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PubMed1994

Cardiorespiratory responses to low-intensity heart rate-controlled exercise in female subjects.

This study compares selected cardiorespiratory responses of six healthy females during exercise on rowing (R), cycle (C) and arm (A) ergometers. Their mean +/- sd age, mass and height were 22.3 +/- 3.0 years, 55.3 +/- 6.3 kg and 161.5 +/- 7.4 cm, respectively. Subjects reported to the laboratory on three separate days without engaging in intense physical activity the day prior to testing. Subjects sat quietly for five minutes on an ergometer prior to a 15 minute, steady-state exercise bout. Target heart rate during the exercise period was set at 115 bpm, and was monitored continually with workload adjustments applied to the ergometers to ensure that the target rate was maintained. CO2 rebreathing using the Sensormedics Horizon MMC was performed twice at steady-state exercise and averaged to examine changes in Q and SV. A one-way repeated measures ANOVA revealed that at similar levels of heart rate (R = 114.0 +/- 2.8; C = 116.0 +/- 2.8; A = 114.8 +/- 6.9 bpm) there were significantly lower Q and SV during arm ergometry (8.43 +/- 0.93 l/min and 72.61 +/- 7.82 ml) than rowing (13.01 +/- 1.61 l/min and 111.57 +/- 13.52 ml) and cycle (11.10 +/- 2.19 l/min and 88.23 +/- 21.94 ml) ergometry, and there were no significant differences in Q and SV between rowing and cycling. These results suggest that arm work during low intensity steady-state aerobic exercise is associated with a reduced stroke volume which is probably related to a reduced venous return during arm work in comparison to other types of exercise.

Adult↗
PubMed1995

Cardiac demands of heavy snow shoveling.

OBJECTIVE: To assess the physiologic responses to manual (shoveling) vs automated (electric snow thrower) snow removal in healthy, untrained men. DESIGN: Observational, controlled trial. SETTING: A community-based, acute care, teaching-research hospital. PARTICIPANTS: A volunteer sample of 10 apparently healthy untrained men (mean +/- SD age = 32.4 +/- 2.1 years) met all eligibility criteria and completed the study. INTERVENTION: Each subject cleared two 10 +/- 2-cm-high, 15-m-long tracts of heavy, wet snow in the cold (2 degrees C), using self-paced manual and automated methods, in random order, with 10- to 15-minute rest periods between each 10-minute bout of work. MAIN OUTCOME MEASURES: Heart rate, blood pressure, oxygen uptake, and perceived exertion during snow removal were compared with values obtained during maximal arm-ergometer and treadmill tests. RESULTS: Mean heart rate during shoveling was 154 and 173 beats per minute at 2 and 10 minutes, respectively, corresponding to 86% and 97% of maximal heart rate. Relative heart rate (percentage of maximal heart rate) during shoveling was inversely related to aerobic fitness (r = -0.65; P = .05). The highest heart rate and perceived exertion responses during shoveling, arm-ergometer, and treadmill testing were comparable. Systolic blood pressure during snow shoveling (198 +/- 17 mm Hg) was significantly greater (P < .003) than during arm ergometry or automated snow removal and slightly greater than during maximal treadmill testing (181 +/- 25 mm Hg). Oxygen uptake during shoveling was similar to that for arm ergometry (5.7 vs 6.3 metabolic equivalents), but lower than for treadmill testing (9.3 metabolic equivalents). Cardiorespiratory and perceived exertion responses were reduced during automated snow removal. CONCLUSION: Heavy snow shoveling elicits myocardial and aerobic demands that rival maximal treadmill and arm-ergometer testing in sedentary men. These responses may contribute to cardiovascular events reported after heavy snowfalls.

Adult↗
PubMed1994

[Ergospirometry: a suitable method for evaluating work capacity in occupational medicine?].

In various industrial tasks elevated physical strain of workers can be expected. In order to identify possible health hazards as soon as possible and to effectively prevent occupational diseases and accidents, a series of occupational health medical examinations are mandatory according to German accident prevention regulations such as VBG 100 "Occupational Health Care", Regulations for Climatic Conditions Underground (KlimaBergV), Regulations for Mine Rescue Teams, etc. Besides a clinical medical inspection and a laboratory blood test as well as urine test the physical fitness and aptitude for several specific occupational hazards are tested by means of a mandatory ergometry test. In the present publication the possible predictive limits as well as the making sense or nonsense of the use of ergometry in occupational aptitude tests under the auspices of German accident prevention regulations will be discussed.

