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p ostprandlal hypotenslon is a common cause of falls lag characteristics Before each meal study, stroke vol-
and syncope in elderly patients, particularly those ume at supme rest was assessed by impedance cardiog-
with coronary artery disease and associated impairments raphy. 5 Although the absolute value of stroke volume
m ventncular diastohc relaxation. ~ These patients are determined by this method may differ from that obtamed
sensitwe to the development of hypotenslon in response by more invaslve methods, relative changes with vari-
to stresses that reduce cardiac preload, including meal ous interventions are reproducible and reliable. 5 Cardiac
ingestion, upright posture, 2 or nitrate medication, or a output was calculated as the product of stroke volume
combination of these. 1 The administration of mtrates m and heart rate. Systemic vascular resistance was calcu-
conjunction with a meal may enhance venous pooling lated as mean arterial blood pressure dwlded by cardiac
and aggravate postprandial blood pressure reduction. In output. Venous occlusion plethysmography6 was used to
contrast, calcium antagonists, such as nicardipme, have assess forearm blood flow, and forearm vascular resis-
less of an effect on cardiac preload and may improve tance was calculated from the mean arterial pressure
ventncular relaxation. 3 Therefore, we hypothesized that divided by the forearm blood flow.
calcium antagonists would have less of an effect on post- All meal studies were performed between 9 and 10
prandial blood pressure reduction than mtrates m elder- A.M. after a fast from midnight the night before. During
ly pauents with coronary artery disease and dlastohc dys- each drug phase of the study, subjects were gwen 1 dose
function. of medication 60 minutes before the study began. The
• • •
subjects were seated for the meal study. Blood pressure
To test flus hypothesis, we conducted a randomized, was measured with an oscdlometnc device (Dynamap TM,
double-blmd, crossover study of the effects of lSOSOrbide Tampa, Honda) at 5-mmute intervals for 10 minutes
dinitrate (Isordll ®, Wyeth-Ayerst Laboratories, Phila- before and for 60 minutes after consumption of a hquld
delphia, Pennsylvania) versus mcardiplne hydrochlonde meal (Instant Breakfast, Carnation, Glendale, Cahfor-
on blood pressure and heart rate responses to a meal. ma). SubJects consumed a total of 390 to 420 kcal over
The study group consisted of 17 subjects (11 men and 6 a 10-mmute period. Cardiac rate and rhythm were mon-
women, age [mean + SEM] 76 + 1 years). SubJects were
recruited from the community and had a history of either
stable angina (n = 10) or a previous myocardial mfarc- TABII: I Baseline Hemodynamlc Characteristics Dunng Each Drug
tion (n = 7) Each study subject underwent 3 meal stud- Phase (n = 17)
les. first, after at least a 1-week washout period without No Drug Isosorblde Nlcardlpme
medication except nltroglycenn as needed ("no drug"),
and after 2 sequential treatment periods w~th nlcardip- Premeal (seated)
Systohc blood 155 + 6 129 + 4* 127 ± 5*
me and isosorbide in random order. Isosorblde or nlcar- pressure (mm Hg)
dipme were each gwen for 3 weeks at a dose of 20 mg D~astohc blood 75 + 2 72 ± 2 67 ± 2*
orally 3 Umes a day. This dose was sufficient to mml- pressure (mm Hg)
m~ze symptoms of angina in all but 1 patient who re- Mean arterial 102 + 3 91 ± 2* 87 + 2*
qun'ed an mcrease in the lSOSOrblde dose to 4 times a pressure (mm Hg)
Heart rate 61 ± 2 66 ± 2 64 ± 2
day. During a 5-day crossover period, 1 drug was tapered (beats/mm)
off wtule the other was gradually increased to the study Supine
dose. Stroke volume (ml) 69 ± 5 62 ± 5 76 + 7
Within the same week as the meal study, a Doppler Cardiac output 4 1 ±03 39±03 50+04t
(L/mm)
echocardlogram was recorded to assess diastolic func- Forearm vascular 67 ± 6 56 + 4 52 ± 5*
tion by measurement of mltral mflow mdexes 4 Mea- reststance (U)
surements of peak E velocity, peak A velocity, and E/A Systemic vascular 27 ± 2 27 ± 3 20 ± 3
ratio were used to evaluate left ventrlcular dlastohc fill- resistance (U)
Supine Doppler
echocardlogram
From tb_ Hebrew Rehabdltation Center for the Aged, 1200 Centre PeakEveloclt',/ 061 ± 0 0 3 064+003 0634:003
Street, Roshndale, Massachusetts 02131, the Beth Israel Hospital, (m/s)
and the Harvard Medical School D~wsion on Aging, Boston, Mass- PeakAveloclty 076±004 081 4:004 0 8 0 ± 0 0 3
achusetts Thrs study was supported by Research Grant AGO9538 (m/s)
from the National Institute on Aging, Bethesda, Maryland, and by E/Arat~o 087±OO8 084+007 083 ±O05
Syntex Laboratones, Palo Alto, Cahfornla Manuscript received July
*p <0 05 versus no drug, l p <0 05 versus ~sosorb~de dmttrate
14, 1994, revised manuscnpt received September 22, 1994, and Dala are expressed as mean ± SEM
accepted September 23
high level of total cholesterol (>200 mg/dl) is a is seen with this diet; m paUents with mitial HDL cho-
A well- known risk factor for development of early
athe~osclerosls. 1 However, low levels of lugh-denslty
lesterol levels <39 mg/dl, an increase is seen. 7 We decid-
ed to investigate whether the response to some of the
hpoprotem (HDL) cholesterol2,3 are even more strongly most commonly used hpid-lowering drugs is also depen-
associated with early coronary artery disease and plaque dent on the iniual level of this hpoprotein.
progression These 2 unfavorable traits possibly have a e • •
synergistic effect.4'5 It has previously been shown that This study included 933 patients with dyshpidenua
the HDL cholesterol response to the European Athero- who were consecutively examined at the lipid clinic The
sclerosis Socmty first-step hpld-lowermg diet6 depends result of hypollp~demm treatment on HDL cholesterol
on basehne HDL cholesterol plasma levels: In patients according to baselme levels was prospectwely evaluat-
with imnal HDL cholesterol levels >39 mg/dl, a decrease ed. Dyslipidemia was diagnosed if the total cholesterol
was >200 mg/dl and the low-densay lipoprotem (LDL)
From the Department of Cardiology and the Department of B~o- cholesterol >130 mg/dl. 6 All patients were mmally treat-
chemistry, Onassls Cardiac Surgery Center, Athens, and the Um- ed for 3 months with the first-step hpid-lowenng diet as
verslty of Athens, Athens, Greece Dr Kolovou's address ts 51,
Aglon Anarglron, 151 24 Maroussl, Athens, Greece Manuscnpt suggested by the European Atheroscleros]s Society.6
receqvedJuly 5, 1994, rewsed manuscnpt received and accepted Dunng this stage, constant dietetic counseling was pro-
September 27, ] 994 vlded. After this interval, plasma samples for lipid analy-
BRIEFREPORTS 293