小剂量氢氯噻嗪治疗原发性高血压的疗效观察

目的:观察两种剂量氢氯噻嗪治疗原发性高血压的疗效.方法:选择门诊1、2级原发型高血压患者102例,随机分为3组,分别给予A组12.5mg氢氯噻嗪,B组25mg氢氯噻嗪和C组25mg氢氯噻嗪联用20mg啰旋内酯固醇,每日清晨一次,观察12周.比较两种不同剂量氢氯噻嗪的降压疗效及主要生化指标.结果:3组治疗前后的收缩压和舒张压都有明显下降,差异有显著性(P＜0.05).治疗8周后,B组出现血清钾下降,血尿酸升高,血糖升高,与治疗前比较差异有显著性(P＜0.05).结论:每日服用12.5mg氢氯噻嗪可有效降低1、2级原发性高血压患者的血压,与25mg相比,降压作用相当,不良反应少.     

氨氯地平与硝苯地平治疗老年原发性高血压的疗效比较

目的:研究氨氯地平与硝苯地平治疗老年原发性高血压的临床效果差异.方法:对2009年6月~2010年6月,我门诊治疗的144例老年原发性高血压患者进行了研究,随机将144例患者分为两组,实验组给药氨氯地平,对照组给药硝苯地平,4周为一个疗程,观察两组患者的血压下降情况及不良反应发生率.结果:氨氯地平治疗总有效率可达87.5%,高于硝苯地平69.4%的总有效率,差异有统计学意义(P＜0.05);氨氯地平不良反应发生率低于硝苯地平组,差异明显,有统计学意义(P＜0.05).结论:氨氯地平治疗老年原发性高血压的临床效果要好于硝苯地平,并且不良反应少,安全性更好,更适合老年患者的治疗.     

利福喷丁与利福平治疗肺结核疗效和安全性的Meta分析

目的:通过Meta分析方法评价利福喷丁与口服利福平治疗肺结核的疗效和安全性,为利福喷丁在临床上的应用提供较为科学、可靠的循证医学证据.方法:计算机检索Ovid-medline、CBMdisc、Pubmed、CNKI、万方及维普等数据库,手工检索肺结核相关的专业杂志,检索1999-2010年国内外期刊公开发表的关于利福喷丁与利福平治疗肺结核疗效和安全性的临床随机对照试验(RCT)或临床对照试验(CCT)文献(检索日期截止至2010年7月).结果:共纳入RCT 18篇,CCT 6篇.疗效方面,利福喷丁与利福平在初治肺结核组2个月痰菌阴转率、复治肺结核组疗程结束时病灶显效率及空洞闭合率、疗程结束后随访2～3年复发率比较差异均有统计学意义(P<0.05),利福喷丁组均优于利福平组;二者治疗复治肺结核2个月痰菌阴转率及疗程结束时初、复治肺结核组痰菌阴转率比较差异无统计学意义(P>0.05),疗程结束时初治肺结核组病灶显效率及空洞闭合率比较差异也无统计学意义(P>0.05).安全性方面,利福喷丁与利福平组药物过敏反应(皮疹、药物热)发生率比较差异无统计学意义(P>0.05),总的药物副反应发生率、肝功异常发生率、ALT升高发生率、血清胆红素升高发生率、胃肠道不良反应发生率及药物中止治疗发生率比较利福喷丁组均低于利福平组(P<0.05).结论:利福喷丁治疗肺结核疗效好,安全性较高,患者耐受性及依从性好,尤其适合复治肺结核患者的化疗.     

新荧光试剂5－（4＇－硝基－2＇－羧基苯偶氮）－4－氧代－2－硫代四氢噻唑的合成及分析应用研究

本文报道了新荧光试剂５－（４＇－硝基－２＇－羧基苯偶氮）－４－氧代－２－硫代四氢噻唑（４ＮＣＰＯＢＴ）的合成及其荧光分析应用。确证了其结构。研究了荧光性质,发现该试剂在溴代十六烷基吡啶存在下,在无水乙醇溶液中与Ｅｕ（Ⅲ）形成稳定的荧光螯合物,其线性范闲为１０×１０￣（－８）～１０×１０￣（－６）ｍｏｌ／Ｌ,检测限为１．５×１０￣（－１０）ｍｏｌ／Ｌ。测定了人工合成样品中的铕,结果满意。     

Efficacy of low-dose combination of bisoprolol/hydrochlorothiazide compared with amlodipine and enalapril in men and women with essential hypertension

The efficacy of the low-dose combination of bisoprolol/hydrochlorothiazide was compared with amlodipine and enalapril. The low-dose combination was found to be at least as effective as amlodipine and more effective than enalapril in both men and women.     

