[Transient subendocardial ischemia in abolition of hypertensive crises with nifedipine]. / Tranzitornaia subéndokardial'naia ishemiia miokarda pri kupirovanii gipertonicheskikh krizov nifedipinom.

Sublingual nifedipine, 30 mg, was used to abolish hypertensive crises in 32 patients. A follow-up of changes in blood pressure, ECG, and echocardiographic parameters evaluating the cardiac performance and central hemodynamics was performed during 4 hours after the drug. The patients with profound myocardial hypertrophy and dilatation at a left ventricular myocardial weight of over 200 g at the peak of the antihypertensive effect occurred for 15-60 min exhibited transient ECG changes by the type of subendocardial ischemia despite an above 25% reduction in mean blood pressure and the lack of severe reflex tachycardia, the pump function of the heart showing no decreases. The ejection fraction increased from 51.0 +/- 2.8 to 62.0 +/- 2.5% (p less than 0.05) due to lower afterload. There were no clinical manifestations typical of myocardial ischemia.

[The specificity of the hypotensive effect of calcium antagonists in hypertension]. / Spetsifichnost' gipotenzivnogo éffekta antagonistov kal'tsiia pri gipertonicheskoi bolezni.

The purpose of the study was to define prognostic criteria that determine individual sensitivity to the hypotensive effect of slow calcium channel blockers. After two weeks of placebo therapy 45 patients suffering from essential hypertension underwent an acute pharmacological test (APT) with nifedipine in a dose of 30 mg. Then the patients received monotherapy with nitrendipine in the increasing doses for 12 weeks. The drug effect on the renin-angiotensin-aldosterone system and the level of ionized calcium in the blood serum was estimated. In 17 patients who responded to the APT by a decrease of the mean arterial pressure (MAP) by not less than 20%, arterial pressure was corrected with nitrendipine administered in a dose not exceeding 20 mg. 28 patients whose MAP dropped by 10 to 20% in response to the APT required higher drug doses (40 mg). 7 patients in whom the MAP dropped less than 10% were practically refractory to the monotherapy with nitrendipine. A close negative correlation was found between the degree of the MAP lowering in response to the APT during nitrendipine monotherapy and plasma renin activity as well as the concentration of ionized calcium in the blood serum. The low content (less than 1.0 mmol/l) of ionized calcium in the blood serum of patients suffering from essential hypertension appeared the most valuable predictor for the hypotensive effect of the slow calcium channel blockers.

[Hemodynamic effects of the treatment of hypertension with the calcium channel blocker diltiazem]. / Gemodinamicheskie éffekty pri lechenii gipertonii blokatorom kal'tsevykh kanalov diltiazemom.

The 1.5-benzotthazepine derivative diltiazem, which blocks slow calcium channels, is an effective hypotensive agent, used for the treatment of moderate hypertension. Treatment with diltiazem alone, its dose adjusted on an individual basis, controlled arterial blood pressure in 58% of the patients. With a 240 mg daily dose, blood pressure was controlled in 12 of 52 patients; when the daily dose was increased to 360 mg, blood pressure was controlled in another 18 patients. In the remaining 22 patients, blood pressure was only controlled after captopril was added in a daily dose of at least 50 mg. The drop of arterial blood pressure was associated with falling total peripheral resistance and end diastolic blood volume, and was accompanied by an increase in left-ventricular ejection fraction and myocardial oxygen want.

[Hemodynamic effect of a combination of prazosin with cardiac depressants in the treatment of hypertension]. / Gemodinamicheskii éffekt sochetaniia prazozina s kardiodepressantami pri lechenii gipertonii.

Arterial blood pressure and central hemodynamic changes were assessed in 44 patients with essential hypertension, uncontrollable by prazosin alone, after propranolol (anaprilin), celiprolol, clonidine (clofelin) or verapamil were added to the treatment schedule. A selective beta 1-adrenoblocker, celiprolol, is shown to be the best option in prazosin-treated patients with reflex increment of heart rate and stroke volume. The prazosin-verapamil combination is also justified in cases of moderately increased pulse rate, while propranolol and clonidine produce no additional hypotensive effect when combined with prazosin.