Sinus automaticity and sinoatrial conduction in severe symptomatic sick sinus syndrome.

Electrophysiologic studies with recordings of sinus node electrograms were performed in 38 patients with severe symptomatic sick sinus syndrome. Thirty-two of the 38 patients had episodic tachyarrhythmias and 17 presented with syncope. The clinically documented sinus or atrial pause was 5.6 +/- 2.8 s (mean +/- SD). Patients were divided into three groups according to electrophysiologic findings. Group I consisted of nine patients with complete sinoatrial block. Sinus node electrograms were recorded during the episodes of long pauses. Seven patients had unidirectional exit block, with the atrial impulse being capable of retrograde penetration to the sinus node causing suppression of sinus automaticity; two had bidirectional sinoatrial block. Group II consisted of 22 patients with either 1:1 sinoatrial conduction (group IIa = 13 patients) or second degree sinoatrial exit block (group IIb = 9 patients) during spontaneous sinus rhythm. Sinoatrial exit block, ranging from 1 to greater than 14 sinus beats, was observed during postpacing pauses that ranged from 1,650 to 37,000 ms (mean 7,286 +/- 6,989). The maximal sinus node recovery time ranged from 770 to 5,580 ms (mean 3,004 +/- 1,686) and was normal in 5 patients and prolonged in 17. Group III consisted of seven patients with no recordable sinus node electrogram, reflecting either a technical failure or a quiescence of sinus activity. The sinus node recovery time in these seven patients ranged from 1,190 to 4,260 ms (mean 2,949 +/- 1,121). Thus, abnormalities in both sinus node automaticity and sinoatrial conduction are responsible for the long sinus or atrial pauses in the sick sinus syndrome. However, complete sinoatrial exit block can occur and cause severe bradycardia with escape rhythm; repetitive sinoatrial exit block plays a major role in producing posttachycardia pauses.

Prognostic value of dobutamine echocardiography in patients after Q-wave or non-Q-wave acute myocardial infarction.

We investigated the role of dobutamine echocardiography in predicting future spontaneous events in patients with Q-wave or non-Q-wave first acute myocardial infarction (AMI). DE was performed in 168 patients with a Q-wave AMI and 105 patients with a non-Q-wave AMI. Patients were observed for hard events (cardiac death and nonfatal reinfarction) and all spontaneous events (hard events and unstable angina). When compared to patients with a Q-wave AMI, patients with non-Q-wave AMI had a higher rate of positive dobutamine echocardiographic results (51.8% vs 80.0%, p <0.0001), greater changes in wall motion score index (WMSI) (0.31+/-0.17 vs 0.42+/-0.23, p = 0.001), and more remote zone ischemia (27.9% vs 43.8%, p = 0.0072). Patients with non-Q-wave infarct had a higher all-event rate, but a similar hard-event rate. In patients with a positive dobutamine echocardiogram (DE), the rate of hard or all events was similar, regardless of different infarct patterns. Patients with a negative DE had a higher event-free survival rate for all events in both Q-wave (85.2% vs 60.9%, p <0.0001) and non-Q-wave (76.2% vs 52.4%, p = 0.0083) groups. By stepwise analysis in the Q-wave group, the most important predictors were peak stress WMSI and diabetes for hard events, and a positive DE and baseline WMSI for all events. However, in the non-Q-wave group, the strongest predictors were dobutamine time for hard events and positive DE for all events. We conclude that a positive DE is a powerful predictor of future spontaneous events in patients after either a Q-wave or non-Q-wave AMI. However, for hard events, high-risk patients with different infarct patterns were recognized with variable efficiency by different dobutamine echocardiographic variables.

Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy.

Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 219 patients with symptomatic, severe rheumatic mitral stenosis. There were 59 men and 160 women, aged 19 to 76 years (mean 43). Pliable, noncalcified valves were present in 139 (group 1), and calcified valves or severe mitral subvalvular lesions, or both, in 80 patients (group 2). Atrial fibrillation was present in 133 patients (61%) and 1+ or 2+ mitral regurgitation in 59 (27%). Technical failure occurred with 3 patients in our early experience. There was no cardiac tamponade or emergency surgery. The only in-hospital death occurred 3 days after the procedure in a group 2 premoribund patient in whom last-resort PTMC created 3+ mitral regurgitation. Mitral regurgitation appeared or increased in 72 patients (33%); 3+ mitral regurgitation resulted in 12 patients (6%). There were 3 systemic embolisms. Atrial left-to-right shunts measured by oximetry developed in 33 patients (15%). Immediately after PTMC, there were significantly reduced (p = 0.0001) left atrial pressure (24.2 +/- 5.6 to 15.1 +/- 5.1 mm Hg), mean pulmonary artery pressure (39.7 +/- 13.0 to 30.6 +/- 10.9 mm Hg) and mitral valve gradient (13.0 +/- 5.1 to 5.7 +/- 2.6 mm Hg). Mitral valve area increased from 1.0 +/- 0.3 to 2.0 +/- 0.7 cm2 (p = 0.0001) and cardiac output from 4.4 +/- 1.4 to 4.7 +/- 1.2 liters/min (p less than 0.01). The results mirrored clinical improvements in 209 patients (97%). Multivariate analysis showed an echo score greater than 8, and valvular calcification and severe subvalvular lesions as independent predictors for suboptimal hemodynamic results.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial natriuretic peptide and vasopressin during percutaneous transvenous mitral valvuloplasty and relation to renin-angiotensin-aldosterone system and renal function.

To study the relation between plasma atrial natriuretic peptide (ANP) and cardiac pressure, and to assess the pathophysiologic significance of ANP in water and electrolyte metabolism, the changes in plasma levels of ANP and arginine vasopressin (AVP) were examined in 11 patients with mitral stenosis who underwent percutaneous transvenous mitral valvuloplasty, and compared with the changes in the renin-angiotensin-aldosterone system and renal function. Immediately after valvuloplasty, plasma ANP levels decreased significantly with a concomitant decrease in mean pressures in the left atrium, the pulmonary artery and the right atrium. Plasma ANP levels decreased to the normal range in 4 of the 6 patients with normal sinus rhythm, while all 5 patients with atrial fibrillation had higher levels despite a similar degree of decrease in atrial pressure. There were significant positive correlations between plasma ANP levels and the mean left atrial pressure (r = 0.61, p less than 0.01), the mean pulmonary arterial pressure (r = 0.49, p less than 0.01) and the mean right atrial pressure (r = 0.54, p less than 0.01). The mean plasma AVP levels, on the other hand, showed a transient increase after valvuloplasty from 0.5 +/- 0.1 to 1.2 +/- 0.4 pg/ml (p less than 0.05). The mean plasma renin activity (1.3 +/- 0.3 vs 2.7 +/- 0.8 ng/ml/hr, p less than 0.05) and plasma aldosterone concentration (8.6 +/- 2.3 vs 17.2 +/- 5.2 ng/dl, p less than 0.05) also increased significantly 30 minutes after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Can dobutamine stress echocardiography predict cardiac events in nonrevascularized diabetic patients following acute myocardial infarction?

STUDY OBJECTIVE: To determine whether the prognostic value of dobutamine stress echocardiography (DSE) performed early after acute myocardial infarction (AMI) is as high in diabetic patients as in nondiabetic patients. DESIGN: Inception cohort study. SETTING: Tertiary cardiac referral center. PATIENTS AND INTERVENTIONS: Three hundred thirty-eight patients (116 diabetic and 222 nondiabetic) who underwent DSE after AMI were followed up for cardiac events. MEASUREMENTS AND RESULTS: Outcome events were as follows: "hard" events consisted of cardiac death and nonfatal reinfarction, while "all events" included hard events and unstable angina. The mean follow-up duration was 21 +/- 9 months. DSE results were positive in 69 diabetic patients (59.5%) and 129 nondiabetic patients (58.1%; p = 0.817). During the follow-up period, there were 25 cardiac deaths, 16 cases of nonfatal reinfarction, and 55 cases of unstable angina. The Kaplan-Meier life table showed that a positive DSE result was associated with a lower event-free survival rate in nondiabetic but not in diabetic patients in terms of hard and all events. By multivariate analysis, a positive DSE result was the strongest independent predictor of future cardiac events in nondiabetic patients. However, in diabetics, a shorter dobutamine time, rather than a positive DSE result, independently predicted cardiac events. CONCLUSIONS: Our preliminary data suggest that different DSE variables should be considered when assessing the likelihood of future events in diabetic and nondiabetic patients after AMI. The observation of shorter dobutamine time, instead of DSE positivity, has a higher prognostic value in diabetics. In diabetic patients, the only significant role of DSE positivity is for predicting future unstable angina; however, its predictive value is not as good as in nondiabetic patients.

Pedal (99m)Tc-sulfur colloid lymphoscintigraphy in primary isolated chylopericardium.

