Noninvasive ambulatory 24-hour blood pressure in patients with high normal blood pressure and exaggerated systolic pressure response to exercise.

Few studies have investigated the significance of abnormal increases in systolic pressure during exercise in patients with high normal blood pressure and its correlation with 24-hour ambulatory blood pressure monitoring and left ventricular structure. This study was performed in 30 sedentary subjects (42 +/- 4 years old) with high normal blood pressure. Fifteen subjects presenting < 220 mm Hg systolic pressure during ergometric exercise were compared with 15 others with systolic pressure > or = 220 mm Hg. Average 24-hour (systolic, 127 +/- 5 versus 142 +/- 4 mm Hg, P < .01; diastolic, 82 +/- 4 versus 92 +/- 3 mm Hg, P < .01), daytime (systolic, 130 +/- 6 versus 144 +/- 4 mm Hg, P < .01; diastolic, 84 +/- 4 versus 92 +/- 4 mm Hg, P < .01), and nighttime (systolic, 116 +/- 7 versus 132 +/- 6 mm Hg, P < .01; diastolic, 72 +/- 6 versus 85 +/- 6 mm Hg, P < .01) ambulatory blood pressure monitoring values were significantly higher in subjects with an exaggerated blood pressure response to exercise. No significant differences were observed in left ventricular morphology. These findings indicate that subjects presenting high normal blood pressure and exaggerated systolic pressure during exercise show significantly high ambulatory blood pressure monitoring values that are not associated with left ventricular hypertrophy.

[Use of carvedilol compared to nifedipine in the treatment of mild and moderate essential arterial hypertension]. / O uso do carvedilol comparado à nifedipina no tratamento da hipertensão arterial essencial leve e moderada.

PURPOSE: To compare the efficacy of carvedilol, a new antihypertensive drug that combines vasodilatory and beta-blocker properties, with nifedipine. METHODS: In a multicenter double-blind trial, 106 mild to moderate essential hypertensive patients were treated with either carvedilol (n = 51), or nifedipine (n = 55) as monotherapy. Following 4 weeks of wash-out/run-in period, patients from the carvedilol group received this drug once a day at a dosage of 25 mg/day for 8 consecutive weeks. In order to maintain the double-blind character of the study, a placebo was administered in the carvedilol group at identical dosage intervals as used in the nifedipine s.r. group. Nifedipine was also administered for 8 weeks at a dosage of 40 mg/day given b.i.d. RESULTS: Both treatments were equally efficient in reducing blood pressure in the seated and upright positions. Blood pressure response to treatment was obtained in 79% and 78% of patients treated with carvedilol and nifedipine, respectively. The carvedilol group did not develop reflex tachycardia which is usually seen when prescribing vasodilators. Blood biochemistry remained unchanged with both treatments. Besides similar blood pressure efficacy, side effects by patients taking carvedilol were less frequent than nifedipine group. CONCLUSION: Carvedilol is a safe, efficient, once/day choice as monotherapy for mild to moderate essential hypertensive patients.

[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.

[Ambulatory monitoring of blood pressure with a new ACE inhibitor--cilazapril]. / Monitorização ambulatorial da pressão arterial com um novo inibidor da ECA--cilazapril.

PURPOSE: To evaluate the tolerability and 24 hours efficacy of a new anti-hypertensive drug: cilazapril. METHODS: In an open non comparative study 20 hypertensive patients (16 females, age from 30 to 60 years, average = 49.4) were followed for 6 weeks: 2 wash out and 4 treatment (5 mg OD). Blood pressure (BP) was measured by casual and ambulatory blood pressure monitoring (ABPM) readings. RESULTS: Comparing washout and treatment periods, ABPM averages both for systolic and diastolic BP (mmHg) showed significant decrease in 24 hours, during day and night sub periods. The decrease was not significant between averages considering the "early morning rising pressure" sub period. Heart rate averages showed significant reduction at all sub periods except during night. Adverse effects were mild and resolved spontaneously (n = 3, 15%). CONCLUSION: Cilazapril seems to be efficacious as antihypertensive. Tolerability is excellent. It preserved circadian rhythm despite significantly reducing blood pressure at all periods evaluated except early morning. A bradycardic effect observed mostly during day period should be better evaluated.

[Circadian rhythm of arterial pressure and use of amlodipine in primary hypertension]. / Ritmo circadiano da pressão arterial e o uso da amlodipina em hipertensão primária.

