A simplified approach to the treatment of hypertension

A new beta-adrenoreceptor blocking drug (timolol) was used in two clinical studies. In the first double blind study administration of hydrochlorothiazide and timolol reduced the mean (formula: see text) blood pressure by 23 mm Hg, compared with a fall of nine mm Hg with administration of hydrochlorothiazide and a placebo. Plasma potassium (K+) levels fell with the administration of hydrochlorothiazide alone, but rose back to control values when patients were given timolol. In the second study (patient blind), Moduretic (hydrochlorothiazide, 50 mg and amiloride, 5 mg) and timolol were given once daily. The mean blood pressure fell by 20 +/- 2 mm Hg allowing hypertension to be controlled by this once-daily regimen; the control persisted throughout the day. Plasma potassium (K+) levels fell slightly after treatment with Moduretic, but the fall was not as great as with hydrochlorothiazide. Of the 65 patients who entered these studies, 35 had not been previously treated and had diastolic blood pressure between 105 mm Hg and 130 mm Hg. In 18 patients the diastolic blood pressure was reduced below 95 mm Hg after treatment with a diuretic alone, in 15 patients treatment with a diuretic and timolol (5 mg to 20 mg) reduced the diastolic blood pressure below 95 mm Hg. In two patients, the diastolic blood pressure was between 95 mm Hg and 100 mm Hg. The response achieved with a relatively simple therapeutic regimen that can be administered once daily suggests that the therapy of most hypertensive patients could be supervised by paramedical personnel.     

Labetalol compared with prindolol plus hydraliazine in the treatment of hypertension: a double-blind cross-over study.

The hypotensive action of labetalol, a new drug with alpha-adrenoceptor and beta-adrenoceptor blocking action, was compared with that of a combination of prindolol and hydrallazine. Fourteen patients with mild to moderately severe hypertension completed a double-blind cross-over study with treatment periods of eight weeks. Both treatments were effective and, in the doses which were used, produced clinically significant lowering of blood pressure (reduction of mean blood pressure by more than 10 mm Hg) both in clinic and in home blood pressures in 12 of the 14 patients. The action of labetalol (600 mg twice a day) was approximately equivalent to that of prindolol (15 mg twice a day) plus hydrallazine (50 mg three times a day). There was a tendency for the second treatment (irrespective of nature) to be more effective than the first. However, when the results for each treatment were combined, the fall in the blood pressure due to labetalol was practically identical with that due to prindolol and hydrallazine. There were no toxic effects from either treatment and side effects were mild. Labetalol is a useful hypotensive drug with effect similar to that of a combination of a beta-adrenoceptor blocking drug and a vasodilator.     

原发性高血压药物干预的临床研究

本文报告133例轻、中度原发性高血压患者服用巯甲丙脯酸、硝苯吡啶、心得安及双塞的降压效果、血浆肾素水平及血流动力学指标。结果发现,硝苯吡啶降低血压,改善血流动力学效应最佳。其有效率达93.62%,优于巯甲丙脯酸组(74.29%)心得安组(47.37％)和双塞治疗组(87.5%)     

几种常用抗高血压药对SHR血压的影响

实验观察了几种常用抗高血压药:普萘洛尔、氢氯噻嗪、哌唑嗪、卡托普利、硝苯地平及尼索地平一次性灌胃给药对自发性高血压大鼠(SHR)血压的影响。结果表明除普萘洛尔外,其它药物皆有明显降压效应。降压峰值多在药后1小时～2小时之间。钙拮抗剂尼索地平和硝苯地平的降压效应具有剂量依赖性,且于降压同时伴短暂心率增加。与硝苯地平相比,尼索地平降压效应较强、且作用平稳、持续时间长、心率加快作用亦较弱,为较理想的抗高血压药。     

Captopril in essential hypertension; contrasting effects of adding hydrochlorothiazide or propranolol

