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

One hundred and ten mild and moderately hypertensive patients were treated with a fixed combination of captopril 50 mg and hydrochlorothiazide 25 mg (Capozide 50) once daily for 12 months. Eighty four patients were treated initially with Capozide 50 12 hourly for 3 months before receiving Capozide 50 o.d.; the other 26 patients received Capozide 50 as initial treatment immediately after the placebo run-in period. Blood pressures were measured 24 hours after ingestion of the drug. Capozide 50 once daily induced statistically significant reductions in supine blood pressure and these beneficial effects were sustained throughout the duration of the trial. In patients receiving Capozide 50 as initial therapy, a gradual hypotensive effect was seen. No clinically significant changes in biochemical or haematological variables were recorded although a small but statistically significant rise in uric acid was noted. This latter effect was attributed to the thiazide component of the combination. The efficacy and safety profile of this once-a-day compound makes it an ideal therapeutic agent for the management of mild and moderate hypertension.
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PMID:Efficacy of captopril and hydrochlorothiazide administered once a day. 353 51

Clopamide pharmacokinetics were determined after oral doses of 5, 10, and 20 mg in normal volunteers. Maximum plasma concentrations occurred within 2 hours and were followed by a monoexponential decline with an elimination half-life of approximately 10 hours. There was an approximately linear relationship between dose and the AUC. Urinary sodium, chloride, and potassium excretion rates indicated that the peak diuretic activity corresponded with peak plasma drug concentrations and probably continued for 12 to 24 hours. There was little difference between the total sodium and chloride output after each dose of clopamide, suggesting that 5 mg may have been close to the top of the dose-response curve. Chlorothiazide, 500 mg, caused less sodium and chloride output with similar potassium loss. During chronic administration to patients with hypertension, hypokalemia was more marked with clopamide, 10 mg daily, than with clopamide, 5 mg, or chlorothiazide, 500 mg daily.
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PMID:Clopamide: plasma concentrations and diuretic effect in humans. 362 84

Thirty-seven patients (19 Blacks and 18 Indians) suffering from mild hypertension were given each of five diuretics separately for 4 weeks after a 'washout' period on placebo of the same duration. The diuretics used were hydrochlorothiazide 25 mg/d (Dichlotride; Frosst MSD), hydrochlorothiazide 25 mg plus triamterene 50 mg (Dyazide; SKF) 1 tablet per day, amiloride hydrochloride 5 mg plus hydrochlorothiazide 50 mg (Moduretic; MSD) 1 tablet per day, chlorthalidone (Hygroton; Geigy) 50 mg/d and indapamide (Natrilix; Servier) 2.5 mg/d. The study showed that during the acute phase of diuretic therapy for the treatment of hypertension plasma potassium levels were decreased by thiazide and thiazide-like diuretics and increased by potassium-sparing diuretics. However, despite the decrease in plasma potassium levels produced by thiazide diuretics and indapamide these levels did not fall to 3.0 mmol/l or less. All the diuretics were effective in lowering the standing mean arterial pressure when compared with placebo values. In the absence of significant hypokalaemia, the choice of a diuretic for the Black hypertensive patient should therefore be determined by its cost.
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PMID:Biochemical changes in black and Indian hypertensive patients on diuretic therapy. 664 35

Approximately 600 people with mild to moderate hypertension were treated with a regimen that started with monotherapy. Reduction in sodium intake achieved adequate blood pressure control in 38 percent, higher than that achieved without therapy (17 percent). Chlorothiazide and propranolol gave satisfactory blood pressure control in 43 and 56 percent of patients, respectively, as sole therapy. When initial blood pressure was greater than 110 mm Hg, satisfactory control was achieved in fewer patients (sodium restriction, 13 percent; chlorothiazide, 30 percent, propranolol 38 percent); in this group, therapy with reduction of sodium intake alone is rarely effective. All measures were about equally successful in treating isolated systolic hypertension. The group given thiazide diuretics alone had an increased number of deaths from myocardial infarcts compared with other groups. This was not seen if a beta-blocking drug or a centrally-acting drug was used in conjunction with the thiazide diuretic. Monotherapy can successfully reduce blood pressure in most patients with mild hypertension. No regimen can be stated to be unequivocally superior to another.
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PMID:Monotherapy in the treatment of hypertension. 682 42