Primary isolated chylopericardium is a rare disorder in which chylous fluid accumulates in the pericardial space. In this case report of a 61-year-old man with chylopericardium, pedal (99m)Tc-sulfur colloid (SC) lymphoscintigraphy was performed after emergent pericardiocentesis, and when there was a recurrent massive pericardial effusion. The results showed that (99m)Tc-SC lymphoscintigraphy can clearly reveal the lymphodynamics in patients with primary isolated chylopericardium. This noninvasive investigation is valuable and can be easily performed either before or after pericardiocentesis.

Effects of hormone replacement therapy on cardiovascular risk factors in postmenopausal women.

OBJECTIVE: To investigate changes in plasma lipoprotein profile, hemostatic factors, platelet aggregation, endothelin-1, and cardiac function during postmenopausal sequential 6-month hormone replacement therapy (HRT). DESIGN: Open longitudinal prospective study. SETTING: Gynecologic department of a medical center. PATIENT(S): Twenty-one healthy hysterectomized postmenopausal women. INTERVENTION(S): Oral E2 valerate (2 mg/d) combined with medroxyprogesterone acetate (MPA) (10 mg/d) during the last 10 days of each 21-day cycle. The treatment period was 6 months. MAIN OUTCOME MEASURE(S): Plasma lipoprotein profile, hemostatic parameters, platelet aggregation, endothelin-1, and left ventricular function. RESULT(S): After 6 months of treatment, total cholesterol, triglyceride, and low density lipoprotein (LDL) cholesterol were significantly progressively reduced. Atherogenic indices of total cholesterol-to-high-density lipoprotein (HDL) cholesterol and LDL-to-HDL cholesterols also showed a significant progressive decline. The concentrations of antithrombin III were significantly increased. The maximum aggregation and slope of platelet aggregation were significantly reduced, but all parameters were more pronounced at 1 month of HRT than at 3 or 6 months. The concentrations of endothelin-1 were significantly reduced (by 16.1%). In the evaluation of left ventricular function, only peak atrial diastolic velocity was significantly reduced. CONCLUSION(S): Combined HRT had favorable effects on lipids and lipoproteins, hemostatic factors, platelet aggregation, endothelin-1, and left ventricular function. However, further study is needed to evaluate the long-term effects of combined HRT, especially on platelet aggregation and cardiac function.

Unruptured left ventricular pseudoaneurysm following myocardial infarction.

A 73 year old man developed a left ventricular pseudoaneurysm following acute myocardial infarction. Coronary angiography showed triple vessel disease with total occlusion of the right coronary artery. On left ventriculography, a serpentine-like pseudoaneurysm was demonstrated that originated from the posterobasal wall of the left ventricle and extended to the right ventricular free wall. He underwent coronary artery bypass surgery with no plication of the pseudoaneurysm. An organised thrombus was also found within the cavity of the pseudoaneurysm. He was doing well approximately eight months after the operation. The prognosis might be determined by the organised thrombus, the serpentine-like structure of pseudoaneurysm, the coronary revascularisation, and the vigorous medical management.

Diagnostic value of dobutamine echocardiography in patients with angina-like symptoms preceding syncope.

Dobutamine echocardiography was performed in 55 patients with syncope which was clinically suspected to be angina-related. We evaluated the value of using a single test, dobutamine echocardiography, in differentiating real ischemia-related from vasovagal syncope which was diagnosed by a tilt test. During testing, supraventricular arrhythmia was provoked in four (7.2%) patients. Dobutamine echocardiography identified all of six (10.9%) patients (sensitivity 100%), who were found with significant coronary stenosis by coronary angiograms. The etiology of syncope in the remaining 45 patients was investigated further by tilt testing, the findings of hypotension and bradycardia during which were compared head to head with those of dobutamine echocardiography. Tilt testing diagnosed vasovagal syncope in 31 patients, in whom only 19 (61.3%) patients developed vasovagal reflex during dobutamine echocardiography. Conclusively, dobutamine echocardiography had a high sensitivity in identifying syncope related to myocardial ischemia in patients with coronary stenosis, but a low sensitivity (61.3%), high specificity (90.5%) and high positive predictive value (81.8%) in detecting the syncope patients with angina caused by vasovagal effect.

Dobutamine-induced hypotension is an independent predictor for mortality in patients with left ventricular dysfunction following myocardial infarction.

