Value of the addition of amlodipine to atenolol in patients with angina pectoris despite adequate beta blockade.

Anginal patients who remain symptomatic despite optimally dosed beta blockade may also be given dihydropyridine calcium antagonists. This treatment regimen was examined in a double-blind parallel, randomized, controlled study in 147 patients with angina and positive bicycle exercise tests despite optimal beta blockade with atenolol (heart rate at rest <60 beats/min). Patients were randomized to atenolol and/or placebo (control), and atenolol and/or amlodipine. The main outcome measurement was exercise tolerance after 8 weeks compared with baseline. After 8 weeks, no significant differences in time to 0.1-mV ST-segment depression, time to chest pain, and time to end of exercise were observed. The number of patients with chest pain during exercise decreased significantly in the amlodipine group (p = 0.04 vs controls). The subgroup of patients with an early (<6 minutes) onset of chest pain at baseline showed a significant increase in time to chest pain after amlodipine (p = 0.0001 vs controls). In the amlodipine group, ST depression and rate-pressure product at submaximum comparable workload decreased to 0.4 mm (0.56) (p = 0.03 vs controls) and 1.223 (2.652) beats/ min x mm Hg (p = 0.01 vs controls). The number of patients in each group with adverse events was not different. The addition of amlodipine to the treatment of patients with myocardial ischemia, despite optimal beta blockade, is well tolerated and may lead to improvement in symptomatic anginal patients, who have a rapid onset of exercise-induced ischemia.

The CO2 conductivity electrode, a fast-responding CO2 microelectrode.

A fast-responding CO2 microelectrode system is presented; it consists of a double-lumen polyethylene catheter provided with a stainless steel catheter tip covered by a CO2-permeable membrane, and connected with each lumen separately to a conductivity cell. The catheter is flushed with bidistilled water at constant flow rate and conductivity of inflowing and outflowing water is measured. The change of conductivity in the water leaving the catheter after exposure of the electrode to a medium containing CO2 is related to the PCO2 of the medium. High sensitivity and fast response, both depending on the flow rate of the carrier water, are shown to oppose each other. When cells are placed at a distance of 45 cm from the membrane, response time for 90% deflection is about 10 sec (at flow rates of 5 ml/min), but when located inside the electrode tip at a distance of within 10 mm from the membrane response time is reduced to about 4 sec. Hydrodynamical aspects concerning dispersion of CO2 in the carrier water and reaction kinetics of CO2 hydration are discussed.

The carbamate equilibrium of bovine hemoglobin at 37 degrees C.

emoglobin-bound CO2 was estimated by a procedure first described by Rossi-Bernardi et al. (1969) in which the carbamate compound is stabilized by rapid mixing with alkali and then separated from other CO2 constituents in solution by gel filtration and ion-exchange chromatography. Carbamate equilibrium of bovine hemoglobin was studied at constant PCO2 (44 mm Hg) and varying pH as well as at constant pH (7.4) and varying PCO2 (ionic strength 0.18, temperature 37.0 degrees C). The difference in Z (deltaZ) between hemoglobin and oxyhemoglobin appeared to be 0.11 plus or minus 0.04 (pH=7.40; PCO2=44 mm Hg) i.e. about half the value observed in human hemoglobin. DeltaZ was shown to account completely for the difference in CO2 content (CCO2) between hemoglobin and oxyhemoglobin when in total equilibrium with CO2. Carbamate determinations on bovine hemoglobin specifically modified at all terminal amino groups (double-blocked carbamylated derivative) did not show any CO2 binding at all, thus giving a final proof for the exclusive role of the terminal amino groups in CO2 binding under physiological conditions. Attempts to calculate the ionization constant (Kz) and the carbamate equilibrium constant (Kc) of the terminal amino groups failed, suggesting that both terminal groups are not equivalent in their CO2 binding properties. This was confirmed by the fact that carbamate data obtained at constant PCO2 and varying pH fitted binding curves derived from two sets of independent but non-equivalent binding sites. Association constants for both kinds of binding sites appeared to differ by a factor of at least 3 in hemoglobin and of about 10 in oxyhemoglobin. From determinations of hemoglobin-bound CO2 and CO2 content of hemoglobin and oxyhemoglobin solutions in total equilibrium with CO2, the apparent first dissociation constant of carbonic acid was calculated as 5.71 plus or minus 0.0061 pH and found to be independent of the oxygenation state of hemoglobin. In contrast with hemoglobin of other species bovine hemoglobin appeared to be not influenced by the presence of 2.3-diphosphoglycerate as far as its CO2-binding properties are concerned.