- Email: [email protected]
Effect of doxazosin and atenolol on endothelial function in essential hypertension
60A
POSTERS: Antihypertensive Drugs
wide began therapy with valsartan or valsartan with hydrochlorothiazide (HCTZ) therapy and completed the study (mean age: 60 years; 72% Caucasian; 56% female). Patients previously received various antihypertensive therapies including angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers, and diuretics. Cough (39%) was the most common symptom resulting in a therapy modification, followed by fatigue (16%), edema (12%), and dizziness (11%). Twenty-seven percent (27%) of patients identified more than one reason for seeking antihypertensive therapy changes. After the change in antihypertensive therapy, 48% of patients reporting cough experienced improvements in their symptomatology. Likewise, improvements were seen in 36% of patients who had fatigue, 23% of patients with edema, and 25% of patients with dizziness. Notable changes were seen in those symptoms that prompted the therapy modification: cough improved in 93% of patients, 80% of patients with fatigue, 87% of patients with edema, and 91% of patients with dizziness. Systolic and diastolic blood pressure measurements also significantly decreased following the change to valsartan therapy (p⬍0.001). Patients’ mental and physical components of quality of life were significantly improved from baseline. Overall, changing antihypertensive therapy to valsartan or valsartan with HCTZ for patients experiencing tolerability symptoms resulted in significant improvements in symptomatology, blood pressure control, and quality of life. Key Words: Quality of Life, Symptomatology, Observational Study
P-77 MEDICATION CHANGES IMPROVING SYSTOLIC BLOOD PRESSURE CONTROL IN PATIENTS REFERRED TO A HYPERTENSION PROGRAM Tulsi Mehta, Ajay Israni, Raymond R. Townsend. Medicine, University of Pennsylvania, Philadelphia, PA, United States. Persistent systolic blood pressure elevation frequently characterizes the ‘uncontrolled’ hypertension in outpatients. To examine medication factors involved in reducing elevated systolic blood pressure we randomly audited the charts of 81 patients attending at least two visits to a dedicated, single practitioner (RRT) based, hypertension program at a university teaching hospital between 1995 and 1999. A predetermined survey tool was used to asses what changes in the outpatient medication regimen were associated with improved systolic blood pressure control. The subjects were 51⫾14 (Mean⫾SD) years old, 51% were women, the racial distribution was 52% White, 33% AA, 3% Hispanic and 10% were diabetic. Seated blood pressure readings (average of two values) in the dominant arm at first visit were 170⫾33 / 81⫾17 mm Hg. The table below shows the number of patients taking each class of indicated medication “prior” to the first visit, compared with their medication profile at their “final” visit to the hypertension program. Subjects took an average of 2.0⫾1.4 medications prior to referral and 2.4⫾1.4 medications at their final visit. ‘@’ indicates p ⬍ 0.05 prior vs final and ‘*’ indicates a p value ⬍ 0.001 comparing drug profile prior to first visit compared with profile at final visit. The potassium-sparing diuretics (K-Sparing) are indicated as being given in a fixed dose combination in bold, and stand-alone in (parenthesis). ‘CCB(-DHP)’ indicates nondihydropyridine calcium channel blocker therapy. Approximately 60% (50/81 subjects) achieved a systolic blood pressure ⬍ 140 mm Hg. Statistically significant drug maneuvers employed to reach this degree of control were the increased usage of angiotensin receptor blockers (ARB), dihydropyrdine calcium channel blockers (DHP), and in particular the use of stand-alone (mostly amiloride) K sparing diuretic therapy. These data show that control of systolic blood pressure is frequently achievable, and the utility of these three classes of
AJH–April 2002–VOL. 15, NO. 4, PART 2
drug therapy in achieving systolic blood pressure control in referred outpatients. Status
ACE-I
ARB
␣1-B
-B
