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

The effect of hydrochlorothiazide 50 mg, amiloride 5 mg (HCTZ-A) (Moduretic; MSD) and its combination with pindolol and nadolol on renal function were compared in patients with mild to moderate essential hypertension (mean untreated supine blood pressure 179 +/- 5.7/108 +/- 2.6 mmHg) with compromised renal function (glomerular filtration rate (GFR) < 85 ml/min). After randomisation to a beta-blocker plus diuretic, the beta-blocker was washed out (diuretic-only period) and the other beta-blocker added. Eleven patients completed the randomised cross-over comparative study, 5 receiving pindolol 15 mg plus 1 dose of HCTZ-A daily for 6 weeks, and 6 nadolol 120 mg plus 1 dose of HCTZ-A daily. The beta-blocker was then withdrawn for 4 weeks, after which each group of patients received 1 dose of HCTZ-A plus the alternative beta-blocker daily for 6 weeks. The GFR was measured using chromium-51-ethylenediamine-tetra-acetic acid at the end of each treatment phase. The mean GFR (+/- SE) fell from 69.6 +/- 5.8 to 60.6 +/- 5.1 ml/min (P < 0.01) during HCTZ-A therapy, whereas the addition of pindolol or nadolol caused no further drop in the GFR. We conclude that mild degrees of renal impairment in essential hypertension may be aggravated by HCTZ-A therapy when given as one tablet of Moduretic daily.
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PMID:Effects of therapy on renal impairment in essential hypertension. 146 89

Plasma potassium levels have been implicated in the genesis of cardiac arrhythmias, particularly in patients receiving diuretic therapy. The present study was undertaken to evaluate the stability of plasma potassium levels throughout a 28-h period. Normal volunteers (n = 8) and subjects with essential hypertension (n = 10) were studied in a clinical research center while receiving controlled dietary intakes. Plasma potassium followed a diurnal rhythm in both groups, with a peak level at 12 h and a trough level at 24 h. The average peak-to-trough difference was 0.62 +/- 0.05 mmol/L. Urinary potassium excretion also followed a diurnal rhythm, with the lowest excretory rate during the evening hours, when plasma potassium reached its nadir. Subjects with essential hypertension were restudied after 4 weeks of hydrochlorothiazide (50 mg/day) and then after an additional 4 weeks of hydrochlorothiazide (50 mg/day) and amiloride (5 mg/day). Hydrochlorothiazide alone reduced plasma potassium at all times of measurement without altering the diurnal rhythm. The combination of hydrochlorothiazide and amiloride resulted in higher plasma potassium levels in the morning, but did not significantly affect evening plasma potassium levels. The frequency of hypokalemia (K less than or equal to 3.0 mmol/L) was related to the time at which the plasma potassium was measured. We conclude that plasma potassium undergoes a diurnal rhythm and that diuretics shift this rhythm to uniformly lower values. This rhythm must be considered when defining the frequency of hypokalemia.
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PMID:The diurnal rhythm of plasma potassium: relationship to diuretic therapy. 171 3

Thirty-one centers in the U.K. recruited 637 patients (aged 21 to 75 years) with mild-to-moderate essential hypertension [diastolic blood pressure (DBP) of 95 to 115 mm Hg, and systolic blood pressure (SBP) less than or equal to 200 mm Hg on three occasions]. After a 4-week placebo run-in period, 533 patients were randomized to receive double-blind 4 mg of lacidipine once daily (n = 268) or 50 mg of atenolol once daily (n = 265). If blood pressure was not controlled after 1 month (control = DBP less than or equal to 90 mm Hg, or less than or equal to 95 mm Hg if reduced by greater than or equal to 15 mm Hg from baseline), dosages were increased to 6 mg of lacidipine once daily or 100 mg of atenolol once daily. Hydrochlorothiazide (HCTZ, 25 mg once daily) was added after 2 months of active treatment if required for blood pressure control. Both lacidipine and atenolol reduced blood pressure to a similar degree over the 5 months of double-blind active treatment. The reduction achieved was maintained for the duration of the open phase of the study (to month 14). The incidence of adverse events was also similar for both drugs, and serious adverse events were rare and thought to be unrelated to the study drug therapy. The results indicate that lacidipine once daily for mild-to-moderate hypertension has an efficacy and safety similar to that of atenolol.
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PMID:A double-blind comparison of the efficacy and safety of lacidipine with atenolol in the treatment of essential hypertension. The United Kingdom Lacidipine Study Group. 172 2

