L. Poletti

Sexual activity in hypertensive men treated with valsartan or carvedilol : A crossover study

The aim of this study was to compare the effect of antihypertensive treatment with valsartan or cavedilol on sexual activity in hypertensive men who were never treated for hypertension. A total of 160 newly diagnosed hypertensive men (diastolic blood pressure [DBP] > or = 95 mm Hg and < 110 mm Hg), aged 40 to 49 years, all married and without any previous sexual disfunction, were enrolled. After a 4-week placebo period, the patients were divided into two groups: a) 120 patients were randomized to receive carvedilol 50 mg once daily or valsartan 80 mg once daily for 16 weeks according to a double-blind, cross-over design; after another 4-week placebo period, patients were crossed over to the alternative regimen for a further 16 weeks; b) 40 patients were treated with placebo according to a single-blind design for 16 weeks. At the screening visit and every 4 weeks thereafter, blood pressure (BP) was evaluated and patients were interviewed by a questionnaire about their sexual activity. Blood pressure was significantly lowered by both treatments, with a 48% of normalization with valsartan and 45% with carvedilol. During the first month of therapy, sexual activity (assessed as number of sexual intercourse episodes per month) declined with both drugs as compared with baseline, although the decrease was statistically significant in the carvedilol (from 8.2 to 4.4 sexual intercourse episodes, P < .01) but not in the valsartan-treated patients (from 8.3 to 6.6 sexual intercourse episodes, not significant). Ongoing with the treatment the sexual activity further worsened with carvedilol (3.7 sexual intercourse episodes per month) while fully recovered and also improved with valsartan (10.2 sexual intercourse episodes per month). The results were confirmed by the cross-over. Erectile dysfunction was a complaint of 15 patients with carvedilol (13.5%), one patient with valsartan (0.9%), and one patient in the placebo group. These findings suggest that carvedilol induces a chronic worsening of sexual activity, whereas valsartan not only does not significantly worsen sexual activity but may even improve it.

Sexual Function in Hypertensive Males Treated with Lisinopril or Atenolol A Cross-Over Study

To evaluate the effect of antihypertensive treatment on sexual activity, 90 hypertensive men, aged 40 to 49 years, all married and without history of sexual dysfunction were treated with 100 mg of atenolol or 20 mg of lisinopril for 16 weeks, according to a double-blind, randomized, cross-over design. During the first month of therapy, sexual activity, assessed as number of sexual intercourse episodes per month, significantly declined with both atenolol (from 7.8 +/- 4.3 to 4.5 +/- 2.8, P < .01 v placebo) and lisinopril (from 7.1 +/- 4.0 to 5.0 +/- 2.5, P < .05 v placebo). Ongoing with the treatment, sexual activity tended toward recovery in the lisinopril (7.7 +/- 4.0 sexual intercourse episodes per month, P = NS v placebo), but not in the atenolol group (4.2 +/- 2.8, P < .01 v placebo), with a statistically significant difference between the two drugs (P < .01). The percentage of patients who complained of sexual dysfunction symptoms was significantly higher in the atenolol- than in the lisinopril-treated group (17% v 3%, P < .05). These findings suggest that atenolol induces a chronic worsening of sexual activity, whereas lisinopril causes only a temporary decline.

Comparative effects of celiprolol, propranolol, oxprenolol, and atenolol on respiratory function in hypertensive patients with chronic obstructive lung disease

SummaryThe aim of the study was to compare the pulmonary effects of four beta-blockers with different ancillary properties: propranolol (non-beta1 selective without ISA), oxprenolol (non-beta1 selective with ISA), atenolol (beta1 selective), and celipropol (beta1 selective with mild beta2-agonist and alpha2-antagonist activity) in hypertensive patients with chronic obstructive lung disease. Ten asthmatic patients, all males, aged 50–66 years were studied. Entry criteria were a) DBP≧95 mmHg and ≦115 mmHg; b) FEV1<70% of the theoretical values; c) FEV1 increase of at least 20% after salbutamol inhalation (200 μg). After a 2-week washout period on placebo, each patient received propranolol (80 mg/day), oxprenolol (80 mg/day), atenolol (100 mg/day), and celiprolol (200 mg/day) for 1 week, according to a randomized, cross-over design. At the end of the washout and of each treatment period, airway function, assessed by FEV1, FVC, and FEV1%, was evaluated by spirometry both in the basal condition and after salbutamol inhalation. Unlike propranolol and oxprenolol, which significantly reduced FEV1 and inhibited the bronchdilator response to inhaled salbutamol, atenolol and celiprolol did not significantly affect respiratory function and did not antagonize salbutamol effects. Celiprolol more closely approached placebo in its respiratory effects than did atenolol, although the differences were not statistically significant.

