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Biomedical subjects

A Barsotti

Publications and source records attributed to A Barsotti.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Evaluation of the effects of diverse therapeutic treatments versus no treatment of patients with neurocardiogenic syncope].

Head-up tilt test was introduced in clinical practice to assess vasovagal syncope and its use has further been extended to evaluate the efficacy of drug administration in these patients. Nevertheless, the effects of tilt test on vasovagal syncope have never been compared with those obtained by ethylephrine or propranolol administration. One hundred and sixty-nine consecutive patients with vasovagal syncope and positive baseline or nitrate-potentiated tilt test (60 degrees upright position for 45 min, or until syncope occurred; 5 mg sublingual isosorbide dinitrate administration if no symptoms occurred) were randomly distributed among three groups: Group A (57 control patients discharged without medical therapy); Group B (56 patients discharged with 75 mg/die ethylephrine); Group C (56 patients discharged with 80 mg/die propranolol). Tilt test was repeated after 1 month, while clinical outcome was evaluated monthly for a mean follow-up of 37.1 +/- 15.6 months. No significant differences in acute tilt-induced syncope recurrence rates were obtained among groups at test repetition since 70.2% of Group A, 69.6% of Group B and 62.5% of Group C experienced syncope. At 3-year follow-up 82.4% of Group A, 83.9% of Group B and 87.5% of Group C (NS among groups) remained symptom free, the most important clinical result being obtained in untreated patients. These data suggest that tilt test execution may prevent syncope recurrence as ethylephrine or propranolol administration. Irrespective of the therapeutical choice, the "controlled reproduction" of symptoms and some psychophysical training of patients to avoid precipitating circumstances, to recognize early symptoms promptly to be reverted by Trendelemburg position, may produce the same clinical improvement as (empiric) ethylephrine or propranolol therapy.

Adolescent↗
PubMed1998

[Pulmonary hypertension in patients with left ventricular dysfunction studied with contrast-enhanced Doppler echocardiography: relations with diastolic parameters and prognostic implications].

In patients with left ventricular dysfunction, the prognostic value of both pulmonary hypertension and mitral flow patterns has been recognized. However, the effect of the association of different degrees of pulmonary hypertension on prognosis and the corresponding left ventricular diastolic dysfunction is not clear. Accordingly, we considered the impact on survival of a categorization based on the relationship between pulmonary artery pressure and left ventricular diastolic dysfunction, as assessed by mitral and pulmonary venous flow analyses. Transthoracic Doppler echocardiography was carried out in 92 patients with ejection fraction < 45%, pulmonary artery systolic pressure > 25 mmHg and sinus rhythm. Tricuspid regurgitant velocity and Doppler parameters derived from transmitral and pulmonary venous flows were evaluated. In the case of inadequate baseline tracings, weak or poor Doppler signals were enhanced by intravenous injection of a galactose-based contrast agent (Levovist 8 ml suspension at a concentration of 400 mg/ml). To select those whose pulmonary hypertension was either proportional or unproportional to left side filling pressures, patients were divided as follows: Group 1 (n = 69) with low discrepancies and Group 2 (n = 23) with marked discrepancies between Doppler estimates of pulmonary artery systolic pressure and left side filling abnormalities. The patients of each group were also classified according to their mitral flow pattern: abnormal relaxation, pseudonormal and restrictive. Mean pulmonary artery systolic pressure was 49 +/- 16 mmHg in the total population, 43 +/- 11 mmHg in Group 1 and 68 +/- 14 mmHg in Group 2 (p < 0.0001). Several mitral and pulmonary venous flow variables significantly correlated with pulmonary artery systolic pressure in the total population and in the study groups. The best correlations were observed in Group 1 as regards the ratio of reverse-to-forward atrial wave duration (r = 0.83), E wave deceleration rate (r = 0.81), E wave deceleration time (r = -0.81) and the systolic fraction of pulmonary venous flow peak velocities (r = -0.75). In Group 1, the lower heart failure-free survival rate at 10 months was observed in patients with restrictive pattern (68%) as opposed to those with pseudonormal (94%) and abnormal relaxation patterns (97%). The overall heart failure-free survival rate in Group 2 was 86%. In conclusion, the classification according to the relationship between pulmonary hypertension and the alterations of left chamber filling may contribute to the prognostic stratification of patients with left ventricular dysfunction. The patients with pulmonary hypertension proportional to the increase in left chamber filling pressures and restrictive pattern exhibited the worst prognosis.

