A comparative study of two beta-blocker-diuretic combinations in the treatment of hypertension

Summary

Twenty patients with mild to severe essential hypertension completed a 12-week open crossover study to compare the effectiveness and tolerance of two beta-blocker/diuretic combinations. Patients were allocated at random to receive treatment for 6 weeks with either 40?mg propranolol plus 12.5?mg hydrochloro-thiazide twice daily or 400?mg acebutolol plus 25?mg hydrochlorothiazide once daily. They were then crossed over to the alternative medication for a further 6 weeks. Blood pressures and pulse rate were monitored in the supine and erect positions at regular intervals, as were side-effects, laboratory variables and ECG. The results showed that both combinations produced significant reductions from baseline in systolic and diastolic blood pressures but that the acebutolol combination produced a significantly greater reduction in diastolic blood pressure. There was no evidence of a treatment sequence effect. The two drug treatments were reasonably well tolerated, with a trend in favour of the acebutolol combination. No clinically significant changes were observed in any of the laboratory parameters investigated and there were no ECG abnormalities.     

Pulmonary function study in old age

Summary

A study was carried out in 100 patients aged between 70 and 90 years to investigate pathological and respiratory function changes in old age. Vitalograph and peak flow meter measurements were made, but blood gas analysis was only carried out in 6 patients in view of the technical difficulties. Analysis of the results showed that there was a definite, moderate, restrictive type of defect in pulmonary function in almost all the patients, in those with generalised senile changes as well as in those with a pathological condition. Blood gas analysis showed a minimum degree of alteration in oxygen tension and saturation with normal carbon dioxide tension.     

Treatment of hypertension in the elderly in 2017/2018 - what’s new?

ABSTRACT

Introduction: Hypertension is highly prevalent in the elderly and represents a major risk factor for cardiovascular complications such as coronary heart disease, stroke, and cognitive dysfunction.

Areas covered: The recently published AHA/ACC and ESC/ESH guidelines for the management of hypertension in adult populations modified their approach towards hypertension in the elderly, particularly in those older than 85 years. The new concepts presented in these guidelines are discussed. They recommend a less conservative threshold and lower blood pressures targets; an emphasis on considering the biological rather than chronological age for patients >85 years, and the use of single-pill combinations to simplify treatment algorithms and increase long-term drug adherence.

Expert opinion: Considering the high prevalence of hypertension in the elderly and the negative impact of untreated hypertension, early detection of hypertension in patients over 60 years old is crucial. The screening of hypertension should be reinforced in patient populations using out-of-office BP measurements. The author supports the latest ESC/ESH guidelines, which define a threshold at >140 mmHg for patients aged 65 to 79 years and >160 mmHg for those >85 years and propose a target BP of 130–140 mmHg, while considering patient frailty and the tolerability of the treatment.     

Acebutolol in the treatment of diabetic patients with hypertension

Summary

A double-blind, parallel group comparison study was carried out in 20 diabetic patients with mild to moderate hypertension to assess the effectiveness and tolerance of acebutolol compared with placebo. After a 4-week wash-out period on placebo, patients received either 400?mg acebutolol or placebo once daily for 12 weeks and then placebo for a further 4 weeks. The results showed that acebutolol was more effective than placebo in lowering raised blood pressure in these patients. No deterioration in diabetic control occurred during the study and no significant side-effects of the drug were observed compared with placebo. In particular, the previously described side-effects of beta-blocker therapy in diabetic patients were not observed as a clinical problem in this study.     

The efficacy and acceptability of the combination of acebutolol and hydrochlorothiazide in the treatment of essential hypertension

Summary

The efficacy and acceptability of a single half-tablet daily of a fixed combination of 400?mg acebutolol and 25?mg hydrochlorothiazide was assessed in a study of 35 patients suffering from mild to moderate essential hypertension. The results of the 22 patients who completed the 3-month active drug period showed that treatment produced a significant reduction in supine systolic and diastolic blood pressure. This effect was apparent from the first week and was maintained throughout the trial. Pulse rate was also lowered by therapy. No clinically significant changes from normal were observed in mean serum potassium and uric acid levels, and no side-effects of treatment were reported.     

