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

Long-term antihypertensive treatment by once-weekly application of transdermal clonidine patches, in doses equivalent to 0.1, 0.2, 0.3 mg of clonidine daily, was evaluated in an open trial of 41 patients with baseline seated diastolic blood pressures of 90 to 103 mmHg. In all the patients, seated diastolic blood pressure was reduced to less than 90 mmHg with transdermal clonidine alone at the end of a dose titration phase of two to six weeks. Thirty-two patients successfully completed at least 22 months of therapy; three patients withdrew because of lack of efficacy and six because of adverse events. In the second treatment year 14 patients required a concomitant diuretic. Mean reductions in seated diastolic blood pressure from baseline values were statistically significant (P less than 0.0001) at all study intervals. The incidence of patient withdrawals resulting from the development of contact dermatitis at the patch application site was 5%; skin irritation not requiring withdrawal occurred in 13 patients during the first year of treatment and in two during the second. The incidence of dry mouth (in 7%) and drowsiness (in 10%) was lower than has been reported during oral clonidine therapy (40% and 35%). The results suggest that transdermal clonidine may be beneficial for the maintenance therapy of many patients with mild hypertension.
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PMID:Long-term treatment with transdermal clonidine in mild hypertension. 274 74

The effects of enalapril maleate were studied in a group of 6 patients with arterial hypertension, hypertensive cardiopathy, multiple metabolic disorders and habitual snoring. Earlier treatment with antihypertensive drugs (diuretics, antiadrenergics, calcium antagonists) had been suspended when a marked deterioration was noted in metabolic parameters and plasmatic electrolytes as well as extremely disturbed sleep. The latter is probably attributable to increased respiratory obstruction during the night as a result of the increased hypertonia of the muscles of the upper air ways due to low blood potassium as well as the central and peripheral effects of the antiadrenergic drugs. After the wash-out period there was a marked improvement in laboratory parameters that continued after treatment with enalapril maleate. In particular, apart from a further slight fall in blood cholesterol and uricaemia there was a statistically significant drop in triglyceride levels. The improvement in the laboratory parameters made it possible to reduce the doses of the drugs being taken for the metabolic disorders. A distinct improvement was also noted in the sleep disturbances especially the excessive drowsiness during the day. There was also a statistically significant drop in arterial, systolic, diastolic and mean blood pressure without any significant change in heart beat. The results indicate that enalapril maleate should be the treatment of choice for those patients in whom high blood pressure is accompanied by alterations to the main metabolic parameters and habitual snoring.
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PMID:[Treatment with enalapril maleate in patients with arterial hypertension, pluri-metabolic syndrome and habitual snoring]. 282 86

Alpha-adrenergic receptors play an important role in the regulation of blood pressure (BP). There are 2 principal types of alpha receptors, alpha 1 and alpha 2, and both participate in circulatory control. Alpha 1 receptors are the classic postsynaptic alpha receptors and are found on vascular smooth muscle. They determine both arteriolar resistance and venous capacitance, and thus BP. Alpha 2 receptors are found both in the brain and in the periphery. In the brain stem, they modulate sympathetic outflow. Their function in the periphery is not yet fully understood, but they may contribute both to control of sympathetic tone and to local and regional blood flow. Drugs that enhance central alpha 2 activity, such as clonidine, guanfacine and the active metabolite of methyldopa, can significantly lower BP and are effective in the long-term control of hypertension, either alone or in combination with other drugs. While central alpha agonists, as a class, share a common pharmacologic mode of action, side effects, e.g., sedation and drowsiness, occur to different degrees with different drugs, and the individual agents also vary in terms of their propensity for causing withdrawal hypertension. The use of low-dose regimens or of newer drugs, such as guanfacine, with its longer half-life and duration of action, may reduce the likelihood of adverse reactions associated with this class of drugs.
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PMID:Alpha-adrenergic receptors and blood pressure control. 286 81

A total of 127 patients with arterial hypertension--64 with symptomatic and 63 with essential, were treated with chlophazolin "Pharmachim" at the Clinic of Therapy of Internal Diseases and Clinical Pharmacology for a period of one year. The drug was used alone in part of the patients and in the rest--in combination with other drugs. Satisfactory effect on the clinical symptoms and the level of blood pressure was attained in all patients treated and in only a small part of them diuretics and beta-blockers were necessary so as to attain better effect in coping with the arterial hypertension. In all patients the drug gave no toxic and allergic reactions, the most frequent adverse affects being the dryness of the mouth and sleepiness.
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PMID:[Treatment with Pharmachim's Chlophazolin of hypertension and symptomatic hypertonia]. 287 53