Diuretic
Prior Final Status Prior Final
23 25 CCB (DHP) 26 44 @
15 26@ CCB (⫺DHP) 14 5@
7 10 K-Sparing 11 (4) 1 (15)*
33 36 ␣2-ago 16 17
48 55 VD/OTHER 3/5 3/5
Key Words: K-Sparing Diuretic, Systolic Hypertension, Outpatient
P-78 CARDIOVASCULAR REACTIVITY AND DIURNAL ARTERIAL COMPLIANCE DURING NEBIVOLOL TREATMENT OF YOUNG OBESE ESSENTIAL HYPERTENSIVES Sergey A. Golubev, Jeffrey J. Tsai, Maxim N. Mily , Vyacheslav V. Afanassiev. Clinical Pharmacology, Vitebsk State Medical University, Vitebsk, Belarus; DynaPulse Analysis Center, Pulse Metric, Inc., San Diego, CA, United States. To evaluate changes in systemic and peripheral hemodynamics in resting, under stress tests and daily life conditions during short-term treatment with nebivolol in a special high-risk population twelve randomly selected verified never treated essential hypertensives (aged 38.6⫾8.4 years, body mass index 31.2⫾5.2 kg/m2) underwent ambulatory blood pressure monitoring (DynaPulse 5000A; Pulse Metric, Inc., USA), standard mental arithmetic (MT) and cold pressor (CT) tests before and 4 weeks after treatment with nebivolol (5 mg once daily). Systemic and local (brachial artery) vascular hemodynamics parameters were derived blindly from each measurement by previously validated web-based pulse dynamics analysis technology. Ambulatory BP and HR were significantly reduced by nebivolol without excessive nighttime falls and variability affecting. 24-hour, but not resting systemic vascular compliance was significantly improved (1.19⫾0.11 vs. 1.36⫾0.16 mL/mm Hg; p⬍0.05) without changes in brachial artery compliance. Nebivolol reduced diastolic BP response to MT (17.0⫾8.5 vs. 14.0⫾11.2 mm Hg; p⬍0.05), and enhanced the rise in systemic vascular resistance during CT (1.5⫾1.6 vs. 4.7⫾3.3 mm Hg; p⬍0.05). Thus, in the studied overweight young essential hypertensives, under significant short-term antihypertensive effects of nebivolol during daily life and MT, favorable changes in systemic but not in brachial artery compliance are registered, probably due to main peripheral points of nitric oxide modulating. The last might result in some discrepancies registered in hemodynamics and compliance changes between different stress tests, resting and 24-hour conditions. Daily arterial compliance evaluation is useful for comprehensive judgement about vascular effects of antihypertensive agents. Key Words: Nebivolol, Arterial Compliance, Cardiovascular Reactivity
P-79 EFFECT OF DOXAZOSIN AND ATENOLOL ON ENDOTHELIAL FUNCTION IN ESSENTIAL HYPERTENSION Giuseppe Schillaci, Simona Marchesi, Gaetano Vaudo, Graziana Lupattelli, Fabio Gemelli, Leonella Pasqualini, Elmo Mannarino. Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. Endothelium plays a primary role in the modulation of vascular tone. However, conflicting results have been reported about the effects of antihypertensive treatment on endothelial function. Forty patients with untreated mild-to-moderate essential hypertension [mean age 48 years (SEM 2 years), sitting BP 159/98 mmHg] were randomized to doxazosin 4 mg once daily (titrated up to 4 mg twice daily) or atenolol 50-100 mg
AJH–April 2002–VOL. 15, NO. 4, PART 2
once daily in an open-label trial. Flow-mediated vasodilation (FMV) of the brachial artery was assessed by 2-dimensional ultrasonography as the percent difference between the brachial artery diameter measured 45-60 seconds after a 4-minute upper-arm occlusion and the baseline diameter. FMV measurement was undertaken at baseline and repeated after 8 weeks of active antihypertensive treatment. Doxazosin and atenolol induced a similar decline in sitting blood pressure at trough (from 158/97 to 147/90 mmHg and from 159/98 to 150/91 mmHg, respectively; all p⬍0.05). FMV improved with both doxazosin (from 4.5⫾1% to 6.9⫾1%) and atenolol (from 4.4⫾1% to 6.3⫾1%, both p⬍0.05), with no difference between the two study drugs. In summary, the present study shows that antihypertensive treatment with doxazosin or atenolol improves flow-mediated vasodilation of the brachial artery, a measure of endothelium dependent vasodilatation.
