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Biomedical subjects

E Grossman

Publications and source records attributed to E Grossman.

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

The calcium antagonist controversy: a posthumous commentary.

In 1995, some retrospective reports showed that certain patients treated with short-acting calcium antagonists were at increased risk for myocardial infarction and had a higher mortality rate compared with patients treated with other cardiovascular drugs. Subsequent reports attempted to establish a connection between calcium antagonists and disorders as diverse as malignancy, Parkinsonism, cognitive dysfunction, and suicide. However, other retrospective studies and, more compelling, several prospective studies have reported that calcium antagonists exert a beneficial effect on morbidity and mortality in a variety of cardiovascular disorders such as hypertension, ischemic heart disease after myocardial infarction, and congestive heart failure due to dilated cardiomyopathy. Calcium antagonists are a heterogeneous drug class, and distinct differences have been documented between short- and long-acting, as well as between dihydropyridine and nondihydropyridine, agents. Sympathetic activation, which is a risk factor for coronary events, occurs with short-acting agents only and is absent with long-acting calcium antagonists. Recent data make it extremely unlikely that calcium antagonists increase the risk of malignancy by affecting apoptosis or immunosuppression or both. Long-acting calcium antagonists have distinct benefits in patients with hypertension and diabetes and may be more beneficial than other drugs in patients with diabetes and left ventricular hypertrophy.

Calcium Channel Blockers↗
PubMed1998

Are beta-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review.

OBJECTIVE: To assess antihypertensive efficacy of beta-blockers and their effects on cardiovascular morbidity and mortality and all-cause morbidity compared with diuretics in elderly patients with hypertension. DATA SOURCE: A MEDLINE search of English-language articles published between January 1966 and January 1998 using the terms hypertension (drug therapy) and elderly or aged or geriatric, and cerebrovascular or cardiovascular diseases, and morbidity or mortality. References from identified articles were also reviewed. DATA SELECTION: Randomized trials lasting at least 1 year, which used as first-line agents diuretics and/or beta-blockers, and reported morbidity and mortality outcomes in elderly patients with hypertension. DATA SYNTHESIS AND RESULTS: Ten trials involving a total of 16164 elderly patients (> or =60 years) were included. Two thirds of the patients assigned to diuretics were well controlled on monotherapy, whereas less than a third of the patients assigned to beta-blockers were well controlled on monotherapy. Diuretic therapy was superior to beta-blockade with regard to all end points and was effective in preventing cerebrovascular events (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.51-0.72), fatal stroke (OR, 0.67; 95% CI, 0.49-0.90), coronary heart disease (OR, 0.74; 95% CI, 0.64-0.85), cardiovascular mortality (OR, 0.75; 95% CI, 0.64-0.87), and all-cause mortality (OR, 0.86; 95% CI, 0.77-0.96). In contrast, beta-blocker therapy only reduced the odds for cerebrovascular events (OR, 0.75; 95% CI, 0.57-0.98) but was ineffective in preventing coronary heart disease, cardiovascular mortality, and all-cause mortality (ORs, 1.01, 0.98, and 1.05, respectively). CONCLUSIONS: In contrast to diuretics, which remain the standard first-line therapy, beta-blockers, until proven otherwise, should no longer be considered appropriate first-line therapy of uncomplicated hypertension in the elderly hypertensive patient.

Adrenergic beta-Antagonists↗
PubMed1998

[Orthostatic hypotension as a manifestation of malignant lymphoproliferative disease].

An 85-year-old man was admitted with 6-month history of incapacitating orthostatic hypotension. Investigation led to the discovery of sympathetic dysautonomia, sensorimotor neuropathy and malignant lymphoproliferative disease. Several attempts to treat the orthostatic hypotension or the neoplastic disease failed to improve his condition. Orthostatic hypotension precipitated by sympathetic dysautonomia may be an infrequent effect of early malignant lymphoproliferative disease.

Aged↗
PubMed1998

Comparative tolerability profile of hypertensive crisis treatments.

