The pharmacokinetics of lisinopril were determined in 6 healthy young, 6 healthy elderly and 6 elderly patients with cardiac failure. Lisinopril (5 mg day-1) was administered for 7 days. Plasma lisinopril concentration was measured at 1, 2, 4, 6, 8 and 24 h on days 1 and 7 of the study. The two elderly groups had higher serum lisinopril concentrations than the healthy young subjects (P less than 0.05). There were no significant differences in any of the areas under the curve (AUC) for lisinopril plasma concentration (over time) between the healthy young and healthy elderly groups. The healthy young patients had AUC values on day 7 lower than elderly patients with cardiac failure (P less than 0.01). Creatinine clearance was correlated with lisinopril clearance (r = 0.63; P = 0.006) and with AUC on day 7 (r = -0.67; P = 0.004). Lisinopril clearance was different in the three groups (P less than 0.05): healthy young patients had the highest and elderly patients with cardiac failure the lowest values. Thus, in the elderly a reduced renal clearance of lisinopril leads to higher and more sustained blood levels. In elderly patients with cardiac failure, renal function should be estimated before lisinopril is prescribed as a reduction in dose may be appropriate.

The electrophysiological effects of xamoterol were studied in ten patients with suspected coronary artery disease by intracardiac electrography. Sino-atrial and atrioventricular conduction times were both slightly shortened by 0.1 mg/kg of xamoterol. The atrioventricular nodal refractory periods were shortened without consistent change in atrial refractoriness. This dose raised mean blood pressure by only 3 mmHg and resting heart rate by only 4 beats/min. The effects suggest a beta 1 agonist activity closer to that of prenalterol than that of pindolol under conditions of rest.

Two hundred patients aged

Results of treatment of 86 hypothermic elderly patients in a purpose-built chamber are presented. They were barrier-nursed, continuously monitored and treated by slow active rewarming by warm air. The early 24-hour mortality did not significantly differ from other published reports. The complications of ‘rewarming shock’ and ‘after drop’ were prevented. It is concluded that a specially built hypothermia room facilitates management of hypothermic elderly patients and is recommended in all geriatric departments.

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