Antihypertensive efficacy and safety of the angiotensin receptor blocker azilsartan in elderly patients with hypertension

Objectives: The number of elderly patients with hypertension has been steadily increasing. However, there are limited data on the safety and efficacy of the new angiotensin type 1 receptor blocker (ARB) azilsartan in elderly patients with hypertension. We investigated the clinical efficacy and safety of azilsartan in this population. Methods: The study population comprised 56 ambulatory patients with essential hypertension. We evaluated the reduction in blood pressure and safety after 12 weeks of treatment with azilsartan in 29 hypertensive patients?≥65 years of age (aged group) in comparison with the findings in 27 patients <65 years of age (non-aged group). Results: Systolic blood pressure in the aged group declined significantly from 155?±?18?mmHg at baseline to 138?±?11?mmHg after 12 weeks of treatment with azilsartan, and that in the non-aged group also declined significantly from 152?±?20?mmHg at baseline to 142?±?13?mmHg after 12 weeks of treatment with azilsartan. There were no significant differences in the magnitude of change in blood pressures from pre-treatment to post-treatment with azilsartan between the non-aged and aged groups. There were no changes in clinical laboratory findings, including serum levels of creatinine, potassium, lipids, and other metabolic variables, after 12 weeks of treatment with azilsartan in both groups. Conclusions: Our findings suggest that azilsartan is effective in lowering blood pressure in elderly patients and may be safe. Therefore, azilsartan could be a valuable option for treating hypertension in elderly and non-elderly patients.     

Antihypertensive efficacy and tolerability of a fixed combination of metoprolol and felodipine in comparison with the individual substances in monotherapy. The Swedish/United Kingdom Study Group.

In this double-blind, randomized, parallel-group study, the aim was to compare the efficacy and tolerability of a new fixed combination of felodipine and metoprolol with the individual components in monotherapy. After a placebo period of 4 weeks, 159 patients with mild to moderate essential hypertension were randomized to extended-release formulations of either felodipine plus metoprolol 10 + 100 mg (FM), felodipine 10 mg (F), or metoprolol 100 mg (M) once daily if supine diastolic blood pressure greater than 95 mm Hg. After 12 weeks of active treatment, the reductions in supine blood pressure (24 h after dosing) were 20/14, 13/10, and 11/8 mm Hg for FM, F, and M, respectively. The difference in change was 7/4 mm Hg (p = 0.004/p = 0.006) and 8/5 mm Hg (p = 0.0002/p less than 0.0001) for the fixed combination and F or M, respectively. Blood pressure control (diastolic blood pressure less than 90 mm Hg after 12 weeks) was significantly better for the combination than for F and M, i.e., 71%, 49% (p = 0.008), and 34% (p = 0.004), respectively. Adverse experiences were those to be expected from previous studies with felodipine and metoprolol and did not differ in frequency between groups. It can be concluded that a fixed combination of metoprolol and felodipine has a clinically relevant and significantly better blood pressure reduction 24 h postdose than the individual substances in monotherapy, without decreased tolerability.     

Felodipine vs hydralazine: a controlled trial as third line therapy in hypertension. Cooperative Study Group.

In a placebo-controlled, double-blind, randomized, parallel group study one hundred and one patients with supine diastolic blood pressure greater than or equal to 100 mm Hg phase V, despite treatment with atenolol 100 mg plus chlorthalidone 25 mg once daily also received either felodipine 5-20 mg twice daily or hydralazine 25-100 mg twice daily for 6 weeks. Felodipine achieved a lower supine blood pressure (mean +/- s.d. 177/108 +/- 29/8-138/82 +/- 19/8 mm Hg) than hydralazine (174/109 +/- 25/8-149/92 +/- 26/11 mm Hg), (P less than 0.05/P less than 0.001). Felodipine also lowered supine diastolic blood pressure to less than 90 mm Hg more often than hydralazine (42 vs 22 patients, P less than 0.001). The incidence of unwanted effects was similar in both groups. The felodipine treated patients experienced more ankle swelling and flushing than those in the hydralazine group who experienced more headache and minor gastro-intestinal upset.     

