PubMed Health⌕ Search

Biomedical subjects

A Roca-Cusachs

Publications and source records attributed to A Roca-Cusachs.

At least 19 recordsLinked to original sources
PubMed2005

[Double blind study of the efficacy and safety of the fixed dose combination of enalapril 10 mg/nitrendipine 20 mg versus the increase of amlopidine dose in essential hypertensive patients not controlled with amlodipine 5 mg].

INTRODUCTION: Combined therapy or dose-tiration are acceptable second-line therapeutic options after a first treatment failure. MATERIAL AND METHODS: This double blind clinical trial compared the fixed dose combination of enalapril 10 mg/nitrendipine 20 mg (E/N) with amlopidine 10 mg (A) in 323 hypertensive patients not previously controlled with amlodipine 5 mg. RESULTS: After 6 weeks of treatment, the E/N and A groups had similar percentages of blood pressure normalization (55% versus 60.2%; p = 0.4588). The adverse events related with the treatment were significantly less frequent with E/N than with a (19.8% versus 37%; p = 0.0029), especially due to a lower incidence of malleolar edema in E/N (11.1% versus 33.6%; p < 0.0001). CONCLUSION: Combining the efficacy and tolerability data, treatment with E/N permitted control of blood pressure of 2.8 patients per every patient with adverse events, while this rate for A was 1.6 to 1.

Amlodipine↗
PubMed2001

Blood pressure variability and leukoaraiosis amount in cerebral small-vessel disease.

OBJECTIVES: To analyze the correlation between blood pressure (BP) variability and leukoaraiosis (LA) amount in patients with symptomatic cerebral small-vessel disease. MATERIALS AND METHODS: We included 25 hypertensive patients: 13 with Binswanger's disease (BD) and 12 with a first-ever lacunar infarction (LI). Baseline office BP was obtained for 3 consecutive weeks. From a 24-h ambulatory BP monitoring performed 1 week later we obtained average systolic (SBP) and diastolic (DBP) BP for daytime, nighttime and 24-h periods. SBP and DBP variability was defined as the within-subject standard deviation of all readings. A standardized cerebral MR was performed in each patient and an LA score was calculated. RESULTS: No statistically significant correlation was obtained between the LA score and any of the following BP values: 1) Baseline SBP and DBP; 2) 24-h, daytime or nighttime SBP and DBP, and 3) 24-h, daytime or nighttime SBP and DBP variability. CONCLUSION: Increased BP variability is not associated with greater amounts of leukoaraiosis.

Aged↗
PubMed2001

Relation between clinical and therapeutic variables and quality of life in hypertension.

OBJECTIVE: Study the relation between quality of life (QoL) and various clinical, therapeutic and sociodemographic variables in treated hypertensive patients. MATERIAL AND METHODS: A prospective study was carried out in 92 primary care centres in Spain. A total of 269 hypertensive patients were selected and 106 healthy normotensive individuals were included as controls. At the time of inclusion a wide range of clinical variables was documented. QoL was assessed at baseline and 1 month after the intensification of antihypertensive therapy, using a self-administered, specific hypertension, 56-item questionnaire in addition to the generic EuroQoL-5D. RESULTS: QoL was poorer among the hypertensive subjects than among the normotensive individuals, even adjusting for the differences observed between the groups (age, sex, education and working status). The same was found with the EuroQol-5D. In the hypertensive subjects, after applying a multiple regression equation, only four variables significantly retained their negative impact on QoL: sex (female), greater organ damage and higher heart rate and weight. After the intensification of antihypertensive therapy with irbesartan, QoL improved significantly. Neither the presence of side-effects during the month of follow-up, nor the degree of BP reduction showed a significant impact on QoL, although the latter came close to statistical significance. CONCLUSIONS: Hypertensive patients have significantly poorer QoL than normotensive subjects, even with adjustment for differences. In hypertensives, QoL is affected by some clinical variables that might help us to identify those with worse QoL. Intensification of antihypertensive therapy produced a positive impact on QoL.

Adult↗
PubMed2001

Nitrendipine and enalapril combination therapy in mild to moderate hypertension: assessment of dose-response relationship by a clinical trial of factorial design.

