海捷亚治疗原发性高血压的临床观察

目的观察海捷亚(氯沙坦钾／氢氯噻嗪片)对原发性高血压患者的降压疗效及不良反应。方法为自身对照方式的多中心研究。选择490例Ⅰ、Ⅱ级原发性高血压病例，服海捷亚(每天晨服一次)共4周，观察用该药期间血压、心率及不良反应情况。结果服海捷亚1周起，收缩压、舒张压、平均动脉压均显著下降(P＜0．01)，至第4周降压幅度最显著(P＜0．001)。海捷亚对老年高血压与较年轻高血压患者同样有效。结论海捷亚能有效控制血压，不良反应少。     

海捷亚对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者降压疗效和睡眠呼吸的影响

目的 观察氯沙坦钾／氢氯噻嗪（海捷亚）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压患者的降压疗效和睡眠呼吸的影响。方法 选择12例OSAHS合并高血压患者，在停服各种降压药物及血管活性药物2w后服用海捷亚，治疗前及治疗后8w分别监测24h动态血压及多导睡眠图。结果 海捷亚可降低OSAHS合并高血压患者24h平均收缩压（SBP）与舒张压（DBP）、白天及夜间平均SBP与DBP（均P〈0.01），降低睡眠呼吸暂停低通气指数（apnea hypopnea index，AHI）及氧减指数（均P〈0．05）。结论 海捷亚可有效降低OSAHS合并高血压患者白天及夜间血压，并可减少睡眠呼吸暂停。     

海捷亚与苯那普利治疗原发性高血压的对比研究

目的比较海捷亚和苯那普利治疗原发性高血压的效果及安全性.方法80例原发性高血压患者经过1周药物洗脱期和2周安慰剂期后,再随机分为两组海捷亚组(每天1片)和苯那普利组(10mg/d),每组40例,疗程8周.在治疗第1、2、4、6、8周末记录血压、心率及不良反应情况.结果治疗8周后两组血压均下降,海捷亚组显效35例,有效4例,无效1例,总有效率为97.5%;苯那普利组显效28例,有效5例,无效7例,总有效率为82.5%,两组比较有统计学差异(P＜0.01).结论海捷亚能有效控制血压,不良反应少.     

缬沙坦和海捷亚对高血压患者心功能及HRV的影响对比

目的比较缬沙坦和海捷亚对高血压患者心功能及心率变异性（HRV）的影响。方法将61例原发性高血压患者随机分成对照组和观察组,分别给予缬沙坦和海捷亚治疗,用药前及用药后8周检测心功能和心率变异性（HRV）,并测量第3天、第1、2、3A、6、8周末的血压水平。结果两组用药8周后心功能指标均显著改善,自主神经功能指标显著提高,交感神经功能指标显著下降（P均〈0．05）;两组用药后心功能指标改善程度无统计学差异（P〉0．05）,HRV各指标比较有统计学差异（P〈0．05）;两组第3天、第1周血压下降的有效率比较有统计学意义（P〈0．05）。结论缬沙坦和海捷亚对高血压患者心功能和自主神经功能均有明显改善作用,海捷亚对自主神经功能的改善作用优于缬沙坦,且降压起效时间更快。     

海捷亚治疗老年原发性高血压的观察

目的：观察海捷亚对老年高血压的治疗作用及对靶器官的影响。方法：40例老年高血压患者口服海捷亚（氯沙坦50mg，氢氯噻嗪12.5mg)1片，每日一次，共8周，治疗前后测血压及行24h动态血压监测（ABPM）。结果：治疗第1周有效率50%，第2周达67.5%，服药4周总有效率达73.3%;谷峰比（T/P）SBP78%，DBP77%；对75.8%患者异常的血压昼夜节律有逆转作用；不良反应轻微，对心率，血钾，尿酸影响较小，结论：海捷亚能快速，平稳控制血压。     

