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Biomedical subjects

W J Louis

Publications and source records attributed to W J Louis.

At least 55 records · Page 3Linked to original sources
PubMed1994

Rapidly developing pseudohypertension after renal transplantation diagnosed by non-auscultated blood pressure measurement.

Pseudohypertension has been reported in elderly, diabetic and uraemic patients. A variety of diagnostic methods have been used, generally with poor results with the exception of arterial catheterisation. We report a case of pseudohypertension that developed in the year following a renal transplant and was diagnosed by the use of oscillometric and photoplethysmographic blood pressure measurement.

Auscultation↗
PubMed1994

A risk-benefit assessment of carvedilol in the treatment of cardiovascular disorders.

Carvedilol is a nonselective beta-adrenoceptor blocking vasodilator drug that may be a promising new agent in the management of cardiovascular disease. The rationale for the development of agents of this type is that the alpha-blocking component may overcome the direct vasoconstrictor consequence of beta 2-blockade, whilst the beta-blocker component may inhibit the reflex tachycardia that occurs following alpha-blockade. In clinical trials published to date, carvedilol has been demonstrated to be effective as an antihypertensive agent as monotherapy and also as additional therapy in those patients whose blood pressure cannot be controlled on other standard agents. It is also effective in the management of angina. Carvedilol has beneficial haemodynamic effects in patients with congestive heart failure. beta-Blocker vasodilator drugs of this type may be particularly useful in this condition as the vasodilator component of the drug may overcome the initial negative inotropy of the beta-blocker. In addition, carvedilol possess potentially useful pharmacological actions. In particular, the drug has antimitogenic and free radical scavenging effects that may make it a useful therapy in the long term management of atherosclerotic vascular disease. Its metabolic profile is also favourable, presumably on the basis of its alpha-blocking properties. Thus, beta 2-mediated adverse effects on peripheral vascular tone, glycaemic control and lipid status appear to be offset by the alpha-blocking property of the drug. Carvedilol thus far appears to be well tolerated, with postural dizziness the major adverse effect, especially in the elderly. As with nonselective beta-blockers, carvedilol is contraindicated in patients with asthma.

Adrenergic beta-Antagonists↗
PubMed1994

Short term effects of pravastatin on blood pressure in hypercholesterolaemic hypertensive patients.

In this study, which was primarily designed to determine the lipid-lowering efficacy of pravastatin in the setting of background antihypertensive therapy with ACE inhibitors and calcium antagonists, we took the opportunity to examine whether pravastatin interacts with antihypertensive therapy to produce additional falls in blood pressure. This may help clarify the mechanism of action of pravastatin's rapid beneficial effects on cardiovascular morbidity. We treated 25 hypertensive hypercholesterolaemic patients with 12 weeks of either pravastatin or placebo in this double blind, placebo controlled parallel group study. Placebo treatment did not alter plasma lipids, whereas 12 weeks' treatment with pravastatin reduced total cholesterol by 27% (from 7.1 +/- 0.27 to 5.2 +/- 0.18, p < 0.001 compared with placebo) and low density lipoprotein cholesterol by 35% (from 4.9 +/- 0.36 to 3.2 +/- 0.17, p < 0.001). There were no changes in systolic or diastolic blood pressure either following 12 weeks' treatment or 3 weeks' withdrawal of pravastatin. Thus, pravastatin remains efficacious as a lipid lowering agent in the presence of antihypertensive therapy but does not enhance the blood pressure lowering action of these drugs. Therefore it is unlikely that blood pressure reduction is the mechanism by which pravastatin mediates its reported short term effects on cardiovascular morbidity.

Blood Pressure↗
PubMed1993

The effects of dietary lipid modification on blood pressure, cardiovascular reactivity and sympathetic activity in man.

