Antihypertensive effect of bopindolol: a multi-centre study.

The objective of the study was to investigate the efficacy of different dose levels of bopindolol monotherapy in hypertension. This potent nonselective beta-adrenergic receptor blocker has intrinsic sympathomimetic activity and long duration of action. Forty-four patients with essential hypertension of mild (n = 40) or moderate (n = 4) severity (90 less than DBP less than or equal to 115 mmHg at the end of the placebo period) entered and completed the single-blind, placebo-controlled trial. The study lasted 14 weeks: 2 weeks on placebo, and 12 weeks on active treatment during which the initial dose of bopindolol, 1 mg daily, was augmented up to 1.5 mg, then to 2 mg at four-week intervals until BP normalized or a maximum dose of 2 mg/day bopindolol was reached. The bopindolol was administered once a day in the morning. Patients were seen every other week in the morning before drug taking, when BP and heart rate, supine and standing, a twelve lead ECG and side-effects were recorded. Compared with placebo, supine BP was significantly reduced by bopindolol: from 169 +/- 2/103 +/- 1 mmHg to 148 +/- 3/92 +/- 1, 144 +/- 3/90 +/- 1 and 136 +/- 2/85 +/- 0.6 mmHg at the end of 4, 8 and 12 weeks of treatments, respectively (P less than 0.01 for each). BP changes during standing were similar. Bopindolol lowered the supine heart rate from 84 +/- 2 to 75 +/- 1, 74 +/- 1, 72 +/- 1 beats/min (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hann syndrome: remission of diabetes insipidus by functional failure of the anterior pituitary gland]. / Uber das Hann-Syndrom: Verschwinden eines Diabetes insipidus durch Funktionsausfall des Hypophysenvorderlappens.

We know that the symptoms of diabetes insipidus develop only in a state of functional capacity of the neurohypophysis. The symptomatology of diabetes insipidus disappears, when the pars anterior of the hypophysis is destructed, whereas the two lobes have antagonistic effects in respect of water metabolism. Describing two cases the authors remember to F. v. Hann as the first describer of this syndroms' complex and postulate the corresponding nomination.

[Correlations among hypoxia, hypercapnia and hyperammonemia in patients with cor pulmonale decompensatum]. / Wechselwirkungen zwischen Hypoxie, Hyperkapnie und Hyperammoniämie bei Patienten mit Cor pulmonale decompensatum.

The correlation between ammonia concentration of the plasma and blood pH, blood gas values was examined in 28 patients with chronic cor pulmonale decompensatum. In cases with central nervous symptoms were found a significant negative correlation between ammonia concentration of the plasma and arterial oxygen saturation, a significant positive correlation between ammonia concentration of the plasma and paCO2, a significant negative correlation between ammonia concentration of the plasma and arterial blood-pH. In cases without central nervous symptoms, however, no significant correlations was established.

[Plasma ammonia concentrations in mucoviscidosis]. / Plasma-Ammoniakkonzentration bei Mukoviszidose.

In 16 children and adolescents suffering from mucoviscidosis the ammonia concentration of the plasma determined by a modified ion exchange method was compared with the clinical degree of severity. The ammonia values of the plasma were compared with several parameters, such as Shwachman stage, the presence of cardio-respiratory insufficiency, blood gas values and liver function tests. In 5 children with cystic fibrosis and cardio-respiratory insufficiency high plasma ammonia values were found. In older children with the disease lasting for a longer time with medium Shwachman stage (stage III) but without cardiorespiratory insufficiency the ammonia values were also relatively high. Cardiorespiratory insufficiency and disturbance of the liver function may play a role in the development of hyperammonemia. A distinct hyperammonemia refers to a bad prognosis in children with cystic fibrosis.

Long-term antihypertensive therapy with guanfacine.

Twenty patients with essential hypertension were treated with guanfacine given in single 1-5 mg daily doses over a period of 24 weeks. Compared with the initial values at the end of the first washout period, there was a significant decrease in blood pressure and heart rate. The most common side effect, dryness of the mouth, usually disappeared after 8-10 weeks of treatment. No changes in laboratory values were seen. In the post-treatment placebo period there were significant increases in blood pressure and heart rate compared with the last readings during the treatment period. However, these never exceeded the pretreatment values. In a second series guanfacine (1-5 mg daily) was abruptly discontinued in 11 patients after 6-20 weeks of treatment. Blood pressure was measured twice a day, in lying and standing positions, during the 4 days preceding abrupt withdrawal of guanfacine and for 7 days after discontinuation. Clopamide was given concurrently to two patients, and this was continued after withdrawal of guanfacine. Only in two patients did the blood pressure rise to values above the initial levels (30 mmHg systolic and 10 diastolic), but no clinical symptoms were observed during the withdrawal. A transitory increase in heart rate between 10 and 30 bpm was observed in five patients after abrupt discontinuation of the drug.

Studies on a new beta-receptor blocking drug, tobanum--1-(2,5-dichlorophenoxy)-3-tertiary-butylamino-2-propanol HCl: its use in cardiovascular hyperkinetic syndrome, hypertension, and angina pectoris, and its effect on respiration.

