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[Treatment of essential hypertension (hypertensive disease) with verapamil and hydrochlorothiazide]

[Article in Bulgarian]

Dimitrov D.

Thirty two patients with essential hypertension, stage I and II according to WHO classification, were treated according to the following schedule: period A--3 X 1 dragee placebo--3 weeks; period B--3 X 1 dragee placebo + 25 mg hydrochlorothiazide in the morning--6 weeks; period C--3 X 1 dragee isoptin 80 mg + 25 mg hydrochlorothiazide in the morning--6 weeks; period D--3 X 1 dragee placebo--2 weeks. Significant decrease of systolic and diastolic arterial pressure was established during period B as compared with period. A. The addition of isoptin to the treatment during period C led to additional reduction of arterial pressure, with no manifestations of severe adverse effects, as observed in 15,6 per cent of the treated patients. The treatment of essential hypertension with isoptin and esidrex is effective and well tolerated with no reciprocal potentiation of the adverse effects of the two preparations, broadening the possibility of successful treatment of essential hypertension.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4024625&dopt=Abstract hydrochlorothiazide Microzide



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Effects of endothelial nitric oxide synthase, alpha-adducin, and other candidate gene polymorphisms on blood pressure response to hydrochlorothiazide.

Turner ST, Chapman AB, Schwartz GL, Boerwinkle E.

Division of Hypertension, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. turner.stephen mayo.edu

BACKGROUND: Pharmacogenetic discoveries may enable greater individualization of antihypertensive drug therapy. We investigated polymorphisms in the genes encoding endothelial nitric oxide synthase (Glu298-->Asp), alpha-adducin (Gly460-->Trp), the beta(1)-adrenoceptor (Arg389-->Gly), beta2-adrenoceptor (Arg16-->Gly), and lipoprotein lipase (Ser447-->Stop) for their potential influences on blood pressure (BP) response to a thiazide diuretic. METHODS: The sample consisted of 291 unrelated non-Hispanic African American adults (150 women and 141 men) and 294 unrelated non-Hispanic white adults (126 women and 168 men) who were between 30 and 59.9 years of age and who had essential hypertension. Previous antihypertensive drug therapy was withdrawn for at least 4 weeks, and subjects were then treated with hydrochlorothiazide (25 mg daily) for 4 weeks to determine BP response. RESULTS: The covariates of ethnicity, gender, age, and waist-to-hip ratio accounted for 26% of interindividual variation in systolic BP response and 11% of interindividual variation in diastolic BP response. After adjustment for covariates, the endothelial nitric oxide synthase Glu298-->Asp polymorphism made an additional statistically significant contribution to predicting diastolic BP response to hydrochlorothiazide, accounting for another 1% of interindividual variation in response (P =.034). In contrast, the other polymorphisms, including the alpha-adducin Gly460-->Trp polymorphism, made no statistically significant contributions to prediction of BP response. CONCLUSIONS: Although we reject the null hypothesis of no genetic effects on BP response to hydrochlorothiazide, the influence of variation at single sites is likely to be small. More extensive characterization of genetic variation is required for pharmacogenetic approaches to become clinically useful in tailoring antihypertensive drug therapy for individual patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14553962&dopt=Abstract hydrochlorothiazide Microzide



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Post-exertion changes in left ventricular systolic time intervals in patients with primary hypertension treated with hydrochlorothiazide, binazine, and propranolol.

Markiewicz K, Gorski L, Cholewa M.

