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PubMed1988

Urinary cations and blood pressure: a collaborative study of 16 districts in China.

Relationships between blood pressure and overnight urinary sodium, potassium and calcium were investigated in 3248 subjects from 16 districts in China. Average systolic (SBP) and diastolic (DBP) blood pressures of subjects from northern, middle and southern China were 116/74.2, 114/70.5 and 110.8/69.6 mmHg, respectively. Urinary sodium, potassium and calcium were 55.1, 8.3 and 1.1 mmol/l for the north, 63.6, 9.2 and 1.6 mmol/l for the middle and 50.0, 8.9 and 1.5 mmol/l for the south, respectively. The urinary sodium to potassium ratio was significantly and positively correlated with SBP and DBP in both males and females. Urinary sodium was weakly and positively correlated with SBP only in the north. Females over the age of 50 years were especially sensitive to sodium intake. Urinary calcium was negatively correlated with DBP in both males and females. Urinary calcium (creatinine) was negatively correlated with SBP in males, and with SBP and DBP in the south. Urinary potassium was negatively correlated with SBP and DBP only in the 20-29 year age group. Urinary potassium (creatinine) was negatively correlated with DBP only in the south. Age and body mass index were positively and level of education negatively correlated with blood pressure. Dietary factors for higher blood pressure in northern China were related to higher sodium, lower potassium and possibly lower calcium intake.

Blood Pressure↗
PubMed1986

Efficacy of sustained-release verapamil: automatic ambulatory blood pressure monitoring.

The potential antihypertensive effect of sustained-release (SR) verapamil was compared to immediate-release (IR) verapamil in a group of patients with essential hypertension. All patients were withdrawn from their previous antihypertensive medication(s) and were entered into an open-label IR verapamil study (dose varying from 80 to 120 mg TID). Patients were subsequently randomized in a double-blind fashion to continue the same dose of IR verapamil or an equivalent dose of SR verapamil. Automatic ambulatory blood pressure recordings were carried out with a Del Mar Avionics PIII Unit in eight patients who were randomized into the SR group. An initial 24-hour recording was performed on the IR verapamil group during the open-label phase and repeated following treatment with SR verapamil. Mean 24-hour systolic blood pressure (SPB) and diastolic blood pressure (DBP) were 143 +/- 18 mmHg and 89 +/- 6 mmHg, respectively, on IR verapamil and 142 +/- 22 and 90 +/- 6 mmHg, respectively, on SR verapamil. There were no statistically significant differences noted between the two groups. Mean SBP and DBP varied similarly during waking and sleeping periods with IR and SR verapamil: With IR verapamil, SBP was 139 +/- 18 and 124 +/- 20 mmHg and DBP was 92 +/- 11 and 84 +/- 13 mmHg during waking and sleeping hours, respectively; with SR verapamil, SBP was 138 +/- 21 and 122 +/- 22 mmHg and DBP 92 +/- 10 and 80 +/- 10 mmHg during waking and sleeping hours, respectively. DBP was less than or equal to 90 mmHg in approximately 70% and 60% of patients in the IR verapamil and SR verapamil groups, respectively. Trough plasma levels of 92 +/- 44 and 67 +/- 32 ng/ml were measured by HPLC, 2 and 4 weeks, respectively, after treatment with IR verapamil. During a similar time interval, SR verapamil revealed plasma levels of 64 +/- 59 and 92 +/- 57 ng/ml, respectively. No correlation between change in DBP and plasma level of verapamil was demonstrated. No significant change in heart rate was observed during the 4-week period. In summary, verapamil is an effective antihypertensive medication and can be administered once a day as a slow-releasing preparation; it is most useful in patients in whom adrenergic blocking drugs are indicated.

Adult↗
PubMed1984

Comparison of nitrendipine combined with low-dose hydrochlorothiazide to hydrochlorothiazide alone in mild to moderate essential hypertension.

