Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085580 (essential hypertension)
 14,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A randomized, double-blind, cross-over study comparing 50 mg hydrochlorothiazide plus 5 mg amiloride (HCTZ/A) with 50 mg hydrochlorothiazide plus 26 mmol potassium chloride (HCTZ/K) was conducted in 18 patients with mild essential hypertension (diastolic pressure 90-105 mmHg). The sequence of treatment was: placebo for 2 weeks, one active drug for 3 weeks, placebo for 2 weeks, the other active drug for 3 weeks. The two agents were significantly and equally efficacious in lowering the systolic and diastolic blood pressure. Baseline vs. treatment mean serum potassium levels were 3.82 vs. 3.78 mmol/l for HCTZ/A and 3.82 vs. 3.70 mmol/l for HCTZ/K. The decrease in serum potassium level from baseline was significant for both agents but not significantly different when the two treatment forms were compared. Both treatment forms elevated fasting serum cholesterol and glucose. Serum triglycerides and uric acid rose significantly with HCTZ/K. Amiloride may affect the tubular handling of uric acid causing increased uric acid excretion, thus counteracting thiazide-induced hyperuricemia. During 3 weeks' extension of the main study, 5 patients received HCTZ/A in double the original dose (100 mg/10 mg) and 6 patients received HCTZ/K in double the original dose (100 mg/52 mmol). No further blood pressure reduction was observed on treatment with these doses. The mean serum potassium levels did not decrease further on doubling the HCTZ/A dose, while a significant fall was observed for HCTZ/K (3.60 vs. 3.42 mmol/l) (p less than 0.05, single tailed t-test). Both drug combinations were well tolerated and side-effects were not significantly different from those during placebo administration. This study demonstrates that 50 mg hydrochlorothiazide plus 26 mmol potassium chloride are as effective as 50 mg hydrochlorothiazide plus 5 mg amiloride, both in reducing blood pressure and preventing hypokalaemia in the treatment of essential hypertension. A small extension study indicates that amiloride might be more effective than potassium chloride in preventing hypokalaemia when high doses (100 mg/day) of hydrochlorothiazide are administered.
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PMID:Hydrochlorothiazide and potassium chloride in comparison with hydrochlorothiazide and amiloride in the treatment of mild hypertension. 391 35

The study involved 13 patients with primary hypertension who exercised on a bicycle ergometer with intensity increasing up to submaximum level. The exercise was carried out in four stages: before treatment (1st study), following one week treatment with 50 mg hydrochlorothiazide daily (2nd study), after one week treatment with the same dose of hydrochlorothiazide and 120 mg binazine daily (3rd study), and after one week treatment with hydrochlorothiazide and binazine, and 60 mg of propranolol daily (4th study). Using the approach of Weissler et al., left ventricular systolic time intervals were analysed at rest, after exercise and up to the 90th minute of restitution. Hydrochlorothiazide and binazine treatment decreased systolic and diastolic blood pressure, the total electromechanical systolic time index (QS2I) and the left ventricular ejection time index (LVETI), and increased the PEP/LVET index at rest and after exercise. Addition of propranolol did not augment the hypotensive effect, while the left ventricular systolic time intervals returned to the values observed before treatment.
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PMID:Post-exertion changes in left ventricular systolic time intervals in patients with primary hypertension treated with hydrochlorothiazide, binazine, and propranolol. 409 41

