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Biomedical subjects

L M Prisant

Publications and source records attributed to L M Prisant.

At least 19 recordsLinked to original sources
PubMed2001

Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group.

Oral sildenafil is an effective treatment for erectile dysfunction (ED), which is a common complaint for patients with hypertension and those taking antihypertensive agents. This post hoc subanalysis assessed the efficacy and safety of sildenafil in men with ED who were receiving concomitant antihypertensive medication. Efficacy was assessed in 3414 men (1218 of whom were taking antihypertensive medication) who received sildenafil (5 to 200 mg) or placebo for 6 weeks to 6 months in 10 double-blind, placebo-controlled studies. The significant improvements in erectile function demonstrated by sildenafil-treated patients were comparable in patients taking and those not taking antihypertensive medication. Safety was assessed in 3975 men (1094 of whom were taking one or more antihypertensive agent, classified as a diuretic, beta-blocker, alpha1-blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker), who received sildenafil or placebo in 18 double-blind, placebo-controlled studies. For patients taking sildenafil and antihypertensive medication, the incidence of treatment-related adverse events (34%) was similar to that for sildenafil-treated patients not taking any antihypertensive agent (38%). The incidences of the most common adverse events and of adverse events potentially related to blood pressure decreases (eg, hypotension, dizziness, and syncope) were similar in both sildenafil groups. The number of antihypertensive medications taken from among the five classes had no effect on the adverse event profile of sildenafil. Sildenafil is an effective and well-tolerated treatment for ED in patients taking concomitant antihypertensive medication, including those on multidrug regimens.

Adult↗
PubMed2000

New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice.

This article is the result of a meeting of the National Council on Potassium in Clinical Practice. The Council, a multidisciplinary group comprising specialists in cardiology, hypertension, epidemiology, pharmacy, and compliance, was formed to examine the critical role of potassium in clinical practice. The goal of the Council was to assess the role of potassium in terms of current medical practice and future clinical applications. The primary outcome of the meeting was the development of guidelines for potassium replacement therapy. These guidelines represent a consensus of the Council members and are intended to provide a general approach to the prevention and treatment of hypokalemia.

Arrhythmias, Cardiac↗
PubMed2000

Management of patients with hypertension and diabetes mellitus: advances in the evidence for intensive treatment.

Diabetes mellitus is common in patients with hypertension, and greatly increases the risk of cardiovascular disease, including myocardial infarction, stroke, and peripheral vascular disease. "The pharmacologic therapy of patients with hypertension and diabetes has been surrounded by controversy because of concerns about the metabolic effects of several antihypertensive agents, as well as concerns about the safety of calcium antagonists. The objective of this review is to re-evaluate the management of diabetic patients with hypertension in light of the latest clinical trials. We also review the importance of intensive blood pressure control in these patients.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2000

Hypertension in the elderly: can we improve results of therapy?

Awareness of and therapy for hypertension in the United States have been increasing in older patients. Despite this improvement, hypertension continues to be poorly controlled in this patient population. The control rate, defined as systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg, is surprisingly low for older patients, despite abundant data documenting the reduction of cardiovascular events by treating both systolic-diastolic and isolated systolic hypertension. Comorbid diseases and physiological alterations in the elderly, including reduced myocardial contractility, renal function, total body water, baroreceptor responsiveness, and cognitive function, must be considered, but in general these have not limited the effectiveness of antihypertensive drug therapy.

Age Factors↗
PubMed2000

Effect of sildenafil citrate on blood pressure and heart rate in men with erectile dysfunction taking concomitant antihypertensive medication. Sildenafil Study Group.

OBJECTIVES: To assess the acute effect of sildenafil citrate on blood pressure and heart rate in men with erectile dysfunction taking concomitant antihypertensive medication. DESIGN: Post-hoc subanalysis of five, 12- or 24-week, prospective, randomized, double-blind, placebo-controlled studies. SETTING: Private-practice and academic urology clinics. PATIENTS: A total of 1685 men with erectile dysfunction of > or = 6 months duration, of whom 667 (sildenafil n = 406, placebo n = 261) were taking antihypertensive medication (diuretic, beta-blocker, alpha-blocker, angiotensin converting enzyme inhibitor, and/or calcium antagonist). Of the patients taking antihypertensive medication, 608 (91%) completed the studies (374 of 406 receiving sildenafil, 234 of 261 receiving placebo). INTERVENTIONS: The last dose of oral sildenafil (25-200 mg) or placebo was taken at home on the morning of the final clinic visit. Patients taking antihypertensive medication maintained usual dosing schedules. MAIN OUTCOME MEASUREMENTS: Sitting systolic (SBP)/diastolic blood pressure (DBP) and heart rate at baseline and after dosing with sildenafil or placebo (end-of-treatment visit). RESULTS: Mean changes from baseline in SBP/DBP for men taking antihypertensive medication were -3.6/-1.9 mmHg for those receiving sildenafil and -0.8/-0.1 mmHg for those receiving placebo compared with -2.2/-2.0 mmHg and -0.1/0.4 mmHg, respectively, for men not taking antihypertensive medication. Mean changes from baseline in heart rate for men taking antihypertensive medication were -0.6 beats/min after sildenafil and 0.9 beats/min after placebo compared with 0.4 beats/min and -0.6 beats/min, respectively, for patients not taking antihypertensive medication. Differences in SBP, DBP, and heart rate between the patients taking and those not taking antihypertensive medication were small. CONCLUSIONS: The acute, short-term effects of oral sildenafil on blood pressure and heart rate in men with erectile dysfunction were small and not likely to be clinically significant in those taking concomitant antihypertensive medication.

