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At least 19 recordsLinked to original sources
PubMed1990

Smoking, antihypertensive treatment benefit, and comprehensive antihypertensive treatment approach: some thoughts on the results of the International Prospective Primary Prevention Study in Hypertension.

Several major studies investigated the possibility of a primary preventive effect of beta-blockers. The International Prospective Primary Prevention Study in Hypertension (IPPPSH) compared a beta-blocker-containing vs. a non-beta-blocker-containing antihypertensive regimen in 6,357 moderate-severe hypertensive men and women treated over 3-5 years. Blood pressure (BP) control was comparable with either regimen. beta-Blocker treatment was associated with less hypokalemia, earlier electrocardiogram normalization, and fewer withdrawals for uncontrolled hypertension. In agreement with the Medical Research Council (MRC) trial on mild hypertension and the Heart Attack Primary Prevention in Hypertension (HAPPHY) trial, but at variance with the Primary Prevention Metoprolol in Patients with Hypertension (MAPHY) study, cardiac event rates were similar in beta-blocker- and non-beta-blocker-treated patients. With either regimen, in-study BP reduction was associated with a lower rate of stroke as well as of cardiac events. In a subgroup analysis, nonsmokers appeared to derive beta-blocker benefit, the results being similar to those of the MRC. Smokers required higher doses of drugs to achieve diastolic target pressure, had a higher heart rate and hematocrit, and a higher cardiac event rate than nonsmokers at any given level of diastolic pressure. Except for the MAPHY trial, these primary prevention studies do not support the concept of a cardiac primary preventive effect of antihypertensive beta-blockade but stress the importance of good BP control and a comprehensive risk factor prevention approach in the management of hypertensive patients.

Adrenergic beta-Antagonists↗
PubMed1991

ACE-inhibition and renoprotection in early diabetic nephropathy. Response to enalapril acutely and in long-term combination with conventional antihypertensive treatment.

Early antihypertensive treatment with beta1 blockers and diuretics has proved to delay progression in diabetic nephropathy. Application of angiotensin converting enzyme inhibitors (ACE-I) may also be relevant. To elucidate possible differences in acute renal response to ACE-I and beta-blockers, kidney function was investigated before and after enalaprilat (10 mg) and metoprolol (10 mg) i.v. in 8 microalbuminuric insulin-dependent diabetic patients on no antihypertensive therapy (Study A). Glomerular filtration rate (clearance of 125I-iothalamate) was unchanged with both agents. ACE-I gave rise to efferent renal vasodilation: renal resistance and filtration fraction fell, renal plasma flow (RPF; 131I-hippuran) tended to rise (2p = 0.07) and blood pressure and urinary albumin excretion rate (UAE; radioimmunoassay) were reduced. In contrast, metoprolol caused a decline in RPF, an increase in renal resistance and filtration fraction, and no change in blood pressure or UAE. In 10 diabetic, nephropathic patients undergoing treatment with metoprolol and thiazide (Study B), the acute response to enalaprilat corresponded closely to that observed in Study A, including a decrease in UAE and blood pressure. Over 6 months the addition of enalapril (20 mg/d) to metoprolol and thiazide produced a more pronounced UAE-reduction, although no significant decrease in blood pressure was observed. The present findings support that ACE-I may process specific renoprotective effects. A combination therapy with beta1 blockers, ACE-I, and diuretics is suggested.

Adult↗
PubMed1987

[Predictive factors of resistance to antihypertensive treatment].

Results of antihypertensive treatment were analyzed in a group of 5,209 hypertensive patients referred in two hypertension Clinics in Paris from 1976 to 1985. Patients were included in the study if they fulfilled the following criteria: 1) at least four visits in the clinic, 2) follow-up period greater than 6 months, 3) initial diastolic blood pressure greater than or equal to 90 mmHg and/or presence of an antihypertensive treatment. After a mean follow-up period of 43 months, blood pressure was reduced from 177/105 mmHg to 148/89 mmHg. However, in spite of at least two antihypertensive drugs, 16.7 p. 100 of these patients had a diastolic blood pressure above 95 mmHg at the end of the follow-up period and were defined as uncontrolled hypertensives (UH). By comparison with controlled hypertensives (CH), UH patients were more frequently males (67.9 vs 56.6 p. 100, p less than 0.001), had a greater known duration of hypertension (11.6 vs 8.7 years, p less than 0.001), and presented at the first visit with higher blood pressures (188/113 vs 174/103 mmHg, p less than 0.001/p less than 0.001), despite a higher rate of antihypertensive treatment (66.6 vs 53.8 p. cent, p less than 0.001), a higher ponderal index (26.3 vs 25.3/kg/m2, p less than 0.01) and a higher prevalence of end-organ damage (23.2 vs 16.3 p. 100, p less than 0.001). Sokolov index, serum creatinine and uric acid levels were higher among UH than among CH patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1976

Pre-treatment workup for antihypertensive treatment.

