[Oximetric study of collateral circulation in hepatic cirrhosis].
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Adult↗
Biomedical subjects
A Pirrelli
Publications and source records attributed to A Pirrelli.
Non-invasive haemodynamic study in hypertensive subjects after treatment with verapamil slow release.
Aim of this study is to investigate the haemodynamic effects, after the short and long-term antihypertensive treatment. After a wash-out period and a placebo treatment period, 30 hypertensive patients received verapamil SR (slow release, 240 mg o.d.) for 30 days. A significant decrease in systolic and diastolic blood pressure was obtained already 4 h after the first administration of verapamil; it was more evident and persistent throughout the study. No significant changes of heart rate or PR interval in ECG were observed. A significant decrease in total vascular resistances, both supine and upright, was evident already 4 h after the drug intake and observed throughout the study. The major effect was obtained after one month. No significant changes of cardiac output, cardiac index and stroke volume were recorded. Furthermore, plasma verapamil levels were measured to confirm that the haemodynamic effects are obtained by low drug concentrations. The present study provides evidence that the antihypertensive effect of verapamil, whose mechanism is the reduction of total vascular resistances, is progressive, long acting and achieved by low plasma levels, when slow release formulation is considered.
Adult↗
Management of antihypertensive treatment with Lisinopril: a chronotherapeutic approach.
Risk for cardiovascular events seems to be higher in the early morning, also as consequence of a rise in blood pressure (BP) values due to the characteristic circadian pattern of BP variability. Therefore, a suitable therapeutic BP control should be tightest during the early morning. On the basis of the ambulatory blood pressure monitoring (ABPM) studies, it has been previously demonstrated that the antihypertensive effect of once daily drug, generally administrated in the morning, decreases at the end of the dosing period. A chronotherapeutic approach to the management of hypertension (this field has been pourly investigated so far) would allow the assessment of the optimum timing of drug dosing, according to the circadian BP rhythm and to the chronorisk maps, in hypertensive patients affected by associated vascular pathologies. This would increase the therapeutic effects. The aim of this study was to assess BP changes due to ACE-inhibitor (Lisinopril 20 mg/die) once daily administration at three different times (8.00 AM, 4.00 PM, 10.00 PM), in order to optimise the dosing time. 40 subjects (mean age +/- SD: 45 +/- 10) affected by primary mild to moderate hypertension were submitted to ABPM for 24 hours, by means of Spacelabs 90207, before and after pharmacological treatment. Patients were randomised to take the drug at 8.00 AM, 4.00 PM or 10.00 PM, and they repeated ABPM every two months, by changing the dosing time. The chronobiological analysis showed: 1) a sensible decrease both in Systolic (S)BP and Diastolic (D)BP without affecting the circadian rhythm, in all evaluations; 2) a greater reduction of SBP and DBP from 6.00 AM to 11.00 AM, period in which cardiovascular risk is higher, after 10.00 PM dosing; 3) no other sensible reduction in SBP and DBP occurred after night administration as compared to that caused by other dosing times. Lisinopril administration at 10.00 PM. has been shown to be much more useful since, although BP circadian rhythm was unmodified, it protects hypertensive patients from both vascular chronorisk and Cruickshank effect (J-curve). Therefore, a chronobiologist antihypertensive treatment in order to increase the therapeutic effect already obtained with the traditional statistic methods.
Adult↗
Efficacy of biofeedback treatment compared with drug therapy in hypertensive patients.
To assess the ability of biofeedback (BFB) in controlling hypertension a study was made of 40 hypertensive patients selected by means of the cardiovascular response to an arithmetic test. The patients were divided into four treatment groups: 10 patients were treated with diuretic therapy (D-T), 10 with beta-blocker therapy (Bb-T), 10 with BFB treatment, while 10 had no treatment at all (N-T). The BFB treatment consisted of 36 sittings where patients were requested to control muscular contraction, peripheric temperature and heart rate (HR) by means of a correlated acoustic signal. The results for blood pressure and HR reductions were compared during a 12-month follow-up period. The results for systolic blood pressure, diastolic blood pressure and HR indicate the efficacy of BFB for selected patients and suggest the possibility of using BFB treatment in the first stages of suspected neurogenic hypertension.
