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Biomedical subjects

A Strano

Publications and source records attributed to A Strano.

At least 19 recordsLinked to original sources
PubMed1992

Regression of structural vascular changes in hypertensives after captopril treatment.

In order to investigate whether hypertension-related structural vascular changes may be influenced by antihypertensive treatment, 10 patients were studied suffering from essential arterial hypertension, five males and five females, aged between 34 and 61 years (mean age: 46.9 +/- 8.13 years). All patients received a placebo for 1 week and then captopril, 75 mg b.i.d. for 3 months. After placebo and captopril treatments, the following parameters were evaluated: SBP, DBP, mean blood pressure (MBP), by the formula 1/3 (SBP + 2 x DBP) and basal and minimal vascular resistances, respectively obtained by the ratios MBP/rest flow and MBP/peak flow. Blood flows have been obtained by strain gauge plethysmography. A significant decrease in systolic (P less than 0.025), diastolic (P less than 0.01) and mean blood pressure (P less than 0.01), basal vascular resistances (52 +/- 19 vs 28 +/- 12 A.U., P less than 0.01) and minimal vascular resistances (6.3 +/- 2.2 vs 3.9 +/- 2.8 A.U., P less than 0.025) has been observed after captopril treatment in comparison to placebo, whereas rest (2.9 +/- 0.7 vs 4.1 +/- 0.9 ml.min-1.100 g-1, P less than 0.01) and peak blood flows (21.3 +/- 5.8 vs 29.7 +/- 9.4 ml.min-1.100 g-1) significantly increased. These data seem to indicate that antihypertensive treatment with the angiotensin-converting enzyme inhibitor, captopril, is not only efficacious in inducing a significant blood pressure decrease, consequent to the reduction of basal vascular resistance (due to the vasodilating effects of the drug), but is also able to reduce minimal vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Cardiovascular structural changes in hypertension: possible regression during long-term antihypertensive treatment.

Arterial hypertension is often complicated by left ventricular hypertrophy (LVH) and by vascular structural changes resulting in decreased proximal and distal compliance. LVH is an adverse prognostic factor because it increases the incidence of sudden death and other morbid events related to ischaemic heart disease, whereas vascular alterations may induce target organ damage and contribute to the maintenance of elevated blood pressure values. Thus, antihypertensive treatment must both reduce blood pressure and halt regression of cardiovascular structural changes. A review of the literature suggests long-term use of calcium antagonists, ACE inhibitors, and beta-blockers may revert LVH. We have found that such long-term drug use not only reduces blood pressure and LVH, but also ventricular arrhythmias that are often related to cardiac hypertrophy; however, diuretics do not have this beneficial effect. As regards vascular disturbances ACE inhibitors partially revert these alterations, whereas beta-blockers do not. Further studies are needed to determine whether there are regional differences in the regression of cardiovascular structural changes or whether different antihypertensive drugs have different effects on these changes.

Animals↗
PubMed1991

[The noninvasive evaluation of the cardiovascular changes in physiological aging].

The physiological aging is frequently associated with structural alterations determining a loss of elasticity both of left ventricular wall (that goes towards hypertrophy), and of great and small arteries and arterioles (that have their compliance reduced). In fact, in our experience, the elderly have, in comparison with younger people, greater values of end diastolic thickness of the septum and of the posterior wall (respectively 10.7 +/- 1.5 vs 9.4 +/- 1 and 10.4 +/- 1.7 vs 9.0 +/- 0.9), of the aortic index, that is inversely related to arterial compliance (0.74 +/- 0.06 vs 0.66 +/- 0.05) as well as of minimal vascular resistances, expression of an impaired maximal vasodilation capacity of the arteriolar bed (4.27 +/- 1.08 vs 3.68 +/- 0.91). At cardiac level the global effect of these changes is a remodelling able to maintain a normal function both at rest and after exercise, i.e., a greater intervention of Frank-Starling mechanisms with increase of the end diastolic volume, in order to counteract the lower chronotropic response to catecholamines. At peripheral level the structural changes in the arterial tree (consequent to an increased collagen content in the intimal and medial components of the vessel walls) lead to an increase in blood pressure with aging: in our study by non-invasive blood pressure monitoring mean 24-hours blood pressure values have been the following ones: 116.4 +/- 3.8/72.1 +/- 7.2 mmHg in 25-35 years aged; 121.8 +/- 9.1/75.9 +/- 5.3 mmHg in 45-55 years aged; and 128.4 +/- 10.1/76.4 +/- 7.8 mmHg in aged more than 60 years. On the other hand, the greater cardiac output during stress, together with the lower arterial vasodilation (consequent also to the impaired function of the baroceptor reflexes) determines an exaggerated systolic blood pressure increase after exercise.

