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Biomedical subjects

G de Simone

Publications and source records attributed to G de Simone.

124 records · Page 7Linked to original sources
PubMed1987

Noninvasive assessment of hemodynamic changes during therapy with nitrendipine in arterial hypertension.

Changes in hemodynamic variables regulating systolic function were examined by M-mode echocardiography in 14 patients with long-duration primary uncomplicated hypertension treated with nitrendipine once daily (20 mg). At the end of treatment (8th week) blood pressure and peripheral resistance were greatly reduced (p less than 0.0001), while the indices of cardiac function (ejection fraction and cardiac index) showed significant increases (p less than 0.01). The variations in ejection fraction were analyzed by multiple linear regression and were mainly influenced by the decrease in end-systolic stress (contribution: 60%). At baseline, despite no radiographic or clinical signs of heart failure, 6 of the studied patients showed impaired systolic function, likely due to the strength of other variables (age, risk factors); in those patients, systolic function was clearly enhanced at the end of treatment, while no change was found in patients with initial normal pump function. Changes in cardiac output were due to a significant increase in heart rate in patients with normal pump function and to improved stroke volume in the others. Left ventricular mass index was slightly reduced (p less than 0.005), primarily because of the reduction in end-diastolic volume (p less than 0.01). When analyzed by the 2 subgroups (with or without impaired systolic function), the left ventricular mass index appeared to be significantly reduced only in those patients with normal basal pump function. This difference was most likely due to the different effects of treatment on end-diastolic volume.

Adult↗
PubMed1986

A role for steroid hormones in the variability of blood pressure determination.

Blood pressure variability was studied in eight patients with renovascular hypertension (group 1) and eight patients with hypertension and partial deficiency of adrenal zona fasciculata 11-hydroxylase (group 2). Systolic, diastolic and mean blood pressure were found to be higher in group 1 than in group 2 when measured at home (P less than 0.001), while no difference was measured when blood pressure was taken in the outpatient clinic. Heart rate was higher in group 1 than in group 2 both at home and in the clinic (P less than 0.005 and P less than 0.05, respectively); a significant increase was observed only in the hospital clinic for group 2 (P less than 0.001). No difference in systolic function and left ventricular mass was found between the two groups. Finally, group 2 exhibited a significant increase (P less than 0.0001) in systolic, diastolic and mean blood pressure in the clinic, compared with that found at home, while group 1 showed a poor increase (P less than 0.05) in systolic blood pressure only. It is suggested that the enzymatic impairment of adrenal glands in group 2 may play a role in the disparity of blood pressure levels determined at home and in the outpatient clinic. Furthermore, our data suggest that differences in blood pressure measurement at home and in the hospital clinic should be taken into account when screening patients with partial deficiency of 11-hydroxylase.

Adrenal Glands↗
PubMed1985

Complete transposition of the great arteries: visualization of left and right outflow tract obstruction by oblique subcostal two-dimensional echocardiography.

Subcostal oblique 2-dimensional echocardiography was performed in 64 infants younger than 2 years with complete transposition of the great arteries (TGA) (situs solitus, concordant atrioventricular and discordant ventriculoarterial connections). All patients examined before cardiac catheterization had a correct diagnosis by 2-dimensional echocardiography using the subcostal oblique views. Twelve patients had associated left ventricular (LV) outflow tract obstruction and 7 had right ventricular (RV) outflow obstruction. The standard parasternal views failed to diagnose obstruction in 1 patients with LV outflow obstruction and 5 with RV outflow obstruction; the subcostal left oblique cut and long axis of the left ventricle visualized all left-sided obstructions, and right-sided obstructions were correctly displayed in 5 of 7 cases using a combination of left oblique and right oblique cuts. Two-dimensional echocardiographic subcostal oblique views allow an excellent definition of the morphologic characteristics of RV and LV outflow tracts in patients with TGA and improve the diagnosis of the outflow obstruction in these malformations.

Child, Preschool↗
PubMed1985

Antihypertensive and cardiovascular effects of nitrendipine: a controlled study vs. placebo.

