Remzi Önder

A Randomised Comparison of the Effects of Nebivolol and Atenolol with and without Chlorthalidone on the Sexual Function of Hypertensive Men

AbstractBackground and objective: Erectile dysfunction, which is common in men with hypertension, has been reported as a common adverse effect of many antihypertensive drug classes, including β-blockers and diuretics. Atenolol and nebivolol are both β1-selective blockers, but nebivolol is a new-generation compound with nitric oxide-mediated vasodilating activity. The aim of the study was to compare the effects of nebivolol and atenolol ± chlorthalidone on the sexual function of hypertensive men. Methods: A total of 131 male patients (mean age 47.3 ± 4.6 years) with newly diagnosed hypertension were included in the study. All the patients were married and had not previously experienced any erectile dysfunction. After a 4-week placebo run-in period, patients were randomised to receive 12 weeks’ therapy with nebivolol 5 mg/day (n = 43), atenolol 50 mg/day (n = 44), or atenolol 50 mg/ day + chlorthalidone 12.5 mg/day (n = 44), according to a double-blind design. After 4 weeks of treatment, drug dosage could be doubled in patients not responding to therapy. Erectile function (instances of successful intercourse/month) was assessed by means of a questionnaire at the end of the placebo run-in period (baseline) and at the end of double-blind treatment. Blood pressure was also assessed at these times. Result: At the end of the 12-week, double-blind treatment period, the mean number of episodes of satisfactory sexual intercourse per month was significantly decreased from baseline in the groups receiving atenolol (from 7.0 to 3.7; p < 0.01) and atenolol + chlorthalidone (from 6.4 to 2.8; p < 0.01). In contrast, the mean number of episodes of satisfactory sexual intercourse per month remained constant in the group of patients receiving nebivolol (6.4 during the baseline assessment and 6.0 during the last month of treatment). Blood pressure and heart rate were significantly decreased from baseline in all treatment groups. Conclusion: Increased release of nitric oxide associated with nebivolol may counteract the detrimental effect of β-blockade on penile erection, thereby allowing maintenance of sexual activity in previously untreated hypertensive men compared with a significant decrease observed in the sexual activity of men receiving atenolol-based treatment.

The Role of Tilt Training in Preventing Recurrent Syncope in Patients with Vasovagal Syncope: A Prospective and Randomized Study

Background: Recurrent vasovagal syncope (VVS) can be a severely disabling disorder that may lead to an important deterioration of quality of life because of the severity and recurrence of episodes. This study sought to investigate the effectiveness of repeated orthostatic self‐training in preventing syncope in patients with recurrent VVS.

Myocardial infarction following a bee sting

We described here a patient envenomated by a bee sting that caused myocardial damage compatible with non-ST elevation acute myocardial infarction. She developed a typical course of myocardial infarction; the ECG changes were reversed to almost all normal limits. She had normal coronary angiography and reversible wall motion abnormalities. Myocardial damage following prolonged spasm in the coronary arteries may be the underlying factor.

Therapeutic benefits of Cilazapril in patients with syndrome X

Objectives: Although the pathophysiology of syndrome X (angina pectoris, positive ECG test findings and normal coronary arteriogram) is unclear, it is generally accepted that intracellular metabolic changes resulting from abnormal constriction of prearteriolar vessels due to endothelium-dependent vasodilation abnormalities may play a role in the pathogenesis. We established the effect of long-term treatment with cilazapril, an angiotensin-converting enzyme inhibitor, which prevents the effect of angiotensin II in the tonic control of vascular resistance. Methods: 18 patients (15 women and 3 men, mean age 43.2 ± 4.6 years) with syndrome X were included in this study. A randomized double-blind crossover placebo-controlled trial was done. After a 1-week washout period, patients received either cilazapril 2 × 2.5 mg or placebo for 3 weeks, followed by 3 weeks of the other therapy. At the end of two periods, an exercise ECG test (modified Bruce protocol) was employed. Results: The magnitude of ST segment depression was significantly decreased during treatment with cilazapril compared with placebo. On the other hand, total exercise time and time to 1 mm ST segment depression were significantly prolonged by cilazapril. However, rate pressure products were not significantly different at peak exercise at or at 1 mm of ST segment depression during both therapies. Conclusion: Cilazapril exerted a beneficial therapeutic effect in cases with syndrome X. The possible mechanism of this effect may be a modulation of coronary tone at the microcirculation level.

