Arnaldo Libretti

Decreased fibrinolytic response to adrenergic stimulation in hypertensive patients

The aim of this study was to assess the function of the fibrinolytic system at rest and in response to adrenergic stimulation in patients with stable essential hypertension as compared with normotensives. At rest, essential arterial hypertensives were characterized by increased levels of circulating tissue-plasminogen activator, associated with an increased activity of its specific inhibitor, the PAI-1. After stress, fibrinolytic response was impaired in essential arterial hypertensives despite a greater release of tissue plasminogen activator by endothelial cells. Therefore, the PAI-1 activity may be increased in essential arterial hypertensives not only at rest, but also after stress. This may represent a risk factor for hypertensive patients.

Captopril for the Treatment of Patients with Hypertension and Peripheral Vascular Disease

Many epidemiological studies have shown up the frequent association of ar terial hypertension (HT) with atherosclerosis of different localizations. How ever, many of the drugs used to treat HT are contraindicated in patients with peripheral vascular disease (PVD), because they cause unfavorable metabolic changes or vasoconstriction. The aim of the present study was to assess the effect of a proven hypotensive drug, captopril, on the peripheral circulation. The drug appeared to be effec tive in improving blood flow to lower limbs, prolonging the pain. Free interval and increasing the angle/arm arteral pressure index.

Plasma and tissue distribution of adriamycin in patients with pelvic cancer.

The levels of adriamycin in plasma, ascitic fluid and normal and neoplastic tissues sampled during surgery of 3 patients with advanced pelvic cancer were measured by fluorimetry. The highest content of fluorescent compounds was found in tumoral masses in necrotic or scarcely viable tissue; viable and invasive tumor areas scored fluorescence levels comparable with normal adnexa. Ascitic fluid contained levels of fluorescence comparable to the last observed phase of plasma levels. Adipose and cutaneous tissue scored the lowest concentrations.

Polarographic assay of submicrogram quantities of cis-dichlorodiamineplatinum (II) in biological samples.

Differential pulse Polarographic assay of the antineoplastic agent cis-dichlorodiamineplatinum II and its analogues was performed after acid oxidative hydrolysis (HCIO4, HNO3, HCI) of biological samples (plasma, tissue homogenates, urine) and reaction with ethylenediamine. Platinum levels and kinetics were determined in blood and urine of patients with non-oat-cell lung carcinoma. Detection limit of the polarographic assay was 0.5 ng platinum; analytical error was ± 3%. Levels of free cis-dichlorodiamineplatinum (II) in plasma fell in samples stored at –20 °C; the half-life of free drug was 38 h.

Plasma β-Thromboglobulin Levels and Claudication Degrees in Patients with Peripheral Vascular Disease

In 30 patients with varying degrees of claudication and 40 normal subjects, plasma levels of β-thromboglobulin were determined. These were significantly higher (p < 0.01) in the patients than in age-matched controls; in the control group the β-thromboglobulin values resulted slightly higher in older subjects. No correlation was found between β-thromboglobulin and the severity of the vascular disease, assessed on the basis of the pain-free interval on the treadmill.

Adriamycin distribution in plasma and blood cells of cancer patients with altered hematocrit

Adriamycin (AM) distribution in the cellular and plasma components of blood has been investigated in cancer patients with hematocrit values ranging from 23 to 49 after i.v. drug doses (40–70 mg/m2). AM was measured by a fluorimetric technique in total blood, plasma and blood cells. Blood levels were found to be related to the dose, and when the number of blood cells per milliliter was low, a smaller amount of AM was found in the cell fraction and a larger amount was found in the plasma fraction. A further result of these studies was that, as already shown in Walker-bearing rats, AM accumulated to a marked extent in blood cells, particularly platelets, as expressed by the drug concentration per unit volume, and persisted longer in white blood cells and platelets than red cells, suggesting that the various cells have different roles in transport, storage or metabolism of the compound.

The vectorcardiogram in Friedreich's ataxia

Abstract A Frank system vectorcardiographic analysis has been performed in 10 patients with Friedreichs ataxia. None had clinical signs of heart failure nor kyphoscoliosis. The electrocardiographic patterns were abnormal in five patients showing signs of left ventricular hypertrophy with inversion of T waves and abnormal rotation of the heart axis, and appeared practically normal in the other five. On the contrary, the vectorcardiographic features were abnormal in all ten patients studied. A prominence of lateral forces was present in the VCG of the first group in accordance with the scalar ECG, while patterns suggestive of diffuse myocardial damage were observed in the patients with a normal electrocardiogram. The vectorcardiographic alterations appeared strictly parallel to the degree of nervous involvement; this was particularly evident in three sisters and in two brothers whose vectorcardiographic abnormalities were similar in type and were proportional to the degree of neurological impairment.