Patients with mild to moderate essential hypertension were treated in four centers with hydrochlorothiazide (HCTZ) 25 mg daily for 4 weeks. Those patients failing to achieve control (supine diastolic blood pressure (DBP) 90 mm Hg or lower) were randomly assigned to nitrendipine (NTP) 5 mg or placebo (PLA) b.i.d. NTP or PLA was increased stepwise to 20 mg b.i.d. as needed to achieve control. Treatment with HCTZ was maintained at 25 mg daily. Eighty-six patients completed the study: 41 in NTP + HCTZ and 45 in PLA + HCTZ groups. Both groups were comparable in baseline characteristics. Supine systolic blood pressure (SBP) was 148.6 +/- 14.4 and DBP was 96.0 +/- 5.4 mm Hg in the NTP + HCTZ group. SBP was 147.4 +/- 16.6 and DBP was 96.4 +/- 5.6 mm Hg in the PLA + HCTZ group. At the end of 7 weeks of titration and treatment with NTP or PLA combined with HCTZ, SBP had fallen to 133.4 +/- 15.1 and DBP to 85.4 +/- 5.9 mm Hg in the NTP + HCTZ group. SBP fell to 138.8 +/- 16.2 and DBP to 90.7 +/- 6.3 mm Hg in the PLA + HCTZ group. The increment in lowering of both SBP and DBP was significantly greater (p = 0.002 and p = 0.0007, respectively) in the NTP + HCTZ group compared to the PLA + HCTZ group.

Adult↗
PubMed1982

Untreated mild hypertension. A report by the Management Committee of the Australian Therapeutic Trial in Mild Hypertension.

In all subjects of the Australian therapeutic trial in mild hypertension, mean pressures for the two screening visits were within the range 95-109 mm Hg for diastolic blood-pressure phase V(DBP) and less than 200 mm Hg for systolic blood-pressure (SBP). In the 1943 control (placebo) subjects mean blood-pressures fell from 158/102 mm Hg at the first screening visit to 144/91 mm Hg 3 years later. At that time pressures remained within the mild hypertension range in 32%, ahd risen above it in 12%, and had fallen below in 48%. Trial end-points (ischaemic heart disease or cerebrovascular accident) occurred in 8%. The outcome was related to the level of initial pressure but not to other characteristics measured at entry. The mean initial pressures of 22 subjects who experienced a cerebrovascular event were higher than those of a matched group with no hypertensive complications, but the 88 subjects who experienced ischaemic-heart-disease events had initial pressures similar to those in a matched control group. The trial end-point rate was related to the average DBP of subjects throughout the trial in those with average DBP greater than or equal to 95 mm Hg, and at those levels subjects on active treatment had a higher incidence than subjects of the placebo group with the same DBP level. For those with average DBP below 95 mm Hg the incidence of trial end-points was not related to blood-pressure level or treatment. 16% of placebo subjects in this mild hypertensive population had a mean DBP of less than 95 mm Hg at the first three visits. If this were taken as an indication to withhold drug treatment, 3 years later one-quarter of them (4% of all subjects) would be found to be hypertensive or to have experienced a trial end-point, and thus inappropriately untreated, while the other 12% would have pressures below 95 mm Hg and have had no trial end-point.

Adult↗
PubMed1981

Use of a nonpenetrating substrate analogue to study the molecular mechanism of the outer membrane dicarboxylate transport system in Escherichia coli K12.

We have recently demonstrated that a cell-surface dicarboxylate-binding protein (DBP) is involved in the outer membrane dicarboxylate transport system in Escherichia coli K12. The present report deals with our findings relating to the mode of action of this protein, and the identity and properties of the outer membrane integral protein which is involved in the translocation of dicarboxylic acids across the hydrophobic regions of the outer membrane. By the use of a nonpenetrating succinate analogue, aspartate-dextran, and through reconstitution studies with purified DBP, the cell-surface DBP is found to play an important role in succinate influx but not efflux. Transport studies with major outer membrane protein mutants indicate that the matrix protein (also referred to as protein I or porin) is the only outer membrane integral protein actively involved in the outer membrane dicarboxylate transport system. In the absence of a functional DBP, porin translocates succinate in a relatively less efficient and nonspecific manner. A tentative working model is proposed for this transport system. In this model, the cell-surface DBP is depicted as the substrate recognition component of the otherwise nonspecific porin channel. Together, this "DBP-porin channel complex" forms an efficient, specific transport channel for dicarboxylic acids.

Biological Transport↗
PubMed1982

Genetic evidence for separate functional domains on the human adenovirus specified, 72 kd, DNA binding protein.