非洛地平缓释片治疗原发性高血压的临床疗效分析

目的探讨非洛地平缓释片治疗高血压的临床效果。方法选择本院2009年12月～2011年6月收治的原发性高血压患者50例,均接受非洛地平缓释片治疗,对其临床资料进行回顾性分析,对治疗前后患者血压、心率进行观察。结果经治疗后50例患者临床总有效率为94．0％（47／50）,治疗前后心率无明显变化（P〉0．05）;与治疗前比较,治疗后患者收缩压及舒张压均明显下降,差异具有统计学意义（P〈0．05）;患者不良反应发生率为8．0％（4／50）,无严重不良反应发生,不影响继续治疗。结论非洛地平对原发性高血压治疗效果较好。不良反应发生率较低,为一种临床较为理想的降压药物。     

Antihypertensive effects of lofexidine in patients with essential hypertension.

1 Single oral doses of lofexidine, 0.1, 0.3, and 0.6 mg produced dose related decreases in supine and standing arterial pressure and heart rate in nineteen patients with essential hypertension. 2 A mean oral antihypertensive threshold dose of less than 0.1 mg was estimated. 3 Lofexidine decreased mean urinary noradrenaline excretion 28% and caused significant retention of sodium and water. 4 The most prominent side effects were sedation and orthostatic dizziness. 5 Lofexidine is pharmacologically similar to, but apparently less potent than clonidine as an antihypertensive agent.     

Antihypertensive efficacy of guanfacine and prazosin in patients with mild to moderate essential hypertension

Guanfacine, an alpha 2 adrenoceptor agonist, was compared with prazosin hydrochloride for the treatment of patients with mild to moderate essential hypertension in an 8-week, double-blind, randomized, parallel evaluation to determine efficacy and safety. The study consisted of a 2-week screening/weaning period (phase I), a 3-week treatment period with chlorthalidone 25 mg every morning (phase II), and an 8-week double-blind treatment period with diuretic plus prazosin or guanfacine (phase III). Those who had an average seated diastolic blood pressure (BP) of 95 to 114 mm Hg at the end of the phase II period were eligible to enter the phase III period and were randomly assigned to chlorthalidone plus either guanfacine, 1 mg every night, or prazosin, 1 mg three times a day. Of the 102 patients who were randomly assigned to guanfacine or prazosin, 80% completed the entire study. Guanfacine and prazosin appeared to be equally effective and reduced seated as well as standing diastolic and systolic BP. The mean seated systolic and diastolic BP were reduced 11/9 mm Hg by guanfacine and 11/10 mm Hg by prazosin. The mean reduction in seated pulse was 3 beats/minute for guanfacine and no change with prazosin. Similar changes occurred in the standing position. Very few adverse effects were reported during the study. Adverse effects with an incidence of 5% or greater for either drug group were dizziness (6% guanfacine, 8% prazosin), xerostomia (6% guanfacine, 2% prazosin), and somnolence (0% guanfacine, 6% prazosin). Three patients (6%) in the prazosin group experienced symptoms of orthostasis requiring premature discontinuation of the drug and termination from the study.     

非洛地平对老年高血压伴肾功能损害患者降压疗效的探讨

目的　探讨非洛地平对老年高血压伴肾功能损害时的降压疗效。方法　选择了近 3年来住院的原发性高血压病人伴轻、中度肾功能损害 1 48例。入选病人入院前 3 d停用各种降压药 ,3 d后 ,测量病人 8:0 0时和 2 0 :0 0时血压各 1次 ,取其平均值作为治疗前基础血压。次日 ,投给非洛地平缓释片 ,每日 5～ 1 0 mg,晨 8时顿服 ,然后用上述方法 ,测量服药后第 1 ,2 ,4周当天血压 ,并与治疗前进行对比分析。结果　治疗后收缩压于第 1周即出现效果 ,统计学处理已有显著性差异 (P <0 .0 5 )。治疗至第 2、第 4周时 ,收缩压下降明显、平稳 (均为 P <0 .0 1 )。而舒张压下降较缓慢 ,治疗第 1周后 ,总有效率仅为 48.6 % ,于第 2周时疗效出现 ,至第 4周时 ,血压一直稳定于正常水平 ,总有效率达 81 .1 %。结论　非洛地平缓释片口服后 ,通过选择性的扩张外周血管而达到降压作用。临床观察中 ,没有发现非洛地平对肾功能有进一步损害。表明当老年高血压病人伴有肾功能损害时 ,非洛地平可作为一种安全、可靠的一线降压药     

Prazosin first dose phenomenon during combined treatment with a beta-adrenoceptor blocker in hypertensive patients.