Valsartan and hydrochlorothiazide in patients with essential hypertension. A multiple dose, double-blind, placebo controlled trial comparing combination therapy with monotherapy

OBJECTIVE: This study compares the antihypertensive efficacy and tolerability of valsartan, a novel angiotensin II antagonist, given with hydrochlorothiazide (HCTZ) vs placebo or vs valsartan or HCTZ alone. DESIGN: 871 adult out-patients with essential hypertension participated in this double-blind study. Patients were randomised in equal number to receive either combination therapy of valsartan (80 mg or 160 mg) and HCTZ (12.5 mg or 25 mg), or valsartan (80 mg or 160 mg) or HCTZ (12.5 mg or 25 mg) alone, or placebo. Patients were treated once daily for 8 weeks and assessed at 2, 4 and 8 weeks after randomisation. MAIN OUTCOME MEASURES: The primary efficacy variable was change from baseline in mean sitting diastolic blood pressure (MSDBP) at end-point. The secondary variable was change in mean sitting systolic blood pressure (MSSBP) from baseline to end-point. RESULTS: All active treatments produced a statistically significant difference in MSDBP (P < 0.001) from baseline to end-point compared with placebo. Similar results were obtained for MSSBP. All combination regimens produced a statistically significantly greater reduction in MSDPB and MSSBP than the corresponding monotherapies. Dizziness and headache were the most common treatment-related adverse experiences reported. Hypokalaemia, associated with the use of thiazide diuretics, was more commonly reported in the higher dose HCTZ 25 mg groups. CONCLUSIONS: Valsartan 80 mg and 160 mg act additively with HCTZ 12.5 mg or 25 mg to lower MSDBP and MSSBP in patients with essential hypertension. The addition of HCTZ to valsartan 80 mg or 160 mg was well tolerated.     

A multifactorial trial design to assess combination therapy in hypertension. Treatment with bisoprolol and hydrochlorothiazide

BACKGROUND: The safety and effectiveness of different dosages and combinations of antihypertensive agents can be efficiently studied using a multifactorial trial design. In consultation with the Cardio-Renal Division of the Food and Drug Administration, we conducted a randomized, double-blind, placebo-controlled, 3 x 4 factorial trial of bisoprolol, a beta 1-selective adrenergic blocking agent, and hydrochlorothiazide. METHODS: A total of 512 patients with mild to moderate essential hypertension were randomized to once-daily treatment with bisoprolol (0, 2.5, 10, or 40 mg), hydrochlorothiazide (0, 6.25, or 25 mg), and all possible combinations. Diastolic and systolic blood pressures were monitored during this 12-week trial. RESULTS: The effects of bisoprolol and hydrochlorothiazide were additive with respect to reductions in diastolic and systolic blood pressures over the dosage ranges studied. The addition of hydrochlorothiazide (or bisoprolol) to therapy with bisoprolol (or hydrochlorothiazide) produced an incremental reduction in blood pressure. Dosages of hydrochlorothiazide as low as 6.25 mg/d contributed a significant antihypertensive effect. A hydrochlorothiazide dosage of 6.25 mg/d produced significantly less hypokalemia and less of an increase in uric acid levels than a dosage of 25 mg/d. The low-dose combination of bisoprolol, 2.5 mg/d, and hydrochlorothiazide, 6.25 mg/d, reduced diastolic blood pressure to lower than 90 mm Hg in 61% of patients and demonstrated a safety profile that compared favorably with that of placebo. CONCLUSIONS: The utility of factorial design trials to characterize dose-response relationships and to test the potential interactions between various antihypertensive agents has been demonstrated. The combination of low dosages of bisoprolol and hydrochlorothiazide may be a rational alternative to conventional stepped-care therapy for the initial treatment of patients with mild to moderate hypertension.     

