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PubMed1985

Treatment of mild to moderate essential hypertension with muzolimine. Two years of follow-up.

This study was carried out in association with medical practitioners who were responsible for observing the patients. In a first phase, 58 subjects younger than 70 years with moderate essential hypertension were allotted at random to treatment with either indapamide (2.5 mg per day) or muzolimine (20 mg per day). The double blind-double dummy study lasted for six months and demonstrated that the two drugs were similar in efficacy and tolerance. At the end of this phase 42 patients whose supine diastolic blood pressure fell to below 100 mmHg were selected to continue the trial with 20 mg per day muzolimine in an open long-term study. The survey comprised two periods: the first lasted for six months, the patients being examined every two months, and the second lasted for one year and patients were seen quarterly. However, 8 subjects entered directly into the second period. At each examination standing and supine blood pressure, heart rate and body weight were noted; blood was sampled to allow measurements of serum plasma parameters. Thus 15 patients were treated with muzolimine over two years and 15 over 18 months. Clinically the fall in blood pressure observed initially was maintained throughout the rest of the trial; but 3 patients needed another drug, i.e. central hypotensor (2 cases) and beta-blocker (1 case). Two subjects complained of transitory cramps, but 3 other complications not imputable to the treatment were observed: one myocardial infarction and 2 strokes. Biologically there was no change in mean plasma potassium level, but 3 patients received a potassium supplement.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1984

[Myoglobinuria secondary to hypokalemia during prolonged diuretic therapy].

Myoglobinuria secondary to hypopotassemia was noted in a hypertensive patient treated for a long period with diuretics (chlorthalidone and indapamide). The picture included hypokalemic myopathy, with myoglobinuria, an increase in serum enzymes related by rhabdomyolysis, and flaccid paralysis. In spite of reinstatement management with potassium chloride, hypopotassemia promoted a torsade de pointes, quickly followed by terminal ventricular fibrillation.

Aged↗
PubMed1982

Effects of different diuretics on tetracycline-induced hyperuraemia and hypercreatininaemia in the rat.

Tetracycline injection (45 mg/kg, i.v.) produced increases in plasma urea and creatinine levels in rats. The greatest increases occurred after 24 hr for urea and after 6 hr for creatinine, the latter effect persisted for at least 30 hr. The actions of six diuretics (acetazolamide, bumetanide, chlorothiazide, chlorthalidone, triamterene and indapamide) given orally either as pretreatment (1 hr before tetracycline injection) or post-treatment (4 hr after tetracycline injection) were examined. When given as pretreatments, all six diuretics reduced the hyperuraemia, and generally the hypercreatininaemia, that existed 24 hr after tetracycline injection. In contrast, when given as post-treatments, only bumetanide reduced the increase in urea and creatinine levels. It is postulated that this protective action of diuretics could occur by their displacement of tetracycline molecules from protein binding sites or by a-direct action on renal function.

Animals↗
PubMed1993

Platelets, growth factors, and vascular smooth-muscle cells in hypertension and diabetes.

