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Biomedical subjects

A Zanchetti

Publications and source records attributed to A Zanchetti.

At least 253 records · Page 14Linked to original sources
PubMed1990

Early alterations of the baroreceptor control of heart rate in patients with acute myocardial infarction.

Experimental coronary occlusion is accompanied by an acute impairment of the baroreceptor-heart rate reflex. This study was planned to determine whether this impairment also occurs in humans. In 30 patients admitted to a coronary care unit for an anterior (n = 14) or inferior (n = 16) transmural myocardial infarction (MI), we measured 1) the increase in RR interval induced by stimulating carotid baroreceptors through progressive reductions in neck chamber pressure, 2) the increase in RR interval induced by stimulating arterial baroreceptors through intravenous boluses of phenylephrine, and 3) the reduction in RR interval induced by deactivating arterial baroreceptors through intravenous boluses of nitroglycerin. Measurements were performed 49.5 +/- 2.4 hours (mean +/- SEM) after the MI. The results were compared with those of five age-matched patients admitted to the coronary care unit for chest pain and found free from ischemic heart disease. The sensitivity of the carotid baroreceptor-heart rate reflex (slope of the linear regression of RR interval over neck pressure changes) was markedly less in MI than in control patients (3.8 +/- 0.5 vs. 5.9 +/- 0.6 msec/mm Hg, p less than 0.05), the reduction being similar in patients with anterior and inferior MI. This was the case also for the baroreflex sensitivity measured by the phenylephrine and the nitroglycerin methods (slope of the linear regression of RR interval over systolic blood pressure changes). However, 10.2 +/- 0.3 days later, the baroreflex sensitivity measured by all three methods increased significantly (p less than 0.05 or 0.01) and became similar to that of control subjects, which showed no significant change from the early to the late period after admission into the coronary care unit. Thus, MI is accompanied by an acute marked impairment of the baroreceptor control of the heart in humans, and this is the case both for an anterior and an inferior MI. The impairment is largely transient in nature, however, and a clear-cut recovery of the baroreflex can be seen a few days later.

Carotid Sinus↗
PubMed1990

Early 24-hour blood pressure elevation in normotensive subjects with parental hypertension.

Subjects with a family history of parental hypertension are reported to have a slightly higher office blood pressure in the prehypertensive stage. Whether this reflects a hyperreactivity to blood pressure measurement or a more permanent blood pressure elevation, however, is not known. In the present study, blood pressure was measured in 15 normotensive subjects whose parents are both hypertensive (FH++), 15 normotensive subjects with one hypertensive parent (FH(+)-), and 15 normotensive subjects whose parents are not hypertensive (FH--); among the three groups, subjects were matched for age, sex, and body mass index. The measurements were made in the office during a variety of laboratory stressors and during a prolonged resting period, and for a 24-hour period (ambulatory blood pressure monitoring). Office blood pressure was higher in the FH++ group than in the FH-- group (p less than 0.05). The pressor responses to laboratory stressors were similar in the two groups, but the FH++ group had higher prolonged resting and 24-hour blood pressure than the FH-- group; the difference was always significant (p less than 0.05) for systolic blood pressure. The FH++ group also had a greater left ventricular mass index (on echocardiographic examination) than the FH-- group (p less than 0.01). The blood pressure values and echocardiographic values of the FH(+)- group tended to be between those of the other two groups. Thus, the higher blood pressure shown by individuals in the prehypertensive stage with a family history of parental hypertension does not reflect a hyperreactivity to stress but an early permanent blood pressure elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1990

First-line treatment in hypertension. Role of perindopril.

