Selection of patients for beta-blocking treatment after myocardial infarction.

Based on published studies of patients the following conclusions may be made: a) Long-term mortality and reinfarction rate can be reduced; b) No practically effective or meaningful restricted selection of patients for treatment with beta blockers is possible; c) Treatment starting when patients have stabilized in hospital usually after 5-7 days is well documented; d) Treatment should be maintained 2-3 years and the individual indications should then be re-evaluated; e) beta Blockers other than timolol, propranolol, metoprolol and alprenolol have yet to be documented.

Pharmacokinetics of intravenous timolol in patients with acute myocardial infarction and in healthy volunteers.

Disappearance pharmacokinetics, pharmacodynamics and general tolerance of i.v. timolol were compared in 12 healthy volunteers and 10 patients with a definite or proven acute myocardial infarction. The drug was administered to the patients immediately on arrival at the hospital after a median delay time of 4 h. Tolerance to the injections was good in both volunteers and patients. The study revealed disappearance pharmacokinetics that were similar in volunteers and patients.

Alphalipoprotein cholesterol levels in relation to acute myocardial infarction and its risk factors.

During 1975-1977 twenty-nine males surviving acute myocardial infarction at an age between 40-44 years were registered in Gothenburg, Sweden. Twenty-five of these were studied and compared with two control groups. One group, the reference group (RG, n = 76), was randomly selected from the male population from which the acute myocardial infarction (AMI) group was derived. A second group, the matched control group (MC, n = 47), consisted of men with no history of coronary heart disease, matched with patients for age, serum cholesterol and body weight index. Serum triglyceride levels were higher and alphalipoprotein cholesterol lower in the AMI group than in RG. Prior to infarction, patients had a higher degree of physical activity at work and a higher tobacco consumption than RG. When AMI cases were compared with MC subjects lower alphalipoprotein cholesterol levels were found in AMI, and they also had a higher tobacco consumption prior to infarction. There was a negative correlation between alphalipoprotein cholesterol levels and tobacco consumption in the RG. The differences in alphalipoprotein cholesterol levels between AMI cases and controls could not attributed to smoking habits, but smoking may at least to some extent exert its effect as a risk factor through influence on alphalipoprotein cholesterol levels.

A double-blind comparison of a novel indanone diuretic (MK-196) with hydrochlorothiazide in the treatment of essential hypertension.

1 The antihypertensive effect and tolerability of MK-196 (10 mg and 15 mg daily) was compared to hydrochlorothiazide (HCT; 50 mg daily) in a 4-week multiclinic, double-blind study involving 42 patients with mild to moderate, essential hypertension. 2 Both doses of MK-196 were as effective and sometimes more effective than HCT in lowering standing and supine systolic and diastolic blood pressures. 3 HCT consistently brought about significant increases in serum uric acid and significant decreases in serum potassium; both doses of MK-196 produced similar but less frequent and smaller changes in both of these parameters. 4 Both doses of MK-196 brought about significant decreases in body weight at Weeks 3 and 4 of drug treatment. 5 Patients taking MK-196 reported fewer adverse clinical reactions (10 mg = 15%; 15 mg = 13% than those taking HCT (21%). 6 MK-196 may offer a therapeutic advantage over HCT as an antihypertensive agent for use in the treatment of mild to moderate, essential hypertension.

Comparative study of metoprolol and alpha-methyldopa in untreated essential hypertension.

The hypotensive actions of metoprolol and alpha-methyldopa have been compared in 37 men with previously untreated essential hypertension; 36 belonged to stage 1 and 1 to stage 2 of the WHO classification. After four weeks of placebo treatment the patients were randomly allocated to treatment with either of the two drugs. Treatment was started with metoprolol 75 mg daily or alpha-methyldopa 375 mg and was doubled after eight weeks. Satisfactory blood pressure control was defined as systolic blood pressure below 160 mm Hg and diastolic below 95 mm Hg. The patients were examined every four weeks and in those with unsatisfactory control the dose was gradually increased up to a maximum daily dose of metoprolol 450 mg or alpha-methyldopa 2250 mg. The trial lasted for 24 weeks after randomization. Five patients dropped out of the study. After six months, satisfactory blood pressure control was recorded in 16 out of 17 patients and 14 out of 15 patients treated with metoprolol and alpha-methyldopa, respectively. The average reduction in blood pressure produced by the two drugs was comparable. One patient in the alpha-methyldopa group developed drug exanthema and two patients a positive Coombs' test. Other side effects were few and did not differ between the two compounds.

A postmyocardial infarction clinic in Göteborg, Sweden. A follow-up of MI patients in a specialized out-patient clinic.

The registration of all myocardial infarctions (MI) in the city of Göteborg started on Jan. 1st 1968, when a special clinic was set up for ambulatory posthospital care of infarction patients. In 1970 this clinic was expanded to cover all patients below 67 years of age with MI in the city of Göteborg, the aim being to standardize and unify patient care and therapeutic regimens to provide opportunities for the study of patient characteristics, natural history, risk factors and effects of preventive measures. Results from such studies have been published, but so far no unified description of this special out-patient unit, nor of any similar unit elsewhere. Patient recruitment, considerations concerning personnel, patient education procedures and return visit routines are covered, together with investigative methods and criteria for the treatment of complications, symptoms and risk factors. The cumulative drop-out rate up to and including 2 years follow-up was only 3%. A brief bibliography of studies originating at the Postmyocardial Infarction Clinic is included.