This multicenter study was designed to assess the clinical efficacy and safety of the new once-daily calcium antagonist lacidipine in the treatment of mild-to-moderate essential hypertension. Patients were randomly assigned to receive, double-blind, either lacidipine (n = 180) or hydrochlorothiazide (HCTZ, n = 182) following a 1-month placebo run-in period. Both drugs were titrated after 1 month if blood pressure was not controlled: lacidipine, from 4 to 6 mg once daily; HCTZ, from 25 to 50 mg once daily. Atenolol was added later if necessary to achieve blood pressure control. Lacidipine and HCTZ were equally effective in controlling the blood pressure levels in the majority of patients (approximately 90% after 4 months). Adverse events were those to be expected with these classes of drug and were reported in 48 (26.7%) of the patients receiving lacidipine treatment and in 34 (18.7%) of those receiving HCTZ. The diuretic produced a significantly higher incidence of hypokalemia.
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PMID:A double-blind comparison of the efficacy and safety of lacidipine and hydrochlorothiazide in essential hypertension. The Southern Italy Lacidipine Study Group. 172 4

The efficacy and tolerability of a preconstituted formulation combining enalapril (20 mg) and hydrochlorothiazide (12.5 mg) were evaluated in patients with essential hypertension unresponsive to enalapril monotherapy (20 mg/day). The duration of this open-lable, multicenter, noncomparative trial was 12 weeks: a two-week washout period followed by ten weeks of active treatment. During the active treatment period, patients received enalapril alone (up to 20 mg/day) for six weeks. At the end of week 6, patients with supine diastolic blood pressure greater than 90 mmHg were treated with the enalapril/hydrochlorothiazide combination therapy (EN/HCTZ). Of the 147 patients who were entered into the study, 81 were not normalized with enalapril alone. At the end of the study period, blood pressure was normalized (supine diastolic blood pressure less than or equal to 90 mmHg) in 60 (74%) of the 81 patients who had received the EN/HCTZ combination. Overall, 86% of the patients achieved satisfactory blood pressure control with this therapeutic regimen. Adverse reactions were mild and transient. Six patients experienced undesirable effects, the most frequent of which was coughing (2 cases). Neither enalapril (20 mg/day) alone nor the EN/HCTZ combination had any significant influence on any of the metabolic parameters evaluated. No hypokalemia and no significant changes in serum lipids occurred in the course of the study.
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PMID:Efficacy and tolerability of enalapril (20 mg)/hydrochlorothiazide (12.5 mg) combination therapy in essential hypertension. 179 May 48

The effects of cilazapril, isosorbide-5-mononitrate (ISMN), hydrochlorothiazide and placebo on systolic and diastolic cardiac function were studied to evaluate the relative importance of afterload and preload reduction on cardiac function in hypertensive patients. In 86 patients with essential hypertension, radionuclide studies were performed before and after a single oral dose of placebo (18 patients), cilazapril 2.5 mg (35 patients), ISMN 20 mg (18 patients) or hydrochlorothiazide 25 mg (15 patients). The effects on blood pressure, heart rate, left ventricular ejection fraction, peak filling rate and time to peak filling rate were measured. Placebo had no significant effect. A comparable blood-pressure-lowering effect was achieved with cilazapril and hydrochlorothiazide. Cilazapril improved diastolic function by increasing the normalized peak filling rate from 2.3 +/- 0.7 to 2.7 +/- 0.7 vol/s (p less than 0.05) and reducing the time to PFR from 174.5 +/- 33.6 to 152.4 +/- 30.8 ms (p less than 0.005). Hydrochlorothiazide and ISMN, however, impaired left ventricular diastolic function: hydrochlorothiazide decreased the normalized peak flow rate from 2.2 +/- 0.6 to 1.9 +/- 0.6 vol/s (p less than 0.05). ISMN prolonged the time to peak flow rate from 176 +/- 36 to 195 +/- 29 ms and increased the percentage of diastole to peak flow rate from 46 to 53% (p less than 0.05), whereas the normalized peak flow rate was unaltered. In conclusion, predominant afterload reduction by cilazapril improves left ventricular diastolic function in hypertensive patients, while preload reduction by diuretics and nitrates impairs it.
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PMID:Comparative evaluation of the effect of afterload- and preload-reducing drugs on diastolic cardiac function in hypertensive patients. 182 42

Thiazide diuretics cause hypokalemia in some, but not all patients. Adding a second diuretic with a different mechanism of action greatly increases the chance of inducing hypokalemia. Suggestive causative factors include hyperaldosteronism, acid-base status, and the degree of natriuresis. Atrial natriuretic hormone (ANH), a circulating peptide secreted primarily by the heart in response to changes in intravascular volume, induces a natriuresis by a mechanism distinct from the thiazides. It was previously shown that furosemide and thiazide diuretics can increase plasma ANH levels in some patients, but reduce ANH levels in others. This phenomenon was investigated in 26 patients with uncomplicated essential hypertension to observe the relationships between ANH and changes in serum potassium (K+) in response to chronic hydrochlorothiazide therapy (HCTZ, 50 mg/day for 1 month). Regression analysis demonstrated significant correlations between K+ level after HCTZ and initial ANH (r = 0.68, P less than .001), change in K+ level and initial ANH (r = 0.40, P less than .05), K+ level after HCTZ and change in ANH (r = -0.64, P less than .001), and change in K+ levels and change in ANH levels (r = -0.38, P less than .05). By multivariate analysis, initial ANH level, but not the plasma aldosterone level, was significantly (P less than .05) related to the change in K+ after HCTZ. These results suggest that initial plasma ANH levels are a marker predictive for diuretic-induced hypokalemia.
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PMID:Atrial natriuretic hormone. Predictive of the hypokalemic response to thiazide therapy in essential hypertension. 184 14

