Impact of calcium antagonists on the cardiovascular system: experience with lacidipine.

The evaluation of haemodynamic patterns in hypertensive patients by radionuclide techniques and a tomographic gamma camera has revealed differences between older and younger patients. In younger hypertensive patients, the hyperkinetic state is reflected in an increase in heart rate and, consequently, an increased cardiac index and left ventricular ejection fraction (LVEF) in comparison with normotensive controls. Older hypertensive patients, however, show a different haemodynamic pattern, with reduced systolic and diastolic function at rest compared with normotensive elderly people, and marked depression of cardiac reserve during exercise. Elderly hypertensive patients also show strikingly higher hyperresistance and reduced peripheral perfusion in comparison with younger hypertensive patients. These haemodynamic differences need to be taken into account when considering antihypertensive treatment. In a study in elderly hypertensive patients, lacidipine treatment (4 mg/day for 90 days) produced a significant decrease in total peripheral resistance and blood pressure, together with a reduction in left ventricular (LV) afterload and an increase in cardiac output and LVEF (tending towards normal values). The LV peak filling rate was also increased, and evaluation of systolic and diastolic cardiac reserve during exercise showed positive changes in cardiac performance. The haemodynamic changes with lacidipine were similar to those produced by other long-acting dihydropyridines [nifedipine gastrointestinal therapeutic system (GITS) and nitrendipine], but changes occurring with nisoldipine were less significant. The reduction in left ventricular hypertrophy (LVH) is an obvious goal of antihypertensive therapy, and several studies have demonstrated the effectiveness of lacidipine treatment in decreasing LVH in hypertensive patients. In hypertensive patients with associated LV dysfunction, favourable effects on global parameters of LV function similar to those with amlodipine have been noted with lacidipine. Myocardial blood flow was strikingly increased during lacidipine treatment and coronary resistance was significantly decreased, both at baseline and after maximal vasodilatation with dipyridamole. Thus, lacidipine's vasodilatory and anti-ischaemic profile makes it an appropriate choice for the treatment of hypertension.

Treatment of patients with essential hypertension: amlodipine 5 mg/benazepril 20 mg compared with amlodipine 5 mg, benazepril 20 mg, and placebo.

This multicenter, double-masked, randomized, parallel-group study compared the efficacy, tolerability, and safety of amlodipine 5 mg/benazepril 20 mg, amlodipine 5 mg, benazepril 20 mg, and placebo in patients with essential hypertension. After a placebo run-in period, 308 patients (all white) were randomized to treatment groups and took medication once daily for 8 weeks. Blood pressure was measured after 4 and 8 weeks of treatment in the 23- to 26-hour period after dosing. Patients wore a noninvasive blood pressure monitor for 24 hours before randomization and before the final visit. Investigators recorded adverse experiences at randomization and at study weeks 4 and 8, and obtained specimens for laboratory testing at randomization and at study week 8. Three hundred seven patients were evaluated for efficacy, and 308 for tolerability and safety. At end point (the last postrandomization measurement for each patient), the reduction in mean sitting diastolic blood pressure with the amlodipine 5 mg/benazepril 20 mg treatment was statistically significantly greater than with any comparative therapy. The results of 24-hour monitoring showed that the amlodipine/benazepril treatment, unlike monotherapy, maintained the hourly mean diastolic blood pressure at < or = 90 mm Hg. A responder rate of 87.0% was observed with amlodipine 5 mg/benazepril 20 mg versus 67.5%, 53.3%, and 15.8% with amlodipine, benazepril, and placebo, respectively. This difference between the amlodipine/benazepril treatment group and each comparative single-agent treatment group was statistically significant. Drug-related adverse events occurred in 15.6% of patients in the amlodipine/benazepril group and in 24.7%, 6.5%, and 11.7% of patients in the amlodipine, benazepril, and placebo groups, respectively. Edema occurred less often in the amlodipine/benazepril group than in the amlodipine group. Overall, once-daily therapy with amlodipine 5 mg/benazepril 20 mg provided an antihypertensive effect that was statistically and clinically superior to amlodipine 5 mg alone, benazepril 20 mg alone, and placebo, was well tolerated, and was associated with less edema than the amlodipine treatment.

