Ruggero Tomei

Antihypertensive effect of lisinopril assessed by 24-hour ambulatory monitoring: a double-blind, placebo-controlled, cross-over study.

Summary: The antihypertensive effect of the angiotensin-converting enzyme (ACE) inhibitor lisinopril administered in a single dose of 20 mg was evaluated by ambulatory blood pressure monitoring (ABPM) in a double-blind, placebo-controlled, cross-over study. Twenty-four patients (21 men and 3 women, mean age 52 ± 6 years) with mild to moderate hypertension were included in the study and randomly assigned to two consecutive treatments with lisinopril 20 mg and placebo, each administered for 4 weeks. On the last day of each treatment, BP was assessed by noninvasive 24-h ABPM. BP was significantly lower after lisinopril than after placebo in a 24-h period (mean 24-h systolic BP (SBP) with lisinopril 120 ± 7 mm Hg and with placebo 135 ± 9 mm Hg; mean day SBP with lisinopril 125 ± 3 mm Hg and with placebo 142 ± 5 mm Hg; mean night SBP with lisinopril 112 ± 4 mm Hg and with placebo 124 ± 6 mm Hg; mean 24-h diastolic BP (DBP) with lisinopril 76 ± 6 mm Hg, and with placebo 87 ± 8 mm Hg; mean day DBP with lisinopril 80 ± 3 mm Hg and with placebo 93 ± 4 mm Hg; mean night DBP with lisinopril 69 ± 2 mm Hg and with placebo 79 ± 5 mm Hg, p < 0.001). Mean 24-h, mean day, and mean night heart rate (HR) did not differ significantly between placebo and lisinopril treatments. Repeated-measures analysis of variance (ANOVA) showed a significant influence on SBP (p 0.001) and DBP (p < 0.001) throughout the treatment. A significant time effect was also evident both for SBP (p 0.001) and DBP (p < 0.001). The interaction of time and treatment was not significant, suggesting that the circadian rhythm of BP was not different during the two treatments. No serious side effects were observed during this study.

Antihypertensive effects of lacidipine during effort in mild to moderate hypertension.

The aim of this study was to evaluate the effects of chronic treatment with lacidipine on blood pressure, heart rate and double product during and immediately after physical effort in mild to moderate hypertensive patients. This was a single-center, randomized, double-blind, crossover, placebo-controlled clinical trial. Eighteen hypertensive patients (56% males, median age 53 years) were randomized to lacidipine 4 mg o.i.d. followed by placebo or to placebo followed by lacidipine 4 mg o.i.d. Lacidipine compared with placebo exerted a significant antihypertensive effect, lowering SBP and DBP both at baseline and either during or after exercise test. The average incremental changes of SBP and DBP between pre-exercise stage and maximal effort did not show any significant differences between treatments. HR during treatment with lacidipine was higher than during treatment with placebo both at rest and after exercise, but at maximal effort, HR was not different from placebo. The average values of DP at maximal effort, and during recovery, did not show any significant differences. Lacidipine 4 mg was effective in lowering blood pressure and in maintaining its antihypertensive effect throughout and after physical exercise, without enhancing double product value, which is an indirect index of myocardial oxygen consumption.

Pitfalls in electrogram interpretation: Subcutaneous cardioverter defibrillator malfunction in Brugada syndrome: MORANI et al .

A patient with Brugada syndrome implanted with subcutaneous implantable cardioverter defibrillator (S‐ICD) had oversensing episodes treated with S‐ICD shocks. Comparable artifacts were not evocable with S‐ICD pocket manipulation. The fluoroscopy excluded S‐ICD macroscopic damage.

The managed ventricular pacing algorithm can be misinterpreted as pacemaker malfunction.

Some pacing algorithms developed to minimize right ventricular pacing have made the interpretation of electrocardiogram sometimes difficult and challenging. We report a case of a 76-year-old man admitted to our Cardiology Department for apparent pacemaker malfunction. Four months before, he had undergone …

Potential Arrhythmogenic Risk of DDI/DDD Pacing Modes During Atrial Fibrillation

In patients with paroxysmal-persistent atrial fibrillation (AF), DDI and DDD pacing modes can be used to assess the clinical burden of AF. This report shows how the DDI mode might trigger ventricular tachyarrhythmias during AF. This potential arrhythmogenic phenomenon should be carefully considered when programming a device in DDI (or DDD) mode in patients with AF.