Chlorthalidone Alone or in Fixed Combination with Slow-Release Metoprolol in the Management of Arterial Hypertension: A Long-Term Study of 545 Patients

1989 ◽  
Vol 17 (4) ◽  
pp. 339-349 ◽  
Author(s):  
E. Bichisao ◽  
L. Merlini ◽  
O. Gambini ◽  
D. Alberti ◽  
G. Pollavini
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Diastolic Blood Pressure ◽  
Slow Release ◽  
Fixed Combination ◽  
Combined Therapy ◽  
Double Blind ◽  
Long Term Study ◽  
Long Term Treatment

In a double-blind trial, 545 out-patients with essential hypertension received 25 mg/day chlorthalidone alone (274 patients) or in fixed combination with 200 mg/day slow-release metoprolol (271 patients) for 8 weeks. Both treatments significantly (P<0.001) decreased systolic and diastolic blood pressure; 45.6% of patients receiving chlorthalidone and 82.5% receiving combined therapy had a diastolic blood pressure of less than 95 mmHg. Patients not controlled by chlorthalidone or chlorthalidone plus metoprolol subsequently received chlorthalidone plus metoprolol (137 patients) or chlorthalidone plus metoprolol plus a third drug (34 patients), respectively, for 8 weeks. A total of 79.5% of patients receiving chlorthalidone plus metoprolol and 61.8% receiving chlorthalidone plus metoprolol plus a third drug had a diastolic blood pressure of less than 95 mmHg. Only 5.9% of patients experienced mild to modérate side-effects. Plasma potassium leveis significantly ( P<0.01) decreased during the first 8 weeks only. It is concluded that a diuretic alone or in fixed combination with a β-blocker is effective in the long-term treatment of arterial hypertension.

A Fixed Combination of Metoprolol Slow-Release and Chlorthalidone, Given Once Daily, in the Long-Term Treatment of Arterial Hypertension

1982 ◽  
Vol 10 (2) ◽  
pp. 82-86 ◽  
Author(s):  
Bruno Floris ◽  
Gianni Franchetta ◽  
Nicola Palestini ◽  
Giulio Sonaglioni ◽  
Paolo Verdecchia ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Slow Release ◽  
Fixed Combination ◽  
Term Treatment ◽  
Once Daily ◽  
Clear Cut ◽  
Long Term Treatment ◽  
Term Basis ◽  
Pre Treatment

A fixed combination of metoprolol slow-release 200 mg and chlorthalidone 25 mg was given once daily over a 3 months period in forty out-patients with mild-to-moderate arterial hypertension stage I or II WHO. The combination elicited a clear-cut antihypertensive effect lasting at least 24 hours after drug. As compared with pre-treatment values, systolic and diastolic blood pressures were gradually reduced within the first month of treatment, remaining nearly constant in the following 2 months. Treatment was well tolerated by all patients. Neither serum potassium nor any other laboratory test (creatinine, glucose, uric acid, etc.) showed significant changes. In conclusion, slow-release metoprolol in fixed association with chlorthalidone provides a safe and effective treatment of arterial hypertension even on a long-term basis. The once daily dosing schedule may considerably improve patient's compliance.

Antiplatelet therapy: new insights on the secondary prevention of stroke

2019 ◽  
pp. 39-51
Author(s):  
Julián García- Rafanell ◽  
Javier Borja
Keyword(s):  
Secondary Prevention ◽  
Safety Profile ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
Double Blind ◽  
Long Term Study ◽  
Long Term Treatment

