المؤلفون: Segura J; Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain., Ruilope LM

المصدر: Vascular health and risk management [Vasc Health Risk Manag] 2013; Vol. 9, pp. 521-8. Date of Electronic Publication: 2013 Sep 16.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't; Review

بيانات الدورية: Publisher: Dove Medical Press Country of Publication: New Zealand NLM ID: 101273479 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1178-2048 (Electronic) Linking ISSN: 11766344 NLM ISO Abbreviation: Vasc Health Risk Manag Subsets: MEDLINE

مواضيع طبية MeSH: Amlodipine/*therapeutic use , Angiotensin II Type 1 Receptor Blockers/*therapeutic use , Antihypertensive Agents/*therapeutic use , Benzimidazoles/*therapeutic use , Benzoates/*therapeutic use , Blood Pressure/*drug effects , Calcium Channel Blockers/*therapeutic use , Diuretics/*therapeutic use , Hydrochlorothiazide/*therapeutic use , Hypertension/*drug therapy, Administration, Oral ; Amlodipine/administration & dosage ; Amlodipine/adverse effects ; Angiotensin II Type 1 Receptor Blockers/administration & dosage ; Angiotensin II Type 1 Receptor Blockers/adverse effects ; Antihypertensive Agents/administration & dosage ; Antihypertensive Agents/adverse effects ; Benzimidazoles/administration & dosage ; Benzimidazoles/adverse effects ; Benzoates/administration & dosage ; Benzoates/adverse effects ; Calcium Channel Blockers/administration & dosage ; Calcium Channel Blockers/adverse effects ; Diuretics/administration & dosage ; Diuretics/adverse effects ; Drug Combinations ; Humans ; Hydrochlorothiazide/administration & dosage ; Hydrochlorothiazide/adverse effects ; Hypertension/diagnosis ; Hypertension/physiopathology ; Tablets ; Telmisartan ; Time Factors ; Treatment Outcome

مستخلص: This review discusses the rationale for earlier use of single-pill combinations (SPCs) of antihypertensive drugs, with a focus on telmisartan/amlodipine (T/A) and telmisartan/hydrochlorothiazide (T/H) SPCs. Compared with the respective monotherapies, the once-daily T/A and T/H SPCs have been shown to result in significantly higher blood pressure (BP) reductions, BP goal rates, and response rates in patients at all stages of hypertension. As expected, BP reductions are highest with the highest dose (T80/A10 and T80/H25) SPCs. Subgroup analyses of the telmisartan trials have reported the efficacy of both SPCs to be consistent, regardless of the patients' age, race, and coexisting diabetes, obesity, or renal impairment. In patients with mild-to-moderate hypertension, the T/A combination provides superior 24-hour BP-lowering efficacy compared with either treatment administered as monotherapy. Similarly, the T/H SPC treatment provides superior 24-hour BP-lowering efficacy, especially in the last 6 hours relative to other renin-angiotensin system inhibitor-based SPCs. The T/A SPC is associated with a lower incidence of edema than amlodipine monotherapy, and the T/H SPC with a lower incidence of hypokalemia than hydrochlorothiazide monotherapy. Existing evidence supports the use of the T/A SPC for the treatment of hypertensive patients with prediabetes, diabetes, or metabolic syndrome, due to the metabolic neutrality of both component drugs, and the use of the T/H SPC for those patients with edema or in need of volume reduction.

المؤلفون: Segura J; Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain. hta@juliansegura.com, Cerezo C, Garcia-Donaire JA, Schmieder RE, Praga M, de la Sierra A, Ruilope LM

المصدر: Journal of the American Society of Hypertension : JASH [J Am Soc Hypertens] 2011 Nov-Dec; Vol. 5 (6), pp. 498-504. Date of Electronic Publication: 2011 Oct 01.

