Alpha-1 adrenoceptor blockade with doxazosin in hypertension: effects on blood pressure and lipoproteins.

The effects of doxazosin, a long-acting alpha-1 adrenoreceptor blocking drug, were observed upon blood pressure and serum lipoproteins. Thirty patients with supine diastolic blood pressure between 90 and 114 mm Hg during single-blind placebo therapy were randomized to double-blind treatment with either doxazosin or further placebo in a parallel-design protocol. Starting at one mg, dosage was doubled every 2 weeks during a 10-week treatment period to a maximum dose of 16 mg once daily. Blood was sampled in the fasting state before and during double-blind therapy for measurement of total cholesterol and triglycerides, cholesterol in the lipoprotein fractions, and apolipoproteins A and B. At the end of 10 weeks of titration, systolic and diastolic blood pressure were each reduced by 14 mm Hg in the standing position when measured 24 hours following the previous dose. Supine pressure was lowered by 6 mm Hg systolic and by 5 mm Hg diastolic at the same time point. Measured hourly for 12 hours following the ingestion of doxazosin, blood pressure was lowered maximally at 4-5 hours when an additional decline of 14/6 mm Hg (systolic/diastolic) was observed in the standing position and 13/6 in the supine posture. Postural dizziness, the most frequent symptomatic complaint, was reported in 4 patients during doxazosin treatment. After brief interruption of treatment in one and dosage adjustment in another, titration was continued in all four and no patient was withdrawn because of side effects. Concerning lipoproteins, the ratio of total cholesterol to HDL cholesterol and of LDL to HDL cholesterol both improved during treatment with doxazosin.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective observations of viral and immunologic abnormalities in homosexual males.

PIP: This article presents preliminary observations on the immunologic and viral status of 103 homosexual men from New York who were enrolled in a prospective study begun in late 1981. At the time of enrollment, none of the study participants had acquired immunodeficiency syndrome (AIDS) as defined by the Centers for Disease Control (CDC). The initial laboratory investigation indicated that 82.7% of the 1st 81 volunteers had a OKT4:OKT8 ratio lower than the control range of 1.4-2.8. 31 (38.3%) of these 81 volunteers had 1 or more of the following signs and symptoms: history of fever, weight loss, diarrhea, lymphadenopathy, recurrent amebiasis, or persistent amebiasis. As part of the initial study, intensive laboratory investigations were performed on 30 of these subjects, including 20 who were symptomatic. Findings included abnormal T-cell markers, elevated immunoglobulins, circulating immune complexes, and cryoglobulins, as well as B-cell dysfunction. Follow-up of these patients 1 year later indicated that there was no significant improvement in T4:T8 ratio, and those volunteers originally identified as symptomatic continued to contribute the most abnormal ratios. A decrease in the absolute number of T4 lymphocytes contributed most to the ratio reversal. In addition, 26 of the 30 volunteers underwent viral isolation studies from 5 body sites or secretions. 23 of 26 were positive for virus from 1 or more sites compared with 3 of 33 heterosexual controls. Isolation of cytomegalovirus, especially from semen, was most frequent. It remains unclear whether the abnormal immunologic findings in healthy homosexual volunteers represent a transient response to viral infection, an epiphenonomenon due to multifactorial causes that make subjects susceptible to an unidentified AIDS agent, or AIDS itself. The cohort study will continue.^ieng