Hexopal in Raynaud's Disease

Abstract

Twenty female patients with primary Raynaud's phenomenon were included in a 9-month open assessment of Hexopal® tablets. Measurements of digital artery blood velocity rates by transcutaneous Doppler techniques, digital artery pressure by micromanometry, and hand blood flow by venous occlusion plethysmography were undertaken at regular intervals throughout the 9 months of the study in fourteen of the patients. Additionally, levels of serum cholesterol and triglycerides and plasma fibrinogen were recorded and a visual analogue assessment was made by the patients of the severity of their condition. In patients with primary Raynaud's phenomenon the blood pressure reductions during reactive hyperaemia were quantitatively more pronounced and prolonged compared to values obtained in adult healthy female subjects. In particular, pressure amplitudes were abolished initially in several cases which later developed progressively towards initial values. Blood flow and velocity rate values in the patients during reactive hyperaemia did not achieve levels previously recorded in normal adult healthy female subjects. Peak flow levels were reduced and the time course of reactive hyperaemia was delayed. Oral treatment with inositol nicotinate (Hexopal) was associated with statistically significant increases in transcutaneous blood velocity at rest and during reactive hyperaemia. There were some increases in hand blood flow, particularly in the group receiving 4 g/day, but the changes did not reach statistical significance. There were appreciable reductions in the time course of reactive hyperaemia phases and early attainment of blood pressure values close to the initial values. Serum cholesterol and triglyceride concentrations and plasma fibrinogen levels showed statistically significant reductions during the first three months of treatment and these reduced levels were sustained for the subsequent six months of the study. Improvements in the patients' visual analogue assessments of the severity of their conditions were statistically significant. The occurrence of significant improvements in digital arterial blood flow rates at rest and during reactive hyperaemia did not occur until the second month of treatment. These findings lend support to the proposal that nicotinic acid derivatives during long-term use may produce improvement in peripheral circulation by a mechanism which differs from the brief vasodilatory effect noted during acute administration.