Exercise Test↗
PubMed1994

[The effect of Lomir (isradipine) on the tolerance for physical loading and on the gas exchange indices of patients with primary pulmonary hypertension].

Spirometry and bicycle ergometry were performed before and 3 weeks, 6 months after lomir treatment (mean dose 10.62 +/- 2.59 mg/day) of 8 patients with primary pulmonary hypertension. It was found that 3 weeks of the treatment produced a significant increase in the maximum power working capacity and performance, in 6 months of the treatment there were positive trends in gas exchange: anaerobic threshold became higher and maximum oxygen consumption rose. Thus, lomir is recommended for management of primary pulmonary hypertension as it improves exercise tolerance and gas exchange measured by means of spirometry and bicycle ergometry useful both for evaluating functional condition of the patients and the disease advance as well as its response to the therapy conducted.

Adult↗
PubMed1994

[A comparative evaluation of 2 physical loading tests in arterial hypertension].

Interrelationships between arterial pressure (AP), physical performance (PP) and arterial hypertension (AH) risk factors were studied in two representative samples of hypertensive subjects using multivariate stepwise regression analysis in the preexercise, exercise and postexercise periods and two exercise tests. Test 1 (standard continuous bicycle ergometry) allowed PP estimation by the work performed and double product (HRmax x SAP/100 max). Test 2 (stepwise intermittent bicycle ergometry by PWCx) estimated PP according to a special formula. Test 1 is standard and therefore is able to provide significant diagnostic, prognostic and rehabilitation information. Test 2 is standard only at its first step, while the second step varies with cardiovascular response to the initial step. This is convenient for definition of permissible exercise dynamic control over exercising subjects, assessment of training efficacy in different regimens and programs. It is concluded that both methods are fit for estimating relations between AP, PP and AH risk factors in exercise and are comparable by the main parameters.

Adult↗
PubMed1994

[Effects of a nucleotide-nucleoside mixture on ischemic muscle metabolism in patients with stage II peripheral arterial occlusive disease. MR spectroscopic and biochemical analytic results].

In order to assess the acute metabolic effects of an intra-arterial infusion of nucleotide-nucleoside-mixture (NNM), 31P-mr-spectroscopy at the site of m. gastrocnemius and metabolite determinations from blood of the femoral artery and vein were carried out in 10 patients with PAOD stage II during ergometric calf exercise to the claudication pain limit. The spectroscopic measurements revealed a greater exercise-induced fall of PCr and a higher increase of Pi in calf muscles during supply of NNM compared with control ergometry. Post-exercise recovery of PCr was distinctly delayed during infusion of NNM. The anaerobic production of energy, however, was sufficient to maintain the ATP concentration to the same extent as under control ergometry. On the other hand, intramuscular lactate acidosis developed to a lower degree with NNM infusion than without NNM. A reduced muscular release of lactate, pyruvate, ammonia and alanine followed from the evaluation of the arteriovenous balance of these metabolites in the femoral vessels indicating a favourable global metabolic effect of NNM infusion in the extremity. The apparent contradiction in the spectroscopic and analytic-biochemical findings can be explained by local blood shunts induced by maximum vasodilation. Noninvasive mr-spectroscopy allows to detect directly and continuously the metabolic impact of ischemia in the calf muscles afflicted by arterial occlusion, whereas the metabolite concentrations in femoral blood are altered by afflux from non-ischemic areas. The known clinical benefit of frequently repeated intra-arterial infusions of NNM is thought to be due to an expansion of collateral circulation and to a favourable influence on endothelial functions.

Adenosine Triphosphate↗
PubMed1993

Anaerobic threshold in wheelchair athletes with cerebral palsy: validity and reliability.

