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N R Robles

Publications and source records attributed to N R Robles.

At least 19 recordsLinked to original sources
PubMed2006

Untoward effects of chronic dual renin-angiotensin system blockade: influence of previous chronic renal failure.

Dual blockade of the renin-angiotensin system (RAS) has increased antiproteinuric effects and so a higher incidence of secondary effects can be expected when this kind of treatment is administered. The aim of this study was to assess the safety of dual blockade of RAS. Seventy-five (54 men and 21 women) patients has been treated in our unit with dual RAS blockade due to proteinuria higher than 1 g/24 h. Mean age was 57.1 +/- 14.0 years. Fifty-three patients had chronic renal failure (CRF) at baseline. Analytical data of 6 months visit and last follow-up visit were recorded. A small reduction of systolic blood pressure and diastolic blood pressure was observed in both treatment groups throughout the study. Neither the CRF patients nor those with normal renal function showed any reduction in mean plasma haemoglobin levels, but differences between groups were significant at the second and third visits (anova). No change was detected in haematocrit. Mean K+ significantly increase at the second visit in the CRF group (from 4.80 +/- 0.64 to 5.23 +/- 0.81 mmol/l, p < 0.001, Student's t-test). There were no changes in normal kidney function group (4.58 +/- 0.37 vs. 4.63 +/- 0.44). At baseline plasmatic creatinine was higher in the CRF group (2.09 +/- 0.60 0.20 mg/dl vs. 0.99 +/- 0.20 mg/dl, p < 0.001, Student's t-test) and creatinine clearance was lower (48.6 +/- 20.7 ml/min vs. 107.0 +/- 0.30 ml/min, p < 0.001, Student's t-test). There was a small increase in creatinine along the follow-up when compared with the normal renal function group (p < 0.001, anova). Conversely, creatinine clearance remain unchanged in the normal renal function group, and there was a decrease in creatinine in CRF patients (p < 0.001). Dual RAS blockade seems to be safe in renal patients even when mild to moderate renal failure is present. Severe hyperkalaemia is uncommon. Small increments in plasmatic creatinine can be seen but they are hardly dangerous. Combined treatment does not significantly influence erythropoiesis.

Analysis of Variance↗
PubMed2005

Hyperhomocysteinemia in patients with mild chronic renal failure.

BACKGROUND: The aim of this study was to evaluate the prevalence of high plasma levels of homocysteine in patients with mild renal failure. METHODS: Forty-six chronic renal failure patients (25 males and 21 females, mean age 55.6+/-14.4 years) were recruited for the study. Mean plasma creatinine was 2.1+/-1.0 mg/dl and mean creatinine clearance was 50.6+/-26.3 ml/min. Patients with severe renal failure were excluded. Patients were compared with a control group with normal renal function (n=35, 22 men and 13 women, mean age 50.0+/-11.5 years). Plasma homocysteine values were measured in both groups at baseline and after an oral overload of methionine. RESULTS: Baseline homocysteine levels of patients were higher than those of controls (16.5+/-7.3 vs. 10.4+/-4.2 micromol/l, p<0.0001). Some 34 patients and 4 controls had increased plasma homocysteine levels at baseline. After the oral overload, 4 more patients had abnormally increased homocysteine levels, meaning that 83% of the patients with chronic renal failure had hyperhomocysteinemia. CONCLUSIONS: Hyperhomocysteinemia is a very common finding among patients with mild renal failure. The need for vitamin supplementation should be evaluated in the first stage of chronic renal failure.

Journal Article↗
PubMed2005

Effectiveness and safety of eprosartan on pulse pressure for the treatment of hypertensive patients.

A multicentre, prospective, non-comparative open-label study was conducted to assess the effect of eprosartan, 600 mg/day, on pulse pressure (PP) in patients with hypertension (stage I or II, Joint National Committee, sixth report) treated in the primary care setting, as well as safety and compliance. The duration of treatment was 16 weeks. Eprosartan decreased PP (-13 mmHg), systolic blood pressure (SBP) (-26 mmHg), diastolic blood pressure (DBP) (-13 mmHg) and mean arterial pressure (MAP) (-17.4 mmHg) significantly (p < 0.0001). The PP/MAP ratio changed significantly from 62 to 59%, so that the reduction of PP was 3% higher than the overall decrease in MAP. Twenty adverse events, mostly gastrointestinal complaints, were recorded in 12 patients (1.9%). Compliance with treatment at the end of the study was 94%. Eprosartan was a well-tolerated and an effective drug in reducing PP, SBP and DBP below the recommended levels in patients with mild-to-moderate essential hypertension, allowing a high therapeutic compliance.

