Hypertension is a major risk factor for cardiovascular events and the goal of treating hypertension is to prevent complications due to these events. However, some other properties, including few side-effects and improvement of the quality of life (QOL), are desirable in a drug as well as its antihypertensive effect. Dehydropydine calcium-channel blockers (DCCBs) are the most frequently used antihypertensive agents in Japan. The antihypertensive effect of DCCBs is satisfactory, but side-effects, e.g. nocturia, flushing and palpitations, are a problem. The aim was to evaluate the effects of a change of treatment from DCCBs on the QOL of hypertensive patients. An open study was performed to evaluate the effects of switching treatment from DCCBs to angiotensin II receptor blocker (ARB) therapy on the QOL of hypertensive patients. The ARBs have been reported to be effective and well-tolerated antihypertensive drugs. Candesartan cilexetil was selected because it is the most frequently used ARB in Japan. One hundred patients with mild to moderate hypertension, being treated with DCCBs, were randomly selected to receive candesartan cilexetil (8-12 mg once a day). The patients were followed for 3 months, while blood pressure (BP), side-effects and QOL were monitored. BP was equally well controlled before and after the change of antihypertensive therapy. The candesartan cilexetil-treated patients exhibited improvement of several aspects of QOL, including general symptoms, physical symptoms and well-being, work and satisfaction and sleep scale. Emotional state and cognitive function also improved. Patients aged 65 years or younger achieved significant improvement of sexual function. Changing treatment from DCCBs to ARB therapy achieved equal BP control with a lower drug dose. Moreover, the change to cadesartan cilexetil had a positive impact on the QOL.
{"title":"The effects of replacing dihydropyridine calcium-channel blockers with angiotensin II receptor blocker on the quality of life of hypertensive patients.","authors":"Shigeki Yamamoto, Takashi Kawashima, Toshiaki Kunitake, Shinichiro Koide, Hiroshi Fujimoto","doi":"10.1080/08038020310016378","DOIUrl":"https://doi.org/10.1080/08038020310016378","url":null,"abstract":"<p><p>Hypertension is a major risk factor for cardiovascular events and the goal of treating hypertension is to prevent complications due to these events. However, some other properties, including few side-effects and improvement of the quality of life (QOL), are desirable in a drug as well as its antihypertensive effect. Dehydropydine calcium-channel blockers (DCCBs) are the most frequently used antihypertensive agents in Japan. The antihypertensive effect of DCCBs is satisfactory, but side-effects, e.g. nocturia, flushing and palpitations, are a problem. The aim was to evaluate the effects of a change of treatment from DCCBs on the QOL of hypertensive patients. An open study was performed to evaluate the effects of switching treatment from DCCBs to angiotensin II receptor blocker (ARB) therapy on the QOL of hypertensive patients. The ARBs have been reported to be effective and well-tolerated antihypertensive drugs. Candesartan cilexetil was selected because it is the most frequently used ARB in Japan. One hundred patients with mild to moderate hypertension, being treated with DCCBs, were randomly selected to receive candesartan cilexetil (8-12 mg once a day). The patients were followed for 3 months, while blood pressure (BP), side-effects and QOL were monitored. BP was equally well controlled before and after the change of antihypertensive therapy. The candesartan cilexetil-treated patients exhibited improvement of several aspects of QOL, including general symptoms, physical symptoms and well-being, work and satisfaction and sleep scale. Emotional state and cognitive function also improved. Patients aged 65 years or younger achieved significant improvement of sexual function. Changing treatment from DCCBs to ARB therapy achieved equal BP control with a lower drug dose. Moreover, the change to cadesartan cilexetil had a positive impact on the QOL.</p>","PeriodicalId":8974,"journal":{"name":"Blood pressure. Supplement","volume":"2 ","pages":"22-8"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08038020310016378","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24195100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-12-01DOI: 10.1080/08038020310020670
Cesare Cuspidi, Gastone Leonetti, Alberto Zanchetti
Left ventricular hypertrophy (LVH) in humans is a common adaptive process induced by different physiological and pathological stimuli [1, 2]. Arterial hypertension is the most frequent cause of pathological LVH, and the development of hypertensive cardiac hypertrophy is considered a compensatory mechanism to normalize the increase wall stress and to preserve myocardial function. However, this adaptive process, which may occur even in early phases of the natural history of arterial hypertension, has a negative prognostic relevance. In fact, epidemiological prospective studies have shown that LVH, diagnosed by electrocardiographic or more accurately by echocardiographic criteria, is a powerful and independent predictor of cardiovascular morbidity, cardiovascular death and all-cause mortality in different clinical settings such as in patients with previous myocardial infarction [3], in patients with or without angiographic evidence of coronary artery disease [4], in asymptomatic hypertensive subjects [5] and the general population [6]. Thus, cardiac