Haemodynamic response and pharmacokinetics after the first dose of quinapril in patients with congestive heart failure.

1. Twenty-four elderly patients with stable, chronic congestive heart failure, NYHA II-IV, requiring addition of an ACE inhibitor to their existing therapy were randomised to receive double-blind a single dose of quinapril 2.5 mg p.

Differentiation between gaseous and formed embolic materials in vivo. Application in prosthetic heart valve patients.

Background And Purpose: Doppler emboli detection is an established technique, but the nature of the underlying embolic material remains unclear. The intensity and spectral distribution of emboli signals could help to distinguish between signals arising from formed and gaseous emboli. We undertook this study to develop and evaluate a differentiation algorithm based on the spectral characteristics of emboli signals.

Interconversion of stroke scales. Implications for therapeutic trials.

Background And Purpose: Stroke scales are intended to measure stroke severity for the purpose of clinical trials. Scores have been used to determine trial entry, to compare patient groups within or between trials, or as a secondary end point. The use of scores as an end point in meta-analysis has not been validated, but such analyses have nevertheless been performed when equivocal results have been obtained using the main outcome measure.

Pharmacological effects of the non-competitive NMDA antagonist CNS 1102 in normal volunteers.

1. Non-competitive antagonists at the glutamatergic N-methyl D-aspartate receptor significantly reduce the volume of ischaemic cerebral infarction in animals and are potential agents for the treatment of acute stroke in humans. 2.

Coagulation activity and emboli counts in patients with prosthetic cardiac valves.

Background And Purpose: The underlying embolic material detected by transcranial Doppler ultrasound in patients with prosthetic heart valves remains unknown. We undertook this study to evaluate the relation between the number of Doppler emboli signals and the activity of the coagulation system.

Methods: Patients with various types of prosthetic valves (n = 120) and patients in atrial fibrillation (n = 20) were monitored for 30 minutes using transcranial Doppler with a 2-MHz probe.

Detection of intracranial emboli in patients with carotid disease.

Transcranial Doppler emboli signal detection has been reported in several patient groups, including patients with symptomatic internal carotid artery stenosis. The potential of this technique in assessing embolic risk and selecting patients for surgery was examined in this study. Selected patients with symptomatic internal carotid artery stenosis underwent combined extracranial and transcranial Doppler study in the Vascular Surgery and Neurovascular Unit.

Prevalence and characteristics of intracranial microemboli signals in patients with different types of prosthetic cardiac valves.

Background And Purpose: Transcranial Doppler detection of microemboli is widely described, but there is no clear evidence of the clinical significance or nature of the embolic material in vivo. Thromboembolism is a major cause of morbidity in patients with prosthetic cardiac valves. We undertook this study to evaluate the prevalence and the acoustic characteristics of microembolic signals in three groups of patients with different prosthetic valves.

Doppler emboli signals vary according to stroke subtype.

Background And Purpose: Doppler ultrasound detection of emboli signals may assist in distinguishing embolic from thrombotic stroke. Selected patient groups have a high incidence of such signals. We have examined consecutive stroke cases to identify the incidence of Doppler emboli in different etiologic subtypes of stroke.

Subclinical embolism in patients undergoing cardiac valve implantation and coronary artery bypass surgery.

Patients undergoing prosthetic valve insertion and coronary artery bypass surgery were examined with transcranial Doppler ultrasound, recently shown to be capable of detecting continuing subclinical emboli in patients with embolic sources. In 30 patients examined at least 1 year after valve surgery, and in whom warfarinisation was stable within defined limits, 20 of 24 patients (83%) with mechanical valves and 3 of 6 patients (50%) with porcine valves had embolic signals. In a serial preoperative and postoperative study in a further 30 patients, of whom 29 had native or bioprosthetic valves, only the one patient with a previous mechanical mitral valve prosthesis had embolic signals preoperatively.

Quantification of ultrasound emboli signals in patients with cardiac and carotid disease.

Background And Purpose: The use of Doppler ultrasound to detect arterial emboli has major implications for the classification and treatment of stroke. Experimental studies indicate that embolic materials produce different ultrasound signals, depending on their acoustic properties. To examine the possibility of characterizing emboli of different sources in the clinical setting, we compared the emboli signals of patients with cardiac embolic sources with those of patients with signals of carotid embolic sources.

