Cadralazine and chlorthalidone as a second-step drug with atenolol in hypertensive patients: Differences in blood pressure control during exercise

Summary The long-term efficacy of a new vasodilator, cadralazine (ISF 2469), and chlorthalidone have been compared in 20 hypertensive patients not adequately controlled by atenolol. After 4 weeks of treatment with atenolol 100 mg once daily, patients whose diastolic blood pressure was >95 mmHg were randomly divided into two groups to receive in addition to atenolol, either cadralazine 15 mg once daily or chlorthalidone 25 mg once daily. Both treatments were administered for 6 months. At the end of treatment with atenolol and after 3 and 6 months of combination therapy, blood pressure and heart rate were measured at rest and during bicycle exercise 24 h after the last dose. Compared to atenolol alone, both cadralazine and chlorthalidone caused a significant and similar reduction in resting blood pressure. Both groups showed an increase in diastolic blood pressure during exercise while receiving atenolol alone. The addition of chlorthalidone did not modify the pressor response to exercise, whereas patients taking cadralazine had a decrease in exercise diastolic blood pressure, which was fully evident after 6 months of therapy. The reduction in exercise diastolic blood pressure induced by cadralazine was proportional to the increase in exercise heart rate, suggesting a fall in peripheral vascular resistance. Chlorthalidone caused a significant increase in serum glucose and uric acid and a decrease in K⁺, whereas no change was observed during cadralazine It is concluded that cadralazine given once a day with atenolol has the same efficacy in controlling blood pressure at rest as the combination of atenolol and chlorthalidone, and in addition it improves the pressor response to dynamic exercise and does not cause unwanted metabolic effects.     

Cardiovascular regulation and lipoprotein profile during administration of co-dergocrine in essential hypertension

Summary Co-dergocrine has recently been demonstrated acutely to lower plasma norepinephrine (NE) and blood pressure (BP) in patients with essential hypertension, and similar results have been obtained during chronic administration of co-dergocrine to healthy men. The present study investigated the effect of 3 weeks of treatment with co-dergocrine 4 mg/day on BP, plasma catecholamines, certain other BP-regulating factors and serum lipoproteins in patients with essential hypertension. Compared to placebo conditions, co-dergocrine decreased supine BP and heart rate by −7% and the upright plasma NE level by −24%. Supine plasma NE also fell (−24%). Total cholesterol and the LDL + VLDL-cholesterol lipoprotein fraction were lowered by −6%. No significant change was observed in plasma renin activity, angiotensin II, aldosterone and epinephrine levels, whole blood and plasma volume, exchangeable sodium, and the cardiovascular responsiveness to NE, angiotensin II and isoproterenol. The findings suggest that in patients with essential hypertension, chronic treatment with co-dergocrine may slightly decrease sympathetic outflow and, at least in the short-term, lower the potentially atherogenic serum LDL + VLDL − cholesterol fraction.     

Pharmacokinetics of ketanserin in patients with essential hypertension

Summary The pharmacokinetics of ketanserin and its main metabolite ketanserin-ol, and the antihypertensive effects of intravenous, single oral and chronic oral (40 mg once daily) administration of ketanserin, have been investigated in a single blind study of 10 patients with uncomplicated mild hypertension. Ketanserin had a terminal half-life of 29.2 h, a plasma clearance of 518 ml/min and a volume of distribution of 18.0 l/kg. Chronic oral intake of 40 mg ketanserin (tablet formulation) gave a peak concentration of unchanged ketanserin of 88 ng/ml after 1.1 h. Its absolute bioavailability was 48%.During chronic therapy the maximal concentration of ketanserin-ol was 208 ng/ml and its half-life of elimination was 35.0 h. As this metabolite can be oxidized back to ketanserin, it contributes to the prolonged half-life of unchanged ketanserin seen during chronic therapy.The blood pressure was reduced by approximately 15% by oral ketanserin. The maximal reduction in blood pressure coincided with the peak concentration of unchanged ketanserin. During chronic therapy with 40 mg once daily blood pressure was reduced over 24 h. The heart rate was slightly reduced and the cardiovascular responses and the plasma noradrenaline concentrations during isometric exercise were only slightly influenced by ketanserin therapy.Thus, unchanged ketanserin has a relatively long half-life during chronic oral therapy and its pharmacokinetics in middle-aged hypertensive patients is similar to that in normal young volunteers.     

氟伐他丁对高血压患者血管内皮依赖性舒张功能的影响

目的　探讨他丁类降脂药是否具有改善高血压患者血管功能的作用。　方法　 ～ 级轻中度高血压患者 5 5人 ,在常规抗高血压治疗的同时 ,加用氟伐他丁 (Flu) 2 0～ 4 0 m g/ d,并与 37例单纯常规抗高血压治疗病人对比。采用彩色多普勒超声检查肱动脉 (BA)和胫前动脉 (TA)的管腔内径。采用充血法测定血管内皮依赖性舒张功能 (Δ Dia- P)。　结果　 Flu治疗 3个月 ,血脂水平明显下降 ,可见 TA血管 Δ Dia- P改善 (% :8.5 1± 3.0 7vs14 .19± 5 .4 1,n=6 ,P<0 .0 5 ) ,以后均维持在较高水平。治疗 3个月时 BA的 ΔDia- P也有改善 ,但未达统计学差异水平 ,治疗 12个月时 BAΔ Dia- P明显改善。多元逐步回归分析在所观察的参数中未发现和血管功能有固定关系的因素。　结论　 Flu能够使接受常规降压药治疗的高血压患者的 Δ Dia- P改善。小剂量长时间的 Flu可以改善血管舒张功能。药物干预后 TA的功能变化出现较早 ,是反映血管功能变化的敏感靶点     