Once-daily administration of perindopril 4mg has been compared with captopril 25mg twice daily, atenolol 50mg once daily or a combination of hydrochlorothiazide 50mg plus amiloride 5mg once daily in double-blind studies of patients with supine diastolic blood pressures between 95 and 125mm Hg. After 3 months' treatment, the average decrease in supine systolic blood pressure with perindopril (26.5mm Hg) was significantly greater than that obtained with captopril (18.9mm Hg) and atenolol (20.6mm Hg), and non-significantly different from that achieved with the diuretic combination (30.6mm Hg). Perindopril reduced diastolic blood pressure by a greater extent than captopril (18.1 vs 11.7mm Hg), whereas the reductions were similar when compared with atenolol (17.4 vs 15.6mm Hg) and the diuretics (19.1 vs 18.4mm Hg). Target blood pressure (supine diastolic less than or equal to 90mm Hg) was achieved in 49 to 72% of patients on perindopril 4 mg/day and in an additional 15% of patients by doubling the dosage. In patients on perindopril who required an additional antihypertensive agent, a diuretic was more effective than a beta-blocker. Withdrawal rates due to adverse effects were similar in all treatment groups and ranged between 4 and 6%. Perindopril was well tolerated. In conclusion, these studies demonstrate that perindopril may be considered as a suitable first-line treatment for mild to moderate hypertension.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1990

Natriuretic effects of calcium antagonists. Clinical implications.

An important characteristic which distinguishes calcium antagonists from traditional vasodilators is their natriuretic rather than antinatriuretic action. Evidence that all classes of calcium antagonists have a natriuretic effect has been provided by intravenous administration in animal experiments. After single oral doses, all calcium antagonists have some natriuretic effect, but its extent differs with different compounds; dihydropyridines have a greater immediate natriuretic response than verapamil or gallopamil. Recent experiments by our group using the newer dihydropyridine derivative, isradipine, indicate that the natriuretic response may occur at even lower doses than the antihypertensive effect. Indeed, doses of 2.5mg, 5.0mg and 7.5mg of this compound caused an increasingly larger fall in blood pressure, while the natriuretic and diuretic effects peaked with the 2.5mg dose. The natriuretic effect is associated with no or a very small change in glomerular filtration rate and with a more consistent increase in renal plasma flow. The duration of the natriuretic action of calcium antagonists is debated. Our studies have shown that this action is evident during the first 2 days of administration of a dihydropyridine, and then seems to disappear; however, a small negative sodium balance persists, an observation that accounts for the absence of any increase in bodyweight or fluid volumes with long term administration of calcium antagonists, despite their vasodilating action. Recent data have shown that under long term treatment with isradipine sodium clearance was still increased a few hours after administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Overview and perspectives of antihypertensive treatment.

An overview of antihypertensive trials shows that, when absolute rather than relative measures of benefit are considered, a large benefit is derived from treating severe hypertension, whereas in mild hypertension the rate of prevented morbid events is relatively small. However, a greater benefit is observed when a mildly elevated diastolic blood pressure is associated with other risk factors. Thus, antihypertensive therapy in the 1990s needs to be regarded as a component, albeit an important one, in a multiple-strategy approach to prevention and reversal of cardiovascular diseases. At a time when many different classes of antihypertensive agents are available, it is reasonable to ask whether some classes are more suitable than others for the treatment of patients with hypertension and concomitant risk factors such as dyslipidaemias and reduced glucose tolerance. It is well known that thiazide diuretics and beta-blockers have potentially adverse effects on lipid and glucose metabolism, that calcium antagonists and ACE-inhibitors are lipid neutral and that alpha-blockers have potentially favourable effects. Although the real impact of some of these changes is unproven, it is possible that one or more of the metabolic side effects of drugs such as diuretics and beta-blockers may offset some of the benefits of reduced blood pressure. Extensive testing of antihypertensive drugs with a favourable profile can be foreseen in the 1990s.

Antihypertensive Agents↗
PubMed1990

A double blind comparison of perindopril and atenolol in essential hypertension.

