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PubMed1981

[Effects of trimethadione on the therapeutic efficiency of atropine and obidoxime in mice poisoned with various phosphoorganic compounds].

This paper was aimed at the observation of trimethadione therapeutic effects while this preparation was used as an agent supplementing the standard therapeutic mixture (cholinolytic and reactivator) for mice poisoning with phospholine--a compound of AO 217 and DEP. The studies covered 216 female mice of Balb C strain, body weight 18-24 g. After the determination of toxic doses of phosphoroorganic preparations administered subcutaneously, therapeutic effects of a mixture of atropine sulphate (10 mg/kg i.p.) and obidoxime (40 mg/kg i.p.) administered immediately after poisoning, were observed. Then trimethadione 300 mg/kg i.p. was of in a dose of 300 mg/kg i.p was added and the effects of that agent on the efficiency of basic medicines were observed. The studies were performed during 2 and 24 hr of observation. The observations prove that the efficiency of the basic therapeutic mixture during 24 hrs of observation of mice poisonings with AO 217 and DFP was respectively: 2.31 x and 2.64 x. In phospholine poisonings no increase in therapeutic effects were found.

Animals↗
PubMed1982

A particular kind of negative therapeutic reaction based on Freud's 'borrowed guilt'.

Freud's clinical discovery of the negative therapeutic reaction was one of the fundamental reasons for his proposing the Structural Theory of the mind. Yet he and subsequent writers provided very few clinical examples to clarify the definitional components of this significant finding. Consequently, there have been frequent controversies as to the various meanings, manifestations and dynamics of the negative therapeutic reaction. In this paper there was an attempt to illustrate a particular kind of negative therapeutic reaction, based on Freud's explanatory concept of 'borrowed guilt', as he expounded it in The Ego and The Id. For this purpose, excerpts from an analysis before the manifestation of the negative therapeutic reaction, during, and following its resolution, are presented in this paper. This manner of presentation may provide a basis for defining the phenomenon and understanding its dynamics within the analytic process. Hopefully, this paper illustrated both one of Freud's meanings of the negative therapeutic reaction, as well as confirmed his optimistic prediction that when it is based on 'borrowed guilt', its resolution is amenable to analysis.

Adult↗
PubMedDate not supplied

[The prospective image the psychotherapist holds of his patient and its effect on the therapeutic process].

Psychonalytic theory of the therapeutic process is predominantly determined by the concepts of transference, resistance and countertransference. Decisive through the insight into the relationship between analyst and patient thus derived may be, the range of, potential meanings of these concepts does not in the first place encompass a complete theory of the therapist-patient-relationship. It mainly indicates how to use the therapeutical techniques which in turn define the theoretical scope of these terms. What is called the real aspects in the therapeutic relation, ie, those relatively free from transference, and their influence on the therapeutical process are so far unterrepresented in the theory of psychoanalysis. Yet the prospective view the therapist holds of his patient most probably has a decisive impact on the course of a treatment. Although the notion of countertransference offers some technical possibilities for correcting this image and for adjusting it to reality it is not sufficient to account for the complexity of the process in the psychoanalytic theory. The real features of the therapeutical relationship are the secret condition, the very background which alone allows the phenomena of transference and counter-transference to be detected as such.

Countertransference↗
PubMed1994

Early morbidity and mortality of non-therapeutic operations for penetrating trauma.

A retrospective study was performed in order to evaluate early morbidity and mortality associated with non-therapeutic operations for penetrating trauma. Over a 3-year period, 1,062 operations were performed on 1,015 patients for penetrating injury: abdomen 860, chest 103, neck 40, and extremities 58. A total of 230 (21.7%) of these operations were non-therapeutic. The incidence of significant complications directly related to the anesthesia or operation in this group of patients was 8.2 per cent. One patient with an additional major thoracic injury died secondary to complications related to a non-therapeutic abdominal operation (0.4%). The average hospital stay for uncomplicated non-therapeutic operations was 5.1 days, and for patients with complications 11.9 days. We conclude that non-therapeutic operations for penetrating trauma are associated with significant morbidity and mortality that must be considered when designing management schemes for penetrating injury.

