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1.
Clin Exp Allergy ; 39(12): 1896-902, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19709069

RESUMO

BACKGROUND: Skin prick testing (SPT) is the basic method for diagnosing IgE-mediated allergies. However, skin reactivity is related to the quality of allergen extracts, which are often poorly defined for occupational allergens. OBJECTIVE: To compare wheat and rye flour SPT solutions from different producers. MATERIALS AND METHODS: Standardized SPTs were performed in seven allergy centres with wheat and rye flour solutions from four producers in 125 symptomatic bakers. Optimal cut-off levels for weal sizes were assessed with the Youden Index. Comparisons between SPT results of different solutions were made with flour-specific IgE (sIgE) as the gold standard. Sensitivities, specificities, positive and negative predictive values, and test efficiencies were calculated and compared with McNemar and chi(2)-tests. The influence of the choice of the gold standard (sIgE or challenge) test was examined for 95 subjects. Additionally, SPT solutions were analysed for protein and antigen content. RESULTS: The optimal cut-off level for all SPT solutions was a weal size of >or=1.5 mm. While differences between wheat and rye flours were small, differences between producers were important. Variability of sensitivities (0.31-0.96), negative predictive values (0.42-0.91), and test efficiencies (0.54-0.90) were higher than variations of specificities (0.74-1.00) and positive predictive values (0.88-1.00). Similar results were obtained when using challenge test results as the gold standard. Variability could be explained by the different antigen contents of the SPT solutions. CONCLUSION: There is a wide variability of SPT solutions for wheat and rye flour from different producers, mainly with respect to sensitivities, negative predictive values, and test efficiencies. Improvement and standardization of SPT solutions used for the diagnosis of baker's asthma are highly recommended.


Assuntos
Antígenos de Plantas/imunologia , Farinha/análise , Hipersensibilidade Alimentar/diagnóstico , Secale/imunologia , Adulto , Antígenos de Plantas/análise , Área Sob a Curva , Asma/diagnóstico , Asma/imunologia , Testes de Provocação Brônquica , Feminino , Hipersensibilidade Alimentar/imunologia , Humanos , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/imunologia , Valor Preditivo dos Testes , Proteínas/análise , Curva ROC , Sensibilidade e Especificidade , Testes Cutâneos/métodos , Triticum/imunologia , Hipersensibilidade a Trigo/diagnóstico , Hipersensibilidade a Trigo/imunologia
2.
Allergy ; 63(7): 897-902, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18588556

RESUMO

BACKGROUND: Wheat and rye flours are among the most important allergens causing occupational asthma. Usually, the diagnosis of baker's asthma is based on inhalation challenge tests with flours. AIMS OF THE STUDY: To evaluate the relevance of flour-specific serum immunoglobulin E (IgE) and skin prick test (SPT) in the diagnosis of baker's asthma and to define flour-specific IgE concentrations and wheal sizes that allow a prediction of the outcome of challenge testing. METHODS: Bronchial and nasal challenge tests with wheat (rye) flour were performed in 71 (95) symptomatic bakers. Determinations of flour-specific IgE as well as SPTs were performed in all subjects. Analyses included the calculation of sensitivity, specificity, positive (PPV) and negative predictive values (NPV) at different IgE concentrations and different wheal sizes, and receiver-operating characteristics (ROC) plots with the challenge result as gold standard. RESULTS: Thirty-seven bakers were positive in the challenge with wheat flour, while 63 were positive with rye flour. Depending on the flour-specific IgE concentrations (wheal size), PPV was 74-100% (74-100%) for wheat and 82-100% (91-100%) for rye flour, respectively. The minimal cut-off values with a PPV of 100% were 2.32 kU/l (5.0 mm) for wheat flour and 9.64 kU/l (4.5 mm) for rye flour. The shapes of the ROC plots were similar for wheat and rye flour. CONCLUSION: High concentrations of flour-specific IgE and clear SPT results in symptomatic bakers are good predictors for a positive challenge test. Challenge tests with flours may be avoided in strongly sensitized bakers.