Adult↗
PubMed2000

Treating hyperlipidemia in African Americans.

The purpose of this paper is to provide information concerning the treatment of hyperlipidemia in African Americans. There is a similar prevalence of hypercholesterolemia in Blacks and Whites, but Blacks have been neglected in most pharmacological studies of hyperlipidemia. Intimal atherosclerotic involvement of the aorta and coronary artery occurs in young Black and White males. Epidemiological studies suggest there is a higher mortality rate due to coronary disease in Blacks vs Whites in the United States. Thirty-four percent of Blacks require a fasting lipid profile and 9% of Black adults aged 20 years or older would require lipid-lowering therapy. However, fewer Blacks (26%) than Whites (47%) are aware of their hypercholesterolemia. Studies with lovastatin and pravastatin show efficacy in the treatment of hypercholesterolemia. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is designed to determine all-cause mortality for subjects receiving pravastatin vs a control group receiving "usual care." Randomized, blinded, prospective trials are needed to assess the impact of hyperlipidemia as a risk factor, and the impact of its reduction in African Americans.

Adolescent↗
PubMed1999

Controversies surrounding the treatment of the hypertensive patient with diabetes.

Diabetes mellitus without previous myocardial infarction carries the same risk of a future myocardial infarction as someone who has had one. Intense glucose, lipid, and blood pressure control in diabetic patients is advocated to reduce cardiovascular events and decrease the incidence of end-stage renal disease, retinal damage, and peripheral vascular disease. Recent studies, including the Systolic Hypertension in the Elderly Program, indicate that low-dose diuretics, compared with placebo, reduce fatal and nonfatal myocardial infarctions but not fatal and nonfatal strokes in diabetic patients. Similarly, captopril (and diuretics) compared with diuretics and beta-blockers decreased fatal and nonfatal myocardial infarctions but not fatal and nonfatal strokes in the Captopril Prevention Project. Intense blood pressure therapy with captopril and intense blood pressure therapy with atenolol equally lowered macrovascular and microvascular events compared with less intense blood pressure treatment in the United Kingdom Prospective Diabetes Study. Fewer myocardial infarctions were seen with enalapril than with nisoldipine in the Appropriate Blood Pressure Control in Diabetes trial. Intense blood pressure control with felodipine, enalapril, and hydrochlorothiazide reduced overall cardiovascular events and mortality but not myocardial infarction and strokes in the Hypertension Optimal Treatment trial. Nitrendipine alone or together with enalapril and hydrochlorothiazide decreased fatal and nonfatal strokes and cardiovascular mortality but not myocardial infarctions in the Systolic Hypertension in Europe trial. These trials, in aggregate, reinforce the importance of intense blood pressure control, which can be achieved only with combination drug therapy rather than a specific monotherapy drug class recommendation.

Adrenergic beta-Antagonists↗
PubMed1999

Low-dose combination therapy as first-line hypertension treatment for blacks and nonblacks.

To assess the efficacy and safety of bisoprolol/6.25-mg hydrochlorothiazide (HCTZ), amlodipine, and enalapril in black and nonblack patients, data from two comparative studies were pooled and subgroup analyses performed. Both studies had similar designs and included all three active treatments. The second study also included a placebo group. Subjects (n = 541) with a sitting diastolic blood pressure of 95-114 mmHg were titrated to achieve a diastolic blood pressure < or = 90 mmHg. The studies included 114 blacks and 427 nonblacks. Results of an intention-to-treat analysis of mean change from baseline after 12 weeks of treatment showed the following: 1) blood pressure was significantly lowered by all three active drugs compared with baseline or placebo; 2) in blacks, bisoprolol/6.25-mg HCTZ resulted in significantly greater reductions of systolic and diastolic blood pressure than enalapril or placebo, but was not significantly different from amlodipine; 3) in nonblacks, bisoprolol/6.25-mg HCTZ resulted in significantly greater reduction of diastolic blood pressure than amlodipine, enalapril, or placebo. The placebo-corrected change in blood pressure was greater for blacks than whites on the bisoprolol/6.25-mg HCTZ combination, but this was not statistically significant. Bisoprolol/6.25-mg HCTZ controlled diastolic blood pressure to < or = 90 mmHg in significantly more patients than enalapril or placebo in blacks and nonblacks. The difference in control rates was not significant versus amlodipine. The incidence of drug-related adverse events was similar between treatments; however, bisoprolol/6.25-mg HCTZ had a lower discontinuation rate due to lack of blood pressure control or adverse experiences in both blacks and nonblacks.