The effect of the beta-receptor blocking drug Tobanum was examined in 10 patients with idiopathic hyperkinetic heart syndrome. The circulation (arm-to-ear) time was determined by indicator-dilution method following methylene blue injection. The appearance, concentration, and dilution time was prolonged in each case 120 min after a single dose of 2.5 mg Tobanum. The heart rate decreased significantly. The hypotensive effect of Tobanum has been evaluated in 10 patients. A 2-week "wash-out" period preceded 5 weeks of adaptive dose administration (7.5-45 mg), and 2 weeks of placebo concluded the study. Both systolic and diastolic pressure and heart rate decreased during treatment with the drug. However, a significant increase again thereafter was observed in both standing and lying positions. The number of anginal attacks, amount of nitroglycerin consumption and the "angina index" decreased significantly in 5 of 10 patients with stable angina during the active treatment period (3 X 2.5 mg daily). Only in 1 case of 10 bronchitis patients and 10 healthy persons was a deterioration of vital capacity and FEV1 values found after a single dose of 2.5 mg Tobanum.

Antihypertensive effect of guanfacine: long-term 'once-a-day' treatment and sudden withdrawal.

1. Twenty patients with essential hypertension were treated with guanfacine given in single daily doses of 1--5 mg over a period of 24 weeks. Compared with the initial values at the end of the first wash-out period, there was a significant decrease of blood pressure and heart rate. The most common side effect, dryness of the mouth, usually disappeared after 8--10 weeks of treatment. No changes in laboratory values were seen. In the post-treatment placebo period there were significant increases in blood pressure and heart rate compared with the last readings during the treatment period. However, these never exceeded the pretreatment values. 2. In a second trial guanfacine (1--5 mg daily) was abruptly discontinued in 11 patients after 6--20 weeks' treatment. Blood pressure was measured twice a day, in lying and standing positions, during the 4 days before abrupt withdrawal of guanfacine and for 7 days after discontinuation. Clopamide was given concurrently to two patients, and this was continued after withdrawal of guanfacine. Only in two patients did the blood pressure rise to values above the initial levels (30 mmHg systolic and 10 mmHg diastolic), but no clinical symptoms were observed during the withdrawal. A transitory increase of heart rate of between 10 and 30 beats/min was observed in five patients after abrupt discontinuation of the drug.

Comparative study of two antihypertensive agents: guanfacine and guanethidine.

1. The antihypertensive effect and side-effects of the new centrally acting agent guanfacine (BS 100-141, Estulic) and guanethidine (Ismelin) were compared in a single-blind, cross-over study. The study consisted of two active treatment periods of 6 weeks each, both preceded by a 1-3 weeks placebo period. 2. Sixteen ambulant patients (six male, ten female) with mild or moderate hypertension were admitted to the study. The patients were also receiving diuretic therapy (clopamide 10-20 mg daily). On average the optimal daily dose of guanfacine was 3 mg and of guanethidine 20 mg. 3. An equally large and significant decrease in blood pressure was produced by both drugs. Both guanfacine and guanethidine caused a very slight reduction in heart rate. Mild orthostatic hypotension occurred in 11 patients during guanethidine therapy. Dryness of the mouth occurred in 13 patients taking guanfacine.

Aortic stenosis--angiodysplasia of the caecum.

A 73-year-old female patient developed beside aortic stenosis angiodysplasia in the caecum, which gave rise to serious, repeated intestinal bleedings. As a result, the patient was admitted to hospital 32 times. Over a period of 8 years she was given 178 litres of blood. The vascular disorder which was the source of bleeding, was detected by mesenterial angiography. After resection of the colonic section concerned, the bleeding stopped. The diagnosis of angiodysplasia of the caecum was confirmed by pathological examination.

[The combination of methyldopa with pindolol in the treatment of hypertension (author's transl)]. / Potenzierung der hypotensiven Wirkung von Alpha-Methyldopa durch Kombination mit Pindolol.

32 patients with moderate or severe hypertension (16 men and 16 women, aged 32--75 years) were treated with alpha-methyldopa (daily dose: 750 mg) + placebo for 2 weeks, then with alpha-methyldopa + pindolol (15--45 mg daily) for 12 weeks. These patients had been under alpha-methyldopa monotherapy before the trial with unsatisfactory results. The simultaneous administration of alpha-methyldopa and pindolol considerably decreased the systolic and diastolic blood pressure, both sitting and standing, and the heart rate. The combination of methyldopa and pindolol was significantly more effective than methyldopa alone.

[Electrodynamic discrepancy of the heart]. / Uber die elektrodynamische Herzdiskrepanz.

Electrodynamic discrepancy was observed in the hearts of 15 out of 144 patients with myocardial infarction who died on account of various complications. Autopsy revealed cardiac rupture with pericardial tamponade in each of the 15 cases. If the ECG shows no typical signs of a myocardial infarction, then with great probability an aortic rupture is present. The pathomechanism of electrodynamic discrepancy of the heart may be explained with the help of Laplace's law and "neuropraxia", "Afterload" and "preload" are reduced to practically nil, the tension of the myocardial walls falls, the effective work of the heart muscle stops and with the considerably lower oxygen requirement of the myocardium the bioelectric activity of the heart is still maintained for 12-30 minutes.