磁场对家兔急性实验性高血压的影响

目的 :探讨内关穴敷磁的降压效应。方法 :40只清醒家兔和 40只麻醉家兔 (其中 2 0只去减压神经 ) ,静脉注射去甲肾上腺素或苯肾上腺素引起急性实验性高血压 ,并于内关穴敷磁 (0 .1～ 0 .2T) ,记录血压、心率和敷磁前及 1h后的血液粘度的变化。结果 :敷磁 1h后各实验组平均动脉压 (MAP)显著下降 (P <0 .0 1)。麻醉和清醒家兔MAP降幅无差异 (P >0 .0 5 ) ,但显著高于去减压神经家兔MAP的降幅 (P <0 .0 1或 0 .0 5 ) ,各实验组全血比粘度显著下降 (P <0 .0 1或 0 .0 5 ) ,实验组与各自对照组心率敷磁前后无差异 (P >0 .0 5 )。结论 :磁场具有降压作用 ,但对心率无影响 ,其降压效应与减压神经的抑制和全血粘度的降低有关 ,与化学感受性升压反射无关     

Neuroblastoma and anaesthesia

The haemodynamic problems associated with anaesthesia and neuroblastoma were reviewed in 52 children who underwent 138 operations at The Hospital for Sick Children, London, UK. At diagnosis 42 patients (81%) had elevated urinary catecholamine metabolites; nine (17%) were hypertensive, of whom eight were treated with adrenergic blockade. The incidence of intra-operative hypertension due to excess catecholamine release was 9% (13/138), and was confined to the group undergoing tumour excision (29%; 13/45). Hypertension was observed more frequently in patients who had not received chemotherapy. It was effectively controlled by labetalol. Patients symptomatic of catecholamine secretion before surgery should be managed in a similar manner for those with a phaeochromocytoma. Surgical manipulation of the tumour predisposes to paroxysmal hypertension. Careful monitoring is advised.     

高血压病人药物治疗期间动态血压变化

目的评价高血压病人药物治疗期间２４ｈ动态血压变化。方法２６例住院的高血压病人经药物治疗４周连续３ｄ随测血压，血压正常后进入本研究。治疗前后进行２４ｈ动态血压监测。结果患者随测血压（８～９ＡＭ，３～４ＰＭ）血压恢复到正常水平，但动态血压显示在一段时间内（６～８ＡＭ，６～１１ＰＭ）平均收缩和舒张压仍明显高于正常人平均水平（Ｐ＜０．０１），而该时间段易被临床医生忽视。结论随测血压不能实际全面反映高血压病人药物治疗的疗效，２４ｈ动态血压的监测可以正确评价高血压病人药物治疗的效果并根据高血压分布的时间来调整降压药的种类和剂量。     

82例高血压患者16项人格特质测验

研究目的应用卡特尔16项人格特质测验探讨原发性高血压患者的人格特征。研究背景高血压病是危害人类健康的常见病之一，发病率逐年上升，但其病因至今尚未阐明，故有必要从心理、人格方面来探讨高血压的发病原因，以利于高血压病的防治。研究方法本文对82例均由2名以上内科医师确诊为原发性高血压、且现在高压仍保持在20／12．7kPa以上的患者进行卡特尔16项人格特质测验，并与78例人群对照分析。结果高血压患者在C－稳定性、E－峙强性、Q－紧张性以及在双重人格因素类型中的适应与焦虑方面与正常对照组有显著差异（P＜0．05）。结论心理－社会因素是促使高血压发生的重要因素，它对高血压病因的阐明有重要意义，同时也使我们越来越重视运用心理、行为疗法，如生物反馈、各种松驰疗法等去防治高血压。     

Role of the Pericytes of Intra－acinar Pulmonary Artery in the Structural Remodeling of Pulmonary Vessels

（吴永平）（车东媛）（张婉蓉），（李文英）ＲｏｌｅｏｆｔｈｅＰｅｒｉｃｙｔｅｓｏｆＩｎｔｒａ－ａｃｉｎａｒＰｕｌｍｏｎａｒｙＡｒｔｅｒｙｉｎｔｈｅＳｔｒｕｃｔｕｒａｌＲｅｍｏｄｅｌｉｎｇｏｆＰｕｌｍｏｎａｒｙＶｅｓｓｅｌｓ￥ＷＵＹｏｎｇ－ｐｉｎｇ；Ｃ...     

高血压病患者血清瘦素含量与胰岛素抵抗水平的相关性研究

目的：探讨高血压病患者血清瘦素水平与胰岛素抵抗的关系。方法：测定217例高血压病患者(男92例，女125例)的空腹血清瘦素含量、空腹血糖、胰岛素、收缩压、舒张压和体质量指数(BMI)，稳态模式评估法计算胰岛素抵抗指数(HOMA-IR)。分析瘦素与其他各项参数的相关性。结果：以HOMA—IR的25％位点，作为判断胰岛素抵抗的切割点，把高血压病患者分为胰岛素抵抗组(IR)和胰岛素敏感组(IS)，血清瘦素浓度IR组显著高于IS组(P＜0．05)。血清瘦素浓度与HOMA—IR呈显著正相关(男性r＝0．407，P＜0．01；女性r＝0．254，P＜0．01)；校正年龄和BMI后，男性组两者仍呈显著正相关(r＝0．219，P＜0．05)，女性组两者无相关；逐步回归分析显示，男性组HOMA—IR为血清瘦素浓度的独立预测因素。结论：男性高血压病患者血清瘦素浓度与胰岛素抵抗直接相关，女性则无直接相关性。性别差异的机制有待进一步探讨。