Antihypertensive Efficacy and Safe Use of Once-Daily Sustained-Release Diltiazem in the Elderly: A Comparison with Captopril

The efficacy and safety of sustained-release diltiazem, 200 – 300 mg once daily was compared with that of captopril, 12.5 – 25 mg twice-daily, in 100 elderly patients (65 – 85 years old) with mild to moderate essential hypertension (supine diastolic blood pressure 95 – 115 mmHg). All patients received placebo for 2 weeks, followed by an 8-week double-blind period, and were randomized to either diltiazem ( n = 50) or captopril ( n = 50). Their blood pressure was measured at trough level at week 4 immediately before dosing, i.e. 24 h post diltiazem dose or 12 h post captopril dose. Also at week 4, in non-responders, diltiazem was increased from 200 to 300 mg once daily and captopril from 12.5 to 25 mg twice daily to achieve a target supine diastolic blood pressure reduction of at least 10 mmHg or a diastolic blood pressure below 90 mmHg. Supine diastolic blood pressure, at week 8, was significantly ( P < 0.001) reduced from 102 ± 1 to 90 ± 1 mmHg with diltiazem and from 103 ± 1 to 89 ± 1 mmHg with captopril, bringing this parameter within normal limits for both groups. Supine systolic blood pressure was also significantly ( P < 0.001) reduced. Target blood pressure was achieved in 68% of patients taking diltiazem and in 70% taking captopril. Distribution of adverse events was comparable in both groups; no significant changes in laboratory or electrocardiographic parameters occurred. Two serious events were reported with captopril: one sudden death and one cerebrovascular stroke. Sustained-release diltiazem once a day is a convenient, well tolerated, first line treatment for hypertension in the elderly, for whom the possibility of using two dose levels allows a close regimen adjustment, 200 mg being recommended as a starting dose.

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Prazosin and Hydrallazine in the Treatment of Hypertension

Clinical Science ◽

10.1042/cs051617s ◽

1976 ◽

Vol 51 (s3) ◽

pp. 617s-619s ◽

Cited By ~ 2

Author(s):

Priscilla Kincaid-Smith ◽

A. S. P. Hua ◽

J. B. Myers ◽

Ileene Macdonald ◽

P. Fang

Keyword(s):

Blood Pressure ◽

Side Effects ◽

Diastolic Blood Pressure ◽

Blocking Agent ◽

Base Line ◽

Double Blind ◽

Supine Diastolic Blood Pressure ◽

Treatment Of Hypertension ◽

Blood Pressures

1. Two vasodilators, prazosin and hydrallazine, have been compared in three double-blind cross-over studies designed to test their effect when used in combination with a β-adrenoceptor-blocking agent and a thiazide. 2. Single doses of 3 mg of prazosin or 75 mg of hydrallazine were administered to patients whose blood pressures remained uncontrolled on a thiazide and a β-adrenoceptor-blocking agent. Both agents produced significant falls in systolic and diastolic blood pressure apparent at 1 h. The effects of prazosin persisted for 6–7 h and those of hydrallazine for 4–6 h. Tachycardia was more marked and more prolonged after hydrallazine and continued after the blood pressure had risen to base-line levels or above. 3. In 6 week and 12 week double-blind cross-over studies, mean falls in blood pressure were similar with prazosin and hydrallazine. Similar falls in the supine diastolic blood pressure were achieved with 1 mg of prazosin and 20 mg of hydrallazine, but for a given fall in supine diastolic blood pressure, prazosin produced a significantly lower standing diastolic blood pressure. 4. Severe side effects were more pronounced after hydrallazine, which necessitated withdrawal of seven patients, whereas only one patient on prazosin withdrew from the trial because of side effects.

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Comparative Evaluation of the Antihypertensive Efficacy of Once-Daily Sustained-Release Isradipine and Lacidipine Using 24-hour Ambulatory Blood-Pressure Monitoring

Journal of International Medical Research ◽

10.1177/030006059502300403 ◽

1995 ◽

Vol 23 (4) ◽

pp. 234-243 ◽

Cited By ~ 4

Author(s):

M Galderisi ◽

A Petrocelli ◽

M Garofalo ◽

A Celentano ◽

A Alfieri ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Sustained Release ◽

Diastolic Blood Pressure ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Random Order ◽

