Speciality
Spotlight

 




 


Cardiology


 


   





Hypertension

    

  • R Turner, for the UK Prospective Diabetes Study Group
    (Radcliffe Infirmary, Oxford, England)


    Tight Blood Pressure Control and Risk of Macrovascular and Microvascular Complications in Type 2 Diabetes: UKPDS 38.


    BMJ 317: 703-713, 1998.

     


    In patients with tight blood pressure control (BP less than 144/82mm Hg) who also had diabetes, there was a 24% reduction in risk in diabetes related end points, 32% reduction in deaths due to diabetes, 44% reduction in stroke and 37% reduction in microvascular diseases. 

       


    There was also 34% reduction in retinopathy, 47% reduction in deterioration of visual
    activity.

       

  • I-W Franz, U
    Tonnesmann, JFM Muler, (Klinik Wehrawald de BfA,
    Todtmoos, Germany)


    Time Course of Complete Normalization of Left Ventricular Hypertrophy During Long-term Antihypertensive Therapy With Angiotensin Converting Enzyme Inhibitors.


    Am J Hypertens 11: 631-639,1 998.

      


    In patients receiving ACE inhibitor therapy, reversal of left ventricular hypertrophy is a prolonged process. Periods of treatment longer than 1 year are needed to assess the benefits. Normalisation requires many years of effective therapy.

  • H Krum, for the Bosentan Hypertension Investigators
    (Monash Univ, Prahran, Victoria, Australia; et al)


    The Effect of an Endothelin-Receptor Antagonist,
    Bosentan, on Blood Pressure in Patients with Essential Hypertensin


    N Engl J Med 338: 784-790, 1998.

      


    The endothelin derived peptide has potent vasoconstrictor effects and may play an important role in the pathogenesis of hypertension and chronic heart failure. It is very important in raising peripheral vascular resistance.

      


    A new endothelin receptor antagonist bosentan lowers blood pressure significantly in patients with hypertension.

     


    In this well conducted large clinical trial, endothelin antagonist bosentan and other drugs of this class may become most important antihypertensive drugs of the future and perhaps also become the drug of choice for the treatment of heart failure.

      

  • K
    Manhem, H Ahlm, I Milsom, et al (Sahlgrens Univ,
    Goteborg, Sweden)


    Transdermal Oestrogen Reduces Daytime Blood Pressure in Hypertensive Women.


    J Hum Hypertens 12: 323-327, 1998.

      


    Most menopausal women have a rise in blood pressure, but the cause has not been determined. It is unclear whether estrogen reduces or increases blood pressure in post menopausal women. 

      


    In a large study, it was found that transdermal oestrogen does not cause any elevation of blood pressure in postmenopausal women with hypertension. Instead, it may produce mild reduction in day time blood pressure, with no change in heart rate.

      

  • Muiesan ML, Salvetti M, Monteduro c, et al
    (Univ of Brescia, Italy)


    Effect of Treatment on Flow-Dependent Vasodilation of the Brachial Artery in Essential Hypertension.


    Hypertension 33[part II]:575-580, 1999

      


    Patients with essential hypertension whose blood pressure is controlled by antihypertensive treatment improve the function of the vascular endothelial, which is reflected by an increased blood flow through the arteries. This has been shown in the brachial artery.

      

  • Jee
    SH, He J, Whelton PK, et al (Yonsei Univ, Seoul, Korea; Johns Hopkins
    Univ, Baltimore, Md; Tulane Univ, New Orelans, La; et al )


    The Effect of Chronic Coffee Drinking on Blood Pressure: A Meta-analysis of Controlled Clinical Trials.


    Hypertension 33: 647-652, 1999.

      


    Analysis of reports on the effect of coffee on the blood pressure in coffee drinkers has shown that coffee may increase both systolic and diastolic blood pressure. The rise for each cup of coffee taken is very small around 0.8mm Hg. However for those who drink many cups of coffee, this may add to a few mm Hg which may be significant.

      

  • Staessen JA, for the Systolic Hypertension in Europe Trial Investigators
    (Univ of Louvain, Leuven, Belgium)


    Predicting Cardiovascular Risk Using Conventional vs Ambulatory Blood Pressure in Older Patients with Systolic Hypertension.


