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Biomedical subjects

V Vertes

Publications and source records attributed to V Vertes.

At least 19 recordsLinked to original sources
PubMed1992

Comparative pharmacokinetics of captopril, enalapril, and quinapril.

This review compares the metabolism and pharmacokinetic profiles of captopril, the first orally active angiotensin-converting enzyme (ACE) inhibitor, and 2 newer ACE inhibitors, enalapril and quinapril. Captopril differs from both enalapril and quinapril in that its chemical structure contains a sulfhydryl group, the presence of which may be important in the development of adverse reactions. Captopril also differs from enalapril and quinapril in its ability to be metabolized in plasma. Enalapril and quinapril are both de-esterified, most likely in the liver, to their active metabolites, enalaprilat and quinaprilat. All 3 ACE inhibitors are eliminated primarily via renal excretion, and renal dysfunction markedly increases the area under the time versus plasma concentration curves. Hepatic dysfunction also slows the conversion of enalapril and quinapril to their active metabolites. There is evidence that both captopril and enalapril, but not quinapril, may accumulate with repeated dosing. The pharmacokinetics of these agents are not significantly modified by co-administration of other drugs. However, captopril does cause marked increases in trough plasma levels of digoxin. Overall, the pharmacokinetic profiles of captopril, enalapril, and quinapril make them suitable for a wide range of patients with hypertension or congestive heart failure.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

Historical reflections on hypertension.

Sixty million Americans have hypertension, a major cardiovascular risk factor. Its presence accelerates the atherosclerotic process, producing strokes, heart attacks, heart failure, renal failure, and peripheral vascular disease. This article highlights the historical landmarks in the study of this disease from the first documented measurement of blood pressure in 1733, through the most recent pharmacologic approaches to treatment. In addition, the roles of the kidney and the renin-angiotensin-aldosterone system are examined.

Aldosterone↗
PubMed1990

A comparison of the efficacy and safety of a beta-blocker, a calcium channel blocker, and a converting enzyme inhibitor in hypertensive blacks.

A double-blind, positively controlled, forced dose titration study comparing the efficacy and safety of atenolol, captopril, and verapamil sustained release as single agents in the treatment of black patients with mild to moderate hypertension (diastolic blood pressure, 95 to 114 mm Hg) was conducted. A total of 394 patients were randomized to one of the three therapies. Mean blood pressures during a 2- to 4-week placebo treatment period (baseline) ranged from 100.4 to 100.7 mm Hg diastolic and 151.7 to 152.5 mm Hg systolic for the three groups. Of the patients, 355 (of whom 345 had assessable data) completed the first treatment period, which consisted of therapy with either 50 mg/d of atenolol, 25 mg every 12 hours of captopril, or 240 mg/d of verapamil sustained release. During the second 4-week treatment period, which 319 patients completed (307 assessable), half of the patients had their antihypertensive medication increased and the other half continued the same dose. Goal blood pressure was defined as a supine diastolic pressure of less than 90 mm Hg or a 10-mm Hg or greater drop in supine diastolic blood pressure from pretreatment levels. Atenolol, captopril, and verapamil sustained release therapy was associated with goal blood pressure achievement during the first treatment period 55.1%, 43.8%, and 65.2% of the time, respectively, and during the second treatment period 59.6%, 57.1%, and 73.0% of the time. Side effects were minimal and comparable for all three drugs.

Adult↗
PubMed1987

Weight reduction for control of systemic hypertension.

It has been well documented that antihypertensive treatment can prolong life and decrease cardiovascular disease in patients with hypertension. Weight reduction is an effective means of decreasing blood pressure. We have treated normal-weight to obese hypertensive patients with weight reduction as a nondrug means of controlling mild to moderate hypertension. Adjunctive therapy included reduced sodium intake (initially 1 g of sodium daily, increased to 2 to 5 g daily), increased physical activity and relaxation techniques. Of the 130 protocol patients, 68 (52%) were normotensive while not taking any medication at the end of the program. Additionally, 36 patients (28%) had lower blood pressure, needed less medication or both; 26 patients (20%) did not have a positive response. Weight reduction is a useful method to control hypertension and a reasonable alternative to drug therapy.

Adult↗
PubMed1984

Very low calorie diets--history, safety and recent developments.