Aged↗
PubMed1998

Effect of acute increase of interstitial myocardial fluid on ventricular function in isolated working rat hearts.

An acute increase of myocardial interstitial fluid may affect ventricular function. In the present study we evaluated the effects of acute changes of myocardial tissue fluid on cardiac function and ultrastructural morphometry. Isolated rat hearts were perfused for 100 min in the working heart mode. Hearts were distributed into 5 groups: controls [perfused with Krebs-Henseleit (KH) isotonic buffer to rat plasma, KH, 287 mOsm], moderate hyposmotic perfusion (75% Hyposm: perfusion with 75% diluted KH, 216 mOsm), highly hyposmotic perfusion (60% Hyposm: perfusion with 60% diluted KH, 170 mOsm), afterload increase (Pre-over: isotonic perfused hearts subjected to an increase of afterload from 72 to 145 cm H2O) and ion dilution (Ion-dil: hearts perfused with a 60% KH with 115 mM sucrose, isotonic, 287 mOsm). We evaluated functional changes, markers of cellular necrosis or damage (CPK, LDH and purine release in coronary effluent), heart weight changes (weight gain and ww/dw ratio) and ultrastructural morphometry (analysis of cell damage, interstitial area, and mitochondrial alterations by a computerized image analysis system). The ww/dw ratio increased significantly only in 60% Hyposm (+140%, p < 0.001) and Pre-over (+63%, p < 0.001 vs control) groups. An impaired myocardial function in 60% Hyposm, Pre-over and Ion-dil groups was observed with cardiac failure at 50, 60 and 60 min, respectively. Enzyme release was significant higher in 60% Hyposm and Pre-over groups and was related to heart weight gain (r = 0.85, p < 0.001). Ultrastructural analysis confirmed a significant increase of interstitial space area (ISA) and mitochondrial damage in 60% Hyposm and Pre-over groups (p < 0.001); a significant (p < 0.05) increase was observed in the Ion-dil group; in 75% Hyposm group, a significant increase of mitochondrial damage was detected (p < 0.05). In brief, a higher functional and morphological deterioration was observed in hearts in which a more evident interstitial edema was detected (60% Hyposm and Pre-over groups). We conclude that, in the experimental condition, an acute increase of myocardial interstitial tissue fluid directly compromises left ventricular function and contributes to the ultrastructural damage to the myocardium.

Animals↗
PubMed1997

Persistence of mammary artery branches and blood supply to the left anterior descending artery.