Antihypertensive effectiveness of a very low fixed-dose combination of moexipril and hydrochlorothiazide

Rest-redistribution 201Tl imaging is currently being used for myocardial viability detection, but the ideal parameters for territory classification have not yet been defined. The aim of this study was to define the optimal criteria for detecting viable myocardium and predicting postrevascularization recovery with rest-redistribution 201Tl SPECT. METHODS: In 29 patients with left ventricular dysfunction, tracer activity within asynergic segments was quantified on rest and redistribution 201Tl SPECT. Viability was defined by the presence of functional recovery, which was detected by comparing wall motion in baseline and follow-up echocardiography. Discriminant function analysis and receiver operating characteristic (ROC) curve analysis were used to evaluate the relationship between 201Tl data and viability. RESULTS: Of 214 dysfunctioning segments (135 a-/dyskinetic), viability was demonstrated in 115 (75 a-/dyskinetic). Both rest and redistribution 201Tl activity in these segments were significantly higher than they were in the nonviable segments (p < 0.0001). Significant (> 10%) reversibility was observed in 39% of the viable and in 36% of the nonviable segments (p = 0.81). Discriminant analysis identified redistribution activity, followed by rest activity, as the most effective predictors of functional recovery. Similar areas were found under the ROC curve for rest (0.68 +/- 0.037) and for redistribution activity (0.70 +/- 0.036) (p = 0.13). ROC curve analysis identified the optimal cutoff for redistribution activity at < 60%, with 147 of 214 (69%) segments correctly classified (sensitivity = 78% and specificity = 58%). In the subset of a-/dyskinetic segments, redistribution activity presented a significantly larger ROC curve area (0.81 +/- 0.038 compared to 0.77 +/- 0.042, p < 0.05), and 103 of 135 (76%) segments were correctly classified (sensitivity = 81% and specificity = 70%). CONCLUSION: Redistribution activity is the most important parameter to be considered in rest-redistribution 201Tl to differentiate viable from nonviable segments; rest activity is also valuable, whereas the meaning of reversibility appears limited. Cutoff values about 60% appear to give the most reasonable balance between sensitivity and specificity.     

The TEAM study--a study of the effectiveness and tolerance of treatment of essential hypertension with a fixed combination of trandolapril and verapamil

In the years 1988 to 1995 among 1355 cattle examined in the frame of iodine deficiency studies in the Czech Republic 404 animals (30%) showed congenital struma. Clinical and postmortal findings are described. A monitoring of iodine content in milk showed lower values in herds with struma prevalence. The insufficient supply of iodine in these animals results from low iodine content of feed or from the goitrogenic influence of nitrate in drinking water or high content of crucifera in feed or other stress factors. An increased iodination of mineral mix in feed is highly recommended.     

Low-dose reserpine/thiazide combination in first-line treatment of hypertension: efficacy and safety compared to an ACE inhibitor

The concept of initiating treatment of mild-to-moderate hypertension with a low-dose combination of reserpine and the thiazide clopamide in comparison to monotherapy with an ACE inhibitor was investigated. A total of 127 adult outpatients with diastolic blood pressure between 100 and 114 mmHg were randomized into this double-blind, parallel group study. After a 2-week wash-out period and a subsequent 2-week placebo run-in period, they were allocated to once-daily treatment with 0.1 mg reserpine plus 5 mg clopamide (R/C), or 5 mg enalapril. If diastolic blood pressure was not normalized after 3 weeks of therapy (i.e. DBP < 90 mmHg), the dosage was doubled from week 4 to 6. The primary efficacy variables were the change from baseline in mean sitting diastolic and systolic blood pressure (DBP/SBP) after 3 weeks of therapy. Secondary variables included the change in DBP and SBP after 6 weeks of therapy, the BP normalization rates at 3 and 6 weeks and, concerning tolerability, the rates of adverse events after 6 weeks of therapy. An intent-to-treat analysis was performed. The reserpine/ clopamide and enalapril groups did not differ with regard to demographic and baseline characteristics (mean age 57 or 58 years, respectively; 63% or 56% males, respectively; mean SBP/DBP after the 2-week placebo period = 156 mmHg/104 mmHg in both groups). After 3 weeks of treatment with one capsule daily, mean SBP/DBP reduction from baseline (24 h after last medication intake) in the R/C combination group was -19.6/ -17.0 mmHg, in the enalapril group -6.1/ -9.5 mmHg (between-group comparison: 2p < 0.01 for both parameters). The normalization rates for DBP (< 90 mmHg) were 64.1% (R/C) and 28.6% (enalapril) (2p < 0.01). Adverse events that were considered possibly or definitely drug-related by the investigator were noted in 11 patients (17.2%) in the R/C group and in 9 patients (14.3%) in the enalapril group (NS). Two patients in the enalapril group discontinued the study prematurely due to adverse events (cough; skin eruption). In the treatment of mild-to-moderate hypertension, a low-dose combination of reserpine and clopamide once a day is considerably more effective than, and as tolerable as, 5-10 mg of enalapril once a day. These findings suggest that treatment with a combination of different antihypertensives with different modes of action in low doses is a rational alternative to conventional monotherapy in the first-line treatment of hypertension. Besides, the "old" reserpine-diuretic regimen also in these days appears to be a rational alternative to "modern" monotherapies.     

