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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In October 1987, Stage II arterial hypertension, probably of primary genesis, was diagnosed in a 52-year-old male patient. There was marked left-ventricular hypertrophy (left-ventricular muscle mass 224g, corresponding to 2.99 g/kg: mass-volume ratio of the left ventricle 1.9 g/ml; end-diastolic septum thickness 15 mm, posterior wall thickness 13 mm). The patient is engaged in endurance sports for 5-12h each week and participates regularly in competitions. He was not advised to terminate athletic activities. The patient's submaximum performance (supine ergometry) is 3.3 watts per kg body weight. Under therapy with 2 x 240 g Verapamil per day, blood pressure decreased in the course of a year by 30/30 mm Hg at rest and 30/20 mm Hg at a specified exercise level. The left ventricular muscle mass decreased by about 70g, the mass-volume ratio normalized to 1.3 g/ml.
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PMID:[Regression of hypertension-induced left heart enlargement in an endurance athlete treated with verapamil RR]. 252 44

Numerous epidemiological studies have shown that systolic and systodisystolic hypertension constitute major risk factors for damaging or fatal cardiovascular accidents in the elderly as well as the young. Furthermore reducing the blood pressure also reduces the risk. In 1983 Fleckenstein investigated the Ca++ and MG++ contact of human arteries and clearly demonstrated that titres of both but especially Ca++ in the arterial wall increased progressively with age. The Authors themselves caused calcinosis of the arterial wall in rats treated with Vitamin D3 and Dihydrotachysterol and were able to prevent the occurrence with Verapamil. It is against this background that the present study compared the efficacy and tolerability of two anti-hypertensive drug groups in the calcium antagonists and the ACE inhibitors (Enalapril Maleate) used individually on two groups of elderly hypertensives. A group of 123 out patients with a mean age of 73 and all suffering from slight-to-moderate hypertension were monitored for 6 months being subjected to the following examinations: clinical assessment including blood pressure measurements lying and standing, biohumoral tests, remote heart X-rays, echocardiography (to establish the Reichek systolic wall stress index) and ECG. The clinical examination and ECG were repeated every 2 weeks for the first 6 months and once a month thereafter. The heart X-rays, echocardiogram and biohumeral tests were performed every 6 months. The patients were divided into two groups I and II and assigned to the selected treatment. The Group I patients were then divided into 3 subgroups and treated with 3 different calcium antagonists (Nifedipine R; Verapamil R and Diltiazem). All group II patients were treated with Enalapril Maleate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Calcium antagonists vs ACE inhibitors in the treatment of essential arterial hypertension in the aged]. 254 2

This case report describes the anaesthetic management of a patient with bilateral phaeochromocytoma and cardiomyopathy. The hypertension and supraventricular tachycardia commonly seen during manipulation of this tumour was controlled by administration of sodium nitroprusside and verapamil. Verapamil allowed effective management of supraventricular rhythm disturbances and arterial blood pressure, and cardiac index remained unchanged during and after phaeochromocytoma removal. As the haemodynamic side-effects of the calcium blocking agent are readily reversed by intravenous calcium chloride, it may have a useful part to play in such cases.
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PMID:Cardiomyopathy in phaeochromocytoma: a case report. 256 35

The kind of interaction of two structurally different calcium channel blockers (verapamil and nicardipine) with both alpha 2-adrenergic agonist and antagonist binding on human platelets was investigated. Only verapamil, but not nicardipine, interacted in vitro with platelet alpha 2-adrenoceptors on [3H]-yohimbine or [3H]-UK 14,304 binding. Verapamil behaves as a weak antagonist competitor for alpha 2-adrenoceptors. In patients with mild essential arterial hypertension, the number of platelet alpha 2-adrenoceptors as well as velocity of aggregatory response to adrenaline, are significantly decreased: -21 and -25%, respectively (p less than 0.05). Verapamil (120 mg t.i.d. orally during 1 month) failed to modify the platelet alpha 2-adrenoceptor number or the adrenaline-induced platelet aggregation in hypertensive patients. These results show that, although interacting in vitro, verapamil does not modify the alpha 2-adrenergic receptivity after 1 month treatment in humans.
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PMID:Verapamil interacts in vitro with alpha 2-adrenoceptors but does not modify alpha 2-receptivity in vivo. 257 96