POSTERS: Antihypertensive Drugs
61A
P-81 PALPITATIONS DURING ANTIHYPERTENSIVE TREATMENT WITH CALCIUM ANTAGONISTS Rafael Herna´ ndez-Herna´ ndez, Luis Alcocer, Manuel Velasco, Ariel J. Reyes, for the LASTLHY Steering Committee. Centroccidental University, Barquisimeto, Venezuela; General Hospital, Mexico City, Mexico; Central University, Caracas, Venezuela; Institute of Cardiovascular Theory, Montevideo, Uruguay. The frequency and the duration of palpitations during fixed-dose antihypertensive monopharmacotherapies with 4 mg lacidipine (L) and with 30 mg nifedipine GITS (N) were evaluated as part of the Latin American Study of Lacidipine in Hypertension. Patients (pts.) with sitting DBP between 100 and 115 mmHg at the end of a 4-week placebo (PI) run-in were randomly assigned to open treatment with L or with N once daily during 16 weeks. BP decreased significantly during the L and N treatments. One/one of the 9/5 pts. On L/N who were withdrawn or dropped out due to adverse events complained of palpitations. The final analysis comprised 248 pts. who completed the study.Palpitations decreased in both groups, despite the established reflex sympathetic activation that occurs in response to the fall in BP caused by dihydropyridines. The reasons for this subjective betterment are unclear. Palpitations (ordinal scale; I: absent) End of Study week
Key Words: Endothelial Function, Atenolol, Doxazosin
P-80 EFFECT OF INDAPAMIDE ON 24 HOURS BLOOD PRESSURE PROFILE AND NEUROHYMORAL FACTORS OF ITS REGULATION
⫺1 (PI end) 1 2 4 (N: n ⫽ 127) 6 8 10 12 14 15 16
L group (n ⴝ 120) Number of Patients I
II
III
IV
83 83 91 85 98 101 99 103 101 100 105
30 29 25 29 19 15 18 16 16 16 14
6 7 4 6 3 4 2 1 2 3 1
1 1 0 0 0 0 1 0 1 1 0
N group (n ⴝ 128) L vs. N* (Fisher’s test) Number of patients
ns* ns* ns* ns* ns* ns* ns* ns* ns* ns* ns*
I
II
III
IV
90 92 92 98 99 100 97 97 101 104 101
29 29 33 22 27 23 27 28 23 21 27
8 5 3 6 2 5 4 2 2 3 0
1 2 0 1 0 0 0 1 2 0 0
Bezrodnaya V. Larissa, Svyshchenko P. Evgenia, Mishchenko A. Larissa, Kupchinskaya G. Elena. Dpt. of Hypertension, Inst. of Cardiology, Kyiv, Ukraine.
Friedman’s test: P ⬍ 0.001; P ⬍ 0.05. * Classes II, III and IV were merged to this purpose. Two sided P ⬎ 0.05.
The aim of investigation was to evaluate the effect of indapamide on circadian blood pressure (BP) profile, dynamics of catecholamines and central hemodynamic paramaters. Essential hypertensive II stade patients (n⫽28) treated with indapamide 2,5 mg once daily within a month were studied. Ambulatory blood pressure monitoring was performed at the end of washout period, 2 and 4 weeks after the beginning of the treatment. The level of epinephrine (E), norepinephrine (NE), (by fluorometric method) were evaluated at 6 and 9 o‘clock in the morning. Parameters of systemic haemodynamic were assessed by M-mode echocardiography prior to and after the treatment. Indapamide 4-week treatment resulted in a significant fall of systolic and diastolic BP during 24 hours, day and night hours ( by 13%, 12,7% and 13,3% for diastolic BP, respectively, P⬍0,001). The systolic BP variability ( 24 hours and during day hours) changed after 4 week of treatment by 26 and 24%, respectively, P⬍0.05, diastolic BR variability - by 15 and 17%, respectively, P⬍0,05. BP load decreased 2-fold for all periods analyzed. Another parameters of ambulatory BP monitoring (BP rise in the morning hours, 24-h index) were improved authentic under indapamide treatment. Indapamide didn‘t influence E and NE levels. The 4-week indapamide treatment didn‘t change the central haemodynamics parameters (left ventricular and atrial dimensions, ejection fraction, left ventricular wall thickness and intraventricular septal thickness). Thus, indapamide significantly decreased BP and at the same time it didn‘t activate the sympathetic nervous system.
