pressure at 4 weeks and 8 weeks respectively. More patients on hydrochlorothiazide attained a diastolic blood pressure of less than 90 mmHg while less patients required doubling of dosage compared to timolol and enalapril. It is concluded that Ethiopian hypertensives may respond better to diuretics than to beta-blockers or angiotensin converting enzyme inhibitors, as found in other black populations.
Subject(s)
Enalapril/therapeutic use , Hydrochlorothiazide/therapeutic use , Hypertension/drug therapy , Timolol/therapeutic use , Adult , Double-Blind Method , Drug Therapy, Combination , Enalapril/administration & dosage , Enalapril/adverse effects , Ethiopia , Female , Humans , Hydrochlorothiazide/administration & dosage , Hydrochlorothiazide/adverse effects , Hypertension/diagnosis , Male , Middle Aged , Timolol/administration & dosage , Timolol/adverse effectsABSTRACT
Seventy-two patients with severe falciparum malaria are described. Twenty-four (33.3%) were complicated by acute renal failure. Comparing patients with renal failure and those without, statistically significant differences occurred regarding presence of cerebral malaria (83% vs 46%), jaundice (92% vs 33%), and death (54% vs 17%). A significantly higher number of patients with renal failure were nonimmune visitors to malaria endemic regions. Renal failure was oliguric in 45% of cases. Dialysis was indicated in 38%, 29% died in early renal failure, and 33% recovered spontaneously. It is concluded that falciparum malaria is frequently complicated by cerebral malaria and renal failure. As nonimmune individuals are prone to develop serious complications, malaria prophylaxis and vigorous treatment of cases is mandatory.
Subject(s)
Acute Kidney Injury/etiology , Malaria/complications , Acute Kidney Injury/diagnosis , Adult , Animals , Female , Humans , Male , Plasmodium falciparumSubject(s)
Gastrointestinal Hemorrhage/etiology , Typhoid Fever/complications , Adult , Humans , MaleSubject(s)
Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Oliguria/physiopathology , Pregnancy , Pregnancy Complications/physiopathologySubject(s)
Polycystic Kidney Diseases/diagnosis , Adult , Ethiopia , Female , Humans , Male , Middle Aged , Polycystic Kidney Diseases/geneticsABSTRACT
We investigated the mechanism by which hypoxemia is produced in patients on dialysis by studying changes in neutrophil count, blood gases and pulmonary function in a patient with only trace amounts of circulating C3 associated with Type II mesangiocapillary glomerulonephritis and a control group of 6 patients with normal C3 levels during a 4 hour hemodialysis. Fifteen minutes after the start of dialysis the neutrophil count fell to 13% of pre-dialysis values in the control group while it only fell to 71% in the study patient. A further fall to 47% occurred in the patient at 30 minutes. A drop in PaO2 by 15% of initial values occurred at 15 and 30 minutes in the controls and the patient respectively matching the trend of fall in the neutrophil count. PaCO2 fell sharply across the dialysis membrane with reciprocol changes in the dialysis bath. Alveolar oxygen tension showed a significant reduction starting at 15 minutes correlating with the reduction in PaO2. The A-a O2 gradient was not altered significantly. These data strongly suggest that the principal mechanism leading to hypoxemia during dialysis is hypoventilation resulting from CO2 loss into the dialysis bath. Complement mediated pulmonary leucostasis may play a secondary role in inducing a quicker fall in PaO2 in the early part of dialysis.