Seven mutations that affect various activities of the multifunctional DNA binding protein (DBP) encoded by human adenovirus have been physically mapped to different locations within DBP gene by marker rescue experiments. Two of these mutants (Ad5ts107 and Ad5ts125) contain a lesion which, under nonpermissive temperatures, decreases the capacity of the protein to bind single-strand DNA, blocks DNA replication, and prevents normal turn-off of viral early genes. In addition, the efficiency of transformation by the ts viruses compared to wild-type virus is increased at the nonpermissive temperature. Both ts mutations are located in the 3' half of the DBP gene (C-terminal half of DBP). In contrast, the alterations in the five host range mutants (Ad2hr400-Ad2hr403, Ad5hr404) which overcome the block to viral late mRNA synthesis in monkey cells, but have no marked effect on DNA replication or early gene expression map in the 5' half of the DBP gene. These results suggest that the 72 kd DBP of adenovirus contains at least two functionally separable domains.

Adenoviruses, Human↗
PubMed1981

Methylation of adenovirus genes in transformed cells and in vitro: influence on the regulation of gene expression?

An inverse correlation has been described between the levels of DNA methylation in specific segments of adenovirus DNA integrated into the genomes of transformed and tumor cells and the extent to which these segments are expressed as messenger RNA. In the adenovirus type 2 (Ad2)-transformed hamster cell lines HE2 and HE3, the virus-specific DNA binding protein (DBP) is not expressed, and the DNA in the DBP gene is completely methylated in all 5'-CCGG-3' sites. At least part of the late promoter/leader sequence of the DBP gene is present in cell lines HE2 and HE3. In line HE1, on the other hand, the DBP is expressed, and the DNA in the DBP gene is unmethylated at the 5'-CCGG-3' (HpaII) sites. The late promotor/leader sequence of the DBP gene is expressed in cytoplasmic RNA isolated from line HE1. The effect of DNA methylation has also been tested in vitro in a microinjection system using Xenopus laevis oocytes. Unmethylated DNA fragments of Ad2 (E2a region) have been found to serve as active templates. When the same fragments are methylated at the 5'-CCGG-3' sites by the HpaII DNA-methyltransferase, viral RNA synthesis is inhibited upon microinjection into oocyte nuclei. These results provide direct evidence for the notion that DNA methylated at highly specific sites is somehow involved in the regulation of gene expression.

5-Methylcytosine↗
PubMed1995

Evidence for a major gene influencing 7-year increases in diastolic blood pressure with age.

The contribution of genetic factors to blood pressure levels is well established. The contribution of genes to the longitudinal change in blood pressure has been less well studied, because of the lack of longitudinal family data. The present study investigated a possible major-gene effect on the observed increase with age in diastolic blood pressure (DBP) levels. Subjects included 965 unmedicated adults (age > or = 18 years) in 73 pedigrees collected in Utah as part of a longitudinal cardiovascular family study. Segregation analysis of DBP change over 7.2 years of follow-up identified a recessive major-gene effect with a gene frequency of p = .23. There was also a significant age effect on the genotypic means, which decreased expression of the major gene at older ages. For those inferred to have the genotype responsible for large DBP increases, DBP increased 32.3%, compared with a 1.5% increase in the nonsusceptible group (P < .0001). The relative risk of developing hypertension between the susceptible and nonsusceptible groups after 7.2 years was 2.4 (P = .006). Baseline DBP reactivities to mental arithmetic (P < .0001), and isometric handgrip (P < .0001) stress tests were greatest in those assigned to the susceptible genotype. We conclude that age-related changes in DBP are influenced by a major gene. Characteristics of this major-gene effect for greater age-related blood pressure increases include greater reactivity to mental and physical stressors. The present study thus provides evidence for genetic control of changes in blood pressure, in addition to the previously suggested genetic control of absolute blood pressure level.

Adult↗
PubMed1995

Adenosine infusion: a rational approach towards induced hypotension.