Adolescent↗
PubMed1994

Reflections on the place of the therapeutic alliance in psychoanalysis.

The connection between the therapeutic alliance and interpretation is examined by means of two distinctions. One distinction is logical and concerns the relation between necessary and sufficient causes, the other is technical and concerns the nature of interpretation. The logical distinction between necessary and sufficient conditions of change is used to help to define the connection between therapeutic alliance and interpretation. It is argued that the therapeutic alliance is a necessary but not a sufficient condition for therapeutic change, whereas interpretation is both a necessary and a sufficient condition. But a logical distinction about the nature of causes can take us only so far in defining the connection between these two aspects of clinical work. A second technical distinction between the explicit and implicit meaning of interpretations is made to further clarify the relative importance of therapeutic alliance and interpretation. It is argued that our efforts to establish and maintain a working alliance work best when they work silently in the implicit dimension of interpretations. Clinical material is introduced to illustrate and test these conclusions.

Adult↗
PubMed1993

[Therapeutic drug monitoring with the help of serum concentration measurements. How are the analytic results distributed in a population?].

Therapeutic drug monitoring includes measurement of serum concentrations of drugs when this is possible and appropriate. A therapeutic range is defined for populations where the serum levels represent an optimal relationship between clinical effects and side effects for most of the individuals in the population. Compared with the rest of the population, some individuals are atypical, both with respect to response to and elimination of drugs. Therapeutic drug monitoring makes individualization of dosages in these individuals easier, but often requires extra effort. Compilation of serum level measurements for different drugs for a period of six months showed that the tailoring of digitoxin, carbamazepine, lithium and phenobarbital is as close to optimal as can be expected for a population. For amitriptyline, digoxin and theophylline, a considerable increase in clinical effect within a population of users could probably be achieved by bringing more individual serum levels from the subtherapeutic into the therapeutic range. Nor does the therapeutic potential of phenytoin, nortriptyline and valproate seem to be fully utilized.

Blood Chemical Analysis↗
PubMed1993

Matrix effects in therapeutic drug monitoring surveys. Proposed protocol to identify error components and quality improvement opportunities.

Therapeutic drugs are not endogenous compounds. Therefore, differing reactivities between proficiency testing and patient samples have potential mechanisms beyond those attributable to alterations of the serum protein base, stabilizing materials, and other manufacturing components. The therapeutic drug monitoring proficiency sample is the ultimate in polypharmacy. Cross-reactivities may be uncovered that may or may not occur with any frequency in patient samples. Drugs are present in therapeutic drug monitoring proficiency samples in the absence of their metabolites, which may alter interactions with the assay systems. The CAP Therapeutic Drug Monitoring Resource Committee has contacted manufacturers when a specific method yields proficiency test results that differ from all other methods and/or the weighed-in target values. Only a few examples have been formally evaluated with the "matrix evaluation protocol." The protocol is very useful and has identified some matrix effects. A protocol is proposed using multiple samples containing survey base material. Data analysis using reciprocal plots will identify interference and corroborate calibration or recovery errors in the presence of survey base material. Data from 1987 through 1991 surveys for lithium and theophylline illustrate this data analysis and show interference from other drugs and suggest calibration errors. Weighted-in target values are the most rigorous method to provide accurate, transferable patient results and convince ourselves and our evaluators that we know what we are measuring. All of us need to be committed to improvement of laboratory procedures. I believe weighed-in target values are the appropriate and achievable goal for proficiency testing the majority of therapeutic drug monitoring analytes. Implementation of target values requires diligent and intricate collaboration among laboratorians, surveyors, manufacturers, and regulators.

Bias↗
PubMed1996

Pharmacological evaluation of novel Alzheimer's disease therapeutics: acetylcholinesterase inhibitors related to galanthamine.

