Right atrium enlargement is related to increased heart damage and mortality in well-controlled hypertension

Background and aimLeft heart remodeling is a well-known pathophysiological effect of arterial hypertension. Right Heart status is not considered in its evaluation. No data are available on right atrium (RA) and its impact on the outcome in hypertension.We wondering to understand whether RA may play a role as a marker of an increased risk for organ damage in well-controlled hypertensives, to probe the clinical significance and whether it could indicate an increased risk.Methods and resultsWe studied well-controlled hypertensive patients. Heart damage was assessed by echocardiography. Patients were subdivided into those with RA area ≤18 cm² (normal RA - Group 1) (554 pts, 227 M, aged 60.35 ± 10.48 years) and those >18 cm² (Increased RA - Group 2) (101 pts, 71 M, age 61.65 ± 9.46 years). Group 2 had a higher left ventricle mass (LVM) and left atrium volume (LAV) both as absolute value (both p < 0.0001) and indexed for body surface area (LVMi p < 0.013; LAVi p = 0.0013). Group 2 showed an increased vascular stiffness (p < 0.0001) and carotid stenosis percentage (p = 0.011). TAPSE (p < 0.0001) resulted significantly increased. In The RA area was significantly correlated directly to LVM and LAV in both groups, but these correlations persisted in indexed values only in Group 2. Moreover, in this group there was a significant direct correlation between RA area and Tricuspid s'wave at echocardiography TDI analysis. Finally, Group 2 had an increased mortality rate compared to Group 1 (Log-Rank p = 0.0006).ConclusionGroup 2 hypertensive patients showed more alterations in dimensional and volumetric left heart parameters, and an increased mortality.     

Fixed combination of candesartan with hydrochloro-thiazide in patients with severe primary hypertension

Objective:The new guidelines for treatment of hypertension by the JNC VII in 2003 permit the initial use of a combination therapy, if blood pressure has to be lowered more than 20/10 mmHg. The aim of this investigation was to document the efficacy and safety of a combination therapy with candesartan cilexetil and hydrochlorothiazide in severe hypertension.

Methods: 116 patients freshly diagnosed as having severe primary hypertension (Grade III) and untreated for this condition were enrolled. The study was performed without a placebo control group for ethical reasons. Thus, all patients were treated for 6 weeks with 16mg candesartan cilexetil plus 12.5mg hydrochlorothiazide daily after forced titration with 8 and 16mg candesartan cilexetil each for < 2 weeks. Sitting trough BP was measured always with the same

device in the morning after 15min at rest, and the median of three measurements was used for analysis. Safety parameters included alanyl aminotransferase (ALAT), aspartyl aminotransferase (ASAT), creatinine, urea, BUN and electrolytes.

Results: The mean reduction in systolic/diastolic BP at the end was 38.1/29.4mmHg. 90.1% of patients were considered to be responders, while 39.6% of patients treated became normotensive (< 140/< 90mmHg). No drug-related adverse events or changes in laboratory parameters were reported.

Conclusion: Although this was an open-label, single-group study, on the basis of efficacy and safety, the combination therapy appears to offer a promising treatment for patients with severe primary hypertension.     

厄贝沙坦氢氯噻嗪片对老年高血压患者血管内皮功能的短期影响

目的 评价厄贝沙坦氢氯噻嗪片对老年高血压患者血管内皮功能的短期影响.方法 选择轻、中度原发性高血压患者106例,分为氢氯噻嗪组50例及厄贝沙坦氢氯噻嗪组56例,两组患者每日晨起分别口服氢氯噻嗪片25 mg及厄贝沙坦氢氯噻嗪片1片,连续12周,检测治疗前后患者的血压、血生化、高敏C反应蛋白（hs-CRP）、血管性血友病因子（vWF）等指标,以及肱动脉内皮依赖性舒张功能（EDD）和颈动脉内膜中层厚度（IMT）的变化.结果 与治疗前比较,氢氯噻嗪组患者治疗后收缩压、舒张压、血钾明显降低（P ＜0.05或P＜0.01）,尿酸明显升高（P＜0.01）,治疗前后vWF、EDD、IMT比较差异无统计学意义（P＞0.05）;厄贝沙坦氢氯噻嗪组患者治疗后收缩压、舒张压、hs-CRP及vWF均明显降低（P＜0.05或P＜0.01）,EDD明显提高（P＜0.05）,治疗前后IMT比较差异无统计学意义（P＞0.05）.两组患者治疗后比较,vWF、EDD比较差异有统计学意义（P＜0.05）.结论 老年轻、中度原发性高血压患者的血管内皮功能的损伤可以逆转,厄贝沙坦氢氯噻嗪片在降压同时可以改善受损的血管内皮功能.     

