Efficacy and safety of sildenafil in Asian males with erectile dysfunction and cardiovascular risk.

OBJECTIVE: Assess the effectiveness of sildenafil in Asian males with erectile dysfunction (ED) and one or more of the co-morbidities, mild-to-moderate hypertension, dyslipidemia, and diabetes. MATERIAL AND METHOD: A six-week, double-blind, randomized, placebo-controlled, multicenter study was carried out in Thailand, Malaysia and Singapore. One hundred and fifty five male subjects were randomized (2:1) to sildenafil (n = 104) or placebo (n = 51). Sildenafil was started at 50 mg and increased (100 mg) or decreased (25 mg) at week 2 if necessary. RESULTS: On the primary efficacy endpoint, sildenafil-treated subjects had significantly better scores on the International Index of Erectile Function (IIEF) questions 3 and 4 than placebo (p < 0.001, both questions). When accumulated into IIEF domains, all five domains were significant in favor of sildenafil. In addition, sildenafil-treated subjects were more satisfied with treatment and had a higher intercourse success rate. The majority of adverse events were mild in severity; the most commonly reported treatment-related events were dizziness (7.7%) and tinnitus (2.9%). CONCLUSION: Sildenafil (25, 50, and 100 mg) was found to be an effective, safe, and well-tolerated treatment for ED in the present study population of Thai, Malaysian, and Singaporean males who also had increased cardiovascular risk

The Atorvastatin Goal Achievement Across Risk Levels: (ATGOAL) study in Thailand.

OBJECTIVE: To evaluate the efficacy and safety of atorvastatin at the starting doses of 10, 20, 40 mg and evaluate the effectiveness of 1 step titrate up regimen. MATERIAL AND METHOD: Two hundred and forty two subjects with dyslipidemia were enrolled and assigned the appropriate dose in relation to their individual cardiovascular risk status and baseline LDL-C levels. If the NCEP targets were not achieved, the doses were titrated up at week 4 and the primary efficacy was evaluated at week 8. RESULTS: A majority of subjects (88.8%) achieved their LDL-C goals at week 8. Almost all of the subject's LDL-C levels reached their goals by week 2 and 4 (81.6% and 87.1%, respectively). Only 10.7% (n = 25) required the sole titration. Each dose provided significant decreases in LDL-C (average -46.4%). Only 36 subjects experienced treatment related adverse events, the majority of these were in the high-risk group (n = 22) with only one subject registering a serious adverse event. CONCLUSION: Atorvastatin is effective and safe for Thai patients with dyslipidemia. The appropriate starting dose has contributed in the achievement of cholesterol reduction.

Microalbuminuria in type 2 diabetic patient with hypertension.

The prevalence of microalbuminuria (MAU) was determined in type 2 diabetic patients with hypertension attending at the Outpatient Department from October 2002 to November 2003. Nephurฎ tests were performed in all cases to detect macroalbuminuria. Patients without any documented urinalysis or those with normoalbuminuria tested previously were enrolled. Demographic and clinical data were collected through questionnaires. Micralฎ tests were subsequently carried out in those who did not have macroalbuminuria. A hundred males (aged of 59.3 + 11.0 years) and 200 females (aged of 60.3 + 10.1 years) were enrolled with the mean BMI of 27.3+ 4.3 kg/m2 (26.9 + 4.1 kg/m2 in males and 27.6 + 4.4 kg/m2 in females). It was found that he prevalence of macroalbuminuria was 7.3% (22/300), 10% in males and 6% in females (p = 0.78), while the prevalence of MAU was 40.7% (113/278), 48.9% in males and 36.7% in females (p = 0.0001). There was no significant differences between patients with normoalbuminuria and those with MAU in age, sex, ethnic, BMI, levels of BP, fasting plasma glucose, glycosylated hemoglobin, creatinine, LDL-C, HDL-C, including the rate of BP normalization recommended by ADA 2003 guidelines and the use of ACE inhibitors or angiotensin receptor blockers. The prevalence of MAU rose in relation with the duration of diabetes of 1 to 5 years (35.5%), >5 to 10 years (50.0%), and > 10 years (63.2%) as well as with an increase in duration of hypertension, i.e. 1 to 5 years (36.0%), > 5 to 10 years (42.0%), and > 10 years (51.0%). Average number of antihypertensive drugs taken was 2.5 + 1.1 to keep the mean BP of 137.5 + 12.3/80.6 + 7.8 mm Hg.

