Choque vasopléjico por envenenamiento con amlodipino y losartán

RESUMEN El choque vasodilatado o también llamado distributivo ocurre cuando las arteriolas presentan una pérdida de contractibilidad por diferentes mecanismos en donde la hipoxia y acidosis suelen ser los principales. La causa más común de este tipo de choque es la sepsis. Sin embargo, existen otras causas como las intoxicaciones con fármacos. Presentamos el manejo en la unidad de cuidados intensivos de un caso de intoxicación con fines de autoeliminación con dosis elevadas de antihipertensivos bloqueantes de canales calcio y antagonistas del receptor de angiotensina II, que requirió soporte hemodinámico y respiratorio.

ABSTRACT Vasodilated or also called distributive shock occurs when the arterioles present a loss of contractility due to different mechanisms in which hypoxia and acidosis are usually the main events. The most common cause of this type of shock is sepsis. However, there are other causes such as drug poisoning. We present the management in the intensive care unit of a case of poisoning for self-elimination purposes with high doses of antihypertensive calcium channel blockers and angiotensin II receptor antagonists, which required hemodynamic and respiratory support.

Effects of S-Amlodipine in the Management of Hypertension in Mongolian Patients

Objective: To evaluate the efficacy and safety of S-Amlodipine in patients suffering from hypertension. Materials and Methods: A multicenter, prospective, open-label, non-comparative, clinical trial was conducted on 364 patients with hypertension in Mongolia. All these patients were treated with S- Amlodipine 2.5 mg or 5 mg orally once daily for a duration of 8 weeks. Results: S-Amlodipine treatment resulted in a considerable drop in blood pressure from baseline. After 8 weeks of treatment, the mean systolic blood pressure had decreased by 12.06 mmHg and the mean diastolic blood pressure had decreased by 8.77 mmHg. Furthermore, both physicians and patients assessed the overall efficacy and rated it as good. Also, during the therapy period, 6 individuals (1.7%) experienced minor or slight adverse symptoms such as cough and headache. Conclusion: The current study confirms that treatment with S-Amlodipine was effective and well-tolerated in the management of hypertension.

Comparison of Microemulsion and Solvent Evaporation Technique for Solubility Enhancement of Amlodipine Besylate

@#Introduction: Amlodipine besylate is a calcium channel blocker indicated for hypertension and angina. It is described as slightly soluble in water and due to its limited solubility, it may result in poor bioavailability. The aim of this study is to enhance the solubility of amlodipine besylate using solvent evaporation method and microemulsion technique and to compare the two methods. Method: Solid dispersions (SD) of amlodipine besylate were developed by employing solvent evaporation method. PEG6000 was the polymer of choice and different drug:polymer ratios were used. Evaluation of the prepared SDs include solubility studies, dissolution studies and scanning electron microscopy (SEM). As for the microemulsion technique, microemulsions were prepared by phase titration method and the optimized microemulsion formulation was then characterized for solubility studies and dissolution studies. Results: SD3 with drug:polymer ratio of 1:4 achieved the highest solubility which was 96.97 mg/ml ± 0.92 whereas the solubility of the optimized microemulsion was found to be 112.54 mg/ml ± 0.92. In solvent evaporation method, as the drug:polymer ratio increases, the solubility and dissolution rate of SDs increases. Conclusion: The two methods had significantly enhance the solubility of amlodipine besylate however the microemulsion technique showed better solubility profile.

Survey on the Actual Condition of the Do-shoho Period of Antihypertensive Drugs for the Introduction of the Refill Prescription System in Japan / 社会薬学

The number of diagnosed hypertensive patients in Japan is estimated to be 9.93 million according to a 2017 patient survey, and the potential number of actual hypertensive patients is estimated to be 43 million. The purpose of the present study was to clarify the actual condition of the Do-shoho (refill of the previous prescription) period for antihypertensive drugs prescribed for a long duration, and to obtain basic data for considering the introduction of a refill system in Japan. Data were collected from the patient medication profile of patients who were prescribed amlodipine OD tablets (Chemiphar®) from July 2012 to December 2019, and the Mann-Whitney U test or Kruskal-Wallis test were performed with the Do-shoho period as the test variable. A generalized linear model was used to analyze the items for which significant differences were obtained. The results of the analysis showed that the factors affecting the duration of the Do-shoho were the prescribing source, diagnosis, and the maximum number of prescription days. Of the patients surveyed (N=321), 199 (62.0%) had a Do-shoho duration of 6 months or longer, which was more than half of the total number of patients. The results suggest that many patients may be eligible for the refill prescription system if pharmacists are able to properly assess the continuation of prescriptions.