A multicentre randomised double-blind trial was performed in order to compare the therapeutic efficacy and acceptability of the angiotensin converting enzyme (ACE) inhibitor perindopril with those of atenolol in mild to moderate hypertension. After one month of placebo, 173 patients with supine diastolic blood pressure (DBP) between 95 and 125 mmHg were randomised to receive perindopril 4 mg once daily or atenolol 50 mg once daily. Monthly assessments were made for three months. Treatment was adjusted at these visits if supine DBP was greater than 90 mmHg; the dose was first doubled (8 mg perindopril or 100 mg atenolol once daily) and then hydrochlorothiazide was added. The pretreatment blood pressure levels were similar in both groups. Supine DBP was 105.5 +/- 0.9 mmHg (n = 85) in the perindopril group and 106.9 +/- 0.9 mmHg (n = 88) in the atenolol group. At the end of the third month, the study target blood pressure (supine DBP less than or equal to 90 mmHg) was achieved in a significantly (P = 0.006) larger percentage of patients in the perindopril group (78%) than in the atenolol group (58%). This appeared to be due to a greater potentiation of the antihypertensive effect by the addition of diuretic to perindopril than to atenolol. The fall in systolic blood pressure was significantly greater in the perindopril group than in the atenolol group (supine: 26.5 +/- 2.0 mmHg vs. 20.6 +/- 2.0 mmHg; P = 0.042) although the fall in DBP was comparable (supine: perindopril 17.4 +/- 0.9 mmHg, atenolol 15.6 +/- 1.1 mmHg; P = 0.195).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Effects of dilevalol on forearm circulation in essential hypertension.

In 6 patients with untreated hypertension of mild or moderate degree, dilevalol was infused in the brachial artery. Doses were calculated to produce plasma levels approximating those achieved after oral dosing (0.03, 0.07, 0.1, 0.3 micrograms.kg-1.min-1) and also to produce plasma levels exceeding oral dosing (0.5, 1.0, 2.0 micrograms.kg-1.min-1) without causing any blood pressure or heart rate changes. The effects of the infusion on forearm blood flow were assessed by venous occlusion plethysmography. Dilevalol caused a progressive increase in flow in all subjects up to the intermediate dose given, with the effect being attenuated when the dose was increased further. Simultaneous propranolol infusion reduced the increase in flow induced by dilevalol, shifting the dilevalol-induced vasodilation dose response curve to the right. Isoproterenol infusion caused a marked, dose-related increase in flow that was equally well reduced by simultaneous infusion of dilevalol or propranolol. These results indicate that dilevalol effectively blocks peripheral vascular beta receptors in humans. The drug also acts as a partial beta 2-receptor agonist, causing vasodilation which can be reduced by co-administration of propranolol.

Adrenergic beta-Agonists↗
PubMed1989

Cardiovascular and renal effects of single administration of three different doses of isradipine in hypertensive patients. Dose-response curves of the different effects.

The antihypertensive, humoral, and renal effects of acute single oral administration of placebo and isradipine, a new dihydropyridine calcium antagonist, at doses of 2.5 mg, 5.0 mg, and 7.5 mg once daily were investigated in 11 patients with mild-to-moderate uncomplicated essential hypertension. The patients maintained a constant daily intake of 100 mmol of sodium and 40 mmol of potassium. Placebo and isradipine were randomly administered to each patient, according to a Latin-square design, at intervals of at least 48 hours. The antihypertensive effect was dose-dependent and peaked at two hours after oral administration; changes at the lowest dose were already statistically significant (p less than 0.01). Increases in heart rate were mild and similar with all isradipine doses. Glomerular filtration rate and renal plasma flow showed a trend towards a dose-dependent rise; plasma renin activity was statistically increased (p less than 0.05) following the highest isradipine dose, whereas plasma aldosterone was unmodified. Isradipine resulted in a statistically significant rise (p less than 0.05) in sodium excretion and urine volume, which was similar with all active doses. In conclusion, the antihypertensive efficacy of isradipine is dose-dependent, whereas the natriuretic and diuretic effects are already at maximum following 2.5 mg per day, the lowest dose in this study.

Antihypertensive Agents↗
PubMed1989

Investigation of reflexes from volume and baroreceptors during converting-enzyme inhibition in humans.

