Neutrophil arachidonic acid level and adhesive capability are increased in essential hypertension

BACKGROUND

We recently demonstrated that arachidonic:linoleic acid ratio of erythrocytes of essential hypertension patients is greater than normal.

OBJECTIVE

To investigate fatty acid composition, capability for adhesion to biological substrate and expression of beta2 integrins of leucocytes obtained from peripheral blood and skin window exudate of essential hypertension patients.

DESIGN

Neutrophil activation state was evaluated by reproducing the various conditions occurring in vivo during the life of the cell (i.e. under the 'resting' condition, such as in peripheral blood, and 'primed' condition, such as after transmigration through the endothelium and after administration of specific chemo-attractants). Because both peripheral blood and skin window leucocytes of the subjects were obtained on the same day, we could be sure that there had been no dietary influences on changes in levels of fatty acid. Thus, the observed changes should reliably reflect the metabolic rate of utilization of fatty acids coupled to the activation and migration of cells.

RESULTS

Leucocytes from essential hypertension patients were richer in arachidonic acid than were the corresponding cells from normotensive subjects; this difference was also evident for functionally activated skin window leucocytes, in spite of there having been a greater loss of poly-unsaturated fatty acids and arachidonic acid after migration. Moreover, a greater than normal arachidonic acid:linoleic acid ratio was shown for the first time to apply for leucocytes of essential hypertension patients, so extending our previous findings on the erythrocytes. Leucocytes from essential hypertension patients, collected both from peripheral blood and from skin window exudate, proved far more adhesive than the corresponding cells from age-matched and sex-matched controls, but this was not associated with a quantitative hyperexpression of beta2 integrins.

CONCLUSIONS

The results suggest that an increase in availability of arachidonic acid in leucocytes could be a further expression of the generalized disturbance of fatty acid levels associated with essential hypertension and that a condition of hyperadhesion of neutrophils could occur spontaneously in vivo during the course of hypertension.

Erythrocyte membrane lipids and serum selenium in post-viral and alcoholic cirrhosis

Erythrocyte-membrane fatty acid composition and cholesterol content were evaluated along with serum selenium in 33 patients with liver cirrhosis and in 40 normal subjects. Thirteen patients were suffering from post-viral (group V) and 20 from alcoholic (group A) cirrhosis. The aim of the study was to elucidate whether membrane lipid abnormalities in cirrhosis were linked to the aetiology of the disease or whether they were the results of the cirrhotic process itself. The patients presented a significant increase in membrane cholesterol, palmitic acid (C16:0) and saturated fatty acids (SFA), and a decrease in polyunsaturated fatty acids (PUFA) and polyunsaturated/saturated fatty acids ratio (P/S) compared with the control group. Serum selenium levels were significantly reduced. When patients were subdivided according to aetiology, the alcoholic patients showed greater lipid composition abnormalities than the viral cirrhotics (higher levels of SFA and lower PUFA and P/S), while pathologic palmitic acid, membrane cholesterol and serum selenium values were confirmed in both groups of patients. In conclusion, low serum selenium and a series of erythrocytes membrane lipid composition abnormalities would appear to be features peculiar to cirrhosis. Alcoholic cirrhotics, on the other hand, show a more deranged erythrocyte membrane lipid profile.

Increased membrane protein phosphorylation and anion transport activity in chorea-acanthocytosis

BACKGROUND AND OBJECTIVE

Chorea-acanthocytosis is a disorder characterized by neuronal degeneration and the presence of acanthocytic erythrocytes on blood smear. The abnormal function and structure of the membrane protein band 3 are considered to be of pathogenetic relevance in determining the erythrocyte defect.

METHODS

In a clinically evident case of chorea-acanthocytosis, the following parameters were investigated: membrane cholesterol and fatty acid composition, sulphate influx (as a measure of the anion transport activity), membrane protein phosphorylation, membrane casein and tyrosin-kinase activities; moreover, the promoter and all exons of the EPB3 gene were screened for possible mutations by single strand conformational polymorphism (SSCP) study.