    JAMA 282:539-546, 1999.

       


    In older patients with uncontrolled hypertension, the best predictor of complication or deleterious effect of hypertension is indicated by the nighttime BP. The second best is the ambulatory systolic blood pressure and the least reliable is the conventional BP measurement in the doctor’s chamber.

      

  • Singh JP, Larson MG, Manolio TA, et al
    (Natl Heart, Lung, and Blood Institute’s Framingham Study, Mass; Natl Heart, Lung, and Blood Inst, Bethesda; Boston
    Univ; et al).


    Blood Pressure Response During Treadmill Testing as Risk Factor for New-Onset Hypertension: The Framingham Heart Study.


    Circulation 99: 19831-1836, 1999.

      


    In normotensive men, who have recently developed hypertension, response to exercise is an excellent indicator on the possibility of progression of hypertension.

      

  • Presented at XII International Symposium on
    Atherosclerosis, Stockholm, Sweden.


    Superstatin boosts Astra Zeneca


    Scrip no.2554, July 5, 2000, p.18

      


    Rosuvastatin (ZD4522) is the most potent cholesterol lowering agent known. It lowers LDL cholesterol by 65% as compared to 25% by current
    statins.

       


    It does not produce hepatotoxicity or myotoxicity. Liver enzymes and CPK remain normal . It has a long half-life (once a day dosing). Rosuvastatin is not metabolised by the liver.

       

  • NA
    Graudal, AM Galloe, P Garred (Univ of Copenhagen)

    Effects of Sodium Restriction on Blood Pressure, Renin, Aldosterone,
    Catecholamines, Cholesterols, and Triglyceride: A Meta-analysis.

    JAMA
    279: 1383-1391, 1998.

     

    Meta-analysis done by the authors indicate that although
    sodium restriction may be a useful part of treatment for
    hypertension, the effect on hormones, lipid profile and clinical
    significance are unknown.
    large
    clinical trials are necessary to assess the effect on stroke, acute
    myocardial infarction and survival.

     

    Editor
    comments that inspite of these uncertainties, it may still be
    beneficial to restrict sodium.

     

  • O
    Vriz, D Piccolo, E Cozzutti, et al (Univ of Padova, Italy).

    The
    Effects of Alcohol Consumption on Ambulatory Blood Pressure and
    Target Organs in Subjects with Borderline to Mild Hypertension
    .   

     
    Am J Hypertens
    11:230-234, 1998
    .


     

    There were 793 men, ages 18 to 45, who were divided into 3
    age-matched groups with similar body mass index: nondrinkers,
    drinkers of less than 50 g/day, and drinkers of 50 g/day or more.

     

    Individuals who consume alcohol 2 or more ounces a day may develop
    substantial hypertension.
    On the other hand, modest to moderate intake of alcohol has
    been associated with less coronary disease.

     

    The
    effect on the left ventricular wall thickness appears to be directly
    related to alcohol consumption.
    The results of this study strongly indicate that excessive
    alcohol intake has a detrimental effect on the heart and the kidney.

       

  • R Troost, E Schwedhelm, S. Rojczyk, et al (Institute of Clinical Pharmacology, Germany).

    Nebivolol decreases systemic oxidative stress in healthy volunteers.

    Br. J.Cl.Pharmacol, Oct.2000; 50(4), 377-379

       

    Summary: Nebivolol is a vasodilating and highly selective B1-adrenoceptor antagonist with additional antioxidative effects.

       

    Isoprostanes are prostaglandin (PG) like compounds which are produced from arachidonic acid. 8-iso PGF2a is one of such isoprostanes formed in-vivo and is increased during experimentally induced oxidative stress and in atherosclerosis.

        

    Whether nebivolol decreases oxidative stress after oral therapeutic antihypertensive dose in man has not been investigated. The present study was to determine the effect of nebivolol on systemic oxidative stress by measuring urinary excretion of 8-iso-PGF2a in healthy volunteers.

