Magnesium depletion in patients on long-term chlorthalidone therapy for essential hypertension

Summary Sixty patients were treated for 1 year for essential uncomplicated hypertension, 30 with beta-blockers alone (BB) and 30 with BB and chlorthalidone (CTD). BB did not affect serum K⁺ or Mg⁺⁺. In the BB-group there was a statistically significant trend towards retention of Mg⁺⁺ in a loading test, but the effect was clinically marginal. BB + CTD reduced serum K⁺ and Mg⁺⁺ and caused significant Mg⁺⁺ depletion, as shown by the Mg⁺⁺ loading test. All the effects were highly significant and were clinically important. The metabolic perturbations due to CTD are potentially dangerous and make this drug unattractive as first choice treatment for hypertension.     

Influence of propranolol and pindolol on the haemodynamic effects of papaverine,isoprenaline and noradrenaline in hypertensive patients

Summary The influence of two -adrenoceptor antagonists, propranolol and pindolol, on the haemodynamic effects of papaverine, isoprenaline and noradrenaline was investigated in 9 male patients with first degree essential hypertension. Propranolol and pindolol were given according to a doubleblind, crossover scheme. Heart rate and blood pressure were measured before and after each treatment. Propranolol 670 µg/kg i. v. reduced the supine and standing systolic blood pressures by 2.3% and 1.6%, respectively. Similarly, the intravenous administration of pindolol 35 µg/kg reduced supine and standing systolic blood pressure by 5.5% and 8.3% respectively (clinically insignificant). Neither drug affected diastolic blood pressure. Following propranolol, there were moderate reductions in supine and standing heart rates, respectively by 24% and 20% (p<0.001). Similarly, but to a lesser extent, pindolol reduced supine and standing heart rate by 12% and 17% (p<0.001). The effects of papaverine, which, at 1.5 mg/kg i. v. reduced systolic blood pressure by 5–10% and increased heart rate by 8–15%, were not significantly influenced by the -blockers. The blood pressure and heart rate responses to isoprenaline, on the other hand, were attenuated or inhibited by both -blockers. While the -blockers inhibited the -adrenoceptor component of noradrenaline, the pressor component of noradrenaline, which is mediated through the -adrenoceptors, was not influenced by propranolol, but was inhibited after pindolol. It is concluded that pindolol differs qualitatively from propranolol in that it inhibited both the -and -adrenoceptor effects of noradrenaline.Abbreviations BP blood pressure - ECG electrocardiogram - HR heart rate - ISA intrinsic sympathomimetic activity     

Slow-release nifedipine: effect on the circadian rhythm of blood pressure in essential hypertension

The aim of this study was to investigate the effect of orally administered, slow-release, nifedipine tablets on the circadian rhythm of blood pressure and heart rate, in hospital patients with clinical diagnosis of hypertension validated by a chronobiologic inferential statistic method. A group of 14 patients (nine women and five men, 47 to 71 years old) with clinical diagnosis of "essential hypertension" underwent automatic blood pressure and heart rate monitoring in a hospital room for 48 hours. Measurements were taken every 15 min by an oscillometric instrument with automatically inflated cuff. The patients received no treatment during the two proceeding weeks and the first day of the study. On the second day, slow-release nifedipine tablets were administered, one at 10 a.m. and one at 10 p.m. A highly significant circadian rhythm was documented for systolic and diastolic blood pressure, mean arterial pressure and heart rate, both in basal conditions and after nifedipine. Blood pressure mesors were higher than reference standards in basal conditions, and were lowered (average decrease = 20 mmHg for systolic and 9 mmHg for diastolic mesor) by nifedipine. A significant, though minor, elevation of heart rate mesor (from 70 to 75 b.p.m.) was also noted during treatment. The circadian amplitudes of blood pressure and heart rate did not differ significantly before and during treatment. In conclusion, the circadian rhythm of blood pressure is still present with the same amplitude after slow-release nifedipine, but is set at a lower pressure level. Heart rate rhythm is also preserved, with only a minor elevation of its mesor.     

Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease

Purpose

The aim of this research was to investigate the association of chronic and aggressive periodontitis with the severity of coronary artery disease which was angiographically verified.

Material and methods

Subjects were selected among the hospitalized patients at the University Hospital Centre Zagreb who had coronary angiography done because of the chest pain. Thorough clinical examination included periodontal indices and clinical and socio-demographic characteristics of participants. Subjects were divided in two test groups, acute coronary syndrome (ACS) and stable coronary artery disease (CAD), and the control group with no significant CAD. Data were analyzed using Kruskal-Wallis and Pearson’s Chi-Square test.

Results

From 106 subjects, 66 (62.3%) were hospitalized for ACS, 22 (20.7%) had stable CAD and only 18 (17.0%) had no significant CAD. Only 26 (24.5%) out of 106 patients were never smokers (p<0.05). Chronic periodontitis was the most common finding with 68.2% in ACS group and 54.5% in stable CAD group, while healthy patients without periodontitis (72.6%) were dominant in the control group (p<0.001). Stable CAD group had the highest mean probing depth (PD) 3.92±1.16, gingival recession (GR) 1.34±0.78, clinical attachment level (CAL) 4.60±1.41 and bleeding on probing (BOP) 45.98±26.19 values, whereas ACS group had mean PD value of 3.77±0.91, GR 1.11±0.66, CAL 4.32±1.08 and BOP 41.30±22.09, and no significant CAD group had mean PD value of 3.27±0.97, GR 0.69±0.37, CAL 3.62±1.04 and BOP 26.39±13.92 (p<0.05).

Conclusion

Periodontitis was shown to be associated with angiographically verified coronary artery disease. Physical inactivity, poor oral hygiene and periodontal inflammation were observed in patients with ACS and stable CAD.Key words: Periodontitis, Periodontal Index, Cardiovascular Diseases, Coronary Artery Disease, Coronary Angiography     

Comparison of stent graft, sirolimus stent, and bare metal stent implanted in patients with acute coronary syndrome: clinical and angiographic follow-up

Strozzi and Anić     

Syndemic and syndemogenesis of low back pain in Latin-American population: a network and cluster analysis

Clinical Rheumatology - Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. To compare and assess clinical,...     

Suspected muscular disease: what to do?

During the last decades important progress in knowledge of hereditary neuromuscular problems could be achieved. Unfortunately, therapeutic management has not yet improved significantly, but diagnostic investigations have become less invasive for most disorders. For the clinician, the most important problem is still realizing that the complains of the patient could be a symptom of a neuromuscular problem. This should be followed by a careful history and clinical examination, to achieve a topical diagnosis (from motoneuron to muscle) and if ever possible already a clinical suspicion of the diagnosis. Investigations like neurophysiological technics, lab investigations, forearm ischemic exercise test or even muscular biopsy might be helpful to achieve this goal. Nowadays verification of the diagnosis is done in most cases by genetic DNA testing or by specific immunohistochemical staining or enzyme determination in muscular biopsy. This diagnostic way enhances the importance of history and clinical examination even in today's modern neurology.     

Primary cardiac lymphoma presenting as atrial flutter and total heart block

Primary cardiac lymphoma is extremely rare. We present the case of a 70-year-old man with primary cardiac lymphoma involving interatrial septum, presenting as atrial flutter and total heart block. The diagnosis was obtained by echocardiography-guided transvenous endocardial biopsy which revealed diffuse large B-cell non-Hodgkin's lymphoma, CD 20+. After six courses of immunochemotherapy the patient achieved complete remission. After 2 months he developed a series of epileptic attacks. Intracerebral lymphoma extension was diagnosed. Two cycles of high-dose methotrexate and cranial irradiation were applied, resulting in a second complete remission.