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1.
A double-blind, crossover study was carried out on the antihypertensive effect of 5 mg ramipril. Continuous 24-h blood pressure monitoring was performed on 15 essential hypertensives [mean (+/- SD) blood pressure 155.2 +/- 6.5/101.3 +/- 4.8 mmHg], 24 h prior to treatment and 48 h after having received either antihypertensive therapy or placebo; the patients taking part in the study had not taken any antihypertensive treatment 4 weeks prior to the beginning of the trial. After receiving 5 mg ramipril the mean 24-h blood pressure was significantly (P less than 0.05) reduced to 148.3 +/- 5.8/91.5 +/- 5.5 mmHg. After 48 h the blood pressure increased to 153.1 +/- 4.8/96.0 +/- 6.4 mmHg. In the placebo group there was only a slight, non-significant reduction in blood pressure on day 1 (154.3 +/- 6.9/97.3 +/- 5.7 mmHg) and during day 2 the blood pressure increased to 155.4 +/- 5.3/99.5 +/- 5.9 mmHg. The results showed that a once-daily administration of 5 mg ramipril produced a reduction in blood pressure, which lasted 24 h. This simple therapeutic regime offers the advantage of being easy for patients to follow and, therefore, promotes compliance with therapy.  相似文献   

2.
Following a randomised cross-over trial of the effect of a four-week 60 mmol/day potassium supplement versus placebo on blood pressure (BP), eight of the original 18 hypertensive subjects continued with a 48 mmol daily potassium supplement for four months. For these eight subjects 24-h potassium excretion during placebo, one month of 60 mmol and four months of 48 mmol daily potassium supplementation phases was 56 ± 23, 102 ± 28 and 90 ± 35 mmol/24 hours, respectively, and mean 24-h BP following each phase was 160 ± 16/89 + 11, 147 ± 13/83 ± 12 and 145 ± 14/81 ± 9 mmHg respectively, a significant fall in mean 24-h SBP between four months of potassium supplement and placebo period of 15 ± 13 mmHg (95% CI: 4, 26 mmHg, p=0.02), although the fall in 24-h DBP was not significant (8 ± 11 mmHg, 95% CI: 0, 17 mmHg, p=0.08). Modest increases in dietary potassium intake could have significant effects on lowering BP in the large proportion of elderly subjects with hypertension.  相似文献   

3.
PurposeThe aim was to compare non-invasive blood pressure measurements with invasive blood pressure measurements in critically ill patients.MethodsNon-invasive blood pressure was measured via automated brachial cuff oscillometry, and simultaneously the radial arterial catheter-derived measurement was recorded as part of a prospective observational study. Measurements of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) were compared using Bland-Altman and error grid analyses.ResultsPaired measurements of blood pressure were available for 736 patients. Observed mean difference (±SD, 95% limits of agreement) between oscillometrically and invasively measured blood pressure was 0.8 mmHg (±15.7 mmHg, −30.2 to 31.7 mmHg) for SAP, −2.9 mmHg (±11.0 mmHg, −24.5 to 18.6 mmHg) for DAP, and −1.0 mmHg (±10.2 mmHg, −21.0 to 18.9 mmHg) for MAP. Error grid analysis showed that the proportions of measurements in risk zones A to E were 78.3%, 20.7%, 1.0%, 0%, and 0.1% for MAP.ConclusionNon-invasive blood pressure measurements using brachial cuff oscillometry showed large limits of agreement compared to invasive measurements in critically ill patients. Error grid analysis showed that measurement differences between oscillometry and the arterial catheter would potentially have triggered at least low-risk treatment decisions in one in five patients.  相似文献   

4.
目的 评价复方氯沙坦的降压疗效及安全性。方法  30例轻中度原发性高血压患者 ,每天服复方氯沙坦 1~ 2片 ,观察降压疗效和对实验室检验结果的影响 ,在治疗 1、2、4、6、8周末记录血压、心率及不良反应情况。结果 服药 1周血压即下降 ,收缩压 /舒张压由治疗前的 (15 0 0± 16 8/10 3 2± 5 6 )mmHg降至 (138 6± 13 3/93 3± 6 9)mmHg ,8周后降至 (12 9 2± 12 6 /87 4± 7 8)mmHg ,心率无明显改变 ,不良反应少。结论 复方氯沙坦每天 1次口服 ,能有效控制血压 ,作用平稳 ,不良反应少 ,服药方便  相似文献   

