F. Giuntoli

The Combination of Chlorthalidone with Nifedipine Does Not Exert an Additive Antihypertensive Effect in Essential Hypertensives: A Crossover Multicenter Study

To evaluate whether the combination of nifedipine with chlorthalidone exerts an additive antihypertensive effect when compared to single-drug treatment, 66 uncomplicated essential hypertensives, whose diastolic blood pressure was > 100 and < 115 mm Hg at the end of a 1-month washout placebo period, received, according to a randomized, double-blind, crossover design, nifedipine (20 mg b.i.d.), chlorthalidone (25 mg o.d.), the two drugs combined at the same doses, and the corresponding placebo. When compared to the randomized placebo the three active treatments significantly (p < 0.001) reduced blood pressure without changing heart rate and body weight. However, blood prssure values were similarly reduced under nifedipine and the combination and were significantly lower (p < 0.05) than those under chlorthalidone. Moreover, the percentage of responders and normalized patients under nifedipine and the two drugs combined were similar and significantly (normalized, p < 0.001; responders, p < 0.02) greater than those under chlorthalidone. Under chlorthalidone and its combination with nifedipine, plasma potassium tended to decrease and blood glucose and serum uric acid were significantly (p < 0.05) increased. These data show that the combination of nifedipine with chlorthalidone does not exert any additive antihypertensive effect when compared to nifedipine alone and that this combination increases both blood glucose and serum uric acid. Taken together these findings indicate that the combination of a dihydropyridine calcium antagonist with a thiazide diuretic is devoid of any clinical significance in the treatment of uncomplicated essential hypertensives.

Chlorthalidone does not increase the hypotensive effect of nifedipine in essential hypertensives: a crossover multicentre study

To determine whether the combination of nifedipine + chlorthalidone exerts an additive antihypertensive effect when compared with single-drug treatment, we studied 66 uncomplicated essential hypertensives, with diastolic blood pressure of greater than 100 and less than 115 mmHg. At the end of a 1-month washout placebo period, using a double-blind crossover design, the patients were randomly allocated to nifedipine (20 mg twice a day), chlorthalidone (25 mg once a day), the two drugs combined at the same doses and the corresponding placebo. Compared with the randomly allocated placebo, the three active treatments significantly reduced blood pressure without changing the heart rate or body weight. Both the absolute and percentage decreases in mean blood pressure induced by nifedipine and the combination compared with placebo were similar and significantly greater than those induced by chlorthalidone. Taken together, these data show that the combination of nifedipine + chlorthalidone does not exert any additive antihypertensive effect compared with nifedipine alone. This finding indicates that the combination of a dihydropyridine calcium antagonist + a thiazide diuretic is probably devoid of any particular clinical significance in the treatment of uncomplicated essential hypertensives.

Antihypertensive effect of once daily sustained release isradipine: a placebo controlled cross-over study

SummaryTo evaluate the magnitude and duration of the antihypertensive effect of sustained release (SRO) isradipine, 37 uncomplicated essential hypertensive patients (diastolic blood pressure 100–115 mm Hg after a one month run-in on placebo) were randomised to receive, according to a double-blind cross-over design, isradipine SRO 5 mg once daily and the corresponding placebo for 1 month. At the end of each treatment period, sitting blood pressure and heart rate were measured immediately before and every hour for 6 h after the last dose. Thirty-four patients [16 m, age 54 (7) y] completed the study.As compared to randomised placebo, isradipine SRO significantly reduced the systolic (SBP) and diastolic (DBP) blood pressure. Absolute DBP decrements versus placebo peaked 6 h after dosing (-8.8 mm Hg) and were not significantly lower (-8.2 mm Hg) at the end of the dose interval. At the same times, the absolute decrements in SBP were -9.8 mm Hg and -9.7 mm Hg, respectively.DBP was normalised in 19 patients (56%) at peak and in 17 (50%) at trough time. The trough to peak efficacy ratio in patients with peak DBP ≤ 90 mm Hg was 70%. Heart rate was slightly increased by isradipine SRO. Adverse effects monitored with a check-list occurred in 8/36 patients (22%) on isradipine SRO and in 4/35 (11%) on randomized placebo.The data suggest that isradipine SRO is an effective antihypertensive drug, with a trough to peak efficacy ratio supporting once daily administration in most mild to moderate essential hypertensives.

Antihypertensive and Metabolic Effects of Nitrendipine in Non-insulin-dependent Diabetes Mellitus with Hypertension

Fifteen non-insulin-dependent diabetes mellitus hypertensive patients received nitrendipine (20-40 mg) for 24 weeks. Mean systolic and diastolic blood pressure decreased significantly from 177/102 mm Hg before treatment to 153/86 mm Hg (p less than 0.001) after treatment. Meanwhile, the heart rate, body weight, indices of glycemic control (glucose, glycosylated hemoglobin, fructosamine, and serum C peptide levels), and serum lipid fractions did not change. It is concluded that nitrendipine does not impair glucose and lipid metabolism in diabetic patients while exerting its antihypertensive effect.

Captopril treatment in elderly hypertensive patients: efficacy and tolerability

Ninety-five elderly (greater than 70 years) hypertensive patients were treated for 3 months with 25-100 mg captopril daily. The mean blood pressure decrease was from 179/101 to 155/87 mmHg (P less than 0.001). The heart rate did not change. The drug was generally well tolerated (patients taking less than 100 mg captopril or captopril + chlorthalidone reported side effects) and there was no change in the biochemical parameters (glucose, uric acid, cholesterol, high density lipoprotein-cholesterol, triglycerides, apoproteins, blood urea nitrogen, creatinine, serum electrolytes). Our open study indicates that captopril is a safe and effective antihypertensive agent in elderly patients. However, some caution is necessary when high doses of captopril (100 mg/day) are used.

Antihypertensive and metabolic effects of lacidipine in patients with NIDDM and/or hypertension

&NA; Diabetes mellitus is often associated with hypertension and is an additional cardiovascular risk factor. It is therefore important that antihypertensive drugs should have no negative metabolic effects. We present here the results of two distinct studies investigating the clinical efficacy and the metabolic effects of lacidipine in hypertensive patients without concomitant diabetes. Patients in the first study (group A) were hypertensive with non‐insulin‐dependent diabetes mellitus (NIDDM) and stable blood glucose levels in the 3 months before entering the study. Patients in the second study (group B) were hypertensive without diabetes mellitus. Before the commencement of the study, antihypertensive treatment was discontinued in all patients for a 4‐week washout period, followed by 4 weeks of run‐in with placebo. Patients were then treated with lacidipine (4 mg o.d.) for 6 months. After 1‐2 months, the dose was doubled in patients with uncontrolled blood pressure. Every 2 months, lipid and carbohydrate metabolism were investigated by blood chemistry analyses. The results demonstrate that lacidipine 4‐8 mg o.d. is efficacious and well tolerated in hypertensive patients, even in the presence of diabetes mellitus.

A pilot study of the effects of omega-3 polyunsaturated fatty acids on blood lipids in hyperlipidemic patients

The effect of treatment with omega-3 polyunsaturated fatty acids on blood lipids was evaluated in 16 patients with hyperlipidemia. The lipid profile was assessed before treatment and at monthly intervals after treatment (1-gm capsule three times daily). The results showed a decrease in blood triglyceride and cholesterol levels and an increase in high-density lipoprotein cholesterol. Tolerance of the treatment was generally good.