Influence of benazepril and captopril on blood pressure, glucocorticoids and progesterone in essential hypertensives.

The antihypertensive activity and the influence of adrenal cortex hormones of benazepril versus captopril were studied in 30 essential hypertensives in a double-blind, randomised, placebo-controlled trial during eight weeks of treatment. Patients started with 50 mg of captopril or 10 mg of benazepril once daily; if normotension had not been obtained after four weeks of treatment the doses were increased to 50 mg twice daily or 20 mg once daily, respectively. 11-Oxycorticosteroids and progesterone in males were measured in blood and daily urine at baseline and at the 4th and the 15th days of drug administration, as well as aldosterone in daily urine by radioimmunoassay, and compared with these data in 15 healthy subjects. Following eight weeks of treatment in 64% and 56% of patients treated with benazepril and captopril respectively, blood pressure was normalised. In the corresponding remaining 14% and 13%, diastolic blood pressure decreased by 10 mmHg and more but not below 90 mmHg. Before treatment excretion of 11-oxycorticosteroids, progesterone and aldosterone was significantly increased without changes in blood levels. After two weeks of treatment 11-oxycorticosteroids and aldosterone excretion decreased (P < 0.05) without progesterone changes, benazepril treatment being more effective in decreasing 11-oxycorticosteroids levels in blood (P < 0.05). In patients with high pretreatment levels of 11-oxycorticosteroids in urine we have noticed the highest antihypertensive effect of both drugs. The main conclusions are that both the ACE inhibitors are effective in mild to moderate essential hypertensives and might decrease glucocorticoids in urine and blood.

Valsartan in heart failure patients previously untreated with an ACE inhibitor.

OBJECTIVE: To evaluate the effect on cardiac hemodynamic parameters of valsartan in patients with chronic stable congestive heart failure previously untreated with ACE inhibitors. METHODS: After a 2 to 4 week run-in period, 116 adult outpatients were randomized to receive valsartan 40, 80 or 160 mg twice daily, the ACE inhibitor lisinopril 5/10 mg once daily, or placebo. At baseline and after 28 days of treatment, cardiac hemodynamic parameters were measured. Tolerability was assessed by adverse events and by any changes in systolic or diastolic blood pressure, body weight, heart rate, and routine laboratory parameters. RESULTS: For the 12 hour time point (trough), all doses of valsartan reduced mean pulmonary capillary wedge pressure (statistically significant for valsartan 40 mg and 160 mg), decreased systemic vascular resistance (statistically significant for all three valsartan doses and for lisinopril at peak and trough), and increased cardiac output (statistically significant for all three valsartan doses at peak, and for 80 and 160 mg at trough). There were no clinically relevant effects on any safety parameters. CONCLUSIONS: Valsartan has beneficial effects on cardiac hemodynamics, and is generally well tolerated in patients with congestive heart failure not taking ACE inhibitors.

[Experience with the use of clopheline in geriatric anesthesiology]. / Opyt primeneniia klofelina v geriatricheskii anesteziologii.

The new aspects of the use of the central adrenopositive agent clopheline as a component of combined endotracheal anesthesia were studied. In distinction to the recommendation of some authors, clopheline was used in the preanesthesia period in an average dose of 2.5-3.0 mcg/kg (in debilitated patients in a dose of 1.8-2.2 mcg/kg). The authors examined 86 patients 60 to 85 years of age during planned and emergency operations on the biliary tract. All of them suffered from arterial hypertension: 70% had three and more concomitant diseases; 20% of patients were related to IB category of anesthesiological risk, 65% to IIB category, and 15% to IIIB category. The condition of peripheral and central hemodynamics, the stress index, and the excretion of the free forms of catecholamines (CA), their precursors, and metabolites were studied. During anesthesia with the use of clopheline by the suggested method, moderate activation of the sympathoadrenal system within the stress-norm occurs. During anesthesia as well as in the postanesthesia period the mechanisms of autoregulation, which contribute to rapid return of the activity of the sympathoadrenal system to the initial level and the control of the relationship of the synthesis and inactivation of CA, their precursors, and metabolites, are maintained. The method made it possible to reduce the doses of barbiturates to 2-3 mg/kg, and the doses of fentanyl by 3-4 times as compared with those in neuroleptanesthesia, which, in turn, facilitated rapid regaining of consciousness, adequate spontaneous breathing, a good cough reflex, and sufficient physical activity immediately after the operation. There were no complaints of pain hyperdynamic circulatory shift, trembling of muscles, suppressed respiration, and acrocyanosis.