The effect of trimetazidine in the treatment of microvascular angina

Although the pathophysiology of microvascular angina is unclear, intracellular metabolic changes are believed to be the main factors. Trimetazidine has an intracellular metabolic effect in coronary insufficiency. The effect of trimetazidine in microvascular angina is unknown. Thirty-five patients (8 men, 27 women, age 36–57 years, mean 43.9±6.4 years) with microvascular angina were included in this study. The effects of trimetazidine (60 mg daily) were investigated in a placebo-controlled, doubleblind study consisting of two 4-week treatment periods. Patients were assessed by symptom-limited exercise testing (Bruce protocol). Heart rate and systolic blood pressure at rest, peak exercise, and the time of 1 mm ST segment depression were not significantly different between placebo and trimetazidine treatment. Trimetazidine prolonged total exercise time and time to 1 mm ST depression compared with placebo. Maximum ST depression was less in patients with trimetazidine therapy than those with placebo. It is concluded that trimetazidine has a beneficial effect in cases with microvascular angina.

The prevalence of silent myocardial ischaemia in patients with white-coat hypertension.

The aim of this study was to estimate the incidence of silent myocardial ischaemia in patients with mild to moderate hypertension, white-coat hypertension (WCH) and those with normal blood pressure. Ambulatory electrocardiographic (ECG) monitoring was carried out in 272 cases with normal blood pressure, 164 cases with mild to moderate hypertension (diastolic blood pressure >95 and <114 mm hg), and 106 cases with white-coat hypertension who were diagnosed with ambulatory blood pressure monitoring. the ages of the patients of all groups were between 42–61 years. there were no differences between the groups according to age, gender and other parameters. there were no anginal symptoms, and resting ecgs were in normal limits in all cases. the diagnosis of silent ischaemia was considered to be present if there was st depression >2 mm/at least 120 sec in ambulatory ECG examination without angina or its equivalent cardiac symptoms. The incidence of silent ischaemia was 6.4%, 18.8%, and 26.2% in cases with normal blood pressure, WCH, and hypertension, respectively. The differences between groups were significant. It was concluded that WCH is not a benign condition, but shares some characteristics with essential hypertension.

Clinically additive effect between doxazosin and amlodipine in the treatment of essential hypertension.

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has reported that combinations of low doses of antihypertensive agents from different classes may provide additional antihypertensive efficacy and minimize the likelihood of dose-dependent adverse effects. Doxazosin and amlodipine, alone and in combination, were compared for efficacy in reducing blood pressure (BP) in 75 patients with predominantly moderate (Stage 2) hypertension. This was a double-blind, randomized, crossover study. After a 2-week washout period, patients in group A (n = 37) received amlodipine 10 mg and patients in group B (n = 38) received doxazosin 4 mg for 6 weeks. All patients then received reduced-dose combination therapy (amlodipine 5 mg and doxazosin 2 mg) for 6 weeks. Subsequently, patients received 6 weeks of monotherapy with the alternate medication (group A received doxazosin 4 mg and group B received amlodipine 10 mg). During both monotherapy periods, doxazosin and amlodipine significantly reduced systolic and diastolic BP (P < .001 v baseline). BP further decreased with combination therapy (P < .01 v monotherapy). The percentage of patients with Stage 2 hypertension who achieved a target BP of < 140/< 90 mm Hg increased from 78% with monotherapy to 94% with combination therapy. Fewer adverse effects were observed during combination therapy. It is concluded that there is an additional fall in blood pressure when reduced doses of doxazosin and amlodipine are used in combination for the treatment of hypertension, suggesting that doxazosin should be considered as an effective add-on treatment to calcium-channel blockers.

