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

Hypertension and certain alterations in serum lipoproteins such as a decrease in high density lipoprotein-cholesterol (HDL-C), an increase in low density lipoprotein-cholesterol (LDL-C) and perhaps also elevated triglycerides (Tg), are complementary coronary risk factors. Moreover, it has become evident that several of the drugs used for standard antihypertensive therapy may also interact with lipoprotein metabolism. The following has been observed after 1 to 12 months of treatment. Various diuretics can significantly increase LDL-C and/or very LDL-C and total C/HDL-C ratio, while HDL-C is often largely unchanged; Tg also are often elevated. LDL-C increased in diuretic-treated men and in chlorthalidone-treated postmenopausal women but not in chlorthalidone-treated premenopausal women. The latter may be protected from this side effect. Drug dosages were usually high in these studies. Indapamide, given at a dose of 2.5 mg/day, seems to exert no relevant effect on the lipoproteins. It is not established whether this difference is related to the nature of the drugs or the doses used. There is little doubt that the dose of chlorthalidone used was greater than that required for a full antihypertensive effect of this drug. Several beta-blockers given as monotherapy induce significant increases in Tg and a tendency for decreases in HDL-C. These changes are most prominent on non-selective beta 1+2-blockers without partial intrinsic sympathomimetic activity (ISA), less pronounced on highly selective beta 1-blockers without ISA, and even more discrete or absent on beta-blockers with distinct ISA. Other sympatholytics such as reserpine, methyldopa, debrisoquine, urapidil, clonidine, labetalol, or postsynaptic alpha-blockers (prazosin, trimazosin, doxazosin etc.) did not affect or, postsynaptic alpha-blockers in particular, sometimes even slightly decreased Tg or LDL-C and very LDL-C values. During combination therapy, diuretic-induced increases in LDL-C were at short term prevented or reversed by the concomitant administration of certain beta-blockers, but not by sympatholytics such as reserpine, methyldopa or clonidine. With combined diuretic-prazosin treatment, a tendency for slightly higher HDL-C was reported. Angiotensin converting enzyme inhibitors (captopril, enalapril) and calcium channel blockers (verapamil, nifedipine, nitrendipine, diltiazem) seem to be largely devoid of undesirable effects on serum lipoproteins. Monotherapy with the potent direct vasodilator carprazidil improved blood pressure and significantly increased HDL-C. Whether and to what extent the observed variations in lipoproteins may persist beyond 1 year of treatment is as yet unclear.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Serum lipoproteins during treatment with antihypertensive drugs. 304 51

Unlike some thiazide diuretics, indapamide--a non-thiazide chlorosulphonamide derivative--has been shown to have a magnesium-sparing effect in normotensive subjects. This effect has not been studied in hypertensive subjects. In a randomised double-blind trial indapamide 2,5 mg and placebo were given daily to a group of elderly patients with mild hypertension, with and without supplemental magnesium chloride. Blood pressure and serum and red blood cell cations were measured. The significant antihypertensive effect of indapamide was confirmed. There was no effect of indapamide on serum and red cell magnesium concentrations compared with placebo, both with and without magnesium supplementation. Indapamide induced hypokalaemia with a shift of sodium into the red cells. In this group of elderly hypertensive subjects indapamide induced potassium but not magnesium loss.
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PMID:Effect of indapamide on serum and red cell cations, with and without magnesium supplementation, in subjects with mild hypertension. 304 87

The effects of indapamide and captopril on office and ambulatory blood pressure control and on general well-being were investigated in 30 active, randomly selected patients from 25 to 68 years old, with mild to moderate essential hypertension (diastolic blood pressure, 92 to 114 mm Hg). Twenty-four-hour ambulatory blood pressure monitoring using an ICR model 5200 portable recorder and evaluation of general well-being were performed prior to and at the end of three months of therapy with indapamide 2.5 mg given once daily, or captopril 12.5 to 50 mg given twice daily. Indapamide and captopril were equally effective in controlling blood pressures in clinic and during 24-hour activities. Although general well-being and subjective symptomatology improved with both treatments, the only significant difference between the two drugs was improvement in the sleep dysfunction scale with indapamide (p less than 0.02). The results shown in this study suggest that both indapamide (2.5 mg) once daily and captopril (12.5 to 50 mg) twice daily are suitable drugs for initial therapy of active patients with mild to moderate hypertension. A fixed once-daily dosage of an antihypertensive agent may, however, increase patient compliance and convenience.
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PMID:Analysis of well-being and 24-hour blood pressure recording in a comparative study between indapamide and captopril. 327 19

Fifteen patients with mild-to-moderate hypertension (10 with normal and five with decreased renal function) were studied after treatment with placebo and low (1 mg), intermediate (2.5 mg), and high (5.0 mg per day) doses of indapamide, each for four weeks. Six patients--five with normal renal function--were classified as nonresponders (decrease in diastolic blood pressure less than 5 mm Hg). The remaining nine patients had dose-related decreases in blood pressure. Patients with or without renal failure showed similar decreases in blood pressure. Blood pressure reduction was associated with a significant decrease in cardiac index in the responders at the highest dose, related to a decrease in left ventricular end-diastolic dimension and stroke volume, whereas heart rate did not increase. This apparent decrease in venous return was associated with a significant decrease in body weight but not plasma volume in the responders. Indapamide did not change plasma norepinephrine levels, but decreased pressor responsiveness to exogenous norepinephrine. Responders had lower initial plasma renin activity and a smaller absolute increase in plasma renin activity while receiving indapamide, whereas angiotensin II pressor responsiveness was decreased more. The results presented indicate that the blood pressure lowering effect of indapamide in the present patient population is observed with or without renal failure and is associated with a decrease in pressor reactivity. In nonresponders, compensatory mechanisms (e.g., renin) may negate the antihypertensive effect of indapamide.
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PMID:Cardiovascular effects of indapamide in hypertensive patients with or without renal failure. A dose-response curve. 334 90

Diuretic therapy is still regarded as the first-step approach in elderly patients with benign or moderate arterial hypertension. Traditional preparations such as thiazides, or potassium-sparing agents, are not devoid of significant side effects, however. Indapamide, a nonthiazide diuretic, has been shown to reduce blood pressure at low doses, in several clinical reports. In the present study, the effect of indapamide (2.5 mg per day) was compared with that of hydrochlorothiazide (50 mg per day) on blood pressure and serum chemistry of 47 elderly hypertensive patients (ages 65 to 91). After a six-week placebo-treatment period, patients were randomly assigned to receive either indapamide or hydrochlorothiazide. At that moment, blood pressure of patients in the supine position averaged 185 +/- 2/107 +/- 2, and 181 +/- 3/102 +/- 2 mm Hg, in the indapamide and hydrochlorothiazide groups, respectively. After 48 weeks of therapy, blood pressure was 162 +/- 3/89 +/- 2 and 170 +/- 2/94 +/- 2 mm Hg in the same groups, respectively. Serum sodium levels remained unchanged in indapamide-treated patients, but decreased progressively from 141 +/- 1 to 134 +/- 1 meq/liter in hydrochlorothiazide-treated patients. Serum potassium levels decreased from 4.50 +/- 0.12 to 4.04 +/- 0.10 meq/liter in indapamide-treated patients, whereas in the patients receiving hydrochlorothiazide, kalemia decreased from 4.23 +/- 0.09 to 3.33 +/- 0.01 meq/liter. Finally, serum uric acid levels did not increase significantly in patients receiving indapamide, whereas it rose from 6.5 +/- 0.4 to 8.7 +/- 0.3 mg/dl in patients treated with hydrochlorothiazide. In conclusion, indapamide resulted in a better control of systolic and diastolic blood pressure in this group of elderly hypertensive patients. In addition, the effect of each drug on blood chemistry differed markedly: indapamide failed to alter significantly the serum ionic composition, whereas hydrochlorothiazide was associated with both hyponatremia and hypokalemia.
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PMID:Hypertension in elderly patients. A comparative study between indapamide and hydrochlorothiazide. 334 91

The efficacy of captopril alone or in combination with indapamide was evaluated in 17 patients with severe hypertension (diastolic greater than 120 mmHg) previously treated with triple antihypertensive therapy, i.e. diuretic, beta-blocker and a vasodilator. After a wash-out period of 1 week, captopril was given initially as 75 mg/day for 2 weeks; at the end of this period, the dosage was doubled to 150 mg/day and continued at this level for a further 2 weeks. Indapamide (2.5 mg/day) was then added to the regimen and administered for 1 month. The results showed that captopril alone lowered, but did not normalize the blood pressure. The mean diastolic pressure was reduced to 117 and 103.8 mmHg after dosages of captopril of 75 mg and 150 mg, respectively. On the addition of indapamide, the blood pressure was normalized to 93.82 mmHg mean diastolic pressure. Systolic readings were similarly reduced. Two patients developed skin rashes while on captopril alone: no other treatment-related side-effects were reported once indapamide therapy had commenced.
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PMID:Antihypertensive effect of indapamide given in conjunction with captopril in severe hypertension. 354 87

Ten hypertensive non-insulin-dependent diabetic patients were treated with the antihypertensive drug indapamide to assess its effect on glucose tolerance over 1 year. Both systolic and diastolic blood pressures fell significantly (p less than 0.001) over the first month of treatment, and no change in plasma glucose or plasma insulin levels during an oral glucose tolerance test occurred at any time. Indapamide is an effective antihypertensive drug and, in contrast to thiazide diuretics, has no adverse effect on glucose tolerance in non-insulin-dependent diabetic patients.
Hypertension
PMID:Effect of indapamide on blood pressure and glucose tolerance in non-insulin-dependent diabetes. 390 19

The results of a study conducted using a new loop diuretic, Azosemide, on a group of 45 patients suffering from hypertension and oedema are reported. Thirty patients were studied in an open trial and in association with other drugs. The remaining 15 exclusively hypertensive patients, were studied in a controlled trial against Indapamide. The patient's standing and recumbent arterial pressure was monitored and all were given periodic weight checks. In the 1st group, Azosemide brought about a significant reduction in arterial pressure, without modifying body weight, but caused considerable weight loss (from 71 to 64 kg) (P less than 0,01) in the oedema patients without altering arterial pressure. In the 2nd group of hypertensive patients, a significant fall in arterial pressure (from 166 to 138 mmHg) was observed, most notably after Azosemide treatment. None of the patients revealed side effects, or alterations in laboratory parameters. It is therefore suggested that Azosemide--given its effectiveness and ease of application--is particularly useful for the diuretic treatment of hypertensive and oedematous patients.
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PMID:[Diuretic and antihypertensive activity of azosemide]. 401 Oct 12

Indapamide is an effective antihypertensive agent for which a dual mechanism of action has been put forward: a limited diuretic activity combined with antivasoconstrictive effects, resulting in decreased peripheral vascular resistance. Results from clinical trials show that 2.5 mg indapamide once daily effectively reduces arterial blood pressure in about two-thirds of patients with mild to moderate hypertension and that this reduction is related to the severity of the hypertension. As a rule, indapamide's blood pressure-reducing effect is rapid in onset (within 1 or 2 weeks) and by 1 month reaches 65% of its maximum, which occurs after 3 to 4 months of treatment. No tachyphylaxis has been observed during long-term treatment, nor has withdrawal syndrome at discontinuation of therapy. Indapamide has been successfully combined with beta blockers, methyldopa, and other antihypertensive agents, adding considerable effectiveness without noticeable increase in adverse reactions. In general, the drug is well tolerated and side effects are mild and rare. Possibly in relation to its limited diuretic activity at 2.5 mg daily, long-term treatment seldom elicits significant changes in electrolyte balance. In addition, indapamide does not induce deleterious effects on carbohydrate and lipid metabolism. Indapamide is an effective, well-tolerated, first-line antihypertensive agent. The fact that long-term administration does not induce biochemical abnormalities that constitute cardiovascular risk factors indicates another advantage of the drug.
Hypertension
PMID:A review of 10 years of experience with indapamide as an antihypertensive agent. 407 33

The beneficial effect of antihypertensive pharmacotherapy in decreasing morbidity and mortality in hypertensive patients may be counteracted by metabolic and biochemical disturbances, such as hypokalemia, hyperglycemia, hyperuricemia, and hyperlipoproteinemia, that occur with the administration of thiazides and related diuretics. Antiatherogenic high-density lipoprotein cholesterol may be unchanged, whereas the potentially atherogenic low-density lipoprotein cholesterol may be increased by long-term therapy with thiazide diuretics. Indapamide is a methylindoline antihypertensive diuretic with a considerable peripheral vasodilatory effect. At a low dose of 2.5 mg daily, it did not alter total circulating cholesterol, in contrast to chlorthalidone. High-density lipoprotein cholesterol levels increased significantly in 20 hypertensive men after 6 months of therapy with indapamide, resulting in a significant fall of the low-density lipoprotein/high-density lipoprotein ratio, an atherogenic risk factor, regardless of preexisting lipid disorders.
Hypertension
PMID:Serum lipoprotein levels during long-term treatment of hypertension with indapamide. 407 36


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