Efficacy and safety of spirapril in mild-to-moderate hypertension.

Spirapril is a new angiotensin-converting enzyme (ACE) inhibitor. It is a prodrug with a resorption of about 50%. The active metabolite spiraprilat reaches maximal plasma concentration within 2-3 h after oral administration.

Is initial dose titration of amlodipine worthwhile in patients with mild to moderate hypertension?

Amlodipine, a dihydropyrimidine calcium antagonist, is effective in the treatment of patients with mild to moderate hypertension at doses of 5-10 mg daily. The aim of the study reported here was to determine whether an early increase in dosage of amlodipine provided an advantage in terms of antihypertensive effect. This was a single-blind, randomised study in 115 patients with mild to moderate hypertension (diastolic blood pressure 95-114 mmHg) conducted at 10 centres with two parallel groups.

Single daily administration of spirapril in the treatment of essential hypertension. A multicentre double-blind comparison of 1, 6, 12 and 24 mg of spirapril once daily.

A total of 171 male and female patients with mild-to-moderate hypertension [diastolic blood pressure (DBP) 100-115 mmHg] entered this randomized, double-blind, multicentre study. A 3-week placebo run-in period was followed by a 5-week active-treatment period during which patients received either 1, 6, 12 or 24 mg of spirpril once daily. Predose sitting blood pressure was taken in the morning by sphygmomanometer as well as by an automatic device (Tonoprint).

[Duodenal duplication cyst--a rare cause of acute recurrent pancreatitis].

We report on a 42-year-old male patient who has been treated over a period of five years because of acute relapsing pancreatitis. The diagnoses of viral pancreatitis, pancreatic pseudocyst, and choledochal cyst type III (choledochocele) have been erroneously made. The clinical and laboratory findings over this period are presented, compared with one another, and analyzed.

How well are the cardiovascular risk profiles modulated by current beta blockers in hypertension?

Epidemiologic studies predict that reduction of the systemic blood pressure by the amount usually achieved in major clinical trials could be expected to reduce cerebrovascular events by 42% and cardiac events by 24%. Although antihypertensive treatment achieves the expected cerebrovascular benefits, the risk of coronary events is reduced by only 14%. The reason for this dichotomy in cardiovascular protection afforded by antihypertensive drugs is unknown.

[Fatal pulmonary embolism after lysis therapy in post-traumatic renal vein thrombosis].

A 30-year-old man was hospitalized because of increasing dyspnoea for 4 weeks. Chest X-ray demonstrated an infiltrate in the right upper lobe and enlargement of the central pulmonary arteries. Lung perfusion scintigraphy revealed, typical of embolism, absent perfusion of the entire right upper lobe, as well as segmental embolism in the left upper and basal lobes.

[Fine needle puncture cytology in metastatic hepatocellular carcinoma].

Distant metastases occur in 50% of cases of HCC. Bones are involved in 11% with the spine as the most important localization. In the reported case a tumorous mass in the liver, suspicious for HCC according to clinical and cytological criteria, was proved to be malignant by the cytologic examination of a metastasis to the sacrum.

Antihypertensive effects of doxazosin in systemic hypertension and comparison with terazosin.

A multicenter, double-blind study compared the antihypertensive efficacy and safety of doxazosin and terazosin as once-daily therapy. Doxazosin, a potent antihypertensive agent, selectively inhibits alpha 1 adrenoceptors. Its pharmacokinetic profile, including gradual onset of action, long plasma elimination half-life and long duration of action, permits once-daily dosing.

Efficacy and safety of doxazosin in hypertension therapy.

In double-blind, controlled, parallel, comparative trials, the blood pressure-lowering effect of doxazosin was compared with that of placebo and other active agents. In 1 large, multicenter study, 903 patients were evaluated: 408 patients received doxazosin; 323, active comparative agents (nadolol, metoprolol, prazosin or hydrochlorothiazide); and 172, placebo. In another smaller study doxazosin was compared with terazosin treatment.

Captopril in the long-term treatment of essential hypertension: changes in the renin-angiotensin-aldosterone system.

We investigated changes in the renin-angiotensin-aldosterone system in seven patients with essential hypertension during treatment with captopril (SQ 14225) (300 to 450 mg/day) for 12 months. While blood pressure decreased, the plasma-renin concentration increased to 700 percent of the initial value (6.1 +/- 2.

[Errors in the treatment of hypertension (author's transl)].

Errors in the treatment of hypertension may occur at any level of the therapeutic concept. They can, however, largely be avoided by considering the following suggestions. A hypertension requiring treatment is usually only detectable by several blood pressure measurements taken on different days.

Successful acute and long-term treatment of renin-induced hypertension in two infants with captopril.

Captopril, an orally active inhibitor of angiotensin-converting-enzyme, offers a new approach in the treatment of renin-induced hypertension, which is refractory to conventional drugs. A 4 months old infant developed after nephrectomy again hypertension which was probably renin-induced. BP did not respond to high doses of methyl-dopa, clonidine, hydralazine, and furosemide.

Electrolyte and water balance in cardiac insufficiency. Recent clinical and experimental data.

The reasons for the disturbances of electrolyte and water balance in cardiac failure are not yet clarified. The decrease of cardiac output in cardiac insufficiency causes humoral regulatory mechanisms such as increased activity of the renin angiotensin-aldosterone system and increased secretion of antidiuretic hormone. These mechanisms in turn lead to an enhancement of renal sodium and water reabsorption.

Regulation of aldosterone secretion in dehydrated babies.

The factors controlling aldosterone secretion were measured in 12 patients with moderate to severe dehydration during the first year of life. Secondary hyperaldosteronism was present in all cases (mean plasma aldosterone concentration 414.6 ng/dl), as well as increased plasma cortisol levels (mean 49.

[Saralasin-induced changes of blood pressure, renin and aldosterone in essential and renal hypertension (author's transl)].

In 34 patients saralasin was infused after variable degrees of sodium depletion in order to differentiate between essential and renin-induced hypertension. After sodium-depletion of short duration mean arterial pressure dropped more than 10 mm Hg in 9 of 25 patients with essential and in 7 of 9 patients with renin-induced hypertension. After long-lasting sodium depletion the fall of mean arterial pressure exceeded 10 mm Hg in 11 of 16 patients with essential and in 8 of 9 patients with renin-induced hypertension.

[Side-effects on longterm treatment with antihypertensives (author's transl)].

Unspecific complaints as a result of lowering the blood pressure and substance-specific side-effects may occur during antihypertensive therapy. The frequency of the side-effects depends on the substance used (10 to 50%) and on the dose. An individual therapy, which in most cases involves the use of several substances, can reduce the frequency of side-effects decisively.

[Hemodynamic changes after angiotensin II blockade by saralasin (author's transl)].

Saralasin, an angiotensin II inhibitor was infused in 10 hypertensive patients. A blood pressure reduction was achieved after stimulation of the renin-angiotensin-system by salt depletion. Heart rate and cardiac output failed to compensate for reduction of blood pressure.