Tilt test results in young and elderly patients with syncope of unknown origin.

The effects of aging on the results of prolonged drug-free tilt testing were studied in 175 consecutive patients with unexplained syncope divided into 3 groups: 59 patients < 40 years old; 57 patients between 40 and 60 years; and 59 patients > 60 years old. Tilt-induced vaso-vagal syncope occurred respectively in 17 (29%), 20 (35%), and 18 patients (31%) in the 3 age groups. Vasodepressor, mixed, and cardioinhibitory vaso-vagal syncope occurred similarly in the 3 groups; organic heart disease and systemic hypertension were more frequent in elderly patients without affecting the incidence of tilt-induced syncope. Blood pressure and heart rate variations during syncope were similar in the 3 age groups; in the first 20 minutes of tilt testing, before the appearance of the vaso-vagal reflex, elderly patients showed greater reduction in blood pressure and smaller increase in heart rate than younger patients. Our data indicate that increasing age determines a different blood pressure and heart rate behavior during tilt testing, but apparently does not influence the incidence of vaso-vagal syncope in patients with syncope of undetermined etiology. As the proportion of patients with a positive isoproterenol tilt test was reported to decline with age, our results suggest that the reduced incidence of syncope during isoproterenol tilt testing could be the expression of impaired autonomic response among elderly syncope patients.

Comparative evaluation of three dosages of slow-release isosorbide dinitrate (60, 80, 100 mg) in chronic angina of the aged.

In a single-blind, placebo-controlled study the acute and chronic antianginal effects of three slow-release (SR) new formulations of isosorbide dinitrate (ISDN 60, 80, 100 mg) have been comparatively evaluated in a group of aged affected by chronic stable effort-induced angina. Compared to placebo, overall the active dose paritetically improved the effort tolerance up to 24 h after the first assumption. In the time course of the trial (2 and 4 weeks) the resting hemodynamic changes induced by the first dose were partially blunted without affecting the exercise related-parameters. Also if plasma levels of ISDN and of its metabolites did not correlate to the degree of physical improvement, the peak increase in effort tolerance was observed under 100 mg treatment. Mild to moderate transient headache was experienced by 50% of actively treated and by 20% of placebo treated patients and no other serious adverse effects have been noted. One may conclude that ISDN in slow-release formulations of 60-100 mg isan effective, safe and well tolerated medication in the management of angina in the aged.

Antihypertensive and hemodynamic effects of slow-release nicardipine.

The antihypertensive efficacy, the hemodynamic effects and the tolerability of a new slow-release nicardipine (SR-Nic) formulation, capsules containing 40 mg of active drug, have been tested in a randomized, double-blind placebo (P)-controlled study. Thirty mild-to-moderate essential hypertensives were enrolled and after a one-week single-blind placebo run-in period randomly allocated to SR-Nic or P twice-day for six weeks. Blood pressure (BP) was measured after 1, 2, 4 and 6 weeks of treatment. Hemodynamic parameters were evaluated non-invasively by the impedance cardiography technique, using the Noninvasive Continuous Cardiac Output Monitor (NNCOM 3, BoMed Medical Manufacturing Ltd), after 2 and 4 weeks of treatment. All the determinations were made before the morning administration, i.e., 12-14 h after evening intake of SR-Nic or P. The blood pressure (p less than .01) and hemodynamic response (p less than .01 for the systemic vascular resistances) in the SR-Nic group significantly differed from those in the P group. At the end of the study, there were decreases in mean systolic/diastolic BP values of 17/12 in the sitting and of 18/12 mmHg in the standing position in the SR-Nic group; in the P group, the changes were +2/-2 in the sitting and +2/-1 mmHg in the standing position. Systemic vascular resistances were reduced by 17.3% in the SR-Nic and by 1.9% in the P group after 4 weeks of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)