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Biomedical subjects

D Degli Esposti

Publications and source records attributed to D Degli Esposti.

16 recordsLinked to original sources
PubMed2004

Effects of losartan and chlorthalidone on blood pressure and renal vascular resistance index in non-diabetic patients with essential hypertension and normal renal function.

Antihypertensive drugs can differ in target organ protection despite similar blood pressure (BP) control. We compared the effects of losartan (L) and chlorthalidone (C) on renal vascular resistance index (RVRI) in 194 grade I to II, non-diabetic hypertensive patients with increased RVRI (>0.68 m/s by echo-Doppler) but normal renal function. Patients were randomly allocated to C 25 mg/d or L 50 mg/d according to a single blind, PROBE study design. After 4 weeks of treatment, 92 patients (48 L/44 C) with BP <140/90 mm Hg were enrolled in the long-term phase of the study. After 12 months a normalization of RVRI was observed in 47 of 48 patients treated with L (97.5%) and only in 14 of 44 of those treated with C (25.8%) despite no differences in BP control. Patients whose RVRI remained elevated during C therapy underwent a 2-week washout period and then were treated with L 50 mg/d for 12 additional months. After that period 28 of 30 (95%) of patients who were nonresponders to C showed a normalization of RVRI despite no differences in BP control. In conclusion, our data suggest that treatment with L can improve renal hemodynamic and exert a protective renal effect beyond BP control in patients with hypertension.

Adult↗
PubMed2001

Hospital attitude survey on organ donation in the Emilia-Romagna region, Italy.

UNLABELLED: The role of hospital staff in the organ procurement process is crucial. Nevertheless, there is little literature about their attitudes toward donation. The Donor Action Hospital Attitude Survey (HAS) comprises a series of questions to assess hospital staff's attitudes, beliefs, and knowledge on organ donation and transplantation. Further analysis of the data will help identify any weak areas in the staff viewpoint and information, highlight potential needs for more education on specific issues, and establish a baseline to monitor future improvements. We used the Donor Action HAS in the Emilia-Romagna region, Italy. The aim of this paper is to assess and better understand the personnel's viewpoint in the 12 main hospitals of the region. The survey was carried out among hospital staff involved in organ donation. 1576 responses were collected (52 % of distributed questionnaires), of which 1024 came from nurses, 475 from physicians, and 77 from other backgrounds. Questions were subdivided into categories, and for every point an overall mark (maximum 3/3) was calculated. RESULTS: 1. Involvement in donation process during the past year: 1.24 /3, 2. Attitudes to organ donation (OD): 2.51 /3, 3. Skills / Self-confidence in donation practices: 1.36 /3, 4. Satisfaction with local transplant coordinator (TC) services: 2.31 /3. The attitude towards organ donation was positive, 1386 respondents support organ donation. A high percentage (93.6 % of respondents) is of the opinion that transplantation helps save other people's lives. Most uncertainty arises on the question whether donation helps families with grief. It is remarkable that only 53 % of those prepared to donate organs have informed the family of their wish. Many respondents do not feel comfortable performing key tasks close to donation. Major difficulties were observed in explaining to a family the concept of brain death (0.98 /3). Knowledge on the concept of brain-death was one of the most requested subjects for improvement. Emilia-Romagna is the region with one of the highest donation rates in Italy (29.9 pmp in 2000). Nevertheless, more profound knowledge of the local situation could help further improve donation.

Adult↗
PubMed2000

Use of statins and blood pressure control in treated hypertensive patients with hypercholesterolemia.

