Comparative efficacy and tolerability of two long-acting calcium antagonists, mibefradil and amlodipine, in essential hypertension. Mibefradil Hypertension Study Group.

In a previous forced-titration trial, mibefradil 100 mg QD was as effective as amlodipine 10 mg QD in reducing sitting diastolic blood pressure (SDBP), and it produced significantly less leg edema than did amlodipine 10 mg QD. The present multicenter, double-masked, randomized, parallel-design trial was performed to assess the reproducibility of these results using a flexible-titration design. Following a 4-week, single-masked, placebo run-in period, 296 patients with a trough SDBP of between 95 and 114 mm Hg (21 to 27 hours postdose) were randomized to receive once-daily treatment with mibefradil 50 mg (n = 146) or amlodipine 5 mg (n = 150). In patients whose trough SDBP was greater than 90 mm Hg after 4 or 8 weeks of double-masked therapy, the dosage was titrated upward to mibefradil 100 mg or amlodipine 10 mg for the remainder of the 12-week active treatment period. A greater proportion of amlodipine-treated patients (65%) than of mibefradil-treated patients (54%) required titration to the higher dose. Despite this difference, statistically equivalent reductions in trough SDBP were observed after 12 weeks of treatment with 50 to 100 mg of mibefradil QD (-11.7 +/- 6.4 mm Hg) and 5 to 10 mg of amlodipine QD (-11.9 +/- 6.9 mm Hg). SDBP was normalized to < or = 90 mm Hg at week 12 in 66% of patients treated with mibefradil and 65% of those receiving amlodipine. The tolerability profile of mibefradil was superior to that of amlodipine, with significantly fewer patients (P = 0.009) reporting leg edema after mibefradil treatment (7%) than after amlodipine treatment (17%). The results of this study confirm those of the previous trial. Once-daily treatment with mibefradil 50 to 100 mg for 12 weeks was as effective as 12 weeks of once-daily treatment with amlodipine 5 to 10 mg in reducing SDBP and was associated with a significantly lower incidence of leg edema.

Renal infarction due to renal artery dysplasia with dissection. Report of a case in a normotensive patient.

A previously healthy 44-year-old man with well-documented normotension had a sudden onset of left flank pain and delayed onset of constitutional symptoms, hematuria, and elevations of lactic dehydrogenase, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, and creatinine levels. Angiography revealed unilateral renal artery fibromuscular dysplasia with dissection and infarction. In the year since, he has remained well and normotensive without therapy. The literature is reviewed.

Benzodiazepine prescribing in a family medicine center.

We monitored benzodiazepine prescribing in a family medicine center for two years. A total of 1,886 prescriptions were written for four benzodiazepines in the following order of frequency: diazepam, chlordiazepoxide, oxazepam, clorazepate. The most frequent diagnostic indications were anxiety neurosis, hysterical neurosis, and vertebral column disorders. Most benzodiazepine recipients were women, but for alcohol abuse more prescriptions were written for men. More than half of the patients were between the ages of 25 and 44 years. Although daily doses were reduced for elderly patients, the course of therapy was often longer. Female physicians wrote fewer prescriptions for men than for women. More prescriptions for benzodiazepines were written during the summer months than during the rest of the year, and more were written on weekdays than on the weekend. Benzodiazepine recipients were given more prescriptions for other drugs than were the rest of the patients in the practice.

GLC assay for lidocaine in human plasma.

A simple, rapid, and highly sensitive method for the GLC analysis of plasma lidocaine is described. Mepivacaine hydrochloride is added as the internal standard; the plasma is deproteinated and centrifuged, and the supernate is alkalinized and extracted into a small volume of carbon disulfide. The column is connected to a flame-ionization detector, and the column oven temperature is programmed from 130 to 260 degrees. Plasma lidocaine concentrations between 0.04 and 8.0 micrograms/ml can be measured accurately, and there is no interference from the monoethylglycinexylidide or glycinexylidide metabolites of lidocaine or from many commonly used drugs and diagnostic agents. The sensitivity, simplicity, and speed of this assay are important in pharmacokinetic studies of lidocaine.