Effect of moxonidine monotherapy and in combination with melatonin on hemodynamic parameters in patients with arterial hypertension

Fifty patients (mean age 53.8 +/- 3.45) with arterial hypertension were examined. They were divided into 2 randomized groups, 25 patients each. One group received moxonidine, 40 mg, alone in the morning, the other had moxonidine in the same dose in combination with melatonin, 3 mg, overnight. The treatment lasted 14 days. Monitoring of blood pressure (BP), heart rate (HR), EchoCG was made before and after treatment. The studies indicated that moxonidine had a pronounced antihypertensive effect by slightly lowering BP overnight and that the chronostructure of BP and HR rhythms was impaired. Addition of melatonin to the moxonidine therapy with greater antihypertensive effects made the chronostructure of circadian BP and HR rhythms normal.     

Chlorthalidone alone or in fixed combination with slow-release metoprolol in the management of arterial hypertension: a long-term study of 545 patients

In a double-blind trial, 545 out-patients with essential hypertension received 25 mg/day chlorthalidone alone (274 patients) or in fixed combination with 200 mg/day slow-release metoprolol (271 patients) for 8 weeks. Both treatments significantly (P less than 0.001) decreased systolic and diastolic blood pressure; 45.6% of patients receiving chlorthalidone and 82.5% receiving combined therapy had a diastolic blood pressure of less than 95 mmHg. Patients not controlled by chlorthalidone or chlorthalidone plus metoprolol subsequently received chlorthalidone plus metoprolol (137 patients) or chlorthalidone plus metoprolol plus a third drug (34 patients), respectively, for 8 weeks. A total of 79.5% of patients receiving chlorthalidone plus metoprolol and 61.8% receiving chlorthalidone plus metoprolol plus a third drug had a diastolic blood pressure of less than 95 mmHg. Only 5.9% of patients experienced mild to moderate side-effects. Plasma potassium levels significantly (P less than 0.01) decreased during the first 8 weeks only. It is concluded that a diuretic alone or in fixed combination with a beta-blocker is effective in the long-term treatment of arterial hypertension.     

Effects of combination therapy with captopril and nifedipine in severe or resistant hypertension

To assess the effect of potent vasodilator therapy in patients with severe or resistant hypertension, 10 patients underwent therapy with captopril and nifedipine alone and in combination. Blood pressure (BP), heart rate, and blood chemistry values were monitored for 4 weeks during captopril monotherapy and after 8 weeks during combination therapy with captopril and nifedipine. Compared with baseline, the BP decreased during captopril monotherapy (180 +/- 11/98 +/- 7 vs. 209 +/- 16/118 +/- 12 mm Hg; P less than 0.005). After the addition of nifedipine, the BP was further reduced (148 +/- 23/85 +/- 16 mm Hg), but there was no change in heart rate. In three patients not achieving the diastolic BP goal during combination therapy with dosing every 8 hours, automatic 24-hour ambulatory BP monitoring demonstrated lack of antihypertensive control for only the last 2 to 3 hours of the dosing interval. These data demonstrate that combination therapy with captopril and nifedipine is effective in patients with severe hypertension, but frequent dosing intervals are necessary for adequate antihypertensive control.     

Therapy comparison between the combination hydergine/nifedipine and nifedipine alone in patients with isolated systolic hypertension

The effect of Hydergine/Nifedipine (Pontuc) on blood pressure in supine or exercise blood pressure as well as subjective well-being was evaluated in a randomized, double-blind interindividual comparison with Nifedipine in 50 elderly out-patients (34 females, 16 males) with mostly pretreated isolated systolic hypertension. In addition to a nearly unchanged diastolic blood pressure during treatment the results prove that the drop in systolic blood pressure was statistically significant greater after treatment with Hydergine/Nifedipine and the normalization rate of the blood pressure was 81% in comparison to 69% after Nifedipine. Both drugs comparatively improved the subjective well-being of these geriatric patients. As drug specific adverse events flush symptoms were more frequent in the Nifedipine group, whereas in the Hydergine/Nifedipine group gastrointestinal symptoms occurred more often.     

