Effects of enalapril on the cardiovascular response to treadmill exercise in patients with mild to moderate systemic hypertension

The effects of the angiotensin converting enzyme inhibitor enalapril on exercise-induced changes in blood pressure and heart rate were evaluated in 15 patients in the early stages of systemic hypertension. Multistage treadmill exercise was performed before and after eight weeks of enalapril administration, and the results of the two trials were compared. In patients at rest, enalapril decreased systolic blood pressure from 172 +/- 18 to 147 +/- 14 mmHg and diastolic blood pressure from 99 +/- 9 to 88 +/- 8 mmHg (both P less than 0.001). In patients at peak exercise, enalapril decreased systolic blood pressure from 216 +/- 13 to 195 +/- 18 mmHg and diastolic blood pressure from 106 +/- 12 to 99 +/- 12 mmHg (both P less than 0.001). There was also a significant decrease in blood pressure during the recovery period after treadmill exercise. Enalapril reduced heart rate at peak exercise (P less than 0.05), but not at rest or during recovery. Thus enalapril alleviated the response of blood pressure to exercise in hypertensive patients and may help prevent hypertensive complications during daily activities.     

Efficacy and tolerability of enalapril and sustained-release verapamil in older patients with mild to moderate essential hypertension

The study involved 113 patients over age 50 years with mild to moderate essential hypertension, randomly assigned to treatment with enalapril (n = 54) or sustained-release verapamil (n = 59). During an eight-week titration period, doses were adjusted to achieve supine diastolic blood pressures (DBP) below 90 mmHg; patients were then given maintenance doses for eight weeks. Mean blood pressures were reduced significantly from 147.7/93.9 mmHg at baseline to 137.7/84.5 mmHg at the end of the maintenance period in the enalapril group and from 155.1/95.1 to 142.4/86.2 mmHg in the verapamil group. In the patients who completed treatment, the mean daily doses required to maintain DBP below 90 mmHg were 9.6 mg of enalapril and 244.9 mg of verapamil. There were 11 treatment failures in the enalapril group and 22 in the verapamil group: eight of the enalapril and 17 of the verapamil patients did not attain goal blood pressures and three and five were withdrawn because of side effects. It is concluded that both enalapril and sustained-release verapamil were generally effective and well tolerated in the treatment of mild to moderate hypertension in the middle-aged and older patients.     

Effects of enalapril on serum lipoproteins in mild essential hypertension

The effect of the angiotensin converting enzyme inhibitor enalapril on serum lipids, apolipoproteins, and lipoproteins was studied in 21 patients with mild essential hypertension. The drug was administered at a dosage of 2.5 to 10 mg daily for 12 weeks. Enalapril significantly decreased the very low-density lipoprotein (VLDL) fraction at eight and 12 weeks. The apolipoprotein (apo) A-I and A-II fractions were significantly increased by 10% and 7.8%, respectively, at 12 weeks. The apo B fraction and the apo B/apo A-I ratio were significantly decreased at eight weeks (8% and 17%, respectively) and at 12 weeks (11% and 19%, respectively). Unchanged were the total cholesterol level, the lipoprotein cholesterol level, the triglyceride level, apo C-II, apo C-III, apo E, and the apo A-I/apo A-II ratio. This study confirmed that enalapril is an effective antihypertensive drug with a favorable effect on the lipid profile.     

A comparison of the efficacy and tolerability of enalapril and sustained-release diltiazem in mild to moderate essential hypertension

The subjects of this multicenter study were 159 patients aged 21 to 76 years with mild to moderate uncomplicated essential hypertension. The patients were randomly assigned to receive up to 40 mg of enalapril daily or 360 mg of sustained-release diltiazem daily for a titration period of eight weeks and then maintenance doses for four weeks. The treatment goal was a supine diastolic blood pressure of less than 90 mmHg or a fall of at least 10 mmHg from baseline. During titration, 62% of the enalapril-treated patients and 51% of the diltiazem-treated patients reached the treatment goal after two weeks, 82% and 74% after four weeks, 87% and 84% after six weeks, and 92% and 87% after eight weeks. During the maintenance period, 85% of the enalapril-treated and 87% of the diltiazem-treated patients maintained the goal blood pressure. Treatment side effects were reported by 21% of the enalapril-treated patients and 29% of the diltiazem-treated patients; treatment was discontinued in two patients from each group because of side effects. It is concluded that both drugs were generally well tolerated and effective in the treatment of adult mild to moderate essential hypertension.     