Prevalence of erectile dysfunction among treated hypertensive males.

OBJECTIVE: Study the prevalence rate of erectile dysfunction (ED) in treated hypertensive males. MATERIAL AND METHOD: Four hundred and twenty nine patients attending the outpatient clinic at Siriraj Hospital between April 2001 and October 2002 were interviewed. The International Index of Erectile Function, a 5-item version (IIEF-5) questionnaire was used. All questions were carried out by a well-trained interviewer. RESULT: Of the 429 patients (mean age of 57.5 +/- 12.0 years) interviewed, 241 cases (56.2%) reported ED. The prevalence was found to increase with age: from 0% in men aged < 40 years, 47.4% in men aged 40-59 years, and 75.3% in men aged > 60 years. Risk of ED was significantly (p < 0. 01) associated with the elderly (OR = 4.7, 95%CI= 3.1-7.1), patients who suffered from hypertension longer than 5 years (OR = 4.0, 95%CI = 2.6-6.1), those with a history of back/pelvic surgery (OR = 2.8, 95%CI = 1.4-4.8), smoking (OR = 1.5, 95%CI = 1.0-2.2), alcohol ingestion (OR = 2.0, 95%CI = 1.3-3.0), diabetes mellitus (OR = 6.3, 95%CI = 3.5-11.2), diuretics (OR = 1.9, 95%CI = 1.3-2.8), and alpha-2 agonist (OR = 7.9, 95%CI = 2.3-26.1) usage. On multivariate regression analyses, the elderly (OR = 4.0, 95%CI = 2.5-6.4), diabetes mellitus (OR = 6.4, 95%CI = 3.5-11.8), the usage of diuretic (OR = 2.1, 95%CI = 1.3-3.4), and alpha-2 agonist (OR = 6.0, 95%CI = 1.7-21.3) predicted ED (p < 0.005 in all categories). Neither history of back/pelvic operation, smoking, alcohol ingestion, overweight (BMI > or = 30 kg/m2), or any other antihypertensive medications independently predicted ED. CONCLUSION: Our results indicated that ED in male hypertensive patients is common and the cause should be sought and avoided. Diabetic patients or those who have been using diuretic or alpha-2 agonists should receive much attention and be routinely evaluated for ED.

Hypertension study among attendants at the Board of Investment Fair 2000.

To study the prevalence of hypertension, blood pressure (BP) controlled and cardiovascular risk factors in people who attended the Board of Investment 2002 Fair (BOI Fair). Altogether 1,774 participants aged more than 15 years old voluntarily participated in BP check-ups during the 3rd-17th February 2000 at the BOI Fair. Three hundred and fifty participants (19.7%) were known cases of hypertension (HT) and 340 participants (19.2%) were newly diagnosed hypertension cases (NHT). Of the HT group, 216 cases were under current treatment (61.7%) and only 69 cases (31.9%) had adequate BP control. Of the NHT group, cardiovascular risk factors were found more frequently than in normotensive participants. This study indicates the necessity of building up awareness in the population, improving in clinical detection, effectively controlling of the risk factors and the normalization of BP. This might prevent hypertension and reduce the cardiovascular disease.

An audit of blood pressure control in clinical practice in Thailand.

To gain "real life" data on the BP control of hypertensive patients in clinical practice in Thailand, a multi-centre cross-sectional study was carried out. Demographic data, cardiovascular risk factors, and antihypertensive regimens were collected. A total of 1,259 patients were enrolled between October 2003 and December 2003, 924 cases from 6 regions of different levels of health care and 335 cases from 4 medical training centres and a tertiary care hospital in Bangkok. Eighty one percent of the patients, age ranged from 45 to 75 years (61.2 +/- 11.6). Forty four percent of patients in audit had a BP < 140/90 mm Hg and only 12.3% of DM patients had attained a JNC 7 recommended BP target of 130/80 mm Hg. Hypercholesterolaemia (65.3%) was the most prevalent risk followed by DM (27. 7%). Antihypertensive drug used at the initial visit compared with the last visit were ARB (0.9% vs 6.1%), ACE Inhibitors (30.1% vs 40.0%), beta-blockers (27.3% vs 46. 7%), CCBs (23.2% vs 37.7%), and diuretics (46.0% vs 53.5%). In addition, the numbers of antihypertensive drugs used at the initial visit compared with the last clinic visit were one drug (62.0% vs 33.0%), two drugs (29.7% vs 45.8%), three drugs or more (3.7% vs 20.4%), with an average of 1.3 +/- 0.6 vs 1.9 +/- 0.8 drugs per patient. Two thirds of patients (66.2%) were on 2 or more antihypertensive drugs. Among the type 2 DM, 5% had records of microalbuminuria, and 50.6% and 9.8% were receiving ACE Inhibitors and ARBs, respectively at the last clinic visit.

