Hypertension in special populations

The effect of amlodipine and enalapril on blood pressure and neurohumoral activation in hypertensive patients with Ribbing's disease (multiple epiphysal dystrophy)

BACKGROUND

In patients with Ribbing's disease (RD)--a form of multiple epiphysal dystrophy--hypertension is frequent, often severe, and accompanied by a relevant cardiac dysfunction.

HYPOTHESIS

This study was undertaken to evaluate the contribution of the calcium antagonist amlodipine and of the angiotensin-converting-enzyme inhibitor enalapril to blood pressure regulation by studying their effect on neurohormonal activation.

METHODS

Fifty hypertensive patients with RD were studied. After a placebo run-in period of 4 to 6 weeks, patients were randomly assigned to receive either amlodipine (10 mg once daily) or enalapril (20 mg once daily) for 6 months.

RESULTS

Both drugs significantly lowered blood pressure. Enalapril did not result in activation of the sympathetic system (as determined by measurement of the plasma norepinephrine level). On the other hand, the hypotensive effect of amlodipine occurred with an increase in heart rate and in the levels of plasma norepinephrine and angiotensin II.

CONCLUSION

It is unclear whether amlodipine may reduce cardiac dysfunction in patients with RD.

Health disparities in transplantation: focus on the complexity and challenge of renal transplantation in African Americans

The field of renal transplantation has grown exponentially as a result of a greater understanding of the immune system and the advent of numerous immunosuppressive agents. Although African Americans and whites have benefited from these advances, equivalent long-term success eludes African Americans who are disadvantaged in gaining access to renal transplantation. This review summarizes the obstacles for African Americans to end-stage renal disease(ESRD) care, focusing on transplantation. Factors that predispose African Americans for ESRD, impede this ethnic group from timely transplantation, and negatively influence graft survival are examined. Possible solutions to these persistent problems are offered.

Controlling isolated systolic hypertension. No time to be complacent

Isolated systolic hypertension (ISH) is the most common form of hypertension in the elderly. It is an even better predictor of morbidity and mortality than is diastolic blood pressure. Several large trials have documented a clear benefit to treating ISH. Therapy should be initiated only after careful evaluation of the patient's overall medical status, because the elderly are at increased risk of adverse effects from medications. Pharmacologic therapy should be started at a low dose and increased slowly, if necessary. If hypertension is still present after the addition of two or three medications, a cause other than essential hypertension should be considered, such as white coat hypertension, secondary hypertension, or pseudohypertension.