Hypertension is an important cardiovascular risk factor and the goal of its pharmacologic treatment is to reduce morbidity and mortality. Treatment is usually initiated with a low dose of a single agent and titrated to a higher dose as required. As many as 50% of patients require the addition of a second agent to achieve satisfactory blood pressure control. The aim of this study was to assess the dose-response relationship of nitrendipine and enalapril alone or in fixed combination in the treatment of mild to moderate hypertension. A total of 496 patients were enrolled in a multicenter, randomized, double-blind, factorial-design, parallel-group clinical trial comparing placebo, nitrendipine (5, 10, and 20 mg) and enalapril (5, 10, and 20 mg) alone or in combination. After a single-blind, 2-week placebo run-in period, 414 patients whose diastolic blood pressure ranged between 90-109 mm Hg were randomly assigned to a treatment group. The combination of nitrendipine and enalapril, particularly regimens including nitrendipine 20 mg and enalapril 5 or 10 mg, were significantly superior to both monotherapies; mean diastolic blood pressure reductions from baseline to last visit were -12.5 and -14.3 mm Hg, respectively. Response surface analysis provided further evidence that these combinations were optimal in terms of anti-hypertensive efficacy. All treatments were well tolerated and the incidence of adverse events did not differ significantly between groups. In summary, the anti-hypertensive efficacy of the combination was found to be superior to both monotherapies at any doses. The dose combination achieving the greatest blood pressure reduction was nitrendipine 20 mg and enalapril 10 mg.

Adolescent↗
PubMed2001

Blood pressure variability in Binswanger's disease and isolated lacunar infarction.

UNLABELLED: To determine whether blood pressure (BP) variability is increased in hypertensive patients with Binswanger's disease (BD), we studied two samples of consecutive treated hypertensive patients: (1) 11 with BD (mean age 71.3 +/- 5.2 years); (2) 16 with lacunar infarction (mean age 65.2 +/- 8.3 years) without cognitive impairment. An averaged baseline office BP was obtained for 3 consecutive weeks. Ambulatory BP monitoring was then carried out to obtain the averaged mean systolic (SBP) and diastolic BP, and BP variability was defined as the standard deviation of consecutive BP values. RESULTS: Diurnal SBP variability was significantly increased in the BD group (p = 0.04). However, with the analysis of covariance for age and baseline office BP, the difference was no longer significant (p = 0.17 and p = 0.09, respectively). We conclude that increased BP variability in BD patients is probably due to older age and increased baseline office BP. Increased BP variability may be a risk factor for small-vessel disease, but not for cognitive impairment.

Age Factors↗
PubMed2000

Myocardial cell damage in human hypertension.

OBJECTIVES: The goal of this study was to investigate the presence of myocardial cell damage in patients with systemic hypertension and its relationship with left ventricular hypertrophy (LVH). BACKGROUND: Although initially compensatory, LVH adversely affects myocellular integrity and contributes to congestive heart failure in hypertensive patients. Noninvasive detection of myocardial damage can be of value. METHODS: We performed imaging studies with 111In-labeled monoclonal antimyosin antibodies to identify myocardial damage in 39 patients with systemic hypertension and variable degrees of LVH. Three groups were considered: 16 asymptomatic patients with normal echocardiographic left ventricular mass (LVM) (group I); 14 asymptomatic patients with LVH (group II) and 9 patients with symptomatic hypertensive heart disease and advanced LVH (group III). The severity of myocardial damage was represented as heart-to-lung (target-to-background) antibody uptake ratio (normal: <1.55). RESULTS: Mean LVM index was 105+/-14 g/m2 in group I, 124+/-24 in group II and 174+/-29 in group III. Heart-to-lung ratios of antimyosin uptake were: 1.45+/-0.14 in group I, 4 of the 16 (25%) patients showing an abnormal scan; 1.50+/-0.07 in group II with abnormal scans in 2 of the 14 (16%) patients and 1.77+/-0.16 (p < 0.001) in group III, all 9 patients presenting with abnormal antimyosin scans. On multivariate regression analysis LVM index was the main variable that independently correlated with the degree of myocardial uptake of antimyosin (r = 0.815; p = 0.001). CONCLUSIONS: This study provides the first in vivo evidence of myocyte damage in patients with hypertension. The severity of myocardial damage can be related to the magnitude of LVH.

Aged↗
PubMed2000

Usefulness of the I/D angiotensin-converting enzyme genotype for detecting the risk of left ventricular hypertrophy in pharmacologically treated hypertensive men.

The insertion/deletion polymorphism (I/D) of the angiotensin-converting enzyme (ACE) gene has been associated in some studies with a higher prevalence of left ventricular hypertrophy (LVH), but few of them were performed on pharmacologically treated hypertensive patients. The present study was undertaken to determine whether ACE genotype determination could help in the identification of pharmacologically treated hypertensive patients at a higher risk of LVH. Ninety-six consecutive men with essential hypertension were selected for the study. Left ventricular mass (LVM) was assessed by echocardiography and indexed by body surface area and 82 patients were considered suitable for the study. Three groups of patients were defined on the basis of their I/D ACE genotype: DD (n = 39), ID (n = 33) and II (n = 10). There were no statistically significant differences between the three groups regarding to the severity of hypertension at diagnosis, degree of control of blood pressure or type of antihypertensive drug therapy used. No statistically significant differences were found between the three groups regarding to LVM index (total 124 +/- 31, DD 121 +/- 29, ID 127 +/- 35 and II 122 +/- 18 g/m2), relative wall thickness (total 0.5 +/- 0. 2, DD 0.5 +/- 0.3, ID 0.48 +/- 0.07 and II 0.47 +/- 0.04) or prevalence of LVH (total 34%, DD 31%, ID 39% and II 30% by Cornell criteria and total 39%, DD 33%, ID 45% and II 40% by Framingham criteria). Furthermore, the I and D allele frequency distribution was similar in the whole group of patients, in patients with LVH, and in a control group of healthy volunteers. Our data do not support that the I/D ACE genotype determination helps in identifying treated hypertensive patients at higher risk of LVH. Journal of Human Hypertension (2000) 14, 327-331