Transhemispheric passage of microemboli in patients with unilateral internal carotid artery occlusion.

Background And Purpose: Ischemic episodes distal to an internal carotid artery occlusion are common. We undertook this study to look for evidence of transhemispheric passage of embolic material in this patient category as a mechanism for embolic events.

Methods: Seven symptomatic patients with unilateral internal carotid artery occlusion and contralateral stenosis were examined by transcranial Doppler ultrasonography with 2-MHz probe (average monitoring time, 2.

The antihypertensive efficacy and tolerability of a low dose combination of ramipril and felodipine ER in mild to moderate essential hypertension.

1. The antihypertensive efficacy and tolerability of a low dose combination of the angiotensin converting enzyme inhibitor ramipril (2.5 mg) and the extended release formulation of the dihydropyridine calcium channel antagonist felodipine (5 mg) were assessed in a double-blind, double dummy placebo controlled, randomised, crossover study in 20 patients (mean age 55.

Angiotensin-converting enzyme inhibitors in heart failure: blood pressure changes after the first dose.

Angiotensin-converting enzyme (ACE) inhibitors prevent the formation of angiotensin II in the circulation and a range of tissues. ACE inhibitors not only are effective, well-tolerated antihypertensive drugs but also improve symptoms and signs in patients with congestive cardiac failure. In addition, they improve long-term survival in these latter patients.

Role of angiotensin in the extravascular system.

Angiotensin receptors are present in many tissue types, including adrenal cortex, renal glomeruli, heart, hypothalamus, liver, pancreas, pituitary, platelets, renal tubules, uterus and vascular smooth muscle. Two high-affinity receptor subtypes have been identified by radioligand binding with antagonists: losartan (DuP 753/MK954) identifies AT1 receptors; PD123177 and CGP42112A are markers for AT2 receptors. Angiotensin II may be produced locally in tissues outside the humoral system.

Blood pressure response to the first dose of angiotensin-converting enzyme inhibitors in congestive heart failure.

Angiotensin-converting enzyme (ACE) inhibitors improve survival in heart failure and delay progression to clinical heart failure in patients with left ventricular dysfunction after myocardial infarction. Increasing numbers of older patients are being considered for such treatment. However, there are reports of excessive and prolonged decreases in blood pressure (BP) after the first dose of some ACE inhibitors.

Dose-ranging study of the angiotensin type I receptor antagonist losartan (DuP753/MK954), in salt-deplete normal man.

In a dose-ranging study, the angiotensin type I receptor antagonist losartan (DuP753/MK954) was administered orally to normal volunteers in whom the renin-angiotensin system (RAS) had been activated by a low sodium diet (40 mmol) and frusemide (40 mg twice daily) for 3 days before study. On the fourth day, subjects (n = 12) received placebo and three active doses (5, 10, 25, 50, or 100 mg) in a randomized, double-blind, three-panel, dose-ranging design. On the study day, 24-h urinary sodium excretion was approximately 10-20 mmol Na, with an increase in renin and aldosterone levels at baseline.

The experiences of an acute stroke unit--implications for multicentre acute stroke trials.

The suitability of 200 consecutive patients admitted to a newly established acute stroke unit was assessed for participation in two multicentre trials currently in their pilot phase: the International Stroke Trial of aspirin and heparin, and the Multicentre Acute Stroke Trial of streptokinase versus placebo. Of the 200 patients (74 men, 126 women, mean age 71 years), 96% had cerebral CT, and 94% had a final diagnosis of cerebrovascular disease. Overall, 50% of patients presented within 6 hours and 70% within 12 hours of the onset of ictus.

Double blind controlled study of low dose intravenous perindoprilat or enalaprilat infusion in elderly patients with heart failure.

Objective: Comparison of the first dose responses to low dose constant rate infusions of diacid angiotensin converting enzyme (ACE) inhibitors.

Design: Double blind, randomised, placebo controlled, parallel group prospective study.

Setting: General hospital inpatient admissions for supervised diuretic withdrawal (24-48 hours) and the introduction of ACE inhibitor treatment.

Therapeutic interventions in acute stroke.

1. Potential therapies for ischaemic stroke include agents to reduce oedema, to improve cerebral perfusion, to reduce excitotoxic damage, to minimise free-radical induced injury and to reduce complications such as deep venous thrombosis. 2.