1 The antihypertensive effect of prazosin has been studied in three groups of hypertensive patients. 2 The drug caused a significant reduction of blood pressure both as monotherapy and combined with alprenolol. 3 The effect of prazosin on blood pressure was more marked at the first dose and especially in combination with alprenolol. 4 No pharmacokinetic interaction between prazosin and alprenolol was observed. 5 Prazosin exhibits an exaggerated first dose effect together with alprenolol. Smaller starting doses of prazosin in combination therapy with beta-adrenoceptor blockers are warranted.     

Felodipine ER formulation in the treatment of mild hypertension: efficacy and tolerability vs placebo.

1. Felodipine is a new calcium-antagonist dihydropyridine derivative with a high degree of selectivity for smooth muscle of arteriolar resistance vessels, as opposed to cardiac cells. 2. In this double-blind, cross-over study the antihypertensive efficacy and tolerability of the new extended release (ER) formulation of felodipine 10 mg, once daily, in patients with mild essential hypertension was evaluated. After a 4-week single-blind placebo period 28 patients (15 males; mean age 48 +/- 12 years) were randomized to receive felodipine 10 mg ER once daily or placebo for 4 weeks and the alternative treatment for a further 4 weeks. Supine blood pressure and heart rate were measured in the out-patients department every 2 weeks, 22-24 h after the last drug administration. 3. Felodipine 10 mg ER induced a significant reduction in blood pressure in comparison with placebo (from 149 +/- 16/97 +/- 6 to 140 +/- 12/89 +/- 6 mm Hg). Heart rate remained unchanged. Seven patients dropped-out; five during felodipine ER administration and two during placebo. 4. A once daily dose of felodipine ER significantly reduces blood pressure in mild hypertensive patients 22-24 h after administration. It is well tolerated and the adverse events are related to its pharmacodynamic effects.     

Plasma lipid fractions during long-term monotherapy with the ISA-containing beta-adrenoceptor blocker bopindolol in hypertensive patients

The influence of bopindolol monotherapy on blood pressure and plasma lipid fractions was investigated in 24 hypertensive patients. Bopindolol lowered blood pressure and heart rate significantly. When compared with placebo no changes were found in the plasma concentrations of total cholesterol, LDL cholesterol and HDL cholesterol. Plasma triglycerides were significantly increased after 4 and 8 weeks but not after 12 weeks of bopindolol. It is concluded that bopindolol is an effective and well tolerated beta-adrenoceptor blocker in hypertensive patients. The fact that it does not lower HDL cholesterol could be a potential advantage.     

老年高血压患者护理干预对降压效果的影响

目的:观察护理干预措施对老年高血压患者的降压效果方法:将患者随机分成两组,在药物治疗的相同情况下,分别采用干预法(84例)和常规法(75例)进行护理,1个月后观察降压效果结果:经护理干预后,两组的降压疗效差异有显著性(P<0.05).结论:护理干预对控制老年人的高血压有较大的作用.     

三恩降压片治疗高血压病66例疗效观察

目的：观察三恩降压片治疗高血压的疗效。方法：66例高血压病人，根据中医辩证分为阴虚火旺组35例，即虚痰湿组31例，均给三恩降压片，每次4片，每日2次，疗程8个月。结果：降压疗效：66例中显效11例，有效32例，无效23例，总有效率65．15％。阴虚火旺组有效率77．14％，阳虚痰湿组51．61％，两组比较P＜0．05，差异有显著意义。症状疗效：66例中有效者47例，有效率71．81％，其中阴虚火旺组有效率为82．85％，阳虚痰湿组为58．06％，两组间比较P＜0．05，差异有显著意义。结论：三恩降压片降压疗效肯定，尤其适用于阴虚火旺型高血压病人。     

The haemodynamic effects of long term felodipine therapy in previously untreated essential hypertension

