Preliminary experience with amlodipine in the pediatric population

The authors retrospectively examined their experience with amlodipine in the treatment of hypertension in 32 pediatric-aged patients, ranging in age from 4 to 26 years, with blood pressure (BP) readings greater than the 90th percentile for age. Amlodipine was used as the sole therapy in 9 patients and with other antihypertensive therapy in 23 patients. Additional antihypertensive drugs used in combination with amlodipine included beta-adrenergic antagonists, ACE inhibitors, and diuretics. The starting dose of amlodipine was 0.13+/-0.09 mg/kg/d. The dose was increased in 20 of 32 patients to 0.23+/-0.13 mg/kg/d. Amlodipine was administered once daily to 26 patients and twice daily to 6 patients. After therapy with amlodipine was initiated, the systolic BP decreased from 141+/-15 to 132+/-9 mm Hg (P=0.01) and the diastolic BP decreased from 84+/-16 to 77+/-8 mmHg (P=0,03). There were a total of 2145 follow-up BP readings. The follow-up systolic BP was lower than the initial BP prior to starting amlodipine 59% of the time and the diastolic BP was lower than the initial BP 61% of the time. The follow-up systolic BP was lower than the 90th percentile predicted for age 33% of the time after starting amlodipine and the diastolic BF was lower than the 90th percentile for age 52% of the time. Adverse effects were noted in 4 of the 32 patients (12.5%). These included fatigue (n=2), dizziness (n=1), and ankle edema (n=1). Amlodipine therapy was discontinued in only 1 patient (the patient with ankle edema). Given its efficacy, the low incidence of adverse effects, and availability as a suspension, amlodipine is an effective agent for the treatment of hypertension in the pediatric-aged patient.     

Treatment of hypertension in Bahrain

OBJECTIVE: To evaluate the adequacy of blood pressure (BP) control and therapeutic appropriateness of antihypertensive drug(s) prescribed, taking into consideration laboratory parameters and the presence of comorbidities, in hypertensive patients. METHODS: Therapeutic audit of medical records of hypertensive patients from 9 primary care health centers in Bahrain using World Health Organization/International Society of Hypertension guidelines criteria. RESULTS: The recommended target BP <140/<90 mmHg was achieved in 37 (16.5%) patients with a mean BP of 126 +/- 6 / 80 +/- 5 mmHg. Groups with inadequate BP control were 15 (6.7%) with normal systolic BP (SBP) and high diastolic BP (DBP), 59 (26.3%) with high SBP and normal DBP, and 113 (50.4%) with high SBP and high DBP. Pulse pressure of the controlled group was 46.3 +/- 5.9, whereas pulse pressures of the inadequately controlled groups with BP cutoffs <140/> or =90, > or =140/<90, and > or =140/> or =90 mmHg were 37.4 +/- 6.1, 72.7 +/- 13.5, and 59.7 +/- 13.6 mmHg, respectively. Of the 281 treated hypertensive patients, 56.6% were on monotherapy; BP of patients on combination therapy versus monotherapy did not differ. The choice of antihypertensives in relation to comorbidities and laboratory findings revealed that many hypertensive patients with dyslipidemia were on beta-blockers and diuretics, 39.3% of patients with ischemic heart disease were on beta-blockers, approximately 20% of patients with hyperuricemia were on diuretics, and 27.6% and 10.4% of patients with isolated systolic hypertension were on diuretics and calcium-channel blockers, respectively. CONCLUSIONS: BP control was achieved in 1 of 6 treated patients. In several instances, metabolic abnormalities and comorbidities were apparently not considered while prescribing antihypertensives. A rational drug therapy approach is needed in treating hypertension to achieve better control rates.     

