Search PubMed⌕ Search

Biomedical subjects

P Verdecchia

Publications and source records attributed to P Verdecchia.

At least 127 records · Page 7Linked to original sources
PubMed1988

Duration of the antihypertensive action of atenolol, enalapril and placebo: a randomized within-patient study using ambulatory blood pressure monitoring.

Atenolol (A) and enalapril (E), two agents widely used as first-line monotherapy in arterial hypertension, have never been compared in their potency and duration of action by using 24-h ambulatory blood pressure monitoring (ABPM). Twelve out-patients (mean age 48.6 years - SD 7) with mild-to-moderate hypertension and supine diastolic blood pressure (Hawksley Random Zero Manometer) greater than 100 mmHg at the end of a 3-week placebo wash-out received, in double-blind and random order, A 100 mg daily, E 20 mg daily and placebo for 4 weeks each, according to a 3 x 3 latin square design. A 24-hour non-invasive ABPM (Spacelabs ICR 5200) was performed at the end of each of the 3 periods. In respect to placebo, both A and E produced a 24-h antihypertensive effect. The frequency of diastolic blood pressure values above 90 mmHg was 50.0% after placebo, 24.5% after A and 28.9% after E (a 51% reduction after A and a 42.3% reduction after E in respect to placebo - both p less than .05). Systolic blood pressure profiles differed less than 5 mmHg between placebo and A, as well as between placebo and E, between 9:30 and 10:30. Diastolic blood pressure profiles differed less than 5 mmHg between placebo and A over 2 h (between 2:30 and 3:30, and between 10:30 and 11:30), and between placebo and E over 2 other h (between 9:30 and 10:30, and between 11:30 and 12:30). None of the routine hematochemical parameters differed between placebo, A and E.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Home ambulatory blood pressure readings do not differ from clinic readings taken at the same time of day.

In most hypertensives clinic blood pressure (BP) is variably higher than home BP, but the underlying mechanisms are uncertain. We investigated whether the 24-hour ambulatory home BP profile as well as the office-home BP discrepancy could vary with the time of day of application of the recording system (from 08.00 h to 19.00 h) in 135 untreated hypertensives who underwent non-invasive home BP monitoring (ICR 5200). Neither systolic nor diastolic 24-hour home BP (average of daily readings, area-under-the-curve) varied significantly with the time of day of application of the system. Clinic BP was about 12% higher than 24-hour home BP in the whole population, mean values being 161.4/102.9 mmHg (office BP) vs 141.2/90.8 mmHg (average 24-hour home readings), as well as in each of the subcohorts based on the time of day of application of the system (all P less than 0.01). However, in none of the subcohorts were there any statistically significant differences between clinic BP and home BP readings taken at the same time of day as the clinic readings. No correlation was found between clinic heart rate and clinic-home discrepancy. We conclude that in essential hypertension 24-hr non-invasive ambulatory BP monitoring can begin indifferently from 08.00 h to 19.00 h with no expected influence of time of application on results and that clinic BP is not dissimilar from home BP at the same time of day.

Adult↗
PubMed1987

High prevalence of septal thickness overestimation in hypertensive subjects and controls.

The aim of our study was to assess the frequency of important problems in the ultrasonic estimate of septal thickness as a consequence of multiple endocardial lines inside the septum in echocardiographic tracings of otherwise good technical quality. We performed an echocardiographic study in a population composed of 311 subjects (131 essential hypertensive subjects and 180 normotensive healthy controls) by using M-mode echocardiography under two-dimensional control, according to the recommendations of the American Society of Echocardiography. We observed the presence of one or more continuous lines inside the septum, each of them simulating an endocardial border and thus producing the appearance of two or more superimposed septal thicknesses differing by 2 mm or more in greater than 50% of the subjects (54% normotensive and 56% hypertensive). Furthermore, within the group of subjects with multiple septal lines, we found the disappearance of at least one of the farthest linear echoes, with resulting septal thinning of almost 2 mm in 58% of the normotensive and 61% of the hypertensive subjects. These findings suggest the need for caution when interpreting echocardiographic measurements of left ventricular septal thickness. We suggest that in the presence of multiple lines inside the septum, the echocardiographic examination should be continued up to the appearance of the thinnest septal image, possibly devoid of multiple lines inside the septum.