Acrylates↗
PubMed2005

Lercanidipine in patients with chronic renal failure: the ZAFRA study.

OBJECTIVE: The objective was primary to evaluate the safe use of a new calcium channel blocker, lercanidipine, in patients with chronic renal failure (CRF). The secondary objective was to study the protective effect of calcium channel blocker on renal function in CRF patients previously treated with ACE inhibitors or angiotensin receptor blockers. DESIGN AND METHODS: The study recruited 203 CRF patients (creatinine >1.4 mg/dL for males, creatinine > 1.2 mg/dL for females, or creatinine clearance <70 mL/min). All patients were receiving ACE inhibitors (63.4%) or angiotensin II antagonist (36.6%) therapy, but they had higher blood pressure than recommended for CRF (130/85 mmHg). No patients were under diuretic treatment. Patients were clinically evaluated 1, 3, and 6 months after starting treatment with lercanidipine. Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to the treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection. RESULTS: 175 patients rendered valuable for the study (age 63.9+/-11.9 years, 52.9% males and 47.1% females). Blood pressure (BP) significantly decreased from 162+/-17/93+/-8.3 mmHg to 132+/-12/78+/-6 mmHg. 89.2% of patients showed a significant BP reduction, and 58.1% achieved optimal BP control (<130/85 mmHg). Seven patients (3.4%) showed untoward effects. Not one case of edema was detected, and the prevalence of adverse effects related to vasodilatation was extremely low (three patients, 1.48%). Plasmatic creatinine did not change (1.9+/-0.5 baseline versus 1.9+/-0.6 mg/dL), but creatinine clearance increased at the end visit (41.8+/-16.0 baseline versus 45.8+/-18.0 mL/min, p=0.019). Plasmatic cholesterol also decreased from 221+/-46 to 211+/-35 mg/dL (p=0.001). CONCLUSIONS: Lercanidipine showed a high antihypertensive effect in CRF patients. It has a good tolerability profile and showed an interesting effect on plasmatic lipids. An improvement in renal function, measured through creatine clearance, was detected.

Aged↗
PubMed2005

[Doxazosine associated to renin-angiotensin blockers and calcioantagonists in chronic renal failure patients].

OBJECTIVE: To evaluate the safety and effectiveness of the alfa-blocker doxazosin GITS in CRF patients. DESIGN AND METHODS: The study recruited 203 CRF patients (creatinine > 1,4 mg/dl for males, creatinine > 1,2 mg/dl for females, or creatinine clearance < 80 ml/min). All patients were receiving ACE inhibitores (63.4%) or angiotensin II antagonist (36.6%) therapy but they had higher blood pressure than recommended for CRF (130/85 mmHg). Patients were clinically evaluated 1, 3 and 6 moths after starting treatment with lercanidipine (10 mg once daily). Patients with high blood pressure in spite of combined therapy with two drugs added doxazosin GITS 4-8 mg once daily to treatment. RESULT: 57 patients rendered evaluable for the study (age 64.8 +/- 12.7 years, 47.4% males and 52.6 females). BP significantly decrease from 164 +/- 17/92 +/- 9 mmHg to 135 +/- 13/78 +/- 8 mmHg. 67.6% patients showed a significant BP reduction and 32.4% gets optimal BP control (< 130/85 mmHg). Two patients (3.6%) showed untoward effects. No biochemical changes were detected. CONCLUSIONS: Doxazosin showed a good antihypertensive effect in CRF patients when used as third drug in resistant severe hypertension. It has a good tolerability profile and showed a neutral profile on biochemical parameters.

Antihypertensive Agents↗
PubMed2004

[Anti-hypertensive effect of eprosartan in diabetic patients].

