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1.
J Telemed Telecare ; 8 Suppl 2: 101-3, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12217157

RESUMO

Congestive heart failure (CHF) is a major and increasing chronic disease in Western society, with a high mortality, morbidity and cost for unplanned hospital admissions. Continuous cardiorespiratory monitoring is required to detect Cheyne-Stokes respiration (CSR). We have tested a new wireless monitoring system and compared it with polysomnography (PSG) and respiratory inductance plethysmography (RIP) in six CHF patients with CSR in a sleep laboratory. The wireless system compared well with RIP for the detection of CSR but less well with PSG, which had unexpected but significant respiratory sensing errors that led to misclassification of the respiratory disorder present. The wireless system could be used to select CHF patients for better-customized treatment at home as part of a specialist-supported community telemedicine programme.


Assuntos
Insuficiência Cardíaca/diagnóstico , Serviços de Assistência Domiciliar , Telemetria/instrumentação , Insuficiência Cardíaca/fisiopatologia , Humanos , Pletismografia , Polissonografia , Telemetria/métodos
2.
J Telemed Telecare ; 7 Suppl 1: 76-7, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11576502

RESUMO

The diagnosis and management of increasing numbers of patients with chronic diseases in the community require new technologies and strategies of care. We have used a new wireless cardiorespiratory telemonitoring system to monitor 14 elderly patients with a variety of chronic diseases at home. The electrocardiogram (ECG), heart rate and variability, and breathing were recorded on two separate occasions for 24 h. There was no difference in the data recorded when a research nurse applied the monitoring system and when the patients applied it themselves. The ECG and heart rate were recorded for 98% of the monitored time, and the frequency and periodicities of breathing were recorded for 74% and 61% of sleep and rest time by visual and automatic analysis, respectively. The results show that 24 h activity and cardiorespiratory telemonitoring can be performed by elderly patients at home. Significant unsuspected abnormalities of breathing and heart rhythm, amenable to treatment, were also detected.


Assuntos
Monitorização Fisiológica/métodos , Telemetria , Idoso , Eletrocardiografia/métodos , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pletismografia de Impedância , Reprodutibilidade dos Testes , Respiração , Autocuidado
3.
J Int Med Res ; 29(2): 100-7, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11393342

RESUMO

This multicentre, randomized, double-blind study compared the anti-hypertensive efficacy and safety of oral once-daily imidapril 5-20 mg and hydrochlorothiazide 12.5-50 mg in elderly patients with mild-to-moderate essential hypertension. After 24 weeks of treatment, there was a significant reduction in mean sitting diastolic blood pressure from 102.5 mmHg to 87.2 mmHg in the imidapril group (n = 226) and from 102.7 mmHg to 87.4 mmHg in the hydrochlorothiazide group (n = 123) (intent-to-treat population). There were corresponding reductions in sitting systolic blood pressure and standing blood pressure. At least one adverse event was reported by 46% of patients in the imidapril group and 53% of patients in the hydrochlorothiazide group. Imidapril 5-20 mg is as effective and well tolerated as hydrochlorothiazide in the treatment of mild-to-moderate hypertension in elderly patients.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Hipertensão/tratamento farmacológico , Imidazóis/uso terapêutico , Imidazolidinas , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Humanos , Imidazóis/efeitos adversos
4.
J Telemed Telecare ; 6 Suppl 1: S119-22, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10793994

RESUMO

We have conducted a trial of a wireless device for continuous cardiopulmonary monitoring. Its performance, user acceptance and safety were assessed for monitoring in the patient's home. The study included 20 patients: six with chronic obstructive pulmonary disease, six with chronic heart failure, seven with atrial fibrillation and palpitations, and one with a snoring problem. The system recorded the heart rate and respiratory rate, blood pressure, electrocardiogram and body temperature. The results were transmitted automatically to a central monitoring station. The accuracy of the measurements was checked by a comparison system and also by conventional measurements performed by a nurse. The system was acceptable to patients and functioned satisfactorily in the home. An important facet of home telemonitoring may turn out to be its greater reliability in collecting objective data.


Assuntos
Monitorização Ambulatorial/normas , Telemedicina/normas , Adulto , Idoso , Doença Crônica , Estudos de Viabilidade , Humanos , Pessoa de Meia-Idade , Monitorização Ambulatorial/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Projetos Piloto , Atenção Primária à Saúde/métodos
5.
BMJ ; 310(6995): 1660-3, 1995 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-7795459

RESUMO

Postmarketing research, often called phase IV trials, is intended to familiarise doctors and patients with newly approved drugs. La Puma and colleagues, in Chicago, studied doctors' and patients' attitudes to whether doctors should receive payment for taking part in such research. We asked for commentaries on their findings from four ethical experts, who put the study in a British context, present the views of patients, and examine some methodological assumptions.


