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

Aspirin has been shown to acutely block the natriuretic effect of spironolactone in the mineralocorticoid-treated normal rat, dog, and man. It has been suggested that aspirin is contraindicated in hypertensive patients receiving spironolactone. Five patients with low-renin essential hypertension and two with hypertension due to primary aldosteronism, all of whom have normalized their blood pressure on chronic spironolactone therapy, were cotreated in a double-blind fashion with either aspirin or aspirin-placebo during alternate six-week periods. Aspirin did not appear to alter the effect of spironolactone on blood pressure, serum electrolytes, urea nitrogen, or plasma renin activity.
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PMID:Failure of aspirin to antagonize the antihypertensive effect of spironolactone in low-renin hypertension. 78 8

1. A group of patients with essential hypertension was divided into three categories on the basis of the plasma renin activity. 2. There was no correlation between the plasma renin activity categorized as high, normal or low and the duration of hypertension, the incidence of left ventricular enlargement, the blood urea nitrogen, serum creatinine, cholesterol or uric acid respectively. 3. Analysis of data showed that the incidence of cardiovascular events in the hypertensive population correlated with the plasma renin activity only in combination with known risk factors.
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PMID:Plasma renin activity and cardiovascular disease. 107 64

Available clinical evidence indicates a high prevalence of hyperuricemia in patients with essential hypertension; this becomes accentuated with diuretic therapy. Since there is an association of hyperlipidemia with hyperuricuria and hypertension and since hyperuricemia is a feature of diuretic therapy, we explored whether these relationships might be provoked by prolonged diuretic therapy. Eighteen male patients with uncomplicated essential hypertension of mild severity were treated for 9 months with hydrochlorothiazide and supplemental potassium chloride, 100 mg and 45 mEq/day, respectively. Arterial pressure, renal function, and serum electrolyte, uric acid, blood glucose, and lipid concentrations were measured several times before and during therapy. Arterial pressure remained significantly reduced during therapy (P less than 0.001); this was associated with reduced serum potassium (P less than 0.01) and increased blood glucose and serum uric acid concentrations (P less than 0.005, P less than .025, respectively). Blood urea nitrogen, serum creatinine, sodium, cholesterol and triglyceride levels did not significantly change with treatment. Thus, although diuretics increase serum uric acid and blood glucose, their effect on serum lipid concentration is negligible.
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PMID:Effects of diuretics on lipid metabolism in patients with essential hypertension. 107 5

We assessed the long-term effects of carvedilol on renal function in 10 patients with mild-to-moderate essential hypertension. After a 2- to 4-week placebo run-in period, all patients received 5 mg carvedilol once daily. If the effect was insufficient, the dosage was successively increased to 10 or 20 mg once daily. The mean +/- SEM duration of treatment was 17.3 +/- 1.0 weeks, and the final mean daily dosage was 13.5 +/- 2.2 mg/day. With treatment, systolic and diastolic blood pressures decreased significantly from 159.7 +/- 1.3 to 140.5 +/- 3.2 mm Hg (p less than 0.001) and from 98.3 +/- 1.0 to 88.2 +/- 2.7 mm Hg (p less than 0.001), respectively. Carvedilol did not cause significant changes in glomerular filtration rate, effective renal plasma flow, blood urea nitrogen, or serum creatinine. Renal vascular resistance decreased significantly from 12.7 +/- 1.4 to 11.2 +/- 1.2 dyne.s.cm-5/1.48 m2 x 10(3) (p less than 0.05). Thus, long-term carvedilol therapy was effective in reducing blood pressure in essential hypertension without causing impairment of renal function.
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PMID:Effect of long-term carvedilol therapy on renal function in essential hypertension. 137 58