Inappropriate vascular smooth-muscle cell (VSMC) growth is the hallmark of vascular pathology in essential hypertension and diabetic macroangiopathy, whereas platelets constitute an important regulator of vessel wall homeostasis because of their content of various growth factors. Numerous abnormalities exist in platelet functions in diabetes and hypertension, such as enhanced activity and altered adhesion and aggregation. Increased thromboxane (TX2) production is characteristic of diabetes, and an elevation of intracellular free Ca2+ is found in platelets of hypertensive patients. By studying the growth patterns of VSMC from spontaneously hypertensive rats (SHRs) vs. those obtained from their normotensive counterparts, Wistar-Kyoto (WKY) rats, we have demonstrated that VSMC from SHRs exhibited a higher specific growth rate, abnormal contact inhibition, and accelerated entry into the S phase of the cell cycle. Moreover, they were hyperresponsive to many growth factors such as calf serum, epidermal growth factor (EGF), platelet-derived growth factor (PDGF), transforming growth factor beta 1 (TGF beta 1), and insulin. Additive effects were observed for EGF and PDGF or EGF and insulin. These intrinsic growth anomalies in cells of hypertensive origin persist in culture indicating their putative primary role in the pathogenesis of hypertension. Endogenous TGF beta 1 revealed an augmented expression of its message levels in SHR VSMC, the difference in mRNA between both strains being more pronounced at high cell density. Further, TGF beta 1 protein synthesis and secretion in VSMC culture were confirmed by immunoprecipitation of de novo labeled TGF beta 1. At high cell density, which most likely represents the physiological state of VSMC, plasmin, an activator of TGF beta 1, significantly stimulated DNA synthesis of VSMC in both strains. The reverse effect was obtained at low cell density. Yet, the fold stimulation was higher in WKY rats, suggesting that TGF beta 1 may be partially activated in SHR VSMC. This is supported by the inhibition of baseline DNA synthesis by TGF beta 1 neutralizing antibody in VSMC of hypertensive origin and not of normotensive controls. TGF beta 1 antisense oligodeoxynucleotide (ODN) nearly normalized the increased proliferation of SHR VSMC in culture. On the other hand, growth-promoting activity (GPA) in platelets of either diabetic or hypertensive patients was higher than in platelets of healthy controls and was found to be normalized by intensive insulin therapy in insulin-dependent diabetic patients. In hypertensive patients, however, hydrochlorothiazide (HCTZ)--even in low doses (25 mg/day)--enhanced the GPA in platelets, whereas other antihypertensive agents such as indapamide, atenolol, and captopril, had neutral effects.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1993

Carbohydrate metabolism in hypertension: influence of treatment.

Epidemiologic studies suggest a close association between hypertension, obesity, and diabetes. It has been demonstrated that essential hypertension, per se, is an insulin-resistant state. However, the pathogenesis of the association between insulin resistance and hypertension is poorly understood. Elevated plasma insulin levels may contribute to the development of hypertension through renal sodium reabsorption, the sympathetic nervous system, the transmembranous cation transport, the renin-angiotensin system, the cardiovascular reactivity, and the atrial natriuretic peptide. Diuretics, beta-blockers, calcium antagonists, angiotensin-converting enzyme (ACE) inhibitors, and alpha 1-antagonists are first-choice drugs in the management of hypertension. Diuretics, except indapamide, impair insulin sensitivity and glucose tolerance. The same negative effects, exerted by beta-blockers, are reduced employing those with selective activity. With few exceptions, calcium antagonists have no adverse influence on carbohydrate metabolism. ACE inhibitors and alpha 1-antagonists do not influence or even improve glucose metabolism.

Adrenergic beta-Antagonists↗
PubMed1993

Serum lipoproteins during treatment with antihypertensive drugs.

Several drugs used for antihypertensive therapy may modify the lipoprotein metabolism. Thiazides in high dosage and loop diuretics can increase serum low-density lipoprotein (LDL) cholesterol and/or very-LDL cholesterol and the total cholesterol/high-density lipoprotein (HDL) cholesterol ratio, while HDL cholesterol is largely unchanged; triglycerides (Tg) are also often elevated. Premenopausal women may be protected from this side effect. Whether diuretic-induced dyslipidemia is dose-dependent and low thiazide doses (i.e., hydrochlorothiazide < or = 12.5 mg daily) are interacting less, awaits clarification. beta-Blockers without intrinsic sympathomimetic activity increase serum triglycerides and tend to lower the potentially antiatherogenic HDL cholesterol. The diuretic-antihypertensive agent indapamide, given at a dose of 2.5 mg/day, is neutral with regard to serum lipoprotein and glucose metabolism. The potassium-sparing diuretic spironolactone, conventional sympatholytic agents, calcium-channel blockers, and probably the serotonin2-receptor antagonist ketanserin, exert no relevant effects on the lipoprotein profile. Angiotensin-converting enzyme inhibitors may slightly decrease serum triglycerides. alpha 1-Receptor blockers slightly decrease LDL cholesterol and Tg and increase HDL cholesterol. Drug-induced development or aggravation of dyslipidemia represents a potentially adverse influence. In the hypertensive population, effective blood pressure control with traditional drug therapy based on thiazide-type diuretics in high dosage led to a distinct decrease in cerebrovascular morbidity and mortality, but failed to satisfactorily reduce coronary complications. The prognostic relevance of drug-induced changes in serum lipoproteins, carbohydrate metabolism and other risk factors or correlates awaits further clarification.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

Treatment of hypertension in the elderly.