Acetylcholinesterase (AChE) inhibitors from several chemical classes have been tested for the symptomatic treatment of Alzheimer's disease; however, the therapeutic success of these compounds has been limited. Recently, another AChE inhibitor, galanthamine hydrobromide (GAL), has shown increased clinical efficacy and safety. Using biochemical, behavioral and pharmacokinetic analyses, this report compares GAL with two of its analogs, 6-O-acetyl-6-O-demethylgalanthamine hydrochloride (P11012) and 6-O-demethyl-6-O[(adamantan-1-yl)-carbonyl]galanthamine hydrochloride (P11149), for their therapeutic potential. P11012 and P11149 were found to be potent, competitive and selective inhibitors of AChE, demonstrating central cholinergic activity, behavioral efficacy and safety. P11012 and P11149, though pharmacokinetic analyses, were shown to act as pro-drugs, yielding significant levels of 6-O-demethylgalanthamine. In vitro, 6-O-demethylgalanthamine was 10- to 20-fold more potent than GAL as an inhibitor of AChE, and it demonstrated greater selectivity for inhibition of AChE vs. butyrylcholinesterase. Like GAL, both P11012 and P11149 showed central cholinergic activity biochemically, by significantly inhibiting rat brain AChE; physiologically, by causing hypothermia; and behaviorally, by attenuating scopolamine-induced deficits in passive avoidance. In addition, GAL, P11012 and P11149 enhanced step-down passive avoidance, another measure of behavioral efficacy. By comparing efficacious doses with primary overt effects, P11012 and P11149 had better oral therapeutic indices than GAL. Oral pharmacokinetic analyses of GAL, P11012 and P11149 revealed differences. Although P11012 and P11149 exhibited similar area under the curve values, 191149 had slower, lower and more sustained concentration maximum levels. P11012 and GAL rapidly reached their concentration maximums, but GAL, in brain had the highest area under the curve and concentration maximum. Because of its composite profile, including duration of action, oral therapeutic index and pharmacokinetics, P11149 is considered the better therapeutic candidate for the treatment of Alzheimer's disease.

Alzheimer Disease↗
PubMed1996

Indications and complications of therapeutic disposable Acuvue contact lenses.

PURPOSE: Although therapeutic hydrogel contact lenses have been used for many years, there have been few reports on the therapeutic use of disposable lenses. We evaluated lens fit, duration of wear, efficacy of therapy, complications, and concurrent treatment in patients with corneal or anterior segment problems who were managed with Acuvue contact lenses for therapeutic purposes. METHODS: We managed 38 patients with corneal or anterior segment disease during 1992-1994. The duration of lens wear ranged from several days to 12 months. Six patients were fit for mechanical reasons, six were fit for symptomatic relief, and 26 were fit as an adjunct to healing. Technical failures included lenses with inadequate movement and lenses that fell out of the eye. Therapeutic failures occurred when lens use did not help resolve the anterior segment problem. RESULTS: Seventy-one percent of patients were fit successfully, and 66% of patients were therapeutic successes. Complications with contact lens fitting included lens loss, discomfort, corneal ulceration, and tight lens syndrome. CONCLUSIONS: Although we found some difficulty in lens fitting, Acuvue lenses may provide a useful, disposable, and less expensive alternative to the traditional bandage contact lens.

Adolescent↗
PubMed1996

Experimental studies of the therapeutic action of electroconvulsive therapy in endogenous depression. The role of the electrical stimulation and of the seizure studied by variation of stimulus intensity and modification by lidocaine of seizure discharge.

