Summary:Five hundred and seven elderly hypertensive patients were followed for 1 year, 371 for 2 years and 270 for 3 years in a double-blind, randomized, controlled trial in which they received either placebo or 25-50mg hydrochlorothiazide and 50-100mg of triamterene daily. One third of the active treatment group also received 250 mg to 2 g methyldopa daily. After 1 year the active treatment group had an average increase in fasting blood sugar of 2.5 mg/dl compared with an average fail of 1.4 mg/dl in the placebo group (P = 0.01). The increase "M blood sugar 1 hour and 2 hours after 50 g oral glucose tended to be greater in the actively treated group but these increases did not achieve statistical significance. The effects of diuretic treatment were established after one year and did not increase further over the next 2 years. Overall there was an increase in fasting blood sugar of 5 mg/dl in the active treatment group which occurred mainly in the first year.The hyperglycaemic effect ofdiuretics appeared to be partly or wholly related to potassium loss since, in both groups, impairment of glucose tolerance was most marked in those in whom serum potassium decreased. The measures of blood sugar were also positively related to systolic pressure before and after treatment.The following centres collaborate in the EWPHE trial:
Low frequency (LF, 0.04-0.15 Hz) and high frequency (HF, 0.15-0.40 Hz) components of heart rate variability have been used to evaluate the autonomic nervous system. The sympathico-vagal balance as well as the renin-angiotensin-aldosterone (RAA) axis are disturbed in the post-acute phase of acute myocardial infarction (AMI). This study examined the relationship between the RAA-axis and spectral indices of the RR-interval and blood pressure (BP) variabilities during postural manoeuvres in the post-AMI period. Power spectral analysis of the RR-interval and BP variability was computed from non-invasive beat-to-beat BP measurements 10-12 days post-AMI, using Fast-Fourier transforms. Concomitantly, hormonal changes of the RAA-axis were determined and data were further correlated with the left ventricular ejection fraction. When the patient moved from the lying to the supine position all RAA-axis parameters significantly increased. Both LF and HF components of total RR-interval variability decreased upon standing, while the LF component of systolic and diastolic BP variability increased and HF components remained constant. In the upright position, plasma renin activity (P<0.01) and angiotensin II (borderline) were inversely related with the LF component of systolic BP. The aldosterone level was dissociated from plasma renin activity and angiotensin II. The left ventricular ejection fraction was inversely correlated (P<0.05) with systolic and diastolic BP variabilities and their LF and HF powers. These results suggest that the renin-angiotensin II system in the post-acute phase of AMI patients treated with aspirin and beta-blocking agents is correlated with cardiovascular autoregulation during postural manoeuvres.
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