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PubMedDate not supplied

Sleep apnea syndrome and diastolic blood pressure elevation during exercise.

BACKGROUND: Several studies assessing the role of obstructive sleep apnea syndrome (OSAS) as an independent risk factor for hypertension have produced conflicting results. Although the sleep apnea syndrome is associated with hypertension, there are no references regarding the blood pressure response of normotensive OSAS patients during exercise. STUDY OBJECTIVES: The aim of this study was to investigate the relationship between diastolic blood pressure (DBP) response during exercise and the severity of OSAS. METHODS: We performed exercise testing a day after polysomnography in 17 normotensive males who were admitted for the first time because of OSAS and in 10 normal subjects who were members of the same families. During maximal incremental exercise test (bicycle ergometry) oxygen consumption (VO(2)) and the DBP were estimated at rest and at peak exercise. VO(2) was also measured when DBP were 100 and 110 mm Hg. RESULTS: At peak exercise DBP was significantly higher in OSAS patients (115.3 +/- 9.2 mm Hg) than in normal subjects (101 +/- 8.4 mm Hg, p < 0.01). OSAS patients reached a DBP of 110 mm Hg with a significantly lower VO(2) than normal subjects (1,881.5 +/- 703.4 vs. 1,972.3 +/- 108.6 ml/min, p = 0.045). VO(2) was not different between the two groups at a DBP of 100 mm Hg (1,211.2 +/- 371.7 vs. 1,536.6 +/- 267.2 ml/min, p = 0.089) but OSAS patients had a significantly lower heart rate than normals (111.2 +/- 13 vs. 118.6 +/- 27.6, p = 0.009). None of the aspects of quality of life, according to the Nottingham Health Profile Questionnaire, Part 1, were significantly different between patients and normal subjects. CONCLUSIONS: Normotensive OSAS patients develop DBP elevation at an earlier stage during exercise compared to normal subjects. This hypertensive response was not correlated with the severity (apnea-hypopnea index, oxygen desaturation parameters) of OSAS. DBP elevation could be a limiting factor of physical performance in this group of patients.

Adult↗
PubMed1999

Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study.

BACKGROUND: Current definitions of hypertension are based on levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP), but not on pulse pressure (PP). We examined whether PP adds useful information for predicting coronary heart disease (CHD) in the population-based Framingham Heart Study. METHODS AND RESULTS: We studied 1924 men and women between 50 and 79 years of age at baseline with no clinical evidence of CHD and not taking antihypertensive drug therapy. Cox regression, adjusted for age, sex, and other risk factors, was used to assess the relations between blood pressure components and CHD risk over a 20-year follow-up. The association with CHD risk was positive for SBP, DBP, and PP, considering each pressure individually; of the 3, PP yielded the largest chi(2) statistic. When SBP and DBP were jointly entered into the multivariable model, the association with CHD risk was positive for SBP (HR, 1.22; 95% CI, 1.15 to 1.30) and negative for DBP (HR, 0. 86; 95% CI, 0.75 to 0.98). Four subgroups were defined according to SBP levels (<120, 120 to 139, 140 to 159, and >/=160 mm Hg). Within each subgroup, the association with CHD risk was negative for DBP and positive for PP. A cross-classification of SBP-DBP levels confirmed these results. CONCLUSIONS: In the middle-aged and elderly, CHD risk increased with lower DBP at any level of SBP>/=120 mm Hg, suggesting that higher PP was an important component of risk. Neither SBP nor DBP was superior to PP in predicting CHD risk.

Aged↗
PubMed2001

Familial factors of blood pressure and adiposity covariation.

In the present study, we used the maximum likelihood approach as implemented by variance analysis and attempted to quantify genetic and environmental components of variance in systolic (SBP) and diastolic (DBP) blood pressure in 514 individuals who belonged to a total of 135 nuclear families of Chuvasha, Russia, ethnic origin. The extent to which these interindividual differences depend on age, gender, body mass index (BMI) and other anthropometric measurements was investigated. Major findings include the following. (1) The variation in both SBP and DBP was significantly affected by genetic factors (h(2)(SBP)=0.51+/-0.13, h(2)(DBP)=0.20+/-0.09), shared household environment, and age. These effects were stronger with respect to SBP, which also showed significant gender differences in baseline values and rate of SBP increase with age. (2) Genetic and common household factors, as well as undetected residual effects, were not completely independent. The respective 3 facets of correlation between SBP and DBP were significant: 0.66+/-0.10, 0.76+/-0.11, and 0.55+/-0.14. (3) SBP and DBP each showed significant phenotypic correlations with BMI and anthropometric factors. These correlations had a substantial genetic component but were not equal for SBP and DBP. SBP showed the highest genetic correlation with arm circumference (r(G)=0.63), whereas for DBP, this was found with hip skinfold (r(G=)0.88). (4) Bivariate heritability estimates, as well as adjustment of BP measurements for BMI and selected anthropometrics, indicated that DBP likely does not have independent genetic heritability. The residual genetic variance of adjusted SBP remained significant, although substantially lower in comparison with the nonadjusted h(2).