5.
Introduction  The haemodynamic response after an IV-loading dose of amiodarone followed by continuous infusion for various supraventricular and ventricular tachycardias was studied in children immediately after corrective surgery for congenital heart defects. Methods  Observational study over a 10-year period. Seventy-one out of 2651 patients (2,885 procedures, 2,106 bypass procedures) received amiodarone therapy for newly detected postoperative tachyarrhythmias. All patients received catecholamine infusions as standard post-op therapy to support cardiac function and output. In most cases a loading dose of amiodarone was given over 1–4 h followed by a continuous infusion. Catecholamine infusion dose requirements were monitored as was heart rate, blood pressure, central venous pressure, and sedation dose requirements pre treatment and at 0.5, 1, 2, 4, 8, 12 and 24 h after the begin of the amiodarone administration. Results  After 1 h there was a significant decrease of heart rate from 194.5 bpm (±31.9) to 157.5 bpm (±34.3) and an increase of the mean arterial blood pressure from 52.8 (±11.4) to 56.0 (±9.8) mmHg, with a subsequent decrease of filling pressures. The catecholamine dose required could be decreased as could the dose for sedation. Rate control was achieved at 277.4 min (±344) and rhythm control at 685.8 min (±988.5) respectively. Based on a preliminary interim analysis a specific treatment protocol was established and used in 32 patients. Conclusion  A slow bolus administration of 5 mg/kg amiodarone over at least 60 min followed by one or two additional boluses or a continuous infusion with 10–20 mg/kg day−1 is a safe treatment strategy without the need for additional inotropic support and with dramatic improvement of heart rate, blood pressure and filling pressures. This protocol can be recommended for paediatric patients in the early postoperative setting.  相似文献   

6.

Introduction

The etiology of essential hypertension is multifactorial. Therefore, treatment with combinations of antihypertensive agents acting on multiple targets is necessary for successful therapy in the majority of patients. According to the experience and clinical data accumulated so far, combination therapy with three agents from different pharmacological classes is required in approx. 30% of patients in order to achieve long-term blood pressure control. The primary objective of the PETRA study was to evaluate the efficacy of blood pressure (BP) control with once daily administration of the different dosage strengths of the once-daily, triple fixed combination of perindopril, indapamide, and amlodipine. The evaluation was based on office BP readings and ambulatory blood pressure monitoring (ABPM) data gathered in routine clinical practice.

Methods

Data from 11,209 hypertensive patients (the proportion of female subjects was 47.6%) were processed and interpreted in a 3-month-long prospective, observational, non-interventional, open-label study conducted in 997 centers in Hungary.

Results

Mean baseline office BP was 156.58 ± 16.10/91.56 ± 9.33 mmHg (mean ± SD), whereas the mean duration of hypertension was 9.48 ± 7.19 years. Mean office BP decreased by 24.81 ± 15.47/11.41 ± 9.90 mmHg after switching to the triple fixed combination of perindopril, indapamide, and amlodipine (p < 0.0001). At the final visit 45.1% of patients took the 5/1.25/5 mg, 33.5% of them 10/2.5/5 mg, and 21.4% of them 10/2.5/10 mg strength of the perindopril/indapamide/amlodipine triple fixed combination. The 24-h blood pressure was obtained in 76 subjects. The mean 24-h BP decreased from 155.51 ± 17.43/85.28 ± 11.48 to 134.63 ± 12.51/77.83 ± 8.99 mmHg (p < 0.0001). Statistically significant (p < 0.0001) and clinically relevant improvement of a number of metabolic parameters—including total cholesterol (?8.6%), LDL-cholesterol (?11.4%), triglyceride (?12.1%), and fasting blood glucose (?6.6%) levels—was observed over the 3-month study period.

Conclusions

During the 3 months of the PETRA study, the outstanding 24-h antihypertensive efficacy of the triple fixed combination of perindopril, indapamide, and amlodipine was confirmed both by office BP readings and by ABPM recordings. This combination may offer a new therapeutic option for hypertensive patients who have failed to achieve the desired BP target on their previous dual combination therapy.