The study involved 13 patients with primary hypertension who exercised on a bicycle ergometer with intensity increasing up to submaximum level. The exercise was carried out in four stages: before treatment (1st study), following one week treatment with 50 mg hydrochlorothiazide daily (2nd study), after one week treatment with the same dose of hydrochlorothiazide and 120 mg binazine daily (3rd study), and after one week treatment with hydrochlorothiazide and binazine, and 60 mg of propranolol daily (4th study). Using the approach of Weissler et al., left ventricular systolic time intervals were analysed at rest, after exercise and up to the 90th minute of restitution. Hydrochlorothiazide and binazine treatment decreased systolic and diastolic blood pressure, the total electromechanical systolic time index (QS2I) and the left ventricular ejection time index (LVETI), and increased the PEP/LVET index at rest and after exercise. Addition of propranolol did not augment the hypotensive effect, while the left ventricular systolic time intervals returned to the values observed before treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4094841&dopt=Abstract hydrochlorothiazide Microzide



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Efficacy and safety of nitrendipine in patients with severe hypertension: a multiclinic study.

Jain AK, McMahon FG, Ryan JR, Maronde R, Vlachakis N, Mroczek W.

The efficacy and safety of nitrendipine in oral doses of 5-40 mg twice daily, alone or in combination with hydrochlorothiazide (50-150 mg/day) and/or propranolol (40-120 mg/day), were evaluated in an open study of 50 patients with severe hypertension with supine diastolic blood pressure (BP) greater than 115 mm Hg. Forty-six patients with an initial mean supine BP of 190/120 +/- 21/8 reached 151/95 +/- 15/6 mm Hg at visit 9, and 40 patients with a baseline BP of 188/120 +/- 21/9 achieved mean BP of 142/87 +/- 15/7 mm Hg at the end of therapy (visit 16). Thirty (75%) of these patients were normotensive: 9 (22%) on nitrendipine alone, 3 (7.5%) on nitrendipine and hydrochlorothiazide, 7 (17.5%) on nitrendipine and propranolol, and 11 (27.5%) on triple therapy. In nine responders to nitrendipine alone, mean BP was reduced from 187/119 to 143/84 mm Hg. Mean standing BPs were similarly decreased. Initially, heart rate increased slightly but decreased to baseline at the end of therapy. Side-effects were generally mild to moderate and were attributable to vasodilatory effects of the drug. Three patients required drug discontinuation because of adverse effects. Addition of propranolol and hydrochlorothiazide was well tolerated. Nitrendipine (20-40 mg twice daily) alone or in combination with propranolol and hydrochlorothiazide offers an alternative therapeutic approach in the management of severe hypertension.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6085366&dopt=Abstract hydrochlorothiazide Microzide



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Cardiac regression and blood pressure control in the Dahl rat treated with either enalapril maleate (MK 421, an angiotensin converting enzyme inhibitor) or hydrochlorothiazide.

Sharma JN, Fernandez PG, Kim BK, Idikio H, Triggle CR.

Enalapril maleate (MK 421), and hydrochlorothiazide were used to evaluate the control of hypertension and reversal of myocardial hypertrophy in Dahl sensitive (DS) and Dahl resistant (DR) rats given either a high (8% NaCl) or a low salt (0.4% NaCl) diet. Groups of six-week-old male DS and DR rats were treated with enalapril (15-100 mg/kg/day) in drinking water for eight weeks. Additional comparable groups of DS and DR were also treated with hydrochlorothiazide (60-400 mg/kg/day). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and heart weight/body weight (Hwt/Bwt) ratio were determined. We observed significant reduction in Hwt/Bwt ratio (P less than 0.001) along with control of SBP and DBP in the DS given a high salt diet treated with either enalapril or hydrochlorothiazide. However, in the DR given a high salt diet, cardiac regression (Hwt/Bwt ratio, P less than 0.05), SBP and DBP (P less than 0.01) reduction were seen only with enalapril. Similarly, cardiac regression (Hwt/Bwt ratio, P less than 0.05) was observed along with reduction of SBP and DBP (P less than 0.001) in the DS given a low salt diet and DR given enalapril. These data indicate that enalapril reduced SBP and DBP in association with cardiac regression in hypertensive and normotensive rats. In contrast, hydrochlorothiazide only reduced SBP, DBP and caused cardiac reversal (Hwt/Bwt ratio) in DS placed on a high salt diet.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6099383&dopt=Abstract hydrochlorothiazide Microzide