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 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a double-blind, randomized, cross-over study in 23 diabetic patients, insulin treated (N = 11) or noninsulin treated (N = 12), with mild to moderate hypertension, the hypotensive effects of captopril and atenolol were compared. Five patients had overt diabetic nephropathy. All patients received 50 mg twice daily of either drug. Treatment periods lasted 6 weeks and were preceded and separated by a placebo period. Two patients dropped out, one because of intermittent claudication during atenolol, one with cardiac arrhythmia during placebo. Blood pressure was reduced from 165 +/- 5/96 +/- 1 to 154 +/- 5/89 +/- 2 mmHg (mean +/- SEM: P less than 0.01) during captopril and from 171 +/- 5/98 +/- 1 to 159 +/- 6/89 +/- 2 mmHg (P less than 0.01) during atenolol. These antihypertensive effects are not significantly different. There was a wide inter- and intraindividual variation in hypotensive response to both drugs, which may have important consequences for treatment strategies. No consistent differences between insulin and noninsulin treated patients were seen. Parameters of glycemic control did not change during any therapy, neither in insulin treated nor in non-insulin treated patients. Albuminuria and renal function did not change. During captopril treatment one patient complained of a non-productive cough. Two patients experienced a severe hypoglycemic reaction during atenolol. No other major side-effects were seen. In conclusion, this study showed equal hypotensive effectivity of 100 mg captopril and 100 mg atenolol daily in hypertensive diabetics, without evident effect on glycemic control.
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PMID:A comparison of the hypotensive effects of captopril and atenolol in the treatment of hypertension in diabetic patients. 265 75

Pentoxifylline, recently approved for the treatment of intermittent claudication, is hepatically cleared with a high degree of first-pass metabolism. Subsequently, the effect of cimetidine on pentoxifylline pharmacokinetics was studied in humans. Ten healthy subjects received, in random cross-over fashion, pentoxifylline 400 mg as a controlled-release tablet every 8 hours with and without cimetidine 300 mg four times a day for 7 days. Pentoxifylline and metabolite plasma concentrations over one dosing interval were measured on day 7 of each phase. The unavailability of an immediate-release pentoxifylline dosage form prevented a single dose trial. Cimetidine significantly increased (P less than .05) pentoxifylline area under the curve at steady state 26.2% from 675 +/- 97 (mean +/- SEM) to 852 +/- 108 ng. hr/mL. The average steady-state plasma concentration increased 27.4% from 84 +/- 12 to 107 +/- 14 ng/mL (P less than .05). Apparent oral clearance decreased 21.5% from 1309 +/- 304 to 1027 +/- 244 mL/min (P less than .02). Significant alterations in pentoxifylline metabolite concentrations were also observed. The results of this trial suggest cimetidine elevates pentoxifylline plasma concentrations, presumably by decreasing apparent oral clearance, although a reduction in total body clearance or an increase in gastric absorption could not be ruled out.
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PMID:Alteration of pentoxifylline pharmacokinetics by cimetidine. 321 31

Tobacco smoking is a risk factor for peripheral arterial disease. During oral glucose tolerance tests (OGTT) in a population study the author and co-workers have earlier shown that smokers have higher blood glucose values early postload and lower values at two hours compared with nonsmokers. Eighty-three patients, all with intermittent claudication but with a normal OGTT, have now been studied according to their response to an oral glucose load. The blood flow resistance during reactive hyperemia, as measured with a calf plethysmograph, was compared between subjects in the quartile of patients with the highest forty-five-minute blood glucose and those in the lowest quartile. The blood flow resistance was significantly higher in the group with a high forty-five-minute blood glucose, 13.3 +/- 1.34 vs 9.5 +/- 0.65 (mean +/- SEM), p less than 0.02. Blood pressure and blood lipids were similar in the two groups. It is suggested that an exaggerated early response in the OGTT might be an independent risk factor for peripheral arterial disease.
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PMID:Lower extremity blood flow in intermittent claudication--the role of oral glucose tolerance test. 366 4

