Psychomotor adaptation in children with severe chronic asthma.

Acute effects of steroid medications or hypoxic-induced brain damage have been hypothesized to cause neuropsychologic impairment in children with severe asthma. The present investigation included neuromotor, cognitive, psychosocial, and medical evaluations of 67 hospitalized asthmatic children from 9 to 14 years of age, at risk for motor dysfunction. Mean scores from the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) were similar to test norm means and were not indicative of neuromotor impairment. Scores of the BOTMP correlated significantly (P less than .01) with measures of child and family psychosocial adaptation but not with measures of cognitive ability, steroid dose at admission, or severity of asthma. Thirteen children had battery composite scores more than 1 SD below age means but did not demonstrate decreased IQ or increased steroid use, respiratory failure, seizures, or abnormal neurologic signs compared with the other 55 children. These results indicate that most severely asthmatic children, including many with histories of hypoxia and high-dose steroid use, do not demonstrate psychomotor impairments indicative of brain damage. It is concluded that neuromotor development in asthmatic children is associated with psychologic characteristics that influence adaptation to illness and activity level.

Labetalol infusion in hypertensive emergencies.

The antihypertensive effects of labetalol infusion (2 mg/min; maximal dose 150 mg) were evaluated in 22 subjects requiring rapid lowering of blood pressure because of severe hypertension, a hypertensive crisis after surgery, or before angiographic examination. Overall systolic and diastolic blood pressures were reduced from 201 +/- 4 to 164 +/- 4 mm Hg and from 123 +/- 3 to 107 +/- 3 mm Hg, respectively. By the end of the infusion, diastolic blood pressure in 16 (73%) subjects was lowered to less than or equal to 110 mm Hg. No adverse effects were encountered, but one subject had a transitory hypotensive episode that did not require treatment. Intravenous labetalol appears effective and well tolerated in the control of blood pressure in hypertensive emergencies.

Antihypertensive effect of indapamide with special emphasis on renal prostaglandin production.

A study was undertaken in 19 patients with benign to moderate essential hypertension to verify the effect of indapamide alone or combined with a beta-blocker on plasma renin activity, plasma aldosterone, serum potassium and urinary prostaglandins PGE2 and PGF2a. Blood pressure was normalized in 11 (58%) patients with 2.5 mg indapamide/day. In the remaining 8 patients, the addition of pindolol resulted in blood pressure control. Under indapamide, a 70% increase in plasma renin activity and 81% (p less than 0.01) in plasma aldosterone was observed, whereas there was an 18% (p less than 0.001) decrease in potassium. Simultaneously, an increase in urinary PGE2 and PGF2a was observed; these values were significant for PGE2 (p less than 0.025). The addition of pindolol did not produce significant change in the biochemical parameters measured. The increase in the excretion rate of primary prostaglandins could play a role in the mode of action of indapamide.

Merits of adding a beta blocker (acebutolol) to a diuretic (hydrochlorothiazide) in the treatment of hypertension.

In a double-blind crossover study, the antihypertensive effect of hydrochlorothiazide alone and in combination with the beta blocker acebutolol was assessed in 18 patients suffering from mild to moderate hypertension. After a placebo period, the patients were placed on hydrochlorothiazide alone for four weeks at a dose of 50 mg daily. Acebutolol was than gradually titrated into the regimen until the optimum dose was established. The average dose was 555 mg per day, with the usual optimum dose 200 mg b.i.d. The patients then entered the crossover portion of the trial during which patients received either hydrocholorothiazide with acebutolol or hydrochlorothiazide with placebo. Each treatment period lasted six weeks. Blood pressure and heart rate were significantly lower with the combination treatment than with hydrochlorothiazide alone. At the end of each treatment period, the mean diastolic blood pressure (erect) was 90.5 mm Hg with hydrochlorothiazide-acebutolol but remained above 100 mm Hg with the diuretic alone. Neither hydrochlorothiazide nor acebutolol produced any significant changes in plasma renin activity or plasma aldosterone. There were very few side effects and no reports of bradycardia.