Dobutamine echocardiography was performed on 297 patients after acute myocardial infarction to assess the prognostic value of dobutamine-induced hypotension in patients with left ventricular dysfunction. Patients were divided into two groups according to ejection fraction (group I, ejection fraction <0.45, n = 123; group II, ejection fraction > or =0.45, n = 174) and were followed for 20+/-8 months. Hypotension was defined as a decrease in systolic blood pressure > or =20 mm Hg, compared with baseline values. The incidence of hypotension was similar in groups I and II (23.6% vs. 18.4%, P = 0.28), and the hypotension was not related to positive dobutamine echocardiography. Univariate analysis showed that the development of hypotension was associated with a higher incidence of cardiac death in group I but not in group II. Multivariate analysis showed that dobutamine-induced hypotension was an independent predictor only for cardiac death in group I and was not related to any other cardiac events in either group. In conclusion, the development of hypotension during dobutamine stress can identify a subgroup with poor ventricular functional reserve and at high risk for cardiac death among patients complicated with left ventricular dysfunction.

Short- and long-term prognostic value of cardiac troponin I and dobutamine echocardiography in patients with stabilized acute coronary syndromes.

BACKGROUND: This study investigated the short- and long-term prognostic values of cardiac troponin I (cTnI) and dobutamine echocardiography (DE) in patients with acute coronary syndrome (ACS) who stabilized after medical treatment. METHODS AND RESULTS: 171 consecutive patients of ACS accepted blood sampling for cTnI at the emergency department and DE at 4.9+/-0.6 days after admission. The prognostic values of cTnI, DE, and combined cTnI and DE were separately investigated at follow up periods of 30 days, 1 year and 3 years for hard events (cardiac death and non-fatal myocardial infarction) and all spontaneous events. CTnI was elevated in 55 (32%) patients and DE was positive in 114 (67%) patients. Elevated cTnI with positive DE were found in 44 (26%) patients. Within 30 days, the combination of elevated cTnI and positive DE provided more accurate prognostic information than each test result alone, and was the only independent predictor for both hard (p=0.014) and all events (p=0.012). After 1 year, cTnI alone had no prognostic value. The combination of an elevated cTnI level and a positive DE only had a prognostic value for all events (p=0.015). However, DE was an independent predictor for both hard (p=0.006) and all events (p=0.002). Neither cTnI alone nor cTnI combined with DE had a significant 3-year prognostic value. However, DE maintained its prognostic value and was still an independent predictor after 3 years for both hard (p=0.024) and all events (p=0.004). CONCLUSIONS: For patients with stabilized ACS, the diagnostic finding of elevated cTnI combined with a positive DE has a better short-term prognostic value than each test alone. However, DE alone has a better long-term prognostic value.

Prognosis after a first Q-wave myocardial infarction in ethnic Chinese people: a prospective study.

The prognosis after a first Q-wave myocardial infarction was investigated in 206 Chinese patients of 65 years or younger who had a predischarge cardiac catheterization and coronary angiography. Three patients studied were lost to follow-up. In the remaining 203 patients with ages of between 28 and 65 years, 101 (49.8%) had 0- or 1-vessel disease, 56 (27.6%) had 2-, and 38 (18.7%) had 3-vessel disease. Significant left main coronary artery stenosis was noted in 8 (3.9%). During a mean follow-up of 33 months, 33 (16.3%) patients had 36 episodes of cardiac events, and 16 (7.9%) died of cardiac causes. Stepwise logistic regression analysis revealed that the left ventricular ejection fraction and left main coronary artery disease were predictors of cardiac mortality, while age and the extent of coronary artery disease were predictors of total cardiac events. There was no variable that could predict recurrence of myocardial infarction.

Coronary artery spasm-induced paroxysmal atrial fibrillation--a case report.

Paroxysmal atrial fibrillation is described in a patient that was consistent with the clinical history developed after induction of coronary artery spasm. The mechanism appeared to be sinus node artery spasm inducing sinus node ischemia. Coronary artery spasm can be a cause of paroxysmal atrial fibrillation.

The role of endothelin-1 in the aorta of post-infarct left ventricular dysfunction rats treated with captopril.