PURPOSE: To evaluate the anti hypertensive efficacy and tolerability of amlodipine given once daily either morning and evening doses. METHODS: Fifty hypertensive patients were admitted into an open non comparative 18 weeks study. All patients were submitted to wash out period of 2 weeks. Afterwards, those with BP inclusion criteria started 5 mg amlodipine, which was titrated until a maximum of 10 mg. Upon reaching the ideal dosage, patients were kept 8 weeks with drug given at 8:00 am and then 8:00 pm. RESULTS: The majority of patients (60%) needed only 5 mg and 24 hours data revealed the following mean systolic BP: V2 (final of wash-out) = 149.3 +/- 4.8; V3 (morning dose) = 150.4 +/- 3.8; V4 (night dose) = 134.1 +/- 2.9; V5 (final of the study) = 129.5 +/- 6.1 (ANOVA p = 0.000; Bonferroni test: p < 0.05; test t of Student: p = 0.13, comparing V2 (final of wash-out) with V4 (night dose) and V5 (final of study). The mean diastolic BP were V2 (final of wash-out) = 96 +/- 3.2 (morning dose) = 96.2 +/- 2.7; V4 (night dose) = 81.9 +/- 2.6; V5 (final of the study) = 77.7 +/- 7.5 (ANOVA: p = 0.000; Bonferroni test: p = < 0.05; test t: p = 0.05). The following systolic percentage over normal values were observed (140 mmHg from 7:00 am to 11:00 pm; 130 mmHg from midnight to 7:00 am): V2 (final of wash-out) = 73.3% during the day and 71.1% at night; V3 (morning dose) = 76% in the morning and 75.6% at night; V4 (night dose) = 29.3% during the day and 39.3% at night; 20.9% during the day and 23% at night. Considering the limits of diurnal diastolic BP 90 mmHg and nocturnal, 80 mmHg, the following percentage of readings over normal limits were observed: V2 (final of wash-out) = 77.8% during the day and 91.8% at night; V3 (morning dose) = 80% during the day and 92.6% at night; V4 (night dose) = 6.7% during the day and 15.6% at night. Three patients presented adverse events, which disappeared spontaneously and discontinuation of treatment was not necessary. CONCLUSION: Amlodipine was considered effective and well tolerated and the majority of patients needed only 5mg daily and no reflex tachycardia was observed. Amlodipine effectively reduced BP throughout 24 h and the circadian rhythm kept unaltered and the evening administration led to a greater nocturnal fall than the morning administration. The remaining periods did not show differences.

[Fosinopril in a daily single dose in mild and moderate hypertension. Brazilian multicenter study]. / Fosinopril em dose única diária na hipertensão leve e moderada. Estudo multicêntrico brasileiro.

PURPOSE: To evaluate during 12 weeks the effectiveness and safety of once-a-day fosinopril (10 or 20 mg/day comparative to placebo) in mild to moderate hypertensives according to an open design comparative to placebo. METHODS: One hundred and nineteen patients were studied; 52 +/- 11 years (mean +/- sd) range 18 a 76 years, 86 women and 33 men, 57% whites, 26% blacks and 17% mulattos, 71 mild hypertensives (95 < or = diastolic pressure < or = 104mmHg) e 48 moderate hypertensives (101 < diastolic pressure < or = 115mmHg). RESULTS: There was a significant reduction in systolic/diastolic pressure on the 6th week of treatment (from 161 +/- 16/103 +/- 7 before to 148 +/- 16/94 +/- 9mmHg on the 6th week). On the 12th week of treatment there was an additional significant reduction in systolic/diastolic pressure (from 148 +/- 16/94 +/- 9 on the 6th week to 145 +/- 17/89 +/- 8mmHg on the 12th week). There was a "favorable" response in 71% of the patients on the 12th week; 62% showed diastolic pressure < or = 90mmHg and 9% presented diastolic reduction > or = 10mmHg. There was no difference in the normalization rates between whites and non-whites, mild and moderate hypertensive, obese and non-obese patients, under or above 50 years of age and those patients from no drug-treatment to those on 3 drug before the study. There was no clinically relevant changes in laboratory evaluations before and at the end of the study. The number of adverse reactions was reduced in comparison with previous treatment. CONCLUSION: Fosinopril, according to our and others data, is effective and safe for the treatment of mild to moderate hypertensives, in whites or non-whites, obese or non-obese, younger or older than 50 years and receiving 0 or 3 drugs before the study.

[Evaluation of efficacy of the enalapril-hydrochlorothiazide combination by ambulatory blood pressure monitoring in essential hypertensive patients]. / Avaliação da eficácia da associação enalapril-hidroclorotiazida através da monitorização ambulatorial da pressão arterial em hipertensos essenciais.

PURPOSE: Evaluation the 24 hours efficacy of once daily enalapril plus hydrochlorothiazide association by ambulatory blood pressure monitoring. METHODS: Thirty-nine essential hypertensive patients (3 male, 36 female; 31 white, 8 non-white; mean age 46,7 years old) with the criteria, after wash-out period, of more than 40% of diurnal diastolic blood pressure measurements above 90mmHg by ambulatory blood pressure monitoring, were allocated for treatment during 8 weeks with once daily administration of enalapril (20mg) plus hydrochlorothiazide (12.5mg) association. RESULTS: After wash-out period, 82 and 42%, respectively, diurnal and nocturnal systolic blood pressure measurements were above 140mmHG; while diastolic values were 79 and 26% above 90mmHg. After 8 weeks of treatment there was a significant reduction in both systolic and diastolic pressure loads, either on nocturnal or diurnal periods; 26 and 5.3% of systolic values were still above 140mmHg and, 31.5 and 7.9% of diastolic measurements were above 90mmHg. Despite the significant fall on blood pressure there was not alteration in heart rate. CONCLUSION: The association of the angiotensin converting enzyme inhibitor, enalapril, plus a diuretic, hydrochlorothiazide, promoted a significant reduction on pressure load and did not interfere with the circadian rhythm of 24 hours blood pressure. These results may indicate that the association as suitable as one of the first choices for treating mild and moderate hypertensive patients.

