Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Several major studies investigated the possibility of a primary preventive effect of beta-blockers. The International Prospective Primary Prevention Study in Hypertension (IPPPSH) compared a beta-blocker-containing vs. a non-beta-blocker-containing antihypertensive regimen in 6,357 moderate-severe hypertensive men and women treated over 3-5 years. Blood pressure (BP) control was comparable with either regimen. beta-Blocker treatment was associated with less hypokalemia, earlier electrocardiogram normalization, and fewer withdrawals for uncontrolled hypertension. In agreement with the Medical Research Council (MRC) trial on mild hypertension and the Heart Attack Primary Prevention in Hypertension (HAPPHY) trial, but at variance with the Primary Prevention Metoprolol in Patients with Hypertension (MAPHY) study, cardiac event rates were similar in beta-blocker- and non-beta-blocker-treated patients. With either regimen, in-study BP reduction was associated with a lower rate of stroke as well as of cardiac events. In a subgroup analysis, nonsmokers appeared to derive beta-blocker benefit, the results being similar to those of the MRC. Smokers required higher doses of drugs to achieve diastolic target pressure, had a higher heart rate and hematocrit, and a higher cardiac event rate than nonsmokers at any given level of diastolic pressure. Except for the MAPHY trial, these primary prevention studies do not support the concept of a cardiac primary preventive effect of antihypertensive beta-blockade but stress the importance of good BP control and a comprehensive risk factor prevention approach in the management of hypertensive patients.
 ...
PMID:Smoking, antihypertensive treatment benefit, and comprehensive antihypertensive treatment approach: some thoughts on the results of the International Prospective Primary Prevention Study in Hypertension. 170 33

Metoprolol is a relatively beta 1-selective beta-blocker used extensively to treat hypertension and angina and as a prophylaxis after myocardial infarction. Conventional formulations are usually administered twice daily and the drug has a tendency to lose its selectivity of action at higher plasma concentrations. Two controlled release formulations, metoprolol CR and metoprolol 'Oros', have made it possible to achieve sustained beta 1-blockade over an entire 24h period and to minimise the loss of selectivity associated with higher plasma concentrations. The CR formulation has been extensively investigated and is the major subject of this review. The 'Oros' formulation is pharmaceutically different from the CR, yet both produce similar plasma concentration profiles and comparable beta 1-blocking effects. The availability of these preparations occurs at a time when increasingly persuasive data are becoming available on the cardioprotective or coronary preventive action of metoprolol.
 ...
PMID:Controlled release metoprolol. Clinical pharmacokinetic and therapeutic implications. 177 47

The cardiovascular responses of 24 healthy young adult males with a parental history of hypertension and 24 males without a parental history of hypertension to an extended active-coping psychological stressor were compared under three drug conditions: placebo, the beta 1-blocking agent metoprolol, and the alpha 1-blocking agent prazosin. In the placebo condition, offspring of hypertensives exhibited significantly greater heart rate, blood volume pulse, and forearm blood flow responses to the task. They also exhibited a significantly greater initial decrease in forearm vascular resistance, which, in contrast to the offspring of normotensives, was no longer significantly different from baseline levels by the end of the session. No group differences in blood pressure response were observed. Metoprolol eliminated the differences in heart rate and forearm vascular resistance responses. Prazosin eliminated the difference in blood volume pulse response and elicited a sustained group difference in forearm vascular resistance. These results implicate the sympathetic nervous system in the exaggerated cardiovascular responsivity to psychological stress in individuals with a family history of essential hypertension. They also suggest that the pattern of increasing vascular resistance in response to this stressor observed in this and other studies in this laboratory reflects alpha-adrenergic activity and not neurohumorally independent autoregulation.
 ...
PMID:Exaggerated sympathetic nervous system response to extended psychological stress in offspring of hypertensives. 188 58

