RESUMEN
The effects of the angiotensin II receptor blocker candesartan and the angiotensin-converting enzyme inhibitor lisinopril on the fibrinolytic system were investigated in a double-blinded, prospective, randomized study. Seventy-seven hypertensive patients taking candesartan (n=41) and lisinopril (n=36) with a systolic blood pressure >130 mm Hg and/or a diastolic blood pressure >80 mm Hg obtained by 24-hour ambulatory blood pressure measurement were included in the study. Blood pressure, plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (tPA), and the molar ratio of PAI-1/tPA were determined before treatment and 6 weeks later. Blood pressure decreased in both groups (candesartan, 155/85 mm Hg to 140/84 mm Hg; P<.05; lisinopril, 152/85 mm Hg to 138/83 mm Hg; P<.05). The fibrinolytic balance was significantly different between treatment groups (molar ratio of PAI-1/tPA: candesartan, 3.66 [2.2;] lisinopril, 5.44 [2.6;] P<.05). In contrast to lisinopril, the balance between coagulation and fibrinolytic activity shifted toward fibrinolysis during candesartan treatment.
Asunto(s)
Antihipertensivos/farmacología , Bencimidazoles/farmacología , Fibrinólisis/efectos de los fármacos , Hipertensión/enzimología , Lisinopril/farmacología , Tetrazoles/farmacología , Adulto , Bloqueadores del Receptor Tipo 1 de Angiotensina II/farmacología , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Bencimidazoles/uso terapéutico , Compuestos de Bifenilo , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Método Doble Ciego , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Lisinopril/uso terapéutico , Masculino , Persona de Mediana Edad , Inhibidor 1 de Activador Plasminogénico/sangre , Estudios Prospectivos , Tetrazoles/uso terapéutico , Activador de Tejido Plasminógeno/sangreRESUMEN
OBJECTIVE: To assess whether the sum of ST segment elevation and depression (ST segment deviation score [SUMSTdev]) is a better predictor for 24 h, nonfatal complications in patients with acute myocardial infarction (MI) than the sum of ST segment elevation (SUMSTelev) alone in the admission electrocardiogram. METHODS: Patients with acute MI receiving thrombolytic therapy were observed and ST scores were evaluated. Nonfatal, 24 h complications were defined as acute congestive heart failure or severe rhythm disturbances within 24 h after the start of thrombolysis. The outcome measures were the relationship between both the SUMSTdev and the SUMSTelev and the occurence of 24 h complications, and the identification of a cut-off value with the highest sensitivity and specificity for the prediction of complications. RESULTS: Three hundred eighty-two patients (288 male patients, mean age 58 years) with acute MI (179 patients with anterior MI) were included in the study. The SUMSTdev was significantly higher in patients with 24 h complications than in patients without complications (anterior MI 23.9 mm versus 11.5 mm, respectively, P<0.001; inferior MI 21.6 mm versus 12.0 mm, respectively, P<0.001). Using the receiver operating characteristic analysis, the SUMSTdev significantly improved the ability to estimate the occurence of 24 h complications for anterior and inferior MI compared with the SUMSTelev (anterior MI 0.87+/-0.03 versus 0.84+/-0.03, P=0.04; inferior MI 0.79+/-0.03 versus 0.74+/-0.04, P=0.03). The optimal cut-off for the SUMSTdev was found at 16 mm for anterior MI and 13 mm for inferior MI. Multivariate regression analysis showed that the SUMSTdev was an independent predictor of the occurrence of early complications in patients with anterior MI (odds ratio 28.4, 95% CI 11.0 to 73.6, P<0.0001) and inferior MI (odds ratio 9.7, 95% CI 4.7 to 20.2, P<0.001). CONCLUSIONS: The SUMSTdev is superior to the SUMSTelev in predicting 24 h, nonfatal complications after acute MI. The use of the SUMSTdev is therefore recommended for the stratification of patients with acute MI into low and high risk patients.