Adult↗
[Relationships between uric acid and plasma lipids in arterial hypertension].
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Cholesterol↗
Short-term preoperative treatment in a case of pheochromocytoma.
The authors show the case of a young drug addict patient with chronic hepatitis affected by pheochromocytoma, owing to his conditions, which was prepared preoperatively with a short term phenoxybenzamine i.v. We had no complications in the perioperative period. Our opinion is that it is possible, when necessary, to administer a short term therapy but this preparation isn't be considered a standard therapeutic program.
Adrenal Gland Neoplasms↗
[Plasma levels and noninvasive hemodynamic profile of slow release verapamil (240 mg). A multicenter study].
Aim of this study was to evaluate the antihypertensive efficacy, tolerability, drug plasma levels and hemodynamic effects after long-term treatment with the slow release (SR) formulation of verapamil (240 mg od). After a wash-out period of two weeks, 96 subjects (39 M, 57 F; mean age: 55 +/- 8.4 years; recruited in 9 centers) with mild to moderate, uncomplicated hypertension received verapamil 240 mg SR od for 24 weeks. The following parameters were considered: systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), ECG, echocardiogram, routine blood and urine chemistries, drug plasma levels. In addition, hemodynamic parameters were assessed in 30 subjects. A significant decrease in SBP and DBP (p < 0.01) was observed already after 1 week of treatment and was evident during all the study. HR was significantly reduced after 4 weeks (p < 0.01). No changes of ECG and echocardiographic parameters occurred. A significant increase in drug plasma levels was measured after 12 and 24 weeks of treatment (p < 0.05), when compared to the values recorded after 1 week. After 24 weeks drug levels were slightly decreases, even if not significantly, when compared to the values observed at the 12th week. No significant changes of cardiac output (CO), cardiac index (CI), stroke volume (SV) were evident. Total vascular resistances (TVR) decreases significantly (p < 0.001) 80 subjects completed the study. These results confirm the antihypertensive efficacy and tolerability of SR formulation of verapamil and suggest that the effective mechanism by which it reduces blood pressure is the progressive reduction of TVR without a sympathetic reflex stimulation. This hemodynamic effect is achieved by small drug concentrations. In conclusion, SR formulation of verapamil allows a good therapeutic control in hypertensive subjects when it is administered od and, therefore, it can be considered a drug of first choice in the treatment of arterial hypertension.
Delayed-Action Preparations↗
Stress reactivity in responder and non-responder hypertensives treated with verapamil and enalapril.
Hypertension was found to be associated with sympathetic overdrive but it is still debated if the antihypertensive agents can differently affect the stress response in hypertensive subjects. Through a psychophysiological study, we evaluated the effect of verapamil (V) and enalapril (E), both as monotherapy and association. Office BP was successfully reduced (< 145/90 mmHg) in 11 patients treated with V (V-Resp) and in 10 patients treated with E (E-Resp). Both the drugs were prescribed in 9 patients (V+E) who did not sufficiently lower their blood pressure (N-Resp) with monotherapy. Patients performed three stressors (color word stroop, cold pressor and handgrip). Extracardiovascular and hemodynamic functions were measured during baseline, stress and recovery periods. The response was evaluated adding the changes occurred in every phase of the psychophysiological session. This was performed before run-in and after any modification of the therapeutic intervention. The emotional arousal (phrontalis muscular contraction, skin conductance, peripheral temperature) was reduced when BP was normal. No change in BP reactivity was found. HR response decreased in V-Resp and cardiac output increased in E-Resp while the vascular reaction was restrained in E-Resp and V-Resp. This was reduced also in N-Resp when they assumed V+E and normalized their arterial pressure. The findings indicate that the sympathetic reactivity may be modified by the therapy. In particular, verapamil restrained the cardiac stress response without lowering the cardiac output and was advantageously associated with enalapril to control the psychophysiological response in more resistant hypertensive patients.
Adult↗