Assuntos
Farinha/efeitos adversos , Imunoglobulina E/imunologia , Doenças Profissionais/diagnóstico , Exposição Ocupacional , Hipersensibilidade a Trigo/diagnóstico , Adulto , Alérgenos/efeitos adversos , Asma/diagnóstico , Asma/imunologia , Testes de Provocação Brônquica , Feminino , Manipulação de Alimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Provocação Nasal , Valor Preditivo dos Testes , Curva ROC , Secale/efeitos adversos , Testes Cutâneos , Triticum/efeitos adversos , Hipersensibilidade a Trigo/imunologia
3.
Hypertension ; 3(3 Pt 2): I18-21, 1981.
Artigo em Inglês | MEDLINE | ID: mdl-7021412

RESUMO

The antihypertensive effect of oral administration of pig pancreatic kallikrein was investigated in a double blind study of 20 patients with essential hypertension. Kallikrein treatment lowered the blood pressure (BP) significantly from 159.5/104.5 to 146.3/92.8 mm Hg in the supine and from 153/106.1 to 136.1/95.6 mm Hg in the standing position. Blood pressure remained unchanged in the placebo group. Urinary kallikrein, sodium excretion, and GFR increased with treatment, but these changes did not reach statistical significance, In the kallikrein-treated patients but not in the placebo group, urinary kallikrein was correlated both to GFR (r = 0.7, p less than 0.001) and sodium excretion (r = 0.5, p less than 0.01). The antihypertensive mechanism of kallikrein treatment remains unknown. It could be speculated that kallikrein may induce changes in local blood flow, mediated by kinin and prostaglandin release.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Calicreínas/uso terapêutico , Administração Oral , Adulto , Pressão Sanguínea/efeitos dos fármacos , Ensaios Clínicos como Assunto , Método Duplo-Cego , Feminino , Humanos , Calicreínas/urina , Masculino , Pessoa de Meia-Idade , Análise de Regressão
4.
J Clin Endocrinol Metab ; 53(3): 626-30, 1981 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-6167591

RESUMO

Inactive renin (prorenin) was measured in plasma from untreated hypertensive patients after acute (60 min) administration of the angiotensin I converting enzyme inhibitor captopril, after 4 weeks of treatment with captopril, and after an acute infusion of the protease inhibitor aprotinin. Inactive renin was unchanged during acute captopril therapy despite a 4-fold increase in active renin. In contrast, after 4 weeks of treatment with captopril, inactive renin had increased 2-fold and active renin was also elevated, but to a greater degree (6-fold). Active renin was significantly suppressed by the aprotinin infusion, to about 25%, but the inactive plasma renin level was apparently unchanged. These studies demonstrate that the time course of the responses of active and inactive plasma renins are different; the inactive renin level seems to change more slowly than does active renin in response to the same stimulus. The results also show that a neutral serine protease inhibitor can rapidly reduce the circulating level of active renin. This observation is consistent with the possibility, but does not prove it, that a kallikrein-like enzyme normally activating prorenin was inhibited by aprotinin.


Assuntos
Aprotinina/uso terapêutico , Captopril/uso terapêutico , Hipertensão/sangue , Prolina/análogos & derivados , Renina/sangue , Aprotinina/administração & dosagem , Captopril/administração & dosagem , Temperatura Baixa , Esquema de Medicação , Precursores Enzimáticos/sangue , Humanos , Hipertensão/tratamento farmacológico
5.
Hypertension ; 9(2): 139-43, 1987 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3818011

RESUMO

The influence of long-term alterations in dietary magnesium intake on blood pressure and on the antihypertensive effect of the calcium antagonist nifedipine was investigated in normotensive Wistar-Kyoto (WKY) and in spontaneously hypertensive rats (SHR). The rats were fed a diet either high (1%), normal (0.1%), or low (0.01%) in magnesium for 12 weeks (WKY) and 20 weeks (SHR), respectively. Nifedipine was added to the diet for 4 weeks in concentrations of 300 and 1000 ppm. Each dose was given for 2 weeks. Plasma and intraerythrocytic concentrations of sodium, potassium, and magnesium were measured before and at the end of nifedipine treatment. Blood was obtained by cardiac puncture. In the WKY and SHR, blood pressure was not influenced by magnesium intake. The blood pressure-lowering effect of nifedipine was most pronounced on normal dietary magnesium and was significantly suppressed in the magnesium-deficient rats. Plasma and intracellular total magnesium concentrations were consistently increased during high and reduced during low dietary intake of the ion. Intracellular sodium concentration increased during magnesium deficiency and was normalized by nifedipine. The marked and long-term alterations in plasma and intracellular concentrations of magnesium did not influence arterial blood pressure levels in either the normotensive WKY or the SHR. Therefore, dietary magnesium intake does not appear to play an important role in long-term regulation of blood pressure in rats. However, magnesium depletion attenuates the blood pressure-lowering effect of nifedipine.


