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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nifedipine antagonises influx of calcium through cell membrane slow channels, and sustained release formulations of the calcium channel blocker have been shown to be effective in the treatment of mild to moderate hypertension and both stable and variant angina pectoris. Preliminary findings also indicate that these formulations are effective in the treatment of Raynaud's phenomenon and hypertension in pregnancy, and that they reduce the frequency of ischaemic episodes in some patients with silent myocardial ischaemia. The exact mechanism of action of nifedipine in all of these disorders has not been defined. However, its potent peripheral and coronary arterial dilator properties, together with improvements in oxygen supply/demand, are of particular importance. A major goal of sustained release therapy is to permit reductions in the frequency of nifedipine administration, preferably to once daily, and thus improve patient compliance. Two new once-daily formulations--the nifedipine gastrointestinal therapeutic system (GITS) and a fixed combination capsule comprising sustained release nifedipine 20 mg and atenolol 50 mg--have exhibited marked antihypertensive efficacy. The GITS preparation has also been used effectively in the treatment of stable angina pectoris, and both formulations appear to be well tolerated. Sustained release nifedipine formulations are generally better tolerated than their conventionally formulated counterparts, particularly with regard to reflex tachycardia. Adverse effects seem to be dose related, are mainly associated with the drug's potent vasodilatory action, and include headache, flushing and dizziness. Generally, these effects are mild to moderate in severity and transient, usually diminishing with continued treatment. Thus, sustained release nifedipine formulations are useful and established cardiovascular therapeutic agents which have demonstrable efficacy in various forms of angina, mild to moderate hypertension and Raynaud's phenomenon. Further, promising results shown by the nifedipine GITS formulation, with its advantage of once daily administration suggest that it is likely to become one of the preferred nifedipine formulations for the treatment of hypertension and the various forms of angina.
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PMID:Sustained release nifedipine formulations. An appraisal of their current uses and prospective roles in the treatment of hypertension, ischaemic heart disease and peripheral vascular disorders. 171 8

In this study of the efficacy and safety of isradipine as first-line therapy in hypertension, 1,647 patients enrolled; 1,472 completed the 4-week placebo run-in period and began treatment with isradipine at 2.5 mg twice daily for 4 weeks. During placebo, 11% (n = 175) of the 1,647 patients withdrew because of normalization of blood pressure, side effects, noncompliance, violation of the study protocol, side effects from concomitant therapy, or other reasons. During isradipine therapy (n = 1,376), blood pressure decreased from 168 +/- 18/102 +/- 8 mm Hg at the end of the placebo period to 155 +/- 17/94 +/- 9 mm Hg after 2 weeks (p less than 0.001) and 151 +/- 16/92 +/- 9 mm Hg after 4 weeks (p less than 0.001). During active treatment, 6.4% (n = 94) were withdrawn because of flushing, headache, edema, palpitations, gastrointestinal side effects, skin rashes, or other side effects, and two patients because of lack of efficacy. The side effect score in the remaining patients worsened for flushing, remained unchanged for edema, but significantly improved for palpitations, fatigue, dizziness, headache, and nervousness. After 4 weeks, 60% of patients had diastolic blood pressures of less than or equal to 90 mm Hg. Thus, isradipine is effective and safe as first-line therapy in patients with primary hypertension as seen in general practice.
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PMID:Calcium antagonists as first-line therapy in hypertension: results of the Swiss Isradipine Study. Swiss Hypertension Society. 172 Apr 76

In this study, the tolerability and safety of ramipril, as monotherapy and in combination with a low dose of furosemide, were assessed in patients with mild-to-moderate hypertension in general practice. After a placebo run-in phase, patients received ramipril as monotherapy in a dose of 2.5 to 5 mg daily for 6 weeks. Nonresponders (diastolic blood pressure greater than 90 mm Hg) entered a double-blind treatment period, and received either 10 mg of ramipril daily, or 5 mg of ramipril in combination with 20 mg of furosemide daily. The tolerability of the study medication was assessed by reported adverse events, and by monitoring blood cell count, electrolytes, serum creatinine, fasting blood glucose, and apolipoproteins AI and B. Of a total of 770 patients who entered the placebo run-in phase, 661 patients were enrolled in the first active treatment period. The most commonly reported adverse events were headache, cough, dizziness, asthenia, cramps, diarrhea, and nausea, but not all of these events were related to ramipril treatment. A total of 38 patients discontinued active treatment due to nonserious adverse events, mainly cough, dizziness, or diarrhea. There appeared to be a relationship between the prevalence of cough and ramipril dosage; however, an increased incidence of cough was also observed during outbreaks of influenza in France. There were no significant changes in laboratory variables during the study.
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PMID:Tolerability of ramipril in a multicenter study of mild-to-moderate hypertension in general practice. 172 26

