Twenty-four hour antihypertensive efficacy of indapamide, 1.5-mg sustained release: results of two randomized double-blind controlled studies.

The antihypertensive efficacy of a 1.5-mg sustained-release formulation (SR 1.5) of indapamide, a diuretic related to thiazide, has been pointed out by using conventional sphygmomanometric measurement 24 h after dosing in clinic, in two large European randomized, double-blind, controlled studies (2 and 3 months).

Valsartan, a new angiotensin II antagonist; blood pressure reduction in essential hypertension compared with an angiotensin converting enzyme inhibitor, enalapril.

OBJECTIVE: To compare the blood pressure reduction induced by valsartan, a new angiotensin II receptor antagonist, with that induced by enalapril, an angiotensin converting enzyme (ACE) inhibitor in essential hypertension. METHODS: In total 189 adult outpatients with uncomplicated essential hypertension participated in this double-blind study. Patients were allocated randomly in equal numbers to be administered 80 mg valsartan or 20 mg enalapril daily for 12 weeks.

[HOT study: quality of the blood pressure control after 2 years follow-up. Pour le Groupe français de l'étude HOT].

Unlabelled: The objective of the HOT study, an international, prospective, randomised study was to determine the optimal level of the blood pressure under treatment, linked with the lowest cardiovascular mortality and morbidity. The target diastolic blood pressure of 80, 85 and 90 mmHg was determined at the randomisation. In order to reach the target blood pressure, a strategy of treatment was predefined: the 1st step was felodipine (a long acting dihydropyridine) and the next steps (if the blood pressure reduction was not enough) proposed the addition of different therapeutic classes and/or the increase of the doses of each drug.

[Long-term clinical tolerance of antihypertensive treatment during the HOT study. Groupe français de l'etude HOT].

The objective of the HOT study, an international, prospective, randomised study is to determine the optimal level of the blood pressure under treatment, in linked with the lowest cardiovascular mortality and morbidity. The target diastolic blood pressure of 80, 85 and 90 mmHg was determined at the randomisation. In order to reach the target blood pressure, a strategy of treatment was determined: the 1st step was felodipine (a long acting dihydropyridine) and the next steps (if the blood pressure reduction is not enough) propose the addition of different therapeutic classes and/or the increase of each drug doses.

Assessment of antihypertensive effect by blood pressure monitoring: applications to bisoprolol and lisinopril in a double-blind study.

The aim of this study was to evaluate the antihypertensive effect of drugs according to the initial ambulatory blood pressure (BP) level. After a 15-day placebo run-in period, 105 patients with moderate essential hypertension (mean age, 52 years) underwent 24-h BP monitoring (spacelabs: 1 measure/15 min). Patients were subdivided into two groups: the "High" group, with 24-h mean values of systolic BP (SBP) > 137 or diastolic BP (DBP) > 87 mm Hg, and the "Low" group, with SBP < or = 137 and DBP < or = 87 mm Hg.

[Short and long-term clinical tolerance of hypertensive treatment during the HOT study (Hypertension Optimal Treatment)].

International, prospective, randomized HOT study aims to determine the optimal BP level under treatment in order to reduce at the most the cardiovascular morbidity/mortality. Defined by randomization, the level to obtain is DBP < or = 80, 85, 90 mmHg. The treatment is started by felodipine 5 mg/day then, if necessary, a bitherapy is prescribed and then, if necessary, a tritherapy.

Repeated measurements of non-invasive ambulatory blood pressure: distinction between reproducibility and the proper effect of placebo.

OBJECTIVE: To determine whether non-invasive ambulatory blood pressure is more reproducible and less affected by the placebo treatment than are clinic blood pressure measurements. METHOD: Thirty-four essential hypertensive outpatients were randomly allocated after a 4-week preselection period in two groups in a cross-over study design. One group received placebo for 4 weeks while the other formed the control group (reproducibility), then the treatments were exchanged for another 4 weeks.

