非洛地平缓释片,比索洛尔和培哚普利对原发性高血压患者24小时血？…

目的：比较非洛地平缓释片、比索洛尔和培哚普利对４８例原发性高血压患的降压疗效。方法：采用随机,单盲和平行对照的方法,运用２４小时动态血压监测之。结果：３种药均能显降低血压,彼此间降低偶测血压的幅度无显差异,非洛地平缓释片和比索洛尔降低２４小时平均和白天平均血压的幅度大于培哚普利。３种药均能有效控制清晨高峰期的血压,它们的降压谷／峰比值都超过６５％。结论：非洛地平缓释片、比索洛尔和培哚普利均可     

非洛地平缓释片、比索洛尔和培哚普利对原发性高血压患者24小时血压的影响

目的 :比较非洛地平缓释片、比索洛尔和培哚普利对 48例原发性高血压患者的降压疗效。方法 :采用随机 ,单盲和平行对照的方法 ,运用 2 4小时动态血压监测之。结果 :3种药均能显著降低血压 ,彼此间降低偶测血压的幅度无显著差异。非洛地平缓释片和比索洛尔降低 2 4小时平均和白天平均血压的幅度大于培哚普利。 3种药均能有效控制清晨高峰期的血压 ,它们的降压谷 /峰比值都超过 6 5 %。结论 :非洛地平缓释片、比索洛尔和培哚普利均可每日服用 1次 ,前 2种药控制 2 4小时血压及清晨醒后的高峰期血压较后者为佳。     

非洛地平与赖诺普利的降压效应及对左室肥厚逆转作用的对比

目的：评价并比较非洛地平及赖诺普利治疗轻、中度原发性高血压（ＥＨ）的降压疗效及对左心室肥厚的逆转作用。方法：选择１２８例轻、中度ＥＨ患者,入选前服用安慰剂２周,随机分为非洛地平组６６例和赖诺普利组６２例。非洛地平组服用非洛地平５～１０ｍｇ／ｄ,赖诺普利组服用赖诺普利１０～２０ｍｇ／ｄ,每日１次,疗程２４周。两组均在治疗前及治疗后的２、１２、２４周分别进行偶测血压、２４ｈ动态血压及超声心动图检查。结果：非洛地平和赖诺普利均能显著降低血压,两药对偶测血压的下降幅度差异无显著性（Ｐ＞０．０５）。非洛地平能有效控制清晨高峰期血压。收缩压、舒张压的谷／峰比值分别是７２％、６７％。非洛地平降低２４ｈ平均血压和白昼血压的幅度大于赖诺普利,而夜间血压降低的幅度显著低于白昼。两药治疗２４周后,室间隔厚度、左心室后壁厚度、左室心肌重量及左室重量指数较治疗前显著改善（Ｐ＜０．００１）。两组药物副反应均较轻。结论：非洛地平能有效降低ＥＨ患者的血压,降低靶器官损害的危险性。     

用动态血压监测比较国产与进口苯磺酸氨氯地平降压疗效

目的比较国产与进口苯磺酸氨氯地平对原发性高血压患者24小时血压的降压疗效.方法采用多中心,随机开放平行对照方法,运用24小时ABPM测压法.结果两药均能显著降低血压,彼此间降压幅度无显著差异.两药均能降低24小时平均、白天平均及夜间平均血压,均能有效控制清晨高峰期血压.结论国产与进口苯磺酸氨氯地平均能有效控制24小时血压及清晨后的高峰期血压.     

非洛地平，氨氯地平对高血压病患者24小时血压的影响

目的比较非洛地平,氨氯地平对高血压病患者24小时血压的降压疗效。 方法采用随机、单盲和平行对照的方法,运用24小时动态血压监测。 结果二药均能显著降低血压,彼此间降低偶测血压的幅度无显著差异。二药均能降低24小时平均,白天平均及夜间平均血压,均能有效控制清晨血压高峰期的血压。 结论　非洛地平,氨氯地平均可每日服用1次,均能有效控制24小时血压及清晨醒后的高峰期血压。     

非洛地平，氨氯地平对高血压病患者24小时血压的影响

目的：比较非洛地平,氨氯地平对高血压病患者24小时血压的降压疗效。方法：采用随机、单盲和平行对照的方法,运用24小时动态血压监测。结果：二药均能显著降低血压、彼此间降低偶测血压的幅度无显著差异。二药均能降低24小时平均,白天平均及夜间平均血压、均能有效控制清晨血压高峰期的血压。结论：非洛地平,氨氯地平均可每日服用1次,均能有效控制24小时血压及清晨醒后的高峰期血压。     