Assuntos
Anti-Hipertensivos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Magnésio/farmacologia , Nifedipino/farmacologia , Animais , Dieta , Magnésio/administração & dosagem , Deficiência de Magnésio/fisiopatologia , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY
6.
Hypertension ; 22(3): 331-8, 1993 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8349326

RESUMO

Blood pressure responses to 1 week of low-salt (20 mmol sodium/d) and high-salt (300 mmol sodium/d) intake were investigated in a single-blind randomized study in 163 white, nonobese normotensive subjects (65 women and 98 men; mean age, 38 +/- 1.2 years). The individuals were classified as salt sensitive when mean arterial blood pressure rose by at least 5 mm Hg during high-salt intake, as salt resistant when mean arterial blood pressure changed by less than 5 mm Hg, and as "counterregulator" when mean arterial blood pressure fell by at least 5 mm Hg during the high-salt diet. Reexamination of 31 subjects showed that this approach to the testing of salt sensitivity was reliable and reproducible. Thirty subjects (18.4%) were classified as salt sensitive, 108 (66.3%) as salt resistant, and 25 (15.3%) as counterregulators. Multiple regression analysis revealed that age, body weight, and family history of hypertension contributed significantly to the change in blood pressure after the diets. Salt sensitivity was more frequent in older subjects and in those with a positive family history of hypertension. An increase in blood pressure after salt restriction was more likely in younger individuals and in those with a negative family history of hypertension. Plasma renin activity and plasma aldosterone concentrations were lower in salt-sensitive compared with salt-resistant and counterregulating subjects. The rise in plasma renin activity during salt restriction was most pronounced in counterregulating subjects. Plasma norepinephrine concentrations were not different among the groups.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Fator Natriurético Atrial/sangue , Pressão Sanguínea/efeitos dos fármacos , Renina/sangue , Cloreto de Sódio/administração & dosagem , Sódio na Dieta/administração & dosagem , Adulto , Fatores Etários , Aldosterona/sangue , Peso Corporal , Saúde da Família , Feminino , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Norepinefrina/sangue , Reprodutibilidade dos Testes , Método Simples-Cego
7.
Am J Med ; 92(4B): 98S-101S, 1992 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-1580290

RESUMO

Despite a marked reduction in cardiovascular morbidity and mortality, treated hypertensive patients remain at increased risk of coronary artery disease and its complications compared with untreated normotensive subjects. Mild hypertension is often associated with other, usually chronic, diseases. The failure of first-line antihypertensive therapy to deal adequately with concomitant disease and associated therapy might account for the poor improvement in the cardiovascular prognosis. This possibility has been addressed in an ongoing trial of novel design, the Perindopril Therapeutic Safety Study, a multicenter, double-blind, randomized and placebo-controlled trial to determine the safety, efficacy, and interaction of angiotensin-converting enzyme (ACE) inhibition with eight of the most common concomitant diseases and their therapies. A total of 480 male and female patients (60 per disease group) aged 30-70 years, with a diastolic pressure of 90-104 mm Hg, were included after a 3-week placebo run-in if they satisfied standard criteria for any of the following: hyperlipidemia, type II diabetes, ischemic heart disease, cardiac arrhythmia, peripheral arterial disease, nephropathy with proteinuria, chronic obstructive lung disease, or rheumatoid arthritis. Of these, 460 patients have completed the 6-week double-blind phase (comprising two assessments, at 3 and 6 weeks), and are currently undergoing assessments every 3 months over a 1-year follow-up period. The end points include the incidence of progression or improvement in concomitant disease, the incidence of positive or negative interaction between ACE inhibition and concomitant therapy, change in blood pressure, adverse biochemical and hemodynamic reactions, self-reported side effects, and quality of life indices. Interim results for the 6-week double blind phase will shortly be available. However, the desirability and feasibility of conducting a study according to this novel design have already been proved.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Indóis/uso terapêutico , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perindopril , Projetos de Pesquisa
8.
Am J Med ; 97(2): 126-34, 1994 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8059778