Complex assessment of efficacy and tolerance of metoprolol CR/ZOK in treating hypertension

AIM: To study efficacy and tolerance of betaloc ZOK (Astra-Zeneca, UK) in patients with stage I-II (WHO classification) essential hypertension. MATERIAL AND METHODS: 27 patients were enrolled in the study (13 men and 14 women, mean age 40.6 +/- 1.57 years). Complete physical examination, ambulatory blood pressure monitoring, assessment of central hemodynamics, microcirculation were made before the treatment and on the treatment week 8. RESULTS: Monotherapy with betalok ZOK (50-100 mg/day) resulted in a significant lowering of mean daily, day and night systolic and diastolic arterial pressure. Variability index was reduced, circadian rhythm of blood pressure did not change. 28% had to take diuretics (arifon or hypotiazide). CONCLUSION: Betaloc ZOK (50-100 mg) is highly effective in patients with mild to moderate essential hypertension.     

beta1-Adrenergic receptor polymorphisms influence the response to metoprolol monotherapy in patients with essential hypertension

OBJECTIVES: The human beta(1)-adrenergic receptor, an important therapeutic target in cardiovascular diseases, has 2 common functional polymorphisms (Ser49Gly and Gly389Arg). Our study aimed to confirm that beta(1)-adrenergic receptor polymorphisms affect the blood pressure response to metoprolol monotherapy in the Chinese population with hypertension. METHODS: beta(1)-Adrenergic receptor genotype was determined by polymerase chain reaction-restriction fragment length polymorphism assay for 223 patients with essential hypertension. Sixty-one patients with certain beta(1)-adrenergic receptor diplotypes, 18 for 49Ser389Arg/49Ser389Arg, 15 for 49Ser389Arg/49Gly389Arg, 19 for 49Ser389Gly/49Gly389Arg, and 9 for 49Ser389Gly/49Ser389Gly, were selected from those 61 for measurement of the antihypertensive effect of metoprolol. Patients were given 25 mg metoprolol every 12 hours for 4 weeks. Heart rate and blood pressure were measured weekly for the duration of metoprolol therapy. RESULTS: The descent of systolic blood pressure after metoprolol administration was significantly different among genotype groups (10.4% +/- 4.0%, 2.8% +/- 4.7%, and 1.1% +/- 1.5% for Arg389Arg, Gly389Arg, and Gly389Gly patients, respectively; P < .001). We also found a similar difference in changes of diastolic blood pressure (6.1% +/- 4.3%, 2.2% +/- 4.2%, and 0.9% +/- 4.0%, respectively; P < .001) and mean arterial pressure (8.1% +/- 3.5%, 2.5% +/- 3.0%, and 1.0% +/- 2.5%, respectively; P > .001) for Arg389Arg, Gly389Arg, and Gly389Gly patients. Ser49Gly variance exhibited a smaller contribution to the antihypertensive effect of metoprolol. Systolic blood pressure decreased significantly in Ser49 homozygous patients compared with Ser49Gly patients (8.4% +/- 3.2% versus 5.3% +/- 5.2%, P = .047). There was a highly significant relationship between diplotype and blood pressure during treatment. Systolic blood pressure significantly decreased in 49Ser389Arg/49Ser389Arg (12.0% +/- 3.8%, P < .001) and 49Ser389Arg/49Gly389Arg (8.4% +/- 5.5%, P < .001) patients, with the decrease in the former being more pronounced (P = .023). We also found a significant decrease in diastolic blood pressure (6.5% +/- 4.7% versus 5.7% +/- 3.2%, respectively; both P < .001) and mean arterial pressure (8.8% +/- 3.2% versus 6.9% +/- 3.7%, respectively; both P < .001) in 49Ser389Arg/49Ser389Arg and 49Ser389Arg/49Gly389Arg patients. However, blood pressure did not change significantly in 49Ser389Gly/49Gly389Arg and 49Ser389Gly/49Ser389Gly patients (all P > .05). CONCLUSIONS: beta(1)-Adrenergic receptor polymorphism was associated with different blood pressure responses to metoprolol therapy in patients with essential hypertension. 49Ser389Arg/49Ser389Arg and 49Ser389Arg/49Gly389Arg patients were good responders to metoprolol therapy; 49Ser389Arg/49Ser389Arg patients had a larger systolic blood pressure reduction than 49Ser389Arg/49Gly389Arg patients did. 49Ser389Gly/49Gly389Arg and 49Ser389Gly/49Ser389Gly patients were nonresponders to metoprolol antihypertensive therapy.     