Carvedilol has been shown to be effective and safe in patients with essential hypertension when given as monotherapy. In this double-blind, randomized, group-comparative study, 2 groups of 59 patients with mild to moderate essential hypertension [median supine systolic/diastolic blood pressure at baseline (SBP/DBP), 168/105 mmHg] were treated with either 25 mg carvedilol once daily (o.d.) or 50 mg atenolol o.d. for 4 weeks. Responders at 4 weeks (DBP, less than 90 mmHg) terminated the study. Nonresponders continued the study. Hydrochlorothiazide (HCTZ) was added at 25 mg o.d. for a further 6 weeks. The median blood pressure decreased under monotherapy with carvedilol (n = 59) from 167/105 at baseline to 155/94 mmHg after 4 weeks, and in the atenolol group (n = 59) it decreased from 168/105 to 162/97 mmHg. The patients who received carvedilol in combination with HCTZ and were evaluated for efficacy (n = 38) showed a decrease in SBP/DBP from 156/97 at the end of monotherapy to 145/88 mmHg after 10 weeks; the combination of atenolol with HCTZ (n = 44) reduced BP from 162/97 to 147/88. Both carvedilol and atenolol were safe when given either alone or in combination with HCTZ. In conclusion, after long-term administration, 25 mg carvedilol o.d. and 50 mg atenolol o.d. significantly reduced both SBP and DBP over 24 h. The addition of HCTZ led to a further increase in antihypertensive efficacy. Combined treatment with carvedilol or atenolol and HCTZ was very well tolerated, without hypotensive events or relevant changes in objective safety parameters.
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PMID:Safety and antihypertensive efficacy of carvedilol and atenolol alone and in combination with hydrochlorothiazide. 197 5

This was a randomized double-blind, multiclinic, parallel, three treatments group study to compare the safety and efficacy of a fixed-ratio combination of enalapril/hydrochlorothiazide (E/HCTZ: 20/12.5-40/25 N = 46) to enalapril (E = 20-40 mg, N = 49) and hydrochlorothiazide (HCTZ: 12.5-25 mg, N = 51) once daily, in the treatment of patients with moderate to severe essential hypertension (100 less than or equal to supine diastolic blood pressure less than or equal to 120 mmHg). A significant decrease of systolic and diastolic blood pressure was shown in the 3 subgroups of patients. The decrease of blood pressure was significantly greater in the E/HCTZ subgroup. After 8 weeks of treatment, the E/HCTZ group had the greatest proportion of normotensive patients (65.9 p. cent, DBP less than or equal to 90 mmHg) and of responders (81.8 p. cent, diastolic blood pressure decrease greater than 10 mmHg). The treatment groups did not differ significantly with respect to clinical adverse events. The study results document the well-known hyperuricemic effect of diuretics and also indicate that the combination of enalapril and HCTZ ameliorates this effects. In this study plasma potassium was slightly but not significantly decreased by HCTZ. The combination of enalapril and hydrochlorothiazide did not alter this parameter. The results support the conclusion that in the treatment of moderate to severe hypertension, the combination enalapril/HCTZ 20/12.5 to 40/25 mg, taken once daily, is more effective than either its components used alone. This combination is well tolerated, probably due to an adequate enalapril/HCTZ dosage ratio.
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PMID:[Comparative study of enalapril, hydrochlorothiazide and their combination in the treatment of essential hypertension]. 202 11

J. W. Franz graded exercise test (GET) was employed to examine healthy subjects, untreated patients with stage I and II essential hypertension and hypertensive subjects treated with hydrochlorthiazide, alpha-methyldopa, prazosine, dilthiazem resultant in normal resting values of blood pressure. Hydrochlorthiazide did not protect the patients from a pathological hypertensive response to GET, whereas alpha-methyldopa and prazosine furnish a physiological hypertensive response in much less number of patients and dilthiazem made possible normal response in the majority of treated patients. GET is suggested for assessing effectiveness of hypertension treatment and individual choice of antihypertensive drugs.
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PMID:[Evaluation of therapy effectiveness in patients with hypertension using graded physical load]. 206 32


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