[Comparison of results of daily blood pressure self-monitoring and general practice monitoring within the scope of a study assessing treatment of hypertension with quinapril]. / Vergleich der Ergebnisse von täglichen Blutdruckselbstmessungen und Praxismessungen im Rahmen einer Studie zur Behandlung der Hypertonie mit Quinapril (Accupro).

24 hour blood pressure monitoring is a well established method in the field of antihypertensive research. Patients self recorded blood pressure values are an additional option to overcome the disadvantages of casual office readings--however they are not frequently used within intervention trials. To prove the usefulness of selfrecordings in clinical trials we investigated both selfrecordings taken twice a day and casual readings within intervals of 1 to 3 weeks, in this study on the efficacy and tolerability of the ACE-inhibitor Accupro. 108 hypertensive patients (grade WHO I to II) were included in this trial for ten weeks. Although blood pressures were measured by the patients using sphygmomanometers of the same type and the physicians, decisions to treat or to increase dosage were based on the patients' recordings only. Accupro was dispensed according to the package leaflet at a daily dosage of 5 mg up to 40 mg. In case of failing response to monotherapy, Accupro was combined with Diltiazem or with a diuretic. 7 patients discontinued the treatment due to mild adverse events, one did not cooperate. 82 of the remaining patients were treated effectively with Accupro monotherapy--60 (73%) got one dose daily, 22 (27%) 2 doses per day,--and in 18 patients a drug combination was required. Therapeutic response (RRd < or = 90 mm Hg) was gained within 86 of the 100 evaluable patients according to the doctors' and 83 according to the patients' records. In this respect the two methods used gave comparable overall results. This somewhat surprising fact is due to the design of the study, because treatment decisions were based on the selfrecordings only. Clinical trials based on selfrecordings are in some points preferable to casual office readings: As patients being normotensive at home should not be included into an interventional study, a change of dosage within this group is avoided. Additionally the compliance of a cooperative patient taking his blood pressure twice daily is at a high level. Measurements of each single patient may be evaluated statistically by time series-analysis regarding longterm distribution of blood pressure-values. Taking the means of selfrecordings over adequate time-intervals eliminates the influence of "outliers" (occasionally extremely high or low values) and also reduces the standard deviation compared to that of the casual readings. Research work based on self recordings provides more information and therefore more security for treatment decisions.

Cardiovascular effects of mianserin--a comparative study with amitriptyline and a placebo in healthy subjects.

The cardiovascular effects of a tricyclic (amitriptyline) and a tetracyclic (mianserin) antidepressant were compared with those of a placebo in a double-blind randomized group-comparative trial stratified for sex in 18 healthy volunteers. The dose of the test preparations was gradually increased to therapeutic level. Duration of treatment was 8 days. Neither test drug affected objective physical condition, intraocular pressure, blood variables or urinalysis, and the effect on blood pressure was found to be negligible. No impressive differences of untoward cardiac effects between the test preparations could be demonstrated. However, the prolongation of the pre-ejection period in amitriptyline-treated males, indicating a negative effect on myocardial contractility, and the reduction of the left ventricular end-systolic volume by mianserin, probably through increasing the ejection fraction, are observations of possible clinical relevance. They lend further support to the assumption that therapeutic doses of tricyclic antidepressants may produce untoward cardiac effects whereas the tetracyclic mianserin seems devoid of such unwanted properties.

[Regression of a Kayser-Fleischer ring in a case of Wilson's disease during penicillamine therapy (author's transl)]. / Die Rückbildung eines Kayser-Fleischer-Ringes bei Morbus Wilson unter Penicillamintherapie.

The disappearance of a Kayser-Fleischer ring induced by the administration of penicillamine (D-penicillamine) for 17 years is described. The ring disappeared only in the lateral and medial portions leaving superior and inferior crescents. Possible mechanisms of this partial regression of the ring ae discussed.

