Journal of cardiovascular pharmacology
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J. Cardiovasc. Pharmacol. · Jan 1991
Review Randomized Controlled Trial Clinical TrialAntihypertensive treatment: is blood pressure-lowering the only goal?
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J. Cardiovasc. Pharmacol. · Jan 1991
ReviewFlunarizine in migraine prophylaxis: the clinical experience.
Apart from the treatment of migraine attacks, prophylaxis may be required when certain criteria of frequency, duration, or severity are met. In a series of placebo-controlled, double-blind studies, the effectiveness of the cerebral calcium antagonist flunarizine (Sibelium) in migraine prophylaxis was shown. In further investigations, the effectiveness of flunarizine was similar to that of propranolol, metoprolol, pizotifene, and methysergide. ⋯ Considering the benefit/risk relation, flunarizine and the beta-adrenergic agents propranolol and metoprolol are now regarded as the drugs of choice. The mechanism of action of flunarizine in migraine prophylaxis is largely unexplained, but the antihypoxic effect of flunarizine is discussed in this context. The search for predicting factors for a successful treatment with flunarizine and the investigation of an injectable solution for the treatment of acute migraine attacks must be left to future research.
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J. Cardiovasc. Pharmacol. · Jan 1991
ReviewThe treatment of hypertension: a therapeutic philosophy for the 1990s.
To date, a range of drugs are available that are generally well tolerated and effective in lowering blood pressure. Although they are successful in reducing stroke, renal failure, and cardiac failure, they have a disappointing and less than expected influence on coronary artery disease and its manifestations. The genetic and environmental factors determining susceptibility to atherosclerosis and coronary artery disease are now more clearly defined and interactions between risk factors and protective mechanisms recognized. ⋯ Dietary and hygienic measures (cessation of smoking and control of alcohol intake) should be combined where necessary with specific treatment of hypertension and hyperlipidemia. Future drug treatment must not only be effective and well tolerated but should complement other preventive approaches. In view of the increasing recognition that blood pressure treatment with a single drug is unlikely to be successful in all patients, there is likely to be a role in the future for pharmacologically coherent low-dose combinations of antihypertensive drugs.
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J. Cardiovasc. Pharmacol. · Jan 1991
ReviewEssential hypertension: hemodynamic and therapeutic changes over 20 years.
The hemodynamic disturbances in essential hypertension depend on the age of the subjects and the severity of the hypertensive state. In a 20-year follow-up study, we demonstrated a shift in the hemodynamic characteristics from a high output/normal resistance pattern in the early phase toward a low-flow/high-resistance pattern in the later period. The arteriovenous oxygen difference increased, particularly during exercise, and the oxygen reserve in venous blood decreased. ⋯ In contrast to the usual beta-blockers, these drugs reduce total peripheral resistance acutely, and reduce cardiac index considerably less; arteriovenous oxygen difference is more normal. In an acute study of carvedilol in 18 patients with essential hypertension, total peripheral resistance was reduced 8% at rest (supine) and 6% during exercise. Exercise heart rate was reduced 12%, but due to an increase in stroke index, the reduction in cardiac index was only 6%-considerably less than what is seen during treatment with conventional beta-blockers.
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J. Cardiovasc. Pharmacol. · Dec 1990
The acute effect of captopril on cerebral blood flow, its CO2 reactivity, and cerebral oxygen metabolism in human volunteers.
The present study was undertaken to examine the effect of captopril on cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2) and CO2 reactivity in eight young healthy volunteers. The mean arterial blood pressure (MABP) was measured intraarterially, and CBF was measured by inhaled xenon-1233. The CO2 reactivity was defined as the relative change in CBF per 0.1 kPa change in arterial CO2. ⋯ Considering the PaCO2 values between 4.0 and 6.5, the CO2 reactivity was 2.4%/0.1 kPa (2.1-2.4) at baseline and increased significantly to 2.9%/0.1 kPa (2.1-3.2) after captopril (p less than 0.05). No side effects were observed. The present study shows an overall unchanged CO2 reactivity; however, with an increased CO2 reactivity of the cerebral vessels for small changes in PaCO2 around the resting value of PaCO2 and a maintained coupling of CBF and CMRO2 after peroral captopril.