氯沙坦钾氢氯噻嗪片治疗老年性原发性高血压疗效分析

目的探讨氯沙坦钾氢氯噻嗪片治疗老年性原发性高血压的临床疗效。方法将100例老年原发性高血压患者口服氯沙坦钾氢氯噻嗪片(氯沙坦钾50 mg,氢氯噻嗪12.5 mg)l片,晨服1次/d,共6周,并定时测血压,观察用药期间血压、心率变化情况及有无不良反应。结果服用氯沙坦钾氢氯噻嗪片2周后,收缩压和舒张压开始显著下降,治疗前、后血压值比较差异有统计学意义(P<0.05),服用6周后降压效果最明显,总有效率达到77.0%,而且无明显的不良反应发生。结论氯沙坦钾氢氯噻嗪片治疗效果确切,能平稳降低老年人高血压,安全性高,不良反应少,值得临床进一步推广应用。     

吲哒帕胺与氢氯噻嗪分别联用氯沙坦治疗高血压伴左室肥厚比较

目的　比较吲哒帕胺 (商品名 :寿比山 )联用氯沙坦 (商品名 :科素亚 )与氢氯噻嗪 (商品名 :双氢克尿噻 )联用氯沙坦长期治疗中、重度高血压的疗效和对左室肥厚 (LVH)、左室舒张功能的影响。方法　 86例高血压伴左室肥厚患者随机分为两组 ,停用降压药 1周。一组用吲哒帕胺 1.5～ 2 .5mg/d联用氯沙坦 5 0～ 10 0mg/d口服治疗 4 8周 ;另一组用氢氯噻嗪 12 .5～ 2 5mg/d联用氯沙坦 5 0～ 10 0mg/d口服治疗 4 8周。 结果　两组血压均显著下降 (P <0 .0 5 ) ,吲哒帕胺联用氯沙坦组和氢氯噻嗪联用氯沙坦组降压总有效率分别为 92 .9% ,90 .0 % (P >0 .0 5 )。两组均可改善LVH及左室舒张功能 (P <0 .0 1) ,但吲哒帕胺联用氯沙坦组改善更明显 ,(P <0 .0 1)。两组不良反应均较少 ,对血脂、血糖代谢的影响吲哒帕胺联用氯沙坦组略优于氢氯噻嗪联用氯沙坦组。结论　吲哒帕胺联用氯沙坦治疗中、重度高血压伴LVH患者的疗效和安全性优于氢氯噻嗪联用氯沙坦 ,是一组适于长程治疗的满意组合     

替米沙坦／氢氯噻嗪复方片治疗轻中度原发性高血压的疗效观察

目的:评价高血压患者接受替米沙坦/氢氯噻嗪复方制剂(复方替米沙坦片,德国勃林格殷格翰产品)治疗轻中度原发性高血压的达标率.方法:采用自身对照、开放单一治疗试验收设计研究方案.共120例轻、中度原发性高血压患者,经药物清洗1～2周后,给予初始剂量复方替米沙坦片1片/d治疗,治疗2周末,如未达标(目标血压:舒张压<85 mmHg)则增加替米沙坦80 mg继续服用2周;在第4周末仍未达标则再增加氢氯噻嗪12.5 mg(即复方替米沙坦片2片/d),治疗8周试验结束.治疗前后监测血糖、血尿酸、肌酐、血脂和血钾.结果:(1)复方替米沙坦片治疗1周后,收缩压/舒张压与治疗前比较,分别降低14.1/8.9 mmHg(P<0.01);8周后,收缩压/舒张压分别降低27.8/15.7 mmHg(P<0.01).(2)在治疗的8周中服用复方替米沙坦1片/d为85例(70.8%);服用复方替米沙坦1片+替米沙坦80 mg/d为28例(23.3%),复方替米沙坦2片/d为7例(5.8%).(3)3例(2.5%)患者出现不良反应.结论:替米沙坦/氢氯噻嗪复方制剂治疗轻、中度原发性高血压安全有效,不良反应较少.     