نوع المنشور: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 101312518 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1933-1711 (Print) Linking ISSN: 18787436 NLM ISO Abbreviation: J Am Soc Hypertens Subsets: MEDLINE

مواضيع طبية MeSH: Amides/*administration & dosage , Amlodipine/*administration & dosage , Calcium Channel Blockers/*administration & dosage , Chlorthalidone/*administration & dosage , Diuretics/*administration & dosage , Fumarates/*administration & dosage , Furosemide/*administration & dosage , Hydrochlorothiazide/*administration & dosage , Hypertension/*drug therapy , Renin/*antagonists & inhibitors, Aged ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Spironolactone/administration & dosage ; Treatment Outcome

مستخلص: We tested the hypothesis that a therapeutic strategy of substituting the diuretic (most commonly hydrochlorothiazide) with chlorthalidone (50 mg/day), and, if needed, the calcium channel blocker with the highest dose of the most commonly used calcium antagonist (amlodipine 10 mg), and adding on top a direct renin inhibitor (aliskiren 300 mg) is effective to treat resistant hypertensive patients not responding to spironolactone. The scheme was tested in a group of 76 patients who had true treatment resistant hypertension (24-hour mean blood pressure ≥130/80 mm Hg while receiving three or more drugs). An effective response to spironolactone was defined as 24-hour ambulatory systolic blood pressure (SBP) drop by more than 20 mm Hg, and was obtained with 25-50 mg in 60 patients (78.9%). In patients with inadequate response to spironolactone (n = 16), we administered the triple combination plus the remaining therapy, a mean decrease of 29 mm Hg (95% CI 11-48; P = .004) for SBP and 12 mm Hg (95% CI: 4-20 mm Hg) for diastolic BP were observed. In only 1 of 16 patients (6%), the response was considered as insufficient. These data indicate the need for further testing this scheme that looks really promising to treat resistant hypertensive patients not responding to spironolactone.
(Copyright © 2011 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

المؤلفون: Campo C; Hypertension Unit, Hospital Universitario 12 de Octubre, Madrid ES-28041, Spain. carlos_campo@mi.madritel.es, Segura J, Roldán C, Alcázar JM, Rodicio JL, Ruilope LM

المصدر: Blood pressure. Supplement [Blood Press Suppl] 2003 Dec; Vol. 2, pp. 16-21.

نوع المنشور: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: Informa Healthcare Country of Publication: Sweden NLM ID: 9300787 Publication Model: Print Cited Medium: Print ISSN: 0803-8023 (Print) Linking ISSN: 08038023 NLM ISO Abbreviation: Blood Press Suppl Subsets: MEDLINE

مواضيع طبية MeSH: Antihypertensive Agents/*administration & dosage , Doxazosin/*administration & dosage , Hydrochlorothiazide/*administration & dosage , Hypertension/*drug therapy, Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antihypertensive Agents/standards ; Antihypertensive Agents/toxicity ; Blood Pressure/drug effects ; Cholesterol/blood ; Doxazosin/standards ; Doxazosin/toxicity ; Female ; Humans ; Hydrochlorothiazide/standards ; Hydrochlorothiazide/toxicity ; Male ; Middle Aged ; Potassium/blood ; Treatment Outcome ; Uric Acid/blood

مستخلص: The objective of this prospective, randomized, open-label, parallel-arm comparative study, with a 4-month follow-up, was to assess the antihypertensive efficacy, tolerability and metabolic safety of doxazosin GITS (gastrointestinal therapeutic system) 4-8 mg/day vs hydrochlorothiazide (HCTZ) 12.5-25 mg/day as add-on therapy in patients not controlled with monotherapy with other drugs. Ninety-eight patients completed the study (mean age 57.4 +/- 15 years, 53% female). Mean systolic/diastolic blood pressure reduction was 8.2/4.5 mmHg in the HCTZ group and 8.9/5.0 mmHg in the doxazosin GITS group, and a strict blood pressure control was achieved in 79% and 83% of the patients, respectively. The incidence rates of adverse events were low and similar in both groups. However, metabolic differences were seen between the groups, doxazosin GITS vs HCTZ, respectively: total cholesterol (mg/dl) 210 +/- 53 vs 231 +/- 62 (p < 0.05), low-density lipoprotein (LDL) cholesterol (mg/dl) 139 +/- 40 vs 161 +/- 57 (p < 0.01), high-density lipoprotein (HDL) cholesterol (mg/dl) 58 +/- 16 vs 48 +/- 13 (p < 0.01), HDL/total cholesterol ratio 27.6 +/- 8 vs 21.2 +/- 7 (p < 0.001), plasma uric acid (mg/dl) 5.3 +/- 2.6 vs 6.8 +/- 3.1 (p < 0.05) and serum potassium (mEq/l) 4.1 +/- 1.3 vs. 3.7 +/- 1.2 (p < 0.01). In conclusion, doxazosin GITS has a tolerability and efficacy profile similar to low doses of thiazide diuretics, with a better evolution of metabolic and electrolyte parameters. Therefore, in patients not controlled with monotherapy, doxazosin GITS can be considered an alternative to the addition of thiazide diuretics.