El monitoreo ambulatorio de presión arterial en la evaluación de la terapéutica antihipertensiva / Ambulatory blood pressure monitoring and antihypertensive therapy evaluation

La más aceptada de la indicaciones del monitoreo ambulatorio de presión arterial es la evaluación del efecto de terapéuticas antihipertensivas y ello se debe a que permite obtener datos tensionales particulares, como los promedios, la carga, medidas de variabilidad y el ritmo circadiano. Estos datos presentan una buena correlación con los datos tisulares hipertensivos y deberían ser corregidos con los tratamientos para cumplir el principal objetivo terapéutico, que es la reducción del riesgo cardiovascular. Ventajas adicionales son la reducción del efecto placebo, la mayor reproducibilidad y la posibilidad de diagnosticar hipertensos de guardapolvo blanco, que no deberán ser tratados con drogas. Aún no hay acuerdo definitivo respecto del valor pronóstico del método; por ende los valores de normalidad deberían tomarse según patrones estadísticos. Se describen diversos métodos de análisis de los valores obtenidos por monitoreo ambulatorio de presión arterial y su utilidad para evaluar las terapéuticas: promedios, carga, perfil circadiano (con el comportamiento de la tensión arterial durante la siesta y la noche), variabilidad, efecto pico, efecto valle y relación valle-pico. Finalmente se discute el valor de los métodos de alisado de Fourier. El monitoreo ambulatorio de presión arterial constituye un método útil en el manejo terapéutico de pacientes hipertensos. Sus potenciales definitivas están en desarrollo para considerarlas en la toma de "decisiones clínicas", profundizando el conocimiento de las implicancias pronósticas de la hipertensión arterial (AU)

El monitoreo ambulatorio de presión arterial en la evaluación de la terapéutica antihipertensiva / Ambulatory blood pressure monitoring and antihypertensive therapy evaluation

La más aceptada de la indicaciones del monitoreo ambulatorio de presión arterial es la evaluación del efecto de terapéuticas antihipertensivas y ello se debe a que permite obtener datos tensionales particulares, como los promedios, la carga, medidas de variabilidad y el ritmo circadiano. Estos datos presentan una buena correlación con los datos tisulares hipertensivos y deberían ser corregidos con los tratamientos para cumplir el principal objetivo terapéutico, que es la reducción del riesgo cardiovascular. Ventajas adicionales son la reducción del efecto placebo, la mayor reproducibilidad y la posibilidad de diagnosticar hipertensos de guardapolvo blanco, que no deberán ser tratados con drogas. Aún no hay acuerdo definitivo respecto del valor pronóstico del método; por ende los valores de normalidad deberían tomarse según patrones estadísticos. Se describen diversos métodos de análisis de los valores obtenidos por monitoreo ambulatorio de presión arterial y su utilidad para evaluar las terapéuticas: promedios, carga, perfil circadiano (con el comportamiento de la tensión arterial durante la siesta y la noche), variabilidad, efecto pico, efecto valle y relación valle-pico. Finalmente se discute el valor de los métodos de alisado de Fourier. El monitoreo ambulatorio de presión arterial constituye un método útil en el manejo terapéutico de pacientes hipertensos. Sus potenciales definitivas están en desarrollo para considerarlas en la toma de "decisiones clínicas", profundizando el conocimiento de las implicancias pronósticas de la hipertensión arterial

Blood pressure control in children of Cordoba, Argentina.

