Rogelio A. Machado

Endothelial dysfunction in normal and abnormal glucose metabolism.

The endothelium is the common target of all cardiovascular risk factors, and functional impairment of the vascular endothelium in response to injury occurs long before the development of visible ath

Dose Assessment and Long-Term Effectiveness of Nitrendipine in the Treatment of Mild and Moderate Hypertensive Patients

To determine the optimal therapeutic dose and the effectiveness of a single daily dose of nitrendipine. 107 patients of both sexes, aged 29–67 years (mean, 51 years), suffering from mild and moderate arterial hypertension with diastolic blood pressure (DBP) of 95–114 mm Hg, were submitted to increasing doses of the drug, beginning with 10 mg b.i.d. in a open trial. All of them were controlled hourly from 8 a.m. to 4 p.m. every 14 days. Treatment was considered effective when DBP reached 90 mm Hg in at least 5 of the 8 hourly controls. When doses were effective, an extra 14 day period was carried out with the same dose administered q.i.d. Ninety-seven patients (90.7%) responded successfully to the drug, and in 70 (65.4 %) a dose of 10–20 mg daily was enough to achieve DBP normal levels. Those who did not respond with up to 60 mg daily were considered therapeutic failures. The onset of action was apparent within 1 h after intake and persisted throughout the day. Thirty-seven patients with successful responses agreed to be included in a long-term treatment with the same doses that normalized their DBP. All of them were controlled every 14 days during a year. Only 31 completed the 24 periods of 2 weeks each, and 6 withdrew from the study at different times; therefore, only 837 controls were made. Eighteen patients (48.6%) continued with the initial dose or were able to reduce it, 11 (29.7%) had to increase it, and 8 (21.6%) remained unchanged. Considering the 837 controlled periods, it was possible to maintain the initial dose in 442 (52.8;), and to reduce or discontinue it in 271 (32.4%), and it was necessary to increase the dose in 124 (14.8%). Only 23 patients (21.5%) showed side effects — mainly those related to vascular type (headaches and rashes) — that may be attributed to the drug. In no case was it necessary to discontinue the treatment. We concluded that nitrendipine is a well-tolerated and effective drug in the treatment of mild and moderate arterial hypertension with oncedaily intake, and its effects continue in long-term treatment.

Mejoría de la capacidad funcional tras tratamiento con levotiroxina en pacientes con insuficiencia cardíaca crónica e hipotiroidismo subclínico

AIM To assess whether levothyroxine treatment improves functional capacity in patients with chronic heart failure (New York Heart Association class i-iii) and subclinical hypothyroidism. METHODS One hundred and sixty-three outpatients with stable chronic heart failure followed up for at least 6 months were enrolled. A physical examination was performed, and laboratory tests including thyroid hormone levels, Doppler echocardiogram, radionuclide ventriculography, and Holter monitoring were requested. Functional capacity was assessed by of the 6-min walk test. Patients with subclinical hypothyroidism were detected and, after undergoing the s6-min walk test, were given replacement therapy. When they reached normal thyrotropin (TSH) levels, the 6-min walk test was performed again. The distance walked in both tests was recorded, and the difference in meters covered by each patient was analyzed. RESULTS Prevalence of subclinical hypothyroidism in patients with heart failure was 13%. These patients walked 292±63m while they were hypothyroid and 350±76m when TSH levels returned to normal, a difference of 58±11m (P<.011). Patients with normal baseline TSH levels showed no significant difference between the 2 6-min walk tests. CONCLUSIONS Patients with chronic heart failure and subclinical hypothyroidism significantly improved their physical performance when normal TSH levels were reached.