Cardiology Update 1998

Overview

In 1998, nitric oxide (NO) was extensively explored. First studies demonstrating a beneficial effect of inhaled NOin patients with pulmonary hypertension, right ventricular dysfunction and intractable heart failure were published.It was further shown, that, in patients with essential hypertension, impaired vasodilatation can be improved byvitamin C as an antioxidant, an effect that can be reversed by NO-synthase inhibition. Unlike arotinolol, which hasno antioxidat effect, carvedilol is a beta- and alpha-blocker with antioxidative properties that may prevent thedevelopment of nitrate tolerance. In clinical cardiology, the main focus is on the prevention and therapy of coronaryheart disease, heart failure and hypertension: a Task force report on the prevention of coronary heart disease inclinical practice. Proceedings on anticoagulant therapy and Guidelines for antithrombotic management werepublished in 1998. There is an agreement that in mild hypertension the decision how to treat should be based on theestimate of cardiovascular risk and not on an arbitrary blood pressure threshold. Diuretics and betablockers shouldbe preferred unless they are contraindicated, or there are positive indications for other drug classes. Studies alsostrongly suggest that therapy with relatively small doses of two different classes of drugs is the effective way to treatthe majority of patients and minimize side effects. In heart failure, the evidence for the current treatment withdiuretics, ACE-inhibitors and digoxin, in selected patients, is well established.

Key words:
therapeutic use of nitric oxide, NO and antioxidants, carvedilol, arotinolol, prevention of coronaryheart disease, management of hypertension, diuretics, silbenafil, xenical.