OBJECTIVES: To examine the systolic (SBP) and diastolic (DBP) blood pressure (mmHg) and heart rate (beats/min) responses to varying doses and rates of adenosine administration in awake and anesthetized swine. DESIGN: Adult swine underwent sterile insertion of chronic carotid artery and jugular vein catheters. After recovery, baseline blood pressure and heart rate values were obtained. Three rates (mg/kg/min) of adenosine were infused in a randomized block design (low: 0.06 for 20 mins; medium: 0.12 for 10 mins; and high: 0.24 for 5 mins) to a total dose of 1.2 mg/kg. After 5 mins of infusion, three separate doses (0.3 mg/kg; 0.6 mg/kg; and 1.2 mg/kg) were compared. RESULTS: In awake animals, only the highest dose significantly decreased (P < or = 0.0001) SBP by 21% and DBP by 43% while increasing heart rate by 32%. At this high dose, the rate of administration was compared. Medium rates significantly decreased (P < or = 0.0002) SPB by 18%, DBP by 33% and elevated heart rate by 27%. High rates caused even greater changes (SBP 21%, DBP 43%, heart rate 32%). The low rate did not alter SBP, DBP or heart rate. Anesthetized swine had a greater decrease in blood pressure, which was not accompanied by alterations in heart rate. CONCLUSIONS: This study clarifies that the blood pressure and heart rate effects of adenosine are both dose and rate dependent in awake and anesthetized swine. The dose dependent responses can be controlled by the rate of administration. Heart rate increased only in the awake state, while in the anesthetized state no alteration of heart rate was observed. The greater decline in SBP and DBP found in anesthetized swine was likely due to the absence of compensatory increases in heart rate as was observed in awake animals.

Adenosine↗
PubMed1994

[Blood pressure variability during rest and left ventricular hypertrophy in the hypertensive patients. A spectrum analytic approach].

OBJECTIVE: To study the relationship between spectral analysis measurement of blood pressure (BP) and heart rate (HR) at rest, in untreated essential hypertension, and their relationship with the development of left ventricular hypertrophy (LVH). DESIGN AND METHODS: 41 untreated hypertensives (25M/16W, age 50 +/- 12, range 23-73) were measured at rest (WHO criteria DBP > 90 mmHg) by digital continuous photoplethysmography (Finapres 2300 (F), 6 mn of measurement in the dorsal decubitus position and standing up). Measurement of LVH (Devereux criteria, left ventricular mass index LVMI, g/m2) to analyse two groups (LVMI+: LVMI > 107 if women and 120 if men; n = 19; LVMI = 137 +/- 25), and (LVMI-; n = 22; LVMI = 92 +/- 17). The overall variability is standard deviation (SD), spectral analysis variability (SA) is FFT of 256 points over 3 periods low (LF: 0.004-0.07Hz), medium (MF: 0.07-0.13Hz), high (HF: 0.13-0.5Hz). Comparisons by Wilcoxon test and Anova (age, sex) (* p < 0.05, ** p < 0.01). RESULTS: By WHO criteria, the SBP was significantly lower in the LVMI-group (153 +/- 10 vs 165 +/- 18**), the DBP was not significantly different (94 +/- 6 vs 96 +/- 10). By continuous measure (F) at rest there was no significant difference for SBP or DBP. On standing up the SBP was significantly lower in the LVMI-group (148 +/- 20 vs 162 +/- 22**). The SD of the DBP at rest was more elevated in the LVMI-group (3.34 vs 3.06*), but not significantly different standing up. There was no significant difference in SBP at rest (6.7 vs 6.32) or standing (9.13 vs 11.5). The Spectral analysis of the MF was significantly elevated in the LVMI-group at rest for SBP (3.56 vs 3.01*), DBP (1.99 vs 1.19*), and HR (1.79 vs 1.77*). This was not significantly different in the LF and HF for SBP, DBP, HR. CONCLUSION: These results are different from those obtained by invasive ambulatory measures. The spontaneous variability in BP and HR at rest is increased when there is no cardiac effect (LVMI-). SA gives additional information in showing that the increase in variability is due to an increase in the Mayer waves, suggesting the existence of an elevation in adrenergic tone in hypertensive patients not having LVH.

Adult↗
PubMed1994

Accuracy of the Omron HEM 706 portable monitor for home measurement of blood pressure.

