Efficacy of atenolol in the short and long-term treatment of patients with effort stable angina.

A double-blind, crossover, randomized placebo controlled study involving 15 patients with effort stable angina, was carried out to assess atenolol (A) 100 mg during an 8-week period. Thereafter, atenolol antianginal efficacy was evaluated in a 6-month follow-up open non-comparative study. No antianginal drugs other than A were administered except for isosorbide dinitrate 5 mg when necessary. At the end of the 2-week wash-out period, and at the end of each 2-week period during the crossover phase of the study, and every 12 weeks during the 6-month follow-up, an ergometric test was performed and the following parameters were evaluated: HR, SBP, DP, Total Work Load (TWL) and S-T changes. The Barlett's test was performed to assess variance homogeneity, while the Tukey Hd test was used to evaluate the parameters during the treatments. During atenolol, the reduction in SBP was close to statistical significance, HR and S-T were significantly reduced (p less than or equal to 0.05) whereas TWL was significantly increased (p less than or equal to 0.05). During long-term atenolol treatment, all cardiovascular parameters clearly improved in comparison to the placebo period, confirming the antianginal efficacy of atenolol, even in the long-term treatment.

Evaluation of a sustained-release buccal nitroglycerin preparation in stable angina pectoris.

The efficacy of a 2.5 mg sustained-release buccal nitroglycerin preparation given 8-hourly in effort-induced stable angina pectoris was investigated by means of graded exercise testing in 15 patients. An initial double-blind crossover study, compared with a placebo (duration six days) was followed by a further 15-day open treatment period on the active drug. Exercise testing was carried out 2 and 7 h after tablet administration at the conclusion of active treatment in the double-blind phase, and 2 h after tablet administration at the conclusion of the open treatment phase. Workload and exercise duration were significantly increased and mean electrocardiographic ST segment depression and ST segment recovery time significantly reduced by buccal nitroglycerin in the initial phase of the study, and these improvements were maintained over the subsequent 15-day assessment period. Systolic blood pressure at rest was significantly decreased by active treatment; other haemodynamic parameters remained unchanged. The study demonstrated the efficacy of sustained-release buccal nitroglycerin in effort-induced stable angina pectoris, and an absence of (+) tolerance to the therapeutic effects of this mode of nitrate administration.

[Role of ambulatory electrocardiography in the evaluation of interventions: rehabilitation of a patient who has undergone surgery]. / Ruolo dell'elettrocardiografia dinamica nella valutazione degli interventi: nella riabilitazione del paziente operato.

The authors relate their own experience with 24 hr Holter monitoring in course of cardiac rehabilitation after coronary bypass surgery as well as after valvular replacement. As regards patients after coronary surgery they report the experience they got in the evaluation of heart rate trend and cardiac arrhythmias as well as in silent ischemia study. About this last problem 116 patients with signs of ischemia both in stress test and in Holter recording are considered out of 491 who had undergone coronary surgery. Ischemia during 24 hr Holter monitoring develops at an heart rate lower than effort ischemia. Holter monitoring proves to be very useful also in patients after valvular replacement to study arrhythmias and to check drugs' efficacy. After displaying the results concerning arrhythmias of 24 hr Holter electrocardiograms recorded in 207 randomized patients who had undergone valvular replacement 15 days before, the authors dwell upon the use of Holter electrocardiography in 82 valvular patients after pharmacological cardioversion and show that major arrhythmias get a clear reduction thanks to rehabilitation.

Treatment of dyslipidaemia with a simple low fat diet and with a combination of a low fat diet and a formulation containing soybean protein.

The first approach to treatment of dyslipidaemia is with diet. Currently, modified soybean protein is often included in the diet. A study was made of 32 patients with types IIa and IIb dyslipidaemia to see what changes in blood lipids could be induced by a simple low fat diet and a diet with modified soybean protein substituted for part of the animal protein. After six weeks on the initial low fat diet, all of the patients had lower total cholesterol and triglyceride levels, but there were no significant changes in the high density lipoprotein-cholesterol levels. The same diet was continued for eight weeks by 19 of the patients, who continued to improve. The 13 patients who had shown the least response to the initial simple low protein diet were given a diet in which the animal protein was partially replaced with modified soybean protein. This diet further decreased the total cholesterol.