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Biomedical subjects

W R Ginks

Publications and source records attributed to W R Ginks.

4 recordsLinked to original sources

Monotherapy with felodipine, a new calcium antagonist, in mild and moderate hypertension.

The role of felodipine, a new calcium antagonist, in monotherapy for mild and moderate hypertension was investigated in a placebo-controlled double-blind study of 109 patients from 13 centres. The patients were randomised in a double-blind fashion to receive felodipine, 2.5 mg b.i.d. (32 patients), 5 mg b.i.d. (30 patients), 10 mg b.i.d. (24 patients), or placebo (23 patients). Two hours after the first tablet was administered, there was a reduction in systolic and diastolic blood pressure, both supine (p less than 0.05) and standing (p less than 0.001), that was significantly correlated with dose. Three and 8 weeks later, 2 h after dosage, this correlation was still apparent in both supine and standing blood pressure (p less than 0.001). One week after randomisation, at 12 hours after administration there was a significant correlation with dose in the standing systolic (p less than 0.05) and diastolic (p less than 0.01) blood pressure. After 8 weeks therapy, a significant correlation with dose occurred in both supine and standing systolic (p less than 0.05) and diastolic (p less than 0.01) blood pressure 12 h after therapy. The proportion of patients completing the study who achieved a supine diastolic blood pressure of 90 mm Hg or less after 8 weeks therapy at 2 h after dosage was 9% on placebo, 67% on felodipine 2.5 mg b.i.d., 57% on felodipine 5 mg b.i.d., and 92% on felodipine 10 mg b.i.d. Felodipine was generally well tolerated although 10 patients on the highest dose withdrew due to adverse experiences. Plasma felodipine levels were significantly correlated with dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral

Value of pacing in cardiac failure associated with chronic atrioventricular block.

The effect of permanent pacing on chronic complete atrioventricular block complicated by cardiac failure was studied in 6 patients by measurement of indirect left atrial pressure 15 minutes after institution of pacing and again 3 to 12 months later. In addition, 21 patients with complete heart block and clinical plus radiological evidence of cardiac failure at the time of pacing 3 to 6 years earlier were also reviewed. Only 1 of 6 patients studied haemodynamically improved and 1 died in cardiac failure. Of 21 patients assessed clinically, 10 had improved and 8 had died after a mean follow-up of 53 months. In the absence of syncope, pacing was of little symptomatic benefit but still may be justified to prolong survival. Both studies indicated a particularly poor prognosis for patients known to have coronary artery disease. No reliable means were found of determining the prognosis in the individual patient with cardiac failure before pacing.

Adult

Long-term prognosis after acute anterior infarction with atrioventricular block.

The purpose of this study was to evaluate the need for permanent pacing in patients who have survived the effects of anterior myocardial infarction with complete heart block and have returned to sinus rhythm but who are left with impairment of intraventricular conduction. We have reviewed 52 patients with complete heart block complicating recent anterior myocardial infarction. Temporary pacing was instituted in all patients. There were 25 hospital survivors who were followed for an average of 49 months. Long-term pacing was established in 4 patients. Of the 21 patients in sinus rhythm, 14 had partial bilateral bundle-branch block with either right bundle-branch block and left anterior hemiblock or right bundle-branch block and left posterior hemiblock; at the end of the follow-up period, 10 of these 14 were alive and well. Furthermore, permanent pacing failed to prevent sudden death in 2 patients. At the present time, therefore, we conclude that long-term pacing is not justified in patients, otherwise asymptomatic, with partial bilateral bundle-branch block persisting after transient complete heart block in anterior myocardial infarction.

Adult