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Biomedical subjects

C V Ram

Publications and source records attributed to C V Ram.

At least 55 records · Page 3Linked to original sources
PubMed1987

Antihypertensive therapy in the elderly. Effects on blood pressure and cerebral blood flow.

Antihypertensive therapy significantly reduces cardiovascular morbidity and mortality in the rapidly growing population of elderly patients. However, the desire to treat more of these patients is dampened by the concern that a reduction in blood pressure may compromise cerebral blood flow, causing untoward consequences. This study evaluated the therapeutic effect of titrated doses of prazosin, an alpha-adrenergic blocking agent, on systemic blood pressure and cerebral blood flow in elderly patients with chronic stable hypertension. Prazosin alone or co-administered with hydrochlorothiazide significantly lowered mean systolic and diastolic blood pressures in 31 elderly hypertensive patients. At the same time, however, there was no significant change in cerebral blood flow, which was measured in eight patients. Neither harmful biochemical changes nor treatment-related adverse effects were observed in any patients. Prazosin therapy alone or in combination with low-dose diuretic therapy was effective in the treatment of hypertension in this elderly population. Furthermore, blood pressure reduction with prazosin therapy was accomplished without compromising cerebral blood flow and without unfavorably altering lipid profiles.

Aged↗
PubMed1987

The inconsistent effects of calcium supplements upon blood pressure in primary hypertension.

The effects of 800 mg of elemental calcium per day (calcium carbonate or calcium citrate) on blood pressure were compared with a placebo in a controlled randomized, crossover, double-blinded trial involving 26 patients with uncomplicated primary hypertension. Each patient took two of the three forms of therapy orally for 8-week intervals with a 2-week washout period in between. Standing mean blood pressure rose an average of 5.7 mm Hg on placebo, rose an average of 0.5 mm Hg on calcium carbonate, and fell an average of 2.2 mm Hg on calcium citrate. Changes in sitting mean pressures averaged +1.9 mm Hg on placebo, -0.4 mm Hg on calcium carbonate, and -0.4 mm Hg on calcium citrate. Some patients had a fall, others had a rise in blood pressure on each form of calcium. Similarly, inconsistent responses were noted among the nine patients who took both forms of calcium. Neither initial nor post-treatment biochemical measures nor patient characteristics were predictive of the blood pressure response. Combinations of various measures and characteristics analyzed by the multiple regression technique explained only 30% of the overall variability in blood pressure. Therefore, until ways can be found to predict the response, calcium supplements should not be routinely prescribed for the treatment of hypertension and, if given for any indication, blood pressure should be monitored.

Adult↗
PubMed1987

Calcium antagonists as antihypertensive agents are effective in all age groups.

Calcium antagonists have added a new dimension to the therapy of hypertension. They have proved to be versatile, effective drugs for the short- and long-term management of hypertension. Since these drugs have favourable effects on tissue blood flow, they offer the hope of providing tissue protection in hypertensive patients. Some investigators have claimed that the effectiveness of calcium antagonists in hypertension is age-dependent, older subjects showing a better response than younger individuals. However, a careful analysis reveals that calcium antagonists are effective in all age groups and the magnitude of response may be related to the level of pretreatment blood pressure.

Aging↗
PubMed1987

Renal hemodynamic effects of ketanserin therapy in essential hypertension.

Ketanserin is a novel agent that has been shown to be a specific 5-HT2-serotonergic antagonist. It has useful antihypertensive properties. Owing to its unique mechanism of action, it has been suggested that ketanserin may have a favorable effect on tissue blood flow during chronic therapy for hypertension. This double-blind study was designed to evaluate the acute (1 week) and chronic (8 weeks) effects of ketanserin on renal hemodynamic parameters and renin-aldosterone axis in patients with uncomplicated hypertension. Compared to placebo, ketanserin caused a significant blood pressure reduction at the end of the 8-week study period. Despite the reduction in systematic arterial pressure, glomerular filtration rate and renal plasma flow were preserved. Ketanserin therapy induced a slight reduction in plasma renin activity and a marginal increase in the sodium excretion. Although the results of this study are limited by the small number of patients, it appears that ketanserin may have favorable renal hemodynamic effects in uncomplicated essential hypertension.