The efficacy of bimatoprost 0.03% monotherapy in patients previously using topical beta-blocker monotherapy for the treatment of glaucoma or ocular hypertension

In an open-label 12-week study, the safety and efficacy of bimatoprost 0.03% was evaluated in 55 patients with open-angle glaucoma or ocular hypertension inadequately controlled by topical beta-blocker monotherapy. Patients discontinued their topical beta-blocker therapy at the baseline visit and began bimatoprost monotherapy that evening. Study visits were at 6 and 12 weeks postbaseline. Bimatoprost reduced intraocular pressure (IOP) 4.5 mm Hg (21.5%; P< .001) from baseline at week 6 and 4.2 mm Hg (19.6%; P< .001) at week 12. Patients were more likely to achieve low target pressures with bimatoprost than with topical beta-blockers. Conjunctival hyperemia was the most commonly reported adverse event. The findings from this study indicate bimatoprost monotherapy provides a substantially greater IOP reduction than topical beta-blocker therapy and allows more patients to achieve a low target pressure. Bimatoprost is an effective alternative to topical beta-blockers for the treatment of glaucoma and ocular hypertension.     

Clinical efficacy of xefocam and its effect on arterial pressure and heart rhythm variability in patients with rheumatoid arthritis in combination with arterial hypertension

AIM: To try clinical response to xefocam, its safety, effects on arterial pressure and heart rhythm variability in rheumatoid arthritis (RA) patients with arterial hypertension (HT). MATERIAL AND METHODS: Xefocam (lornoxicam), a new non-steroid antiinflammatory drug, was given for 12 weeks in a daily dose 12 mg/day to 44 RA patients (mean age 54.5 +/- 7.3 years). 24-h arterial pressure monitoring was made with Cardiotens-01 device. RESULTS: Xefocam in a dose 12 mg/day has shown good tolerance, a high analgetic and antiinflammatory effect as indicated by a positive response of articular syndrome, a significant fall of systolic arterial pressure, decreased heart rate, better heart rhythm variability. CONCLUSION: In hypertensive RA patients xefocam in a dose 12 mg/day proved effective and safe.     

The efficacy of lysinopril (and/or its combination with hydrochlorothiazide) in patients with essential hypertension

The aim of the study was to estimate the efficacy of lysinopril (and/or its combination with hydrochlorothiazide) in terms of alteration of the diurnal AP profile and heart rhythm in patients with essential hypertension (EH). The study included 47 patients (18 men. 29 women) with grade 1-3 EN (I-II stages). They were given lysinopril at a single dose of 3-5 mg/day after the initial non-treatment period of 1-2 weeks. The dose was increased up to 20 mg in the absence of effect within the first 3-5 days and supplemented with 12.5 hydrochlorothiazide if the response was still absent after 4 weeks. The follow up period was 4 and 12 weeks. Lysinopril was shown to effectively reduce AP in 72.3% of the patients within 4 weeks and in 87.2% if given in combination with hydrochlorothiazide for 12 weeks. It is concluded that long-term monotherapy or combined therapy with lysinopril stabilizes the disturbed diurnal AP profile, decreases variability and morning rises of AP, normalizes vegetative regulation of heart rhythms, and promotes regression of myocardial hypertrophy.     