OBJECTIVES: To examine the effect of dietary lipid modification on 24-h ambulatory blood pressure, cardiovascular reactivity and sympathetic activity in man. DESIGN: Twenty-four normal volunteers consumed either a high-fat or a low-fat diet for 2 weeks in an open, randomized, crossover study of duration 6 weeks. Diets were isocaloric and balanced for sodium and potassium content. METHODS: Cardiovascular reactivity was assessed by measurement of blood pressure responses to incremental infusions of angiotensin II and noradrenaline, and to sympathetic reflex testing. Plasma noradrenaline spillover and clearance rates were estimated using [3H]-noradrenaline infusion. RESULTS: Total plasma cholesterol and low-density lipoprotein-cholesterol levels both fell significantly on the low-fat compared with the high-fat diet, as did heart rate and mean arterial pressure (recorded by 24-h ambulatory monitoring). These changes were accompanied by reductions in blood pressure responses to cold pressor testing and to noradrenaline infusion on the low-fat diet. Plasma noradrenaline spillover and clearance rates did not change. Post hoc analysis showed an association between oral contraceptive use and increased noradrenaline sensitivity on the high-fat diet among the females tested. CONCLUSION: Dietary fat intake alters heart rate, blood pressure and cardiovascular reactivity to noradrenaline in man without changes in basal noradrenaline metabolism.

Adult↗
PubMed1993

Partial agonist activity of celiprolol.

Celiprolol given intravenously (i.v.) to pithed rats in the dose range of 0.1-10,000 micrograms/g produced a dose-dependent increase in heart rate (HR) which was greatest (123 beats/min) at 1,000-3,000 micrograms/kg. This partial agonist effect was blocked by the selective beta 1-adrenoceptor antagonist CGP 20712A. Celiprolol also produced a vasodepressor effect in this dose range which was abolished by the relatively selective beta 2-adrenoceptor antagonist ICI 118551 but not CGP 20712A. The magnitude of this intrinsic sympathomimetic activity (ISA) response was not significantly altered by reserpine pretreatment. Celiprolol also antagonised the effects of isoprenaline 0.05 microgram/kg on HR and blood pressure (BP). The beta 1 selectivity of celiprolol as an antagonist in pithed rats (beta 1/beta 2 = 340:1) was similar to that observed in studies with isolated guinea pig atria and trachea (beta 1/beta 2 = 63:1), both being considerably greater than that observed with atenolol. Celiprolol, however, like atenolol, potentiated the bronchoconstrictor responses to histamine (3 micrograms/kg). Metabolic studies of rats and human urine failed to show significant amounts of potentially vasoactive metabolites. These data are consistent with celiprolol acting as both a beta 1- and beta 2- adrenoceptor partial agonist.

Adrenergic beta-Antagonists↗
PubMed1992

Computer-aided mapping of the beta-adrenoceptor. 1. Explanation for effect of para substitution on blocking activity at the beta-1-adrenoceptor.

Anomalously low affinities for the beta-1-adrenoceptor are seen for members of a series of para-substituted N-isopropylphenoxypropanolamines in which the substituent is able to conjugate with the aromatic ring. The energy of conjugation was calculated using the AM1 semiempirical molecular orbital method and appears to correlate with the loss of binding energy, and hence affinity for the receptor. This suggests that binding is associated with movement of the substituent out of the plane of the aromatic ring due to steric interference with the receptor. A previously unrecognized binding site for aromatic groups off the para position is also identified.

Adrenergic beta-Antagonists↗
PubMed1992

Alpha 2-adrenoceptor and catecholamine-insensitive binding sites for [3H]rilmenidine in membranes from rat cerebral cortex.

The kinetic and pharmacological characteristics of the binding of the oxazoline antihypertensive drug, [3H]rilmenidine, to membranes of rat cerebral cortex have been determined. Computerised resolution of curvi-linear, equilibrium binding isotherms was consistent with the existence of two distinct binding sites for [3H]rilmenidine: Kd 17.3 +/- 7.41 nM, Bmax 0.197 +/- 0.06 pmol/mg protein and Kd 254 +/- 48 nM, Bmax 1.59 +/- 0.08 pmol/mg protein. Moreover, the resolution of two association and dissociation rates also suggested the existence of two binding site populations. Drug inhibition studies revealed that specific binding of [3H]rilmenidine (2 nM) was only inhibited by a maximum of 50% by the catecholamines, adrenaline and noradrenaline, but was completely inhibited by some oxazolines, by guanabenz (a guanidino drug) and by several imidazoline compounds including naphazoline, oxymetazoline and clonidine. Binding isotherms for these drugs were also best fit by a two-site model. The relative Ki values at the high affinity site for [3H]rilmenidine and the number of these high affinity sites are consistent with this site being an alpha 2-adrenoceptor. The high affinity of oxymetazoline and low affinity of prazosin for high affinity [3H]rilmenidine binding sites together with the rank order of potency of oxymetazoline greater than phentolamine greater than SKF 104078 greater than ARC-239 greater than prazosin suggest that [3H]rilmenidine binds to the alpha 2A sub-type of adrenoceptor. Computer-resolved Ki values for drugs at the larger number of lower affinity binding sites were very similar to Ki values determined in the presence of 10 microM adrenaline (used to block alpha 2-adrenoceptor binding).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Agonists↗
PubMed1992

Antihypertensive efficacy and safety of perindopril in mild-to-moderate essential hypertension: results of a double-blind multicenter study versus atenolol.

