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Biomedical subjects

B Krönig

Publications and source records attributed to B Krönig.

At least 19 recordsLinked to original sources
PubMed1997

Different concepts in first-line treatment of essential hypertension. Comparison of a low-dose reserpine-thiazide combination with nitrendipine monotherapy. German Reserpine in Hypertension Study Group.

Low-dose combination therapy has been proposed as a rational first-line approach to hypertension treatment. We compared the efficacy and tolerability of the fixed combination of reserpine (0.1 mg) plus the thiazide clopamid (5 mg) with its single components and the calcium-antagonist nitrendipine (20 mg) in a randomized, double-blind, parallel study of 273 hypertensive patients with diastolic blood pressure (BP) between 100 and 114 mm Hg. The four groups did not differ regarding baseline characteristics (mean age, 58 years; 51% men; mean BP after a 2-week placebo period, 158 to 160/103 to 104 mm Hg). After 6 weeks of treatment with one capsule daily, mean reductions in sitting BP from baseline at 24 hours after dosing in the reserpine-clopamid combination, reserpine, clopamid, and nitrendipine groups were -23.0/-17.1, -14.0/-11.7, -13.6/-11.9, and -11.6/-12.3 mm Hg, respectively (2P < .01). The corresponding normalization rates (diastolic BP < 90 mm Hg) were 55%, 40%, 36%, and 33% (2P = .11). All patients whose BP had not been normalized at this point received two capsules of the respective medication once daily from weeks 7 to 12. At week 12, mean BP reductions were -25.7/-18.1, -14.6/-12.2, -17.7/-13.4, and -14.9/-15.3 mm Hg in the four groups, respectively (2P < .01). The respective normalization rates were 69%, 35%, 39%, and 45% (2P < .0001). Linear regression modeling indicated that reserpine and clopamid combined acted more than additively. As regards tolerability, adverse experiences were observed in 27%, 28%, 29%, and 48% of patients, respectively (2P < .05). The respective rates of premature discontinuation because of adverse effects were 3%, 3%, 7%, and 13% (2P = .06). In conclusion, a low-dose combination of reserpine and clopamid lowered BP significantly more than both the components alone and nitrendipine. Moreover, the combination was tolerated as well as its components and significantly better than nitrendipine. Thus, the use of this low-dose reserpine-thiazide combination appears to be a rational alternative to conventional monotherapy in the first-line treatment of hypertension.

Adolescent↗
PubMed1996

Ambulatory blood pressure measuring devices.

During the last 6 years ABPM has become a widely used method in the diagnosis and treatment of hypertensive patients as well as in correlating the disease to prognosis. Up to January 1995, the international market offered 43 devices from 31 manufacturers. In Germany there are 18 devices available on the market from 10 different manufactures. Mainly, two different techniques are applied, ausculation and oscillometry, each having some advantages and disadvantages: The oscillometric technique may be preferable in patients with hyperkinetic circulation (e.g., pregnancy), with ausculatory gap and when surrounding noises are interfering, whereas the auscultatory technique, being the original method, has some advantages in patients with dysrhythmias and atrial fibrillation, as well as in dynamic (bicycle) exercise. The auscultatory method may be optimized by using ECG-, respectively oscillometric gating. The future development, which has already been realized in seven international recorders, offers the opportunity of either using auscultatory and/or oscillometric techniques during the same recording. To estimate the "true" sleeping interval more precisely a "day-night-button" at the recorder side is helpful. Furthermore, an uniform computer printout of the mean values of day- and night-time intervals, together with the widely approved limits of normotension should be achieved; last, but not least, an important factor for the widespread use of ABPM in general practice, as well as in the hospital, will be the prices of the recorders. Which have been reduced to about DM 3000-6000 in Germany (January 1996).

Blood Pressure Monitors↗
PubMed1996

Antihypertensive efficacy and orthostatic tolerance of bunazosin vs nitrendipine: a multicentre double-blind randomized controlled study.

A multicentre double-blind randomized controlled study was conducted in 358 patients with mild to moderate essential hypertension. The goal was to compare the antihypertensive efficacy, tolerability, and in particular postural hypotension of the alpha 1-adrenoreceptor blocker bunazosin with the calcium channel blocker nitrendipine. Both treatment groups had comparable baseline blood pressure (BP) values, namely diastolic BP (DBP) of 103.8 +/- 5.6 mm Hg in the bunazosin group, and 103.4 +/- 6.0 mm Hg in the nitrendipine group, respectively. Baseline systolic BPs (SBP) were 149.7 +/- 14.4 mm Hg (bunazosin) and 149.2 +/- 14.3 mm Hg (nitrendipine). After 12 weeks of therapy, reduction of DBP (-6.1 +/- 11.7 mm Hg on bunazosin vs -6.9 +/- 9.9 mm Hg on nitrendipine; P = n.s.), and SBP (-4.4 +/- 14.3 mm Hg on bunazosin vs -7.0 +/- 14.4 mm Hg on nitrendipine; P = n.s.) was similar in both groups. During a provocative orthostatic tolerance test after the first dose, the incidence of prae-collapses (ie termination of the test due to orthostatic complaints) was higher on bunazosin (17 vs 2; P < 0.05) but orthostatic dysregulation symptoms (symptom score 1.37 on bunazosin vs 0.95 on nitrendipine; n.s.) and collapses (four on bunazosin vs one on nitrendipine; n.s.) occurred to a similar extent in both treatment groups. Three and 9 weeks after treatment, no increased susceptibility to orthostatic stress compared to baseline could be found in either group. Under daily life conditions, the frequency of orthostatic dysregulation was identical in both groups (0.8%). Bunazosin, however, was far better tolerated with 43.8% of the patients complaining of adverse events as opposed to 63.6% on nitrendipine (P < 0.001). The rate of early discontinuations due to adverse events was only 1.3% on bunazosin compared to 13.6% on nitrendipine (P < 0.001). In conclusion, bunazosin has a similar antihypertensive efficacy as nitrendipine. Despite an initially higher susceptibility to orthostatic stress under a provocative manoeuver, bunazosin evoked the same low incidence of orthostatic dysregulation symptoms as nitrendipine under daily life conditions, but was significantly better tolerated than nitrendipine.