hypertrophy cannot be considered a physiological process and seems to be associated with maladaptive changes that affect the prognosis. There is no doubt that the most important factor for the high prevalence of LVH in hypertension is the pressure overload on the heart, although several factors directly enhancing myofibrillar replication and possibly connective tissue growth (cardiac sympathetic drive, plasma catecholamines, angiotensin II, insulin and endothelin) are more active or more frequently present in hypertensive patients than in normotensive subjects [7]. A rise in left ventricular (LV) wall stress determined by high systolic intraventricular pressure represents a potent stimulus for the development of LVH, which in turn reduces the wall stress. According to the Laplace law, the stress on the LV wall is directly proportional to the intraventricular pressure and squared radius, and is inversely related to wall thickness. The increase in wall thickness, intended to normalize or attenuate the wall stress, is secondary to cardiac muscle cell hypertrophy and a significant rise in the number of sarcomeres, which are arranged in parallel when the hypertrophy is concentric and longitudinally when the hypertrophy is eccentric [8]. This compensatory change is accompanied by at least three negative consequences. First, the capillary growth in the heart does not keep place with the rise in ventricular mass; second, coronary small arteries and arterioles undergo morphological and functional changes, which lead to increased coronary resistance and reduced coronary reserve [9, 10]. Third, the pathological increase in LV mass is associated with a disproportional proliferation of extracellular collagen matrix, which combined with impaired myocardial perfusion may contribute to the development of diastolic dysfunction and arrhythmias [11, 12]. In the present short review, we would like to focus the attention on
{"title":"Left ventricular hypertrophy regression with antihypertensive treatment: focus on Candesartan.","authors":"Cesare Cuspidi, Gastone Leonetti, Alberto Zanchetti","doi":"10.1080/08038020310020670","DOIUrl":"https://doi.org/10.1080/08038020310020670","url":null,"abstract":"Left ventricular hypertrophy (LVH) in humans is a common adaptive process induced by different physiological and pathological stimuli [1, 2]. Arterial hypertension is the most frequent cause of pathological LVH, and the development of hypertensive cardiac hypertrophy is considered a compensatory mechanism to normalize the increase wall stress and to preserve myocardial function. However, this adaptive process, which may occur even in early phases of the natural history of arterial hypertension, has a negative prognostic relevance. In fact, epidemiological prospective studies have shown that LVH, diagnosed by electrocardiographic or more accurately by echocardiographic criteria, is a powerful and independent predictor of cardiovascular morbidity, cardiovascular death and all-cause mortality in different clinical settings such as in patients with previous myocardial infarction [3], in patients with or without angiographic evidence of coronary artery disease [4], in asymptomatic hypertensive subjects [5] and the general population [6]. Thus, cardiac hypertrophy cannot be considered a physiological process and seems to be associated with maladaptive changes that affect the prognosis. There is no doubt that the most important factor for the high prevalence of LVH in hypertension is the pressure overload on the heart, although several factors directly enhancing myofibrillar replication and possibly connective tissue growth (cardiac sympathetic drive, plasma catecholamines, angiotensin II, insulin and endothelin) are more active or more frequently present in hypertensive patients than in normotensive subjects [7]. A rise in left ventricular (LV) wall stress determined by high systolic intraventricular pressure represents a potent stimulus for the development of LVH, which in turn reduces the wall stress. According to the Laplace law, the stress on the LV wall is directly proportional to the intraventricular pressure and squared radius, and is inversely related to wall thickness. The increase in wall thickness, intended to normalize or attenuate the wall stress, is secondary to cardiac muscle cell hypertrophy and a significant rise in the number of sarcomeres, which are arranged in parallel when the hypertrophy is concentric and longitudinally when the hypertrophy is eccentric [8]. This compensatory change is accompanied by at least three negative consequences. First, the capillary growth in the heart does not keep place with the rise in ventricular mass; second, coronary small arteries and arterioles undergo morphological and functional changes, which lead to increased coronary resistance and reduced coronary reserve [9, 10]. Third, the pathological increase in LV mass is associated with a disproportional proliferation of extracellular collagen matrix, which combined with impaired myocardial perfusion may contribute to the development of diastolic dysfunction and arrhythmias [11, 12]. In the present short review, we would like to focus the attention on ","PeriodicalId":8974,"journal":{"name":"Blood pressure. Supplement","volume":"2 ","pages":"5-15"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08038020310020670","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24195098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roberto J S Franco, Suely Goldflus, Mari McQuitty, Wille Oigman
