It is believed that aspirin counteracts some of the beneficial action of ACE inhibitors, although the mechanism involved are unknown. It has been speculated that bradykinin or substance P, both potenciated by ACE inhibitors, may be involved.
We have shown that exogenous bradykinin and substance P cause vasodilation in patients with heart failure, that there is no effect of intra arterial on its own, and thede is no effect or aspirin, intra arterial or oral, on the responses to bradykinin and substance P. Demonstrasion of these responsive to bradykinin and substance is novel in patients with heart failure, and is only partly consistent with previous wodk in vitro, in animals and in healty vollunterss.
Rabu, 17 Juni 2009
Suboptimal Dosage of ACEI in Heart Failure
Previous mortality studies have indicated that the ideal target dosage of ACE inhibitors in patients with chronic heart failure is 50-100% of the maximum recomaded drug dosage.
The evidence available is consistent with the recommindation seen to recur in the medical literatur-that is, to titrate the dose of ACE inhibitor to the highest tolerated by each patient, aiming to at least meet the target doses of the major mortality studies. The problems is that the typical dose pescribed in current common practice falls weel short of this. critically, the findings of our study suggest that arround 25% of patients with chronic heart failure are receiving a suboptimal dose of ACE inhibitor without good reason. There also remains some room for improving the proportion of patients sterted on an ACE inhibitor.
The evidence available is consistent with the recommindation seen to recur in the medical literatur-that is, to titrate the dose of ACE inhibitor to the highest tolerated by each patient, aiming to at least meet the target doses of the major mortality studies. The problems is that the typical dose pescribed in current common practice falls weel short of this. critically, the findings of our study suggest that arround 25% of patients with chronic heart failure are receiving a suboptimal dose of ACE inhibitor without good reason. There also remains some room for improving the proportion of patients sterted on an ACE inhibitor.
Difficulties Associated with Treatment in Eldery Patients
Heart failure is common in eldery patients but may be very difficult to treat due to the presence of polypharmacy, multipple commorbid diagnose and agreater susceptibility to adverse events. However, few data are available to quantify the range and extent of these underlying problems as fail eldery patients are seldom included in major heart failure clinical trials.
This retrospective study highlights some of the diagnostic and management difficulties associated with heart failure in the frail older patients. Although the numbers studied are relatively smal and the data collected were from routine daily practice. The study ilustrates a number of important issues in the very old heart failur patients. Although the majority of the findings are not new, the study provides quantitative data on polypharmacy, incontinence, cognitive disfunction and depresion in the eldery heart failure patiens. Awareness of the extent and implication of these associated factors may facillitate optimum management.
This retrospective study highlights some of the diagnostic and management difficulties associated with heart failure in the frail older patients. Although the numbers studied are relatively smal and the data collected were from routine daily practice. The study ilustrates a number of important issues in the very old heart failur patients. Although the majority of the findings are not new, the study provides quantitative data on polypharmacy, incontinence, cognitive disfunction and depresion in the eldery heart failure patiens. Awareness of the extent and implication of these associated factors may facillitate optimum management.
Insufficient Treatment of Heart Failure in Eldery
The rate of mortality and morbidity are high in elderly patients with congestive heart failure.
Although age has been confirmed to be a powerful predictor of mortality (in elderly patients with hypertention), evidence based recomanded treatments are less often prescribed and laboratory test are less frequently performed. Thus, to improve quality of care and outcome of older patients, there is a need to develope targeted management strategies to better translate the advancing medical knowledge into clinical practice.
Although age has been confirmed to be a powerful predictor of mortality (in elderly patients with hypertention), evidence based recomanded treatments are less often prescribed and laboratory test are less frequently performed. Thus, to improve quality of care and outcome of older patients, there is a need to develope targeted management strategies to better translate the advancing medical knowledge into clinical practice.