Funding

EGIS Pharmaceuticals PLC.
  相似文献   

7.
ObjectiveWe aimed to investigate whether high blood pressure and hypertension are associated with epistaxis.MethodsA retrospective study with a propensity score matching analysis was performed at the emergency departments (EDs) of a tertiary university hospital. The mean blood pressure (BP, systolic and diastolic) and proportion of subjects with elevated BP (systolic >120 and/or diastolic >80 mmHg) at presentation were compared between the epistaxis group and matched control group. The proportion of patients with newly diagnosed hypertension within six months between the two groups was also compared.ResultsA total of 1353 patients with epistaxis and the same number of those with simple lacerations were matched. The mean systolic and diastolic BPs of the epistaxis group were significantly higher than those of the matched control group (157.1 ± 26.4 and 91.4 ± 17.0 mmHg versus 144.9 ± 32.4 and 84.2 ± 13.5 mmHg) (P < 0.001). The proportion of patients with elevated BP at presentation was also significantly higher in the epistaxis group (91.4%) than in the matched control group (86.2%) (P < 0.001). Of the 724 (53.5%) patients without pre-existing hypertension in the epistaxis group, 660 patients were followed, of whom 107 (16.2%) were newly diagnosed with hypertension within 6 months, which was a significantly higher percentage than among the matched controls (4.9%, P < 0.001)ConclusionThe patients with epistaxis had elevated BP at presentation and a higher proportion of newly diagnosed hypertension within six months compared to the matched controls.  相似文献   

8.
Blood pressure is not adequately controlled in almost 50% of patients with hypertension who are in receipt of antihypertensive therapy. This multicentre, prospective, open-label trial was designed to determine whether or not once-daily telmisartan 80 mg reduced blood pressure during the last 6 h of the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive therapy. The study comprised 100 patients (47 males, 53 females) who had failed to respond satisfactorily to prior treatment given for a minimum of 3 months. At screening, 24-h ambulatory blood pressure monitoring (ABPM) was conducted after the patient had been treated with the currently prescribed antihypertensive medication. Following 5 weeks of telmisartan 80 mg treatment, ABPM was repeated. Telmisartan significantly reduced mean systolic blood pressure, diastolic blood pressure (DBP) and pulse pressure compared with previous antihypertensive therapy over each time interval (24-h, morning, night-time and the last 6 h of the dosing interval [2.00 a.m.-8.00 a.m.]) analysed. In addition, more than 90% of patients responded successfully (clinic DBP <90 mmHg or a >10 mmHg reduction in clinic DBP) at the end of telmisartan treatment. In conclusion, telmisartan provides effective blood pressure control throughout the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive medication.  相似文献   

9.
Felodipine is a new dihydropyridine calcium antagonist which selectively relaxes vascular smooth muscle. It lovers dose-dependently blood pressure in hypertensives patients. In this multicentre double-blind study, 113 patients (mean age 50 +/- 14 years) whose diastolic blood pressure was higher than 95 mmHg after withdrawal of an eventual antihypertensive therapy and a week of placebo administration. The patients received randomly either felodipine (5 mg x 2/j during two weeks and then 10 mg x 2/day) either atenolol (100 mg/day) during two months. Antihypertensive effects of these two drug regimens were not significantly different. Supine blood pressure decreased from 177 +/- 22/107 +/- 8 mmHg to 152 +/- 27/91 +/- 13 mmHg with felodipine and from 176 +/- 19/107 +/- 8 to 152 +/- 24/91 +/- 12 with atenolol. Side effects recorded by means of active questioning were ankle oedemas and headache with felodipine and fatigue and headache with atenolol.  相似文献   

