Biomedical subjects
Publications and source records attributed to F Rhomberg.
24 hypertensive patients were treated with 300-450 mg tiapamil daily for 2-6 months. The antihypertensive effect of this new calcium entry blocking agent was expressed by a reduction even of extremely elevated blood pressures to the normotensive, but not to the hypotensive range, in 20 patients. The drug was well tolerated.
Alpha-methyldopa and guanfacine, both of which are predominantly centrally acting antihypertensives, were compared in a double-blind randomized trial involving seven practising physicians and a total of 78 patients. The whole trial lasted one year, with individual treatment periods of between 5 and 14 weeks. The reduction achieved in mean systolic and also diastolic blood pressure did not differ significantly between the two groups; nor was there any significant difference in responder or nonresponder rates. Blood pressure was normalized in approximately 80% of the patients in both groups. The incidence of side effects was kept down by starting treatment with a low dose and increasing it gradually. The average dose at the end of the trial was 2.6 mg daily for the guanfacine patients and 750 mg daily for those given alphamethyldopa.
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Estulic (guanfacine), a new centrally acting antihypertensive agent derived from guanidine, was administered to 13 patients with established essential hypertension. Therapeutic effect and safety were evaluated in all patients during the first year. Blood pressure normalization was elicited in 6 patients and a good therapeutic response in 5. Two patients did not respond to the monotherapy. Dryness of the mouth was observed in 11 patients during the first year and tiredness in 4. At the end of the first year, 3 patients out of 7 who completed the 1-year treatment still complained of dry mouth. Five patients continued for a second year of treatment. In all of them the blood pressure was normalized and only one patient suffered from dryness of the mouth. Estulic was usually given once daily in the evening; in some patients it was given twice daily. At the end of the first year, doses between 2 and 7 mg were used (mean 3.4 mg); during the second year 2 mg/day was administered to 2 patients, 3 mg/day to 2 patients and 5 mg to 1 patient. No impairment of laboratory values was seen during long-term treatment. In one patient with renal insufficiency the treatment had to be discontinued owing to deterioration of the underlying disease. After withdrawal of the drug, no rebound hypertension was observed.
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The blood pressure lowering effects of spironolactone have been studied in 40 subjects with benign essential hypertension in an attempt to determine the optimum starting dose for the drug. The trial was carried out by the double blind method. In almost all patients 100-400 mg spironolactone caused a signnificant decrease in diastolic and systolic arterial pressure. Present findings indicate that 100-200 mg spironolactone represents the optimum attack dose. The medication caused a significant rise in serum potassium. Other parameters were not affected by the treatment. In conclusion, it would appear that spironolactone--in association with other antihypertensive regiments--may improve the treatment of essential hypertension, especially in patients showing a tendency to hypokalemia and uricemia, and may offer an additional possibility or alternative in the therapy of hypertensive diseases.
Patients, particularly older ones, with internal medical diseases, may be hazards for the dental treatment. Therefore, anamnestic data seem to be most important in order to uncover the hazard patient (diabetes, survived heart attacks, anticoagulation, rheumatic heart affections, hypertonics, allergies). Local anesthesia can be another problem, because it may lead to collapse (psychogenous or from anaphylactic shock). Focal infection, although in general overrated in its importance for the general organism, may pose some problems before heart surgery and antibiotic therapy previously may seem necessary. Finally, therapeutic consequences from emergencies in the dental office are reviewed.
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