Twenty-four patients with moderate to severe hypertension were treated for four weeks with captopril, an oral inhibitor of angiotensin-converting enzyme. The fall in blood pressure with captopril alone correlated with pretreatment plasma renin activity. The effect of adding either hydrochlorothiazide or propranolol to the captopril treatment was then studied. The addition of hydrochlorothiazide to captopril produced a dose-dependent fall in blood pressure. At the higher dose of the diuretic this fall in blood pressure correlated with weight loss, suggesting that when the diuretic-induced compensatory rise in angiotensin II is prevented by captopril the fall in blood pressure becomes dependent on loss of sodium and water. In contrast, the addition of propranolol to captopril produced no further fall in blood pressure, suggesting that inhibition of angiotensin-converting enzyme prevents the blood pressure lowering effect of propranolol. This may have implications for the mechanism whereby beta-blockers alone lower blood pressure. These contrasting effects of hydrochlorothiazide and propranolol in the presence of captopril indicate that in patients whose hypertension is not controlled by captopril alone the addition of increasing doses of diuretic is likely to control the blood pressure. The addition of a beta-blocker, however, is less likely to be effective.     

Metabolic effects of chlorothiazide and propranolol on essential hypertension--a double-blind, cross-over design clinical trial]

Several studies have shown that antihypertensive drugs therapy could reduce morbidity and mortality of hypertension related complication such as stroke, congestive heart failure and renal failure, but there was no significant reduction of coronary heart disease. The benefit of the treatment on morbidity and mortality may be counterbalanced by adversed metabolic effects of long-term therapy. The purpose of this study is to evaluate the blood pressure-lowering and adverse metabolic effects of chlorothiazide and propranolol monotherapy. A double-blind, cross-over design clinical trial was performed for 42 cases (22 males and 20 females) with the mean age of 52 (from 30 to 59 years old). After 2 weeks run-in period, the patients were assigned to group A and B with age and sex stratification. Chlorothiazide and propranolol were given for 12 weeks in alternative with 2 weeks placebo washout period. Our studies have shown that, chlorothiazide and propranolol could reduce both systolic and diastolic blood pressure significantly. But they also associated with adverse metabolic effects. Serum uric acid and triglyceride increased and decreased the concentration of high density lipoprotein cholesterol (HDL-C). Those changes could counterbalance the benefit of blood pressure-lowering effect of antihypertension. Carefully monitoring the adverse metabolic effects closely is necessary in therapy with these drugs.     

托拉塞米治疗合并舒张性心衰的老年顽固性高血压的临床观察

【】目的 观察在其他降压药物基础上联合托拉塞米治疗合并心衰的老年顽固性高血压临床疗效及安全性。方法 选择我院就诊的59 例合并舒张性心衰的老年顽固性高血压患者,入选前患者已给予3种以上降压药物,所用降压药物含噻嗪类或呋塞米片剂,但不含螺内酯,进行规范化治疗,入选后停原来所用利尿剂改用托拉塞米片剂,进行自身前后对照研究,观察4周,进行疗效评定。结果在治疗4周后较之前的平均血压下降明显( P ＜ 0. 05) ,患者降压疗效差异有统计学意义,同时心功能得到改善。结论 合并舒张性心衰的老年顽固性高血压在联合使用其他降压药的基础上,给予托拉塞米治疗可得到较好的降压效果并改善心功能的作用。     

Labetalol: potent antihypertensive agent that blocks both alpha- and beta-adrenergic receptors.

Labetalol was administered as the sole antihypertensive agent to 20 ambulatory patients with mild to moderate hypertension. The mean systolic and diastolic blood pressures (+/- standard error of the mean) with the patients sitting fell significantly (P < 0.001), from 145.5 +/- 3.2 and 103.7 +/- 1.6 mm Hg respectively at the start of labetalol therapy (after a period free of antihypertensive medication) to 125.7 +/- 2.0 and 87.2 +/- 1.1 mm Hg by the end of the trial. The diastolic blood pressure was well controlled (90 mm Hg or less) with labetalol therapy in 90% of the patients. The medication was well tolerated, and no orthostatic fall in the diastolic blood pressure was observed. Pharmacologically labetalol most closely resembles a combination of a nonselective beta-adrenergic blocker like propranolol and a postsynaptic alpha-adrenergic blocker like prazosin.     

Effects of antihypertensive agents on blood velocity: implications for atherogenesis.

