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

Up to the present the relationship between arterial hypertension or its treatment and cardiovascular complications has been evaluated in terms of the incidence of events, such as fatal and nonfatal myocardial infarction or stroke and cardiac deaths. However, cardiovascular events are not the direct consequence of blood pressure elevation, which, on the contrary, is responsible for atherosclerotic disease. Quantitative ultrasonography is a sensitive, specific and reproducible technique which, in comparison to arteriography, is non invasive and less expensive. The availability of this technique has allowed us to do some studies, one just published, another in the elaboration phase and others ongoing, aimed at evaluating the effects of antihypertensive agents on carotid changes in hypertensive patients. The European Lacidipine Study on Atherosclerosis (ELSA) compares the effects of lacidipine, a calcium-antagonist and of atenolol, a beta-blocker, on blood pressure, on carotid vessel modifications, and on the incidence of cardiovascular events in patients with mild to moderate hypertension with a 4-year follow-up period. Preliminary results of the study, which were concerned with the demographic characteristics of the first 1000 randomized patients enrolled, indicate that 84% of the patients had a carotid plaque, 15% had thickening of the intima-media, and 1% had a normal vessel. These results are both surprising and significant in that they admonish the physician not to neglect patients with mild to moderate hypertension even when they have neither complications nor other risk factors.
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PMID:[The preliminary clinical evidence from the ELSA study. The European Lacidipine Study on Atherosclerosis]. 856 72

Calcium channel blockers are increasingly used in the treatment of hypertension. Newer calcium channel blockers of the dihydropyridine group have longer elimination half-lives (t1/2) that permit once-daily dosage and are generally better tolerated than their parent compound. In this study, the efficacy and safety of lacidipine and amlodipine were compared in 65 patients with mild-to-moderate hypertension attending the hypertension outpatient clinic of a teaching hospital in a randomized double-blind cross-over trial with dose titration. Lacidipine and amlodipine both significantly reduced systolic blood pressure (SBP: by 19.2 +/- 13.5 and 22.3 +/- 15.3 mm Hg, respectively) and diastolic BP (DBP: 13.3 +/- 4.2 and 12.3 +/- 5.3 mm Hg, respectively) 24 h postdose. There were no significant differences in their antihypertensive effects. The incidence of adverse events (AE) was 3% for lacidipine and 8% for amlodipine. The incidence of withdrawal from the study due to side effects was 0% for lacidipine and 3% for amlodipine. These results suggest that lacidipine is well-tolerated, and is as effective as amlodipine as a once-daily antihypertensive agent.
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PMID:Relative efficacy and tolerability of lacidipine and amlodipine in patients with mild-to-moderate hypertension: a randomized double-blind study. 885 91

The development of atherosclerosis is clearly linked to the level of blood pressure. This is illustrated by the difference of atheroma formation in arteries as compared to veins, the development of atherosclerosis in veins transplanted to the arterial circulation or the finding of atherosclerosis also in the pulmonary circulation as an effect of pulmonary hypertension. Several experimental studies have also illuminated the strong link between high blood pressure and the development of atherosclerosis. From a therapeutic point of view it is worth noting that the lowering of blood pressure per se has a positive effect on the development of atherosclerosis. In particular, calcium antagonists have been shown, in numerous experimental studies, to have an antiatherosclerotic effect. The positive results in animal studies led to studies in man, the first of which was the MIDAS Study. The Multicentre Isradipine Diuretic Atherosclerosis (MIDAS) Study was a comparison between the dihydropyridine-derived calcium antagonist isradipine and hydrochlorothiazide in 883 hypertensive patients. B-mode ultrasonography of the carotid artery was used in order to evaluate changes in wall thickness and the development of atherosclerotic plaques during a 3-year period. The final publication has yet to appear in a medical journal. However, the study and its main findings have been presented at several international scientific meetings. In brief, isradipine was significantly more effective than hydrochlorothiazide in preventing an increase in intima-media thickness at several points of measurement in the carotid artery in spite of the fact that systolic blood pressure was not lowered as effectively by isradipine as by the diuretic therapy. There are numerous lessons to be learnt from MIDAS for future studies of this kind. A good example of this is the European Lacidipine Study of Atherosclerosis (ELSA) which is currently in progress in several European countries. By careful analysis of MIDAS an improved study design has been created, which should result in a definitive and irrefutable answer to the issue of the clinical importance of calcium antagonist treatment in the prevention of atherosclerosis.
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PMID:How to study the role of hypertension in atherosclerosis. Lessons from MIDAS. Multicentre Isradipine Diuretic Atherosclerosis Study. 897 77