RESUMO

PURPOSE: Many hypertensive patients have other, usually long-term diseases. Antihypertensive therapy may interfere with these diseases and their therapies. In the present study, the possible interactions of the ACE-inhibitor perindopril with several of the most common long-term diseases was evaluated. PATIENTS AND METHODS: In a multicenter, double-blind, randomized, placebo-controlled trial, the effect of perindopril was evaluated in 490 patients with mild essential hypertension and any one of the following concomitant diseases: hyperlipidemia, type II diabetes mellitus, ischemic heart disease, cardiac arrhythmia, peripheral arterial occlusive disease, nephropathy with proteinuria, chronic obstructive pulmonary disease, or degenerative joint disease treated with nonsteroidal anti-inflammatory drugs (NSAIDs). After a 3-week single-blind placebo run-in, the patients received either perindopril (4 mg/d) or matching placebo for 6 weeks. RESULTS: Blood pressure was effectively reduced by perindopril irrespective of the associated disease. The rate of spontaneously reported side effects was low. Treatment with perindopril was free from adverse interactions with the concomitant diseases and therapies. Moreover, favorable actions could be observed in patients with ischemic heart disease (reduction of maximal ST-segment depression during peak exercise and decrease in the number of angina attacks), in patients with proteinuria (decrease in albuminuria in patients with normal serum creatinine levels), and in patients with NSAID-treatment (increase in prostaglandin E2 concentration in gastric mucosa suggesting gastric cytoprotection). CONCLUSION: This trial shows that ACE-inhibition with perindopril represents a simple, safe, and effective short-term therapeutic option for the large proportion of patients with mild essential hypertension and concomitant diseases and therapies.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Indóis/uso terapêutico , Adulto , Idoso , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Indóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Perindopril , Resultado do Tratamento
9.
J Hypertens ; 11(7): 743-9, 1993 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8228194

RESUMO

OBJECTIVE: The effects of severe and moderate sodium restriction on blood pressure, neurohormonal activity and serum lipids were studied in non-obese normotensive adults. METHODS: In the first part of the study, 163 subjects were randomly assigned to a diet of 20 or 300 mmol/day sodium for 1 week each. In the second part, 25 subjects were given a diet of 85 or 200 mmol/day sodium for 4 weeks each in random order. RESULTS: After severe salt restriction 19% of the subjects had a significant decline (salt-sensitive group), 15% showed a significant rise (counter-regulator group) and 66% exhibited no change in blood pressure (salt-resistant group). Severe sodium restriction increased plasma renin activity and noradrenaline concentration, as well as serum total and low-density lipoprotein-cholesterol and triglycerides. After correction for haematocrit, only the changes in total and low-density lipoprotein-cholesterol remained significant. The rise in plasma renin activity during salt restriction was steeper in the counter-regulator group than in the other groups, whereas the changes in plasma noradrenaline concentrations were similar in all groups. During moderate salt restriction, plasma renin activity and noradrenaline concentration were significantly increased, but serum lipid concentrations and blood pressure did not change. CONCLUSION: In non-obese normotensive adults, severe and moderate salt restriction stimulates neurohormonal activity. In contrast to severe salt restriction, a moderate reduction in dietary salt intake does not influence blood lipids in normotensive subjects.


Assuntos
Pressão Sanguínea , Dieta Hipossódica , Lipídeos/sangue , Norepinefrina/sangue , Renina/sangue , Adulto , Feminino , Humanos , Masculino , Concentração Osmolar , Valores de Referência
10.
Am J Cardiol ; 71(17): 32E-37E, 1993 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-8328365

