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Query: UMLS:C0085580 (essential hypertension)
 14,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sleep apnea syndrome is a relatively common disease, with an overwhelmingly male predominance. The female:male ratio is about 1:15-20, depending on the specific age group. In light of findings linking sleep apnea syndrome to essential hypertension, it is hypothesized that the syndrome may contribute to the sex differential in mortality. In most of the developed countries women have longer life expectancy than men even after adjustment for various lifestyles and biologica variables Mortality from heart disease accounts for 40% of the total sex differential. The fact that the 2-5 fold sex differential for heart disease mortality is reduced to much lesser extent by multivariate adjustment than the sex differential for mortality from all causes, and that it is minimally affected by the exclusion of all persons with a history of chronic diseases, indicates that other risk factors should be sought. I propose the hypothesis that Sleep Apnea Syndrome (SAS), which almost exclusively affects males, contributes to the sex differential in mortality from coronary heart disease. Sleep Apnea Syndrome is a relatively common disease. It is the most preponderant finding among patients referred to diagnostic sleep laboratories, particularly among patients complaining of excessive daytime sleepiness. Its incidence among the adult male population (age greater than 21 years) was estimated to be at least 1-1.5%. It is considerably higher than that, at least 5 to 7 fold, in the 40 to 60 years age group, and in specific high-risk populations such as the morbidly obese. The female:male ratio is about 1:15-20, depending on the specific age group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sleep apnea syndrome: is it a contributing factor to the sex differential in mortality? 364 99

This study assessed the antihypertensive efficacy and side effects of clonidine administered transdermally. Twenty-five patients with mild to moderate essential hypertension (seated diastolic blood pressure 95-120 mm Hg with diuretic therapy alone) controlled with oral diuretic plus oral clonidine were enrolled. Transdermal clonidine was substituted for oral clonidine and titrated until adequate blood pressure control (seated diastolic blood pressure less than 90 mm Hg) was attained. At the end of titration, seated morning blood pressure averaged 129/90 +/- 15/5 mm Hg (mean +/- standard deviation) compared to 136/96 +/- 13/7 mm Hg (p less than 0.01/0.001) during oral clonidine administration. Standing morning blood pressure was also lower during transdermal than oral therapy (131/94 +/- 16/5 vs 136/99 +/- 14/7, p less than 0.05/0.001). Afternoon blood pressures (at peak effect of oral dose) were virtually identical during oral and transdermal therapy in both seated and standing positions. Typical side effects of oral clonidine, including dry mouth, drowsiness, and sexual dysfunction, were reduced during transdermal therapy. There was less morning-to-afternoon variability of blood pressure control and plasma clonidine concentrations during transdermal than during oral therapy. One patient left the study because of drowsiness and two because of skin reactions to the transdermal skin patch. Mild transient local skin irritation occurred frequently. Transdermal clonidine plus a diuretic is an effective treatment for mild to moderate essential hypertension, improves compliance and reduces side effects of therapy.
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PMID:Transdermal administration of clonidine: a new approach to antihypertensive therapy. 395 4

17 subjects with essential hypertension (14 male, 3 female - ages: 40-69 years), 13 of whom continued their previous anti-hypertensive therapy, completed a double-blind cross-over trial of ketanserin 40 mg twice daily versus placebo tablets twice daily - each treatment phase was six weeks in duration. For the group as a whole, blood pressure (BP) was reduced in the ketanserin phase compared with the placebo phase; supine mean BP decrease: 4 +/- 1 mm Hg (p less than 0.05); standing mean BP decrease: 7 +/- 1 mm Hg (p less than 0.001). Heart rate (HR) was also significantly decreased in the ketanserin phase by 5 +/- 1 beats/minute (p less than 0.001). When individual subgroups were analysed the reductions in BP and HR were greater in subjects already receiving anti-hypertensives, diuretic and/or beta blockers. Changes were observed in 24 hour urine sodium and potassium excretion - sodium (mmol/day): placebo 137 +/- 17, ketanserin 174 +/- 19 (p less than 0.05); potassium (mmol/day): placebo 74 +/- 8, ketanserin 57 +/- 5. For the group as a whole there were no significant adverse effects during the ketanserin phase, although two subjects had a dose reduction of ketanserin because of drowsiness and dizziness. Two additional subjects withdrew from the study due to adverse effects, one in the placebo phase. In conclusion ketanserin in the dose administered has a modest hypotensive effect which is best seen in subjects already receiving other anti-hypertensive agents.
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PMID:The effect of ketanserin on blood pressure and biochemical parameters in treated patients with essential hypertension. 614 14