The European Lacidipine Study on Atherosclerosis (ELSA) is a multinational interventional clinical trial aimed at determining the antiatherosclerotic effects of Lacidipine, a calcium antagonist, when compared to atenolol, a beta-blocker, on the carotid arteries of 2300 cardiovascular asymptomatic patients with moderately high blood pressure. Quantitative B-mode ultrasound imaging is being used to measure the intima-media thickness of a standardized section of the carotid arteries including the distal common, bifurcation, and proximal internal carotids. Prospective investigations of large samples of population using ultrasonographic endpoints rely heavily on the precision and reproducibility of the method. Therefore, specific quality control protocols are required to determine and monitor cross-sectional and longitudinal stability of the measurement reproducibility. In ELSA, the ultrasound methodology was specifically designed to include a set of procedures to quality control the critical components of measurement variation including instrumentation, and ultrasound operators, i.e. sonographers and readers. The ELSA clinical trial will provide the largest set of prospective quality control data on the use of quantitative B-mode ultrasound imaging.
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PMID:Ultrasound protocol and quality control procedures in the European Lacidipine Study on Atherosclerosis (ELSA). 897 78

The antihypertensive activity of losartan potassium (losartan, Cozaar), an angiotensin II receptor antagonist, was evaluated in a parallel 12-week, double-blind, placebo-controlled trial in hypertensive patients with mild-to-moderate hypertension. After a 4-week, single-blind, placebo lead-in period, which included monitoring of baseline variables, 366 patients with a group mean sitting diastolic blood pressure of 101 +/- 5 (s.d.) mmHg were assigned randomly to one of three treatment groups: placebo, losartan 50 mg, or losartan 50 mg with the option to titrate to 100 mg after the first 6 weeks if the target sitting diastolic blood pressure (< 90 mmHg) was not reached. To assess the potential blood pressure response associated with the act of titration, patients in the placebo and losartan 50 mg treatment groups with a sitting diastolic blood pressure of > or = 90 mmHg at week 6 were mock titrated (changed to a new tablet containing the same study medication and dose). Sitting diastolic blood pressure was also evaluated at the end of the trial during a 1-week off-drug period to assess for rebound hypertension. At week 6, patients in the active-drug-treatment arms experienced significantly greater peak (6 h post-dose) and trough (24 h post-dose) reduction in systolic and diastolic sitting blood pressures compared with placebo (p < or = 0.01). Based on trough blood pressures at week 12, active drug (both arms) was more effective than placebo in lowering sitting diastolic blood pressure, with a very small additional benefit associated with increasing the dose of losartan to 100 mg in patients who did not reach the target blood pressure after the first 6 weeks on losartan 50 mg. There was no evidence of rebound hypertension during 1 week after withdrawal of losartan. The correlation between baseline plasma renin activity and reduction in peak and trough blood pressure at week 12, although statistically significant, was generally poor in the active treatment groups. In this trial, losartan was efficacious and well tolerated, and was similar to placebo with regard to adverse-experience profile. Adverse experiences that could reasonably be related to excessive lowering of blood pressure were not common and there was no evidence of rebound hypertension.
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PMID:Comparative antihypertensive effects of losartan 50 mg and losartan 50 mg titrated to 100 mg in patients with essential hypertension. 911 24

Hypertension is a major risk factor for cardiovascular disease. It affects approximately one in five, or 20 per cent of Canadians. The consequences of untreated hypertension include myocardial infarction, stroke, congestive heart failure, peripheral vascular disease and renal disease. By lowering a person's diastolic blood pressure 5 to 6 mmHg, their chances of having a stroke are reduced by 35 to 40 per cent and 20 to 25 per cent for coronary heart disease. While the treatment for hypertension includes both nonpharmacological and pharmacological therapy, this article will explore losartan or Cozaar, which falls under the newest class of antihypertensive drugs, angiotensin II antagonists.
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PMID:Losartan: a new antihypertensive drug. 923 21