Microalbuminuria prevalence study (MAPS) in hypertensive patients with type 2 diabetes in Thailand.

BACKGROUND: Microalbuminuria represents the earliest clinical evidence of diabetic nephropathy, and is a marker of increased cardiovascular (CV) morbidity and mortality. OBJECTIVES: This analysis of Thai data from the Microalbuminuria Prevalence Study (MAPS) assessed the prevalence of macroalbuminuria and microalbuminuria in hypertensive patients with type 2 diabetes. DESIGN: Cross-sectional clinic-based epidemiological study. MATERIAL AND METHOD: A total of 100 patients were enrolled, of which 97 patients constituted the per-protocol population (patients with bacteriuria and haematuria were excluded). Patients attended one study visit with no follow-up. RESULTS: Overall, the prevalence of diabetic kidney disease was high, with macroalbuminuria contributing 13.4% [9.9-16.9; 95% confidence interval (CI)] and microalbuminuria contributing 43.3% [38.3-48.3; 95%CI]. CONCLUSION: Annual screening for microalbuminuria is recommended for all patients with type 2 diabetes, as early treatment is critical for reducing CV risks. Clinical studies have shown that renin-angiotensin system inhibitors can slow the progression of diabetic nephropathy.

Efficacy and safety of rilmenidine, a selective imidazoline I1 receptor binding ligand, in mild-to-moderate Thai hypertensive patients.

BACKGROUND: Rilmenidine is an antihypertensive agent that selectively binds to imidazoline I1 receptor located in the brainstem and kidney. It acts both centrally by reducing sympathetic overactivity and in the kidney by decreasing water and sodium overload. This dual action leads to the immediate and delayed control of blood pressure caused by this drug. OBJECTIVE: The aim of this study was to assess the efficacy and safety of rilmenidine as monotherapy in mild-to-moderate essential hypertensive patients. METHOD: An 8-week, open-labeled, multicenter study was conducted in Thai patients with mild-to-moderate essential hypertension. Rilmenidine 1 mg/day was given for 8 weeks. The dose could be titrated up to 2 mg/day according to the patient's blood pressure response at week 4. The primary efficacy parameters were the mean reductions in systolic and diastolic blood pressure. The proportions of patients whose blood pressure normalized or responded were evaluated as secondary efficacy parameters. Safety parameters were assessed by the changes in heart rate and reported side effects during the treatment period. RESULTS: 103 subjects (44.7% men) with a mean age of 53 +/- 9.7 years completed the 8-week follow-up. At baseline, 46.6 per cent and 53.4 per cent of the patients were classified with mild and moderate hypertension, respectively. The mean blood pressure was 154/93 mmHg. After the 8-week treatment, there was a significant decrease in blood pressure to 140/86 mmHg (p < 0.001), with mean pressure reduction of 14/7.5 mmHg. The normalization rate was 44 per cent and the response rate was 68 per cent. No significant changes were found for mean heart rate and any laboratory parameters tested. Only 17 patients reported mild and transient side effects such as drowsiness and dryness of the mouth and throat, which required no treatment. CONCLUSION: This study has shown that rilmenidine is an effective and well tolerated monotherapy in Thai patients with mild-to-moderate essential hypertension.

The efficacy and tolerability of an angiotensin II receptor blocker, telmisartan, in Thai patients with mild to moderate essential hypertension.

This open-labeled single-blinded study was performed to evaluate the efficacy and tolerability of telmisartan in the treatment of mild to moderate essential hypertension. Each patient was assigned to take a placebo for 4 weeks followed by once daily-titrated telmisartan (40-80 mg) for 8 weeks. "Office BP" and "24-hour ambulatory BP" measurements (24-h ABPM) were recorded as scheduled. Thirty-one patients (10 males: 21 females) with a mean age of 48.1 years were enrolled. The final SBP/DBP reductions of 14.6 +/- 14.2/9.9 +/- 6.2 mm Hg were obtained. Full response defined as office DBP reduction of > or = 10 mm Hg from baseline and/or DBP < 90 mm Hg was achieved in 73.3 per cent of cases. Excluding 5 cases of white coat HT diagnosed by 24-h ABPM, full response rate (DBP reduction of > or = 10 mm Hg from baseline and/or < 85 mm Hg) was 76 per cent. Trough to peak ratio and smoothness index for SBP/DBP were highly acceptable (0.75/0.76 and 0.97/1.01, respectively). There were 4 cases of adverse events (2 cases of dizziness, 1 case of headache, and 1 case of acute myocardial infarction).