2013-2017年黄石市中心医院中老年慢性阻塞性肺疾病急性加重期患者病原菌的分布及耐药性分析

目的 了解黄石市中心医院不同年龄段慢性阻塞性肺疾病急性加重（AECOPD）住院患者感染病原菌分布情况及耐药性特点。方法 分析黄石市中心医院2013年1月-2017年10月痰培养检出病原菌的554例AECOPD患者的病原菌分布和耐药性。结果 40~65岁和≥ 65岁患者均以革兰阴性菌为主,40~65岁患者排名前3位的病原菌分别为流感嗜血杆菌（18.54%）、铜绿假单胞菌（15.89%）和大肠埃希菌（13.58%）;≥ 65岁患者排名前3位的病原菌分别为铜绿假单胞菌（22.51%）、鲍曼不动杆菌（15.43%）和大肠埃希菌（14.15%）。≥ 65岁患者铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌的分离率显著大于40~65岁,流感嗜血杆菌、肺炎克雷伯杆菌和肺炎链球菌的分离率显著小于40~65岁,差异均有统计学意义（P<0.05）。≥ 65岁患者铜绿假单胞菌和大肠埃希菌的耐药率普遍大于40~65岁患者,其中铜绿假单胞菌对头孢他啶、左氧氟沙星、环丙沙星的耐药率和大肠埃希菌对哌拉西林他唑巴坦、头孢他啶、左氧氟沙星、环丙沙星的耐药率差异性均有统计学意义（P<0.05）。结论 黄石市中心医院AECOPD患者病原菌均以革兰阴性菌为主,但不同年龄段病原菌的构成和耐药性并不完全相同。依据不同年龄段患者病原菌分布及耐药性监测结果指导抗菌药物合理用药,是治疗AECOPD的关键。     

Anti-arrhythmic properties of acebutolol (Bay c 7705), a new cardioselective β-adrenergic blocking agent: a preliminary report

Summary

A study was carried out in 20 ambulatory patients with various heart diseases and different forms of cardiac arrhythmias to evaluate the anti-arrhythmic effect of acebutolol when given orally(400?mg/day). Long-term (4 hour) ECGs were monitored before and after 3 days of treatment. The results showed that after acebutolol treatment 60% of all the arrhythmias were prevented or abolished, 16% were improved, and only 24 % persisted unchanged.     

Safety profile of extended-release morphine sulfate with sequestered naltrexone hydrochloride in older patients: pooled analysis of three clinical trials

Objective Clinical trial safety data following chronic administration of extended-release opioids within an older population is limited. Embeda* is an extended-release formulation of morphine sulfate surrounding sequestered naltrexone hydrochloride (MSN) and is designed to deter opioid misuse and abuse. The present analysis compared pooled safety outcomes among patients aged ≥65 years and those aged <65 years from three phase 2/3 studies (ranging from 2 weeks to 12 months) in patients treated with MSN.

Research design and methods Subgroup analysis of patients aged ≥65 years and <65 years was performed on pooled data for adverse events (AEs), potentially clinically significant laboratory values (hematology/chemistry), and signs/symptoms of opioid withdrawal using the Clinical Opiate Withdrawal Scale (COWS) (phase 3 trials only) for patients who received at least one dose (short-term studies, maximum dose was 160?mg/d or 320?mg/d depending on study; long-term study, no maximum dose) of study medication during titration and maintenance phases.

Clinical trial registration ClinicalTrials.gov: NCT00420992, NCT00415597.

Results During titration, 173 (17.1%) of 1012 patients treated with MSN were aged ≥65 years, while during maintenance 76/564 (13.5%) patients were aged ≥65 years. Treatment-emergent AEs were similar in frequency and type between the two cohorts, with the most common being constipation, nausea, and somnolence; no consistent patterns relating to age and only one possibly treatment-related serious AE in patients ≥65 years was noted. No clinically significant differences in laboratory values or COWS scores (average maximum score ≤2.5) were observed between age groups.

Conclusions Safety outcomes following daily administration of MSN (2 weeks–12 months) were similar between patients aged ≥65 years and?<65 years. Key limitations include the variable study designs and length of treatment (2 weeks–12 months), small sample size, and the inclusion of only those patients who were otherwise in relatively good health with restrictions on concomitant medications.     

An open study of sub-lingual buprenorphine in the treatment of chronic pain in the elderly

Summary

Fifty-one patients aged over 65 years with chronic pain entered an open study to assess the efficacy and tolerance of low-dose (0.1?mg) sub-lingual buprenorphine administered 3 to 4-times a day over a 14-day period. There was significant improvement in symptoms during the treatment period and the drug was well tolerated, with good compliance. Patients aged over 80 years responded comparatively better than those aged between 65 and 80 years. The incidence of unwanted effects was low and constipation was only reported by 1 patient.     

