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PubMed2002

[Efficacy and tolerance of rilmenidine in patients with mild to moderate hypertension. Results of a Czech and Slovak 6-month multicenter study].

AIM OF THE STUDY: To evaluate the efficacy and tolerability of rilmenidine (Tenaxum) in the dose of 1-2 mg in patients with mild to moderate hypertension. GROUP OF PATIENTS AND METHODS: 243 patients (53% men, 47% women, mean age 52 +/- 11 years with mild to moderate essential hypertension were included into the study. Several cardiovascular risk factors for CAD were reported in the investigated group of patients: dyslipidaemia in 54%, obesity in 29%, diabetes mellitus in 14% and smoking in 17% of subjects. 87% of patients were subjects with newly diagnosed untreated or shortly (< 3 months) treated hypertension. In remaining hypertensives the antihypertensive therapy was withdrawn two weeks before the beginning of rilmenidine treatment. The following parameters were studied: BMI, sitting and upright casual blood pressure, heart rate and basal laboratory tests. If necesary, additional therapy with indapamide or perindopril was allowed. RESULTS: Rilmenidine treatment resulted in normalisation of blood pressure (BP) or significant (decrease of SBP/DBP = 20/10 mm Hg) blood pressure decrease in 69%, 22% of subjects, respectively. At the end of 6-month period significant BP decrease was noted: 134 +/- 6/83 +/- 5 mm Hg vs. 161 +/- 12/99 +/- 6 mm Hg (p < 0.001). Marked BP decrease was observed already during first visit after active treatment for 3 weeks. Six months of rilmenidine treatment led to significant heart rate decrease (71/min. +/- 8 vs. 74/min. +/- 9, p < 0.01). No significant laboratory (plasma Na, K, creatinine, urea, glycemia, triglycerides, haematocrit) changes were reported after rilmenidine treatment with the only exception of mild, but significant plasma cholesterol decrease. Rilmenidine had very good acceptability and mild side effects were noted in small percentage of patients. CONCLUSION: Rilmenidine is a centraly acting drug of IInd generation (imidazoline I1 receptors agonist) with potent antihypertensive and mild negative chronotropic effect. Rilmenidine has very good clinical tolerability without negative influence on metabolic parameters.

Adrenergic alpha-Agonists↗
PubMed2003

[Tongue angioedema associated with angiotensin-converting enzyme inhibitor (diagnosis, differential diagnosis, treatment)].

Angioneurotic edema is a rare (0.1-0.2%) but potentially life-threatening side effect of angiotensin-converting enzyme inhibitors. It can result in serious respiratory distress, airway obstruction and death. Angiotensin-converting enzyme inhibitors associated angioedema is clinically poorly recognized and frequently underestimated condition. A case history of patient with angioneurotic edema due to treatment with ramipril is presented. A 51-year-old man has been sequentially treated for two years with atenolol, indapamide, enalapril, and fosinopril due to primary arterial hypertension. When the treatment was switched to ramipril 5 mg twice a day the fourth dose of the drug was followed by swelling of lips, tongue, and pharynx without symptoms of airway obstruction. Ramipril was discontinued, prednisolone 120 mg and loratidine 10 mg were given. Symptoms of angioedema gradually disappeared. Mechanisms of angioedema are not fully clear. Pharmacological action of angiotensin-converting enzyme inhibitors on bradykinin and substance P, immunological mechanisms and disarrangements in complement system are discussed. Treatment includes immediate withdrawal of angiotensin-converting enzyme inhibitors and acute therapy with epinephrine 0.3-0.5 ml subcutaneous, 50 mg diphenhydramine s/c or i/v, 40-50 mg methylprednisolone. Future treatment with angiotensin-converting enzyme inhibitors is contraindicated.

Algorithms↗
PubMed1992

Antihypertensive therapy in diabetic patients.