This review discusses the pathophysiology and treatment of hypertension in the elderly. Evidence of the risks associated with systolic hypertension in particular is discussed in relation to the elderly population. The results of recent large-scale, placebo-controlled trials of hypertension in the elderly, including the Systolic Hypertension in the Elderly Program, the Swedish Trial in Old Patients with Hypertension, and the Medical Research Council trials, confirm the benefits of treatment in this population. However, pathophysiologic processes in the elderly may predispose them to drug side effects; therefore, selection of appropriate therapy is critical to the success of treatment. Various treatment options are available that may be suitable in subsets of the elderly population, particularly when low-dose regimens are used. Indapamide, a sulfonamide diuretic, may be particularly well suited for treatment of hypertension in the elderly because of its demonstrated efficacy and safety at low doses.

Aged↗
PubMed1993

[Cardiac hypertrophy in hypertension--clinical significance and possibilities of control].

Left ventricular hypertrophy constitutes an essential risk factor for sudden death, myocardial infarction and heart failure. The death rates of patients with ECG-demonstrated cardiac hypertrophy are 4.8 times as high as those of healthy subjects. Cardiac hypertrophy is associated with a substantially increased incidence of ventricular arrhythmias. The condition is treatable in most patients. While the most effective group of drugs for controlling cardiac hypertrophy are ACE inhibitors; methyldopa, calcium antagonists, and beta-blockers have also proved useful in the management of cardiac hypertrophy in hypertension. Diuretics other than indapamide are not appropriate for treating cardiac hypertrophy. An additional benefit of ACE inhibitor administration is they can favourable affect increased levels of collagen in the hypertrophic myocardium. The prognosis of hypertensive patients, whose treatment has lead to regression in cardiac hypertrophy in hypertension, is markedly better than that of patients in whom regression fails to be achieved. A role in the development of cardiac hypertrophy in hypertension, in addition to the blood pressure level, is played by a number of mechanisms; it is the genetic factor which has received most attention recently. As the prognosis of hypertrophic patients has been found to correlate more closely with left ventricular weight, determined by echocardiography, than with blood pressure, echocardiography should be employed more often in the future to help optimize antihypertensive therapy.

Death, Sudden, Cardiac↗
PubMed1995

Diabetes and hypertension.

Diabetes and hypertension have a higher than expected comorbidity. They share common etiology, pathophysiology, and organ effects. Long-term therapeutic goals are to prevent renal failure and atherosclerosis. Management should inhibit pathophysiologic mechanisms and avoid stimulating them. The most appropriate pharmacologic agents to treat hypertension in the diabetic are ACE inhibitors, selected calcium channel blockers, alpha adrenengic blockers, and certain central alpha agonists. The only diuretics that should be used are indapamide and torsemide.

Antihypertensive Agents↗
PubMed1995

PROGRESS (perindopril protection against recurrent stroke study): rationale and design. PROGRESS Management Committee [corrected].

RATIONALE: Patients with a history of cerebrovascular disease have a very high risk of stroke, and usual levels of both systolic and diastolic blood pressure are directly and continuously associated with this risk. Trials of blood pressure lowering in patients with transient ischaemic attacks or stroke have been too small to reliably detect the effects on stroke risk of the modest blood pressure reductions achieved. OBJECTIVES: The primary objective of PROGRESS is to determine precisely the effects of blood pressure reduction with an angiotensin converting enzyme (ACE) inhibitor-based regimen on the stroke risk in patients with a history of transient ischaemic attacks or minor stroke. DESIGN: The study is a randomized, double-blind, placebo-controlled clinical trial. Before randomization, there is a 4-week run-in phase on open-label ACE inhibitor treatment. The scheduled duration of treatment and follow-up is 4-5 years. SETTING: The study will be conducted in collaborating clinical centres in Australia, Belgium, the People's Republic of China, France, Italy, Japan, New Zealand, Sweden and the United Kingdom. PATIENTS: The study will involve 6000 patients with a history of transient ischaemic attacks or stroke (ischaemic or haemorrhagic) in the past 5 years. To be eligible patients should have no definite indication for or contra-indication to treatment with an ACE inhibitor and no disability likely to prevent regular attendance at study clinics. INTERVENTIONS: Study treatment will comprise perindopril and indapamide or matching placebos for patients without an indication for or contra-indication to treatment with a diuretic, perindopril alone or matching placebo for all other patients. STUDY OUTCOMES: The primary study outcome is total strokes and secondary outcomes include fatal or disabling strokes, total major cardiovascular events, cardiovascular deaths, cognitive function and dementia, and disability and dependency.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Blood pressure lowering for the secondary prevention of stroke: rationale and design for PROGRESS.