Key Words: Calcium Channel Blocker, Palpitations
Key Words: Indapamid, Blood Pressure Monitoring, Vasoactive Hormones
P-82 RESPONSES OF BLOOD PRESSURE AND OF HEART RATE TO THE FIRST DOSE OF TWO CALCIUM ANTAGONISTS Rafael Herna´ ndez-Herna´ ndez, Luis Alcocer, Manuel Velasco, Ariel J. Reyes, for the LASTLHY Steering Committee. Centroccidental Univeristy, Barquisimeto, Venezuela; General Hospital, Mexico City, Mexico; Central University, Caracas, Venezuela; Intitute of Cardiovascular Theory, Montevideo, Uruguay. The responses of BP and of radial pulse rate (HR) to the first dose of 4 mg lacidipine (L) and of 30 mg nifedipine GITS (N) were assessed as part of the Latin American Study of Lacidipine in Hypertension. Patients with sitting diastolic BP (D) of 100-115 mmHg at the end of a 4-week placebo run-in were randomly assigned to open treatment with L or with N. The first dose was taken at experimental hour (EH) 0. S: systolic BP.L, which is absorbed more rapidly than N, decreased BP quicker and caused an earlier reflex increase in HR than N. In a similar study, HR was found to increase by 15-18 b.p.m. 60 min after intake of 10 mg of classic nifedipine (Herna´ ndez R, et al. Arch Ven Farmacol 1985;2:315-322).
POSTERS: Antihypertensive Drugs
wide began therapy with valsartan or valsartan with hydrochlorothiazide (HCTZ) therapy and completed the study (mean age: 60 years; 72% Caucasian; 56% female). Patients previously received various antihypertensive therapies including angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers, and diuretics. Cough (39%) was the most common symptom resulting in a therapy modification, followed by fatigue (16%), edema (12%), and dizziness (11%). Twenty-seven percent (27%) of patients identified more than one reason for seeking antihypertensive therapy changes. After the change in antihypertensive therapy, 48% of patients reporting cough experienced improvements in their symptomatology. Likewise, improvements were seen in 36% of patients who had fatigue, 23% of patients with edema, and 25% of patients with dizziness. Notable changes were seen in those symptoms that prompted the therapy modification: cough improved in 93% of patients, 80% of patients with fatigue, 87% of patients with edema, and 91% of patients with dizziness. Systolic and diastolic blood pressure measurements also significantly decreased following the change to valsartan therapy (p⬍0.001). Patients’ mental and physical components of quality of life were significantly improved from baseline. Overall, changing antihypertensive therapy to valsartan or valsartan with HCTZ for patients experiencing tolerability symptoms resulted in significant improvements in symptomatology, blood pressure control, and quality of life. Key Words: Quality of Life, Symptomatology, Observational Study
P-77 MEDICATION CHANGES IMPROVING SYSTOLIC BLOOD PRESSURE CONTROL IN PATIENTS REFERRED TO A HYPERTENSION PROGRAM Tulsi Mehta, Ajay Israni, Raymond R. Townsend. Medicine, University of Pennsylvania, Philadelphia, PA, United States. Persistent systolic blood pressure elevation frequently characterizes the ‘uncontrolled’ hypertension in outpatients. To examine medication factors involved in reducing elevated systolic blood pressure we randomly audited the charts of 81 patients attending at least two visits to a dedicated, single practitioner (RRT) based, hypertension program at a university teaching hospital between 1995 and 1999. A predetermined survey tool was used to asses what changes in the outpatient medication regimen were associated with improved systolic blood pressure control. The subjects were 51⫾14 (Mean⫾SD) years old, 51% were women, the racial distribution was 52% White, 33% AA, 3% Hispanic and 10% were diabetic. Seated blood pressure readings (average of