Efficacy of enalapril in essential hypertension and its comparison with atenolol

The effect of enalapril was evaluated in 67 patients with essential hypertension, and its therapeutic efficacy was compared with atenolol in a placebo run-in, single-blind, cross-over trial. Enalapril significantly reduced blood pressure in all grades of essential hypertension. As monotherapy it 'normalized' blood pressure in 88%, 50% and 25% of patients with mild, moderate and severe hypertension respectively. Optimal dose for most of the patients was 20 to 40 mg/day. Comparison with atenolol revealed almost parallel efficacy of the two drugs, although enalapril produced a significantly greater reduction in systolic blood pressure in patients with mild and moderate hypertension (P less than 0.01 in each group). No serious side effects were encountered with either drug. Enalapril, therefore, has a potent and slightly superior antihypertensive effect to that of atenolol, and may be used as a 'first-step' drug in the treatment of hypertensive patients.     

A comparison of once and twice daily atenolol in hypertension.

The hypertensive action of atenolol has been studied in a randomized double-blind crossover comparison. Twelve patients showed a highly significant reduction in average supine systolic and diastolic blood pressures from pre-treatment values of 196.3/115.9 to 159.1/89.2 mmHg (26.1/15.4 kPa to 22.2/11.9 kPa) after 2 weeks on once daily atenolol. No dose-related reduction in blood pressure was seen and the single 100 mg daily dose was as effective as 100 mg twice daily or 50 mg twice daily. Blood pressures recorded after 2 weeks'' atenolol were lower than those obtained at 7 days irrespective of dose.     

缬沙坦与贝那普利治疗原发性高血压疗效对比研究

目的:对照观察缬沙坦(valsartan)与贝那普利(benazepril)治疗原发性高血压的疗效及安全性。方法:随机观察缬沙坦与贝那普利治疗原发性高血压4周的有效率,并分组进行对照。结果:缬沙坦治疗4周总有效率为75%,贝那普利总有效率为70%,两组疗效差异无统计学意义(P>0.05)。结论:缬沙坦是一种安全有效,耐受性好,不良反应少的降压药物。     

A comparison of diltiazem and atenolol in angina

Diltiazem was compared to atenolol in a double-blind trial involving 78 patients suffering from coronary heart disease. Following a 2 week control period, patients were randomly allocated to 6 weeks treatment with one or the other drug. The patients themselves made daily records of anginal attacks, trinitrate requirements, well-being and exercise tolerance. With both drugs there were highly significant reductions in the anginal attack rate and trinitrate requirements, and significant improvement on the other measures. However, there were no significant between drug differences. The incidence of side effects with diltiazem was very low and no patient had to omit treatment for this reason, although three patients did so on atenolol.     

Randomised controlled comparative study of methyldopa and oxprenolol in treatment of hypertension in pregnancy

One hundred pregnant women with hypertension (defined as diastolic blood pressure at or above 95 mm Hg) were allocated at random to treatment with methyldopa or oxprenolol and were compared with nonhypertensive controls matched according to parity and gestation at delivery. The patients were also stratified into those entering the study early (before 32 weeks' gestation) and those entering late (after 32 weeks' gestation). Although there were no differences in diastolic blood pressure between the hypertensive groups before or during treatment, in the early entry group the systolic blood pressure at entry of those allocated to oxprenolol was significantly higher than that of those receiving methyldopa; this difference remained throughout the treatment period. Also in the early entry group further increments of drug treatment were required to control blood pressure of patients receiving oxprenolol than in those receiving methyldopa. The eventual fetal outcome for all patients treated with methyldopa was the same as that for those treated with oxprenolol; birth weight, placental weight, head circumference, and Apgar score were not significantly different and there were no stillbirths in either group.     

Comparison of nisoldipine and nifedipine as additional treatment in hypertension inadequately controlled by atenolol.

