MIS (Multicentric Isradipine Study of antihypertensive therapy).
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One-year open Multicentric Isradipine Study (MIS) performed in 7 centres in Czechoslovakia included 144 patients with mild and moderate hypertension. Isradipine was given at a dose of 2.5 mg daily. If normalization of diastolic blood pressure (BP) had not been reached, the dosage was increased to 5 mg. Monotherapy with isradipine normalized diastolic BP in 44% of patients. Isradipine (5 mg daily) was combined with bopindolol in patients in whom isradipine alone failed to normalize diastolic BP. These had higher mean systolic and diastolic BP, body weight, erythrocyte and platelet counts at the beginning of the study. The combination of isradipine with bopindolol normalized diastolic BP in 87% of the group at the end of 48 weeks' treatment. Tolerance was excellent in 82% of patients. Treatment was discontinued in 8% patients, undesirable effects being the reason in 2%, ineffective therapy in 2% and poor adherence to therapy in 4%. Isradipine in monotherapy or in combination with bopindolol did not exert an adverse effect on the metabolic risk factors of ischaemic heart disease (cholesterol, glycaemia).Keywords:
Isradipine
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Dilated Cardiomyopathy
Doppler imaging
Diastolic heart failure
Brain natriuretic peptide
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The hypotensive effect of isradipine was assessed in 26 male patients, aged 40 to 64 years, with hypertension. After withdrawal of previous antihypertensive treatment and a four-week placebo period, patients were randomized into a double-blind active-treatment period of eight weeks to receive either placebo or 1.25 to 2.5 mg isradipine twice daily. Twenty-four-hour ambulatory blood pressure was measured by Accutracker (Suntech, Oxford, England) after the placebo period and at the end of the active-treatment period. In the isradipine group n = 13), both systolic and diastolic blood pressure and number of blood pressure spikes decreased significantly (P < .0001), whereas there was a significant increase of these variables in the placebo control group (n = 13). The results of this study indicate that, in these subjects, blood pressure control was achieved throughout the 24-h period by monotherapy with isradipine. Am J Hypertens 1991;4:161S–162S
Isradipine
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Isradipine
Tolerability
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Purpose: We aimed to investigate if baseline NTproBNP and clinical variables, predict incident atrial fibrillation (AF) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). Methods: From a prospective registry, we assessed 984 PPCI patients. In univariate and multivariate regression analysis, we investigated the association of NTproBNP level determined just prior to PPCI, peri-procedural systolic and diastolic blood pressure, infarct size (maximum CK), gender and age, with the incidence of AF. A Kaplan-Meier curve with quartiles of NTproBNP was computed with a log-rank test to assess for significance of differences. Results: NTproBNP was higher (1297 pg/ml versus 570 pg/ml) in patients with versus without incident AF. In univariate analysis, NTproBNP was significantly associated with incident AF (OR 1,11, 95% CI 1,03-1,21, P=0,009). In multivariate analysis, age was the strongest predictor of incident AF (highest quartiles versus lowest quartile OR 7,04, 95% CI 2,77 -17,87, P<0,001). NTproBNP (OR 1,09, 95% CI 1,00 -1,20, P=0,049), systolic blood pressure (OR 0,98, 95% CI 0,97 -1,00, P=0,021) and infarct size (OR 1,18, 95% CI 1,04 -1,33, P=0,01) were also independently associated with incident AF. Gender, target lesion vessel and diastolic blood pressure were not associated with incident AF. Kaplan-Meier curves (Figure 1) depict that higher NTproBNP quartile is significantly (P=0,001) associated with incident AF. Figure 1. Kaplan-Meier curves Conclusion: Age is strongly predictive for incident AF in STEMI patients undergoing PPCI. NTproBNP and infarct size are also independent predictors of incident AF, whereas peri-procedural systolic blood pressure is inversely related to incident AF.