Most hypertensive patients need more than one drug to reach recommended blood-pressure targets. We investigated the effects on 24-h ambulatory blood pressure (ABP) of the angiotensin-receptor blocker, valsartan, in combination with hydrochlorothiazide (HCTZ), compared with the calcium-channel blocker amlodipine in a Brazilian population in a multicentre, double-blind, double-dummy, parallel group, controlled study in 373 patients with essential hypertension. After a 2-week washout period, patients with a mean sitting systolic blood pressure (SBP) of 160-190 mmHg were randomized to receive either valsartan 160 mg o.d., or amlodipine 5 mg o.d. for 2 weeks and subsequently force-titrated to valsartan 160 mg/HCTZ 25 mg o.d. or amlodipine 10 mg o.d. This regimen was continued until the end of the study at week 8. The primary efficacy parameter was the change from baseline to week 8 in mean 24-h SBP. Secondary endpoints were change in mean 24-h diastolic blood pressure (DBP), tolerability and safety of treatments. Valsartan/HCTZ achieved a mean reduction in systolic ABP of -19.1 +/- 11.3 mmHg compared with -20.7 +/- 12.0 mmHg with amlodipine (p = 0.324 for the comparison) and in diastolic ABP by -11.1 +/- 7.4 mmHg vs -11.6 +/- 7.2 mmHg by amlodipine (p = 0.853 for the comparison). The valsartan/HCTZ group exhibited markedly lower rates of adverse events and discontinuations than the amlodipine group. Peripheral oedemas were far more frequent with amlodipine than with valsartan/ HCTZ (1.6% with valsartan/HCTZ; 16.8% with amlodipine). Thus, the valsartan 160 mg/HCTZ 25 mg combination appears to be as efficacious as amlodipine 10 mg in this patient population but better tolerated.
{"title":"Efficacy and tolerability of the combination valsartan/hydrochlorothiazide compared with amlodipine in a mild-to-moderately hypertensive Brazilian population.","authors":"Roberto J S Franco, Suely Goldflus, Mari McQuitty, Wille Oigman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Most hypertensive patients need more than one drug to reach recommended blood-pressure targets. We investigated the effects on 24-h ambulatory blood pressure (ABP) of the angiotensin-receptor blocker, valsartan, in combination with hydrochlorothiazide (HCTZ), compared with the calcium-channel blocker amlodipine in a Brazilian population in a multicentre, double-blind, double-dummy, parallel group, controlled study in 373 patients with essential hypertension. After a 2-week washout period, patients with a mean sitting systolic blood pressure (SBP) of 160-190 mmHg were randomized to receive either valsartan 160 mg o.d., or amlodipine 5 mg o.d. for 2 weeks and subsequently force-titrated to valsartan 160 mg/HCTZ 25 mg o.d. or amlodipine 10 mg o.d. This regimen was continued until the end of the study at week 8. The primary efficacy parameter was the change from baseline to week 8 in mean 24-h SBP. Secondary endpoints were change in mean 24-h diastolic blood pressure (DBP), tolerability and safety of treatments. Valsartan/HCTZ achieved a mean reduction in systolic ABP of -19.1 +/- 11.3 mmHg compared with -20.7 +/- 12.0 mmHg with amlodipine (p = 0.324 for the comparison) and in diastolic ABP by -11.1 +/- 7.4 mmHg vs -11.6 +/- 7.2 mmHg by amlodipine (p = 0.853 for the comparison). The valsartan/HCTZ group exhibited markedly lower rates of adverse events and discontinuations than the amlodipine group. Peripheral oedemas were far more frequent with amlodipine than with valsartan/ HCTZ (1.6% with valsartan/HCTZ; 16.8% with amlodipine). Thus, the valsartan 160 mg/HCTZ 25 mg combination appears to be as efficacious as amlodipine 10 mg in this patient population but better tolerated.</p>","PeriodicalId":8974,"journal":{"name":"Blood pressure. Supplement","volume":"2 ","pages":"41-7"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24195103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-12-01DOI: 10.1080/08038020310021967
R Düsing
The present open and prospective study was performed to investigate the effect of the angiotensin II receptor blocker (ARB) valsartan on sexual function in hypertensive males. Patients who were either newly treated or who were switched from other treatment regimens received valsartan 80-160 mg/day. Blood pressure decreased from an average of 158/94 mmHg to 136/82 mmHg during the 6 months of treatment (p < 0.001). The patients' sexual function was assessed before valsartan and after 6 months of treatment using the International Index of Erectile Function (IIEF), an internationally validated 15-item questionnaire. The IIEF addresses the relevant domains of male sexual function, i.e. erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. At baseline, 75.4% of the total group of 3502 patients investigated and 65.0% of the subgroup of patients without previous antihypertensive treatment (n = 952) could be diagnosed as having erectile dysfunction (ED) according to the IIEF. Valsartan therapy markedly reduced ED in these groups to 53% and 45% (p < 0.0001), respectively. Improved ED was associated with highly significant improvements in orgasmic function, intercourse and overall satisfaction both in the total and previously untreated groups. In addition, sexual desire averaged 5.64 +/- 1.99 IIEF units in the total and 5.99 +/- 2.03 in the group without antihypertensive treatment at baseline. Valsartan markedly increased these numbers to 6.82 +/- 1.72 and 7.06 +/- 1.68 (p < 0.0001), respectively. The results of our open study suggest that the ARB valsartan improves sexual function in hypertensive males.