Flow-independent angiography (FIA), an approach that isolates arterial blood using MR relaxation characteristics rather than flow effects, was evaluated for application in peripheral vascular disease (PVD). First, pilot studies were conducted in which FIA coronal projection images were obtained from controls and symptomatic patients with PVD to assess clinical utility. All control images corresponded to the expected leg arterial anatomy with little interference from deep veins (one of five) and muscle (zero of five). Superficial venous signal was less well suppressed in comparison to deep veins (four of five). Images of symptomatic patients were less consistent with difficulty suppressing muscle and deep venous signal in some cases and edema when present. We then compared T2 values for muscle (T2m, tibialis anterior), arterial blood (femoral and popliteal arteries), and venous blood (femoral, popliteal, and saphenous veins) in controls (n = 8) and symptomatic patients with intermittent claudication (n = 5) or ischemic rest pain (n = 7). Changes in T2 measurements of various tissues accounted for poorer contrast in symptomatic patients. Patients with ischemic rest pain had significantly higher T2m compared with controls (T2m = 39.3 +/- 2.1 (1 standard error of the mean [SEM]) versus 30.9 +/- .4, P < .01). For all measurements, other than saphenous vein, variances were greater in symptomatic patients. To realize the inherent advantages of FIA for this clinical application, additional work on suppression of signals from muscle, veins, and edema is required. One promising approach involves shifting from projection images to three-dimensional acquisitions for improved tissue suppression.
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PMID:Flow-independent angiography for peripheral vascular disease: initial in-vivo results. 924 81

Peripheral arterial disease (PAD) is a major cause of morbidity and mortality. Endothelial function, which is a measure of vascular health, is impaired in patients with PAD. We examined the effects of 6 months of aerobic exercise rehabilitation on brachial artery endothelial function, assessed using high-frequency ultrasonography, and calf blood flow in 19 older PAD patients (age 69 +/- 1 years, mean +/- SEM) with intermittent claudication (ankle to brachial artery index of 0.73 +/- 0.04). After exercise, the time to onset of claudication pain increased by 94%, from 271 +/- 49 to 525 +/- 80 seconds (p <0.01), and the time to maximal claudication pain increased by 43%, from 623 +/- 77 to 889 +/- 75 seconds (p <0.05). Exercise rehabilitation increased the flow-mediated brachial arterial diameter by 61%, from 0.18 +/- 0.03 to 0.29 +/- 0.04 mm (p <0.005), as well as the relative change in brachial arterial diameter from the resting state by 60%, from 4.81 +/- 0.82% to 7.97 +/- 1.03% (p <0.005). Maximal calf blood flow (14.2 +/- 1.0 vs 19.2 +/- 2.0 ml/100 ml/min; p = 0.04), and postocclusive reactive hyperemic blood flow (9.8 +/- 0.8 vs 11.3 +/- 0.7 ml/100 ml/min; p = 0.1) increased 35% and 15%, respectively. In conclusion, exercise rehabilitation improved ambulatory function, endothelial-dependent dilation, and calf blood flow in older PAD patients with intermittent claudication.
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PMID:Effects of exercise rehabilitation on endothelial reactivity in older patients with peripheral arterial disease. 1116 69

The purpose of this study was to determine whether peripheral arterial disease (PAD) subjects had impaired temporal and spatial gait characteristics compared to non-PAD controls at preferred and rapid self-selected walking paces. A total of 28 PAD subjects with intermittent claudication (age = 71 +/- 1; mean +/- SEM) and 15 non-PAD controls with at least one cardiovascular risk factor but no ambulatory leg pain (age = 71 +/- 1) were recruited. Gait parameters consisting of velocity, cadence, stride length, swing time, stance time, single-support time, double-support time, and base of support were recorded at the preferred and rapid walking paces. At the rapid walking pace, velocity was 22% slower (p < 0.001) in the PAD subjects compared with the non-PAD controls (99.9 +/- 3.3 vs. 117.5 +/- 5.3 cm/s) due to an 8% (p = 0.019) slower cadence (99.9 +/- 1.7 vs. 103.3 +/- 2.4 steps/min) and a 14% (p < 0.001) shorter stride length (119.8 +/- 2.9 vs. 135.8 +/- 4.2 cm/stride). The PAD subjects spent 5% less of the gait cycle in the swing phase (p = 0.006) and 3% more in stance (p = 0.006) than their non-PAD counterparts. During the stance phase, the PAD subjects spent 5% less of the gait cycle in single-stance (p=0.004) and 16% more in double-stance (p = 0.007). Similar results were obtained at the preferred walking pace. In conclusion, compared with the controls, PAD subjects adopted an ambulatory pattern that favored greater gait stability at the expense of greater walking speed at either their preferred or rapid self-selected paces.
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PMID:Altered gait profile in subjects with peripheral arterial disease. 1135 58