Adrenal cortical carcinoma presenting as liver abscess: Report of a case.

A 60 year-old woman presented with clinical signs and symptoms of liver abscess. She had a cystic mass on the right lobe of the liver. Liver needle aspiration was performed and anchovy-paste like material was obtained. She recovered after treatment with oral metronidazole even though investigations for Entamoeba histolytica were negative. Two and a half years later, she returned with the same clinical signs and symptoms. Liver needle aspirations were performed many times and the same anchovy-paste like material was obtained but no definite diagnosis was made. Finally, laparotomy showed an extrahepatic retroperitoneal cystic mass of the right adrenal gland adjacent to the liver. Intravenous pyelography, adrenal CT scan and adrenal angiography were performed. The tumor was removed and the final histopathological diagnosis was adrenal cortical carcinoma.

Acceptability and tolerability of lacidipine in hypertensive patients.

A multicenter study on the efficacy and tolerability of lacidipine in ambulatory Thai hypertensive patients was carried out in the Out-patient Department at Siriraj Hospital, Ramathibodi Hospital and Rajvidhi Hospital from October 1996 to July 1997. There were 46 patients who had mild to moderate hypertension (DBP>95 mmHg and <115mmHg). The enrolled-patients consisted of male : female = 20 : 26, age ranged between 23-69 years (51.98+9.49 years). The study showed that lacidipine 2-6 mg given once daily was able to normalize sitting BP (DBP < 90 mmHg) in 32 cases (69.4%). Among them, normalization of BP could be achieved by lacidipine 2 mg/d in 24 cases (52.2%), 4 mg/d in 4 cases and 6 mg/d in 2 cases. This study revealed that lacidipine in the therapeutic dose of 2-6 mg/d did not induce reflex tachycardia, metabolic derangement and importantly, did not produce any serious side effects.

Takayasu’s arteritis in 174 Thai patients.

A testrospective study of 174 patients (46 male, 128 female, male: female = 1 : 2.78) suffered from Takayasu’s arteritis since 1980 was performed. Most cases were found in age range from 11 to 30 year old. The major symptoms observed in this disease were headache 45.98%, dyspnea on exertion 34.48%, blurred vision 24.14%, intermittent claudication 18.39%, fever 17.24%, chest pain 16.09% and hemiplegia 14.37%. Physical signs detected included hypertension 75.29%, unequal pulses 66.67%, pulsatile mass and/or vascular bruits at the abdomen and neck 27.59% and 10.34%, respectively. Congestive cardiac failire and left ventricular hypertrophy were observed in a quarter of the patients. For laboratory findings, the frequently sedimentation rate (ESR) was found to be a good indicator of arch and abdominal aortogram of 137 Takayasu’s arteritis patients revealed that aorta and nearly all of its main branches were involved, renal arteries 65.69%, abdominal aorta 51.82%, subclavian arteries 40.15% and thoracic aorta 29.93%. Two patients died, one was from cerebral hemorrhage and the other was from renal failure.

Radiotherapy and malignant pheochromocytoma.

This is a report of a case of a 19-year old female patient who suffered from malignant pheochromocytoma with metastasis to abdominal paraaortic lymph nodes, liver and spleen. She was treated with partial resection of the tumor mass and received 2,000 rads radiation twice within 5 years on the metastasized lesions combined with antihypertensive deugs: prazosin (blocker) and propranolol (blocker). Reduction in size of the metastatic lesions and controlled blood pressure were achieved. Now, the patient in still alive, enjoying life and happy after 12 years of treatment.

Plasma renin activity in Thai essential Hypertension.

Plasma renin activity was measured by redioimmunoassay in 38 Thai essential hypertension. There were three types detected : -Low renin = 7 cases (18.42%) normal renin = 27 cases (71.05%) and high renin = 4 cases (10.53%) No relationship was found between 24 hours specimen urine sodium and plasma renin as is found in normal populations. However, cardiovascular complication were observed in the high and normal renin subgroups especially in the high renin subgroup but no stroke or heart attack was observed in the low renin subgroup.