Heart rate and blood velocity are major determinants of flow disturbances at arterial bifurcations. Since endothelial damage due to flow disturbances is thought to be significant in the pathogenesis of atherosclerosis, the effects of drugs on these parameters have to be considered in the selection of medications to prevent atherosclerosis. To determine the effects of antihypertensive drugs on heart rate and blood velocity 15 patients with hypertension were treated with placebo, hydrochlorothiazide, nadolol, propranolol and hydralazine in sequence. The doses given produced significant changes in heart rate and blood pressure, and Doppler ultrasonographic recording of aortic blood velocity showed that there were significant changes in peak blood velocity. Nadolol and propranolol produced significantly lower values of heart rate x blood velocity than placebo, hydralazine and hydrochlorothiazide.     

阶梯式治疗中、重度高血压八年随访研究

107例中、重度高血压病人接受双氢克尿塞、心得安及肼苯达嗪等药按方案式梯阶治疗达八年。其中41％病人用第一阶梯药物、51％用第二阶梯、8％以第三阶梯治疗,均控制血压于正常或接近正常水平。阶梯的选择与血压的高度及年龄有关,与高血压分期无明确关系。本文证实有效的降压治疗可逆转已肥大的左心室,并对长期服用双氢克尿塞所致高尿酸血症进行了讨论。     

Exercise training combined with antihypertensive drug therapy. Effects on lipids, blood pressure, and left ventricular mass

We studied exercise training combined with the use of antihypertensive drugs and examined the following questions. (1) Are there additive antihypertensive benefits with exercise and drug therapy combined? (2) Does drug therapy limit exercise-induced lipid improvements? (3) Does exercise that includes weight training and walking/jogging affect the left ventricle? Fifty-two hypertensive men were randomly assigned, double-blind, to diltiazem hydrochloride, sustained release (360 mg daily), propranolol hydrochloride (240 mg daily), or placebo and exercised three times per week for 10 weeks. Baseline blood pressure (145/97 mm Hg) fell after training (131/84 mm Hg) in all groups. Exercise decreased total and low-density lipoprotein cholesterol levels in all groups. Increases in the levels of high-density lipoprotein cholesterol were similar in placebo and diltiazem groups, whereas the propranolol group changed in an opposite direction. In all groups, left ventricular mass increased with training, while diastolic function was unchanged. We conclude that (1) drug therapy provided no additive benefit to the antihypertensive effects of exercise, (2) propranolol limited improvements in high-density lipoprotein cholesterol, and (3) exercise did not adversely affect the left ventricle.     

苯磺酸左旋氨氯地平治疗老年单纯收缩期高血压的临床观察

目的利用动态血压监测观察老年单纯收缩期高血压（ISH）患者在不同时间服左旋氨氯地平降压治疗疗效,探讨其临床意义。方法选未服用降压药物或停用其他降压药物治疗7天以上的86例老年单纯收缩期高血压（ISH）患者,随机分为早上服药组（n=42例）和晚上服药组（n=44例）,口服苯磺酸左旋氨氯地平2．5mg／d,每日观察诊室血压。所有患者药物治疗前后行动态血压监测,共治疗12周。结果经左旋氨氯地平治疗后2组患者诊室血压明显降低（P〈O．05）,且下降程度相近,无统计学意义（P〉0．05）。动态血压显示2组治疗后均能降低24h血压,降压程度相近,无统计学意义（P〉0．05）。早上服药组白天血压达标（SBP〈135mmHg）者占46．2％,夜间血压达标（SBP〈125mmHg）者占31．7％。晚上服药组白天血压这标（SBP〈135mmHg）者占42．5％,夜间血压达标（SBP〈125mmHg）者占51．3％。结论左旋氨氯地平对老年单纯收缩期高血压（ISH）患者有较好的降压效果,特别是对夜间血压升高非杓型高血压患者在晚上服药可以提高夜间血压达标率,更好纠正血压昼夜节律异常,以减少高血压患者心、脑、肾等靶器官损害。     