氯沙坦钾氢氯噻嗪片治疗老年原发性高血压的临床效果

目的 对氯沙坦钾氢氯噻嗪片治疗老年原发性高血压的价值进行观察。方法 选取收治的老年原发性高血压患者140例,按就诊前后顺序分成对照组与观察组各70例。对照组采取氢氯噻嗪片治疗,观察组采取氯沙坦钾氢氯噻嗪片治疗;对两组临床治疗效果、治疗前后血压变化及不良反应发生情况进行比较。结果 观察组总有效率(91.4%)明显高于对照组,差异显著(χ2=6.295,P0.05)。治疗后,两组收缩压、舒张压均低于治疗前,差异显著(P0.05);且观察组收缩压、舒张压均低于对照组,差异显著(P0.05);观察组不良反应发生率(2.9%)显著低于对照组(12.9%),差异有统计学意义(P0.05)。结论 对老年原发性高血压予以氯沙坦钾氢氯噻嗪片治疗,疗效明显,具备临床推广价值。     

厄贝沙坦氢氯噻嗪治疗老年原发性高血压疗效观察

目的：探讨厄贝沙坦氢氯噻嗪治疗原发性高血压的临床疗效。方法：将110例老年原发性高血压患者随机分为观察组和对照组各55例。观察组服用厄贝沙坦氢氯噻嗪40mg＋12．4mg；对照组给予依那普利5mg联用硝苯地平缓释片10mg，口服，2次／d。结果：观察组显效30例，有效18例，总有效率为87．3％；对照组显效29例，有效18例，总有效率为85.5％。两组疗效比较差异无显著性（P〉0．05）。与治疗前相比，两组收缩压和舒张压均显著降低（P〈0．05），两组之间收缩压和舒张压在治疗前后均无显著性差异（P〉0．05）。结论：厄贝沙坦氢氯噻嗪能有效治疗老年原发性高血压，疗效可靠。     

氯沙坦、氢氯噻嗪联合治疗对高血压患者左室肥厚逆转作用的临床观察

目的:观察氯沙坦、氢氯噻嗪联合治疗的降压疗效和对左室肥厚的逆转作用。方法:44例原发性高血压患者,每日口服1次氯沙坦50mg、氢氯噻嗪12.5mg,治疗6周后观察降压疗效。对其中16例伴左室肥厚及左室增大者给予连续服药25周,以超声心动图观察治疗后心脏结构的变化。结果:44例高血压病人治疗6周以后平均收缩压下降(45.2±9.0)mmHg,舒张压下降(24.1±8.0)mmHg,差别均有显著性(P<0.01);合并左室肥厚的16例病人治疗25周以后,左室舒张末内径、左室后壁厚度、室间隔厚度及左房内径均明显缩小。结论:氯沙坦、氢氯噻嗪联合治疗降压作用明显,并且逆转左室肥厚。     

氢氯噻嗪氯沙坦及其复方制剂对高血压患者血清尿酸水平的影响

目的探讨原发性高血压(EH)合并血清高尿酸发病情况;观察噻嗪类利尿剂氢氯噻嗪、血管紧张素受体拮抗剂氯沙坦及其复方制剂(氯沙坦+氢氯噻嗪)降压治疗6周后EH患者血清尿酸(SUA)及电解质的变化。方法选择重庆北部新区第一人民医院心内科2009年4月至2013年12月门诊及住院确诊并连续诊疗的EH患者1 079例,其中男女之比662∶417,平均年龄(60.97±12.4)岁,完整记录患者治疗前后血压1 007例、肾功能及电解质603例。结果 EH患者合并高尿酸血症的发生率为25.76%(278/1079);和EH组比较,EH合并高尿酸血症组患者的肌酐及体质量指数升高,且内生肌酐清除率降低(均P0.05)。于降压治疗6周后68.92%(694/1 007)的患者收缩压小于40mm Hg,84.81%(854/1 007)的患者舒张压小于90mm Hg。不同药物降压治疗后SUA和血钾变化:小剂量氢氯噻嗪组SUA平均升高(43.82±71.78)μmol/L(P0.01),氯沙坦组平均下降(44.97±90.64)μmol/L(P0.01,100mg组优于50mg组),氯沙坦+氢氯噻嗪组平均下降(7.46±84.62)μmol/L,三组药物治疗后SUA之间的差异有统计学意义(P0.05);低剂量氢氯噻嗪组血钾平均下降(0.31±0.43)mmol/L(P0.01),与氯沙坦组[(0.06±0.42)mmol/L]和氯沙坦+氢氯噻嗪组[(-0.04±0.43)mmol/L]比较,差异也有统计学意义(P0.05)。结论高血压合并高尿酸血症者有体质量指数增加和肾功能损害趋势;低剂量噻嗪类利尿剂会加重SUA增高和低血钾,氯沙坦呈剂量依赖性降低SUA,而氯沙坦+氢氯噻嗪介于两者之间。     