Adult↗
PubMed1986

[Cardiac protection and antihypertensive therapy: facts and theories].

After a brief introduction on the problems involved in the interpretation of long-term trials, the methods and the results of large clinical trials, on cardioprotection (defined as the ability of a drug to reduce mortality from all causes or fatal cardiovascular events) are reviewed, with the aim of providing useful clinical information for the treatment of the hypertensive patients. At the end of the review the author draws the following conclusions: The benefits of antihypertensive therapy reported in male patients suffering from severe hypertension are such that further controlled trials with placebo are not acceptable from an ethical point of view. The incidence of fatal and non fatal cardiovascular events is relatively low in mild uncomplicated hypertension but increases three-fold in the presence or organ involvement. A statistically significant reduction of mortality from all causes and of fatal cardiovascular events has been obtained in such patients by means of antihypertensive treatment in the Australian trial, contrary to the results of the MRC trial and the Oslo study. Furthermore, the HDFP trial has shown that mortality from all causes an fatal cardiovascular events are less frequent among patients in stepped care than among those in referred care. The EWPHE trial has demonstrated that antihypertensive treatment reduces non fatal complications and probably reduces mortality in elderly hypertensive patients. Diuretics, sympatholytics and beta-blockers have been used in the large trials on cardioprotection. When several trials prove the equivalence of drugs of different efficacy and safety, it is acceptable to extend the results obtained with such drugs to the therapeutic class they belong to. An example is represented by the results of the MRC and IPPPSH trials on cardioprotection with beta-blockers in male non-smokers suffering from mild-moderate hypertension.

Adult↗
PubMed1985

Blood pressure changes over 20 years in nuns in a secluded order.

Blood pressure was recorded for 20 years in 138 nuns in a secluded order and in 126 lay women taken as controls. During the study period none of the nuns or control women smoked, took oral contraceptives or changed residence. Diet was unrestricted and comparable in the two groups. Subjects of both groups were consecutively enrolled without any selection parameters. During the 20 years of observation, systolic and diastolic blood pressure rose with age in the control women but remained almost unchanged in the nuns. The mean of the regression slope of systolic and diastolic blood pressure versus age, which was calculated for each subject, was 0.089 and 0.054 respectively in the nuns, as opposed to 2.171 and 0.742 in the lay women (both P < 0.001). Secluded nuns, who spend almost all their time in silence and prayer in the virtual absence of company apart from when attending religious celebrations, thus showed almost no change in blood pressure with age over a 20-year period. The results support the hypothesis that, at least in women, everyday stress may be a determinant of the progressive increase in blood pressure with ageing.

Adult↗
PubMed1985

Age and responses to isometric exercise in hypertension: possible predictors of the antihypertensive effect of diuretics and beta-blockers.

In a multicenter, randomized, double-blind study, 108 hypertensive patients were treated with either chlorthalidone 25 mg or slow-release metoprolol 200 mg both given once daily over 4 weeks. Blood pressure and heart rate at rest and at the peak of an isometric exercise test (30% of maximal voluntary contraction for 3 min) were recorded at random and at the end of the study. Both treatments induced a significant (p less than 0.01) blood pressure reduction at rest and at the peak exercise, 50.0% of patients on chlorthalidone and 59.2% on metoprolol, respectively, having a lying diastolic blood pressure less than 95 mmHg. A weak but significant (p less than 0.001) positive correlation was found between age and change in systolic and diastolic blood pressure after chlorthalidone. Such a relationship was absent in the metoprolol group, where a significant (p less than 0.01) positive correlation was found between diastolic pressure rise from rest to the peak exercise at randomization, and the reduction in resting diastolic pressure at the end of the study. Treatments were well tolerated, only a decrease (p less than 0.05) in serum potassium (from 4.4 to 4.0 mEq/l) in the chlorthalidone group was observed. Results suggest that age may influence the antihypertensive response to chlorthalidone, while diastolic pressure rise in isometric exercise may predict the degree of pressure response to sustained beta-adrenergic blockade with metoprolol.