强化超滤对老年维持性血液透析患者高血压的影响

目的 观察通过强化超滤以进一步降低干体质量对老年维持性血液透析患者高血压的影响.方法 老年维持性血液透析合并高血压患者34名分为对照组和超滤组.对照组维持常规血液透析及常规超滤.超滤组维持常规血液透析,并持续缓慢增加超滤量,降低干体质量.观察持续28周,比较2组患者干体质量和血压的变化. 结果 基点处2组患者干体质量基本相同[(64.81±13.26)Kg和(64.49±13.83) Kg,t=0.508,P=0.618],透析前收缩压[(155.12±13.77)mmHg和(155.47±9.92) mmHg,t=0.086,P=0.932](1mmHg=0.133Kpa)及舒张压[(78.59±11.41)mmHg和(78.71±10.96) mmHg,t=0.031,P=0.976]未见明显差异(P＞0.05).观察第28周时,2组患者干体重体质量分别为(65.56±13.75)Kg和(62.22±13.34)Kg,较前下降(0.36±1.12)Kg和(2.27±1.03)Kg,超滤组于体质量低于对照组(t=3.785,P=0.002).透析前收缩压为(155.29±12.73) mmHg和(139.82±4.14) mHg,分别和较前下降(0.53±4.57) mmHg和(14.29±10.55) mmHg,超滤组收缩压低于对照组(t=4.767,P=0.000).透析前舒张压分别为(79.12±9.84) mmHg和(68.24±3.57) mmHg,分别较前下降(0.53±4.57) mmHg和(9.00±9.46) mmHg,超滤组舒张压低于对照组(t=4.298,P=0.000). 结论 通过强化超滤降低干体质量,有利于老年维持性血液透析患者高血压的控制.     

Antihypertensive effectiveness of very low doses of hydrochlorothiazide: results of the PHICOG Trial

A large, multicenter, randomized, placebo-controlled, double-blind trial was carried out to determine the effects of the lowest dose of commercially available hydrochlorothiazide. Thus, Dyazide (which contains 25 mg of hydrochlorothiazide and 50 mg of triamterene in an approximately 50% bioavailable form), one capsule, was given daily to patients with either mild or moderate hypertension (supine diastolic blood pressure of 95 to 115 mmHg) for eight weeks. At the end of this eight-week period, supine diastolic blood pressure (SDBP) fell by 11.3 +/- 6.7 mmHg (mean +/- SD) in the Dyazide-treated compared to 4.6 +/- 6.9 mmHg in the placebo-treated group (P less than 0.001). In two thirds of the patients receiving active treatment the fall in SDBP was more than 10 mmHg, and in over half SDBP was completely normalized (ie, SDBP less than 90 mmHg). Supine systolic blood pressure fell by 14.7 +/- 12.3 mmHg in the Dyazide-treated group compared to 5.3 +/- 11.6 mmHg in the placebo-treated group (P less than 0.001). Approximately 80% of the antihypertensive effect occurred within two weeks and after four weeks there was no further significant reduction. Mildly (SDBP = 95 to 104 mmHg) and moderately (SDBP = 105 to 115 mmHg) hypertensive patients responded similarly to treatment. All studied subpopulations responded to treatment with a reduction of SDBP of at least an average of 10 mmHg; the best responders were blacks, women, the elderly (greater than 65 years old), and patients weighing less than 170 lbs. Side effects were mild and infrequent. In conclusion, by examining the effects of Dyazide (one capsule/day), this investigation demonstrated the effectiveness of low-dose hydrochlorothiazide in antihypertensive therapy and quantified it both in the general population and in clinically relevant subpopulations.     

No adverse effect of non-steroidal anti-inflammatory drugs, sulindac and diclofenac sodium, on blood pressure control with a calcium antagonist, nifedipine, in elderly hypertensive patients.

Effect of non-steroidal anti-inflammatory drug (NSAID) on blood pressure (BP) control was evaluated in elderly hypertensive patients treated with calcium antagonist. The study was based on a randomized, crossover design to compare the effect of an NSAID, sulindac, with that of another NSAID, diclofenac sodium, in the hypertension treatment. The study was completed in six elderly female subjects (the average age: 66 +/- 3 year) whose systolic BP and diastolic BP were more than 160 mmHg and more than 95 mmHg, respectively. When BP was controlled by nifedipine (20 mg x 2 per day in slow releasing form) within normal limits, sulindac (100 mg x 3 per day) or diclofenac sodium (25 mg x 3 per day) was administered for a week. After one week-washout period, the other NSAID was substituted. Plasma and urinary variables were measured on the final day of each study period. The average systolic BP and diastolic BP and the entry of study were 167 +/- 5 mmHg and 93 +/- 5 mmHg, respectively. Nifedipine significantly decreased the systolic BP to 140 +/- 4 mmHg (p less than 0.02) and the diastolic BP to 84 +/- 4 mmHg (p less than 0.05). Addition of either sulindac or diclofenac sodium did not affect BP, whereas urinary PGE2 excretion and plasma renin activity were significantly inhibited. Plasma creatinine and electrolyte concentration were not changed by the NSAIDs. The results indicate that either sulindac or diclofenac sodium does not interfere with control of hypertension by a calcium antagonist, nifedipine in in elderly hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

