High blood pressure. Causes, symptoms, treatments

Rationale for the chemical development of angiotensin II receptor antagonists.


At the population level, the hemorrhagic risk associated with warfarin therapy combined with antiplatelet therapy appears to outweigh the benefits. These findings suggest that clinicians should carefully consider the risks and benefits when recommending combined antiplatelet therapy for patients receiving warfarin who do not meet the evidence-based criteria for such therapy.

To assess the utility of dipyridamole thallium testing in symptomatic and asymptomatic patients with diabetes undergoing vascular surgery.

In spite of some data being added to our knowledge of the effect of antiplatelets in secondary prevention of brain ischemic lesion in recent years, the main reasons to perform a second European Stroke Prevention Study (ESPS 2), which started in 1987-1988, were: (a) clarify the relative roles of aspirin (ASA) and dipyridamole (DP) alone or in combination; (b) confirm the efficacy of small doses of ASA and, so doing, decrease the number of drop-outs due to ASA side effects; (c) join information to the effect of antiplatelets in complete stroke. General characteristics of the sample of 6602 patients are presented and compared with other major trials and series. The patients in the four treatment arms (aspirin, dipyridamole, aspirin + dipyridamole and placebo) are compared. The more relevant features and risk factors known to influence long term prognosis are described and discussed. The small proportion of patients included with TIA (23.7%) and the comparability among treatment groups are stressed. No relevant differences have been found, among groups, on the sex or age distribution, prevalence of hypertension, diabetes, previous vascular events or atrial fibrillation, nor in the characteristics of the accident leading to the inclusion in trial.

RCTs of active drug versus placebo in patients with ESRD undergoing haemodialysis via an A-V fistula or prosthetic interposition A-V graft.

The dynamics of cross-sectional, isochronic, and integral maps of electric potential distribution during the dipyridamole test was examined in 35 patients with verified coronary heart disease and 12 control patients. Basic differences were found in changes of excitation propagation velocities and positive potential amplitude in the groups examined. A local increase in R wave areas on the maps of positive potential differences was found to be the most significant mapping sign of transient myocardial ischemia (the sensitivity, specificity, and diagnostic accuracy being more than 97%). The diagnostic accuracy of an absolute or relative increase in the integral time and amplitude parameters of the mapping was 77% and 70%, respectively.

Sixty-five patients were given 25 to 50 g of glucose and, after approximately 60 min, an injection of 370 MBq (10 mCi) of F-18 fluorodeoxyglucose. After a 35-min distribution phase, patients underwent exercise or pharmacologic stress followed by administration of 925 MBq (25 mCi) of Tc-99m MIBI. Five patients underwent F-18 fluorodeoxyglucose position emission tomography before dual-isotope SPECT:

Cardiovascular complications of sickle cell anaemia (SCA) are relatively infrequent compared with other cerebral and skeletal insults. However, myocardial infarction and cardiac dysfunction have been reported in autopsied patients with SCA. When left ventricular functional parameters of gated SPECT and echocardiography were compared incidentally in children with SCA, some 26% of patients were found to have evident myocardial ischaemia. This stimulated the current work with the aim to further analyse these incidental findings and evaluate the possible role of SPECT in early detection of coronary insufficiency in children with SCA.

: Antiplatelet agents and anticoagulants are the two major classes of antithrombotic therapy used for stroke prevention. The etiology and mechanism of the stroke must be considered in order to make the best decision regarding which agent(s) to use for secondary stroke prevention. The recent Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) study showed that clopidogrel and aspirin plus extended-release dipyridamole had similar event rates in terms of recurrent stroke, but clopidogrel was better tolerated, with fewer bleeding events. Several new anticoagulants are poised to replace warfarin for stroke prevention in the setting of atrial fibrillation. These include dabigatran (a new oral direct thrombin inhibitor) and possibly apixaban (a new oral factor Xa inhibitor). These new medications are much easier to use than warfarin and may be more effective and safer, with fewer drug and food interactions and no need for routine blood monitoring. Thus, these new medications may improve adherence as well as clinicians' inclination to treat with anticoagulation.

The response to various drugs was studied in relation to intracranial vascularization under ultrasound control. The investigation was made in 461 patients (258 females and 203 males) aged between 18 and 87 years. Vasoactive substances interacting with the synaptic neurotransmitters metabolism directly or via CNS were used: papaverine, vincamine, sadamin, nicergoline, carbocromen, clonidine, captopril, magnesium sulphate, nifedipine, piracetam, nicotine, caffeine, dipyridamole, histamine, fentanyl. The normal arterial response was compared with the response of the involved atherosclerotic artery or with congenital malformation. The tests value in the diagnosis of neurologic vascular diseases is discussed.