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Biomedical subjects

K Hayduk

Publications and source records attributed to K Hayduk.

At least 19 recordsLinked to original sources
PubMed1999

Efficacy and safety of spirapril in mild-to-moderate hypertension.

Spirapril is a new angiotensin-converting enzyme (ACE) inhibitor. It is a prodrug with a resorption of about 50%. The active metabolite spiraprilat reaches maximal plasma concentration within 2-3 h after oral administration. Spirapril can be administered once daily because of its long duration of action caused by an elimination half-life of about 40 h. It undergoes renal and hepatic elimination. In contrast to other ACE inhibitors it has a narrow dose range; therefore, the recommended dose is 6 mg for most patients without the need for dose titration. Spirapril has no relevant drug interactions. In several studies, spirapril was given to patients with mild-to-moderate essential hypertension at doses of 1-24 mg/day. There was an identical blood pressure lowering effect at doses of 6-24 mg/day; doses of 1-3 mg/day were less effective. Twenty-four-hour blood pressure monitoring showed a trough:peak ratio up to 0.84. In studies comparing the effect of spirapril with enalapril, lisinopril, trandolapril or captopril, spirapril was at least as effective as the other substances. Besides treating uncomplicated mild-to-moderate essential hypertension, spirapril can be used in patients with diseases accompanying hypertension such as heart and renal diseases, diabetes mellitus, and lipid disturbances. Possible advantages of spirapril compared to other ACE inhibitors are the dual mechanism of elimination, the lack of need for dose titration and a low incidence of cough.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1999

Is initial dose titration of amlodipine worthwhile in patients with mild to moderate hypertension?

Amlodipine, a dihydropyrimidine calcium antagonist, is effective in the treatment of patients with mild to moderate hypertension at doses of 5-10 mg daily. The aim of the study reported here was to determine whether an early increase in dosage of amlodipine provided an advantage in terms of antihypertensive effect. This was a single-blind, randomised study in 115 patients with mild to moderate hypertension (diastolic blood pressure 95-114 mmHg) conducted at 10 centres with two parallel groups. Group I received amlodipine 5 mg once daily for the entire 10-week treatment period, while group II received amlodipine 5 mg once daily for two weeks, with the option to increase the dose to 10 mg once daily were the diastolic blood pressure to exceed 90 mmHg. The dose was increased in 40% of group II patients (20/50). Diastolic and systolic blood pressure decreased steadily until the end of the sixth week of treatment in both groups, with no statistically significant difference between the groups. The response rate (diastolic blood pressure < or = 90 mmHg) at the end of treatment was 84% in both groups. Because there is no advantage in an early increase in dosage of amlodipine in terms of antihypertensive effect, a dose increase should not be considered until after six weeks of treatment at 5 mg once daily.

Amlodipine↗
PubMed1994

Single daily administration of spirapril in the treatment of essential hypertension. A multicentre double-blind comparison of 1, 6, 12 and 24 mg of spirapril once daily.

A total of 171 male and female patients with mild-to-moderate hypertension [diastolic blood pressure (DBP) 100-115 mmHg] entered this randomized, double-blind, multicentre study. A 3-week placebo run-in period was followed by a 5-week active-treatment period during which patients received either 1, 6, 12 or 24 mg of spirpril once daily. Predose sitting blood pressure was taken in the morning by sphygmomanometer as well as by an automatic device (Tonoprint). Spirapril in doses of 6, 12 or 24 mg once daily significantly and similarly lowered systolic blood pressure (SBP) and DBP compared with 1 mg once daily. The rates of blood pressure normalization (DBP < or = 90 mmHg) were 12.5%, 37.5%, 30.8% and 28.9% with 1, 6, 12 and 24 mg, respectively. The percentage of patients experiencing a DBP reduction of at least 10 mmHg was 25.0%, 56.3%, 48.7% and 52.6% and 1, 6, 12 and 24 mg of spirapril, respectively. No serious or severe adverse events related or uncertain if related to the study medication were observed. The effective 6-mg dose was as well tolerated as the inefficacious 1-mg dose. In conclusion, in patients with mild-to-moderate essential hypertension, 6 mg of spirapril once daily is an efficacious and safe antihypertensive therapy with a favourable benefit-risk profile.

Adult↗
PubMed1993

How well are the cardiovascular risk profiles modulated by current beta blockers in hypertension?

Epidemiologic studies predict that reduction of the systemic blood pressure by the amount usually achieved in major clinical trials could be expected to reduce cerebrovascular events by 42% and cardiac events by 24%. Although antihypertensive treatment achieves the expected cerebrovascular benefits, the risk of coronary events is reduced by only 14%. The reason for this dichotomy in cardiovascular protection afforded by antihypertensive drugs is unknown. Compared to treatment with other antihypertensive drugs, treatment with beta-adrenoceptor antagonists has not yielded a superior outcome despite the fact that they possess some cardiac pharmacodynamic properties that could be potentially advantageous in the prevention of coronary heart disease. It is an untested argument that conventional beta-adrenoceptor antagonists possess unwanted metabolic effects that may counter some of their potential cardiac benefits. Newer drugs of this group possess ancillary metabolic characteristics which may convey more cardiac protection, but in the absence of results of formal clinical trials this hypothesis remains to be tested.