Periodontal management of a patient with chronic kidney disease: a case report

The association between periodontal disease and chronic kidney disease (CKD) has been recognized over the years. Gingival overgrowth may be a side effect of some of the drugs prescribed for patients with CKD. Objective: The objective of this manuscript was to report the dental management of a patient with chronic renal disease who presented periodontitis and gingival overgrowth. Case report: A 55 years old male patient sought dental treatment, and was diagnosed with generalized periodontitis in advanced stage and gingival overgrowth. The overgrowth was associated to the use of amlodipine, a longacting calcium channel blocker. The treatment consisted of interruption of amlodipine, sessions of oral hygiene instruction and basic periodontal therapy. Thereafter, conventional periodontal therapy, with scaling and root planning of the four hemiarches, surgical periodontal therapy and gingivectomy of the overgrowth were performed. Considering periodontal sites with a probing depth (PD) > 4mm at baseline, mean PD was reduced (baseline: 5.94 ± 1.80; follow-up: 2.76 ± 1.38), as well as mean clinical attachment loss (baseline: 5.55 ± 1.51; followup: 4.52 ± 1.47). Periodontal disease was controlled and there was no recurrence of gingival overgrowth after 18 months of follow-up. Conclusion: The management of the reported patient with CKD and periodontal involvement included discontinuation of amlodipine, basic and advanced periodontal therapy and gingivectomy. Proper oral hygiene may help to prevent recurrence of the gingival overgrowth and to maintain periodontal health.

Introdução: A associação entre doença periodontal e doença renal crônica (DRC) tem sido reconhecida nos últimos anos. O crescimento gengival excessivo pode ser um efeito colateral de alguns medicamentos prescritos para pacientes com DRC. Objetivos: O objetivo deste estudo foi relatar o manejo odontológico de um paciente com DRC que apresentava periodontite e aumento gengival. Relato do caso: Um paciente do sexo masculino, 55 anos, procurou atendimento odontológico e foi diagnosticado com periodontite generalizada em estágio avançado e crescimento gengival associado ao uso de anlodipina, um bloqueador dos canais de cálcio de ação prolongada. O tratamento consistiu em interrupção da anlodipina, sessões de instruções de higiene bucal e terapia periodontal básica. Posteriormente, foi realizada terapia periodontal convencional, com raspagem e alisamento radicular dos quatro hemiarcos, seguida de cirurgia periodontal a retalho e gengivectomia. Considerando os sítios periodontais com profundidade de bolsa à sondagem (PBS) > 4mm no início do tratamento, a média de PBS foi reduzida (início: 5,94 ± 1,80; final: 2,76 ± 1,38), bem como a média do nível clínico de inserção (início: 5,55 ± 1,51; final: 4,52 ± 1,47). A doença periodontal foi controlada e não houve recorrência do crescimento gengival após 18 meses de acompanhamento. Conclusão: O tratamento odontológico deste paciente com DRC e envolvimento periodontal incluiu a interrupção da anlodipina, terapia periodontal básica e avançada e gengivectomia. A higiene bucal adequada pode ajudar a prevenir a recorrência do crescimento gengival excessivo e a manutenção de um estado periodontal saudável.