The safety and efficacy of labetalol and hydrochlorothiazide (HCTZ) were compared in a group of 34 patients aged 65 years or older with mild to moderate essential hypertension. After a 4-week placebo run-in period, during which all previous antihypertensive medication was discontinued, patients were randomized to receive either labetalol (100 mg bid) or HCTZ (25 mg bid). The patients' blood pressure and heart rate were evaluated biweekly and drug dosage was titrated (up to 400 mg and 50 mg bid of labetalol and HCTZ, respectively) to achieve a standing diastolic blood pressure less than 90 mm Hg. Patients underwent 24-hour ambulatory blood pressure monitoring at the end of the placebo run-in period and again after the 6-week titration period. Both labetalol and HCTZ significantly (P less than .01) reduced standing systolic (-19.4 vs -27.7 mm Hg) and diastolic (-14.0 vs -15.2 mm Hg) blood pressures following 12 weeks of treatment. Both antihypertensives effectively controlled the 24-hour ambulatory blood pressure, however, the labetalol group experienced a significantly lower rate of rise in diastolic blood pressure (P = .02) and mean arterial pressure (P = .02) during the acceleration period (400-1200) compared to the HCTZ group. HCTZ caused significant decreases in serum potassium (P less than .01) and alkaline phosphatase (P less than .05) and increases in uric acid (P less than .01) and urea nitrogen (P = .07). These results indicate that labetalol may offer some unique advantages over thiazide diuretics that may be particularly important in the treatment of elderly patients with hypertension.
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PMID:Comparison of labetalol and hydrochlorothiazide in elderly patients with hypertension using 24-hour ambulatory blood pressure monitoring. 235 3

Malignant hypertension developed in an 18-year-old man whose primary hypertension had been diagnosed by chance. Standing blood pressure was 290/170 mmHg. Tests of renal function revealed high blood urea nitrogen and creatinine levels and low levels of both effective renal plasma flow and the glomerular filtration rate. Plasma renin activity and levels of angiotensin II and aldosterone were greatly elevated. Severe concentric left ventricular hypertrophy was noted. The patient received standard antihypertensive treatment with furosemide, propranolol, nifedipine, and prazosin, but his blood pressure did not decrease and there was no improvement in the clinical or biochemical measures. The patient was then given 20 mg of enalapril daily for one year. The inhibition of angiotensin converting enzyme immediately reduced blood pressure. Angiotensin II and aldosterone levels became normal, kidney function and hemodynamics improved, and echocardiograms revealed that the left ventricular hypertrophy had regressed. The results confirm the pathogenetic role of angiotensin II in the development of the malignant phase of hypertension.
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PMID:Treatment of malignant hypertension with an angiotensin converting enzyme inhibitor. 255 Jan 35

In a multicenter, double-blind comparison of acebutolol and hydrochlorothiazide in patients with mild to moderate essential hypertension (diastolic blood pressure, 95 to 114 mm Hg) in 182 and 178 patients, respectively, each agent reduced systolic and diastolic pressures to a similar significant degree: acebutolol, 15.9 and 14.9 mm Hg; hydrochlorothiazide, 15.2 and 13.3 mm Hg (p less than 0.001 vs baseline). Acebutolol significantly reduced heart rate by 8.9 bpm at the end of dose titration (p = 0.001), with no further decrease seen during maintenance. Fourteen patients on each treatment regimen were discontinued from the study because of side effects. However, significantly more hydrochlorothiazide patients experienced side effects of arrhythmia, anorexia, and flatulence; in addition, more hydrochlorothiazide patients developed abnormal levels of serum glucose, uric acid, blood urea nitrogen, serum potassium, and chloride. In a single-center study of patients who remained hypertensive while receiving diuretics, six of nine patients receiving acebutolol concomitantly with a diuretic responded (seated diastolic blood pressure reduced below 90 mm Hg), whereas no patients receiving placebo and diuretic concomitantly responded (p less than 0.01). Patients taking both acebutolol and diuretic had significant reductions in diastolic blood pressure (11 mm Hg) and heart rate (16 bpm) compared with those taking diuretic alone (p less than 0.05, less than 0.01) and those taking both placebo and diuretic (p less than 0.05). No significant side effects were noted. Acebutolol is as effective as hydrochlorothiazide as monotherapy for mild to moderate essential hypertension and, in addition, is effective when added to a diuretic in patients who remain hypertensive while taking diuretics.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of acebutolol and hydrochlorothiazide in essential hypertension. 285 81