Combined therapy with amlodipin and lisinopril in arterial hypertension: efficacy of a low-dose combination

AIM: To assess antihypertensive efficacy of a low-dose combination of amlodipin with lisinopril in the treatment of patients with arterial hypertension (AH) of the second degree. MATERIAL AND METHODS: A total of 42 patients with the second degree of AH (16 males, 26 females, mean age 55-9 +/- 1.9 years) entered an open, comparative and controlled trial. They were divided into three groups by the treatment. Group 1 (n = 14) received amlodipin (normodipin, Gedeon Richter) monotherapy in a mean dose 8.9 +/- 0.6 mg/day, group 2 (n = 12) - lisinopril (diroton, Gedeon Richter) in a mean dose 17.5 +/- 1.4 mg/day, group 3 (n = 16) was given combined therapy with amlodipin+lisinopril in a dose 6.8 +/- 0.7 and 8.7 +/- 0.6 mg/day, respectively. The drugs were given for 12 weeks. The efficacy of the treatment was assessed by the results of 24-h monitoring of blood pressure, echocardiography, endothelium-related vasodilatation of the brachial artery (ERVD), dopplerographic investigation of circulation in the middle cerebral artery (MCA), heart rate and cost-effect estimation. RESULTS: Combined low-dose treatment with amlodipin and lisinopril for 12 weeks allowed achievement of target blood pressure in more patients and lower systolic and diastolic blood pressure than monotherapy with each of the drugs. There was also a positive effect on E/A index, ERVD, MCA circulation. CONCLUSION: Low-dose combined treatment with lisinopril and amlodipin is more effective and cost-efficient. Moreover, lisinopril addition to amlodipin corrects side effects of amlodipin on central nervous system.     

卡维地洛与美多心安对高血压患者治疗效果的比较研究

目的　评价国产卡维地洛的降压效应与安全性。方法　 90例原发性高血压患者随机分为观察组与对照组 ,分别口服国产卡维地洛 1片 (10mg)或美多心安 1片 (2 5mg) ,2次 /d ,4周为 1疗程。 结果　卡维地洛组服药 4周后收缩压 (SBP)及舒张压 (DBP)与治疗前比较分别下降 (18.92± 11.5 8)、(12 .34± 7.2 5 )mmHg(P <0 .0 1) ,美多心安组与治疗前比较分别下降 (19.13± 9.70 )、(13.5 0± 7.4 6 )mmHg(P <0 .0 1) ;观察组与对照组总有效率分别为 89.4 8%与 80 .4 3% ,两组比较无显著差异 (P >0 .0 5 )。两药的不良反应均轻微 ,发生率分别为 2 .7%和 4 .4 %。结论　卡维地洛是一种安全有效的抗高血压药物     

Barnidipine monotherapy and combination therapy in older patients with essential hypertension: a long-term study

The long-term (2 year) safety and efficacy of barnidipine was assessed in an open-label, dose-titration, multicentre study of 236 patients aged > or = 75 years with a sitting diastolic blood pressure (DBP) > or = 95 mmHg. All eligible patients started treatment with barnidipine 10 mg once daily. After at least 4 weeks treatment, the dose of barnidipine was titrated upwards to 20 mg daily in patients who did not achieve normalisation of blood pressure (sitting DBP < 90 mmHg). After at least another 4 weeks of treatment an ACE inhibitor or diuretic was added if necessary. Barnidipine monotherapy was the final treatment in 74% of patients in the ITT population (50% barnidipine 10 mg, 24% barnidipine 20 mg). The overall response rate was 84.1% at endpoint. Overall mean sitting DBP decreased by 18.4 mmHg from 102.1 mmHg at baseline to 83.7 mmHg at endpoint. Although a total of 82.2% of patients reported at least one adverse event, only 37.4% of patients experienced an adverse event that was possibly or probably related to the study medication. Many patients experienced adverse events associated with co-existing diseases common in older people. It can be concluded that barnidipine as monotherapy or in combination with ACE inhibitors or diuretics is safe and effective in older patients with essential hypertension.     

Comparison of the efficacy and long-term tolerability of a combination of atenolol and nifedipine with atenolol alone in the treatment of hypertension

This randomised, double-blind crossover study in 30 hypertensive patients has demonstrated that the fixed combination of atenolol (50 mg) and nifedipine retard (20 mg) once daily lowered blood pressure to a significantly greater extent than atenolol (50 mg once daily) alone. In a follow-up six-month open tolerance study there was no evidence of tachyphylaxis, and treatment with the fixed combination was well tolerated. In selected hypertensive patients use of this fixed formulation may result in improved blood pressure control and benefit patient compliance.     