The efficacy and tolerability of barnidipine hydrochloride in Thai patients with hypertension

This open-label, blinded study was performed to evaluate the efficacy and tolerability of barnidipine at a titrated dose of 10-15 mg once daily for 8 weeks in the treatment of essential hypertension in 40 Thai patients. 'Office' blood pressure (BP) and 24-h ambulatory BP measurements were recorded. A systolic BP/diastolic BP (SBP/DBP) reduction of 18.0 +/- 13.6/9.1 +/- 6.6 mmHg was obtained. The full response rate among patients with systolic and diastolic hypertension was 63% using either SBP or DBP criteria, and 54% using both SBP and DBP criteria. One of the two patients with isolated systolic hypertension had a full response, and the BP in two of the three patients with isolated diastolic hypertension was normalized. The trough-to-peak ratio and smoothness index for SBP/DBP were acceptable (0.76 +/- 0.63/0.55 +/- 0.26 and 1.2 +/- 0.4/1.2 +/- 0.3, respectively). In conclusion, once-daily barnidipine monotherapy provides effective 24-h BP control and is generally well tolerated in ambulatory patients.     

Effect of telmisartan on the proteinuria and circadian blood pressure profile in chronic renal patients.

Telmisartan is a type 1 angiotensin II (AT(1)) receptor blocker, effective and safe in the treatment of arterial hypertension. However, data with respect to circadian blood pressure (BP) monitoring and urinary protein (uP) excretion are lacking in normotensive or mild hypertensive patients with chronic renal diseases. This study has evaluated the effects of 80 mg telmisartan, given as monotherapy, on 24 h BP levels and uP loss in 16 non-diabetic patients affected by proteinuric renal disease. These patients did not meet the recommended values of mean BP, i.e. < 98 mmHg, when proteinuria was 0.5-1.0 g/d and mean BP < 92 mmHg, when proteinuria was 1-3 g/d. Patients with diastolic BP > 114 mmHg, nephrotic syndrome or severe renal failure (creatinine clearance < 20 ml/min) were excluded. After 4.2 +/- 2.7 month therapy, ambulatory BP monitoring showed a significant decrease (P < 0.001) of 24 h BP levels: systolic 135 +/- 11 vs. 122 +/- 13 mmHg, diastolic 84.4 +/- 8.1 vs. 75.9 +/- 8.5 mmHg, mean 101 +/- 8 vs. 91 +/- 9 mmHg. The effect was quite evident during either day-time or night-time. Clinic BP levels also significantly decreased (P < 0.001), and five patients reached the target values. uP excretion lowered by 37% (median) from 1.60 +/- 0.90 to 1.06 +/- 0.63 g/24 h (P < 0.01). No change in creatinine clearance (53.3 +/- 31.1 vs. 51.7 +/- 30.9 ml/min) or serum potassium level (4.3 +/- 0.3 vs. 4.4 +/- 0.4 mEq/l) was observed. Our results show that 80 mg of telmisartan, taken once daily, is effective in reducing uP excretion and BP throughout the 24 h, in normotensive or mild hypertensive renal patients. Since evidence exists that adequate control of BP, including during night-time, and reduction of proteinuria play a crucial role in the protection of renal function, telmisartan can be usefully considered in the conservative treatment of renal patients.     