Finoptin and sensit produced a favourable effect in the treatment of 290 patients with initial manifestations of deficient blood supply to the brain, encephalopathy attended by circulatory disturbances and ischemic brain insult. Changes in the systemic and cerebral hemodynamics were more pronounced in middle-aged and elderly patients suffering from hypertension or its combination with atherosclerosis.
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PMID:[Calcium antagonists (finoptin and senzit) in the treatment of cerebrovascular disorders]. 258 41

Seven healthy male volunteers were studied at the end of 7 days placebo period and after 7 days treatment with verapamil (120 mg twice daily). Verapamil increased significantly plasma renin activity and urinary excretion of 6-keto prostaglandin F1 alpha without significant modification of plasma aldosterone. Metoclopramide (10 mg i. v.) induced a significant increase of plasma aldosterone with the peak values 15 min after the injection of the drug. The results indicate that verapamil does not lead to secondary hyperaldosteronism which is characteristic of most other vasodilators. The increase of prostacyclin, measured as 6-keto prostaglandin F1 alpha can contribute to the efficacy of verapamil in patients with ischemic heart disease and hypertension. The present study suggests that the aldosterone response to metoclopramide is not directly dependent on calcium, but an indirect effect of calcium through renin-angiotensin system cannot be excluded.
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PMID:Effect of verapamil on renin-angiotensin-aldosterone system, urinary 6-keto prostaglandin F1 alpha and aldosterone response to metoclopramide in normal man. 263 2

The effects of one month's treatment with each of nifedipine, verapamil, diltiazem, propranolol and placebo, given in random order, on fasting plasma glucose, haemoglobin Alc, serum fructosamine, immunoreactive insulin, cholesterol, and triglyceride were studied in a group of 19 patients with hypertension and non-insulin dependent diabetes mellitus. The metabolic effects of the active drugs were generally small but fasting plasma glucose was increased by propranolol from 9.3 +/- 3.0 to 10.4 +/- 3.4 mmol/l (P less than 0.01) (mean +/- SD) and to 10.1 +/- 3.2 mmol/l (P less than 0.05) by nifedipine. Serum fructosamine was increased from 2.75 +/- 0.53 to 2.89 +/- 0.62 mmol/l (P less than 0.05) by diltiazem and to 2.91 +/- 0.65 (P less than 0.05) by propranolol. Verapamil increased fasting serum immunoreactive insulin: diltiazem and propranolol tended to reduce it. Propranolol but not the other drugs significantly increased serum triglyceride. Calcium antagonists may be preferable to beta adrenoceptor blockers for the treatment of hypertensive diabetics. Of the three calcium antagonists we studied, verapamil may have advantages over nifedipine and diltiazem.
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PMID:The effects of verapamil, diltiazem, nifedipine and propranolol on metabolic control in hypertensives with non-insulin dependent diabetes mellitus. 265 57

The action of some of the most frequently used antihypertensive drugs (reserpine, clonidine, furosemide, propranolol, verapamil) on carbohydrate metabolism in diabetics was studied in an acute experiment with the help of artificial endocrine pancreas (Biostator). The aim of the study is to facilitate the selection of the most suitable drug to be used in the combination of diabetes and hypertension. 42 patients with diabetes mellitus type II were studied divided into 5 groups of 7 patients each according to the number of drugs examined and a control group also of 7 patients. The drugs propranolol and furosemide exert an unfavourable action both on the beta-cell function and the peripheral insulin efficiency. Verapamil and clonidine influence mainly the insulin secretion by a minimum effect on insulin efficiency. Only the drug reserpine practically does not influence the insulin secretion and efficiency.
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PMID:[Effect of antihypertensive drugs on insulin secretion and efficacy]. 266 37