Adipose Tissue↗
PubMed2001

Effect of aging on the prognostic significance of ambulatory systolic, diastolic, and pulse pressure in essential hypertension.

BACKGROUND: This study compared the relative prognostic significance of 24 hour intra-arterial ambulatory systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) parameters in middle-aged versus elderly hypertensives. METHODS AND RESULTS: A total of 546 subjects aged <60 years and 142 subjects aged >/=60 years who had undergone baseline pretreatment 24-hour intra-arterial ambulatory blood pressure monitoring were followed for 9.2+/-4.1 years. Multivariate analysis showed that in younger subjects, 24-hour, daytime, and nighttime DBP, MAP, and SBP, when considered individually, were positively related to morbid events; DBP parameters provided the best predictive values. In the group >/=60 years (elderly group), 24-hour, daytime, and nighttime PP and SBP were the most predictive parameters, whereas ambulatory DBP and MAP measurements failed to provide any prognostic value. When 24-hour values of SBP and DBP were jointly included in the baseline model, DBP (z=2.02, P=0.04) but not SBP (z=-0.43, P=0.67) was related to outcome in younger subjects, whereas in the elderly group, SBP (z=3.33, P=0.001) was positively and DBP (z=-1.75, P=0.07) was negatively related to outcome. Clinic blood pressure measurements failed to provide any independent prognostic value in either age group. CONCLUSIONS: The relative prognostic significance of ambulatory blood pressure components depends on age; DBP parameters provided the best prognostic value in middle-aged individuals, whereas PP parameters were the most predictive in the elderly. This may reflect differing underlying hemodynamic mechanisms of hypertension in these age groups.

Adult↗
PubMedDate not supplied

Deathbed phenomena and their effect on a palliative care team: a pilot study.

Anecdotal evidence suggests that death may be heralded by deathbed phenomena (DBP) such as visions that comfort the dying and prepare them spiritually for death. Medical practitioners have been slow to recognize DBP, and there has been little research into the spiritual effect that DBP have on caregivers or on how these phenomena influence their work. A pilot study looking into the occurrence of DBP was conducted by the palliative care team at Camden Primary Care Trust. Interviews revealed that patients regularly report these phenomena as an important part of their dying process, and that DBP are far broader than the traditional image of an apparition at the end of the bed. Results of the interviews raise concerns about the lack of education or training to help palliative care teams recognize the wider implications of DBP and deal with difficult questions or situations associated with them. Many DBP may go unreported because of this. Results of this pilot study also suggest that DBP are not drug-induced, and that patients would rather talk to nurses than doctors about their experiences.

Adult↗
PubMed2006

Acute and long-term effects of in utero exposure of rats to di(n-butyl) phthalate on testicular germ cell development and proliferation.

This study investigated effects of in utero exposure [embryonic day (e)13.5-e21.5] to di(n-butyl) phthalate (DBP) on fetal gonocytes and postnatal germ cell (GC) development in rats and focused on changes (delayed development) relevant to the postulated origins of human carcinoma-in situ cells. DBP treatment resulted in both early (e15.5-e17.5) and late (e19.5-e21.5) effects on gonocytes. The former involved delayed entry of proliferating gonocytes into quiescence, as indicated by prolongation/overexpression of octamer-binding transcription factor 3/4 and retinoblastoma protein phosphorylated at Ser 807/811 and Ki67 plus a 2- to 4-fold increase in gonocyte apoptosis. The late effect of DBP was to induce a greater than 10-fold increase in occurrence of multinucleated gonocytes. GC numbers in DBP-exposed males were reduced (P < 0.01) by 37, 53, 79, and 80% at e21.5 and postnatal d (d) 4, 8, and 15, respectively, with recovery to normal in scrotal testes between postnatal d 25 and 90. The DBP-induced decrease in GC numbers at d 4-8 was associated with delayed exit from quiescence, as indicated by retinoblastoma protein expression and a 28% reduction (P < 0.001) in GC proliferation index at d 6, although the latter was increased by 84% at d 25. The postnatal GC changes were associated with the early, but not late, effects of DBP on gonocytes as short-term DBP treatment from e19.5 to e20.5, induced multinucleated gonocytes as effectively as did treatment from e13.5 to e20.5, but did not reduce GC numbers on d 4. In conclusion, fetal DBP exposure delays normal GC development in both fetal (as early as e15.5) and postnatal life with the possibility of consequences for fertility.

Animals↗
PubMed1985

1,25-Dihydroxyvitamin D and vitamin D-binding protein are both decreased in streptozotocin-diabetic rats.