The aims of the present study were 1) to evaluate blood pressure (BP) and its distribution curve in a highly representative population of children and adolescents from Cordoba, Argentina, to determine the normal BP pattern, and 2) to establish the relation between other factors and BP levels. BP data recorded during the years 1984-1987 were evaluated in 280,584 children and adolescents aged 5-15 years (52.1% boys and 47.9% girls) corresponding to the nine sanitary districts of the province (urban, rural, mountain, and plains areas), which represent 75% of the children of the whole province. Recordings were carried out by trained physicians who used pediatric BP cuffs and calibrated sphygmomanometers. Korotkoff periods 1 and 5 were considered as the systolic and diastolic BP, respectively. BP was recorded in groups of three to five students with students in a sitting position as part of the routine physical examination and after a thorough explanation of the methodology. For statistical analysis, the Student's t test and stepwise regression analysis were used. Percentile tables and curves were prepared for each age and sex group. Weight and height values were added to the information obtained. Diastolic BP was greater in girls than in boys between the ages of 11 and 14. Systolic BP was lower and diastolic BP was higher in the US Task Force study compared with these findings. Of all the independent variables evaluated, weight influenced BP the most. Age had less influence on BP when height and weight were normalized by regression analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamic effects of nitrendipine on systolic ventricular function, diastolic ventricular function, and peripheral circulation in essential hypertension.

Twenty patients (aged 33-60 years) with mild to moderate essential hypertension were studied to assess systolic ventricular function, diastolic ventricular function, and peripheral hemodynamic changes induced by nitrendipine during rest and effort, comparing the acute and chronic treatment phases. We used a randomized, placebo-controlled, double-blind, crossover protocol in the acute phase and a paired, placebo group controlled study, with 20 mg single oral daily dose for a 3-week treatment period (chronic phase). The cardiac and peripheral hemodynamic parameters were quantified by noninvasive radionuclides techniques. During acute treatment, peripheral hemodynamics showed a predominantly arteriolar vasodilatory effect with a significant fall in the previously elevated forearm vascular resistance values (-38%, p less than 0.01) and an important increase in forearm blood flow (+49%, p less than 0.01) without any changes in venous capacity. Simultaneously, nitrendipine produced a significant drop in total peripheral resistance (-36%, p less than 0.01), systolic blood pressure (-13%, p less than 0.01), and diastolic blood pressured (-17%, p less than 0.01). The sudden reduction in left ventricular (LV) afterload caused a reflex increase in heart rate (HR) (+12%, p less than 0.01), cardiac index (+37%, p less than 0.01), LV ejection fraction (+17%, p less than 0.01), and peak ejection rate, with an important decrease in LV end systolic volume (-30%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Radiation treatment in advanced cancer of the lung]. / Tratamiento radiante en cáncer avanzado de pulmón.

This is an attempt to evaluate the results of the radiotherapeutic treatment in patients with advanced lung cancer. The results of a series of 200 patients with lung cancer no oat cell. Average age: 59 years, ranging from 39 to 78, with male frank predominance (174/200). The histologic diagnosis was obtained in 159/200 (79.5%) of the patients of which, 52.8% were epidermoid carcinomas. The series was classified in three staging according to the American Joint Committee for Cancer Staging and End Results Reporting (AJC); the results was: 172/100 (86%) E III and 28/200 (14%) E I and II. The main objective of this work was the anlysis of E III which was subdivided into E III M0 and E III M1 for its study according to the absence or presence of metastasis when making the diagnosis. Besides, the patients were classified according to their clinical state at the beginning of treatment (performance status) following the Zubrod's scales. The statistics analysis shows the prognostic relevance of this parameter. The results of the two plans of irradiation treatment were analysed: continuous cycle (60 Gy in 6 weeks) and split course (2 cycles of 30 Gy in two weeks with three weeks of rest in between). There were not statisticaly significant difference either in the clinical or in the radiological response in both groups. Both groups were correlated under the following parameters: a) Performance Status, b) immediate response to treatment, c) quality of life after radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Tratamiento radiante en cáncer avanzado de pulmón. / [Radiation treatment in advanced cancer of the lung]

This is an attempt to evaluate the results of the radiotherapeutic treatment in patients with advanced lung cancer. The results of a series of 200 patients with lung cancer no oat cell. Average age: 59 years, ranging from 39 to 78, with male frank predominance (174/200). The histologic diagnosis was obtained in 159/200 (79.5