Adrenergic beta-Antagonists↗
PubMed1985

Serum theophylline and ventilatory function in chronic obstructive lung disease. Comparison between two slow-release formulations of theophylline.

Pharmacokinetics and ventilatory response to Theodur (Th) was compared to that of Aminomal R (AR) in a randomized within-patient double-blind study, carried out in patients with chronic obstructive lung disease. Both slow-release preparations of theophylline were given every 12 hours for 14 days each at the end of a placebo wash-out period. Th and AR did not differ significantly in their bronchodilating effect at 3 and 12 hours after intake. Salbutamol consumption was not dissimilar in the 2 preparations. Mean serum theophylline levels remained within the therapeutic range at 2, 3 and 12 hours after sustained administration of both Th and AR, but were slightly lower and less fluctuating after Th. Gastrointestinal side effects such as epigastric discomfort, nausea, abdominal pain and diarrhea were more common after AR, a result likely due to its higher content of anhydrous theophylline per tablet (474 mg vs 300 mg in Th). In conclusion, we failed to detect differences between Th and AR in their bronchodilating effect after sustained treatment in patients with chronic obstructive lung disease. Th, however, although containing less theophylline per tablet, resulted in comparable theophylline levels with similar ventilatory response, in presence of a better gastrointestinal tolerability. These results suggest a better bioavailability of Th, likely accounted for by a more advanced pharmaceutical technology.

Albuterol↗
PubMed1984

Plasma norepinephrine and left ventricular hypertrophy in systemic hypertension.

The relations between some pressure and humoral factors, and some echocardiographic indexes of left ventricular (LV) hypertrophy were studied in 64 patients with essential hypertension. Fifty-seven percent of these patients showed echocardiographic evidence of LV hypertrophy (LV mass greater than 215 g). Multivariate stepwise regression analysis showed that only mean blood pressure (BP) and circulating norepinephrine (NE) levels were significantly related to LV mass index in the group of patients with LV hypertrophy. However, mean BP was the only factor related to LV mass index in the subgroup of patients with LV hypertrophy and plasma NE within the normal laboratory range, whereas NE was the sole factor related to LV mass index in the subgroup with LV hypertrophy and abnormally elevated NE levels (greater than mean + 2 standard deviations of the normal laboratory range). Correlation of LV mass index vs NE was -0.35 (not significant) in the former group of patients and 0.89 (p less than 0.01) in the latter group. NE showed no relation with the echocardiographic variables in the hypertensive patients without LV hypertrophy; in this group, diastolic BP was the only factor related to LV mass index. Circulating NE levels were slightly higher in patients with LV hypertrophy (213 +/- 68 ng/liter) than in those without LV hypertrophy (187 +/- 46 ng/liter), but differences were not significant when adjusting NE for age. Plasma renin activity was not dissimilar in the absence or presence of hypertrophy. In conclusion, our findings suggest that NE might be associated with pressure factors in regulating LV hypertrophy development only in a subgroup of hypertensive patients characterized by echocardiographic LV hypertrophy and abnormally elevated circulating NE levels.

Adult↗
PubMed1984

Influence of intravenous beta-adrenergic blockade with or without partial agonist activity upon plasma cyclic AMP and catecholamines in healthy subjects.