RESUMO

A multicenter, double-blind, randomized, and placebo-controlled trial, the Perindopril Therapeutic Safety Study (PUTS), was designed to assess the interaction between angiotensin-converting enzyme (ACE) inhibition and the diseases and therapies commonly found associated with mild hypertension. A total of 480 male and female patients aged 30-70 years with a diastolic pressure of 90-104 mm Hg were included after a 3-week placebo run-in if they satisfied standard criteria for any of the following: hyperlipidemia, type II diabetes, ischemic heart disease, cardiac arrhythmia, peripheral arterial occlusive disease, nephropathy with proteinuria, chronic obstructive lung disease or treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). At the end of the placebo run-in period, patients were randomly assigned to either placebo or perindopril 4 mg once daily. A total of 460 patients completed the 6-week double-blind phase, comprising 3 assessments at 1, 3, and 6 weeks. In this report, the principal results obtained in 5 disease groups (hyperlipidemia, type II diabetes, ischemic heart disease, nephropathy with proteinuria, and NSAID treatment) will be reported. A total of 269 patients belonging to one of the aforementioned 5 disease groups completed the double-blind phase of the study and were included for statistical evaluation. In the perindopril group, systolic and diastolic blood pressures decreased significantly more than in the placebo group, and a sitting diastolic blood pressure of 90 mm Hg was achieved in 65% of patients in the perindopril group and 30% of patients in the placebo group. The incidence of symptoms spontaneously reported by the patients was low: 2 patients of the perindopril group complained of cough.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Hipertensão/tratamento farmacológico , Indóis/uso terapêutico , Adulto , Idoso , Angina Pectoris/complicações , Anti-Inflamatórios não Esteroides/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Método Duplo-Cego , Feminino , Humanos , Hiperlipidemias/complicações , Hipertensão/complicações , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Perindopril , Proteinúria/complicações , Resultado do Tratamento
11.
Am J Hypertens ; 8(8): 829-36, 1995 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-7576400

RESUMO

Blood pressure responses to 1 week of low (20 mmol sodium/day) and high (300 mmol sodium/day) salt intake were investigated in a double-blind, randomized study in 46 white, nonobese subjects with essential hypertension (13 women, 33 men; mean age 45.3 +/- 2.2 years, age range 25 to 80 years). The individuals were classified as salt-sensitive when mean arterial blood pressure rose by at least 5 mm Hg during high salt intake, as salt-resistant when mean arterial blood pressure changed by less than 5 mm Hg, and as "counter-regulators" when mean arterial blood pressure fell by at least 5 mm Hg during the high salt diet. Mean arterial blood pressure of all subjects taken together increased from 101.9 +/- 1.4 mm Hg during salt restriction to 103.7 +/- 1.5 mm Hg (P < .05) during salt loading. Eleven subjects (23.9%) were classified as salt-sensitive, 27 (58.7%) as salt-resistant, and 8 (17.4%) as counter-regulators. Multiple regression analysis revealed that age, but not baseline blood pressure, sex, body mass index, or family history of hypertension contributed significantly to the change in blood pressure following the diets. Ten of the 11 salt-sensitive subjects were older than the median age of 45 years. In salt-sensitive, as compared to salt-resistant, hypertensive subjects, creatinine clearance was lower and plasma renin activity was suppressed at baseline as well as during low and high salt intake. In contrast, plasma concentrations of norepinephrine and atrial natriuretic peptide were elevated in salt-sensitive subjects. These differences between the groups appeared, at least partially, to be age-related.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Pressão Sanguínea/fisiologia , Dieta Hipossódica , Hipertensão/dietoterapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aldosterona/sangue , Fator Natriurético Atrial/sangue , Índice de Massa Corporal , Creatinina/metabolismo , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Hipertensão/genética , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Norepinefrina/sangue , Análise de Regressão , Renina/sangue , Sódio/metabolismo
12.
Am J Hypertens ; 7(10 Pt 1): 913-8, 1994 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7826555

RESUMO

Besides its dose-dependent alpha- and beta-adrenoceptor-mediated vascular action, hormonal effects of epinephrine also involve the activation of renin secretion by direct stimulation of renal beta 1-adrenoceptors. To determine the interrelation between increased plasma renin activity in response to epinephrine and plasma aldosterone concentration and renal excretion of potassium and sodium, 26 normal subjects were subjected to 4 h of an intravenous infusion of low-dose epinephrine (12 ng/kg/min). Epinephrine infusion raised mean plasma epinephrine concentration 2.8-fold above control (P < .001). Plasma renin activity (PRA) increased by 56% (P < .01) during epinephrine infusion, whereas plasma aldosterone concentration remained constant. Infusion of epinephrine also resulted in markedly suppressed urinary potassium excretion (-32%; P < .025), while urinary sodium excretion was not altered. Serum potassium was decreased by 4.1% during epinephrine (P < .025). Systolic blood pressure and heart rate did not change, and diastolic blood pressure was slightly reduced by 5 mm Hg (P < .025). In summary, during low-dose epinephrine infusion PRA is markedly increased while plasma aldosterone remains unchanged. The fall in urinary potassium excretion in the presence of reduced serum potassium concentration is most likely mediated via the beta-adrenoceptor-mediated shift of potassium into cells. This in turn may prevent a concomitant rise of plasma aldosterone, which subsequently contributes to the blunted kaliuresis and unchanged natriuresis found during the epinephrine-induced rise of PRA. In conclusion, the epinephrine-induced fall in serum potassium appears to be the predominant regulator of plasma aldosterone concentration even in the presence of a stimulated PRA.