A 3-month double-blind multicenter trial compared the efficacy and safety of perindopril, a new angiotensin-converting enzyme (ACE) inhibitor, with atenolol in mild-to-moderate essential hypertension. A total of 190 patients, 49 of whom were diabetic, entered the perindopril-atenolol comparison. Of these, 163 had been previously treated and had a 4-week run-in period on placebo; 27 had previously been untreated and received placebo for 2 weeks. At entry, all patients who had a supine diastolic blood pressure (DBP) of 95-115 mm Hg were randomized to receive perindopril 2 mg or atenolol 25 mg, once daily. Patients were assessed at 2 weekly intervals for the first month and then monthly for 2 more months. If supine DBP was greater than 90 mm Hg, treatment was increased by stepwise doubling of dose up to 8 mg perindopril or 100 mg atenolol once daily, and later by the addition of hydrochlorothiazide 25 mg, (indapamide 2.5 mg in diabetic patients) once daily. The two groups were homogeneous prior to treatment except for supine and erect heart rate, which were higher in the perindopril group than in the atenolol group (p less than 0.05). Mean supine DBP was 101.1 +/- 0.6 mm Hg in the perindopril group (n = 94) and 99.9 +/- 0.6 mm Hg in the atenolol group (n = 96). After 3 months' active treatment, 74% of patients in the perindopril group achieved a supine DBP of less than or equal to 90 mm Hg and 73% of patients in the atenolol group achieved the same goal. Monotherapy controlled supine DBP in 67% of the perindopril group and 63% of the atenolol group. The decrease in supine DBP was not significantly different between the two groups (-12.9 +/- 0.9 versus -14.7 +/- 0.9 mm Hg) but the decrease in erect DBP was lower in the perindopril group (-10.3 +/- 0.9 versus - 13.4 +/- 1.0 mm Hg, p less than 0.02). Heart rate was reduced in the atenolol group (p less than 0.001). Sixteen patients withdrew from the study; nine were attributed to adverse events, two in the perindopril group and seven, including one death, in the atenolol group. Cough was spontaneously reported by 13% patients of the perindopril group and 1% patients of the atenolol group. In 5% of the perindopril cases this was mild and associated with upper respiratory tract infection. The nature and incidence of other symptoms were similar with both drugs.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Pharmacokinetic comparison of a slow-release clonidine with a conventional formulation after acute and chronic administration in hypertensives.

The pharmacokinetic characteristics of a slow-release formulation of clonidine (150 micrograms) were compared with those of a conventional formulation (75 micrograms) after acute and chronic (2 week) administration to 12 hypertensive subjects. The Tmax of the slow-release formulation was significantly later than for the conventional formulation after both acute (8.3 +/- 6 hr vs. 2.1 +/- 2 hr) and chronic administration (4.0 +/- 3 hr vs. 2.5 +/- 2 hr). Although the Tmax did not change significantly with acute and chronic administration of the conventional preparation, it was significantly shorter after chronic administration of the slow-release formulation when acute and chronic administration were compared. The Cmax was approximately 60% lower for the slow-release formulation (1 x 150 micrograms; 0.42 +/- 0.09 ng/mL) compared with the conventional formulation (2 x 75 micrograms; 0.70 +/- 0.12 ng/mL) after acute administration, whereas in the steady state, in which the dose of the conventional preparation was halved (75 micrograms), the Cmax values were comparable: 1 x 150 micrograms-0.99 +/- 0.27 ng/mL, 1 x 75 micrograms-0.84 +/- 0.20 ng/mL and the dose-normalized interdose AUC were identical for the conventional (16.2 +/- 4.3 ng/mL.hr) and slow release (16.6 +/- 5.3 ng/mL.hr) products. T1/2 values for the conventional formulation of clonidine exceeded 20 hours in all but one subject and were considerably longer than those in previous reports, including those of the authors, in which a less sensitive assay was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

A study of the alpha-1 adrenoceptor blocker prazosin in the prophylactic management of autonomic dysreflexia in high spinal cord injury patients.