The prevalence of primary and secondary hypertension and of heart and kidney involvement was thoroughly studied in 689 hypertensive subjects derived from a blood pressure screening examination of a total population sample of Swedish men (n = 7,452). The prevalence of secondary hypertension was found to be only 5%, the prevalence of surgically curable hypertension being even lower. Left ventricular hypertrophy and slight heart enlargement were each found in about one-third of the hypertensive patients, while severe heart enlargement, left ventricular hypertrophy on ECG, proteinuria, abnormal serum creatinine and urinary sediment were each found in about 5%. On the basis of these findings, a minimum pre-treatment workup in uncomplicated hypertension is proposed.

Antihypertensive Agents↗
PubMed1986

Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years. Report from a double-blind international multicenter study.

In a randomized double-blind study (N = 562), a traditional treatment schedule, starting antihypertensive treatment in elderly hypertensive patients (60 to 75 years old) with 25 mg of hydrochlorothiazide once daily and doubling the dose if a satisfactory response was not achieved, was compared with antihypertensive treatment of 100 mg of metoprolol once daily, adding 12.5 mg of hydrochlorothiazide for patients whose response was not satisfactorialy achieved with metoprolol alone. Systolic and diastolic blood pressure was significantly reduced with both regimens. The frequency rates of responders (diastolic blood pressure, less than or equal to 95 mm Hg) in the metoprolol group and the hydrochlorothiazide group were 50% and 47% after four weeks and 65% and 61% after eight weeks, respectively. There were no significant differences in total symptom score or single symptoms between the regimens, but significantly more patients had hypokalemia and hyperuricemia with the hydrochlorothiazide regimen. Thus, we conclude that beginning antihypertensive treatment with 100 mg of metoprolol once daily and adding a small dose of hydrochlorothiazide (12.5 mg) in patients whose response is not satisfactory with metoprolol alone appears to be effective and safe in elderly hypertensive patients.

Aged↗
PubMed1988

Responders and non-responders to antihypertensive treatment.

Responders to antihypertensive treatment have been defined as any patient with a fall in mean arterial pressure, however small; any patient with a fall in mean arterial pressure of 5%, 10% or greater; and any patient achieving a goal blood pressure, usually a diastolic pressure less than 90 mm Hg. Non-responders are normally defined as those who do not fit into the category of a responder. Blood pressure, however, varies considerably during follow-up, and diastolic pressure has a within-subject standard deviation of 8 mm Hg. Blood pressure varies according to environmental factors such as temperature, diet and stress, and tends to drift downwards during follow-up as the patient becomes accustomed to having blood pressure taken, to the place of measurement and to the observer. In a statistical sense, responders may be defined as the 2.5% with a fall in DBP greater than 16 mm Hg, yet in clinical studies of a low sodium diet reports have indicated that 50% have experienced an increase in pressure and 50% a fall (responders). Although the characteristics of those with a fall in pressure are of interest and should be compared with those who do not respond, a 50:50 division is unlikely to help. Methods of identifying true responders and non-responders are discussed in this brief review, along with the errors that may arise from a misclassification and problems of conducting further trials of treatment on the non-responders.

Antihypertensive Agents↗
PubMed1987

Effects of antihypertensive treatment on cerebral perfusion.

Antihypertensive treatment reduces the risk of ischemic strokes and cerebral hemorrhage as complications of excessive or long-standing hypertension. However, neurologic dysfunction and brain damage may also accompany short-term, and under certain conditions, even long-term antihypertensive treatment. Therefore, treatment should be instituted restrictively and cautiously. Special regard should be given to the action of antihypertensive drugs on cerebral perfusion in patients with an increased risk for the development of treatment-induced cerebral ischemic complications, such as patients with hypertensive encephalopathy or autonomic dysfunction, and elderly patients with suspected sclerotic stenosis of cerebral or neck arteries. The structural and functional lesions of cerebral vessels observed in acute and chronic hypertension are reviewed, as are the effects of antihypertensive drugs on cerebral blood flow. Calcium channel blockers and angiotensin-converting enzyme inhibitors may have advantages as first-line drugs in the treatment of patients with an elevated risk of cerebral hypoperfusion, because of the selective action of these agents on vasoconstricted vessels and their differential effects in varying regional vascular beds. The excellent efficacy of these drugs in the short- and long-term treatment of hypertension may lead to changes in the traditional management of hypertensive emergencies as well as in management strategies for other patients at risk for treatment-induced complications.