10.
Patients with Parkinson disease (PD) present blunted nocturnal blood pressure fall and similar ambulatory blood pressure variability (ABPV) measured by standard deviation (SD) and coefficient of variation (CV) compared with healthy subjects. However, these classical indices of ABPV have limited validity in individuals with circadian blood pressure alterations. New indices, such as the average of daytime and night‐time standard deviation weighted by the duration of the daytime and night‐time intervals (SDdn) and the average real variability (ARV), remove the influence of the daytime and the night‐time periods on ABPV. This study assessed ABPV by SDdn and ARV in PD. Twenty‐one patients with PD (11 men, 66 ± 2 years, stages 2–3 of modified Hoehn & Yahr) and 21 matched controls without Parkinson disease (9 men, 64 ± 1 years old) underwent blood pressure monitoring for 24 h. ABPV was analysed by 24 h, daytime and night‐time SD and CV, and by the SDdn and ARV. Systolic/diastolic 24‐h and night‐time SD and CV were similar between the patients with PD and the controls. The patients with PD presented higher daytime systolic/diastolic CV and SD than the controls (10·4 ± 0·9/12·3 ± 0·8 versus 7·0 ± 0·3/9·9 ± 0·5%, P<0·05; 12·6 ± 1·0/9·1 ± 0·5 versus 8·6 ± 0·4/7·5 ± 0·3 mmHg, P<0·05, respectively) as well as higher systolic/diastolic SDdn (10·9 ± 0·8/8·2 ± 0·5 versus 8·2 ± 0·3/7·1 ± 0·2 mmHg, P<0·05, respectively) and ARV (8·8 ± 0·6/6·9 ± 0·3 versus 7·2 ± 0·2/6·0 ± 0·2 mmHg, P<0·05, respectively). In conclusion, patients with PD have higher ABPV than control subjects as assessed by SDd, CVd, SDdn and AVR.  相似文献   

11.
In anesthesia and critical care, invasive arterial blood pressure monitoring is the gold standard against which other methods of monitoring are compared. In this assessment of the Philips MP90 monitor, the objective was to determine whether or not oscillometric measurements were within the accuracy standards set by the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS). Three hundred and one invasive and noninvasive paired measurements were obtained from eleven adult patients on the neurosurgical service at Stanford University Medical Center. Bland–Altman plots were created to assess agreement between the two measurement systems. Paired correlation analysis, bias and precision calculations were performed. Oscillometric blood pressure measurements correlated with arterial measurements yielding Pearson r values of 0.68, 0.67 and 0.62 for systolic, diastolic and mean pressures, respectively (P < 0.01.) Mean differences with 95% confidence intervals were −3.8 mmHg ± 13.6, −2.4 mmHg ± 10.0, and 4.0 mmHg ± 13.1 for systolic, diastolic and mean pressures, respectively. The mean difference for these measurements was ≤5 mmHg as stipulated by the AAMI guidelines, but the standard deviation was greater than the 8 mmHg allowed by the AAMI guidelines. When the BHS guidelines were applied, the device merited a grade “D” for systolic and mean arterial pressure, and a grade “C” for diastolic pressure, with the highest possible grade level being “A.” There was a poor correlation between noninvasive and invasive measurements of arterial blood pressure as measured with a cuff and radial arterial cannula using the Philips MP90 monitor. These inaccuracies could lead to unnecessary interventions, or lack of appropriate interventions in anesthetic management. Further study is needed to specify the absolute inaccuracy of the monitor, and to determine if accuracy between the two methods varies with patient co-morbidities, surgical procedures, or anesthetic management. Mireles SA, Jaffe RA, Drover DR, Brock-Utne JG. A poor correlation exists between oscillometric and radial arterial blood pressure as measured by the Philips MP90 monitor.  相似文献   

12.
BackgroundForearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable. However there is little evidence utilising clinical populations to support this substitution.ObjectivesTo determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients. The secondary objective was to explore the relationship of blood pressure differences with age, sex, ethnicity, smoking history and obesity.DesignSingle centre comparison study.SettingAdult Emergency Department, Tertiary Trauma Centre.ParticipantsForty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board.MethodsA random assignment of order of measurement for left upper arm and forearm blood pressures was utilised. Participants were eligible if they were aged 18 years or older, had been assigned an Australasian Triage Scale code of 2, 3, 4, or 5, were able to consent, and able to have blood pressures measured on their left arm whilst lying at a 45° angle. The Bland–Altman method of statistical analysis was used, with the level of agreement for clinical acceptability for the systolic, diastolic and mean arterial pressure defined as ±10 mmHg.ResultsThe forearm measure overestimated systolic (mean difference 2.2 mmHg, 95% limits of agreement ±19 mmHg), diastolic (mean difference 3.4 mmHg, 95% limits of agreement ±14.4 mmHg), and mean arterial pressures (mean difference 4.1 mmHg, 95% limits of agreement ±13.7 mmHg). The systolic measure was not significantly different from zero. Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene's test (p = 0.002, F-statistic = 11.09). Blood pressure disparity was not associated with participant characteristics.ConclusionsForearm measures cannot routinely replace upper arm measures for blood pressure measurement. If the clinical picture requires use of forearm blood pressure, the potential variance from an upper arm measure is ±19 mmHg for systolic pressure, although the variability may be close to ±10 mmHg if the systolic blood pressure is below 140 mmHg.  相似文献   