糖尿病肾病合并高血压1例治疗分析

目的探讨糖尿病肾病合并高血压患者降压药物的合理选择。方法根据患者的全程药学监护,分析1例糖尿病肾病合并高血压患者的药物使用情况。结果血管紧张素受体阻断剂(ARB)+钙通道阻滞剂(CCB)联合用于糖尿病肾病合并高血压,不仅很好地控制了血压,而且延缓了肾病的发展。结论对于糖尿病肾病合并高血压患者的治疗,应首选肾素-血管紧张素-醛固酮系统(RAAS)阻断剂、血管紧张素转换酶抑制剂(ACEI)/ARB,在此基础上可联合CCB或利尿剂,三联用药疗效也较好。     

不同价格降压药物对高血压患者血压达标的影响

目的了解高血压患者不同价格降压药物使用情况及其对血压达标的影响。方法调查高血压患者2100例,年龄28～80岁,平均年龄（62．5±12．1）岁。调查的项目包括：文化程度、用药前后血压、病史、所用药物的名称及每日剂量等。结果自费患者中：①不同文化程度患者之间不同价格药物的使用有明显差异（P〈0．01）,大多数低学历患者使用低价格药物,许多高学历患者也使用低价格药物;②不同病史的患者用药也有明显差异（P〈0．05）,随着病史的延长,高价格药物的使用逐渐增多;③高价格药物单用或与其他价格药物联合使用,治疗达标率都较高。结论文化程度的高低及病史的长短可以影响自费高血压患者对降压药物的选择,从而影响对血压的控制。     

A comparative evaluation of therapeutic effects of once a day dose of losartan potassium versus enalapril maleate in mild to moderate essential hypertension

Hypertension is a major public health problem both in the developing and developed countries of the world and if untreated, can lead to various fatal complications like cerebral stroke, encephalopathy, ischaemic heart disease (IHD), renal failure and sudden cardiac death, etc. In the present study, a comparative evaluation was made between angiotensin-II receptor antagonists like losartan potassium (50 mg daily) and angiotensin converting enzyme (ACE) inhibitors like enalapril maleate (5 mg daily) in 100 patients (50 males and 50 females having 25-50 years of age) of mild to moderate essential hypertension with diastolic blood pressure (DBP) 90-109 mmHg. Both the drugs were tried as monotherapy for their clinical efficacy, safety, tolerability and adverse effect profile in this open trial. Losartan potassium lowered the DBP to <90 mmHg in 62% of the patients at the end of 8 weeks compared to 40% in the enalapril group. Percentage of side effects with losartan was 20 and 50 with enalapril. It is concluded that both the drugs are effective antihypertensive agents and cause significant and comparable fall in systolic blood pressure (SBP) and DBP in patients of mild to moderate essential hypertension. But losartan potassium has been found to be more effective with fewer side effects when compared to enalapril maleate.     

Furosemide compared with hydrochlorothiazide. Long-term treatment of hypertension.

In a double-blind crossover study, the effectiveness of furosemide, 40 mg twice daily, was compared with hydrochlorothiazide, 50 mg twice daily, in hypertensive patients. Both hydrochlorothiazide and furosemide significantly reduced blood pressure (BP) during three months of therapy. However, the fall in BP was consistently greater with hydrochlorothiazide than with furosemide, although the difference was significant only with respect to systolic BP. The somewhat greater antihypertensive effectiveness of hydrochlorothiazide may be related to its longer action permitting a more continuous diuretic effect and, hence, maintenance of reduced extracellular fluid volume throughout the 24-hour period.     

西酞普兰治疗伴焦虑症状老年高血压的疗效

目的探讨抗抑郁剂西酞普兰治疗伴有焦虑症状的老年高血压患者的临床疗效。方法 63例老年高血压患者,汉密顿焦虑量表（HAMA-14）评分≥14分,随机分为研究组（n=32）与对照组（n=31）,研究组给予降压药物与西酞普兰治疗,对照组只给降压药物治疗。观察8周。结果治疗后两组患者的收缩压、舒张压、HAMA总分均下降,差异有统计学意义（P〈0.05或P〈0.01）。研究组治疗后的收缩压、舒张压、HAMA总分均低于对照组（P〈0.05或P〈0.01）。结论西酞普兰治疗老年高血压患者的焦虑症状疗效肯定,安全性好,适合作为老年患者的首选。     