Assuntos
Atitude Frente a Saúde , Conflito de Interesses , Revelação , Honorários Médicos , Consentimento Livre e Esclarecido , Vigilância de Produtos Comercializados , Experimentação Humana Terapêutica , Adulto , Atitude do Pessoal de Saúde , Pesquisa Biomédica , Ensaios Clínicos Fase IV como Assunto , Comitês de Ética em Pesquisa , Ética Médica , Feminino , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Sujeitos da Pesquisa , Revelação da Verdade , Reino Unido , Estados Unidos
7.
Br J Clin Pharmacol ; 37(3): 265-72, 1994 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-8198936

RESUMO

1. We describe an approach involving a smaller, shorter study, leading onto a longer, larger study in which the antihypertensive effects of ascending doses of imidapril, a new ACE inhibitor, were investigated. Both studies were planned prospectively, assuming a clinically useful fall in BP to be 8 mm Hg (s.d. = 9). The studies included patients with mild to moderate essential hypertension (baseline sitting diastolic blood pressure (SDBP) 95-115 mm Hg). After a placebo run-in of 2-3 weeks patients received either placebo or imidapril 2.5, 5, 10 or 20 mg in the 2 week study (n = 91) or imidapril 5, 10, 20 or 40 mg in the 4 week study (n = 162). 2. The overall mean baseline SDBP was 103.4 mm Hg (s.d. 0.62) in the initial study and 101.5 mm Hg (s.d. 0.41) in the 4 week study. 3. Compared with placebo, imidapril 10, 20 and 40 mg significantly reduced SDBP. There was no significant difference between these doses, suggesting that 10 mg achieved maximal ACE inhibition in most patients. The 2.5 mg dose showed no significant effect. The 5 mg dose gave an intermediate effect. In both studies the overall incidence of adverse events was similar in the imidapril and placebo groups, and was not worrying.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Imidazóis/administração & dosagem , Imidazolidinas , Adolescente , Adulto , Idoso , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Imidazóis/efeitos adversos , Imidazóis/farmacologia , Imidazóis/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Br J Clin Pharmacol ; 35(6): 623-8, 1993 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8329290

RESUMO

1. Dilevalol (R,R-labetalol) is a non-selective beta-adrenoceptor antagonist with beta 2-adrenoceptor agonist activity. Its effects after 1 month's administration on heart rate, blood pressure and muscle blood flow were studied in a double-blind crossover comparison with nifedipine in 16 hypertensive patients. 2. Dilevalol and nifedipine were similarly effective in lowering systolic and diastolic blood pressure at rest, but dilevalol limited the rise in systolic blood pressure induced by exercise more than nifedipine (rise of 27 vs 53 mm Hg respectively, P < 0.01). 3. Dilevalol decreased resting heart rate compared with nifedipine (73 vs 92 beats min-1 respectively, P < 0.01). Dilevalol limited the exercise induced rise in heart rate more than nifedipine (36 vs 48 beats min-1 respectively, P < 0.01). 4. Muscle blood flow (measured by strain gauge plethysmography) was not affected by either dilevalol or nifedipine at rest. After exercise, dilevalol caused an increase in excess blood flow compared with placebo (10.8 vs 5.1 ml min-1 dl-1 respectively, P < 0.01). The difference between dilevalol and nifedipine did not reach statistical significance (10.8 vs 6.5 ml min-1 dl-1 respectively, P > 0.05). 5. On blood pressure and heart rate, dilevalol demonstrated beta-adrenoceptor blocker activity at rest and on exercise. On muscle blood flow, dilevalol appeared to have no effect at rest, but may have acted as a beta-adrenoceptor blocker rather than as a beta 2-adrenoceptor agonist during exercise.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Hipertensão/fisiopatologia , Labetalol/farmacologia , Músculos/irrigação sanguínea , Nifedipino/farmacologia , Adolescente , Adulto , Idoso , Método Duplo-Cego , Exercício Físico/fisiologia , Humanos , Perna (Membro)/irrigação sanguínea , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/efeitos dos fármacos , Descanso/fisiologia
10.
J Clin Pharmacol ; 33(2): 146-9, 1993 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8440763