OBJECTIVES: There is little information available regarding local vasomotor regulating processes in chronic heart failure. In this study, we tested the hypothesis that chronic heart failure impaired the endothelial function, and long term captopril treatment might reverse endothelial activity through tissue endothelin (ET) pathway. METHODS: Forty Sprague-Dawley rats were divided into 4 groups including 15 rats in each of the sham-operated with or without captopril-treated groups and 5 rats in each of large infarcted with or without captopril-treated groups. RESULTS: Concentration-response curves obtained in aortic rings without endothelium revealed no difference in nitroprusside-induced relaxation. With endothelium, rightward shifting was noted only in the untreated large infarct group during acetylcholine-induced relaxation. As compared to the non-treated group, plasma ET-1 concentrations were lower in the captopril-treated with or without large infarct groups. However, endothelin-like immunoreactivity in endothelial cells and cytoplasma of smooth muscle cells of the media of the aorta were lower only in the non-treated large infarct group. CONCLUSIONS: Endothelial function was impaired in the chronic heart failure model. Coverting enzyme inhibitor might improve endothelial function through the Local endothelin pathway.

Changes of endothelin-1 and atrial natriuretic peptide during dobutamine stress echocardiography.

The aim of this study was to test the hypothesis that plasma endothelin-1 (ET-1) and atrial natriuretic peptide (ANP) concentrations in patients with ischemic heart disease are related either to myocardial ischemia or left ventricular (LV) dysfunction during dobutamine stress echocardiography. Plasma concentrations of ET-1 and ANP were measured in three patient groups. Group I (n = 21) patients had normal stress echocardiography and a resting LV ejection fraction (LVEF) of 40% or more. Group II (n = 32) had positive stress echocardiography and a resting LVEF of more than 40%. Group III (n = 18) had positive stress echocardiography with a resting LVEF of less than 40%. All three groups were subjected to thallium 201 scintigraphy and coronary angiography studies. The resting LV end-diastolic pressure was significantly higher in groups II and III than in Group I. The LVEF decreased significantly in group III compared to groups I and II. In the resting state, groups II and III had higher ET-1 concentrations than Group I (p = 0.021 and p = 0.039, respectively). The plasma ANP concentration was higher in group III than in groups I and II (p = 0.005 and p = 0.054, respectively). During peak dobutamine infusion, the ET-1 concentration dropped 8.7% from the baseline in group I, 10.2% in group II, and 10.5% in group III. The ANP concentrations were increased in all three groups but only the increase in Group II reached statistical significance. In conclusion, in patients with suspected ischemic heart disease, the concentrations of ET-1 and ANP may predict significant anatomic and functional coronary artery disease. However, ET-1 does not play a pathophysiologic role during an ischemic attack.

Intravenous atropine relieves coronary arterial spasm and hemodynamic decompensation during recovery after exercise.

A 66-year-old man developed right coronary arterial spasm and hemodynamic decompensation during the early recovery phase of a treadmill exercise test. The unstable condition was corrected immediately after intravenous administration of atropine. A subsequent coronary angiographic study revealed insignificant right coronary artery stenosis. The pathophysiology of this response may be related to rapid alterations in autonomic balance during recovery after exercise. To our knowledge, this is the 1st reported case in which atropine effected immediate reversal of coronary arterial spasm and hemodynamic decompensation that were induced by exercise, rather than by pharmacologic agents. Atropine might be an effective treatment in patients who experience exercise-induced coronary arterial spasm and hemodynamic decompensation, but further investigation is warranted.

Coronary vasospasm inducing dynamic left ventricular outflow tract obstruction.

An 80-year-old man was admitted to the emergency department of our institution due to acute, anterior-wall myocardial infarction and cardiogenic shock. Two-dimensional echocardiography revealed systolic anterior motion of the mitral leaflets with severe left ventricular outflow tract obstruction. Although coronary angiography showed normal coronary arteries, an ergonovine provocation test induced diffuse coronary constriction of the left coronary artery, with chest pain, and ST-T changes seen on the electrocardiogram. These clinical signs caused us to suspect coronary spasm. The present case serves as a reminder that coronary vasospasm may be a factor in the development of dynamic left ventricular outflow tract obstruction. Early detection and intensive efforts to relieve vasospasm, including emergency coronary angiography and intracoronary injection of nitroglycerin, are essential.

Comparison of antihypertensive efficacy and tolerability of losartan and extended-release felodipine in patients with mild to moderate hypertension.