持续气道正压通气联合降压药物治疗对OSAHS合并高血压患者的降压效果观察

目的探讨持续气道正压通气(CPAP)联合降压药物治疗对合并高血压的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压的影响。方法 82例OSAHS合并高血压患者随机分为对照组38例,以常规降压药物治疗;CPAP治疗组44例,在常规降压药物治疗基础上每晚加用CPAP治疗。治疗12周后,比较两组患者药物治疗的改变情况及24h血压监测等指标变化。结果 12周治疗后,除对照组夜间平均收缩压(nSBP)与治疗前差异无统计学意义外(P0.05),CPAP组与对照组治疗后各项血压指标与治疗前均有显著差异(P0.05),且CPAP组各项血压指标降低幅度均高于对照组。CPAP组血压降至正常率为75.0%(33/44),对照组(140/90mmHg)为52.6%(20/38)。CPAP组有8例(18.2%)患者停用降压药,13例(29.5%)单药可维持血压于正常范围,9例(20.5%)需3种药物控制血压。对照组均需要2种或以上降压药控制血压,23例(60.6%)需3种药物控制血压。上述指标两组间均有显著差异(P0.01)。CPAP组治疗后血压杓型改变由10例增加为29例(22.7%～65.9%,P0.01);对照组血压杓型改变由10例增加为14例(26.3%～36.8%,P0.05)。结论 CPAP联合药物治疗对OSAHS合并高血压患者疗效好于单纯药物治疗。对合并高血压的OSAHS患者,CPAP治疗可以减少服用降压药的品种,部分患者可停用降压药。     

Long-term cost-effectiveness of various initial monotherapies for mild to moderate hypertension

To evaluate the comparative efficacy and cost-effectiveness of various antihypertensive medications in persons aged 35 through 64 years with diastolic blood pressure of 95 mm Hg or greater and no known coronary heart disease, we used the Coronary Heart Disease Policy Model, which is a computer simulation of overall mortality as well as the mortality, morbidity, and cost of coronary heart disease in the US population. From the pooled literature, we estimated the antihypertensive and total cholesterol effects of various antihypertensive regimens. For 20 years of simulated therapy from 1990 through 2010, the cost per year of life saved was projected to be $10,900 for propranolol hydrochloride; $16,400 for hydrochlorothiazide; $31,600 for nifedipine; $61,900 for prazosin hydrochloride; and $72,100 for captopril. Doubling the cholesterol effects of the agents under study did not significantly change their effectiveness because, in general, lowering diastolic blood pressure by 1 mm Hg was equivalent to lowering the cholesterol level by 6%. Although any projection requires multiple estimates, each of which may be open to debate, propranolol appears to be the preferred initial option under most of a variety of alternative assumptions.     

噻吗洛尔与贝美前列素联合治疗开角型青光眼和高眼压症的临床效果研究

目的:探讨噻吗洛尔与贝美前列素联合治疗开角型青光眼和高眼压症的临床效果。方法:选择原发性开角型青光眼患者13例,分为噻吗洛尔组和联合用药组,联合组滴用0.03%贝美前列腺素每日1次和0.5%噻吗洛尔每日2次,疗程均为12周。噻吗洛尔组仅仅使用0.5%噻吗洛尔每日2次;治疗前、治疗后1月、2月及3月随访,测量眼压并观察眼局部及全身不良反应;对所有患者详细记录治疗前及治疗后用Goldmann压平眼压计测量的眼压,眼压测定时间为上午8时、11时,下午4时。结果:用药1个月、2个月、3个月与用药前比较,差异均有统计学意义,P<0.05;A组和B组,两组比较差异无统计学意义,P>0.05,但A组,平均降压幅度大于B组,且长时间维持眼压水平更为稳定;在一天的各时段,0.03%的联合用药每日1次的降眼压效果较0.5%的噻吗洛尔每日2次的降眼压效果明显(P<0.01),两组比较差异有统计学意义,P<0.05,且每日内贝美前列腺素联合组,维持眼压水平更为稳定。结论:噻吗洛尔与贝美前列素联合组降眼压疗效明确,且无明显毒副作用。