Prazosin versus propranolol plus prazosin: a comparison in diuretic-treated hypertensive patients

The antihypertensive efficacy of prazosin was compared with that of a combination of prazosin and propranolol in 14 patients with essential hypertension. All patients had sitting diastolic blood pressures greater than or equal to 95 mm Hg despite daily therapy with 50 mg of hydrochlorothiazide and 240 mg of propranolol. After a 4-week monitoring period, patients were divided randomly into 2 groups in whom either (1) propranolol was reduced to 120 mg/day (to avoid potential hypotension) and prazosin was added, starting with an initial dose of 1 mg twice daily, or (2) propranolol was tapered and discontinued as prazosin was added. The average doses of prazosin were 7.4 and 7.6 mg/day, respectively. After 12 weeks of therapy, blood pressure was reduced in both groups, and there was no significant difference in the reduction of blood pressure or dose of prazosin in the 2 groups. Mean heart rate increased significantly in both groups (p less than 0.01), but more so in the group of patients who discontinued propranolol therapy. Thus, when a combination of 50 mg/day of hydrochlorothiazide and 240 mg/day of propranolol is insufficient to control hypertension, the addition of prazosin is shown to decrease blood pressure whether or not propranolol is continued.     

Treatment of acute gout in hospitalized patients

OBJECTIVE: To record practice patterns of treatment of acute gout in hospitalized patients. METHODS: We performed a retrospective chart review of hospitalized patients diagnosed with gout. RESULTS: Seventy-nine (43%) patients were diagnosed with acute gout during their hospitalization. Fifty-eight (73%) patients with acute gout were found to have a reduction in their glomerular filtration rate. Twenty patients (25%) underwent arthrocentesis. The most widely used drugs for acute gout were colchicine, n = 42 (53%), and nonsteroidal antiinflammatory drugs (NSAID), n = 40 (51%). Combination therapy was used in 52% of patients with acute gout. Thiry-six (86%) patients treated with colchicine and 32 (80%) patients treated with NSAID had renal failure. DISCUSSION: Crystal analysis, the gold standard for diagnosing gout, was performed in only 25% of patients suspected of acute gout. Combination antiinflammatory agents are used in over 50% of patients despite the absence of evidence to support use of such combinations. Renal failure was present in 73% of patients with acute gout. Colchicine and NSAID should therefore be used with caution in these patients. Practice patterns vary widely and often appear to be in conflict with recommended diagnostic and treatment measures for acute gout.     

Effect of coffee and cigarette smoking on the blood pressure of untreated and diuretic-treated hypertensive patients

Patients with mild hypertension who habitually smoked cigarettes and consumed caffeine were examined after they abstained from caffeine and cigarettes overnight. Their mean blood pressure (147/89 mm Hg) was substantially lower than values recorded in the clinic (164/102 mm Hg) and remained so when they continued to abstain (149/94 mm Hg at two hours). Smoking two cigarettes (3.4 mg nicotine) elevated blood pressure by 10/8 mm Hg, but for only 15 minutes. Drinking coffee (200 mg caffeine) elevated blood pressure by up to 10/7 mm Hg between one and two hours. Combined coffee ingestion and cigarette smoking caused a sustained rise in blood pressure from 5 to 120 minutes to levels similar to those measured in the clinic (162/102 mm Hg at two hours). Similar results were obtained in thiazide-treated patients. The interaction of coffee and cigarettes on blood pressure, but not on pulse rate, was significant. The pressor effect of cigarette smoking and caffeine ingestion in combination may be important in the evaluation of patients with mild hypertension.     

Exercise-induced arrhythmias in diuretic-treated patients with uncomplicated systemic hypertension

Although hypertensive patients have been shown to have a higher prevalence of arrhythmias during ambulatory monitoring when treated with diuretic drugs than when untreated, the effects of maximal aerobic stress on arrhythmia frequency in such patients is unknown. The incidence of arrhythmias during graded maximal treadmill exercise in a group of 68 subjects with mild, clinically uncomplicated systemic hypertension treated chronically with diuretics alone for a median of 4.5 years was compared with that in an age-matched normotensive control group. The prevalence of exercise-induced arrhythmias was higher in the group treated with diuretics than in the control group, 57% vs 38% (p less than 0.05). This difference was entirely due to the higher incidence of isolated atrial or ventricular premature complexes in the diuretic-treated patients, 44% vs 26% (p less than 0.05). There was no difference in the incidence of frequent (more than 10% of beats) or complex supraventricular or ventricular premature complexes between the diuretic-treated and control groups. Within the diuretic group, no difference in the incidence of simple or complex arrhythmia was found between men and women, between those with and those without rest or exercise-induced electrocardiographic abnormalities or between those with a serum potassium level of less than 3.7 mEq/liter vs those with a level of 3.7 mEq/liter or greater. Thus, patients with uncomplicated hypertension treated with chronic diuretic monotherapy do not appear to be at increased risk for major arrhythmias during aerobic exercise.     

