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are usually stabilized on antihypertensive therapy either in the hospital or when attending the outpatient clinic. However, the BP of hypertensive patients often shows a marked fall from outpatient levels during a period of hospitalization. 2 noted a 10% to 20% decline in both systolic and diastolic pressure in almost 85% of their 91 patients following admission to hospital. The max-

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Leukotriene synthesis may be increased in a variety of inflammatory diseases. Urinary leukotriene E4 is a stable metabolite of leukotrienes C4 and D4 which has previously been found to be increased in exacerbations of severe asthma and after antigen inhalation. Levels of urinary LTE4 in seven patients during and after a severe flare of atopic dermatitis were measured by high-performance liquid chromatography (HPLC) and radioimmunoassay (RIA). Mean urinary LTE4 levels (+/- SEM) were not increased during (16.7 +/- 3.7 pg/mumol) or after (16.9 +/- 4.8 mumol) the acute exacerbation of atopic dermatitis when compared with the normal range (mean = 23.8 [95% confidence interval 19.9-28.2] pg/mumol creatinine). These findings do not provide evidence of cysteine leukotriene involvement in the pathogenesis of atopic dermatitis.

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In a cross-over study, the cardiovascular effects of dobutamine were assessed in 11 patients who had undergone operation for replacement of the mitral or aortic valve approximately four hours earlier. In 9 of these the effects of isoprenaline were assessed for comparison. Dose-resporse curves were obtained using four dose levels of dobutamine in the range 1-25-10 Vg/kg per min and of isoprenaline in the range of 0 005-0 04 [tg/kg per min. Both drugs produced similar dose-dependent increases in heart rate and cardiac output and a dosedependent decrease in peripheral resistance. Mean arterial pressure was only slightly increased by either drug. The positive inotropic effect of dobutamine was confirmed, but the chronotropic effect was not significantly different from that of isoprenaline. This contrasts with the findings of previous studies, and possible reasons for this are discussed.One of the most serious sequels of cardiac surgery is naline were compared in 9 patients, the other 2 cardiovascular failure associated with low cardiac receiving dobutamine alone. Only those patients output (Dietzman et al., 1969). Isoprenaline is of in sinus rhythm and free of other postoperative benefit in this situation (Harrison, Kerber, and complications requiring continuous intensive treatAlderman, 1970) but its use is often limited by the ment were included in the study. Patients in atrial development of excessive tachycardia or of ven-fibrillation were excluded because dobutamine is tricular arrhythmias (Beregovich et al., 1971). The known to shorten atrioventricular conduction time results of animal (McRitchie et al., 1973; Tuttle, (Sinno et al., 1973). All were receiving intermittent 1974; Tuttle and Mills, 1975) and clinical studies positive-pressure respiration via endotracheal tube in man (Jewitt et al., 1974) suggests that dobuta-and had been sedated intravenously with diazepam mine, a novel sympathomimetic amine, has a lesser and papaveretum (2-5 to 5*0 mg of each). No other chronotropic effect than isoprenaline at doses drugs had been given after operation. The study equipotent in inotropic effect.took place approximately four hours after the end The purpose of the present clinical study was to of the operation and other intravenous infusions compare the effects of dobutamine and isoprenaline were interrupted during administration of dobutaon heart rate, cardiac output, and arterial pressure mine or isoprenaline.during the early postoperative period after heart Heart rate was determined by auscultation for one valve replacement. minute. Cardiac output was measured by the indicator dilution technique. Indocyanine green Patients and methods (5 mg dissolved in 1 ml saline) was injected through a pulmonary artery catheter inserted at the time of Eleven patients (5 male, 6 female) aged 16 to 63 operation. Blood from a cannulated radial artery years (mean 4041) were studied. All had undergone was pumped through a Gilford cuvette densitometer single valve replacement (6 aortic, 5 mitral) with using a Harvard pump. Post-stud...

on behalf of the Systolic Hypertension in Europe InvestigatorsThe Systolic Hypertension in Europe (Syst-Eur) trial proved that blood pressure (BP) lowering therapy starting with nitrendipine reduces the risk of cardiovascular complications in older (у60 years) patients with isolated systolic hypertension (systolic BP у160 mm Hg and diastolic BP Ͻ95 mm Hg). After the completion of the Syst-Eur trial on 14 February 1997, 3506 consenting patients (93.0% of those eligible) were enrolled in phase 2 of the Syst-Eur trial. This open follow-up study aims to confirm the safety of long-term antihypertensive therapy based on a dihydropyridine. To lower the sitting systolic BP below 150 mm Hg (target BP), the first-line agent nitrendipine (10-40 mg/day) may be associated with enalapril (5-20 mg/day), hydrochlorothiazide (12.5-25 mg/day), both add-on study drugs, or if required any other antihypertensive agent. On 1 November 1998, 3248 patients were still being followed, 86 patients had proceeded to non-supervised follow-up, and 43 had died. The median follow-up in Syst-Eur 2 was 14.3 months. At Keywords: calcium-channel blockade; elderly; dihydropyridine; isolated systolic hypertension IntroductionIn 1989 the European Working Party on High Blood Pressure in the Elderly started the placebo-controlled double-blind Systolic Hypertension in Europe trial (Syst-Eur). 1 Active treatment was initiated with the dihydropyridine calcium-channel blocker nitrendipine 2 with the possible addition of enalapril, hydrochlorothiazide or both drugs. The Syst-Eur trial stopped on 14 February 1997 according to predefined rules, 3 because the second of four planned interim analyses had shown a significant benefit for stroke, the primary end-point. 1 At the Syst-Eur investigators meeting in March 1997, the decision was taken to keep the Syst-Eur patients in followup. This article summarizes the rationale and protocol of this study, named Systolic Hypertension in Correspondence: Dr Jan A Staessen, Klinisch Laboratorium Hypertensie, Inwendige Geneeskunde-Cardiologie, UZ Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium Received 14 October 1998; accepted 21 October 1998 the last available visit, systolic/diastolic BP in the patients formerly randomised to placebo (n = 1682) or active treatment (n = 1824), had decreased by 13.2/5.2 mm Hg and by 4.6/1.6 mm Hg, respectively, so that the between-group BP difference was 1.7 mm Hg systolic (95% Cl: 0.8 to 2.6 mm Hg; P Ͻ 0.001) and 0.9 mm Hg diastolic (95% Cl: 0.4 to 1.5 mm mm Hg; P Ͻ 0.001). At the beginning of Syst-Eur 2, the goal BP was reached by 25.4% and 50.6% of the former placebo and activetreatment groups; at the last visit these proportions were 55.9% and 63.1%, respectively. At that moment, 45.9% of the patients were on monotherapy with nitrendipine, 29.3% took nitrendipine in combination with other study drugs. Until the end of 2001, BP control of the Syst-Eur 2 patients will be further improved. Cardiovascular complications and adverse events, such as cancer or gastro-intestinal bleeding, wi...