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Although the plasma levels of PAI-1 significantly reduced after treatment in both groups, the reduction of PAI-1 levels was more pronounced in group 2. These data indicated that administration of aldosterone antagonists in combination with ACEI had additional benefit on fibrinolysis in chronic hypertensive patients.
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To document the standard of care that patients hospitalized with HF in Israel received during a 2 month period.
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Licorice, the primary ingredient of the Japanese herbal medicine shakuyaku-kanzo-to, can cause pseudoaldosteronism. Thus, shakuyaku-kanzo-to can cause this condition.
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The patient was treated with cyproterone acetate 2 mg/day and ethinylestradiol 0.035 mg/day in combination with spironolactone 100 mg/day as well as with laser hair removal. The patient's symptoms had improved considerably after 1 year of treatment. A cardiometabolic risk assessment, including a standard oral glucose tolerance test and a lipid profile before and after treatment, revealed normal fasting and 2 h plasma glucose levels both at baseline and after 12 months, and a low-normal HDL-cholesterol level that returned to normal after 12 months.
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Optimization of RAS inhibition was safe, hemodynamically well tolerated, and associated with improvements in Framingham score (P = .001) and quality of life as well as reductions in the cardiothoracic index (P = .002), brain natriuretic peptide level (P = .032), and RANTES (regulated on activation, normal T expressed and secreted) level (P = .001). Left ventricular ejection fraction increased by 2.3% (P = .25); in patients with an LVEF < or = 45% at baseline, it increased by 2.8% (P = .017). Treatment with carvedilol was associated with a trend toward an increase in LVEF (absolute difference between groups, 2.3%; P = .094). The addition of carvedilol was safe, hemodynamically well tolerated, and not associated with symptomatic bradycardia.
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Plasma aldosterone concentration increased in cats treated with SPIR (235 ng/mL, baseline; 935 ng/mL, 2 months; 1,077 ng/mL, 4 months; P < .001 at 2 and 4 months). No significant treatment effect was identified for early or early-late summated diastolic mitral annular velocity or any other variable except plasma aldosterone concentration. Severe facial ulcerative dermatitis developed in 4 of 13 cats treated with SPIR, requiring discontinuation of the drug.
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Parenteral administration of progesterone in normal man provokes an increased sodium and chloride urinary secretion during the 1st days of treatment with no change in kaliuresis. This effect is antagonist to aldosterone. Like spironolactone, progesterone competes with the mineralcorticoid cytoplasmic receptor of renal distal tubular cells. The lack of net variation of kaliuresis under progesterone remains however ill understood. In the healthy subject progesterone-induced natriuresis stimulates plasma renin activity and secondary aldosteronism restricts the amplitude of total sodium loss. Progesterone action may therefore account for the stimulation of the angiotensin renin system during the luteal phase of the menstrual cycle and also contribute to the increased aldosterone secretion during pregnancy. Its pathogenetic role in premenstrual edema is controversial. 17-hydroxyprogesterone which is secreted in large amounts during adrenal hyperplasia due to a block of 21 hydroxylase, has a natriuretic action comparable to that of progesterone, which accounts for the constant activation of the renin system in that condition. Synthetic progestatives do not have the natriuretic action of progesterone; their affinity for the renal tubular receptor in vitro is very small or nil. They do not, however, seem to account for the arterial hypertension observable with the estroprogestative pill. They should be used with care in the woman with hypertension. On the other hand, oral contraception with continuous minimal doses of progestatives seem quite well tolerated with regard to blood pressure. (author's modified)
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The MiREnDa trial is a prospective randomized, placebo-controlled, double-blind, parallel group, multi-centre, intervention study investigating the effects of spironolactone (50 mg daily) compared with placebo in maintenance haemodialysis patients. The change in LV mass index (LVMI) as assessed by cardiac magnet resonance imaging (CMR) constitutes the primary efficacy end point. Secondary end points include changes in LV geometry and function, office and 24-h ambulatory blood pressure, cardiac arrhythmias, vascular function parameters, measures of heart failure and quality of life. Pre-dialysis potassium levels and the incidence of threatening hyperkalaemia (pre-dialysis potassium ≥6.5 mmol/L) constitute safety end points.