Assuntos
Aldosterona/sangue , Epinefrina/farmacologia , Sistema Renina-Angiotensina/efeitos dos fármacos , Renina/sangue , Adulto , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Relação Dose-Resposta a Droga , Epinefrina/administração & dosagem , Humanos , Infusões Intravenosas , Masculino , Potássio/urina , Sistema Renina-Angiotensina/fisiologia , Sódio/urina
13.
Am J Hypertens ; 9(9): 902-8, 1996 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8879347

RESUMO

Elevated plasma epinephrine concentrations may impair blood pressure homeostasis and renal sodium and volume excretion in response to central hypervolemia. We studied the effects of a low-dose epinephrine infusion (12 ng/kg/min) on cardiovascular and renal responses to a thermoneutral head-out water immersion in eleven healthy men. Responses to water immersion without epinephrine were characterized by significant suppression of plasma renin activity (PRA), plasma aldosterone concentration, and renal norepinephrine excretion, and an augmentation of natriuresis and diuresis. Epinephrine infusion, which raised mean plasma epinephrine concentration 4.3-fold, slightly increased plasma norepinephrine and renal norepinephrine excretion, markedly stimulated PRA (+66.7%), but decreased plasma aldosterone (-11.7%), and augmented renal sodium and volume excretion. Despite the presence of the epinephrine infusion, water immersion continued both to suppress PRA and aldosterone, and to increase natriuresis and diuresis in a qualitatively similar pattern. During all conditions blood pressure and heart rate remained unchanged. It is concluded that physiologic responses to central hypervolemia are not impaired at stress levels of circulating epinephrine. During epinephrine infusion, despite a concomitant increase in plasma norepinephrine and a stimulation of PRA, blood pressure remained constant in response to water immersion due to an augmentation of natriuresis and diuresis.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Epinefrina/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Imersão/fisiopatologia , Rim/fisiologia , Adulto , Aldosterona/sangue , Cloretos/metabolismo , Creatinina/metabolismo , Epinefrina/administração & dosagem , Epinefrina/metabolismo , Hematócrito , Humanos , Rim/efeitos dos fármacos , Masculino , Norepinefrina/metabolismo , Concentração Osmolar , Potássio/sangue , Renina/sangue , Sódio/sangue
14.
Drug Saf ; 15(1): 72-8, 1996 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8862965

RESUMO

A dry, tickly and often bothersome cough is the most common adverse effect of ACE inhibitors. Recent studies indicate that cough may develop in around 10% of the patients treated with ACE inhibitors. In half of these patients, the ACE inhibitor has to be discontinued. Cough has emerged as a class effect occurring with all ACE inhibitors with no clear difference between the single substances. While ACE inhibition is safe in the vast majority of patients with obstructive airways disease, asthmatic symptoms or exacerbation of asthma as well as a rise in bronchial reactivity have been occasionally reported. ACE inhibition increases the cough reflex. The mechanisms underlying ACE inhibitor-induced cough are probably linked to suppression of kininase II activity, which may be followed by an accumulation of kinins, substance P and prostaglandins. Physicians should be aware that a dry cough is the most common adverse effect of ACE inhibitors and that this symptom may occur not necessarily shortly after institution of therapy but months or even a year later. Replacement by another ACE inhibitor should not be tried, since the cough will almost always recur on rechallenge with the same or another ACE inhibitor. After withdrawal of the ACE inhibitor, which is the treatment of choice, cough will resolve usually within a few days.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Espasmo Brônquico/induzido quimicamente , Tosse/induzido quimicamente , Obstrução das Vias Respiratórias/induzido quimicamente , Tosse/tratamento farmacológico , Humanos , Incidência , Cininas/efeitos dos fármacos , Cininas/fisiologia
15.
Curr Med Res Opin ; 11(8): 533-42, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-2553335