Diabetes mellitus (DM)-linked metabolic alterations and hypertension concomitantly accelerate or precipitate cerebrovascular and coronary heart disease, nephropathy, retinopathy and widespread macroangiopathy, thereby conferring to diabetic patients a very high risk of morbidity, disability and early death. Therefore, the long-term care for diabetic patients should be aimed at concomitant metabolic and blood pressure (BP) control. Dietary measures are indispensable; a high fibre, low fat, low salt diet is recommended, complemented with caloric restriction and physical exercise when body weight is above the ideal. Antidiabetic pharmacotherapy involves an unresolved dilemma. The desired achievement of euglycemia necessitates effective levels of insulin, but hyperinsulinemia (due to parenteral [over]treatment in insulin-dependent DM) is suspected to promote atherogenesis and represents a coronary risk factor and perhaps even facilitates hypertension. Considering antihypertensive pharmacotherapy, thiazide-type or loop diuretics are problematic drugs in DM because they can aggravate metabolic alterations. These agents also seem to exert only a limited preventive or regressive effect on left ventricular hypertrophy (LVH); beta-blockers are also not considered ideal, since they decrease the awareness of hypoglycemia and tend to promote glucose intolerance. Unselective beta-blockers in particular promote peripheral ischemia and insulin-induced hypoglycemia, while beta-blockers without intrinsic sympathomimetic activity lower serum HDL-cholesterol. Calcium antagonists and ACE inhibitors have equivalent antihypertensive efficacy, do not impair carbohydrate and lipid homeostasis or peripheral perfusion and can effectively improve LVH. Certain ACE inhibitors may even slightly ameliorate abnormal insulin sensitivity and plasma glucose levels. While alpha-blockers share most of these desirable properties, these agents are more prone to precipitate orthostatic hypotension in the diabetic patient. The non-thiazide diuretic indapamide and the serotonin2-antagonist ketanserin also combine antihypertensive efficacy with metabolic neutrality. The ultimate goal of therapy is to improve life prognosis. In essential hypertension, conventional drug treatment based on diuretics in high dosage satisfactorily reduced cerebrovascular but not coronary complications or sudden death. In diabetic patients, the influence of antihypertensive therapy on prognosis has not been assessed prospectively. Based on retrospective analyses, Warram et al reported a 3.8 times higher mortality in diabetics treated with diuretics alone, than in diabetics with untreated hypertension (Arch Intern Med. 1991;151:1350). H. H. Parving calculated that effective BP control in patients with diabetic nephropathy might reduce 10 year-mortality from about 65 to 20 percent (J Hypertension. 1990; 8[Suppl 7]:187).(ABSTRACT TRUNCATED AT 400 WORDS)

Antihypertensive Agents↗
PubMed1992

Sodium, large arteries and diuretic compounds in hypertension.

BACKGROUND: Clinical and experimental data have shown that different antihypertensive drugs do not cause similar changes in arterial compliance for an equipotent blood pressure reduction. There are no clear data on the effects of sodium and diuretics on the visco-elastic properties of the hypertensive arterial wall. DATA ANALYSIS: Cross-sectional epidemiological studies suggest that for given values of age and blood pressure, pulse wave velocity is lower in the presence than in the absence of a low sodium intake. Longitudinal studies indicate that in hypertensive subjects, a low sodium intake is associated with a larger brachial artery diameter than that seen with a high sodium intake. In hypertension in the elderly and in severe hypertension with end-stage renal disease, a sodium overload reduces arterial compliance and distensibility independently of blood pressure changes. In animal studies, the diuretic compounds cycletanine and indapamide increase systemic and carotid compliance independently of blood pressure changes. In contrast, in a crossover study in hypertensive subjects, the diuretic agent hydrochlorothiazide did not change arterial compliance and pulse wave velocity while the calcium entry-blocker felodipine did improve these hemodynamic parameters. CONCLUSION: The studies reviewed indicate that sodium may act on the arterial wall independently of blood pressure changes. the contribution made by counter-regulatory mechanisms, which may be related to the renin-angiotensin and the sympathetic nervous systems, might explain the differences between the clinical and the experimental changes observed with diuretic compounds.

Animals↗
PubMed2003

[Randomized trials in the prevention of recurrent calcium oxalate stones].

Kidney stone, with or without lumbar pain, is a major health care problem because of its prevalence and cost for both the patient and the society. Although, surgical procedures are well known, medical treatment and recurrences prophylaxis are uncodified. Fifteen stone recurrence prevention studies have been reviewed, evaluating dietary intake and drugs. The most important factor is a daily diuresis of at least 2 liters. Calcium intake shouldn't be restricted, whereas oxalate, sodium, and protein intakes have to be limited. Hyper and normocalciuretic kidney stone formers improve their outcome with thiazide or indapamide treatment. Hyperuricosuria justifies allopurinol. Potassium citrate (without sodium) may decrease recurrence risk, even in patients without hypocitraturia.

Calcium Oxalate↗
PubMed2003

[Results of pharmacoepidemiological study of arterial hypertension in Russia (PIFAGOR)].

