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Biomedical subjects

E Paciaroni

Publications and source records attributed to E Paciaroni.

At least 19 recordsLinked to original sources
PubMed1992

Nicardipine retard in the therapy of elderly diabetic hypertensives: final report of observational study.

OBJECTIVE: An uncontrolled multicentre study was carried out in 10 hospitals of the Marche Region of central Italy, to evaluate the efficacy and tolerability of 40 mg nicardipine retard in elderly hypertensive patients with diabetes mellitus type II. DESIGN: The study lasted 6 months, single-blind for the first 3 months and open thereafter. The blood pressure criteria were 165 mmHg systolic and/or 95 mmHg diastolic measured at least three times consecutively in untreated patients or after 10 days of drug washout. PATIENTS: All subjects had a proven diagnosis of diabetes mellitus type II and were greater than or equal to 65 years of age. RESULTS: After the first 14 days of active treatment with nicardipine [corrected] retard at 40 mg/day, supine systolic blood pressure had fallen to 164.3 +/- 12.7 mmHg and diastolic to 92.2 +/- 7.3 mmHg (P less than 0.001). This first phase normalized blood pressure in 41.1% of patients. In 58.9% of patients the dose was doubled because goal blood pressure had not been achieved. After 4 weeks of therapy, mean supine systolic/diastolic values had fallen to 156.5 +/- 11.0/88.5 +/- 6.8 mmHg (P less than 0.001), and the proportion of patients requiring 80 mg/day had risen to 63.2%, with only 36.8% able to continue on the single dose. In 24.2% of the patients, monotherapy at 80 mg/day was not sufficient to normalize blood pressure and a second associated drug (enalapril, 10 mg/day) was administered. The mean blood pressure decrease induced by therapy was statistically significant from the second week of treatment (P less than 0.001). No significant variation in metabolic parameters was recorded during treatment. CONCLUSIONS: Nicardipine [corrected] retard was effective and well tolerated in elderly subjects, both clinically and metabolically.

Aged↗
PubMed1991

The mild hypertension enigma.

This study examines the problem of the correlation between mild arterial hypertension and cardiovascular damage. The authors examine the results of the most important trials carried out and, on the basis of their evaluations, suggest the need to review the current clinical policy of considering mild arterial hypertension as an important risk factor directly related to cardiovascular disease. Since the therapeutic trials carried out on mild hypertension did not substantially reduce the total and cardiac mortality rate, it seems to be probable that arterial hypertension is a progression acceleration marker of atheromatous disease. According to this theory, a therapy which aims merely at returning the pressure values to normal limits will probably not change the natural course of the atheromatous process.

Cardiovascular Diseases↗
PubMed1991

Discontinuous transdermal nitroglycerin as treatment for stable angina in the elderly: a double-blind multicentre study. The Transdermal TNG Trial Group of Istituto Nazionale Ricovero e Cura Anziani (I.N.R.C.A.).

A transdermal nitroglycerin (TNG) patch (10 mg.24 h-1), using a daily overnight 8-h free interval, was assessed by means of a multicentre trial in 96 elderly patients with stable angina (age greater than or equal to 65 years). The main entry requirement was a reproducible exercise-induced ST depression (greater than or equal to 1 mm) appearing at a load of 60 to 90 W, during an incremental bicycle ergometer test (10 W.min-1). During the study only one other antianginal drug and sublingual TNG tablets were allowed. The protocol consisted of a run-in period (mean 10 days), followed by a double-blind, randomized, parallel, placebo-controlled 28-day phase and a single-blind active treatment phase of the same duration. The exercise test parameters, the number of spontaneous anginal attacks and any unwanted effects were evaluated at the end of every study phase. In the double-blind phase, no ergometric values changed with placebo while transdermal TNG significantly improved total workload and double product by 36.4% and 7.7% at the maximal workload respectively and by 49.8% and 13.5% at the time to onset of 1 mm ST depression respectively and reduced ST depression (-58.8%) at the equivalent baseline workload. Anginal attacks decreased by 61.5% and 30.8% with TNG patch and placebo respectively. A similar trend was seen at the end of the single-blind active treatment period in patients who had received placebo in the double-blind phase. Nine patients failed to complete the study; six for unwanted effects (four in the active group and two in the placebo group) and three for other reasons.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1991

Biochemical effects of urapidil on red cell membrane ion transport systems in a population of elderly essential hypertensives.