High serum cholesterol has been frequently reported in patients with arterial hypertension in whom it might influence the blood pressure control. The aim of this study was to compare the extent of blood pressure changes in 41 patients with hypertension and hypercholesterolemia, taking antihypertensive drugs and treated for 3 months with statins (HC-S; pravastatin or simvastatin) and compared with matched controls with high (HC-D; 44) or normal serum cholesterol (NC-D; 45) undergoing antihypertensive treatment combined with dietary treatment alone. After 3 months of follow-up, a greater reduction of systolic (SBP) and diastolic (DBP) blood pressure values was observed in HC-S patients (ASBP/DBP, -11.3 +/-3/-10.6 +/- 2%) when compared with both HC-D (deltaSBP/DBP, -6.6 +/- 2/-6.1 +/- 2%; p < 0.05) and NC-D (deltaSBP/DBP, -6.9 +/- 2/-6.8 +/- 1.5%; p < 0.05). In statin-treated patients, a slight linear relation has been found between the percentage changes in DBP and those in plasma total cholesterol (R = 0.37, p = 0.043), whereas no relation was found with SBP changes (R =0.11; p = 0.35). In conclusion, the results of this study demonstrate that the use of statins in combination with antihypertensive drugs can improve blood pressure control in patients with uncontrolled hypertension and high serum cholesterol levels. The additional blood pressure reduction observed in patients treated with statins is clinically relevant and only partially related to the lipid-lowering effect.

Adult↗
PubMed2000

[The transplant coordinator].

Spain was the first European country adopting a strategy of organ procurement based on a specific health professional named transplant coordinator, who was first established in Catalunya in the middle eighties. In principle, the transplant coordinator is a doctor with hospital experience who is involved full time in organ procurement. The transplant coordination activity is available without interruption, due to a team work. Transplant coordination is based on four main functions: clinical, research, training and communication, management. The principles of transplant coordination according to the Spanish model are reported in the recently approved Italian law on transplantation (law 91/1999), indicating the coordinator's specific functions: a) communication to the regional reference centre of the data concerning the possible organ donors, b) preparation of the documents needed, c) relationship with the donors' family, d) information and education of the population on transplantation issues.

Humans↗
PubMed1996

Low dose of ACE-inhibitor enhances sodium excretion in volume expanded patients with borderline hypertension.

The purpose of the present study was to separately investigate the effects of two different dosages of captopril on pressor, vascular and humoral response to acute extracellular volume expansion in patients with borderline hypertension (BHT). Thirty-five patients were randomly allocated in two groups undergoing acute saline infusion (0.40 ml/min/kg for 45 min and 0.15 ml/min/kg for 75 min)before and after a 7-day period of treatment with either placebo or captopril at the dose of 12.5 (LD-CAP) or 50 mg (HD-CAP) twice a day. At baseline the effects of LD-CAP were limited to an increase in PRA and to a decrease in plasma aldosterone whereas HD-CAP decreased systolic and diastolic blood pressure (SBP, DBP), forearm vascular resistance (FVR) and increased venous distensibility (VV(30)) as well. After saline loading patients treated with HD-CAP showed an increase in SBP, DBP not observed in patients allocated to LD-CAP. Urinary sodium excretion in response to NaCl loading was selectively enhanced by LD-CAP (+25%) whereas HD-CAP did not (+6.3%). The present data suggest that low-doses of ACE-inhibitors acting through a selective blockade of RAA not associated with hemodynamic changes can enhance the natriuretic response to acute volume expansion in borderline hypertensives.

Adult↗
PubMed1993

Early and late angiotensin-converting enzyme inhibition in acute myocardial infarction.

Studies in animals and humans have shown that angiotensin-converting enzyme (ACE) inhibitors can prevent or at least attenuate ventricular dilation and remodeling following acute myocardial infarction (MI) and can improve subsequent left ventricular dysfunction, a strong predictor of survival. The question as to which patients will benefit most from ACE inhibitor therapy and the optimal timing of administration of such intervention after the onset of symptoms is still matter of debate, even if it is hypothesized that a greater benefit in terms of remodeling prevention may occur after early administration. However, while it is currently accepted that patients with asymptomatic postinfarctual left ventricular dysfunction can benefit from long-term administration of an ACE inhibitor when therapy is started late, the usefulness of an early administration is still to be clarified. In this setting, the question of early versus late ACE inhibitor treatment has to be related to the different evolving pattern of myocardial infarction with regard to the different degrees of postinfarction ventricular dysfunction and neurohormonal activation, whose extent could influence the effect of ACE inhibition. For example, not all patients with acute MI show progressive ventricular dilation. Early dilation is frequent in patients with anterior localization of necrosis, whereas it is usually not relevant in patients with acute inferior MI. Thus, different postinfarction patterns may differently influence the clinical success of therapeutic interventions, which can be instituted at various stages following acute MI.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1993