拜新同与北京降压0号或海捷亚合用治疗老年性单纯性收缩期高血压疗效观察

目的：观察和分析拜新同分别联合北京降压0号或海捷亚治疗老年性单纯性收缩期高血压（ISH）的疗效及对代谢的影响。方法：选择83例老年ISH患者随机分为3组，拜新同组（A组，n=28，拜新同30mg，1次／d），拜新同与北京降压0号合用组（B组，n=28，拜新同30mg，1次／d，北京降压0号1片，1次／d），拜新同与海捷亚合用组（C组，n=27，拜新同30mg，1次／d，海捷亚50mg，1次／d）。3组治疗疗程均为12周，观察3组治疗前后的血压及肝肾功能、血糖、血脂、电解质等指标的变化。结果：B、C组降压总有效率相当，其对随测血压、24h动态血压的控制疗效接近；B、C组血压控制效果明显优于A组；3组治疗前后心率及生化指标无明显改变。结论：拜新同与北京降压0号或海捷亚合用降低老年ISH均有较显著且相似的疗效．与单用拜新同比较效果更好。     

Efficacy of OSMO-Adalat in patients with arterial hypertension in combination with kinked precerebral arteries

AIM: To evaluate effectiveness of OSMO-adalat in combination of arterial hypertension (AH) with kinked precerebral arteries (KPA). MATERIAL AND METHODS: Before and after a 3-month course of OSMO-Adalat in a dose 30 and 60 mg, 28 patients with AH (degree 2-3) and KPA were examined for arterial pressure (AP), dyscirculatory encephalopathy, orthostatic stability, ischemic heart disease, transitory ischemic attacks, side effects of therapy. RESULTS: A complete normalization of AP was achieved in 9(32.1%) patients, in the rest patients the effect was partial. 24-h AP profile improved in all the cases. OSMO-Adalt relieved coronary insufficiency and dyscirculatory encephalopathy, improved tolerance of orthostatic loads. Syncopes, transitory ischemic attacks and strokes were not observed. Severe head ache was the cause of the treatment discontinuation in one patient. CONCLUSIONS: Therapy with OSMO-Adalat of patients with AH combination with KPA provides a good hypotensive effect and relieves symptoms of encephalopathy, myocardial ischemia and orthostatic insufficiency in low risk of side effects.     

A fixed combination of metoprolol slow-release and chlorthalidone, given once daily, in the long-term treatment of arterial hypertension

A fixed combination of metoprolol slow-release 200 mg and chlorthalidone 25 mg was given once daily over a 3 months period in forty out-patients with mild-to-moderate arterial hypertension stage I or II WHO. The combination elicited a clear-cut antihypertensive effect lasting at least 24 hours after drug. As compared with pre-treatment values, systolic and diastolic blood pressures were gradually reduced within the first month of treatment, remaining nearly constant in the following 2 months. Treatment was well tolerated by all patients. Neither serum potassium nor any other laboratory test (creative, glucose, uric acid, etc) showed significant changes. In conclusion, slow-release metoprolol fixed association with chlorthalidone provides a safe and effective treatment of arterial hypertension even on a long-term basis. The once daily dosing schedule may considerably improve patient's compliance.     

Use of crystepin in combination with obsidan in patients with diabetes mellitus with arterial hypertension

Examination included 70 patients with diabetes mellitus in combination with arterial hypertension of different origin (II stage essential hypertension and symptomatic renal arterial hypertension). Crystepin (2-3 tablets per 24 h) in combination with beta-adrenoblocker obsidan (40-80 mg/24 h) was used for treatment. Basic hemodynamic parameters and the state of the renin-aldosterone system were determined. The hemodynamic hypotensive effects in these patients due to the influence of the above therapy are uniform and depend on the form of attendant arterial hypertension. The hypotensive effect of crystepin used in combination with obsidan was more pronounced in patients with diabetes and II stage essential hypertension than that in those with diabetes and renal hypertension. The concentration of aldosterone and renin activity of blood plasma in patients with diabetes and arterial hypertension during treatment with crystepin and obsidan had no regular connection with the hemodynamic parameters.     