氯沙坦合用氢氯噻嗪治疗老年高血压的临床研究

目的探讨氯沙坦合用氢氯噻嗪治疗老年高血压的疗效及其副作用。方法对68例老年高血压患者应用氯沙坦(科素亚)50 mg每日1次;同时合用氢氯噻嗪(双氢克尿塞)12.5 mg,每日1次,均晨顿服,2周后降压疗效不满意,氯沙坦加至100 mg,每日1次,疗程共12周。观察治疗前后随测血压、血糖、血脂、血钾、血尿酸和肝肾功能。结果氯沙坦合用氢氯噻嗪降压总有效率达89.7%,疗效显著,无明显副作用。结论氯沙坦合用氢氯噻嗪治疗老年高血压安全、有效。     

氨氯地平与氢氯噻嗪联用治疗老年高血压疗效观察

目的研究氨氯地平与氢氯噻嗪联用治疗老年轻、中度原发性高血压的疗效和安全性。方法73例轻、中度老年原发性高血压患者随机分成两组,治疗组服用氨氯地平2.5mg,1次/d;氢氯噻嗪12.5mg,1次/d;对照组单用氨氯地平2.5mg/d,两组均治疗4周。观察用药前后疗效及不良反应。结果治疗后两组血压均较治疗前显著下降(P<0.01)。氨氯地平联用氢氯噻嗪组总有效率为94.7%,单用氨氯地平组总有效率为76.3%,有显著性差异(P<0.05),药物相关不良反应治疗组显著低于对照组(2.8%vs16.2%,P<0.05)。结论氨氯地平与氢氯噻嗪联用疗效高、副作用少,且耐受性和安全性较好。     

硝苯地平联合卡托普利与厄贝沙坦氢氯噻嗪治疗原发性高血压的疗效比较

目的比较厄贝沙垃氢氯噻嗪与硝苯地平联用卡托普利对原发性高血压降压的疗效。方法选择原发性高血压病患者80例,随机分为A、B两组,每组各40例。A组服用厄贝沙坦氢氯噻嗪150 mg+12.5 mg;对反应不足者,可睡前加服1片,且此剂量为每日最大服用剂量。B组每次口服硝苯地平10 mg加卡托普利25 mg.每日3次。连续口服3 d后,根据血压情况增减剂量。观察期为4周。结果与治疗前相比,A、B组病人收缩压和舒张压均降低(P<0.05),A、B两组之间收缩压和舒张压在治疗前后均无显著差别(P<0.05)。A、B两组有效率分别为82.6%和78.3%。不良反应分别为12.5%和15.0%,两组间无显著差异(P<0.05)。结论国产厄贝沙坦氢氯噻嗪能有效治疗老年原发性高血压,安全有效。     