Blood Pressure and Angiotention Converting Enzyme Inhibitor Use in Hypertensive Patients with Cronic Renal Insufficiency
Control of hypertention in patients with cronic renal failure rduce the risk of progression to end stage renal disease and development of cardiovascular disease. In particular, use of ACE inhibitors has been associated with a delayed loss of renal funtion, although, it is curently unknown if this property is being utilised by prescribing physicians.
We conclude that achieved BP control among hypertensive CRI (chdonic renal insufficiency) subject, thoug no worse than that among those without CRI, remained suboptimal. Patient with a CrCI (creatinin clearence) 21 to 40 mL/min - a population that should be targeted for ACE inhibitor treatment-were actualy less likely to be prescribed ACE inhibitors0. Our data identify areas in which the care of patients with CRI can be improved. Education concerning the importance of agressive BP lowering and apropriate ACE inhibitors use, as well as earlier referal to njephrologist for-co management of CRI patients, may improve the care of the large number of ambulatory patients with reduce renal function.
We conclude that achieved BP control among hypertensive CRI (chdonic renal insufficiency) subject, thoug no worse than that among those without CRI, remained suboptimal. Patient with a CrCI (creatinin clearence) 21 to 40 mL/min - a population that should be targeted for ACE inhibitor treatment-were actualy less likely to be prescribed ACE inhibitors0. Our data identify areas in which the care of patients with CRI can be improved. Education concerning the importance of agressive BP lowering and apropriate ACE inhibitors use, as well as earlier referal to njephrologist for-co management of CRI patients, may improve the care of the large number of ambulatory patients with reduce renal function.
Effect on Progression of Arterial Stiffness in Patients with Hypertention
Arterial stiffness, reflected by a hight pulse4 wave velocity (PWV), is suspected to be an independent risk factor for cardiovascular disease. patients with hypertention often have increased arterial stiffness, but it is unknown if a causal relationshipexist between the two.
The present longitudinal study shows that accelerated arterial aging in treated hypertensive subjects is in large measure explained by uncontroled blood pressure levels, high HR (heart rate), and altered renal function. controlling blood pressure and lowering HR could reduce age related progression of arterial stiffness.
The present longitudinal study shows that accelerated arterial aging in treated hypertensive subjects is in large measure explained by uncontroled blood pressure levels, high HR (heart rate), and altered renal function. controlling blood pressure and lowering HR could reduce age related progression of arterial stiffness.
Physician-related Barriers to Effective Management
It has been suggested that primary care physicians may not be agressive enought in their management of hypertention. Potential barriers to mthe effective management of hypertention have been identified; these include physician practice patterns, patient management time constrains, drug adverse events, and the complexcity of prescribing and/or monitoring antihypertensive drug regiment.
our finding suggest that a important reason why physicians do not treat hypertention more aggressively is that they are willing to accept an elevated systolic BP in their patients. Our findings seem to suggest that physicians are familiar with the guidelines for treating hypertention but do not implement this knowledge into their everyday practice. this has important publict health impact becouse of the possitive association between systolic BP and cardiovascullar disease. The findings of this study provide useful information for designingeffective physician interventions for the management of patients with uncontrolled hypertention.
our finding suggest that a important reason why physicians do not treat hypertention more aggressively is that they are willing to accept an elevated systolic BP in their patients. Our findings seem to suggest that physicians are familiar with the guidelines for treating hypertention but do not implement this knowledge into their everyday practice. this has important publict health impact becouse of the possitive association between systolic BP and cardiovascullar disease. The findings of this study provide useful information for designingeffective physician interventions for the management of patients with uncontrolled hypertention.
Effect on Perindopril on Autonomic Modulation of the Heart and Left Ventricular Function
Left ventricular (LV) dysfunction and decreased heart rate variabilty are independent predictors of mortality and it is unclear if there is a relationship between the two. ACE inhibitors have been shown to reduce the risk of morbidity and mortality in patients with heart failure. But the exact mechanisms involved are unknown. Effects on the autonomic nervous system and humoral balance are reflected in changes in heart rate variability.