13.
Takeda Medical (A & D) TM 2420 is an automatic ambulatory blood pressure monitoring system employing the auscultatory technique. The device was used under stable conditions and compared to readings from the Hawksley randomzero sphygmomanometer using a double headset stethoscope and a Y-connection. We tested 85 subjects (aged 13–89 years, systolic blood pressure 85–212 mmHg, diastolic blood pressure 40–116 mmHg) and found a difference amounting to 1.6±6.7 mmHg (mean±SD) for systolic and 2.1±4.5 mmHg for diastolic readings (Hawksley-TM 2420). In 62 subjects a comparison with simultaneous measurement on the opposite arm with the Hawksley manometer showed similar results. When comparing intra-arterial readings from 10 subjects, a difference (intra-arterial-TM 2420) of -1.9±12.1 mmHg was found for systolic pressures, while the diastolic difference was -10.7±8.7 mmHg. Twenty-four hour monitoring was performed on 80 subjects; 70 of these yielded usable tracings. The proportion of successful recordings was acceptable, but the device was not suitable for bicycle stress testing. The quality of the accessories provided with the equipment could be improved, but in spite of this the monitoring system was found to be recommendable for clinical use.  相似文献   

14.
The rate of progression of nephropathy was studied in 6 young male diabetics with intermittent proteinuria (Albustixr`) and in 10 young male diabetics with constant proteinuria by measuring glomerular filtration rate (GFR), renal plasma flow (RPF), and urinary albumin excretion by exact techniques. Albumin excretion was elevated in both the recumbent and the erect position in patients with intermittent proteinuria. GFR and RPF were at the same level as in diabetics without proteinuria, and no deterioration in renal function was noted during a mean control period of 32 months. In the patients with constant proteinuria the fall rate during a mean period of 33.6 months for GFR and RPF was 0.91 ml/min/month ± 0.68 (S.D.) and 4.38 ml/min/month ± 3.23 (S.D.) respectively. Initial fall rate in GFR correlated well with long-term fall rate, both of which were studied in 7 patients. In the same patients there was a positive correlation between the fall rate in GFR and diastolic blood pressure as well as albumin clearance. In 8 patients with constant proteinuria and mean blood pressure of 159/101 mmHg, antihypertensive treatment was started with propranolol alone or combined with hydralazine and furosemide. During a treatment period of 47 days blood pressure was reduced to 143/93 mmHg, and in the same period urinary albumin excretion was reduced significantly from a mean value of 3547 μg/min to 2414 μg/min (P < 0.01). Further control studies will clarify whether end-stage of renal insufficiency will be postponed by antihypertensive treatment.  相似文献   

15.

Background

Hypertension and type 2 diabetes mellitus (T2DM) synergistically deteriorate the vascular environment, making blood pressure reduction challenging, and substantially increasing cardiovascular risk.

Methods

In the real-life, open-label, observational, PICASSO study, 9,257 hypertensive patients unsuccessfully treated with antihypertensives were switched to fixed-dose combination of perindopril 10 mg/indapamide 2.5 mg. In this subgroup analysis, we analyzed changes in blood pressure and laboratory parameters of 2,762 hypertensive patients with T2DM or pre-diabetes.

Results

After 3 months of treatment, significant decreases in office blood pressure were noted in the whole cohort (?27.0 ± 14.8/?12.7 ± 9.8 mmHg; p < 0.001). Significant decreases were also recorded in patients with grade 1 hypertension (19.2 ± 10.0/?9.4 ± 7.9 mmHg), grade 2 (29.2 ± 10.9/?13.3 ± 8.7 mmHg) and grade 3 (?45.1 ± 15.4/?21.5 ± 11.2 mmHg). Significant decreases in ambulatory blood pressure were also noted (n = 93). In patients previously treated with angiotensin-converting enzyme inhibitor ± hydrochlorothiazide or angiotensin receptor blocker ± hydrochlorothiazide, mean 24-h blood pressure decreased by 23.4 ± 13.9/11.5 ± 9.7 and 22.3 ± 8.7/10.4 ± 13.2 mmHg, respectively (p < 0.001). Treatment was well tolerated and the switch to treatment with perindopril/indapamide was associated with improvements in laboratory parameters.