Serie de Casos: Intoxicación por Amlodipino / Case Series: Amlodipine Intoxication

Resumen INTRODUCCIÓN: La intoxicación por distintas drogas es una importante causa de morbimortalidad en la edad pediátrica. No obstante, la intoxicación por amlodipino, que es un fármaco dihidropiridinico del grupo de calcioantagonistas ampliamente usado, no se encuentra bien documentada en Ecuador. El tratamiento se basa en implementar medidas para el shock clásico, en conjunto con medidas específicas para este tipo de intoxicación. CASOS CLÍNICOS: Presentamos dos reportes de casos clínicos de pacientes adolescentes ingresadas en unidad de cuidados intensivos pediátricos (UCIP), por intento autolítico mediante ingesta de amlodipino en conjunto con otros fármacos. EVOLUCIÓN: Durante su estancia hospitalaria presentaron cuadros evolutivos distintos. En ambos casos se necesitó manejo con drogas vasoactivas, modificando su dosis de acuerdo a respuesta clínica. En los dos casos se administró gluconato de calcio por horario y otras medidas de soporte descritas en el presente manuscrito. Finalmente, las dos pacientes presentaron buena evolución y fueron dadas de alta, con previa valoración y seguimiento de psicología y psiquiatría. CONCLUSIÓN: La intoxicación por amlodipino ha sido descrita escasamente debido a su baja frecuencia, a esto se añade el poco conocimiento basado en evidencia; motivos que la constituyen como un reto diagnóstico y terapéutico. Destacamos, en base a nuestra experiencia, la importancia de un alto índice de sospecha y de priorizar el inicio de vasopresores sobre la reanimación hídrica. Adicionalmente, recomendamos documentar la dosis exacta de ingesta e indagar sobre el consumo de otros fármacos para clasificar adecuadamente la gravedad de la intoxicación y establecer un plan de tratamiento. Finalmente, la monitorización y evaluación clínica constante y el apoyo de exámenes de laboratorio guiarán la conducta.(au)

BACKGROUND: Drug poisoning is an important cause of morbidity and mortality in pediatric patients. However, amlodipine poisoning, a widely used dihydropyridine calcium chanel blocker, is not fully documented in Ecuador. Treatment consists of classic measures for shock management and specific measures for this type of intoxication. CASE REPORTS: We present two case reports, both of teenage patients admitted into the pediatric intensive care unit for suicide attempt by taking amlodipine and some other drugs. EVOLUTION: During hospital stay, they presented a different evolutionary course. In both cases vasoactive drugs were needed, dosage was modified according to clinical course. Also in both patients, calcium gluconate was administered along with other support measures described in this paper. Finally, both patients presented a good outcome and were discharged after psychological and psychiatric assessment and follow up. CONCLUSION: The low frequency of amlodipine poisoning and the lack of evidence-based knowledge, constitute it as a diagnostic and therapeutic challenge. Based on our experience, we highlight the importance of early suspicion and prioritizing the use of vasopressors over fluid resuscitation. Additionally, we recommend documenting the exact dose of intake and inquiring about consumption of other drugs to properly classify the severity of the poisoning and stablish the treatment plan. Finally, constant clinical monitoring and support of laboratory tests will guide the conduct.(au)

Prescribing Trends of Amlodipine in Outpatient Setting

Aim: This study aims to illustrate the Prescribing Trendsof Amlodipine in Outpatient Setting in Al-Kharj city.Methodology:This is a retrospective study that was conducted in a public hospital in Alkharjcity. The outpatient prescriptions were reviewed to evaluate the prescription patternsof Amlodipine. The data were collected and analyzed using Excel software, the descriptive data were represented by frequencies and percentages. Results:The majority of amlodipine prescriptions were for patients more than 40 years old.The most prescribed departments were internal medicine followed by emergency and cardiology department. Amlodipine was mainly prescribed by resident physicians.Conclusion:Amlodipine is one of the most prescribed antihypertensivedrugs. It is prescribed mainly by residents, many of them without sufficient experiences. This may lead to inappropriate prescribing patterns, as a result more efforts needed to increase the knowledge of prescribers regarding the appropriate use of cardiovascular medicines including amlodipine

Pattern of use of anti-hypertensive drugs amongst hypertensive patients in a tertiary care hospital: a cross sectional, observational study