A 24-week dose-titration study of the angiotensin-converting enzyme inhibitor imidapril in the treatment of mild-to-moderate essential hypertension in the elderly

This multicentre, randomized, double-blind study compared the anti-hypertensive efficacy and safety of oral once-daily imidapril 5-20 mg and hydrochlorothiazide 12.5-50 mg in elderly patients with mild-to-moderate essential hypertension. After 24 weeks of treatment, there was a significant reduction in mean sitting diastolic blood pressure from 102.5 mmHg to 87.2 mmHg in the imidapril group (n = 226) and from 102.7 mmHg to 87.4 mmHg in the hydrochlorothiazide group (n = 123) (intent-to-treat population). There were corresponding reductions in sitting systolic blood pressure and standing blood pressure. At least one adverse event was reported by 46% of patients in the imidapril group and 53% of patients in the hydrochlorothiazide group. Imidapril 5-20 mg is as effective and well tolerated as hydrochlorothiazide in the treatment of mild-to-moderate hypertension in elderly patients.     

Comparative efficacy of perindopril and enalapril once daily using 24-hour ambulatory blood pressure monitoring

ACE inhibitors are important therapeutic agents in controlling hypertension, correcting some of its pathophysiological derangement and improving its prognosis. While there are many such agents, there may be some important differences between them. This placebo run-in, double blind, crossover study, using 24-hour ambulatory blood pressure monitoring, compares the efficacy of perindopril 4-8 mg and enalapril 10-20 mg as once daily antihypertensive agents on 32 patients. For diastolic blood pressure (DBP), perindopril had a placebo-corrected peak (P) reduction of blood pressure (BP) of -6.4 +/- 1.3 mmHg vs its placebo-corrected trough (T) of -5.2 +/- 1.7 mmHg. Enalapril had a reduction in DBP of -8.5 +/- 1.3 mmHg (P) and -5.7 +/- 1.7 mmHg (T). For systolic blood pressure (SBP), perindopril had a reduction of -7.5 +/- 1.6 mmHg (P) vs -7.3 +/- 2.2 mmHg (T) compared to enalapril with -10.8 +/- 1.6 mmHg (P) vs -8.3 +/- 2.3 mmHg (T). Placebo-corrected trough-to-peak ratio (SBP/DBP) for perindopril was 0.97/0.81 vs 0.77/0.67 for enalapril. There was no difference noted in 24-hour mean BP, area under the curve or post-dose casual BP measurements. Both perindopril and enalapril were well tolerated and the two treatment groups had similar safety profiles. Perindopril thus had a predictable and sustained blood pressure effect giving a 24-hour cover for the patient without excessive peak effect or poor trough effect.     

Effects of chronic cetamolol therapy on resting, ambulatory, and exercise blood pressure and heart rate

We studied blood pressure (BP) and heart rate (HR) responses in 12 patients with hypertension who were receiving cetamolol, a cardioselective beta-blocker with intrinsic sympathomimetic activity. The BP and HR parameters were evaluated at rest (casual, office readings), with ambulatory BP monitoring, and after treadmill exercise testing. At a mean (+/- SD) dose of 46 +/- 21 mg/day, casual supine BP decreased by 10/12 mm Hg (P less than 0.05 for systolic; P less than 0.01 for diastolic) compared with placebo, while HR decreased 4 bpm. Cetamolol resulted in a significant reduction in the mean 24-hour systolic BP. The most striking reduction occurred in the BP at work (23 mm Hg), with almost no decrease in the BP during sleep. Ambulatory HR reductions occurred while the subjects were at work (9 bpm; P less than 0.05) but not while at home (awake) or during sleep. The mean duration of exercise was the same during cetamolol and placebo phases, but both HR and BP fell significantly at peak performance after cetamolol. These data suggest that cetamolol reduces BP without lowering HR at rest. During periods of increased adrenergic activity such as work and dynamic exercise, both HR and BP are reduced.     