双歧杆菌四联活菌片联合多潘立酮对小儿功能性消化不良的临床疗效及其对血浆P物质和胃动素水平的影响

目的 探讨双歧杆菌四联活菌片联合多潘立酮对小儿功能性消化不良胃电节律、血浆P物质及胃动素水平的影响。方法 选取2016年3月—2019年3月徐州市第一人民医院108例功能性消化不良患儿作为研究对象,根据随机数字表法将患者分为对照组和观察组,每组各54例。对照组患儿餐前30 min口服多潘立酮混悬液,3岁以内3~4 mL/次,3次/d;4~6岁患儿5~6 mL/次,3次/d;7岁以上患儿7~10 mL/次,3次/d。观察组患儿在对照组的基础上口服双歧杆菌四联活菌片,1~6岁患儿1.0 g/次,2~3次/d;6岁以上患儿1.0~1.5 g/次,3次/d。两组均连续治疗14 d。观察两组患儿的临床疗效,同时比较两组治疗前后的症状评分、胃电节律异常发生率、血浆P物质和胃动素水平。结果 治疗后,观察组患儿治疗总有效率为94.44%,显著高于对照组的79.63%,两组比较差异具有统计学意义（P<0.05）。治疗后,两组患者各症状评分均明显降低（P<0.05）,且观察组症状评分显著低于对照组（P<0.05）。治疗后,两组患儿餐前及餐后胃电节律异常发生率均明显降低（P<0.05）,且观察组胃电节律异常发生率显著低于对照组（P<0.05）。治疗后,两组患儿血浆P物质及胃动素水平均明显升高（P<0.05）,且观察组P物质及胃动素水平显著高于对照组（P<0.05）。结论 双歧杆菌四联活菌片联合多潘立酮可通过改善胃电节律、提高血浆P物质及胃动素水平的影响来改善患儿临床症状,疗效确切,值得在小儿功能性消化不良治疗中应用推广。     

中国高血压患者用药依从性的meta分析

目的：对中国高血压患者的药物依从性（Medication Adherence,MA）的研究进行了Meta分析,并探讨了不同年龄组、性别和文化程度的MA差异。 方法：使用三个英文数据库（Pubmed,Web of Science和Embase）和三个中文数据库（知网,万方和维普）检索2010年1月至2018年9月的相关文献。随机效应模式被应用去计算效应量大小和95％CI。另外进行了亚组分析,以确定这些比较中潜在的异质性来源。Egger’s的测试和Begg’s测试用于评估发表偏倚。 结果：共27篇文献被纳入本次研究,包括来自14个省、3个直辖市和1个特别行政区的20,140名参与者。整体纳入研究的汇总效应大小值为42.0％（95％CI：36.0％-48.0％）。通过亚组分析,合并的8项Morisky药物依从性量表（MMAS-8）值为49.4％（95％CI：38.9％-59.9％）。4项Morisky药物依从量表（MMAS-4）值为37.5％（95％CI：31.1％-44.0％）。具有初中或以下,高中,大专或以上学历的患者的MA结果分别为49.5％,49.6％和53.6％。男性患者（47.5％）的药物依从性略低于女性（48.4％）。 60岁及以上的患者（51.0％）的MA高于60岁以下的患者（46.9％）。在发达地区的参与者的MA（48.3％）比不发达地区（37.5％）更高。 结论：中国高血压患者MA相对较低,不同的测量工具会可能会影响患者的MA测量结果,学历、性别、经济水平是高血压患者MA的影响因素。目前急需有效的干预措施来解决和缓解这一问题。     

Antihypertensive efficacy and safety of the angiotensin receptor blocker azilsartan in elderly patients with hypertension