Twenty-eight patients (11 Caucasian, 17 black) whose blood pressure was more than 160/96 mmHg after 4 weeks on placebo added to atenolol 100 mg/day were randomly given, in addition, nisoldipine 10 mg or nifedipine 20 mg each twice a day for 8 weeks in a double-blind cross-over study. There was a statistically significant (P < 0.001) fall in blood pressure with no change in heart rate, both supine and erect, on both drugs. There were no significant differences between nisoldipine and nifedipine. Adverse effects were recorded in 15%, 17% and 35% of the patients available for safety comparison for placebo, nisoldipine and nifedipine, respectively. There were no significant differences between the black and Caucasian patients in blood pressure responses, although the study had only a low power to detect these. However, the fasting serum triglyceride levels at the end of both calcium antagonist treatment periods were highly significantly lower in the black patients compared with the Caucasian patients. Nisoldipine, which has a higher coronary vascular selectivity and less negative inotropism than nifedipine, is as effective and as well tolerated as nifedipine in patients whose hypertension is inadequately controlled on atenolol. It may have a special role in hypertensive patients with impaired left ventricular function.     

Hypokalemia during the treatment of arterial hypertension with diuretics.

In a study of 50 patients with uncomplicated arterial hypertension the administration of hydrochlorothiazide, 50 to 100 mg daily or every other day, with or without reserpine, 0.25 mg daily, resulted in a fall in the mean blood pressure from 182/113 to 144/92 mm Hg. The mean duration of therapy was 19 months. The mean serum potassium concentration was 4.3 mmol/l before the onset of therapy. It fell during the first 6 weeks of treatment, but seldom below 3.5 mmol/l, then rose gradually and spontaneously to 4.1 mmol/l after 19 months of therapy. All the patients remained asymptomatic. These findings bring into question the routine use of potassium supplements or a potassium-sparing diuretic, such as spironolactone or triamterene, during the treatment of hypertension with diuretics such as the thiazides. The use of potassium supplements or a potassium-sparing agent may induce hyperkalemia in spite of the simultaneous administration of a diuretic that acts more proximally. Since hyperkalemia is potentially lethal, the serum potassium concentration should be carefully monitored in any patient receiving potassium supplements or a potassium-sparing agent.     

A comparison between spironolactone and hydrochlorothiazide with and without alpha-methyldopa in the treatment of hypertension.

In a single blind crossover trial, spironolactone (50 mg twice a day), and hydrochlorothiazide (50 mg twice a day) were equally effective hypotensive agents in 16 patients with untreated essential hypertension. The addition of alpha-methyldopa (250 mg three times a day) to each agent produced a further significant and equal fall in blood pressure. Spironolactone therapy was assoicated with fewer clinical and biochemical side effects. The hypotensive effect of the diuretics was independent of the renin status of the patients.     

巯甲丙脯酸,尼群地平对高血压左室肥厚逆转作用的疗效比较

目的 观察疏甲丙脯酸对左室肥厚的消退作用。方法 观察４５例高血压患者口服疏甲丙脯酸一年前后血压,左室形态结构变化,并与４５例尼群地平组对比。结果 疏甲丙脯酸和尼群地平组治疗后左室重量指数（ＬＶＭＩ）均降低Ｐ〈０．００１,两组疗效相似。提示两药能有效降低血压,逆转左室肥厚。结论 巯甲丙脯酸在治疗高血压左室肥厚时,可考虑为首选药物之一。     

肺动脉高压的当代治疗

直到20世纪90年代,钙通道阻滞剂和肺移植仍是仅有的动脉型肺动脉高压(PAH)的治疗措施.然而随着对PAH病理生理机制认识的明确,特异性治疗药物也不断开发.目前用于PAH的特异治疗药物分为3类:前列环素类似物、磷酸二酯酶5抑制剂及内皮素受体拮抗剂.     

