Search

The possible implication of the beta-sympathoadrenergic system in regulating the rhythmicity of the renin-angiotensin-aldosterone system (RAAS) was studied in ten normotensive volunteers and in thirty-nine essential hypertensive patients. The study was carried out by simultaneous radioimmunological measurements of diurnal levels of plasma renin and aldosterone before and during acute oral medication of beta-adrenoceptors with propranolol. Acute beta-blockade was seen to blunt the circadian periodicity of plasma renin and aldosterone in normotensives and in hypertensives with normal or high renin patterns. Conversely propranolol was seen to be ineffective in low-renin patients. The disappearance of the circadian rhythms under beta-adrenoceptor blockade tends to suggest the existence of a beta-adrenergic control of RAAS cyclicity in normal condition, as well as in normal or high renin essential hypertension. The inefficacy of propranolol in hyporeninemic hypertensives is consistent with the hypothesis that low-renin essemtoa; juertemsopm os a state in which the sympatho beta-adrenergic mechanism controlling the function of RAAS has no biologic time structure.

While the technics of cardiac pacing have shown to have a precise role in the diagnosis and treatment of ventricular arrhythmias on a temporary basis, the role of permanent antiarrhythmic devices (PAD) in the treatment of these arrhythmias is still ill defined mainly because of the technological limits concerning the pacemakers and the frequent complications observed during the attempts to interrupt such tachycardias. On the basis of the available data and of theoretical considerations, three groups of pts susceptible of treatment with PAD can be selected: a) pts with brady-dependent arrhythmias where PAD is used as a prophylactic mean; b) pts with recurrent sustained ventricular tachycardia refractory to medical treatment, in whom PAD can be used to interrupt tachycardia; c) pts affected by ventricular fibrillation or rapidly deteriorating ventricular tachycardia (sudden death pts), refractory to conventional treatment, in whom the implantable defibrillator represents the only therapeutic possibility. Even if scanty, the data available seem to confirm that PAD does have a role in the treatment of malignant arrhythmias, although in selected cases and almost always together with drug treatment.