Objectives: The number of elderly patients with hypertension has been steadily increasing. However, there are limited data on the safety and efficacy of the new angiotensin type 1 receptor blocker (ARB) azilsartan in elderly patients with hypertension. We investigated the clinical efficacy and safety of azilsartan in this population. Methods: The study population comprised 56 ambulatory patients with essential hypertension. We evaluated the reduction in blood pressure and safety after 12 weeks of treatment with azilsartan in 29 hypertensive patients?≥65 years of age (aged group) in comparison with the findings in 27 patients <65 years of age (non-aged group). Results: Systolic blood pressure in the aged group declined significantly from 155?±?18?mmHg at baseline to 138?±?11?mmHg after 12 weeks of treatment with azilsartan, and that in the non-aged group also declined significantly from 152?±?20?mmHg at baseline to 142?±?13?mmHg after 12 weeks of treatment with azilsartan. There were no significant differences in the magnitude of change in blood pressures from pre-treatment to post-treatment with azilsartan between the non-aged and aged groups. There were no changes in clinical laboratory findings, including serum levels of creatinine, potassium, lipids, and other metabolic variables, after 12 weeks of treatment with azilsartan in both groups. Conclusions: Our findings suggest that azilsartan is effective in lowering blood pressure in elderly patients and may be safe. Therefore, azilsartan could be a valuable option for treating hypertension in elderly and non-elderly patients.     

Current treatment of hypertension in patients with coronary artery disease recommended by different guidelines

Introduction: It is important to know how to treat hypertension in patients with coronary artery disease (CAD). The reason for the review was to update this treatment and to discuss the 2015 American Heart Association/American College of Cardiology/American Society of Hypertension 2015 guidelines of treatment of hypertension in patients with CAD.

Areas covered: Studies between 1968 and 2015 were reviewed on treatment of hypertension in patients with CAD using a Medline search, and studies between 1977 and 2015 were reported. Hypertension should be treated with beta blockers and ACE inhibitors or angiotensin receptor blockers (ARBs). Long-acting nitrates are effective antianginal and anti-ischemic drugs. Calcium-channel blockers (CCBs) may be added if angina persists despite beta blockers and long-acting nitrates. The 2015 guidelines recommend that the blood pressure should be < 140/90 mm Hg in patients aged ≤ 80 years and the systolic blood pressure < 150 mm Hg if they are ≥ 80 years.

Expert opinion: Hypertension in patients with CAD should be treated with beta blockers and ACE inhibitors or ARBs. Long-acting nitrates are effective antianginal and anti-ischemic drugs. CCBs may be added if angina persists despite beta blockers and long-acting nitrates. The blood pressure should be < 140/90 mm Hg in patients aged < 80 years and the systolic blood pressure < 150 mm Hg if they are ≥ 80 years.     

老年高血压与高脂血症的关系探讨

目的：探讨老年高血压与高脂血症之间的关系及用阿托伐他汀降脂治疗后对血压的影响。方法：随机抽查728例50岁以上中、老年人，主要进行血雎与血脂的调查（均排除继发性高血压）．并对再次入围的高血压合并高脂血症的随机40例患者进行5个月的降脂治疗。结果：（1）中、老年人高脂血症的患病率为52．47％，高血压者的患病率为40．52％，其中高脂血症合并高血压者的患病率为23.76％，尤高脂血症的高血压患病率为16．71％，且后两者随年龄的增长而增高。（2）对高脂血症合并高血压患者在原有降压药基础上给予阿托伐他汀治疗后血压较服药前有所下降。结论：揭示了老年高血压与高血脂症的密切关系。阿托伐他汀对高脂血症合并高血压患者在原有降压药的基础上有降压疗效。     

Effect of age on response to rivastigmine or donepezil in patients with Alzheimer's disease

ABSTRACT

Background: Younger Alzheimer's disease (AD) patients appear to differ genetically and neuropathologically from older AD patients, and may experience a more aggressive disease course compared with older patients. A randomised trial investigated the efficacy and tolerability of rivastigmine, an inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), and donepezil, an AChE-selective inhibitor, in patients with AD over a 2-year period. This retrospective analysis investigated whether younger and older patients showed differential tolerability and efficacy responses to cholinesterase inhibitor treatment.

Methods: For the current analysis, patients were divided according to age at baseline: those aged < 75 years and those aged ≥ 75 years. Efficacy measures were the Severe Impairment Battery (SIB), Neuropsychiatric Inventory (NPI), Global Deterioration Scale (GDS), Mini-Mental State Examination (MMSE) and the AD Cooperative Study Activities of Daily Living scale (ADCS‐ADL). Changes in efficacy parameters and adverse event frequencies were calculated for rivastigmine and donepezil-treated patients in both age groups. Exploratory analyses were also conducted on SIB, ADCS‐ADL and NPI in patients who consented to pharmacogenetic testing at baseline. Genotyping of the apolipoprotein E (APOE) ε4 allele and the BuChE K-variant was conducted using the TaqMan assay. Main efficacy analyses were based on an intent-to-treat last observation carried forward (ITT‐LOCF) population.