The antihypertensive and cardiovascular effects of nitrendipine, a calcium entry blocker similar to nifedipine, have been evaluated in a double-blind, placebo-controlled study in 20 patients with hypertension. At baseline and at the end of the 8-week period (nitrendipine, 20 mg once a day, or placebo, 1 tablet once a day) the following parameters were measured: systolic and diastolic blood pressure (BP) and heart rate (HR) at rest by an automatic recorder; BP, HR, and cardiac workload (systolic BP X HR) during exercise testing on a bicycle; left ventricular mass (LVMe according to the method of Devereux) and cross-sectional area (CSA), and main parameters of systolic function (end diastolic volume, end systolic volume [ESV], and ejection fraction [EF]) by M mode echocardiography. There was a significant decrease in BP at rest (163/108 vs. 144/92 mm Hg; P less than 0.001) and during exercise in subjects receiving nitrendipine, while placebo did not modify these parameters. LVMe (from 195 to 188 gm; P less than 0.01) and CSA (from 20.2 to 19.8 cm2; P less than 0.05) were reduced by nitrendipine, which also improved cardiac performance (ESV fell from 44 to 38 ml [P less than 0.001] and EF fell from 62% to 66% [P less than 0.01]). No effect was observed in the placebo group. Our results indicate that nitrendipine is a powerful antihypertensive agent that also improves cardiac performance and slightly but significantly reduces left ventricular mass.

Administration, Oral↗
PubMed1985

Slow-release nifedipine versus placebo in the treatment of arterial hypertension. A double blind ergometric evaluation of cardiac workload.

The effects of slow-release nifedipine on blood pressure and cardiac workload have been studied during bicycle exercise testing in a randomized, double blind trial in 20 patients with mild to moderate hypertension. After a fortnight's wash-out, patients were allocated to either slow-release nifedipine (20 mg twice daily) or placebo for a 2-month period. At baseline and at the end of treatment blood pressure and heart rate were measured at rest and during ergometric exercise; cardiac workload was calculated as the product of systolic blood pressure by heart rate. Significant decreases in blood pressure at rest and in cardiac workload on exercise were demonstrated at the end of nifedipine treatment. The reduction of cardiac workload was mainly due to the lower baseline values of resting blood pressure. Heart rate showed a reduction of its increase during ergometric exercise at the end of nifedipine treatment as compared to baseline, likely due to an improvement in stroke volume.

Adult↗
PubMed1984

Changes in left ventricular mass during a double-blind study with chlorthalidone and slow-release nifedipine.

The presence of a possible correlation between changes in left ventricular mass of hypertensive patients and the degree of blood pressure reduction with different antihypertensive drugs has been investigated in 40 outpatients by M-mode echocardiography. Ten of these, with blood pressure in normal limits with different antihypertensive treatment had their therapy changed in chlorthalidone 25 mg/day without any run-in (Group A); other 30 patients, with a previously uncontrolled blood pressure, after a 14 day run-in, were randomly allocated to chlorthalidone 25 mg/day (Group B), slow release nifedipine 20 mg/day (Group C) or placebo (Group D). At the end of the eight week treatment period a further decrease in systolic blood pressure was observed in Group A without changes in ventricular mass; an highly significant decrease in both systolic and diastolic blood pressure was observed in B and C but only patients on chlorthalidone changed their ventricular mass; no change in both blood pressure and ventricular mass was observed on placebo. As changes in ventricular mass are not correlated with blood pressure reduction, we conclude that other, not well defined factors, apart from the decrease in duration and degree of left ventricular systolic wall tension, may be responsible for reversal of left ventricular hypertrophy.

Adult↗
PubMed1984

Cardiac rhabdomyoma: surgical treatment in the neonate.

Primary cardiac tumors are rare. Of the benign lesions, rhabdomyoma predominates in infants and children. The natural history of patients with cardiac rhabdomyoma is poor. About 50% die in the first month of life and 80% by 1 year of age. We report on the two youngest infants ever operated upon successfully for removal of symptomatic ventricular cardiac rhabdomyoma. The operations were performed through a left ventriculotomy in one and through a right ventriculotomy in the other during the first day of life.

Cardiac Output, Low↗
PubMed1981

[Evaluation by exercise test of effects of a single oral dose of atenolol in patients with stable angina (author's transl)].

Thirty patients with stable angina have been undergone a multistage treadmill test, after a single oral dose of 100 mg of Atenolol, a beta 1 . selective blocking agent, in comparison to a previous test carried out after an identical looking placebo tablet. After placebo all the patients showed ischemic ST segment response (ST depression greater than 1 mm), 25 of them interrupting the test because of anginal pain (20 patients), or of ST depression greater than 3 mm (3 patients), or of ventricular ectopics (one patient), or of fatigue (one patient). After Atenolol 10 patients completed the planned test, 7 of them without ischemic changes of ST. 27 patients (90%) showed increased working capacity with significant reduction of heart-rate (FC), systolic blood pressure (PAS) and their product and of ST depression, either before and during and at the end of exercise. The recovery time of ischemic ECG change has been significantly reduced. The observed increased working capacity is attributed to the reduced myocardial O2 consumption expressed from the reduction of the product FC x PAS. Nevertheless at the end of exercise test after beta-blocking drug this product didn't reach the threshold value at which the test was interrupted in the first test after placebo. The authors discuss the possible cause of this effect of beta-blocking drugs, which could be attributed to a reduction of coronary blood flow and/or to an increased myocardial tension because of increased end diastolic ventricular volume. However the Authors outline that the per cent increases of FC, PAS, and FC x PAS have not been reduced by the Atenolol, unlike their absolute values, at the threshold of angina: the ischemic reveals itself at same levels of per cent increase of the factors of O2 myocardial consumption, the later reaching of threshold values depending on the lower starting values. The advantages of Atenolol as regards the other beta-blocking drugs (better acceptability, stability and duration of action) are outlined too.

