Insulin resistance and vitamin D deficiency in patients with chronic kidney disease stage 2-3.

Vitamin D status and the relationship between serum 25(OH) vitamin D concentrations and the components of insulin resistance were examined in 120 patients with chronic kidney disease stage 2 and 3. Insulin sensitivity/resistance was calculated by the quantitative insulin sensitivity check index (QUICKI). In this analysis, the prevalence of insulin resistance was 42 %.

Effects of long-term cholecalciferol supplementation on mineral metabolism and calciotropic hormones in chronic kidney disease.

Background: Data on the efficacy and safety of long-term vitamin D supplementation in chronic kidney disease (CKD) are scarce. We assessed the effects of the 12-month vitamin D(3) treatment on mineral metabolism and calciotropic hormones in patients with CKD stages 2-4.

Methods: Eighty-seven patients (mean age 66 years, men/women 33/54) were randomized to cholecalciferol treatment with either 5,000 or 20,000 IU/week.

[Evaluation of the antihypertensive efficacy and tolerability of fixed very low-dose perindopril/indapamid combination in patients with mild to moderate hypertension. Results of a Czech and Slovak multicentric study].

Aim Of The Study: To evaluate the efficacy and tolerability of fixed, low-dose perindopril (2 mg) and indapamide (0.625 mg) combination in patients with mild to moderate hypertension. Secondary aim of the study was to assess the influence of this combination on basic echocardiographic parameters.

[Treatment of postmenopausal osteoporosis with raloxifene].

The authors present the results of the international multicentric clinical study (MORE--The Multiple Outcomes of Raloxifen Evaluation) of postmenopausal osteoporosis by raloxifen, participated by the authors. The evaluation of MORE indicated that raloxifen represents another further significant possibility of the treatment of postmenopausal osteoporosis by increasing bone density of vertebrae and femoral neck, and reducing the risk of vertebral fractures.

[Hypertension in pregnancy].

Hypertensive disorders are the most common medical complications of pregnancy and are an important cause of maternal and perinatal morbidity and mortality. The author presents a review on Hypertension in pregnancy from the point of view of classification, diagnosis and treatment. According to JNC 6 and WHO/ISH recommendations hypertensive disorders of pregnancy can be divided into three categories: 1.

[The effect of monotherapy with ciprofibrate and in combination with acetylsalicylic acid on the spectrum of lipids, thromboxane and fibrinogen in patients with atherosclerosis and hyperlipoproteinemia].

Ciprofibrate is one of the basic drugs used to lower risk values of lipid parameters and fibrinogen in atherosclerosis patients. Since antiaggregation treatment with acetylsalicylic acid is a complex part of obligatory therapy of these patients, the authors studied the influence of ciprofibrate on chosen lipid parameters, fibrinogen and thromboxane in monotherapy, and also in combination with acetylsalicylic acid (ASA) in patients with advanced atherosclerosis and hyperlipoproteinemia. In the first group of patients (A-C, n = 12) after one month of low-lipid diet acetylsalicylic acid in a dose of 100 mg was administered daily during a period of 2 months followed by addition of 100 mg of ciprofabrate daily during the next 2 months.

[Celiprolol improves glucose metabolism in essential hypertension].

The authors investigated in 18 patients with essential hypertension the action of celiprolol (usually in combination with a diuretic) on the glucose and lipid metabolism in an open three-month trial. They evaluated the glucose, insulin and C-peptide concentration during an oral glucose tolerance test (oGTT) and the serum lipid concentration before and after treatment. It was revealed: 1.

[Prevention of progression in nephropathies].

Intermittent dialysis is excessively expensive and pretentious psychologically and socially. As a result the research is concentrated on the prevention of kidney disease progression. Preventive measures: a) Protein restriction forms the basis of nonpharmacologic measures.

Effects of angiotensin-converting enzyme inhibitors on glucose and lipid metabolism in essential hypertension.

Data of 52 patients, 29 women and 23 men aged 32-68 years (mean age 47 years) with essential hypertension, participating in three open therapeutic trials with either enalapril, lisinopril, or perindopril were evaluated to assess the effects of angiotensin-converting enzyme (ACE) inhibition on glucose and lipid metabolism. The 75-g oral glucose tolerance test (oGTT) was performed, and plasma glucose and insulin levels, as well as total cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglycerides levels were determined before and after the 8- to 12-week treatment. Minor differences in the blood pressure (BP)-lowering effect and metabolic response were obtained with the ACE inhibitors studied; only lisinopril improved glucose tolerance significantly; blood lipids were not changed by any drug.

[Diuretics in the treatment of hypertension].

Diuretics are one of the basic groups of antihypertensive drugs. They have also certain limitations and undesirable effects which are better defined than in other more recently developed antihypertensives. Undesirable effects can be prevented by early combination of saluretics with K+ sparing diuretics or other antihypertensive drugs and by prevention of metabolic disorders (in particular insulin resistance and dyslipoproteinaemia) and by prescription of small doses.

[Treatment of hypertension in kidney diseases].