Hypertensive crisis is defined as a severe elevation in BP and is classified as either urgency or emergency. In hypertensive urgency there is no end-organ injury and no evidence that acute BP lowering is beneficial. Indeed, rapid uncontrolled pressure reduction may be harmful. Therefore, in hypertensive urgencies BP should be lowered gradually over 24 to 48 hours using oral antihypertensives. When the cause of transient BP elevations is easily identified, appropriate treatment should be given. When the cause is unknown, an oral antihypertensive should be given. The efficacy of available treatments appear similar; however, the underlying pathophysiological and clinical findings, mechanism of action and potential for adverse effects should guide choice. Captopril should be avoided in patients with bilateral renal artery stenosis or unilateral renal artery stenosis in patients with a solitary kidney. Nifedipine and other dihydropyridines increase heart rate whereas clonidine, beta-blockers and labetalol tend to decrease it. This is particularly important in patients with ischaemic heart disease. Labetalol and beta-blockers are contraindicated in patients with bronchospasm and bradycardia or heart blocks. Clonidine should be avoided if mental acuity is desired. In hypertensive emergency there is an immediate threat to the integrity of the cardiovascular system. BP should be immediately reduced to avoid further end organ damage. Sodium nitroprusside is the most popular agent. Nitroglycerin (glyceryl trinitrate) is preferred when there is acute coronary insufficiency. A beta-blocker may be added in some patients. Loop diuretics, nitroglycerin and sodium nitroprusside are effective in patients with concomitant pulmonary oedema. Enalaprilat is also theoretically helpful, especially when the renin system might be activated. Initial treatment of aortic dissection involves rapid, controlled titration of arterial pressure to normal levels using intravenous sodium nitroprusside and a beta-blocker. If beta-blockers are contraindicated, urapidil or trimetaphan camsilate are alternatives. Hydralazine is the drug of choice for patients with eclampsia. Labetalol, urapidil or calcium antagonists are possible alternatives if hydralazine fails or is contraindicated. For patients with catecholamine-induced crises, an alpha-blocker such as phentolamine should be given; labetalol or sodium nitroprusside with beta-blockers are alternatives. There are few, if any, comparative or randomised trials providing definitive conclusions about the efficacy and safety of comparative agents. Some investigators recommend decreasing the diastolic BP to no less than 100 to 110 mm Hg. A reasonable approach for most patients with hypertensive emergencies is to lower the mean arterial pressure by 25% over the initial 2 to 4 hours with the most specific antihypertensive regimen.

Acute Disease↗
PubMed1998

Effect of calcium antagonists on sympathetic activity.

OBJECTIVE: We evaluated the effects of calcium antagonists on sympathetic activity in hypertensive patients by searching Medline for English language articles published between 1975 and May 1996 using the terms calcium antagonists, sympathetic nervous system and catecholamines. METHODS: Data from clinical studies reporting only the effects of calcium antagonists on blood pressure, heart rate and plasma norepinephrine (NE) levels in patients with hypertension were analysed according to class of calcium antagonist (dihydropyridine vs non-dihydropyridine), their duration of action (short-acting (SA) vs long-acting (LA)) and treatment duration. RESULTS: We identified 63 studies involving 1252 patients. Acutely after single dosing, SA calcium antagonists decreased mean arterial pressure by 13.7 +/- 1.1% and increased heart rate by 13.7 +/- 1.4% and NE levels by 28.6% +/- 2.5%. Change in NE levels correlated with change in heart rate (r = 0.59, P < 0.01) and inversely with change in arterial pressure (r = 0.46, P < 0.05) in patients taking dihydropyridine calcium antagonists acutely. With sustained therapy, both classes of SA calcium antagonists increased NE levels. Whereas NE levels remained slightly elevated and heart rate unchanged with LA dihydropyridine calcium antagonists, both heart rate and NE levels decreased with LA non-dihydropyridine calcium antagonists. SA calcium antagonists stimulate sympathetic activity when given acutely and over the long term, irrespective of their molecular structure. In contrast, sympathetic activation is less pronounced with LA dihydropyridine calcium antagonists and falls with LA non-dihydropyridine calcium antagonists. CONCLUSIONS: The present findings offer a possible pathophysiological explanation for the increase in morbidity and mortablity observed in some studies using SA calcium antagonists.

Blood Pressure↗
PubMed1997

Effect of calcium antagonists on plasma norepinephrine levels, heart rate, and blood pressure.

