Eficácia e tolerabilidade da associação captopril + hidroclorotiazida no tratamento da hipertensão arterial leve a moderada. Estudo multicêntrico / Efficacy and tolerability of the association of efficacy and tolerability of the association of captopril + hydrochlorothiazide in the treatment of mild-to-moderate hypertension. A multicenter trial hypertension. A multicenter trial

PURPOSE--To evaluate the antihypertensive efficacy and tolerability of captopril 50 mg + hydrochlorothiazide 25 mg daily in mild to moderate primary hypertension. METHODS--Out-patients (n = 471) with mild to moderate hypertension, diastolic blood pressure (DBP) 95-115 mmHg, with 15 days of washout, were included to the treatment initially with half tablet of the association of captopril 50 mg + hydrochlorothiazide 25 mg once daily, for 30 days. After this period, patients with DBP > 90 mmHg had the dosage duplicated, while the others had the same dosage for 60 days more. Evaluation was performed 15 days before and then every month during active drug. RESULTS--Twenty six patients were withdrawn, 13 (2.7) by adverse effects and 13 by protocol violation. At the end of the wash-out period, the blood pressure (BP), 162 +/- 16/103 +/- 6 mmHg decreased significantly at the 30th day to 146 +/- 14/92 +/- 8 mmHg (p < 0.001 vs 0th day); 139 +/- 12/86 +/- 7 mmHg at the 60th day, (p < 0.001 vs 30th day), and further to 136 +/- 11/84 +/- 5 mmHg, (p < 0.001 vs day 0) till the end of the 90th day. Antihypertensive efficacy (DBP < or = 90 mmHg and decreased of the DBP > or = 10 mmHg) was obtained in 82 of the patients. There was no difference in BP control considering race, hypertension level, previous antihypertensive treatment and obesity. Cough (4) was the main adverse event. CONCLUSION--Captopril + hydrochlorothiazide was effective and safe in the treatment of mild to moderate hypertension. The favorable response was observed in 82 of the patients independently of race, hypertensive level, previous antihypertensive treatment and obesity. Low incidence of side effects was reported, with no difference from others reported in the literature.

Hipertensão arterial em pacientes obesos com hipertrofia cardíaca. Efeitos do captopril sobre a sensibilidade à insulina e hormônio de crescimento / Hypertension in Obese Patienfs with Cardiac Hypertrophy. Effects of Captopril in the Insulin Sensitivity and Growth Hormone

PURPOSE--To evaluate the effects of captopril (Cpt).on carbohydrate metabolism and growth hormone (GH) in adults hypertensive obese patients with normal (NGT) or impaired (IGT) glucose tolerance and left ventricular hypertrophy. METHODS--Ten patients (53 +/- 8 years), 8 women and 2 men, white, body mass index (BMI) > or = 26kg/m2, left ventricular mass index (LVMI) > 135g/m2 in man and > 110g/m2 in woman, with diastolic blood pressure (DBP) 95-115mmHg after 3 weeks of placebo, were identified by oral glucose tolerance test (OGTT-75g) as either with NGT or IGT, and treated with Cpt 25mg t.i.d. for 8 weeks. At the 8 weeks, dosage was increased to 50mg b.i.d. if DBP > 90mmHg or the decrease of the DBP < 10, during the next 8 weeks. OGTT and clonidine tests (0,04mg/kg) with determinations, every 30 minutes of glucose, insulin, and GH during 2 hours, were performed. RESULTS--Cpt lowered SBP and DBP in the NGT group and IGT group. The LVMI and the left ventricular mass (LVM) decreased in the IGT group with no significant change in the NGT group. Cpt promoted in the IGT group decrease in the area under the curve (AUC) of glucose, and AUC of insulin, with increase of the AUC of the percent of the beta cell function, AUC of HC, and insulin sensitivity index with no significantly change in the NGT group. CONCLUSION--Adults hypertensive obese patients with IGT had decreased significantly in mean fasting level of GH concentrations compared to age, race, and BMI matched hypertensive patients with NGT. Treatment with Cpt induced a significant increased of the GH, with improvement of the metabolism in patients with IGT.

Tratamento da hipertensão arterial leve e moderada com fosinopril: comparaçäo de efeitos adversos com outros anti-hipertensivos / Treatment of Mild-to-Moderate Hypertension with Fosinopril. Adverse Reactions Compared with other Antihypertensives

PURPOSE--To evaluate the adverse reactions of fosinopril with other antihypertensives used as monotherapy. METHODS--Out-patients (n = 2,568) with diagnostic of mild to moderate hypertension, diastolic blood pressure (DBP) 95-115mmHg, with no antihypertensive treatment for 15 days, were included to treatment initially with fosinopril (F) 10mg, once daily, for six weeks. After this period, patients with DBP > 95mmHg had the dosage, once daily, increased to 20mg, while the others were maintained with the same dosage for six more weeks. Adverse reactions of 822 patients treated as monotherapy were grouped as absent, musculoskeletal, cardiovascular, cough, gastrointestinal, neurological, genital-urinary dysfunctions and dermatological and compared with 1,568 with F. Monotherapy consist in alpha-methyldopa (100 patients); beta-blocker (129); calcium blocker (106); diuretic (394); and another ACE inhibitors (93). RESULTS--At the end of the period without treatment, the blood pressure (BP), 165 +/- 16/105 +/- 7mmHg decreased significantly at 6th week to 144 +/- 15/91 +/- 9mmHg (p < 0.05 vs week 0) with further lowering to 139 +/- 13/86 +/- 7mmHg till the end of 12th week. BP response (DBP < or = 90mmHg) was obtained in 89per cent of the patients with F. Absence of adverse reactions were > or = 70 per cent in patients with F compared to other drugs. CONCLUSION--Fosinopril has demonstrated therapeutic efficacy and less adverse reactions compared to antihypertensives used previously as monotherapy