Calcium and vitamin D metabolism were studied in streptozotocin-treated rats up to 10 days after the induction of diabetes. Proteinuria, hypercalciuria, and hyperphosphaturia appeared as early as 3 days after diabetes induction and were reversed by insulin. The serum proteins and fasting calcium concentrations were decreased in untreated diabetic rats. The concentration of serum vitamin D binding protein (DBP) was higher in male than in female control rats (mean +/- SD; 555 +/- 73 vs. 348 +/- 28 mg/liter, P less than 0.001). When sequentially measured in male untreated diabetic rats, DBP concentration steadily decreased. Compared with control values, DBP was reduced 19%, 28%, and 32% on days 3, 6, and 10, respectively, after induction of diabetes in male rats. In female animals, DBP was reduced 22% on day 10 of diabetes. DBP concentration was corrected by insulin treatment of diabetic rats and remained normal in streptozotocin-treated animals that did not develop diabetes. The serum concentration of 25-hydroxyvitamin D3 was similar in both sexes and was not affected by diabetes. Like DBP, the concentration of total 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] was higher in male than in female control rats (120 +/- 24 vs. 96 +/- 17 ng/liter, P less than 0.001), but 10 days after induction of diabetes this concentration decreased by 37% and 29% in male and female rats, respectively. The free 1,25-(OH)2D3 concentration, estimated from the molar 1,25-(OH)2D3/DBP ratio, was similar in both sexes and was not decreased by diabetes. We conclude that experimental diabetes in the rat induces a decrease in DBP concentration and a concomitant decrease in total but not in free 1,25-(OH)2D3 concentrations. This may indicate that diabetes decreases circulating 1,25-(OH)2D3 concentrations through alterations in DBP levels.

Animals↗
PubMed1991

On the mechanisms for the selective action of vitamin D analogs.

A variety of analogs of 1,25-(OH)2D3 with less calcemic activity and lower receptor binding affinity than 1,25-(OH)2D3 have been developed. However, these compounds have equal or greater ability to differentiate leukemia cells and psoriatic fibroblasts and to suppress PTH synthesis and secretion. The mechanism for this selectivity has not been elucidated. Because the lower potency of ergocalciferol compared to cholecalciferol in preventing or curing rickets in chicks was associated with a lower affinity of the avian vitamin D binding protein (DBP) for vitamin D2, we tested five analogs with low calcemic activity including 22-oxa-1,25-(OH)2D3 (OCT), MC903, 1,25-(OH)2-16 ene-23-yne D3, 1,25-(OH)2-26,27 dihomo-22-ene-D3, and 1,25-(OH)2-24-trihomo-22-ene-D3 for their affinity for rat serum DBP. All analogs had a low affinity for DBP, ranging from 50-3000 times less than that of 1,25-(OH)2D3. OCT also bound with low affinity to dog and human serum DBP. We tested with OCT the possible consequences of its low affinity for serum DBP. One of the functions of DBP is to prolong the lifetime of 1,25-(OH)2D3 in circulation. Quantification of the metabolic clearance rate (MCR) of OCT in 8 normal dogs using a single bolus injection technique showed that OCT was cleared at a rate of 48.2 +/- 7.5 ml/min, approximately 6-7 times more rapidly than 1,25-(OH)2D3 (6.8 +/- 0.4 ml/min). The estimated half-life of OCT in the circulation was 2.5 +/- 0.3 h compared to 7.0 +/- 0.6; n = 7 for 1,25-(OH)2D3. As our primary interest is the potential of OCT in treating the secondary hyperparathyroidism of CRF, we also measured the MCR of OCT in 5/6 nephrectomized dogs. Uremia does not affect the rate of clearance of OCT from the circulation (MCR: 56.8 +/- 4.5; t1/2 = 2.1 +/- 0.2 n = 4). Despite its shorter half-life, OCT suppressed PTH secretion in vivo in uremic dogs. The effects of low binding to DBP on the percentage uremic dogs. The effects of low binding to DBP on the percentage of free sterol were determined using an ultrafiltration procedure. We compared the proportion of free (unbound) OCT and 1,25-(OH)2D3 in 0.1% BSA-PBS with concentrations of human serum ranging from 0-25%. The proportion of OCT in the free form was significantly higher than that of 1,25-(OH)2D3 for every serum concentration tested. The physiological relevance of a higher percentage of free OCT was tested in normal human macrophages.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1985

Serum protein binding of 1,25-dihydroxyvitamin D: a reevaluation by direct measurement of free metabolite levels.