Background: Hypertension is one of the primary modifiable risk factors for cardiac and renal diseases and is the single most important risk factor for stroke. Despite different guidelines for management of hypertension like Joint National Committee, British Hypertension Society, National Institute for Health and Care Excellence; there are still the clouds of controversy. The objective of the study was to evaluate the prescribing pattern of antihypertensive drugs among the patients attending medicine outpatient department of a tertiary care teaching hospitalMethods: A cross-sectional, observational study was conducted in our hospital over a period of six months. Relevant information was collected from medical records of 209 hypertensive patients fulfilling inclusion criteria. The collected data were sorted and analyzed.Results: Out of 209 patients, maximum were of age group of 45-65 years (55.02%). 115 (55.02%) were male and 94 (44.97%) were female. Diabetes mellitus (24.4%) was the most common associated disease with hypertension. Most of the patients had received single antihypertensive drugs (49.28%). Among the monotherapy category calcium channel blocker (82.78%) was the most commonly prescribed antihypertensive drug class followed by angiotensin receptor blocker (36.36%). Amlodipine (81.82%) was the most common among calcium channel blockers. The most frequent fixed drug combination prescribed consisted of amlodipine and atenolol. Most of the drugs were prescribed in generic name (90.9%).Conclusions: The treatment pattern, in general, conformed to standard treatment guidelines.

Chiral discrimination of amlodipine from pharmaceutical products using capillary electrophoresis

The present work describes the development of a capillary electrophoresis (CE) method for the chiral discrimination of amlodipine (AML) enantiomers using cyclodextrine (CD) derivatives as chiral selectors. A large number of native and derivatized, neutral and ionized CD derivatives were screened to find the optimal chiral selector; and carboximethyl-β-CD (CM-β-CD) was selected for the enantiomeric discrimination. A factorial analysis study was performed by orthogonal experimental design in which several factors were varied at the same time to optimize the separation method. The optimized method (25 mM phosphate buffer, pH = 9.0, 15 mM CM-β-CD, 15 ºC, + 25 kV, 30 mbar/1 second, detection wavelength 230 nm) was successfully applied for the baseline separation of AML enantiomers within 5 minutes. Successful validation and application of the proposed CE method suggest its routine use in enantioselective control of AML in pharmaceutical preparations.

Evaluation of losartan plus hydrochlorothiazide combination therapy against amlodipine monotherapy in patients of hypertension

Background: Microalbuminuria has been shown to predict cardiovascular disease (CVD) in patients with hypertension. Recently the FDC of losartan and hydrochlorothiazide (HCTZ) has been reported to be effective for achieving a target BP level and also improvement in cardiovascular prognosis. The present study was conducted to compare effect of losartan plus hydrochlorothiazide combination therapy and high dose amlodipine monotherapy on blood pressure and microalbuminuria.Methods: Total 184 patients with hypertension were randomly allocated to two groups. The patients in group 1 received Amlodipine 5 mg orally for first 4 weeks. The patients from group 2 received losartan 50 mg orally for first 4 weeks. Patients in group 1 were titrated to amlodipine 10 mg orally for next 4 weeks. The patients in group 2 were titrated to FDC of losartan (50 mg) plus HCTZ (12.5 mg) for next 4 weeks. Follow杣p visits were scheduled at 4 weeks and 8 weeks. Pulse rate, sSBP and sDBP were estimated at each follow杣p. Microalbuminuria was estimated at 8 weeks.Results: There was no significant difference in mean change in sSBP, sDBP and pulse rate between two treatment groups (p>0.05). There was greater reduction in microalbuminuria in group 2 patients (p<0.0001). The adverse effects such as flushing and lower extremity oedema were significantly more in amlodipine group (p<0.05).Conclusions: Losartan plus HCTZ has similar effect on BP, better safety profile and superior effect on microalbuminuria level reduction.