The aim of our work was to verify the effect of urapidil on membrane ion transport systems. This was a randomized, double-blind, cross-over study which evaluated the clinical and biochemical effects of urapidil (30 mg twice daily in comparison with placebo) in a group of 10 elderly hypertensive patients (3 male, 7 female ranging from 68 to 90 years, mean age 79.2 +/- 7.6 years). For the evaluation in fresh erythrocytes of principal ion transport systems (cotransport Na+/K+, countertransport Na+/Li+, Na+/K+ ATPase pump. intracellular Na+ and K+) we used the nystatin technique. We found that urapidil activated the red cell membrane ions cotransport system (basal values: 83.7 +/- 50.3 mumol Na+ RBC 1-1.h-1, after 1 month of urapidil therapy: 181.5 +/- 89.3 mumol Na+ RBC 1-1.h-1) (P less than 0.01), without significant changes in the other biochemical parameters evaluated. Our data suggest that one of the mechanisms of the urapidil antihypertensive effect could involve an increase in the membrane sodium cotransport system.

Aged↗
PubMed1991

Impedance cardiography for repeated determination of stroke volume in elderly hypertensives: correlation with pulsed Doppler echocardiography.

In this double-blind, crossover study the authors have validated stroke volume determination by impedance cardiography against the pulsed Doppler echocardiographic method in elderly hypertensives. They found a good correlation between the stroke volume values obtained by the two methods over a range of values from 30 to 130 mL. The coefficient of linear regression was about .95 at each visit. The mean of the differences was -0.73 mL with a standard deviation of 8.46. Given that individual differences are normally distributed, the values corresponding to 2 standard deviations of the mean define a range covering 95% of the observed differences. From the distribution of the data around the mean plot it appears that, in comparison with pulsed Doppler, impedance cardiography tends to slightly underestimate stroke volumes of greater than 90 mL and to overestimate values of less than 50 mL. The results of this study indicate that impedance cardiography may represent a reliable alternative to pulsed Doppler echocardiography for the noninvasive estimation of cardiac output at rest in elderly patients.

Aged↗
PubMed1991

[A computerized method for studying contractility of isolated cardiac myocytes].

In recent years methods for the isolation of cardiac myocytes have gained increasing interest. Single cardiac cells represent an effective model for the study of cardiac contractility thanks to their features of simplified preparation. This improves the understanding of cardiac contractile properties and the effects of cardio-active substances. Moreover, it has been demonstrated that the isolation procedure does not alter the basic characteristics of the original tissue. The contractility indices in multicellular models are derived from the direct measurement of mechanical parameters (pressure and tension). These are difficult to perform in the case of isolated cardiac myocytes for which optical techniques of measurement proved particularly suitable. A system based on the video motion detector technique has been used to measure the extent of shortening. The cell is observed using a video camera connected with a phase contrast microscope. The video dimension analyser receives the cell image from the video camera and its output is a voltage proportional to the cell length. This signal is sent to a personal computer for acquisition and analysis. The signal is then digitalized by an analog to digital conversion board and subsequently elaborated to calculate the contraction parameters. Then these values are visualized on the computer screen, printed and stored with other pertinent information typed by the user. The result is the creation of a data file, available for further processing.

Animals↗
PubMed1990

[The problem of hypercholesterolemia in the aged].

This paper deals with the problems of hypercholesterolaemia in the elderly. We have significant results that show an important relationship between serum cholesterol and cardiovascular diseases in the adult, but the same has not yet been definitely established for the elderly. After examination of the available data, the Authors suggest that--after a through clinical evaluation--the elderly should also be treated given that there are data to suggest and hypothesize the positive action of a hypolipemic diet until at least the age of seventy five years. The therapy, whenever possible, could be dietetic; but from relevant results obtained, used together with HMG-CoA reductase inhibitors, these drugs are a good therapeutic approach to the problem, also in the elderly. To support this opinion, the Authors show the results obtained with the use of Simvastatin in a group of old patients.