Adrenergic beta-Antagonists↗
PubMed1993

[Duodenal duplication cyst--a rare cause of acute recurrent pancreatitis].

We report on a 42-year-old male patient who has been treated over a period of five years because of acute relapsing pancreatitis. The diagnoses of viral pancreatitis, pancreatic pseudocyst, and choledochal cyst type III (choledochocele) have been erroneously made. The clinical and laboratory findings over this period are presented, compared with one another, and analyzed. The correct diagnosis of a duodenal duplication cyst filled with multiple calculi and lying within the lumen of the duodenum could not be established until intraoperative findings and histological examinations were completed. The pathogenesis of relapsing acute pancreatitis associated with duodenal duplication cyst filled with multiple calculi is proposed, based on the analysis of these findings and the literature review.

Acute Disease↗
PubMed1992

[Fatal pulmonary embolism after lysis therapy in post-traumatic renal vein thrombosis].

A 30-year-old man was hospitalized because of increasing dyspnoea for 4 weeks. Chest X-ray demonstrated an infiltrate in the right upper lobe and enlargement of the central pulmonary arteries. Lung perfusion scintigraphy revealed, typical of embolism, absent perfusion of the entire right upper lobe, as well as segmental embolism in the left upper and basal lobes. Phlebography of the legs and pelvis was unremarkable. Intravenous heparin treatment was begun (initially 1,250 IU/h, then dosage adjusted according to the partial thromboplastin time). Nonetheless the patient's condition deteriorated the next day and the respiratory failure increased (pO2 61 mm Hg despite oxygen supply). Streptokinase was then infused in ultra-high dosage, 9 million units over 6 hours. But the patient died of cardiocirculatory failure 4 hours after the streptokinase infusion had been finished. Autopsy revealed fulminant recurrent pulmonary embolism with occlusion of the right main pulmonary artery. The emboli had their origin in renal vein thrombosis extending into the inferior vena cava, which had probably been caused by slight trauma to the flank during a game of squash 6 weeks previously.

Adult↗
PubMed1989

[Fine needle puncture cytology in metastatic hepatocellular carcinoma].

Distant metastases occur in 50% of cases of HCC. Bones are involved in 11% with the spine as the most important localization. In the reported case a tumorous mass in the liver, suspicious for HCC according to clinical and cytological criteria, was proved to be malignant by the cytologic examination of a metastasis to the sacrum.

Aged↗
PubMed1987

Efficacy and safety of doxazosin in hypertension therapy.

In double-blind, controlled, parallel, comparative trials, the blood pressure-lowering effect of doxazosin was compared with that of placebo and other active agents. In 1 large, multicenter study, 903 patients were evaluated: 408 patients received doxazosin; 323, active comparative agents (nadolol, metoprolol, prazosin or hydrochlorothiazide); and 172, placebo. In another smaller study doxazosin was compared with terazosin treatment. Doxazosin administered as monotherapy lowered blood pressure significantly when compared with baseline and the placebo-treated group. Doxazosin therapy resulted in substantial reductions from baseline readings for systolic and diastolic blood pressure in both the standing and supine positions; the effect of doxazosin was similar to that of the comparative drugs; however, unlike beta blockers, no significant change in heart rate was demonstrated. The effectiveness and safety of doxazosin are practically identical in young and elderly patients, as well as in blacks and whites. Doxazosin exhibited a favorable lipid profile and the reported side effects of doxazosin were comparable to those observed with placebo and other study drugs. Another multicenter trial reported that doxazosin therapy was effective at low doses; 76% of those responders achieved controlled blood pressure at a mean dosage of 3.3 mg daily.

Adrenergic beta-Antagonists↗
PubMed1987

Antihypertensive effects of doxazosin in systemic hypertension and comparison with terazosin.

A multicenter, double-blind study compared the antihypertensive efficacy and safety of doxazosin and terazosin as once-daily therapy. Doxazosin, a potent antihypertensive agent, selectively inhibits alpha 1 adrenoceptors. Its pharmacokinetic profile, including gradual onset of action, long plasma elimination half-life and long duration of action, permits once-daily dosing. Terazosin, a structural analog of prazosin, also inhibits alpha 1 adrenoceptors and is recommended as once or twice-daily therapy. Nineteen (73%) of 26 patients randomly assigned to receive doxazosin were therapeutic successes; 17 (65%) achieved normalized blood pressure (defined as blood pressure less than or equal to 90 mm Hg). The mean final daily dosage in patients classified as therapeutic successes was 2.4 mg. Eighteen (64%) of 28 terazosin-treated patients were considered therapeutic successes; 16 (57%) achieved normalized blood pressure. The mean final daily dosage in patients classified as therapeutic successes was 5.6 mg. Treatment-related side effects were observed in 30% of doxazosin-treated and 39% of terazosin-treated patients. Most side effects observed in either treatment group were mild or moderate and either disappeared or were tolerated with continued therapy. Doxazosin is an effective, well-tolerated, once-daily antihypertensive agent; it is comparable with terazosin but at a lower daily dosage.