OBJECTIVE: Diabetes mellitus seems to induce an special difficulty to control the high blood pressure. This effect is more severe on the SBP. Previous reports suggest that a new angiotensin receptor blocker, eprosartan, might have a higher efficacy to reduce SBP. It has been evaluated the BP decrease obtained with eprosartan in a group of diabetics patients compared to non diabetic patients. MATERIAL AND METHODS: 81 patients were recruited of whom 65 have ended follow-up. 34 patients were diabetics (mean age 66.7+/-10.7 years, 15 men and 19 women) and 31 were non diabetics control patients (mean age 61.8+/-12,8 years, 13 men and 18 women). All patients were treated with (600 mg) once daily. The doses was ingested in the morning. They were made three follow up visits (1, 3 and 6 mo after the first visit). RESULTS: SBP was significantly decreased both in diabetics (baseline 170.9+/-12.0, final 139.1+/-13.0 mmHg, p < 0.001) and in non diabetics group (baseline 169.9+/-18.0, final 142.0+/-13.3 mmHg, p < 0.001). DBP was also reduced in both groups (diabetics: baseline 92.9+/-9.7, final 78.4+/-8.5 mmHg, p < 0.001; non diabetics: baseline 95.6+/-7.9, final 79.1+/-7.4 mmHg, p < 0.001). Differences between the groups were not significant in any visit. Final BP reduction reached was -31.7/-14.6 mmHg in diabetics vs -27,6/-16,5 mmHg in non diabetics patients (difference is not significant) Pulse pressure changes were not different between the two groups (diabetics, 17.8+/-14.5, vs non diabetics, 11.1+/-13.2 mmHg). Two diabetic patients need a second drug to achieve BP goal and no one in non diabetic group. No adverse effects were reported. CONCLUSIONS: Eprosartan seems to be an effective drug to reduce SBP, DBP and pulse pressure with the same effectiveness in diabetics and non diabetic patients.

Acrylates↗
PubMed2004

[Lercanidipine in diabetic patients with renal failure].

OBJECTIVE: To evaluate the safe use of a new calcium channel blocker, lercanidipine, in diabetic chronic renal failure (CRF) patients. DESIGN AND METHODS: The study recruited 42 diabetic CRF patients (creatinine > 1.4 mg/dl for males, creatinine > 1.2 mg/dl for females, or creatinine clearance < 70 ml/min). Mean age was 68.2 +/- 9.1 years. 53.8% were males and 46.2% females. Three patients were type 1 diabetics and 39 ones were type II. All patients were receiving ACE inhibitors (67.4%) or angiotensin II antagonist (32.6%) therapy but they had higher blood pressure than recommended for CRF patients (130/85 mmHg). No patients were under diuretic treatment. Patients were clinically evaluated 1, 3 and 6 months after starting treatment with lercanidipine. Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection. RESULTS: BP significantly decrease from 163 +/- 18/90 +/- 8 mmHg to 134 +/- 12/77 +/- 9 mmHg. One half of patients showed significant reduction of blood pressure, 26.7% reached the target blood pressure (< 130/85 mmHg) and 20.0% gets optimal BP control (< 130/85 mmHg). No one patient showed untoward effects. No edema was detected nor adverse effects related to vasodilatation were found. Plasmatic creatinine did not change (1.9 +/- 0.5 baseline vs 1.8 +/- 0.5 mg/dl) and creatinine clearance increased at the end visit (40.1 +/- 14.5 baseline vs 45.4 +/- 18.2 ml/min) but the difference was not significant. Proteinuria was unchanged. CONCLUSIONS: Lercanidipine showed a good antihypertensive effect in diabetics CRF patients. It has a good tolerability profile and showed neutral effect on plasmatic lipids. Neither impairment of renal function nor increment in proteinuria were detected.

Aged↗
PubMed2003

[Evaluation of lercanidipine in the general practice setting].

OBJECTIVE: To determine the efficacy and tolerability of a long-acting dihydropyridine in the clinical settings of general practice. MATERIAL AND METHODS: 110 essential hypertensives were included (age 62.3 +/- 10.8 years, 51 men and 53 women, 38/ obese -IMC >30 kg/m2, ten diabetics). 104 patients ended the followup. Patients were treated with lercanidipine 10 mg once daily in the morning. Follow-up lasted 6 months. When blood pressure was not controlled (BP < 140/90 mmHg) in any visit, a second drug was added, excluding calcium channel blockers. Antiadrenergic drugs were recommended. If patients were not controlled ittwo consecutive visits they were excluded from follow-up. RESULTS: Significant reductions in both systolic (baseline 157.4 +/- 11.7 vs 131.1 +/- 6.8 mmHg, p < 0,001) and diastolic BP (baseline 94.7 +/- 5.8 vs 80.0 +/- 5.5 mmHg, p < 0,001) were attained at six months. Mean SBP decrease was 26.7 mmHg and mean DBP reduction was 15.6 mmHg. At the study end, 84.3/ of the patients achieved a BP < 140/90 mmHg. Thirty patients needed a second drug to become controlled (26 at the study end). The overall incidence of adverse effects was 4,4/ (n=6) and just three patients withdrew the treatment due to untoward effects. Plasmatic cholesterol lowered from 225.3 +/- 41.0 to 216.7 +/- 25.3 mg/dl (p = 0,03) and urate decreased from 5.6 +/- 1.6 to 5.1 +/- 1.4 mgldl, p = 0,03). CONCLUSIONS: Lercanidipine is a calcium channel blockers of high efficacy and low incidence of adverse effects in the clinical settings of general practice. It seems to have a positive metabolic effects on plasmatic levels of cholesterol and urate.