Blood pressure behaviour in chronic daily headache

The objective was to examine the association between high blood pressure (BP) and chronic daily headache using 24-h ambulatory blood pressure monitorization (24-h ABPM). This was a cross sectional study in an out-patient clinic. Women were selected among patients referred for first evaluation, 62 with chronic daily headache and 57 without chronic daily headache. The main outcome measures were mean office systolic and diastolic blood pressure (BP), mean systolic and diastolic daytime and night-time BP and BP load, and mean systolic and diastolic nocturnal fall. Office systolic BP was 138.2 mmHg for women with chronic daily headache and 141.7 mmHg for women without headache (P = 0.36). Office diastolic BP was 88.9 mmHg for women with headache and 92.7 mmHg for women without headache (P = 0.17). Mean daytime and mean night-time systolic BP was, respectively, 122.2 mmHg and 108.8 mmHg for women with headache and 122.9 mmHg and 109.5 for women without headache (P = 0.82 and P = 0.80, respectively). Mean daytime and mean night-time diastolic BP was, respectively, 78.6 mmHg and 65.4 mmHg for women with headache and 79.9 mmHg and 67.1 mmHg for the women without headache (P = 0.80 and P = 0.45, respectively). There was no difference between the two groups regarding systolic and diastolic BP load and nocturnal systolic and diastolic fall. No significant difference in BP values was observed in women with chronic daily headache compared with women without headache using 24-h ABPM.     

Antihypertensive effect of oral potassium aspartate supplementation in mild to moderate arterial hypertension.

BACKGROUND: Previous studies showed that potassium chloride (48-120 mmol/day) supplementation reduced arterial blood pressure (BP) in hypertensive patients. OBJECTIVES: Our aim was to evaluate the effect of a lower dose of potassium aspartate salt on BP in individuals with essential arterial hypertension. METHODS: One hundred and four patients (65 males, age 53 +/- 12 years) with mild to moderate essential hypertension (systolic/diastolic BP 154.2/96.2 +/- 10.8/5.4 mmHg) were allocated in two comparable groups of 52 to receive or not 30 mmol/day per os of potassium aspartate supplementation for four weeks. Office and 24-h BP, as well as serum and urinary electrolytes, were measured at baseline and at the follow-up visit after four weeks. RESULTS: Office and 24-h BP did not change in the control group, while these values were significantly reduced in the potassium supplementation group. Changes in office (systolic BP: 154.4 +/- 8.2 vs. 142.2 +/- 7.6 mmHg; diastolic BP: 95.0 +/- 5.6 vs. 87.2 +/- 4.3 mmHg, P < 0.001 for both) and 24-h BP (systolic BP: 142.7 +/- 8.2 vs. 134.8 +/- 6.3 mmHg; diastolic BP: 90.8 +/- 4.4 vs. 84.6 +/- 3.8 mmHg, P < 0.001 for both) following potassium supplementation were highly significant. The changes in day time and night time BP were similar. The treated group showed significantly increased potassium serum level and 24-h urinary excretion of potassium (P < 0.01 in both cases) after four weeks, while the untreated group showed no significant changes of the same parameters. Urinary Na/K ratio decreased significantly with potassium supplementation (P < 0.001). In the treated group changes in office (r = 0.58, P < 0.001) and 24-h SBP (r = 0.51, P < 0.001), but not in DBP (r = 0.29 and r = 0.25, n.s.), correlated positively with the urinary Na/K ratio at baseline. CONCLUSIONS: A relatively low supplementation of 30 mmol/day of potassium as aspartate lowered office and 24-h ambulatory BP in subjects with mild to moderate essential hypertension. The antihypertensive effect was sustained throughout the day, and was greater in the patients with high basal urinary Na/K ratio.     

A placebo-controlled comparison of the efficacy and tolerability of candesartan cilexetil, 8 mg, and losartan, 50 mg, as monotherapy in patients with essential hypertension, using 36-h ambulatory blood pressure monitoring

