Effect of Short-Term Antihypertensive Therapy on Left Ventricular Wall Tension A Double-Blind Comparison of Isradipine and Nifedipine
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The comparative efficacy of the calcium antagonists isradipine and nifedipine in reducing left ventricular peak systolic wall tension was assessed in 25 patients with essential hypertension (20 men, 5 women; mean age: 49 years). After 2 weeks of treatment with either isradipine (2.5 mg twice daily) or slow-release nifedipine (20 mg twice daily), blood pressure was similarly reduced in both groups of patients whereas the thickness of the interventricular septum and left ventricular free wall did not change. Echocardiographic end-diastolic volume of the left ventricle showed no change whereas end-systolic volume significantly decreased with isradipine, but not with nifedipine retard. This led to a significant reduction in peak systolic wall tension in the isradipine group, but not in the nifedipine group. In conclusion, antihypertensive treatment with isradipine produces a reduction in peak systolic wall tension which is not seen with nifedipine, probably because of its negative inotropic effect. Am J Hypertens 1993;6:92S-94SKeywords:
Isradipine
Interventricular septum
As the magnitude of drug response may depend on its input rate, we investigated the rate of administration-effect relationship of the new dihydropyridine isradipine. Ten healthy volunteers received (double-blind and cross-over) isradipine 1 mg i.v. (5 min), 5 mg solution, 5 mg tablet, 10 mg sustained release, and placebo. Blood pressure and heart rate were recorded for 24 h. A single dose of slow-release formulation isradipine does not induce significant hemodynamic effects in healthy subjects. The maximal BP fall was comparable with either i.v., solution, and conventional tablet administration. This is due to a stronger heart rate counter-regulation, linked to rapid isradipine administration. These results imply that slow input rates of isradipine are more effective in lowering blood pressure.
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Calcium antagonists, particularly those derived from the dihydropyridine class, have shown remarkable efficacy in the treatment of hypertension and other cardiovascular disorders. This review will concentrate on the use of one of the newer compounds in this category, isradipine, in the treatment of arterial hypertension. Isradipine is a calcium antagonist with marked vascular selectivity and, in practical terms, is devoid of cardiac effects. Its usefulness in hypertension is well documented, both when used as single drug treatment and in combination with other agents, particularly beta-blockers. Isradipine is well tolerated, does not cause metabolic disturbances and, apart from the typical dihydropyridine-type vascular adverse effects, e.g. flushing and ankle oedema, it does not cause any specific side effect. Some results obtained with isradipine in animal studies, e.g. the antiatherosclerotic effect and the brain tissue preserving effect seen in experimental stroke, appear to hold great promise for future important clinical applications for isradipine.
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The objective of the study was to assess the effects of the calcium antagonist isradipine on plasma lipids, lipoproteins, and apolipoproteins in patients with essential hypertension. After a four-week placebo wash-out period, 73 patients (41 men, 32 women) were studied in a double-blind, randomized, crossover study comparing sustained-release isradipine (isradipine SR) with the standard isradipine formulation. Nineteen patients received 5 mg/day and 54 patients 10 mg/day. Lipids were evaluated at the end of the placebo period and after 12 weeks of treatment with isradipine. In both treatment groups, lipid and lipoproteins were not modified. However, apolipoprotein A-I levels increased significantly (P < .001) and the ratio of apolipoprotein B to apolipoprotein A-I concentration decreased significantly (P < .01) irrespective of gender. These data show that the levels of plasma apolipoprotein A-I, a strong predictor of coronary heart disease, are favorably affected by isradipine of either formulation. The mechanisms of this effect remain to be elucidated. Am J Hypertens 1991;4:181S–184S
Isradipine
Crossover study
Lipid Profile
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Calcium channel blocker
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Interventricular septum
Parasternal line
Doppler imaging
Endocardium
Systole
Basal (medicine)
Cardiac cycle
Isovolumetric contraction
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Abstract Background and Aims Pathology of the cardiovascular system is the leading cause of death in patients with CKD, while determining the causes of the formation of cardiac events is often difficult. Method We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle. Results We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle. Conclusion The mechanisms of damage to the heart and blood vessels in patients with CKD begin to function already in the initial stage of renal failure and increase as it progresses. The need to know the data of clinical, laboratory and instrumental examination methods at the terminal stage of CKD is dictated, first of all, by the possibility of exposure to them. An important stimulus for conducting an echocardiographic examination is the early detection and correction of cardiovascular disorders, in connection with the prospect of increasing the survival of patients after kidney transplantation.
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MIS is a one-year Multicentre Isradipine Study of the treatment of essential hypertension, in which participated seven centres in Czechoslovakia. The study comprised 144 patients with mild or medium severe hypertension. Isradipine belongs into the group of dihydropyridine derivatives with a high specific and low non-specific affinity to dihydropyridine binding sites of the L-type of calcium channels. After a four-week placebo period isradipine treatment (2.5 mg (1/2 tablet twice a day/was started. This dose increased to 5 mg (1 tablet twice a day) unless normalization of the diastolic pressure was achieved by a smaller dose. Monotherapy with isradipine normalized the diastolic pressure (less than 90 mmHg) in 44% of the hypertonic patients. 56% hypertonics where monotherapy with isradipine did not reduce the diastolic pressure below 90 mmHg were treated by a combination of isradipine and bopindolol. This group of patients had a significantly higher systolic and diastolic pressure, a higher number of erythrocytes and thrombocytes at the onset of the investigation. Addition of bopindolol to isradipine proved very effective. At the end of the one-year study 87% of the patients had a normal diastolic pressure. Isradipine as monotherapy and combined with bopindolol did not influence the metabolic risk factors of IHD and drug tolerance was very good.
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Aim:The aim of this study was to establish M-mode echocardiographic reference values in Pantja goats and to study the effect of gender and body weight (BW) on these parameters. Materials and Methods:A total of 18, clinically healthy, adult Pantja goats of either sex, aged 2-4 years and weighing 10-44 kg were included in the study.Echocardiographic examination was performed in the standing unsedated animal.All measurements were made from the right parasternal long-axis left ventricular outflow tract view of the heart.The following parameters were recorded: Left ventricular internal diameter at diastole and systole, interventricular septal thickness at diastole and systole, left ventricular posterior wall (LVPW) thickness at diastole and systole, end diastolic and systolic volumes, stroke volume, fractional shortening, ejection fraction, percent systolic thickening of interventricular septum, percent systolic thickening of LVPW, cardiac output, left atrial (LA) diameter at diastole and systole, aortic (AO) root diameter at diastole and systole, LA/AO, LA posterior wall thickness at diastole and systole, left ventricular ejection time, DE amplitude, EF slope, AC interval and e-point to septal separation.Results: This study demonstrated specific reference ranges of M-mode echocardiographic parameters and indices in healthy Pantja goats.Normal echocardiographic values obtained in Pantja goats were quite different from other goat breeds.Gender had no influence on echocardiographic parameters, while high correlations were found between most echocardiographic parameters and BW. Conclusion:The echocardiographic values obtained in the study may serve as a reference for future studies in this breed, for cardiovascular disease diagnosis and for utilizing the goat as a model for cardiac disorders in humans.
Interventricular septum
Systole
End-systolic volume
Parasternal line
Cardiac cycle
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