RESULTS

The sulphate influx, the Ser/Thr phosphorylation level, and the membrane casein-kinase activity were increased in chorea-acanthocytosis compared with normal controls. In the intact vanadate-treated 32P-labelled erythrocytes, Tyr-phosphorylation of the cytoplasmic domain of band 3, as well as the poly(Glu, Tyr) kinase activity in the membranes, were enhanced in the patient's sample. Apparent molecular weight and concentration of band 3 on SDS/PAGE analysis, membrane fatty acid composition and cholesterol/phospholipid molar ratio were normal and the SSCP study of EPB3 exons did not show any abnormal polymorphisms.

INTERPRETATIONS AND CONCLUSIONS

An abnormal degree of phosphorylation of membrane proteins, in particular of band 2 (beta-subunit) and band 3, may contribute in determining both change of cell shape and increased anion transport in chorea-acanthocytosis.

Increased membrane ratios of metabolite to precursor fatty acid in essential hypertension

Desaturase enzymes are responsible for the conversion of essential fatty acids to the longer-chain eicosanoid precursors. These enzymes require zinc as an essential cofactor, and the following ratios-C20:4/C18:2, C20:5/C18:3, and C22:6/C20:5-are considered indexes of their activity. We analyzed these parameters in plasma and erythrocyte membranes of 105 essential hypertensive patients, 20 white coat hypertensive patients, and 100 age-matched normotensive control subjects. Dietary analysis excluded significant quantitative and qualitative differences in fatty acid dietary intake between essential hypertensive patients and normotensive control subjects. Zinc levels and C20:4/C18:2, C20:5/C18:3, and C22:6/ C20:5 ratios were significantly higher in essential hypertensive patients than control subjects, whereas white coat hypertensive patients showed intermediate values for all these parameters. These data provide evidence for an alteration in fatty acid metabolism of essential hypertensive patients, consistent with increased activity of desaturase enzymes. The consequent greater bioavailability of eicosanoid precursors, and in particular of arachidonic acid, could affect several vascular functions and have a bearing on the pathogenesis or complications of hypertension.

Relationships between serum uric acid and lipids in healthy subjects

BACKGROUND

Raised serum uric acid (SUA) levels are associated with conditions at high risk for coronary heart disease. SUA levels can be partly modified by the diet, but little is known about the association of SUA with several dietary factors, particularly the quality of ingested lipids.

METHODS

The associations between SUA levels and biological and dietary factors were investigated in a sample of 90 healthy subjects (45 males and 45 females; ages 55.6 +/- 18 years) living in Nove, a village near Vicenza (Veneto Region, northern Italy). A careful selection of subjects to exclude those with chronic or acute disease (influencing SUA directly or indirectly through their pharmacological treatments) was obtained with the collaboration of three general practitioners operating in Nove.

RESULTS

SUA was higher among men than among women and higher among postmenopausal women than among women of child-bearing age (P < 0.01). Stepwise multiple linear regression analysis of the population as a whole showed that serum triglycerides and total RBC omega-6 PUFA were significant and independent predictors of a consistent proportion of serum uric acid variability (R = 0.59; R2 = 0.332; P < 0.001). Taking men and postmenopausal women together, the result was the same.

CONCLUSIONS

Triglycerides and SUA are related even in the normal population and not only in "Syndrome X." Dietary enrichment with omega-6 PUFA might be useful for the negative modulation of SUA.

Changes of fatty acid composition and oxidative metabolism of human neutrophils migrating into an inflammatory exudate

The peripheral blood neutrophils and the neutrophils accumulated into a skin-window experimental exudate were compared for their ability to release superoxide anion (O2-) and for their fatty acid composition, determined by capillary gaschromatography. The basal O2- release and the phorbol myristate acetate (PMA)-induced O2- release were not significantly different in the two neutrophil populations, while in response to formyl-methionyl-leucyl-phenylalanine (fMLP) the exudate cells showed an activity that was two fold higher than that of blood cells. The most significant changes of fatty acid composition of exudate versus blood cells were the following: i) increase of C16:0 (palmitic acid) from 21.3 +/- 1.2% to 23.5 +/- 1.3% (+ 10.2%) of total fatty acids (p < 0.001),ii) increase of C18:2 (linoleic acid) from 9.3 +/- 1.7% to 11.0 +/- 2.1% (+ 18.3%) (p = 0.005), iii) decrease of C20:4 (arachidonic acid) from 12.8 +/- 1.6% to 10.6 +/- 1.2% (-17.3%) (p < 0.001), whereas C18:1 (oleic acid) did not change. The total content of saturated or unsaturated fatty acids did not change. In exudate cells, a strong negative correlation was found between palmitic acid content and O2- release in response to both fMLP and PMA (r = -0.52, p < 0.02 and r = -0.49, p < 0.05, respectively) whereas arachidonic acid correlated positively, but weakly, with O2- (r = 0.40, p = 0.07 and r = 0.47, p = 0.05, with fMLP and PMA as stimulants respectively). A positive correlation was also found between the arachidonic acid content of blood cells and the number of cells that migrated into the inflammatory exudate. These results indicate that the process of extravasation from blood into the exudate causes specific and consistent modifications of the fatty acid composition of neutrophils and suggest that these modifications have a role in the activation and the regulation of the O2- forming system.