Adrenal-enucleated, mononephrectomized rats given a high salt diet rapidly develop malignant hypertension, characterized by the presence of necrotizing vascular lesions in a number of organs and tissues. If a normal salt intake is provided, or if hydrochlorothiazide is given together with a high salt diet, there is, instead, the delayed onset of benign hypertension which either stabilizes or increases in intensity extremely slowly; Such animals display few, if any, pathologic vascular changes other than occasional focal glomerular hyalinization, show insignificant cardiac enlargement, and do not exhibit alterations in the serum sodium or potassium. Occasional animals behave atypically and develop malignant hypertension despite normal salt consumption, demonstrating that in susceptible rats excess salt is not essential to this disorder. Hydrochlorothiazide given to rats that imbibed distilled water postoperatively prevented hypertension entirely for 97 days, when one of eight rats developed mild hypertension and some others reached what is regarded as a prehypertensive range. It is concluded that adrenal regeneration provides a physiological milieu favorable to the development of benign hypertension, which is not, as a rule, manifest until regeneration is complete. Salt excess converts the response into one in which malignant hypertension begins during regeneration and worsens rapidly thereafter until death. The course and findings are compared with those of the benign and malignant phases of clinical essential hypertension, and the implications of the similarities are discussed.
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PMID:Benign and malignant hypertension after adrenal enucleation in the rat. Relationship to salt intake, response to hydrochlorothiazide, and similarity to essential hypertension. 602 46

M-mode echocardiography was used in 12 patients with essential hypertension to study changes in cardiac anatomy during long-term therapy with hydrochlorothiazide (50 to 100 mg) and alpha-methyldopa (500 to 1,750 mg). Echocardiographic examination was performed after six weeks of treatment with hydrochlorothiazide alone and after four to six weeks, six months, and nine months of treatment with both hydrochlorothiazide and alpha-methyldopa. Hydrochlorothiazide alone induced a small, and not significant, change in blood pressure (from 157 +/- 16 (SD)/105 +/- 9 to 150 +/- 14/101 +/- 5 mm Hg). Changes in echocardiographic parameters of cardiac anatomy were not observed during short-term diuretic therapy. Addition of alpha-methyldopa further reduced blood pressure (to 133 +/- 11/90 +/- 6 mm Hg, p less than 0.001), which was maintained throughout the study. Gradual decreases in diastolic septal thickness (from 10.9 +/- 1.1 to 9.5 +/- 1.0 mm, p less than 0.01), relative wall thickness (from 0.40 +/- 0.06 to 0.36 +/- 0.06, p less than 0.05) and left ventricular cross-sectional area (from 18.9 +/- 2.9 to 17.3 +/- 2.6 cm2, p less than 0.05) were observed. Posterior wall thickness did not change significantly during the study. The results provide evidence for regression of echocardiographic parameters of cardiac muscle mass during long-term antihypertensive treatment with a diuretic and a centrally-acting sympatholytic drug. Regression of left ventricular mass was not clearly related to changes in casual blood pressure. However, patients who showed a decrease in septal thickness tended to have a greater decrease in systolic blood pressure than those in whom septal thickness did not change during therapy. Moreover, patients in whom a decrease in left ventricular transverse dimension was observed, had a greater decrease in both systolic and diastolic blood pressure than those in whom left ventricular diastolic dimension did not change.
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PMID:Effect of long-term antihypertensive therapy on cardiac anatomy in patients with essential hypertension. 622 88

Thirty-nine patients were entered into a 12-week, randomized, double-blind, parallel protocol to assess the safety and efficacy of enalapril (MK-421, 10 to 20 mg bid), hydrochlorothiazide (HCTZ, 25 to 50 mg bid), or combined drug therapy (MK-421 + HCTZ) for the treatment of primary hypertension. Specifically monitored were the effects of each drug program on BP and pulse, serum chemistries, body fluid composition and weight, renal function, and the renin-angiotensin-aldosterone axis. Results indicate that MK-421, HCTZ, and combined therapy were equally effective in lowering BP; none of the therapies significantly altered glomerular filtration rate or effective renal plasma flow. Patients on MK-421 experienced no change in volume, an increase in plasma potassium, no change in fractional sodium or potassium excretion, and a decreased urine osmolality associated with an enhanced free-water clearance. Plasma renin activity was increased, plasma angiotensin II was decreased, and plasma aldosterone was unchanged. In contrast, patients on HCTZ developed volume contraction, hypokalemia associated with an increase in fractional sodium and potassium excretion, and an increased urine osmolality associated with a decreased free-water clearance. Plasma renin activity was increased, however, plasma angiotensin II and plasma aldosterone were unchanged. Patients on combined therapy with MK-421 + HCTZ demonstrated qualitatively similar changes in serum chemistries, body fluid volumes, and renal function compared with patients receiving HCTZ alone, whereas changes in the renin-angiotensin-aldosterone system in these patients were qualitatively similar, but more marked, compared with those occurring in patients receiving MK-421 alone. We conclude that MK-421 is an effective first-step antihypertensive agent that does not produce adverse metabolic, volume, or renal effects.
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PMID:Comparative studies: enalapril versus hydrochlorothiazide as first-step therapy for the treatment of primary hypertension. 633 Nov 57