BACKGROUND: Partial harvesting of the left internal mammary artery (LIMA) is a widespread technique used during minimally invasive coronary operations performed through a left anterior small thoracotomy. The influence of persisting LIMA branches was investigated to evaluate their effect on the blood flow of the left anterior descending artery. METHODS: Thirty patients, 15 with totally (group A) and 15 with partially (group B) harvested LIMAs, were evaluated. All the patients underwent postoperative angiography, during which a flow map of the LIMA was performed. The average peak velocity and the diastolic-to-systolic peak velocity ratio were recorded. The LIMA graft flow pattern was recorded in the proximal and distal thirds of the artery. Intramammary adenosine (12 to 14 microg) was injected and the average peak velocities before and after injection were calculated. RESULTS: The average peak velocity was similar in both groups in the proximal and distal thirds of the LIMA (25 +/- 7 and 26 +/- 5 cm/sec, respectively, in group A versus 27 +/- 5 and 25 +/- 5 cm/sec, respectively in group B; p = NS). The diastolic-to-systolic peak velocity ratio was similar proximally (0.78 +/- 0.3 in group A versus 0.69 +/- 0.3 cm/s in group B; p = NS), but not distally (1.72 +/- 0.1 in group A versus 0.97 +/- 0.3 in group B; p < 0.0005). The LIMA graft flow reserve was similar both proximally and distally (2.6 +/- 0.6 and 2.5 +/- 0.3 cm/s, respectively, in group A versus 2.6 +/- 0.5 and 2.6 +/- 0.3 cm/s, respectively, in group B; p = NS). CONCLUSIONS: The persistence of LIMA branches does not influence the blood flow of the left anterior descending artery after acute adenosine-induced myocardial hyperemia. If a left anterior small thoracotomy is used in left anterior descending artery direct revascularization, complete LIMA harvesting is not mandatory and depends on the personal preference of the surgeon.

Aged↗
PubMed1997

Epidemiology and costs of venous diseases in central Italy. The San Valentino Venous Disease Project.

The Prevalence of Early Atherosclerosis study aims to define the prevalence of subclinical atherosclerosis in a typical population of central Italy. A concomitant study evaluates the prevalence of venous diseases. The prevalence of superficial and deep venous disease, the prevalence of venous thrombosis and pulmonary embolism, and the prevalence of the most common venous malformations were studied through use of medical history, a questionnaire, and noninvasive investigations. The costs of venous problems were also considered. Of some 2000 inhabitants, 746 (379 women; mean age 46.3 +/- 7 years; range eight to ninety-four) have been screened. No significant difference in trend increase of the relationship age/percent of subjects with venous problems was observed for superficial venous disease. The increase in the proportion of subjects with lipodermatosclerosis and venous ulcerations appeared to be correlated with age (r = 0.543). Evidence accepted for pulmonary embolisms was pulmonary angiogram or evidence on ventilation+perfusion lung scans. According to these criteria the number of documented deep vein thromboses and pulmonary embolisms was very limited with a larger number of suspected disease entities. There was no significant correlation between age and pulmonary embolism or deep venous thrombosis distribution. The number of venous and/or arteriovenous malformations was comparable along the age axis in the different age groups. Only a limited number of these malformations (in less that 1% of subjects) had caused a clinical problem. The treatments used for venous problems have been reported in a questionnaire and subdivided into occasional treatments and chronic treatments (when used for periods longer than twelve months). The percent of subjects using different treatment was also studied. Treatments were divided in: (1) over-the-counter products (or any treatment not requiring prescription); (2) specialized drug (for venous diseases); (3) compression; (4) surgery (any type of surgical treatment); (5) sclerotherapy; (6) combined treatments (ie, sclerotherapy and surgery); (7) alternative treatments (herbal products etc). Finally, the average costs per year for treatment, for investigations, and the costs due to lost working days were recorded. In conclusion some 12% of the evaluated population sample (male population 46%) had or had been affected in the past by a venous problem and 50% of them had received some type of treatment.

Adolescent↗
PubMed1997

[Ischemic preconditioning of the myocardium: the role of changes in the permeability of the coronary microcirculation].