{"title":"Effect of the angiotensin II antagonist valsartan on sexual function in hypertensive men.","authors":"R Düsing","doi":"10.1080/08038020310021967","DOIUrl":"https://doi.org/10.1080/08038020310021967","url":null,"abstract":"<p><p>The present open and prospective study was performed to investigate the effect of the angiotensin II receptor blocker (ARB) valsartan on sexual function in hypertensive males. Patients who were either newly treated or who were switched from other treatment regimens received valsartan 80-160 mg/day. Blood pressure decreased from an average of 158/94 mmHg to 136/82 mmHg during the 6 months of treatment (p < 0.001). The patients' sexual function was assessed before valsartan and after 6 months of treatment using the International Index of Erectile Function (IIEF), an internationally validated 15-item questionnaire. The IIEF addresses the relevant domains of male sexual function, i.e. erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. At baseline, 75.4% of the total group of 3502 patients investigated and 65.0% of the subgroup of patients without previous antihypertensive treatment (n = 952) could be diagnosed as having erectile dysfunction (ED) according to the IIEF. Valsartan therapy markedly reduced ED in these groups to 53% and 45% (p < 0.0001), respectively. Improved ED was associated with highly significant improvements in orgasmic function, intercourse and overall satisfaction both in the total and previously untreated groups. In addition, sexual desire averaged 5.64 +/- 1.99 IIEF units in the total and 5.99 +/- 2.03 in the group without antihypertensive treatment at baseline. Valsartan markedly increased these numbers to 6.82 +/- 1.72 and 7.06 +/- 1.68 (p < 0.0001), respectively. The results of our open study suggest that the ARB valsartan improves sexual function in hypertensive males.</p>","PeriodicalId":8974,"journal":{"name":"Blood pressure. Supplement","volume":"2 ","pages":"29-34"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08038020310021967","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24195101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Guido Grassi, Fosca Quarti Trevano, Annalisa Facchini, Torakis Toutouzas, Bernard Chanu, Giuseppe Mancia
The objective of this 12-week double-blind randomized multicentre study was to compare the efficacy and tolerability of nebivolol, a recently developed beta-blocking agent with vasodilating properties, to the classical beta-blocker atenolol. After a placebo run-in phase, 205 mild-to-moderate middle-age essential hypertensives were randomized to either nebivolol 5 mg daily (n = 105) or atenolol 100 mg daily (n = 100) over a period of 12 weeks. The primary endpoint of the study was the change in sitting systolic and diastolic blood pressure (SBP and DBP respectively) from baseline to week 12 of treatment. The two drugs induced similar significant antihypertensive effects, the SBP and DBP reduction amounting to -18.2 +/-14.0 and -14.6 +/-7.9 mmHg (mean +/- SD) for atenolol and -19.1 +/-12.9 and -14.8 +/- 7.1 for nebivolol (p < 0.01 for all). This was the case also for standing blood pressure. Sitting and standing heart rate values were significantly reduced by both drugs, the bradicardic response induced by nebivolol treatment being significantly less than atenolol. Distribution of responders and non- responders was similar for nebivolol and atenolol, while the former drug showed a better tolerability profile and a lower incidence of side-effects. These data provide evidence, that, for the same antihypertensive effects, nebivolol shows a better tolerability profile than atenolol and a lower incidence of adverse effects.