RESUMO

The influence of chronic perindopril treatment on digoxin pharmacokinetics was investigated in 10 patients with mild chronic heart failure under stable diuretic and digitalis treatment and normal renal function. Digoxin was administered at a dose of 0.125 mg/day (n = 2) or 0.250 mg/day (n = 8). The 24-hour steady-state digoxin profile was assessed before and after concomitant administration of perindopril for 1 month at doses of 2 mg once a day for the first 8 days and 4 mg once a day for the remaining 21 days. Chronic treatment with perindopril produced no significant effect on mean (+/- standard deviation) digoxin serum area under the curve for 24 hours (17.9 +/- 7.4 versus 16.3 +/- 4.4 ng/mL.h), peak digoxin concentration (1.3 +/- 0.54 versus 1.2 +/- 0.36 ng/mL), time to peak concentration (3 versus 4 hours), and apparent oral clearance of digoxin (237.7 +/- 109.6 versus 237.4 +/- 79.5 mL/min). Clinical and biologic tolerance of perindopril was good throughout the study. Chronic administration of perindopril did not alter steady-state digoxin kinetics in patients with mild chronic heart failure and normal renal function, indicating that no adaptation of the digoxin dose is required during co-prescription with perindopril in such patients.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/farmacologia , Digoxina/farmacocinética , Insuficiência Cardíaca/metabolismo , Indóis/farmacologia , Idoso , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/metabolismo , Digoxina/administração & dosagem , Digoxina/sangue , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Indóis/administração & dosagem , Indóis/metabolismo , Masculino , Perindopril , Fatores de Tempo
12.
Eur Heart J ; 13(2): 256-60, 1992 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-1555625

RESUMO

In a randomised, double-blind, crossover study of oral sustained-release verapamil 360 mg o.d. ('SR-verapamil') and oral nifedipine 20 mg t.d.s. in 19 patients with chronic stable angina pectoris, significantly greater improvement from baseline was seen with SR-verapamil than with nifedipine. Mean exercise duration was 380 +/- 108 s with SR-verapamil and 343 +/- 130 s with nifedipine (P less than 0.05); mean time to onset of angina was 326 +/- 79 s with SR-verapamil and 239 +/- 79 s with nifedipine (P less than 0.01); median time to 1 mm ST depression was 252 s (range 114-579) with SR-verapamil and 182 s (range 84-582) with nifedipine (P less than 0.01); mean ST depression at maximum exercise was 1.65 +/- 0.56 mm with SR-verapamil and 2.17 +/- 0.98 mm with nifedipine (P less than 0.05). Ambulatory ECG recordings indicated a trend in favour of SR-verapamil (median ST-time integral 0.00 [range 0-24.16] mm h-1 with SR-verapamil, 1.15 [range 0-12.50] mm h-1 with nifedipine, not significant). Median glyceryl trinitrate consumption was significantly lower (P less than 0.05) with SR-verapamil (0.21; range 0-1.25 per day) than with nifedipine (0.31; range 0-1.32 per day), but there was no significant difference between angina attack frequency. Adverse events were reported by two patients with SR-verapamil and nine with nifedipine. Once-daily sustained-release verapamil 360 mg has a significantly better effect on exercise tolerance than nifedipine 20 mg t.d.s. and also appears to be better-tolerated.


Assuntos
Angina Pectoris/tratamento farmacológico , Eletrocardiografia/efeitos dos fármacos , Teste de Esforço/efeitos dos fármacos , Nifedipino/administração & dosagem , Verapamil/administração & dosagem , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Preparações de Ação Retardada , Método Duplo-Cego , Eletrocardiografia Ambulatorial/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Nifedipino/efeitos adversos , Nitroglicerina/administração & dosagem , Verapamil/efeitos adversos
13.
Eur J Clin Pharmacol ; 42(3): 341-2, 1992.
Artigo em Inglês | MEDLINE | ID: mdl-1577055

RESUMO

In an 8-week comparative study, 410 patients were treated with nitroglycerin spray and 387 with conventional 500 mcg sublingual tablets. Data were analysed to compare the two treatments and to compare the results in older patients (greater than or equal to 65 y) with younger patients (less than 65 y). Spray was significantly superior to tablets in terms of number of patients helped, speed of pain relief and reduction in the number of attacks from pre-study levels. The occurrence of headache was significantly less in the spray group. There was no significant difference in the number or nature of adverse events but more spray patients reported taste disturbance. The clinical advantages seen in the entire population were maintained when the two age categories were considered separately. Further, 95% of patients found the spray convenient. The authors conclude that improved efficacy together with improved stability of the spray without loss of convenience makes Nitrolingual spray an acceptable alternative to tablets irrespective of patients' age.