Adult↗
PubMed1997

A randomized, double-blind comparison of the antihypertensive efficacy and safety of once-daily losartan compared to twice-daily captopril in mild to moderate essential hypertension.

INTRODUCTION: The antihypertensive efficacy and safety of losartan, a specific and selective angiotensin II (AII) receptor antagonist, was compared to captopril in patients with mild or moderate essential hypertension. DESIGN: This multinational, randomized trial consisted of a 4-week single-blind, placebo baseline period followed by a 12-week double-blind, parallel comparison of once-daily administration of losartan 50 mg or twice-daily administration of captopril 25 mg. After 6 weeks of treatment, the daily dosage was doubled in patients whose sitting diastolic blood pressure (SiDBP) remained > or = 90 mm Hg. PATIENTS: Patients with essential hypertension having a mean trough SiDBP of 95-115 mm Hg after the placebo baseline period were randomized to losartan (N = 192) or captopril (N = 204) treatment. MAIN OUTCOME MEASURES: The primary efficacy variable was the mean change from baseline to Week 12 in trough SiDBP. Safety was assessed by recording spontaneously reported or observed adverse experiences and clinical laboratory measurements. RESULTS: After 12 weeks, both treatments produced clinically important reductions in trough SiDBP and sitting systolic blood pressure (SiSBP). These mean reductions (SiDBP, SiSBP) were significantly greater in the losartan group (-11.5 and -15.4 mm Hg, respectively) than in the captopril group (-9.3 and -12.2 mm Hg, respectively) (p = 0.010 for diastolic and p = 0.023 for systolic). The percentage of patients exhibiting an excellent (trough SiDBP < 90 mm Hg) or good (trough SiDBP > 90 mm Hg, with decrease of > or = 10 mm Hg) antihypertensive response to losartan and captopril therapy at Week 12 was comparable (60.0% and 54.7%, respectively). The percentage of patients reporting a clinical adverse experience considered drug-related by the investigator was 13% in the captopril group and 10% in the losartan group. The incidence of drug-related cough was 2.6% in the losartan group and 4.4% in the captopril group. CONCLUSION: Once daily administration of losartan 50 to 100 mg is an effective treatment for patients with essential mild to moderate hypertension. The antihypertensive efficacy of losartan 50/100 mg is significantly greater than that of twice daily captopril 25/50 mg. Both treatments were generally well-tolerated. The number of patients with the side effect of cough was higher following captopril.

Antihypertensive Agents↗
PubMed1993

Lowering blood pressure. How far, how fast?

There is a general consensus that high blood pressure (BP) must be lowered gradually. A reduction in BP beyond the limits of the autoregulatory curve may compromise perfusion of vital organs, resulting in organ ischaemia. However, a reduction in high BP offers protection against cerebral events, and some protection against coronary heart disease. The limited protection against coronary heart disease provided by BP reduction may be partially explained by the so-called 'J-shaped curve': a reduction in diastolic blood pressure below 85 mmHg may lead to a paradoxical increase in coronary events, although this effect is by no means well established. In addition, the incidence of several events associated with cardiovascular disease peaks during morning hours, at a time when some antihypertensive drugs are least effective. This may also explain the limited coronary protection achieved after administration of antihypertensive drugs.

Blood Pressure↗
PubMed1992

[Quality of life in arterial hypertension].

BACKGROUND: Quality of life is a key issue for the consideration of hypertension therapy. However, reliable and sensitive evaluation methods are not available in Spain. To this end, a quality of life questionnaire has been elaborated, its yield has been evaluated, and the influence of hypertension and several associated variables on the quality of life has been assessed. METHODS: A questionnaire on quality of life consisting of 62 items was elaborated. Its final evaluation was divided in an overall value and in four subindexes related with anxiety, depression, side effects, and somatic complaints. It was applied to two groups of hypertensive patients, one from hospital care (n = 90) and another from primary care (n = 89), and to a control group (n = 76). RESULTS: Although both populations with hypertension were significantly different regarding age, sex, use of therapies, organic impact and blood pressure, they were overall similar in quality of life. However, quality of life was different from that in control group, which showed better indices. In the hypertensive population, sex, severity of hypertension, type of therapy or duration of the disease did not have any influence on quality of life. CONCLUSIONS: The overall similar quality of life in both hypertensive groups (in spite of the many significant differences in their descriptive features) and the different quality of life between hypertensive and normotensive individuals (in spite of the similitude of their demographic parameters) suggest that the diagnosis of hypertension has by itself a greater influence on the quality of life than several hypertension-associated variables. It has also been found that the method used was sensitive and valid. Therefore, the use of the quality of life questionnaire can be a useful instrument for the monitorization of hypertensive patients.