{"title":"Efficacy and tolerability profile of nebivolol vs atenolol in mild-to-moderate essential hypertension: results of a double-blind randomized multicentre trial.","authors":"Guido Grassi, Fosca Quarti Trevano, Annalisa Facchini, Torakis Toutouzas, Bernard Chanu, Giuseppe Mancia","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The objective of this 12-week double-blind randomized multicentre study was to compare the efficacy and tolerability of nebivolol, a recently developed beta-blocking agent with vasodilating properties, to the classical beta-blocker atenolol. After a placebo run-in phase, 205 mild-to-moderate middle-age essential hypertensives were randomized to either nebivolol 5 mg daily (n = 105) or atenolol 100 mg daily (n = 100) over a period of 12 weeks. The primary endpoint of the study was the change in sitting systolic and diastolic blood pressure (SBP and DBP respectively) from baseline to week 12 of treatment. The two drugs induced similar significant antihypertensive effects, the SBP and DBP reduction amounting to -18.2 +/-14.0 and -14.6 +/-7.9 mmHg (mean +/- SD) for atenolol and -19.1 +/-12.9 and -14.8 +/- 7.1 for nebivolol (p < 0.01 for all). This was the case also for standing blood pressure. Sitting and standing heart rate values were significantly reduced by both drugs, the bradicardic response induced by nebivolol treatment being significantly less than atenolol. Distribution of responders and non- responders was similar for nebivolol and atenolol, while the former drug showed a better tolerability profile and a lower incidence of side-effects. These data provide evidence, that, for the same antihypertensive effects, nebivolol shows a better tolerability profile than atenolol and a lower incidence of adverse effects.</p>","PeriodicalId":8974,"journal":{"name":"Blood pressure. Supplement","volume":"2 ","pages":"35-40"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24195102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-05-01DOI: 10.1080/08038020310000131
Thomas Hedner, Sverre E Kjeldsen, Anders Himmelmann
Access to effective and well-tolerated drugs is paramount to achieve effective management and control of hypertension. During recent years, we have seen an increased availability of well-performed studies relating to documentation of the efficacy and tolerability of various drug regiments in groups of hypertensive patients. One of the ambitions of Blood Pressure has been to put a priority in the publication of relevant clinical trials related to the therapeutic aspects of hypertension. Due to a lack of space in the journal, it has previously not been possible for us to fulfill this ambition and publish a major part of the contributions related to various aspects of antihypertensive drug therapy. Blood Pressure is therefore introducing a new type of supplement issue, where important contributions to therapeutic aspects of the management of hypertension are collected in one volume. The present issue of Blood Pressure is the first in a row of such supplements, containing papers related to the pharmacological management of hypertension. In this first issue, Blood Pressure Drug Therapy Supplement, Professor Per Lund-Johansen reviews the use of doxazosin GITS in patients with hypertension and BPH. The pharmacokinetic and effect profile of the new extended-release gastrointestinal therapeutics (GITS) formulation is reviewed, especially in terms of its improved tolerability compared to the standard doxazosin formulation. Furthermore, several aspects of dihydropyridine calcium antagonist treatment of hypertensive patients are presented. The group of Borghi et al describes the tolerability profile of the dihydropyridine calcium-channel blocker lercanidipine in comparison with a number of other clinically available calcium antagonists. Moreover, the effects of nifedipine on carotid and femoral arterial wall thickness is described by Terpstra and co-workers, and Kawano et al. describes the effect of a novel once a day nifedipine CR preparation in hypertensive patients, especially in relation to the morning surge. The efficacy of valsartan/hydrochlorothiazide combination therapy is reported in a large group of hypertensive patients who are inadequately controlled after monotherapy with the AT1 antagonist. Interestingly, Mallion et al. report a 70% responder rate in elderly patients on this fixed combination regimen. The editors of Blood Pressure are confident that the papers of this and future issues of Blood Pressure Drug Therapy Supplements will receive substantial interest from our readers, the scientific community and practicing physicians. Out ambition is to maintain this service to our readers and publish additional supplements at least on a twice-yearly basis.