Antiplatelet agents represent an important part of the therapeutic armamentarium in the prevention of stroke. Among them, aspirin is the gold standard but its chronic use has been associated with gastric intolerance, gastrointestinal and systemic hemorrhages and drug-resistance. Triflusal is a new antiplatelet agent from the family of salicylates but is not derived from aspirin and has a more selective mechanism of action : inhibition of thromboxane A2 in the platelet  with no effect on prostacyclin biosynthesis in the endothelium.  In the quest for the search of new antiplatelet agents, triflusal has shown a similar relative risk reduction than aspirin for the prevention of  stroke but with reduced severe hemorrhagic side effects. The efficacy and better safety profile of triflusal vs aspirin in the secondary prevention of stroke has been demonstrated in major,  randomized and double blind clinical trials and confirmed after a long term study with a mean follow up of 17 years, as well as in  a Cochrane meta-analysis. Aspirin, but not triflusal, increased antihypertensive therapy requirements during long term treatment  in the secondary prevention of stroke. In patients with atrial fibrillation, the combination of oral anticoagulants with triflusal has shown increased efficacy  versus the standard oral single anticoagulation treatment with no increase of haemorrhagic risk.  Studies have shown that the risk of upper gastrointestinal bleeding associated with the use of triflusal was negligible whereas the hemorrhagic risk associated  with the use of aspirin, including low doses aspirin, was evident. Triflusal was well tolerated in asthmatic patients with aspirin-exacerbated –respiratory-diseases. The efficacy of triflusal in secondary prevention of stroke and its better safety profile when compared to aspirin has been recognized in important International Guidelines including the European Stroke Organization Guidelines.

Slow-Release Terbutaline and Theophylline for the Long-Term Therapy of Children With Asthma: A Latin Square and Factorial Study of Drug Effects and Interactions

PEDIATRICS ◽  
1989 ◽  
Vol 84 (1) ◽  
pp. 119-125
Author(s):  
Olivia Kit Wun Chow ◽  
Kam Pui Fung
Keyword(s):  
Side Effects ◽  
Slow Release ◽  
Clinical Symptoms ◽  
Combined Therapy ◽  
Latin Square ◽  
Term Therapy ◽  
Long Term Effects ◽  
Long Term Treatment ◽  
Children With Asthma

To evaluate the long-term effects of slow-release formulations of theophylline and terbutaline on pulmonary function, clinical symptoms, and side effects, 24 children with stable and moderately severe perennial asthma participated in a prospective double-blind crossover study. The patients and the treatments were randomized according to the Latin square design to eliminate all possible period/climate biases throughout the protracted study period. The treatments consisted of terbutaline, 5 mg, theophylline, 200 mg, the combination, and placebo, given twice daily orally and crossing over every 28 days. The two drugs, administered alone or in combination, improved lung function and symptoms when compared with placebo. The interaction of theophylline and terbutaline was quantitatively shown by 2 x 2 factorial statistical design to be essentially additive rather than synergistic in the control of asthma. No increase in side effects was noted when the combined therapy was used. These findings suggest therapeutic advantages to combining submaximal oral doses of sustained-release theophylline and terbutaline for the long-term treatment of children with asthma.

Agomelatine versus escitalopram in major depressive disorders : a randomized double-blind, long term study focusing on sleep satisfaction and emotional blunting

2011 ◽  
Vol 26 (S2) ◽  
pp. 619-619 ◽  
Author(s):  
E. Corruble ◽  
C. Bélaidi ◽  
G.M. Goodwin
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Statistical Significance ◽  
Controlled Study ◽  
Major Depressive ◽  
Double Blind ◽  
Long Term Study ◽  
Long Term Treatment

The novel antidepressant agomelatine is a MT1/MT2 receptor agonist and a 5HT2c receptor antagonist, whose efficacy is demonstrated in Major Depressive Disorder (MDD) (1). In an international 24-week double-blind randomized controlled study, the effects of agomelatine 25–50 mg/d (n = 164) were compared to those of escitalopram 10-20 mg/d (n = 160) on satisfaction about sleep (Visual Analogic Scale), depressive symptoms (Hamilton Depression Rating Scale (HAM-D)) and emotions in a subset of 45 patients having completed the Oxford Depression Questionnaire (2).Both drugs improved depressive symptoms (mean decrease in HAM-D score from baseline: -19.9 with agomelatine and -19.2 with escitalopram; percentage of remitters: 69.6% with agomelatine and 63.1% with escitalopram, LOCF endpoint) and the satisfaction about sleep. Interestingly, the wellness feeling on waking was more improved with agomelatine as compared to escitalopram (p = 0.025), indicating a better alertness on waking with agomelatine than escitalopram.Moreover, emotional blunting was less frequent with agomelatine as compared to escitalopram: 28% on agomelatine vs 60% on escitalopram felt that their emotions lacked intensity with a trend to statistical significance (p = 0.063) and 16% of patients on agomelatine vs 53% on escitalopram felt that things that they cared about before illness did not seem important any more (p = 0.024). Finally, less patients withdrew due to emergent adverse events with agomelatine (4.3%) as compared to escitalopram (10.6%), (p = 0.029). To conclude, this study shows some potential clinical advantages of agomelatine as compared to escitalopram in the long term treatment of MDD.