A prospective comparison of four study designs used in assessing safety and effectiveness of drug therapy in hypertension management

The objective of the study was to compare prospectively the impact of study design on drug therapy safety and effectiveness data obtained in hypertension management. The main study was a randomized controlled clinical trial of four different prospective study designs used in postmarketing assessment involving 1008 primary care practices in nine Canadian provinces. Two thousand nine hundred sixty-four patients with mild to moderate hypertension received an angiotensin converting enzyme (ACE) inhibitor daily for 14 weeks in one of four postmarketing studies--a randomized double-blind clinical trial (RCT) (10 to 40 mg fosinopril daily v 5 to 20 mg enalapril daily), two structured open label trials of 10 to 40 mg fosinopril daily (one with free drugs), or an unstructured open label trial of 10 to 40 mg fosinopril daily. Patient demographic and baseline characteristics, systolic and diastolic blood pressures, adverse events reported, and data quality were recorded as the outcome measures. The results showed that the RCT patients were titrated to higher doses of ACE inhibitor than patients in the open studies, P < .008; patients in the open studies were more likely to receive adjuvant diuretic therapy, P < .008. The decrease in blood pressure was similar for patients in all four studies, mean decrease in systolic BP was between 18 and 20 mm Hg, mean decrease in diastolic BP was between 11 and 13 mm Hg. Fewer patients in the unstructured open trial reported adverse events than patients in the RCT; a 55% relative reduction in reported adverse events (P < .008) was associated with the unstructured trial. There were also fewer drug-related adverse events per patient reported in the unstructured study (17 per 100 patients) than in the other studies (27 to 41 per 100 patients), P < .008. Physician preference for rounding off blood pressure measurements to 0 or 5 occurred most often in the unstructured open trial (P < .008). In conclusion, despite differences in dose titration and in the use of adjuvant therapy, antihypertensive drug therapy effectiveness observed in an RCT may be similar to uncontrolled postmarketing studies. Open trials with scheduled follow-up visits are as effective in detecting severe adverse events as RCT, but postmarketing studies with unstructured schedules of follow-up are insufficient in identifying drug-related adverse events and have poorer quality data.     

Short report: ramipril and hydrochlorothiazide combination therapy in hypertension: a clinical trial of factorial design. The East Germany Collaborative Trial Group

OBJECTIVE: To identify appropriate dosages of ramipril and hydrochlorothiazide (HCT) when given in combination once a day for the treatment of essential hypertension. DESIGN: A 2- or 4-week placebo run-in followed by 6-week, double-blind, parallel-group phase: 4 x 3 factorial (2.5, 5 and 10 mg ramipril; 12.5 and 25 mg HCT; all six combinations; placebo). SETTING: Office practice (21 centres). PATIENTS AND PARTICIPANTS: Patients with mild-to-moderate essential hypertension (World Health Organization stage I-II; supine diastolic blood pressure 100-115 mmHg in last 2 weeks of run-in): 581 enrolled, 534 randomly assigned to double-blind therapy and 517 completed. MAIN OUTCOME MEASURES: Reduction in supine and standing blood pressure. RESULTS: In pairwise comparisons, the combinations of 5 mg ramipril with 12.5 and 25 mg HCT and 10 mg ramipril with 12.5 mg HCT consistently produced significantly greater blood pressure reductions than their respective components. Response surface analyses were performed, and a stairstep model was constructed to characterize the shape of the dose-response surface. The combinations involving 5 and 10 mg ramipril with 12.5 and 25 mg HCT were again more effective than their components. Withdrawals and adverse effects were minimal for all treatments. A large drop in serum potassium was observed on 25 mg HCT, but not on combination therapy. Addition of ramipril appeared to reduce the hyperuricaemic effect of HCT. CONCLUSIONS: Several dosage combinations of ramipril plus HCT produced significantly greater blood pressure reductions than the monotherapies at the same dosages. Overall, the combination of 5 mg ramipril and 25 mg HCT gave the best mean reduction. Combination therapy with ramipril plus HCT was safe and effective for patients with mild-to-moderate essential hypertension.