AIM: To assess physicians preferences concerning the use of various groups of antihypertensive drugs in Russia. METHODS: Special questionnaires containing 8 questions related to preferential adherence to representatives of various groups of antihypertensive drugs were distributed among practicing physicians who routinely treated patients with hypertension. RESULTS: Of questionnaires returned between January and July of 2002 from 34 towns 530 were considered valid for analysis. Half of responses (50.4%) were from hospital physicians, 40.5% - from physicians of policlinics (outpatient clinics), 9.1% - from physicians working in other health care facilities. Most of respondents were internists (60.8%) and cardiologists (32.7%). Preferences concerning prescription of antihypertensive drugs were distributed in the following way: angiotensin converting enzyme inhibitors - 32% (50% captopril and enalapril); beta-adrenoblockers - 27% (77% atenolol, metoprolol and propranolol); diuretics (hydrochlorothiazide and indapamide) - 22%; calcium antagonists - 15% (81% verapamil, nifedipine, diltiazem, 64% - long acting preparations); angiotensin receptor blockers - 1.7%; centrally acting drugs - 1.5%; alpha-adrenoblockers - 0.8%. CONCLUSION: Tendencies in real life treatment of patients with hypertension in Russia should be considered positive. Basic antihypertensive therapy included agents (mostly long-acting) from 4 main classes and the use of outdated drugs such as clonidine and reserpine was low.

Antihypertensive Agents↗
PubMed2005

Adult hypertension: reducing cardiovascular morbidity and mortality.

(1) Since our last review of treatments for arterial hypertension in 1999 (Prescrire International no.41), many new data have been published and new antihypertensive drugs have appeared on the market. (2) The working definition of hypertension is unchanged, namely blood pressure of at least 160/95 mm Hg in the general population, and at least 140/80 mm Hg in patients with diabetes and a history of stroke; these figures must be found on several occasions using a standardised method, with the patient at rest. (3) The goals of antihypertensive therapy are to reduce mortality and cardiovascular events, and not simply to drive blood pressure below a fixed (and often controversial) threshold. (4) Some drug and non drug interventions have a positive risk-benefit balance in the long term. (5) When antihypertensive drug therapy is needed, trials based on clinical endpoints show that it is best to start treatment with a single drug. (6) New data support the use of certain thiazide diuretics (chlortalidone, or hydrochlorothiazide if chlortalidone is not available) as first line treatment for most hypertensive patients, including non diabetic adults, diabetic adults, elderly subjects (over 65 years), and stroke patients. Some betablockers and angiotensin-converting-enzyme inhibitors (ACE inhibitor) are second-line alternatives. (7) Assessment of other antihypertensive drugs has also progressed since 1999, including indapamide (thiazide-like diuretic), amlodipine, diltiazem and verapamil (calcium channel blockers), lisinopril (ACE inhibitor), and losartan and valsartan (angiotensin II antagonists). However, these drugs are not as thoroughly evaluated as thiazide diuretics, betablockers and some ACE inhibitors.

Adrenergic alpha-Antagonists↗
PubMed2005

[A clinical intervention study among 463 essential hypertensive patients with metabolic syndrome].

OBJECTIVE: To study the role of baseline risk factors in predicting the onset of diabetes among essential hypertensive patients with metabolic syndrome (MS) and to evaluate an ideal therapeutic regime that could reduce the risk factors and risk of onset of diabetes. METHODS: A randomized parallel clinical trial in essential hypertensive patients of grade 1 or 2 was conducted. Two of the three components (1) increased waist circumference and/or BMI; (2) increased triglycerides (TG) and/or decreased high-density lipoprotein cholesterol; (3) impaired glucose tolerance (IGT) were present define the MS. The three intervention therapy groups were: indapamide + fosinopril (I + F, n = 151); atenolol + nitrendipine (A + N, n = 160); atenolol + nitrendipine + metformin (A + N + M, n = 152). Each case was followed-up monthly and the dosage of medicine taken be adjusted according to their BP level. The plasma glucose during fasting and two hours after taking 75 g glucose orally was also measured every six months. The new onset of diabetes was diagnosed according to the criteria. OGTT, insulin release test, lipid analysis, body weight and waist circumference were measured again at the last follow-up. RESULTS: (1) The lowering of BP was similar among the three groups (P > 0.05). 23 new diabetes onsets occurred, being 10 in group I + F and 8 in group A + N and 5 in group A + N + M, respectively (P > 0.05); (2) Proportions of patients' risk factors decreased significantly in group A + N or A + N + M, e.g. the proportions of high TG in each group reduced by 14.7% and 9.3% respectively (P < 0.05), the central fat distribution reduced by 16.7% and 15.9% respectively (P < 0.05) and the IGT reduced by 6.6% and 29.6% respectively (P < 0.05). However no changes were found in group I + F; (3) After 1 year and 5 months' follow-up, the proportions of main risk factors (high TG, central fat distribution and IGT) in the three groups were 91%, 96%, 83% and 90%, 88%, 47%, respectively. The difference of IGT was significant between two groups (P < 0.01) and the proportions of having three risk factors were 70% and 31% in the two groups (P < 0.01); (4) I + F group was better than A + N group in reduction of TG and central fat distribution. And A + N + M group improved in all risk factors. CONCLUSIONS: IGT alone or combined with increased TG plus abdominal obesity are the most important risk factors in predicting a new onset of diabetes among essential hypertensive patients with MS. Metformin in combination with atenolol plus nitrendipine can significantly prevent the onset of diabetes as well as improve patients' metabolic abnormality.