Influences of lipid and non-lipid nutritional parameters on factor VII coagulant activity in normal subjects: the Nove study

Community-based studies have suggested that the dietary intake of total fat influences factor VII coagulant activity (FVIIc), a predictor of fatal events from coronary heart disease (CHD). Nevertheless, the question whether the quality of dietary fats, with special reference to fatty acids (FAs), influences FVIIc is unsolved. The authors investigated in 90 healthy volunteers living in Nove, a village near Vicenza (northern Italy), the relationships between FVIIc and the plasma concentration of individual FAs. Several indices of other nutritional factors that have recently received increasing attention as determinants of CHD risk (antioxidant vitamins A and E, oligoelements) were also included in the multivariate analysis. The stepwise multiple linear regression analysis revealed body mass index (BMI), and the concentrations of plasma stearic acid (C18:0) and serum copper as significant independent predictors of a substantial proportion of FVIIc variability (R = 0 center dot 52; R2 = 0 center dot 27; P < 0 center dot 001). This study substantially supports the role of the plasma concentration of stearic acid as an important factor in modulating FVIIc.

Omega-3 polyunsaturated fatty acid supplements and ambulatory blood pressure monitoring parameters in patients with mild essential hypertension

OBJECTIVE

To evaluate the effects of low doses of omega-3 polyunsaturated fatty acids on ambulatory blood pressure monitoring parameters in a group of mild essential hypertensives.

PATIENTS

We studied 24 consecutive essential hypertensive patients from our outpatient clinic with mild hypertension (diastolic blood pressure < or = 105 mmHg), no previous treatment for 4 weeks at least and no other disease.

METHODS

After a 3-month run-in period, the patients entered an intervention phase and were given 3 g omega-3 polyunsaturated fatty acids (85% eicosapentaenoic and docosahexaenoic acid concentrate) daily for 4 months; this phase was followed by a 4-month washout period. Ambulatory blood pressure monitoring was performed at the end of each phase; erythrocyte membrane fatty acids were assessed to check compliance.

RESULTS

After 4 months of treatment, erythrocyte omega-3 polyunsaturated fatty acids significantly increased but average systolic and diastolic blood pressure and the heart rate did not significantly change; no significant variations were recorded in blood pressure or heart rate variability (assessed as blood pressure and heart rate SD) nor in the diurnal blood pressure rhythm. After washout, a significant decrease was observed in erythrocyte omega-3 polyunsaturated fatty acids but the ambulatory blood pressure monitoring parameters were not substantially modified.

CONCLUSIONS

The present data show that low doses of omega-3 polyunsaturated fatty acids as a single treatment are not effective in lowering blood pressure or the heart rate in mild essential hypertensive patients, despite a significant change in fatty acid cell membrane composition. Nor does this treatment seem likely to affect blood pressure variability or the diurnal rhythm.

[Atrial septal aneurysm. Report of two clinical cases and review of the literature]

We report two cases of atrial septal aneurysm, one associated with paroxysmal supraventricular tachycardia, the second with atrial septal defect. In both cases there were verified some transitory ischemic attacks. Carotid ultrasonography excluded atherosclerosis lesions. Two-dimensional transthoracic echocardiography showed an atrial septal aneurysm which, in the second case, was associated with atrial septal defect as demonstrated by color Doppler. The therapy is discussed in the case of septal atrial aneurysm associated with transitory ischemic attack, anticoagulant therapy is indicated; in the other, surgical correction of the defect is necessary.

