Neuropeptide-Y (NPY) is a peptide proposed to modulate the effect of the sympathetic nervous system on blood pressure control and contribute to the development of essential hypertension. To assess the possible influence of gender on its role, we evaluated plasma NPY, noradrenaline (NA) and adrenaline (A) concentrations in men and women with essential hypertension. No difference in NPY concentration was found between genders, but NPY concentration was elevated in both hypertensive men and women. NA levels were similar in all investigated hyper- and normotensives, while A was increased only in hypertensive men. These results suggest various patterns of sympatho-adrenal activity in gender subgroups of patients with essential hypertension.
The aim of the present study was to assess the efficacy and tolerability of a calcium antagonist/beta-blocker fixed combination tablet used as first-line antihypertesnive therapy in comparison with an angiotensin converting enzyme inhibitor and placebo. Patients with uncomplicated essential hypertension (diastolic blood pressure between 95 and 110 mm Hg at the end of a 4-week run-in period) were randomly allocated to a double-blind, 12-week treatment with either a combination tablet of felodipine and metoprolol (Logimax), 5/50 mg daily (n = 321), enalapril, 10 mg daily (n = 321), or placebo (n = 304), with the possibility of doubling the dose after 4 or 8 weeks of treatment if needed (diastolic blood pressure remaining >90 mm Hg). The combined felodipine-metoprolol treatment controlled blood pressure (diastolic < or =90 mm Hg 24 h after dose) in 72% of patients after 12 weeks, as compared with 49% for enalapril and 30% for placebo. A dose adjustment was required in 38% of patients receiving the combination, in 63% of patients allocated to placebo, and 61% of enalapril-treated patients. The overall incidence of adverse events was 54.5% during felodipine-metoprolol treatment; the corresponding values for enalapril and placebo were 51.7% and 47.4%, respectively. Withdrawal of treatment due to adverse events occurred in 18 patients treated with the combination, in 10 patients on enalapril, and 12 patients on placebo. No significant change in patients' well-being was observed in either of the three study groups. These results show that a fixed combination tablet of felodipine and metoprolol allows to normalize blood pressure in a substantially larger fraction of patients than enalapril given alone. This improved efficacy is obtained without impairing the tolerability. The fixed-dose combination of felodipine and metoprolol, therefore, may become a valuable option to initiate antihypertensive treatment.
In 25 men with acute myocardial infarction simultaneous determinations of free fatty acid (FFA), noradrenaline, and adrenaline were made in blood samples obtained on the 1st and the ioth day after the acute attack. In the acute phase of myocardial infarction the levels of FFA and noradrenaline were significantly higher than on the ioth day of illness and revealed a highly significant positive correlation. The blood adrenaline levels were not significantly raised and did not correlate with the FFA levels. Patients and methods Twenty-five men with acute myocardial infarction, consecutively admitted to the coronary care unit, were studied. The age range was 35-65 years, with a mean of 5I-4 years. The diagnosis of myocardial infarction was based on the clinical picture, typical electrocardiographic findings, and raised enzyme levels. None of the patients received heparin, corticosteroids, clofibrate, glucose infusions, or other drugs which might have influenced the parameters studied. None of the patients had a history of diabetes mellitus. The patients were continuously monitored with an oscilloscope, with frequent pulse and blood pressure measurements. The venous blood samples of about 25 ml were obtained within I2 hours from the onset of the acute attack, at least 5 hours after a meal. The infarction was transmural in 22 patients and subendocardial in 3 patients. The localization of the infarction was anterior in 8 patients, anterolateral and inferolateral in 2 patients each, and inferior in 8 patients. None of the patients had evidence of shock. Four patients gave a history of hypertension. In 4 patients the systolic blood pressure was i6o mmHg or higher, and in IO patients the diastolic blood pressure equalled or exceeded 95 mmHg at the time of blood collection.Various degrees of heart failure were found in i8 patients; in I2 of them the symptoms of heart
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