Adult↗
PubMed2005

[Effects of blood pressure lowering treatment on stroke recurrence in patients with cerebrovascular diseases-a large-scale, randomized, placebo controlled trial].

OBJECTIVES: To investigate the effects of blood pressure lowering treatment on stroke recurrence among Chinese patients with previous cerebrovascular diseases. METHODS: Patients were eligible if they had a history of stroke or transient ischaemic attack (TIA) within the previous 5 years. Participants had no definite indication or contraindication for study drugs. There were no blood pressure entry criteria. This study was a large-scale randomised, double-blind, placebo controlled clinical trial. After 4 weeks run-in period, 1520 randomised patients received either ACE inhibitor-perindopril (+ diuretic-indapamide) treatment or matching placebo for 4 years. The primary study outcome was stroke event. Secondary outcomes included cardiovascular death, myocardial infarction, all-cause death and blood pressure. RESULTS: Ssven hundred and sixty-two were assigned active treatment and 758 assigned placebo. The characteristics of randomised patients of active and control groups were similar. In active and control groups: 70.8% and 70.5% were male, 93.8% and 93.4% had a history of stroke (haemorrhagic or cerebral infarction). Baseline mean blood pressure in the active and control groups were 145.3 +/- 20.2/86.8 +/- 11.1 mm Hg and 145.3 +/- 20.3/87.2 +/- 10.8 mm Hg, and mean age were 63.9 +/- 7.5 and 63.8 +/- 7.7 years, respectively. Blood pressure in those assigned active treatment was reduced on average 14/6 mm Hg more than placebo at 4 years. During double-blind treatment, active treatment reduced stroke recurrence (8.8% vs 19.4%) by 55% (P < 0.001), myocardial infarction (1.4% vs 2.8%) by 48% (P = 0.070), cardiovascular mortality (3.6% vs 6.6.%) by 45% (P = 0.010), and all-cause mortality (6.3% vs 9.8%) by 36% (P = 0.010). These benefits were achieved similarly in all subgroups: male or female, middle-aged or elderly, with or without hypertensive, cerebral infarct or haemorrhagic stroke. CONCLUSION: 4 years of blood pressure lowering treatment was beneficial in Chinese patients with previous cerebrovascular diseases.

Aged↗
PubMedDate not supplied

[Diuretic therapy in heart failure].

Diuretic therapy is a drug therapy that increases urine volume, but not glomerular filtration rate (GFR). The diuretics act predominantly on tubular sites; the drugs that increase GRF are the aminophyllines, the positive inotropy or vasoactive substances that increase afferent arteriolar flux or intraglomerular pressure. We can divide the diuretics into six categories: 1) carbonic anhydrase inhibitors: acetazolamide, dichlorphenamide, methazolamide; 2) osmotic diuretics: glycerol, mannitol, urea; 3) loop diuretics: furosemide, bumetanide, ethacrynic acid, piretanide, torsemide; 4) thiazide and thiazide-like diuretics: chlorothiazide, trichlormethiazide, indapamide, chlorthalidone, metolazone; 5) potassium-sparers: a) kidney epithelial sodium channel inhibitors: amiloride and triamterene; b) aldosterone receptor antagonists: spironolactone, canrenoate potassium, eplerenone; 6) ADH antagonists: lithium salts, demeclocycline and ethanol. Diuretic therapy is useful in treating acute and chronic renal insufficiency, congestive heart failure, cirrhosis, overhydration and hypertension. Diuretic therapy increases urine volume, ion loss (except Na+, K+), and modifies diffusion (dilute urine) and convection mechanisms (reduced tubular absorption). Therefore, diuretics are very useful non-dangerous drugs.