Aged↗
PubMed2002

[Comparison of the antihypertensive activity of fosinopril and irbesartan].

OBJECTIVE: To compare the antihypertensive effect of two daily single dose drugs acting on the renin-angiotensin axis by two different ways. METHODS: Thirty patients were randomized to receive either irbesartan (150 mg once daily) (n = 15, mean age 65.2 +/- 8.7 years, 9 men and 6 women) or fosinopril (20 mg once daily) (n = 15, mean age 57.4 +/- 11.5 years, 4 men and 11 women, difference are not significant) during 12 weeks. When needed, hydroclorothiazide (12.5 mg) was added to treatment to improve hypotensive response. RESULTS: A reduction of SBP and DBP was observed in both treatment groups throughout the study. In order to obtain further BP reduction, hydrochlorothiazide was added to 6 patients with inadequate BP response at the 4th week (3 patients in the irbesartan group) and 8th week (2 patients in irbesartan group and 1 patient in fosinopril group). SBP was reduced in irbesartan group from 157.7 +/- 11.2 to 131.0 +/- 8.7 mmHg (12th week, p < 0.001). DBP decreases from 94.1 +/- 5.6 to 82.7 +/- 4.2 mmHg (p < 0.001). In fosinopril group SBP was reduced from 147.9 +/- 11.7 to 132.2 +/- 12.4 mmHg (p < 0.001) and DBP decreases from 92.3 +/- 6.3 to 84.0 +/- 5.4 mmHg (p < 0.001). Final between group differences in BP are not significant. Final BP reduction in irbesartan group (26.7 +/- 11.6 mmHg) was bigger than that obtained in fosinopril group (15.6 +/- 11.6 mmHg, p = 0.011). BP reduction was significant in fosinopril group from the first month (SBP 140.7 +/- 12.2, p = 0.021; DBP 87.2 +/- 6.2, p = 0.003). In irbesartan group BP reduction was not significant until the second month (SBP 135.5 +/- 10.4, p < 0.001; DBP 85.3 +/- 4.3, p < 0.001). CONCLUSIONS: Fosinopril and irbesartan seems to be equally effective to reduce DBP. Irbesartan might have higher effectiveness on systolic blood pressure. Irbesartan act more gradually than fosinopril and this may be useful to prevent from acute blood pressure falls.

Aged↗
PubMed2001

[IgA nephropathy].

Explore the source record for details and available documents.

Glomerulonephritis, IGA↗
PubMed2001

Acute effect of hemodialysis with polyacrylonitrile membrane on nerve conduction velocities.

AIM: Non cellulosic membranes, as polyacrylonitrile (AN69) improves middle-molecules purification through hemodialysis, and this increased clearance of middle-molecules may have benefical effects on uremic polyneuropathy. We have tried to evaluate this effect comparing nerve conduction velocities before and after hemodialysis with either AN69 or cellulose acetate (CA). PATIENTS AND METHODS: Eight patients in hemodialysis with AN69 for more than three months (4 men and 4 women, mean age 58.4 +/- 12.9 years, mean time in hemodialysis 9.3 +/- 7.5 months). Motor conduction velocities (MCV) and sensory conduction velocities (SCV) were measured predialysis and postdialysis with AN69 and, one week later, predialysis and postdialysis with CA. RESULTS: There were no differences neither in Kt/V values (AN69 1.27 +/- 0.36 vs CA 1.16 +/- 0.26) nor in TAC ones (AN69 40.8 +/- 17.4 vs CA 40.8 +/- 21.3 mg/dL). After hemodialysis with AN69 MCV significantly increased (42.0 +/- 3.0 vs 40.6 +/- 2.6 m/s baseline, p < 0.05). SCV was also enhanced (45.3 +/- 2.2 vs 41.1 +/- 3.4 m/s baseline, p < 0.05). After hemodialysis with CA neither MCV changed (42.7 +/- 1.6 vs 42.0 +/- 2.3 m/s baseline), nor did SCV (45.8 +/- 5.8 vs 44.8 +/- 3.0 m/s baseline). CONCLUSIONS: Hemodialysis with AN69 acutely improved SCV and MCV. This effect was not seen with CA hemodialysis.