Validation of methodology for assay, pharmaceutical equivalence, and comparative dissolution profile for tablets containing amlodipine besylate

The amlodipine besylate is indicated as a first choice in the treatment of hypertension. Many similar and generic drugproducts companies were able to bring out to the market dosage forms containing amlodipine besylate with lowerprices. In this context, the aim of this work was to validate a simple method for the determination of amlodipinecontent in tablets by ultraviolet spectrophotometry and to perform pharmaceutical equivalence and dissolution profilestudies for three similar and one generic drug products and their respective innovator tablet containing amlodipine(5 mg). The developed method for the determination of amlodipine content proved to be linear, precise, accurate,robust, and appropriate for employment in the quality control of tablets containing amlodipine besylate. The reference(R), similar (S1, S2, and S3), and generic (G) drug products all fulfilled the specifications for the tests of identification,average weight, hardness, friability, disintegration, drug content, content uniformity, and dissolution. However, incomparative dissolution profile studies, the dissolution efficiency of products G and S2 was statistically different fromproduct R, which may indirectly lead to the unsuitable bioavailability and therapeutic inefficacy. Thus, there is a needfor tighter legislation and inspection regarding the quality of pharmaceutical products already on the market.

A study on drug utilization pattern of antihypertensive drugs in hypertensive diabetic patients

Background: Hypertension management is of paramount importance in diabetic patients for reduction of cardiovascular and other complications. The objective of the present study was to assess prescribing pattern of antihypertensive drugs in hypertensive type 2 diabetic patients and evaluate them by comparing with Eighth Joint National Committee (JNC-8) hypertension treatment guidelines.Methods: A prospective observational study was carried out on 110 hypertensive type 2 diabetic patients of age 41-80 years visiting outpatient department of Medicine at G.S. Medical College and Hospital, UP, India for 4 months. JNC-8 hypertension management guideline was considered while evaluating the prescribed drugs. All the relevant data was collected from the prescription card of the patient on a preformed performa and analyzed using descriptive statistics.Results: Total of 176 drugs was prescribed to the study patients among which two drug combination therapy (55.45%) was mostly used. The most common group prescribed was angiotensin receptor blocker (ARB) (29.45%) and ARB+CCB (calcium channel blockers) (34.92%) were the commonest fixed drug combination. Overall, it was amlodipine (21.47%) that was most frequently prescribed among all antihypertensive drugs.Conclusions: ARB was the most commonest class, ARB+CCB was the most frequent fixed drug combination prescribed to the study patient while amlodipine was the highly utilized individual antihypertensive drug in the study. Prescriptions evaluation revealed that 94.88% prescription were rational and were in accordance with the JNC-8 hypertension treatment guidelines except the use of beta blockers (5.12%).

Development And Validation Of Analytical Method For Quantification Of Acetic Acid Content In Amlodipine Besylate

Objective: To develop and validate a simple and accurate cost-effective titrimetric method according to International Conference Harmonization (ICH) guidelines for acetic acid content in Amlodipine Besylate. Methods: The titration based on general acid-base reaction to form water and salt. Sodium hydroxide act as a strong base and titrated against weak acid (acetic acid). Phenolphthalein used as an indicator and colorless to pink is the endpoint. Sodium hydroxide is standardized with primary standard potassium hydrogen phthalate. Results: The method was linear in the range of 0.75 to 30.25 μg/ml with a correlation coefficient 0.9999. Limit of detection (LOD) and limit of quantitation (LOQ) value were found to be 0.61 and 1.85 μg/ml, respectively. The percentage recovery (98.20–99.97%) and percentage relative standard deviation (%RSD) is less than 2% within the acceptable limit of ICH guidelines. The robustness and ruggedness results were excellent. Method is accurate and precise, no interference from excipients. Conclusion: A new analytical titrimetric method was developed and validated as per ICH guidelines for the determination of acetic acid content in amlodipine. This proposed method applied for routine analysis of acetic acid content in bulk and pharmaceutical formulations of amlodipine besylate.