海捷亚与苯那普利治疗原发性高血压的对比研究

目的:比较海捷亚和苯那普利治疗原发性高血压的效果及安全性。方法:80例原发性高血压患者经过1周药物洗脱期和2周安慰剂期后,再随机分为两组:海捷亚组(每天1片)和苯那普利组(10mg/d),每组40例,疗程8周。在治疗第1、2、4、6、8周末记录血压、心率及不良反应情况。结果:治疗8周后两组血压均下降,海捷亚组显效35例,有效4例,无效1例,总有效率为 97.5％;苯那普利组显效 28例,有效 5例,无效 7例,总有效率为 82.5％,两组比较有统计学差异(P<0.01)。结论:海捷亚能有效控制血压,不良反应少。     

海捷亚治疗高龄高血压患者疗效和耐受性的研究

目的高龄患者由于肝肾功能的减退,常规剂量药物治疗往往会带来更多的不良反应。本文旨在评价应用常规剂量海捷亚（氯沙坦50mg。氢氯噻嗪12．5mg固定复方制剂治疗高龄高血压患者的降压疗效,对血钾、尿酸、肾功能等的影响及不良反应。方法63例≥80岁的高龄高血压患者。对照组为54例年龄在65—79岁的老年高血压患者。两组均给予海捷亚1^#/d,用药4周。测定用药前后血压、血尿酸、血清钾、血肌酐及用药后不良反应。结果：两组用药4周后血压均明显降低,两组间降压幅度没有统计学意义（P〉0．05）。两组治疗前后血清钾、血尿酸、血肌酐变化差异无统计学意义（P〉0．05）,且无明显不良反应。结论海捷亚在高龄高血压患者中降压疗效肯定．不会引起低血压、血钾升高,降低、血尿酸的升高、肾功能减退,没有不能耐受的不良反应。     

氯沙坦钾/氢氯噻嗪复方片治疗中度原发性高血压的疗效及其对左室重构的影响

目的评价单用氯沙坦钾片与氯沙坦钾/氢氯噻嗪复方片（海捷亚）治疗2级原发性高血压的疗效和不良反应及对左心室重构的影响。方法选择76例2级原发性高血压患者,随机分为两组。对照组口服氯沙坦钾片,1片/d;观察组口服氯沙坦钾/氢氯噻嗪复方片,1片/d;两组疗程均为12周。观察治疗前后的血压、心肌肥厚状况、不良反应。结果76例患者均坚持完成研究,其中观察组38例中显效22例,有效12例,无效4例;对照组38例中显效17例,有效9例,无效12例,两组疗效比较差异有统计学意义（T=0.563,P〈0.05）。观察组25例伴有心肌肥厚的患者,超声心动图指标有明显改善（P〈0.05）;对照组23例伴有心肌肥厚的患者,超声心动图指标无明显改善（P〉0.05）。且观察组舒张压达标率明显优于对照组（P〈0.05）。两组患者的不良反应轻微且均能耐受。结论氯沙坦钾/氢氯噻嗪复方片降压疗效确切,且可以逆转左心室肥厚。可作为治疗中度原发性高血压的一线药物。     

乐卡地平与氨氯地平治疗老年原发性高血压的比较

目的：以氨氯地平作对照，观察乐卡地平的降压疗效。方法：选择Ⅰ-Ⅱ级老年高血压患者46例，经停用降血压药1周后，随机分成A组（23例）；口服乐卡地平10mg/d；B组（23例）；口服氯氯地平5mg/d，连续治疗4周，观察血压、心率、血糖，血脂、肝肾功能，不良反应等指标。结果：（1）乐卡地平与氨氯地平降压作用明显（P＜0．05），对偶测血压，脉压有下降作用（P＜0．05），两组之间降压疗效无明显差异（P＞0．05）；（2）用药前后心率无明显差异（P＜0．05）；（3）两组生化指标治疗前后无明显差异（P＞0．05）。患者耐受性好，不良反应较少。结论：乐卡地平是治疗Ⅰ-Ⅱ级高血压的有效而安全的药物，是适合老年高血压患者降压治疗的药物。     