A reliable, well-validated home blood pressure (BP) self-measurement device could have an important role in the management of hypertension by the early identification of 'white coat' hypertensives. Under rigorous assessment such devices have not performed well in the estimation of DBP, particularly in the hypertensive range. We assessed the Omron HEM 706 device (oscillometric) for home measurement of BP according to the standards set out by the British Hypertension Society protocol and the Association for the Advancement of Medical Instrumentation (AAMI). The device was compared with simultaneous measurements made by two 'blinded' observers using a standard mercury sphygmomanometer in the same arm in 85 subjects aged 17-76 years with a wide range of BPs. The device was satisfactory over the whole BP range (SBP 89-188 mmHg, DBP 44-118 mmHg), with a B grading for SBP and a C grading for DBP (British Hypertension Society protocol) and a PASS for both SBP and DBP (AAMI). For the diastolic hypertensive range 90-120 mmHg, where most clinical decisions are made, the device scored a B grade for SBP and an A grade for DBP, with a PASS for both SBP and DBP. We conclude the Omron HEM 706 device for home BP measurement is highly satisfactory, particularly in the mild to moderate hypertension range, and is suitable for clinical use.

Adolescent↗
PubMed1994

Correlates and predictive models for blood pressure values in residents of two communities in Taiwan.

Factors predicting systolic blood pressure (SBP) and diastolic blood pressure (DBP) were extensively studied in residents aged 18 years and above from 10 villages in two Taiwanese communities. In women, the associated factors identified included age, body mass index, waist/hip ratio (not selected as a factor for DBP), plasma uric acid, plasma chloride, urinary sodium/creatinine ratio, urinary calcium/creatinine ratio, education level, ancestral origin, parental hypertension status, and marital status. In men, the factors were age, body mass index, plasma triglyceride concentration, urinary sodium/creatinine ratio, smoking status, alcohol drinking status, parental hypertension status (not selected for DBP), and marital status (not selected for DBP). The degree of BP variation which could be significantly explained by the measured factors differed between SBP and DBP, and differed between men and women: 18% in men and 39% in women for SBP variation; 15% in men and 27% in women for DBP variation. Factors other than those included in the models should be explored, particularly for men. This study identifies, for Chinese populations, predictive factors of BP well-known in Western societies (BMI, urinary sodium, plasma uric acid, alcohol consumption) and factors less emphasized in other studies (plasma triglyceride and marital status). A positive association between BP and urinary Na, a lack of association between BP and urinary K, and opposite findings in the relationship between BP and the education level for men (positive relation) and women (negative relation) are worth noting.

Adolescent↗
PubMed1994

24-hour ambulatory blood pressure monitoring and spirapril in mild to severe essential hypertension: a randomized dose comparison.

This was a multicentre randomized, double-blind, parallel-group study to compare the antihypertensive efficacy of spirapril at 3 mg with 12 mg once daily, as determined by 24-hour ambulatory blood pressure monitoring (ABPM), in patients with mild to severe essential hypertension. Following a 4-week placebo run-in phase, 52 male and female outpatients, aged 23-67 years with mild to severe essential hypertension [diastolic blood pressure (DBP) > or = 100 mmHg and < 120 mmHg] were randomized to receive spirapril at either 3 mg or 12 mg once daily for 8 weeks. At the end of active treatment and using the standard mercury sphygmomanometer, the number of responders (sitting DBP < 90 mmHg, but decrease > or = 10 mmHg) was the same in both groups (32% and 37%). There were mean decrease in both systolic blood pressure (SBP) and DBP at trough with both 3 mg and 12 mg doses: -9/-7 mmHg and -12/-7 mmHg, respectively. The rate of normalization (trough DBP < or = 90 mmHg) was 12% and 30% with the 3 mg and 12 mg doses, respectively. Of the 44 patients whose daytime ABPM could be compared, one of 20 patients taking 3 mg of spirapril, and 9 of 24 taking 12 mg of spirapril achieved a DBP < or = 90 mmHg for all time intervals while awake. The differences in blood pressure-lowering were significant with both SBP and DBP during the day and at the end of the dosing interval (p < 0.001 and p < 0.01, respectively). The changes from baseline at 24 hours postdose for SBP/DBP were -3/-6 mmHg with 3 mg and -14/-12 mmHg with 12 mg of spirapril.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

[Specifics of interaction between benz(a)pyrene and dibenzo(a,l)pyrene with DNA of various mouse tissues].

Fjord-region polycyclic aromatic hydrocarbon (PAH) dibenz (a,l)pyrene (DBP) is the most potent carcinogen in the PAH group. To elucidate the molecular mechanism of the unusual carcinogenic potency of DBP, the levels of DNA adducts in various tissues of the mouse were measured, following an intraperitoneal administration of DBP or a bay-region PAH benz(a)pyrene (BP) in equimolar doses. DBP was found to form much more DNA adducts. While BP formed adducts via fjord-region diol-epoxide formation only, DBP did the same via formation, too. It is suggested that the superior carcinogenic potency of DBP is due to these peculiarities of DNA adduct formation.