Therapy with perindopril 2 mg/d appears to decrease sympathetic modulation of the heart, increase parasympathetic modulation of the heart, and improve LV function, all of which are prognostic factors in patients with HF (heart failure) after AMI.
Therapy with perindopril 2 mg/d appears to decrease sympathetic modulation of the heart, increase parasympathetic modulation of the heart, and improve LV function, all of which are prognostic factors in patients with HF (heart failure) after AMI.
Firs Dose Haemodynamic Tolerance
ACE inhibitors reduce morbidity and mortality in patients with heart fillure and are considered first-line treatments. However, hypotention, with potentialy significant consequentces, may occur in some patients following their first dose. Studies haves suggested that not all ACE inhibitors induce first dose hypotention and that some may be more suitable to initiate therapy than others.
In the clinical setting we conclude that a qualitative difference exists between the different ACE inhibitors with respect to first dose hypotention in patients with heart failure. Perindopril has shown less reduction in blood pressure, with a lower number of symtomatic or asymtomatic hypotensive episodes and therefore appears to be amore suitable ACE inhibittors for the initiation of heart fillure treatment than the other agents tasted.
In the clinical setting we conclude that a qualitative difference exists between the different ACE inhibitors with respect to first dose hypotention in patients with heart failure. Perindopril has shown less reduction in blood pressure, with a lower number of symtomatic or asymtomatic hypotensive episodes and therefore appears to be amore suitable ACE inhibittors for the initiation of heart fillure treatment than the other agents tasted.
Efficacy of Perindopril on Haemodynamic Parameters
Early arterial wave reflections increase central artery and left ventricular pressures during late systole. It has been proposed that delaying arterial wave reflections may control hypertention and prevent cardiac complications.
Both drugs induced a drecease in carotied artery PP (pulse pressure) via quite different mechanisms; a significant reduction in AWR (arterial wave reflections) following perindopril and a decrease in heart ejection variables and aortic PWV (pulse wave velocity) following atenolol.
Both drugs induced a drecease in carotied artery PP (pulse pressure) via quite different mechanisms; a significant reduction in AWR (arterial wave reflections) following perindopril and a decrease in heart ejection variables and aortic PWV (pulse wave velocity) following atenolol.
Efficacy and safety of perindopril In Acute Myocardial Infarction
ACE inhibition is beneficial in patients with acute myocardial infarction (MI) but can cause hypotention which is associated morbidity and mortality. Perindopril has been shown to cause less hypotention in heart failure patients.
In patients with AMI (acute myocardial infarction), perindopril cause less hypotention than captopril on intiation of therapy. During the first 6 hours after the initial dose, the minimum levels of sistolic and diastolic BP were higher with perindopril, whereas the maximum decrease in BP observed was significantly earlier and greather with captopril. As a result the target dose of ACE inhibitor was attained in a higher proportion of patients on initiation...there was no difference in the clinical out come betwen the 2 treatments at 6 month
In patients with AMI (acute myocardial infarction), perindopril cause less hypotention than captopril on intiation of therapy. During the first 6 hours after the initial dose, the minimum levels of sistolic and diastolic BP were higher with perindopril, whereas the maximum decrease in BP observed was significantly earlier and greather with captopril. As a result the target dose of ACE inhibitor was attained in a higher proportion of patients on initiation...there was no difference in the clinical out come betwen the 2 treatments at 6 month
Selasa, 16 Juni 2009
Anti Ischemic Properties of Perindopril
ACE inhibition is benificial in patients with coronary artery desease, but the mecanisms of action involved are unknown. it si possible thatb benefits effects observed during exercise in patients with coronary disorders are due to non-cardiac effects, such as periperal arterial of pulmonary function, rather than effect on cardiac function.
this study investigated the efficacy and tolerability of long-term treatment with perindopril(dai-ichi pharmaceutical) for the prevention of strees-induced myocardial ischemia in patients with coronary disorders.