This study examined the validity and reliability of the anaerobic threshold (AT) using blood lactate (ATLa) and respiratory gas exchange (ATg) criteria during cycle ergometry (CE) and wheelchair ergometry (WE) in athletes with spastic cerebral palsy (CP). Eleven subjects attempted a discontinuous incremental test protocol, two minutes work interspersed with one minute rest, twice each on the CE and WE. Only five out of the 11 subjects were able to complete the CE tests, whereas all the subjects were able to complete the WE test. Inadequate hip flexion due to muscle spasticity was the primary limiting factor during the CE tests. Although the maximal aerobic power using this protocol was reliable during WE (r = 0.89, p < .05), the validity and reliability of the AT identified by two independent evaluators using these two techniques was questionable. Evaluator 1 was able to identify ATLa and ATg in seven out of the 11 cases, whereas evaluator 2 was successful in five and seven cases, respectively. It is unclear from these results whether the poor validity and reliability of the AT was due to the discontinuous test protocol used, or whether it was due to inconsistencies in the rate of lactate diffusion from the muscle into the blood due to variations in muscle spasticity during the test.

Adult↗
PubMed1995

[Symptomatic and silent myocardial ischemia during drug therapy and after aortocoronary bypass].

In 53 patients with stable angina pectoris 24-hour ambulatory electrocardiographic monitoring (Holter) and bicycle ergometry were used before and six months after a coronary bypass. The examination before operation was made while anti-ischaemic medication was administered, the examination after revascularization was done without medication. The patients were divided into group A (31 patients where complete revascularization of the myocardium was made) and group B (22 patients with incomplete revascularization) and the results were compared during medication and after aortocoronary bypass. In patients of group A revascularization prolonged significantly the load period during ergometry, as compared with medication (from 7.2 +/- 2.2 min. to 9.1 +/- 2.4 min., p < 0.01), the depression of the ST segment in lead V5 was reduced (from 1.3 +/- 0.8 mm to 0.8 +/- 1.0 mm, p < 0.05) and the number of painful episodes during Holter monitoring (from 1 +/- 1 to 0, p < 0.01). In patients of group B none these parameters improved. Medicamentous treatment eliminated ischaemia during a load in 16% of patients in group A, while revascularization did so in 61% (p < 0.01). In patients of group B the success rate of medication was 9%, in revascularization 14% (p = n.s.). During Holter monitoring after revascularization no episodes of ST depressions associated with anginous pain were recorded, although the mean number of silent episodes of ST depressions per 24 hours was 6 +/- 8 in patients of group B and 1 +/- 2 in patients of group A. In patients with stable angina pectoris complete revascularization is significantly more effective than anti-ischaemic medication as regards tolerance of loads and suppression of myocardial ischaemia. Silent myocardial ischaemia is frequent after aortocoronary bypasses and its possible occurrence should be taken into account, in particular in patients with incomplete revascularization.

Adrenergic beta-Antagonists↗
PubMed1977

[Significance of isoenzymes for the prognostic evaluation of acute hepatitis--studies under load].

100 patients who got over a virus hepatitis underwent a bicycle ergometry. At the beginning and at the end of the experiment as well as 24 hours after this the isoenzymes of aldolase, GOT and LDH in the plasma were determined by means of kinetic methods. On the basis of the activities of the isoenzymes for the test persons (children and adults of either sex) an arrangement in the groups pathologic--suspicious--normal can be carried out which is compared with the physiologic parameters and the clinic. The results of bicycle ergometry much differ. High effects without pathological changes of the activities of isoenzymes are an objective criterion of the quick, riskless rehabilitation of the test persons.

Acute Disease↗
PubMed1996

[The late cardiac sequelae after mantle-field irradiation. The results in Erlangen's patient caseload].

