The Camerano study on hypertension: the problem of arterial hypertension in the elderly

The Camerano study on arterial hypertension (AH) was a cross-sectional study, carried out on a large population sample in a small town in central Italy. The main goal was to reveal both the prevalence and certain characteristics of AH in the population examined. The main results, can be summarized as follows: (i) The occurrence of AH in the old (65-74 years) and very old (> or = 75 years) groups was 43.3 and 57.4%, respectively. (ii) isolated systolic hypertension (ISH) was found in 1.7, 23.6 and 3.9% in the adult, old and very old subjects, respectively. (iii) The association of AH with some of the more common cardiovascular risk factors (dyslipidemia, hyperglycemia, obesity, etc.) was significant for all the risk factors in the adult group, while in the old group there was a significant association only with the body mass index. (iv) Blood pressure (BP) values during the medical visits were evaluated, and adult versus old subjects were compared, but no significant differences were found.

Comparative study of terfenadine and cetirizine in hay fever: assessment of efficacy and central nervous system effects

A daily dose of either terfenadine 120 mg or cetirizine 10 mg was compared in two parallel groups of patients suffering from hay fever. According to a double-blind, double-dummy, randomized design, 28 patients were treated with one of the two drugs once daily in the morning for 2 weeks during the 1990 grass pollen season. The severity of nasal congestion, rhinorrhea, sneezing, nasopharyngeal itching and itchy, watery, red eyes was evaluated by the investigator after a 1-week run-in period and at the end of the treatment. The patients made a daily record of the severity of symptoms on a diary card. In addition, drug-related central nervous system (CNS) effects were assessed at baseline and at the end of the treatment by neuropsychological tests aimed at investigating selective and sustained attention, visuomotor abilities and anxiety, and by quantitative, bit-mapped EEG. Both terfenadine and cetirizine produced a significant improvement in symptoms at endpoint without any significant difference between the two drugs. Drowsiness was referred by one patient in each treatment group. No significant impairment of psychomotor performance occurred with either drug. Quantitative EEG showed a significant power increase in the relative (%) delta band in both groups of treated patients. Although the difference was not statistically significant, a tendency towards greater involvement of the CNS was observed with the use of cetirizine. In conclusion, the results of this study confirm that terfenadine and cetirizine are equally effective in the management of hay fever. Some differentiated untoward EEG changes were also observed in relation to the drugs used, without any variation in neuropsychological performance.

Nicardipine retard in the therapy of elderly diabetic hypertensives: final report of observational study

OBJECTIVE

An uncontrolled multicentre study was carried out in 10 hospitals of the Marche Region of central Italy, to evaluate the efficacy and tolerability of 40 mg nicardipine retard in elderly hypertensive patients with diabetes mellitus type II.

DESIGN

The study lasted 6 months, single-blind for the first 3 months and open thereafter. The blood pressure criteria were 165 mmHg systolic and/or 95 mmHg diastolic measured at least three times consecutively in untreated patients or after 10 days of drug washout.

PATIENTS

All subjects had a proven diagnosis of diabetes mellitus type II and were greater than or equal to 65 years of age.

RESULTS

After the first 14 days of active treatment with nicardipine [corrected] retard at 40 mg/day, supine systolic blood pressure had fallen to 164.3 +/- 12.7 mmHg and diastolic to 92.2 +/- 7.3 mmHg (P less than 0.001). This first phase normalized blood pressure in 41.1% of patients. In 58.9% of patients the dose was doubled because goal blood pressure had not been achieved. After 4 weeks of therapy, mean supine systolic/diastolic values had fallen to 156.5 +/- 11.0/88.5 +/- 6.8 mmHg (P less than 0.001), and the proportion of patients requiring 80 mg/day had risen to 63.2%, with only 36.8% able to continue on the single dose. In 24.2% of the patients, monotherapy at 80 mg/day was not sufficient to normalize blood pressure and a second associated drug (enalapril, 10 mg/day) was administered. The mean blood pressure decrease induced by therapy was statistically significant from the second week of treatment (P less than 0.001). No significant variation in metabolic parameters was recorded during treatment.

CONCLUSIONS

Nicardipine [corrected] retard was effective and well tolerated in elderly subjects, both clinically and metabolically.

Simvastatin in the treatment of hypercholesterolemia in elderly patients

Twenty elderly (mean age, 69 years), hypercholesterolemic patients (low-density lipoprotein [LDL] levels greater than or equal to 160 mg/dl) were supplied a lipid-lowering diet for one month and then received 10 mg of simvastatin daily for 12 months. Total cholesterol levels fell significantly, from 304.6 mg/dl at baseline to 277.4 mg/dl after one month on the diet, to 245.9 mg/dl after one month of simvastatin, and to 216.1 mg/dl after two months of simvastatin; total cholesterol levels remained significantly lower (221.6 mg/dl at month 12). LDL levels decreased significantly, from 217.6 mg/dl at baseline to 130.4 mg/dl at month 12. High-density lipoprotein levels increased significantly only at months 2 and 3. Apolipoprotein (apo) A levels increased significantly, from 147.2 mg/dl at baseline to 217.9 mg/dl at month 12. There were no significant changes in triglyceride or apo B levels. No changes in blood pressure, heart rate, or body weight or in results of laboratory tests were noted. Few side effects were reported. It is concluded that simvastatin is safe and effective in the treatment of hypercholesterolemia in elderly patients.

Characterization of the rabbit aorta endothelium-dependent cholinergic receptor by agonist equipotent molar doses

The endothelium-dependent acetylcholine, metacholine, carbachol, betanechol, and furtrethonium relaxation values have been measured in vitro for the rabbit aorta, in presence of a high concentration of hexamethonium. The produced EPMR values complete the values that were obtained in a previous experiment under analogous conditions for rat bladder, ileum, iris, stomach, and trachea preparations. The complete set was analyzed by new statistical techniques of data analysis and display, which are both simpler and more precise than the statistical modeling techniques used by us in the past. This has led to new results concerning the clustering of drugs and of receptors, as well as to a characterization of the endothelium receptor.