Intracellular magnesium deficiency and effect of oral magnesium on blood pressure and red cell sodium transport in diuretic-treated hypertensive patients

The effects of magnesium supplementation were tested in 20 patients with essential hypertension receiving long-term thiazide diuretic treatment (Th group) and 21 age-matched untreated patients (EHT group). Intra-erythrocyte cations, water content and the ouabain-sensitive sodium efflux rate constant were measured. The Th group received magnesium supplementations as MgO (600 mg Mg/day) for 4 weeks. In the Th group intra-erythrocyte magnesium and the sodium efflux rate constant were lower and red cell sodium was higher than in the EHT group. During magnesium supplementation, there were significant decreases (p less than 0.01) in intra-erythrocyte sodium content and mean blood pressure, and increases (p less than 0.005) in red cell magnesium content and the sodium efflux rate constant. These effects of magnesium were more evident in 9 patients who were unresponsive to diuretic therapy, a definite reduction in mean blood pressure, from 104.8 +/- 2.7 mmHg to 94.4 +/- 2.2 mmHg (p less than 0.001), being observed. In the remaining 11 patients, however, blood pressure remained unchanged. The sodium efflux rate constant was positively correlated with red cell magnesium content and negatively correlated with sodium content (r = 0.61, p less than 0.005 and r = -0.57, p less than 0.01, respectively). These results indicate that long-term diuretic treatment may give rise to intracellular magnesium deficiency and a suppression of cell membrane active sodium transport. The results also suggest that oral magnesium may decrease intracellular sodium, possibly through the activation of Na-K-ATPase, which in turn may contribute to the reduction in blood pressure. Therefore, magnesium supplementation may be a worthwhile additional therapy for diuretics.     

心血管疾病患者急性痛风的治疗选择

急性痛风患者常合并心血管疾病,现有指南鲜有明确推荐的药物治疗方案.本文主要聚焦心血管疾病和急性痛风共病的患者群体,对心血管疾病患者发生高尿酸血症和(或)急性痛风的危险因素、痛风急性期抗炎镇痛治疗方案进行文献综述,以期减少心血管疾病患者痛风急性发作,并为临床药物治疗决策提供依据.     

Prognostic factors associated with early gout flare recurrence in patients initiating urate-lowering therapy during an acute gout flare

Clinical Rheumatology - Lowering serum urate levels below the threshold for crystal formation with urate-lowering therapy (ULT) has been associated with a lower risk for gout flare reoccurrences....     

质子泵抑制剂治疗稳定期痛风合并上消化道出血患者对痛风急性发作的影响

目的探讨使用质子泵抑制剂治疗稳定期痛风合并上消化道出血患者对痛风急性发作影响的可能原因及发生机制。方法选择稳定期痛风合并上消化道出血患者20例作为观察组,以同期住院既往无痛风病史的高尿酸血症合并上消化道出血患者20例作为对照组,比较两组患者使用质子泵抑制剂治疗前后尿pH值、血尿酸及电解质水平,以及治疗后痛风发作情况。结果治疗期间观察组20例均出现痛风急性发作,使用质子泵抑制剂至临床出现痛风性关节炎急性发作时间在1～8(3.95±1.79)d,表现为发热、关节不同程度红肿、疼痛及功能活动障碍。对照组均未出现上述临床症状。治疗后两组患者血尿酸水平均较治疗前升高,血清K~+与Ca~(2+)较治疗前降低,血清Cl~-较治疗前升高,差异均具有统计学意义(P0.05);治疗后两组患者Na~+无明显变化(P0.05)。结论质子泵抑制剂可能在一定程度上对肾小管H~+-K~+-ATP酶产生抑制作用或损伤肾小管功能,进而促使痛风复发或加重。     

The acute phase response in gout

We studied the acute phase response in gout. Oral temperature, white blood cell count and differential, platelet count, Westergren erythrocyte sedimentation rate (ESR), and serum levels of the acute phase reactants serum amyloid A protein (SAA) and C-reactive protein (CRP) were all elevated. The number of involved joints correlated with levels of ESR, SAA and CRP. CRP correlated with temperature, differential count, ESR and SAA. The acute phase response resolved rapidly with treatment.     

Twice-daily low-dose captopril in diuretic-treated hypertensives

Twice-daily captopril (25 mg) and placebo were compared in ten hypertensive patients who were already receiving bendrofluazide. After six weeks therapy, captopril produced significant antihypertensive effects one to six hours after dosing but these did not persist at eleven to twelve hours. Plasma renin concentration was increased for twelve hours after captopril but inhibition of angiotensin II activity was lost by twelve hours. During the period when captopril reduced blood pressure significantly, effective renal plasma flow and hepatic blood flow were unchanged although renal vascular resistance was reduced. There was no evidence that captopril altered plasma sodium, potassium or magnesium concentrations following bendrofluazide. Thus, in thiazide-treated patients, captopril 25 mg produces significant blood pressure reduction for at least six hours after dosing, without impairing renal or hepatic blood flow. However, twice-daily low-dose captopril does not adequately control blood pressure throughout the dosage interval.     

Early changes in plasma and urinary potassium in diuretic-treated patients with systemic hypertension

Two groups of patients with uncomplicated systemic hypertension were studied. Group 1 included 11 patients who had overt hypokalemia with diuretic drug treatment, and group 2 included 11 patients who remained normokalemic. After baseline studies without treatment were performed, both groups received hydrochlorothiazide, 50 mg twice daily. Plasma potassium (PK) was significantly reduced within the first day of treatment and stabilized by day 7 in both groups. The average decrease in PK was 1.0 +/- 0.1 mEq/liter (p less than 0.01) in the first group and 0.6 +/- 0.2 mEq/liter (p less than 0.01) in the second group. Cumulative losses of K were approximately 200 mEq in the hypokalemic group and were minimal in the normokalemic group as assessed by 24-hour urinary collections. Patients in the hypokalemic group also had a greater reduction in body weight and blood pressure. Supplementation with KCl, 96 mEq/day, or triamterene, 200 mg/day, in 9 hypokalemic patients resulted in an increase of PK to approximately 3.5 mEq/liter leveling off by day 7, and a cumulative K retention of approximately 200 mEq. Thus, overt thiazide-induced hypokalemia was associated with small and biologically unimportant losses of K from body stores. With replacement therapy the estimated amount of retained K was also small.