Aging↗
PubMed1991

[Vascular damage in arterial hypertension: its noninvasive assessment].

Arterial hypertension is a definite risk factor for the atherosclerotic disease and thus has a primary role in the genesis of cardiovascular diseases, but it acts also though a direct structural damage of great and small arteries and arterioles. Up to date, clinical research and technological advancements have made possible the development of instruments and methods for the evaluation of the vascular damage. Ultrasonographic methods are now the better non invasive tools for the study of arterial diseases, allowing a definition power comparable to angiography, and giving useful data on characters and composition of plaques, also minimal, at the level of the arterial district of lower limbs, epiaortic, renal, and abdominal vessels. These methods allow the study of the vascular lesion under the hemodynamic (CW or pulsed Doppler with spectral signal analysis) and the morphological profile (high resolution echotomography) or both echo-Doppler duplex scanning or color flow imaging). Arterial compliance of great vessels can be studied through the Doppler evaluation of pulsed wave velocity along the arterial tree. Other useful parameters are the aortic distensibility (ratio between % change in arterial volume and blood pressure), the elastic module, the index of arterial rigidity and the aortic index (ratio between pulse pressure and stroke volume). By using this latter parameter we demonstrated a significant decrease of arterial compliance that is proportional to the severity of blood pressure values. Small vessels may be studied through strain-gauge plethysmography, that allows to obtain the regional blood flows at the hand and forearm (skin circulation) and the calf (muscular circulation) both in basal conditions and after ischaemic stimulus. From the ratio between mean arterial pressure and post-ischemic blood flow it is possible to obtain minimal vascular resistances, expression of the maximal vasodilatation capacity in the arteriolar bed. With this method we showed that minimal vascular resistances increase proportionally with the increase of blood pressure in borderline hypertensives, in mild, moderate and severe stable arterial hypertension and in hypertension of the aged. The cutaneous microcirculation may be studied also by laser Doppler and capillaroscopy, that show a reduced capillary perfusion in hypertension. Clinically, these diagnostic tools are also extremely useful for studying the effects of antihypertensive treatment on structure and function of arterial vessels, as it seems that some drugs are able to counteract the structural alterations related to hypertension.

Arteriosclerosis↗
PubMed1991

A double-blind, multicenter, placebo-controlled, dose comparison study of orally administered defibrotide: preliminary results in patients with peripheral arterial disease.

Defibrotide is a polydeoxyribonucleotide drug known to modulate the endothelial cell release of t-PA, PAI, and PGI-2 and to improve blood flow and perfusion. A double-blind, multicenter, placebo-controlled, dose comparison study was carried out to test the long-term efficacy and safety of defibrotide in patients with PAD (Leriche stage 2). Informed patients suffering from PAD were enrolled, and after a 15-day washout period were randomly allocated in a double-blind fashion to one of the three following treatments: defibrotide 400 mg (1 cps) b.i.d. for 6 months, defibrotide 400 mg o.d., or placebo. Absolute walking distance (AWD, treadmill) and ankle-arm pressure ratio (Winsor Index, WI) were evaluated at the beginning and after 30, 90, and 180 days after therapy. Two hundred twenty seven patients were recruited and 193 patients were included in the final analysis (800 mg: 67; 400 mg: 60; placebo: 66). All treatments brought about an increase in AWD placebo = +17%; 400 mg = +47%, 800 mg = +52%); however, patients treated with defibrotide exhibited a significantly better AWD at the end of treatment in comparison with placebo (p less than 0.01). AWD was not significantly different in the 400-mg and 800-mg groups. There was a trend indicating a possible improvement of WI after defibrotide, with higher WI in 800-mg patients in comparison with placebo (p less than 0.05). However, this difference was partly due to a decrease in arterial blood pressure elicited by the drug. The tolerability in all groups was optimal. These results indicate that orally administered defibrotide exerts symtomatic benefit in PAD patients and daily doses of 400 or 800 mg seem to be equivalent.