Agrandamiento gingival generalizado en un paciente con trasplante renal / Generalized gingival enlargement in a patient with renal transplant

Introducción: El agrandamiento gingival es el aumento exagerado y desfigurante del volumen de la encía. Su aparición se asocia a fármacos, entre los que se encuentran los inmunosupresores y los bloqueadores de los canales de calcio como la ciclosporina A y amlodipino. Objetivo: Describir un caso clínico de agrandamiento gingival asociado a ciclosporina A y amlodipino, con periodontitis crónica subyacente, su tratamiento y prevención de recidiva. Presentación del caso: Paciente masculino, de 50 años de edad, antecedentes de hipertensión arterial, asma bronquial y hepatitis C, además de presentar insuficiencia renal crónica para la cual se le realizó un trasplante renal. Recibe tratamiento con ciclosporina A y amlodipino. Al examen clínico se observaron aumento de volumen generalizado en la encía, que cubría completamente la corona de los dientes, bolsas periodontales de 5 a 8 mm, sangramiento gingival y movilidad dentaria. Principales comentarios: El proceso diagnóstico permitió comprobar que además del agrandamiento gingival generalizado existía una periodontitis crónica generalizada. Conclusiones: La ingestión de un inmunosupresor como la ciclosporina A con el uso de un bloqueador de los canales de calcio, el amlodipino, y la influencia de factores de connotación local, parecen ser los responsables de la aparición combinada del agrandamiento gingival generalizado y la periodontitis crónica concomitante. La fase higiénica contribuyó considerablemente a mejorar el estado periodontal, cuya solución definitiva se alcanzó con la cirugía periodontal convencional. Se corrobora la importancia del examen periodontal en pacientes candidatos a trasplantes de órganos(AU)

Introduction: Gingival enlargement is an exaggerated and disfiguring increase in gum volume, associating its appearance with drugs like immunosuppressants and calcium channel's blockers such as cyclosporine A and Amlodipine. Objective: To describe a clinical case of gingival enlargement associated to cyclosporine A and amlodipine, presenting chronic underlying periodontitis, its treatment and prevention in case of recurrence. Case Presentation: Male patient, 50 years old with a history of arterial hypertension, bronchial asthma and hepatitis C, and presenting chronic renal failure leading renal transplant. The patient was treated with cyclosporine A and amlodipine. In the clinical examination was observed an increased volume in the gum, which completely covered the crown of the teeth, also periodontal bags of 5 to 8 mm, gingival bleeding and dental mobility. Main Comments: The diagnostic process allowed to verify that in addition to the generalized gingival enlargement there was a generalized chronic periodontitis. Conclusions: The ingestion of an immunosuppressant such as Cyclosporin A with the use of a calcium channel's blocker, amlodipine, and the influence of local connotation factors seem to be responsible for the combined appearance of generalized gingival enlargement and concomitant chronic periodontitis. The hygienic phase contributed considerably to improve the periodontal state, whose definitive solution was achieved with conventional periodontal surgery. The importance of periodontal examination in patients who are candidates for organ transplants is corroborated(AU)

Separation And Analysis Of Amlodipine/Benazepril Combination In Capsules By A Novel Ion Pair Liquid Chromatography

Objective: The objective of this study was to develop and validate a novel ion-pair liquid chromatography method, in order to separate and assay of amlodipine/benazepril combination in capsules. This method was a fast, practical and additional choice in quality control laboratories. Methods: The chromatographic conditions comprised of a classical C18-type stationary phase (250 × 4.6 mm, 5μ), with a mobile phase consisting of: 45% of 10-3 M of cetrimide and 55% acetonitrile. The flow rate was 1 ml/min; the detection wavelength was at 242 nm, under ambient temperature. Results: The method was validated for linearity with correlation coefficients very close to one, the accuracy with mean recovery values between 95.0-105.0%, precision with relative standard deviations of the calculated concentrations less than 5.0% and specificity in the presence of degradation products and excipients. Conclusion: The results presented in this paper showed that the developed method was fast and applicable, for the separation and determination of amlodipine/benazepril combination in capsules.

