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Survival after aortic dissection in giant cell arteritis.

pressure or hypotensive episodes were recorded during the trial. Among the side effects, mild flushing (35%) and headache (24%) were the most frequent in isradipine recipients. This study has demonstrated the favourable effects of isradipine on patients with Raynaud's phenomenon; moreover, it is the first to demonstrate a significant reduction in plasma concentrations of ET-1 during calcium antagonist treatment. The most usual manifestations of Raynaud's phenomenon are pain and numbness in the fingers, which in some subjects can be complicated by skin ulcers5 requiring prompt intervention.3 4 In the present study, isradipine was able to reduce the frequency, severity, and disabling nature of acute attacks of Raynaud's phenomenon; this result agrees with previous experience of the use of calcium antagonists in patients with Raynaud's phenomenon,' 3 4 and reflects an appropriate selection of patients to receive the treatment. In addition, the clinicoserological manifestations and changes in capillaroscopic findings in this series of patients, including those with type I and type II Raynaud's phenomenon, were relatively homogeneous. The clinical improvement of our patients with Raynaud's phenomenon in response to isradipine was reflected in a reduction in plasma concentrations ofET-1. Although the pathophysiological ftmction of ET-1 remains unknown,"3 a number of vascular disorders are characterised by increased concentrations of this vasoactive peptide." How isradipine may influence the titres ofET-1 is difficult to explain but, because ET-l is released in response to ischaemic stimuli," we hypothesise that isradipine is able to induce a change in ET-l concentrations indirectly, by improving tissue perfusion. The findings of this preliminary investigation merit further investigation in larger series of patients with Raynaud's phenomenon.