Adult↗
PubMedDate not supplied

Diastolic dysfunction in arterial hypertension.

Left ventricular diastolic properties are important markers of pump function and are frequently abnormal when myocardial insults alter tissue structure. Alterations can be limited to the early diastolic phase (early active relaxation) or to late diastolic filling (late ventricular compliance), but more often involve regulation of both phases of diastole. In asymptomatic patients with arterial hypertension, left ventricular relaxation is often prolonged, independently, at least in part, of cardiac loading conditions and left ventricular geometry, but this abnormality is associated with early signs of systolic dysfunction. Uncontrolled hypertension, diabetes, and obesity are most often associated with ischemic heart disease and impaired diastolic function. Reducing blood pressure with antihypertension therapy will reduce myocardial afterload, regress LVH, and improve systolic and diastolic function. In patients with symptoms of CHF with a normal ejection fraction, however, changes in therapy may be indicated. Greater emphasis should be placed on using medications that decrease myocardial load, but also reduce the effects of neurohormonal activation. (c)2001 by Le Jacq Communications, Inc.

Antihypertensive Agents↗
PubMedDate not supplied

Left ventricular mass reduction during salt depletion in arterial hypertension.

Long-term therapy with antihypertensive agents that reduce sympathetic nervous system activity has been demonstrated by echocardiographic measurements to reverse left ventricular hypertrophy. This investigation evaluated the effects of salt depletion obtained by both chlorthalidone (25 mg/day) and severe restriction of salt intake (about 1016 mg Na+/day) on left ventricular mass (LVM) in as short a time as 12 weeks. Before the study, the patients had been off medication and on a balanced diet without salt restriction for at least 2 weeks; they were then randomly allocated to either the diuretic or low-salt regimen for 6 weeks and finally to alternative treatment according to a crossover model. Blood pressure, body weight, myocardial mass, and noninvasive measurements of left ventricular function (LVF) were determined at baseline and at the end of both periods of treatment. Results were evaluated by two-way analysis of variance in randomized blocks. Systolic and diastolic blood pressure and LVM were significantly and similarly reduced by diuretic therapy or salt restriction. A significant correlation was demonstrated between noninvasive measurements of LVM, expressed as cross-sectional area, and systolic blood pressure. No impairment of LVF could be detected over the treatment period.

Adult↗
PubMedDate not supplied

Partial deficiency of adrenal 11-hydroxylase. A possible cause of primary hypertension.

Results of supraphysiological adrenocorticotropic hormone (ACTH) stimulation of biosynthetic pathways of adrenal zona fasciculata indicate that a deficiency of 11-hydroxylase exists in patients with essential hypertension. The deficiency is suggested by the much greater stimulus of synthesis of deoxycorticosterone (DOC) and deoxycortisol in hypertensive subjects than in controls (p less than 0.001). No significant difference in the synthesis of cortisol, corticosterone, progesterone, 17-hydroxyprogesterone (17-OHP), and delta-4-androstenedione (D4) was observed between the two groups. The ratios for synthesis of DOC and corticosterone and for deoxycortisol and cortisol found in hypertensive patients were significantly higher than those found in controls (p less than 0.001); no significant difference was observed in the synthesis of 17-OHP and progesterone. The synthesis of DOC and deoxycortisol was not significantly correlated with either blood pressure or plasma renin activity. Plasma renin activity was significantly lower in hypertensive subjects than in normotensive subjects (p less than 0.0001), while no difference was found in aldosterone secretion between the two groups. The 11-hydroxylase deficiency in the adrenal zona fasciculata may be one of the genetic factors causing hypertension together with environmental factors (particularly salt intake and work-related stress). The investigation performed in our study may be useful for the evaluation of adrenal zona fasciculata enzymatic activities during the study of hypertensive patients.

17-Hydroxycorticosteroids↗