Clinical assessment of a novel antihypertensive drug combination was undertaken in a group of essential hypertensive patients (n = 20). The effects of several doses of clonidine and its association with prazosin on blood pressure (BP), systolic time intervals (STI), and electrocardiogram (ECG) were investigated. Clonidine monotherapy induced a good BP control at 60%. BP was controlled in those patients in which prazosin was combined with clonidine (87.7%). LVETc was reduced by 0.3, 0.6, and 0.9 mg clonidine daily (p less than 0.05). PEPc was increased by only 0.9 mg, and it was diminished after its combination with 20 mg prazosin daily (p less than 0.05). PEP/LVET index was significantly increased by a higher dose of clonidine (p less than 0.05). ECG intervals did not change with the exception of PR, which was prolonged by 0.9 mg clonidine daily (p less than 0.05). Dry mouth, sedation, constipation, and drowsiness were the main side effects observed during the investigation. These results suggest an alternative treatment of essential hypertension, with a novel clinical application of drugs such as clonidine and prazosin, which have pharmacologic action via different alpha-adrenergic mechanisms.
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PMID:Clonidine and prazosin in the treatment of hypertensive outpatients--a preliminary study. 664 91

The long-term haemodynamic effects of ketanserin, a new serotonin-antagonist, was examined in 13 patients of both sexes (age range 24-62 years) with mild and moderate essential hypertension (EH). Cardiac output (CO) and intra-arterial blood pressure (BP) were measured at rest and during exercise before and after nine months of therapy. On ketanserin the mean casual BP was lowered by 15/21 mmHg to 152/91 mmHg and five of the 13 patients became 'normotensive' (BP less than 140/90 mmHg). The intra-arterial systolic pressure fell by 5-8% and the diastolic pressure by 5-11% from pretreatment levels at rest supine, sitting and during 50, 100 and 150 W exercise. The fall in BP was associated with a reduction in CO at rest while during exercise both a fall in CO and in total peripheral resistance contributed to the hypotensive effect. The fall in CO was due to a reduction in heart rate (average: -4 to 8 beats/min). The stroke volume remained unchanged in all settings and oxygen consumption was not affected by the drug. Body weight and body fluid volumes did not change significantly. Eight patients complained of drowsiness and lack of concentration. It is concluded that in mild and moderate EH ketanserin induces a moderate BP reduction associated with a fall in CO. There is no large vasodilating effect after long-term ketanserin treatment either at rest or during exercise. Ketanserin does not influence body fluid balance. The incidence of side-effects is high.
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PMID:Long-term effects on central haemodynamics and body fluid volumes of ketanserin in essential hypertension studies at rest and during dynamic exercise. 668 Nov 81

The clinical pharmacology of a central antihypertensive drug, guanfacine, was studied in sustained essential hypertension. The study of the haemodynamics, performed in 7 patients demonstrated a significant decrease in blood pressure and a fall in heart rate (less than the one observed with clonidine): the peripheral resistances remained unchanged after 4 days treatment. A clinical trial was carried out in 20 patients with sustained essential hypertension. Guanfacine was given orally (2 to 4 mg/day) during 2 months; the results of this study confirmed the antihypertensive effect of the drug. The most frequent side effects were dryness of the mouth and sleepiness. Guanfacine kinetics were studied in patients after single and repeated oral doses. The plasma concentrations were fitted in a two compartments open model with first order absorption. Steady state plasma level during a long term treatment can be determined with the predicted values derived from simulation of the initial individual kinetic studies. For a 2 mg dosage the biological half-life was 22.8 +/- 3.6 h. Guanfacine kinetics were linear according to the dosage. In moderate permanent essential hypertension guanfacine can be easily prescribed in monotherapy at a posology of 2 to 4 mg/day.
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PMID:[Clinical pharmacology of the antihypertensive action of guanfacine]. 677 9

Patients with mild to moderate essential hypertension were treated with guanabenz plus placebo (26 patients) or guanabenz plus hydrochlorothiazide (26 patients) for one year. Ambulatory plasma renin activity was determined during placebo treatment, after four weeks and one year of treatment with the study drugs, and one month after discontinuation of guanabenz while continuing the same hydrochlorothiazide dosage. Treatment with guanabenz plus hydrochlorothiazide proved more satisfactory than treatment with guanabenz plus placebo in that fewer patients were treatment failures, a smaller dosage of guanabenz was required, better control of supine blood pressure was achieved, and no increase in guanabenz dosage was needed to maintain chronic blood pressure control. Drowsiness, dry mouth, and dizziness were the side effects noted most commonly. Plasma renin activity was not significantly suppressed by chronic guanabenz therapy. Thus, guanabenz is an effective new antihypertensive that provides optimal blood pressure control when used with a diuretic.
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PMID:Effect of guanabenz and hydrochlorothiazide on blood pressure and plasma renin activity. 701 28

