[Relationship of average level and variability of blood pressure with the geometry of the left ventricle in systemic hypertension]. / Relação do nível médio e variabilidade da pressão arterial com a geometria do ventrículo esquerdo na hipertensão arterial sistêmica.

PURPOSE: To study the relation between the average level and variability of blood pressure (VBP) obtained by ambulatory monitoring (AMBP) and the geometric pattern (GP) of the left ventricle (LV) obtained by echocardiography (ECHO) in patients with hypertension (Hy) METHODS: AMBP and ECHO were performed in 37 patients with Hy, divided into three groups: group A--11 women using antihypertensive therapy (AH); group B--15 men using AH and group C--7 male and 4 female without AH. The GP of LV was obtained by ECHO based on mass index (MI) and relative thickness of the wall (RTW). Mean systolic (MSBP) and diastolic (MDBP) were analyzed during daytime (DT) and nighttime (NT) periods. VBP was defined by mean standard deviation (SD) of mean pressures considered. RESULTS: In G-A, there was a significant association between the MI and both VBP and MSBP (r = 0.65 and p < 0.005, r = 0.61, and p < 0.005, respectively), and MSBP and VBP during the DP (r = 0.64 and p < 0.005, r = 0.75, and p < 0.005). In G-B, there was a relation between the LVRTW (r = 0.55 and p < 0.005), and MSBP during the DP (r = 0.65 and p < 0.005). In G-C, there was a significant association (p < 0.005) between the MI and the MDBP in the DP and with the MSBP in the NP (r valueS ranged from 0.51 to 0.66). There was also a significant relation (p < 0.005) between the LVRTW and the SD of all variables in both DP and NP (r ranged from 0.47 to 0.78 and mean diastolic in the wakeful period (r = 0.42 to 0.78) and MDBP in the DP (r = 0.42 and p < 0.05). CONCLUSION: Both the increase in VBP and the mean BP are involved in the changes of LVGP in Hy.

[A Brazilian multicenter study to evaluate the clinical effectiveness and tolerance of isradipine SRO using ambulatory monitoring of arterial pressure in the treatment of mild and moderate arterial hypertension]. / Estudo multicêntrico brasileiro de avaliação de eficácia clínica e tolerabilidade da isradipina SRO através da monitorização ambulatorial da pressão arterial no tratamento da hipertensão arterial leve e moderada.

PURPOSE: To evaluate clinical efficacy and tolerability of isradipine SRO (I.SRO), 5 mg O.D. in essential hypertensives. METHODS: Eighty-three of 87 selected outpatients with a mean age of 51.3 years (ranging from 25 to 65), 33 male, 48 white, 29 black and others of different races, who had clinical supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg underwent the study. After a three-week wash-out period, patients received I.SRO 5 mg O.D. at 8:00 am for a six-week period (phase I). After this phase, patients received I.SRO 5 mg O.D. at 8:00 pm for a six-week period (phase II). The patients had a follow-up with an interval of three weeks and the ambulatorial blood pressure monitoring (ABPM) for 24 hours was performed with a SpaceLabs 90207 or Del Mar Avionics devices after the wash-out period and at the end of phases I and II. Measurements were performed at 15-min intervals during the day (6 am to 10 pm) and at 30-min intervals during the night (10 pm to 6 am). RESULTS: a) Heart rate did not show significant changes during the treatment period (phases I and II) when compared with the wash-out period; b) causal blood pressure: at the end of both treatment periods (phases I and II) there were statistically significant decreases (p < 0.001) in supine SBP and DBP compared with wash-out values. The mean SBP decreased from 161.6 +/- 14 to 144.3 +/- 13 mmHg (phase I) and to 141.8 +/- 13 mmHg (phase II). The mean DBP decreased from 103.4 +/- 6 to 91.2 +/- 7 (phase I) and to 89.1 +/- 8 (phase II); c) ABPM: the mean systolic 24-h ambulatory blood pressure was significantly reduced (p < 0.001) from 148.8 +/- 17 to 137.2 +/- 15 mmHg (phase I) and to 133.4 +/- 13 mmHg (phase II). The mean diastolic 24-h ambulatory blood pressure was significantly decreased (p < 0.001) from 94.3 +/- 9 to 87.0 +/- 9 (phase I) and to 85.8 +/- 8 mmHg (phase II). The mean daytime and nighttime, systolic and diastolic 24-h ambulatory blood pressure were: wash-out--152.3 +/- 17, 140.2 +/- 21, 97.4 +/- 9, 86.8 +/- 13; phase I--139.9 +/- 15, 130.0 +/- 17, 89.3 +/- 9, 81.3 +/- 10; phase II--136.7 +/- 13, 125.3 +/- 15, 88.5 +/- 8, 79.1 +/- 10, respectively. Blood pressure load (percentage of systolic blood pressure values > 140 mmHg or of diastolic blood pressure values > 90 mmHg) was significantly reduced from 62.2/62% (SBP/DBP), on the was-out, to 37.9/39.9% (SBP/DBP) on phase I and to 32.3/34.3% (SBP/DBP) on phase II; d) side effects: most frequently related were palpitations (2.3%), headache (1.1%), flush (1%) and ankle oedema (1%). They were in general, mild-to-moderate and disappeared after the first 3 weeks of treatment. Only two patients were withdrawn because of headache (one of them with previous diagnosis of migraine). CONCLUSION: I.SRO, given by oral route, in the dosage of 5 mg O.D. as monotherapy, was effective and well tolerated, promoted significant reduction on 24-h ambulatory blood pressure attenuating the early morning rise and did not interfere with the circadian rhythm of blood pressure. No significant differences were detected in the BP lowering effect when I.SRO was given during the morning or evening. These results may indicate that the drug is as suitable as one of the first choice for treating mild and moderate hypertensive patients.

