[Vasodilator agents in the treatment of hypertension of the lesser circulation].
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Raynaud's phenomenon is usually a benign acrosyndrome which few of the currently available therapies improve significantly. This makes the evaluation of the efficacy of vasodilators very difficult, especially as there are no standardised complementary investigations to quantify their effects. Assessment is based essentially on careful interrogation and the use of an analogical scale remains the method of reference. The multiplicity of factors inducing the acrosyndrome necessitates cross-over trials versus placebo over sufficiently long periods of observation (if possible, one month). As regards follow-up and objective evaluation, reactivity to cold is a promising method providing the tests can be standardised with respect to methodology and expression of results.
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The aim of this work is the evaluation of the hemodynamic effects during the 24 hours following a single administration of a new arterial vasodilator, cadralazine, in 12 patients whose mean age is 66 years and who present severe cardiac insufficiency. A clinical and hemodynamic examination was made before administration of the medicine in 3 doses at 12 hour intervals in order to check the stationary state of the patients, and then at 1 h, 2 h, 4 h, 6 h, 8 h, 12 h, 20 h and 24 h after 30 mg, and then 60 mg of cadralazine. We did not observe any significant change in cardiac frequency, nor in the systolic arterial pressure nor in the diastolic arterial pressure of the pulmonary artery, after either 30 mg or 60 mg. On the other hand, with 30 mg of cadralazine we observed a significant increase of the cardiac index, with a maximum between the 6th and 8th hour (1.58 +/- 0.51 l.min-1.m-2 before treatment to 2.66 +/- 0,75 l.min-1.m-2 8 hours after, p less than 0.001) and a fall of total systemic resistance which declined from 2,478 +/- 421 dyn.s-1.cm-5 before treatment to 1,449 +/- 369 dyn.s-1.cm-5, p less than 0.001, 8 hours after, as well as an increase in the power of the left ventricule (from 2.80 +/- 0.8 before treatment to 4.73 +/- 1.2 kg/min 8 hours after, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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It has been shown in experiments on adult cats that chronic treatment of normotensive animals with vasodilators leads to inconsistent changes in the transmural potential difference and electrolyte balance of the wall of blood vessels. A permanent correlation has been revealed to exist between vasodilation and increased electronegativity of the intima with regard to advention. Euphylline gives rise to potassium accumulation by the wall of blood vessels, whereas sodium nitrite produces no appreciable action on the electrolyte balance in the vascular wall. Angiotrophin and no-spa do not alter arterial pressure and transmural potential difference.
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