Three methods of electroconvulsive therapy (ECT) were compared in respect of therapeutic effect in 69 attacks of endogenous depression in 65 patients, not previously treated by ECT during the actual period of illness. The treatments were given under barbiturate narcosis, with full muscular relaxation, administration of oxygen and electroencephalographic recording of the seizure discharge. In two methods grand mal seizures were evoked by supraliminal (A) and liminal stimulation (B), in the third (C) lidocaine (3 mg/kg i.v.) was given before the application of liminal stimulation. The seizure discharges in C were markedly shortened and their pattern modified, while between A and B the duration and pattern of the seizures were similar (Table 1). The patients were referred to the three treatments at random and the groups may be regarded as having a similar prognosis (Table 2-5, 7). The therapeutic outcome was estimated by rating several depressive symptoms according to a rating scale worked out for the purpose. The rating was performed before treatment, one week after the fourth treatment (a treatment pause was then made) and one week after the completed series. To obtain more reliable measures the scores for the various symptoms were added together to form a total score, which was then divided into a depression score and a retardation score, presumably measuring mainly depressive mood and psychomotor retardation. Differences in rating scores on two rating occasions were taken as measures of improvement. In addition, a global rating of improvement was made. The rating procedure was double blind. The principal results were: 1. After four treatments (three patients who recovered after three treatments included) the degree of improvement was in the rank order ABC with significant group differences for a few scores. After the completed series of treatments improvement in groups A and B did not differ significantly whereas in group C it was significantly smaller for some scores (Table 9). 2. The total number of treatments was significantly higher in group C than in group A and B, which did not differ significantly between themselves (Table 10). 3. A measure of therapeutic efficiency, improvement per treatment, was computed by dividing the degree of improvement as obtained from the differences in the combined scores and from the global score of improvement, by the number of treatments. After four treatments the improvement per treatment was highest in group A and lowest in group C, although in the comparisons AB and BC most differences did not reach significance. After the completed series the improvement per treatment did not differ significantly in groups A and B whereas in group C it was significantly less (Table 10). 4. In comparison with groups A and B, the total duration of seizure discharges was significantly shorter in group C both after four treatments and, in spite of the higher number of treatments, after the completed series. The improvement per second of seizure discharge was not significantly different in the groups although there was a tendency to a lower effect per second in group B (Table 11). It is concluded from these results that shortening of the seizure discharge decreases the therapeutic efficiency of ECT. Increase of the stimulus intensity, which apparently does not change the seizure discharge, possibly gives a more rapid therapeutic response but does not change the final degree of improvement or the number of treatments required to reach it. The depression-relieving effect of ECT is bound to seizure activity and not, or only slightly, to other effects of electrical stimulation.

Adult↗
PubMed1996

New therapeutic agents marketed in 1995.

In 1995, the Food and Drug Administration (FDA) approved 28 new molecular entities (NMEs), 26 of which are for therapeutic use and two of which are diagnostic agents. Fourteen of the NMEs for therapeutic use were both approved and marketed in the United States in 1995. In addition, eight other NMEs and a biological agent for therapeutic use that the FDA approved before 1995 (most in late 1994) were marketed during the year. Thus, a total of 23 therapeutic agents reached the U.S. market for the first time in 1995. Many of the 12 therapeutic agents approved in 1995, but not marketed before the end of the year, were available in early 1996. This review considers the drugs' most important properties and compares them with other available agents with similar properties. This discussion is not intended to be all inclusive; when additional information is needed, more comprehensive references and the product literature should be consulted.

Cardiovascular Agents↗
PubMed1995

Comparison of the nitric oxide synthase inhibitors methylarginine and aminoguanidine as prophylactic and therapeutic agents in rat adjuvant arthritis.