Lipid Profile during Antihypertensive Treatment

SummarySome antihypertensive drugs adversely affect the plasma lipid profile, and this has to be taken into account when choosing treatment for hypertension because it may offset the beneficial blood pressure-lowering effect of these agents. In this study, the long term effects of verapamil sustained release (SR) 240mg daily and enalapril 20mg daily on plasma lipid levels were investigated in 931 patients with mild to moderate hypertension. Patients whose blood pressure was not effectively lowered after at least 1 month of monotherapy had either enalapril 20mg once daily added to their verapamil treatment or hydrochlorothiazide 12.5mg once daily added to their enalapril treatment. Blood pressure and lipid profile were assessed before and after 6 months of treatment.Of 864 evaluable patients, 563 patients (65.1%) were successfully treated with monotherapy and 220 patients (25.5%) required combination therapy. A total of 81 patients withdrew from the trial. Systolic and diastolic blood pressure were significantly reduced by treatment with either verapamil or enalapril, and heart rate was reduced slightly, but significantly, by both treatments.Total cholesterol, triglycerides and low density lipoprotein were significantly reduced by both treatments. High density lipoprotein levels were significantly increased in verapamil recipients, but not in enalapril recipients. Adverse effects occurred in 37 (3.9%) patients receiving verapamil SR and 25 (2.7%) patients receiving enalapril.In conclusion, long term treatment with the antihypertensive agents verapamil and enalapril, alone or in combination regimens, significantly improved the plasma lipid profile. Verapamil SR had the most beneficial effect on plasma lipid levels.

Effects of treatment with verapamil SR and captopril on the lipid profile of hypertensive patients

SummaryThe potential beneficial effects of antihypertensive drugs on cardiovascular morbidity and mortality may be compromised by their adverse effects on serum lipid levels. In our study we compared verapamil and captopril and evaluated their effects on blood pressure and on serum lipid and lipoprotein levels, with particular attention to lipoprotein(a) [Lp(a)].20 hypertensive patients were treated with sustained release verapamil 240mg once daily or captopril 25mg twice daily for 3 months in a double-blind randomised study. Diastolic blood pressure was reduced from 100 ± 3mm Hg to 87 ± 6mm Hg (p < 0.01) and from 100 ± 5mm Hg to 92 ± 7mm Hg (p < 0.05) in the verapamil and captopril groups, respectively. Small but significant changes in serum lipid levels were noted: total cholesterol was reduced from 6 to 5.8 mmol/L (verapamil) and from 6.1 to 5.9 mmol/L (captopril); low density lipoprotein (LDL) cholesterol was reduced from 4 to 3.8 mmol/L (verapamil) and from 4.2 to 3.9 mmol/L (captopril); apolipoprotein C-III was reduced from 0.3 ± 0.07 to 0.2 ± 0.06 mmol/L (9.7 ± 2.5 to 9.2 ± 2.3 mg/dl) [verapamil] and from 0.2 ± 0.1 to 0.2 ± 0.09 mmol/L (9.1 ± 3.7 to 8.3 ±3.4 mg/dl) [captopril]; apolipoprotein A-II increased only with verapamil (p < 0.02). Lp(a) levels showed only minor changes in individual patients.In conclusion, in our study verapamil and captopril were effective antihypertensive agents and did not adversely effect the lipid profile.

Isolated office hypertension: are there any markers of future blood pressure status?

BackgroundThe introduction of ambulatory blood pressure monitoring into clinical practice has defined a clinical condition called ‘isolated office hypertension’. ObjectiveThe aim of this study was to evaluate the long‐term systolic and diastolic blood pressure changes in patients with isolated office hypertension and to identify the presence of markers capable of identifying which patients will develop sustained hypertension. MethodsAll the 407 patients enrolled had a random office systolic or/and diastolic blood pressure of over 140/90 mmHg and a mean daytime ambulatory blood pressure of 130/84 mmHg or less. At enrolment, each patient underwent a ‘baseline examination’ made up of a physical evaluation, a 24 h ambulatory blood pressure monitoring, and a mental arithmetic test performed at the end of the 24 h ambulatory monitoring. ResultsOf the 173 patients finally studied, 102 (58.9%) developed sustained hypertension with an increase in both ambulatory systolic and diastolic blood pressure. At the time of the baseline examination, the patients were divided into two groups. Group A included patients with mean ambulatory systolic and diastolic blood pressures in the first hour of 130/84 mmHg or less; group B included patients with mean ambulatory systolic and diastolic pressures in the first hour of greater than 130/84 mmHg. During the mental arithmetic test, the systolic and heart rate values increased significantly only in group B patients. Of the 102 patients who had become hypertensive by the time of the follow‐up examination, 84 (82%) belonged to group B. ConclusionThese data suggest that isolated office hypertension may indeed be a transitional state towards the development of sustained hypertension. Moreover, the mean ambulatory blood pressure value during the first hour can be considered to be a marker of a higher risk of developing sustained hypertension.