Treatment of mild and moderate hypertension with enalapril (multicenter study of enap and enap N in Ukraine)

AIM: Assessment of efficiency and safety of enalapril (enap) and its combination with hydrochlorotiaside (enap-N). MATERIALS AND METHODS: 127 patients with mild and moderate blood hypertension entered an open non-comparative multicenter trial. 60 of them received enap (group 1), 67--enap N (group 2). Group 1 patients were given enap for 2 weeks in a dose 10 mg/day. If this dose was not adequate to normalize blood pressure, it was raised to 20-40 mg/day. Patients of group 2 received enap-N one tablet a day for 3 weeks. If the pressure persisted higher than 140/90 mm Hg, the treatment was continued for 3 weeks more in a dose of 2 tablets a day. RESULTS: Blood pressure lowered under 140/90 mm Hg in 40 patients of group 1 (66.7%). Systolic pressure dropped by 10 mm Hg minimum and diastolic by 5 mm minimum in 18 group 1 patients (30%). Enap-N reduced blood pressure under 140-90 mm Hg in 44 of 67 patients (65.7%). Systolic and diastolic pressure dropped, respectively, in 23(34.3%) patients. CONCLUSION: Enap and enap-N tablets were found highly effective and well tolerated. Side effects were caused by lowering of blood pressure.     

Ramipril and methyldopa compared in patients with mild to moderate hypertension

Twenty-seven patients with mild to moderate essential hypertension were randomly assigned to receive 5 mg of ramipril once daily or 250 mg of methyldopa twice daily for eight weeks. Similar reductions in diastolic blood pressure and heart rate were noted in the two treatment groups during treatment. Perhaps because of the limited number of patients, no between-group differences in the results of a measure of quality of life were found, but on overall assessments of treatment outcome by patients and the investigator, slightly better outcome was apparent in the ramipril-treated patients. No side effects or clinically significant changes in laboratory test results were reported. It is concluded that ramipril is a safe and effective agent in mild to moderate hypertension when administered as a single daily dose.     

The treatment of mild to moderate hypertension in patients with diabetes mellitus

The treatment of mild to moderate hypertension in patients with diabetes mellitus is reviewed in this article. The effect of diabetic hypertension on the heart and kidney is discussed. Treatment guidelines for diabetic hypertension are provided, based on principles derived from the pathophysiology. These principles include choosing an agent that maintains or improves lipids, potassium, insulin sensitivity, and quality of life. Individuals with diabetic hypertension should be assessed for their risk of developing coronary artery disease or nephropathy, since certain antihypertensive agents may help prevent these diseases. A simple method for selecting appropriate drugs is also presented.     

Prevalence of nocturnal hypoxaemia amongst men with mild to moderate hypertension

Thirty men (aged 35-65) with untreated essential hypertension (BP greater than or equal to 140/90), confirmed by 24-h ambulatory monitoring, had overnight recordings of arterial oxygen saturation (SaO2) in their own homes. The overnight saturation records were compared with those from a group of 30 normotensive control subjects matched for age, height and weight. The groups did not exhibit significant differences in any of the following parameters of overnight oxygenation: median SaO2, lowest SaO2 or frequency of 3 or 4 per cent dips in SaO2. We conclude that essential hypertension is not associated with excessive arterial hypoxaemia such as might be due to a sleep apnoea syndrome.     

氯沙坦治疗轻中度原发性高血压病的临床研究：附57例报告

目的：探讨氯沙坦治疗轻、中度原发性高血压病的临床疗效。方法：１１３例原发性高血压患者随机分为两组,氯沙坦组（治疗组,５７例）：５０￣１００ｍｇ／ｄ口服,疗程半年;依那普利组（对照组,５６例）：５￣１５ｍｇ／ｄ口服,疗程半年。治疗前后做动态血压监测,肝、肾功能,血糖等检查,测定血浆肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡｎｇⅡ）、醛固酮、内皮素等。结果：治疗组降压总有效率为７２％（４１例）;降压幅度（ｋ     

缬沙坦治疗轻、中度原发性高血压的临床研究——附117例报告

目的：评价缬沙坦治疗轻、中度原发性高血压的临床疗效及安全性。方法：缬沙坦组（５９例,８０ｍｇ／ｄ及１６０ｍｇ／ｄ）和氯沙坦组（对照组,５８例,５０ｍｇ／ｄ至１００ｍｇ／ｄ）均边续服药半年。结果：两组总有效率、降压幅度、收缩压和舒张压的谷／峰比值分别为７５％和７４％、３．５ｋＰａ／２．０ｋＰａ和３．４ｋＰａ／２．１ｋＰａ、０．８２和０．８１、０．７８和０．７９,组间比较均无显著性差异（Ｐ〉０．０５）;两组治疗后血浆贤素活性、血管紧张素Ⅱ均升高（Ｐ〈０．０５～０．０１）;醛固酮、内皮素均降低（均为Ｐ〈０．０５）,但组间比较无显著性差异（Ｐ〉０．０５）。血尿酸也明显下降（均为Ｐ〈０．０５）,基础值越高,降幅越大,且氯沙坦组更显著（Ｐ〈０．０５）。随访半年,两组心、脑血管事件发生率相似（Ｐ〉０．０５）,两组不良反应轻微     