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Left ventricular remodeling (LVR), an increase in left ventricular end-diastolic volume index > or = 20%, is an adverse consequence of myocardial infarction. The aim of this study was to assess the association between LVR and adiponectin, which has been shown to protect against myocardial ischemia-reperfusion injury.In 75 patients echocardiographic examination was performed one year after ST-segment elevation myocardial infarction, successfully treated with primary percutaneous coronary intervention (pPCI). Two groups of patients were analyzed: those with LVR (n = 15) and those without LVR (n = 60).The predictors of LVR were: anterior myocardial infarction, glucose at admission, baseline C-reactive protein, adiponectin, and echocardiographic parameters: left ventricular end-diastolic and end-systolic volume indices, ejection fraction < 40% and left ventricular wall motion score index (WMSI) at discharge. On multivariable regression analysis, lower adiponectin level (OR = 0.67, 95% CI 0.49-0.91, p < 0.05) and higher WMSI (OR = 20.14, 95% CI 2.62-154.82, p < 0.01) were the only independent negative predictors of LVR. The optimal cut-off for adiponectin for predicting LVR was < or = 4.7 mg/mL (sensitivity: 73%, specificity: 85%) and this level increased the risk of LVR 15-fold (95% CI 4.05-59.87, p = 0.0001).Baseline low blood adiponectin concentration, along with WMSI, can be considered as a predictor of the LVR in male patients one year after myocardial infarction and pPCI.
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It is known that not only postinfarction left ventricular (LV) remodeling but also chronic regional myocardial hypoperfusion may cause a compensatory hypertrophy of undamaged areas of the left ventricle. Can chronic LV hypoperfusion lead to the development of mitral regurgitation (MR) in CAD patients without previous myocardial infarction We selected patients with significant coronary stenosis (>75%) of at least one epicardial artery who had no acute or previous myocardial infarction: 1162 patients without MR and 76 patients with moderate and severe MR. Patients with MR more often had higher NYHA functional class (II-IV) (91.7 vs 63.0%, p =0.004) and arrhythmias (60.3 vs 14.6%, p<0.001). They also had significantly higher echocardiographic indices of left atrial dimension (23.5+/-2.9 vs. 20.3+/-2.1 mm/m2). MR was independently associated with NYHA class of congestive heart failure, arrhythmias, and index of the left atrium size. No association between MR and the localization of significant coronary lesions was found.
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This study was performed to determine the relation between inducible sustained ventricular tachycardia (ISVT) by programmed electrical stimulation and angiographic, clinical and echographic data in patients with coronary artery disease. The aim of this study was to explore if these inducible arrhythmias are associated with any specific "arrhythmogenic" pattern of coronary artery disease. 129 consecutive patients with coronary artery disease and ISVT were evaluated by left ventriculography and coronary arteriography by standard techniques. The mean age of the patients was 46 years with a range of 21 to 72 years, 74% of them were males. A significant stenosis of the main left coronary artery (>50%) appeared to be more frequent in arrhythmia patients (31%). Also proximal left anterior descending artery stenosis was more frequent in in the arrhythmia patients (48%). "Main left equivalent" lesions, defined as a significant stenosis of the proximal left anterior descending artery and the proximal left circumflex artery was significantly more frequent among the arrhythmia patients (51%). Using the quantitive wall motion analysis, a strong relationship was found between the number of abnormally contracting segments and the presence of inducible sustained ventricular tachycardia. The results of the present study suggest that ISVT in patients with coronary artery disease are more frequently associated with lesions of the main left coronary artery or the proximal left anterior descending artery.
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Paroxysmal atrial fibrillation
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Calcium channel blockers are being used as a first line antihypertensive agents. This was a double blind randomised study to analyse the comparative efficacy of amlodipine and slow relase isradipine as a monotherapy in hypertensive patients. Forthy five patients were analysed, twenty five in isradipine and twenty inamlodipine groups. Systolic blood pressure and diastolic blood Pressure reduced significantly in both groups. There was no statistical difference between the decrements with either agents. Heart rate did not show any signficant change with both the agents. Side effects were nearly similar in both groups. there were no blochemical effects during the course of study. This study shows that amlodipine and Isradipine slow release at equipotent dosage are equally effective in controlling systolic and diastolic blood pressure without significant effect on heart rate. Side effects were similar.
Isradipine
Amlodipine
Calcium channel blocker
Felodipine
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