In isolated working rat hearts we have evaluated the effects of preconditioning on postischemic coronary endothelial permeability. Isolated Wistar male rat hearts were used and subdivided into three groups: Group A, control hearts submitted to 20 min global normothermic ischemia; Group B, hearts subjected, before ischemia, to preconditioning (three phases of 3 min ischemia, each one followed to 2 min Langendorff reperfusion; Group C, hearts submitted to preconditioning and hypertonic reperfusion (by adding 80 mM sucrose to normal perfusion buffer), in order to increase the effects on postischemic interstitial fluid accumulation (osmotic forces balance). A 65 min working heart reperfusion was also performed to assess functional response. We have evaluate the hemodynamic changes (coronary and aortic flows, systolic aortic pressure, work minute), reperfusion arrhythmias, heart weight changes (ww/dw), myocardial enzyme release (creatine phosphokinase and lactic dehydrogenase) and microcirculation permeability changes (FITC.albumin diffusion), as an index of endothelial function. In Group B, a significant reduction of ischemia-reperfusion damage (functional recovery, enzyme release and arrhythmias) was detected with respect to Group A. In Group C this reduction was significantly more evident with respect to groups A and B. In Groups B and C, a significant reduction in myocardial reperfusion (ww/dw: A: 5.9 +/- 0.5, B: 4.9 +/- 1.1, p < 0.02 vs A, C: 4.4 +/- 0.6, p < 0.01 vs A) edema and FITC-albumin diffusion (A: 32.8 +/- 5.9% area; B: 16.3 +/- 6.1% area, p < 0.01 vs A; C: 13.3 +/- 4.5% area, p < 0.01 vs A), especially in perimyocytic space was also observed. Data show that preconditioning may exert a cardioprotective effect by reducing endothelial postischemic functional alterations (vascular permeability) and reperfusion edema. The importance of fluid diffusion within the interstitium in the development of reperfusion damage is supported by better postischemic recovery in Group C, in which an interference on osmotic load was performed.

Animals↗
PubMed1997

[The prognostic value of activation of the hypophyseal and adrenal cortical systems in severe heart failure].

The aim of this study was to evaluate changes of pituitary and adrenal cortex hormones in patients with congestive heart failure according to NYHA functional classes and to detect possible prognostic effects of these changes. We studied 101 patients: 60 with congestive heart failure, in absence of clinical, anamnestic signs of endocrine diseases (Group I, 37 males, 23 females; mean age 62 +/- 7.2 years) and 41 patients with cardiac diseases without signs of congestive heart failure, homogeneous for age and sex (Group II, 23 males, 18 females; mean age 61 +/- 8.5 years). All patients were submitted to a 12 month follow-up in order to evaluate hormonal changes. Hormonal study was performed through radioimmunoassay technique. Plasma levels of insulin, growth hormone (GH), adrenocorticotropine (ACTH), cortisol and prolactin (PRL) were evaluated. We observed in Group I a significant increase of cortisol and GH with respect to Group II. No significant difference occurred in plasma levels of insulin, PRL and ACTH. Subdividing Group I patients on the basis of NYHA classification, significant increase (p < 0.05) in cortisol and GH was observed in IV NYHA functional class with respect to II and III NYHA ones. Moreover a significant reduction (p < 0.02) of ACTH in IV NYHA functional class was also detected. Plasma levels of cortisol and GH were also significantly higher in patients dead during the follow-up with respect to survivors. Statistical analysis showed a linear negative correlation between cortisol and ACTH in III NYHA functional class (p < 0.03), a negative correlation between cortisol and radius/thickness ratio (p < 0.03) and between cortisol and serum glutamic oxalacetic transaminase (p < 0.05). In IV NYHA functional class a significant negative correlation between cortisol and shortening fraction (p < 0.05) also occurred. Plasma levels of cortisol and GH were significantly higher (p < 0.05) in IV NYHA functional class with respect to II and III classes, with associated significant reduction of shortening fraction (p < 0.05). Our data confirm that, besides catecholamines and renin-angiotensin-aldosterone system, in the presence of severe congestive heart failure (IV NYHA functional class), a significant activation of pituitary and adrenal cortex hormones occurs. It is still an open question whether this activation plays a pathogenetic role in the evolution of heart failure, but the significant increase of these hormones (GH and cortisol) seems to be significant negative prognostic markers.

Adrenal Cortex↗
PubMed1997

[Prevalence of venous diseases. The San Valentino screening and prevalence study].