The ability of the alpha-1 adrenoceptor antagonist, prazosin, to reduce the severity and duration of episodes of autonomic dysreflexia was studied in cervical and high thoracic spinal cord injury patients with documented episodes of autonomic dysreflexia. Sixteen patients participated in a double blind parallel group study comparing prazosin 3 mg b.d. with placebo given for 2 weeks. Both groups were matched for age, sex and baseline severity of autonomic dysreflexia episodes. Prazosin was well tolerated and did not produce a significant lowering of resting blood pressure. Compared to baseline measurements, patients allocated to prazosin therapy were found to have fewer severe episodes of autonomic dysreflexia and during these episodes to have significant reductions in average rise in systolic and diastolic blood pressure, symptom duration and requirement for acute antihypertensive medication. The severity of headache during individual autonomic dysreflexia episodes was also diminished with prazosin therapy. No symptom parameter was significantly altered by placebo therapy. It is concluded that prazosin is superior to placebo in the prophylactic management of autonomic dysreflexia and that these findings are consistent with suggestions that alpha-1 adrenoceptors play an important role in the pathogenesis of this syndrome.

Adolescent↗
PubMed1992

Preprogalanin mRNA is increased in vagal motor neurons following axotomy.

Expression of preprogalanin and tyrosine hydroxylase mRNA was examined in the rat dorsal vagal complex following nodose ganglionectomy and cervical vagotomy, using in situ hybridization of specific 35S-labelled oligonucleotides. Seven days after unilateral cervical vagotomy (and nodose ganglionectomy), neurons in the ipsilateral dorsal motor nucleus of the vagus and nucleus ambiguus expressed 6- to 10-fold increased levels of preprogalanin mRNA. In contrast, tyrosine hydroxylase mRNA was no longer expressed by cells of the dorsal motor nucleus of the vagus after the lesion. These results demonstrate that changes in the expression of the galanin and tyrosine hydroxylase genes occur in vagal motor neurons following lesion of their axons. More generally, these results, and those from other laboratories, demonstrate that specific alterations of neuropeptide and neurotransmitter production, are part of the reactive process activated by nerve injury.

Animals↗
PubMed1992

Expression of c-fos and NGFI-A messenger RNA in the medulla oblongata of the anaesthetized rat following stimulation of vagal and cardiovascular afferents.

Messenger RNA encoding the immediate early genes (IEGs) c-fos and NGFI-A was localized by in situ hybridization of specific 35S-labelled oligonucleotides to detect activated neurones in the medulla oblongata following unilateral electrical stimulation of the vagus (nX) and aortic depressor nerve (ADN), and following mechanical stimulation of the left carotid sinus (CS). In electrically stimulated rats, c-fos and NGFI-A mRNA was strongly expressed in the nucleus tractus solitarius (NTS) (predominantly ipsilaterally), area postrema (AP) and in a dorsal subregion of the paratrigeminal nucleus (PTN). Lower levels of c-fos and NGFI-A mRNA were seen in the ipsilateral NTS and PTN following mechanical stimulation of the left CS. In general these data correlate with the topography of innervation by the different nerve afferents, although the expression in the PTN (and in some cases the AP) would not be predicted on the basis of neuronal innervation patterns reported for the rat. Expression of these IEGs also occurred in the rostral and caudal ventrolateral medulla and inferior olive of both stimulated and sham-operated rats; presumably due to effects of the anaesthesia and surgical procedures. In conclusion the localization of the expression of c-fos and NGFI-A mRNAs represents a useful neuroanatomical technique for detecting the cell bodies of neurones that are activated by cardiovascular nerve afferents and should allow the further characterization of the neurochemical identity of these neurones.

Afferent Pathways↗
PubMed1992

Cardiovascular and vasoactive hormone responses to bladder distension in spinal and normal man.