培哚普利治疗原发性高血压的临床观察

目的观察培哚普利对原发性高血压的降压作用及副反应。方法３７例轻中度原发性高血压患者予培哚普利共８周，评价对随诊血压及２４ｈ动态血压的影响。结果治疗４周收缩压（ＳＢＰ）无明显降低（Ｐ＞０．０５），舒张压（ＤＢＰ）明显降低（Ｐ＜０．００１），８周ＳＢＰ、ＤＢＰ均明显降低（Ｐ＜０．００１），随诊血压降压有效率分别为５４．１％（４周）及６７．６％（８周），２４ｈ动态血压曲线８周时呈明显下降，除咳嗽外未发现其他严重副反应。结论培哚普利对轻中度原发性高血压是安全有效的降压药物。     

海捷亚和科素亚双盲、随机、对照降压疗效临床研究

目的本研究旨在对比评价氯沙坦钾/氢氯噻嗪(海捷亚组)和氯沙坦钾(科素亚)治疗原发性高血压病的疗效、安全性和耐受性。方法179例原发性高血压门诊患者（舒张压95mmHg～115mmHg）参加了双盲、随机对照的临床治疗研究。经过2周安慰剂洗脱期后,患者被随机分入海捷亚组(氯沙坦钾加氢氯噻嗪),或科素亚组(氯沙坦钾50mg～100mg),每日服药一次。168例患者完成了8周治疗研究。疗效判定标准为4,8周DBP血压下降到正常或下降10～19mmHg以上为有效。结果两组血压均较药前显著下降。海捷亚有效率81.9%(4周),88.0%(8周)较单纯科素亚组的41.2%和50.6%组高。两组间心率和不良反应为15%～19%,两组无明显差异。结论氯沙坦钾片和氢氯噻嗪联合使用治疗原发性高血压疗效比单用氯沙坦钾片好。海捷亚的安全性和耐受性同科素亚。     

拜新同与科素亚或海捷亚合用的降压疗效观察

目的研究和评价拜新同与科素亚或海捷亚合用降压疗效及对代谢的影响。方法选择45例中、重度原发性高血压患者,随机分成3组,每组各15例。拜新同组:单用拜新同30mg,每日1次;拜新同与科素亚合用组:拜新同30mg,每日1次,加科素亚50mg,每日1次;拜新同与海捷亚合用组:拜新同30mg,每日1次,加海捷亚50mg,每日1次。3组疗程均为12周。观察3组治疗前后的随测血压(CBP)和24h动态血压(ABPM)及生化指标。结果拜新同加海捷亚组降压总有效率及CBP、ABPM的变化均明显优于拜新同单用组和拜新同与科素亚合用组。治疗前后心率和生化指标则无明显改变。结论拜新同与海捷亚联合应用降低中、重度高血压效果较单用拜新同组以及拜新同和科素亚合用组更有效,且对代谢无影响。     

伊贝沙坦和培哚普利治疗老年高血压疗效和安全性

目的　评价伊贝沙坦和培哚普利对老年高血压病人的降压疗效及安全性,尤其是对坐位舒张压的影响。　方法　选用住院的 1~2级高血压病人 212例,服培哚普利为对照组 106例, 4mg/d,服伊贝沙坦为试验组 106例, 150mg/d,服药后第 3天、第 2、4、6周和第 8周,分别观察其血压变化、自觉症状和有关实验室检查,第 4周谷值坐位舒张压高于90mmHg者,加服吲哒帕胺 1. 25mg/d。　结果　除尿酸升高外,治疗前和治疗 8周后在血生化、肝酶和血脂等方面均无统计学差别,收缩压(SBP)在治疗后第 4周,舒张压(DBP)在第 6周降到正常,并一直稳定到第 8周。2组治疗后不同时期与治疗前相比,SBP和DBP均相差显著。加用吲哒帕胺的病例在第 6周平均谷值坐位DBP进一步下降并相差显著。治疗后试验组总有效率 81. 2%,对照组 79. 6%,试验组显效率、有效率均高于对照组,并有统计学意义,P<0 .05。对照组中咳嗽明显高于试验组,相差非常显著。　结论　伊贝沙坦和培哚普利均能有效控制和稳定血压,尤其在加用小剂量吲哚帕胺后,对谷值坐位DBP高者。但伊贝沙坦降低24h后谷值舒张压作用更好一些,不良反应更少。     