[The pharmacology and clinical aspects of the prostanoids].

Prostanoids are derivative of arachidonic acid and arising from a common endoperoxide and they possess multiple and even opposing effects. Their main function is to control haemostasis and to maintain vascular homeostasis. Among these compounds thromboxane, generated by platelets, is a powerful vasoconstrictor and an inducer of platelet aggregation; prostaglandin E1 (PGE1) and prostacyclin (PGI2) are potent vasodilator and inhibitor of platelet aggregation. For these properties PGE1 and PGE2 are object of interest for the potential therapeutical use in treatment of atherosclerotic diseases, where mechanisms of vascular defense are altered and amplified. Pharmacokinetic and pharmacodynamic characteristics of these compound have been per se a good rationale for plenty of experimental studies which generated enthusiasm and hope of new therapeutic means in patients with surgically unreconstructible peripheral arterial disease. Nevertheless clinical trials have to face many difficulties deriving from their properties themselves. PGE1 and PGI2 are unstable hormones with local action and it is difficult to employ them in clinical practice. Moreover their protean action is often implicated in not unusual adverse effects. The development of compounds with a prostacyclin-type of action, but long lasting and therefore easier to handle, undoubtedly facilitated clinical research. But we still lack firm indications for a correct therapeutic use. Limb ischemia is the condition in which prostanoids were mostly studied. Although anecdotal reports or uncontrolled studies provided encouraging results, several controlled trials failed to demonstrate a consistent efficacy of either PGE1 or PGI2, whilst metanalytic review of controlled trials on iloprost demonstrated an efficacy on critical and less severe limb ischemia, thromboangiitis obliterans and Raynaud's phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial Occlusive Diseases↗
PubMed1993

Ace-inhibitors and experimental atherosclerosis.

The role of renin-angiotensin system in the development of atherosclerosis is not yet defined, even though several actions of angiotensin II have been suggested as contributing to the development of the atherosclerotic lesion. Local renin-angiotensin system may exert a variety of autocrine or paracrine influences on vascular tissue leading to important trophic and growth regulatory effects and participating to well known events in atherogenesis as control of smooth muscle cell growth and proliferation. The existence and the specific function of components of this system in blood vessels wall suggest its possible involvement in atherosclerotic process. On these bases, the antiatherogenic properties of ACE-inhibitors have been recently evaluated in animal models where a protective effect of ACE-inhibition over the development of experimental atherosclerotic lesions has been observed. This favorable effect could follow the antihypertensive action of ACE-inhibitors even whether other potential mechanisms, including prevention of angiotensin II-induced vascular proliferation and interference with sympathetic nervous system activity and insulin sensitivity, have to be considered. Despite some clear-cut experimental evidences, the clinical importance of such findings as well as the precise mechanisms by which ACE-inhibition is able to interfere with the pathogenesis of atherosclerosis is still matter of debate and need to be assessed in future investigations.

Angiotensin II↗
PubMed1992

ACE-inhibitors and atherosclerosis.