Results: Of the 994 patients who received the study drug, 362 (36.4%) were younger than 75 years and 632 (63.6%) were aged 75 years or over. Rivastigmine provided significant benefits in younger patients compared with donepezil on the NPI‐10, NPI‐12, NPI‐D, GDS and ADCS‐ADL (all p < 0.05, ITT‐LOCF). With the exception of the NPI‐D in favour of donepezil (?p < 0.05, ITT‐LOCF), no significant treatment differences were observed in older patients. Younger patients with two wild-type BuChE alleles had a significantly greater response to rivastigmine than donepezil on the ADCS‐ADL (?p < 0.01, ITT‐LOCF) and SIB (?p < 0.05, ITT‐LOCF). The most common adverse events were nausea and vomiting and these were more frequent in rivastigmine-treated patients.

Conclusion: In this sub group analysis, patients younger than 75 years of age showed greater treatment responses to rivastigmine than donepezil. Analysis of response by BuChE genotype suggests that this differential effect may be due to the inhibition of BuChE, in addition to AChE, by rivastigmine.     

非洛地平缓释片治疗社区高血压的疗效与依从性研究

目的:了解非洛地平缓释片治疗社区高血压的临床疗效和患者依从性,为社区高血压防治提供依据。方法:采用随机单盲将300名深圳市梅林社区管理的高血压患者分成2组,A组150例子尼群地平片20 mg,po,bid;B组150例予非洛地平缓释片5 mg,po,qd。疗程均为24周。每8周末测血压,并统计治疗依从性及药品不良反应。结果:治疗第8、16、24周末,与A组比较,B组血压下降幅度、治疗依从性差异均有统计学意义(P<0.05)。结论:非洛地平缓释片治疗社区高血压患者疗效显著,治疗依从性好,可作为治疗社区高血压的首选药物。     

Assessment of the efficacy and acceptability of an acebutolol/ hydkhlorothiazide combination in the treatment of mild to moderate essential hypertension

Summary

The efficacy and acceptability of single daily doses of a fixed combination of 400?mg acebutolol and 25?mg hydrochlorothiazide were assessed in an open study of 30 patients suffering from mild to moderate essential hypertension. Results from 20 patients who completed the 6-months' active drug period, and 9 patients whose treatment was terminated at various times before the end of this period, indicated significant reduction in the systolic and diastolic blood pressure in supine, sitting and standing positions. This effect was apparent from the first month on drug therapy and was maintained thoughout the 6-month trial. In no patient was withdrawal from this study attributable to side-effects of the drug. Results indicate good control of hypertension by a single dose of the combined drugs and good patient compliance was observed during the study. Potassium loss, frequently experienced during hydrochlorothiazide treatment, was not observed in the presence of acebutolol.     

清降片治疗小儿肺胃蕴热证咽喉肿痛的疗效观察

目的 评价清降片治疗7～14岁学龄儿童肺胃蕴热证咽喉肿痛的有效性和安全性。方法 采用分层区组随机、双盲双模拟、阳性药平行对照、多中心临床研究,非劣效性检验的方法。选取7～14岁学龄儿童肺胃蕴热证240例,按1:1分为治疗组和对照组。两组分别给予清降片和小儿咽扁颗粒,疗程为5 d。结果 PP分析中,中医病证疗效的愈显率(即总有效率)对照组为79.63%,治疗组为81.82%,疾病疗效的愈显率对照组为77.78%,治疗组为77.27%。采用按中心分层的CMHX2法统计,两组在各访视点的中医病证疗效、疾病疗效比较,差异均无统计学意义,且PP分析、ITT分析的结论一致。同时对于中医病证疗效的非劣效性检验结果显示,清降片组愈显率不低于小儿咽扁颗粒组(P< 0.05),且PP分析、ITT分析的结论一致。结论 清降片在治疗儿童肺胃蕴热证咽喉肿痛方面不仅适用于1～6岁儿童,同样适用于7～14岁学龄儿童;且具有较好的疗效性和安全性,其疗效不劣于对照药小儿咽扁颗粒。