Long-Term Oral Calcium Supplementation Reduces Diastolic Blood Pressure in End Stage Renal Disease. A Randomized, Double-Blind, Placebo Controlled Study

1994 ◽  
Vol 17 (1) ◽  
pp. 37-40 ◽  
Author(s):  
L.J. Petersen ◽  
M. Rudnicki ◽  
J. Højsted
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Calcium Supplementation ◽  
Controlled Study ◽  
Double Blind ◽  
Oral Calcium ◽  
Calcium Supply ◽  
Stage Renal Disease ◽  
End Stage

Previous studies suggest that oral calcium supply reduces blood pressure in patients with mild to moderate hypertension. The aim of this study was to determine whether oral calcium supply reduces blood pressure in patients undergoing haemodialysis. The study was randomized, double-blind, and placebo controlled. Eleven patients received two grams of calcium per day and 12 patients received placebo. Three patients (one from the calcium group and two from the placebo group) dropped out within the first month. The groups were comparable at inclusion regarding blood pressure, weight, and serum values. Blood pressure measurements were auscultatory with a mercury manometer and diastolic blood pressure was measured as Korotkoff phase V. At inclusion a significant positive correlation between serum phosphate and blood pressure was found. After a study period of six months a significant reduction in diastolic blood pressure was found between the two groups (p < 0.05), but no difference was found in systolic blood pressure. The reduction in diastolic blood pressure was 6.9 mmHg of the pretreatment level in the calcium group. In conclusion, the treatment of secondary hyperparathyroidism with oral calcium gives good benefits in the regulation of diastolic blood pressure. A well controlled phosphate homeostasis may also be of importance for the control of blood pressure in haemodialysis patients.

Long-Term Treatment with Slow-Release Frusemide Compared with Thiazide Treatment in Arterial Hypertension

1989 ◽  
Vol 17 (6) ◽  
pp. 552-559 ◽  
Author(s):  
H. Jørgensen ◽  
N. Anderssen ◽  
T. Silsand ◽  
L.-E. Peterson
Keyword(s):  
Arterial Hypertension ◽  
Antihypertensive Effect ◽  
Slow Release ◽  
Serum Glucose ◽  
Term Treatment ◽  
Moderate Essential Hypertension ◽  
Fasting Serum ◽  
Long Term Treatment ◽  
Previously Treated

The effect of 30 mg/day slow-release frusemide given orally for 12 months was studied in 64 patients previously treated with thiazides for mild to moderate essential hypertension. Frusemide had a significant antihypertensive effect ( P<0.001), and compared to thiazides significantly reduced fasting serum glucose ( P<0.015), haemoglobin A1c ( P<0.025), albumin ( P<0.025) and serum calcium ( P<0.025), and significantly increased serum sodium and chloride concentrations ( P<0.0001). There was also a non-significant trend for frusemide to reduce serum total cholesterol, triglycerides and urate, and to increase serum potassium. Frusemide was well tolerated in all but three patients. It is concluded that slow-release frusemide has a comparable antihypertensive effect to that of thiazide diuretics, but has fewer metabolic side-effects, and should be used in preference to thiazides for the treatment of arterial hypertension when a diuretic is indicated.

Effect of Long-Term, Once-Daily Administration of Atenolol, Metoprolol, Pindolol and Slow-Release Propranolol on Ambulatory Blood Pressure and its Variability

1982 ◽  
Vol 63 (s8) ◽  
pp. 459s-460s ◽  
Author(s):  
J. S. Floras ◽  
J. V. Jones ◽  
M. O. Hassan ◽  
P. Sleight
Keyword(s):  
Blood Pressure ◽  
Slow Release ◽  
Antihypertensive Agents ◽  
Double Blind ◽  
Once Daily ◽  
Arterial Blood ◽  
Before And After ◽  
Receptor Blockers ◽  
Β Receptor

1. Twenty-four-hour intra-arterial blood pressure recordings were made before and after chronic β-receptor blockade in 34 patients with essential hypertension. 2. Subjects were randomized in double blind fashion to either atenolol, metoprolol, pindolol or slow-release propranolol. 3. Drugs were administered in a once-daily variable dose regimen for a period of 3–8 months (mean 5.0 ± sd 1.4). 4. All four drugs reduced blood pressure significantly 24 h after the last dose but there were considerable differences in control when each intervening hour was assessed separately. 5. Not all β-receptor blockers in conventional formulations are equally effective as antihypertensive agents over 24 h when taken once daily.