Once Daily ◽

Blood Pressures ◽

Blood Pressure Range

In this single-blind crossover study the antihypertensive efficacies of two dihydropyridine calcium antagonists, sustained-release isradipine and lacidipine, were compared using clinic and ambulatory blood-pressure measurements. After a 2-week placebo wash-out, 34 patients (19 men, 15 women, mean age 49 years) with mild to moderate hypertension (diastolic blood pressure range 95 – 110 mmHg) were treated with 5 mg sustained-release isradipine for 4 weeks and 4 mg lacidipine for 4 weeks in a random order. Medications were taken once daily at 08.00 h. Clinic and ambulatory blood pressures were recorded at the end of each placebo or treatment period. Two patients stopped isradipine and six lacidipine because of severe adverse effects. Clinic systolic and diastolic blood pressures decreased by an average of 17/14 mmHg with isradipine and 17/13 mmHg with lacidipine, compared with placebo ( P < 0.01 in both cases), without a change in heart rate. Mean ambulatory 24-h and daytime systolic and diastolic blood pressure were significantly reduced by sustained-release isradipine and lacidipine ( P < 0.05 and P < 0.01, respectively). At night systolic blood pressure fell compared with placebo ( P < 0.05 with both drugs) whereas the reduction in diastolic blood pressure was not statistically significant. Mean 24-h heart rate remained unchanged. Blood-pressure variability did not differ significantly between the two drugs or between either drug and the placebo. The antihypertensive effects of sustained-release isradipine and lacidipine were similar, but the tolerability of isradipine appears to be greater since it caused fewer withdrawals.

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Pengaruh Senam Lansia Aerobic Low Impact Training Terhadap Penurunan Tekanan Darah Pada Lansia Penderita Hipertensi

Jurnal Keperawatan Muhammadiyah ◽

10.30651/jkm.v4i2.3167 ◽

2019 ◽

Vol 4 (2) ◽

Author(s):

Yhenti Widjayanti ◽

Veronika Silalahi ◽

Priska Merrianda

Keyword(s):

Blood Pressure ◽

Aerobic Exercise ◽

Diastolic Blood Pressure ◽

Diastolic Pressure ◽

Statistical Tests ◽

Blood Pressure Reduction ◽

Simple Random Sampling ◽

The Elderly ◽

Pharmacological Management ◽

Post Test

Hypertension is a disease with a systolic > 140 mmHg and a diastolic > 90 mmHg. This disease often occurs in the elderly due to aging as cell, physiological, and psychological changes occur. Phenomenon found in Griya Usila Santo Yosef many elderly were hypertensive suferer. One non-pharmacological management for hypertension is low impact training aerobic exercise. This study aims to analyse effect of low impact training aerobic exercise on decreasing blood pressure in elderly with hypertension. Desiign of this study was a pre-experimental design with a one group pre-post test design. The independent variable in this study was low impact aerobic exercise, and the dependent variable was blood pressure. Respondents of this study were 32 elderly people with hypertension who fulfilled the inclusion criteria whom were collected by simple random sampling. Results of this study showed that mean of systolic and diastolic blood pressure before intervention was 149.84 ± 6.66 and 83.25 ± 11.41, mean systolic and diastolic blood pressure after intervention was 145.09 ± 5.71 and 79.44 ± 11, 55, and the results of paired T-Test statistical tests with SPSS 20 software were obtained p (0,000) <α (α = 0.05) for the systolic and diastolic pressure. It meant that there was an influence of low impact aerobic exercise on blood pressure reduction. Based on the results of the research, elderly gymnastics aerobic low impact is important in which the training given to elderly patients hypertension to help in controling blood pressure. Keywords: Hypertension, Elderly, Aerobic Low Impact Exercise

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SGLT2 inhibitors and lower limb complications: an updated meta‐analysis

Cardiovascular Diabetology ◽

10.1186/s12933-021-01276-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Chu Lin ◽

Xingyun Zhu ◽

Xiaoling Cai ◽

Wenjia Yang ◽

Fang Lv ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Lower Limb ◽

Blood Pressure Reduction ◽

Random Effect Model ◽

Diabetic Patients ◽

Controlled Trials ◽

Pressure Reduction ◽

Effect Model ◽

Meta Regression

Abstract Background To exam the associations between the use of sodium glucose co-transporter 2 inhibitor (SGLT2i) and the risk of lower limb complications, and to analyze the associated factors. Methods Pubmed, Medline, Embase, the Cochrane Center Register of Controlled Trials for Studies and Clinicaltrial.gov were searched from the inception to November 2020. Randomized controlled trials of SGLT2i conducted in population containing diabetic patients with reports of amputation, peripheral arterial disease (PAD) and diabetic foot (DF) events were included. Random-effect model, fixed-effect model and meta-regression analysis were accordingly used. Result The numbers of SGLT2i users versus non-SGLT2i users in the analyses of amputation, PAD and DF were 40,925/33,414, 36,446/28,685 and 31,907/25,570 respectively. Compared with non-SGLT2i users, the risks of amputation and PAD were slightly increased in patients with canagliflozin treatment (amputation: OR = 1.60, 95% CI 1.04 to 2.46; PAD: OR = 1.53, 95 % CI 1.14 to 2.05). Meta-regression analyses indicated that greater weight reduction in SGLT2i users was significantly associated with the increased risks of amputation (β = − 0.461, 95% CI − 0.726 to − 0.197), PAD (β = − 0.359, 95% CI − 0.545 to − 0.172) and DF (β = − 0.476, 95% CI − 0.836 to − 0.116). Lower baseline diastolic blood pressure (β = − 0.528, 95% CI − 0.852 to − 0.205), more systolic blood pressure reduction (β = − 0.207, 95% CI − 0.390 to − 0.023) and more diastolic blood pressure reduction (β = − 0.312, 95% CI − 0.610 to − 0.015) were significantly associated with the increased risks of amputation, PAD and DF respectively in patients with SGLT2i treatment. Conclusions The risks of amputation and PAD were slightly increased in patients with canagliflozin treatment. Reductions in body weight and blood pressure were associated with lower limb complications in patients with SGLT2i treatment.