Many patients with high spinal cord injury experience exaggerated blood pressure rises in response to bladder distension. To examine the humoral mechanisms associated with these responses, ECG heart rate, blood pressure and vasoactive hormone levels were measured at baseline and during bladder distension following slow bladder filling in 23 subjects: 9 high spinal lesion patients, 7 low spinal lesion patients and 7 normal control subjects. Systolic blood pressure rose significantly during bladder distension in the high spinal lesion group by an average of 56 mm Hg (48%) and diastolic blood pressure rose by 22 mm Hg (47%), while heart rate fell by a mean of 7.4 beats per minute (15%). By contrast, neither systolic or diastolic blood pressure nor heart rate changed significantly during bladder distension in the low spinal lesion or normal control group. There were no significant changes in plasma levels of noradrenaline, renin, aldosterone, vasopressin, arginine, or atrial natriuretic peptide during bladder distension to account for the blood pressure rise in the high spinal lesion group. These findings suggest that humoral mechanisms are unlikely to play a major role in the mediation of pressor responses to bladder distension in high spinal lesion patients.

Blood Pressure↗
PubMed1992

Risk factors for cardiovascular disease in chronic spinal cord injury patients.

To establish whether the reported increased cardiovascular (CV) morbidity in spinal cord injury (SCI) patients is due to increased levels of established CV risk factors, we assessed overall CV risk in 102 consecutive patients aged 25-64 by calculation of a 'risk factor score' (RFS) derived from the MRFIT study (age, diastolic blood pressure (DBP), total cholesterol (TC) level, cigarettes/day, sex), obtaining a percentile position amongst an age and sex matched peer group from the 1983 Australian Risk Factor Prevalence Study. Chronic SCI patients had a very low overall percentile position of risk of 26.03 + 15.06 (mean +/- S.D.) and those patients with SCI for greater than 10 years had only a slightly higher risk position of 33.16 +/- 29.66. The low relative risk in SCI patients was due mainly to significantly lower DBP levels (67 +/- 13 mm hg), as TC levels (5.38 +/- 1.60 mmol/L) and cigarette consumption (31% smokers, mode 11-20/day) were similar to the control population (83 +/- 12 mmHg, 5.68 +/- 1.2 mmol/L, 28% smokers, mode 11-20/day, respectively). As other known risk factors such as lipoprotein cholesterol fractions were not included in the RFS index, these were measured in 327 consecutive SCI patients. HDL cholesterol levels, which are negatively correlated with CV risk, were significantly lower in SCI patients (1.12 +/- 0.30 mmol/L) compared to controls (1.35 +/- 0.35 mmol/L) and those patients more than 10 years post SCI had still lower levels (1.02 +/- 0.40). These data suggest that the reported increased incidence of CV disease in SCI patients is unexplained by increases in BP, TC or smoking. However, low HDL levels may contribute to CV risk and the role of other risk factors such as increased vascular reactivity remain to be established.

Adult↗
PubMed1992

Nature of [3H]rilmenidine binding to membranes of rat cerebral cortex.

The binding of [3H]rilmenidine to membranes of rat cerebral cortex was studied in order to ascertain which receptor populations this novel antihypertensive interacts with in the cortex. A catecholamine-sensitive, alpha 2-adrenoceptor binding site was identified which represented up to 50% of specific, 2 nmol/L [3H]rilmenidine binding and was displaceable by the catecholamines in the rank order epinephrine----norepinephrine----dopamine----isoproterenol. Some imidazolines such as clonidine, naphazoline, and idazoxan and the guanidino compound guanabenz completely and potently inhibited [3H]rilmenidine binding from both catecholamine-sensitive and -insensitive sites. The substituted imidazole and guanidine, cimetidine, and amiloride, respectively, showed no affinity for [3H]rilmenidine binding. The pharmacologic profile of the catecholamine-insensitive [3H]rilmenidine site in rat cerebral cortex suggests it may be novel, as it has the features of an imidazoline-guanidino-oxazoline binding site. However, its identity requires further characterization.

Adrenergic alpha-Agonists↗
PubMed1992

Induction of c-jun expression in vagal motoneurones following axotomy.

Using in situ hybridization, we have measured c-jun mRNA expression in the caudal medulla oblongata of the rat following sectioning of the cervical vagus nerve. Twenty four hours after either unilateral cervical vagotomy or nodose ganglionectomy, motoneurones in the ipsilateral dorsal motor nucleus of the vagus and nucleus ambiguus expressed increased (2-3 fold) levels of c-jun mRNA. After 7 days, c-jun mRNA expression was further elevated to levels 8-10-fold higher than basal. These results demonstrate an unusual, long-lasting activation of a member of the 'leucine zipper' class of immediate early gene, and suggest that immediate early genes such as c-jun may be responsible for the regulation of the expression of structural protein and neuropeptide genes that have been demonstrated to occur following nerve injury.

Animals↗