In the present study, that the long-term treatment with perindopril prolonged the time to onset of symtomps and reduced the magnitude of electrocardiographic ST-segment changes and the left ventricullar wall motion score in the DSE(Dobutamin Stress Echocardiography) test. this is, to out knowledge, the first direct evidence t5hat long-term blocade patients with CAD(Coronary Artery Disease).
this study investigated the efficacy and tolerability of long-term treatment with perindopril(dai-ichi pharmaceutical) for the prevention of strees-induced myocardial ischemia in patients with coronary disorders.
In the present study, that the long-term treatment with perindopril prolonged the time to onset of symtomps and reduced the magnitude of electrocardiographic ST-segment changes and the left ventricullar wall motion score in the DSE(Dobutamin Stress Echocardiography) test. this is, to out knowledge, the first direct evidence t5hat long-term blocade patients with CAD(Coronary Artery Disease).
Perindopril Restores Endothelial Dysfunction In Patients With Ischemic heart disease
ACE Inhibitors such as perindopril improve outcomes in patients with ischemic heart disorders, althought the cellular mechanisms of action are not fully understood. this study investigated the effect of perindopril on expression of ACE, angiotensin type 1 reseptors, inducible nitric oxide synthase (NOS) and endothelial NOS in patients with ischemic heart disorders.
ACE inhibiton with perindopril for more than 2 weeks supressed both circulating and tissue ACE in the edothelium and adventitia of blood vessels and increased vascular eNOS (endothelial NOS) and iNOS (inducible NOS) expression in patient with ischemic heart desease. These effects of ACE inhibiton may play an important role in restoring endothelial dysfunction in patient with iscemic haert desease. However, ACE inhibition is also associated with increased vascular AT1 (angiotenton type 1) receptor expression, our results suggest that more animals studies and clinical trials are therefore required to addres further this important issue.
ACE inhibiton with perindopril for more than 2 weeks supressed both circulating and tissue ACE in the edothelium and adventitia of blood vessels and increased vascular eNOS (endothelial NOS) and iNOS (inducible NOS) expression in patient with ischemic heart desease. These effects of ACE inhibiton may play an important role in restoring endothelial dysfunction in patient with iscemic haert desease. However, ACE inhibition is also associated with increased vascular AT1 (angiotenton type 1) receptor expression, our results suggest that more animals studies and clinical trials are therefore required to addres further this important issue.
Senin, 08 Juni 2009
Ace Inhibitor and Cerebral Perfusion
Introduction
Ofer the last fifteen years a number of large trials have demonstrated the benefit of angiotensin-converting enzyme (ACE) inhibitors in a wide variety diseases states. Most recently, the Perindopil Protection Against Recurent Stroke Study (PROGRESS) has provided evidence that an ACE inhibitor-based regimen reduces the incidence of stroke. Althought the mecanism which underlies this benefit remains undevined, the result of the progressstudy have stimulated interest in the neurohumoral control of the cerebrovascular circulation, as they suggest thatb ACE inhibision may lead to improvement in impaired intracranial haemodinamics. this articel will provide an overviewof the role of the renin angiotension system in the modulasion of cerebral blood flow, and will discusesthe effectof ACE inhibision on blood pressuran cerebral perfussion in the contect of hipertensionand cerebovascular desease.
Ofer the last fifteen years a number of large trials have demonstrated the benefit of angiotensin-converting enzyme (ACE) inhibitors in a wide variety diseases states. Most recently, the Perindopil Protection Against Recurent Stroke Study (PROGRESS) has provided evidence that an ACE inhibitor-based regimen reduces the incidence of stroke. Althought the mecanism which underlies this benefit remains undevined, the result of the progressstudy have stimulated interest in the neurohumoral control of the cerebrovascular circulation, as they suggest thatb ACE inhibision may lead to improvement in impaired intracranial haemodinamics. this articel will provide an overviewof the role of the renin angiotension system in the modulasion of cerebral blood flow, and will discusesthe effectof ACE inhibision on blood pressuran cerebral perfussion in the contect of hipertensionand cerebovascular desease.
Langganan:
Postingan (Atom)