losartan-potassium and Angina-Pectoris

There is still controversy concerning the optimal target hemoglobin during treatment with recombinant human erythropoietin (rHuEPO). Some evidence suggests that hemoglobin concentrations higher than currently recommended lead to improvements in cognitive function, physical performance, and rehabilitation. At least in patients with advanced cardiac disease, however, one controlled trial failed to show a benefit from normalizing predialysis hemoglobin concentrations. In contrast, preliminary observations in three additional studies (albeit with limited statistical power) failed to show adverse cardiovascular effects from normalization of hemoglobin, but definite benefit with respect to quality of life, physical performance, and cardiac geometry. These observations are consistent with the notion that hemoglobin concentrations higher than those recommended by the National Kidney Foundation Dialysis Outcomes Quality Initiative Anemia Work Group are beneficial, at least in patients without advanced cardiac disease.

Topics: Anemia, Iron-Deficiency; Angina Pectoris; Controlled Clinical Trials as Topic; Erythropoietin; Female; Heart Function Tests; Hemoglobins; Humans; Kidney Failure, Chronic; Male; Prognosis; Recombinant Proteins; Renal Dialysis; Treatment Outcome

Topics: Adult; Aged; Aged, 80 and over; Anemia; Angina Pectoris; Arrhythmias, Cardiac; Drug Evaluation; Erythropoietin; Female; Follow-Up Studies; Humans; Immunologic Factors; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Myocardial Ischemia; Recombinant Proteins; Renal Dialysis

Deliberate self-administration of recombinant human erythropoietin (rHuEpo) in a patient without anemia has never been documented. The case of a 62-year-old man who worked in an allied health care field and surreptitiously injected the drug, causing his hematocrit to increase to a dangerously high level is presented. Resultant complications of the misuse of erythropoietin in this patient included worsening hypertension, exacerbation of chronic lung disease and development of new onset angina. Medical management consisted of endotracheal intubation with mechanical ventilation, intravenous hydration, and serial phlebotomy. The unusual possibility of erythropoietin abuse must be added to the differential diagnosis with a patient with unexplained polycythemia. This case highlights the potential abuse of biological growth factors that may mask medical conditions.

Topics: Angina Pectoris; Bloodletting; Delusions; Diagnosis, Differential; Drug Overdose; Erythropoietin; Fluid Therapy; Hematocrit; Humans; Hypertension; Lung Diseases, Obstructive; Male; Middle Aged; Polycythemia; Respiration, Artificial; Self Medication; Substance-Related Disorders

We studied the effects of recombinant human erythropoietin (rEPO) on angina pectoris in patients with chronic maintenance hemodialysis. We evaluated hemodynamic changes and exercise tolerance in 6 patients underwent symptom-limited treadmill exercise tests, before and 3-months after treatment with rEPO. Hemoglobin concentration and hematocrit increased significantly from 8.1 +/- 1.0 to 10.3 +/- 1.1 g/dl, from 25.7 +/- 2.7 to 31.5 +/- 2.5%, respectively. Exercise duration increased significantly from 291 +/- 68 to 396 +/- 77 sec. Maximal oxygen uptake (VO2max) also increased significantly from 18.3 +/- 3.3 to 24.2 +/- 3.4 ml/kg/min during correction of anemia. Systolic blood pressure (SBP) and pressure rate product (PRP) at rest, and at maximal exercise showed no significant changes, on the other hand ischemic ST change at maximal exercise decreased significantly from 1.2 +/- 0.7 to 0.2 +/- 0.3 mm under 3-months treatment. Our results suggest that improvement of exercise capacity and ST depression in patients with chronic hemodialysis is the outcome of increased coronary oxygen supply with unchanged cardiac oxygen demand after correction of renal anemia treated with rEPO.

Topics: Adult; Aged; Anemia; Angina Pectoris; Erythropoietin; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Recombinant Proteins; Renal Dialysis