Effect of irbesartan monotherapy compared with ACE inhibitors and calcium-channel blockers on patient compliance in essential hypertension patients: a multicenter, open-labeled, three-armed study.

Objectives. This multicenter, three‐armed, open‐labeled study investigated patient compliance of patients receiving irbesartan, angiotensin‐converting enzyme (ACE) inhibitors or calcium‐channel blockers (CCB) for essential hypertension for a 6‐month period. Patients were either newly diagnosed or switched from existing antihypertensive medication due to lack of efficacy or side‐effects. Methods. Patients were started monotherapy with irbesartan (n = 377), ACE inhibitors (n = 298) or CCB (n = 308) and were reevaluated on 1st, 3rd, and 6th months of the treatment. The primary endpoint was patient compliance, assessed by proportion of patients who had taken their study medication every day. Efficacy was recorded as mean reductions in blood pressure and the proportion of patients whose blood pressure normalized. Tolerability was assessed by reported adverse events. Results. Significantly more patients receiving irbesartan had complied with study medication after 3 and 6 months of treatment than ACE inhibitors or CCB. Significantly fewer patients receiving irbesartan needed to change their antihypertensive medication. All three study treatments exhibited similar efficacy profiles, but irbesartan had significantly less adverse events. Conclusions. This study demonstrated that patient compliance to irbesartan was significantly superior to other study treatments. Irbesartan is therefore a suitable first‐line therapy for essential hypertension in everyday clinical practice.

Sustained-release verapamil and trandolapril, alone and in combination, in the treatment of obese hypertensive patients: a double-blind pilot study

The purpose of this pilot study was to compare the ability of sustained-release verapamil (verapamil SR) and trandolapril, both alone and combined in half doses, to reduce blood pressure in obese patients with mild-to-moderate essential hypertension. Twenty patients (13 men and 7 women) took part in the study. Ten (group A) received verapamil SR 240 mg/d, and 10 (group B) received trandolapril 2 mg/d for 6 weeks. All patients were then given both drugs in half-doses for 6 weeks. After combination therapy, group B received verapamil SR 240 mg/d, and group A received trandolapril 2 mg/d for 6 weeks. When verapamil and trandolapril were used alone, systolic and diastolic blood pressures decreased significantly in each group. However, systolic and diastolic blood pressures fell further when combination therapy was used and rose slightly when the treatment was changed again to single-drug therapy. Side effects were fewer during the combination therapy. Thus the combination of half doses of verapamil SR and trandolapril was more effective in reducing blood pressure in obese patients with mild-to-moderate essential hypertension than a full dose of either drug given alone.

Effects of valsartan and enalapril on regression of left ventricular hypertrophy in patients with mild to moderate hypertension: A randomized, double-blind study

Abstract Objective This study was undertaken to compare the effects of valsartan with those of enalapril on regression of left ventricular hypertrophy in patients with mild to moderate hypertension. Background The effect of angiotensin II receptor antagonists on regression of left ventricular hypertrophy in patients with hypertension has been established in several studies. The effects of these agents have also been compared with those of other antihypertensive drugs such as diuretics or beta-receptor blocking agents. However, no study has compared angiotensin II receptor antagonists with angiotensin-converting-enzyme (ACE) inhibitors. The effect of ACE inhibitors on regression of left ventricular hypertrophy is superior to that of other antihypertensive drugs. Methods Forty patients with mild to moderate hypertension and left ventricular hypertrophy were included in this randomized, double-blind study. Patients were divided into 2 groups. No between-group differences were noted with regard to age, systolic and diastolic blood pressures, duration of hypertension, and left ventricular mass index, which was measured by M-mode echocardiography. Twenty patients received enalapril 20 mg/d, and 20 patients received valsartan 80 mg/d. Echocardiographic measurements were repeated at 3 and 6 months, and blood pressure was measured every 15 days. Results Systolic and diastolic blood pressures decreased significantly at 3 and 6 months in both groups ( P P P Conclusions In patients with left ventricular hypertrophy caused by hypertension, valsartan is as effective as enalapril in reducing left ventricular hypertrophy.