Felodipine, a dihydropyridine calcium-channel antagonist, significantly reduces systolic and diastolic blood pressure (BP) in patients with hypertension and has been associated with beneficial hemodynamic effects in patients with chronic stable angina pectoris or congestive heart failure (CHF). In hypertensive patients, felodipine does not appear to significantly affect glomerular filtration rate, creatinine clearance, glucose tolerance, or plasma lipoprotein concentrations. Studies comparing felodipine with other agents as monotherapy in mild to moderate hypertension have demonstrated felodipine to be at least as efficacious as hydrochlorothiazide (HCTZ) and HCTZ plus amiloride hydrochloride in combination. Comparisons of felodipine with other agents as adjuncts to beta-blocker or diuretic therapy have shown felodipine to be at least as effective as HCTZ, propranolol hydrochloride, prazosin hydrochloride, and nifedipine. Evaluations of patients with chronic stable angina are limited, and additional studies are needed before felodipine can be recommended for the routine management of angina pectoris. Similarly, additional studies are essential to delineate the role of felodipine, if any, in the management of CHF. In the management of hypertension, felodipine 5-40 mg/d significantly reduces systolic and diastolic BP. Although some patients may be controlled throughout the entire dosing interval when felodipine is administered bid, many patients will require more frequent dosing to obtain adequate BP control. Adverse effects associated with felodipine are similar to those of other dihydropyridine calcium-channel antagonists and include peripheral edema, headache, dizziness, flushing, and fatigue. A potentially clinically important drug interaction was observed when felodipine was administered concomitantly with theophylline aminopropanol; significant decreases in theophylline concentrations were noted. In summary, felodipine appears to be safe and effective for the management of hypertension when used alone or in combination with other antihypertensive agents. The efficacy of felodipine in the management of chronic stable angina pectoris and CHF requires further investigation.
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PMID:Felodipine: a new dihydropyridine calcium-channel antagonist. 176 37

Sixty hypertensives admitted into medical wards were interviewed in depth to determine reasons for their previous drop out of treatment. Eighty five percent of the patients were lacking in motivation. This was related to patients' lack of understanding concerning hypertension and its treatment, erroneous beliefs concerning hypertension held by patients and patients' perceived barrier to treatment. The evidence for these reasons were as follows: 95% of the patients were unaware that hypertension is a long term condition requiring life-long treatment, 60% were unable to state the likely consequences of uncontrolled hypertension, 78% equated relief of symptoms like headache, dizziness with control of hypertension, 52% believed long term consumption of 'western' medication was harmful, 12% believed they had been cured by traditional (bomoh or sinseh) treatment, 72% complained of long waiting time required to obtain care. Economic reasons however were unimportant. Patient education and more convenient clinic locations are necessary but insufficient to ensure compliance. They are particular elements, among others, of a 'good' doctor-patient relationship, which fundamentally is the critical determinant of compliance.
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PMID:The Mentakab Hypertension Study project. Part II--Why do hypertensives drop out of treatment? 177 4

Undetected hypertension is an obstacle to effective blood pressure control in the community. A study was done to assess the justification of screening in the outpatient department. Only 13% of all visits to the outpatient department resulted in an attempt to detect hypertension. The common reasons leading to blood pressure measurement were headache and dizziness. Current practice of hypertension detection appeared inadequate and irrational. Nine per cent of all visits to the outpatient department were already accounted for by hypertensives. A screening survey found that 30% of all non-hypertensive patients attending outpatient department aged 30 years or more had blood pressure greater than or equal to 140/90 mmHg. The drop out rate among these newly diagnosed hypertensives was 100%. Existing resources are already inadequate and existing hypertension care has also been shown to be inadequate. Screening can only be expected to considerably increase hypertensive patient load without however any assurance that effective long term care can be delivered. Labelling people as hypertensives in this manner may be harmful. The question of screening cannot be considered individually, separate from the entire problem of hypertension control. Detection must be linked to treatment in a programme designed to promote compliance and capable of delivering adequate care before it can be justified.
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PMID:The Mentakab Hypertension Study Project. Part III--Detection of hypertension in the outpatient department. 178 80

