Isradipine Twice Daily Lowers Blood Pressure Over 24 H

The objective of this study was to compare the effects of isradipine and placebo on blood pressure (BP) at the end of the dosing interval (‘trough'). Following a three-week placebo period, 187 patients who had previously shown a response to treatment with isradipine (based on office BP measurements) were randomized to double-blind treatment with 2.5 mg isradipine twice daily or placebo for six weeks. Four of these patients withdrew from the study during the double-blind phase because of adverse events (one taking isradipine and three taking placebo). Blood pressure during the double-blind study was always measured 12 h after drug administration (trough values). The rate of normalization [defined as diastolic BP (DBP) ≤ 90 mm Hg] was 52/96 (54%) in the isradipine-treated group compared with 30/87 (33%) in the placebo group. A further 12/96 (12%) patients taking isradipine showed a fall in DBP of ≥ 10 mm Hg, although their DBP was still not < 90 mm Hg, compared with 5/87 (6%) patients receiving placebo. This difference was statistically significant (P = .003). Thus, isradipine in a dose of 2.5 mg twice daily lowers blood pressure over 24 h. Am J Hypertens 1991;4:131S-134

Isradipine Twice Daily Lowers Blood Pressure Over 24 H

The objective of this study was to compare the effects of isradipine and placebo on blood pressure (BP) at the end of the dosing interval (‘trough'). Following a three-week placebo period, 187 patients who had previously shown a response to treatment with isradipine (based on office BP measurements) were randomized to double-blind treatment with 2.5 mg isradipine twice daily or placebo for six weeks. Four of these patients withdrew from the study during the double-blind phase because of adverse events (one taking isradipine and three taking placebo). Blood pressure during the double-blind study was always measured 12 h after drug administration (trough values). The rate of normalization [defined as diastolic BP (DBP) ≤ 90 mm Hg] was 52/96 (54%) in the isradipine-treated group compared with 30/87 (33%) in the placebo group. A further 12/96 (12%) patients taking isradipine showed a fall in DBP of ≥ 10 mm Hg, although their DBP was still not < 90 mm Hg, compared with 5/87 (6%) patients receiving placebo. This difference was statistically significant (P = .003). Thus, isradipine in a dose of 2.5 mg twice daily lowers blood pressure over 24 h. Am J Hypertens 1991;4:131S-134

In-vitro validation, with histology, of intravascular ultrasound in renal arteries

Objective. To investigate the feasibility of using intravascular ultrasound to characterize normal and diseased renal arteries. Materials and methods. Forty-four renal artery specimens from 21 humans, removed at autopsy, were studied with intravascular ultrasound in vitro. From each vascular specimen, two to four sets of corresponding intravascular ultrasound images and histologic sections were subjected to qualitative analysis. The renal arterial wall was considered normal by intravascular ultrasound when the wall thickness (intima and media) was 0.5 mm or less. On intravascular ultrasound imaging, a distinction was made between bright lesions with or without peripheral shadowing (i.e. calcification). Histological sections were examined and fibromuscular lesions were scored with or without calcifications. Quantitative analysis of a multitude of intravascular ultrasound cross-sections (interval 5 mm) included assessment of the lumen area, vessel area, plaque area and percentage area obstructed. The target site (smallest lumen area) was compared with a reference site (largest lumen area before the first major side branch). Results. Of the 130 corresponding intravascular ultrasound images and histologic sections analysed, 55 were normal and 75 presented a bright lesion on ultrasound; in 31 lesions, peripheral shadowing was involved. The sensitivity of the intravascular ultrasound in detecting calcifications was 87%, and the specificity was 89%. Lumen area reduction at the target site was associated with vessel and plaque area enlargement in eight specimens, with plaque area enlargement in 12 specimens and with a vessel area reduction in 21 specimens

Inter-observer variability in the angiographic assessment of renal artery stenosis: DRASTIC study group. Dutch Renal Artery Stenosis Intervention Coorperative

Objective. To assess inter-observer agreement in the interpretation of renal angiograms. Design. Comparison of the assessment of renal angiograms by three experienced radiologists, who evaluated the number of renal arteries and the presence, location, aspect and severity of a renal artery stenosis. Setting. General hospital and university hospital serving urban and rural populations. Patients. Patients with difficult-to-treat hypertension referred for diagnostic work-up; 312 angiograms with the intra-arterial digital subtraction technique were obtained from 289 consecutive patients. Main outcome measures. Inter-observer agreement was tested for the following parameters: number of arteries per kidney, presence of stenosis, location of stenosis (truncal, ostial), aspect of stenosis (concentric, eccentric, post-stenotic dilatation), severity of stenosis (reduction of lumen diameter in categories of 30%, 40%, etc. to 100%), and overall quality of the angiographic images. Kappa (κ) values and weighted κ between the three pairs of radiologists were used as estimates of inter-observer agreement. Results. Agreement about the number of renal arteries was reasonable (κ = 0.50-0.72), as was agreement about the presence of stenosis (κ = 0.68-0.86). Agreement about stenosis location and aspect was poor (κ = 0.26-0.47 and κ = 0.15-0.26, respectively). There was general agreement about the severity of stenosis (weighted κ = 0.65-0.70), but it was not possible to distinguish between 50 and 60% stenosis or between 60 and 70% stenosis (κ < 0.40). No correlation was found between agreement on severity of stenosis and the quality of the images. Conclusions. It is not realistic to make statements about what degree of renal artery stenosis is clinically significant, as long as the intra-arterial angiogram with digital subtraction remains the gold standard. It is likewise risky to rely too strongly on stenosis morphology as visualized by renal angiography in choosing between balloon angioplasty and stent deployment