RESUMO

A multi-centre, randomized, blind comparative group study was carried out in 202 adult patients, who had suffered from asthma for at least 2 years, to assess the effectiveness and tolerability of maintenance treatment with either 4 mg nedocromil sodium 4-times daily, 0.1 mg beclomethasone dipropionate 4-times daily or 2 puffs of placebo 4-times daily, given by inhalation. Lung function (FEV1 and sRaw) measurements were made at the beginning and end of a 2-week baseline period and then after 3 and 6 weeks of treatment: assessment were also made of asthma severity. Patients recorded daily on diary cards details of morning and evening PEFR, usage of inhaled bronchodilators, severity of dyspnoea, cough and morning tightness. The results showed that, compared with placebo, both nedocromil sodium and beclomethasone dipropionate-treated patients showed an improvement in FEV1 and a reduction in sRaw values: PEFR increased slightly in all three groups. There was an improvement in asthma severity, diminished rate of dyspnoea and cough, and reduced usage of inhaled bronchodilators in patients receiving active treatment but not in those on placebo. Overall assessment of treatment efficacy by both investigators and patients showed that opinions were significantly in favour of active treatment over placebo. Treatment was well tolerated and no serious side-effects were reported. It was concluded that at the dosages used nedocromil sodium was comparable with and equivalent to inhaled beclomethasone dipropionate in nearly all of the parameters assessed, and both drugs were superior to placebo in the maintenance treatment of asthma in adult patients.


Assuntos
Asma/tratamento farmacológico , Beclometasona/uso terapêutico , Quinolonas/uso terapêutico , Adolescente , Adulto , Idoso , Análise de Variância , Beclometasona/administração & dosagem , Criança , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Nedocromil , Placebos , Quinolonas/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
J Hum Hypertens ; 8(2): 145-9, 1994 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8207741

RESUMO

Thiazide diuretics are considered as the choice drug to combine with ACE inhibitors for the treatment of hypertension. However, there is much evidence showing that the combination of ACE inhibitors with a calcium channel blocker is effective and safe. We compared the safety and efficacy of perindopril 8 mg once daily plus nifedipine SR 10 mg twice daily with perindopril 8 mg once daily plus hydrochlorothiazide (HCTZ) 12.5 mg once daily in a two phase three month study. After a one month placebo run-in period, patients whose DBP averaged 95-125 mmHg received perindopril 4 mg once daily for the first open phase (n = 524). After one month those whose DBP remained > 90 mmHg were prescribed perindopril 8 mg once daily for a second month. Among them, those whose DBP were still > 90 mmHg entered the second phase for one month, in a double-blind fashion. Fifty-three patients received HCTZ (BP: 161.2/99.2 +/- 2.0/0.9 mmHg), 57 received nifedipine (BP: 161.4/98.7 +/- 2.2/0.7 mmHg). Five patients withdrew due to side-effects, three patients in the perindopril plus nifedipine group and two in the perindopril plus HCTZ group. After one month there was a significant drop in BP (P < 0.01) in both groups: perindopril plus HCTZ (-13.9/-11.9 mmHg) and perindopril plus nifedipine (-12.1/-10.8 mmHg). Heart rate was not significantly modified: perindopril plus HCTZ (-1.30 beats/min), perindopril plus nifedipine (+0.54 beats/min). There were no significant difference between the two combinations for BP reduction and heart rate. The incidence of adverse experiences was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Anti-Hipertensivos/uso terapêutico , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Indóis/uso terapêutico , Adolescente , Adulto , Idoso , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/normas , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Hidroclorotiazida/efeitos adversos , Hidroclorotiazida/normas , Hipertensão/fisiopatologia , Indóis/efeitos adversos , Indóis/normas , Masculino , Pessoa de Meia-Idade , Perindopril , Índice de Gravidade de Doença , Fatores de Tempo
17.
J Hum Hypertens ; 6(5): 387-92, 1992 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-1464896