The effect of long-term therapy of hypertension with antihypertensive drugs was investigated in 117 previously untreated patients (15 women, 102 men; mean age 46.4 +/- 9 years) with echocardiographically proven left-ventricular hypertrophy. 22 patients (group 1) received 100 mg/d Gallopamil, 25 (group 2) received 200 mg/d Metoprolol, 35 daily received both 50 mg Atenolol and 20 mg Nifedipine (group 3), 14 received daily 200 mg Acebutolol plus 20 mg Nifedipine (group 4), and 21 (group 5) 50 mg Atenolol plus 10 mg Enalapril daily. The treatment period lasted a mean of 38 (36.2-42.3) months. Left-ventricular muscle mass index (LVMI) as well as septal and posterior-wall thickness decreased significantly after 12.8 and 38.5 months (P less than 0.001). After a mean of 38.5 months LVMI had decreased by 36.7% in group 1, 35.1% in group 2, 42.3% in group 3, 45% in group 4 and 39.6% in group 5. LVMI was within normal range (less than or equal to 95 g/m2) in 81 of the 117 patients (69.2%) at the end of the treatment period. There was, however, no significant increase of the end-diastolic dimension of the left ventricle, but a significant increase of "fractional shortening" as a measure of myocardial contractility.
 ...
PMID:[Regression of left ventricular hypertrophy in hypertensive patients under long-term therapy with antihypertensive agents]. 213 9

In two separate but similarly designed placebo-controlled studies, the efficacy of metoprolol CR/ZOK 50 mg once daily was evaluated in 64 patients (mean age 53 years) with mild hypertension (Study I) and in 34 elderly patients (mean age 68 years) with mild to moderate hypertension (Study II). Both studies were of randomized, double-blind, parallel-group design, the entry criteria for diastolic blood pressure being greater than or equal to 90 less than 105 mm Hg in Study I and greater than or equal to 95 less than 110 mm Hg in Study II. Study I: The impact of metoprolol CR/ZOK 50 mg once daily for 4 weeks compared with placebo 24 hours post dosing was to produce a significant reduction in supine (P = .0001), and standing (P less than .0001) systolic blood pressures and the standing diastolic pressure (P = .035). The supine diastolic pressure was lower after metoprolol CR/ZOK but not significantly so. Study II: Metoprolol CR/ZOK 50 mg daily given to elderly hypertensives when compared with placebo 24 hours post dosing produced a significant fall in supine (P = .022) and standing (P = .022) diastolic pressure. Systolic pressure and heart rate were not significantly reduced. One patient in Study II had a nonfatal myocardial infarct whilst receiving placebo. There were no other serious adverse effects in either study and no patients were withdrawn from the trial because of drug related unwanted events. The studies indicate that 50 mg metoprolol CR/ZOK may be an effective antihypertensive agent which may prove useful in the treatment of mild to moderate hypertension, particularly in the elderly.
 ...
PMID:The efficacy of low dose metoprolol CR/ZOK in mild hypertension and in elderly patients with mild to moderate hypertension. 217 83

Because hypertension is a major risk factor for cardiovascular disease it would be expected that therapeutic reduction of blood pressure would protect patients from coronary heart disease (CHD). Twelve long-term trials involving over 40,000 patients have been performed to study the effectiveness of diuretics and beta-blockers in controlling blood pressure and reducing cardiovascular morbidity and mortality. However, no other drugs have been tested. The Hypertension Detection and Follow-up Program, European Working Party in the Elderly and the Metoprolol Atherosclerosis Prevention in Hypertension trial were the only studies where a significant reduction in total, cardiac and cardiovascular mortality were observed. Moreover three large trials have demonstrated some reduction in CHD among male nonsmokers. This review examines all these trials as well as some of the reasons for this disappointing outcome. New trials using modern antihypertensive drugs should be performed to analyze whether they contribute directly to protection from coronary events and other cardiovascular complications.
 ...
PMID:[Effect of antihypertensive therapy on the prevalence of ischemic cardiopathy in arterial hypertension. New contributions]. 218 56

