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A low dose of vesnarinone may be an effective and safe treatment for congestive heart failure. Treatment with a higher dose may cause life-threatening complications. Among 477 patients with congestive heart failure, 239 were treated with 60 milligrams (mg) of vesnarinone per day and 238 were treated with a placebo, or inactive substance. Twenty-six patients treated with vesnarinone had progressively worse heart failure or died, compared with 50 patients who received a placebo. Patients in the vesnarinone group experienced a significant improvement in their quality of life over a 12-week period. Of 87 patients with congestive heart failure who were treated with 120 mg of vesnarinone per day, 16 died and half of these deaths occurred within the first six weeks of treatment. Treatment with 120 mg of vesnarinone per day was discontinued because it was too dangerous.

Objective: Hypertension affects 73 million Americans and costs the US healthcare system over $73 billion annually. Despite increasing awareness of the consequences of uncontrolled hypertension, numerous antihypertensive pharmacologic clinical studies and consistent updates to hypertension guidelines, control rates are suboptimal and have not met national goals. Among treated hypertensives, only 45% of women and 51% of men have reached blood pressure (BP) levels below 140/90 mmHg. Individualization of antihypertensive regimens with hemodynamic information from impedance cardiography (ICG) has been advocated to further improve hypertension control rates. We therefore undertook a quantitative analysis of the trials evaluating the role of ICG as an adjunct to therapeutic decision-making in the treatment of hypertension and the attainment of BP control.Methods: Five studies comprising a total population of 759 patients met the inclusion criteria. Two randomized controlled trials (RCTs) involving a total of 268 patients and three single-arm prospective trials with 491 patients were evaluated using ICG data to guide therapeutic decision-making in the treatment of hypertensive patients.Results: Significant benefit was found in both RCTs for ICG-guided BP treatment. The combined odds ratio for the two trials was 2.41 (95% CI = 1.44-4.05, p = 0.0008), in favor of ICG treatment, meaning that it was more than twice as likely to achieve BP success when using ICG than if ICG was not used. Success attainment of goal BP of <140/90 mmHg was 67% in the ICG-guided arms of the combined randomized trials. Overall success in the single-arm prospective trials of ICG-guided BP treatment was a similar 68%.Conclusion: The results of this meta-analysis confirm the value of using ICG-derived hemodynamic data as an adjunct to therapeutic decision-making in the treatment of hypertension. The data reviewed here demonstrate that ICG-based approaches are in keeping with previously advocated strategies incorporating patient-individualized drug regimens, evidence-based medicine, and practical, easy to apply, cost-effective principles to further improve hypertension control rates. [ABSTRACT FROM PUBLISHER]

Chronic hypophosphataemia is associated with reversible depression in myocardial performance of the intact heart. To define the basis for this, we studied the mechanical and electrical properties of isolated left ventricular papillary muscles from rats with 6 weeks of phosphorus depletion (P6), 6 weeks of phosphorus repletion and age-matched controls (C). Muscles were perfused with Tyrode's solution (Ca2+ = 2.4 mmol·litre−1, K+ = 4.0 mmol·litre−1, dextrose = 5.5 mmol·litre−1) and driven at 0.1 Hz. P6 muscles had slowed isometric relaxation (T1/2R), depressed velocity of shortening and relaxation and prolongation of the transmembrane action potential to 75% of complete repolarisation. These results suggest that the slow relaxation phase may be the result of the prolonged APD75 and that the depressed myocardial performance in the intact heart may be based on impaired relaxation and reduced the velocity of shortening associated with hypophosphataemia. This view is supported by our finding that these alterations are reversible with phosphate repletion. [ABSTRACT FROM PUBLISHER]