Efficacy and safety of delapril plus manidipine compared with enalapril plus hydrochlorothiazide in mild to moderate essential hypertension: results of a randomized trial

BACKGROUND: The use of combination therapy is required to achieve blood pressure targets in 40% to 75% of patients with hypertension. There have been few studies comparing the efficacy and tolerability of the new fixed combination of the angiotensin-converting enzyme (ACE) inhibitor delapril 30 mg and the calcium channel antagonist manidipine 10 mg with those of a standard combination of another ACE inhibitor and a diuretic. OBJECTIVE: The aim of this study was to compare the antihypertensive efficacy and tolerability of delapril 30 mg given alone or with manidipine 10 mg with those of enalapril 20 mg given alone or with hydrochlorothiazide (HCTZ) 12.5 mg in patients with mild to moderate essential hypertension. METHODS: This was a multicenter, active-controlled, parallel-group trial. After an initial 2-week placebo run-in period, patients aged 18 to 75 years with diastolic blood pressure (DBP) > or =90 and < or =109 mm Hg were randomized in a 2:1 ratio to receive delapril or enalapril for 8 weeks. After the initial 8 weeks, nonresponders (DBP > or =85 mm Hg) received an additional 8 weeks of treatment with a fixed combination of delapril + manidipine or enalapril + HCTZ; patients whose DBP was normalized continued their initial monotherapy through the end of the study. The primary efficacy variable was the change in sitting DBP at the end of treatment. Secondary efficacy variables were the percentage of patients whose DBP was normalized (DBP Z:85 mm Hg) and the percentage of responders (> or =10-mm Hg reduction in DBP or DBP <85 mm Hg). RESULTS: One hundred sixty patients (84 men, 76 women) were randomized to receive delapril (n = 106) or enalapril (n = 54). After 16 weeks of treatment, the mean (SD) reduction in DBP was similar with the 2 treatments (delapril, -14 [8] mm Hg; enalapril, -15 [8] mm Hg). In the delapril and enalapril groups, DBP was normalized in a respective 55 (51.9%) and 29 (53.7%) patients, and 77 (72.6%) and 38 (70.4%) were responders; there was no significant difference between groups. Tolerability was also similar in both groups--10 (9.4%) patients in the delapril group and 5 (9.3%) in the enalapril group experienced adverse events that were judged related to treatment. CONCLUSIONS: The results of this study suggest that delapril alone or combined with manidipine is well tolerated and as effective as enalapril alone or combined with HCTZ in lowering blood pressure in patients with mild to moderate essential hypertension.     

Use of nebivolol in patients with mild and moderate hypertension

AIM: To evaluate the effectiveness and safety of the beta-adrenoblocker nebivolol in patients with mild and moderate essential hypertension. MATERIAL AND METHODS: The trial enrolled 20 patients. 11 of them had mild and 9 moderate arterial hypertension (mean age 47.1 +/- 9.52 years, hypertension history 6.98 +/- 2.75 years). 2-5 days after discontinuation of hypotensive drugs the examination was made including blood count, ECG, echocardiography, 24-h AP monitoring. It was repeated on days 56-60 of nebivolol therapy. Arterial pressure and heart rate were measured at the start of the treatment and 1, 3, 5 and 8 weeks later. RESULTS: Nebivolol treatment significantly reduced systolic arterial pressure in 30% and diastolic arterial pressure in 50% patients, heart rate decreased on the treatment day 7-10. On the treatment day 56-60 systolic and diastolic pressure lowered significantly in 53.3% and 66.7% patients, respectively. The analysis of changes in echocardiographic evidence found no significant shifts in volume and linear parameters. Nebivolol was well tolerated by 85% patients. Side effects included head ache, cardialgia, dizziness, weakness and nausea. CONCLUSION: Nebivolol (nebilet) is an effective hypotensive drug with mild side effects. Further studies on nebivolol effects on myocardial mass are needed.     