Animals↗
PubMed1997

Factor analysis, a more accurate method to be used in epidemiological studies of blood pressure in children.

The aim of our study is to evaluate whether factor analysis is better able to explain the variability of systolic blood pressure (SBP) and diastolic blood pressure (DBP) when compared with regression analysis, which is the usual tool to study a set of variables related to blood pressure (BP). SBP, DBP, weight, height, BMI, triceps skin-fold, sexual maturation and rurality were studied in 889 children aged 5-18 years (389 boys and 500 girls). The proposed method transforms any set of variables into a set of new variables (factors) which are uncorrelated with each other. One of the factors obtained clearly explains the BP variance of the. With this method, the algorithm accepts all meaningful variables, while regressions reject most of them. This method also explains a larger amount of BP variability, losing as little information as possible. In our sample the percentage of the total variance (communality) explained by the three factors was 80.3% for SBP, 88.1% for DBP in males, 79.3% for SBP and 90.7% for DBP in females. For the same sample, regressions only explained 41.2% in males and 41.9% in females for SBP, 40.9% in males and 47.2% in females for DBP. In conclusion, this method is more accurate for epidemiological studies producing a better overall score than regression analysis, losing almost no information from the sample. Two important strengths of the proposed methodology are as follows. First, it yields a unique, easy to calculate and flexible cardiovascular index for children, thus circumventing the problem of making decisions based on two variables (SBP and DBP). Second, such an index is the result of a methodology where specific BP variability is isolated rather than explained.

Adolescent↗
PubMed1997

A randomised crossover comparison of reserpine and sustained-release nifedipine in hypertension.

OBJECTIVE: To compare the effectiveness of the combination of hydrochlorothiazide (HCT) plus sustained-release nifedipine with the combination of HCT plus reserpine in lowering high blood pressure (BP) unresponsive to HCT monotherapy. DESIGN: An open, randomised crossover drug trial. SETTING: Outpatients' clinic in Parirenyatwa Hospital, Harare, a tertiary referral centre. SUBJECTS: 32 Black patients of both sexes with newly diagnosed or previously treated hypertension aged between 21 and 65 years who had a BP > 140/95 after receiving HCT 25 mg daily for four weeks were studied. INTERVENTION: Patients were kept on HCT 25 mg daily and were randomised to receive either reserpine 0.25 mg daily or nifedipine (Adalat Retard) 20 mg bd for four weeks. This was followed by a two week washout period during which patients received HCT 25 mg daily only. After the washout period patients were crossed over to the alternative treatment for four weeks. Patients were kept on HCT 25 mg daily throughout the trial. MAIN OUTCOME MEASURES: The main outcome measure was the fall in BP which was taken as the difference between the BP at baseline and the BP at the end of each treatment period. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements were taken. RESULTS: Both second line drugs were effective in lowering SBP and DBP and there was no significant difference between them. Nifedipine reduced SBP by 18.9 mmHg (95% CI 12.1 to 25.7) and DBP by 9.6 mmHg (95% CI 7.2 to 12.0). Reserpine reduced SBP by 15.9 mmHg (95% CI 8.4 to 23.4) and DBP by 11.1 mmHg (95% CI 7.5 to 14.6). However, only two patients attained the target DBP of < or = 90 mmHg after each active treatment period. CONCLUSION AND RECOMMENDATIONS: Since both agents were equally effective in reducing both SBP and DBP and reserpine is much cheaper than nifedipine, it is recommended that for a developing country like Zimbabwe, the combination of HCT and reserpine at the above doses should be used as the first step to treat mild to moderate hypertension without evidence of end organ damage. However, further trials should compare BP lowering effects as well as end organ protection offered by the trial drugs.

Adult↗
PubMed1998

Regression of left ventricular hypertrophy in hypertensive patients after 1 year of treatment with rilmenidine: a double-blind, randomized, controlled (versus nifedipine) study.