Although verapamil is a well-established treatment for angina, cardiac arrhythmias and cardiomyopathies, this review reflects current interest in calcium antagonists as anti-hypertensive agents by focusing on the role of verapamil in hypertension. Verapamil is a phenylalkylamine derivative which antagonises calcium influx through the slow channels of vascular smooth muscle and cardiac cell membranes. By reducing intracellular free calcium concentrations, verapamil causes coronary and peripheral vasodilation and depresses myocardial contractility and electrical activity in the atrioventricular and sinoatrial nodes. Verapamil is well suited for the management of essential hypertension since it produces generalised systemic vasodilation resulting in a marked reduction in systemic vascular resistance and, consequently, blood pressure. Evidence from clinical studies supports the role of oral verapamil as an effective and well-tolerated first-line treatment for the management of patients with mild to moderate essential hypertension. Clinical studies have shown that verapamil is more effective the higher the pretreatment blood pressure and some authors have found a more pronounced antihypertensive effect in older patients or in patients with low plasma renin activity. Sustained release verapamil formulations are available for oral administration which, as a single daily dose, are as effective in lowering blood pressure over 24 hours as equivalent doses of conventional verapamil formulations given 3 times daily. As a first-line antihypertensive agent, oral verapamil is equivalent to several other calcium antagonists, beta-blockers, diuretics, angiotensin-converting enzyme (ACE) inhibitors and other vasodilators, and is not associated with many of the common adverse effects of these treatments. Verapamil may be preferred as an alternative first-line antihypertensive treatment to diuretics in elderly patients because it has similar efficacy in these patients without causing the adverse effects commonly linked with diuretic treatment. Furthermore, because verapamil does not cause bronchoconstriction, it may be used in preference to beta-blockers in patients with asthma or chronic obstructive airway disease. Reflex tachycardia, orthostatic hypotension or development of tolerance is not evident following verapamil administration. As a second- or third-line treatment for patients refractory to established antihypertensive regimens, verapamil produces marked blood pressure reductions when combined with diuretics and/or ACE inhibitors, beta-blockers and vasodilators such as prazosin.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Verapamil. An updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension. 267 May 11

Calcium entry blockers have been used during general anesthesia in order to control hypertension and tachyarrhythmias. It is well known that both calcium entry blockers (CEBs) and inhalation anesthetics have depressant effects on atrioventricular (AV) conduction and sinus automaticity. Therefore, this study was designed to evaluate combined effects of either halothane, enflurane, isoflurane, or sevoflurane and CEBs (verapamil, diltiazem, or nifedipine) on AV conduction. The following 3 sets of experiments were performed using 90 mongrel dogs anesthetized with ketamine 100-150 mg im, thiamylal 25 mg/kg iv and nitrous-oxide with 50% oxygen. Experiment 1: to evaluate the effects of ketamine and thiamylal on AV conduction. Experiment 2: to evaluate drug interactions of halothane with CEBs. Experiment 3: to evaluate the combined effects of four different inhalation anesthetics at equipotent concentrations (0.8% halothane, 1.6% enflurane, 1.2% isoflurane, and 1.7% sevoflurane) and verapamil. The following variables were measured utilizing His bundle electrocardiogram: Sinus cycle length (SCL), AV conduction time (AH interval), His Purkinje conduction time (HV interval), effective and functional refractory period of AV node (ERP and FRP). It was confirmed that ketamine im and thiamylal iv used for induction of anesthesia did not change AV conduction time from experiment 1. The combined effects of either verapamil (0.1 mg/kg) or diltiazem (0.15 mg/kg) and 0.8% halothane were additive on AV conduction. Although nifedipine (0.01 mg/kg) did not affect AV conduction, there was the significant prolongation of SCL with halothane compared to without halothane. In experiment 3, 0.8% halothane and 1.6% enflurane were stronger than 1.2% isoflurane and 1.7% sevoflurane concerning inhibitory effects on AV conduction. Verapamil had some deleterious effects in 1.6% halothane or 3.2% enflurane anesthesia because of extreme inhibitory effects on AV conduction and sinus automaticity. In conclusion, caution must be exercised in usage of CEBs if inhalation anesthetics are used in higher concentrations.
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PMID:[Comparative effects of inhalation anesthetics on atrioventricular conduction with and without calcium entry blockers]. 272 26


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