two values) in the dominant arm at first visit were 170⫾33 / 81⫾17 mm Hg. The table below shows the number of patients taking each class of indicated medication “prior” to the first visit, compared with their medication profile at their “final” visit to the hypertension program. Subjects took an average of 2.0⫾1.4 medications prior to referral and 2.4⫾1.4 medications at their final visit. ‘@’ indicates p ⬍ 0.05 prior vs final and ‘*’ indicates a p value ⬍ 0.001 comparing drug profile prior to first visit compared with profile at final visit. The potassium-sparing diuretics (K-Sparing) are indicated as being given in a fixed dose combination in bold, and stand-alone in (parenthesis). ‘CCB(-DHP)’ indicates nondihydropyridine calcium channel blocker therapy. Approximately 60% (50/81 subjects) achieved a systolic blood pressure ⬍ 140 mm Hg. Statistically significant drug maneuvers employed to reach this degree of control were the increased usage of angiotensin receptor blockers (ARB), dihydropyrdine calcium channel blockers (DHP), and in particular the use of stand-alone (mostly amiloride) K sparing diuretic therapy. These data show that control of systolic blood pressure is frequently achievable, and the utility of these three classes of
AJH–April 2002–VOL. 15, NO. 4, PART 2
drug therapy in achieving systolic blood pressure control in referred outpatients. Status
ACE-I
ARB
␣1-B
-B
Diuretic
Prior Final Status Prior Final
23 25 CCB (DHP) 26 44 @
15 26@ CCB (⫺DHP) 14 5@
7 10 K-Sparing 11 (4) 1 (15)*
33 36 ␣2-ago 16 17
48 55 VD/OTHER 3/5 3/5
Key Words: K-Sparing Diuretic, Systolic Hypertension, Outpatient
P-78 CARDIOVASCULAR REACTIVITY AND DIURNAL ARTERIAL COMPLIANCE DURING NEBIVOLOL TREATMENT OF YOUNG OBESE ESSENTIAL HYPERTENSIVES Sergey A. Golubev, Jeffrey J. Tsai, Maxim N. Mily , Vyacheslav V. Afanassiev. Clinical Pharmacology, Vitebsk State Medical University, Vitebsk, Belarus; DynaPulse Analysis Center, Pulse Metric, Inc., San Diego, CA, United States. To evaluate changes in systemic and peripheral hemodynamics in resting, under stress tests and daily life conditions during short-term treatment with nebivolol in a special high-risk population twelve randomly selected verified never treated essential hypertensives (aged 38.6⫾8.4 years, body mass index 31.2⫾5.2 kg/m2) underwent ambulatory blood pressure monitoring (DynaPulse 5000A; Pulse Metric, Inc., USA), standard mental arithmetic (MT) and cold pressor (CT) tests before and 4 weeks after treatment with nebivolol (5 mg once daily). Systemic and local (brachial artery) vascular hemodynamics parameters were derived blindly from each measurement by previously validated web-based pulse dynamics analysis technology. Ambulatory BP and HR were significantly reduced by nebivolol without excessive nighttime falls and variability affecting. 24-hour, but not resting systemic vascular compliance was significantly improved (1.19⫾0.11 vs. 1.36⫾0.16 mL/mm Hg; p⬍0.05) without changes in brachial artery compliance. Nebivolol reduced diastolic BP response to MT (17.0⫾8.5 vs. 14.0⫾11.2 mm Hg; p⬍0.05), and enhanced the rise in systemic vascular resistance during CT (1.5⫾1.6 vs. 4.7⫾3.3 mm Hg; p⬍0.05). Thus, in the studied overweight young essential hypertensives, under significant short-term antihypertensive effects of nebivolol during daily life and MT, favorable changes in systemic but not in brachial artery compliance are registered, probably due to main peripheral points of nitric oxide modulating. The last might result in some discrepancies registered in hemodynamics and compliance changes between different stress tests, resting and 24-hour conditions. Daily arterial compliance evaluation is useful for comprehensive judgement about vascular effects of antihypertensive agents. Key Words: Nebivolol, Arterial Compliance, Cardiovascular Reactivity
