Thrombolytic therapy in the Caribbean

Over the past 30 years, mortality from acute myocardial infarction (MI) has decreased substantially in developing countries. While this decline is attributed, in part to a reduction in coronary risk factors, some reports have identified improved theraputic management as being equally responsible for decline. Currently available treatment for patients presenting with ST segment elevation MI (MIs associated with complete occlusion of a coronary artery) includes the concomitant administration of aspirin ƒ-blockers, angiotensin-converting enzyme (ACE) inhibitors, and either thrombolytics or primary percutaneous transluminal angioplasty (PTCA) (AU)

Diabetic nephropathy, hypertension and pregnancy outcome

Nephropathy is a complication of diabetes mellitus that can affect women in their reproductive years. Modern management has improved the outcome of class F diabetic mothers and their infants. Drug therapy to control glucose levels, and blood pressure, as well as identifying preconceptionally, women at high risk for complications are the cornerstone for the achievement of good outcomes. Fetal survival rates of 95 percent are achievable. Although many woman with diabetic neuropathy experience a transient decline in renal function during pregnancy, pregnancy per se does not appear to hasten the natural progression to end stage renal disease. The association between the progression of renal disease in individuals with diabetes mellitus and inadequate blood pressure control requires aggressive treatment. Systolic blood pressure above 130mmHg and diastolic above 85 mmHg in pregnant women with diabetic nephropathy should be treated. Although angiotensin converting enzyme (ACE) inhibitors should be avoided during pregnancy, agents such as calcium channel blockers can be used with equally good results. Furthermore, these agents seem to have similar long-term effects of antihypertensive drug use on normotensive pregnant women with overt proteinuria. Nevertheless, preconceptional treatment with either ACE-inhibitors or calcium channel blockers seem to have a positive effect on the development of proteinuria throughout pregnancy. Therefore, patients with diabetic nephropathy contemplating pregnancy may be counseled that pregnancy is not contraindicated; that with stringent metabolic and blood pressure control, maternal and perinatal survival rates as high; that maternal and neonatal morbidity remains increased; however, the intercurrent pregnancy is not expected to accelerate the rate of decline of renal disease in lost patients with diabetic nephropathy. However, selected subpopulation of patients with moderate to severe baseline renal impairment may experience acceleration in their renal disease. These patients would benefit from renal transplant or stable dialysis therapy before initating pregnancy.(Au)

The efficacy and acceptability of perindopril for the treatment of essential hypertension in a Caribbean population

This study aims at assessing the efficacy and acceptability of perindopril in a Caribbean population. 435 patients from the English speaking and Dutch Caribbean islands with essential hypertension with a diastolic BP between 95 and 125 mmHg. were enrolled into an open dose titration study of perindopril of 3 months duration. 95 percent of patients were controlled (diastolic BP <90 mmHg.) with perindopril in monotherapy; and an additional 7.81 percent were controlled with the addition of hydrochlorothiazide 25 mg. Control was similar in the black population with a mean supine blood pressure reduction of 23.1 mm Hg. systolic and 17.1 mmHg diastolic. Perindopril was well tolerated with a low reported incidence of cough. This study confirms the antihypertensive efficacy of perindopril in mild to moderate hypertension in the Caribbean population and more specifically in the Afro-Caribbean population, as well as its clinical and biological acceptability. (summary)

State of the art lecture: pharmacological intervention for the reduction of progression of diabetic nephropathy - abstract