The efficacy, safety, and tolerability of lofexidine, a centrally acting imidazoline derivative, were compared to that of clonidine in a randomized double-blind trial in 28 patients with moderate essential hypertension. The study consisted of a washout phase, a placebo phase, a drug titration phase (0.2 to 1.6 mg/day, with hydrochlorothiazide added at 0.4 mg daily for supine and erect diastolic blood pressure above 90 mm Hg), and a maintenance phase lasting 3 mo. During the titration phase supine systolic and diastolic pressures fell in lofexidine patients from 143 +/- 4/98 +/- 3 to 122 +/- 3/81 +/- 2 mm Hg and in clonidine patients from 154 +/- 6/101 +/- 2 to 124 +/- 4/81 +/- 2 mm Hg (P less than 0.01), and erect systolic and diastolic pressures fell in lofexidine patients from 143 +/- 3/105 +/- 2 to 116 +/- 3/85 +/- 2 mm Hg and in clonidine patients from 156 +/- 6/104 +/- 2 to 117 +/- 4/82 +/- 2 mm Hg (P less than 0.01). Maximal doses of lofexidine and clonidine in combination with hydrochlorothiazide had equivalent antihypertensive effects, but when the effects of lofexidine and clonidine were compared at each dose level, larger doses of lofexidine patients in either the supine or erect position during the titration phase but heart rate fell in the clonidine patients (P less than 0.05) over the same period. Dry mouth and drowsiness were reported in both groups but were both less frequent and less severe in the lofexidine group than the clonidine group.
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PMID:Lofexidine and clonidine in moderate essential hypertension. 703 May 78

The results of a double-blind cross-over study designed to evaluate the antihypertensive efficacy and safety of guanabenz versus methyldopa in mild-to-moderate essential hypertension are presented. Thirty patients were randomly assigned to a group receiving either guanabenz or methyldopa as initial therapy for 8 weeks, followed by a 2-week wash-out period; the patients then took the other trial medication for 8 weeks. There was a significant fall in both standing and supine systolic and diastolic blood pressures during each treatment period, but no statistically significant difference between the guanabenz and methyldopa periods. However, there was a significant difference between the two drugs as regards side-effects. In the guanabenz group 21% of patients stopped taking the drug because of side-effects or inefficacy compared with none of the patients in the methyldopa group. The overall incidence of adverse experiences was 76% for guanabenz and 50% for methyldopa. There was a statistically significantly greater incidence of dry mouth with guanabenz then with methyldopa, while drowsiness was common in both groups. It is concluded that guanabenz is as effective as methyldopa in the therapy of mild-to-moderate essential hypertension but that the side-effects, particularly dry mouth, will seriously limit its usefulness.
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PMID:Guanabenz versus methyldopa in the therapy of mild-to-moderate hypertension. 705 65

Lofexidine, a new centrally acting antihypertensive agent, was compared in a double-blind study with clonidine in the treatment of mild (standing diastolic blood pressure 95-104 mm Hg) or moderate (105-129 mm Hg) essential hypertension. In dialy dosages of 0.2 or 0.4 mg, monotherapy with lofexidine produced significant decreases in blood pressure and heart rate that were not different from those with clonidine. Blood pressure and heart rate were not different from those with clonidine. Blood pressure control (supine and standing diastolic pressure less than 90 mm Hg) occurred in seven of eight mild hypertensives treated with lofexidine and in seven of ten treated with clonidine. In moderate hypertension, three of 11 and seven of ten, ten of the 14 responders to clonidine required dosages of 0.4 mg daily or less. The maximum dosage tested was 1.6 mg daily. Concomitant hydrochlorothiazide therapy was given to eight of the lofexidine responders and 12 of the clonidine responders. For both drugs, drowsiness and dry mouth were the chief complaints. Neither agent changed standard clinical biochemistries except for decreased potassium and increased bicarbonate concentrations due to concurrent diuretic therapy. Lofexidine to have clinical characteristics similar to those of clonidine. Each of these agents is best used in lower doses, which are frequently effective and less likely to produce symptomatic complaints.
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PMID:Centrally acting antihypertensive agents: a comparison of lofexidine with clonidine. 722 19


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