enalapril and Syndrome

To elicit the role of endothelial dysfunction in development of cardiorenal syndrome in patients with diabetes mellitus type 1 (DM1) with diabetic nephropathy (DN) and to evaluate the efficacy of endotheliotropic drugs: nebivolol (a selective beta-blocker) and enalapril (ACE inhibitor).. The trial enrolled 60 patients with DM1: 15 patients with normoalbuminuria (NAU), 15 patients with microalbuminuria (MAU), 15 patients with proteinuria (PU) and 15 with chronic renal failure (CRF). The control group consisted of 15 healthy volunteers matched by sex and age. All the patients were examined for endothelium-dependent dilation of the brachial artery (by duplex scanning in the test with reactive hyperemia), serum markers of endothelial dysfunction (endothelin-1--ET-1), Willebrand factor (WF), inflammation markers (C-reactive protein-CRP), incidence rate of ischemic heart disease (IHD). 24-h arterial pressure monitoring and echocardiography were also made. For 12 weeks the patients were given nebivolol monotherapy in a dose 5 mg/day or enalapril monotherapy in a dose 10 mg/day. The effects of these drugs on urinary excretion of albumin and protein, arterial pressure, circadial rhythm of arterial pressure and endothelial dysfunction were studied.. In DM1 patients DN advances with an increase in development of IHD: in MAU--by 13%, PU--by 33%, CRF--53%. Concentric hypertrophy and left ventricular remodeling were registered in 33, 40 and 60% of cases, respectively. A circadian rhythm disturbance correlated with DN severity. DN progression was associated with increasing endothelial dysfunction. It is shown that nebivolol and enalapril correct endothelial dysfunction, have comparable antiproteinuric and antihypertensive actions at different stages of nephropathy.. A close correlation was found between DN progression and development of cardiovascular pathology in DM1 patients. This serves the basis of cardiorenal syndrome. These two pathologies are associated with vascular endothelial dysfunction which leads to disorders in vascular tonicity regulation.

Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Angiotensin-Converting Enzyme Inhibitors; Benzopyrans; Biomarkers; Diabetes Mellitus, Type 1; Diabetic Angiopathies; Diabetic Nephropathies; Enalapril; Endothelium, Vascular; Ethanolamines; Female; Humans; Male; Middle Aged; Myocardial Ischemia; Nebivolol; Syndrome

To assess duration of a clinical response and tolerance of structum in patients with low back pain (LBP) and comorbid cardiovascular disease.. 25 patients with primary LBP and coronary heart disease (n = 13) and/or essential arterial hypertension (n = 18) were examined and treated for 6 months with structum.. To the end of the first treatment months structum significantly relieved pain intensity, spinal motility, increased exercise tolerance. Excellent and good response to structum were observed in 71% patients, no response was in 29%. Tolerance of the drug was good in 23 (92%) patients. The effect persisted for 3 months. CHD characteristics did not change while arterial pressure went down noticiably.. Structum is highly effective in the treatment of LBP. Its long-term intake had no effect on CHD.

Topics: Adult; Aged; Chondroitin Sulfates; Coronary Disease; Drug Therapy, Combination; Enalapril; Exercise Tolerance; Female; Humans; Hypertension; Low Back Pain; Male; Middle Aged; Syndrome; Treatment Outcome

During the course of a long-term, prospective, randomized study in 77 hypertensive nephrosclerosis patients, five patients developed evidence suggestive of renal artery stenosis. However, arteriography demonstrated patent renal arteries. The evidence suggestive of renal artery stenosis was: (1) converting-enzyme inhibitor (CEI)-induced renal dysfunction including marked and reversible increases in serum creatinine and urea concentrations, (2) minoxidil-induced hyperreninemia despite beta-adrenoceptor blockade and volume expansion, and (3) minoxidil-induced salt and water retention with diuretic resistant edema. Thus, the renal dysfunction induced by CEI in these patients with patent renal arteries is similar to the alterations occurring in patients having bilateral renal artery stenosis. The diuretic resistant edema and the beta-adrenoceptor blocker resistant high renin release are also functional alterations of renal artery stenosis. We suspect that the long-standing and usually severe hypertension in these patients has caused sufficient arteriolar hypertrophy or sclerosis to interfere with renal blood flow and to induce these functional lesions of renal artery stenosis. With widespread use of the new CEI agents in patients with renal disease, this syndrome suggestive of renal artery stenosis may be encountered in as many as 10% of hypertensive nephrosclerosis patients during long-term treatment with converting-enzyme inhibitors.

Topics: Angiography; Blood Pressure; Body Weight; Creatinine; Double-Blind Method; Enalapril; Humans; Hydralazine; Hypertension; Minoxidil; Nephrosclerosis; Prospective Studies; Random Allocation; Renal Artery; Renal Artery Obstruction; Renin; Syndrome

MIRAGE syndrome is a recently discovered rare genetic disease characterized by myelodysplasia (M), infection (I), growth restriction (R), adrenal hypoplasia (A), genital phenotypes (G), and enteropathy (E), caused by a gain-of-function mutation in the SAMD9 gene. We encountered a girl with molecularly-confirmed MIRAGE syndrome who developed steroid-resistant nephrotic syndrome.. She was born at 33 weeks gestational age with a birth weight of 1064 g. She showed growth failure, mild developmental delays, intractable enteropathy and recurrent pneumonia. She was diagnosed as MIRAGE syndrome by whole exome sequencing and a novel SAMD9 variant (c.4615 T > A, p.Leu1539Ile) was identified at age four. Biopsied skin fibroblast cells showed changes in the endosome system that are characteristic of MIRAGE syndrome, supporting the genetic diagnosis. Proteinuria was noted at age one, following nephrotic syndrome at age five. A renal biopsy showed focal segmental glomerulosclerosis (FSGS) with immune deposits. Steroid treatment was ineffective. Because we speculated that her nephrosis was a result of genetic FSGS, we decided not to introduce immunosuppressive agents and instead started enalapril to reduce proteinuria. Although her proteinuria persisted, her renal function was normal at age eight.. This is the first detailed report of a MIRAGE syndrome patient with nephrotic syndrome. Because patients with MIRAGE syndrome have structural abnormalities in the endosomal system, we speculate that dysfunction of endocytosis in podocytes might be a possible mechanism for proteinuria.