Nephrogenic diabetes insipidus: treat with caution

Current therapy for congenital nephrogenic diabetes insipidus consists of appropriate water intake coupled with decreased urine output obtained by means of a low-sodium diet and a combination of thiazide diuretics with renal prostaglandins inhibitors or amiloride. We report a case of congenital nephrogenic diabetes insipidus that was complicated by paradoxical water intoxication secondary to liberal water intake and the initiation of hydrochlorothiazide and indomethacin combination therapy. This report emphasizes the importance of evaluating the water balance and of a quick response with strict protocols following the initiation of indomethacin and thiazide diuretics in nephrogenic diabetes insipidus.     

单剂量与多剂量口服复方奥美沙坦酯片的药动学研究

目的:研究健康受试者口服复方奥美沙坦酯片后的药动学。方法:采用高效液相色谱法测定单剂量与多剂量口服复方奥美沙坦酯片后氢氯噻嗪与奥美沙坦的血药浓度,并利用DAS药动学软件计算药动学参数。结果:单剂量给药后氢氯噻嗪与奥美沙坦的主要药动学参数分别为:t1/2(9.7±3.4)、(6.3±2.0)h,Cmax(69.7±19.8)、(635.1±237.7)μg.L-1,AUC0～48(737.8±110.6)、(4 438.4±1 058.1)μg.h.L-1,AUC0～∞(760.4±128.2)、(4 467.0±1 115.6)μg.h.L-1;多剂量给药后氢氯噻嗪与奥美沙坦的主要药动学参数分别为:t1/2(11.4±2.8)、(5.8±2.0)h,Cmax(82.3±26.4)、(694.3±251.2)μg.L-1,AUC0～48(753.2±147.4)、(4 701.3±1 196.6)μg.h.L-1,AUC0～∞(789.3±172.2)、(4 735.0±1 235.1)μg.h.L-1。结论:复方奥美沙坦酯片2组分在健康受试者体内的吸收速率和消除速度不随连续给药变化,连续给药后药物在体内蓄积不明显。     

HPLC法测定新温肾消肿丸中氢氯噻嗪的含量

目的:建立以高效液相色谱法测定新温肾消肿丸中氢氯噻嗪含量的方法方法:色谱柱为Kromasil 60-5CN柱(250 mm×4.6 mm,5μm),流动相为甲醇-0.05 moL·L~(-1)磷酸二氢钾溶液(磷酸调pH 3.0)=49:51,检测波长为226 nm。结果:氢氯噻嗪的检测浓度在2.227～44.540μg·mL~(-1)范围内与峰面积积分值呈良好线性关系(r=0.9999);平均回收率为100.70%, RSD=1.64%(n=6)。结论:本法简便、快速、准确,可用于新温肾消肿丸的质量控制。     

山莨菪碱、非那根和双氢克尿噻联合治疗小儿秋季腹泻的疗效观察

目的：探讨山莨菪碱、非那根和双氢克尿噻联合治疗小儿秋季腹泻的疗效。方法：将193例秋季腹泻患儿随机分成对照组84例和观察组109例。对照组给予调整饮食、抗病毒、维持水电解质平衡等综合治疗;观察组加用山莨菪碱、非那根和双氢克尿噻口服治疗。结果：观察组的总有效率为97.0%,明显高于对照组的79.8%,组间差异有统计学意义（P〈0.01）。结论：山莨菪碱、非那根和双氢克尿噻联合治疗小儿秋季腹泻疗效确切,方便安全,值得借鉴。     

缬沙坦联合氢氯噻嗪治疗高血压的疗效观察

目的观察缬沙坦联合氢氯噻嗪治疗高血压的临床疗效。方法 80例患者随机分为观察组和对照组各40例。观察组给予缬沙坦联合氢氯噻嗪治疗,对照组给予卡托普利联合硝苯地平控释片治疗。2组疗程均为6个月。观察2组血压改善情况。结果观察组总有效率为97.5%高于对照组的92.5%,差异有统计学意义（P〈0.05）。2组治疗后血压均较治疗前改善,且观察组改善情况优于对照组,差异均有统计学意义（P〈0.05）。结论缬沙坦联合氢氯噻嗪治疗高血压疗效好、安全性好,且用药依从性好,是理想的降压治疗方法。     

国产厄贝沙坦/氢氯噻嗪治疗原发性高血压疗效观察

目的评价国产厄贝沙坦/氢氯噻嗪对高血压患者的临床疗效。方法选择74例原发性高血压患者,日服1～2片厄贝沙坦/氢氯噻嗪,于4、8周前后观察24h动态血压监测结果。结果治疗4、8周后,24h平均血压下降26.74/14.46mmHg,31.82/18.25mmHg。结论国产厄贝沙坦/氢氯噻嗪日服1次对原发性高血压疗效确切。