In a randomised within-subject double-blind study, 7 healthy male volunteers, aged 32 to 40 years, received at rest intravenous infusions of 2 mg propranolol (devoid of partial agonist activity), 2 mg oxprenolol (with partial agonist activity) and placebo. Cuff blood pressure did not vary after any of the 3 treatments. The heart rate did not change after placebo, but fell in the first 5 min both after propranolol and oxprenolol (p less than 0.01); the rate was slightly lower after propranolol than oxprenolol (p less than 0.05). The heart rate remained lower after both beta-blockers than placebo from 5 to 60 min after the infusion (both p less than 0.01), but the difference between the two beta-blockers was no longer significant. Plasma cyclic AMP showed a peak rise at 2 and 3 min after oxprenolol, and remained unchanged at those times after propranolol and placebo. From the 5th to the 60th min after infusion, the cyclic AMP concentration was lower after both beta-blockers than placebo, and with a slightly but not significantly higher level on oxprenolol than propranolol. Plasma noradrenaline and adrenaline were higher after the beta-blockers compared to placebo. Oxprenolol evoked a smaller and non-significant rise in both catecholamines. That oxprenolol, unlike propranolol, causes a sudden rise in plasma cyclic AMP soon after an i.v. infusion may be due to its partial agonist activity.

Adrenergic beta-Agonists↗
PubMed1984

Noninvasive assessment of chronotropic and inotropic response to preferential beta-1 and beta-2 adrenoceptor stimulation.

The relative chronotropic and inotropic activity of preferential beta 1- and beta 2-adrenoceptor stimulation was investigated in seven healthy male subjects in a randomized within-subject, single-blind study. Two doses of beta 1-selective agonist prenalterol (1 mg/hr or 2 mg/hr) and of beta 2-selective agonist salbutamol (300 micrograms/hr or 600 micrograms/hr) were infused intravenously in four separate sessions, with intervals of at least 48 hr between sessions. At each session cuff blood pressure and heart rate (HR) were measured and some hemodynamic information on the inotropic state were derived by echocardiography. Both prenalterol and salbutamol induced increases in HR, but tachycardia was greater after salbutamol, whereas the positive inotropic response to beta-stimulation was greater after prenalterol. At comparable HR rises (prenalterol, from 66.0 +/- 5.5 to 72.2 +/- 4 bpm; salbutamol, from 64.6 +/- 6 to 70.0 +/- 7 bpm), inotropic response seemed to be greater after prenalterol than after salbutamol (systolic blood pressure [SBP]: 133.5 +/- 8 and 120.7 +/- 8 mm Hg; mean velocity of circumferential fiber shortening [Vcf]: 1.54 +/- 0.13 and 1.31 +/- 0.12 c/s; ejection fraction [EF]: 72.4% +/- 5% and 69.5% +/- 4%; stroke index: 47.4 +/- 4 and 41.7 +/- 3 ml/m2). In presence of a chronotropic effect (HR from 64.6 +/- 6 to 70.0 +/- 7 bpm), the low salbutamol dose did not induce any changes in the indices of inotropism (SBP: from 119.2 +/- 6 to 120.7 +/- 8 mm Hg; mean Vcf: from 1.28 +/- 0.11 to 1.31 +/- 0.12 c/s; EF: from 68.1% +/- 5% to 69.5% +/- 4%; stroke index: from 40.2 +/- 3 to 41.7 +/- 3 ml/m2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Agonists↗
PubMed1984

Ventilatory effects of selective beta 1-(prenalterol) or beta 2-(salbutamol) adrenoceptor agonism in man.

We compared the ventilatory effects of prenalterol (beta 1-selective adrenoceptor agonist) with those of salbutamol (beta 2-selective adrenoceptor agonist) in 6 healthy volunteers. Two intravenous doses of prenalterol (1 mg/60 min, 2 mg/60 min) and of salbutamol (300 micrograms/60 min, 600 micrograms/60 min) were given in random order in 4 separate sessions of 60 minutes each. Pulmonary ventilation per minute (V'E) increased only on the high dose of salbutamol. Mouth occlusion pressure (P0.1) did not vary either on prenalterol or on salbutamol. Only the high dose of salbutamol induced (1) an increase in tidal volume (VT) without changes in respiratory rate (RR), (2) an increase in mean inspiratory flow (VT/Ti) without changes in the fraction of inspiratory time to total cycle duration (Ti/Ttot). During forced expiration, salbutamol elicited a small bronchodilating effect at the level of both large (FEV1, FEF25-75, FEF50) and small (FEV3, FEF75-85, FEF75) airways. Prenalterol induced a very small dilatation of the large airways, and a somewhat more pronounced effect at the level of the small airways. Neither the indexes of ventilatory pattern nor those of bronchial tone showed any statistical or biological differences between values on prenalterol and values on salbutamol. However, both the former and the latter indexes showed a trend to be higher on salbutamol than on prenalterol. Results suggest that salbutamol-induced increase in pulmonary ventilation per minute in subjects without bronchial obstruction is likely the result of a reduced bronchomotor tone at rest, leading to an increase in tidal volume because of the rise in the VT/Ti ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Agonists↗
PubMed1984

