Use of calcium-channel blocking drugs in hypertrophic cardiomyopathy.

Verapamil exerts a wide spectrum of hemodynamic effects in patients with hypertrophic cardiomyopathy (HC), and its administration offers an important alternative to beta-receptor blocker therapy in such patients. The intravenous administration of verapamil to 62 patients in the catheterization laboratory decreased systolic blood pressure from 118 +/- 17 to 102 +/- 17 mm Hg (p less than 0.001). It had no significant effect on heart rate, mean pulmonary artery wedge pressure, left ventricular (LV) end-diastolic pressure or cardiac output; however, LV outflow gradient in the basal state decreased from 62 +/- 34 to 29 +/- 34 mm Hg (p less than 0.05). These findings demonstrate a decrease in LV outflow tract obstruction. Radionuclide angiography indicated the major action responsible for the reduction in obstruction appears to be an improvement in LV diastolic function. Short-term nifedipine administration to patients with HC produced no significant effect on LV outflow tract gradients and early diastolic filling. Short-term double-blind studies showed that verapamil improved exercise time by 26 +/- 35% (p less than 0.005) compared with placebo, whereas propranolol improved it by 21 +/- 35% (p less than 0.025). In a separate study, verapamil improved exercise duration by 38 +/- 58% (p = 0.02) compared with placebo, whereas nifedipine improved it by 20 +/- 47% (difference is not significant). Verapamil resulted in a more beneficial subjective symptomatic response than propranolol or nifedipine when compared with placebo. Long-term verapamil therapy was instituted in 227 patients; 133 of these patients have continued taking the medication for an average of 25 +/- 13 months because their quality of life improved compared with what they experienced with their former therapy (usually beta blocker). Improved exercise capacity of 40% has been maintained in 32 patients for 2 years. A decrease in ventricular septal thickness of 1.5 +/- 2.6 mm was also found in 32 patients studied after 39 +/- 8 months of verapamil therapy. Nine patients died during follow-up study, but it is unclear whether the drug increased survival or, conversely, whether any of the deaths could be attributed to verapamil administration. Significant adverse electrophysiologic and hemodynamic effects were seen in 59 instances. The electrophysiologic events, atrioventricular block and sinus arrest, were definitely verapamil-related, but it is uncertain how many of the hemodynamic problems of hypotension and pulmonary congestion were drug-related.(ABSTRACT TRUNCATED AT 400 WORDS)

Exercise capacity and hemodynamics in persons aged 20 to 50 years with systemic hypertension treated with diltiazem and atenolol.

Hemodynamic responses and exercise capacity were studied during maximal exercise in 25 young hypertensive persons (mean age 40 years) taking placebo, diltiazem (mean 216 mg/day) and atenolol (mean 80 mg/day). The study was a crossover, double-blind, randomized trial, each medication period lasting 2 months. Sitting blood pressure (BP) was 160 +/- 19/109 +/- 8 mm Hg after run-in. Both drugs decreased BP significantly, diltiazem by 10/ 11 mm Hg and atenolol by 16/14 mm Hg (difference not significant between drugs). During exercise there were no differences among patients taking placebo, diltiazem and atenolol in peak workload and rating of perceived exertion. Atenolol significantly attenuated the increase in heart rate, BP and heart rate-BP product at each workload. Diastolic BP during exercise was significantly lower (6 to 10 mm Hg) during diltiazem therapy than during placebo at each workload. Thus, both diltiazem and atenolol decrease rest BP significantly without impairing exercise capacity.

Components of Type A behavior and the first-year prognosis of a myocardial infarction.

This study examined prospectively the role of Type A behavior and its subcomponents in the first-year prognosis of myocardial infarction (MI). Anger expression, irritability, and cynicism were assessed as traits related to the hostility component of the construct. The sample comprised 92 patients, less than 65 yr old, who survived the acute phase of their first MI. Psychological data was collected by self-report questionnaires during the initial hospital stay. Type A behavior was measured by the Jenkins Activity Survey and by the Finnish Type A Scale. Factors were controlled for age, sex, social status, and the MI severity. The results showed that patient who had a reinfarction or died during the first year reported more irritability and experienced anger more often than patients surviving without any complications. From the standard subcomponents only the Speed-Impatience factor of the JAS predicted poor prognosis. Our results indicated that the global Type A scores were not associated with the prognosis of MI.