Conclusions

Data from this diabetes subgroup analysis suggest that fixed combination of perindopril 10 mg/indapamide 2.5 mg should be routinely considered for the treatment of hypertension in diabetic patients who are unsuccessfully managed with other antihypertensive medications.  相似文献   

16.
BackgroundNardostachys jatamansi (D.Don) DC, commonly known as muskroot and Indian spikenard, is a small, perennial, flowering, rhizomatous species of the Caprifoliaceae family. Nardostachys jatamansi (D.Don) DC (Sumbul-ut-teeb) has been used in Unani Medicine since antiquity. It is one of the important drugs mentioned by Ibn-e-Sina (Avicenna) in his treatise “Kitab al-Adwiya al- Qalbiya” for cardiac diseases. The drug has been shown to exhibit anxiolytic, sedative, antispasmodic, tranquillizing, and anti hypertensive activity.AimThe aim of the present study was to examine the efficacy of Nardostachys jatamansi in reducing blood pressure in hypertensive patients.MethodsThe single blind randomized, placebo controlled study was conducted with 40 patients aged between 35–70 years. The participants were randomly allocated to receive either a total of 3 g of N. Jatamansi (1capsule 3 times a day) or placebo for 4 weeks. Patients using ≤ 2 antihypertensive drugs with stage 1 hypertension were included in the study. Systolic and diastolic Blood pressure was recorded at baseline and at every week for four weeks. MINICHAL score (for Quality of Life) was recorded at baseline and at the end of the trial.ResultsAfter the four weeks of treatment, there was a statistically significant reduction in average systolic blood pressure 144.20 ± 11.35 mmHg (CI, 138.89–149.51) to 134.30 ± 10.08 mmHg (CI, 129.58–139.02), p < 0.001) and diastolic blood pressure (94.9. ± 3.4 mmHg (CI 93.30–96.49) to 83.10 ± 5.29 mmHg (CI 80.62–85.57), p < 0.001) in the N. Jatamansi group whereas there was no significant difference in systolic blood pressure (143.40 ± 8.39 mmHg (CI, 139.47–147.33) to 142. ± 11.68 mmHg (CI, 136.53–147.47) p = 0.148) and diastolic blood pressure 95.10 ± 3.70 mmHg (CI, 93.37–96.83) to 94.80 ± 3.69 mmHg, (CI93.07–96.52) p = 0.186) in placebo group. A comparison between baseline and post treatment, MINICHAL score in N. Jatamansi group showed significant reduction 10.85 ± 1.27 (CI, 10.25–11.44) to 6.20 ± 1.77, (CI, 5.37–7.02) p < 0.001) whereas there was no significant difference in placebo group 11.05 ± 1.50 (CI, 10.34–11.75) to 10.85 ± 1.26, 95 % (CI, 10.25–11.44) p = 0.103).ConclusionThe present findings suggest that N. Jatamansi is effective in reducing both systolic and diastolic blood pressure in essential hypertension. Moreover studies on efficacy of different doses and treatment duration of test drug are required to finetune these observations.  相似文献   

17.
Hypertension is a major risk factor for coronary heart disease, stroke, heart failure and renal disease. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure 7 defined hypertension as a blood pressure of more than 140/90 mmHg and recommended to initiate treatment with a two-drug combination for stage 2 hypertension (blood pressure of 160-179/100-109 mmHg). The need for drug combinations is clear from a patient and physician perspective as they provide more effective blood pressure lowering, reduce pill burden, improve compliance and decrease hypertension-related morbidity and mortality. Angiotensin II receptor blocker therapy has been proven to be well tolerated and effective in the management of hypertension, chronic heart failure with left ventricular dysfunction and the prevention and progression of diabetic renal disease. Blockers of the renin-angiotensin system are an important component of antihypertensive combination therapy. Thiazide-type diuretics are usually added to increase the blood pressure lowering efficacy. Fixed drug-drug combinations of both principles, such as candesartan/hydrochlorothiazide, are highly effective in lowering blood pressure while providing improved compliance, a good tolerability and largely neutral metabolic profile. In this article, we review the literature for the role of candesartan-based therapy for hypertension, stroke, diabetes mellitus and heart failure.  相似文献   

18.

