Left ventricular mass, serum electrolyte levels and cardiac arrhythmias in patients with mild hypertension treated with cilazapril or hydrochlorothiazide.

Thirty-five patients with mild hypertension (WHO Class I) participated in a double-blind cross-over study involving two 8-week periods of treatment with cilazapril 2.5-5 mg once daily or hydrochlorothiazide 25-50 mg once daily, in each case preceded by a 4-week placebo period. Thirty-two patients completed the study, the aim of which was to compare the effects of the drugs on serum electrolyte levels, left ventricular mass and cardiac arrhythmias, as assessed by echocardiography and 48-h Holter monitoring. Both drugs significantly reduced systolic (P < 0.01) and diastolic (P < 0.001) blood pressures (comparisons with placebo periods). Cilazapril and hydrochlorothiazide had opposite effects on ventricular ectopic activity. The beneficial effect of cilazapril on ventricular extrasystole counts correlated significantly (P < 0.001) with the reduction of left ventricular mass index. Hydrochlorothiazide had no effects on left ventricular mass or diastolic function. Serum potassium values were significantly (P < 0.001) reduced by hydrochlorothiazide but there was no correlation between changes in potassium levels and changes in ventricular ectopic activity. The results of the study suggest that hydrochlorothiazide and cilazapril were equally effective in reducing blood pressure, but only cilazapril reduced left ventricular hypertrophy and suppressed ventricular ectopic activity.

The effect of potassium and potassium plus magnesium supplementation on ventricular extrasystoles in mild hypertensives treated with hydrochlorothiazide.

Eleven mild hypertensives with base-line ventricular extrasystoles underwent a 24-week period of treatment with hydrochlorothiazide 50 mg daily. After 8 weeks of treatment either potassium as hydrochloride 1 g twice daily, or a combination of potassium hydrochloride 1 g and magnesium hydroxide 500 mg twice daily was added to the diuretic therapy in a randomised, double-blind, cross-over design. Each treatment period lasted 8 weeks. Supplementation with potassium or potassium plus magnesium resulted in a clear trend for suppression of ventricular ectopic activity. There was no difference in ventricular extrasystoles between the two supplementation groups. Supplementation with potassium plus magnesium but not with potassium only, resulted in a significant rise in serum potassium values (P less than 0.01). Our study suggests that potassium should be supplemented in thiazide-treated hypertensives who are prone to develop ventricular extrasystoles. Addition of magnesium to potassium supplementation does not result in further improvement in ventricular ectopic suppression.

Combined action of enalapril or timolol with hydrochlorothiazide plus amiloride in hypertension.

59 mild to moderate hypertensives were treated for four weeks with 50 mg hydrochlorothiazide plus 5 mg of amiloride, then concomitantly with these diuretics with either enalapril (10-20 mg) or timolol (10-20 mg) in two parallel treatment groups for an additional 12 weeks in an open study. Addition of these drugs lowered the blood pressure by 25 +/- 3/16 +/- 2 mm Hg and 15 +/- 3/14 +/- 1 mm Hg, respectively. The difference of the reduction of the systolic blood pressure between enalapril and timolol group at the end of the combined treatment was statistically significant (p less than 0.01). The mean serum potassium was elevated by 0.3 mmol/l after addition of enalapril to the diuretic treatment, but none of the patients developed hyperkalaemia. No adverse effects on other routine laboratory values were observed. Both drug combinations can be considered efficient, well tolerated and safe in the treatment of mild to moderate hypertension.

Cardiac arrhythmias in hypertensive outpatients on various diuretics. Correlation between incidence and serum potassium and magnesium levels.

Twenty-four hypertensive out-patients (WHO I) underwent an ambulatory 24-hour electrocardiogram-monitoring both before and after 8 weeks treatment with either hydrochlorothiazide (20-50 mg/day, N = 6), indacrinone (50-100 mg/day, N = 6) or indacrinone plus amiloride (50-100 mg and 5-10 mg/day, N = 12) in a double-blind fashion in 3 parallel groups. A 4-weeks placebo run-in period preceded the active treatment. Serum potassium fell significantly in the hydrochlorothiazide group (p less than 0.001) and in the indacrinone group (p less than 0.005). Serum magnesium values remained unchanged. In 4 out of the 24 patients ventricular ectopic activity increased but there was no correlation with changes in serum potassium or magnesium values in these patients. Treatment with different diuretics had a similar influence on the occurrence of ventricular extrasystoles.

Life support for 10 weeks with successful fetal outcome after fatal maternal brain damage.

A 31 year old woman in whom subarachnoid and intracerebral haemorrhage occurred during the second trimester of pregnancy was sustained in intensive care with a respirator for 10 weeks. Computed tomography of the brain showed bilateral intraventricular haemorrhages. Because of drug resistant hypotonic episodes at 31 weeks' gestation caesarean section was performed, and a boy was delivered. The woman died of spontaneous cardiac arrest two days after caesarean section, and the boy showed normal development. Life support can be continued for several weeks in a modern intensive care unit after fatal insult to the brain even in a pregnant woman without affecting the fetus.