Comparative study of anti-inflammatory property of calcium channel blocker and aspirin in albino rats

Background: Calcium channel blockers are being used in the treatment of hypertension, ischemic heart disease, cardiac arrhythmias etc. They act by blocking the slow calcium channels. Influx of calcium is an essential step in the release of histamine and 5HT from mast cells and in the synthesis and release of prostaglandins. They are the main mediators in the process of inflammation. The aim of the present study was to compare anti-inflammatory properties of calcium channel blockers and aspirin in albino rats.Methods: Present study was prospective intervention study carried out to compare anti-inflammatory properties of calcium channel blockers and aspirin in albino rats. Total 30 albino rats were used, and they were divided into 5 groups of 6 each. First group of rats was control group where normal saline was used. Second group was standard group where aspirin was used. Remaining three groups were test groups and given nifedipine, amlodipine and diltiazem respectively. Effects were observed and compared between the groups.Results: In carrageenan method, the anti-inflammatory response of Aspirin was significantly higher. Nifedipine response was <aspirin but >diltiazem. The response of amlodipine was not significantly > that of control percent inhibition. In histamine method, the anti-inflammatory response of aspirin was significantly highest. Anti-inflammatory response of nifedipine was < aspirin but > diltiazem. Diltiazem response was < nifedipine but > amlodipine. In formaldehyde method, aspirin inhibition was highest at 96.2% followed by nifedipine (90.7%), diltiazem (75.9%) and amlodipine (3.7%). In cotton wool pellet granuloma, the mean dry granuloma weight was least for aspirin and percent anti-inflammatory activity was significantly high.Conclusions: Calcium channel blockers (nifedipine, diltiazem) have shown comparable anti-inflammatory property with that of aspirin. Further clinical studies are required for confirmation.

Circulating microparticles and central blood pressure according to antihypertensive strategy

OBJECTIVES: This prospective, randomized, open-label study aimed to compare the effects of antihypertensive treatment based on amlodipine or hydrochlorothiazide on the circulating microparticles and central blood pressure values of hypertensive patients. METHODS: The effects of treatments on circulating microparticles were assessed during monotherapy and after the consecutive addition of valsartan and rosuvastatin followed by the withdrawal of rosuvastatin. Each treatment period lasted for 30 days. Central blood pressure and pulse wave velocity were measured at the end of each period. Endothelial, monocyte, and platelet circulating microparticles were determined by flow cytometry. Central blood pressure values and pulse wave velocity were recorded at the end of each treatment period. RESULTS: No differences in brachial blood pressure were observed between the treatment groups throughout the study. Although similar central blood pressure values were observed during monotherapy, lower systolic and diastolic central blood pressure values and early and late blood pressure peaks were observed in the amlodipine arm after the addition of valsartan alone or combined with rosuvastatin. Hydrochlorothiazide-based therapy was associated with a lower number of endothelial microparticles throughout the study, whereas a higher number of platelet microparticles was observed after rosuvastatin withdrawal in the amlodipine arm. CONCLUSIONS: Despite similar brachial blood pressure values between groups throughout the study, exposure to amlodipine was associated with lower central blood pressure values after combination with valsartan, indicating a beneficial interaction. Differences between circulating microparticles were modest and were mainly influenced by rosuvastatin withdrawal in the amlodipine arm.

Influence of rifampin in effectiveness of antihypertensive drugs in patients with hypertension: A case report and literature review / 吉林大学学报(医学版)

Objective: To discuss the diagnosis and treatment process of abnormally elevated blood pressure in the patient treated with rifampicin and antihypertensive drugs, to analyze the interaction between rifampicin and antihypertensive drugs, and to improve the clinicians' understanding of the administration in the patients. Methods: The clinical materials of a patient treated with rifampicin and antihypertensive drugs were collected, and the relationship between the blood pressure change and drug was analyzed. The changes of concentrations of dihydropyridine-based calcium antagonists after administration of rifampin were observed and the relative literatures were reviewed. Results: A 58-year-old man with coughing and coughing for 1 month was admitted to hospital. The patient was definitely diagnosed as tuberculosis and hypertension before admission; the patient was treated with rifampicin, isoniazid, ethambutol, pyrazinamide, and felodipine together. The original treatment plan was continued and the blood pressure of the patient was monitored. On the 9th day of anti-tuberculosis treatment, the patient developed dizziness, chest tightness, and severe fluctuations in blood pressure. Then rifampicin was stopped and antihypertensive drugs were adjusted. At the beginning of blood pressure fluctuation of the patient, the combination of angiotensin-converting enzyme inhibitors and the increasing dose of dihydropyridine-based calcium antagonists did not control the blood pressure. The blood pressure began to decrease significantly at 36 h after rifampin was stopped. On the 18th day of anti-tuberculosis treatment, the original antihypertensive plan was restored and the blood pressure remained stable. Conclusion: Rifampicin can sometimes significantly reduce the effect iveness of antihypertensive drugs (such as dihydropyridine calcium antagonists), and the clinicians should pay attention to it.