Appropriate control of blood pressure has been shown to reduce morbidity and mortality in patients with hypertension. Losartan potassium, a selective antagonist of the angiotensin II type 1 (AT1) receptor, has been shown to lower blood pressure in patients with hypertension. The purpose of this study was to compare the efficacy and tolerability of losartan and extended-release (ER) felodipine in Taiwanese patients with mild to moderate hypertension. Patients with mild to moderate hypertension (sitting diastolic blood pressure, 95-115 mm Hg) were enrolled in this prospective, randomized, parallel study. Sitting blood pressure, heart rate, adverse reactions, and serum biochemistry values were assessed during 2 weeks of placebo and 12 weeks of active treatment. Each patient received 50 mg of losartan or 5 mg of felodipine ER once daily, and the dosage was adjusted to double the initial level at week 6 if necessary. Of the 44 patients randomly allocated to receive losartan (n = 23) or felodipine (n = 21) therapy, 37 completed the study; three patients in the losartan group and four in the felodipine group withdrew because of adverse experiences, or were lost to follow-up. The mean reductions in sitting diastolic blood pressure at 6 and 12 weeks were significant with both losartan (-8.6 and -11.38 mm Hg, respectively) and felodipine (-9.2 and -10.69 mm Hg, respectively), and did not differ significantly between the two groups. Both losartan and ER felodipine were well tolerated by patients. However, the ER felodipine group had a significantly higher rate of drug-related flushing than the losartan group (24% vs 0%, p = 0.022). The results indicate that once-daily administration of losartan is as effective and well tolerated as once-daily ER felodipine in blood pressure reduction.

Hemodynamic and clinical efficacies of catheter balloon percutaneous transvenous mitral commissurotomy: experience of 100 patients with rheumatic mitral stenosis.

From January 1987 to December 1988, 100 patients with symptomatic severe rheumatic mitral stenosis underwent percutaneous transvenous mitral commissurotomy (PTMC). The patients included 32 males and 68 females, aged 19-71 years (mean of 41). Mild mitral regurgitation (grade 1 or 2) was present in 23 patients and a history of thromboembolism in 12. One patient had had mitral restenosis after surgical open mitral commissurotomy 9 years earlier. The mitral valve was successfully dilated in 97 patients. PTMC resulted in immediate improvements in hemodynamic measurements. The left atrial pressure decreased from 24.5 +/- 5.3 to 14.8 +/- 5.2 mmHg (p less than 0.001), the mean mitral transvalvular gradient from 13.8 +/- 4.8 to 5.0 +/- 2.8 mmHg (p less than 0.001), and the mean pulmonary artery pressure from 38.8 +/- 12.0 to 30.6 +/- 10.3 mmHg (p less than 0.001). The mitral valve area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). The cardiac output increased from 4.5 +/- 1.2 to 4.84 +/- 1.2 L/min (p less than 0.05). The right atrial pressure did not change significantly after PTMC (6.5 +/- 3.8 vs 6.4 +/- 4.0 mmHg). The mitral valve area measured by 2-D echocardiograms increased from 1.04 +/- 0.48 to 1.88 +/- 0.66 cm2 after PTMC (p less than 0.001). All 97 patients were followed for 6-24 months (median of 13) after the PTMC. After an initial recovery period of 1-2 weeks, all patients reported improvements in symptoms and in New York Heart Association (NYHA) functional class by at least one class. A comparison between treadmill exercise test durations before, and 3 months after PTMC, showed an increase from 9.1 +/- 4.3 to 15.4 +/- 3.8 minutes (n = 60; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the efficacy and tolerability of telmisartan 40 mg vs. enalapril 10 mg in the treatment of mild-to-moderate hypertension: a multicentre, double-blind study in Taiwanese patients.

The purpose of this randomised, double-blind, double-dummy, parallel-group study was to evaluate the efficacy and tolerability of telmisartan 40 mg once daily vs. enalapril 10 mg once daily in 147 Taiwanese patients with mild-to-moderate essential hypertension (diastolic blood pressure [DBP] 90-109 mmHg). After 6 weeks' treatment, telmisartan produced a significantly greater reduction from baseline in the primary endpoint of trough seated DBP compared with enalapril 10 mg (11.7 vs. 8.7 mmHg, respectively; p = 0.02). Numerically greater reductions compared with baseline in seated systolic blood pressure (SBP), standing DBP, and standing SBP were achieved with telmisartan compared with enalapril. Also, numerically greater proportions of patients achieved blood pressure control (DBP/systolic blood pressure [SBP] <90/140 mmHg) and responded to treatment (reduction from baseline in trough seated DBP > or = 10 mmHg and/or post-treatment DBP <90 mmHg; reduction from baseline in trough seated SBP > or = 10 mmHg and/or post-treatment SBP <140 mmHg) with telmisartan 40 mg compared with enalapril 10 mg. Although both treatments were well tolerated, the incidence of cough was markedly lower with telmisartan 40 mg (8.5%) than with enalapril 10 mg (18.4%) in this population of Taiwanese hypertensive patients.