One hundred twenty-six patients with mild to moderate hypertension responsive to beta-adrenergic blocking agents--alone or in combination with other antihypertensive drugs--entered this open-label, multicenter study designed to evaluate the safety and tolerability of metoprolol OROS (metoprolol fumarate). Metoprolol OROS was given once daily for 14 weeks in doses ranging from 100 to 600 mg. Satisfactory blood pressure control was achieved by 85% of the patients at doses between 100 and 400 mg. Mean diastolic blood pressure was maintained at or below 90 mm Hg. Adverse reactions were experienced by 29% of the patients; most of these reactions were mild or moderate, and none was unexpected for treatment with a beta-blocker. Only three patients withdrew because of adverse reactions. The results of this study indicate that metoprolol OROS given once daily is safe and well tolerated.
 ...
PMID:Safety and tolerability of metoprolol OROS in hypertension treatment. 238 34

The authors tested in an open, uncontrolled trial in a group of 23 patients with essential hypertension grade I-II (WHO classification) the effect of Metoprolol OROS. The OROS system is a new form of Metoprolol administration which makes it possible to maintain by a single dose per day a steady plasma concentration, while preserving the cardioselectivity and total 24-hour effectiveness during treatment of hypertension and angina pectoris. After eight weeks of Metoprolol OROS administration, in doses gradually adjusted to the therapeutic action, gradually a significant decrease of the heart rate (HR) occurred, of the systolic blood pressure (BPs) and diastolic blood pressure (BPd) (p less than 0.01 for all values) in a recumbent as well as upright position. A reduction of the BPd in an upright position by greater than or equal to 10 mm Hg was achieved in 85% of the patients, in 73.9% of the patients the BPd in an upright position dropped below 95 mm Hg. Four patients developed side-effects which were mild to medium severe (vertigo, palpitations, fatigue, sensation of tremor, tension in the lower extremities). Two patients discontinued treatment early, the main reason in both being palpitations which were under better conversely, in two patients palpitations which were not adequately controlled by previous metoprolol treatment, disappeared completely during Metoprolol OROS treatment. During the trial no significant changes in the investigated laboratory values incl. total cholesterol were recorded, Metoprolol OROS administered once per day is an effective, safe and well tolerated preparation in treatment of mild to medium severe essential hypertension.
 ...
PMID:[The effect of OROS metoprolol in mild and moderately severe essential hypertension]. 239 74

The influence of single oral doses of 200 mg celiprolol, 100 mg atenolol, and 200 mg metoprolol on airway resistance (Raw) FEV1, VC, and MEF 50 was studied in a randomized double-blind crossover trial. Eighteen patients with hypertension and asthma, 14 men and 4 women, aged 43-75 years, took part. Pulmonary function tests were performed in the morning before treatment and 2 and 5 h after each treatment in the whole-body plethysmograph. The use of bronchodilators was not allowed during the 3 days. There was no significant change in airway resistance, FEV1, and MEF 50 after celiprolol and a slight increase of vital capacity at 2 h. After atenolol there was a decrease of FEV1 and MEF 50 at 5 h. Metoprolol caused an increase in resistance at 2 and 5 h and a fall in FEV1, VC, and MEF 50 at 2 and 5 h. Two patients required bronchodilator therapy after metoprolol and were excluded from evaluation. We conclude that celiprolol appears to be a safe drug in the treatment of asthmatic patients.
 ...
PMID:The effect of the cardioselective beta blocker celiprolol on pulmonary function in asthmatic patients. 242 62

The effect of beta-blocking agents on post-myocardial infarction patients with a history of hypertension or elevated blood pressure (BP) at baseline in two prospective placebo-controlled postinfarction studies using beta-adrenoceptor blocking agents (the Stockholm Metoprolol Trial and the Norwegian Timolol Study) is discussed. The results of both of these trials indicate that active beta-blockade reduces the incidence of nonfatal reinfarction, although the BP levels were similar in the two treatment groups. The differences in the efficacy of treatment in previous studies of hypertension are discussed. So far, none of the studies has shown a significant difference in mortality when different antihypertensive therapies have been compared in the same study. Some aspects of designing future trials comparing different treatment regimens in hypertension are discussed.
 ...
PMID:Beta-blockade in ischemic heart disease and hypertension. 248 Nov 71


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>