Adult↗
PubMed1990

Age-related antihypertensive and haemodynamic effects of verapamil SR: clinical results and effects on atrial natriuretic peptide.

The antihypertensive effect of the calcium-antagonist verapamil was investigated in two groups of patients, adult hypertensives (AH, less than 65 years of age) and elderly hypertensives (EH, greater than 65 years of age), who were treated with 240 mg p.o. sustained-release (SR) verapamil for 4 months. Arterial blood pressure was significantly reduced in both groups: the responders' rate was 65% in the AH group and 82% in the EG group. The heart rate was slightly but not significantly reduced. An improvement in cardiac haemodynamics was observed [cardiac index (CI), from 3.00 +/- 0.51 to 3.25 +/- 0.83 ml min-1 m-2 in AH and from 2.35 +/- 1.08 to 3.04 +/- 0.86 ml min-1 m-2 in EG]. We also evaluated the plasma concentrations of atrial natriuretic peptide (ANP) before and after treatment; ANP levels increased significantly only in the EH group. No serious side effects occurred. In conclusion, verapamil SR provided effective and well-tolerated antihypertensive treatment in both adult and elderly patients.

Age Factors↗
PubMed1989

Evaluation of plasmatic ANP levels in subjects affected by essential arterial hypertension and in a group of patients undergoing dialysis.

In the first part of this study we selected 24 hypertensive subjects (11 males, 13 females, mean age 55.4 +/- 10.2 years) affected by essential arterial hypertension (EAH). Eleven people (5 males, 6 females, mean age 21.6 +/- 9.5 years) had one or two hypertensive parents. Seventeen subjects (8 males, 9 females, mean age 56.4 +/- 5.9 years) were the control group. Plasmatic ANP was measured using the RIA method, after extracting the peptide on Sep-Pak C18 cartridges. The results show the following ANP values: healthy control subjects 27.6 +/- 8.6 pg/ml; offspring of essentially hypertensive subjects 25.6 +/- 7.7 pg/ml; essentially hypertensive subjects 45.5 +/- 24.9* pg/ml* (P less than 0.005). In the second part of our study, we evaluated the plasma levels of this hormone in a group of subjects undergoing dialysis. The group consisted of 21 subjects (12 males, 9 females, mean age 63.1 +/- 10.5 years), 11 of whom were affected by EAH. ANP evaluation was done during the dialysis after a "long" dialytic interval of three days. Both groups showed a noticeable increase in ANP levels, even if the hypertensive group had overall higher values (254.5 +/- 134.9 pg/ml, vs. 188.7 +/- 113.7 pg/ml). All subjects, after dialysis, had ANP values significantly lower than the initial ones.

Aged↗
PubMed1989

[Evaluation of the efficacy and tolerability of a fixed dose combination of captopril (CPT) 50 mg and hydrochlorothiazide (HCTZ) 15 mg in the elderly].

In this double blind study we have evaluated the efficacy and tolerability of the association Captopril 50 mg + hydrochlorothiazide 15 mg/die vs hydrochlorothiazide 25 mg/die in aged patients with hypertension. Both drugs showed a good antihypertensive efficacy, and a better efficacy on diastolic blood pressure was shown by the association Captopril + hydrochlorothiazide.

Aged↗
PubMed1989

A double-blind comparative study of ketanserin with atenolol in essential hypertension.

Sixty patients, with mild to moderate essential hypertension, were considered for a double-blind trial comparing the effects of ketanserin and atenolol. After 2 weeks of placebo, a group of 30 patients was given ketanserin 20 mg twice daily for 15 days and 40 mg twice daily for the subsequent 45 days, while the second group (30 patients) was given atenolol for 60 days at the dose of 100 mg once daily. Blood pressure and pulse rate in the supine and standing positions were evaluated every 15 days. After the beginning of treatment with ketanserin, there was a gradual but highly significant decrease of the diastolic and systolic blood pressure values. No important side-effects or significant alterations in the biochemical parameters considered were observed during treatment with ketanserin.