       

    The study has demonstrated that oral administration of nebivolol at standard antihypertensive doses decreases significantly urinary excretion of the isoprostane 8-iso-PGF2a. This strongly supports the hypothesis that nebivolol exerts systemic anti-oxidant effects. This provides a rationale for further clinical studies on antioxidative effects of nebivolol in cardiovascular disease




 

 

Speciality Spotlight

 

   

Hypertension
    

  • R Turner, for the UK Prospective Diabetes Study Group (Radcliffe Infirmary, Oxford, England)
    Tight Blood Pressure Control and Risk of Macrovascular and Microvascular Complications in Type 2 Diabetes: UKPDS 38.
    BMJ 317: 703-713, 1998.
     
    In patients with tight blood pressure control (BP less than 144/82mm Hg) who also had diabetes, there was a 24% reduction in risk in diabetes related end points, 32% reduction in deaths due to diabetes, 44% reduction in stroke and 37% reduction in microvascular diseases. 
       
    There was also 34% reduction in retinopathy, 47% reduction in deterioration of visual activity.
       

  • I-W Franz, U Tonnesmann, JFM Muler, (Klinik Wehrawald de BfA, Todtmoos, Germany)
    Time Course of Complete Normalization of Left Ventricular Hypertrophy During Long-term Antihypertensive Therapy With Angiotensin Converting Enzyme Inhibitors.
    Am J Hypertens 11: 631-639,1 998.
      
    In patients receiving ACE inhibitor therapy, reversal of left ventricular hypertrophy is a prolonged process. Periods of treatment longer than 1 year are needed to assess the benefits. Normalisation requires many years of effective therapy.

  • H Krum, for the Bosentan Hypertension Investigators (Monash Univ, Prahran, Victoria, Australia; et al)
    The Effect of an Endothelin-Receptor Antagonist, Bosentan, on Blood Pressure in Patients with Essential Hypertensin
    N Engl J Med 338: 784-790, 1998.
      
    The endothelin derived peptide has potent vasoconstrictor effects and may play an important role in the pathogenesis of hypertension and chronic heart failure. It is very important in raising peripheral vascular resistance.
      
    A new endothelin receptor antagonist bosentan lowers blood pressure significantly in patients with hypertension.
     
    In this well conducted large clinical trial, endothelin antagonist bosentan and other drugs of this class may become most important antihypertensive drugs of the future and perhaps also become the drug of choice for the treatment of heart failure.
      

  • K Manhem, H Ahlm, I Milsom, et al (Sahlgrens Univ, Goteborg, Sweden)
    Transdermal Oestrogen Reduces Daytime Blood Pressure in Hypertensive Women.
    J Hum Hypertens 12: 323-327, 1998.
      
    Most menopausal women have a rise in blood pressure, but the cause has not been determined. It is unclear whether estrogen reduces or increases blood pressure in post menopausal women. 
      
    In a large study, it was found that transdermal oestrogen does not cause any elevation of blood pressure in postmenopausal women with hypertension. Instead, it may produce mild reduction in day time blood pressure, with no change in heart rate.
      

  • Muiesan ML, Salvetti M, Monteduro c, et al (Univ of Brescia, Italy)
    Effect of Treatment on Flow-Dependent Vasodilation of the Brachial Artery in Essential Hypertension.
    Hypertension 33[part II]:575-580, 1999
      
    Patients with essential hypertension whose blood pressure is controlled by antihypertensive treatment improve the function of the vascular endothelial, which is reflected by an increased blood flow through the arteries. This has been shown in the brachial artery.
      

  • Jee SH, He J, Whelton PK, et al (Yonsei Univ, Seoul, Korea; Johns Hopkins Univ, Baltimore, Md; Tulane Univ, New Orelans, La; et al )
    The Effect of Chronic Coffee Drinking on Blood Pressure: A Meta-analysis of Controlled Clinical Trials.
    Hypertension 33: 647-652, 1999.
      
    Analysis of reports on the effect of coffee on the blood pressure in coffee drinkers has shown that coffee may increase both systolic and diastolic blood pressure. The rise for each cup of coffee taken is very small around 0.8mm Hg. However for those who drink many cups of coffee, this may add to a few mm Hg which may be significant.
      

  • Staessen JA, for the Systolic Hypertension in Europe Trial Investigators (Univ of Louvain, Leuven, Belgium)
    Predicting Cardiovascular Risk Using Conventional vs Ambulatory Blood Pressure in Older Patients with Systolic Hypertension.
    JAMA 282:539-546, 1999.
       