Twenty patients with moderate to severe essential hypertension were randomized in a paralleled, double-blind, 22-week study of captopril (ten) and enalapril (ten) following four weeks of hydrochlorothiazide (50 mg/d) baseline treatment. The captopril group was administered 25 mg tid and increased to 100 mg tid, while the enalapril group began with 5 mg bid and increased to 20 mg bid, depending on the patient's blood pressure (BP) response. Methyldopa, 250 mg to 500 mg bid and 1,000 mg bid, was administered to patients in both groups if BP was not adequately controlled. Patients were seen every two weeks for BP monitoring and metabolic evaluation. Each group showed a significant and equal decrease in BP, with the effect being the greatest on the diastolic pressure, supine and upright. Of the 20 patients, ten (four whites and six blacks) required methyldopa for adequate BP control. Four patients, two from each group, developed reversible prerenal azotemia (BUN [blood urea nitrogen] congruent to 50 mg/dL). No other clinical or metabolic side effects were noted. We concluded that captopril and enalapril were equally effective in lowering BP in the dosages given; no racial differences in BP response were noted, although more black patients required the addition of methyldopa for adequate BP control; and both drugs were safe and well tolerated.
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PMID:A comparative study of captopril and enalapril in patients with severe hypertension. 298 58

Twenty-four black men with mild to moderate essential hypertension were enrolled in an open-label trial comparing the efficacy of two doses of Capozide (captopril and hydrochlorothiazide). All antihypertensive drugs were discontinued and patients then received placebo for 2 weeks. Twenty-two patients, mean age 59.1 +/- 14.3 years, with sitting diastolic blood pressure (BP) 92 to 110 mm Hg, entered the 6-week active-drug phase. Eleven patients (Group A) were randomized to Capozide 25/15 and 11 (Group B) to Capozide 50/15. Baseline mean BPs were 151.0/100.7 mm Hg in Group A and 153.1/100.7 mm Hg in Group B. At week 6, mean BPs were 128.7/84.4 mm Hg in Group A and 126.8/82.7 mm Hg in Group B. Uric acid, blood urea nitrogen and creatinine levels rose slightly in both groups. There were no adverse events. Eighteen patients had normal BPs at study completion. Twice-daily Capozide treatment is effective and well tolerated in blacks; patients responded equally well to both doses.
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PMID:Treating black hypertensives with capozide. 304 29

Total body elemental composition was measured in 40 patients with well documented heart failure who were oedema-free on digoxin and diuretics. The results were compared with values for 20 patients with untreated essential hypertension matched for height, weight, age, and sex. Total body potassium alone was also measured in 20 normal subjects also matched for anthropomorphic measurements. Patients with hypertension had a very similar total body potassium content to that of normal subjects, but patients with heart failure had significantly reduced total body potassium. This could not be explained by muscle wasting because total body nitrogen, largely present in muscle tissue, was well maintained. When total body potassium was expressed as a ratio of potassium to nitrogen mass a consistent depletion of potassium was revealed in the group with heart failure. Potassium depletion was poorly related to diuretic dose, severity of heart failure, age, or renal function. Activation of the renin-angiotensin-aldosterone system was, however, related to hypokalaemia and potassium depletion. Such patients also had significantly lower concentrations of serum sodium and blood pressure. Serum potassium was related directly to total body potassium. Despite the absence of clinically apparent oedema total body chlorine was not consistently increased in heart failure, but the calculated extracellular fluid volume remained expanded in the heart failure group. Total body sodium was significantly increased in patients with heart failure, but less than half of this increase could be accounted for by extracellular fluid volume expansion. Potassium depletion in heart failure may account in part for the high frequency of arrhythmias and sudden death in this condition.
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PMID:Total body electrolyte composition in patients with heart failure: a comparison with normal subjects and patients with untreated hypertension. 331 Oct 97


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