RESUMO

Dry cough is one of the most common side-effects of angiotensin converting enzyme inhibitors. The mechanism of cough induced by ACE inhibitors is not completely understood and may be related to bronchial hyperreactivity and/or an accumulation of kinins. In a placebo-controlled, double-blind randomised study, the effect of captopril on lung function and bronchial reactivity to histamine and bradykinin was investigated in eight asthmatic and 12 hypertensive patients (six with and six without cough during previous ACE inhibition). Lung function did not change in any patient after a single (25 mg) or short-term (2 x 25 mg for two weeks) administration of captopril. Bronchial reactivity to histamine and bradykinin remained unaltered in all groups. In hypertensive patients with cough, reactivity to histamine tended to be more pronounced and bronchial hyperreactivity to be more frequent than in those without cough. In conclusion, the present results do not support a major role for kinins in cough induced by ACE inhibition. On the other hand, bronchial hyperreactivity may be important in some patients. Additionally, these results demonstrate that treatment with ACE inhibitors is safe in most patients with bronchial asthma.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Asma/tratamento farmacológico , Brônquios/fisiopatologia , Tosse/induzido quimicamente , Hipertensão/tratamento farmacológico , Pulmão/fisiopatologia , Adulto , Resistência das Vias Respiratórias , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Asma/fisiopatologia , Bradicinina , Brônquios/efeitos dos fármacos , Testes de Provocação Brônquica , Captopril/efeitos adversos , Captopril/uso terapêutico , Método Duplo-Cego , Histamina , Humanos , Hipertensão/fisiopatologia , Pulmão/efeitos dos fármacos
18.
Am J Med Sci ; 307 Suppl 1: S87-90, 1994 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8141172

RESUMO

The effects of severe and moderate sodium restriction on blood pressure and serum lipids were studied in nonobese normotensive adults. Subjects (n = 163) were given a low (20 mmol Na/d) and high (300 mmol Na/d) salt diet for 1 week each in random order. Of these subjects, 25 were selected to participate in a second study with moderate salt restriction (85 mmol na/d) or "normal" sodium diet (200 mmol Na/d) given for 4 weeks each in random order. After severe salt restriction, 19% of the 163 subjects had a significant decrease in blood pressure (salt-sensitive), 15% showed a significant rise (counter-regulator), and 66% exhibited no change (salt-resistant). Severe sodium restriction increased serum total and low density lipoprotein (LDL) cholesterol and triglycerides. After correction for hematocrit, the changes in blood lipids remained significant in the counter regulators only. After moderate salt restriction, serum lipid concentrations and blood pressure did not change.


Assuntos
Pressão Sanguínea , Lipídeos/sangue , Cloreto de Sódio/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Rofo ; 146(6): 657-63, 1987 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-3037636

RESUMO

One hundred and thirty-three patients with lymph node enlargement from various causes were examined by MR tomography, using 0.5 and 1.5 Tesla. Amongst these, there were 27 patients with chronically enlarged lymph nodes and histologically confirmed sarcoidosis; these showed characteristic T1 intervals. Enlarged lymph nodes due to chronic inflammatory conditions can be differentiated from lymph nodes with malignant lymphoma, or from lymph node metastases from carcinomas. Although there are problems with the determination of relaxation times on MR tomography, this may be a valuable method for the differential diagnosis of sarcoid.


Assuntos
Pneumopatias/diagnóstico , Espectroscopia de Ressonância Magnética , Sarcoidose/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Linfonodos/patologia , Linfadenite/diagnóstico , Linfadenite/patologia , Linfoma não Hodgkin/diagnóstico , Masculino , Pessoa de Meia-Idade , Sarcoidose/patologia
20.
Rofo ; 149(5): 458-65, 1988 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-2848273

RESUMO

One hundred and sixty-four patients with pulmonary fibrosis were examined by CT and by conventional radiological methods. Sixty patients had asbestosis, thirty-nine silicosis, forty sarcoidosis and twenty-five had idiopathic pulmonary fibrosis. CT is superior to conventional radiography in evaluating interstitial pulmonary changes, particularly of the pleura and the lung parenchyma. Areas of fibrosis and of emphysema can be demonstrated without any overlap. In sixty-nine patients there were some findings which could only be demonstrated by CT. In asbestosis, silicosis and sarcoidosis the CT classification of the lung parenchyma which we have suggested produces significantly better correlation with vital capacity than can be achieved from conventional chest films, according to the guide-lines of the I.L.O.


Assuntos
Fibrose Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Asbestose/diagnóstico por imagem , Asbestose/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrose Pulmonar/fisiopatologia , Sarcoidose/diagnóstico por imagem , Sarcoidose/fisiopatologia , Silicose/diagnóstico por imagem , Silicose/fisiopatologia , Capacidade Vital
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