Adrenergic alpha-Antagonists↗
PubMed1982

Captopril in the long-term treatment of essential hypertension: changes in the renin-angiotensin-aldosterone system.

We investigated changes in the renin-angiotensin-aldosterone system in seven patients with essential hypertension during treatment with captopril (SQ 14225) (300 to 450 mg/day) for 12 months. While blood pressure decreased, the plasma-renin concentration increased to 700 percent of the initial value (6.1 +/- 2.5 ng angiotensin l/ml . h) and angiotensin I increased to about 300 percent of the basal value (179 +/- 32 pg/ml). Converting enzyme inhibition resulted in a 30 percent decrease in plasma angiotension II levels from a basal level of 66 +/- 21 pg/ml. Plasma aldosterone decreased 52 percent from 63 +/- 13 pg/ml initially. These changes in hormone levels were maintained throughout the study. There was no significant change in serum sodium and serum potassium concentration.

Aldosterone↗
PubMed1981

[Errors in the treatment of hypertension (author's transl)].

Errors in the treatment of hypertension may occur at any level of the therapeutic concept. They can, however, largely be avoided by considering the following suggestions. A hypertension requiring treatment is usually only detectable by several blood pressure measurements taken on different days. A diagnostic confirmation of the hypertensive disease should precede the onset of the antihypertensive therapy. General measures and dietetic restrictions and indispensable to any hypertensive therapy. Drug therapy can only be successful if it is individual, if side-effects are avoided and if contraindications are taken into consideration. In addition the frequency of taking the drug and the necessary number of tablets to regulate the blood pressure must be kept as low as possible.

Adrenergic beta-Antagonists↗
PubMed1980

Successful acute and long-term treatment of renin-induced hypertension in two infants with captopril.

Captopril, an orally active inhibitor of angiotensin-converting-enzyme, offers a new approach in the treatment of renin-induced hypertension, which is refractory to conventional drugs. A 4 months old infant developed after nephrectomy again hypertension which was probably renin-induced. BP did not respond to high doses of methyl-dopa, clonidine, hydralazine, and furosemide. An acute BP response to captopril was seen at a daily dose of 150 mg. During long-term treatment 75 mg captopril and 12.5 mg hydrochlorothiazide resulted in normalization of BP. In a second child with renin-induced hypertension since the firth month of life, treatment wiht hydralazine, clonidine and hydrochlorothiazide was in part effective, but failure to thrive was progressive. Captopril treatment was started at the age of 20 months. BP was lowered at a daily dose of 75 mg and normalized during long-term therapy with 50 mg. Side effects were not seen.

Captopril↗
PubMed1979

Regulation of aldosterone secretion in dehydrated babies.

The factors controlling aldosterone secretion were measured in 12 patients with moderate to severe dehydration during the first year of life. Secondary hyperaldosteronism was present in all cases (mean plasma aldosterone concentration 414.6 ng/dl), as well as increased plasma cortisol levels (mean 49.7 microgram/dl). Plasma cortisol, an indirect parameter of stimulation of the adrenal cortex by ACTH, showed the highest correlation with plasma aldosterone (r = 0.82). Despite a mean elevation of 168 ng AT/ml/h the plasma renin concentration did not seem to play the dominant role in the regulation of aldosterone secretion in these infants. High serum sodium concentrations have a clearly inhibiting effect on aldosterone secretion as shown by the negative correlation coefficient of r = 0.80.

Aldosterone↗
PubMed1978

[Saralasin-induced changes of blood pressure, renin and aldosterone in essential and renal hypertension (author's transl)].

In 34 patients saralasin was infused after variable degrees of sodium depletion in order to differentiate between essential and renin-induced hypertension. After sodium-depletion of short duration mean arterial pressure dropped more than 10 mm Hg in 9 of 25 patients with essential and in 7 of 9 patients with renin-induced hypertension. After long-lasting sodium depletion the fall of mean arterial pressure exceeded 10 mm Hg in 11 of 16 patients with essential and in 8 of 9 patients with renin-induced hypertension. Thus saralasin did not discriminate essential and renin-induced hypertension. Also, plasma renin concentration before and after saralasin did not allow to differentiate between the two forms of hypertension. The changes of renin during infusion of saralasin was negatively correlated to the change of blood pressure. Renal vein renin ratio in patients with renovascular hypertension was not modified by saralasin. Renin and aldosterone changed inversely during saralasin infusion.

Aldosterone↗