氯沙坦及氨氯地平对肾移植患者24 h尿蛋白及血、尿转化生长因子β_1的影响

目的:观察氯沙坦和氨氯地平对肾移植患者24 h尿蛋白及血、尿转化生长因子β_1的影响.方法:选择佛山市第一人民医院初次肾移植后伴轻、中度高血压(收缩压140～170 mm Hg,舒张压85～100 mm Hg, 1 mm Hg=0.133 kPa)患者40例,男23例,女17例,年龄(38.6±19.2)岁,随机数字表法分为氯沙坦组和氨氯地平组,每组20例.氯沙坦组口服氯沙坦50 mg/d治疗,氨氯地平组口服氨氯地平5 mg/d治疗,要求患者血压控制在130/80 mm Hg以下,治疗6个月后检测血压、肾功能、24 h蛋白尿与血、尿转化生长因子β_1水平.结果:40例患者均进入结果分析.患者用药后收缩压、舒张压均显著下降(P < 0.05),治疗6个月后,收缩压、舒张压均降至正常水平 (P < 0.01).治疗期间,2组血压下降值及平均动脉压比较差异无显著性意义 (P > 0.05).2组治疗总有效率比较差异无显著性意义 (P > 0.05).2组患者治疗前后血尿素氮、肌酐和血尿酸差异无显著性意义 (P > 0.05).治疗6个月后,氯沙坦组24 h尿蛋白与血、尿转化生长因子β_1水平较治疗前显著下降 (P < 0.05),氨氯地平组24 h尿蛋白与血、尿转化生长因子β_1水平无明显变化 (P > 0.05).氯沙坦组24 h尿蛋白与血、尿转化生长因子β_1水平均低于氨氯地平组 (P < 0.05).结论:氯沙坦与氨氯地平均可有效地控制肾移植患者的高血压状态,但氯沙坦可明显降低肾移植患者24 h尿蛋白与血、尿中转化生长因子β_1水平,氨氯地平的作用不明显.     

Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan

The efficacy and safety of Iosartan and valsartan were evaluated in a multicenter, double-blind, randomized trial in patients with mild to moderate essential hypertension. Blood pressure responses to once-daily treatment with either losartan 50 mg (n = 93) or valsartan 80 mg (n = 94) for 6 weeks were assessed through measurements taken in the clinic and by 24-hour ambulatory blood pressure monitoring (ABPM). Both drugs significantly reduced clinic sitting systolic (SiSBP) and diastolic blood pressure (SiDBP) at 2, 4, and 6 weeks. Maximum reductions from baseline in SiSBP and SiDBP on 24hour ABPM were also significant with the two treatments. The reduction in blood pressure was more consistent across patients in the losartan group, as indicated by a numerically smaller variability in change from baseline on all ABPM measures, which achieved significance at peak (P = .017) and during the day (P = .002). In addition, the numerically larger smoothness index with losartan suggested a more homogeneous antihypertensive effect throughout the 24-hour dosing interval. The anti hypertensive response rate was 54% with losartan and 46% with valsartan. Three days after discontinuation of therapy, SiDBP remained below baseline in 73% of losartan and 63% of valsartan patients. Both agents were generally well tolerated. Losartan, but not valsartan, significantly decreased serum uric acid an average 0.4 mg/dL at week 6. In conclusion, once-daily losartan 50 mg and valsartan 80 mg had similar anti hypertensive effects in patients with mild to moderate essential hypertension. Losartan produced a more consistent blood pressure-lowering response and significantly lowered uric acid, suggesting potentially meaningful differences between these two A II receptor antagonists.     