OBJECTIVE: To assess the effect of 1-year treatment with rilmenidine, an oxazoline compound that exerts its antihypertensive effects through binding to imidazoline receptors in the brainstem, on left ventricular hypertrophy (LVH) secondary to essential, mild-to-moderate hypertension [supine diastolic blood pressure (DBP)95-115 mmHg]. METHODS: We performed a double-blind, randomized, controlled (versus slow-release nifedipine) trial. Adjustment of treatment took place every month (M) between inclusion (MO) and an evaluation after 6 months (M6), then during M9 and after 1 year (M12) to achieve supine DBP values < or = 90 mmHg. Patients were dropped from our study if they had DBP> 95mmHg during two consecutive visits or DBP>115 mmHg on one occasion. The daily dosage of rilmenidine was 1 mg, and could be increased to 2 mg/day. The daily dosage of slow-release nifedipine was started from the beginning at the maximum dosage of 40 mg/day, so that there was no true adjustment of treatment despite the allocation of patients to a different unit in the case of DBP> 95 mmHg. The primary criterion was the change in left ventricular mass index (LVMI, g/m2), assessed by echocardiography, between MO and M12 for patients who completed the trial. RESULTS: After a 1-month placebo run-in period, 76 patients were selected and 73 were included (35 treated with rilmenidine and 38 treated with nifedipine). Fifteen patients withdrew from the study and two completed the study with a major deviation from protocol, leaving 56 patients (24 treated with rilmenidine and 32 treated with nifedipine) for a per-protocol analysis. Baseline demographic characteristics and history of arterial hypertension for the rilmenidine and nifedipine groups were similar, for included patients and for those taken into account for the per-protocol analysis. Between MO and M12, DBP in members of the per-protocol population was adequately controlled for those in the rilmenidine group (102.7+/-4.6 versus 88.5+/-7.1 mmHg, respectively) and for those in the nifedipine group (102.7+/-5.1 versus 85.6+/-79 mmHg, respectively). During MO, LVMI of patients in the rilmenidine group (176.9+/-41.3 g/m2) was slightly higher than that of patients in the nifedipine group (172.6+/-35.1 g/m2). During M12, LVMI was observed to have decreased both for patients in the rilmenidine group (to 154.8+/-40.2 g/m2, a decrease of 22.1+/-23.3 g/m2, P< 0.001) and for those in the nifedipine group (to 145.6+/-36.4 g/m2, a decrease of 26.9+/-29.5 g/m2, P< 0.001) but the difference between these two groups was not significant (P= 0.5). CONCLUSION: One-year treatment with a daily dosage of 1 or 2 mg rilmenidine achieves a significant reduction of left ventricular mass, which is not statistically different than that occurring with a daily dosage of 40 mg of slow-release nifedipine.

Adult↗
PubMed2004

Analysis of heart rate variability in hypertensive patients before and after treatment with angiotensin II-converting enzyme inhibitors.

OBJECTIVE: To compare heart rate variability in normotensive and hypertensive individuals and to observe the behavior of the autonomic nervous system after treatment with angiotensin II-converting enzyme inhibitors. METHOD: The study comprised 286 patients diagnosed with arterial hypertension (AH) for the first time and divided into 4 groups according to diastolic blood pressure (DBP) levels: group A -- DBP<90 mmHg; group B -- DBP 90-99 mmHg; group C -- DBP 100-109 mmHg; group D -- DBP>110 mmHg. Group A (110 healthy individuals) and group C (79 patients with moderate AH) underwent 24-hour Holter-ECG with analysis of heart rate variability in time domain (TD) and frequency domain (FD). The group C patients were treated with ACE inhibitors for 3 months, and, after this period, they underwent a new 24-hour Holter-ECG study for assessing heart rate variability, the values being compared with those of normotensive individuals. RESULTS: The SDNN and PNN50 parameters (TD), and the LF spectrum (FD) were significantly different in the 2 groups, with clearly reduced values in hypertensive individuals (P<0.05). Group C patients, after treatment with ACE inhibitors, showed a recovery in all variables of heart rate variability, achieving values close to those of normotensive individuals. CONCLUSION: Heart rate variability was reduced in hypertensive patients when compared with that in normotensive individuals, indicating a decrease in the baroreceptor reflex. A functional autonomic adjustment after the antihypertensive treatment with ACEI was observed, indicating recovery of parasympathetic tonus.

Adolescent↗