动态血压监测方法评价比索洛尔及阿替洛尔的降压疗效

对４０例原发性高血压患者采用２４小时动态血压监测方法对β受体阻滞剂（比索洛尔、阿替洛尔）进行降压疗效的比较。结果显示：２种药物均能达到全天的降压疗效；比索洛尔２４小时对收缩压及舒张压的降压作用强于阿替洛尔；比索洛尔２４小时中对舒张压降低的百分率明显强于收缩压，并能在夜间保持持续降压状态；２种药物对心率的降低无差异性。这提示，比索洛尔的降压疗效（２４小时１次口服）优于阿替洛尔。     

氯沙坦钾,培哚普利对高血压患者24小时血压的影响

目的：观察氯沙坦钾、培哚普利对１０４例高血压患的降压疗效。方法：采用随机、单盲和交叉的方法，监测２４地动态血压。结果：两药均能显降压。氯沙坦钾降低２４小时平均血压和日间平均血压的幅度大于培哚普利，而且夜间降压平缓。两药的降压谷／峰比都超过６２％。结论：氯沙坦钾和培哚普利均可做为轻中度高血压病人常规降压药物，前更适用于构型高血压和同时伴有冠心病的患。     

拉西地平对老年高血压病患者24小时血压的影响

应用24小时动态血压监测仪观察钙离子拮抗剂拉西地平和转换酶抑制剂赖诺普利对老年高血压病患者的降压疗效,评价其对血压和降压谷峰比值的作用。临床资料1.对象:148例轻中度高血压病患者符合WHO高血压病诊断标准,均排除继发性高血压。年龄均>60岁,按服用药物分为两组。拉西地平     

赖诺普利与依那普利治疗高血压病的对比研究

本研究用随机、单盲、组间、平行对照的方法，用新一代血管紧张素转换酶抑制剂赖诺普利对高血压病患者进行为期４周的治疗观察，并与另一种血管紧张素转换酶抑制剂依那普利进行对比。赖诺普利剂量为１０～８０ｍｇ／ｄ；依那普利为５～４０ｍｇ／ｄ，每天１次服用。通过２２５例的观察显示两药的降压有效率无明显差异，但赖诺普利控制２４小时的血压明显较依那普利为优，不良反应的发生率赖诺普利较依那普利为少。咳嗽的发生率两药相仿。赖诺普利有效病例的平均剂量为３４．１ｍｇ／ｄ，故建议常用剂量为１０～４０ｍｇ／ｄ，每日早餐后服用。研究证实赖诺普利是一安全、有效的降压药。     

Various approaches to evaluating the kinetics and efficacy of three antihypertensive drugs in terms of variations in blood pressure and heart rate

BACKGROUND: Ambulatory blood pressure measurements allow better evaluation of the effects of antihypertensive drugs on the diurnal profile of blood pressure. Various strategies, such as determining peak: trough ratio and smoothness indexd, with and without smoothing of raw data by Fourier analysis, have been put forward to define the efficacy and duration of action of antihypertensive drugs better. To date there has been little interest in the time scale of maximum effect after intake of the drug and few data regarding effects on variability of heart rate exist.OBJECTIVE: To compare the effects of three antihypertensive agents (10 mg bisoprolol, 2 mg lacidipine and 20 mg lisinopril) on the peak: trough ratio, the smoothness index and the peak response slope for blood pressure and heart rate. METHODS: After a e-week washout period, 99 patients were randomly allocated in double-blind fashion to one of the three drugs. Ambulatory blood pressure measurements were taken upon entry to the study and after 6 weeks of treatment. The diurnal profile of blood pressure was smoothed using fast Fourier analysis. RESULTS: Each of the three treatments had a similar antihypertensive effect over the 24 h. The trough:peak blood pressure ratio for the group as a whole was higher than the value calculated on an individual basis. There was no difference among the peak response slopes for the three treatments; because one integrates three variables (peak, trough and time to maximal effect) this variable expresses large variations in individual cases. We observed differences among the smoothness indices of diastolic blood pressure for the durgs. Studying heart rate during the time of peak effect on blood pressure provides new findings. With bisoprolol, because the heart rate decreased both at the peak and at the trough, the ratio provides a good estimate of a balanced 24 h effect. In contrast, with lacidipine, the rise in heart rate over the 24 h renders use of this ratio impractical. The smoothness index with bisoprolol is significantly higher than those with lacidipine and lisinopril. Examination of individual heart rate slopes shows that there is a large variability for lacidipine and bisoprolol which is not significantly correlated to the slopes of blood pressure. CONCLUSION: To understand the effects of antihypertensive medication fully, various aspects need to be taken into account, namely the trough:peak ratio, the smoothness index and the peak response slope, each one of which is complementary to the analysis of the efficacy. Furthermore, it also seems necessary to study the heart rate, which can be significantly influenced by certain drugs and hence has important implications for the overall haemodynamic state.     

