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It has been conclusively established that treatment of hypertension in patients with type 2 (non-insulin-dependent) diabetes mellitus will significantly reduce the incidence of stroke, heart failure and progression of diabetic complications. β-Blockers are effective antihypertensive agents which, in long term studies, have proven beneficial in reducing important clinical end-points. However nonselective β-blockers may have a negative effect on lipid profiles and contribute to hypoglycaemic unawareness, thus preventing their use in some patients with diabetes mellitus. The development of newer and more selective β-blockers has overcome many of these problems. In addition, some of the newer agents have novel properties such as release of nitric oxide, which theoretically would make them more attractive in patients with diabetes mellitus. Overall, the adverse metabolic effects of β-blockers do not appear to be important in clinical practice and these agents should no longer be contraindicated in patients with type 2 diabetes mellitus. Their proven cardiovascular benefits would seem to easily tip the balance in favour of their use. [ABSTRACT FROM AUTHOR]

Fundamental differences in the pharmacodynamic and pharmacokinetic profiles of beta-adrenergic blocking agents must be considered in optimizing their efficacy and determining the appropriate selection of these drugs in different patients. Beta blockers are contraindicated in patients with asthma and should be used cautiously in heart failure. Clinically important distinctions are related to whether a beta blocker is beta1-selective or nonselective. Most adverse effects of beta-blocker use are related to interference with beta2-mediated functions including bronchodilation, vasodilation, and mobilization of free fatty acids. To achieve the potential benefits of beta1 blockade (decreased heart rate, blood pressure, cardiac workload, and excitability), a low plasma concentration of a beta1-selective drug is required. Adverse effects of beta blockers can be further decreased by selecting a sustained-release beta1-selective drug. Beta blockers are further differentiated on the basis of lipophilicity or hydrophilicity. Lipophilic beta blockers cross the blood-brain barrier, whereas hydrophilic agents do not enter the central nervous system. Some lipophilic agents (metroprolol, timolol, and propanolol) have been shown to decrease mortality in coronary heart disease, particularly sudden cardiac death. [ABSTRACT FROM AUTHOR]

Considers the problem of sudden death from heart disease and the role of beta-blockers and other agents in preventing sudden death. Reduction of atheroma formation, reduction of the risk for ventricular fibrillation, reduction of mortality of post-myocardial infarction patients with the use of beta-blockers; Importance of initiating and maintaining beta-blocker therapy.

The article discusses the issue of children's health care treatment worldwide. The author reviews the difficulties facing clinical research on medicines for children. It is suggested that the relatively small market related to children's health care conspires against adequate investment in children's medicines by the pharmaceutical industry. Various research documents and legislation involving children's health care in the United States and Europe is discussed.

Reports the findings of the Swedish Trial in Old Patients with Hypertension 2 (STOP). Questions as to which treatment for hypertension in the elderly is most effective; Antihypertensive therapy; ACE inhibitors.

Presents several medical correspondence in Great Britain. Need for changes in the national immunization policy; Relationship between breathing rate and pneumonia; Growth and clotting factors in adult life.