Adrenergic alpha-Antagonists↗
PubMed1994

[Results and evaluation of long-term blood pressure monitoring].

Using validated equipment for ABPM (by the indirect, intermittent, oscillometric and/or auscultatory method) reproducible results for day- and night-time blood-pressure, early morning readings, and blood-pressure variability may be obtained. The frequency of recordings should be about 15-min while awake and about 30-min during sleep-time, with at least 50 validated readings in 24-h to get an informative recording. Standardization could be achieved for the normotensive mean day-time value (upper limit 135/85 mmHg) and mean night-time recording (at least minus 10% compared to the day-time mean value). Using ABPM the diagnosis of arterial hypertension may be optimized, e.g. patients with white-coat hypertension could be discovered as well as those with diminished day-night rhythm ("non-dippers"); with the latter condition cerebral or myocardial damage might occur as consequence of primary hypertension; even more so, secondary hypertension may be discovered in patients with "non-dipper" constellation. In respect to therapy, a "profile-adjusted" medication may be obtained by ABPM; side-effects, which could be produced by "overtreatment", may be discovered. Since day- as well as night-time values, possibly even early morning pressures and the blood-pressure variability are positively correlated to cerebral and cardiovascular complications, ABPM becomes an important prognostic tool.

Arousal↗
PubMed1991

[Development of direct and indirect ambulatory 24-hour blood pressure monitoring].

The direct ambulatory 24-hour blood-pressure monitoring has been applied in two ways. With the so called "Oxford-system", blood pressure is recorded via a cannula in the brachial artery which is connected to a perfusion unit that is worn around the neck, on the front of the chest, with a tape recorder carried in a pouch on the patient's belt. Using the micro-catheter blood-pressure telemetry recording is done in the same way, but transmission of the data to a stationary-receiving unit is managed by telemetry. The usage of the latter method is limited by the weight and complexity of the patient-sited equipment. Compared to the Oxford-system there is the advantage of continuously observing the patients blood-pressure "on-line" during the recording. The invasive character of both methods limits the application to special, scientific investigations. In recent years the indirect recording machines for 24-hour blood-pressure monitoring has been developed further. They are now accurate, easy to apply and simple to work out. Beside the auscultatory way of recording, with or without ECG-gating, the oscillometry recording machines have been improved. There should be automatically-operated intervals with recordings in day-time every 15-20 minutes and during the night every 30 minutes. The recorded data should be analysed by computer, calculating mean values with standard deviations in day-time and night-time separately. Further more, there should be a listing of reading-errors and probably corrected measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1990

Blood-pressure-lowering effect of carvedilol vs nitrendipine in geriatric hypertensives.

Carvedilol and nitrendipine were given for 12 weeks in a double-blind study to 81 elderly patients (greater than or equal to 60 years) with essential hypertension. The effects on blood pressure were measured (Riva Rocci) before medication and after 2 h with the patient in a lying and standing position after 4 weeks of placebo therapy as well as after 4, 8 and 12 weeks of treatment. Carvedilol (25 mg/o.d.) reduced blood pressure measured in the supine and erect position very successfully, similar to the reduction achieved with nitrendipine (20 mg/o.d.), without influencing the pulse rate. Both substances were well tolerated. Carvedilol is an alternative substance for lowering high blood pressure in elderly hypertensive patients.

Adrenergic beta-Antagonists↗
PubMed1987

Felodipine versus Moduretic. A double-blind parallel-group multicentre study.

In a double-blind parallel-group study 133 patients with mild to moderate essential hypertension were randomised to felodipine 5mg twice daily or Moduretic mite every morning after a run-in placebo period of 1 to 2 weeks. All previous antihypertensive therapy was withdrawn at the start of the run-in period. After 4 weeks the dose of felodipine was increased to 10mg twice daily, and Moduretic mite was replaced by Moduretic in patients with a diastolic blood pressure of greater than 80mm Hg. On the low dose, the supine blood pressure on felodipine was reduced by 24/14mm Hg from 174/105mm Hg, and on Moduretic mite by 19/11mm Hg from 171/103mm Hg. After the increase in dosage blood pressure was lowered further. There was no statistically significant difference in blood pressure reduction between the 2 groups. Severe adverse drug experiences (ADEs) were few and equally distributed. However, more felodipine patients were withdrawn because of ADEs. Potassium levels decreased and uric acid levels increased significantly in the Moduretic group.

Adult↗