Adult↗
PubMed1987

A multicenter trial of low dose captopril administered twice daily in patients with essential hypertension unresponsive to beta blocker-diuretic treatment.

Two hundred and one patients with essential hypertension, whose supine diastolic blood pressure (SDBP) was greater than or equal to 95 mmHg following 2 weeks of treatment with the optimal dose of a beta blocker-diuretic combination (Phase 1), were randomly assigned to the addition of either 25 or 50 mg captopril BID for 6 weeks (Phase 2). At the end of Phase 2, the dose of captopril was doubled in the patients not normalized (SDBP greater than or equal to 95 mmHg) and maintained in the others (SDBP less than 95) for an additional 4 weeks (Phase 3). At the end of Phase 3, the beta blocker was withdrawn in the normalized (SDBP less than 95 mmHg) patients, and captopril plus diuretic was given for 4 weeks (Phase 4). The addition of captopril at either dose level led to a significant fall (p less than 0.01) in standing and supine diastolic and systolic blood pressure after the first 2 weeks of treatment. There was no significant difference in response between the two dose levels of captopril. At the end of Phase 2, 59.4% and 55.8% of patients, respectively, assigned to 25 and 50 mg captopril BID, were normalized. Doubling the dose of captopril (Phase 3) led to approximately an additional 30% of patients being normalized. At the end of Phase 4 (captopril plus diuretic) the SDBP was still less than 95 mmHg in 63% of patients, whereas it was increased in the others. Side effects were noted in 10 patients (5%). The incidence was similar in each treatment group, and a total of four patients (2%) were withdrawn due to side effects.

Adrenergic beta-Antagonists↗
PubMed1987

Antihypertensive efficacy and tolerability of captopril in the elderly: comparison with hydrochlorothiazide and placebo in a multicentre, double-blind study.

In this study we compared the antihypertensive efficacy and tolerability of captopril at 25 mg twice daily, hydrochlorothiazide (HCTZ), 12.5 mg twice daily and placebo in a multicentre, double-blind, randomized study that included 152 essential hypertensive patients (77 males, 75 females, 87 WHO stage I, 65 WHO stage II, aged 69 +/- 4 years, mean +/- s.d.). Supine and standing blood pressure were similarly reduced by captopril and HCTZ (P less than 0.01 for both compared with placebo). The heart rate did not change. Captopril (25-30 mg twice daily) and HCTZ (12.5 mg twice daily), alone or in combination, maintained their antihypertensive effect during a 24-week single-blind follow-up study. During the follow-up, diastolic blood pressure remained less than 100 mmHg in seven essential hypertensives on placebo, in 45 on captopril and in 25 on HCTZ. Side effects were observed in seven essential hypertensives during placebo (treatment withdrawn in two), in eight during HCTZ and in three during captopril. Serum potassium was reduced (P less than 0.05) and uric acid was increased (P less than 0.01) only during HCTZ. We conclude that captopril and HCTZ have similar antihypertensive efficacy in the elderly; however, captopril appears to be better tolerated.

Aged↗
PubMed1985

Acebutolol-induced decrease of mononuclear leukocyte beta-adrenoceptors in hypertension.

The regulatory action exerted on receptors by acebutolol, a cardioselective beta-blocker containing intrinsic sympathomimetic activity, has been investigated. beta-Adrenoceptor affinity and density of human mononuclear leukocytes were assayed in hypertensive patients before and after treatment with 400 mg/day acebutolol. While receptor affinity showed no changes between pre- and post-treatment values, a statistically significant decrease has been demonstrated in receptor density following treatment. Blood pressure and heart rate were also measured in order to test the efficacy of the administered drug. All these parameters showed a fall in the post-treatment values. It is concluded that the partial agonist acebutolol, in spite of the fact that it acts clinically as a beta-blocker, has the regulatory mechanism characteristic of agonists.

Acebutolol↗