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The use of high dosages of corticosteroids in the treatment of giant cell arteritis is based on the need to suppress vascular inflammation and decrease the risk of blindnessto reduce the risk of developing a secondary infection.
When used for the long term in large numbers, high doses of ACE inhibitors are associated with an increase in atherosclerosis, blood pressure, and cardiovascular risk factors. Because in large doses they can increase the chance of the progression of giant cell arteritis and blindness to a secondary infection, and cause premature complications, high doses should not be used to treat patients with giant cell arteritis. To further explore these potential risks associated with ACE inhibitors, a recent study has examined the effects of two different doses of ACE inhibitors in 20 patients whose giant cell arteritis occurred over a relatively brief period of time in both hemispheres. These results reveal that both doses of ACE inhibitors reduce the size of the infarcts, but in different ways.
The results of this study were published in the American Journal of Cardiology.
“The clinical implications for the use of high doses of corticosteroids in people with giant cell arteritis are not yet established,” said Dr. K. L. Doshi, the assistant professor of dermatology at the UCLA School of Medicine, who led the study. “More studies are needed to understand the extent to which these two drug classes act and how these different doses might lead to different consequences for the condition.”
The study authors examined the effects on the plaque-forming cell lining of 20 patients with giant cell arteritis with hemispheric lesions that were both large and complex in size with some areas of irregularity. In this large sample size, the use of both high and low doses of ACE inhibitors in each site was analyzed to determine how these drugs affected plaque-forming cell lining.
Each patient underwent surgical treatment using a combination of a mesh stent and a stent with a mesh that included both the upper and a lower mesh. This approach had the advantage of decreasing tissue bleeding through multiple stents that would otherwise not have been used.
Patients were randomized to receive either a 50 milligram dose of aspirin alone or with an ACE inhibitor. All patients were initially tested for hemodynamic and vascular status, and then received either treatment once to see if they improved or if the condition progressed.
Patients assigned to receive a 50-mg dose of aspirin received a double-blind procedure. Two independent blinded investigators from a different research group assessed the clinical progress of patients, and then the blinded subjects were administered aspirin once at each site. The double-blind technique ensured that each patient would receive exactly the same medicine
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