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Efficacy and safety of a drug are essential criteria to be fulfilled before a new drug receives recommendation. This review focuses on the safety of ibopamine in the treatment of chronic heart failure. Ibopamine is a new, orally active drug with a predominant action on dopaminergic adrenoceptors. As a result, it reduces systemic vascular resistance, increases cardiac output, and increases renal flow. Ibopamine also modulates the neuroendocrine reflexes in heart failure; plasma renin activity and norepinephrine and aldosterone plasma concentrations are reduced, both immediately and during sustained administration. Ibopamine has proved to be safe in many thousands of heart failure patients during longterm therapy. This augurs well for its use as an alternative or additive therapy in the treatment of patients with chronic heart failure., In congestive heart failure, the heart cannot keep up with the needs of the body and the constriction of peripheral blood vessels both decreases the flow of blood and increases the workload of the heart. For decades, the primary treatment has been digoxin, which stimulates the heart, or diuretics, which decrease the blood pressure and hence, the workload of the heart. Drugs that inhibit the alpha receptors for adrenalin, the alpha adrenergic antagonists, inhibit the constriction of peripheral blood vessels and can reduce the workload of the heart. Inhibitors of angiotensin-converting enzyme may be used to reduce blood pressure and the retention of water and sodium. New drugs are being introduced that may add to the choices available to the physician. Ibopamine is a drug that is likely to become important in treating congestive heart failure. The drug is similar to the naturally occurring substance dopamine, and acts primarily on the dopamine receptors. The drug, which is metabolized in the blood to its active form epinine, also stimulates all types of adrenoreceptors. The net effect is that ibopamine relaxes the peripheral blood vessels and increases the strength of the heart. Unlike many drugs of closely related structure, ibopamine also improves the flow of blood through the kidneys. Extensive studies have failed to identify any serious adverse cardiovascular effects of ibopamine. There have been no observed increases in the likelihood of abnormal heart beats among patients that have been treated with ibopamine. The results of studies indicate that ibopamine is safe and does not aggravate some of the conditions that may lead to death in the patient with heart failure. An important finding is that the effects of ibopamine are additive to the effects of the commonly used drugs digoxin and the diuretics. Therefore, it may be possible to improve the efficacy of treatment by using both drugs before heart failure progresses beyond its earliest stages. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background: Renal artery stenosis is a rare cause of hypertension. The gold standard for diagnosing renal artery stenosis, renal angiography, is invasive and costly. Objective: To develop a prediction rule for renal artery stenosis from clinical characteristics that can be used to select patients for renal angiography. Design: Logistic regression analysis of data from a prospective cohort of patients suspected of having renal artery stenosis. A prediction rule was derived from the regression model for use in clinical practice. Setting: 26 hypertension clinics in the Netherlands. Patients: 477 hypertensive patients who underwent renal angiography because they had drug-resistant hypertension or an increase in serum creatinine concentration during therapy with angiotensin-converting enzyme inhibitors. Results: Age, sex, atherosclerotic vascular disease, recent onset of hypertension, smoking history, body mass index, presence of an abdominal bruit, serum creatinine concentration, and serum cholesterol level were selected as predictors. The regression model was reliable (goodness-of-fit test, P [is greater than] 0.2) and discriminated well between patients with stenosis and those with essential hypertension (area under the receiver-operating characteristic curve, 0.84). The diagnostic accuracy of the regression model was similar to that of renal scintigraphy, which had a sensitivity of 72% and a specificity of 90%. Conclusions: In the diagnostic workup of patients suspected of having renal artery stenosis, the clinical prediction rule can be considered as an alternative to renal scintigraphy. It can help to select patients for renal angiography in an efficient manner by reducing the number of angiographic procedures without the risk for missing many renal artery stenoses., A clinical profile based on laboratory tests and clinical and demographic characteristics can reliably predict high blood pressure caused by renal artery stenosis in hypertensive patients. Restricted flow in the renal artery in the kidney is usually diagnosed by renal scintigraphy, an expensive and invasive procedure. Researchers studied 477 hypertensive patients undergoing kidney angiography, and found that a predictive model based on age, gender, vascular disease, serum creatinine concentration, and other factors reliably identified the patients with renal artery stenosis. Using such a predictive profile, physicians could reduce the number of patients who unnecessarily undergo renal scintigraphy.