Isolated office hypertension: are there any markers of future blood pressure status?

BACKGROUND: The introduction of ambulatory blood pressure monitoring into clinical practice has defined a clinical condition called 'isolated office hypertension'. OBJECTIVE: The aim of this study was to evaluate the long-term systolic and diastolic blood pressure changes in patients with isolated office hypertension and to identify the presence of markers capable of identifying which patients will develop sustained hypertension. METHODS: All the 407 patients enrolled had a random office systolic or/and diastolic blood pressure of over 140/90mmHg and a mean daytime ambulatory blood pressure of 130/84mmHg or less. At enrollment, each patient underwent a 'baseline examination' made up of a physical evaluation, a 24h ambulatory blood pressure monitoring, and a mental arithmetic test performed at the end of the 24h ambulatory monitoring. RESULTS: Of the 173 patients finally studied, 102 (58.9%) developed sustained hypertension with an increase in both ambulatory systolic and diastolic blood pressure. At the time of the baseline examination, the patients were divided into two groups. Group A included patients with mean ambulatory systolic and diastolic blood pressures in the first hour of 130/84mmHg or less; group B included patients with mean ambulatory systolic and diastolic pressures in the first hour of greater than 130/84mmHg. During the mental arithmetic test, the systolic and heart rate values increased significantly only in group B patients. Of the 102 patients who had become hypertensive by the time of the follow-up examination, 84 (82%) belonged to group B. CONCLUSION: These data suggest that isolated office hypertension may indeed be a transitional state towards the development of sustained hypertension. Moreover, the mean ambulatory blood pressure value during the first hour can be considered to be a marker of a higher risk of developing sustained hypertension.     

Impact of obesity on 24-hour ambulatory blood pressure and hypertension

The purpose of the present study was to determine the relationship between body mass index (BMI) and parameters derived from 24-hour ambulatory blood pressure monitoring including mean 24-hour daytime and nighttime systolic and diastolic blood pressures, 24-hour daytime and nighttime pulse pressure, mean 24-hour daytime and nighttime heart rate, dipping and nondipping status. 3216 outpatient subjects who visited our hypertension center and were never treated with antihypertensive medication underwent 24-hour blood pressure monitoring. BMI was significantly correlated with clinic systolic and diastolic blood pressures. Significant correlations were also found between BMI and mean 24-hour daytime and nighttime systolic blood pressure, 24-hour daytime and nighttime pulse pressure, and mean 24-hour daytime and nighttime heart rate. In multivariate regression analysis, clinic systolic, diastolic blood pressure, mean 24-hour systolic blood pressure, 24-hour pulse pressure, and high-density lipoprotein were independently correlated with BMI. The incidence of white coat hypertension was higher in overweight and obese patients than in normal weight subjects. Confirmed ambulatory blood pressure hypertension was also found to be higher in overweight and obese individuals compared with normal weight subjects. Our data also highlight the higher incidence of nondipping status in obesity. These findings suggest that obese patients had increased ambulatory blood pressure parameters and altered circadian blood pressure rhythm with increased prevalence of nondipping status.     

Use of graded exercise testing in assessing the hypertensive patient

Twenty-five patients with suspected hypertension were studied using the “Oxford” continuous intra-arterial blood pressure recording technique. Each patient carried out graded exercise on a bicycle ergometer, using a standard protocol, and then underwent a fully ambulatory 24-h outpatient blood pressure recording. Using computer analysis, ambulatory blood pressure in each patient was characterised by measuring the mean daytime systolic and diastolic pressures. Exercise was found to be associated with a characteristic increase in systolic and diastolic blood pressure. Submaximal and maximal exercise blood pressures were shown to correlate strongly with ambulatory blood pressure. A much weaker correlation was found between clinic and ambulatory blood pressure. These findings suggest that the blood pressure response to exercise may be a better indicator of elevated blood pressure than a casual clinic blood pressure in individual borderline subjects.     