特发性肺动脉高压患者营养风险与运动耐量间相关性的研究

目的：探讨特发性肺动脉高压患者（idiopathic pulmonary arterial hypertension, IPAH）营养风险与运动耐量间的关系。方法：根据营养风险筛查2002标准（Nutritional Risk Screening 2002, NRS-2002）（以下简称NRS）, 对96例IPAH患者进行营养风险评估, 并根据评分结果分为有营养风险组（n=46）及无营养风险组（n=50）, 2组分别进行血气分析、肺功能检测及心肺运动试验,比较2组间的差异。结果：IPAH有营养风险组与无营养风险组间的性别、年龄、身高及血气分析结果差异均无统计学意义（P均>0.05）, 而有营养风险组患者的体重及体质量指数显著低于无营养风险组（P<0.01）。肺功能检测, 有营养风险组的用力肺活量（forced vital capacity, FVC）、第一秒用力呼气容积（forced expiratory volume in one second, FEV₁）、FVC占预计值百分比（FVC%pred）、FEV₁占预计值百分比（FEV₁%pred）、一氧化碳弥散量（diffusing capacity for carbon monoxide, DL_CO）、DL_CO占预计值百分比（DL_CO%pred）均低于无营养风险组（P均<0.05）, 而2组间其他指标[一秒率（FEV₁/FVC）、深吸气量、肺总量、残气量、残总比（残气量/肺总量比值）]差异无统计学意义（P均>0.05）。心肺运动试验检查, 有营养风险组的峰值功率、峰值摄氧量、峰值通气量、峰值公斤摄氧量、峰值摄氧量占预计值百分比均低于无营养风险组（P 均<0.05）, 而2组间的峰值氧脉搏差异无统计学意义（P>0.05）。96例IPAH患者的NRS评分与峰值功率、峰值摄氧量呈显著负相关（r=-0.335和-0.342, P均<0.01）, NRS评分与峰值公斤摄氧量呈负相关（r=-0.213, P<0.05）。结论：有营养风险的IPAH患者的肺通气功能及弥散功能降低更显著, 运动耐量下降更明显,而NRS评分可反映其运动耐量。     

Primary hemostasis activity in patients with arterial hypertension and impaired glucose tolerance treated with trandolapril

The study was designed to evaluate effect of trandolapril, an ACE inhibitor, on platelet aggregation in patients with arterial hypertension and impaired glucose tolerance. The drug was given to 38 patients for 12 weeks. The key end points were dynamics of the blood lipid spectrum, lipid peroxidation in plasma and platelets, antioxidative protection of the blood's liquid medium and platelets, platelet aggregation. The data obtained were treated using Student's t-test. They show that trandolapril exerts positive effect on peroxidation syndrome and reduces platelet aggregation.     

Comparative anti-hypertensive effectiveness and tolerance of drugs in patients with mild and moderate arterial hypertension

120 patients with mild and moderate arterial hypertension were treated outpatiently for 6 weeks with dilren (group 1), norvask (group 2), invoril (group 3) and caposide (group 4). Each group consisted of 30 patients. The drugs were given in doses: 300 mg/day, 5-10 mg/day, 10-20 mg/day and 1 tablet a day (50 mg capoten + 25 mg hydrochlortiaside), respectively. Arterial pressure was measured by patients in the morning and in the evening. A complete hypotensive response (AP < 140/90 mm Hg) to dilren was achieved in 25(83.3) patients, norvask in 22(73.3%), invoril in 18(60%), caposide in 13(43.3%) patients. The other 45(37.5%) patients responded partially. Side effects occurred in 31(25.8%) of 120 patients. In caposide, norvask, invoril and dilren treatment they were recorded in 9(30.3%), 8(26.7%), 8(26.7%) and 6(20%) patients, respectively. 11 patients withdrew because of side effects. Thus, dilren (300 mg/day), norvask (5-10 mg/day) and invoril (10-20 mg/day) are effective and safe in mild and moderate arterial hypertension. Caposide (1 tablet a day) failed to provide an adequate fall in arterial pressure throughout 24 hours.