OBJECTIVE: To compare the nitric oxide synthase (NOS) inhibitors NG-methyl-L-arginine (L-NMA) and aminoguanidine (AG) as prophylactic and therapeutic agents in rat adjuvant induced arthritis (AIA). METHODS: Arthritis was induced in male Lewis rats by the injection of adjuvant into the base of the tail. L-NMA or AG was administered twice daily by gastric intubation starting at the time of adjuvant injection, just before the onset of clinical symptoms, or after the onset of clinical symptoms. Paw swelling, plasma fibrinogen levels and urinary NO2-/NO3- excretion were measured to assess the effect of the inhibitors on the arthritis response and whole body NO biosynthesis. Selected joints were also evaluated histopathologically. The abilities of L-NMA, AG and another NOS inhibitor, NG-nitro-L-arginine methyl ester (L-NAME), to inhibit NO production by chondrocytes and synoviocytes were also compared. RESULTS: Treatment with L-NMA (400 mg/kg/day) or AG (500 mg/kg/day) reduced the urinary excretion of NO2-/NO3- to the control level. L-NMA suppressed the development of AIA when administered prophylactically; however, its antiarthritic properties declined with increasing delay of application. It was only weakly effective against established AIA. AG had neither a prophylactic nor a therapeutic antiarthritic effect. AG and L-NAME were much weaker inhibitors of NO production by chondrocytes and synoviocytes than L-NMA. CONCLUSION: Although L-NMA completely suppresses the development of AIA when administered prophylactically, it is much less effective when administered therapeutically. Furthermore, not all inhibitors of NOS show equal prophylactic activity against AIA. In addition, NOS inhibitors may be only weakly therapeutic, or even detrimental, in established disease. These findings should be considered when evaluating NOS inhibitors as potential therapeutic agents for the treatment of established human arthritis.

Animals↗
PubMed1997

Recurrent pyogenic cholangitis in Asian immigrants to the United States: natural history and role of therapeutic ERCP.

We reviewed the clinical presentation, cholangiographic features, and long-term outcomes in 41 patients with recurrent pyogenic cholangitis (RPC, "Oriental" cholangiohepatitis) who underwent ERCP at our institution, comparing patients who were initially managed with therapeutic ERCP, immediate hepatobiliary surgery, and no intervention. Patients undergoing only diagnostic ERCP had recurrent symptoms in 62% of cases, twice as often as patients managed initially by therapeutic ERCP or immediate surgery. These former patients required subsequent surgery more often than patients in the latter two groups. Outcomes for patients with diffuse biliary calculi were no different between patients managed by therapeutic ERCP or by immediate hepatobiliary surgery. In the 15 patients with only extrahepatic stones, 7/9 (71%) managed by therapeutic endoscopy and 7/8 (87.5%) managed by immediate hepatobiliary surgery were asymptomatic at almost two years mean follow-up (P > 0.05). Patients having undergone at least one definitive hepatobiliary surgery had fewer recurrences when managed by repeat surgery, although the difference was not statistically significant. Four of six (67%) patients with dominant strictures managed endoscopically are asymptomatic at mean follow-up of 15 months. Our study emphasizes the recurrent nature of symptoms in RPC and supports the primary role of therapeutic ERCP in managing these patients, especially those with extrahepatic stone disease alone.

Asia, Southeastern↗
PubMed1976

Effects of therapeutic concentrations of diphenylhydantoin on transmembrane potentials of normal and depressed Purkinje fibers.

Standard intracellular microelectrode techniques were used to study canine Purkinje fibers (PF) which had been superfused with blood or Tyrode's solution to determine the cardiac cellular electrophysiologic changes induced by antiarrhythmic concentrations of diphenylhydantoin (DPH). Some PF were normal whereas others were depressed by stretch, exposure to ouabain (125 mug/1) or superfusion with a solution in which all Na+ was replaced by tetraethylammonium. For normal fibers, therapeutic concentrations of DPH (DPH) induced slight decreases in action potential (AP) amplitude, maximum upstroke velocity of phase O (Vmax) and membrane responsiveness and somewhat greater decreases in AP duration. For fibers moderately depressed by ouabain or stretch, with reduced AP amplitude, maximum diastolic potential and Vmax, therapeutic [DPH] increased these variables. Fibers markedly depressed by Na-free solution or stretch developed slow response AP. The amplitude and Vmax of the AP were decreased by therapeutic [DPH]. Therapeutic [DPH] also suppressed automaticity and ouabain-induced delayed afterdepolarizations. Our studies suggest that the slight depression of normal PF AP characteristics induced by therapeutic [DPH] probably is of little significance with respect to antiarrhythmic effect. In contrast, both the improvement of AP characteristics of moderately depressed fibers and further depression of severely depressed fibers caused by [DPH] might modify arrhythmias. Effects of DPH on automaticity and delayed afterdepolarizations also would contribute to its antiarrhythmic effect.