{"title":"Novel aspects of therapeutics in Blood Pressure: drug therapy supplements.","authors":"Thomas Hedner, Sverre E Kjeldsen, Anders Himmelmann","doi":"10.1080/08038020310000131","DOIUrl":"https://doi.org/10.1080/08038020310000131","url":null,"abstract":"Access to effective and well-tolerated drugs is paramount to achieve effective management and control of hypertension. During recent years, we have seen an increased availability of well-performed studies relating to documentation of the efficacy and tolerability of various drug regiments in groups of hypertensive patients. One of the ambitions of Blood Pressure has been to put a priority in the publication of relevant clinical trials related to the therapeutic aspects of hypertension. Due to a lack of space in the journal, it has previously not been possible for us to fulfill this ambition and publish a major part of the contributions related to various aspects of antihypertensive drug therapy. Blood Pressure is therefore introducing a new type of supplement issue, where important contributions to therapeutic aspects of the management of hypertension are collected in one volume. The present issue of Blood Pressure is the first in a row of such supplements, containing papers related to the pharmacological management of hypertension. In this first issue, Blood Pressure Drug Therapy Supplement, Professor Per Lund-Johansen reviews the use of doxazosin GITS in patients with hypertension and BPH. The pharmacokinetic and effect profile of the new extended-release gastrointestinal therapeutics (GITS) formulation is reviewed, especially in terms of its improved tolerability compared to the standard doxazosin formulation. Furthermore, several aspects of dihydropyridine calcium antagonist treatment of hypertensive patients are presented. The group of Borghi et al describes the tolerability profile of the dihydropyridine calcium-channel blocker lercanidipine in comparison with a number of other clinically available calcium antagonists. Moreover, the effects of nifedipine on carotid and femoral arterial wall thickness is described by Terpstra and co-workers, and Kawano et al. describes the effect of a novel once a day nifedipine CR preparation in hypertensive patients, especially in relation to the morning surge. The efficacy of valsartan/hydrochlorothiazide combination therapy is reported in a large group of hypertensive patients who are inadequately controlled after monotherapy with the AT1 antagonist. Interestingly, Mallion et al. report a 70% responder rate in elderly patients on this fixed combination regimen. The editors of Blood Pressure are confident that the papers of this and future issues of Blood Pressure Drug Therapy Supplements will receive substantial interest from our readers, the scientific community and practicing physicians. Out ambition is to maintain this service to our readers and publish additional supplements at least on a twice-yearly basis.","PeriodicalId":8974,"journal":{"name":"Blood pressure. Supplement","volume":" ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2003-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08038020310000131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29460626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-05-01DOI: 10.1080/08038020310000087
Claudio Borghi, Maria Grazia Prandin, Ada Dormi, Ettore Ambrosioni
The objective of this 8-week open-label study was to compare the tolerability of lercanidipine, a dihydropyridine calcium-channel antagonist (CA), with that of other CAs in the treatment of hypertension. Subjects already taking amlodipine, felodipine, nifedipine gastrointestinal therapeutic system (GITS), or nitrendipine and experiencing CA-specific adverse effects (AEs) were switched to lercanidipine for 4 weeks and then rechallenged with their initial treatment for 4 weeks. Results showed that at comparable levels of BP, lercanidipine was associated with a significantly lower incidence of ankle edema, flushing, rash, headache and dizziness compared with other CAs (p < 0.001). After 4 weeks of lercanidipine, mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was 142.1/86.7 mmHg. After rechallenge with other CAs for 4 weeks, mean SBP/DBP was 141.1/86.7 mmHg. In this open-label study, lercanidipine compared with other CA seems to provide a significant improvement in tolerability with comparable antihypertensive effect.
{"title":"Improved tolerability of the dihydropyridine calcium-channel antagonist lercanidipine: the lercanidipine challenge trial.","authors":"Claudio Borghi, Maria Grazia Prandin, Ada Dormi, Ettore Ambrosioni","doi":"10.1080/08038020310000087","DOIUrl":"https://doi.org/10.1080/08038020310000087","url":null,"abstract":"<p><p>The objective of this 8-week open-label study was to compare the tolerability of lercanidipine, a dihydropyridine calcium-channel antagonist (CA), with that of other CAs in the treatment of hypertension. Subjects already taking amlodipine, felodipine, nifedipine gastrointestinal therapeutic system (GITS), or nitrendipine and experiencing CA-specific adverse effects (AEs) were switched to lercanidipine for 4 weeks and then rechallenged with their initial treatment for 4 weeks. Results showed that at comparable levels of BP, lercanidipine was associated with a significantly lower incidence of ankle edema, flushing, rash, headache and dizziness compared with other CAs (p < 0.001). After 4 weeks of lercanidipine, mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was 142.1/86.7 mmHg. After rechallenge with other CAs for 4 weeks, mean SBP/DBP was 141.1/86.7 mmHg. In this open-label study, lercanidipine compared with other CA seems to provide a significant improvement in tolerability with comparable antihypertensive effect.</p>","PeriodicalId":8974,"journal":{"name":"Blood pressure. Supplement","volume":"1 ","pages":"14-21"},"PeriodicalIF":0.0,"publicationDate":"2003-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08038020310000087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22432401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-05-01DOI: 10.1080/08038020310000096
Willem F Terpstra, Johan F May, Andries J Smit, Pieter A de Graeff, Harry J G M Crijns
Background: Experimental and clinical evidence suggests that calcium-channel blockers may retard the atherosclerotic process after long-term treatment. Whether these effects exist after intermediate-term treatment in hypertensive patients is mainly unknown.