肺动脉高压的治疗展望

动脉型肺动脉高压(pulmonary arterial hypertension,PAH)的治疗近年来备受药物研发领域的关注.前列环素类药物、内皮素受体拮抗剂和磷酸二酯酶5抑制剂等虽然能延缓病情,但是仍没有达到治愈PAH的目标.随着对PAH发病机制认识的逐渐深入,一些新的药物与治疗策略的出现将可能使PAH的治疗情况得到改观.     

螺内酯治疗难治性高血压23例疗效观察

目的观察螺内酯治疗难治性高血压的疗效。方法把45例门诊难治性高血压患者随机分成治疗组23例和对照组22例,对照组接受改善生活方式和包括利尿剂在内的抗高血压药物的基础治疗,治疗组在基础治疗的同时加用螺内酯（醛固酮拮抗剂）20mg,每天一次,测量治疗前、治疗3周后所有患者血压及检测治疗组治疗前后血钾水平。结果治疗组收缩压、舒张压治疗3周后与治疗前比较,差异有统计学意义,P〈0.05,治疗组治疗前后血钾均在正常范围内。结论在定期检测血钾的情况下,难治性高血压患者在利尿剂、钙离子拮抗剂和血管紧张素转换酶抑制剂基础上加用小剂量螺内酯可取得满意的降压效果。     

A comparison of beta adrenergic blocking drugs in the treatment of hypertension

Beta adrenergic blocking drugs were found to be effective hypotensive agents in the long-term treatment of patients with hypertension. In 40% of patients they appeared to be an extremely satisfactory antihypertensive agent. The fall in blood pressure was confirmed in a double blind study which also indicated that propranolol, prindolol, alprenolol and MK 950 (timolol) had similar antihypertensive properties. Propranolol and timolol reduced the pulse rate more than prindolol and alprenolol but the fall in blood pressure induced by the four drugs was not significantly different. The incidence of volunteered side effects was low, but when questioned specifically a large number of patients has disturbance of their dream pattern. This was more frequent and severe with prindolol and alprenolol. In this study bronchospasm was associated with the use of propranolol and timolol but not with that of prindolol and alprenolol.     

比索洛尔和安替洛尔治疗原发性高血压的随机双盲研究

５９例原发性高血压患随机双盲分为比索洛尔（Ｂｓｐ）组及安替洛尔（Ａｔｅ）组，比较两组降压疗效，Ｂｓｐ组总有效率为１００％，Ａｔｅ组总有效率为９６．４％。两组疗效无显性差异。两组均有减慢心率作用，对血糖、血脂、肝肾功能、血清电解质、尿酸、血尿常规均无明显不良反应。两种药物作用时间较长，可每日服药１次。     

A comparison of verapamil and propranolol for the initial treatment of hypertension. Racial differences in response

We compared verapamil and propranolol hydrochloride for monotherapy of hypertension. Verapamil lowered blood pressure (BP) more effectively than propranolol in black and white patients. Verapamil was equally effective in blacks and whites, whereas propranolol was more effective in whites. Heart rate was reduced by 6.0 beats per minute by verapamil, and by 13.6 beats per minute by propranolol. In blacks, verapamil lowered systolic BP 16.9 vs 8.1 mm Hg for propranolol; verapamil reduced diastolic BP 12.8 vs 8.6 mm Hg for propranolol. In whites, verapamil lowered systolic BP 19.0 vs 12.7 mm Hg for propranolol; verapamil reduced diastolic BP 16.7 vs 12.3 mm Hg for propranolol. Increases in systolic BP were observed in 22% and 3.4% of patients receiving propranolol and verapamil, respectively. The PR interval was increased from 163.5 to 174.9 ms for verapamil vs 160.3 to 164.4 ms for propranolol. Constipation (15%) and headaches (10%) were most frequent complaints for verapamil vs fatigue (18%) and dizziness (7%) for propranolol. Changes in blood biochemistry values were of small magnitude. We conclude that verapamil monotherapy is a safe and effective means of achieving BP control in patients with essential hypertension.