A Randomized, Double-Blind Clinical Trial to Determine the Efficacy of Imidapril vs. Enalapril in Patients with Stage 1 to 2 Essential Hypertension

BACKGROUND: Imidapril is a long-acting angiotensin converting enzyme inhibitor, which has been demons-trated to be effective in reducing blood pressure. The purpose of this study is to compare the antihypertensive efficacy, safety and tolerability of imidapril and enalapril in patients with stage 1 to 2 essential hypertension. METHODS: In this double-blind, double-dummy, randomized, parallel study, the efficacy, safety and tolerability of once-daily imidapril versus once-daily enalapril were evaluated in 84 patients with stage 1 - 2 hypertension during 8 weeks. If antihypertensive response was insufficient after 4 week treatment period, the dosage for both study drugs doubled until the end of study. RESULTS: Data from 84 patients who completed the study were eligible for per-protocol analysis. An adequate antihypertensive effect was observed in 47.6% (20/42) in the imidapril group and in 23.8% (10/42) in enalapril group. There was statistically significant difference between the two treatments in the percentage of patients achieving a "reduced blood pressure". The pulse rate did not changed in both groups. Safety profiles were similar between treatments. CONCLUSION: In patients with mild to moderate hypertension, the imidapril group showed better response with regard to antihypertensive effect. Both imidapril and enalapril were well tolerated with similar safety profiles.

The risk factors of blood pressure in primary hypertension patients / 성인간호학회지

The purpose of this study was to investigate the relation between hypertension and risk factors. A positive association between obesity, age, serum lipid and such life style factors as smoking, exercise, alcoholic beverage use with blood pressure problems and the prevalence of hypertension has been described in many studies. Therefore to identify and evaluate the effects of variables, which were known to be related to hypertension, multiple regression analysis was performed. We studied 110 subjects. The participants were 45 men and 65 women who visited one university hospital located in Seoul from January to December 1998. All 110 persons were identified as having primary hypertension by their physicians. The significant risk factors identified for hypertension were Obesity, BMI, length of time with hypertension. The results were as follows; 1. The systolic blood pressure average in 110 subjects was 156.65mmHg +/- 14.08mmHg, the diastolic blood pressure average was 100.73mmHg +/- 5.64mmHg. 18.2% of the subjects were smokers, 26.4% of the subjects were drinkers, and 33.6% of the subjects exercised regularly. 13.6% had a family history of hypertension. The average mean pressure was 119.37 +/- 7.40mmHg. The average history of hypertension was 28.36 +/- 34.56months. The average body weight of subjective was 65.25kg, and their average BMI was 24.54kg/m2. The average serum cholesterol of the subjects was 204.54mg/dl, HDL was 50.93mg/dl. 2. The result of this study were that variables which showed significance rationale for high systolic blood pressure in hypertension were mean arterial pressure(R2=0.808), and age(R2=0.032). And the variables which showed significance rationale for diastolic blood pressure in hypertension were mean arterial pressure(R2=0.697), age(R2=0.051), sex(R2=0.014), and somking(R2=0.010). And the best variable for prediction of mean blood pressure was the length of history of the disease. 3. According to multiple regression analysis by demographic variables, age and the length of history of hypertension were predictable variables for hypertension. And mean the blood pressure was identified best explaining variable of hypertension by biophysical variables. Therefore, life style modification for hypertension patients as a primary regimen is less important than for normal blood pressure patients. Life style modification is important intervention for normal blood pressure subjects, on the other hand drug therapy and its compliance is the most important intervention for hypertensive subjects. So to regulate blood pressure and prevent the complication of hypertension, the first regime of all should pharmacologic therapy. There is a need to develop nursing intervention to improve pharmacologic compliance for primary hypertension patients.

A Randomized, Double-Blind Clinical Trial to Determine the Efficacy of Carvedilol vs. Atenolol in Patients with Stage 1 to 2 Essential Hypertension

BACKGROUND: Carvedilol, an antihypertensive agent with beta-blocking and vasodilating pro-perties, has been demonstrated to be effective in reducing blood pressure. The purpose of this study is to compare the antihypertensive efficacy, safety and tolerability of carvedilol and atenolol in patients with stage 1 to 2 essential hypertension. METHODS: In this double-blind, double-dummy, randomized, parallel study, the efficacy, safety and tolerability of once-daily carvedilol versus once-daily atenolol were evaluated in 58 patients for 8 weeks with stage 1-2 hypertension. If mean peak sitting diastolic blood pressure was equal to or greater than 90mmHg after a 4 week treatment period, the dosage for both study drugs were doubled until the end of study. RESULTS: Data from 58 of 73 patients who completed the study were eligible for per-protocol analysis. At 4 weeks post treatment commencement, mean reductions in peak sitting diastolic blood pressure were 13.9mmHg (95% confidence interval 17.1-11.4) with 25mg carvedilol and 13.6mmHg (95% confidence interval 16.8-10.3) with 50mg atenolol. After the 8 week treatment period with dose titration, mean reductions in peak sitting diastolic blood pressure were 14.7mmHg (95% confidence interval 17.8-11.6) with 50mg carvedilol and 13.6mmHg (95% confidence interval 17.3-9.9) with 100mg atenolol. There were no statistically significant differences between the two treatments in the percentage of patients achieving a normalized blood pressure or in the degree of change in mean peak sitting diastolic blood pressure. Safety profiles were similar between treatments. One patient withdrew due to severe bradycardia development during the second week of treatment with atenolol. CONCLUSION: In patients with mild to moderate hypertension, there were no significant differences between the efficacy of carvedilol or atenolol with regard to antihypertensive effect. Both carvedilol and atenolol were well tolerated with similar safety profiles.

The Antihypertensive Efficacy, Safety, and Tolerability of Losartan Versus Fosinopril in Patients with Hypertension

BACKGROUND: Losartan potassium, an orally active, highly selective AT (1) angiotensin II receptor inhibitor, effectively reduces blood pressure by directly blocking receptors. The purpose of this study is to compare the antihypertensive efficacy, safety and tolerability of losartan potassium and fosinopril in patients with stage 1 to 3 hypertnesion. METHODS: In this comparative, open labelled, randomized, parallel study, the efficacy, safety and tolerability of once-daily losartan (50mg) versus once-daily fosinopril (10mg) were evaluated over twelve weeks in 96 patients with stage 1-3 hypertension. If trough sitting diastolic blood pressure was equal to or greater than 90mmHg after a 6 week treatment period, the dosage for both study drugs was doubled until the end of the study (week 12). RESULTS: After 6 weeks of treatment, mean reductions in trough sitting diastolic blood pressure were 7.4mmHg (95% confidence interval 5.0-9.9) with 50mg losartan and 6.7mmHg (95% confidence interval 4.4-9.2)with 10mg fosinopril. After 12 weeks of treatment (after dose titration), mean reductions in trough sitting diastolic blood pressure were 9.4mmHg (95% confidence interval 6.7-12.1) with losartan and 10.3mmHg (95% confidence interval 7.6-12.9) with fosinopril. At weeks 6 and 12, there were no dignificant difference in the mean reduction of through ditting diastolic blood pressure between the losartan group and the fosinopril group. Losartan and fosinopril were well tolerated without significant clinical and laboratory adverse reactions. The incidence of dry cough was lower in the losartan group than in the fosinopril group but not statistically significant. CONCLUSIONS: The antihypertensive effect of once-daily administration of losartan is similar to that of once-daily administration of fosinopril in patients with hypertension. Both losartan and fosinopril are well tolerated without significant adverse reaction.