Adrenergic beta-Antagonists↗
PubMed1990

Regression of left ventricular hypertrophy in hypertensive patients: responses to exercise by antihypertensive treatment.

The effects of various antihypertensive treatments on the echocardiographic and electrocardiographic findings of left ventricular (LV) hypertrophy were studied in 75 patients with essential hypertension. The hemodynamic effects of the therapy during exercise were also compared. LV mass by echocardiogram was significantly reduced by beta-blockade and angiotensin converting enzyme inhibition (ACEI), but only slightly reduced by Ca channel blockade. QRS high voltage criteria of LV hypertrophy by electrocardiogram were reduced by all 3 of these antihypertensive treatments. At submaximal exercise, the pressor responses were attenuated by captopril, but not influenced by metoprolol or nifedipine. The increase in plasma norepinephrine by exercise was significantly suppressed after captopril, but was somewhat augmented after metoprolol or nifedipine. These observations indicate that the responses of hemodynamics and sympathetic nervous activity to exercise are different after the treatment by beta-blocker, Ca channel blocker or ACEI, in spite of the equal antihypertensive effect. However, it is suggested that the regression of LV hypertrophy might be induced by antihypertensive therapy, though the different grade by the individual drug.

Adrenergic beta-Antagonists↗
PubMed1990

Concomitant considerations in long-term antihypertensive treatment.

Even with antihypertensive therapy, the risks in hypertensive patients, especially the incidence of coronary events, cannot be lowered to that of the normotensive population. Therefore, the metabolic effects of long-term therapy on lipid metabolism and the efficacy of antihypertensive drugs to lower blood pressure were studied as possible explanations for this partial therapeutic failure. Hypertensive patients who participated in a long-term trial provided a unique opportunity to observe the effects of long-term treatment and of then discontinuing antihypertensive therapy. During treatment, increases in total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides following hydrochlorothiazide, and increases of LDL-C and triglycerides and a decrease of high-density lipoprotein cholesterol (HDL-C) following atenolol were observed up to 42 months. After 5.2 +/- 1.4 years of randomised antihypertensive treatment, cessation of hydrochlorothiazide led to a decrease of total cholesterol from 6.40 to 5.98 mmol/l and of LDL-C from 4.33 to 3.89 mmol/l. After discontinuation of atenolol, LDL-C decreased from 4.20 to 3.89 mmol/l and triglycerides from 2.21 to 1.91 mmol/l, whereas HDL-C increased from 0.96 to 1.17 mmol/l (all differences significant). Thus the adverse effects of both agents persisted for more than five years and were reversible after medication was discontinued. In recent years titration to the lowest possible dose of antihypertensive agents has been suggested to avoid adverse metabolic alterations and subjective side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[The brain and arterial hypertension. 2. Effects of antihypertensive treatment on cerebral circulation].

Antihypertensive treatment may, for the same effect on hypertension, have a very different influence on the cerebral blood flow and the autoregulation curve. For instance, sodium nitroprusside, a potent vasodilator, risks to be poorly tolerated from the cerebral standpoint, when the sympathetic system is not inhibited. Diazoxide has no direct vasodilating effect on the cerebral vessels but, because of its marked hypotensive action must be used in divided doses. Hydralazine, a strong vasodilator, must be avoided in case of cerebral edema and hypertensive encephalopathy. Diuretics and beta-blockers, on a long-term basis, do not significantly modify the cerebral blood flow while alpha-methyl-dopa would increase it and facilitate a return to normal of the autoregulation curve. Captopril has demonstrated experimentally, interesting properties: in anaesthetized rats, it shifts the autoregulation curve to the left, i.e. toward lower pressures and it reduces the autoregulation curve to the left, i.e. toward lower pressures and it reduces the autoregulation limits; in awaken subjects, the decreased lower limit is also observed, explaining the good central tolerance of marked blood pressure reductions; on the contrary, its effects on the upper limit of the plateau are, unquestionably, counterbalanced by the effects of sympathetic stimulation concomitant with sudden blood pressure rises. As for calcium inhibitor, they do not seem to influence the long-term autoregulation of the cerebral flow.

Administration, Oral↗
PubMed1986

Na+-Li+ countertransport and electrolyte composition in erythrocytes of patients with essential hypertension before and after antihypertensive treatment.