Action Potentials↗
PubMed1998

Impact of the diagnostic methods on the therapeutic strategies.

Over the last 25 years the diagnostic approaches and therapeutic strategies of breast cancer have dramatically changed. The relationship between diagnosis and therapy has gradually become more complex due to the ever more sophisticated diagnostic tools (mammographic screening, digital mammography, magnetic resonance, SPECT scan and FDG-PET), which have improved resolution limits and accuracy, and also due to the different therapeutic planning applied to breast cancer in these years (conservative surgery, neo-adjuvant chemotherapy, axillary dissection or not). Thus, in this paper, we have briefly analyzed the many open questions in breast cancer management and the clinical challenges of present diagnostic tools in relation to pre-, peri- and postoperative phases, and to therapeutic strategies in general. The main goal of mammographic screening is to detect early invasive cancers and to treat them at the first useful moment. However, at which age should one begin screening, and what is the impact on overall survival, the cost-effectiveness, and, most of all, the best operative approach to suspect lesions? Can digital mammography give a better quality of imaging with respect to conventional mammography? Does unexpected multicentricity and/or multifocality, which is sometimes showed by magnetic resonance, have any clinical relevance? Is this technique really better than traditional methods for the identification of local recurrence? Is scintimammography able to improve the low diagnostic accuracy of mammography on non-palpable breast lesions? Moreover, at present, the need for axillary dissection and its therapeutic and staging value is deeply debated: however, clinical detection of axillary metastases is not a reliable diagnostic tool and there are no conventional radiologic techniques to be used: recently nuclear medicine imaging has provided various approaches, such as SPECT scan with different tracers, FDG-PET, or lymphoscintigraphy with gamma probe sentinel biopsy: there are not only methodologic but also phylosophic differences in using these techniques. Neo-adjuvant chemotherapy has allowed a dramatic reduction of primary breast cancer with a replanning of the surgical approach to large breast tumours but, at the same time, has posed new questions such as the adequacy of diagnostic pre- and perioperative revaluation. Finally, does postoperative follow-up take advantage of intensive diagnostic programs and are there therapeutic margins which would improve survival of patients with metastatic disease? This paper is an attempt to analyze the answers given in the literature. Nevertheless, at present, this matter is globally in progress and a scientific debate will provide, in the near future, a new promising scenario for breast cancer management.

Age Factors↗
PubMed1997

Cytokines and therapeutic oligonucleotides.

Therapeutic oligonucleotides - short strands of synthetic nucleic acids - encompass antisense and aptamer oligonucleotides. Antisense oligonucleotides are designed to bind to target RNA by complementary base pairing and to inhibit translation of the target protein. Antisense oligonucleotides enable specific inhibition of cytokine synthesis. In contrast, aptamer oligonucleotides are able to bind directly to specific proteins. This binding depends on the sequence of the oligonucleotide. Aptamer oligonucleotides with CpG motifs can exert strong immunostimulatory effects. Both kinds of therapeutic oligonucleotides - antisense and aptamer oligonucleotides - provide promising tools to modulate immunological functions. Recently, therapeutic oligonucleotides have moved towards clinical application. An antisense oligonucleotide directed against the proinflammatory intercellular adhesion molecule 1 (ICAM-1) is currently being tested in clinical trials for therapy of inflammatory disease. Immunostimulatory aptamer oligonucleotides are in preclinical development for immunotherapy. In the present review we summarize the application of therapeutic oligonucleotides to modulate immunological functions. We include technological aspects as well as current therapeutic concepts and clinical studies.

Animals↗
PubMed1998

Gene-modified tumor vaccine with therapeutic potential shifts tumor-specific T cell response from a type 2 to a type 1 cytokine profile.

Vaccination with a poorly immunogenic/nonimmunogenic tumor fails to protect the host from a subsequent challenge with the same tumor. The mechanisms underlying the failure of these tumors to sensitize therapeutic T cells are not clearly understood, but the inability of host T cells to recognize tumor has been implicated. In this study, vaccination with the poorly immunogenic B16BL6-D5 (D5 H-2b) tumor fails to generate therapeutic T cells from the tumor vaccine-draining lymph nodes (TVDLN) in our adoptive immunotherapy model. However, if vaccination is performed with an allogeneic MHC class I gene (H-2 Kd)-modified tumor, the T cells obtained from the TVDLN are therapeutic after activation with anti-CD3 and IL-2. Lymph nodes (LN) draining both D5 and D5-Kd tumor vaccines contained increased numbers of cells with reduced expression of L-selectin (L-selectin(low/-)) compared with naive LN. This implies that vaccination led to sensitization of T cells even in LN draining the unmodified D5 tumor. L-selectin(low/-) cells from D5-Kd, but not D5, TVDLN were therapeutic in our animal model. No antitumor activity was seen in the high level L-selectin T cells. L-selectin(low/-) T cells exhibited tumor-specific cytokine release that was type 2 (IL-4, IL-10) following vaccination with native D5 and type 1 (IFN-gamma) following vaccination with gene-modified D5-Kd. Our data suggest that the failure of unmodified D5 to generate therapeutic T cells is not due to an inability to recognize tumor Ags, but, rather, to the induction of an immune response that is ineffective in mediating tumor regression, i.e., immune deviation.

Animals↗
PubMed1998

[Ambulatory blood pressure, intima media thickness, global cardiovascular risk and therapeutic decisions].

OBJECTIVE: To determine the influence of ambulatory blood pressure monitoring (ABPM), carotid intima media thickness (IMT) and global cardiovascular risk on the therapeutic strategies issued from our hypertension unit. METHODS: All essential uncomplicated and never treated hypertensive patients referred to our hypertension unit between 1996 and 1997 for etiologic or target organ damage evaluation were considered eligible. We excluded diabetics and patients with renal disease who need a specific therapeutical approach. 54 patients (44.7 +/- 10.1 years) were included (40 men). All patients underwent an ABPM measurement. The right common carotid IMT measurement had been performed (0.06 +/- 09 mm). The global cardiovascular risks were assessed with the Framingham prediction chart taking into account age, sex, total cholesterol, smoking status and systolic office blood pressure. According to the therapeutic decision three groups were made up: group 1 lifestyle counselling (n = 13), group 2 single drug therapy (n = 31), and group 3 combination therapy (n = 10). RESULTS: No significant difference was found in age, sex ratio, prevalence of severe hypertension, office systolic blood pressure, body mass index, global cardiovascular risk between the three groups. In contrast ABP (24 h ABP mmHg: group 1: 128.23 +/- 6.91/79.7 +/- 6.4; group 2: 140.48 +/- 9.7/97.48 +/- 8.17; group 3: 152.4 +/- 15.35/99.4 +/- 12.14 p < .0001) and IMT (group 1: 10.55 +/- .09, group 2: .59 +/- .07, group 3: .66 +/- .11 p = .02), were significantly higher in group 3 than in group 2 and in group 1. The percentage of white coat hypertensives was higher in group 1 than in group 3 (group 1: 61.5%, group 2: 3.2%, group 3: 0%). In the whole population, the higher was the global cardiovascular risk, the higher was the common carotid intima media thickness. In this study the global cardiovascular risks are not related to therapeutic decisions. Therapeutic strategies are influenced by ABP level and by the vascular remodeling which depends partly on the global cardiovascular risk.

Adult↗