In 14 elderly male residents of a veterans' care complex who were receiving diuretic therapy for cardiac failure, oral potassium (K) supplements were withdrawn. Plasma and erythrocyte K levels were measured immediately before and six weeks after withdrawal of the supplements (38 mEq K daily). The controls comprised 19 elderly residents without disease and not taking drugs likely to influence K status. Study subjects and controls were receiving the same diet (average daily K content 100 mEq). After withdrawal of K supplements, the mean plasma K level fell significantly but the mean erythrocyte K level remained unchanged and did not differ from the control values. For a further six weeks after the withdrawal period, 7 subjects were treated with Aldactazide (diuretic hydrochlorothiazide plus K-sparing spironolactone). The plasma K level increased significantly but the erythrocyte K level remained unchanged. It was concluded that, in this setting, diuretic-induced hypokalemia is not necessarily accompanied by intracellular K depletion and that routine prophylaxis with K supplements or K-sparing agents is unnecessary and not without risk. Such therapy should be reserved for patients considered at special risk of K depletion because of known poor dietary intake, advanced liver disease, secondary hyperaldosteronism with renovascular hypertension, gastrointestinal losses, or nondiuretic medication known to affect K status adversely.
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PMID:Diuretics and the institutional elderly: a case against routine potassium prescribing. 720 9

Among 54 patients attending a hospital hypertension clinic and receiving the fixed-combination diuretic Moduretic (hydrochlorothiazide 50 mg, amiloride 5 mg), there was a 44.4% incidence of hypokalaemia. The mean drop in plasma potassium level was 0.69 mmol/L (P less than 0.0001), the mean low level being 2.81 mmol/L. Seventy-four per cent of falls occurred within 52 weeks of the start of therapy, 19.5 weeks being the average period between a normal and a low plasma potassium level. There was no difference in the fall in potassium level between male and female subjects, and beta-blockers were not obviously protective, although there was a statistically significant smaller fall in potassium level in females treated with them. The clinical significance of the unexpected hypokalaemia is uncertain; but even with fixed-combination diuretics, it remains necessary to monitor the plasma potassium level regularly in order to avoid complicating situations. The results of the present study would cast doubt on the efficacy of 5 mg of amiloride with 50 mg of hydrochlorothiazide in fixed-combination form in preventing hypokalaemia in this clinical situation.
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PMID:Plasma potassium levels in hypertensive patients receiving fixed-combination diuretic therapy. 739 77

Only approximately 40% to 50% of hypertensive patients will achieve goal blood pressures of <140/ 90 mm Hg with monotherapy, regardless of the medication used. Fixed-dose combination therapy with two different classes of antihypertensive agents will achieve goal pressures in more than 70%. The sixth Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure has suggested that the use of combination therapy is appropriate as initial treatment. The advantages of combinations include: 1) greater blood pressure decrease and response rates than monotherapy; 2) fewer side effects with small doses of two drugs than with large doses of one agent; 3) improved adherence to treatment; and 4) possibly lower cost of therapy. Many different combinations of diuretics and beta-blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists, as well as ACE inhibitors and calcium antagonists are available. Two of these, Ziac and Capozide, have been approved as initial therapy. It is possible that the number of hypertensive individuals controlled at goal blood pressure levels will be increased if combination therapy is used as initial treatment.
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PMID:The role of combination therapy in the treatment of hypertension. 965 66