The effect of antihypertensive treatment with 6-12 mg of the loop diuretic piretanide over 12 weeks on Na+-Li+ countertransport, and on extra- and intracellular electrolyte composition was studied in 10 previously untreated patients with essential hypertension. These data were compared with 10 sex- and age-matched controls. Blood pressure fell from 180 +/- 18.3/110.5 +/- 9.8 to 154.7 +/- 9.7/92.5 +/- 10.9 mmHg during treatment. Na+-Li+ countertransport was significantly higher in hypertensives (0.36 +/- 0.13 mmol X l-1 rbc X h-1) compared with controls (0.25 +/- 0.05; P less than 0.05). Na+-Li+ countertransport and intracellular electrolyte composition remained unchanged whereas the extracellular potassium concentration fell from 4.28 +/- 0.51 to 3.98 +/- 0.36 mmol/l (P less than 0.05). No increase in the intracellular Na+ content as compared with normotensive controls was found. It is concluded that the intracellular Na+ concentration is not a marker for essential hypertension. The Na+-Li+ countertransport does not seem to be directly related to elevated blood pressure but seems to be a general marker for diseases associated with an increased risk for the development of hypertension.

Adult↗
PubMed1987

Effect of antihypertensive treatment on kidney function in diabetic nephropathy.

The effect of long term, aggressive antihypertensive treatment on kidney function in diabetic nephropathy was studied prospectively in 11 insulin dependent diabetics (mean age 30). During the mean pretreatment period of 32 (range 23-66) months the glomerular filtration rate decreased significantly and albuminuria and the arterial blood pressure increased significantly. During the 72 (range 32-91) month period of antihypertensive treatment the average arterial blood pressure fell from 143/96 mm Hg to 129/84 mm Hg and albuminuria decreased from 1038 micrograms/min to 504 micrograms/min. The rate of decline in the glomerular filtration rate decreased from 0.89 (range 0.44-1.46) ml/min/month before treatment to 0.22 (range 0.01-0.40) ml/min/month during treatment. The rate of decline in the glomerular filtration rate was significantly smaller during the second three years compared with the first three years in patients who received long term antihypertensive treatment (greater than or equal to 6 years). One patient died from acute myocardial infarction (glomerular filtration rate 46 ml/min/1.74 m2). Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy.

Adult↗
PubMed1989

The risk of hypertension: successes and failures of antihypertensive treatment.

All the antihypertensive trials that have compared active treatment with placebo have given similar and, at the same time, different results. In all trials the therapeutic quotient is above 1, indicating that in all trials mortality and morbidity may be lower (by at least 20%) in the actively treated group. However, the prevented event rate, an absolute measure of benefit, indicates a very large benefit (24 events prevented every 100 patient-years) in the trials involving severe hypertension, and a quite small rate (0.15 event prevented every 100 patient-years) in the MRC mild hypertension trial. Although, taken as a whole, the results of treatment of mild hypertension may appear only moderately encouraging, a considerably greater benefit is observed when a mildly elevated diastolic blood pressure is associated with other risk factors, such as the male sex, cigarette smoking, high blood cholesterol level and elevated systolic blood pressure. Emphasis has been placed, in recent years, upon other limitations in the success of antihypertensive therapy, and it has been stressed that the very effective prevention of cerebrovascular events in the treated hypertensive has not been matched by an equally effective prevention of coronary events. It has also been shown that the risk in treated hypertensives remains higher than that of the general population. Understanding the limitations of current antihypertensive therapy may help in extending treatment successes in the future. A hypothesis that has been recently advanced is that some of the failures of antihypertensive therapy may result from excessive lowering of blood pressure especially in hypertensive patients with ischaemic heart disease (the problem of the 'J'-shaped curve).(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1990

The effect of antihypertensive treatment on kidney function in insulin-dependent (type I) diabetics with renal failure.

Diabetic nephropathy is the dominant cause of hypertension in insulin-dependent diabetics, and long-term rigid antihypertensive treatment inhibits the progression of nephropathy, probably even when there is renal insufficiency. In our clinical study 14 insulin-dependent diabetics with diabetic nephropathy and renal failure (glomerular filtration rate [GFR] 0.39 +/- 0.12 ml/sec) underwent rigid blood pressure treatment. Antihypertensive therapy included furosemide, propranolol, dihydralazine and nifedipine. The whole group showed a lowering in mean blood pressures from 150.1 +/- 2.3/91.3 +/- 1.4 mm Hg to 139.8 +/- 3.1/86.5 +/- 2.0 mm Hg (p less than 0.01). During the observation period the mean decline in glomerular filtration rate decreased from -0.022 +/- 0.003 ml/sec per month to -0.010 +/- 0.007 ml/sec per month. In 10 out of 14 patients with very advanced nephropathy the further decline of GFR halted markedly. Thus, vigorous blood pressure control is able to postpone endstage renal disease even in advanced diabetic nephropathy.