To evaluate the effects of calcium antagonists on sympathetic activity in hypertensive patients, a MEDLINE search for English language articles published between 1975 and May 1996 using the terms calcium antagonists, sympathetic nervous system, and catecholamines was conducted. Clinical studies only reporting the effects of calcium antagonists on blood pressure, heart rate, and plasma norepinephrine (NE) levels in patients with hypertension were included. Data were combined and analyzed according to class of calcium antagonist (dihydropyridine vs nondihydropyridine), their duration of action (short-acting [SA] vs long-acting [LA]), and treatment duration. We identified 63 studies involving 1,252 patients. Acutely after single dosing, SA calcium antagonists decreased mean arterial pressure by 13.7 +/- 1.1% and increased heart rate by 13.7 +/- 1.4% and NE levels by 28.6 +/- 2.5%. Change in NE levels correlated with change in heart rate (r = 0.59, p <0.01) and inversely with change in arterial pressure (r = 0.46, p <0.05) in patients taking dihydropyridine calcium antagonists acutely. With sustained therapy, both classes of SA calcium antagonists increased NE levels. Whereas NE levels remained slightly elevated and heart rate unchanged with LA dihydropyridine calcium antagonists, both heart rate and NE levels decreased with LA nondihydropyridine calcium antagonists. SA calcium antagonists stimulate sympathetic activity when given acutely and over the long term, irrespective of their molecular structure. Sympathetic activation is less pronounced with LA dihydropyridine calcium antagonists and decreases with LA nondihydropyridine calcium antagonists. These data offer a possible pathophysiologic explanation for the increase in morbidity and mortality observed in some studies using SA calcium antagonists.

Adult↗
PubMed1997

Does hormone replacement therapy inhibit coronary artery calcification?

OBJECTIVE: To determine the association between the use of hormone replacement therapy (HRT) and coronary calcium, in postmenopausal women who had no history of coronary artery disease by double helical computed tomography (CT). METHODS: We used CT to compare the prevalence and extent of coronary calcium in 41 postmenopausal women who were on HRT from the first year of menopause and 37 age-matched controls who had never used HRT. RESULTS: Both groups had a similar rate of smoking, hypertension, a positive family history, and hypercholesterolemia. Coronary calcification was observed in 28.2% of the 78 women studied. The prevalence of coronary calcium was significantly lower among HRT users: six of the 47 (14.6%), compared with 16 of the 37 nonusers (43.2%) (P < .01). The recorded risk factors had no effect on the prevalence of coronary calcium. Stepwise logistic regression analysis, including age, coronary risk factors, and HRT use as independent variables, yielded HRT as the only variable determining the presence of coronary calcium (odds ratio = 0.2; 95% confidence interval 0.06, 0.63; P = .006). CONCLUSION: The lower incidence of coronary calcium in the HRT users suggests that HRT is associated with decreased prevalence of the coronary calcification.

Calcinosis↗
PubMed1997

Combination therapy and target organ protection in hypertension and diabetes mellitus.

Both essential hypertension and diabetes mellitus affect the same major target organs-the brain, the fundi, the heart, and the kidneys. The common denominator of hypertensive/diabetic target organ disease is the vascular tree. Both hypertension and diabetes are well identified risk factors for atherogenesis. Coronary artery disease is much more common in diabetic hypertensive patients than in patients suffering from hypertension or diabetes alone. Typical for the diabetic hypertensive heart are extensive degenerative changes and a greater degree of hypertrophy compared with the nondiabetic hypertensive heart. The combined presence of hypertension and diabetes concomitantly affects glomerular filtration rate and renal blood flow, thereby greatly accelerating a decrease in renal function. Hypertension accelerates the development of diabetic retinopathy; hypertensive/diabetic cerebral disease leads to vascular dementia, transient ischemic attacks, and strokes. A decrease in the hemodynamic and glycemic burden is the primary goal in the management of the hypertensive diabetic patients. Both diuretics and beta-blockers have been reported to adversely affect the overall risk factor profile in the diabetic patient. In contrast, the postsynaptic alpha-blockers, the calcium antagonists, and the angiotensin-converting enzyme inhibitors have been reported to be either neutral or beneficial with regard to the overall metabolic risk factor profile. The combination of a heart rate lowering calcium antagonist, particularly verapamil, with an ACE inhibitor offers some potential to either prevent or reverse target organ disease associated with hypertension and diabetes.