Aged↗
PubMed1987

Geriatric hypertension: antihypertensive therapy in coronary artery disease.

Systemic hypertension is a common clinical problem in the elderly. There is emerging evidence to suggest that with careful utilization of antihypertensive drugs, blood pressure can be lowered in the elderly population. Whether isolated systolic hypertension should be treated aggressively remains an unanswered question despite the evidence that systolic hypertension can cause certain cardiovascular complications. An elderly patient with hypertension and concomitant coronary artery disease merits proper blood pressure control with appropriate drugs to prevent progression of coronary disease. The therapeutic objective is not only to lower the blood pressure but to accomplish this goal with drugs which are likely to have a favorable effect on coronary artery disease. Changing trends in the drug therapy of hypertension indicate that calcium antagonists and beta-blocking drugs offer a therapeutic advantage in elderly hypertensive patients with coronary artery diseases.

Adrenergic beta-Antagonists↗
PubMed1987

Therapeutic survey: hypertensive emergencies.

The most crucial aspect is to ascertain whether the patient's condition truly warrants emergency management. The choice of oral versus parenteral drug(s) depends on the urgency of the situation as well as the patient's general condition. The level to which the blood pressure should be lowered varies with the type of hypertensive crisis and should be strictly individualized. There is no predestined level for the goal of therapy. Complications of therapy--namely, hypotension and ischemic brain damage, can occur in patients receiving multiple potent antihypertensive drugs in large doses without adequate monitoring. Such complications can be minimized by gentle lowering of blood pressure. An asymptomatic patient who presents with severe hypertension, i.e., a diastolic blood pressure 130-140 mmHg, need not be treated with parenteral drugs. After the resolution of a hypertensive crisis, one should determine the possible factors that might have contributed to the development of the hypertensive crisis such as non-adherence to prescribed therapy or the presence and/or progression of a secondary form of hypertension such as renal artery stenosis.

Administration, Oral↗
PubMed1985

Failure of alpha-methyltyrosine to prevent hypertensive crisis in pheochromocytoma.

Sudden onset of a hypertensive crisis occurred shortly after induction of anesthesia in a patient with malignant pheochromocytoma, despite preoperative medical preparation with alpha-methyltyrosine (alpha-methyl-p-tyrosine) and propranolol hydrochloride. Other investigators have advocated alpha-methyltyrosine as the medical therapy of choice in the preoperative preparation of patients with pheochromocytoma. This case emphasizes the caution that should be exercised when using alpha-methyltyrosine preoperatively, without concurrent alpha-adrenergic blocking agents, to prevent intraoperative hypertensive crisis.

Adrenal Gland Neoplasms↗
PubMed1984

Should mild hypertension be treated? Choosing the middle course.

While the benefits obtained by treating moderate and severe hypertension are clearly documented, the same is not true for mild hypertension. Since mild hypertension (by any definition) is widely prevalent, therapeutic recommendations must not be made casually. The decision to treat mild hypertension must be made only after careful consideration of the overall risk profile and the direction of the blood pressure level.

Adult↗
PubMed1984

Beta-adrenergic blockade alone does not decrease renal perfusion in black hypertensives.

We assessed the effects on renal haemodynamics in 18 black patients with essential hypertension of acute and chronic beta-adrenergic blockade with three agents having different properties: atenolol, nadolol or propranolol. Six patients received each drug. In our patients the antihypertensive response to beta-blockers was minimal or nonexistent. This permitted us to analyse the effects on renal haemodynamics of 'pure' beta-blockade, as opposed to the combined effects of beta-blockade and decreased systemic perfusion pressure. In this setting, neither acute nor chronic administration (two months) of each of these agents decreased renal perfusion. We conclude, therefore, that beta-blockade per se has no deleterious effect on renal function and previous observations are most probably accounted for by the blood pressure lowering effect of these drugs, either alone or coupled with beta-blockade of the renal vasculature allowing unopposed alpha-sympathetically mediated vasoconstriction.

Adrenergic beta-Antagonists↗
PubMed1984

Comparison of nitrendipine combined with low-dose hydrochlorothiazide to hydrochlorothiazide alone in mild to moderate essential hypertension.