Using the technique of centrifugal ultrafiltration isodialysis to measure the free concentration of 1,25-dihydroxyvitamin D [1,25-(OH)2D], we determined the affinity of serum proteins for 1,25-(OH)2D both by Scatchard analysis (increasing ligand concentration at fixed binding site concentrations) and by a novel analysis in which the binding site concentrations were varied (serial dilution) at fixed ligand concentrations. The high affinity binding constant in serum for 1,25-(OH)2D was 3.7 X 10(7) M-1 by Scatchard analysis and 4.2 X 10(7) M-1 by serial dilution analysis. Human serum albumin had a much lower affinity for 1,25-(OH)2D (5.4 X 10(4) M-1). When vitamin D-binding protein (DBP) was selectively removed from serum by an actin affinity column, the affinity of the remaining serum proteins for 1,25-(OH)2D was that of albumin. Postulating a two-site model (DBP and albumin) for transport of 1,25-(OH)2D in serum and incorporating the estimated affinity constants of DBP and albumin for this metabolite, we calculated that 85% of total circulating 1,25-(OH)2D is transported in blood bound to DBP in normal individuals (0.4% is free and 14.6% is bound to albumin). In patients with liver disease, 73% is bound to DBP (1.1% is free and 25.9% is bound to albumin). Using this same two site model, we found a reasonable correlation (r = 0.612; P less than 0.001) between the measured free 1,25-(OH)2D level and the calculated free 1,25-(OH)2D level in serum based on albumin and DBP concentrations in 16 normal subjects and 16 patients with liver disease. These results confirm the concept that although DBP is the principal protein carrier of 1,25-(OH)2D in serum, albumin is a major secondary carrier, especially in patients with low DBP levels.

Adult↗
PubMed2006

A positive association between leptin and blood pressure of normal range in Japanese men.

The results of previous studies on the relationship between leptin and blood pressure are discordant. We investigated to what extent the serum leptin level was related to blood pressure independent of the degree of insulin resistance. The subjects were 1916 men aged 34-69 years whose mean body mass index (BMI) was 23.0 kg/m2. Blood pressure was regressed by leptin concentrations with adjustments for age, BMI, insulin resistance, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, physical activity, drinking habits and smoking status. Leptin was associated with diastolic blood pressure (DBP) (standardized beta: 0.092, p = 0.003), but not with systolic blood pressure (SBP) (standardized beta: 0.035, p = 0.25), although insulin resistance was positively associated with both SBP and DBP (standardized beta: 0.175 for SBP, p < 0.001 and 0.114 for DBP, p < 0.001) among all subjects. After subjects were divided into those with normal blood pressure (SBP <130 mmHg and DBP <85 mmHg) and those with higher blood pressure, leptin was positively and significantly associated with DBP (standardized beta: 0.106, p = 0.012) independent of the degree of insulin resistance, but not with SBP (standardized beta: 0.064, p = 0.13) among subjects in the normal blood pressure range. Among the subjects with higher blood pressure, however, neither the association of leptin with SBP nor that of leptin with DBP was statistically significant. These findings suggest that leptin may maintain and increase arterial tone, resulting in the elevation of DBP only within normal blood pressure range. It is also likely that leptin is a physiological mediator--or at least a marker--of some degree of DBP elevation in obesity.

Adult↗
PubMed2001

Relationship between free and total 1,25-dihydroxyvitamin D in conditions of modified binding.

OBJECTIVE: A novel assay was employed to study the free 1,25-dihydroxyvitamin D (1,25(OH)2D) concentrations in various populations with different levels of 1,25(OH)2D and vitamin D binding protein (DBP). DESIGN: In 12 healthy women before and after 3 months of oral estrogen/progestagen treatment, 10 pregnant women, and 16 patients with a nephrotic syndrome and normal renal function, the concentrations of total and free 1,25(OH)2D, DBP and albumin were assessed. METHODS: The total concentration of 1,25(OH)2D in serum was assessed using a radioreceptor assay. The free fraction of 1,25(OH)2D was measured using symmetric dialysis. DBP was assessed using single radial immunodiffusion. Serum albumin concentrations were measured on an automated analyzer. RESULTS: In healthy women, the concentrations of total 1,25(OH)2D, free 1,25(OH)2D and DBP were 132+/-19 pmol/l, 92+/-30 fmol/l and 5.59+/-0.43 micromol/l. After 3 months of estrogen/progestagen treatment, total 1,25(OH)2D and DBP levels rose significantly to 175+/-51 pmol/l and 8.32+/-1.59 micromol/l (P< or =0.05 and P< or =0.001); the free 1,25(OH)2D remained unchanged (105+/-39 fmol/l; not significant). Pregnant women had significantly higher levels of total 1,25(OH)2D and DBP (239+/-68 pmol/l and 11.32+/-1.77 micromol/l; both P</=0.001); the free 1,25(OH)2D level, however, was not different (104+/-27 fmol/l; not significant). Unexpectedly, in patients with nephrotic syndrome, no lower DBP levels were found (5.36+/-0.84 micromol/l) relative to that in controls. Despite this, levels of both total (69+/-26 pmol/l, P< or =0.001) and free 1,25(OH)2D (53+/-28 fmol/l; P< or =0.001) were significantly lower than in controls. Albumin levels were lowered from 628+/-38 micromol/l to 300+/-84 micromol/l (P < or = 0.001). CONCLUSIONS: Higher estrogen levels result in higher DBP levels, with a parallel rise in total 1,25(OH)2D levels but without a change in the biologically active free fraction. The results in patients with nephrotic syndrome show that, with increasing glomerular protein leakage, the free 1,25(OH)2D concentration cannot be maintained.