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Once-Daily Treatment for Mixed Anxiety/Depressive States: A Comparison of Slow Release Amitriptyline and Fluphenazine with Nortriptyline

Journal of International Medical Research ◽

10.1177/030006057700500206 ◽

1977 ◽

Vol 5 (2) ◽

pp. 109-113 ◽

Cited By ~ 3

Author(s):

R V Magnus ◽

A A Schiff

Keyword(s):

Side Effects ◽

Sustained Release ◽

Slow Release ◽

Anxiolytic Effect ◽

Daily Treatment ◽

Dry Mouth ◽

Double Blind ◽

Once Daily ◽

Therapeutic Advantage ◽

Depressive States

Patients suffering from mixed anxiety/depressive states referred to a psychiatric out-patient clinic completed a four week course of either a once-daily tablet of 30 mg nortriptyline with 1· 5 mg fluphenazine, or a sustained release capsule of 50 mg amitriptyline once daily, on a double-blind basis. Depression improved satisfactorily on either treatment, but there was a greater reduction of anxiety on fluphenazine/nortriptyline. Drowsiness, however, occurred more frequently among the patients on amitriptyline, suggesting the sedative properties of this drug did not substitute adequately for a specific anxiolytic effect. Dry mouth was also noticeably more frequent with amitriptyline. As might be expected on pharmacokinetic and physiological grounds, the results suggest that the sustained release characteristics of the amitriptyline preparation lead to a maximization of side-effects during the day without conferring any therapeutic advantage.

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Comparison of 24-Hour Ambulatory Central Blood Pressure Reduction Efficacy Between Fixed Amlodipine or Up-Titrated Hydrochlorothiazide Plus Losartan: The K-Central Study

American Journal of Hypertension ◽

10.1093/ajh/hpz050 ◽

2019 ◽

Vol 32 (10) ◽

pp. 992-1002

Author(s):

Eun Joo Cho ◽

Hae Young Lee ◽

Ki Chul Sung ◽

Sungha Park ◽

Il-Suk Sohn ◽

...

Keyword(s):

Blood Pressure ◽

Wave Reflection ◽

Pulse Wave ◽

Blood Pressure Reduction ◽

Multicenter Trial ◽

Aortic Pulse Wave Velocity ◽

Fixed Dose ◽

Central Hemodynamics ◽

Velocity Pulse ◽

Double Blind

Abstract OBJECTIVE The main objective of this study was to evaluate non-inferiority of office mean systolic blood pressure (BP) reduction efficacy and superiority of 24-hour ambulatory central BP reduction efficacy between losartan combined with fixed dose amlodipine (L/A group) and dose up-titrated hydrochlorothiazide (L/H group) according to office BP. METHODS We conducted a prospective, randomized, double-blind multicenter trial in 231 patients with hypertensive (mean age = 59.2 ± 12.2 years). Patients received losartan 50 mg monotherapy for 4 weeks, followed by additional use of amlodipine 5 mg or hydrochlorothiazide 12.5 mg for 20 weeks after randomization. The patients who did not achieve the BP goal after 4 weeks’ randomization received an increased dose of 100 mg/5 mg for the L/A group and 100 mg/25 mg for L/H group, respectively. The 24-hour ambulatory central BP was measured at baseline and after 20 weeks’ treatment. RESULTS Office mean systolic BP reduction of L/A group was not inferior to L/H group after 4 weeks’ treatment (–17.6 ± 13.3 vs. –14.4 ± 12.6 mm Hg, P = 0.0863) and was not significantly different after 20 weeks’ treatment. (–15.7 ± 14.0 vs. –14.7 ± 15.1 mm Hg, P = 0.6130) The 24-hour ambulatory central systolic BP was significantly more reduced in the L/A group compared with that in the L/H group after 20 weeks’ treatment (–9.37 ± 10.67 vs. –6.28 ± 10.50 mm Hg, P = 0.0407). The 24-hour ambulatory central systolic BP at the completion of the study and its reduction magnitude were independently associated with reductions in aortic pulse wave velocity, pulse pressure, and wave reflection magnitude. CONCLUSION Office systolic BP reduction with L/A was not inferior to L/H after 4 week’s treatment. The combination of losartan and amlodipine was more favorable in 24-hour ambulatory central hemodynamics beyond BP-lowering efficacy than the combination of losartan and hydrochlorothiazide, regardless of office BP. CLINICAL TRIALS REGISTRATION NCT02294539

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