Aged↗
PubMed1998

Low-dose combination treatment for hypertension versus single-drug treatment-bisoprolol/hydrochlorothiazide versus amlodipine, enalapril, and placebo: combined analysis of comparative studies.

To assess the efficacy and safety of 2.5, 5, and 10 mg bisoprolol/6. 25 mg hydrochlorothiazide (HCTZ), 2.5, 5, and 10 mg amlodipine; and 5, 10, 20, and 40 mg enalapril in subjects (n = 541) with a sitting diastolic blood pressure of 95 to 114 mm Hg, data from two comparative studies were pooled. All drugs were titrated to a diastolic blood pressure 90 mm Hg or less. Both studies were double-blind, randomized, parallel dose escalation trials with similar designs and included three active treatments. The second study also had a placebo group. The mean change from baseline of systolic and diastolic blood pressure for placebo (n = 79) was -0. 1/-2.2 mm Hg; amlodipine (n = 154), -12.4/-10.3 mm Hg; enalapril (n = 155), -9.4/-8.2 mm Hg; and bisoprolol/HCTZ (n = 155), -14.0/-12.0. Overall efficacy analyses documented a statistically significant decrease in sitting diastolic blood pressure for bisoprolol/6.25 mg HCTZ compared with placebo, amlodipine, and enalapril. There was a significant reduction in sitting systolic blood pressure for bisoprolol/6.25 mg HCTZ compared with placebo and enalapril but not amlodipine. Also, there was a significant decrease in sitting heart rate for bisoprolol/6.25 mg HCTZ (-6.2 beats/min) compared with placebo (+0.1 beats/min), amlodipine (+1.2 beats/min), and enalapril (+0.5 beats/min). The control rate (diastolic blood pressure < or = 90 mm Hg) for bisoprolol/6.25 mg HCTZ (66.5%) was significantly better than for placebo (21.8%) and enalapril (47.1%) but not amlodipine (58.4%). Of those patients achieving and maintaining control, 49% of the bisoprolol/6.25 mg HCTZ subjects were on the lowest two doses compared with 30% of the amlodipine and 26% of the enalapril subjects. Percentages of patients reporting at least one drug-related adverse event through week 12 were 27%, 24%, 28%, and 25% for placebo, bisoprolol/6.25 mg HCTZ, amlodipine, and enalapril (not significant). Lower doses of two drugs in fixed combination can provide as good or better blood pressure control compared with higher doses of a single drug with similar tolerability and safety.

Amlodipine↗
PubMed1998

Calcium antagonists--pharmacologic considerations.

Calcium antagonists work by blocking the entrance of calcium from the outside of the cell to the inside of the cell through the voltage-dependent calcium channels. There are three major L-type (high voltage) calcium channel blocker sites (a dihydropyridine site for nifedipine, a phenylalkylamine for verapamil, and a benzothiazepine site for diltiazem) and a tetralol T-type (low voltage) calcium antagonist. Calcium antagonists differ in terms of their tissue affinity and vascular selectivity resulting in different therapeutic applications. The initial disadvantage of a short-half has been overcome with drug delivery systems that lower blood pressure over a twenty-four hour period. These calcium antagonists are effective in lowering blood pressure and reducing anginal episodes in African Americans and whites, regardless of age or renin level.

Angina, Unstable↗
PubMed1998

Calcium antagonists--clinical considerations.

Calcium antagonists are useful for treating hypertension, stable exertional and vasospastic angina, and supraventricular arrhythmias. Recent studies have proven their ability to decrease the rate of nonfatal strokes. Short-acting calcium antagonists should be avoided with hypertensive emergencies and urgencies, unstable angina, and acute myocardial infarction. The use of calcium antagonists in systolic heart failure should not be as the primary therapy. Care must be taken in using non-dihydropyridines because of multiple drug-drug interactions. Prospective trials are in progress through the next decade that will compare traditional drugs such as diuretics and beta-blockers to calcium antagonists, converting enzyme inhibitors, and angiotensin II receptor blockers.

Administration, Sublingual↗
PubMed1997

Metyrosine and pheochromocytoma.