) of the patients of which, 52.8

were epidermoid carcinomas. The series was classified in three staging according to the American Joint Committee for Cancer Staging and End Results Reporting (AJC); the results was: 172/100 (86

) E III and 28/200 (14

) E I and II. The main objective of this work was the anlysis of E III which was subdivided into E III M0 and E III M1 for its study according to the absence or presence of metastasis when making the diagnosis. Besides, the patients were classified according to their clinical state at the beginning of treatment (performance status) following the Zubrods scales. The statistics analysis shows the prognostic relevance of this parameter. The results of the two plans of irradiation treatment were analysed: continuous cycle (60 Gy in 6 weeks) and split course (2 cycles of 30 Gy in two weeks with three weeks of rest in between). There were not statisticaly significant difference either in the clinical or in the radiological response in both groups. Both groups were correlated under the following parameters: a) Performance Status, b) immediate response to treatment, c) quality of life after radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Lymphscintigraphies of the internal mammary ganglion chain: our experience.

In this study we have evaluated 301 internal mammary lymphoscintigraphies. The results were compared with the histology of internal mammary lymphoscintigraphies, lymphatic chain and axillary lymph nodes, with the anatomo-pathological stage of the disease, with primary tumor site, and also with patients survival. The influence of breast surgery and radiotherapy on the internal breast is shown in the results of the said 301 internal breast lymphscannings. We understand LCMI as a procedure that helps to evaluate the disease stage, to plan therapeutics, to provide a prognosis factor.

Evaluation of severe ventricular arrhythmias in chronic Chagas' heart disease by effort test and Holter monitoring.

The objective of the present study was to evaluate the ability of the gradual effort test (GET) to detect ventricular extrasystoles (VE), and, in particular, to identify patients with high arrhythmic risk in Chagas' heart disease, as well as to compare the results to those obtained by 24 h ambulatory electrocardiographic monitoring (Holter monitoring). A total of 103 Chagasic patients aged 20 to 55 years who exhibited no clinical signs of heart failure or complex arrhythmias under resting conditions were submitted to 24 h Holter monitoring and to a GET with discontinuous loads first applied to reach 120 bpm and then submaximal or maximal heart rate. The results of 24 h ambulatory electrocardiographic monitoring demonstrated that 52.4% of patients had no VE, 20.4% had few isolated VE (Grade I), 1.9% had frequent monomorphic VE (grade II), 4.8% very frequent polymorphic VE (grade III), and the remaining 20.4% had repetitive forms (doubles or bursts of 3 or more) classified as grade IV. In 68% of these patients, the GET did not detect VE. These were the patients who showed no arrhythmias or isolated VE during the Holter test. The 32% of patients who exhibited VE when submitted to the GET included all patients shown to have grade III and grade IV arrhythmia (27 cases) and 5 patients shown to have grade I arrhythmia by the Holter test. The GET showed 100% sensitivity in the detection of pathological (greater than 100 VE daily) and high-risk arrhythmias (greater than 1000 VE per 24 h, polymorphism or repetitive forms), with a specificity of 93 and 92%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic value of the different methods for evaluation of bone metastasis in breast carcinoma.

A group of 263 patients portraying breast Ca staged through the clinic, is studied and evaluated by different methods of diagnosis as regards bone metastasis. A clinical investigation of bone pain, specific laboratory determinations for Ca-P-alkaline phosphatase; bone X ray, bone scintigraphy with gamma camera are carried on. In some pre-selected cases bone biopsy performed. A 15.9% of the patients with breast Ca showed bone metastasis. Scintigraphy was positive in a 100% of these cases, pain in 62%, X ray in 41%. The final results of laboratory were discarded since they were not considered reliable. Highly specific positive zones for bone metastasis and benign bone pathology were detected when sectioning the spine in the classical zones. A methodological sequence is proposed.