BACKGROUND: Usual blood pressure levels have been shown to be directly and continuously associated with the risks of initial and recurrent stroke. Blood pressure lowering has been demonstrated to reduce the risk of a first stroke in hypertensive patients, but there is uncertainty about the effects of reducing blood pressure in patients with a history of cerebrovascular disease, for whom stroke risks are particularly high. The primary objective of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) is to determine the effects of blood pressure reduction on stroke risk in patients with a history of cerebrovascular disease. DESIGN AND TREATMENT: PROGRESS is a randomized, double-blind, placebo-controlled clinical trial of an angiotensin converting enzyme (ACE) inhibitor-based blood pressure lowering treatment regimen. Before randomization, there is a 4-week run-in phase on open-label treatment, after which patients are assigned to continued treatment or to placebo. Following randomization, the trial treatments comprise perindopril (4 mg daily) plus indapamide (2.5 mg daily) or matching placebos for patients without an indication for or contraindication to treatment with a diuretic, and perindopril alone or matching placebo for all other patients. The scheduled duration of treatment and follow-up is a minimum of 4 years. PATIENTS: The study will involve 6000 patients with a proven transient ischaemic attack (including amaurosis fugax) or stroke (cerebral infarct, cerebral haemorrhage or stroke of unknown type) in the past 5 years. The patients selected will have no known definite indication for or contraindication to treatment with an ACE inhibitor and no disability likely to prevent regular attendance at study clinics. Patients will be recruited from collaborating clinical centres in Australia, Belgium, China, France, Italy, Japan, New Zealand, Sweden and the United Kingdom. MAJOR OUTCOMES: Stroke is the primary study outcome, and secondary outcomes include fatal or disabling strokes, total major cardiovascular events, cardiovascular deaths and dementia.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

[Diuretics and diabetes mellitus].

The term "diuretics" describes a concerning pharmacological action and side effects heterogeneous class of drugs. The special advantage of using diuretics includes reducing edema and expanded plasma volume often associated with hypertension and cardiovascular disease. Diuretics are one of the 5 major classes of antihypertensive agents recommended for the initial drug therapy of hypertension. However, currently treatment of hypertension with diuretics is controversial, because of potentially adverse effects on the cardiovascular risk profile, including deterioration in glucose control especially in patients with impaired glucose tolerance. Additionally there is concern about excess mortality associated with diuretic therapy and diabetes mellitus. The metabolic side effects on glucose metabolism and lipid profile are related to the type of diuretic and its dosage. The adverse effects of thiazides on insulin action, glycemia and lipid profile are dose dependent and can be minimized by using low doses. In contrast, indapamide seems not to alter glucose metabolism and lipid profile. The choice of diuretic depends on concomitant disease. In patients with nephropathy potassium sparing agents should not be used, however furosemid can be used even in high doses. Beside focus on indication of diuretics in patients with diabetes and their metabolic side effects treatment of therapy resistant hypertension in these patients are discussed in this review.

Antihypertensive Agents↗
PubMedDate not supplied

Phototoxicity to sulphonamide derived oral antidiabetics and diuretics. Comparative in vitro and in vivo investigations.