The involvement of the circulating and local renin-angiotensin system in atherosclerotic process has been hypothesized on the basis of experimental data showing presence and specific actions of the components of this system in the vascular wall. In particular, angiotensin II may participate in well known events in atherogenesis as the control of smooth muscle cell growth and proliferation. Recent studies have shown an effect of angiotensin converting enzyme (ACE) inhibition on the development of atherosclerosis in animal models. Captopril and cilazapril prevent myointimal proliferation after vascular injury in rat. Captopril reduces aortic cholesterol content and percentage intimal aortic surface covered by lesions in Watanabe heritable hyperlipidemic rabbits. Captopril also significantly reduces the progression of carotid and coronary lesions in monkeys fed a high cholesterol diet. In addition, a role for converting enzyme inhibitors in reducing aortic and microvascular growth either in hypertensive or normotensive rats has been demonstrated. It is possible that ACE-inhibitors prevent angiotensin II-induced vascular proliferation and thereby suppress the development of atherosclerosis in animals. It is also conceivable that the blood pressure effects of ACE-inhibitors could play a role in the antiatherosclerotic effect shown by these drugs, even though this explanation cannot be addressed by studies dealing with normotensive animals. Then, other mechanisms could be involved, including hypothesized effects of blockade of the renin-angiotensin system on sympathetic nervous system activity, regulation of vascular growth factors and insulin sensitivity. The clinical significance of these experimental findings is unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin II↗
PubMed1992

"Oesophageal angina" in patients with angina pectoris: a possible side effect of chronic therapy with nitroderivates and Ca-antagonists.

The study was carried out on 18 patients with angina pectoris in whom the usual treatment with nitroderivatives and/or Ca-antagonists did not improve or prevent the angina-like chest pain in the absence of unstable angina. The patients underwent the following oesophageal examinations: X-ray, endoscopy-biopsy, manometry, acid perfusion test and 24-hour oesophageal pH ambulatory monitoring, the latter two being made in association with dynamic ECG. The presence of coronary insufficiency had been previously determined by means of ECG and scintigraphic stress tests and, when necessary, coronary arteriography was performed. In 10/18 patients severe oesophageal motor disorders were observed, the most frequent being diffuse oesophageal spasm. In the entire group the lower oesophageal sphincter basal tone was significantly lower than normal. In 14/18 patients a pathologic gastroesophageal reflux was detected: in 2 of these patients a temporal correlation between pain attacks and episodes of gastroesophageal reflux were observed in the absence of ECG modifications. Acid perfusion test induced the angina-like chest pain in another 2 patients without ECG modifications. In conclusion, the angina-like chest pain of these patients is not due to a failure of the antianginal therapy in relieving the coronary insufficiency, but is most probably related to gastroesophageal reflux. This oesophageal disorder may be considered a side effect caused by prolonged therapy with nitroderivatives and Ca-antagonists. In fact, these drugs decrease the lower oesophageal sphincter tone which is the main barrier against the reflux of gastric contents into the oesophagus so favoring gastroesophageal reflux and related disorders, including oesophageal pain.

Aged↗
PubMed1991

Myocardial metabolic and hemodynamic effects of a sustained intravenous infusion of nifedipine with and without metoprolol in patients with unstable angina.

We tested the usefulness of a sustained intravenous infusion of nifedipine and a combination of nifedipine and metoprolol in the early management of 14 patients with unstable angina pectoris. After a 24-hour run-in period, nifedipine was titrated in a stepwise fashion (mean dose 27 +/- 7 micrograms/min). After nifedipine treatment coronary blood flow increased from 150 +/- 66 to 183 +/- 74 ml/min (p less than 0.05), whereas double product, myocardial oxygen consumption, and both arterial and coronary sinus (nor)epinephrine levels were unchanged. Myocardial lactate uptake increased from 3.4 +/- 26.1 to 31.3 +/- 26.6 mumol/min (p less than 0.005) and free fatty acid uptake from 7.2 +/- 22.1 to 34.5 +/- 33.7 mumol/min (p less than 0.05). A small nonsignificant improvement in amino acid metabolism was observed. Metoprolol was added in seven patients and led to a decrease in double product (-2.2 +/- 1.6 x 10(3); p less than 0.01) and myocardial oxygen consumption (-3.2 +/- 3.8 ml/min; p less than 0.05). The lactate uptake/oxygen uptake ratio increased by 18% after metoprolol (p = NS). The number of episodes of chest pain decreased from 2.4 +/- 1.1/24 hours to 0.1 +/- 0.2 in the nifedipine group and from 2.9 +/- 1.1/24 hours to 0.3 +/- 0.5 in the nifedipine plus metoprolol group (both p less than 0.01). We conclude that in the acute phase of unstable angina, intravenous nifedipine can be carefully titrated to improve coronary blood flow and oxidative metabolism. The addition of metoprolol is also associated with a reduction in myocardial oxygen demand. This treatment results in significant hemodynamic stability.

