Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan. Losartan Trial Investigators.

The efficacy and safety of losartan and valsartan were evaluated in a multicenter, double-blind, randomized trial in patients with mild to moderate essential hypertension. Blood pressure responses to once-daily treatment with either losartan 50 mg (n = 93) or valsartan 80 mg (n = 94) for 6 weeks were assessed through measurements taken in the clinic and by 24-hour ambulatory blood pressure monitoring (ABPM). Both drugs significantly reduced clinic sitting systolic (SiSBP) and diastolic blood pressure (SiDBP) at 2, 4, and 6 weeks. Maximum reductions from baseline in SiSBP and SiDBP on 24-hour ABPM were also significant with the two treatments. The reduction in blood pressure was more consistent across patients in the losartan group, as indicated by a numerically smaller variability in change from baseline on all ABPM measures, which achieved significance at peak (P = .017) and during the day (P = .002). In addition, the numerically larger smoothness index with losartan suggested a more homogeneous antihypertensive effect throughout the 24-hour dosing interval. The antihypertensive response rate was 54% with losartan and 46% with valsartan. Three days after discontinuation of therapy, SiDBP remained below baseline in 73% of losartan and 63% of valsartan patients. Both agents were generally well tolerated. Losartan, but not valsartan, significantly decreased serum uric acid an average 0.4 mg/dL at week 6. In conclusion, once-daily losartan 50 mg and valsartan 80 mg had similar antihypertensive effects in patients with mild to moderate essential hypertension. Losartan produced a more consistent blood pressure-lowering response and significantly lowered uric acid, suggesting potentially meaningful differences between these two A II receptor antagonists.

[Cerebrovascular complications of Takayasu's disease]. / Complicaciones cerebrovasculares de la enfermedad de Takayasu.

We report four young women with Takayasu's arteritis who developed an ischemic stroke. In three of these patients, this complication heralded the onset of the disease. Three patients also had seizures. In all cases, the diagnosis was suspected on the basis of an abnormal cardiovascular examination showing absent carotid or radial pulses, carotid bruits or significant asymmetries in blood pressure determinations. The aortogram showed that three patients had Takayasu's arteritis type I, with affection confined to the aortic arch and supra-aortic trunks, and the other patient had Takayasu's arteritis type III with additional involvement of the descending aorta. Three patients had an elevated erythrocyte sedimentation rate and were treated with corticosteroids. Takayasu's arteritis should be suspected in young patients, especially women, presenting with a cerebral infarct or seizures who also have an abnormal cardiovascular examination. The diagnosis is usually confirmed by aortography, following Ishikawa's diagnostic criteria. Corticosteroid therapy may be of value in patients with an elevated erythrocyte sedimentation rate.

[Myocardial infarct without pathologic Q waves]. / Infarto del miocardio sin ondas Q patológicas.

Neither the presence nor the absence of pathological Q waves are related to the transmural or subendocardial localization of an acute myocardial infarction. The prognosis of an acute myocardial infarction without pathological Q waves is controversial. We studied 23 hospitalized patients with prolonged, typical chest pain, enzymatic elevation, an EKG without pathological Q waves but with changes in ventricular repolarization and a positive scintigraphy with radioactive pyrophosphates. The patients were classified in two groups according to the pattern of pyrophosphate uptake; group A had grade 2+ focal uptake (N = 13) and group B with grade 2+ diffuse uptake (N = 10). The level of serum glutamic transaminase was significantly greater in group A as compared to group B (p less than 0.05). However, levels of creatine kinase and lactic dehydrogenase were no different. The clinical hospital course was similar in both groups. Eleven patients were followed by 31.7 months: 30.4% had chronic angina, one underwent coronary bypass surgery, another suffered a recurrent myocardial infarction and there were no deaths. The diagnosis of acute myocardial infarction should be suspected in patients with prolonged angor pectoris, electrocardiographic changes in ventricular repolarization, increased enzymatic levels and a positive scintigraphy with a grade 2+ diffuse myocardial uptake of Tc 99m pyrophosphates. The diagnosis is certain if the uptake has a focal distribution.