Propranolol-hydralazine combination in essential hypertension

The efficacy of a propranolol-hydralazine combination tablet was compared with that of each of its two components in the twice-daily treatment of mild to moderate essential hypertension (diastolic blood pressure: 100 to 125 mmHg). After a three-week, single-blind, placebo period, a 9- to 18-week, single-blind, dose-finding phase with the combination was performed. The daily doses of propranolol/hydralazine were 40 mg/25 mg, 80 mg/25 mg, 80 mg/50 mg, 120 mg/50 mg, 160 mg/50 mg, and 160 mg/100 mg. Of 83 patients, 73 (88%) had decreases in diastolic blood pressure equal to or greater than 10 mmHg. Thirty-eight (46%) patients had a diastolic blood pressure equal to or less than 90 mmHg while taking 80 mg propranolol/50 mg hydralazine or less given BID. Mean systolic and diastolic pressures were reduced by 16.8 mmHg (10.9%) and 17.6 mmHg (16.7%), respectively (P less than 0.001). A ten-week, double-blind, parallel-treatment phase followed in which patients were randomly assigned to the combination tablet or to propranolol or hydralazine. There were significantly larger increases in mean systolic (P less than 0.01) and mean diastolic (P less than 0.03) blood pressure when the components were taken alone than with the combination from the mean of the last three weekly dose-finding visits to the mean of the last four biweekly parallel-treatment visits. The changes in systolic/diastolic blood pressures were: hydralazine (n = 30), 14.43/8.62 mmHg; propranolol (n = 24), 9.87/6.09 mmHg; and the combination (n = 27), 1.47/1.53 mmHg. During the parallel-treatment phase, the proportions of patients with new complaints were: hydralazine, 16/31 (52%); propranolol, 10/25 (40%); and the combination, 11/27 (41%). In the hydralazine group, three patients had cardiovascular events (severe tachycardia, mild palpitations, and skipped heart beats) and two patients had mild anxiety; no such occurrences were noted in the propranolol or combination group. The mean change (increase) in heart rate from the end of dose-finding to the end of the double-blind period was significantly larger for patients taking hydralazine than for patients taking propranolol or the combination. Mean changes for these groups were: hydralazine, 12.4 beats/min; propranolol, 2.9 beats/min; and the combination, 1.8 beats/min (P = 0.0001). This study found the combination of propranolol plus hydralazine to be safe and more effective than either component.     

缬沙坦与依那普利、氨氯地平治疗高血压疗效比较

目的　与依那普利及氨氯地平相比较评价缬沙坦治疗原发性高血压病的疗效及安全性。方法　采用随机双盲试验 ,将 2 3 5例轻、中度高血压病患者随机分为缬沙坦组 (n =82 )、依那普利组 (n =76)和氨氯地平组 (n =77)。分别服用缬沙坦 80mg/d、依那普利 10mg/d或氨氯地平 5mg/d ,共 8周。用药 4周后对舒张压≥ 90mmHg者 ,以上剂量加倍。 结果　 8周末缬沙坦、依那普利和氨氯地平均能有效降压 ,有效率分别为 63 .4%、65 .8%、64 .9% ;组间差异无统计学意义。三者降压幅度无显著性差异 (P >0 .0 5 )。依那普利组干咳发生率达 14 .5 % (11/ 76) ,缬沙坦组干咳发生率为 1.2 % (1/82 ) ,二者相比差异有显著性 (P <0 .0 1) ,氨氯地平组出现面部潮红 3 .9% (3 / 77) ,踝肿 2 .6% (2 / 77) ,与前两组相比有显著性差异 (P <0 .0 1)。结论　缬沙坦治疗轻、中度高血压病疗效确切 ,可逆转患者心肌重塑 ,耐受性好     

Effects of losartan and candesartan monotherapy and losartan/hydrochlorothiazide combination therapy in patients with mild to moderate hypertension. Losartan Trial Investigators