Objective: To determine the 26-week effects of the long-acting calcium-channel blocker nifedipine on intima media thickness (IMT) in newly found hypertensive patients.
Design: Open-label study with blinded end-point analysis.
Methods: From a population survey, 131 previously untreated mild hypertensives (4 x systolic blood pressure between 160 and 220 mmHg and/or diastolic blood pressure between 95 and 115 mmHg) were included. Patients were treated with long-acting nifedipine 30-60 mg targeted to reach a predetermined drop in blood pressure. Prior to and after 26 weeks of treatment, IMT was measured by ultrasonography in the carotid and femoral artery. The combined mean maximal far wall IMT was used as primary endpoint. Change from baseline was evaluated by paired t-test in an intention-to-treat analysis.
Results: The mean maximal far wall IMT at baseline was 1.03 +/- 0.23 mm, and decreased by 0.078 mm (95% confidence interval, CI 0.044-0.111) after treatment. Regression analysis, including baseline IMT and changes of blood pressure, showed that reduction of IMT was mostly influenced by baseline IMT (p < 0.001; model R2 = 0.1).
Conclusion: Our observations show that 26 weeks of nifedipine treatment inhibits IMT progression in these newly found hypertensive patients. This effect was mostly seen in arterial walls with highest IMT before treatment, suggesting that patients with highest cardiovascular risk benefit most of antihypertensive treatment.
{"title":"Effects of nifedipine on carotid and femoral arterial wall thickness in previously untreated hypertensive patients.","authors":"Willem F Terpstra, Johan F May, Andries J Smit, Pieter A de Graeff, Harry J G M Crijns","doi":"10.1080/08038020310000096","DOIUrl":"https://doi.org/10.1080/08038020310000096","url":null,"abstract":"<p><strong>Background: </strong>Experimental and clinical evidence suggests that calcium-channel blockers may retard the atherosclerotic process after long-term treatment. Whether these effects exist after intermediate-term treatment in hypertensive patients is mainly unknown.</p><p><strong>Objective: </strong>To determine the 26-week effects of the long-acting calcium-channel blocker nifedipine on intima media thickness (IMT) in newly found hypertensive patients.</p><p><strong>Design: </strong>Open-label study with blinded end-point analysis.</p><p><strong>Methods: </strong>From a population survey, 131 previously untreated mild hypertensives (4 x systolic blood pressure between 160 and 220 mmHg and/or diastolic blood pressure between 95 and 115 mmHg) were included. Patients were treated with long-acting nifedipine 30-60 mg targeted to reach a predetermined drop in blood pressure. Prior to and after 26 weeks of treatment, IMT was measured by ultrasonography in the carotid and femoral artery. The combined mean maximal far wall IMT was used as primary endpoint. Change from baseline was evaluated by paired t-test in an intention-to-treat analysis.</p><p><strong>Results: </strong>The mean maximal far wall IMT at baseline was 1.03 +/- 0.23 mm, and decreased by 0.078 mm (95% confidence interval, CI 0.044-0.111) after treatment. Regression analysis, including baseline IMT and changes of blood pressure, showed that reduction of IMT was mostly influenced by baseline IMT (p < 0.001; model R2 = 0.1).</p><p><strong>Conclusion: </strong>Our observations show that 26 weeks of nifedipine treatment inhibits IMT progression in these newly found hypertensive patients. This effect was mostly seen in arterial walls with highest IMT before treatment, suggesting that patients with highest cardiovascular risk benefit most of antihypertensive treatment.</p>","PeriodicalId":8974,"journal":{"name":"Blood pressure. Supplement","volume":"1 ","pages":"22-9"},"PeriodicalIF":0.0,"publicationDate":"2003-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08038020310000096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22432402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-05-01DOI: 10.1080/08038020310000122
Jean-Michel Mallion, Renzo Carretta, Peter Trenkwalder, Jean-Felipe Martinez, Andrzej Tykarski, Ivor Teitelbaum, Pascale Oddou, Timothy Fagan
Objective: This double-blind parallel-group randomized trial compared the efficacy and safety of fixed combination valsartan 160 mg/hydrochlorothiazide 12.5 mg (Val 160/HCTZ 12.5) once daily (o.d.) and Val 160/hydrochlorothiazide 25 mg (Val 160/HCTZ 25) o.d. vs Val 160 o.d. monotherapy in patients with mild-to-moderate essential hypertension not adequately controlled with valsartan monotherapy.
