Clinical use of captopril in Takayasu's disease.

Three patients with Takayasu's disease (TD), initially observed with hypertension and/or congestive heart failure, were treated with captopril, an orally active inhibitor of converting enzyme. As arteritis in this disease is diffuse and extensive, surgical correction of renovascular hypertension is often delayed or impossible. Our experience enables us to recommend captopril for conservative treatment in TD.

Pleural fluid to serum bilirubin concentration ratio for the separation of transudates from exudates.

Whether fluid accumulating in the pleural space is a transudate or an exudate is determined by the widely used criteria of the pleural fluid to serum LDH and protein concentration ratios. Such a distinction is important for limiting the extent of the differential diagnosis of possible causes for this condition. We have found that a pleural fluid to serum total bilirubin ratio can serve the same purpose. The correlation of a bilirubin concentration ratio of 0.6 or more with the presence of an exudate as determined by established criteria is statistically highly significant; and its sensitivity, specificity, positive predictive accuracy, and overall accuracy in relation to etiology and LDH or protein criteria (Light's criteria) are about 90 percent. Hence, the bilirubin criterion is statistically equivalent to the widely accepted LDH and protein criteria.

Homocysteine levels in hypertensive patients with a history of cardiac or cerebral atherothrombotic events.

Hypertension is one of the most important risk factors for cardiovascular morbidity and mortality. Recently it has been suggested that the amino acid homocysteine contributes to this process. This study evaluates whether elevated plasma levels of homocysteine in hypertensive patients are associated with increased risk for cardiovascular events. Fifty hypertensive patients with a documented history of cerebral or cardiac events were age and gender matched to 50 hypertensive patients with no evidence of any cerebral or cardiac event. Demographic details, duration of hypertension, presence of other risk factors, and use of antihypertensive medications were recorded for each patient. Plasma levels of homocysteine were measured by high-performance liquid chromatography technology. The two groups had similar demographic parameters, with a mean age of 64.6 +/- 9.4 years. Patients with cardiovascular events were more likely to be past smokers and to have been treated with calcium antagonists, aspirin, and nitrates. Homocysteine levels were 12.1 +/- 5.8 micromol/L in those with documented cardiovascular disease and 11.1 +/- 4.7 micromol/L in those without (P = NS). Levels of plasma homocysteine were higher in those with hypercholesterolemia (P = .03) and in smokers, and tended to be lower in those who used beta-blockers, angiotensin converting enzyme (ACE) inhibitors, diuretics, and nitrates. Thus, hyperhomocysteinemia is not a feature of hypertensive patients with atherothrombotic events and there is no support for additive or synergistic effects between these two independent risk factors.

Verapamil versus nifedipine in slow-release preparations for the treatment of mild to moderate hypertension.

A crossover study with 24-hour ambulatory blood pressure monitoring was conducted on 30 hypertensive patients, using slow-release preparations of verapamil and nifedipine. Both drugs proved effective hypotensive agents. Nifedipine was slightly, but not significantly, more potent. Fewer side effects were observed with verapamil, but both drugs were well tolerated.

Left ventricular mass in hypertension: correlation with casual, exercise and ambulatory blood pressure.

The purpose of this work was to assess the best haemodynamic determinant of left ventricular hypertrophy (LVH) in patients with essential hypertension. We studied the relationships between left ventricular mass (LVM) and casual, exercise and 24h ambulatory blood pressure monitoring (ABPM) in 60 newly discovered patients with mild to moderate essential hypertension. LVM was only weakly related to both casual and exercise blood pressure, while it was significantly related to average ABPM values. Diastolic hypertensive load, calculated as the percentage of diastolic measurements > 90 mmHg, was the best predictor of the development of LVH (r = 0.51, P < 0.001). Six of six patients with a diastolic load > 50% had LVH, whereas only two of 18 patients (11%) with a diastolic load < 10% had LVH (P < 0.001). In conclusion, in patients with mild to moderate essential hypertension, LVM is poorly related to both casual and exercise blood pressure, but is related to ABPM. Blood pressure load is the best determinant of LVH. These findings suggest that blood pressure load should be considered when analysing ABPM.

Felodipine in the treatment of severe refractory hypertension.