Acrylic Resins↗
PubMed2001

Acute effect of hemodialysis on sympathetic skin response.

Sympathetic skin response (SSR) is a useful and simple test for unmyelinated axon function in peripheral sensorimotor neuropathies. SSR was tested on a group of patients undergoing chronic regular hemodialysis before and after a single dialysis session. Nineteen patients in hemodialysis for more than three months were included. Nine patients were on dialysis with cellulosic membranes (CA, 3 male and 6 female, aged 57.7 +/- 16.4 years) and ten ones were on dialysis with non-cellulosic membranes (NC, 4 male and 6 female, aged 50.2 +/- 15.9 years) were studied. There were no differences neither in Kt/V values (NC 1.37 +/- 0.34 vs. CA 1.22 +/- 0.27) nor in TAC ones (NC 41.5 +/- 18.2 vs. CA 41.3 +/- 14.1 mg/dL). After hemodialysis with NC amplitude significantly increased (994 +/- 1015 vs. 382 +/- 465 microv baseline, p < 0.05). Latency did not change (1.76 +/- 0.83 vs. 2.07 +/- 0.50 s baseline). After hemodialysis with CA neither amplitude changed (1368 +/- 1074 vs. 1240 +/- 1594 microv baseline), nor did latency (1.79 +/- 0.35 vs. 1.94 +/- 0.59 s baseline). Hemodialysis with non-cellulosic membranes (but not with cellulose acetate) yields a short-term improvement of sympathetic skin response. This effect is similar to those seen in nerve conduction velocities and it may be related to increased middle-molecules depuration.

Adult↗
PubMed2001

[Ambulatory blood pressure monitoring in young patients].

OBJECTIVE: To defining the criteria for performing ambulatory blood pressure monitoring (ABPM) in young patients. METHOD: It is reported the experience with ABPM on 52 consecutive patients (younger than 30 years old) consulting for hypertension (mean age 23.4 +/- 4.9 years). The ambulatory BP was measured noninvasively for twenty-seven hours by the Spacelabs 90207 device programmed to measure BP every fifteen minutes during daytime and every 20 minutes during nighttime. The definition of daytime and nighttime was made on the basis of wakefulness and sleep or bed rest periods, obtained from a diary kept by the subject, normal nocturnal BP drop was defined as a decrease higher of 10% versus daytime values. It was defined normal BP an 24 hours ambulatory BP < 130/80 mmHg. RESULTS: Thirty seven patients (71%) were normotensives. There were not differences between normotensive and hypertensive patients neither by age (normotensive 23.9 +/- 12.5, hypertensive 23.3 +/- 4.0 years), nor by sex (normotensive, 21 men and 16 women; hypertensive, 10 men and 3 women). Mean 24 h BP of normotensive patients was 119/72 mmHg (p < 0.001 vs. hypertensive, 135/89 mmHg). There were not differences in nocturnal BP drop. White-coat reaction was more intense in normotensive patients (1.17 +/- 0.12, vs. hypertensive 1.04 +/- 0.08, p < 0.001). Four hypertensives showed white-coat reaction (1.11 +/- 0.05). CONCLUSION: ABPM is a helpful diagnostic tool in young patients. It should be routinely performed as first exploration in all patients younger than 30 years consulting for hypertension.

Adolescent↗
PubMed2000

[Blood pressure variability and cardiovascular morbimortality].

Blood pressure is a changing parameter that is influenced by intrinsic body rhythms, physical and emotional environmental factors that act on the individual, and the differences produced by activity and rest periods of every subject. Blood pressure variability seems to be related with target organ damage due to high blood pressure. Its specific effect on left ventricular mass is likely, although it is not absolutely confirmed. Testing blood pressure variability should be a routine exploration in patients with a target organ lesion.

Blood Pressure↗