A postmarketing evaluation of guanfacine hydrochloride in mild to moderate hypertension

More than 5,000 primary-care physicians enrolled more than 22,000 patients with mild to moderate hypertension in a postmarketing study in which guanfacine hydrochloride, a centrally acting antihypertensive agent, was given for 28 days. The objectives of the evaluation were: (1) to obtain broad experience with guanfacine for the management of essential hypertension in a clinical practice setting; (2) to obtain information on patient acceptance of guanfacine, 1 mg HS, for the control of essential hypertension; and (3) to obtain more information on the drug's safety in clinical practice. Patients had to be at least 21 years of age, to be receiving a thiazide-type diuretic, and to have a sitting diastolic blood pressure of 95 to 114 mmHg. Women who were pregnant or lactating or planning to become pregnant during the evaluation were excluded. Blood pressure and heart rate were measured before guanfacine was started and at the completion of the study. Adverse on-therapy events were reported at the return visit. The average blood pressure in the general patient population decreased by 17/12 mmHg, that is, from 164/100 to 147/88 mmHg in four weeks. The magnitude of the reduction was not significantly influenced by age, race, sex, duration of hypertension, or the use of concomitant antihypertensive therapy. Adding guanfacine to another antihypertensive regimen resulted in mean reductions of 11 to 15 mmHg diastolic pressure, and the substitution of guanfacine for another antihypertensive agent resulted in mean reductions of 10 to 11 mmHg diastolic pressure. The most common side effect reported was dry mouth in 6% of patients, followed by dizziness, somnolence, fatigue, headache, and nausea, each reported in fewer than 3% of patients. More than 80% of the participants continued to receive guanfacine after the study. Of the total patient population, 7% discontinued guanfacine because of lack of efficacy, 10% because of side effects, and 3% for other reasons. The results of this large postmarketing study confirmed the results of controlled clinical trials conducted prior to marketing.     

坎地沙坦对轻中度高血压患者颈动脉重构的影响

目的:观察以坎地沙坦为基础的降压治疗对原发性高血压患者颈动脉内中膜厚度、内中膜厚度/血管内径的影响,探讨坎地沙坦降血压以外的心血管保护作用。方法:63例1～2级原发性高血压患者,超声检测其颈动脉的内中膜厚度和内径,给予以坎地沙坦为基础的降压治疗,根据患者血压的反应加用小剂量的氢氯噻嗪,6个月后超声复查颈动脉情况。结果:63例原发性高血压患者,收缩压在治疗前为(155.08±7.926)mm Hg,治疗6个月后为(128.44±3.509)mm Hg;舒张压治疗前(96.06±4.586),治疗6个月后(81.24±4.257)mm Hg;心率治疗前为(77.21±7.565)次/min,治疗6个月后为(72.79±3.976)次/min,治疗前、后比较差异有统计学意义(P<0.05)。治疗6个月后,内中膜厚度较治疗前减少(0.088±0.046)mm,内径较治疗前增加(0.138±0.069)mm,内中膜厚度/血管内径较治疗前减少(0.032±0.020),差异均有统计学意义(P<0.01)。结论:以坎地沙坦为基础,加用小剂量利尿剂的降压方案具有良好的临床效果,具有确切的改善动脉粥样硬化作用。     

Nitrendipine once daily compared with nicardipine in the treatment of mild to moderate hypertension

Twenty-four patients with mild to moderate hypertension were randomly assigned to 42 days of treatment with 20 mg of nitrendipine once daily or 20 mg of nicardipine thrice daily. In the nitrendipine-treated and nicardipine-treated patients, respectively, mean resting blood pressure decreased from 163 +/- 12 and 161 +/- 11 mmHg at baseline to 152 +/- 12 and 146 +/- 9 mmHg at six weeks (P less than 0.001). Blood pressures were reduced after one day of treatment, followed by an attenuation of the drug effect. In both treatment groups, blood pressures after cycloergometric, isometric, and cold-pressure tests were significantly lower at six weeks than at baseline; at six weeks, blood pressures were also significantly reduced two hours after drug administration, compared with those at or just before drug administration. It is concluded that nitrendipine taken once daily is safe and effective in the treatment of mild to moderate hypertension.     

Effects of pinacidil on serum lipid, lipoprotein, and apolipoprotein levels in patients with mild to moderate hypertension

Twenty-two patients with mild to moderate hypertension received 20 mg of pinacidil daily for six weeks, followed by 40 mg daily for another six weeks. Levels of serum triglyceride and apolipoproteins C-II and C-III decreased significantly; high-density lipoprotein cholesterol levels increased significantly during treatment. These changes were more prominent in patients with total triglyceride levels of 150 mg/dl or over. The results suggest that pinacidil has a preferential action on triglyceride-rich lipoprotein metabolism.