PubMed · 11028306
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M Nishinaga, T Ozawa. 2000. [Direct vasodilator].. https://pubmed.ncbi.nlm.nih.gov/11028306/
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Clinical trial investigators often record a great deal of baseline data on each patient at randomization. When reporting the trial's findings such baseline data can be used for (i) subgroup analyses which explore whether there is evidence that the treatment difference depends on certain patient characteristics, (ii) covariate-adjusted analyses which aim to refine the analysis of the overall treatment difference by taking account of the fact that some baseline characteristics are related to outcome and may be unbalanced between treatment groups, and (iii) baseline comparisons which compare the baseline characteristics of patients in each treatment group for any possible (unlucky) differences. This paper examines how these issues are currently tackled in the medical journals, based on a recent survey of 50 trial reports in four major journals. The statistical ramifications are explored, major problems are highlighted and recommendations for future practice are proposed. Key issues include: the overuse and overinterpretation of subgroup analyses; the underuse of appropriate statistical tests for interaction; inconsistencies in the use of covariate-adjustment; the lack of clear guidelines on covariate selection; the overuse of baseline comparisons in some studies; the misuses of significance tests for baseline comparability, and the need for trials to have a predefined statistical analysis plan for all these uses of baseline data.
A WELL IDENTIFIED RISK FACTOR: Other than systolic, diastolic and mean pressure, arterial pulse pressure (or differential pressure) is an independent factor of cardiovascular and notably coronary risk. The role of this factor is now clearly quantified in untreated hypertensive patients, but also in treated apparently controlled patients, and in patients with normal blood pressure. Demonstration of the deleterious role of an increase in pulse pressure was also made in populations at high risk of events such as heart failure, post-infarction or in hemodialyzed patients. FROM A THERAPEUTIC POINT OF VIEW: Antihypertensive treatments have inconstant efficacy on pulse pressure and new therapeutic routes appear promising. However, in the absence of available proof that a strategy axed on the decrease in pulse pressure improves cardiovascular prognosis, current recommendations do not yet include pulse pressure levels in therapeutic strategies. AN EFFICIENT MARKER: Whilst awaiting further data, the measurement of pulse pressure, because of its pertinence and simplicity, provides the practitioner with one of the most efficient markers for screening persons at high risk of cardiovascular and particularly coronary risk.
The aim of the present study was to prepare controlled-release tablets of poorly-soluble drug, felodipine, and various erodable lipophilic excipients. Spray chilling was used to formulate the drug and the excipients into solid dispersion microparticles, which were then compressed. The microparticles were characterised by Fourier transform infrared spectroscopy, hot-stage microscopy, scanning electron microscopy, and image analysis. The amine and the carbonyl groups of felodipine formed hydrogen bonds with the carriers. The shape of the particles was spherical with the median particle diameter ranging from 25 to 35 microm. Surprisingly, the degree of crystallinity in felodipine and the ease of tablet disintegration played a more significant role on the felodipine dissolution rate than the matrix lipophilicity. Felodipine release rate was slowest from the least lipophilic tablets.