Poor results from orthodox diets for the obese have emphasized the need for suitable alternatives such as very low calorie diets (VLCD). These have now been in use for some ten years and their advantages and pitfalls are well known. Initial investigations were based on the use of total fasting and examining the significance of protein supplementation during therapeutic starvation. Subsequent studies employed ordinary food stuffs as the protein source but included no carbohydrate. Others developed formula diets which involved the use of both protein and carbohydrate. In the U.S.A. diets such as these are either monitored by the medical profession or in some instances sold directly to the public. In these connections two areas of concern have emerged. One is the ability of patients to maintain weight loss and most importantly, the safety of the programme itself. It is now well established that unless some follow-up support is made available patients will not be stabilized at the reduced weight level. The use of behaviour modification, increased physical activity and the concept of free and fixed calories offers the hope of a more complete answer to weight control. The safety of VLCD became a cause for concern when liquid protein sold over the counter was associated with a number of deaths for which other causes could not be determined. Subsequent monitoring has indicated that where patients are maintained on high quality protein supplement the potentially lethal arrhythmias associated with liquid protein are not seen. On the basis of clinical experience in over 4000 patients it is felt that three factors are necessary for any programme to be maximally safe and efficient. These elements are proper patient selection, high quality supplement and proper patient monitoring.

Adolescent↗
PubMed1979

Ticrynafen and hydrochlorothiazide. A double-blind study of antihypertensive properties with an open crossover.

Twenty-eight patients completed a double-blind study of the antihypertensive effects of ticrynafen compared with those of hydrochlorothiazide. The results of blood pressure reduction were comparable in the two groups. After six months, 12 patients were crossed over to ticrynafen therapy from hydrochlorothiazide. They maintained their blood pressure reduction. The most striking difference between the two groups was in the uric acid response. The uric acid level in the patients receiving hydrochlorothiazide therapy rose from a baseline of 5.9 to 7.5 mg/dL (normal range, 3.0 to 8.0 mg/dL). The uric acid level of those patients receiving ticrynafen therapy decreased from a baseline of 6.4 mg/dL to a low of 3.3 mg/dL. In view of ticrynafen's appreciable antihypertensive and uric-acid-lowering effects, it appears to be a useful new antihypertensive drug.

Adult↗
PubMed1979

The preoperative patient wit hypertension.

Preoperative medical evaluation of the hypertensive patient has a dual focus: (1) to establish an appropriate level of blood pressure control before anesthesia and surgery; and (2) to assess the degree of cardiovascular impairment, with particular attention to brain, heart, and kidney. Close communication between clinician and anesthesiologist can do much to ensure the patient's safety. Interpretation of the results of the preoperative examination is aided by the clinician's prior knowledge of the patient: the onset and history of his hypertension, his record of compliance to an antihypertensive regimen, his blood pressure response during previous hospitalizations and surgical procedures. Though there is no longer any question that antihypertensive medications should be continued in the preoperative period, side-effects of thiazide therapy may need treatment before or during surgery. Again, the clinician's fuller knowledge of the patient will help to alert the anesthesiologist to the need for special caution.

Anesthesia↗
PubMed1979

The massively obese hypertensive patient: an analysis of blood pressure response to weight reduction with supplemented fasting.

A 42.4% incidence of hypertension was seen in 783 massively obese patients admitted to a supplemented fasting program between February 1974 and November 1976. Chosen for this study were the 99 hypertensives who had not received any antihypertensive medication before admission. The blood pressure response after 1 week of inhospital fasting was compared with that at the end of a period of outpatient fasting. Reduction in blood pressure was noted in 85 patients by the end of the first week; by the end of the fasting period, 68 patients were normotensive. We conclude that the elevated blood pressure common in a high percentage of massively obese patients is primarily volume-dependent.

Blood Pressure↗
PubMed1977

Supplemented fasting as a large-scale outpatient program.

Although supplemented fasting is now established as an efficient means of achieving substantial weight reduction in massively obese persons, widespread application of this treatment is contingent on its successful adaptation to a large-scale outpatient regimen. Of 519 patients treated as outpatients, 78% lost a minimum of 18.2 kg during the course of treatment. The overall rate of weight loss was 1.5 kg/wk, with females averaging 1.3 kg/wk and males, 2.1 kg/wk. The majority of patients tolerated the regimen well and were able to continue normal daily activities without experiencing any serious side effects.

Body Weight↗
PubMed1975

The pathophysiology of renovascular hypertension.

Renovascular hypertension, comprising a small percentage of the total hypertensive population, stands out as remarkably important, being the most common cause of surgically correctable hypertension. Its precise diagnosis can be accomplished by judicious application of recently available sophisticated laboratory methods and correct prediction of curability is now possible. Careful selection of cases among the vast numbers of hypertensives by routine screening procedures is essential. The selected few deserve more complete studies including bilateral renal vein renin measurements. Rapid sequence pyelography, split function studies, radioisotope renorgram, and renal arteriography accurately define the presence of a significant structural abnormality involving the renal circulation on either side. Significant bilateral renal vein plasma renin differential, done under appropriate conditions of volume depletion and upright posture, in the absence of interference by concurrent antihypertensive drug therapy, establishes a causal relationship between the structural abnormality and the high blood pressure. A thorough knowledge of the normal physiology of the renin-angiotensin-aldosterone system and its inappropriate response in renovascular hypertension and other related clinical conditions is clearly necessary if one is to plan diagnostic studies intelligently and interpret the results correctly.

Aldosterone↗