Left ventricular hypertrophy regression in hypertensive patients treated with metoprolol.

The long-term effects of metoprolol monotherapy, 100 mg b.i.d., for 16-18 months, were investigated in 8 previously untreated essentially hypertensive patients (resting blood pressure greater than 155/95 mmHg) and echocardiographic evidence of left ventricular hypertrophy (LVH) (left ventricular mass by Penn Cube formula greater than 215 g). Echocardiographic studies, according to the American Society of Echocardiography recording techniques and measurements criteria, were performed before starting treatment and at the end of follow-up. Metoprolol induced a decrease in systolic and diastolic blood pressure and heart rate, accompanied by a reduction of interventricular septum and posterior wall thickness (from 1.21 cm to 1.10 cm, and from 1.15 cm to 1.06 cm, respectively), left ventricular mass index and mean wall stress. All these changes were significant (p less than 0.01). Cardiac index decreased from 3017 ml/m2 to 2632 ml/m2 (p less than 0.01), mostly because of the reduction in the heart rate. In fact, stroke index, ejection fraction and fractional shortening all slightly increased during treatment in respect to pre-treatment values. Plasma renin activity fell from 1.45 ng/ml/h to 0.81 ng/ml/h (p less than 0.01), whereas both plasma noradrenaline and adrenaline concentration at rest did not change. Results indicate that in essentially hypertensive patients who have already developed LVH as a consequence of the hypertension, a long-term metoprolol therapy can successfully induce a reversal of LVH together with an effective blood pressure control, without noticeable adverse effects of changes in cardiac performance.

Adult↗
PubMed1983

Acute effects of beta 1 agonism with prenalterol on catecholamine circulating levels in patients with congestive heart failure.

The effects of a single intravenous infusion of prenalterol, a beta 1 selective agonist, on haemodynamics (echocardiography) and venous plasma catecholamine concentration were studied in 8 patients with severe congestive heart failure. In these patients, age-adjusted plasma norepinephrine (NE) and epinephrine (E) levels before prenalterol infusion were higher compared to values found in 10 control healthy subjects (both P less than 0.01). In heart failure patients, circulating NE levels were not dissimilar in 2 samples drawn 60 and 0 minutes before commencing prenalterol infusion (772.0 +/- 131 ng/l [mean +/- SD] and 775.5 +/- 130.0 ng/l respectively). Prenalterol induced a significant improvement in the cardiac index, stroke index, ejection fraction and velocity of circumferential fiber shortening, associated with a moderate but significant decrease in peripheral vascular resistance. All these changes persisted for 60 minutes after the end of infusion. Circulating NE levels were 604.0 +/- 125 ng/l at 60 min. after start of infusion (P less than 0.01 vs pre-infusion levels) and 526.1 +/- 108 ng/l at 60 min. after the end of infusion (P less than 0.01 vs pre-infusion levels). Plasma E showed a slight decrease, which did not attain statistical significance. Heart rate and diastolic blood pressure remained unchanged during and after infusion, while systolic blood pressure increased by 10-15 mmHg during and after infusion. We conclude that a single 1-hour prenalterol infusion in patients with severe congestive heart failure induces an haemodynamic improvement associated with a reduction of previously elevated circulating NE levels. This reduction could indicate a lowering in the intensity of the afferent stimulus for the reflex sympathetic overactivity.

Adrenergic beta-Agonists↗