Summary Sixteen patients with previously untreated mild/moderate hypertension (WHO Stage I) were studied: 7 women and 9 men, mean age 56.2 y. Haemodynamics, central and pulmonary blood volumes were measured by radionuclide techniques and repeated after 8 weeks felodipine therapy. To achieve a target diastolic blood pressure of < 95 mm Hg 12 patients required 5 mg bid, 2 10 mg bid and 1 2.5 mg bid; 1 withdrew after 2 weeks.Mean (SD) arterial blood pressure (mm Hg) was 189/106 before, and 182/103 after 2 weeks placebo treatment and fell to 148/84 after 8 weeks felodipine therapy. Relative systemic vascular resistance fell by 19% from 2146 to 1734 dyn.s.cm^–5. There were no significant changes in heart rate, cardiac index, total blood volume, pulmonary blood volume or left ventricular ejection fraction. Plasma renin activity did not rise significantly. Short lived vasodilator side effects occurred in 7/16 patients during initial treatment and mild ankle oedema persisted in 4/16 patients.In contrast to the haemodynamic changes seen acutely with felodipine, the only sustained changes after 8 weeks therapy are reductions in systemic vascular resistance and blood pressure.     

贝那普利与非洛地平联合治疗高血压合并糖尿病的临床观察

目的观察贝那普利与非洛地平联合治疗高血压合并糖尿病的疗效。方法选择高血压合并糖尿病患者64例,随机分为2组,贝那普利组32例,给予贝那普利10nag,1次／d,联合治疗组32例,在贝那普利组治疗基础上加用非洛地平5mg,1次／d,均治疗4周,治疗前后检测收缩压、舒张压、空腹血糖,并对比分析治疗前后上述指标差异。结果治疗4周后2组血压均下降,组内治疗前后比较均有统计学意义（P〈0．01）,联合治疗组降压幅度高于贝那普利组,与治疗前后比较差异有统计学意义（P〈0．01）。结论贝那普利与非洛地平联合应用降压疗效更好。     

Antihypertensive efficacy of indapamide SR in hypertensive patients uncontrolled with a background therapy: the NATIVE study*

ABSTRACT

Objectives: Antihypertensive monotherapy rarely achieves blood pressure (BP) control. NATIVE (NATrilix SR use in combInation antihypertensiVe thErapy) evaluated indapamide sustained release (SR) in hypertensive patients receiving background therapy.

Research design and methods: Patients remaining hypertensive (systolic BP [SBP], 145–180?mmHg; diastolic BP [DBP], 95–105?mmHg) while receiving an angiotensin-converting enzyme (ACE) inhibitor (n = 709), β-blocker (n = 629), calcium-channel blocker (CCB; n = 493), angiotensin II type 1 receptor blocker (ARB; n = 75), α-blocker (n = 29) or other therapy (n = 6) were enrolled, recruited by physicians from 228 centres in Pakistan. Indapamide SR 1.5?mg was administered daily for 3 months with background therapy. BP was assessed every 2 weeks, and blood glucose and total cholesterol were evaluated at baseline and study end in a patient subgroup. Adverse events were also recorded.

Main outcome measures and results: Of 2073 enrolled patients (49% males; mean age 51 years), 1941 received indapamide SR and background therapy. SBP and DBP decreased significantly (SBP, 166 ± 16?mmHg at baseline vs. 132 ± 12?mmHg at 3 months; DBP, 102 ± 8?mmHg vs. 83 ± 6?mmHg; both p < 0.0001 vs. baseline). Patients uncontrolled with an ACE inhibitor, β-blocker, CCB or ARB achieved an SBP/DBP decrease of 34 ± 15/19 ± 9, 33 ± 17/19 ± 10, 33 ± 15/18 ± 8 or 35 ± 16/20 ± 12?mmHg, respectively (all p < 0.0001). In all, 84% of patients achieved target SBP (≤?140?mmHg) and 61% achieved BP normalisation (SBP <?140, DBP <?90?mmHg). The absence of placebo control may lead to an overestimation of the extent of the BP reduction achieved. Glucose and cholesterol levels were unaffected by indapamide SR. Four percent of patients experienced side-effects, which were mild-to-moderate in severity.

Conclusions: In patients with hypertension despite antihypertensive therapy, indapamide SR significantly reduced BP with a good acceptability profile. Indapamide SR may represent an effective additional therapy for patients who do not achieve BP goals with other antihypertensive agents.     

Circulatory and metabolic effects of a combined alpha- and beta-adrenoceptor blocker (labetalol) in hypertension of pregnancy.