The oral antidiabetics chlorpropamide, glibenclamide, glipizide, gliquiudone, glymidine, tolazamide and tolbutamide, and the diuretics bemetizide, bendroflumethiazide, benzylhydrochlorothiazide, bumetanide, butizide, chlortalidone, furosemide, hydrochlorothiazide, hydroflumethiazide, indapamide, piretanide, polythiazide, trichlormethiazide, and xipamide were investigated for potential phototoxicity in vitro using a cell culture model, and in vivo in hairless mice. After exposure to broad band UVA, the majority of the substances tested in vitro yielded a phototoxic action leading to loss of culture forming ability. In vivo, all tested substances induced edema or ulceration, and lead to a significantly increase in skin fold thickness of the mouse skin. In all, a number of substances not described to induce clinical photosensitivity nor phototoxicity in vitro or in vivo were detected in our testing. When determining potential photosensitizers, it seems important to utilize different test methods, as not all substances will exhibit action in a given assay.

Administration, Oral↗
PubMed1997

Evaluation of phototoxic properties of oral antidiabetics and diuretics. Photohemolysis model as a screening method for recognizing potential photosensitizing drugs.

The oral hypoglycemic drugs carbutamide, chlorpropamide, glibenclamide, glubornuride, gliclazide, glipizide, gliquidone, glisoxepide, glymidine, tolazamide and tolbutamide, and the diuretics acetazolamide, bemetizide, bendroflumethiazide, benzthiazide, benzylhydrochlorothiazide, bumetanide, butizide, chlorazanile, chlorothiazide, chlortalidone, clopamide, cyclopenthiazide, cyclothiazide, diazoxide, etozoline, furosemide, hydrochlorothiazide, hydroflumethiazide, indapamide, mefruside, metolazone, piretanide, polythiazide, trichlormethiazide, and xipamide were investigated for photohemolytic properties in vitro. Irradiation with a SOL 3 apparatus (solar simulating irradiation) revealed hemolysis in the presence of five oral hypoglycemic agents and in the presence of 19 out of the 25 tested diuretics. Photohemolysis was induced in the presence of three substances, respectively, after exposure to UVA or visible light. UVB alone did not induce phototoxic hemolysis in the presence of the tested drugs. Compared to clinical reports on photosensitivity reactions, the photohemolysis model seems a good predictive model in recognizing potential photosensitizing sulfonamides.

Dermatitis, Phototoxic↗
PubMed1998

Differential atrial versus ventricular activities of class III potassium channel blockers.

The atrial versus ventricular activities of Class III agents with differing K+ channel blocking profiles were assessed in vitro in ferret atrial and right ventricular papillary muscles. In concentration-effective refractory period (ERP) response studies at 2 Hz and 32 degreesC, the selective IKr blockers dofetilide, E-4031 and d-sotalol, as well as ibutilide, an IKr blocker also reported to enhance inward Na+ current, displayed markedly greater efficacies in increasing atrial ERP (+90-110%) versus ventricular ERP (+10-20%). RP58866, a blocker of IK1 and IKr, and tedisamil, primarily a blocker of Ito and IKr, increased atrial ERP with approximately 10-fold greater potencies than ventricular ERP, but with similar efficacies for both tissues (+60-80% with RP58866; +150-160% with tedisamil). Azimilide, a blocker of IKr and IKs, and indapamide, a blocker of IKs, displayed essentially "balanced" activities, increasing atrial and ventricular ERP with equivalent potencies and efficacies (+40-60% increases for both tissues). Frequency-dependence profiles at 32 degrees C varied between atrial and ventricular tissues, and there was no general correspondence between atrial versus ventricular selectivity and frequency-dependence profiles. In the papillary muscle preparation, increasing temperature from 32 degrees C to 37 degrees C altered both magnitude and frequency dependence of response to K+ channel blockers. These findings support the potential to selectively modulate atrial versus ventricular refractoriness with the targeting of appropriate K+ channel subtypes, and further demonstrate the differential frequency and temperature dependence of varying K+ channel subtype blockade. Ultimately, the identification and targeting of an appropriate K+ channel subtype or mix of subtypes may result in the achievement of optimal atrial-selective activity for the treatment of supraventricular arrhythmias.

Animals↗
PubMedDate not supplied

Stevens-Johnson syndrome from tetrazepam.