OBJECTIVE: The goal of this multicenter, double-blind, randomized, parallel-group study was to compare the effects of losartan potassium (hereafter referred to as losartan), candesartan cilexitil (hereafter referred to as candesartan), and losartan/hydrochlorothiazide (HCTZ) in patients with mild to moderate hypertension (sitting diastolic blood pressure [SiDBP] 95-115 mm Hg). METHODS: A total of 1161 patients were randomized in a 2:2:1 ratio to 12 weeks of treatment with losartan 50 mg QD, possibly titrated to 100 mg QD (n = 461); candesartan 8 mg QD, possibly titrated to 16 mg QD (n = 468); or losartan 50 mg QD, possibly titrated to losartan 50 mg plus HCTZ 12.5 mg QD (n = 232). At 6 weeks, the regimens of patients not reaching a goal SiDBP <90 mm Hg were titrated as described, whereas patients achieving this goal continued with low-dose monotherapy. The single primary end point at 12 weeks tested the equivalence of the 2 monotherapy regimens, predefined as a maximum between-treatment difference in the mean change from baseline trough SiDBP of 2.5 mm Hg. RESULTS: At 12 weeks, changes in SiDBP/sitting systolic blood pressure (SiSBP) of -12.4/-14.4 mm Hg with losartan 50 mg/100 mg and -13.1/-15.8 mm Hg with candesartan 8 mg/16 mg demonstrated equivalence between the 2 monotherapy regimens (95% CI for difference in SiDBP, -1.6 to 0.2). At 12 weeks, the losartan 50 mg/50 mg plus HCTZ 12.5 mg regimen had reduced SiDBP/SiSBP significantly more (-14.3/-18.0 mm Hg) than either the candesartan 8 mg/16 mg (SiDBP, P = 0.045; SiSBP, P = 0.017) or losartan 50 mg/100 mg regimen (SiDBP and SiSBP, P = 0.001). During the last 6 weeks, patients whose regimen had been titrated to losartan 50 mg plus HCTZ 12.5 mg (n = 114) showed a greater reduction in SiDBP/SiSBP (-14.5/ -18.7 mm Hg) than did those whose regimen had been titrated to either losartan 100 mg (-10.5/-12.3 mm Hg; n = 211) or candesartan 16 mg (-11.5/-13.2 mm Hg; n = 206), representing a clinically meaningful > or = 2.5-mm Hg) difference. All 3 treatments were well tolerated, with few patients experiencing drug-related adverse events (6.9% losartan 50 mg/100 mg, 7.5% candesartan 8 mg/16 mg, 3.0% losartan 50 mg/ 50 mg plus HCTZ 12.5 mg). Candesartan 8 mg/16 mg increased serum uric acid levels (0.13 mg/dL; 95% CI, 0.04 to 0.23), whereas losartan 50 mg/100 mg decreased them (-0.14 mg/dL; 95% CI, -0.24 to -0.04), and losartan 50 mg/50 mg plus HCTZ 12.5 mg left them unchanged (0.06 mg/dL; 95% CI, -0.07 to 0.20). CONCLUSIONS: Losartan 50 mg/100 mg and candesartan 8 mg/16 mg were comparable treatments in terms of blood pressure reduction. After titration, losartan 50 mg plus HCTZ 12.5 mg was superior to either candesartan 16 mg or losartan 100 mg in reducing hypertension. Losartan, but not candesartan, lowered serum uric acid levels and attenuated the expected increase in uric acid levels with HCTZ 12.5 mg.     

舌下含服卡托普利与依那普利急性降压作用的比较

为探讨卡托普利与依那普利两药的急性降压作用与安全性，将高血压病患者４２例随机分为两组，其中２２例以卡托普利５０ｍｇ舌下含服为治疗组，２０例采用依那普利１０ｍｇ舌下含服为对照组。结果显示，两种药物均能显著降低收缩压和舒张压，其中收缩压降低的有效率均为１００．０％，舒张压降低有效率在两组分别为８１．８％和８５．０％，收缩压下降幅度大于舒张压。疗效无显著性差异。两药均不干扰心率，对血糖、血脂、血清电解质、肝肾功能无不良影响。舌下含服卡托普利的起效时间和作用高峰时间较依那普利明显提前（Ｐ＜０．０１）。提示依那普利不宜用于高血压急症的即刻治疗     

Comparison of the efficacy and safety of losartan (50-100 mg) with the T-type calcium channel blocker mibefradil (50-100 mg) in mild to moderate hypertension