Adult↗
PubMed1985

Healing of spontaneous periodontal defects in dogs treated with xenogeneic demineralized bone.

This study was undertaken to histologically, clinically and radiographically evaluate the sequence of healing following implantation of bovine demineralized bone powder (DBP) into severe, spontaneous periodontal defects in beagle dogs. Eight dogs with documented severe periodontitis were treated surgically following initial debridement. One quadrant in each arch was treated with conventional flap surgery and the others were treated with surgery followed by DBP implantation. Animals received postoperative debridement and clinical and radiographic evaluation. Two dogs were sacrificed at 1, 3, 6 or 12 months postoperatively, and the jaws were evaluated histologically. Clinically, DBP was well tolerated by recipients. No evidence of localized inflammatory response or delayed hypersensitivity reaction was noted. Significant reductions in gingival inflammation were noted in both experimental and control sites at 1 month postoperatively compared to preoperative scores. Equivalent periodontal pocket reduction was noted between test and experimental sites and remained significant at 12 months. Radiographically, no differences were noted in the rate of bone loss between control and test sites. Histologic evaluation demonstrated the presence of DBP at 1 month following implantation, but the material was replaced with new bone by the next sacrifice period. Periodontal ligament fibers of standard orientation were seen extending from DBP-induced bone to the root surface by 1 month after implantation. An intact epithelial attachment appeared to be present 1 month after the implantation of DBP. No differences in root surfaces were detected between test and control groups. Ankylosis was a rare finding, noted equally between test and control sites. DBP did not appear to predispose to external root resorption. In later stages, histologic evidence of advancing periodontitis was noted equally in both control and experimental groups. While DBP successfully induced new bone formation, the inability to adequately maintain the periodontal tissues due to bacterial accumulation in this model combined with recurrent pocket formation, precluded any conclusion regarding long-term advantage. Based on these findings, clinical trials of this or similar materials are recommended.

Alveolar Process↗
PubMed1999

Cardiovascular risks related to increased diastolic, systolic and pulse pressure. An epidemiologist's point of view.

Since the introduction of the sphygmomanometer at the beginning to the 20th century, the significance of diastolic (DBP), Systolic (DBP) and pulse pressure (PP) as hypertensive cardiovascular risk factors has been controversial. These historical controversies are reviewed. Initially, DBP was thought to be the best measure of risk, but more recently both SBP and DBP, which ever is higher, are used in classifying hypertensive cardiovascular risk. There are problems with the present guidelines, in that SBP and DBP represent only two inflection points on the propagated pulse wave that is measured by cuff readings at the peripheral brachial artery. The heart is exposed to the central aortic pressure not to the brachial artery pressure. Moreover, both peripheral vascular resistance and large artery stiffness contribute to hypertensive cardiovascular risk. In middle-aged and elderly, elevated SBP is a better surrogate measurement of resistance than DBP, but SBP underestimates large artery stiffness. PP, the difference between peak SBP and end DBP, is the single best blood pressure surrogate for large artery stiffness. Epidemiological studies over the past decade point to SBP and DBP as the best cardiovascular risk markers for young subjects, whereas PP takes over as the more powerful risk marker for middle-aged and elderly subjects. These findings support the concept that cardiovascular events are more related to the pulsatile stress of large artery stiffness during systole than the steady-state stress of small vessel resistance during diastole. Therefore, at similar elevations of SBP, subjects with isolated systolic hypertension are at greater risk for cardiovascular events than those with combined systolic/diastolic hypertension.

Aging↗
PubMed1999

[Angiotensin-II receptor inhibitors in hemodialysed uremia patients with arterial hypertension: candesartan cilexitil versus losartan].