The PAP/PEA (Prevalence of Early Atherosclerosis) study aims to define the prevalence of subclinical atherosclerosis in a typical population of central Italy. A concomitant study evaluates the prevalence of venous diseases. The first group of 850 patients evaluated, indicated the prevalence of superficial ve-nous disease, the prevalence of deep venous thrombosis and pulmonary embolism and the prevalence of the most common venous malformations. Also the costs of venous problems was considered. In conclusion some 12% of the evaluated population sample (male population 46%) had or had been affected in the past by a venous problem and 50% of them had been under some form of treatment.

Adolescent↗
PubMed1997

[Ventricular remodeling after myocardial revascularization with venous grafts].

Left ventricular remodeling, through long-term left ventricular chamber dilation and increased wall stress can result in alteration of ventricular architecture and impairment of systolic and diastolic performance. Most of the studies regard post acute myocardial infarction remodeling, knowledge is still lacking about preoperative and postoperative factors which predict the long-term prognosis of patients who underwent venous coronary artery bypass graft surgery. We evaluated 243 patients (225 males, 18 females, mean age 65 +/- 7.3 years) submitted to venous coronary artery bypass graft surgery and 10-year follow-up (123 +/- 20 months). Global mortality was 17.6% (n = 43), significantly higher in patients with ejection fraction (EF) < 50% (log-rank test p < 0.001). The survivors (n = 200) were subdivided into two groups according to postoperative EF: patients with EF > or = 50% (n = 160) and patients with EF < 50% (n = 40). Multivariate analysis revealed that cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia, smoking), number of grafts and infarct location were not associated with EF reduction. Only multivessel disease was significantly associated with EF reduction (p = 0.008). Preoperative echocardiographic parameter analysis evidenced that regional ventricular wall motion score was significantly higher in patients with reduced EF (EF < 50% 11 +/- 7.5; EF > or = 50% 6 +/- 4.1, p < 0.001) and left ventricular dilation (p < 0.001). Multivariate analysis revealed that the strongest correlates of EF < 50% were left ventricular wall motion score index > 10 (odds ratio 5.8, 95% confidence interval 2.8-11.7) and multivessel disease (odds ratio 9.0, 95% confidence interval 2.6-31.08). This study revealed that echocardiographic detection of preoperative ventricular wall motion score may be useful to assess patients at high risk of ventricular remodeling after venous coronary artery bypass graft surgery.

Aged↗
PubMed1997

[Endothelium-protective effects of epinine (N-methyldopamine) in myocardial ischemia-reperfusion in the isolated working rat heart].

The effect of cardiac dopaminergic receptors stimulation with epinine (N-methyldopamine) on reperfusion injury was investigated in isolated working rat heart submitted to 15 min of global ischemia. Isolated Wistar rat hearts (n = 75) were used and subdivided into five groups: Group A control hearts, Group B epinine 10 ng/ml, Group C epinine 20 ng/ml, Group D epinine 40 ng/ml, Group E epinine 80 ng/ml. The drug was added to the perfusion buffer at the beginning of experimental procedures. Hemodynamic parameters, heart rhythm (epicardial ECG), heart weight changes, coronary microvascular permeability (FITC-albumin diffusion) and myocytes damage (necrosis enzymes release, immunoperoxidase labeling anti-LDH antibody) were evaluated. After ischemia in groups B and C a significant reduction of functional alterations and myocytes damage was observed with respect to Group A associated with a significant reduction of reperfusion edema (heart weight: Group A +29 +/- 3.5%, Group B +15 +/- 3.8%, Group C 16 +/- 5%, Group D 27 +/- 5%, Group E 33 +/- 4%). At reperfusion time, a significant proarrhythmic effect occurred only in groups D and E. A significant reduction of postischemic endothelial FITC-albumin diffusion was also observed in groups B and C (FITC-albumin diffusion, Group A 32.8 +/- 6% area, Group B 16.33 +/- 5% area, Group C 21.7 +/- 4.5% area, Group D 30 +/- 5% area, Group E 35 +/- 7% area). Our data show that, in isolated working rat heart, the dopaminergic stimulation with low-doses epinine may exert a cardioprotective effect against ischemia-reperfusion damage by modulating endothelial permeability changes and improving coronary microcirculation. The importance of dopaminergic receptors is also suggested by the evidence that at higher doses, when alpha and beta-adrenoceptors stimulation occurs, this cardioprotective effect is significantly reduced or lost.