The objective of this study was to compare the antihypertensive efficacy and safety of losartan and mibefradil. 324 outpatients (57 +/- 9.2 years) with mild to moderate hypertension were randomly allocated in a double-blind fashion to receive 50 mg of losartan or mibefradil once daily p.o. for 6 weeks after 2 weeks of placebo run-in. Titration was then forced to 100 mg of losartan or mibefradil for an additional 6 weeks. Patients were assessed at baseline, 6 and 12 weeks. The primary efficacy variable was change in predose sitting diastolic (SDBP) and systolic (SSBP) blood pressure at 12 weeks. Secondary variables included change in mean 24-hour ambulatory blood pressure and comparison of safety and tolerability. Both treatments lowered SSBP and SDBP at 6 and 12 weeks (week 6: mibefradil -14/-9 mm Hg; losartan -12/-7 mm Hg) (P <0.001). The primary objective, a difference between treatments in reduction of SSBP and SDBP at week 12 could be demonstrated (mibefradil -22/-16 mm Hg; losartan -16/-10 mm Hg) (P=0.003 and P=0.001, respectively). Twenty-four-hour SBP and 24-hour DBP were reduced (P<0.001) within each treatment group at weeks 6 and 12. The secondary objective, a difference between treatments in reduction of 24-hour blood pressure at week 12 could be demonstrated (P<0.001). Twenty-four-hour heart rate was lowered in the mibefradil group at weeks 6 and 12 (P < 0.001). Responder rates at 6 and 12 weeks were 56.2% and 78.5% for mibefradil versus 56.1% and 55.3% for losartan (P = 0.001). Both treatments were equally well tolerated. This study demonstrates that 50 mg losartan is comparably effective to 50 mg mibefradil in the treatment of mild to moderate hypertension with 100 mg mibefradil being more potent than losartan.     

Clinical Efficacy and Safety of Lower-Dose Indapamide Therapy in the Treatment of Patients with Mild to Moderate Hypertension

Previous clinical studies with indapamide, an indoline antihypertensive drug with diuretic and vasodilating activities, have shown a dose relationship associated with potassium loss. Two placebo-controlled, randomized, double-blind, parallel clinical studies were, therefore, done to evaluate the safety and efficacy of a low dose (1.25 mg) of indapamide and to determine if an improved safety profile could be produced while maintaining efficacy with a 1.25-mg dose in patients with mild to moderate essential hypertension. Four hundred seventeen (417) adult patients with mild to moderate essential hypertension (sitting diastolic blood pressure greater-than-or-equal 95 mmHg and less-than-or-equal 110 mmHg) were enrolled in two clinical studies; 209 patients were randomized to indapamide 1.25 mg and 208 patients to placebo. Patients received single-blind placebo for a 4-week washout period followed by an 8-week double-blind treatment period during which patients received either indapamide 1.25 mg or placebo. The primary efficacy endpoint was the mean change from baseline to week 8 in sitting diastolic blood pressure. Secondary efficacy variables were the proportion of patients whose sitting diastolic blood pressure had decreased greater-than-or-equal 10 mmHg and/or had a sitting diastolic blood pressure of less-than-or-equal 90 mmHg (treatment success) at all visits and at endpoint, mean changes from baseline in sitting diastolic blood pressure at designated timepoints and at endpoint, and mean changes from baseline in standing diastolic blood pressure and in sitting and standing systolic blood pressure at all visits and at endpoint. Results of these trials were pooled in order to have a larger patient population in an attempt to detect trends not readily apparent with a smaller sample size. In the primary analysis, indapamide produced statistically significantly (p = 0.0001) greater reductions in sitting diastolic blood pressure than placebo after 8 weeks of therapy. In the secondary analysis, the percentage of indapamide-treated patients who achieved treatment success after 8 weeks of therapy was statistically significantly (p < 0.0001) higher compared to placebo-treated patients. In addition, indapamide produced a statistically significantly (p = 0.0001) superior reduction compared to placebo in sitting systolic and standing systolic and diastolic blood pressure after 8 weeks of therapy. The incidence of drug-related adverse events between patients in the indapamide and placebo groups was similar. There were no clinically meaningful differences in laboratory values, including serum potassium, between the patients in the indapamide and placebo groups. Low-dose (1.25 mg) indapamide proved to be safe and effective in the treatment of mild to moderate hypertension.     