We present a case of a patient showing a cutaneous and systemic affectation compatible with the Stevens-Johnson syndrome due to the intake of tetrazepam as a muscular relaxant. The symptoms remitted after the suspension of the involved medicines and after treatment with systemic corticoids. Months later, a study with patch tests, with the standard battery and the medicines that she took (indapamide, tetrazepam, acetyl salicylic acid, botriozolam and levomepromazine) was carried out. She presented positivity to tetrazepam at 48 and 96 hours. The oral provocations with the other medicines, which she consumed, were negative. The study of cross reactivity with other benzodiazepines was negative. In the medical literature, different cutaneous affectations regarding benzodiazepine use (generalised drug eruptions, contact dermatitis, erythema multiforme, ...) have been described byt non Stevens-Johnson syndrome. The patch tests are useful in the diagnosis of this type of cutaneous reactions, avoiding in this way the achievement of oral provocations, with the potential risk for the patient that they imply. The absence of cross-reactions with other substances of the same group has to be pointed out, even with those with which keeps great structural similarity as the diazepam. In spite of the absence of cross reactions with the rest of benzodiazepines, faced with the seriousness of the case presented, it is advised to the patient to avoid this type of medicines.

Aged↗
PubMed1999

Block of potassium currents in guinea pig ventricular myocytes and lengthening of cardiac repolarization in man by the histamine H1 receptor antagonist diphenhydramine.

Treatment with second generation histamine H1 receptor antagonists has been associated with lengthening of the Q-T interval and proarrhythmia. Similarly, lengthening of the Q-T interval has been reported in patients after overdosing with diphenhydramine (DPH), a first generation agent. Therefore, our study was designed 1) to assess effects of DPH on cardiac repolarization and 2) to characterize effects of the drug on major voltage-dependent cardiac K+ currents. First, we noticed that oral administration of DPH at usual dosages to healthy volunteers or to patients (prior to angioplasty) was associated with prolongation of the Q-Tc interval. Although this effect was modest in most individuals, Q-Tc was increased more than 20 ms in 7 of 20 patients. Second, we noticed that exposure of isolated guinea pig hearts to DPH 10(-5) M caused a lengthening of monophasic action potential duration. This effect was potentiated by the combined perfusion of other K+ channel blockers such as indapamide. Finally, experiments performed with the patch-clamp technique demonstrated unequivocal block of the rapid component of the delayed rectifier (IKr) by DPH; however, IC50 determined for block of IKr (3 x 10(-5) M) is approximately 40-fold greater than plasma concentrations of the drug measured at usual dosages (7 x 10(-7) M). Consequently, in agreement with the long-term clinical use of the drug, prolongation of cardiac repolarization should be minimal in most patients at usual dosages but may be observed with overdosing. Nevertheless, caution remains since excessive lengthening of cardiac repolarization may occur after administration of DPH with other drugs due to 1) concomitant block of other ionic currents or 2) pharmacokinetic interactions leading to toxic concentrations of DPH.

Action Potentials↗
PubMed1981

Relationship between plasma catecholamines and urinary catecholamine excretion rates in normal subjects and certain diseased states.

Relationships between plasma norepinephrine (PNE) or epinephrine (PE) and urinary norepinephrine (UNE) or epinephrine (UE) excretion rates were studied in 37 normal subjects, 39 patients with benign essential hypertension, 23 with unilateral renal hypertension, and 20 with bilateral renal disease (serum creatinine 2.3 +/- 2.6 mg/100 ml). measurements were also performed after 6 weeks of diuretic treatment in 27 normal subjects and all patients with essential hypertension. In the untreated state, PNE and UNE values were generally normal in essential or unilateral renal hypertension; PNE tended to be decreased in diabetics and increased in bilateral renal disease. Diuretic treatment caused a tendency for slightly increased PNE and UNE. UNE correlated significantly with supine PNE or upright PNE or their mean value, and this relationship appeared to be comparable between untreated normal subjects and the various patients groups, except for a tendency for slightly higher PNE at given UNE values in bilateral renal disease. No significant correlations between UE and PE were apparent in the normal subjects or patient groups. These data demonstrate a dissociation of UE from PE levels. In contrast, UNE is an approximative index of PNE, and this relationship appeared to be generally unaltered in essential or unilateral renal hypertension. In patients with bilateral renal disease the slight shift of this relationship indicates that consideration of renal function is necessary for interpretation of NE levels.

Adult↗