Acute Kidney Injury↗
PubMedDate not supplied

The effect of long-term antihypertensive treatment on medial hypertrophy of cerebral arteries in spontaneously hypertensive rats.

The effects of antihypertensive treatment on the structural changes of middle cerebral arteries (MCA) were studied quantitatively and morphometrically in young spontaneously hypertensive rats (SHR). Fifteen male SHR, 10 weeks of age, were divided into control and experimental groups. In the experimental group, the animals were administered hydralazine and guanethidine for the following 10 weeks. At the age of 20 weeks, mean arterial blood pressure of experimental animals was 177 +/- 9 mm Hg (mean +/- SD), being significantly lower than that of 195 +/- 12 mm Hg in control ones. Media thickness of large (external diameter greater than or equal to 200 micron) and medium sized MCA (150-200 micron) in treated SHR was 12.3 +/- 2.8 and 6.3 +/- 1.1 micron, respectively, being significantly smaller than that of 14.0 +/- 2.2 and 8.5 +/- 2.6 micron, respectively, in control SHR. The media cross-sectional area and the ratio of media thickness to external diameter were also significantly reduced by antihypertensive treatment. In the smaller vessels (75-150 micron), however, vascular morphometry revealed no difference between the two groups. Long-term antihypertensive treatment during the early phase of hypertension attenuates the development of medial hypertrophy in large cerebral arteries.

Animals↗
PubMed1987

[Influence of long-term antihypertensive treatment on cerebral ischemia induced by bilateral common carotid artery ligation in SHRSR--protective effect of nicardipine hydrochloride].

We have already reported that the long-term antihypertensive treatment reduced the degree of cerebral ischemia induced by bilateral common carotid artery ligation (BLCL) in stoke-resistant spontaneously hypertensive rats (SHRSR). This antihypertensive treatment was achieved by the combination of captopril and hydroflumethiazide. In this study, nicardipine hydrochloride which is one of the Ca2+ antagonist was similarly administrated to SHRSR for 8-10 weeks (T-SHR). The effect of long-term antihypertensive treatment by this agent on cerebral ischemia induce by BLCL was investigated and compared with untreated SHRSR (U-SHR). The degree of cerebral ischemia 4 hr after BLCL was estimated by the levels of brain energy metabolites (ATP, lactate, c-AMP) and brain water content. The brain metabolites and water content were measured in the forebrain and hindbrain of each hemisphere. And also the histopathological study on brain vessels 3 hr after BLCL was achieved by using scanning electron microscopy (SEM). The blood pressure of T-SHR gradually declined from 185 +/- 10 mmHg (mean +/- S.D.) to 154 +/- 8 mmHg after 8-10 weeks of antihypertensive treatment. However the blood pressure of U-SHR spontaneously changed from 185 +/- 8 mmHg to 206 +/- 12 mmHg after 8-10 weeks. The blood pressure of T-SHR after the treatment was significantly lower than that of U-SHR. The levels of ATP and c-AMP in T-SHR after BLCL were statistically higher than those in U-SHR, and the lactate levels in T-SHR were significantly lower than in U-SHR in the both fore- and hindbrain.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Cardiovascular and renal effects of long-term antihypertensive treatment.

To study whether restoration of a normal circulatory system could be achieved with antihypertensive treatment, 13 hypertensive men with structural cardiovascular changes and 37 normotensive control subjects were investigated by echocardiography, apexcardiography, plethysmography, inulin and p-amino-hippurate clearance, and determination of 24-hour urinary excretion of albumin, first at age 49 years and again seven years later. All men were untreated at the first investigation. Immediately thereafter, therapy with the cardioselective beta-adrenoceptor blocker metoprolol tartrate was initiated in the hypertensive men. Seven years of antihypertensive treatment resulted in (1) normalization of central and peripheral hemodynamic variables, (2) reversal of left ventricular hypertrophy in proportion to achieved blood pressure control, (3) normalization of systolic wall stress and a well-preserved systolic left ventricular function, (4) normalization of diastolic left ventricular function, and (5) normalization of increased microalbuminuria and a decrease in renal vascular resistance, with no change in glomerular filtration rate compared with control subjects. In conclusion, the findings strongly indicate that regression of cardiovascular structural changes can be achieved with long-term antihypertensive treatment.

Drug Therapy, Combination↗