Introduction

In everyday medical practice, physicians often need to manage patients whose blood pressure is not well controlled. Those with a history of cerebrovascular disease are a high-risk group in need of rapid blood pressure control.

Methods

The PICASSO study was a real-life, observational trial involving 9257 inadequately treated hypertensive patients who were switched from previous therapy to the fixed-dose combination of perindopril 10 mg/indapamide 2.5 mg (PI) for 3 months. A subanalysis of data of 1117 hypertensive patients who met the clinical criteria of previous stroke or transient ischemic attack was performed. Twenty-four hour ambulatory blood pressure measurements (ABPMs) were also done in a small group of patients (n:38).

Results

At baseline, mean systolic/diastolic blood pressure (SBP/DBP) was 161.5?±?15.2/93.1?±?9.9 mmHg. After 1 month with the fixed dose of PI, average office SBP/DBP decreased to 140.0?±?11.9/83.5?±?7.7 mmHg. After 3 months, SBP/DBP had dropped to 132.9?±?9.8/80.0?±?6.2 mmHg, by 28.6?±?15.5/13.1?±?10.0 mmHg (p?<?0.001). Blood pressure control rate (<?140/90 mmHg) was 67.3% after 3 months. When data were stratified by baseline blood pressure, decreases in SBP/DBP were statistically significant in patients with all grades (1–3) of hypertension. In patients previously treated with an angiotensin-converting enzyme inhibitor?±?hydrochlorothiazide (n?=?677), blood pressure decreased by 29.8?±?15.5/13.3?±?10.2 mmHg (p?<?0.001). Decreases in 24-h ABPM values were also significant (n?=?38). Treatment was well tolerated; only a few adverse events were recorded.

Conclusion

This study suggests that fixed combination perindopril 10 mg/indapamide 2.5 mg is an effective and well-tolerated treatment for patients with a history of stroke or transient ischemic attack.

Funding

EGIS Pharmaceuticals Plc.
  相似文献   

19.
The purpose of this study was to determine whether nitrate supplementation augments cutaneous reactive hyperaemia. Seven participants were tested pre‐ and postnitrate supplementation (25 ml beetroot juice); participants consumed one shot per day for 3 days. Participants were instrumented with two microdialysis fibres: control (Ringer's solution) and NO synthase inhibition (20 mM L‐NAME). Skin blood flow was measured via laser‐Doppler flowmetry (LDF). A blood pressure cuff was placed on the experimental arm and inflated to 250 mmHg for 5 mins to occlude arterial inflow. The cuff was released, and the resultant reactive hyperaemia was measured. Blood pressure was continuously measured via plethysmography from a finger on the non‐experimental arm. Cutaneous vascular conductance was calculated (LDF/MAP) and normalized to maximal vasodilatation (%CVCmax). Only diastolic blood pressure was reduced following nitrate supplementation (71 ± 2 vs. 66 ± 1 mmHg; P<0·05). There was no effect of nitrate supplementation on peak reactive hyperaemia at control (Pre: 52 ± 3 vs. Post: 57 ± 2%CVCmax) or L‐NAME (Pre: 52 ± 2 vs. Post: 59 ± 4%CVCmax) sites. There was no effect of nitrate supplementation on total reactive hyperaemia at either control (Pre: 4197 ± 943 vs. Post: 4523 ± 1040%CVCmax * sec) or L‐NAME (Pre: 5108 ± 997 vs. Post: 5694 ± 1002%CVCmax * sec) sites. These data suggest cutaneous reactive hyperaemia is unaffected by dietary nitrate supplementation in healthy humans.  相似文献   

20.
Whole-day ambulatory blood pressure monitoring provides a better diagnosis of hypertension and a better prediction of long-term cardiovascular complications than conventional office measurements. Ambulatory monitoring is a reliable technique for the assessment of antihypertensive drugs. First, it determines truly hypertensive patients in whom treatment is appropriate. Second, ambulatory blood pressure monitoring helps to evaluate the efficacy of antihypertensive therapy during average working days. Finally, this method allows investigators to establish the duration of antihypertensive activity of new drug formulations, and thereby to improve compliance.  相似文献   

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