Long-Term Treatment of Essential Hypertension with Nadolol and Hydrochlorothiazide: A Two-Year Follow-Up

1982 ◽  
Vol 10 (2) ◽  
pp. 87-91 ◽  
Author(s):  
M M El-Mehairy ◽  
A Shaker ◽  
M Ramadan ◽  
S Hamza ◽  
S S Tadros
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Combined Therapy ◽  
Term Treatment ◽  
Once Daily ◽  
Supine Blood Pressure ◽  
End Of Treatment ◽  
Long Term Treatment ◽  
Adrenergic Blocker

After 3 weeks of placebo administration, thirty-two mildly or moderately hypertensive patients were treated with hydrochlorothiazide (HCZ) for 3 weeks, then with HCZ plus nadolol, a new beta-adrenergic blocker, for 2 years. The dose of HCZ was 50 mg once daily for all except two patients, who received 50 mg twice a day. The dose of nadolol ranged from 40 mg to 240 mg, once daily. The average supine blood pressure decreased from 182/110 mm Hg at the end of the placebo period to 170/104 mm Hg at the end of treatment with HCZ alone. Nadolol was added to the regimen, and the average supine blood pressure decreased further to 132/88 mm Hg at the end of 3 months of combined therapy. It remained essentially unchanged for the duration of the 2-year study, and no increases in the dosage of either drug were needed. Side-effects were mild, and none required a change in dosage. A once-daily dose of nadolol combined with HCZ appears to be safe and effective therapy for the long-term treatment of mild or moderate essential hypertension.

Desmopressin Tablets in the Treatment of Severe Nocturnal Enuresis in Adolescents

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 841-846
Author(s):  
Arne Stenberg ◽  
Göran Läckgren
Keyword(s):  
Nocturnal Enuresis ◽  
Term Treatment ◽  
Dose Titration ◽  
Optimal Dosage ◽  
Double Blind ◽  
Long Term Study ◽  
Titration Period ◽  
Long Term Treatment ◽  
Clinically Significant

Background. In recent years the treatment of primary nocturnal enuresis (PNE) with desmopressin (DDAVP) has been promising. The route of administration until now had been intranasal, but because the tablets were introduced for the treatment of diabetes insipidus they have also become available for the treatment of PNE. Objectives. To find the optimal dosage of desmopressin tablets and to compare desmopressin's efficacy with placebo in a group of adolescents with severe monosymptomatic enuresis. The long-term safety of desmopressin was also studied in the same group of patients. Methods. The effect of oral desmopressin (1-deamino-8-D-arginine-vasopressin) (DDAVP® tablets, Minirin®) was investigated in 25 adolescents (ages 11 to 21 years) with severe monosymptomatic nocturnal enuresis. The first part of the dose-ranging study comprised a single-blind dose titration period, followed by a double-blind, crossover efficacy period comparing desmopressin with placebo. The final part was an open long-term study consisting of two 12-week treatment periods. The efficacy of the drug was measured in reductions of the number of wet nights per week. Results. During the first dose-titration period, the majority of the patients were given desmopressin 400 µg, and the number of wet nights decreased from a mean of 4.9 to 2.8. During the double-blind period, a significant reduction of wet nights was observed (1.8 vs 4.1 for placebo). During the two long-term periods, 48% and 53% of the patients could be classified as responders (0 to 1 wet night per week) and 22% and 23.5% as intermediate responders (2 to 3 wet nights per week). No weight gain was observed due to water retention. After cessation of the drug, 44% of the patients had a significant decrease in the number of wet nights. Conclusions. Oral desmopressin has a clinically significant effect on patients with PNE, and therapy is safe when administered as long-term treatment.

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