المؤلفون: Campo C; Hypertension Unit, 12 de Octubre Hospital, Madrid, Spain. campo@bbvnet.com, Fernández G, González-Esteban J, Segura J, Ruilope LM

مؤلفون مشاركون: ESPADA Study Group

المصدر: Blood pressure [Blood Press] 2000; Vol. 9 (6), pp. 355-62.

نوع المنشور: Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Validation Study

بيانات الدورية: Publisher: Taylor & Francis Country of Publication: England NLM ID: 9301454 Publication Model: Print Cited Medium: Print ISSN: 0803-7051 (Print) Linking ISSN: 08037051 NLM ISO Abbreviation: Blood Press Subsets: MEDLINE

مواضيع طبية MeSH: Antihypertensive Agents/*administration & dosage , Antihypertensive Agents/*therapeutic use , Blood Pressure Monitoring, Ambulatory/*standards , Enalapril/*administration & dosage , Enalapril/*therapeutic use , Hydrochlorothiazide/*administration & dosage , Hydrochlorothiazide/*therapeutic use , Hypertension/*physiopathology, Age Factors ; Aged ; Antihypertensive Agents/pharmacology ; Blood Pressure Determination ; Circadian Rhythm ; Cohort Studies ; Confidence Intervals ; Drug Therapy, Combination ; Enalapril/pharmacology ; Female ; Hemodynamics ; Humans ; Hydrochlorothiazide/pharmacology ; Hypertension/drug therapy ; Longitudinal Studies ; Male ; Middle Aged ; Office Visits ; Prospective Studies ; Reproducibility of Results ; Sex Factors

مستخلص: The introduction and generalization of 24-h ambulatory blood pressure (BP) monitoring has shown the clinical relevance of home BP. The aim of this study was to assess the validity of home-measured BP for monitoring and controlling patients with arterial hypertension while on a homogeneous treatment. An additional objective was to establish the degree of office BP control obtained. This was a prospective, longitudinal, observational and multicenter study in a cohort of 156 patients of both sexes, aged over 18 years and with essential hypertension. All of them received the fixed combination enalapril/HCTZ 20/6 mg as the only hypertensive agent for at least 4 weeks previously. Office BP was the average of three measurements. For home BP, a semi-automated device (OMRON HEM 705 CP) was used. The patients measured their BP twice a day for 2 consecutive days. The average differences between the two measuring methods were low, but significant: 3.99 mmHg for systolic BP (SBP; p < 0.05), 2.02 mmHg for diastolic BP (DBP; p < 0.05). Pearson's regression coefficient between the office and home values was highly significant (p < 0.0001) for SBP, DBP and heart rate. Home BP measurement was highly reproducible as shown by the high within-class correlation coefficient for individual measurements on the first day compared with the second: 0.88 (95% confidence interval, CI 0.82-0.92; p < 0.00001) for SBP and 0.89 for DBP (95% CI 0.83-0.93; p < 0.00001). The percentage of patients with strict office DBP and SBP control (< 140/90 mmHg) was 61.3% and with DBP control (<90 mmHg) 92%. In conclusion, in the ESPADA study, the application of home BP measurement is valid, reproducible and shows a high correlation with office BP.