Assuntos
Envelhecimento/fisiologia , Angina Pectoris/tratamento farmacológico , Nitroglicerina/administração & dosagem , Administração por Inalação , Administração Sublingual , Idoso , Distribuição de Qui-Quadrado , Medicina de Família e Comunidade , Humanos , Nitroglicerina/uso terapêutico , Comprimidos
14.
Br J Clin Pharmacol ; 33(1): 93-9, 1992 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-1311597

RESUMO

1. Perindopril, an orally active angiotensin converting enzyme inhibitor, was given to 23 hypertensive patients with stable chronic renal failure for 15 days. The dose of perindopril was 2 or 4 mg once a day according to the degree of renal failure. The creatinine clearance of the patients ranged from 6 to 67 ml min-1 1.73 m-2. The pharmacokinetics of perindopril and perindoprilat, its active metabolite, were studied after acute and chronic administration of perindopril. 2. The drug was well tolerated and creatinine clearance was unaltered by treatment. 3. In both groups, steady-state was reached within 3 days of chronic treatment. 4. After both acute and chronic drug administration renal impairment had no effect on perindopril pharmacokinetics but the pharmacokinetics of perindoprilat were altered significantly. After chronic administration the serum accumulation ratio was 1.81 in patients with mild renal failure and 5.35 in patients with severe renal failure. Chronic administration did not modify the renal clearance of perindoprilat nor its elimination half-life. 5. A significant correlation between the renal clearance of perindoprilat and creatinine clearance was observed (r = 0.87 first dose, r = 0.83 last chronic dose). 6. A non-linear relationship between serum perindoprilat concentration and inhibition of angiotensin converting enzyme was described by a modified Hill equation. Values of IC50 were 1.11 +/- 0.07 micrograms I-1 (mean +/- s.d.) in patients with severe renal failure and 1.81 +/- 0.20 micrograms l-1 in patients with moderate renal failure. Chronic administration increased maximal inhibition and decreased the time to maximal inhibition only in patients with severe renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Inibidores da Enzima Conversora de Angiotensina/farmacocinética , Anti-Hipertensivos/farmacocinética , Hipertensão/metabolismo , Indóis/farmacocinética , Falência Renal Crônica/metabolismo , Peptidil Dipeptidase A/sangue , Idoso , Feminino , Humanos , Indóis/administração & dosagem , Indóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Perindopril
16.
BMJ ; 303(6810): 1138, 1991 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-1747598
17.
BMJ ; 302(6781): 907, 1991 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-1859564
20.
Cardiovasc Drugs Ther ; 4 Suppl 1: 93-5, 1990 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-2285656

RESUMO

Ketanserin is a serotonin S2-receptor antagonist that lowers blood pressure and inhibits platelet aggregation. Ketanserin treatment is also associated with prolongation of the corrected QT interval. The recently reported Prevention of Atherosclerotic Complications with Ketanserin (PACK) trial confirmed this prolongation of QT and also revealed a significant excess of deaths in patients receiving ketanserin together with potassium-losing diuretics. The investigators suggested that this excess of deaths may have been attributable to exacerbation of hypokalemia-induced ventricular arrhythmias by the repolarization-prolonging effect of ketanserin. However, drugs that prolong the QT interval may affect ventricular ectopic activity beneficially, and our study was designed to evaluate the effects of ketanserin on ventricular ectopic activity. Twenty patients (18 male, 2 female) aged 42-73 years were studied, each having at least 15 ventricular ectopic beats/hour. The study design was a double-blind, crossover comparison of ketanserin, 40 mg twice daily, and placebo, both given for 1 week. Ventricular ectopic activity was assessed by 48-hour Holter electrocardiogram (ECG) tapes at the end of each treatment period. Ketanserin treatment was associated with prolongation of repolarization, as reflected by the significant mean increases in both QT interval (+30 ms; p less than 0.001) and corrected QT interval (+20 ms; p less than 0.05). The mean overall degree of ventricular ectopic activity, as represented by a score based on the Lown classification, was significantly reduced (p less than 0.05). This was associated with a concordant improvement in the individual indices of ectopic activity. Our results show that ketanserin significantly suppressed ventricular ectopic activity in our normokalemic patients.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Arritmias Cardíacas/tratamento farmacológico , Ketanserina/uso terapêutico , Adulto , Idoso , Arritmias Cardíacas/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Eletrocardiografia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Humanos , Ketanserina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Potássio/sangue
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