    In older patients with uncontrolled hypertension, the best predictor of complication or deleterious effect of hypertension is indicated by the nighttime BP. The second best is the ambulatory systolic blood pressure and the least reliable is the conventional BP measurement in the doctor’s chamber.
      

  • Singh JP, Larson MG, Manolio TA, et al (Natl Heart, Lung, and Blood Institute’s Framingham Study, Mass; Natl Heart, Lung, and Blood Inst, Bethesda; Boston Univ; et al).
    Blood Pressure Response During Treadmill Testing as Risk Factor for New-Onset Hypertension: The Framingham Heart Study.
    Circulation 99: 19831-1836, 1999.
      
    In normotensive men, who have recently developed hypertension, response to exercise is an excellent indicator on the possibility of progression of hypertension.
      

  • Presented at XII International Symposium on Atherosclerosis, Stockholm, Sweden.
    Superstatin boosts Astra Zeneca
    Scrip no.2554, July 5, 2000, p.18
      
    Rosuvastatin (ZD4522) is the most potent cholesterol lowering agent known. It lowers LDL cholesterol by 65% as compared to 25% by current statins.
       
    It does not produce hepatotoxicity or myotoxicity. Liver enzymes and CPK remain normal . It has a long half-life (once a day dosing). Rosuvastatin is not metabolised by the liver.
       

  • NA Graudal, AM Galloe, P Garred (Univ of Copenhagen)
    Effects of Sodium Restriction on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterols, and Triglyceride: A Meta-analysis.
    JAMA 279: 1383-1391, 1998.
     
    Meta-analysis done by the authors indicate that although sodium restriction may be a useful part of treatment for hypertension, the effect on hormones, lipid profile and clinical significance are unknown. large clinical trials are necessary to assess the effect on stroke, acute myocardial infarction and survival.
     
    Editor comments that inspite of these uncertainties, it may still be beneficial to restrict sodium.
     

  • O Vriz, D Piccolo, E Cozzutti, et al (Univ of Padova, Italy).
    The Effects of Alcohol Consumption on Ambulatory Blood Pressure and Target Organs in Subjects with Borderline to Mild Hypertension.   
     
    Am J Hypertens 11:230-234, 1998.
     
    There were 793 men, ages 18 to 45, who were divided into 3 age-matched groups with similar body mass index: nondrinkers, drinkers of less than 50 g/day, and drinkers of 50 g/day or more.
     
    Individuals who consume alcohol 2 or more ounces a day may develop substantial hypertension. On the other hand, modest to moderate intake of alcohol has been associated with less coronary disease.
     
    The effect on the left ventricular wall thickness appears to be directly related to alcohol consumption. The results of this study strongly indicate that excessive alcohol intake has a detrimental effect on the heart and the kidney.
       

  • R Troost, E Schwedhelm, S. Rojczyk, et al (Institute of Clinical Pharmacology, Germany).
    Nebivolol decreases systemic oxidative stress in healthy volunteers.
    Br. J.Cl.Pharmacol, Oct.2000; 50(4), 377-379
       
    Summary: Nebivolol is a vasodilating and highly selective B1-adrenoceptor antagonist with additional antioxidative effects.
       
    Isoprostanes are prostaglandin (PG) like compounds which are produced from arachidonic acid. 8-iso PGF2a is one of such isoprostanes formed in-vivo and is increased during experimentally induced oxidative stress and in atherosclerosis.
        
    Whether nebivolol decreases oxidative stress after oral therapeutic antihypertensive dose in man has not been investigated. The present study was to determine the effect of nebivolol on systemic oxidative stress by measuring urinary excretion of 8-iso-PGF2a in healthy volunteers.
       
    The study has demonstrated that oral administration of nebivolol at standard antihypertensive doses decreases significantly urinary excretion of the isoprostane 8-iso-PGF2a. This strongly supports the hypothesis that nebivolol exerts systemic anti-oxidant effects. This provides a rationale for further clinical studies on antioxidative effects of nebivolol in cardiovascular disease

 

By |2022-07-20T16:44:27+00:00July 20, 2022|Uncategorized|Comments Off on Hypertension

About the Author: