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

Recent trials have linked calcium antagonists with adverse cardiovascular events in hypertensive patients with diabetes. A closer examination of these trials (in particular the Appropriate Blood Pressure Control in Diabetes [ABCD] trial and the Fosinopril Versus Amlodipine Cardiovascular Events Trial [FACET]) reveals a lack of data from which to draw conclusions of harm. In fact, based on the results of these trials and the recent Hypertension Optimal Treatment (HOT) Trial, one may conclude that the combination of a calcium antagonist with an ACE inhibitor is a rational therapeutic choice in patients with coexisting hypertension and diabetes.
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PMID:Calcium antagonists and cardiovascular risk in diabetes. 982 45

Optimal treatment of hypertension requires the use of effective antihypertensive drugs. Calcium channel blockers are widely used in the treatment of hypertension and appear to be particularly efficacious in ethnic Chinese patients. The aim of this open-label study was to prospectively investigate the efficacy and tolerability of three dihydropyridine calcium channel blockers in sequence, using the same protocol for each. After 2 weeks of placebo treatment, 73 males and 45 females (mean age, 45 +/- 10 years; mean weight, 67 +/- 10 kg) with essential hypertension (diastolic blood pressure, 95 to 115 mm Hg) were treated with amlodipine (n = 41), felodipine (n = 38), or isradipine (n = 39) for 8 weeks, with dose titration after 4 weeks. Mean seated systolic and diastolic blood pressure decreased by 23/17, 30/17, and 20/15 mm Hg after 8 weeks of treatment with amlodipine, felodipine, and isradipine, respectively. These reductions were all statistically significant. Blood pressure was controlled (defined as diastolic pressure < 90 mm Hg at the final visit or a decrease from baseline of > or = 10 mm Hg) in 85%, 74%, and 74% of patients receiving amlodipine, felodipine, and isradipine, respectively. There were no significant changes in heart rate, plasma lipid levels, or serum biochemistry markers with any of the three treatments. No serious adverse events occurred, but mild adverse effects, including headaches, flushing, tachycardia, dizziness, and edema, were reported; 1 (2%), 6 (16%), and 5 (13%) patients receiving amlodipine, felodipine, and isradipine, respectively, withdrew from the study (P < 0.05). The results of this study indicate that all three drugs are highly effective in lowering blood pressure and are well tolerated in Chinese patients with mild-to-moderate hypertension.
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PMID:Amlodipine, felodipine, and isradipine in the treatment of Chinese patients with mild-to-moderate hypertension. 991 9

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. In the elderly patient, often with mild but prolonged elevation of plasma thyroid hormones, symptoms and signs of heart failure and complicating atrial fibrillation (AF) may dominate the clinical picture and mask the more classic endocrine manifestations of the disease. Impaired cardiopulmonary function and exercise capacity, significantly more marked in older patients, is observed in hyperthyroidism. Thyrotoxicosis can aggravate pre-existing heart disease and can also lead to AF, congestive heart failure, or worsening of angina pectoris. Regarding the high incidence of AF in older patients with hyperthyroidism, it is also important to detect subclinical hyperthyroidism in older patients with AF, thus warranting the measurement of the serum thyrotropin (TSH) concentration for early recognition and treatment. Most cardiac abnormalities return to normal once a euthyroid state has been achieved, although AF may persist in a minority. Optimal treatment requires rapid and definitive antithyroid therapy. Furthermore, anticoagulation is recommended for thyrotoxic patients with AF older than 50 years, those who have histories of previous emboli, hypertension, or with echocardiographic evidence of left atrial enlargement and/or myxomatous valves.
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PMID:Cardiac risks of hyperthyroidism in the elderly. 992 Mar 73

In the Hypertension Optimal Treatment (HOT) study, hypertensive patients who were randomly assigned to undergo antihypertensive treatment to achieve a goal diastolic blood pressure of 80 mm Hg or lower did not experience fewer cardiovascular events than did patients who received treatment with goal pressures of 85 or 90 mm Hg. Such aggressive antihypertensive treatment was safe and well tolerated, and did result in fewer cardiovascular events in the subset of patients with diabetes. All patients were randomly assigned to take aspirin 75 mg/day or placebo, and patients in the aspirin group had a 15% lower rate of major cardiovascular events and myocardial infarctions than did patients who received placebo. This finding establishes the efficacy of aspirin in preventing strokes and myocardial infarctions in hypertensive patients.
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PMID:Aggressive blood pressure lowering is safe, but benefit is still hard to prove. 998 56

Taking into consideration the available data in 1998, we believe that short-acting calcium antagonists should no longer be used in hypertensive patients. The practice of using oral or sublingual nifedipine in hypertensive emergency or pseudoemergency should be abandoned because it can lead to serious side effects such as syncope, myocardial infarction, stroke and even death. However, the use of a low dose of the long-acting formulations seems to be safe and promising in patients with essential hypertension. In the Hypertension Optimal Treatment (HOT) trial a calcium-antagonist based combination therapy reduced blood pressure by over 20 mmHg in most of the nearly 19,000 patients. Cardiovascular mortality in this study was with 3.8 per 1000 patient years clearlylower as compared to 6.5 per 1000 patient years reported in previous intervention trials. A long-acting dihydropyridine calcium antagonist was used in 78% of these patients. Clearly the calcium antagonists controversy was helpful in alerting physicians to the fact that hypertension remains a surrogate endpoint and that not all drugs that reduce blood pressure will reduce morbidity and mortality to the same extent. What was completely unnecessary, however, was the inappropriate news media coverage to the calcium blocker controversy that led to panic and confusion among patients and frustration among physicians. In this context we should perhaps remember the first rule in the treatment of Sir George Pickering: "Never frighten your patients."
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PMID:[Calcium antagonists in cardiovascular diseases--a valuable controversy, but unnecessary panic]. 1006 34

Optimal methods of endotracheal anesthesia using non-opiate drugs of four classes (clofelin, transamine, contrykal, ketanes) have been fundamentally grounded developed and tried in extensive and traumatic operations for ENT malignant and vascular tumors as well as inflammation in patients of high anesthesiological operative risk. The drugs were used in 174 patients including 13 children. 87.9% of the patients had concomitant diseases: blood hypertension, coronary heart disease, chronic nonspecific pulmonary diseases, bronchial asthma, asthmatic bronchitis, diabetes mellitus, anemia. Adequate stable anesthesia was achieved in reduced dosage of conventional anesthesiological agents.
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PMID:[Use of nonopiate agents for anesthesia in ENT patients at high surgical-anesthesiological risk]. 1008 93

Optimal management of hypertension involves finding a balance among its benefits, risks and costs. Cost-effectiveness analysis helps to clarify not only the trade-offs between the costs and benefits of treatment, but also the trade-offs between the risks and benefits, and the costs and quality of therapy. Existing analyses of hypertension treatment suggest a consistent set of strategies by which cost-effectiveness may be improved. These include strategies to increase the effectiveness of therapy, such as excluding false-positive diagnoses of hypertension, and according higher priority to treating patients with sustained elevations of diastolic blood pressure above 100mm Hg. A complementary set of strategies involve reducing the costs of therapy by prescribing lower-cost first-step regimens, making use of the minimum effective dose for particular medicines and attempting step-down therapy for suitable patients. Consideration of economic factors in initiating hypertension treatment is consistent with sound clinical practice.
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PMID:Economic factors in the initiation of antihypertensive therapy. 1014 45

The Hypertension Optimal Treatment (HOT) study showed that substantial reductions in blood pressure and a corresponding lowering of the risk of myocardial infarction could be achieved by intensive antihypertensive therapy. A cost-effectiveness analysis was performed to determine the possible economic consequences of three different targets of diastolic blood pressure lowering--< or = 90 mm Hg, < or = 85 mm Hg, and < or = 80 mm Hg, and of the coadministration of aspirin. The cost of each drug was first estimated at high and low dosage. Next, by drawing on data from the HOT trial, the mixture and dosage of drugs for each level of blood pressure control were estimated. This allowed computation of the annual cost of drugs for each blood pressure target. Because the rate of myocardial infarction (MI) was the only endpoint that differed significantly among the three target blood pressure groups, the MI risk data were converted into years of life gained on the basis of fatalities from MI averted. The cost-effectiveness ratios, expressed as cost per year of life gained, were most favorable for the < or = 90-mm Hg treatment target group ($4262) and for added aspirin treatment ($12,710). For moderately aggressive treatment (blood pressure < or = 85 mm Hg), the cost-effectiveness ratio escalated incrementally to $86,360 and with intensive treatment to $658,370 per year of life gained. Thus treatment to a target of 90 mm Hg and coadministering aspirin were considered highly cost effective, whereas treatments to lower the blood pressure further to 85 mm Hg were marginally cost effective; intensive blood pressure lowering down to 80 mm Hg was not cost effective.
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PMID:Cost effectiveness of intensive treatment of hypertension. Based on presentations by Donald S. Shepard, PhD; and Dominic Hodgkin, PhD. 1033 8

The HOT study (Hypertension Optimal Treatment) was designed to answer three questions: What is the optimum target diastolic blood pressure (DBP) level that treatment should reach for the greatest reduction in cardiovascular mortality risk; whether there are additional benefits with a progressive reduction of diastolic blood pressure from 90 to below 80 mmHg; and whether low-dose acetylsalicylic acid is of any additional benefit in the primary prevention of myocardial infarction in treated hypertensive patients? To resolve this posing, more than 19,000 essential hypertensives were recruited in 26 countries worldwide by 1,904 investigators with a follow-up period of almost 4 years. Patients were randomly assigned to three different diastolic blood pressure targets: < or = 90 mmHg, < or = 85 mmHg or < or = 80 mmHg respectively. Additionally, in each group, patients were randomly assigned to acetylsalicylic acid or placebo. The follow-up period was about 4 years. Although the HOT trial failed to demonstrate the primary objective for which it was designed, of defining optimum target diastolic blood pressure to be achieved by antihypertensive treatment, this HOT study has helped to clarify very important issues related to blood pressure lowering such as the nonexistence of the J-shaped curve concept in hypertension, the possibility of achieving substantial improvement in blood pressure control by the use of antihypertensive combination therapy, the additional benefit of low-dose aspirin in primary prevention of myocardial infarction among treated hypertensives, and the demonstration of the necessity of reducing diastolic blood pressure below 80 mmHg in diabetic hypertensive patients. For all these reasons, the HOT study is destined to become among the most relevant hypertension intervention studies of this century.
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PMID:[Repercussions in clinical practice of the results of the HOT (Hypertension Optimal Treatment) study]. 1037 69

In 1998 the final results were presented of two large intervention trials in hypertension, the Hypertension Optimal Treatment Study (HOT) and the Captopril Prevention Project (CAPPP). Both were initiated from Sweden although the HOT Study was conducted in 26 countries worldwide and the CAPPP Study in Finland and Sweden. The HOT and CAPPP trials and their principal results will be reviewed briefly here. In addition a brief up-date will be provided of three ongoing intervention trials in hypertension that were also initiated from Sweden: the Swedish Trial in Old Patients with Hypertension-2 (STOP-Hypertension-), the Nordic Diltiazem (NORDIL) Study and the Study on Cognition and Prognosis in Elderly Hypertensives (SCOPE).
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PMID:Recent intervention trials in hypertension initiated in Sweden--HOT, CAPPP and others. Hypertension Optimal Treatment Study. Captopril Prevention Project. 1042 77


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