The authors review recent therapeutic procedures in arterial hypertension associated with renal disease. Treatment of hypertension is comprehensive, it comprises non-medicamentous procedures, pharmacotherapy and in some affections also interventional and surgical therapy. Effective reduction of the blood pressure to values < or = 140/90 mmHg unequivocally retards progression of renal disease, the development of nephrosclerosis and delays the development of renal insufficiency.

[24-hour effect and tolerance for perindopril (Prestarium) in mild and moderate essential hypertension].

A multicentre investigation of antihypertensive treatment by perindopril was conducted in three centres of Czechoslovakia. The investigation comprised 51 patients with mild to moderate essential hypertension (diastolic pressure 95-115 mmHg) who were taking perindopril for a period of three months, the initial dose being 4 mg (1 tablet per day). If the blood pressure did not drop to normal levels (dBP < 90 mmHg), the dose was increased to 8 mg after 1 month and if after 2 months of treatment the blood pressure did not reach normal levels, a thiazide diuretic was added.

Metabolic effects of enalapril in the treatment of essential hypertension.

In an open two-month study with an initial placebo period, the effect of enalapril on glucose tolerance, insulin (IRI) sensitivity and lipid profile was evaluated in 20 patients with mild to moderate essential hypertension. The following results were obtained: 1. Enalapril produced a favourable effect of blood pressure both in monotherapy and if combined with a diuretic.

Bopindolol: Czechoslovak experience with a new beta blocker in the treatment of hypertension.

Bopindolol is a nonselective beta blocker with mild intrinsic sympathomimetic activity. One of the drug's main benefits is its prolonged effect, lasting for 24 hours, which makes it possible to administer bopindolol in a single daily dose, a fact that may improve patient adherence to therapy. A double-blind study was performed in two centers, comparing bopindolol with metoprolol in 86 hypertensive patients.

Platelet-activating effect of low-density lipoprotein and its reversal by isradipine.

The effect of the calcium antagonist isradipine on platelet aggregation (induced ex vivo by serotonin and low-density lipoprotein [LDL]) was studied in 17 nonsmoking patients with essential hypertension. Platelet aggregation was measured after a four-week placebo period, and after four and 12 weeks of treatment with isradipine. Both the serotonin-induced and the LDL plus serotonin-induced platelet aggregation were significantly decreased after four weeks of isradipine treatment compared with placebo.

A high-performance liquid chromatographic method for the determination of stobadin pharmacokinetics in serum.

A high-performance liquid chromatographic method was developed to determine stobadin pharmacokinetics in dog and man. The relative bioavailability of stobadin dipalmitate compared with dihydrochloride was 46.4 per cent in dog.

Serotonin and platelet activation during treatment with isradipine.

The effect of the calcium antagonist isradipine on serotonin metabolism and platelet aggregation was studied in 17 patients with essential hypertension. Platelet serotonin content, plasma serotonin, 5-hydroxyindoleacetic acid levels, and platelet aggregation [induced ex vivo by serotonin and low-density lipoprotein (LDL)] were measured after a 4-week placebo period and after 12 weeks of oral treatment with isradipine. Isradipine treatment significantly inhibited platelet aggregation induced by LDL and serotonin; the amplifying effect of LDL on serotonin-induced aggregation seen with placebo was not observed after 12 weeks of treatment with isradipine.

Acute effect of urapidil on peripheral serotonin metabolism.

In a cross-over study, the effect of 25 mg urapidil infusion (U, Ebrantil 25, Byk-Gulden, FRG) on serotonin (5HT) metabolism and platelet aggregation (PA) was compared with the effect of placebo (P) in 7 patients with essential hypertension. No changes in 5HT and 5-hydroxyindolacetic acid (5HIAA) plasma levels and platelet 5HT content were observed. PA induced ex vivo by ADP decreased significantly.

Low-density lipoprotein amplifies the platelet response to serotonin in human plasma.

The effect of low-density lipoprotein, serotonin and low-density lipoprotein plus serotonin on platelet aggregation (measured ex vivo in plasma) was studied in 28 normotensive subjects (15 non-smokers, 13 smokers) and 15 previously untreated non-smoking patients with essential hypertension. Low-density lipoprotein alone had no platelet-activating effect. Serotonin-induced platelet aggregation was enhanced by low-density lipoprotein in both the normotensive and the hypertensive subjects.

[Bopindolol does not affect normal glucose and lipid metabolism in hypertensive patients].

The authors administered to ten patients with mild to medium severe hypertension and with a normal glucose tolerance and serum lipid spectrum bopindolol in amounts of 0.5 to 2 mg/day in the course of 12 months. They revealed: a) bopindolol reduced effectively the blood pressure with a maximum decline already during the first month, b) It reduced significantly the heart rate, c) it did not cause deterioration of the glucose tolerance and did not interfere with the response of immunoreactive insulin (IRI) after a glucose load, d) it did not influence significantly the levels of lipoprotein cholesterol, total cholesterol, VLDL cholesterol, HDL cholesterol; within the reference range a slight increase of LDL cholesterol was recorded during the 12th month; e) it did not influence the concentration of triglycerides, apolipoprotein A1 and apolipoprotein B.