Diabetes Complications↗
PubMed1997

The effects of a combined low-sodium, high-potassium, high-calcium diet on blood pressure in patients with mild hypertension.

Nutritional sodium, potassium and calcium are considered to be important regulators of blood pressure (BP). The present study evaluates the effects of combined low-sodium (LS), high-potassium (HK), high-calcium (HCa) diet on BP in patients with mild essential hypertension. Thirty-six patients (26 M, 10 F), 24-67 years of age (mean 46 +/- 8), participated in the study. Patients were divided into three groups and given a diet consisting of three 1-month segments, which they followed in different order. Group 1 (n = 11) received LS diet followed by the addition of HCa and then HK. The order in Group 2 (n = 12) was HK-LS-HCa; and in Group 3 (n = 13) it was HCa-HK-LS. The third month of the study all patients were eating a combined LS, HK and HCa diet. Urinary electrolytes were measured to confirm compliance with the diets. After 1 month of the LS diet urinary sodium excretion decreased significantly by 25 mmols/day (95% CI, 1-48 mmols/day); (P < 0.05). Eighteen patients did not comply with the diet. Systolic BP (SBP) only slightly decreased, from 142 mm Hg (95% CI, 137-146 mm Hg) to 138 mm Hg (95% CI, 133-142 mm Hg); (P = 0.11). The change in SBP was related to the change in urinary sodium excretion (R = 0.46; P = 0.006). After 1 month of the HK diet, urinary potassium excretion increased by only 5 mmols/day (P = NS). BP was unaffected by HK and HCa diet. At the end of the study, urinary sodium excretion decreased from 183 mmols/day (95% CI, 155-211 mmols/day) to 148 mmols/day (95% CI, 131-165 mmols/day); (P < 0.05), urinary potassium excretion slightly increased from 75 mmols/day (95% CI, 68-82 mmols/day) to 85 mmols/day (95% CI, 76-94 mmols/day); (P = 0.09), and urinary calcium excretion remained unchanged. BP did not decrease. It is concluded that only the LS diet may be advantageous in patients with mild essential hypertension.

Adult↗
PubMed1997

Prevalence of modalities of headaches and bruxism among patients with craniomandibular disorder.

This study compared the presence of headache and bruxing behavior among 133 craniomandibular disorder patients (CMD) referred to the The Center For the Study Of Craniomandibular Disorders and to the presence of headache and bruxing behavior occurring in 133 controls seeking routine dental care. Both patients and controls were consecutive referrals to the clinic occurring over a three year period. The mean age of the CMD group was 38 years (range 28-42), and the mean age of the controls was 37 years (range 25-44). The information gathered included questionnaire and clinical examination. Different types of headaches, signs and symptoms of CMD, and bruxing behavior were assessed both in the CMD group and in the corresponding control group. Results of this study showed that bruxing behavior and headache pain were significantly more prevalent in the CMD group (57%, 76%) than in the corresponding control group (37%, 49%). Of the three types of headache observed, tension and combination headaches were more prevalent in the CMD group (n = 48 = 36% and n = 37 = 28%). Migraine headache was more prevalent in the CMD group (n = 16 = 12%) than in the control group (n = 3 = 2%). It was concluded that headache and bruxing behavior predominated in CMD patients. This data reinforces the need to assess headache pain and signs and symptoms of bruxing behavior in CMD patients, particularly in those suffering chronic facial pain and headache.

Adult↗
PubMed1997

Peripartum cardiomyopathy occurring in a patient previously treated with doxorubicin.

We present a 28-year-old primigravida woman in whom congestive heart failure developed 3 months after delivery of a neonate. The patient underwent doxorubicin treatment 10 years previously. The combined cardiotoxicity of prior doxorubicin treatment and pregnancy is considered, and the importance of careful follow-up of cardiac function during pregnancy and postpartum in patients previously treated with doxorubicin is stressed.

Adult↗