The effects on blood pressure, the renin-angiotensin-aldosterone and the kallikrein-kinin systems were investigated in 32 patients with primary hypertension WHO stage I-II treated with captopril. Hydrochlorothiazide was added if needed to achieve a supine diastolic blood pressure of less than or equal to 90 mmHg. A placebo control group (n=8) was treated similarly. Supine mean arterial pressure fell from 133 +/- 10 on placebo to 114 +/- 12 mmHg after 4 weeks on captopril. At the same time plasma aldosterone decreased from 263 +/- 188 to 164 +/- 101 pmol . 1(-1), 24 h urinary excretion of aldosterone from 18 +/- 12 to 12 +/- 10 nmol and kallikrein from 9.0 +/- 6.7 to 6.2 +/- 4.1 nkat. Plasma angiotensin II was significantly reduced after two weeks treatment from 23.2 +/- 8.6 to 17.0 +/- 6.7 pmol . 1(-1). Before, but not during captopril, 24 h urinary kallikrein excretion correlated with plasma aldosterone levels and 24 h urinary aldosterone excretion (r=0.44 p, less than 0.05 and r=0.53, p less than 0.01, respectively). Mean arterial pressure reduction on captopril correlated with pretreatment PRA (r=0.44, p less than 0.05) but not with other measured hormone levels or changes therein. The addition of hydrochlorothiazide caused a further fall in blood pressure, but increased plasma aldosterone and 24 h urinary kallikrein excretion. Hydrochlorothiazide alone increased only 24 h urinary aldosterone excretion significantly. These findings indicate that, besides aldosterone secretion and renal arterial pressure, further mechanisms regulating the release of and activity of the renal kallikrein-kinin system exist.
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PMID:Captopril, aldosterone and urinary kallikrein in primary hypertension. 634 63

The antihypertensive effect of once and twice daily hydrochlorothiazide administration was compared in 24 ambulatory patients with essential hypertension. Hydrochlorothiazide 100 mg daily taken as a single morning dose or as a twice daily divided dose was administered to 24 previously diagnosed hypertensive patients in a double-blind cross-over fashion for 12 weeks. No patient received other antihypertensive agents or medications known to influence blood pressure. Sitting and standing blood pressure, weight, pulse, tablet count, and subjective complaints of side effects were obtained at study weeks 3 and 6 on each treatment schedule. There was no significant difference between the mean sitting systolic (133 and 131 mm Hg) or diastolic (85 and 84 mm Hg) blood pressure measurements at study weeks 3 and 6 for each treatment schedule. Comparison of standing mean systolic and diastolic blood pressure and mean arterial pressure produced similar results. Subjective complaints of medication side effects, including orthostasis or urinary frequency, did not differ between treatment schedules. This study suggests that hydrochlorothiazide may be effectively administered once daily for the treatment of hypertension.
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PMID:Antihypertensive effect of hydrochlorothiazide administered once or twice daily. 676 88