Therapeutic effect of amlodipine atorvastatin calcium tablet on hypertensive patients and its influence on blood pressure and blood lipids / 心血管康复医学杂志

Objective :To explore therapeutic effect of amlodipine atorvastatin calcium tablet on hypertensive pa-tients .Methods : A total of 112 hypertensive patients treated in our hospital were randomly and equally divided into amlodipine group (received amlodipine 5mg／d) and amlodipine atorvastatin group (received amlodipine atorvastatin calcium tablet 15mg／d) ,both groups were treated for eight weeks .Therapeutic effect and incidence of adverse reac- tions ,blood pressure and blood lipids before and after treatment were compared between two groups .Results : Com-pared with before treatment ,there were significant reduction in levels of blood pressure and blood lipids (except sig-nificant rise in HDL-C level) in two groups after treatment , P＜0-05 or ＜0-01 ;compared with amlodipine group , there was significant rise in total effective rate (62-5% vs.96-4%, P＝0-001) ,and significant reduction in inci-dence rate of adverse reactions (28-5% vs.3-5%) , P＝ 0-003 ;significant reductions in levels of blood pressure [ (147-5 ± 10-1)／(90-7 ± 8-2) mmHg vs.(133-2 ± 9-4)／(86-9 ± 8-2) mmHg] ,total cholesterol [ (5-7 ± 1-3) mmol／L vs .(5-2 ± 0-8) mmol／L] ,triglyceride [(2-5 ± 1-2) mmol／L vs.(1-9 ± 0-5) mmol／L] and low density lip-oprotein cholesterol [ (4-1 ± 0-7) mmol／L vs.(3-1 ± 0-6) mmol／L] in amlodipine atorvastatin group , P＜0-05 or＜0-01- Conclusion : Amlodipine atorvastatin calcium tablet can significantly improve blood pressure and blood lipids with few adverse reactions in hypertensive patients ,which is worth extending .

Influence of benidipine on blood pressure ,left ventricular hypertrophy ,UACR and baPWV in patients with morning hypertension / 心血管康复医学杂志

Objective :To explore influence of benidipine on blood pressure ,left ventricular hypertrophy (LVH) ,u—rine microalbuminuria／creatinine ratio (UACR ) and brachial—ankle pulse wave velocity (baPWV ) in patients with morning hypertension (MH).Methods : A total of 142 patients with essential hypertension treated in our department were randomly and equally divided into benidipine group and amlodipine group .The 24h ambulatory blood pressure (24hABP) before and two months after treatment ,ultrasonography ,urine microalbumin (UMA ) and creatinine (Ucr) and baPWV before and six months after treatment were measured in two groups ,and UACR was calculated . Results : Compared with before treatment , there were significant reduction in blood pressure in two groups after treatment ( P＝0.001 all) ,but there were no significant difference in blood pressure between two groups after treat—ment , P＞0. 05 all .Compared with amlodipine group after treatment ,there were significant rise in total effective rates of MH (56.06% vs .74.24%) and daytime blood pressure (62.12% vs.78.79%) in benidipine group , P＜0.05 both .Compared with before treatment , after treatment , there was significant reduction in UACR in two groups ( P＝0. 001 both) ,but there were no significant difference in UCG indexes and baPWV , P＞0.05 all.Com—pared with amlodipine group after treatment ,there was significant reduction in UACR [ (18.25 ± 1.53) μg／mg vs. (16.54 ± 1.42) μg／mg , P＝0.001] in benidipine group ,there were no significant difference in UCG indexes and baPWV between two groups ,P＞0.05 all.Conclusion : Both amlodipine and benidipine can effectively control blood pressure ;and benidipine possesses more significant therapeutic effect on total effective rates and UACR .