This double-blind, randomised, controlled study compared the efficacy of candesartan cilexetil 8 mg (n = 87) and losartan 50 mg (n = 89), once daily for 6 weeks, relative to placebo (n = 80) in patients with mild-to-moderate essential hypertension (diastolic blood pressure (DBP): 95-115 mmHg). Ambulatory BP measurements were done every 15 min over 36 h. At the end of the 6-week treatment, the mean change in DBP between the baseline and the 0-24-h period after the last dose of study medication was greater in patients receiving candesartan cilexetil 8 mg (-7.3 mmHg +/- 6.9 mmHg) compared with losartan 50 mg (-5.1 mmHg +/- 4.9 mmHg) (p < 0.05) or placebo (0.3 mmHg +/- 6.5 mmHg) (p < 0.001). The mean change in systolic BP (SBP) during this time was greater in patients receiving candesartan cilexetil 8 mg (-10.8 mmHg +/- 11.3 mmHg), or losartan 50 mg (-8.8 mmHg +/- 8.9 mmHg) than placebo (1.2 mmHg +/- 9.9 mmHg) (p < 0.001). Candesartan cilexetil 8 mg was associated with a greater reduction in DBP and SBP, relative to placebo, when compared with losartan 50 mg, during both daytime and night-time, and between 12 and 24 h after dosing (p < 0.001). Both active treatments were well tolerated. In patients with mild-to-moderate essential hypertension, candesartan cilexetil 8 mg therefore had greater, more consistent antihypertensive efficacy throughout the day and the night, and long-lasting efficacy after the last dose, compared with losartan 50 mg. This greater efficacy is maintained with an excellent tolerability associated with members of the angiotensin Il type 1-receptor blocker class.     

Management of uncontrolled hypertension in a nurse-led clinic compared with conventional care for patients with type 2 diabetes

OBJECTIVE: To compare the effectiveness of a nurse-led hypertension clinic with conventional community care in general practice in the management of uncontrolled hypertension in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We studied 120 men and women outpatient attendees (61% non-Caucasian) with type 2 diabetes and a seated blood pressure (BP) >or=140/80 mmHg. All patients were being treated for hypertension, and 71% had increased urinary albumin excretion (UAE). Patients were allocated to either a nurse-led hypertension clinic or conventional primary care. The primary outcome measure was a change in systolic BP. Secondary outcome measures were total cholesterol, HDL cholesterol, total triglycerides, HbA(1c), UAE, serum creatinine, and changes in absolute stroke and coronary heart disease (CHD) risk scores. RESULTS: The mean (95% CI) difference in the decrement of systolic BP was 12.6 mmHg (5.9-19.3) (P = 0.000) in favor of the nurse-led group, whose patients were three times more likely to a reach target systolic BP <140 mmHg compared with conventional care (P = 0.003). A significant fall in 10-year CHD (P = 0.004) and stroke risk (P = 0.000) scores occurred only in the nurse-led group. There were no significant differences in the reduction of diastolic BP or any of the other secondary outcome measures at 6 months. CONCLUSIONS: Compared with conventional care, a nurse-led hypertension clinic is a more effective intervention for patients with type 2 diabetes and uncontrolled hypertension. A target systolic BP <140 mmHg is more readily achieved and may be associated with significant reductions in 10-year cardiovascular disease risk scores.     

Effect of losartan plus hydrochlorothiazide on nitric oxide status in 'nondipper' hypertensive patients

The objective of this study was to investigate the effects of losartan (100 mg) plus hydrochlorothiazide (HCTZ; 25 mg) on nitric oxide (NO) production and blood pressure (BP) in "nondipper" severe hypertensive patients. Twelve hypertensive "nondipper patients" (6 of each gender) with sitting systolic/diastolic BP of 188.0 +/- 5.2/116.2 +/- 1.2 mm Hg were studied by 24-hour ambulatory blood pressure monitoring (ABPM) after daily administration of 100 mg losartan plus 25 mg HCTZ for a period of 12 weeks. Office and mean 24-hour, as well as mean awake- and sleep-time systolic/diastolic BP, serum NO levels, and urinary excretion of NO were measured after the placebo period (3 weeks) and after 12 weeks of therapy. At the end of the 12-week treatment period, the mean 24-hour systolic/diastolic BP decreased significantly from 158.6 +/- 4.7/102.2 +/- 2.6 mm Hg (placebo period) to 140.3 +/- 4.8/90.9 +/- 3.3 mm Hg (P = 0.001/< or = 0.002). The mean BP (systolic/diastolic) during the waking period was reduced from 159.3 +/- 4.4/103.0 +/- 2.5 mm Hg to 135.0 +/- 4.4/88.2 +/- 3.1 (P < or = 0.007/P < or = 0.002), whereas the mean BP (systolic/diastolic) during the sleeping hours changed from 154.9 +/- 5.3/98.9 +/- 3.1 to 140.9 +/- 4.6 (P = 0.035)/91.7 +/- 3.2 mm Hg (P = 0.035/P = 0.051). Serum NO levels increased from 40.89 +/- 5.69 microM/L (placebo period) to 67.35 +/- 6.96 microM/L (posttreatment; P < or = 0.007), whereas the 24-hour urinary NO excretion did not change significantly (69.71 +/- 3.68 microM/L [placebo period] vs 79.64 +/- 4.25 microM/L [posttreatment]; P < or = 0.16). Urinary clearance of NO also did not change. Serum NO levels increased significantly without a significant change in urinary NO excretion. BP was significantly reduced but without modifying the nondipper pattern in these patients.     