[Reduced endothelium-dependent peripheral vasodilation in the aged]

Endothelial dysfunction may be present years before the clinical manifestations of atherosclerosis, which is particularly frequent in the late decades of life. Therefore, we have evaluated the presence of endothelial dysfunction in the elderly by measuring, by echo-Doppler technique, the vasodilatation of brachial artery in response to the hyperemia following forearm occlusion and decompression, a response that is dependent on endothelial function. We studied 10 subjects > 65 years (mean 72 +/- 8) and 10 subjects < 65 years (mean 40 +/- 6) all without clinical signs and without risk factors for atherosclerosis. The increase in brachial arterial flow during reactive hyperemia was similar in the young and elderly subjects (152 +/- 74% vs 129 +/- 63%, NS). While in the young at peak hyperemia we found a significant increase in brachial artery diameter from 3.4 +/- 0.9 to 4.1 +/- 1.0 mm (p < 0.005), there was no significant change in the elderly (from 3.0 +/- 0.7 to 3.1 +/- 0.7 mm, NS). In both groups sublingual glyceryl trinitrate produced a significant increase in brachial artery diameter (from 3.0 +/- 0.7 to 3.5 +/- 0.8 mm in the elderly, p < 0.01, and from 3.4 +/- 0.9 to 3.9 +/- 0.9 mm in the young subjects, p < 0.01, NS among groups), showing the absence in the elderly of structural vascular changes potentially responsible for absence of dilatation. In conclusion, elderly subjects without clinical signs or risk factors for atherosclerosis have a vascular endothelial dysfunction that may play an important role in pathologic processes of the cardiovascular system in the late decades of life.

Fatty acids and antioxidant micronutrients in psoriatic arthritis

OBJECTIVE

Red blood cell (RBC) fatty acid composition and micronutrient status were investigated in patients with psoriatic arthritis (PsA), with special regard to their relationship to clinical variables.

METHODS

RBC fatty acid composition, selenium status--serum selenium and RBC glutathione-peroxidase activity (GSH-Px)--plasma copper, plasma and RBC zinc, plasma vitamins A and E, and RBC thiobarbiturate reactive substances (TBARS) after H2O2 exposure as an index of susceptibility to lipoperoxidation were measured in 25 patients with PsA and in 25 sex and age matched controls.

RESULTS

A significant increase in C16:0 (p < 0.01) and in total saturated fatty acids (SFA) (p < 0.05), a significant decrease in C18:2 (p < 0.05), C20:4 (p < 0.001) and omega-6 polyunsaturated fatty acids (PUFA) (p < 0.001), a lower level of serum selenium (p < 0.01) and an increased level of plasma copper (p < 0.05) were observed in patients with PsA in comparison with controls. Significant direct correlations were observed between RBC SFA and erythrocyte sedimentation rate (ESR) (r = 0.445), duration of disease (r = 0.403) and morning stiffness (r = 0.434).

CONCLUSION

As in other reports for rheumatoid arthritis (RA), our results support the view that an abnormal fatty acid pattern might be a particular metabolic modification involved or associated with the pathogenesis of rheumatic diseases.

Effects of hypertension on intimal-medial thickness, left ventricular mass and aortic distensibility

The aim of the study was to evaluate arterial distensibility, intimal-medial thickening of the common carotid artery, left ventricular mass and the eventual correlations among these parameters in the hypertensive state. Our study population consisted of 89 hypertensive patients aged 35 to 80 years (mean age 60.8 +/- 10.6 years), and 76 normotensive subjects aged 45 to 85 years (mean age 61.2 +/- 11.1 years). Those patients constantly presenting systolic blood pressure values > or = 160 mmHg or diastolic blood pressure > 90 mmHg were diagnosed as hypertensive. Each patient underwent a B-mode echotomographic examination of the extracranial carotid tract performed with a Vingmed CFM 750 echotomographer with a 7.5 MHz probe and M-mode echocardiography with a Vingmed CFM 750 device equipped with a 3.0 MHz transducer. The results show the intimal-media thickness value in hypertensive patients (0.90 +/- 0.22 mm on the right and 0.92 +/- 0.22 mm on the left), was significantly greater than that in normotensive subjects (0.64 +/- 0.13 mm on the right and 0.64 +/- 0.13 mm on the left, p < 0.001); in hypertensive subjects, interventricular septum thickness (12.1 +/- 1.25 mm) was significantly greater than that in normotensive patients (9.1 +/- 0.77 mm, p < 0.001). In conclusion, we can say that hypertensive subjects have higher values of common carotid artery intimal-medial thickness than normotensives and that this finding is associated with the presence of left ventricular hypertrophy and with a reduction in arterial compliance. Vascular ultrasonography, as well as echocardiography and arterial mechanography can show, in hypertensive subjects, cardiac and vascular abnormalities in a non invasive way.