伊贝沙坦对轻中度原发性高血压左室肥厚的逆转作用

目的:观察伊贝沙坦对轻中度原发性高血压左室肥厚的逆转作用。方法:采用自身对照试验,对83例轻中度原发性高血压左室肥厚的患者,服用伊贝沙坦150mg/d治疗,如4周无效加至300mg/d,共12周,随访患者血压、超声心动图变化以及服药耐受性。结果:12周后,所有患者血压均较入院时明显下降(P<0.05),室间隔厚度(IVST)、心室后壁厚度(PWT)、左室重指数(LVMI)均明显减少,E/A比例明显增加,(P均<0.01),说明左室肥厚减轻,左室舒张功能得到改善,且无明显不良反应。结论:伊贝沙坦是一个安全、有效的降压药物,同时能逆转左室肥厚。     

Early Antihypertensive Efficacy of Olmesartan Medoxomil

The authors assessed the early antihypertensive efficacy of olmesartan medoxomil (OM) in a 12‐week prospective observational study. Of 2221 patients with untreated hypertension who received OM (mainly 10 or 20 mg), 331 patients whose blood pressure (BP) was measured at 1 week after initiation of treatment were defined as the ``early BP determination group,'' whereas the remaining 1890 patients were defined as the ``standard BP determination group.'' Baseline characteristics, doses of OM, concomitant drugs used, and BP during treatment did not differ between the 2 groups. The achievement rate of BP target (<140/90 mm Hg) was 28.4% at 1 week in the early BP determination group and 28.3% at 2 weeks in the standard BP determination group (P=NS). Rates of adverse drug reactions in the 2 groups were similar. The present study suggests that OM is safe and effective in reducing BP at an early time point of treatment.     

A Phase II intra‐patient dose‐escalation trial of weight‐based darbepoetin alfa with or without granulocyte‐colony stimulating factor in myelodysplastic syndromes

This Phase II study evaluated darbepoetin alfa (DA) in 24 patients with predominantly low or intermediate‐1 risk myelodysplastic syndrome (MDS). Intra‐patient dose escalation of DA was undertaken in three 6‐week dose cohorts until a major erythroid response was achieved: 4.5 mcg/kg/week, 9 mcg/kg/week, and 9 mcg/kg/week plus granulocyte‐colony stimulating factor (G‐CSF) 2.5 mcg/kg twice weekly. Patients with refractory anemia with ringed sideroblasts (RARS) commenced DA at 9 mcg/kg/week. The weight‐based dosing regimen translated into a median starting DA dose of 390 mcg/week. Erythroid responses were observed in 16/24 patients (67%; 12 major and 4 minor), with a median response duration of 11 months in major responders. Addition of G‐CSF generated a major erythroid response in 7/15 patients (47%) who suboptimally responded to DA alone. DA was well tolerated, except for worsening of baseline mild hypertension and renal insufficiency in one patient with diabetes. IPSS score <0.5 and RBC transfusions <2 units/month increased the probability of an erythroid response. A minority of subjects (12%) developed low‐level non‐neutralizing anti‐DA antibodies. Our data indicate that weekly weight‐based dosing of DA, with the addition of G‐CSF in selected individuals, can be an effective erythropoietic option in a high proportion of lower‐risk MDS patients. Am. J. Hematol, 2009. © 2008 Wiley‐Liss, Inc.     