Animals↗
PubMed1996

Sarcoplasmic reticulum calcium uptake in human myocardium subjected to ischemia and reperfusion during cardiac surgery.

We evaluated the effect of ischemia and reperfusion on sarcoplasmic reticulum Ca uptake in patients subjected to cardiac surgery. Our series included 16 patients (seven female, nine male, age 63 +/- 2 years): five were subjected to aortic valve replacement, five to aortic and mitral valve replacement, six to coronary artery bypass graft. In each case no clinical, electrocardiographic or echocardiographic evidence of perioperative infarction was observed. Biopsies were obtained from the right atrium of each patient before starting extracorporeal circulation, and after the recovery of spontaneous contractile activity, i.e. after cardioplegia-ischemia-reperfusion. The tissue was homogenized, and oxalate-supported Ca uptake, which represents sarcoplasmic reticulum Ca uptake, was measured in the unfractionated homogenate. The assay was performed under basal conditions and in the presence of 900 microM ryanodine, in order to block sarcoplasmic reticulum Ca release channels. Under basal conditions at pCa = 5.85 the rate of sarcoplasmic reticulum Ca uptake averaged 4.76 +/- 0.37 nmol/min per mg of protein in the pre-ischemic samples, and decreased significantly in the post-ischemic samples (3.09 +/- 0.29 nmol/min per mg, P < 0.01). A significant decrease of Ca uptake after ischemia and reperfusion was observed also in the presence of ryanodine (3.53 +/- 0.48 nmol/min per mg) compared to pre-ischemic values (5.98 +/- 0.56 nmol/min per mg, P < 0.01). Additional experiments showed no change in the Ca sensitivity of Ca uptake in the postischemic samples (Kca = 0.48 +/- 0.02 microM, no significant difference after ischemia and reperfusion). In conclusion, active sarcoplasmic reticulum Ca transport was impaired in human atrial myocardium after reversible ischemia and reperfusion.

Aged↗
PubMed1996

Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass.

BACKGROUND: We explored the possibility of anastomosing the left anterior internal mammary artery (LIMA) to the left anterior descending artery in a beating heart via a left anterior small thoracotomy. METHODS: This procedure was performed in 155 of 162 scheduled patients; in 7 (4.3%) the left anterior descending artery was not suitable or was too small. The chest was opened in the fourth intercostal space (mean wound length, 10.5 cm) and the LIMA was harvested for about 4 cm. The left anterior descending artery was occluded by means of two 4/0 Prolene (Ethicon, Somerville, NJ) sutures, and the proximal suture was snared. The anastomosis was performed with two 8/0 Prolene sutures while the heart was beating. Early postoperatively all patients underwent repeat angiography or a Doppler flow assessment of the LIMA or both. RESULTS: The LIMA was connected directly to the left anterior descending artery in 144 patients and with interposition of an inferior epigastric artery in 11. In 2 patients the diagonal branch was also grafted using an inferior epigastric artery from the LIMA. One patient (0.6%) died 38 days after the operation due to multiorgan failure. Nine patients (5.8%) had failure requiring a redo operation: 7 (4.5%) early and 2 (1.3%) late. One additional patient had a late percutaneous transluminal coronary angioplasty for anastomotic stenosis. At a mean 5.6 months of follow-up, 143 patients (92.2%) were alive, asymptomatic with or without medical treatment, and without cardiac events. CONCLUSIONS: Left internal mammary artery-to-left anterior descending artery anastomosis performed on a beating heart via a left anterior small thoracotomy is a safe procedure. In selected patients the operation has good early and midterm results.