Administration, Oral↗
PubMed1990

Thromboxane biosynthesis and platelet function in type II diabetes mellitus.

It has been suggested that platelet hyperreactivity in patients with diabetes mellitus is associated with increased platelet production of thromboxane. We therefore compared the excretion of a thromboxane metabolite and platelet function in 50 patients with Type II diabetes mellitus who had normal renal function and clinical evidence of macrovascular disease and in 32 healthy controls. The mean (+/- SD) excretion rate of urinary 11-dehydro-thromboxane B2 was significantly higher in the patients than in the controls (5.94 +/- 3.68 vs. 1.50 +/- 0.79 nmol per day; P less than 0.001), irrespective of the type of macrovascular complication. Tight metabolic control achieved with insulin therapy reduced the levels of 11-dehydro-thromboxane B2 by approximately 50 percent. The fractional conversion of exogenous thromboxane B2 (infused at a rate of 4.5, 45.3, or 226.4 fmol per kilogram of body weight per second) to urinary 11-dehydro-thromboxane B2 was assessed in four patients, in whom it averaged 5.4 +/- 0.1 percent; this value did not differ from that measured in healthy subjects. Aspirin in low doses (50 mg per day for seven days) reduced urinary excretion of the metabolite by approximately 80 percent in four patients. The fact that thromboxane biosynthesis recovered over the following 10 days was consistent with a platelet origin of the urinary metabolite.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Alterations of calcium metabolism in spontaneously hypertensive rats.

We have examined the femurs of eight male spontaneously hypertensive rats and eight male Wistar Kyoto rats, aged 24 weeks. The mineral density of the bones was determined at the mid-point of the femurs by dual photon absorptiometry and the calcium content was estimated on bone ash by atomic absorption spectrophotometry. The data show that spontaneously hypertensive rats have lower bone density and calcium content than do age-matched Wistar Kyoto rats.

Absorptiometry, Photon↗
PubMed1990

[Tolerance and effectiveness of transdermal nitroglycerin in angina pectoris. A multicenter study. Adesitrin Italian Study Group].

A multicenter open study was carried out in order to evaluate the tolerability and antianginal efficacy of the nitroglycerin "multilayer transdermal system". Forty eight cardiologic centers enrolled 506 outpatients (123 females and 383 males), mean age: 61 +/- 8 (SD) years, with effort angina (43%), angina at rest (17%) and mixed angina (40%), not well controlled by their previous antianginal therapy (greater than or equal to 2 anginal attacks a weeks). The duration of the treatment with 5 or 10 mg/die was 10 weeks with a control every 2 weeks. At the end of the study, the weekly frequency of anginal attacks was reduced by 88%, and 60% of the patients were free from anginal attacks. In 117 patients, studied by ergometer test, the exercise time increased by 31% (p less than 0.001) and the ST depression decreased by 63% (p less than 0.001). The treatment was interrupted in 9.1% of the patients: in 4.55% for unwanted effects (headache and/or local intolerance) and in 4.55% for other reasons. The same unwanted effects, but of mild or moderate severity, were observed in 18.4% of the patients, most of them during the first 2 weeks of the treatment. In conclusion, the "multilayer system" for delivering transdermal nitroglycerin showed a good clinical and ergometer efficacy and was well tolerated and accepted by the anginal patients in study.

Administration, Cutaneous↗
PubMed1990

Cardiac arrhythmias as correlated with the circadian rhythm of arterial pressure in hypertensive subjects with and without left ventricular hypertrophy.

To evaluate the relationship among supraventricular and ventricular arrhythmias with blood pressure and heart rate (HR) values, we studied 2 groups of 20 hypertensive men with (group I) and without (group II) left ventricular hypertrophy. Ambulatory electrocardiographic tracings were recorded continuously, together with ambulatory arterial pressure. Systolic (SBP) and diastolic (DBP) blood pressure values measured over 24 h showed no difference between the two groups, but we found greater variability in SBP in group I. The incidence of ventricular and supraventricular arrhythmias was significantly higher in patients of group I; moreover, we found a strong correlation between the incidence of ventricular extrasystoles (VPCs) and SBP, DBP, and HR values in group I, whereas in group II the incidence of supraventricular extrasystoles (APCs) was higher during peaks of SBP and HR values. The relationship between APCs and SBP observed in group II may be attributable to the pressure stimulus on a normal atrium, and the significant correlation between VPCs and SBP, DBP, and HR values may be due to episodes of subendocardial ischemia or to the influence of adrenergic stimulation on previously compromised myocardial tissue.