Selenium status, fatty acids, vitamins A and E, and aging: the Nove Study

To investigate the relationships between aging and selenium status, vitamins A and E, and plasma and erythrocyte fatty acids, we studied 105 healthy subjects (53 women, 52 men) living in Nove, a village near Vicenza (Veneto Region, northern Italy). The subjects were distributed equally for age and sex into four groups: group 1, 20-39 y; group 2, 40-59 y; group 3, 60-75 y; and group 4, > 75 y. A careful selection of subjects to exclude those with chronic or acute diseases was obtained with the collaboration of the three general practitioners operating in Nove. Aging was associated with a progressive decrease in selenium status and in the ratio of plasma and erythrocyte polyunsaturated to saturated fatty acids (P:S). Stepwise multiple linear analysis revealed age, vitamin A, and n-6 polyunsaturated fatty acids (PUFAs) as useful predictors of a substantial proportion of the selenium variability (R = 0.618, R2 = 0.382; P < 0.001) and age and erythrocyte oleic acid as predictors of erythrocyte glutathione peroxidase variability (R = 0.413, R2 = 0.17; P < 0.001).

Factors affecting the thiobarbituric acid test as index of red blood cell susceptibility to lipid peroxidation: a multivariate analysis

The relationship between formation of thiobarbituric acid reactive substances (TBARS) in red blood cells (RBC) after exposure to H2O2 and factors potentially able to modulate it was investigated by a multivariate analysis in 92 healthy volunteers. The independent covariates considered were: RBC membrane fatty acids and cholesterol, RBC antioxidant enzymes and zinc, plasma vitamins A and E and serum selenium, zinc and copper. The stepwise multiple-linear-regression analysis revealed RBC membrane fatty acids and cholesterol as predictors of a consistent proportion of the RBC-TBARS variability whereas none of the antioxidants entered the equation. The unsaturation index was the most important individual predictor; RBC-TBARS increased with increasing concentrations of total omega-3 polyunsaturated fatty acids, C 20:5 omega-3 and cholesterol, whereas they decreased with increasing concentrations of total monounsaturated fatty acids, saturated fatty acids, C 16:0 and C 18:0. It is suggested that formation of TBARS, at least in currently used conditions, reflects mainly the lipid composition of the tissue under investigation, without giving sufficient information about the status of the antioxidant defences.

Effects of nicardipine on intimal-medial thickness and arterial distensibility in hypertensive patients. Preliminary results after 6 months

BACKGROUND

The aim of this study was to evaluate the effects of nicardipine, at the dosage of 80 mg/day in two administrations, on blood pressure, intimal-media thickness of the common carotid artery and on arterial distensibility after 6 months of therapy. The study population consisted of 23 patients, 13 male and 10 female, mean age 61.7 +/- 10.1 years, with systolic blood pressure 170.4 +/- 14.5 mmHg and diastolic blood pressure 98.3 +/- 5.7 mmHg, affected by essential arterial hypertension of slight to moderate degree. Twenty-three subjects underwent high resolution B-mode echotomography of the common carotid artery, performed twice by the same operator within a one-week period. Treatment for 6 months with slow release Nicardipine at a dosage of 80 mg in two daily administrations was seen to be efficient in reducing systolic and diastolic blood pressure values. It also reduced the carotid-femoral pulse wave velocity. The results of our study show that 6 month's treatment with slow-release Nicardipine at 80 mg in two daily administrations, in effective reducing systolic and diastolic blood pressure values, and, to a slightly significant degree, in reducing the value of the intimal-medial thickness of the common carotid. Naturally the data which emerge from our study are preliminary and require a definitive analysis at the end the study, which is foreseen after a two year period from the enrolment of at least one hundred patients.

