Orthostatic hypertension: profile of a Nigerian population

Background: The aim of this study was to determine the prevalence, age, sex distribution and blood pressure (BP) pattern of patients with orthostatic hypertension in a cohort of hypertensives. Method: A total of 179 patients on follow-up treatment in a hypertension clinic were assessed for age, sex and BP in the seated position, and after two minutes in the erect position, on three consecutive visits. Orthostatic hypertension was defined as an increase in systolic blood pressure (SBP) of ≥ 20 mmHg on more than one occasion in the erect position. Orthostatic hypotension was defined as a decrease in BP on more than one occasion, between the seated and erect SBP, of ≥ 20 mmHg. The mean ages of the participants with and without orthostatic hypertension were compared by t-test for any significant difference. The means of the seated SBP of participants with and without orthostatic hypertension were also compared with the t-test. The effect of gender on orthostatic hypertension was tested with a chi-square (χ²). The differences between the mean seated and mean erect SBPs of participants with and without orthostatic hypertension were compared with the paired t-test. Results: Thirty-eight (21.23%) of the participants had orthostatic hypertension. The mean age of those with orthostatic hypertension was not significantly different from that of the participants without orthostatic hypertension (p-value = 0.789). There was no significant effect of gender on orthostatic hypertension (p-value = 0.795). The mean of the seated SBP was significantly lower in the participants with orthostatic hypertension (p-value = 0.008). The mean seated SBP was significantly different from the mean erect SBP for those with orthostatic hypertension, compared to those without orthostatic hypertension (p-value = 0.000 vs. p-value = 0.169). Five (2.79%) of the participants had orthostatic hypotension. Conclusion: Orthostatic hypertension, a form of BP dysregulation, may be more common among treated hypertensives than what is presently known

The Substitution of Phentolamine with an Equal amount of Chlorpromazine as an Alpha-Blocker in Vasoactive Cocktails used for Intracavernous Injection Therapy for the Treatment of Erectile Dysfunction

Introduction: This brief report describes the replacement of phentolamine mesylate with an equal amount of chlorpromazine HCl in vasoactive drug mixtures used as intracavernous (IC) injection therapy for treating erectile dysfunction (ED). Phentolamine; amongst other drugs; had been used in drug injection therapy for the treatment of ED; but was replaced as single drug therapy by more effective drugs; such as alprostadil (prostaglandin E1). It has; however; still widely been used as alpha-blocking agent in vasoactive drug cocktails. Phentolamine has a synergistic effect with alprostadil; papaverine and atropine in drug combination cocktails. These injection mixtures are very effective for treating ED and are commonly known as bimixtures; trimixtures and quadmixtures. The vasoactive drug; phentolamine; was withdrawn from the market in South Africa. Chlorpromazine (a phenothiazine) was suggested as an alternative alpha-blocking agent to be used in drug cocktails for the IC treatment of ED.Methods: Three hundred and sixty-four (364) patients were questioned and evaluated during follow-up visits to an ED clinic after phentolamine mesylate was replaced with an equal amount of chlorpromazine HCL in their regular IC injection preparations. The collected data is based on results from self-administration at home.Results: No significantly unusual adverse effects or altered efficacy of the new preparations were reported. The patients noted a change in the colour of the drug mixtures that contain chlorpromazine and papaverine. Despite this slight change in colour; the effectiveness of the mixtures remained the same if a use-before date of three months was adhered to.Conclusion: The results indicate that phentolamine mesylate can effectively be replaced with an equal amount of chlorpromazine HCL in IC drug cocktails for the treatment of ED