A double-blind multicenter trial compared rilmenidine with placebo in the treatment of 126 patients with mild to moderate hypertension after a 4-week placebo run-in period. Patients with mild hypertension (study 1) with mean supine diastolic blood pressure (BP) between 95 and 104 mm Hg received either rilmenidine 1 mg/day (n = 31) or placebo (n = 35) for 4 weeks. In study 2, patients with moderate hypertension (mean supine diastolic BP between 105 and 115 mm Hg) received either rilmenidine 1 mg twice a day (n = 30) or placebo twice a day (n = 30) for 4 weeks. All 61 patients taking rilmenidine completed the study; 8 of the 65 patients taking placebo were withdrawn because of an increase in BP. Rilmenidine significantly reduced mean systolic and diastolic BP compared with placebo in both studies. BP was normalized (systolic less than 160 mm Hg and diastolic less than or equal to 90 mm Hg in 61% of the patients taking rilmenidine as opposed to 23% of those taking placebo (p less than 0.001). There was no significant difference in the incidence of either dry mouth or daytime drowsiness between rilmenidine, 1 mg/day, and placebo. Dry mouth was significantly more frequent with rilmenidine, 2 mg/day, than with placebo, but this difference was transient and no longer significant at the end of the study. No unexpected adverse effects occurred. Rilmenidine as single therapy appears to be effective and well accepted in the management of mild to moderate hypertension, in particular at the 1-mg/day dose, which normalized 84% of mild hypertensive patients and did not induce any significant adverse effects compared with placebo.
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PMID:Efficacy and acceptability of rilmenidine for mild to moderate systemic hypertension. 289 64

To assess the long-term acceptability and efficacy of rilmenidine (S 3341), patients with placebo-resistant hypertension (diastolic blood pressure [BP] greater than or equal to 95 mm Hg and less than 115 mm Hg) were included in an open 1-year treatment study. Eight examinations allowed treatment adaptation if diastolic BP remained greater than or equal to 90 mm Hg (monotherapy with rilmenidine, 1 or 2 mg/day, followed by the addition of a diuretic, then tritherapy). Three hundred seventeen patients, aged 58.0 +/- 0.7 years, were included. Two hundred sixty-nine were followed for 1 year and 48 withdrew from the trial without any symptom suggesting a withdrawal syndrome: 4 because of adverse effects; 6, lack of efficacy despite triple therapy; 9, intercurrent diseases; 10, noncompliance independent of adverse effects; 18, personal reasons not associated with treatment; and 1, lost to follow-up. On the 12th month, the decrease in supine systolic and diastolic BP reached 25 and 17 mm Hg with monotherapy (n = 150), 26 and 17 mm Hg with double therapy (n = 90) and 20 and 15 mm Hg with triple therapy (n = 29). BP was normalized (diastolic BP less than or equal to 90 mm Hg) on months 6 and 12 in 80 and 84% of the patients, respectively. Monotherapy was maintained in 66 and 60% of these patients, respectively, two-thirds being treated with 1 mg once daily. Adverse effects with monotherapy were mainly observed at the beginning of treatment in 3 to 8%: dry mouth, asthenia, gastralgia, palpitations, drowsiness, insomnia; other adverse effects were rare (1 to 2%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Efficacy and safety of rilmenidine for arterial hypertension. 289 68

More than 5,000 primary-care physicians enrolled more than 22,000 patients with mild to moderate hypertension in a postmarketing study in which guanfacine hydrochloride, a centrally acting antihypertensive agent, was given for 28 days. The objectives of the evaluation were: (1) to obtain broad experience with guanfacine for the management of essential hypertension in a clinical practice setting; (2) to obtain information on patient acceptance of guanfacine, 1 mg HS, for the control of essential hypertension; and (3) to obtain more information on the drug's safety in clinical practice. Patients had to be at least 21 years of age, to be receiving a thiazide-type diuretic, and to have a sitting diastolic blood pressure of 95 to 114 mmHg. Women who were pregnant or lactating or planning to become pregnant during the evaluation were excluded. Blood pressure and heart rate were measured before guanfacine was started and at the completion of the study. Adverse on-therapy events were reported at the return visit. The average blood pressure in the general patient population decreased by 17/12 mmHg, that is, from 164/100 to 147/88 mmHg in four weeks. The magnitude of the reduction was not significantly influenced by age, race, sex, duration of hypertension, or the use of concomitant antihypertensive therapy. Adding guanfacine to another antihypertensive regimen resulted in mean reductions of 11 to 15 mmHg diastolic pressure, and the substitution of guanfacine for another antihypertensive agent resulted in mean reductions of 10 to 11 mmHg diastolic pressure. The most common side effect reported was dry mouth in 6% of patients, followed by dizziness, somnolence, fatigue, headache, and nausea, each reported in fewer than 3% of patients. More than 80% of the participants continued to receive guanfacine after the study. Of the total patient population, 7% discontinued guanfacine because of lack of efficacy, 10% because of side effects, and 3% for other reasons. The results of this large postmarketing study confirmed the results of controlled clinical trials conducted prior to marketing.
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PMID:A postmarketing evaluation of guanfacine hydrochloride in mild to moderate hypertension. 306 7