Diuretics↗
PubMedDate not supplied

[Management of arterial hypertension in octogenarian].

Hypertension is the most common chronic condition for which elderly people see a health provider and is increasing in prevalence as people age. The most powerful risk factor for death, cardiovascular death, and hypertension in large populations is age. In the very elderly patient the most common abnormality is elevated systolic blood pressure, which is much more predictive of stroke and heart disease death. With the exception of the Antihypertensive and Lipid Lowering to prevent Heart Attack Trial (ALLHAT), recent trials have emphasized the overriding importance of lowering blood pressure rather than the specific agent chosen to begin therapy. A metaanalysis of 7 clinical trials that enrolled 1.670 subjects > 80 years od age indicated that active antihypertensive drug therapy significantly reduce stroke by 34% and heart failure by 39% was associated with a non significant 6 increase in mortality. The Hypertension in the Very Elderly Trial (HYVET) will enrol 2.100 patients > 80 years of age and will compare 2 groups randomized to indapamide +/- perindopril versus placebo +/- placebo for incident stroke during 5 years follow-up. This study should answer lingering question about whether active antihypertensive therapy is associated with a major and significant reduction in cardiovascular morbidity and mortality in this age group as it clearly does in younger hypertensives. For frail patients, further studies are needed to assess the potential risks associated to antihypertensive therapy according to the characteristics of the geriatric patient.

Aged, 80 and over↗
PubMed2006

[A case of severe hyponatremia in a patient suffering from epilepsy and using oxcarbazepine].

A 70-year-old patient treated with oxcarbazepine experienced severe hyponatremia. The patient used oxcarbazepine (600 mg twice a day) concomitantly with diuretics (torasemide 10 mg and indapamide 1.25 mg once per day), perindopril, an angiotensin-converting enzyme inhibitor, and amlodipine, a Ca(2+) channel blocker. The patient complained of a nausea, malaise, diplopia, drowsiness, apathy, decreased diuresis (creatinine clearance - 41.51 ml/min), and exacerbation of epileptic seizures. Sodium concentration in the plasma was 113 mmol/l. The patient was hospitalized. It was suggested that a decrease in plasma sodium concentration was caused by oxcarbazepine used together with diuretics for six months. Oxcarbazepine-induced hyponatremia is reported in 22.2-50% of patients, although symptoms are present only in 5.9% of patients. The most common symptoms of central nervous system injury, experienced by patients, are drowsiness, dizziness, decreased cognitive function, coordination impairment, etc. Physicians not always in time pay proper attention to undesirable antiepileptic drug-induced effects, which can be dangerous.

Aged↗
PubMed2005

[Disturbances in aggregability of red blood cells in essential hypertension].

The study was performed to find the relationship between rheological properties of erythrocytes and the effectiveness of antihypertensive therapy both in patients suffering from essential hypertension as well as in spontaneously hypertensive rats (SHR). Additionally, in patients receiving the same antihypertensive therapy we evaluated the effect of aspirin at a low and high dose on aggregation of erythrocytes. We found that in a consequence of uniformed antihypertensive therapy which in patients lasted minimum one year and consisted of one of ACE inhibitors (enalapril or perindopril or captopril), one of beta-antagonists (metoprolol or bisoprolol) and diuretic agent (indapamid), while SHR lasted 8 days and consisted of ACE inhibitor (chinapril), blood pressure lowered and red blood cell rheology was significantly improved. For the first time we observed that antihypertensive treatment which advantageously decreased the aggregability of erythrocytes was diminished by a high dose of aspirin (300 mg/day).

Adult↗
PubMed1991

Diuretic profile of a novel loop diuretic torasemide in rats and dogs.

In the present study, the authors have examined the diuretic action of a novel loop diuretic torasemide and compared it to those of other diuretics, employing normal rats and dogs. Oral administration of torasemide elicited a dose-dependent increase in urine volume and electrolyte excretion, and elevated the urinary Na/K ratio in rats. These effects were more potent than those of the other diuretics furosemide, trichlormethiazide, indapamide and spironolactone. Moreover, torasemide exhibited a similar or higher urinary Na/K ratio than the combination of these diuretics and spironolactone. In a study employing anaesthetized dogs, i.v. injection of torasemide resulted in a higher urinary Na/K ratio in comparison to furosemide, in addition to potent and long-lasting diuretic activity.

