A comparison of four primary classes of antihypertensive monotherapy in Thai patients.

Efficacy of four primary classes of antihypertensive agents (diuretics, angiotensin converting enzyme inhibitors, calcium antagonists, adrenergic inhibiting drugs) were compared by using a crossectional medical record survey between July 1997 and January 1998. Only hypertensive cases with initial monotherapy were studied. The evaluations were 1) blood pressure response after drug titration and 2) blood pressure response during the maintenance phase. Two hundred and eighty nine patients were studied. After dose titration, the mean reduction in systolic blood pressure with calcium antagonists (33 +/- 24 mmHg, mean +/- SD) was better than other drugs (p < 0.05) while there was no difference in the other three drug classes in systolic blood pressure reduction. The mean reduction in diastolic blood pressure with calcium antagonists (17 +/- 9 mmHg) was better than angiotensin converting enzyme inhibitors (13 +/- 9, p = 0.02) but without significant difference compared to the other two drug classes. There was no difference in diastolic blood pressure reduction from diuretics, angiotensin converting enzyme inhibitors and adrenergic inhibiting drugs. In the maintenance phase, the response rate for calcium antagonists (82.6%) was better than angiotensin converting enzyme inhibitors (54.2%, p = 0.004) but was not better than the other two drug classes. Response rates for diuretics, angiotensin converting enzyme inhibitors and adrenergic inhibiting drugs were not statistically different.

Intravenous nicardipine for the treatment of severe hypertension. A dose-titration infusion to therapeutic response.

Intravenous nicardipine titration, starting with 10 mg/hr and increased slowly every 4 minutes by the rate 1 mg/hr until target supine DBP of 90 mmHg was achieved, was a very effective and safe method for patients with very severe hypertension. All patients had their BP under good control with few adverse effects. Although the heart rate rose significantly there were only four cases with palpitation and one case with chest pain which spontaneously recovered without sequele.

Efficacy and acceptability of perindopril in essential hypertension.

The clinical efficacy and acceptability of once-daily perindopril (4 to 8 mg) monotherapy and in combination with hydrochlorothiazide (50 mg/day) was studied in mild to moderate stable essential hypertensive patients in 4 centres in Thailand. After 2-4 weeks of placebo run-in period, patients received active treatment for 3 months starting with 4 mg perindopril once daily. Dose titration was at second and third month of active treatment if the supine DBP was > 90 mmHg. The dose was doubled and if necessary, 50 mg/day hydrochlorothiazide was added in the last month. The results in 95 patients showed that the mean reduction in supine SBP/DBP at 1, 2 and 3 months of treatment was 10.3/8.0, 13.2/8.7 and 19.1/13.7 mmHg respectively. At the end of the study, 80 per cent of the patients showed normalisation of the supine diastolic blood pressure (supine DBP < or = 90 mmHg) with 30 per cent receiving combined therapy of perindopril and hydrochlorothiazide. There was no significant change in routine haematology or serum biochemistry except for slight increase of potassium levels in patients receiving 8 mg perindopril monotherapy. The incidence of side effects and withdrawal from treatment were quite low. Cough was the major side effect reported comprising 13.6 per cent with only 1 case withdrawn. The study confirms the previous studies that perindopril had satisfactory antihypertensive efficacy and acceptability profiles.