Red blood cells and platelet membrane fatty acids in non-dialyzed and dialyzed uremics

Three groups of patients with chronic renal failure (CRF), 16 non-dialyzed, 16 undergoing haemodialysis (HD), 16 undergoing continuous ambulatory peritoneal dialysis (CAPD), and 48 controls were examined. We analyzed the fatty acid composition in membranes from erythrocytes and platelets and the platelet malondialdehyde (MDA) production as an index of thromboxane metabolism. Marked differences in erythrocytes fatty acid composition were observed between patients with CRF and controls and, particularly, among the three groups of patients with CRF. Patients on CAPD were characterized by an increase in oleic acid, while haemodialyzed had a marked increase in arachidonic acid. Platelet fatty acid composition showed similar differences, suggesting a 'systemic' membrane abnormality. Platelet MDA was increased in haemodialyzed and positively correlated with the platelet arachidonate content.

[The evaluation of atherosclerotic lesions of the extracranial carotid arteries in hypertensive subjects. A study by B-mode and pulsed Doppler echotomography]

Arterial hypertension is considered an independent atherosclerotic risk factor. In hypertensive patients it increases cardiovascular morbidity and mortality risk. The aim of the study was to emphasize the presence of atherosclerotic lesions at the level of extracranial carotid tree in patients with essential arterial hypertension. In 110 hypertensive patients (63 males, 47 females) mean age 66 +/- 16 years, and in 100 normotensive patients (66 males, 34 females) mean age 65 +/- 15 years, high-resolution B-mode pulsed wave Doppler echotomography of internal, external and common carotid artery of both sides was performed. The value of the intimal-medial complex thickness of common carotid was measured, and the stenosis percentage evaluated by B-mode pulsed wave Doppler echotomography. Atherosclerotic plaques were classified according to their echogenic characteristic and surface; their localization was then evaluated. In hypertensive patients we observed the presence of common carotid intimal-medial thickening in 75.4%, atherosclerotic plaques in 60.9% and stenosis in 17.9%; 58.3% of these ones were localized at internal carotid, 33.3% at common carotid and 8.3% at external carotid. We observed that 36% of the 100 normotensive patients presented common carotid intimal-medial thickening (p < 0.001 versus hypertensives), 25% atherosclerotic plaques (p < 0.001 versus hypertensives) and 8% stenoses; 50% of these stenosis were localized at internal carotid, the second half at external carotid. In conclusion, high-resolution B-mode echotomography study with pulsed wave Doppler spectral analysis represents a necessary method to evaluate the condition of the extracranial carotid tree in patients with hypertension.

Effects induced by olive oil-rich diet on erythrocytes membrane lipids and sodium-potassium transports in postmenopausal hypertensive women

Since we have observed that monounsaturated fatty acids (MUFA) enriched diet modifies red cell membrane lipids and cation transport systems in normotensive subjects, we similarly evaluated a group of hypertensive patients undergoing an analogous dietary modification. In a group of 18 moderately hypertensive women, the diet was supplemented for two months with olive oil (about 45 g/day), which replaced an equal amount of seasoning fats. Before and after this period, red cell fatty acid composition was evaluated by gas-chromatography in order to verify diet compliance: a significant increase in oleic acid was observed, while the content of saturated and polyunsaturated fatty acids remained unchanged. After olive oil, maximal rates of Na-K pump (5580 +/- 329 vs 6995 +/- 390, p less than 0.001) and Na-K cotransport (Na-COT 544 +/- 52 vs 877 +/- 46, p less than 0.001: K-COT 790 +/- 76 vs 1176 +/- 66, p less than 0.001), cell Na content (9.58 +/- 0.4 vs 10.61 +/- 0.6, p less than 0.03) and passive permeability for Na (936 +/- 74 vs 1836 +/- 102, p less than 0.001) rose significantly. Although the reduction in maximal rate of the Li-Na CT after olive oil was not significant, it was the only cation transport parameter being correlated with the variations of membrane lipids, namely negatively with UFA (r = -0.528, p less than 0.05) and positively with SFA (r = 0.482, p less than 0.005). The change in maximal rate of Li-Na CT was also correlated with the variation of systolic and diastolic BP (r = 0.50, p less than 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

[The clinico-instrumental evaluation of the efficacy of picotamide in treating chronic obstructive arteriopathies of the lower extremities]