A comparison of nisoldipine ER and amlodipine for the treatment of mild to moderate hypertension

This multicentre, double-blind, double-dummy, randomised trial compared the efficacy and tolerability of nisoldipine extended release (10-40 mg) and amlodipine (2.5-10 mg) in 161 patients. The primary end point was a between-treatment comparison of change from baseline to week 8 in mean office diastolic blood pressure (DBP). The least squares mean reductions in systolic (S)BP/DBP (+/- standard error) for nisoldipine and amlodipine were -11.7/-9.3 +/- 1.4/0.8 and -14.3/-12.0 +/- 1.4/0.8 mmHg, respectively. The DBP treatment difference was 2.7 mmHg (90% confidence interval: 1.1 to 4.3 mmHg; p = 0.005). Tolerability profiles were similar between treatments. The drug acquisition cost per mmHg DBP reduction was 40% lower with nisoldipine; an acquisition cost analysis revealed that amlodipine was 80% more expensive than nisoldipine for treating hypertension. In summary, nisoldipine and amlodipine provide clinically equivalent antihypertensive efficacy; however, nisoldipine is more economical than amlodipine.     

Effects of α, β–blocker, arotinolol chloride, on 24–h blood pressure–difference between elderly and younger hypertensive patients

To assess the effect of age on the circadian blood pressure (BP) after an α, β–adrenergic blocker, the ambulatory BP was measured before and after arotinolol chloride administration in nine younger (mean age 491 years) and 14 older (721 years) patients with essential hypertension. After a 4–week control period, arotinolol chloride was administered twice daily (08:00 and 20:00 hours) for 8 weeks and the ambulatory BP was measured non–invasively at the end of the control and treatment period. Arotinolol significantly reduced the daytime systolic BP from 1523 to 1409 mmHg (P < 005) and night–time systolic BP from 1373 to 1223 mmHg (P < 001) in the younger hypertensive patients. In contrast, in the older group, the night–time systolic BP did not show a significant change, although the daytime systolic BP was significantly reduced from 1550 to 1422 mmHg (P < 002). Diastolic BP in both groups was significantly reduced by arotinolol during the day and night. Night–time reduction of BP was significantly less in the older group (– 86 vs –151 mmHg for the systolic pressure P < 001; – 58 vs –98 mmHg for the diastolic pressure P <001).     

Detection of a systolic pressure threshold for reliable readings in pulse oximetry

OBJECTIVE: To determine the error of measurement in pulse oximetry with a decreased arterial perfusion and to identify a systolic pressure threshold for (1) initial detection and (2) a reliable reading of oxygen saturation. DESIGN: An experimental clinical prospective study. The study was approved by the local ethics committee. SETTING: Eighteen bed intensive care unit at a University hospital. PATIENTS AND PARTICIPANTS: Twenty-five adult mechanically ventilated and critically ill patients in the ICU during a 3-month period. INTERVENTIONS: A blood pressure cuff at the upper arm (same side as an arterial catheter already in place) was inflated to decrease the arterial pulsatile flow. The cuff was deflated stepwise and the resulting oxygen saturation was measured simultaneously. The error of measurement [delta S = SpO2 (baseline)-SpO2 (indicated)] was calculated for each 5 mmHg of blood pressure (BP). MEASUREMENTS AND RESULTS: Twenty-five patients (9 female, 16 male, 48 +/- 15.9 years old) with a mean SpO2 of 98.3 +/- 1.5% and a BP of 129 +/- 18.4 mmHg participated. The mean systolic BP to obtain initial readings with pulse oximetry was 45.8 +/- 17.7 (range, 25-101) mmHg (35% of the baseline pressure) resulting in lower readings of pulse oximetry (mean -11.5 +/- 13.6%, range -45 to +4%). With a systolic BP > 80 mmHg the mean bias was within the manufacturers limits of +/-2%. CONCLUSIONS: Pulse oximetry is reliable with a systolic blood pressure > 80 mmHg. The lower the BP, the lower the pulse oximetry readings leading to a bias of up to -45%.     