Twenty four hour blood pressure (BP) monitoring was carried out and structural state of left ventricular myocardium assessed in 20 patients with mild and moderate hypertension before and after 24 weeks of therapy with Hyzaar - fixed dose combination of losartan (50 mg) and hydrochlorothiazide (12.5 mg). According to data of 24-hour BP monitoring the use of Hyzaar was associated with lowering of diurnal (by 26.9/17.2+/-3/2 mm Hg, p<0.001), nocturnal (by 32.6/18.9+/-3/2 mm Hg, p<0.001), pulse (p<0.001) BP, and rate of morning systolic BP rise (p<0.05), decrease of nocturnal systolic and diastolic BP variability, and improvement of 24-hour BP rhythm. Trough/peak coefficients for systolic and diastolic BP (70 and 76%, respectively) reflected sufficient and steady hypotensive effect throughout 24 hours after single dose of Hyzaar. Target BP level was achieved in 70% of patients. At the background of 24-week treatment with Hyzaar left ventricular myocardial mass index significantly decreased (from 120.1+/-3.5 to 108.6+/-3.1 g/m2, D=11.5+/-1.0, p<0.001) and became normal in 60% of patients. Correlation analysis revealed independence of cardioprotective action of therapy from its hypotensive activity. Thus therapy with Hyzaar produced hypotensive and cardioprotective effects which were independent from each other.
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PMID:[Therapy of patients with arterial hypertension with fixed dose combination of losartan and hydrochlorothiazide. Effect on 24 hour blood pressure and left-ventricular hypertrophy]. 1459 57

Previous studies have demonstrated that antihypertensive treatment resets baroreflex control of heart rate (HR) and increases cardiac vagal baroreflex sensitivity. However, it is uncertain whether baroreflex control of muscle sympathetic nerve activity (MSNA) also resets after treatment. We tested the hypothesis that chronic antihypertensive therapy alters baroreflex regulation of MSNA in patients with untreated moderate hypertension. Seven newly diagnosed patients with systolic blood pressure (BP) of 159+/-5 mm Hg (mean+/-SE) and diastolic BP of 103+/-4 mm Hg were studied before and after 1 to 2 weeks ' and 3 months (chronic) of antihypertensive treatment with losartan-hydrochlorothiazide (Hyzaar). MSNA and hemodynamics were measured supine, during a Valsalva maneuver (VM), and at 70 degrees head-up tilt (HUT) for 10 minutes. Data were compared with those obtained in 7 age-matched healthy controls. We found that Hyzaar lowered mean BP acutely and chronically by 20+/-4 and 23+/-3 mm Hg (both P<0.01) but did not change HR. Supine MSNA increased by 43+/-11% and 34+/-11% after acute and chronic treatment (both P<0.01). However, MSNA responses to VM and HUT did not differ after treatment compared with before treatment, indicating unchanged reflex control. These data indicate that sympathetic neural activity was augmented substantially by antihypertensive treatment with Hyzaar, consistent with an ongoing baroreflex unloading, and did not return to baseline or "reset" after 3 months of therapy. We speculate that persistent and marked sympathetic activation by the baroreflex may be a potential mechanism for hypertension that is refractory to antihypertensive therapy and may provide a target mechanism for persistent morbidity despite adequate BP control.
Hypertension 2005 Apr
PMID:Persistent sympathetic activation during chronic antihypertensive therapy: a potential mechanism for long term morbidity? 1612 77

This article narrates the development and promotion in the 1950s and 1960s of Merck, Sharp & Dohme's Diuril (chlorothiazide), an antihypertensive drug, which played a significant role in the redefinition of high blood pressure as a widespread target for chronic pharmaceutical consumption. The joined careers of Diuril and hypertension in the late twentieth century demonstrate the connections between the clinical research, clinical practice, and marketing practices through which pharmaceuticals and disease categories come to define one another. By examining a series of internal documents preserved in the Merck Archives alongside a careful reading of the clinical literature and industry journals of the time, this article explores how the ambitions of marketers, physicians, and public health advocates found convergence in the expanding pharmaceutical prevention of chronic diseases.
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PMID:Releasing the flood waters: diuril and the reshaping of hypertension. 1632 86


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