This article emphasizes the importance of testing baroreceptor and cardiopulmonary receptor control of circulation during angiotensin-converting enzyme (ACE) inhibitor treatment in hypertensives, because removal of angiotensin II-dependent stimulation of the sympathetic nervous system could impair reflex blood pressure homeostasis. In essential hypertensive subjects, the sympathetic vasoconstriction that occurs in skeletal muscle after deactivation of cardiopulmonary receptors was reduced after short-term or prolonged administration of the ACE inhibitor, captopril. However, another sympathetic target of the cardiopulmonary reflex, that is, renin release, was unaltered by both short-term and prolonged administration of captopril. Furthermore, the blood pressure and heart rate influences of arterial baroreceptors were preserved or even enhanced after administration of captopril. Thus important reflex mechanisms for cardiovascular homeostasis are not adversely affected by ACE inhibition, which preserves blood pressure levels during gravity challenges or exercise. Preliminary data suggest that this may be even more evident for benazepril.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

Neural control of renin release.

Among the major mechanisms controlling the renal release of renin, renal nerves are known to exert a direct stimulating action on juxtaglomerular cells that is mediated by beta-adrenoceptors. Activation of the renal nerves also exerts an important permissive role in order to amplify and possibly accelerate responses to stimuli affecting the vascular and macula densa mechanisms. Reduction of renal perfusion pressure, intravenous infusion of furosemide, and captopril administration cause a greater increase in renin release from innervated kidneys than from denervated kidneys. A complex interaction between neural and non-neural mechanisms in the control of renin secretion is suggested. Efferent renal nerve activity controlling the renin secretion rate is mainly under the inhibitory influence of vagal afferent fibers originating from the cardiopulmonary region. Recent experiments have demonstrated that a similar reflex tonic inhibition of renin secretion is also exerted by renal afferent fibers.

Humans↗
PubMed1989

Marked blood pressure fluctuations during narcoleptic attacks alternating with abnormal wakefulness: effects of treatment with clonidine.

A middle-aged man was admitted to our department because of sleep-wake cycle disorders (alternating hypersomnia and sleeplessness), bipolar behavioural disturbances and marked fluctuations in blood pressure and heart rate. Neither evident precipitating stimuli nor an obvious cause for his illness were found. When tests that normally activate intrinsic autonomic responses were performed, two distinct circulatory patterns were recognized. During hypersomnia (phase A), cardiovascular reflex activity was blunted or abolished and orthostasis could not be maintained. The clinical, biochemical, behavioural pictures and the observed decrease in sympathetic outflow resembled the effects of clonidine administration. On the contrary, during sleeplessness (phase B) the autonomic pathways were functionally integral and orthostatic hypotension was not detected. The clinical, biochemical, behavioural features and cardiovascular overactivity closely mimicked the abrupt withdrawal syndrome encountered with clonidine. Three hypothetical mechanisms are advanced to explain this intriguing case as well as the acute and chronic relief of our patient's clinical problem following institution of clonidine therapy (phase C). The role played by central alpha adrenoceptors in integrating sleep-wake, cardiovascular and behavioural functions is also suggested.

Blood Pressure↗
PubMed1989

Nadolol prevents the exercise-induced rise in lymphocyte beta-receptor number in borderline hypertension.

Thirteen borderline hypertensives were investigated at rest and during dynamic exercise, before and after therapy with nadolol (40-80 mg/day for 7-28 days), in order to evaluate regulation of the number of lymphocyte beta-receptors. Systolic blood pressure and the heart rate were measured before and after 15 min of bicycle exercise, both with and without nadolol therapy; blood samples were withdrawn for adrenaline, noradrenaline and lymphocyte beta-receptor determinations. Nadolol induced a significant decrease in systolic blood pressure and the heart rate at rest, while plasma catecholamines and lymphocyte beta-receptors did not change significantly. Of the physiological responses to dynamic exercise (increases in systolic blood pressure, heart rate, plasma noradrenaline levels and adrenaline and lymphocyte beta-receptors), only the rise in beta-receptors was entirely prevented, and the increase in the heart rate was significantly attenuated by nadolol. It is suggested that the lack of a rise in the number of beta-receptors during exercise may contribute to the blunted exercise-induced tachycardia in patients taking nadolol.