BACKGROUND: Severe hemodynamic instability may occur during surgery for removal of pheochromocytoma, unless there is preoperative pharmacological treatment. OBJECTIVE: To evaluate the effects of metyrosine (alpha-methyl-p-tyrosine), a catecholamine synthesis inhibitor, and alpha-blockade with prazosin or phenoxybenzamine on cardiovascular morbidity during surgery for pheochromocytoma. METHODS: A retrospective analysis was made of patients followed up at the Medical College of Georgia, Augusta, during 28 years who received metyrosine and prazosin (n = 6), metyrosine and phenoxybenzamine alone (n = 14), phenoxybenzamine alone (n = 6), or no medication (n = 7) during 3 weeks before tumor removal. The percentage of patients not requiring pressors or phentolamine during the intraoperative period as well as the perioperative peak systolic pressures and peak heart rates were estimated in each group. RESULTS: There was a significant (P < .05) increase in intraoperative peak systolic pressures without preoperative treatment (mean +/- SD, 243 +/- 40 mm Hg) vs metyrosine (mean +/- SD, 168 +/- 27 mm Hg). Ninety-five percent of patients who received metyrosine did not require pressors intraoperatively vs 50% with phenoxybenzamine alone. Eighty-one percent of patients pretreated with metyrosine did not require intraoperative phentolamine vs 33% with phenoxybenzamine alone and 29% without medications. Two patients in the no medication group died as a results of hypertensive crisis. CONCLUSIONS: The combination of alpha-metyrosine and alpha-blockade results in better blood pressure control and less need for use of antihypertensive medication or pressors during surgery, compared with the classical method of single-agent adrenergic blockade. Preoperative treatment with metyrosine along with an alpha-blocker is a useful strategy for decreasing the surgical morbidity in patients with pheochromocytoma and assumes greater importance as long as the availability of phentolamine for intraoperative use is a problem.

Adolescent↗
PubMed1997

Beta-blocker use in systolic heart failure and dilated cardiomyopathy.

Statistics regarding long-term survival for patients with heart failure are discouraging today. Converting enzyme inhibitors have produced a modest effect on mortality. beta-Blockers may be the next addition to standard therapy for heart failure because they generate consistent improvements in hemodynamic factors, symptom scores, and submaximal exercise tolerance in randomized, controlled clinical trials. They augment ejection fraction, reduce heart volume, and consistently lower neurohormonal activation as reflected by plasma norepinephrine levels. Trials with carvedilol and bisoprolol suggest an effect on mortality similar to that with converting enzyme inhibitor trials. Future studies, especially the beta-blocker Evaluation Survival Trial (BEST), with mortality as the main end point should elucidate the degree of effect on mortality further.

Adrenergic beta-Antagonists↗
PubMed1997

Hypertension: the rediscovery of combination therapy.

Awareness and treatment of hypertension in the United States has been improving for older patients, but hypertension continues in many cases to be poorly controlled. Three options exist if initial therapy fails to achieve target blood pressure: upward drug titration, substituting another drug, or combination drug therapy. Combination therapy is the attempt to optimize blood pressure control by using two or more agents with additive or synergistic effects. Problems with this approach include noncompliance due to complicated regimens, adverse drug reactions, and the added expense of multiple medications. However, the newer fixed-dose combination products have been shown to offer improved blood pressure control, simplification of drug regimens, decreased adverse reactions, improved compliance, and cost-effectiveness.

Aged↗
PubMed1996

Efficacy and tolerability of lovastatin in 459 African-Americans with hypercholesterolemia.

A paucity of substantive data from clinical drug trials is available specifically evaluating the effects of therapy for hypercholesterolemia in African-Americans, even though a substantial number are candidates for medical advice and intervention for high blood cholesterol. The efficacy and safety of lovastatin in 459 African-Americans with hypercholesterolemia were studied in the Expanded Clinical Evaluation of Lovastatin study, a multicenter, double-blind, diet- and placebo-controlled trial. This trial involved 8,245 patients who were randomly assigned, regardless of race, to receive placebo or lovastatin at doses of 20 mg once daily, 40 mg once daily, 20 mg twice daily, or 40 mg twice daily for 48 weeks. Among African-Americans, lovastatin produced sustained, dose-related (p <0.001) decreases in low-density lipoprotein cholesterol (20% to 38%), total cholesterol (14% to 28%), and triglycerides (8% to 15%). From 75% to 96% of African-Americans treated with lovastatin achieved the National Cholesterol Education Program goal of low-density lipoprotien cholesterol <160 mg/di, and from 33% to 71% achieved the goal <130 mg/di. The safety profile of lovastotin in African-Americans was generally favorable. A relatively high incidence of creatine kinase levels greater than the upper limit of normal was observed in African-Americans during the study, i.e., 63% in the placebo group and similar levels in lovastatin treatment groups. Lovastatin is highly effective and generally well tolerated as therapy for primary hypercholesterolemia in African-Americans.

Black or African American↗