[Progress in the therapy of acute and chronic cardiac insufficiency by means of systemic vasodilators. Studies with prazosin and nitroglycerin]. / Fortschritte in der Therapie der akuten und chronischen Herzinsuffizienz durch den Einsatz systemischer Vasodilatatoren. Untersuchungen mit Prazosin und Nitroglyzerin.

In acute and chronic left heart failure peripheral resistance is elevated due to increased sympathetic tone. This should compensate the decrease in stroke volume. In the diseased left ventricle however the augmentation of afterload leads to further reduction of stroke volume and to increase of heart size and myocardial oxygen consumption. This vitious cycle may be interrupted by vasodilators. Drugs like nitroglycerin, mainly acting on the venous system, reduce preload and thereby relieve symptoms of pulmonary congestion (backward failure). Phentholamin on the other hand primarily reduces afterload by an action on the resistance vessels and thereby increases cardiac output (forward failure). Nitroprusside has effects on both, the capacity and resistance vessels. So nigroglycerin is the remedy of choice in acute pulmonary edema. Nitroprusside in leftf heart failure in acute myocardial infarction and Phentolamin in acute left ventricular failure due to critical rise in blood pressure. For long term treatment of chronic left heart failure (coronary heart disease, cardiomyopathy, rheumatic heart disease) hydralazin or prazosin may be used as well as long acting nitrates.

[Exercise tolerance of patients with artificial cardiac pacemakers (author's transl)]. / Körperliche Belastbarkeit von Herzschrittmacherträgern.

In order to determine their exercise tolerance, 20 patients with artificial ventricular demand pacemakers below the age of seventy were studied by bicycle ergometry. Only 30% of the patients showed a normal exercise tolerance according to the criteria by Kaltenbach, while 70% stopped the test prematurely because of leg fatigue, dyspnoe or chest pain. In terms of their exercise tolerance, there was no difference between patients who developed normal sinus rhythm or rapid atrial fibrillation during the exercise and those who remained at the fixed pacemaker rate throughout the test. It is concluded, therefore, that the exercise tolerance of pacemaker-patients is not only limited by the fixed heart rate but mainly by the underlying heart disease (coronary heart disease, cardiomyopathy, hypertensive heart disease etc.) and the general physical condition of the patients. In an age-matched control group of 20 patients 50% showed a normal exercise tolerance and the duration of exercise in this group was only slightly longer (21%) than in the pacemaker-group.

[Diagnosis of adriamycin myocardiopathy using echocardiography]. / Diagnostik der Adriamycin-Myocardiopathie mittels Echokardiographie.

27 patients with a mean cumulative dose of 450 +/- 150 mg adriamycin for the treatment of solid malignoma and clinical symptoms of left heart failure are examined by echocardiography. 14 patients had an abnormal ejection fraction, 21 patients an abnormal mean circumferential fiber shortening and 4 patients presented with pericardial effusion. The results demonstrate that echocardiography is a safe, noninvasive and reliable method for diagnosing a reduced left ventricular function in patients treated with adriamycin.

[Comparative study on the saluretic activity of etacrynic acid and BAY g 2821 in patients with cardiac decompensation (author's transl)]. / Saluretischer Wirkungsvergleich von Etacrynsäure mit BAY g 2821 bei Patienten mit kardialer Dekompensation.

In a randomised double-blind comparative study 40 mg 3-amino-1-(3,4-dichloro-alpha-methyl-benzyl)-2-pyrazolin-5-one (BAY g 2821), a novel diuretic agent, were tested against 50 mg etacrynic acid in patients with cardiac decompensation. BAY g 2821 has a rapid onset of action which slowly decreases until 12 h after administration. Within a period between the second and the fourth hour after administration, the efficacy of BAY g 2821 is superior to that of etacrynic acid. The difference is statistically significant. The total elimination of BAY g 2821 is markedly more pronounced than that of etacrynic acid throughout the 5-day treatment course. Neither subjective nor objective side effects were observed.