Biomedical subjects
Publications and source records attributed to P Walger.
Two cases of Sipple's syndrome with the typical signs of medullary carcinoma of the thyroid, pheochromecytoma and parathyroid adenoma are presented. Cushing's disease and marfanoid habitus were demonstrated. They are classified as multiple endocrine adenopathy type 2A and 2B according to the modern nomenclature.
The antihypertensive efficacy and side effects of a transdermal therapeutic system containing 2.5 mg clonidine (clonidine-TTS) was investigated in 21 patients with essential hypertension over a period of 10 weeks. The system was designed to release 0.1 mg clonidine/24 h. Mean systolic and diastolic blood pressure fell from 160 +/- 17/106 +/- 7 mm Hg to 139 +/- 16/91 +/- 8 mm Hg after 4 weeks and to 135 +/- 14/89 +/- 8 mm Hg after 10 weeks (p less than 0.001). Sufficient blood pressure control was achieved by one clonidine-TTS weekly in 24% and by 2 clonidine-TTS in 33% of the patients. 43% of all cases required additional oral therapy with 50 mg hydrochlorothiazide/day. However, antihypertensive action was accompanied by a high incidence of local skin reactions. These skin reactions with erythema, itching and red papules occurred in 6 of the 21 patients (29%) after treatment with TTS for at least 4 weeks. Patch testing with the various components of clonidine-TTS in 4 patients identified clonidine-allergy of delayed type in 3 cases. Typical clonidine side effects such as fatigue, dry mouth, constipation and sexual disturbances were moderate. It is concluded that clonidine-TTS has a good and continuous antihypertensive action. However, the high incidence of skin reactions limits its use in the treatment of essential hypertension.
The antihypertensive effects and side-effects of a clonidine transdermal therapeutic system (clonidine-TTS) were examined over 10 weeks in 22 patients with essential hypertension. The clonidine-TTS containing a 2.5 mg drug reservoir was designed to release 0.1 mg clonidine/24 h for seven days through a micropore rate-controlling membrane. In the total group mean systolic and diastolic blood pressure decreased from 162 +/- 14/106 +/- 4 mmHg to 137 +/- 17/92 +/- 8 mmHg after four weeks and 136 +/- 13/90 +/- 7 mmHg after 10 weeks (P less than 0.001). Five patients (23%) responded well to one clonidine-TTS (diastolic blood pressure less than or equal to 95 mmHg) and seven patients (32%) needed two clonidine-TTS. Additional oral therapy with 50 mg hydrochlorothiazide/day resulted in reduction of blood pressure to normal in six of the remaining 10 patients. This good pressure response was, however, accompanied by a high incidence of local allergic skin reactions of delayed type (type IV) in seven (32%) of the 22 cases. Patch testing with various components of clonidine-TTS which was performed in four of the seven patients showed in three cases allergic contact dermatitis to clonidine. Our results demonstrate a good and sustained antihypertensive action of clonidine-TTS. However, the extraordinarily high incidence of skin allergy to clonidine limits its use in the treatment of essential hypertension.
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1 The long-term effect of the converting-enzyme inhibitor captopril was investigated in 76 patients with various forms of severe hypertension, most cases being resistant to a standardised triple therapy (100 mg hydrochlorothiazide or 80-500 mg frusemide; 320 mg propranolol; and 200 mg hydralazine). 2 In each of the three groups examined (essential, renovascular, and renal parenchymatous hypertension) captopril led to a prompt and sustained reduction in systolic and diastolic blood pressure. Up to an observation time of 2 1/2 years patients with renovascular hypertension showed a more pronounced fall in mean diastolic blood pressures than those with essential hypertension. About 90% of all patients required a diuretic and a substantial percentage of patients needed propranolol as a third drug. 3 The most frequent side effects were skin manifestations, taste disturbances, dizziness, and non-productive cough. Serious adverse effects were rare and included one case of leucopenia and one of the nephrotic syndrome, both of them reversed after withdrawal of captopril. Further analysis showed that side effects occurred mainly in patients with impaired kidney function receiving relatively high dosages of captopril (greater than 200 mg/day). 4 Our results show that captopril is a very potent blood-pressure-lowering agent in severe hypertension, especially in cases with renovascular hypertension.
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