BACKGROUND: The aim of this study was to evaluate, in patients with chronic renal failure in hemodialysis and arterial hypertension, the effectiveness of a new angiotensin II receptor antagonist, the candesartan cilexitil, comparing it with losartan, the first of this new class of drugs. METHODS: We have selected 128 patients with chronic renal failure (92 males and 36 females, mean age 56 +/- 6 years) and arterial hypertension, subjected to hemodialysis 3 times a week, with hemodialytic seniority of 90 +/- 10 months. The inclusion criteria in the study were given from the presence, after 15 days of pharmacological wash-out, of values of diastolic blood pressure (DBP) > or = 95 mmHg and systolic blood pressure (SBP) > or = 150 mmHg, despite a hemodialysis correctly performed. Patients were divided into two groups whether they received single blind randomized candesartan cilexitil 16 mg or losartan 50 mg at hour 8.00 for a period of 8 weeks at the end of which, after a period of pharmacological wash-out of 15 days, the drugs were administered to inverted groups for other 8 weeks. After 4 and 8 weeks of treatment an evaluation of the anti-hypertensive effectiveness by means of medical complete visit and measurement of blood pressure were made. The statistical analysis was made by means of Student's t test for paired data. RESULTS: All the patients concluded the study. After 4 weeks of treatment SBP and DBP were reduced in the group with candesartan cilexitil with regard to baseline values (SBP 151.8 +/- 6.3 vs 159.8 +/- 5.1 mmHg, p < 0.05; DBP 93.6 +/- 4.5 vs 98.1 +/- 3.7 mmHg, p < 0.05). In the losartan group (SBP 151.8 +/- 6.3 vs 158.7 +/- 5.5 mmHg, p < 0.05; DBP 93.6 +/- 4.5 vs 97.5 +/- 3.8 mmHg, p < 0.05) no significant reduction in blood pressure values was observed compared with baseline values (SBP 158.7 +/- 5.5 vs 159.8 +/- 5.1 mmHg, NS; DBP 97.5 +/- 3.8 vs 98.1 +/- 3.7 mmHg, NS). After 8 weeks of treatment in the candesartan cilexitil group (SBP 128.3 +/- 5.9 vs 159.8 +/- 5.1 mmHg, p < 0.05; DBP 81.5 +/- 4.1 vs 98.1 +/- 3.7 mmHg, p < 0.05) and in the losartan group (SBP 151.7 +/- 5.1 vs 159.8 +/- 5.1 mmHg, p < 0.05; DBP 92.7 +/- 3.9 vs 98.1 +/- 3.7 mmHg, p < 0.05) blood pressure values were reduced in the same manner as at baseline. By comparing the two drugs, candesartan cilexitil proved to have a better antihypertensive effectiveness (SBP 128.3 +/- 5.9 vs 151.7 +/- 5.1 mmHg, p < 0.05; DBP 81.5 +/- 4.1 vs 92.7 +/- 3.9 mmHg, p < 0.05). CONCLUSIONS: Our experience suggests that angiotensin II receptor antagonists may be a therapeutic remarkable option in patients with chronic renal failure in hemodialysis and arterial hypertension; the antihypertensive effect seems to be class-specific. Nevertheless, at least for our data, a better and more rapid antihypertensive results was obtained with candesartan cilexitil.

Angiotensin Receptor Antagonists↗
PubMed1998

Prazosin GITS vs sustained release nifedipine in patients with hypertension and abnormal lipid profile: a randomized, controlled, multicenter study. Madras Hypertension Study Group.

OBJECTIVE: To compare the long-term antihypertensive efficacy, tolerability, and metabolic effects of prazosin GITS and a sustained release (SR) preparation of nifedipine. DESIGN: Randomized, controlled, multicenter study of 26 weeks duration. SETTING: Office practices of 24 physicians in Chennai, Tamil Nadu, India. PATIENTS: Males and females, aged 30 to 70 yrs, with hypertension of JNC V stage 1 or 2 at the end of a 2-week placebo run-in period, and an abnormal lipid profile. Sufficient number of patients recruited so that at least 60 complete the entire study. INTERVENTIONS: Prazosin GITS (Minipress XL, 2.5-5 mg once daily) or sustained release nifedipine (Nicardia Retard 10-20 mg twice daily) for upto 6 weeks, continued upto 24 weeks in those showing a pre-defined response (SBP and/or DBP normalized, or DBP fall of at least 10 mm Hg with actual value of DBP < 95 mm Hg). Patients allocated to either of the two interventions by randomization. OUTCOME MEASURES: Percent patients showing pre-defined BP response at week 6; percent patients with DBP < 90 mm Hg, SBP < 140 mm Hg, and both; percent patients with DBP fall > or = 10 mm Hg; mean fall in BP among those receiving treatment for 24 weeks; mean change in blood glucose and serum lipids at the end of weeks 8, 16, and 24 of treatment; frequency and intensity of adverse events judged probably or definitely related to the drug. RESULTS: 54 patients randomized to prazosin GITS group and 52 to nifedipine SR group. Of these, 39 in prazosin GITS group (M 23, F 16; mean age-50. 6 yr, SEM 1.66) and 36 in nifedipine SR group (M 20, F 16; mean age-52.3 yr, SEM 1.71) completed the study. Percent patients with DBP < 90 mm Hg at 24 weeks: prazosin GITS--100%, nifedipine SR--100%; SBP < 140 mm Hg: prazosin GITS--94.9%, nifedipine SR--91.7%; both DBP < 90 mm Hg and SBP < 140 mm Hg: prazosin GITS--92.3%, nifedipine SR--91.7%; percent patients with DBP fall of 10 mm Hg or more at 24 weeks: prazosin GITS--76.9%, nifedipine SR--83.3%. The mean fall in the systolic and diastolic blood pressure from the end-of-placebo-phase values to all the other time points was comparable in the 2 groups. Treatment with prazosin GITS did not produce any statistically or clinically significant change in the metabolic parameters at the end of 24 weeks, while with nifedipine SR there was a significant increase in the serum LDL values at 24 weeks (p = 0.009). Adverse events probably or definitely related to the drug: prazosin GITS--1.9%, nifedipine SR--2.1%. CONCLUSION: Both drugs were equally effective and well tolerated. While prazosin GITS was neutral on serum lipids, use of nifedipine SR was associated with a significant increase in serum LDL cholesterol at the end of 24 weeks.