Method: A total of 2002 patients whose BP was inadequately controlled with 4 weeks of Val 160 mg o.d. monotherapy were randomized to treatment for 8 weeks with Val 160 (n = 666), Val 160/HCTZ 12.5 (n = 670) or Val 160/HCTZ 25 (n = 666).
Results: Active treatment significantly reduced BP in all groups over the 12 weeks of the study (p < 0.001). The greatest reductions were achieved with Val 160/HCTZ 25. Reductions were 10.8, 12.8 and 14.2 mmHg (sitting diastolic blood pressure) and 15.7, 19.4 and 21.8 mmHg (sitting systolic blood pressure), for the Val 160, Val 160/HCTZ 12.5 and Val 160/HCTZ 25 groups, respectively. Responder rates were high in all groups (49%, 62% and 68%). In elderly patients (> or = 65 years) responder rates of 70% were achieved with Val 160/HCTZ 25. All treatments were well tolerated, in all patient groups.
Conclusions: The combination of Val 160 plus HCTZ 12.5 or HCTZ 25 provides effective and well-tolerated treatment in patients inadequately controlled after 4 weeks of monotherapy. In elderly patients a responder rate of 70% was achieved with Val 160/HCTZ 25.
{"title":"Valsartan/hydrochlorothiazide is effective in hypertensive patients inadequately controlled by valsartan monotherapy.","authors":"Jean-Michel Mallion, Renzo Carretta, Peter Trenkwalder, Jean-Felipe Martinez, Andrzej Tykarski, Ivor Teitelbaum, Pascale Oddou, Timothy Fagan","doi":"10.1080/08038020310000122","DOIUrl":"https://doi.org/10.1080/08038020310000122","url":null,"abstract":"<p><strong>Objective: </strong>This double-blind parallel-group randomized trial compared the efficacy and safety of fixed combination valsartan 160 mg/hydrochlorothiazide 12.5 mg (Val 160/HCTZ 12.5) once daily (o.d.) and Val 160/hydrochlorothiazide 25 mg (Val 160/HCTZ 25) o.d. vs Val 160 o.d. monotherapy in patients with mild-to-moderate essential hypertension not adequately controlled with valsartan monotherapy.</p><p><strong>Method: </strong>A total of 2002 patients whose BP was inadequately controlled with 4 weeks of Val 160 mg o.d. monotherapy were randomized to treatment for 8 weeks with Val 160 (n = 666), Val 160/HCTZ 12.5 (n = 670) or Val 160/HCTZ 25 (n = 666).</p><p><strong>Results: </strong>Active treatment significantly reduced BP in all groups over the 12 weeks of the study (p < 0.001). The greatest reductions were achieved with Val 160/HCTZ 25. Reductions were 10.8, 12.8 and 14.2 mmHg (sitting diastolic blood pressure) and 15.7, 19.4 and 21.8 mmHg (sitting systolic blood pressure), for the Val 160, Val 160/HCTZ 12.5 and Val 160/HCTZ 25 groups, respectively. Responder rates were high in all groups (49%, 62% and 68%). In elderly patients (> or = 65 years) responder rates of 70% were achieved with Val 160/HCTZ 25. All treatments were well tolerated, in all patient groups.</p><p><strong>Conclusions: </strong>The combination of Val 160 plus HCTZ 12.5 or HCTZ 25 provides effective and well-tolerated treatment in patients inadequately controlled after 4 weeks of monotherapy. In elderly patients a responder rate of 70% was achieved with Val 160/HCTZ 25.</p>","PeriodicalId":8974,"journal":{"name":"Blood pressure. Supplement","volume":"1 ","pages":"36-43"},"PeriodicalIF":0.0,"publicationDate":"2003-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08038020310000122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22432404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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