In 25 patients (19 males and 6 females) suffering from chronic arteriopathy of lower extremities at Fontaine stage II, the clinical efficacy of picotamide was investigated in double blind, cross over placebo-controlled study. Patients were assigned randomly to the treatment with placebo or picotamide (900 mg/die) for three months and, after 15 days of wash-out, to the treatment with picotamide or placebo for the same period. Painfree walking distance and ankle/arm systolic pressure ratio improved significantly only during picotamide treatment. Laboratory monitoring revealed a significant decrease in platelet aggregation and an increase of fibrinogen degradation products only during picotamide treatment. Three patients during picotamide treatment referred transient gastrointestinal discomfort (nausea, vomiting and diarrhoea); however in no case the treatment was suspended because of the appearance of these symptoms. These results indicate that picotamide is an effective drug in the management of chronic arteriopathy of lower extremities.

Differences in blood pressure profile between young and elderly hypertensive patients

We studied 40 subjects, 20 under 60 yrs old (10 normotensive and 10 hypertensive) and 20 over 60 yrs old (10 normotensive and 10 hypertensive). Each patient underwent a 24-hour ambulatory blood pressure monitoring (8:00 a.m. to 8:00 a.m.), by a noninvasive method using an ICR 5300 apparatus. Systolic blood pressure was significantly higher on random measurement and during the daytime in the older patients. Although comparison of the other parameters did not reveal significant differences, we noted a tendency to higher systolic values among the older group, and higher diastolic values in the younger one. The variability of the values was slightly higher, although not significantly, among the older patients. In both groups random systolic measurements, and in the younger group diastolic values as well, were significantly higher than mean 24 hour values. The incidence of abnormal systolic BP values ranged from 18.8% to 100% (mean 60.2% +/- 28.9) in younger hypertensives, and from 54% to 100% (mean 76.5% +/- 14.4) in older patients. The incidence of abnormal diastolic BP values ranged from 64.5% to 100% (mean 80.4% +/- 15.6) in younger patients and from 47.2% to 96% (mean 67.8% +/- 15.8) in older patients. The correlation between mean systolic and diastolic values recorded from 8:00 to 10:00 a.m., and mean 24-hour values was significant in young hypertensives, while in the older group there was a significant correlation only for diastolic BP. The lack of significance for systolic values is probably due to a greater variability in systolic pressure in elderly subjects during the morning.(ABSTRACT TRUNCATED AT 250 WORDS)

Transmembrane cation fluxes and fatty acid composition of erythrocytes in psoriatic patients

Cation transport systems and lipid composition of erythrocyte membrane were studied in 27 psoriatic patients and in 34 healthy individuals. Whereas intracellular Na and K content, Na- and K-passive permeability and Li-Na countertransport of psoriatics did not show any statistical difference from normals, the Na/K ATPase pump activity was significantly higher and Na-K cotransport was significantly lower. Membrane lipid composition of psoriatics was different from normals: an increase in arachidonic acid and in unsaturated (poly- and total unsaturated) fatty acid content was found. A positive correlation was demonstrated between unsaturated/saturated fatty acid ratio and Na/K ATPase pump activity. These results demonstrate an alteration of erythrocyte Na/K ATPase pump and Na-K cotransport in psoriasis. These alterations of cation transport are associated with a perturbation of membrane fatty acid composition which appears a widespread phenomenon in cells of psoriatic patients.

[Evaluation at midterm of the clinico-instrumental efficacy and tolerance of picotamide in patients with obliterative arteriopathy of the lower limbs]

After a 4-week wash-out period, picotamide was administered to 25 patients affected by chronic arteriopathy of the lower limbs (scale 2 according to Fontaine) at a dose of 900 mg/die for 90 days, and then at a dose of 600 mg/die for a further 90 days, in order to assess its efficacy according to the following parameters: duration of gait, residual pressure index (RPI) resting the ankles, hematochemicals, electrocardiogram. At the end of the study a statistically significant increase was observed in the duration of gait and RPI at the ankles and, of the hematochemical parameters, in an increase in fibrogenic degradation products. Adverse reactions were only observed in 3 patients and regressed spontaneously. In conclusion, picotamide was found to be efficacious in patients affected by chronic obliterating arteriopathy of the lower limbs with the possibility of reducing the dose after 3 months of therapy.