Review of international safety data for lisinopril-hydrochlorothiazide combination treatment.

A total of 930 patients have been evaluated for safety in a programme of clinical trials for lisinopril-hydrochlorothiazide combination treatment. Combination therapy with these two agents is generally well tolerated. In clinical trials, adverse experiences in patients treated with a lisinopril-hydrochlorothiazide combination were dizziness (7.5%), headache (5.2%), cough (3.9%), fatigue (3.7%), orthostatic effects (3.2%), diarrhoea (2.5%), nausea (2.2%) and upper respiratory tract infection (2.2%). Withdrawals from treatment have been relatively infrequent comprising dizziness (0.8%), headache (0.3%), cough (0.6%), fatigue (0.4%), diarrhoea (0.2%), orthostatic effects and nausea (0.1% each). The most common laboratory adverse experiences in patients on therapy with the lisinopril-hydrochlorothiazide combination are: increases in serum glucose, triglycerides, uric acid, serum creatinine, blood urea nitrogen and blood urea; and decreases in serum potassium. However, in individual controlled studies, the addition of lisinopril to treatment with hydrochlorothiazide results in attenuation of some of the potentially adverse metabolic affects of the diuretic. Adverse experiences in the patients treated for periods of 50 weeks or more, the elderly and the renally impaired are similar to those seen in the total population. Overall the available data indicate that a fixed dose combination of lisinopril-hydrochlorothiazide is a well-tolerated therapeutic option in patients with mild-to-moderate hypertension.

Duration of angiotensin-converting enzyme inhibition: implications for tolerability.

A large co-ordinated multinational clinical-trial programme in hypertension has provided comparative data on adverse events in patients on lisinopril (n = 318) compared with enalapril (n = 321) and in 230 patients on lisinopril versus captopril (n = 235). The three groups were demographically well matched with regard to age and duration of treatment. However, in comparison with the lisinopril group, the captopril-treated group had a slightly higher proportion of males (NS). The incidence of adverse events on lisinopril was similar to that on enalapril (10.4 vs. 8.7%, NS) and captopril (11.7 vs. 11.9%, NS). The incidence of withdrawals was similar on lisinopril and enalapril (1.9 vs. 1.9%, NS) and captopril (4.8 vs. 3.0%, NS). The most frequently reported events affected the digestive, respiratory, or nervous and psychiatric systems of the body. The pattern of events and withdrawals was similar for all three drugs. The incidence of laboratory changes for lisinopril versus enalapril and lisinopril versus captopril was similar. The safety profiles of all three drugs were comparable in young and elderly patients. First-dose hypotension was reported for 2 of 548 patients on lisinopril, and renal failure was reported for 3 of 286 patients on enalapril. Overall, the events reflected the class-specific effects previously identified for angiotensin-converting enzyme inhibitors. The data indicate that long-acting angiotensin-converting enzyme inhibitors do not impose any additional side-effect risk in hypertension.

Traumatic left ventricular aneurysm: report of a case with normal coronary arteries.

A 26-year-old male had an anterior myocardial infarction following blunt chest trauma. He developed a left ventricular aneurysm despite coronary angiography being normal.

Modern cardiac pacing: the role of dual chamber systems.

Atrial synchronous or dual chamber pacemakers are at the forefront of current pacing technology. This article discusses the mechanisms of dual chamber pacing and considers the role of such systems in modern clinical practice.

Day case cardiac catheterisation using the Sones technique.

Cardiac catheterisation using the Sones technique was planned as a day case procedure in 855 of 1662 consecutive patients admitted for cardiac catheterisation. Of these, 810 (95%) were discharged the same day. Forty-five (5%) needed overnight hospitalization, 34 for reasons connected with the procedure and 11 for other reasons. No serious complications occurred and there were no deaths. The cost of day stay was approximately half that incurred using overnight stay. Thus, cardiac catheterisation using the Sones technique on a day case basis is safe and may produce significant cost efficiency.

Echocardiographic demonstration of Escherichia coli endocarditis restricted to the pulmonary valve.

A 25 year old man with no history of heart disease presented with sweats and rigors. Echocardiography showed a large vegetation on the pulmonary valve and blood cultures grew Escherichia coli. Because of recurrent pulmonary emboli a large vegetation on the anterior leaflet of the pulmonary valve was excised. He recovered after a full course of antibiotics.

Thrombolysis for myocardial infarction.

Treating myocardial infarction by dissolving occlusive thrombi in coronary arteries is an attractive idea. Although some thrombolytic agents have been available for many years their use in this role has only recently been critically examined. The place of thrombolysis in the management of myocardial infarction has yet to be determined.

Recurrent rheumatic fever.

Although recurrent rheumatic fever in adults is uncommon and the recurrence rate declines with age and with the interval from the attack, we describe a patient who has had four attacks of rheumatic fever, two in childhood and two in adult life.