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author:("silac, J H")
1.  Tolerability of combined treatment with verapamil and beta-blockers in angina resistant to monotherapy. 
Postgraduate Medical Journal  1985;61(713):229-232.
We have used a combination of a beta-blocker and verapamil to treat 42 consecutive patients with angina resistant to either agent alone. Patients with heart failure, heart block or uncontrolled hypertension were excluded. The mean duration of follow-up was 6.5 months. Thirty-six patients (81%) reported an improvement and the number of angina attacks was reduced from 17/week to 5/week. Side effects necessitated withdrawal of one or both drugs in 6 patients, 2 of whom developed bradyarrhythmias not solely related to drug treatment. The most common complication was mild left ventricular failure (6) treated by reducing or stopping the beta-blocker. The data suggest that the combination of verapamil and a beta-blocker may be used in a relatively unselected group of patients with difficult angina. However, as dosage adjustment and close observation may be necessary to minimise side effects, the use of this combination should be limited to hospital practice.
PMCID: PMC2418202  PMID: 2858847
5.  Hydralazine once daily in hypertension. 
The effects of hydralazine formulation and dose interval were assessed in 20 patients with hypertension well controlled on conventional hydralazine tablets, 100 mg twice daily, in addition to atenolol and a diuretic. The double-blind study used four regimens crossed over in random order at five-week intervals; placebo; conventional hydralazine 100 mg twice daily; conventional hydralazine 200 mg once daily; and slow-release hydralazine 200 mg once daily. Blood pressure and pulse rate were assessed soon after (2.5 +/- 0.9 h) and immediately before taking hydralazine (previous dose: once daily, 26.5 +/- 0.9 h; twice daily, 13.6 +/- 2.0 h). Seventeen patients completed the study. All hydralazine regimens were associated with significant falls in blood pressure. Once-daily treatment with conventional hydralazine was unsatisfactory, as its hypotensive effect waned at 24 h; there was a significant difference between the peak and trough effects on blood pressure and pulse in rapid acetylators. Compared with placebo twice-daily conventional hydralazine and once-daily slow-release hydralazine gave satisfactory control for 24 hours in both rapid and slow acetylators, though the hypotensive effect was larger in the slow acetylators. It is concluded that there is no need to administer hydralazine more than twice daily.
PMCID: PMC1498542  PMID: 6805621
7.  Why hypertensive patients vary in their response to oral debrisoquine. 
British Medical Journal  1977;1(6058):422-425.
The relation between dose, systemic availability, and response to oral debrisoquine was studied in 13 hypertensive patients receiving no other treatment. In 11 who received the same daily dose (40 mg) the fall in mean standing systolic blood pressure varied between 0-3 and 44-4 mm Hg. There was a ninefold difference in the daily urinary excretion and pre-dose plasma concentration of unchanged drug but an inverse correlation between daily urinary excretion of debrisoquine and its 4-hydroxy metabolite (r= -0-86), suggesting that a low recovery of debrisoquine occurs because of extensive metabolism. There was a significant correlation between the fall in standing systolic blood pressure and the mean daily urinary excretion (r= +0-82) and pre-dose plasma concentration (r= +0-82) of unchanged debrisoquine. In contrast, there was a significant inverse correlation between the urinary recovery of the metabolite and the fall in blood pressure (r= -0-82). The availability of debrisoquine is the major determinant of response to this drug. In the absence of side effects a poor response may be an indication to increase the daily dose rather than add another hypotensive agent.
PMCID: PMC1604845  PMID: 837136
8.  Successful pregnancy soon after oral contraceptive-associated malignant hypertension 
Postgraduate Medical Journal  1980;56(661):790-791.
A woman who developed malignant hypertension while taking a very low oestrogen oral contraceptive underwent an uncomplicated pregnancy conceived 3 months later. Her BP was well controlled with propranolol alone.
PMCID: PMC2426073  PMID: 7267484
9.  Clinical evaluation of Dinamap 845 automated blood pressure recorder. 
British Heart Journal  1980;43(2):202-205.
The Dinamap 845 blood pressure recorder has been evaluated over a wide range of blood pressure by comparison with the Hawksley random zero sphygmomanometer in 32 subjects, six of whom had a cardiac arrhythmia. Group mean radings for systolic and phase 5 diastolic pressure were almost identical but Dinamap diastolic values were on average significantly lower (mean difference 3.4 mmHg) than phase 4 diastolic readings obtained with the Hawksley machine. Correlations between readings with the two instruments were high but the slopes and intercepts of the regression for systolic but not diastolic pressure were significantly different from unity and zero, respectively. The Dinamap is easy to use, portable, and capable of rejecting some motion artefact. Its major disadvantage is that the systolic blood pressure measurement is limited to a maximum of 210 mmHg, a point not made clear in the manufacturer's literature. Nevertheless, the Dinamap 845 is acceptable for blood pressure determinations in subjects who are normotensive or who have mild hypertension.
PMCID: PMC482263  PMID: 7362713
10.  Diuretic treatment of resistant hypertension. 
British Medical Journal  1980;281(6248):1101-1103.
In patients with hypertension resistant to three or four drugs including a thiazide diuretic substitution of frusemide for the thiazide, or the addition of spironolactone, produced significant reductions in blood pressure and body weight. The response did not depend on the presence of overt fluid retention, renal impairment, or the use of antihypertensive drugs of high potency. Women had larger responses than men. Expansion of the plasma or extracellular fluid volume is an important cause of resistance to treatment even when a thiazide diuretic is used. An increase in diuretic treatment should be tried before using the postganglionic adrenergic blockers or minoxidil in resistant hypertension.
PMCID: PMC1714545  PMID: 7427599

Results 1-10 (10)