Conventional and ambulatory blood pressure measurement in older patients with isolated systolic hypertension:second progress report on the ambulatory blood pressure monitoring project in the Syst-Eur trial

OBJECTIVES: To compare clinic and ambulatory blood pressure measurement and the reproducibility of these measurements in older patients with isolated systolic hypertension.PATIENTS: A total of 477 patients aged >/= 60 years with isolated systolic hypertension on clinic measurement were monitored during the placebo run-in phase of the Syst-Eur trial. METHODS: The time-weighted 24 h blood pressure, clock time day and night blood pressure, the cumulative sum-derived crest and trough blood pressure and the high and low blood pressure levels of the square-wave model were computed. The daily alteration between the high and low blood pressure spans was quantified using the clock time day-night difference, the cumulative sum-derived circadian alteration magnitude, the Fourier amplitude and the difference between the high and low blood pressure levels of the square-wave model. RESULTS: The daytime ambulatory systolic blood pressure was, on average, 21 mmHg lower than the clinic blood pressure, whereasthe diastolic blood pressure was, on average, similar with both techniques of measurement. In the 132 patients who underwent repeat measurements, clinic blood pressure levels and the parameters describing the difference betgween the daily high and low blood pressure spans were equally reproducible. However, both were less reproducible than the ambulatory blood pressure levels. The repeatability coefficients, expressed as percentages of near maximum variation, were 50 and 51% for the clinic systolic and diastolic blood pressures, 30 and 33% for the mean 24 h systolic and diastolic blood pressures and between 44 and 54% for the parameters describing the daily alteration between the high and low blood pressure spans. CONCLUSION: In older patients with isolated systolic hypertension, clinic and ambulatory systolic blood pressure may differ greatly; the prognostic significance of this difference remains to be elucidated. Furthermore, the level of blood pressure in these patients is more reproducible by ambulatory measurement than it is by clinic measurement.     

Ambulatory blood pressure monitoring in elderly patients with isolated systolic hypertension.

OBJECTIVES: This study compared clinic and ambulatory blood pressure measurement and the reproducibility of these measurements in older patients with isolated systolic hypertension (ISH). PATIENTS: Eighty-seven patients aged greater than or equal to 60 years with ISH on clinic measurement were followed in the placebo run-in phase of the Syst-Eur trial. METHODS: Clinic blood pressure was defined as the mean of two blood pressure readings on each of three clinic visits (six readings in total). Ambulatory blood pressure was measured over 24 h using non-invasive ambulatory blood pressure monitors. RESULTS: Daytime ambulatory systolic pressure was, on average, 21 mmHg lower than the clinic blood pressure, whereas diastolic pressure was, on average, similar with both techniques of measurement. In the 42 patients who had repeat measurements, clinic blood pressure levels nad the amplitude of the diurnal blood pressure profile (fitted by Fourier analysis) were equally reproducible. However, both were less reproducible than ambulatory blood pressure levels. The repeatability coefficients, expressed as per cent of near maximum variation (four times the standard deviation of a given measurement), were 52% and 45% for the clinic systolic and diastolic pressures, 56% and 42% for the amplitude of the diurnal profile, and 29% and 26% for mean 24-h pressures. CONCLUSIONS: In older patients with ISH, clinic and ambulatory systolic blood pressure measurements may differ largely: the prognostic significance of this difference remains to be elucidated. Furthermore, in these patients the level of pressure is more reproducible by daytime ambulatory blood pressure measurement than by clinic measurement.     

Comparative Effects of Telmisartan in the Treatment of Hypertension

Three separate randomized, double-blind, parallel-group, 12-week trials compared telmisartan with enalapril, lisinopril, and amlodipine for treating mild to moderate hypertension. Telmisartan 80 mg was associated with a significantly greater mean decrease in trough systolic and diastolic blood pressure than enalapril 20 mg (p<0.05). Mean decreases in trough systolic and diastolic blood pressure with telmisartan (40, 80, and 160 mg) and lisinopril (10, 20, and 40 mg) were similar. Telmisartan (40, 80, and 120 mg) provided greater decreases in mean hourly systolic and diastolic blood pressure throughout the 24-hour dosing interval, including the last 4 hours of the dosing period, than amlodipine (5 and 10 mg). Telmisartan was associated with a lower incidence of treatment-related cough than lisinopril and enalapril and less treatment-related angioedema than amlodipine. These data suggest that for treating mild to moderate hypertension, telmisartan has efficacy similar to lisinopril, greater efficacy than enalapril and amlodipine throughout the 24-hour dosing interval, and better tolerability than these angiotensin-converting enzyme inhibitors and amlodipine.     