Adult↗
PubMed1998

Prazosin GITS vs atenolol in patients with hypertension and normal lipid profile: a randomized, controlled multicenter study. Hyderabad Hypertension Study Group.

OBJECTIVE: To compare the long-term antihypertensive efficacy, tolerability, and metabolic effects of prazosin GITS and atenolol. DESIGN: Randomized, controlled, multicenter study of 26 weeks duration. SETTING: Office practices of 24 physicians in Hyderabad, Andhra Pradesh, India. PATIENTS: Males and females, aged 30 to 70 yrs, with hypertension of JNC V stage 1 or 2 at the end of a 2-week placebo run-in period, and a normal lipid profile. Sufficient number of patients recruited so that at least 60 complete the entire study. INTERVENTIONS: Prazosin GITS (Minipress XL, 2.5-5 mg once daily) or atenolol (Tenormin 50-100 mg once daily) for upto 6 weeks, continued upto 24 weeks in those showing a pre-defined response (SBP and/or DBP normalized, or DBP fall of at least 10 mm Hg with actual value of DBP < 95 mm Hg). Patients allocated to either of the two interventions by randomization. OUTCOME MEASURES: Percent patients showing pre-defined BP response at week 6; percent patients with DBP < 90 mm Hg, SBP < 140 mm Hg, and both; percent patients with DBP fall > or = 10 mm Hg; mean fall in BP among those receiving treatment for 24 weeks; mean change in serum lipids at the end of weeks 8, 16, and 24 of treatment; mean change in laboratory parameters for safety at the end of week 24; frequency and intensity of adverse events judged probably or definitely related to the drug. RESULTS: 62 patients randomized to prazosin GITS group and 60 to atenolol group. Of these, 39 in prazosin GITS group (M 23, F 16; mean age-48.4 yr, SEM 1.60) and 39 in atenolol group (M 24, F 15; mean age-42.9 yr, SEM 1.48) completed the entire study. Percent patients with DBP < 90 mm Hg at 24 weeks: prazosin GITS--92.3%, atenolol--92.3%; SBP < 140 mm Hg: prazosin GITS--89.7% atenolol--94.9% both DBP < 90 mm Hg and SBP < 140 mm Hg: prazosin GITS--87.2%, atenolol--89.7%; percent patients with DBP fall of 10 mm Hg or more at 24 weeks: prazosin GITS--92.3%, atenolol--100%. The mean fall in the systolic and diastolic blood pressure from the end-of-placebo-phase values to all the other time points was comparable in the 2 groups, except at week 2, when the fall was greater for atenolol (8.8 mm Hg vs 11.4 mm Hg, p = 0.05). Treatment with prazosin GITS resulted in a favourable effect on the serum lipid profile at the end of 24 weeks (p = 0.02 for total cholesterol, p = 0.015 for the ratio of total to HDL cholesterol, p = 0.04 for LDL cholesterol). Atenolol, on the other hand, did not produce any significant change in the metabolic parameters at the end of 24 weeks. Adverse events probably or definitely related to the drug: prazosin GITS--in 10.3% patients, atenolol--in 16.7% patients. CONCLUSION: In the doses used, both prazosin GITS and atenolol had comparable efficacy and tolerability. While atenolol was neutral on serum lipids, prazosin GITS showed a beneficial effect at the end of 24 weeks.

Adult↗
PubMed1998

A randomized, controlled, multicenter study to compare prazosin GITS with enalapril in hypertensive patients with diabetes mellitus. Bombay Hypertension Study Group.

