Showing papers by "John G.F. Cleland published in 1984"

Captopril in heart-failure - a double-blind controlled trial

Abstract: The effect of the converting enzyme inhibitor captopril as long term treatment was investigated in 14 patients with severe congestive heart failure in a double blind trial. Captopril reduced plasma concentrations of angiotensin II and noradrenaline, with a converse increase in active renin concentration. Effective renal plasma flow increased and renal vascular resistance fell; glomerular filtration rate did not change. Serum urea and creatinine concentrations rose. Both serum and total body potassium contents increased; there were no long term changes in serum concentration or total body content of sodium. Exercise tolerance was appreciably improved, and dyspnoea and fatigue lessened. Left ventricular end systolic and end diastolic dimensions were reduced. There was an appreciable reduction in complex ventricular ectopic rhythms. Adverse effects were few: weight gain and fluid retention were evident in five patients when captopril was introduced and two patients initially experienced mild postural dizziness; rashes in two patients did not recur when the drug was reintroduced at a lower dose; there was a significant reduction in white cell count overall, but the lowest individual white cell count was 4000 X 10(6)/l. Captopril thus seemed to be of considerable value in the long term treatment of severe cardiac failure.

The World Fertility Survey and Contraceptive Prevalence Surveys: a comparison of substantive results

Abstract: This paper deals with the findings of the World Fertility Survey (WFS) and Contraceptive Prevalence Surveys (CPSs) in five areas of common interest: fertility, contraceptive use, measuring the effect of the availability of contraceptives on levels of use, the unmet need for family planning services, and breastfeeding. The comparisons have several implications for those designing surveys of fertility and family planning in developing countries, among them, that women should be asked for the dates of at least their last two births (not just the last birth as in the CPSs) in order to ensure accurate estimates of fertility and duration of breastfeeding.

Angiotensin converting enzyme inhibition in heart failure.

Abstract: Captopril, the first orally effective converting enzyme inhibitor, was administered to 14 patients with chronic heart failure for 6 week periods, in a double-blind crossover comparison with placebo. Captopril improved symptoms and exercise performance, while left ventricular internal dimensions were reduced. The fall in blood pressure induced by captopril was well tolerated. Glomerular filtration rate was reduced and effective renal plasma flow increased on captopril. No decline in body weight or total body sodium was seen, suggesting that a natriuresis had not occurred. Serum and total body potassium rose. Ventricular arrhythmias declined.

Renin and angiotensin responses to posture and exercise in elderly patients with heart failure

Abstract: Activation of the renin-angiotensin system may in part be responsible for the abnormally increased vascular tone which occurs in heart failure; it has also been suggested that this system's responsiveness may diminish with age. We investigated the effects of posture and upright exercise on renin, angiotensin II, aldosterone and catecholamines in 8 patients over 65 years and in 10 patients under 65 years, all of whom had congestive heart failure. Samples were taken supine, after 5 min standing in the upright posture, and after exercise. Exercise time was similar between the two groups [5·3 ± 1·9 min (mean ± SD) in the younger group, compared with 5·2 ± 3·4 min in the older group]. Resting renin and angiotensin II were similar and rose on standing with a further increase during exercise; there were no statistically significant differences between the groups. However, aldosterone rose during exercise only in the younger group, while increases in plasma noradrenaline were greater in the elderly. This study implies that the efficacy of angiotensin converting enzyme inhibitors is likely to be maintained in the elderly patient with heart failure.