PURPOSE: We have retrospectively evaluated the cardiac function in patients after mantle-irradiation for Hodgkin's disease. PATIENTS AND METHODS: Forty-three patients, mean age 39.8 +/- 13 years, who had been treated with mantle-irradiation from 1979 through 1984 at the University of Erlangen-Nürnberg, were examined. All of them were in first remission at 5 to 11 years (mean 8.1 years) after radiotherapy (n = 24) or combined modality treatment (n = 19). Mantle-irradiation had been administered through equally weighted anterioposterior-posterioanterior portals with 5 fractions of 2 Gy per week up to a total mediastinal dose of 41.8 +/- 7 Gy (including boost). The examination program included anamnesis, physical examination, Doppler echocardiography and ergometry. Hundred and twenty-two non-irradiated volunteers and cardiological patients were used as control group. RESULTS: None of the patients suffered from clinical symptoms. Pericardial thickening was present in 26%. The left ventricular end-systolic diameter (31.3 +/- 5.5 mm, normal value 26 to 42 mm) and the thickness of the left ventricular posterior wall (8.1 +/- 1.8 mm, normal value 6 to 11 mm) were within the normal range. The left ventricular ejection fraction was also normal (67.1 +/- 8% in patients versus 67.0 +/- 8% in control subjects). Evaluation of diastolic parameters, however, revealed significant changes. The isovolumic relaxation time was significantly decreased as compared to the control group (38.8 +/- 17 ms versus 50.8 +/- 21 ms, p < 0.05). The same we found for the shortening fraction (33.6 +/- 6% versus 38.1 +/- 6%, p < 0.05). The most significant changes were found after combined modality therapy, especially after radiotherapy and anthracycline-based chemotherapy. 30% of the patients were tachycardic (pulse > 100/min) at rest. At ergometry, the frequency of signs of ischemia (5%), conduction disturbances (2%), and rhythm disturbances (7%) was not elevated. CONCLUSIONS: In this retrospective investigation, patients after mantle irradiation with modern techniques showed only minimal cardiologic abnormalities within the first 10 years after treatment. The most sensitive parameters were the isovolumic relaxation times. The clinical relevance of such findings remains to be defined. Pathophysiologically, our findings (decreased relaxation time plus tachycardia) support the theory that myocardial damage after radiotherapy may result in subsequent increased beta-receptor density as proposed by Schultz-Hector et al. [21] on the basis of experimental data.

Adult↗
PubMed1995

Exercise increases endothelin-1 plasma concentrations in patients with coronary artery disease: modulatory role of LDL cholesterol and of pentaerithrityltetranitrate.

Previous studies suggest that ET-1 plays a role in induction of coronary artery disease (CAD). It was shown that secretion of endothelin-1 (ET-1) by the vascular endothelium is enhanced in atherosclerotic alterations and may be antagonized by EDRF. The objective of the present study was to investigate the effects of ergometric exercise on plasma ET-1 concentrations, and the potential modulatory role of LDL cholesterol, and the effects of an orally administered nitrate, PETN, in patients with CAD. Ten men with CAD and 10 healthy men underwent bicycle ergometry according to the WHO-standards. Venous blood samples for determination of ET-1 concentrations were drawn directly before and 5 min after ergometric exercise. Patients were randomized and treated for 72 h in a crossover design either with placebo or pentaerithrityltetranitrate (PETN). After 72 h the identical ergometric protocol was repeated. Basal plasma levels of ET-1 were 6.1 +/- 0.7 pg/ml (patients) and 5.5 +/- 0.6 pg/ml (controls) (n.s.). After ergometric exercise ET-1 plasma concentrations rose significantly (7.3 +/- 0.9 pg/ml; p < 0.05) in the patient group under placebo treatment, whereas they remained constant (5.5 +/- 0.7 pg/ml) with PETN treatment. ET-1 levels remained unaffected by ergometric exercise in healthy controls. Mean LDL cholesterol plasma levels in patients with CAD were 156 +/- 8 mg% and 152 +/- 7 mg% in healthy controls. In the patient group there was a significant (p < 0.002) positive correlation between the exercise-induced increase in ET-1 and the LDL cholesterol plasma concentrations (r = 0.85). Blood pressure and heart rate were not modified by PETN treatment. In patients with CAD bicycle ergometry induced an increase in ET-1 plasma concentrations. The positive correlation with the LDL cholesterol plasma levels indicates that LDL cholesterol is involved in regulation of ET-1 secretion in vivo. PETN therapy completely abolished the exercise-induced increase in ET-1 plasma levels. This may result from local hemodynamic effects of the nitrate; hypothetically a nitrate-induced rise in the local NO concentrations can be considered. The clinical implications of these findings remain elusive. However, the findings of the present study are in accordance with the beneficial clinical effects of nitrates in patients with CAD.

Cholesterol, LDL↗
PubMed1996

[Good results of outpatient pulmonary rehabilitation: 2-year experience in the Rijnlands Zeehospitium in Katwijk].