Adult↗
PubMed1992

Systemic and regional hemodynamic effects of 1,25-dihydroxyvitamin D3 administration.

OBJECTIVE: To evaluate the cardiovascular effects of 1,25-dihydroxyvitamin D3 (1,25-D). DESIGN: Recent studies suggest that Ca-regulating hormones may contribute to the genesis of hypertension. We determined systemic and regional hemodynamics 24 h after administration of 1,25-D or vehicle to normal conscious Sprague-Dawley rats. In addition, to dissociate the vascular effects of 1,25-D from changes in serum ionized Ca2+, 1,25-D and vehicle were administered to rats maintained for 3 days on a low-Ca diet. To evaluate the effect of the slight rise in serum ionized Ca2+ with 1,25-D administration, we infused CaCl or vehicle over 1 h into normal rats to raise the serum Ca2+ to near that of rats treated with 1,25-D. METHODS: The radioactive microsphere technique was used. RESULTS: Systemic hemodynamics (blood pressure, heart rate, cardiac output, total peripheral resistance and stroke volume) did not differ between the two groups receiving a normal-Ca diet. In these rats 1,25-D significantly decreased renal blood flow (RBF), increased renal vascular resistance (RVR) and slightly increased serum ionized Ca2+. Similarly, in rats receiving a low-Ca diet, 1,25-D administration decreased renal blood flow, increased renal vascular resistance and caused only a minimal increase in serum ionized Ca2+. A low-Ca diet also increased heart rate, cardiac blood flow and renal blood flow. Although CaCl infusion raised serum ionized Ca2+, blood pressure, renal blood flow and renal vascular resistance did not change significantly. CONCLUSION: 1,25-D may constrict the renal vasculature directly or indirectly by enhancing the vascular sensitivity to circulating vasoconstrictors.

Animals↗
PubMed1991

[Seasonal variations of lipids and arterial pressure].

BACKGROUND: The presence of a seasonal variation in serum lipids and blood pressure is often described in the literature. METHODS: With the aim of analyzing this seasonal influence blood pressure and lipid (total cholesterol and cholesterol corresponding to different lipoprotein, triglycerides and AI and B apolipoprotein families) values were studied over 12 months in 36 normotense healthy males (mean age 36 +/- 6 years), a third of whom presented diverse base lipid alterations. A variance analysis of the relative intraindividual values (to study monthly differences) was carried out and a Student's t test was performed for the absolute values and grouped into two periods (summer and winter) and according to two categories (normal and hyperlipemic). RESULTS: No significant modification was observed in any of the parameters studied with the exception of the intrapersonal variation coefficient of the triglycerides which was significantly higher in the hyperlipemic individuals. CONCLUSIONS: In the population studied no seasonal modification was observed in blood pressure or different lipid concentrations analyzed. The slight variation of temperature observed and the elevated sunstroke in Spain in addition to the youth of the population studied may explain the lack of seasonal variation.

Adult↗
PubMed1991

The impact of a patient education programme in the control of hypertension.

The value of patient education programmes in the control of hypertension is controversial. We have conducted a prospective study to investigate a patient education programme in our clinic. Every new patient was randomised into one of two different groups: a control group (CG, n = 149) and an intervention group (IG, n = 138); the latter group was invited to attend two educational talks and subsequently one tutorial meeting. Blood pressure, heart rate, Quetelet Index, attendance, knowledge level, analytical parameters and the prevalence of other risk factors were measured in both groups before and after 6 months follow-up. No significant differences were detected between the two groups initially. At 6 months, both groups significantly lowered their BP; the only differences observed between groups (IG vs. CG) were: the number of correct answers to the questionnaire (14.5 +/- 3.7 vs. 12.9 +/- 3.7, P less than 0.01), the rate of occasional therapeutic abandonment (10.3 vs. 25%, P less than 0.05), 24 h sodium excretion (97 +/- 45 vs. 127 +/- 68 mmol/l, P less than 0.01) and the number of withdrawals (39 vs. 25%, P less than 0.05). We conclude that in spite of increased knowledge, less frequent abandonment of drug treatment and better observance of a low salt diet, patients in the IG had an increase in the number of drop-outs. Our data suggest that education in hypertension clinics should play a supportive role rather than a primary one in the control of high blood pressure.

Aged↗