Anesthesia↗
PubMed1991

[Diuretics in arterial hypertension: a firm commitment for the 90's?].

A clinical pharmacology review of thiazide diuretics is presented in this paper, highlighting the mechanism of action, dosage considerations in order to optimize both the monotherapy or combination treatment, most relevant metabolic effects and adverse reactions, and clinically significant drug interactions. Reference is made to several attemps of limiting or reducing the popularity of their use which took place in mid eighties. At present, there are no data to substantiate that diuretics are implicated for the lack of a consistent reduction in coronary heart disease events. As a consequence of the renewed interest in the development of drugs with diuretic antihypertensive action, the physiologic changes associated with the use of indapamide have been briefly characterized. This agent is also perceived as having more favourable neutral metabolic profile at subnatriuretic dosage. After careful consideration of relevant scientific evidence and a critical appraisal of individualized approach to antihypertensive therapy, diuretics should be given serious consideration as valid alternative to modern antihypertensive agents in years to come.

Diuretics↗
PubMed1990

[The role of therapy with a Ca++ antagonists (nifedipine) in the long-term prognosis of hypertensive patients with previous myocardial infarction].

One hundred and twenty-two patients suffering from slight or moderate essential arterial hypertension with a previous history of myocardial infarction were selected for inclusion in this study. Patients were divided into two groups of 61 according to the type of anti-hypertensive therapy received. Patients in group 1 received nifedipine (30 mg p.d.), while patients in group 2 were treated using other anti-hypertensive therapy (diuretics, alpha-methyldopa, clonidine, indapamide). At the end of the follow-up period, which lasted 5 years, a statistically significant improvement in the following factors was observed in group 1 in comparison to the control group: (a) an improved response of both SBP (p less than 0.001) and DBP (p less than 0.001) levels to anti-hypertensive therapy; (b) a more significant diminution in the thickness of the interventricular septum (p less than 0.001) and the posterior wall of the left ventricle (p less than 0.001) assessed using ultrasonography; (c) a reduced number of cases of post-infarction angina (p less than 0.05); (d) fewer cases of recurrent infarction (p less than 0.05); (e) fewer deaths as a result of re-infarction (p less than 0.01). These results confirm that the vascular and cardioprotective effects of nifedipine give a good long-term outcome in hypertensive patients with a previous history of myocardial infarction.

Adult↗
PubMedDate not supplied

Role of Ca++ antagonists (nifedipine) in the long-term prognosis of hypertensive patients with previous history of myocardial infarction.

One hundred and twenty-two patients suffering from slight or moderate essential arterial hypertension with a previous history of myocardial infarction were selected for inclusion in this study. Patients were divided into two groups of 61 according to the type of anti-hypertensive therapy received. Patients in Group 1 received nifedipine (30 mg p.d.), while patients in Group 2 were treated using other anti-hypertensive therapy (diuretics, alpha-methyldopa, clonidine, indapamide). At the end of the follow-up period, which lasted 5 years, a statistically significant improvement in the following factors was observed in Group 1 in comparison to the control group: (a) an improved response of both SBP (p less than 0.001) and DBP (p less than 0.001) levels to anti-hypertensive therapy; (b) a more significant diminution in the thickness of the interventricular septum (p less than 0.001) and the posterior wall of the left ventricle (p less than 0.001) assessed using ultrasonography; (c) a reduced number of cases of post-infarction angina (p less than 0.05); (d) fewer cases of recurrent infarction (p less than 0.05); (e) fewer deaths as a result of re-infarction (p less than 0.01). These results confirm that the vascular and cardioprotective effects of nifedipine give a good long-term outcome in hypertensive patients with a previous history of myocardial infarction.

Adult↗
PubMed1989

Risk factor interactions for coronary heart disease.

There is now an increasing awareness of the atherogenicity of the individual lipoprotein subfractions. In addition, the effects of commonly used antihypertensive drugs has been a cause for concern. Thiazides and loop diuretics both increase LDL cholesterol, but indapamide and spironolactone have no apparent effects. Beta-blocker monotherapy may also increase triglycerides whilst post-synaptic alpha-blockers do not affect, or slightly lower triglycerides, total cholesterol, LDL and VLDL levels.

Antihypertensive Agents↗