1 Seven women with hypertension of pregnancy were given the combined alpha- and beta-adrenoceptor blocking drug labetalol (50 mg i.v.) in their last trimester. Acute effects were studied for 3 h after administration. 2 Systolic and diastolic blood pressures were significantly reduced from 143 +/- 4 (s.e. mean) to 127 +/- 5 mmHg and from 101 +/- 2 to 88 +/- 2 mmHg, respectively. Maternal heart rate fell significantly from 77 +/- 5 to 68 +/- 3 beats/min. The changes remained during the 3 h of observation. Foetal heart rate was not affected. No side-effects were encountered. 3 Plasma noradrenaline increased significantly from 1.54 +/- 0.16 to a peak value of 2.37 +/- 0.41 nmol/l suggesting sympathetic activation following labetalol. Plasma adrenaline levels were essentially unchanged. Plasma glucose, insulin and C-peptide showed only minor changes. No major effects on lipid metabolism were seen except a significant fall of nonesterified fatty acids at 60 min. Plasma cyclic AMP increased significantly throughout the observation period, perhaps indicating beta-adrenoceptor agonist activity of labetalol. 4 The effectiveness of labetalol as an acute hypertensive agent together with apparent absence of metabolic disturbances and other side-effects makes it an interesting drug for the treatment of hypertension during pregnancy.     

国产复方非洛地平缓释片治疗原发性高血压的疗效和安全性

目的 评价国产复方非洛地平缓释片治疗轻、中度原发性高血压的疗效和安全性.方法 采用多中心、随机、双盲双模拟、前瞻性平行对照方法,从321例高血压患者中筛选出经非洛地平(5mg)单药治疗4wk、血压不能满意控制者217例,随机分为试验组和对照组,继续治疗8wk,分别服用复方非洛地平缓释片(由马来酸依那普利和缓释非洛地平组成,5mg/5mg)1片和非洛地平缓释片(5mg)、马来酸依那普利片(5mg)各1片.双盲治疗4wk后DBP不低于90mm Hg(1mm Hg=0.133kPa)者剂量加倍.结果 前4wk非洛地平单药治疗的有效率32.4%,降压无效而人组者血压平均下降(5.4±3.3/2.7±1.9)mm Hg.后8wk联合用药降压的总有效率试验组和对照组分别为88.3%和92.2%,血压分别进一步下降16.2/10.5mm Hg和14.8/11.4mm Hg.单药的不良反应主要为头痛、头晕、头胀、面部潮红等(12.0%).双盲试验期不良反应总发生率试验组和对照组分别为19.4%和14.7%,其中干咳发生率分别占6.5%和8.3%.结论 国产复方非洛地平缓释片治疗轻、中度原发性高血压安全、有效.     

高血压社区管理和综合干预对高血压患者的控制疗效研究

目的：探讨高血压社区管理和综合干预对高血压患者的控制疗效。方法选取2013年2月~2014年2月本社区的257例高血压患者作为研究对象,为其建立档案,详细记录其当前血压和各项生化指标,在1年内给予运动、用药、饮食、健康教育、心理等指导,观察并比较干预前后患者的知晓率、治疗率、控制率、遵医嘱率以及血糖、血脂的好转率等。结果经有效干预后,患者对高血压的知晓率显著增高,其血压由（170±8） mm Hg下降至（135±11）mm Hg,治疗率由30.7%上升至68.5%,控制率则由20.2%上升至40.5%,高血脂以及高血糖也趋向好转,干预前后的各项指标比较差异有统计学意义（P〈0.05）。结论对社区内的高血压患者采取规范化的社区管理和综合干预不仅能够有效控制血压,还能够提高患者的生活质量,值得临床推广应用。     

波依定(非洛地平缓释剂)联用卡托普利治疗老年性高血压病128例临床疗效观察

目的：考察波依定(非洛地平缓释剂)联用卡托普利治疗老年性高血压病的疗效。方法：256例高血压病患者随机分成两组。A组：波依定联用卡托普利128例；B组：单用卡托普利128例。观察降压疗效及对心率、血脂、血糖及肾功能的影响。结果：A组显效101例，有效20例，无效7例，总有效率为94．53％；B组显效58例，有效43例，无效27例，总有效率为78．90％。两组比较有显著差异，两组治疗前后心率、血脂、血糖、肾功能无明显变化。结论：波依定、卡托普利合用降压效果明显，同时对心率、血脂、血糖、肾功能无明显影响，可以用于联合治疗老年性高血压病。