Individual smoothing of blood pressure profiles to define responders or non-responders to drugs.

OBJECTIVE: To compare different methods of individual therapyh efficacy assessment in order to define responding subjects. METHODS: Hypertensive patients were included in three double-blind clinical trials (placebo versus bisoprolol, lisinopril and amlodipine) and ambulatory blood pressure measurements (four per hour) were performed at the end of each month. We analysed the effect of therapy (placebo minus treatment) according to the following criteria: type of model (hourly mean, moving average, fast Fourier analysis), determination of the time to the peak effect (the lowest value of the modelled blood pressure) and the sampling time around this peak (1, 2,.

Acceptability and tolerance of ambulatory blood pressure measurement in the hypertensive patient.

OBJECTIVE: To establish the acceptability and tolerance of ambulatory blood pressure monitoring (ABPM). METHODS: A two-part questionnaire was completed by the doctor; one part before ABPM and the second after the recording. The pre-recording data concern the demographic data of the patient: previous illness, symptoms, reaction of the patient, anthropometric data, treatment details and the reason for ABPM.

Benefits of electronic pillboxes in evaluating treatment compliance of patients with mild to moderate hypertension.

Objective: This study was designed to assess the compliance of hypertensive patients with a once-daily regimen of the angiotensin converting enzyme (ACE) inhibitor trandolapril and to evaluate the antihypertensive efficacy of the drug in relation to the time interval between taking the final dose and measuring the blood pressure (BP).

Design: After a 2-week wash-out period, hypertensive patients, recruited by cardiologists, received trandolapril 2 mg once daily in the morning for 4 weeks.

Methods: In order to assess compliance, each patient's supply of trandolapril capsules was presented in a pillbox that incorporated in its lid a microprocessor that recorded the date and time of each occasion that it was opened.

Non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity.

Aim: The objective of this study was to evaluate the relationship between non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity in hypertensive patients.

Subjects And Methods: Ambulatory blood pressure measurements (15-min intervals for 24 h) and continuous blood pressure measurements (Finapres, 20 min at rest after a 10-min resting period) were performed in 123 untreated hypertensives (resting diastolic blood pressure > or = 90 mmHg; 80 males, 43 females; mean +/- SD age 49 +/- 12 years, range 19-73). Fourier series were used to model 24-h blood pressure profiles (four harmonics).

[Behavior of patients with mild-to-moderate arterial hypertension in relation to their treatment. Contribution of an electronic pillbox].

The objective of the MACH1 study (MEMS for the Assessment of Compliance of Hypertensives) was to evaluate the real behaviour of patients in relation to antihypertensive treatment administered as a single daily dose. After a 2-week period during which no other antihypertensive was allowed to be administered, 590 patients with mild-to-moderate hypertension received 2 mg of trandolapril as a single daily dose in the morning between 7:00 a.m.

[Baroreflex sensitivity and vascular involvement in hypertension].

Unlabelled: Relationships between baroreflex sensitivity (BRS) and arterial distensibility are evaluated by continuous measurement of blood pressure (Finapres) and carotid-femoral pulse wave velocity measurement (PWV); 73 subjects are recruited on WHO criteria (age: 48 +/- 13). An ambulatory measurement of BP is also performed to evaluate the mean BP 24 level. The BRS is evaluated at rest during 20 min of acquisition data in a lying position, using a dedicated software [(automatic detection by of BP sequences were 3 or more systolic BP and RR interval increased of 1 mmHg for SBP and 4 ms for RR (PS+/RR+) or decreased (PS-/RR-)].

[Paradoxic changes in the morphology of blood pressure wave in hypertensive heart diseases].

Unlabelled: The objective is to study the relation between left ventricular (LV) effect (index of LV mass (LVMI) and index of inotropic state) and arterial compliance determined but the proximal aortic pressure waveform and by the carotid femoral pulse wave velocity.