The Effects of cyclooxygenase-2 inhibitors and nonsteroidal anti-inflammatory therapy on 24-hour blood pressure in patients with hypertension, osteoarthritis, and type 2 diabetes mellitus

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors may attenuate the efficacy of antihypertensive agents in high-risk patients. Therefore, we conducted a double-blind, randomized trial to evaluate the effects of celecoxib, rofecoxib, and naproxen on 24-hour blood pressure (BP) in patients with type 2 diabetes, hypertension, and osteoarthritis. METHODS: Patients were randomly assigned to treatment with 200 mg of celecoxib once daily (n = 136), 25 mg of rofecoxib once daily (n = 138), or 500 mg of naproxen twice daily (n = 130) for 12 weeks. Twenty-four-hour ambulatory BP monitoring and validated arthritis efficacy assessments were conducted at randomization and at weeks 6 and 12 of treatment. The primary end point was the mean change from baseline in average 24-hour systolic BP at week 6. RESULTS: Reductions in osteoarthritis symptoms, including pain, mobility, and stiffness, were similar in all treatment groups. The mean +/- SE 24-hour systolic BP following 6 weeks of therapy was increased significantly by rofecoxib (from 130.3 +/- 1.2 to 134.5 +/- 1.4 mm Hg; P < .001) but not by celecoxib (132.0 +/- 1.3 to 131.9 +/- 1.3 mm Hg; P = .54) or naproxen (133.7 +/- 1.5 to 133.0 +/- 1.4 mm Hg; P = .74). The BP difference between rofecoxib and celecoxib was 3.78 mm Hg (95% confidence interval, 1.18-6.38; P = .005); between rofecoxib and naproxen, 3.85 mm Hg (95% confidence interval, 1.15-6.55; P = .005). The proportion of patients with controlled hypertension at baseline who developed ambulatory hypertension by week 6 (24-hour systolic BP>135 mm Hg) was significantly greater with rofecoxib (30%) than with celecoxib (16%) (P = .05) but not significantly greater than with naproxen (19%). CONCLUSIONS: At equally effective doses for osteoarthritis management, treatment with rofecoxib but not celecoxib or naproxen induced a significant increase in 24-hour systolic BP. However, destabilization of hypertension control occurred to some extent in all 3 treatment groups; this phenomenon was seen more often in patients treated with rofecoxib than with the other therapies.     

Familial influence upon NaCl sensitivity in patients with essential hypertension.

OBJECTIVE: The role of genetic factors in the pathogenesis of essential hypertension has not been fully clarified. In order to characterize the relation between NaCl sensitivity and genetic features of hypertension, the responses to dietary Na manipulations were examined in essential hypertensive patients with and without a family history of hypertension. METHODS: Fifteen essential hypertensive patients, both of whose parents were hypertensive, were compared with 25 hypertensive patients in whom a family history of hypertension was known to be absent in first- and second-degree relatives. There were no differences in gender distribution, age, blood pressure or duration of hypertension between the two groups. Subjects were studied as inpatients on a daily diet of 170 mmol NaCl for 1 week, followed by 1 week on a low-NaCl diet (50 mmol/day) and then by 1 week on a high-NaCl diet (340 mmol/day). RESULTS: Plasma renin activity on a low-NaCl diet was lower, and the erythrocyte Na+ concentration on both diets higher, in hypertensive patients with than in those without a family history. The elevations in mean blood pressure and in erythrocyte Na+ concentration with a high-NaCl diet were greater in patients with a family history. A significant correlation between the change in mean blood pressure and the change in erythrocyte Na+ concentration was found in patients with a positive family history, but not in those with a negative family history. CONCLUSIONS: Essential hypertensive patients with an apparent hereditary component of hypertension can be characterized as the low-renin and Na-sensitive subgroup with intracellular Na+ accumulation. Genetic features may underlie, at least in part, the heterogeneity of essential hypertension.