Arrhythmias, Cardiac↗
PubMed1990

Double-blind controlled study of the efficacy and pharmacological properties of heparan sulfate in patients with occlusive arterial disease of the lower limbs.

The effect of a 60 day administration of 200 mg heparan sulfate (Hemovasal 100 b.i.d.) or 100 mg mesoglycan (50 mg b.i.d.) was assessed under double blind design in forty patients (thirty-six males and four females) with peripheral occlusive arterial disease with respect to pain-free walking distance and various haemorheological and haemostasiological variables, platelet aggregation and blood chemistry. The pain-free walking distance significantly improved with heparan sulfate (up 67% from baseline 200.0 +/- 22.5 m and up 34%, with mesoglycan from baseline 207.7 +/- 23.4 m). Heparan sulfate significantly stimulated fibrinolysis and reduced platelet aggregability: these findings suggest an action of heparan sulfate on the endothelial cells, thus reducing their thrombogenicity. The results of the study thus confirm the activity of heparan sulfate in peripheral vascular disease, correcting the conditions which constitute the basis of increased thrombotic risk.

Aged↗
PubMed1989

[Therapy of hyperlipidemia. Clinical experience with clinofibrate].

The results are reported of a double-blind crossover trial intended to evaluate the effectiveness and safety of a new aryloxy derivative compared to placebo. Twenty patients with hyperlipidemia not responding to dietary treatment received either one capsule of the active substance or of placebo (200 mg) three times daily for 16 weeks. Total cholesterol, HDL and triglycerides showed the following changes at the of the treatment period: -11%, +6% and -48% with clinofibrate and -1%, -4% and -1% during control periods. The substance was well tolerated; only in one patient clinofibrate was withdrawn as a precaution in view of the onset of medium severe diarrhea and abdominal pain.

Adult↗
PubMed1989

Effects of synvinolin on platelet aggregation and thromboxane B2 synthesis in type IIa hypercholesterolemic patients.

An increased susceptibility of platelets to aggregation induced by various agents and a higher production of active arachidonate metabolism have been described in type IIa hypercholesterolemia. This study was designed to evaluate whether changes in platelet function could be observed in hypercholesterolemic patients after synvinolin therapy. Administration of synvinolin to 12 type IIa hypercholesterolemic patients for 24 weeks had a lipid lowering effect and resulted in a marked reduction of platelet aggregation and thromboxane formation induced by collagen and arachidonate. Maximum response was achieved at 4-8 weeks and lipid lowering effects at 2 weeks. This finding indicates that platelet changes cannot be explained by a direct effect of synvinolin on platelets, and the antiplatelet response may therefore depend on platelet membrane lipid composition changes, particularly in the platelet cholesterol content of platelet membranes, following substantial reductions of total plasma cholesterol and LDL-cholesterol.

Aged↗
PubMed1989

Noninvasive blood pressure monitoring evaluation of verapamil slow-release 240-mg antihypertensive effectiveness.

The aim of our study was to evaluate the antihypertensive effectiveness of verapamil slow-release (SR), administered once a day. We studied 11 patients, 7 male and 4 female, with an average age of 53.6 +/- 12.86 years, who had essential hypertension. After a drug washout period of at least 15 days, placebo was administered (one tablet per day), and then patients received verapamil SR 240 mg/day at 8:00 a.m. for at least 2 weeks. At the end of the washout, placebo, and active drug treatment periods we performed ambulatory intermittent blood pressure monitoring for 24 h using a Squibb Spacelabs pressurometer. After verapamil treatment, in comparison to placebo, a significant reduction of systolic (SBP) and diastolic blood pressure (DBP) (154.91 +/- 13.34/94.29 +/- 9.48 vs. 143.73 +/- 11.39/84.6 +/- 7.99 mm Hg; p less than 0.005), was observed without significant changes of the circadian blood pressure pattern. Moreover, we observed a significant reduction of SBP and DBP variability mainly during daytime, whereas this behavior was not evident for heart rate. In conclusion, verapamil SR seems useful to obtain a constant and significant reduction of 24-h blood pressure values with a significant reduction of SBP and DBP variability.

Blood Pressure↗