P-79 EFFECT OF DOXAZOSIN AND ATENOLOL ON ENDOTHELIAL FUNCTION IN ESSENTIAL HYPERTENSION Giuseppe Schillaci, Simona Marchesi, Gaetano Vaudo, Graziana Lupattelli, Fabio Gemelli, Leonella Pasqualini, Elmo Mannarino. Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. Endothelium plays a primary role in the modulation of vascular tone. However, conflicting results have been reported about the effects of antihypertensive treatment on endothelial function. Forty patients with untreated mild-to-moderate essential hypertension [mean age 48 years (SEM 2 years), sitting BP 159/98 mmHg] were randomized to doxazosin 4 mg once daily (titrated up to 4 mg twice daily) or atenolol 50-100 mg
AJH–April 2002–VOL. 15, NO. 4, PART 2
once daily in an open-label trial. Flow-mediated vasodilation (FMV) of the brachial artery was assessed by 2-dimensional ultrasonography as the percent difference between the brachial artery diameter measured 45-60 seconds after a 4-minute upper-arm occlusion and the baseline diameter. FMV measurement was undertaken at baseline and repeated after 8 weeks of active antihypertensive treatment. Doxazosin and atenolol induced a similar decline in sitting blood pressure at trough (from 158/97 to 147/90 mmHg and from 159/98 to 150/91 mmHg, respectively; all p⬍0.05). FMV improved with both doxazosin (from 4.5⫾1% to 6.9⫾1%) and atenolol (from 4.4⫾1% to 6.3⫾1%, both p⬍0.05), with no difference between the two study drugs. In summary, the present study shows that antihypertensive treatment with doxazosin or atenolol improves flow-mediated vasodilation of the brachial artery, a measure of endothelium dependent vasodilatation.
POSTERS: Antihypertensive Drugs
61A
P-81 PALPITATIONS DURING ANTIHYPERTENSIVE TREATMENT WITH CALCIUM ANTAGONISTS Rafael Herna´ ndez-Herna´ ndez, Luis Alcocer, Manuel Velasco, Ariel J. Reyes, for the LASTLHY Steering Committee. Centroccidental University, Barquisimeto, Venezuela; General Hospital, Mexico City, Mexico; Central University, Caracas, Venezuela; Institute of Cardiovascular Theory, Montevideo, Uruguay. The frequency and the duration of palpitations during fixed-dose antihypertensive monopharmacotherapies with 4 mg lacidipine (L) and with 30 mg nifedipine GITS (N) were evaluated as part of the Latin American Study of Lacidipine in Hypertension. Patients (pts.) with sitting DBP between 100 and 115 mmHg at the end of a 4-week placebo (PI) run-in were randomly assigned to open treatment with L or with N once daily during 16 weeks. BP decreased significantly during the L and N treatments. One/one of the 9/5 pts. On L/N who were withdrawn or dropped out due to adverse events complained of palpitations. The final analysis comprised 248 pts. who completed the study.Palpitations decreased in both groups, despite the established reflex sympathetic activation that occurs in response to the fall in BP caused by dihydropyridines. The reasons for this subjective betterment are unclear. Palpitations (ordinal scale; I: absent) End of Study week
Key Words: Endothelial Function, Atenolol, Doxazosin
P-80 EFFECT OF INDAPAMIDE ON 24 HOURS BLOOD PRESSURE PROFILE AND NEUROHYMORAL FACTORS OF ITS REGULATION
⫺1 (PI end) 1 2 4 (N: n ⫽ 127) 6 8 10 12 14 15 16
L group (n ⴝ 120) Number of Patients I
II
III
IV
83 83 91 85 98 101 99 103 101 100 105
30 29 25 29 19 15 18 16 16 16 14
6 7 4 6 3 4 2 1 2 3 1
1 1 0 0 0 0 1 0 1 1 0
N group (n ⴝ 128) L vs. N* (Fisher’s test) Number of patients
ns* ns* ns* ns* ns* ns* ns* ns* ns* ns* ns*
I
II
III
IV
90 92 92 98 99 100 97 97 101 104 101
29 29 33 22 27 23 27 28 23 21 27
8 5 3 6 2 5 4 2 2 3 0
1 2 0 1 0 0 0 1 2 0 0
Bezrodnaya V. Larissa, Svyshchenko P. Evgenia, Mishchenko A. Larissa, Kupchinskaya G. Elena. Dpt. of Hypertension, Inst. of Cardiology, Kyiv, Ukraine.