Material: 72 untreated hypertensives; systolic blood pressure (SBP) 170 +/- 18 mmHg/diastolic blood pressure (DBP); heart rate: 69 +/- 9 batt/min; age: 48 +/- 13 years; duration of hypertension 4.6 +/- 4.

[Comparison of blood pressure profile during exercise with benazepril 10 mg and benazepril 5 mg/hydrochlorothiazide 6.25 mg fixed combination].

This double-blind placebo-controlled study was designed to compare the efficacy of benazepril 10 mg (BZ 10) and the low-dose combination benazepril 5 mg/hydrochlorothiazide 6.25 mg (BZ + HCTZ) on exercise blood pressure in 71 patients with mild to moderate hypertension (diastolic blood pressure 95 to 114 mmHg at the end of a 2 week placebo run-in). A significant fall of systolic (SBF) and diastolic (DBP) blood pressure at rest was seen after a 4-week treatment period in the two active groups (-21.

Second-generation calcium antagonists and ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring (ABPM) is a particularly useful method for evaluating the effects of antihypertensive drugs. ABPM allows the therapeutic effect of an agent to be assessed continually by a large number of measurements, and the greater number of readings contributes to the higher degree of reproducibility associated with ABPM compared to other methods for measuring blood pressure. ABPM also enable measurements to be taken in "real-life" situations and removes the problem of observer bias.

[Action of labetalol on norepinephrine myocardial content in left ventricular hypertrophy in hypertensive patients].

The high incidence of cardiovascular morbidity and mortality in hypertensive patients with left ventricular hypertrophy shows the great interest in understanding the pathophysiology of this process. Many reports suggest the role of catecholamines in generating left ventricular hypertrophy. The aim of this study is to evaluate the effect of labetalol on myocardial norepinephrine content in hypertensive subjects with left ventricular hypertrophy by using an isotopic norepinephrine marker, the 123I-meta-iodobenzylguanidine (123I-MIBG).

[Evaluation of norepinephrine content in the myocardium in hypertensive patients with left ventricular hypertrophy].

The sympathetic nervous system seems to be a non hemodynamic factor involved in the development of hypertension and in left ventricular hypertrophy determinism. The aim of this study was to estimate the myocardial norepinephrine content in essential hypertensive patients, using a reliable radio-iodinated marker of norepinephrine: the 123I-meta-iodobenzylguanidine (123I-meta-iodobenzylguanidine). Eight male and female hypertensive patients with left ventricular hypertrophy and average age of 52 +/- 9 years underwent a resting, ambulatory and effort blood pressure measure.

[Non invasive evaluation of cardiovascular effects of nebivolol in patients with cardiac insufficiency].

The results of several studies, mostly without controls, have suggested that betablockers, administered at progressively increasing doses, may be beneficial in cardiac failure. Based on this hypothesis, betablockers with a peripheral vasodilator effect, such as Nebivolol, could be particularly valuable in this indication. A preliminary study of its tolerance, haemodynamic and neurohormonal effects was carried out with a noninvasive methodology in 12 patients with cardiac failure in sinus rhythm, 8 men and 4 women (average age 53 +/- 12 years), all of whom had Class III or IV symptoms according to the NYHA Classification.

[Analysis of results of the determination of ambulatory blood pressure].

Although there has never been a consensus about the presentation and analysis of the results of ambulatory blood pressure recordings, it is important to define the stages and useful means both for studying individual and groups of recordings (therapeutic trials): individual recordings: edition of results, 24 hour display, quantification of the blood pressure over predefined periods, comparison with reference values; therapeutic trials: verification of the quality of the recordings (consecutive hours without measurements, artefacts), preparation of the results for analysis (grouped in hourly mean values), search for confusing factors and non-adherence to the protocol, analysis of efficacy over 24 hours and predefined periods, partial studies (non-responders, normalisation of blood pressure with respect to reference values, control of efficacy over more than 24 hours...