Adult↗
PubMed1989

Right ventricular wall thickness and function in hypertensive patients with and without left ventricular hypertrophy: echo-Doppler study.

The structure and function of the right ventricle in arterial hypertension have been the subject of only a few reports. The present study evaluated the functional and structural changes in both left and right ventricles. Doppler and standard echocardiography were performed in 58 hypertensive patients (33 without and 25 with left ventricular hypertrophy). We concluded that right ventricular wall thickness is significantly increased in hypertensive patients compared with normotensive subjects, and that there is a significant, direct correlation between right and left ventricular thickness. Abnormalities in right and left ventricular filling, characterized by a reduction in early and an increase in late diastolic flow velocity, occur in hypertensive patients, and there is a direct correlation between late mitral and tricuspidal flow velocities and left and right ventricular thickness.

Adult↗
PubMed1989

Role of the renal nerves in the natriuretic response to vasopressin infusion.

The present study was designed to determine whether renal nerves influence the natriuretic response to an infusion of vasopressin. Experiments were performed on anaesthetized rats in which the response to vasopressin of the innervated kidney was compared with that of the contralateral surgically denervated kidney. During the vasopressin infusion the natriuretic effect was evident in both kidneys and was proportionally greater in the innervated kidney than in the denervated one. Efferent renal nerve activity, recorded in three additional animals, decreased during the vasopressin infusion. Our data demonstrate that the natriuretic response of the innervated kidney is larger than that of the denervated kidney, probably because of an associated decrease in efferent renal nerve activity.

Animals↗
PubMed1989

Time-course of the changes in blood pressure and in plasma renin activity during the first week after dilation of renal artery stenosis.

We measured arterial pressure and plasma renin activity throughout the first week after a technically successful percutaneous transluminal renal angioplasty (PTRA) in 12 patients with hypertension and unilateral renal artery stenosis. Mean arterial pressure fell from 126 +/- 4 to 105 +/- 3 mmHg within 1-2 days of PTRA and stabilized thereafter; in addition, plasma renin activity decreased sharply during the first 2 days after the angioplasty (from 5.2 +/- 2.3 to 1.3 +/- 0.3 ng/ml per h) but continued to decline, reaching 0.8 +/- 0.2 ng/ml per h at the end of the study. When the antihypertensive effect of PTRA was examined in relation to baseline values of plasma renin activity, the patients with low, intermediate and high plasma renin activity showed percentage decreases in mean arterial pressure of, respectively, 6%, 16% and 19% by the sixth day of observation after the angioplasty. No overall correlation was found between the changes in arterial pressure and those in plasma renin activity induced by PTRA. These data suggest that the beneficial effect of PTRA on blood pressure can be estimated within a few days and that the reduction in the activity of the renin system is the principal but not the sole mechanism responsible for it.

Adult↗
PubMed1989

Osmoregulation of vasopressin during acute lowering of arterial pressure by clonidine in moderate hypertension.

Hypertonic saline (100 mmol in 50 ml) was injected intravenously over 5 min in two groups of moderate essential hypertensive patients (group 1, n = 13; group 2, n = 6). In group 2, arterial pressure had been lowered by infusion of clonidine (0.3 mg in 100 ml saline), from 186 +/- 8/116 +/- 3 to 146 +/- 9/98 +/- 5 mmHg (mean +/- s.e.m.). The hypertonic stimulus increased the plasma osmolality of all subjects from 288 +/- 1 to 296 +/- 1 mosmol/kg (P less than 0.01). Plasma vasopressin increased from baseline values that were not significantly different (P less than 0.01) in each of the two groups. The increase in plasma vasopressin was significantly greater (P less than 0.05) in the group 2 hypertensives with a reduced arterial pressure (+7.81 +/- 1.79 pg/ml) than in the group 1 untreated hypertensives (+3.15 +/- 1.2 pg/ml). In our study, acute lowering of arterial pressure by clonidine did not significantly change baseline vasopressin, but facilitated osmotically induced vasopressin secretion.

Blood Pressure↗