The authors describe the results of studying the anti-inflammatory effect of indomethacin in 102 young men suffering from acute rheumatic fever (ARF). It has been shown that indomethacin has a remarkable anti-inflammatory effect both on the general disease manifestations and on the basic symptoms. For instance, in ARF patients, fever disappeared on days 2-4 of the treatment whereas the signs of arthritis on days 7-8 of the treatment, on the average. Besides, indomethacin produced a marked analgesic effect, since in 84% of the patients, arthralgias diminished on days 2-3 from the onset of indomethacin treatment. Practically, in all the patients, they disappeared simultaneously with arthritis phenomena. Disorders of rhythm and conduction also disappeared on days 2-4 from the treatment onset, while the end part of the ventricular complex returned to normal a little bit later (days 13-15). Subjective symptoms of rheumocarditis disappeared completely by the end of the treatment. Within the same time, dynamic mesodiastolic murmur and additional sounds also disappeared, the deadening of sounds noticeably decreased, the intensity of systolic murmur declined. The overwhelming majority of the patients demonstrated normalization of the heart size. Side effects were recorded in 11 patients. They were largely arterial hypertension, epigastric pains, dizziness and headaches which disappeared as a result of corrective therapy and a short-term reduction of the indomethacin dose.
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PMID:[The results of the indomethacin treatment of patients with acute rheumatic fever]. 180 12

Isradipine is a new dihydropyridine calcium antagonist with a high degree of selectivity for the coronary, cerebral, and skeletal muscle vasculature. The drug has minimal depressant activity on sinoatrial node automaticity and negligible negative chronotropic, dromotropic, and inotropic actions. Isradipine reduces blood pressure and systemic vascular resistance without changes in cardiac output and stroke volume. Renal blood flow is maintained while renal vascular resistance is reduced; this is accompanied by both short- and long-term diuretic and natriuretic effects. Doses of 1.25 to 5 mg twice daily lowers blood pressure effectively over 24 h. In open as well as placebo-controlled trials, 2.5 to 10 mg isradipine twice daily was safe and well tolerated, and reduced systolic and diastolic values in up to 85% of patients with mild-to-moderate hypertension. Efficacy is similar to those of nifedipine and nitrendipine, and potentially superior to those of propranolol, atenolol, prazosin, hydrochlorothiazide, and diltiazem. The drug can be safely combined with beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and diuretics. Adverse effects are dose-dependent and secondary to arterial vasodilatation, such as headache, flushing, ankle edema, dizziness, palpitations, and tachycardia. At the recommended dose of 2.5 mg twice daily, the total incidence of side effects does not differ from that with placebo. The antiatherosclerotic, antitrophic, and cerebroprotective effects seen in experimental animal models are promising for the drug in the treatment of human hypertension. Isradipine may not only reduce blood pressure, but may also reduce the risk for the consequences of this peril, namely, cerebral stroke and myocardial infarction.
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PMID:The place of isradipine in the treatment of hypertension. 182 26

Data from clinical trials with benazepril suggest that the safety profile of benazepril is similar to that of other angiotensin-converting enzyme (ACE) inhibitors. Treatment-related side effects occurred in 20% of benazepril-treated patients and in 18% of patients receiving placebo. The most commonly reported side effects with benazepril were headache, dizziness, and fatigue. The incidence of side effects was not affected by the degree of hypertension, age, gender, race, dosage, or the degree of renal impairment. Side effects believed to be related to the pharmacologic action of ACE inhibitors as a class include symptomatic hypotension, which occurred at a relatively low rate with benazepril, and hyperkalemia and elevation of serum creatinine, which occurred to the same extent with benazepril as has been noted with other ACE inhibitors. The mechanism of cough as an ACE inhibitor side effect is unknown; the incidence was similar to that with other ACE inhibitors. Rash and taste disturbance have occurred rarely with benazepril. The incidence of neutropenia and of proteinuria was the same in both the benazepril and placebo groups. Renal failure in hypertensive patients treated with benazepril has not been reported. Overall, benazepril is generally well tolerated by hypertensive patients. The incidence of most side effects is comparable to that with other ACE inhibitors and placebo.
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PMID:Safety profile of benazepril in essential hypertension. 189 40

Clinical and epidemiological features of 72 cases of boutonneuse fever, detected from 1979 to 1986 at the "Hospital del Insalud de Cartagena" (Murcia), are reviewed. The most important clinical features are commented on (fever, rash, tache noire), as well as the less important (dizziness, cough, conjunctivitis, sensorial changes). Several epidemiological factors were analyzed, temperature having been found to be the most significant in our area. The complications observed mainly affected patients with risk factors (senility, thrombocytopenia, hyponatremia, high blood pressure) being particularly severe in a patient who developed lethal DIC and in another 2 who developed pulmonary thromboembolism. The prophylactic measures suggested were the strict control of animals susceptible to parasites and organizing of disinfestation campaigns in the endemic areas.
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PMID:[A clinical epidemiological study of Mediterranean boutonneuse fever in the Cartagena area]. 191 50


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