Topics: Angiotensin-Converting Enzyme Inhibitors; Enalapril; Esophageal Motility Disorders; Exome Sequencing; Female; Glomerulosclerosis, Focal Segmental; Glucocorticoids; Growth Disorders; Humans; Hypoadrenocorticism, Familial; Immunologic Deficiency Syndromes; Infant; Infections; Intestinal Diseases; Intracellular Signaling Peptides and Proteins; Mutation; Myelodysplastic Syndromes; Nephrotic Syndrome; Syndrome; Treatment Failure; Urogenital Abnormalities

6 hours after the second dose (5 mg) of enalapril 9 males and 6 females (mean age 34.93 +/- 1.03 years) with endomyocardial fibrosis (EMF) underwent ECG and pulsed Doppler echocardiography to study enalapril effect on cardiohemodynamics. As shown by ventricular diastolic function and systolic flow in the pulmonary artery with estimation of mean pressure in the pulmonary artery according to Kitabatake, enalapril (renitek) affects positively cardiohemodynamics of EMF patients: improvement of ventricular diastolic function occurred in line with a significant fall in the pulmonary artery pressure. It is noted that application of Doppler echocardiography is essential for detection of restriction syndrome.

Topics: Adult; Analysis of Variance; Cardiomyopathy, Restrictive; Drug Evaluation; Echocardiography; Electrocardiography; Enalapril; Endomyocardial Fibrosis; Female; Hemodynamics; Humans; Male; Syndrome

Topics: Aged; Angioplasty, Balloon; Enalapril; Humans; Hypertension, Renovascular; Hyponatremia; Male; Renal Artery Obstruction; Syndrome

To investigate whether the syndrome of low systemic vascular resistance (SVR) following cardiac surgery and cardiopulmonary bypass (CPB) is more common in patients taking angiotensin-converting enzyme inhibitors (ACE-inhibitors) or calcium antagonists.. A case-control study, with cases ("low SVR syndrome") identified from intensive care unit observation charts. These cases were each matched to two controls identified from the same group of charts during the same time period. Exposure (ACE-inhibitors or calcium antagonists) was determined in a blinded fashion from the patient's medical record.. Cardiothoracic surgical unit in a teaching hospital.. We identified 42 cases of low SVR syndrome; these were matched to 84 controls.. There was no association between therapy with ACE-inhibitors and the low SVR syndrome following CPB (odds ratio [OR], 1.33; 95% confidence interval [CI], 0.53-3.34), nor with calcium antagonists (OR, 0.49; 95% CI, 0.21-1.13). The incidence of the low SVR syndrome was 7.4%. Patients who develop the low SVR syndrome are more likely to be treated with noradrenaline, adrenaline and dopamine, and spend more time in the cardiothoracic intensive care unit.. The "low SVR syndrome" following CPB is not associated with preoperative therapy with ACE-inhibitors or calcium antagonists.

Topics: Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Captopril; Cardiopulmonary Bypass; Case-Control Studies; Coronary Artery Bypass; Critical Care; Diltiazem; Dopamine; Enalapril; Female; Heart Valves; Humans; Length of Stay; Male; Middle Aged; Nifedipine; Norepinephrine; Retrospective Studies; Single-Blind Method; Syndrome; Vascular Resistance; Verapamil

Ten patients with severe pulmonary hypertension due to Toxic Oil Syndrome underwent cardiac catheterization to analyse the acute effect of intrapulmonary injection of 1.25 mg of enalaprilat. Haemodynamic parameters were obtained at basal state, 15, 30, 45 and 60 minutes after administration of the drug. Enalaprillat did not produce any statistically significant changes in pulmonary pressures and resistances or cardiac output. This lack of response is unknown but may be related to the presence of endothelial damage and fixed pulmonary vascular lesions observed at autopsy in three patients.

Topics: Enalapril; Fatty Acids, Monounsaturated; Humans; Hypertension, Pulmonary; Injections, Intra-Arterial; Plant Oils; Pulmonary Circulation; Pulmonary Wedge Pressure; Rapeseed Oil; Respiratory Distress Syndrome; Syndrome; Vascular Resistance

An examination of the literature provides the basis for a definition of first dose iatrogenic hypotension or "first dose syndrome", its nature, degree and frequency. The drugs that often cause this phenomenon are listed with details of the mechanisms involved as are the physiological, pathological and iatrogenic conditions that may trigger and/or exacerbate the gravity and duration of the syndrome. In a series of patients with essential arterial hypertension treated with ACE inhibitors, 6 developed first dose syndrome, two of them after captopril and 4 after enalapril maleate, two of whom were also receiving theophylline and nitro derivates. Though wide personal experience suggests that first dose syndrome caused by ACE inhibitors is a rare event and those drugs are undeniably effective and well tolerated, treatment should always start with minimum doses administered before bed time especially in patients receiving other medication and/or presenting the physiological or pathological conditions in which first dose syndrome has already been observed and described.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Captopril; Enalapril; Female; Humans; Hypotension, Orthostatic; Male; Middle Aged; Syndrome; Theophylline