Plasma lipids during chronic antihypertensive therapy with different β-blockers

The aim of this study was to compare the effects of long-term monotherapy with five different beta-blockers on plasma lipids in patients with essential hypertension. We studied 99 male patients, aged 35-55 years, with mild to moderate hypertension, who worked in the same community. After a 1-month placebo period, patients were assigned to receive propranolol (160 mg/day), atenolol (100 mg/day), bisoprolol (10 mg/day), mepindolol (10 mg/day), or celiprolol (400 mg/day). Therapy was continued for 2 years. Blood pressure (BP), heart rate, and blood samples for evaluation of total cholesterol (TC), LDL-cholesterol (LDL-C), triglycerides (TG) and HDL-cholesterol (HDL-C) were taken before and after the initial placebo period, and subsequently every 6 months from the beginning of active treatment. All beta-blockers caused similar reductions in BP that were maintained throughout the study. None of the beta-blockers significantly affected TC or LDL-C. Propranolol, a nonselective beta-blocker, caused the most pronounced changes in TG (+33 to 43%) and in HDL-C (-30 to -32%). Atenolol, a beta 1-selective agent, had the same quantitative effects, but to a lesser extent (TG + 23 to 30%; HDL-C -15 to -19%). Bisoprolol, more beta 1-selective than atenolol, and mepindolol, nonselective with ISA, increased TG (+20 to 28% and +14 to 25%, respectively) but did not significantly affect HDL-C. In contrast, celiprolol, a highly cardioselective beta-blocker with beta 2-partial agonism, improved lipid risk factors by significantly reducing TG (-14 to -21%) and increasing HDL-C (+8 to 14%).(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term effects of amlodipine versus fosinopril on microalbuminuria in elderly hypertensive patients with type 2 diabetes mellitus

Abstract Objective The aim of this study was to compare the effects on urinary albumin excretion (UAE) of amlodipine versus fosinopril in elderly hypertensive patients with type 2 diabetes mellitus. Methods We studied 147 elderly (60 to 75 years) hypertensive patients (diastolic blood pressure > 90 mm Hg) with concomitant, well-controlled type 2 diabetes mellitus. After a 4-week placebo period (at the beginning of which current antihypertensive agents were discontinued), they were randomly allocated to receive amlodipine 5 to 10 mg once daily (n = 73) or fosinopril 10 to 20 mg once daily (n = 74) for 24 months. Nonresponders to monotherapy were discontinued after 8 weeks. At the end of the placebo period and after 3, 6, 12, 18, and 24 months of treatment, blood pressure (BP), glycosylated hemoglobin A 1c , UAE, and creatinine clearance were determined. Results Seventy-nine patients completed the 24-month study. Both amlodipine and fosinopril similarly reduced BP without affecting glucose homeostasis. At 3 months, UAE was significantly reduced ( P P P P Conclusions Based on these results, we concluded that long-term treatment with both amlodipine and fosinopril was effective in reducing UAE in elderly hypertensive patients with type 2 diabetes mellitus and microalbuminuria.

Left ventricular anatomy and function in normotensive young adults with hypertensive parents Study at rest and during handgrip

Using digitized M-mode echocardiograms, we evaluated left ventricular (LV) anatomy and function at rest and during handgrip in 24 normotensive young adults with both parents hypertensive (HP+), each matched for age, sex, body weight, and body surface area with one normotensive adult with both parents normotensive (HP-). LV parameters were within the normal range in all HP+ and HP-. At rest, HP+ as compared to HP- had higher systolic and diastolic blood pressure (BP), septal and posterior wall thickness, and LV mass; LV diastolic diameter and end-systolic wall stress were similar in the two groups. Modified midwall fractional shortening, peak shortening rate of LV diameter and peak thickening rate of LV posterior wall, indices of LV systolic function, and peak lengthening rate of LV diameter and peak thinning rate of LV posterior wall, indices of ventricular relaxation, were significantly higher in HP+. Handgrip induced significant (P < .001) and percent-comparable increases of systolic and diastolic BP, heart rate, and cardiac output in HP+ and HP-; peak shortening and lengthening rates of LV diameter and peak thickening and thinning rates of LV posterior wall increased significantly in HP-, whereas in HP+ the value of the four parameters, higher at rest as compared to HP-, did not show any further increase. In conclusion, normotensive young adults with high genetic risk for hypertension have higher BP and thicker and overactive LV as compared to subjects with normotensive parents. Handgrip stimulates LV function in offspring of normotensives, but not the already hyperkinetic LV of hypertensive offspring.

β-blocker effects on plasma lipids in antihypertensive therapy : importance of the duration of treatment and the lipid status before treatment

The aim of this study was to evaluate the effects of long-term monotherapy with four β-blockers provided with different pharmacological properties on plasma lipids in both normocholesterolemic and hypercholesterolemic hypertensive patients. After a 1-month run-in period on placebo. 70 hypertensive patients with basal total cholesterol (TC) 220 mg/dl were treated for 3 years with propranolol 160 mg/day or atenolol 100 mg/day or bisoprolol 10 mg/day or mepindolol 10 mg/day, while 59 hypertensive patients with basal TC > 220 mg/dl were given the same β-blockers at the same dosage for 6 months. In both normocholesterolemic and hypercholesterolemic hypertensive patients. HDL-C and triglyceride (TG) levels showed significant changes that appeared to be related to the type of β-blocker used and to the duration of therapy. Nonselective, non-ISA (intrinsic sympathomimetic activity) propranolol caused the most pronounced changes, decreasing HDL-C and increasing TG concentrations; β1-selective atenolol and bisoprolol had similar, but less remarkable effects; even more discrete changes were observed on mepindolol (with ISA). The variations in HDL-C and TG values reached their peak in 6–12 months of β-blocker therapy; then, after a plateau phase, they showed a progressive trend toward pretreatment levels. In hypercholesterolemic patients, the percent change in both HDL-C and TG values was lower compared to normocholesterolemic patients.