Effect of treatment with nebivolol on parameters of oxidative stress in type 2 diabetics with mild to moderate hypertension

AIM: The aim of this study was to examine the effect of the cadioselective B(1)-adrenoceptor blocker nebivolol on glycaemic control, lipid profile and markers of oxidative stress in patients with type 2 diabetes over a 6-month period. METHODS: Twenty-six patients with mild to moderate hypertension (140-160 mmHg systolic, 90-105 mmHg diastolic) confirmed on 24-h blood pressure monitoring, were treated with nebivolol 5 mg daily for 6 months. Total serum cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) subfractions, lipid hydroperoxides (LHPs) and total antioxidant capacity (TAC) were measured before and after 6 months of treatment. RESULTS: Nebivolol, as expected, reduced mean daytime systolic and diastolic pressures on ambulatory monitoring (149 +/- 9 to 140 +/- 13 mmHg, P = 0.02 and 84 +/- 7 to 77 +/- 9 mmHg, P < 0.001). There were no significant changes in serum cholesterol or triglycerides following treatment but a significant increase in HDL cholesterol was noted (1.12 +/- 0.19 to 1.25 +/- 0.36 mmol/L, P = 0.008). Patients showed a highly significant reduction in TAC from 501 +/- 57 to 422 +/- 29 trolox equivalent (P < 0.001). Baseline LHPs were very high and showed no significant change over the 6-month period (18.7 +/- 7.4 and 18.7 +/- 10.9 micromol/L). The LDL score increased significantly from 1.7 +/- 0.7 to 2.3 +/- 0.7 (P = 0.0002) at 6 months suggesting a change to a more atherogenic lipid profile. Neither weight nor glycaemic control changed during treatment. CONCLUSION: Nebivolol appears to be lipid neutral and may even have a positive effect on HDL cholesterol. Despite this it may promote the formation of potentially atherogenic LDL subfractions possibly as a result of reduced antioxidant defences. Further studies are needed to clarify the changes observed in parameters of oxidative stress.     

Co-renitek treatment of patients with moderate and severe forms of hypertensive disease

AIM: To evaluate efficacy and tolerance of a compound drug co-renitec combining an ACE inhibitor enalapril maleate and diuretic hydrochlorothiazide co-renitec taken for 16 weeks in essential hypertension (EH). MATERIAL AND METHODS: 28 patients with EH (16 males and 12 females aged 47-74 years) of mean duration 13.1 +/- 1.6 years. Blood pressure (BP) was monitored for 24 hours with the device SL 90207 (SpaceLabs Medical, USA). Microalbuminuria (MAU) was estimated with the use of immunoturbodimetric test. RESULTS: By 24-hour monitoring, co-renitec reduced day BP by 14.9/8.9 +/- 3/2 mm Hg, nocturnal BP lowered by 18.6/11.4 +/- 3/2 mmHg, pulse pressure also fell. Coefficient T/P was 53.5% for systolic BP (SBP) and 59.6% for diastolic BP (DBP). The target SBP was reached in 77% patients, target DBP--in 69%. Co-renitec significantly decreased MAU, albumines excretion normalized in 46% patients. CONCLUSION: Co-renitec lowers both day and nocturnal blood pressure, improves 24-h rhythm of BP, has a positive effect on the kidneys. This allows its recommendation as a first-line drug in patients with moderate and severe EH.