Oscar Román

Cardiac Rehabilitation after Acute Myocardial Infarction

Since the effect of cardiac rehabilitation (CR) on morbidity and mortality due to myocardial infarction on a long-term basis appears controversial, a controlled follow-up survey was conducted from 197

Effect of celiprolol on large and small arteries of the forearm circulation in hypertensive patients

SummaryCeliprolol, a new highly cardioselective beta blocker, also has direct vasodilating properties. Since the noninvasive echo Doppler technique applied to the forearm circulation (brachial artery) allows the differentiation of arteriolar vasodilation (revealed by the increasing arterial blood flow velocity) from vasodilation of large arteries (shown by an increase in arterial diameter), it seems important to study the site of celiprolols vasodilating effect. Thirty-five hypertensive patients, (21 male, 14 female; mean age, 59±11, range 42–79 years) were treated with increasing doses of celiprolol, 200 and 400 mg, over 15 days. The duplex echo Doppler technique (Aloka 7.5 M Hz probe) was used before and during each celiprolol dose period. Statistical analysis was performed by Students paired t test. It was observed that celiprolol significantly increases the brachial artery diameter in a dose-dependent manner, and also increases the blood flow velocity (not being direct dose-related). Since the increase in diameter was clear with a higher dose, a dose-dependent increase in blood volume, a decrease in peripheral resistance, and an increase in compliance followed. Since the higher dose of celiprolol did not further reduce blood pressure (BP) in comparison to the lower dose, and a dose-dependent increase in arterial diameter and compliance occurred and a vasodilating effect of celiprolol on arterial wall ensued that was not related to BP.In conclusion, in the doses used, celiprolol dilates both arterioles and large arteries, but the mechanism of action needs to be clarified.

EFFECTS OF PINDOLOL AND PROPRANOLOL ON BLOOD LIPIDS IN HYPERTENSIVE PATIENTS

SummarySince beta-blockers could affect lipid levels at the therapeutic dose range in hypertensive patients, a parallel 6-month randomized trial with pindolol (PDL) (16 pts.) and propranolol (PPL) (23 pts.) was designed (mean age=55+7.1 years and 57+8.0 years; 9 males, 7 females and 15 males, 8 females, respectively). Total cholesterol, LDL and HDL fractions, and triglycerides (TGs) were determined before (washout phase) and during 1, 3, and 6 months of therapy. Patients were instructed to maintain their usual dietary habits. Daily drug doses were adjusted step by step to attain an optimal hypotensive effect (PDL 15–45 mg, PPL 180–240 mg). In the PPL-treated group, total cholesterol and LDL did not change significantly, HDL decreased (from 45.2 to 40.5 mg/dl, p<0.05) and TG increased (from 133 to 169 mg/dl, p<0.05). In the PDL group total cholesterol and LDL did not change either, but HDL increased (35.9 to 44.7 mg/dl, p<0.01) and TGs, were reduced (from 169 to 131 mg/dl, p<0.05). No dose-effect relationship was recorded. It is concluded that pindolol does not negatively influence HDL nor the TG blood lipid profile as does PPL. Accordingly, pindolol might be preferred to propranolol in the treatment of hypertensive patients with an unfavorable lipid profile, but this assumption remains to be proven in larger, prospective, long-term followup trials.

Effects of Pindolol and Clopamide on Blood Lipids in Arterial Hypertensive Patients

The effects of clopamide, pindolol and its combination on plasma lipids in 49 hypertensive patients (WHO I-II), divided into three parallel randomized groups, were studied over a 6 months period. Total cholesterol, triglycerides, HDL and LDL cholesterol fractions were determined twice during an initial 4-week washout phase, and after a 1-, 3- and 6-month active hypotensive drug phase. Patients were instructed to maintain their usual dietary habits. Daily drug doses were adjusted progressively to attain optimal hypotensive effects. In the clopamide monotherapy group, total cholesterol increased significantly (p less than 0.05); triglycerides and LDL showed a tendency to increase while for HDL a tendency to decrease was observed. In the pindolol monotherapy group, a significant reduction of triglycerides (p less than 0.01) and a significant increase of HDL cholesterol (p less than 0.05) were recorded. No significant changes in total cholesterol or LDL fraction were observed. Combined pindolol-clopamide therapy decreased total triglycerides (NS), increased HDL significantly (p less than 0.05) and did not influence total cholesterol and LDL fraction. It is concluded that pindolol does not negatively influence blood lipids as the thiazide-type diuretic clopamide does, and that when both drugs are used together, the beta-blocker can probably counterbalance the diuretic-induced negative effects on blood lipids. Accordingly, it is suggested that pindolol could be a more favorable beta-blocker drug to be used on hypertensive subjects with metabolic coronary risk factors.

Diagnóstico precoz y prevención de la enfermedad ateroesclerótica sistémica

Existe evidencia significativa en varias comunicaciones que los sujetos con presion arterial ligeramente sobre el nivel normal de 120/80 mmHg, pero bajo 140/90 mmHg, considerados pre-hipertensos en los ultimos Consensos internacionales, presentan signos precoces de alteracion cardiovascular propios de la enfermedad arterioescleroti-ca. Ademas, estos cambios iniciales se presentan asociados a algunos factores de riesgo C-V, en especial de diabetes, dislipidemia, obesidad y sedentarismo. Por tanto, se ha propuesto cambiar el paradigma basado en las cifras de PA por otro que involucre las alteraciones precoces y los factores de riesgo. En esta etapa inicial de la enfermedad arterial, es preciso evaluar su riesgo multifactorial a 5 o 10 anos plazo, y de acuerdo a este, planificar las medidas terapeuticas de manejo de los FR y del posible uso de drogas antihipertensivas. De este modo se podra implementar una profilaxis primaria racional y muy posiblemente eficaz.