OBJECTIVE: To compare the long-term antihypertensive efficacy, tolerability, and metabolic effects of prazosin GITS and enalapril. DESIGN: Randomized, controlled, multicenter study of 26 weeks duration. SETTING: Office practices of 20 physicians in Mumbai, India. PATIENTS: Males and females, aged 30 to 70 yrs, with hypertension of JNC V stage 1 or 2 at the end of a 2-week placebo run-in period, and diabetes mellitus with at least acceptable glycaemic control (FBS < or = 140 mg/dl, 2-hr PMBS < or = 200 mg/dl, and glycosylated hemoglobin < or = 9.5%). Sufficient number of patients recruited so that at least 60 complete the entire study. INTERVENTIONS: Prazosin GITS (Minipress XL, 2.5-5 mg once daily) or enalapril (Enam, 5-10 mg once daily) for upto 6 weeks; continued upto 24 weeks in those showing a pre-defined response (SBP and/or DBP normalized, or DBP fall of at least 10 mm Hg with actual value of DBP < 95 mm Hg). Patients allocated to either of the two interventions by randomization. OUTCOME MEASURES: Percent patients showing pre-defined BP response at week 6; percent patients with DBP < 90 mm Hg, SBP < 140 mm Hg, and both; percent patients with DBP fall > or = 10 mm Hg; mean fall in BP among those receiving treatment for 24 weeks; mean change in serum lipids at the end of weeks 8, 16, and 24 of treatment; mean change in blood sugar and glycosylated hemoglobin at the end of weeks 8, 16, and 24 of treatment; mean change in 12-hr urinary microalbuminuria and laboratory parameters for safety at the end of week 24; frequency and intensity of adverse events judged probably or definitely related to the drug. RESULTS: Forty-Eight patients randomized to prazosin GITS group and 41 to enalapril group. Of these, 31 in prazosin GITS group (M 19, F 12; mean age-53.4 yr, SEM 1.68) and 29 in enalapril group (M17, F 12; mean age-54.7 yr, SEM 1.64) completed the entire study. Percent patients with DBP < 90 mm Hg at 24 weeks: prazosin GITS--71.0%, enalapril--72.4%; SBP < 140 mm Hg: prazosin GITS--54.8%, enalapril--55.2; both DBP < 90 mm Hg and SBP < 140 mm Hg: prazosin GITS--54.8%, enalapril--44.8%; percent patients with DBP fall of 10 mm Hg or more at 24 weeks: prazosin GITS--77.4%, enalapril--72.4%. The mean fall in the systolic and diastolic blood pressure from the end-of-placebo-phase values to all the other time points was comparable in the two groups. Treatment with prazosin GITS resulted in a favourable effect on serum triglycerides at the end of 8 weeks (p = 0.017) and 16 weeks (p = 0.011), and no detrimental effect or a marginal beneficial effect on total cholesterol, HDL cholesterol, and LDL cholesterol. Enalapril group, on the other hand, showed a significant increase in LDL cholesterol at the end of 24 weeks (p = 0.018), and a marginal increase in total cholesterol, but a beneficial effect on triglycerides at the end of 16 weeks (p = 0.015). Neither drug had any effect on glycosylated hemoglobin and 12-hr urinary microalbuminuria. Treatment with both drugs was associated with an increase in FBS and 2-hr PMBS, but this rise reached statistical significance only in prazosin GITS group. Adverse events probably or definitely related to the drug: prazosin GITS--2 of 44 patients (4.5%), enalapril--6 of 39 patients (15.4%). CONCLUSION: 1. In the doses used, prazosin GITS showed comparable antihypertensive efficacy to enalapril. 2. While enalapril had variable effect, prazosin GITS showed a consistent beneficial effect on some of the serum lipid fractions. 3. The 3-fold difference in the incidence of side effects, although not statistically significant for the available sample size, may be clinically relevant.

Adult↗
PubMed2001

Evaluation of drainage times and alarms with various automated peritoneal dialysis modalities.

This paper assesses the variation in total drainage time (TDT) and number of alarms due to low drainage volume (LDV) in automated peritoneal dialysis (APD) patients with varying catheter performance. Catheter performance was measured by drainage break point (DBP) in a supine position. Six patients with DBP > or = 80% underwent three types of APD: non tidal, 50% tidal, and 80% tidal. Six patients with DBP < 70% underwent two types of APD: non tidal and tidal fixed at 5% below DBP. In every case, the fill volume was 2.3 L. For the purpose of the study, each treatment was continued for seven consecutive nights. Home Choice Pro (Baxter Healthcare Corporation, Deerfield, Illinois, U.S.A.) was used to calculate the TDT and LDV. With both the non tidal and tidal treatments, TDT was higher in patients with DBP < 70% as compared with patients with DBP > or = 80%. In the latter group, 50% tidal was the most effective technique in reducing TDT. In patients with DBP < 70%, the tidal treatment reduced not only TDT, but also LDV alarms, as compared to the non tidal treatment. In conclusion, choosing the tidal method helps to reduce LDV alarms and TDT, especially in patients with a low DBP. The Home Choice Pro device is an effective aid in setting up and assessing the dialytic prescription.

Catheterization↗