Conventional and ambulatory measurements of blood pressure in old patients with isolated systolic hypertension: baseline observations in the Syst-Eur trial

OBJECTIVES: To compare clinic and am measurements of blood pressure in old patients with isolated systolic hypertension and their reproducibilities. PATIENTS: In total 610 patients aged >/= 60 years with isolated systolic hypertension detected by clinic measurement were monitored during the placebo run-in phase of the Syst-Eur trial. METHODS: The time-weighted 24 h blood pressure, clock-time day and night blood pressures, the cumulative-sum-derived crest and trough blood pressures and the high and low blood pressure levels according to the square-wave model were computed. The daily alteration between the high and low spans of blood pressure was quantified using the day-night difference, the cumulative-sum-derived magnitude of circadian alteration, the Fourier amplitude and the difference between the high and low blood pressure levels of the square-wave model. RESULTS: The daytime am systolic blood pressure was, on average, 21 mmHg lower than the clinic systolic blood pressure, whereas diastolic pressure was, on average, similar with both techniques of measurement. Clinic levels of blood pressure in the 141 patients who underwent repeat measurements and the parameters describing the difference between the daily high and low spans of blood pressure were equally reproducible. However, both were less reproducible than the ambulatory blood pressure levels. The reproducibility coefficients, expressed as percentages of near maximum variation, were 49 and 50% for the clinic systolic and diastolic blood pressures, 30 and 32% for the mean 24 h systolic and diastolic blood pressures and 45-55% for the parameters describing the daily alteration between the high and low spans of blood pressure. CONCLUSION: Values of blood pressure in old patients with isolated systolic hypertension were more reproducible for ambulatory than they were for clinic measurements. Levels in patients selected because they have a high clinic blood pressure may be substantially higher with conventional than they are with daytime ambulatory measurement. The prognostic significance of this difference for the present patients is currently under investigation.     

Comparative Effects of Telmisartan in the Treatment of Hypertension

Three separate randomized, double-blind, parallel-group, 12-week trials compared telmisartan with enalapril, lisinopril, and amlodipine for treating mild to moderate hypertension. Telmisartan 80 mg was associated with a significantly greater mean decrease in trough systolic and diastolic blood pressure than enalapril 20 mg (p<0.05). Mean decreases in trough systolic and diastolic blood pressure with telmisartan (40, 80, and 160 mg) and lisinopril (10, 20, and 40 mg) were similar. Telmisartan (40, 80, and 120 mg) provided greater decreases in mean hourly systolic and diastolic blood pressure throughout the 24-hour dosing interval, including the last 4 hours of the dosing period, than amlodipine (5 and 10 mg). Telmisartan was associated with a lower incidence of treatment-related cough than lisinopril and enalapril and less treatment-related angioedema than amlodipine. These data suggest that for treating mild to moderate hypertension, telmisartan has efficacy similar to lisinopril, greater efficacy than enalapril and amlodipine throughout the 24-hour dosing interval, and better tolerability than these angiotensin-converting enzyme inhibitors and amlodipine.     

Relationships between 24 h blood pressure load and target organ damage in patients with mild-to-moderate essential hypertension

OBJECTIVE: To analyse the relationships between 24 h blood pressure load (the percentage of systolic/diastolic blood pressures exceeding 140/90 mmHg while awake and 120/80 mmHg during sleep) and some indices of hypertensive target organ involvement, independently of the mean level of 24 h blood pressure. METHODS: One hundred and thirty patients with mild-to-moderate hypertension underwent 24 h ambulatory blood pressure monitoring, ocular fundus examination, microalbuminuria assay and two-dimensional guided M-mode echocardiography. The study population was divided into subsets according to the systolic and diastolic 24 h blood pressure load values predicted from the regression equation relating 24 h blood pressure load to 24 h mean blood pressure. The subjects with an observed load above this predicted value were included in the higher blood pressure load groups, the remaining ones being included in the lower groups. RESULTS: Relative myocardial wall thickness and total peripheral resistance were greater, and mid-wall fractional shortening, end-systolic stress-corrected mid-wall fractional shortening and cardiac index lower, in the subjects with a higher systolic blood pressure load. Moreover, the stroke index:pulse pressure ratio was reduced, and a greater prevalence of hypertensive retinopathy was observed in the higher systolic load group. On the contrary, no statistically significant difference was found for any of the cardiac, renal and funduscopic parameters examined when the two groups with a higher and lower 24 h diastolic blood pressure load were compared. CONCLUSIONS: Our results seem to suggest that, in mild-to-moderate arterial hypertension, a high 24 h systolic blood pressure load may be associated, independently of the average level of 24 h systolic ambulatory blood pressure, with an adverse cardiovascular risk profile.