Friedman’s test: P ⬍ 0.001; P ⬍ 0.05. * Classes II, III and IV were merged to this purpose. Two sided P ⬎ 0.05.
The aim of investigation was to evaluate the effect of indapamide on circadian blood pressure (BP) profile, dynamics of catecholamines and central hemodynamic paramaters. Essential hypertensive II stade patients (n⫽28) treated with indapamide 2,5 mg once daily within a month were studied. Ambulatory blood pressure monitoring was performed at the end of washout period, 2 and 4 weeks after the beginning of the treatment. The level of epinephrine (E), norepinephrine (NE), (by fluorometric method) were evaluated at 6 and 9 o‘clock in the morning. Parameters of systemic haemodynamic were assessed by M-mode echocardiography prior to and after the treatment. Indapamide 4-week treatment resulted in a significant fall of systolic and diastolic BP during 24 hours, day and night hours ( by 13%, 12,7% and 13,3% for diastolic BP, respectively, P⬍0,001). The systolic BP variability ( 24 hours and during day hours) changed after 4 week of treatment by 26 and 24%, respectively, P⬍0.05, diastolic BR variability - by 15 and 17%, respectively, P⬍0,05. BP load decreased 2-fold for all periods analyzed. Another parameters of ambulatory BP monitoring (BP rise in the morning hours, 24-h index) were improved authentic under indapamide treatment. Indapamide didn‘t influence E and NE levels. The 4-week indapamide treatment didn‘t change the central haemodynamics parameters (left ventricular and atrial dimensions, ejection fraction, left ventricular wall thickness and intraventricular septal thickness). Thus, indapamide significantly decreased BP and at the same time it didn‘t activate the sympathetic nervous system.
Key Words: Calcium Channel Blocker, Palpitations
Key Words: Indapamid, Blood Pressure Monitoring, Vasoactive Hormones
P-82 RESPONSES OF BLOOD PRESSURE AND OF HEART RATE TO THE FIRST DOSE OF TWO CALCIUM ANTAGONISTS Rafael Herna´ ndez-Herna´ ndez, Luis Alcocer, Manuel Velasco, Ariel J. Reyes, for the LASTLHY Steering Committee. Centroccidental Univeristy, Barquisimeto, Venezuela; General Hospital, Mexico City, Mexico; Central University, Caracas, Venezuela; Intitute of Cardiovascular Theory, Montevideo, Uruguay. The responses of BP and of radial pulse rate (HR) to the first dose of 4 mg lacidipine (L) and of 30 mg nifedipine GITS (N) were assessed as part of the Latin American Study of Lacidipine in Hypertension. Patients with sitting diastolic BP (D) of 100-115 mmHg at the end of a 4-week placebo run-in were randomly assigned to open treatment with L or with N. The first dose was taken at experimental hour (EH) 0. S: systolic BP.L, which is absorbed more rapidly than N, decreased BP quicker and caused an earlier reflex increase in HR than N. In a similar study, HR was found to increase by 15-18 b.p.m. 60 min after intake of 10 mg of classic nifedipine (Herna´ ndez R, et al. Arch Ven Farmacol 1985;2:315-322).