OBJECTIVE: To describe the results of outpatient pulmonary rehabilitation of patients with asthma and chronic obstructive pulmonary disease (COPD). DESIGN: Descriptive. SETTING: Rijnlands Zeehospitium, Katwijk, the Netherlands. METHODS: In the period June 1991-September 1993, 64 patients participated in pulmonary rehabilitation. They were divided into three groups according to the results of spirometry: group I: FEV1 > 60% of predicted value; group 2: FEV1 40-60%; group 3: FEV1 < 40%. Data were collected by spirometry, bicycle ergometry, walking distance and the Questionnaire for asthma and COPD-patients, which measures quality of life, compliance with therapy, ability to cope and social support. Patients visited the outpatient clinic three times a week, during three months for training and guidance in a multidisciplinary setting, and attended a health education programme. RESULTS: Significant results were obtained in exercise performance at bicycle ergometry and walking distance. The psychosocial results showed improvement in quality of life, compliance with therapy and ability to cope. Group 1 and group 2 improved on almost every parameter, in group 3 the results in exercise performance were less striking. With respect to psychosocial parameters, group 3 showed significant reduction in anger, dyspnoea and fatigue. CONCLUSION: Pulmonary rehabilitation on an outpatient basis showed positive results that were most striking in patients with asthma or mild COPD. The results in patients with severe COPD were less, but still evident.

Activities of Daily Living↗
PubMed1996

Ø[The effect of physical exercise on glycemia on healthy subjects following administration of glimepiride].

Sulfonylureas predispose to hypoglycaemia during and after exercise. The hypoglycaemic effect of the novel sulfonylurea glimepiride (G; CAS 93479-97-1) in male healthy volunteers under these conditions. Each subject was exposed to three experimental situations, administration of 3 mg G and rest, administration of 3 mg G and 60 min of bicycle ergometry (E) (work load adjusted to a heart rate of 120 bpm), or placebo (P) and bicycle ergometry as mentioned. Each of these was preceded and followed by 60 min of physical rest. Base line glycaemia was comparable (PE 83 +/- 8 mg/dl, GR 84 +/- 5 mg/dl, GE 86 +/- 7 mg/dl) and fell during GR to 63 +/- 6 mg/dl after 150 min. During GE glycaemia ceased to decline after 30 min exercise, and rose thereafter reaching values comparable to PE after 150 min (80 +/- 8 vs. 82 +/- 7 mg/dl). Serum insulin concentrations rose during exercise following administration of G to 6-7 microU/ml (AUC during the period 60-120 min after administration: GE 371 +/- 81 microU/ml.60 min, GR 414 +/- 77 microU/ml.60 min), and fell during PE to 4 microU/ml (265 +/- 49 microU/ml.60; p < 0.001 vs. GE and GR). During GE serum insulin concentrations fell to 6 microU/ml at the end of exercise and thereafter (AUC during the period 120-180 min after administration: 340 +/- 82 microU/ml.60 min), whereas they remained at 7 microU/ml during GR (399 +/- 109 microU/ml.60 min; p = 0.087 vs. GE). In conclusion, exercise blunts the hypoglycaemic effect of glimepiride in healthy individuals.

Adult↗
PubMed1996

[Detection of stress-induced myocardial ischemia in isolated coronary ectasia and aneurysm (dilatative coronaropathy)].

Forty eight patients with bilateral isolated non-stenotic coronary artery ectasia or aneurysm without associated cardiac defects ("dilated coronaropathy") were identified in consecutive diagnostic cardiac catheterizations between 1986-6/1994 (angiographic incidence 0.44%). Ectasia was defined as a luminal dilatation of the 1.5-2-fold, aneurysm of more than double the normal limits. In 16 patients a myocardial infarction (5 non-q-infarctions/11 q-wave-infarctions) was the indication for coronary angiography, a thrombotic occlusion of the infarct vessel was documented in 8/16 patients. In patients without myocardial infarction (study group) an evaluation of exercise-induced myocardial ischemia was performed by means of a coronary sinus lactate study, treadmill ergometry and Thallium-201-scintigraphy. A corresponding coronary insufficiency was objective in all tests in the study group. An exercise-induced myocardial ischemia was found in 21/31 in the coronary sinus study, 19/29 in the treadmill ergometry and 13/26 patients in the scintigraphy; significant differences were found in comparison to the results of a control group of patients without heart disease (n = 29, p < 0.001). After administration of 0.8 mg nitroglycerin (NTG) a further significant deterioration of myocardial ischemia was measured in the 21 patients with pathologic lactate metabolism developing a frank cardiac lactate production (p < 0.03). The extent of myocardial ischemia in the coronary sinus study was significantly correlated to the coronary diameters of the proximal and middle segments of the Ramus interventricularis anterior and the middle segment of the Ramus circumflexus (r = 0.87, p < 0.02). A differentiation between ectasia and aneurysm therefore seems to be of functional relevance. Angiographic stigmata of an impaired coronary blood flow such as a segmental to and from movement and a local deposition of dye were found significantly more often with increasing coronary diameters (p < 0.04). "Dilated coronaropathy" is an entity of non-stenotic, ischemic coronary artery disease. NTG was of no therapeutic benefit or led to an aggravation of the exercise-induced myocardial ischemia. Because of this potential adverse effect the administration of NTG should be avoided in "dilated coronaropathy".

Adult↗
PubMed1996

Blood pressure measurement during ergometric stress testing.

Evaluation of high blood pressure would be greatly facilitated by a standardized test procedure that could enable comparable and reproducible blood pressure determinations to be made. It would also be useful to have a standardized method for monitoring sympathetic activity, so that the occurrence and magnitude of inordinate stress responses could be assessed more accurately. One way to meet these requirements is through standardized ergometric testing at workloads of 50 to 100 watts using increments of 10 watts/ min or 25 watts/2 min (cuff blood pressure measurements). Between the ages of 20 and 50 years the criteria for a hypertensive response during exercise are blood pressure values of more than 200/100 mg Hg (mean + 1 SD of the normotensives) at a workload of 100 W. In the recovery phase, blood pressure is considered as being hypertensive if a value of 140/90 mm Hg is exceeded in the fifth minute. There are several studies showing that the blood pressure response to ergometry predicts future hypertension in patients with normal resting blood pressure. Patients suffering from mild hypertension showed significantly (p < 0.001) higher blood pressures (213 +/- 22/116 +/- 11 mm Hg) at 100 W and after exercise than age-matched normotensives (188 +/- 14/92 +/- 9 mm Hg) but significantly (p < 0.001) lower values than hypertensives with stable hypertension (225 +/- 22/126 +/- 11 mm Hg). Using the normal upper limits for blood pressure during and after ergometry, the ergometric procedure revealed that 50% of the patients with borderline hypertension at rest could be classified as hypertensives. Follow-up examinations several years (average 3.8 years) later subsequently showed that 97% of the ergometric-positive borderline hypertensives developed established hypertension. Ergometric studies also assume a prognostic importance, with respect to prevention of acute and chronic complications of hypertension. Therefore, we must require that antihypertensive drugs not only normalize the resting blood pressure, but also lower the blood pressure adequately in stressful situations. This requirement is by no means satisfied by all hypertensive drugs that are effective at rest.

Adult↗
PubMed1996

Automated blood pressure measurement during ergometric stress testing: possibilities of Finapres.

BACKGROUND: The accurate recording of the blood pressure response to ergometry is of increasing interest in clinical practice, yet its measurement is susceptible to considerable error. We searched the literature for studies that describe devices designed for automated measurement of indirect blood pressure during dynamic exercise. As a possible alternative we studied in seven normotensive subjects noninvasive continuous finger arterial and simultaneously recorded intrabrachial pressure before, during and after maximal bicycle ergometry to 220-340 watts. RESULTS: The automated devices designed to pick up the Korotkoff sounds, even with support of R-wave EKG detection, amplification of K-sounds and/or implementation of microprocessor technology did not achieve the accuracy of conventional Riva-Rocci-Korotkoff sphygmomanometry. At maximal exercise brachial systolic, diastolic and mean responses were 67 +/- 20, 13 +/- 7 mm Hg and 35 +/- 13 respectively. In the finger systolic pressure increased significantly more (85 +/- 29 mm Hg, p < 0.05) but comparable responses were found for diastolic and mean pressure (18 +/- 12 mm Hg and 36 +/- 18). CONCLUSIONS: Automated blood pressure devices are not an improvement over conventional auscultatory measurement. Finger blood pressure can be measured even at maximal exercise, with a reliable continuous measurement of intrabrachial responses for mean and diastolic pressures.