Nitrendipine 20 MG Once Daily Versus Nicardipine Slow Release 40 MG Twice Daily in Mild Essential Hypertension: Evaluation by 24-Hour Ambulatory Blood Pressure Monitoring

The extent and duration of the blood pressure (BP) lowering effect of 20 mg nitrendipine (NIT) once daily and 40 mg nicardipine slow release (NIC) twice daily were compared in 12 men (aged 39-55 years) with mild essential hypertension according to a randomized, cross over study. Twenty-four-hour non invasive ambulatory BP monitoring (Spacelabs 5200) was performed at the end of a 2-week placebo run-in and after 4 weeks of each active treatment; automatic BP measurements were programmed at 15-min intervals. Both treatments significantly (p less than .01) reduced mean 24-hour and daytime systolic (SBP) and diastolic (DBP) BP, but had different effects on daytime BP profiles. NIT decreased SBP and DBP (p less than .05) in 5 out of 8 two-hour subperiods (from 8 a.m. to 6 p.m.), followed by a loss of effect; NIC reduced SBP and DBP (p less than .05) in 7 out of 8 two-hour subperiods (from 8 a.m. to 10 p.m.). During the night-time, NIT reduced mean SBP (p less than .05) and NIC both mean SBP and DBP values (p less than .05; p less than .05 vs NIT for SBP). Heart rate was not affected by either treatment. Thus, after short-term treatment in mild essential hypertensives nitrendipine once daily was not as effective as nicardipine slow release twice daily in reducing blood pressure throughout the 24 hours.

P-10: Different effect of valsartan and lisinopril on sildenafil use in hypertensive men with erectile dysfunction

The aim of the stuty is to evaluate the effect of antihypertensive treatment with valsartan or lisinopril on sildenafil use in impotent hypertensive men. Thirty-eight mild to moderate (DBP 90 105 mmHg) hypertensive patients, aged 46-65 years, able to have an erection only with sildenafil, were studied. After a 4 week placebo period the patients were randomized to valsartan 160 mg od or to lisinopril 20 mg od for 16 weeks; then after a 4 week placebo period they were crossed to the alternative regimen for other 16 weeks according to a cross-over design. At the end of each placebo period and every 4 weeks during the active periods, BP was measured and the patients filled out in privacy a questionnaire addressing the use of sildenafil during the previous 4 weeks. The results are shown in the table. In conclusions both drugs induced a similar BP lowering; however only during the chronic treatment with valsartan the use of sildenafil significantly increased. It suggests that Angiotensin II antagonism induces an increase in sexual desire in impotent hypertensive men. It could be related to the reactive stimulation of Angiotensin cascade due to AT1 receptors blockade.

Adding losartan to lisinopril therapy in patients with hypertension: Assessment by 24-hour ambulatory blood pressure monitoring

Abstract The aim of this study was to assess the effects of adding losartan to lisinopril on 24-hour blood pressure (BP) values and on the reninangiotensin system (RAS) in patients with hypertension whose condition was not controlled by lisinopril monotherapy. We studied 52 patients with essential hypertension (27 men, 25 women; mean age, 56 ± 6 years) with sitting diastolic blood pressure (DBF) > 90 mm Hg after 4 weeks of monotherapy with lisinopril 10 mg once daily. The patients were randomly allocated to receive either losartan 50 mg once daily in addition to lisinopril 10 mg once daily or a double dose of lisinopril (20 mg once daily) for 4 weeks, according to a doublemasked, crossover design. At the end of each treatment period, casual BP and heart rate were measured, noninvasive 24-hour ambulatory blood pressure monitoring was performed, and a blood sample was obtained to measure plasma renin activity (PRA) and angiotensin (Ang) I and II levels. The combined administration of losartan 50 mg and lisinopril 10 mg produced a greater reduction in both ambulatory and casual systolic BP and DBP values compared with lisinopril 20 mg. The additive BP-lowering effect of the combination therapy occurred during both the 24-hour period and the single daytime and nighttime subperiods, without interfering with the normal circadian BP pattern. Furthermore, the losartanlisinopril combination increased PRA and Ang I more than lisinopril 20 mg and decreased the losartan-induced peak value of Ang II. Results of this study suggest that the addition of losartan to lisinopril therapy was more effective in decreasing BP and increasing PRA and Ang I than doubling the lisinopril dose; therefore, a more complete RAS blockade might improve BP control in patients with hypertension.