The efficacy of felodipine and tolerance of this drug was examined in 52 patients, 23 men and 29 women, 18-76 years of age, in whom it either replaced previous therapies of nifedipine and other vasodilators, or was added to a constant dose of beta blockers and diuretics or another previous therapy, which was unchanged. Felodipine significantly reduced blood pressure (BP), from 192.3 +/- 31.9/114.3 +/- 18.0 to 155.7 +/- 19.5/93.8 +/- 11.5 mm Hg, with no change in pulse rate. There were no significant biochemical changes, renal deterioration or blood sugar disequilibrium. Adverse reactions including flushes and leg edema could be tolerated by most of the patients, however six patients dropped out. Orthostasis dictated a decrease in felodipine dosage. Felodipine appears to be a highly potent, well tolerated drug and offers a substitute treatment for severe hypertensives refractory to other vasodilators.

[Indapamide--a substitute diuretic for hypertensives with hyperglycemia and/or dyslipidemia].

Diuretics are among the first drugs offered to the hypertensive patient. However, they can induce metabolic changes resulting in cardiovascular insult. Especially noteworthy are increased levels of glucose and lipids. Indapamide is a diuretic and vasodilator that does not raise blood glucose or lipid levels. We therefore investigated its use as a substitute diuretic in patients whose treatment had resulted in hyperglycemia and/or hyperlipidemia. In 24 hypertensives, Indapamide, 2.5 mg daily, replaced the diuretic therapy they were receiving. Blood pressure, blood glucose, hemoglobin A1C and lipid profile were measured before and every month during the 6 months of Indapamide treatment. Replacement of diuretics with Indapamide significantly reduced blood glucose from 148 +/- 53 mg/dl to 127 +/- 37, p = 0.05 HbA1C from 8.42 +/- 0.4 mg/dl to 7.7 +/- 2.0, p = 0.05; total cholesterol from 253 +/- 45 mg/dl to 228 +/- 43, p < 0.05; and triglycerides from 224 +/- 145 mg/dl to 176 +/- 91, p < 0.05. Blood pressure was better controlled with Indapamide than with previous medications. It was reduced from an average of 155 +/- 1 systolic and 89 +/- 8 diastolic (mm Hg), to 142 +/- 13 and 83 +/- 7, respectively, p < 0.05. We conclude that Indapamide is safe and effective in lowering blood pressure and contributes to better control of blood glucose and lipid levels in diabetic and dyslipidemic patients, compared to standard diuretics.

Nifedipine GITS replacing nifedipine SR: ambulatory blood pressure assessment of efficacy.

The relative efficacy of two formulations of nifedipine, slow release (SR) and gastrointestinal therapeutic system (GITS), to lower blood pressure in hypertensive patients was evaluated in a prospective study. Nifedipine GITS 30 mg/day replaced nifedipine SR, 20 mg b.i.d. in 38 patients, 23 monitored by routine blood pressure measurements and 15 by ambulatory monitoring. Nifedipine GITS achieved a marked reduction in blood pressure with a smaller dose than nifedipine SR: 30 versus 40 mg/day, respectively. It is concluded that patients with hypertension controlled on a twice-daily dose of nifedipine prolonged action can be converted to a lower once-daily dose of nifedipine GITS without experiencing any increase in blood pressure. Tolerability and compliance improved when switching to the GITS formulation.

Angiotensin converting enzyme in bleomycin-treated patients.

Angiotensin converting enzyme activity (ACE) was measured in two patient groups treated with a bleomycin combination. One group, with squamous cell carcinoma was treated according to the Price et al. [1975] protocol, with low doses of bleomycin. The second group, with testicular tumors, was treated according to the Einhorn and Donohue [1977] protocol, with high doses of bleomycin. No change in serum angiotensin converting enzyme activity was observed in the low dosage group. A late and prolonged elevation, not connected to the acute injection, was observed in the high dosage group. There is an indication that the monitoring of ACE may be helpful in establishing the prognosis of the treated patients.

Multiple Salmonella enteritidis leg abscesses in a patient with systemic lupus erythematosus.

We describe a 19 year old woman with systemic lupus erythematosus on corticosteroid therapy, who developed bilateral, multiple, gas-forming Salmonella enteritidis leg abscesses and osteomyelitis mimicking deep vein thrombosis. The infection was treated successfully by a combination of surgical drainage and intravenous ceftriaxone, followed by prolonged oral pefloxacin. This rare case of gas-producing S. enteritidis emphasizes the difficulty in diagnosing such complications in active systemic lupus erythematosus.