The authors report the case of a 2-year-old infant who presented with paroxysm and short changes characterized by acute drowsiness, cold sweats, ocular reversion, facial cyanosis, and bradycardia. Between these attacks, the condition was normal, suggesting diencephalic seizures. Over 2 months five fits were observed by the parents when some to-and-fro bobbing of the head onto the trunk appeared during drowsiness. One electroencephalogram was normal without a slow background or spikes discharges. As the skull radiographs showed erosion of the jugum and chronic intracranial hypertension features, a CT scan was performed and showed hydrocephalus associated with a congenital suprasellar cyst. The cyst was opened into basal cisterns with cystoperitoneal shunt. The histological examination revealed that it was an arachnoid cyst. Six months later, the infant was free of diencephalic seizures and head bobbing. Thus, we can assert that there was a direct relationship between this cyst and the diencephalic seizures. From this case, the authors make a review of the clinical features of diencephalic epilepsy, and their different causes and show that both diencephalic epilepsy and suprasellar arachnoid cysts are not common.
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PMID:Diencephalic epilepsy with congenital suprasellar arachnoid cyst in an infant. 316 81

A number of symptoms that appear to be associated with high blood pressure (headache, dizziness, epistaxis, tinnitus, weakness, drowsiness), and are usually regarded as secondary to hypertension or to antihypertensive drug therapy, were studied in 3858 elderly patients, 67.8% of whom were hypertensive. Of the hypertensive patients, 71.2% were under treatment. Headaches and dizziness were significantly more prevalent in the hypertensive than in the normotensive subjects (32.5 versus 27.4% and 41.5 versus 35.3%, respectively; P less than 0.05) and in treated compared with untreated hypertensives (33.3 versus 29.4% and 43.3 versus 37.1%; P less than 0.05). These differences disappeared after statistical correction for 'awareness of hypertension'. In multiple logistic analysis, female sex, age and awareness of hypertension were significantly associated with a higher prevalence of symptoms, whereas hypertension and antihypertensive treatment were not. We conclude that the presence of these symptoms does not constitute a reliable criterion for starting antihypertensive treatment or judging its efficacy.
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PMID:Prevalence of symptoms generally attributed to hypertension or its treatment: study on blood pressure in elderly outpatients (SPAA). 321 43

Aggregating platelets release serotonin, which induces contraction of most vascular smooth muscle by activation of S2-serotoninergic receptors. Serotonin released in the circulation may contribute to the increase in peripheral resistance of hypertension as the responsiveness of blood vessels from hypertensive animals and humans to the vasoconstrictor action of the monoamine is augmented. The data obtained with the new antihypertensive agent ketanserin may favor that interpretation. Ketanserin is a selective S2-serotoninergic antagonist with additional alpha 1-adrenergic blocking properties. In humans, it has a terminal half-life of 12 to 25 hours and is eliminated predominantly by the liver. The hemodynamic profile of ketanserin is that of a vasodilator drug with actions on both resistance and capacitance vessels. On short-term intravenous administration, it lowers blood pressure in hypertensive patients with minimal reflex changes in cardiovascular function. When given orally long term to hypertensive patients, ketanserin causes a sustained reduction in arterial blood pressure, comparable to that obtained with either beta-adrenergic blockers or diuretics. Several studies have shown a greater efficacy in older (greater than 60 years of age) than in younger patients independent of starting pressure. Side effects mainly consist of dizziness, somnolence, and dry mouth, but they are usually not severe. The mechanism underlying the antihypertensive effect of ketanserin is unclear. It cannot be attributed to either S2-serotoninergic or alpha 1-adrenergic blockade alone, but an interaction between the two effects appears to be required.
Hypertension 1988 Feb
PMID:Serotoninergic mechanisms in hypertension. Focus on the effects of ketanserin. 327 10


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