Patients with mild to moderate essential hypertension were treated in four centers with hydrochlorothiazide (HCTZ) 25 mg daily for 4 weeks. Those patients failing to achieve control (supine diastolic blood pressure (DBP) 90 mm Hg or lower) were randomly assigned to nitrendipine (NTP) 5 mg or placebo (PLA) b.i.d. NTP or PLA was increased stepwise to 20 mg b.i.d. as needed to achieve control. Treatment with HCTZ was maintained at 25 mg daily. Eighty-six patients completed the study: 41 in NTP + HCTZ and 45 in PLA + HCTZ groups. Both groups were comparable in baseline characteristics. Supine systolic blood pressure (SBP) was 148.6 +/- 14.4 and DBP was 96.0 +/- 5.4 mm Hg in the NTP + HCTZ group. SBP was 147.4 +/- 16.6 and DBP was 96.4 +/- 5.6 mm Hg in the PLA + HCTZ group. At the end of 7 weeks of titration and treatment with NTP or PLA combined with HCTZ, SBP had fallen to 133.4 +/- 15.1 and DBP to 85.4 +/- 5.9 mm Hg in the NTP + HCTZ group. SBP fell to 138.8 +/- 16.2 and DBP to 90.7 +/- 6.3 mm Hg in the PLA + HCTZ group. The increment in lowering of both SBP and DBP was significantly greater (p = 0.002 and p = 0.0007, respectively) in the NTP + HCTZ group compared to the PLA + HCTZ group.

Adult↗
PubMed1984

Hypertensive crisis.

Although uncommon, hypertensive crisis must be recognized properly and quickly so that immediate treatment can be instituted to prevent serious and irreversible complications. It is important to bear in mind that it is not necessarily the absolute level of hypertension that signals impending danger but the function of an affected target organ such as the heart or kidneys that allows the physician to make the diagnosis of hypertensive crisis. There are a variety of potent antihypertensive drugs that can lower the blood pressure promptly, but the choice must be based on careful clinical and hemodynamic assessment of the patient. The goal is to lower the blood pressure and to stabilize or improve the target organ function without causing underperfusion.

Antihypertensive Agents↗
PubMed1984

Acute aortic dissection.

Acute aortic dissection is the most lethal complication affecting the aorta. The use of two-dimensional echocardiography and computed tomography has greatly expanded the physician's ability to establish this diagnosis through noninvasive techniques. Surgery is the definitive treatment for type I and II dissection, whereas medical management with drugs that reduce cardiac output remains the treatment of choice in type III dissection. With improvements in surgical techniques, including cardiopulmonary bypass and composite grafting, immediate and long-term morbidity and mortality have been significantly reduced.

Aortic Dissection↗
PubMed1984

Effect of pindolol on potassium homeostasis in patients with essential hypertension.

A study of the effects of pindolol on potassium homeostasis was undertaken in 25 patients (19 women, 6 men) with essential hypertension. The patients were maintained on their usual diet and were withdrawn from antihypertensive therapy for three weeks before the study began. They were then randomly assigned to one of three treatment groups: (a) pindolol, 15 mg daily; (b) hydrochlorothiazide, 50 mg daily; and (c) both drugs combined. Total body potassium (TBK), urine aldosterone excretion, and plasma renin activity (PRA) were measured after eight weeks of therapy and compared with pretreatment values. Mean PRA remained unchanged in patients taking only pindolol or the drug combination, but it rose significantly in patients taking only hydrochlorothiazide. Mean urine aldosterone concentrations fell in patients taking only pindolol, rose in those taking only hydrochlorothiazide, and remained unchanged in those taking the combination. Mean TBK concentrations rose significantly in patients taking only pindolol or the combination, and fell significantly in those taking only hydrochlorothiazide. The rise in TBK concentrations with the combination clearly suggests that pindolol offsets the potassium wastage induced by diuretics, though probably by a mechanism outside the renin-aldosterone system. Because of this rise, it may be possible to eliminate potassium supplementation in patients taking the combination pindolol and hydrochlorothiazide.

Adult↗