Reduction of bloodpressure has been known, from the work of Parving et al (1987), to reduce the rate of decline of renal function in the nephropathy associated with Type-1 diabetes mellitus (IDDM), using conventional anti-hypertensive agents. More recently, interest in angiotensin-converting enzyme inhibitors (ACE-Is), and calcium channel blockers (CCBs) in the treatment of diabetic nephropathy, has been forthcoming. In diabetic nephropathy, induced in rats by streptozotocin, ACE-Is clearly alter renal haemodynamics and reduce proteinuria. Reduction of proteinuria is also seen in humans with diabetic nephropathy, and there is a suggestion of preservation of renal function, although no long-term studies have been published. Two studies are underway in non-hypertensive microalbuminuric subjects, but these have also not been published. The group of ACE-Is appears to have similar action in reducing proteinuria in diabetic nephropathy, but the same cannot be said for the CCBs. They differ in their action in reducing proteinuria, and dilitiazem may stand alone in reducing proteinuria in human diabetic nephropathy. Debate continues on the mechanism for reduction in proteinuria. Amelioration in systemic hypertension plays a role for all classes of antihypertensive drugs used, but the ACE-Is may alter glomerular permselectivity and thereby bring about reduction in proteinuria. Dietary reduction or protein intake may also play a protein preserving renal function as may reduction of lipids (AU)

The efficacy and acceptability of Perindopril for the treatment of essential hypertension in a Caribbean population

Angiotensin converting enzyme Inhibitors (ACEIs) are reported to have a lower efficacy in black hypertensive patients, particularly in monotherapy. However, no studies have examined the efficacy of ACEIs in a Caribbean population. A dose titration study was performed with perindopril in the English and Dutch Caribbean islands to assess the efficacy and acceptability of Perindopril in this population. 435 patients with essential hypertension, with a diastolic BP between 95 and 125 mmHg were enrolled into this 3-month open study. Out of 333 patients who completed this study, 285 patients (69.3 per cent) were successfully controlled (diastolic BP<90 mmHg). An additional 45 (7.81 per cent) patients were controlled with the addition of hydrochlorothiazide 25 mg. Supine BP was reduced from 168.2 mmHg (+/- 1.08) systolic and 105.6 mmHg (+/- .48) diastolic to 149.12 mmHg (+/- 0.98) systolic and 91.95 mmHg (+/- 0.55) diastolic (p<0.001) after 2 months of perindopril in monotherapy. Supine BP was reduced further at the end of the 3-month treatment period to 144.3 mmHg (+/- 0.91) systolic and 88.39 mmHg (+/- 0.46) diastolic (p<0.001). There was no significant difference between the black population and the total population. Perindopril was well tolerated with a low reported incidence of cough. Withdrawal due to adverse events was also low at 2.3 per cent (10 patients). The anti-hypertensive efficacy of perindopril in a Caribbean population and more specifically, the black Caribbean population with mild to moderate hypertension, is confirmed in this study together with its clinical and biological acceptability (AU)

The efficacy and acceptability perindopril for the treatment of essential hypertension in a Caribbean population

Angiotensin converting enzyme inhibitors (ACEIs) are reported to have a lower efficacy in black hypertensive patients, particularly in monotherapy. However, no studies have examined the efficacy of ACEIs in a Caribbean population. A dose titration study was performed with perindopril in the English and Dutch Caribbean islands to assess the efficacy and acceptability of perindopril in this population. 435 patients with essential hypertension, with a diastolic BP between 95 and 125 mmHg were enrolled into this 3-month open study. Out of 333 patients who complete the study, 285 patients (69.3 percent) were successfully controlled (diastolic BP<90 mmHg). An additional 45 (7.81 percent) patients were controlled with the addition of hydrochlorothiazide 25 mg. Supine BP was reduced from 168.2 mmHg (ñ1.08) systolic and 105.6 mmHg (ñ0.48) diastolic to 149.12 mmHg (ñ0.98) systolic and 91.95 mmHg (ñ0.55) diastolic (p<0.001) after 2 months of perindopril in monotherapy. Supine BP was reduced further at the end of the 3-month treatment period to 144.3 mmHg (ñ0.91) systolic and 88.39 mmHg (ñ0.46) diastolic (p<0.001). There was no significant difference between the black population and the total population. Perindopril was well tolerated with a low reported incidence of cough. Withdrawal due to adverse events was also low at 2.3 percent (10 patients). The anti-hypertensive efficacy of perindopril in a Caribbean population and more specifically, the black Caribbean population with mild to moderate hypertension, is confirmed in this study together with its clinical and biological acceptability (AU)