Blood pressure, cardiac output, plasma volume, renin, and aldosterone were measured in 13 patients with essential hypertension on placebo and after 1, 4, and 12 wk on hydrochlorothiazide 100 mg daily. In 9 patients the same variables were also measured after 24 and 36 wk. Hydrochlorothiazide lowered mean arterial pressure (p less than 0.01). Cardiac output was reduced after 4 and 12 wk of treatment, followed by a return to placebo levels. Stroke volume changed in the same way but heart rate and total peripheral resistance did not differ from placebo values. Plasma volume was reduced after 1 and 24 wk. Renin was permanently elevated (p less than 0.01), but aldosterone rose only during the first 12 wk of treatment. A comparison between responders (greater than 10% fall in mean arterial pressure) and nonresponders (less than 10% fall) revealed different hemodynamic patterns. In responders the initial fall in cardiac output was followed by a return to pretreatment levels, whereas in nonresponders it was permanently reduced. Consequently, total peripheral resistance was lowered only in responders. Nonresponders tended to show a greater degree of plasma volume depletion and greater stimulation of renin and aldosterone, which probably contributed to elevated peripheral resistance. It is concluded that changes in cardiac output are unlikely to be of decisive importance in the ultimate reduction of peripheral resistance in responders to thiazide therapy.
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PMID:Hemodynamic changes during long-term thiazide treatment of essential hypertension in responders and nonresponders. 698 24

1 In a placebo-controlled study, the respective anti-hypertensive effects of hydrochlorothiazide and hydrochlorothiazide plus the beta-adrenoceptor blocker acebutolol were assessed in 18 patients with moderately severe essential hypertension. 2 Hydrochlorothiazide 100 mg daily decreased the mean supine blood pressures from 163/107 mmHg to 150/103 mmHg. Addition of acebutolol in a single-blind fashion in doses up to 800 mg daily reduced mean supine pressure to 137/95 mmHg. Further increases in acebutolol dosage to a maximum of 2000 mg daily in 13 patients whose hypertension was not well controlled on lower doses resulted in a mean supine blood pressure of 132/92 mmHg.
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PMID:Antihypertensive action of acebutolol (Sectral) when used concomitantly with hydrochlorothiazide. 705 18

Because none of the major studies used to document adverse or beneficial metabolic effects of antihypertensive drugs were made of non-Western patients with a non-Western diet, we compared doxazosin and hydrochlorothiazide in Korean patients receiving a Korean diet to determine if one regimen is superior to the other in terms of efficacy, adverse metabolic effects, or both. The randomized, double-blind, parallel study of Korean hypertensive patients compared the effects of oral doxazosin (mean +/- SD dose, 10.3 +/- 6.3 mg/day) and oral hydrochlorothiazide (44.0 + 11.0 mg/day) on blood pressure (BP) and lipid metabolism. The results of 48 patients treated for 20 weeks are reported here. Systolic (p < 0.001) and diastolic (p < 0.001) BP (SBP, DBP) were significantly lower in both groups at the end of the treatment period. Doxazosin significantly increased high-density-lipoprotein (HDL) cholesterol from a baseline of 1.10 +/- 0.31 to 1.27 +/- 0.30 mM (p < 0.05) and HDL/total cholesterol from 0.25 +/- 0.1 to 0.28 +/- 0.1 mM (p < 0.01). Hydrochlorothiazide significantly increased triglyceride from a baseline of 1.63 +/- 0.71 to 2.02 +/- 0.87 mM (p < 0.05). In contrast to Western studies, hydrochlorothiazide demonstrated no adverse effect on total, low-density-lipoprotein (LDL), or HDL cholesterol, or on HDL/total cholesterol. Indeed, HDL cholesterol was increased by 0.16 mM (p < 0.01). As in Western patients, doxazosin is effective for treatment of essential hypertension in Koreans and has no adverse effects but some beneficial effects on lipids.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of doxazosin and hydrochlorothiazide on lipid levels in Korean patients with essential hypertension. 750 34


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