Clinical efficacy and tolerability of isradipine in the treatment of mild-to-moderate hypertension in young and elderly patients.

The clinical efficacy and tolerability of isradipine was evaluated in 63 patients with mild-to-moderate hypertension [supine systolic blood pressure (SBP) greater than or equal to 160 mm Hg and diastolic blood pressure (DBP) greater than or equal to 95 mm Hg]. Patients were divided into two groups according to age: group A (n = 41), aged 37-69 years (mean age of 54 +/- 7 years); group B (n = 22), aged 70-80 years (mean age of 72.8 +/- 2.4 years). After a 3-week washout period, group A received 2.5 mg of isradipine twice daily for 6 weeks. Group B received 1.25 mg of isradipine initially, increasing to 2.5 mg twice daily according to treatment response and tolerability. At the end of treatment (week 6), there were statistically significant decreases (p less than 0.01) in supine SBP and DBP in both groups compared with baseline values: the mean SBP in groups A and B decreased from 160.0 +/- 14.7 to 133.6 +/- 10.0 mm Hg and from 161.6 +/- 17.8 to 134.8 +/- 10.9 mm Hg, respectively; the mean DBP in groups A and B decreased from 101.3 +/- 3.0 to 83.6 +/- 5.5 mm Hg and from 101.3 +/- 8.4 to 84.2 +/- 3.6 mm Hg, respectively. Clinical and laboratory parameters did not change significantly during treatment. Side effects (headache, flushing, palpitations, and edema) were mild/moderate and disappeared after the first 2 weeks of treatment. In conclusion, 2.5 mg of isradipine twice daily is effective and well tolerated in the treatment of mild-to-moderate hypertension regardless of patient age.

[Isradipine: a Brazilian multicenter study for the evaluation of the efficacy and safety in the treatment of mild and moderate arterial hypertension]. / Isradipina: estudo multicêntrico brasileiro de avaliação de eficácia e tolerabilidade no tratamento da hipertensão arterial leve e moderada.

PURPOSE: To evaluate the efficacy and tolerability of isradipine, a new dihydropyridine calcium antagonist, in the treatment of mild-to-moderate hypertension. PATIENTS AND METHODS: One hundred and eighty outpatients with different races, who had supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg, with a mean age of 52.03 +/- 11.47 years, 70 men, 110 women; underwent the study. After a two-week wash-out period patients received isradipine 2.5 mg b.i.d. for 90 days. Follow-up visits were performed at the 30th, 60th and 90th days of treatment. RESULTS: At the end of treatment (90 days), a statistically significant decrease (p < 0.05) in SBP and DBP in supine position was observed. A mean SBP was reduced from 159.28 +/- 16.99 to 142.51 +/- 15.12, and mean DBP declined from 101.49 +/- 6.82 to 86.63 +/- 7.40. Heart rate, weight, electrocardiograms and laboratory tests did not shows significant changes during treatment when compared to baseline evaluation. The most frequent related side effects (headache and dizziness with nausea) were transient, and at the end of the study 96.7% of the patients did not have any complaint. However, two patients were withdrawn from the trial because of important headache. CONCLUSION: Isradipine 2.5 mg by oral route, b.i.d. has shown to be effective and well tolerated in the treatment of mild-to-moderate hypertension in patients of both sexes and several ages and races.