Adult↗
PubMed1996

Twenty-four-hour antihypertensive efficacy of felodipine 10 mg extended-release: the Italian inter-university study.

We assessed the 24-h antihypertensive efficacy of an extended-release (ER) 10-mg formulation of the dihydropyridine felodipine in mild-to-moderate essential hypertension [World Health Organization (WHO) stage I-II]. Thirty patients, 23 men and 7 women, aged 37-70 years (mean 53 +/- 9 years) participated in a double-blind, randomized, cross-over study of felodipine 10 mg ER versus placebo. An ambulatory daytime diastolic blood pressure (DBP) >90 mm Hg at the end of a 4-week run-in period was necessary to enter the 10-week treatment phase. Twenty-nine patients completed the treatment phase. Twenty-two underwent a 2-day single-blind placebo follow-up to assess residual drug effects. All patients underwent ambulatory BP monitoring (ABPM) by Spacelabs 90207 recorders. Recorders were programmed to make automatic BP and heart rate (HR) measurements every 15 min throughout the 24 h. Felodipine 10 mg ER significantly (p < 0.01) reduced ambulatory systolic BP (SBP) and DBP values throughout the 24-h, day (7 a.m. to 11 p.m.) and night (11 p.m. to 7 a.m.) periods, but not influencing average ambulatory HR values. Trough-to-peak (T/P) ratios, calculated on the average ambulatory BP values measured in the 7-9 a.m. 2-h interval of the second day of ABPM (before the new drug administration: trough) and in the 10 a.m. to 12 noon 2-h interval of the first day of ABPM (peak BP-lowering effect), were 0.71 and 0.58 for SBP and DBP, respectively. Individual T/P calculations, after post hoc selection of nonresponders, gave superimposable results, the consistency of which was judged on mean, median, and confidence intervals (CI). However, the wide variability of the individual T/P ratios suggests that this method cannot be the only means to evaluate the duration of action of an antihypertensive drug by ABPM. The long-acting BP-lowering drug effect was clearly shown by the ABPM performed in the follow-up when SBP and DBP average values of the 24-h, day, and night periods were still reduced. Felodipine 10 mg ER effectively reduced BP in patients with mild-to-moderate hypertension, showing prolonged duration of its antihypertensive action beyond the time of the next dose.

Adult↗
PubMed1996

Ultrasound morphology classification of the arterial wall and cardiovascular events in a 6-year follow-up study.

A 6-year follow-up based on an arterial morphology classification defined with an ultrasound assessment of carotid and femoral artery bifurcations was conducted on 2322 asymptomatic subjects. Four morphology classes were considered. When 2000 subjects (86% of total subjects; 1124 males, 876 females) completed a 6-year follow-up, the study was terminated. At 6 years, no cardiovascular events were observed in subjects who were in class I (80.05% of the population sample) at inclusion; there were 69 events in classes II, III, and IV (19.95% of the population; incidence, 17.3%); 59 events, including the five deaths, occurred in classes III and IV (10.85% of the population), producing an event incidence of 27.2%. The increased event rate in classes II, III, and IV was significant (log-rank test; P < .05, P < .025, and P < .025, respectively). Thus, the arterial morphology classification identified 19.95% of the population (subjects in classes II, III, and IV) in which all events occurred. There was a higher (P < .05) rate of progression of altered arterial morphology in 6 years in classes III (26.5% of subjects progressed) and IV (41.9% progressed) than in classes I and II. The total number of cigarette-years was higher (P < .05) in classes II, III, and IV than in class I. In conclusion, the ultrasound-based arterial classification was useful in selecting from the population sample 80.05% of subjects (class I) who remained event-free for 6 years. All events occurred in class II, III, and IV subjects (19.95%), and all five deaths (0.25% of the population) occurred in classes III and IV (10.85% of the sample).

Adult↗