14 research outputs found
Fibrinolytic/hemostatic variables in arterial hypertension: Response to treatment with irbesartan or atenolol
Essential hypertension is often accompanied by abnormalities of the
coagulation/fibrinolytic system, predisposing to a procoagulant state.
The aim of the present study was to compare the effects of atenolol
(beta(1)-blocker agent) and irbesartan (angiotensin II type 1 receptor
antagonist) on plasma levels of hemostatic/fibrinolytic and endothelial
function markers in a cohort of previously untreated hypertensives.
Fifty-four patients were randomly assigned to atenolol 25 to 150 mg (26
patients) or irbesartan 75 to 300 mg (28 patients). The plasma levels of
plasminogen activator inhibitor-1 antigen, thrombomodulin, tissue factor
pathway inhibitor antigen, fibrinogen, and factor XII were determined
before and after 6 months of therapy. Age, gender distribution, body
mass index, lipid profile, and baseline values of the measured markers
were similar in both groups. Baseline values for systolic and diastolic
blood pressure, as well as the reduction after treatment, were not
significantly different between the two groups. Treatment with
irbesartan was associated with a significant decrease in the levels of
all the parameters. Similar findings were observed in the atenolol
group, except for factor XII and tissue factor pathway inhibitor levels,
which were not significantly decreased in this group. The reduction,
however, of fibrinogen, plasminogen activator inhibitor-1, and
thrombomodulin was significantly greater in the irbesartan than in the
atenolol group. In conclusion, the results indicated that, despite an
equally controlled blood pressure, 6-month therapy with irbesartan was
associated with a more favorable modification of hemostatic/fibrinolytic
status than atenolol. (C) 2000 American Journal of Hypertension, Ltd
Resistance to activated protein C and FV Leiden mutation in patients with a history of acute myocardial infarction or primary hypertension
This study was designed to investigate both resistance to activated
protein C (APC-R) and the factor FV Q506 mutation incidence in patients
with a history of acute myocardial infarction (AMI) and patients with
primary hypertension (PH), a highrisk group for arterial thrombosis.
Eighty patients with a history of AMI (group A), 160 patients with a
history of PH (group B), and 124 age-matched controls without arterial
disease (group C) were studied. APC-R was determined using the Coatest
APC Resistance Kit of Chromagenix, Sweden. The prevalence of the FV Q506
mutation was estimated by DNA analysis (Bertina method). The prevalence
of the FV Q506 mutation was 20%, 13.75%, and 8% in groups A, B, and
C, respectively (A v C P = .0466). The prevalence of APC-R was 47.5% in
group A v 13% in group C (P < .0001) and 36.25% in group B v13% in
group C (P < .0001). The response to activated protein C expressed as
mean value +/- SD was 2.05 +/- 0.33 in group A v 2.56 +/- 0.46 in group
C (P < .05) and 2 +/- 0.22 in group B v 2.56 +/- 0.46 in group C (P <
.05). These findings suggest that patients with a history of AMI or PH
have a significantly increased incidence of both APC-R and FV Q506
mutation compared with the control group. These findings support the
hypothesis that these anticoagulant defects may be risk factors for
arterial thrombosis. (C) 2000 American Journal of Hypertension, Ltd
Elevated plasma immunoreactive leptin levels preexist in healthy offspring of patients with essential hypertension
Background Plasma leptin levels and plasma insulin levels have been
found to be elevated in patients with essential hypertension (EH) and
have been suggested to be components of the metabolic syndrome.
Increased heart rate (HR) may predict the development of EH in normal or
borderline-hypertensive individuals. The aim of our study was to test
the hypothesis that elevated plasma leptin and insulin levels as well as
systolic blood pressure (SBP) and diastolic blood pressure (DBP) and
increased resting HR preexist in the healthy offspring of patients with
EH.
Methods and Results Twenty-six (12 male, 14 female) healthy offspring of
hypertensive patients, mean age 16 +/- 2.5 years and body mass index
(BMI) of 21.5 +/- 2.8 kg/m(2) (group A), and 30 (14 mole, 16 female)
healthy offspring of normotensive patients, mean age 17 +/- 2.3 years
and BMI of 21.9 +/- 2.4 kg/m(2) (group B), were studied. (The two groups
were matched for sex, age, and BMI). Mean SEP, DBP, resting HR, plasma
leptin, and plasma insulin levels (radioimmunoassay method) were
determined in the whole study population. Mean SEP, DBP, and resting HR
were significantly higher in group A than in group B (120 +/- 12 vs 112
+/- 9.5 mm Hg, 77 +/- 9 vs 72 +/- 7 mm Hg, 79 +/- 8 vs 75 +/- 5
beats/min, P < .01, P < .05, and P < .05, respectively). Plasma leptin
and insulin levels were significantly higher in group A than in group B
(9 +/- 5.06 vs 5.6 +/- 2.5 ng/ml and 20.11 +/- 11.3 vs 14.8 +/- 5.2 mu
IU/ml, P < .01 and P < .05, respectively).
Conclusions Our findings support the hypothesis that hyperleptinemia,
hyperinsulinemia, and elevated blood pressure and resting HR preexist in
the healthy offspring of patients with EH
Pharmacological and Non-pharmacological Treatment for Decompensated Heart Failure: What Is New?
Purpose of the Review:
Acute heart failure (AHF) is a life-threatening clinical condition that requires prompt medical attention. The aim of the current review is to summarise the results of recent clinical trials conducted in patients with AHF.
Recent Findings:
Several novel compounds have apparently beneficial acute effects on cardiovascular haemodynamics and patients’ symptoms, but their administration has not yet translated into improved survival and has been deleterious in some cases.
Summary:
The management of patients with AHF is challenging and reflects the heterogeneity of patient’s presentation, the complexity and severity of a multi-organ syndrome, and the limited therapeutic options, usually restricted to a combination of diuretics and vasodilators. Ongoing trials of novel treatments may provide evidence of an effect on outcomes