Adult↗
PubMed1991

[Thrombolytic drugs in acute myocardial infarct].

Thrombolytic therapy has a primary role in modifying evolving acute myocardial infarction by restoration of patency of infarct-related artery. All thrombolytic agents convert plasminogen to plasmin; 3 of them (streptokinase, urokinase and anisoylated human plasminogen streptokinase activator complex-APSAC) are not specific for fibrin and 2 (rt-PA, scu-PA) are relatively clot-specific and have limited systemic fibrinolytic activity. To date, the largest experience has been with streptokinase, which is derived from streptococci and therefore has the potential to cause allergic reactions, more frequent with repeat doses of the drug. Streptokinase is not clot-selective; despite significant systemic fibrinolysis, which is an usual consequence, major bleeding complications are uncommon. Another problem with streptokinase is hypotension, which depends on infusion rate. APSAC differs from the parent streptokinase-plasminogen complex with kinetics well suited to a sustained thrombolytic effect. Although it was expected to have clot selectivity, this feature is missed at the dose needed in the treatment of acute myocardial infarction. rt-PA is a natural occurring serum protease which presents important clot specificity with limited systemic fibrinolytic activity. However, the risk of major bleeding is not less than that observed with thrombolytic agents without clot selectivity. Of considerable interest is the potential for urokinase and prourokinase to act synergistically with other thrombolytic agents, with hypothetic improvement in efficacy and safety of thrombolytic therapy. Despite some different features among various thrombolytic agents, they are equally safe and effective in salvaging myocardium and in assuring survival benefit after acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Anistreplase↗
PubMedDate not supplied

Fixed combinations of delapril plus indapamide vs fosinopril plus hydrochlorothiazide in mild to moderate essential hypertension.

This 12-week randomized, parallel-group, multicenter study compared fixed combinations of delapril (D) 30 mg plus indapamide (I) 2.5 mg and fosinopril (F) 20 mg plus hydrochlorothiazide (H) 12.5 mg in 171 adult patients with mild to moderate essential hypertension. After a 2-week placebo run-in, sitting and standing systolic (SBP) and diastolic blood pressure (DBP) was measured by conventional sphygmomanometry. The primary efficacy endpoint was the percentage of normalized (sitting DBP < or =90 mm Hg) and responder (sitting DBP reduction of 10 mm Hg or DBP < or =90 mm Hg) patients. Treatment effects were analyzed in the intention-to-treat (ITT; n = 171) and the per-protocol (PP; n = 167) populations. The percentage of normalized and responder patients did not differ significantly between the D + I (87.4% and 92%) and the F + H (81% and 86.9%) ITT groups. Similar results were seen in the PP population. In ITT and PP patients, sitting and standing SBP and DBP values were comparable at baseline in the two groups and were significantly (P<.01) and similarly reduced at weeks 4, 8, and 12. Neither treatment induced reflex tachycardia, and both regimens were well tolerated. Four patients in the F + H group dropped out because of adverse events. In this study, the efficacy and safety of D + I were comparable to those of F + H in patients with mild to moderate essential hypertension.

Angiotensin-Converting Enzyme Inhibitors↗