Losartan versus valsartan in the treatment of patients with mild to moderate essential hypertension: data from a multicenter, randomized, double-blind, 12-week trial

BACKGROUND: Losartan, the first of the angiotensin II receptor blockers (ARBs) to be introduced, has been studied extensively in comparison with other classes of antihypertensive agents. Less research has been conducted on the efficacy and tolerability of losartan compared with that of other ARBs. OBJECTIVE: This randomized, multicenter, double-blind, parallel-group equivalence study was conducted to compare the antihypertensive efficacy and tolerability of a once-daily regimen of losartan with that of valsartan. METHODS: Patients > or = 21 years of age with mild to moderate hypertension, defined as a trough sitting diastolic blood pressure (SiDBP) between 95 and 115 mm Hg, were randomized to receive once-daily losartan (50 mg) or valsartan (80 mg) for 12 weeks. At the end of the sixth treatment week, patients in both groups with trough SiDBP > or = 90 mm Hg had their dose doubled for the remainder of the treatment period. Analysis of variance was used to compare treatment groups with respect to change in mean trough SiDBP from baseline to week 12. Within-treatment changes were analyzed using the paired t test. With at least 220 patients per treatment group, the study had 90% power to place a 90% CI on the difference between losartan and valsartan in SiDBP within the equivalence interval of +/- 2.5 mm Hg. RESULTS: A total of 495 patients were randomized, 247 to the losartan group and 248 to the valsartan group: 456 patients completed the study. Adjusted mean change from baseline values for trough SiDBP atthe end of 12 weeks of treatment were significantly different (P < 0.001) from zero in both the losartan group (-9.9 mm Hg) and the valsartan group (-10.1 mm Hg). At week 12, losartan was as effective as valsartan in lowering SiDBP, with a between-group difference of 0.2 mm Hg (90% CI, -1.3 to 1.7; P = 0.827). At week 6, the difference in SiDBP between groups was -1.3 mm Hg (90% CI, -2.7 to 0.0; P = 0.106). A similar pattern of results was obtained at weeks 6 and 12 for sitting systolic blood pressure. The percentage of patients reaching the SiDBP goal at week 6 (46% [112/2411 losartan; 42% [103/245] valsartan) and week 12 (57% [139/243] losartan; 59% [145/245] valsartan) was not significantly different between the treatment groups. Both losartan and valsartan were similarly well tolerated. Over the 12 weeks, the laboratory profiles of the 2 drugs were similar except for serum uric acid levels, which decreased from 6.0 to 5.7 mg/dL in the losartan group and increased from 5.9 to 6.0 mg/dL in the valsartan group (P = 0.001 for between-treatment difference). CONCLUSIONS: At starting and titrated doses, losartan and valsartan are similarly effective in reducing blood pressure in patients with mild to moderate hypertension. Losartan, but not valsartan, was associated with a decrease in serum uric acid levels.     

雷公藤多苷联合氯沙坦或氨氯地平治疗肾移植后蛋白尿

背景:蛋白尿和蛋白尿多少是影响移植肾功能存活的独立危险因素,雷公藤多苷或氯沙坦均有降尿蛋白作用.目的:观察雷公藤多苷联合氯沙坦或氨氯地平对治疗肾移植后蛋白尿的临床效果.方法:选择佛山市第一人民医院随访的肾移植后伴轻、中度高血压及蛋白尿患者40例,随机数字表法分为2组,雷公藤多苷+氯沙坦组口服雷公藤多苷0.5 mg/(kg·d),氯沙坦50 mg/d;雷公藤多苷+氨氯地平组口服雷公藤多苷0.5 mg/(kg·d),氨氯地平5 mg/d,要求血压控制在130/80 mm Hg(1 mm Hg=0.133 kPa)以下,观察治疗6个月,检测血压、肝肾功能、血尿常规,药物浓度,24 h尿蛋白,药物不良反应.结果与结论:40例患者均进入结果分析,患者用药后收缩压、舒张压均显著下降(P < 0.05),治疗6个月后,收缩压、舒张压均降至正常水平(P < 0.01).两组血压下降值、平均动脉压及治疗总有效率差异无显著性意义(P > 0.05).两组患者治疗前后血尿素氮、肌酐和血尿酸差异无显著性意义(P > 0.05).尿蛋白均减少,但差异亦无显著性意义(P > 0.05);环孢素用量较前减少(P < 0.05).提示雷公藤多苷联合氯沙坦或氨氯地平用于肾移植后伴轻、中度高血压伴蛋白尿患者,能平稳降压,减少环孢素用量,减少蛋白尿,保护移植肾肾功能.