Comparison of two adrenergic beta-receptor blocking agents, alprenolol and propranolol, in treatment of angina pectoris.
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Biomedical subjects
Publications and source records attributed to G Nyberg.
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Twenty-one patients with angina pectoris took part in a double-blind cross-over comparison of alprenolol (an adrenergic beta-blocker), pentanitrol (pentaerythritol tetranitrate), and placebo. Two-thirds of the patients were clinically improved on alprenolol 100 mg. four times daily, which was found to be significantly better than pentanitrol 30 mg. four times daily and placebo. There was also an indication of reduced severity of anginal attacks during alprenolol therapy. It is concluded that success in at least two-thirds can be expected with alprenolol. No serious complications or side-effects occurred during alprenolol treatment.
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The objective of this single-dose study was to evaluate the pharmacokinetics and haemodynamic changes in healthy male subjects following the administration of three oral (5, 15, and 40 mg) and two intravenous (1 and 3 mg) doses of felodipine, a new calcium antagonist with a selective effect on the peripheral resistance vessels. Felodipine was rapidly absorbed within 1 h when administered as an oral solution, but underwent extensive presystemic elimination. The systemic availability varied between 10 and 23 per cent. The disposition was adequately described by a two-compartment model: the disposition was essentially dose-independent up to 40 mg orally and 3 mg intravenously. Felodipine produced significant dose-dependent reduction of diastolic blood pressure and a significant reflexogenic increase in heart rate, without having any major effect on systolic blood pressure. These changes indicate that felodipine acts predominantly as an arteriodilator. The decrease in diastolic blood pressure and increase in heart rate were closely correlated with the plasma concentrations of unchanged felodipine, being maximal at 0.5 h and lasting for at least 4 h after the highest dose.
Specimens of human adipose tissue were maintained in vitro for one week and cell size as well as metabolic rates determined before and after the culture period. Large fat cells from obese donors decreased towards 'normal' cell size while this was not the case for cells from non-obese donors. This decrease was probably due to the increased lipolysis found while glucose incorporation was unchanged. Analogous to the findings with obese subjects placed on a weight-reducing regimen, the present data show that when large fat cells are removed from their anabolic, hyperinsulinic environment, 'normalization' in cell size occurs.
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Glomerular ultrastructure was studied in 12 long-term insulin dependent diabetic patients with fairly advanced nephropathy. This article discusses the observation of capillary profiles in the glomerular tuft of a deviating ultrastructure: the basement membrane (BM) is focally extremely thin and in between it presents a very loose fluffy texture, resembling the BM in immature glomeruli. Such thin-walled capillaries (TWC) constituted 1 to 5% of total capillary length and surface. The second observation reported here is the presence of vessels within the BM of Bowman's capsule. These capillaries were lined with fenestrated endothelium, and the capsular epithelium sometimes presented foot process formation. It is suggested that both types of capillaries represent new vessel formation in the renal corpuscle in these cases of advanced diabetic glomerulopathy.
The suggested harmful effect of dietary protein on renal function in diabetic nephropathy was tested in three groups of insulin-dependent diabetic patients: 1) 10 patients without signs of nephropathy in spite of at least 30 years of diabetes; 2) 11 patients with nephropathy and reduced but stable glomerular filtration rate (GFR) (decline less than 4 ml/min per year [mean 1.8] during the last 2 years); 3) 10 patients with progressive nephropathy with GFR declining by an average of 11 ml/min per year. Dietary protein intake was estimated from a dietary history interview, as well as from urinary excretion of nitrogen (mean = 4.7 samples). Both methods showed a wide range of protein intake in all three groups of patients (0.6-2.3 g/kg body weight [BW]). The mean values did not differ between the groups, 1.30, 1.34, and 1.24 g/kg BW by interview, and 1.20, 1.10, and 1.13 g based on urinary nitrogen levels. There was no correlation between rate of decline of GFR and protein intake, even in those patients with no or minimal decline. These results do not support the hypothesis that dietary protein is a factor of importance in the development or progression of human diabetic nephropathy.
Twenty-seven patients with Type I diabetes and diabetic nephropathy were repeatedly tested (mean, 6 times per patient) for residual urine volumes with a noninvasive technique. Results in 43 of 162 investigations (27%) were abnormal, with residual volumes of greater than 15 ml. Twelve of 162 (7%) showed a residual volume greater than 100 ml. In any individual patient the occurrence of residual volumes was not a consistent finding, and the volumes varied. Pathologic residual volumes were more common in men, but all those with bacteriuria were women. All patients with residual volumes (N = 16) were given voiding instructions. There was no increase in residual volumes during the observation period (mean, 32 months), the median residual volume being 8 ml at the first observation and 5 ml at the last observation. The occurrence of residual urine could not be shown to correlate with progression of renal insufficiency. It is suggested that all patients with long-standing Type I diabetes should be tested by a noninvasive technique for residual urine volume and given voiding instructions to avoid acute retention episodes and complete atony of the bladder.
Six young healthy males received on four different occasions 0.4 mg/kg i.v. of propranolol. 0.04 mg/kg i.v. of atropine, atropine following propranolol or saline. heart rate and blood pressure were recorded at rest (supine, sitting, and standing) and during isometric and dynamic exercise. On the basis of heart rate changes under the influence of drugs, the sympathetic contribution to heart rate was 25% at supine rest, 33% in the standing position, 45% during handgrip, and 74% during bicycle exercise that raised heart rate to 153/min. These results suggest that with increasing muscular activity the contribution of parasympathetic tone to heart rate decreases from about 75% at supine rest to about 25% at submaximal exercise. Extrapolation of the heart rate plots indicate that parasympathetic tone is virtually abolished at exercise loads resulting in a heart rate of about 200 beats/min.
1. A study of the influence of single oral doses of the adrenergic-beta-receptor anatagonists alprenolol (100 mg) and propranolol (50 mg) on the accommodation of the lens was made in six healthy male subjects. 2. There was no significant influence of either drug on lens accommodation.
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The effects of 6 weeks of treatment with captopril on the renal hemodynamics of 16 patients with treatment-resistant renal hypertension (six had diabetic nephropathy, seven had other renal parenchymatous disease, and three had renovascular disease) were studied. Significant changes in glomerular filtration rate, filtration fraction, plasma renin activity, urinary aldosterone, and mean blood pressure were noted in the patients with renal parenchymatous disease, but not in those with diabetic nephropathy. Renal blood flow remained unchanged in all patients. Captopril was well tolerated.