Patients with peripheral arterial disease (PAD) and intermittent claudication often have coronary artery disease (CAD) and other comorbid medical problems. There is a paucity of information on the impact of coexistent medical conditions on exercise capacity and functional status in patients with PAD. This study examined the impact of CAD, diabetes, cigarette smoking, prior peripheral surgical revascularization and other medical conditions on claudication pain times and peak oxygen capacity (VO2) during maximal effort treadmill testing in 119 male outpatient volunteers (ankle-brachial index (ABI) of 0.65 +/- 0.2, mean +/- SEM) with a history of Fontaine Stage II PAD. Smoking status was significantly related to ambulatory function. Current smokers had a lower peak VO2 expressed in l/min than either former or never smokers (ANCOVA adjusted for age, p = 0.003). However, after adjustment for body weight, there was only a trend for a difference in peak VO2 between current (13.2 +/- 0.5 ml/kg per min), former (14.2 +/- 0.4 ml/kg per min) and never (15.4 +/- 1.0 ml/kg per min) smokers (ANCOVA, p = 0.10). Current smokers had a shorter time to onset of claudication pain (p = 0.023) and shorter maximal claudication pain times (p = 0.029) than former or never smokers (p = 0.023). The ABI 1 min after cessation of exercise was also lower in smokers compared to former and never smokers (p = 0.018). There were no significant differences in functional performance measures or time to recovery from maximal claudication pain when patients were categorized on the presence or absence of CAD, diabetes, peripheral revascularization, arthritis, hypertension or dyslipidemia. Therefore, smoking adversely affected exercise capacity in these PAD patients, whereas the presence of CAD, diabetes and other medical problems had a relatively minor impact on exercise capacity. In conclusion, the relatively minor impact of comorbid medical conditions on walking ability in patients with PAD reflects the overwhelming limitation in ambulatory function due to the claudication pain.
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PMID:Comorbidities and exercise capacity in older patients with intermittent claudication. 1178 70

The purpose of this study was to determine whether peripheral arterial disease (PAD) subjects with a history of falling had more impaired physical function than their non-falling counterparts. A total of 120 PAD subjects (26%) who had fallen over the past year and 346 PAD subjects (74%) who had not fallen were evaluated. Additionally, subjects were characterized on physical function, consisting of balance, strength, ambulatory function, and monitored physical activity, as well as PAD-specific measures of ankle/brachial pressure index (ABPI) and treadmill claudication distances. Full-tandem stance time was 19% shorter (p < 0.001) in the fallers than in the non-fallers (7.2 +/- 0.3 vs 8.9 +/- 0.1 s; mean +/- SEM), and the self-reported ability to climb stairs was 36% lower (27 +/- 4 vs 42 +/- 2%). Furthermore, the fallers were 126% more likely (p < 0.001) to report ambulatory stumbling and unsteadiness, took 14% longer (p = 0.022) to perform five sequential sit-to-stand transfers using an armless chair, covered 16% shorter distance (p < 0.001) during a 6-min walk test, and were 25% less physically active than the non-fallers. The groups had similar ABPI and treadmill claudication distances (p < 0.05). A history of falling was independently related to the self-reported ability to climb stairs, the full-tandem stance time, self-reported ambulatory stumbling and unsteadiness, and daily physical activity (multiple R = 0.47, p < 0.001). In conclusion, impairments in multiple domains of physical function were associated with a history of falling in PAD subjects with intermittent claudication. Furthermore, the link between poor physical function and falling was independent of PAD severity.
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PMID:The relationship between history of falling and physical function in subjects with peripheral arterial disease. 1195 87

Chronic ischemic pain is a leading cause of pain in the lower extremities. A neuropathic component in ischemic pain has been shown. Neuropathic pain questionnaires are established as a common tool in pain research. The aim of this study was to analyze the clinical nature and the character of chronic ischemic pain in peripheral arterial disease (PAD). One hundred and two patients suffering from symptomatic PAD (Fontaine stages II-IV) were surveyed using validated pain questionnaires (VAS, NPSI, S-LANSS, PDI, SF-MPQ). Pain related disability was 22.7+/-1.7 (mean+/-SEM) in patients with intermittent claudication (CI) and 34.0+/-2.3 in patients with critical limb ischemia (CLI). Neuropathic pain questionnaires revealed distinctly higher scores for CLI than for CI: The S-LANSS indicated pain of predominantly neuropathic origin in patients with CLI (17.2+/-0.8) compared to CI (6.7+/-0.8; p<0.001). Global NPSI scores were 34.1+/-3.1 for CLI and 6.6+/-1.1 for CI (p<0.001). S-LANSS and NPSI correlated well (Spearman's rho=0.779; p<0.001). The SF-MPQ revealed that patients with CLI scored significantly higher for pain descriptors stabbing, hot-burning, tender and cruel-punishing compared to those with CI. The results suggest that the character of ischemic pain changes from nociceptive pain in patients with CI to predominantly neuropathic pain in patients with CLI. A neuropathic pain component seems to be a serious aspect in CLI, while it is not in CI. Questionnaires might be a helpful tool to investigate and diagnose ischemic pain.
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PMID:Characteristics of chronic ischemic pain in patients with peripheral arterial disease. 1847 16