Use of ACE inhibitors and ARBs in hypertensive women of childbearing age.

BACKGROUND AND OBJECTIVE: Treatment with angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) during pregnancy can cause severe foetal abnormalities. This study aimed to identify the proportion of women of childbearing age taking ACE inhibitors or ARBs on referral to a tertiary Hypertension Clinic. DESIGN: Retrospective cohort study. METHODS: A cohort of female patients aged 16-45 years was identified from approximately 1500 new referrals from January 2004 to October 2006, excluding those not taking antihypertensive medication. ACE inhibitors and ARBs were grouped together for the purposes of the study. Contraceptive status was established where possible. RESULTS: Forty seven of 101 (47%) women aged 16-45 years were taking an ACE inhibitor (35) an ARB (11) or both (1) of whom 26 (55%) were aged 16-40 years. In this younger group, eight were using no contraception and three were using barrier methods only. CONCLUSIONS: Many GPs continue to prescribe ACE inhibitors and ARBs to women of childbearing age. A quarter of women in the study were taking these agents and were 40 years or less; of these many were not using reliable contraception. These women are at risk of foetal malformation and poor perinatal outcomes if they become pregnant. The British Hypertension Guidelines may put younger women at risk if general practitioners are unaware of potential foetotoxic and teratogenic consequences of prescribing ACE inhibitors and ARBs to women of child bearing age.

A cryoclamp for the rapid cryofixation of the isolated blood-perfused rabbit cardiac papillary muscle preparation at predefined times during the contraction cycle.

There is increasing evidence that the distribution of monovalent cations in cardiac cells may be non-uniform, particularly in the region immediately beneath the sarcolemma, and we have proposed that a build-up of sodium in this region could be an important factor in the development of ischaemia-reperfusion injury. Electron probe X-ray microanalysis is ideal for the study of such changes in distribution but the application of the technique to this problem imposes severe requirements on the specimen and on the method for cryofixation. The specimen must be perfused through its vasculature so that it can be made truly ischaemic and be successfully reperfused. It is necessary to be able to cryofix the specimen without disturbance of its blood supply, electrical stimulation or temperature. It is also important to know the time in the contraction cycle when cryofixation occurs. Here we describe the design of an automated cryofixation device which can be used to cryofix a blood perfused papillary muscle preparation at predetermined time points in the contraction cycle. Preliminary data obtained from the analysis of rabbit papillary muscles subjected to varying periods of ischaemia are included as an example of the use of the cryoclamp.