Showing papers on "Spironolactone published in 1972"

Comparison of Surgery and Prolonged Spironolactone Therapy in Patients with Hypertension, Aldosterone Excess, and Low Plasma Renin

Abstract: The effect of prolonged preoperative treatment with spironolactone has been studied in a series of 67 patients with hypertension, aldosterone excess, and low plasma renin. In the series as a whole a highly significant reduction in both systolic and diastolic pressures was achieved, with no evidence of escape from control during therapy lasting several years in some cases. The drug was equally effective in controlling blood pressure in patients with and without adrenocortical adenomata. Occasional unresponsive patients were encountered in both groups; pretreatment blood urea levels in these were significantly higher than in the responsive patients. The hypotensive effect of spironolactone usually predicted the subsequent response to adrenal surgery.Spironolactone in all cases corrected plasma electrolyte abnormalities; significant increases in total exchangeable (or total body) potassium and significant reductions in total exchangeable sodium, total body water, extracellular fluid, and plasma volumes were seen. Plasma urea rose during treatment and there was a slight fall in mean body weight. Significant increases in peripheral venous plasma renin and angiotensin II concentrations occurred during treatment.In two patients no increase in aldosterone secretion rate was found during treatment, although plasma aldosterone rose in three of four subjects studied.Severe side effects were rare; in only two of the 67 patients did the drug have to be stopped.In addition to its routine preoperative use, spironolactone can now be advised as long-term therapy in selected patients.

The Syndrome of Essential Hypertension and Suppressed Plasma Renin Activity: Normalization of Blood Pressure With Spironolactone

Abstract: Because amino-glutethimide, an inhibitor of steroid synthesis, lowers the blood pressure of patients with essential hypertension and suppressed renin activity, the present double-blind study was designed to assess the effect of the mineralocorticoid antagonist, spironolactone, on blood pressure in such patients. Twenty-three of 24 patients with suppressed renin activity responded to spironolactone, 400 mg/day for six weeks. Average decrease in mean blood pressure was 20 mm Hg. There was no response to placebo. A control group of 18 patients with essential hypertension and normal renin activity showed no significant change in blood pressure in response to spironolactone or placebo. Fourteen spironolactone-responsive patients were normotensive when maintained on doses of 100 to 200 mg/day. This study supports the concept that the syndrome of essential hypertension with suppressed renin activity is related to mineralocorticoid secretion.

Spironolactone and hydrochlorothiazide in essential hypertension. Blood pressure response and plasma renin activity.

Abstract: Hypertensive patients with low plasma renin activity are suspected of having mineralocorticoid excess. We treated 26 hypertensive patients with the mineralocorticoid antagonist, spironolactone, 200 mg daily, and 25 patients with hydrochlorothiazide, 100 mg daily, for 12 weeks. Patients with low renin activity (below 250 ng/100 ml, 10 mEq sodium diet, upright position) and low normal renin activity (250 to 400 ng/100 ml) responded to both drugs with a significantly larger fall in blood pressure than was achieved by patients with renin activity above 400 ng/100 ml. Fall in blood pressure was related to the initial weight loss induced by spironolactone (r =.51), but was not related to the weight loss induced by hydrochlorothiazide. Both spironolactone and hydrochlorothiazide are more effective in reducing blood pressure in patients with low and low-normal renin activity than in other hypertensive patients.

Glucagon in heart failure and in cardiogenic shock. Experience in 50 patients.

Abstract: Intravenous glucagon, in doses of 2.5-15 mg/hour, was administered to 50 patients for periods of 1-7 days. Forty patients had either intractable heart failure or cardiogenic shock or both; the remaining 10 had less severe heart disease. In all patients glucagon was added to conventional therapy. Twenty-two of the 40 with very severe heart failure showed a clinical improvement, and 18 were discharged from the hospital; 16 of the 18 patients who did not respond died in the hospital. Only two of the 10 with less severe heart disease improved with glucagon but all could be discharged from the hospital. Glucagon did not initiate or aggravate a tendency to arrhythmias in any of the 17 patients with acute myocardial infarction. In two patients with bradycardia and cardiac failure due to beta-adrenergic blocking drugs, glucagon increased heart rate and there was clinical improvement in heart failure. However, there was no effect in two patients with digitalis-induced nodal bradycardia and heart failure. Nausea wa...

The Diagnostic and Therapeutic Value of Spironolactone in Patients with Systemic Hypertension

Abstract: The effect of spironolactone (300 mg/day) for 28 days onthe systemic blood pressure has been studied in 4 normal and 22 hypertensive subjects in an attempt to distinguish those patients with primary aldosteronism who are suitable for adrenal exploration No patient had any evidence of primary parenchymal renal disease Full blood pressure control was achieved in 8 patients Of these, 2 had renal artery stenosis, 2 microadenomata of the adrenal glands and 4 a solitary adrenal adenoma Significant reductions in blood pressure were also noted in the remaining 14 patients, but normal values had not been attained in the 28 days of study Although reductions in blood pressure were usually accompanied by a negative cumulative sodium balance, this was not an invariable feature and there was other convincing evidence to suggest that the hypotensive effect of spironolactone might be mediated through mechanism(s) independent of changes in external sodium balance The interrelationships between the above observations and the plasma electrolyte, renin and aldosterone concentrations are discussed

Faecal sodium-potassium ratio and aldosteronism in experimental hypertension in the rat.

Abstract: SUMMARY 1. Renal artery constriction and sham operation produced a temporary fall in the faecal sodium/potassium (Na/K) ratio of rats. When contralateral nephrectomy had been performed, the ratio rose to normal with the development of hypertension. With an intact opposite kidney the ratio remained low, but was elevated by spironolactone. With or without contralateral nephrectomy, the ratio was normal in chronically hypertensive animals (> 28 days). 2. Balance studies showed sodium depletion in hypertensive rats with a normal kidney in situ. It is suggested that this stimulates aldosterone secretion and the faecal electrolyte changes.

Influence of Spironolactone and Dexamethasone on Phosphoprotein Phosphatase in the Rat Liver, Kidney and Spleen

Abstract: Phosphoprotein phosphatase activity is markedly increased in the rat liver, barely stimulated in the kidney, but not influenced in the spleen, by spironolactone treatment. Dexamethasone is ineffective in these respects, whereas cycloheximide, dactinomycin and SKF 525-A significantly interfered with the action of spironolactone. Our findings demonstrate that spironolactone can induce both microsomal and extramicrosomal enzymes.