Adult↗
PubMed1996

Pantoprazole has no influence on steady state pharmacokinetics and pharmacodynamics of metoprolol in healthy volunteers.

The new H+/K+ ATPase inhibitor pantoprazole, a substituted benzimidazole, is metabolized by the hepatic cytochrome P450 enzymes 2C19 or 3A4 and subsequently undergoes phase II metabolism. The widely used beta 1-adrenoreceptor-blocking agent metoprolol is metabolized via CYP2D6. The influence of pantoprazole on the pharmacokinetics of an orally administered zero order kinetics formulation (ZOK) of metoprolol was the objective of this study. Eighteen volunteers (9 female, 9 male, age 20-44 years) completed the randomized, double-blind crossover study. Each subject received either 95 mg metoprolol and placebo (reference (R)) or 95 mg metoprolol and 40 mg pantoprazole (test (T)) as oral doses (sid) for 5 consecutive days. On day 5 of each period serum concentrations of R- and S-metoprolol were determined and a treadmill ergometry was performed. The primary pharmacokinetic characteristics for extent and rate of absorption were AUC(0-24h) and % PTF, respectively. To assess the pharmacodynamic effect of metoprolol the excess area under the effect vs. time curve was calculated for heart rate during ergometry (AUCexHR). Point estimate and 90% confidence limits (CI) for the ratios of population medians of T and R were given. The respective point estimates (90% CI) of the ratios of both primary and secondary characteristics were entirely within the equivalence range of 0.80 and 1.25 for both enantiomers of metoprolol. Moreover, equivalence could be shown for the pharmacodynamic characteristic AUCexHR. Hence, it was concluded that pantoprazole does not interact with metoprolol pharmacokinetics or pharmacodynamics. Therefore, no dose adjustment of metoprolol during therapy with pantoprazole is necessary.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

[Prevalence of hypertensive response to exercise in a group of healthy young male athletes. Relationship with left ventricular mass and prospective clinical implications].

AIM: We examined the prevalence of hypertensive response to exercise in a group of healthy young male athletes and evaluate the relationship between this exaggerated blood pressure response to exercise and left ventricular mass. METHODS: We studied 37 healthy male athletes (18 soccer players, 12 mountain climbers and 7 canoeists) at a similar level of physical conditioning at the time of the study. The age ranged from 16 to 37 (mean +/- SD: 25.9 +/- 6 yrs.). They underwent basal measurements of heart rate and blood pressure, maximum cycle ergometry in the erect position (increasing 50 W each 3 minutes until exhaustion) and basal echocardiography-Doppler. The statistical analysis was performed using a non-paired Student-t-test. RESULTS: A hypertensive response to exercise was observed in 8 of the 37 athletes (21.6%). In these 8 athletes the mean left ventricular mass index was 204.88 +/- 63.22 g/m2 estimated by echocardiography, whereas the mean in athletes without exaggerated blood pressure response to exercise was 143.29 +/- 27.51 g/m2 (p < 0.0001). All the athletes with hypertensive response to exercise showed left ventricular hypertrophy, being severe in 75% of them. Of the athletes without hypertensive response to exercise, 44.9% did not exhibit left ventricular hypertrophy. A left ventricular mass index of > or = 190 g/m2 was observed in 50% of athletes with exaggerated blood pressure response to exercise, versus only 6.8% of athletes without it. CONCLUSIONS: A fairly high prevalence of hypertensive response to exercise was observed in our series of healthy young male athletes. The athletes with exaggerated blood pressure response to exercise exhibited a significantly greater left ventricular mass than athletes without it. According to current general knowledge, this group of healthy athletes with hypertensive response to exercise could be prone to develop future chronic high blood pressure at rest and non-physiologic left ventricular hypertrophy. Thus, ergometry may be a useful test to prospectively identify a group of individuals at increased risk for developing essential arterial hypertension, potentially allowing early intervention before hypertension may contribute to cardiovascular risk.

Adolescent↗