There are few studies on the use of dihydropyridine calcium antagonists in hypertensive patients with moderate renal insufficiency. We undertook an open study on the effects on renal function, albumin excretion and blood pressure of the slow-onset, long-acting dihydropyridine calcium antagonist, lacidipine, in 14 patients with stable, chronic renal insufficiency (mean assessed GFR 0.78 ml/s, range 0.50-1.17 ml/s) and moderate hypertension. Following a 2 week washout phase, lacidipine was administered for 24 weeks in a dose of 2 mg/day with the dose being titrated at 2 weekly intervals to a maximum of 6 mg/day in order to achieve adequate blood pressure control. Frusemide was introduced if blood pressure was not controlled on the maximum lacidipine dose. Blood pressure, creatinine clearance, 24 h urinary albumin excretion and plasma creatinine and albumin concentrations were measured at regular intervals throughout the study. Isotopic GFR was determined at the end of the washout period and at week 24. Lacidipine was not very effective in controlling blood pressure and had an adverse effect on renal function. In 3 patients with an incipient nephrotic syndrome this necessitated withdrawal from the study. Mean GFR of the 10 patients who completed the study decreased from 0.69 ml/s/1.73 m2 at baseline to 0.56 ml/s/1.73 m2 at week 24 (p = 0.006) with a decline in GFR being observed in 9 of these patients. The decrease in GFR was greatest in patients with poorly controlled blood pressure. An insignificant increase in mean urinary albumin excretion occurred during the study with this increase being observed only in patients with albuminuria > 1 g/24 h at baseline. These findings indicated that systemic hypertension altered glomerular hemodynamics and that the vasodilatation of pre-glomerular vessels which followed introduction of the calcium antagonist may have exacerbated this situation. The withdrawal of an angiotensin converting enzyme inhibitor during the washout period may have contributed to these changes. We suggest that renal function should be monitored closely in patients with renal insufficiency when a calcium antagonist is being used to control blood pressure, particularly in those with either marginal blood pressure control, significant albuminuria or an incipient nephrotic syndrome.
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PMID:Effect of lacidipine, a dihydropyridine calcium antagonist on renal function of hypertensive patients with renal insufficiency. 935 56

In the treatment of hypertension, some patients may go off control while still on the drugs. This occurs especially with sympathetic inhibitors and vasodilators. Lacidipine, a new calcium antagonist acts principally by vasodilatation. After a wash out period, patients with mild to moderate hypertension received 4 mg of Lacidipine for two weeks. After evaluation at two weeks, those uncontrolled received 6 mg of Lacidipine, while those controlled continued with 4 mg of Lacidipine for another two weeks. By the next evaluation, while patients continued whatever doses they were on, any one who had gone off control had 25 mg of Hydrochlorothiazide added. They were evaluated finally after another two weeks. It was found in this study that 91.3% (21/23) were controlled by the end with only Lacidipine either in 4 mg or 6 mg doses. Another 8.7% (2/23) initially controlled on Lacidipine went off control while still on the drug, and were eventually controlled by adding Hydrochlorothiazide. Some transient side effects not warranting discontinuation were encountered. It is concluded that Lacidipine is effective as monotherapy in mildly to moderately hypertensive Nigerian Africans; with good tolerance and safety profile. Where transient control is encountered, addition of a diuretic could be beneficial.
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PMID:The effect of lacidipine on patients with mild to moderate hypertension and the effect of a combination of lacidipine and hydrochlorothiazide in the treatment of hypertension uncontrolled after four weeks of lacidipine treatment: an open study. 964 60

Effectiveness of Cozaar monotherapy (50 mg at 8 a.m.) was compared to that of Cozaar combination with melatonin (3 mg before sleep) in 21 patients with hypertension stage II (mean age 62 years). Clinical symptoms and hemodynamic parameters were evaluated with ECG and blood pressure monitoring. The findings were processed with statistical methods and Kosinor-analysis. Cozaar alone had moderate hypotensive and vasodilating effects, affected circadian rhythm of systolic and diastolic blood pressure, heart rate. Combination Cozaar + melatonin reduced blood pressure more noticeably, diminished cardiac output, energy consumption of the myocardium, normalized normal chronostructure of blood pressure and heart rate circadian rhythms.
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PMID:[Comparative study of the effectiveness of Cozaar monotherapy and Cozaar and melatonin combined therapy in aged patients with hypertension]. 1006 94

The article presents data on effects of losartan (Cozaar of the Merck-Sharp-Dohme firm, USA) on neurohumoral indices in patients with mild to moderate forms of hypertension. Apart from optimum hypotensive effect and modulating influence on morphofunctional parameters of the heart losartan was found to be endowed with a broad spectrum of neurohumoral effects (reduction in the ejection of catecholamines, natriuretic hormone, stabilization of indices for the renin-angiotensin system etc.). Moreover, the given drug preparation does not have appreciable effect on the activity of the kallikrein-kinin system, by which property it differs favourably from angiotensin-converting enzyme inhibitors.
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PMID:[Neurohumoral changes in patients with mild and moderate forms of hypertension under the influence of losartan]. 1042 62


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