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ic.ac.uk
Despite normal indices of left ventricular (LV) chamber function, patients with LV hypertrophy (LVH) due to hypertension are thought to have depressed midwall systolic shortening compared with normotensives. The aims of the present study were (1) to confirm this observation and (2) to assess the effects of antihypertensive therapy that cause regression of LVH on LV systolic function assessed at both the midwall and endocardium. Thirty-eight previously untreated hypertensive subjects with LVH underwent echocardiography and were compared with 38 normotensive control subjects. Comparisons between the group with LVH and the control group revealed no significant differences in cardiac output (4. 32+/-0.23 versus 4.55+/-0.21 L/min), ejection fraction (62.5+/-2% versus 66.4+/-1.07%), or endocardial fractional shortening (34.5+/-1.45% versus 37.0+/-0.82%), but shortening assessed at the midwall was significantly less in the group with LVH (17.9+/-1.11% versus 21.6+/-0.63%, P<0.01). Subsequently, 32 patients with uncontrolled hypertension (24 previously untreated and 8 on existing antihypertensive therapy) underwent treatment with ramipril, with the addition of felodipine and bendrofluazide if required, to reduce blood pressure to <140/90 mm Hg. These 32 patients underwent echocardiography at baseline, after blood pressure control, and after an additional 6 months of tight blood pressure control. Good blood pressure control was achieved after 6 months compared with baseline (143/86+/-2.8/1.4 versus 174/103+/-4.1/1.9 mm Hg; P<0.01) with significant regression of LV mass index (124+/-3.4 versus 145+/-3.8 g/m(2), P<0.01). LV fractional shortening assessed at the midwall improved with regression of LVH (21.9+/-0.84 and 18.7+/-1. 19%, P<0.05), with posttreatment midwall shortening being similar to that of the normal control subjects evaluated in the first study. Hypertensive patients with LVH have depressed midwall systolic shortening despite normal indices of LV chamber function. Regression of LVH after good blood pressure control improved midwall shortening to normal levels.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11082139&dopt=Abstract
tanabe.co.jp
OBJECTIVE: To demonstrate tissue selective brady-kinin (BK) potentiating action of angiotensin converting enzyme inhibitors, we studied effects of imidaprilat and ramiprilat, active metabolites of imidapril and ramipril, respectively, on bronchoconstriction and hypotension both induced by BK in vasopressin-infused anesthetized guinea pigs. METHODS: We measured pulmonary inflation pressure and blood pressure in vasopressin-infused anesthetized guinea pigs at the same time. BK-induced changes in pulmonary inflation pressure and blood pressure before and after the administration of ACE inhibitor were compared. RESULTS: Imidaprilat and ramiprilat enhanced BK-induced hypotension comparably, and this effect was inhibited by Nomega-nitro-L-arginin-methylester (L-NAME, a nitric oxide synthetase inhibitor). Although imidaprilat did not affect BK-induced bronchoconstriction, ramiprilat enhanced the broncho-constriction significantly. SR48968, a selective NK2 receptor antagonist, significantly inhibited the enhancing effect of ramiprilat on BK-induced bronchoconstriction. CONCLUSION: These results suggest that enhancement of BK-induced hypotension by imidaprilat and ramiprilat is mediated by nitric oxide (NO), but the mediator of the enhancing action of ramiprilat on BK-induced bronchoconstriction is mainly neurokinin A.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11089901&dopt=Abstract
Am J Cardiol. 1987 Apr 24;59(10):86D-91D.
Effect of ramipril, a new angiotensin converting enzyme inhibitor, on diurnal variations of blood pressure in essential hypertension.
Kaneko Y, Omae T, Yoshinaga K, Iimura O, Inagaki Y, Ishii M, Saruta T, Yamada K, Kumahara Y, Ito K, et al.
The effect of ramipril on diurnal variations of blood pressure was studied in patients with mild to moderate essential hypertension in groups given once- (n = 18) and twice-daily (n = 21) administration with daily dosages ranging from 2.5 to 10 mg. After ramipril treatment, the blood pressure of patients in both groups was significantly reduced, and no significant differences in diurnal variation of blood pressure were observed between the 2 groups. The pulse rate did not change after administration of ramipril and no serious side effects were observed. In consideration of patient compliance, once-daily administration of ramipril seems to be optimal for the treatment of essential hypertension.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3034040&dopt=Abstract
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