[Treatment of mild and moderate cardiac failure with captopril. A multicenter study]. / Tratamento da insuficiência cardíaca leve e moderada com captopril. Estudo multicêntrico.

PURPOSE: Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class II and III (NYHA) congestive heart failure (CHF). METHODS: One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 +/- 11); 67 were male and 66 were caucasians. The etiologies of the heart failure were: hypertensive heart disease 47 (40.9%), ischemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idiopathic cardiomyopathy 15 (13.0%), and other causes 6 (5.2%). Diuretic and digitalis were maintained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. RESULTS: The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 +/- 13.1 mg/day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 (85.2%) patients and remained unchanged in 17 (14.8%) (p < 0.01). The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment. CONCLUSION: The addition of captopril to the conventional therapy of class II and III CHF was associated with significant improvement of functional class and with good tolerability.

[Captopril in mild and moderate arterial hypertension resistant to diuretic therapy. A multicenter study]. / Captopril na hipertensão arterial level e moderada resistente à diureticoterapia. Estudo multicêntrico.

PURPOSE: To evaluate the antihypertensive effect of captopril in mild and moderate hypertensive patients uncontrolled with diuretics. METHODS: Low dose of captopril (25 to 50 mg) bid were associated during 9 weeks in 120 patients previously treated with 100 mg of hydrochlorothiazide. A subgroup of patients (74) were followed additionally for 3 weeks with the same dose of the drugs administered as a single dose. The patients were clinically evaluated after two weeks placebo, and each three weeks of active drugs. Blood pressure normalization were considered when diastolic arterial pressure was < or = 90 mmHg. Laboratory tests were measured before diuretic, before captopril and at the end of combined twelve weeks treatment. RESULTS: After 15 days washout, the baseline supine arterial pressure, 168 +/- 2/ 109 +/- 1 mmHg decrease significantly with diuretic to 151 +/- 1/ 101 +/- 1 mmHg and the drop was further increased with captopril b.i.d., with a mean dose of 44 +/- 1 mg, to 137 +/- 1/ 90 +/- 1 mmHg. Blood pressure normalization was obtained in 58% patients with captopril b.i.d. and in 63% as single dose. Blood pressure normalization was achieved in 63% of non-white patients and in 56% patients over 45 years old. Plasmatic potassium decreased significantly with diuretic and did not recovered when captopril was associated. CONCLUSION: Our results indicate that the addition of low dose of captopril twice or once a day may result in a marked additional blood pressure reduction in cases of insufficient control by the diuretic alone.

[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.

Tratamento da hipertensäo arterial sistêmica com urapidil: estudo multicêntrico comparativo com nifedipina / Treatment of sistematic arterial hypertension with urapradil multicenter studies comparative with nifedipina

Estudo multicêntrico, aberto, comparativo entre o Urapidil e a Nifedipina, alocando os pacientes, aleatoriamente, em dois grupos de tratamento, com 95 pacientes (46 pacientes tratados com Urapidil e 49 pacientes tratados com Nifedipina). Houve um período de washout de duas a quatro semanas e, um período de tratamento ativo de 10 semanas, sendo que, após duas semanas, a dose inicial (Urapidil: 60mg/d e Nifedipina: 40mg/d) foi duplicada nos pacientes näo-responsivos. O critério de normalizaçäo foi o de uma pressäo diastólica igual ou inferior a 90 mmHg ou 10% na reduçäo, se a diastólica fosse inferior a 100mmHg. Nos 95 pacientes estudados a porporçäo de pacientes responsivos foi de 78% paa o Urapidil e de 76% para a Nifedipina; a queda de pressäo levou a 139/88mmHg; no grupo do Urapidil e 131/83mmHg no grupo da Nifedipina. A tolerância foi satisfatória com o Urapidil, sendo as principais queixas a vertigem, o mal-estar e a fraqueza que apareceram em 10 doentes; entre os pacientes tratados com Nifedipina 17 apresentaram queixas de cefaléia e 14 pacientes apresentaram vertigem e flushing

[Anti-hypertensive efficacy and tolerability of sustained-release prazosin hydrochloride. A Brazilian multicenter study]. / Eficácia anti-hipertensiva e tolerabilidade do cloridrato de prazosina de liberação lenta. Estudo multicêntrico brasileiro.

PURPOSE: To evaluate the efficacy and tolerability of a single daily dose of sustained-release (SR) formulation of prazosin hydrochloride. PATIENTS AND METHODS: 1393 outpatients in a multicenter open comparative trial. 644 patients had mild hypertension and 749 patients had moderate hypertension. The mean age was 47.63 years, 745 (53.52%) were male, 1011 (72.84%) white and 279 (20.1%) black. The patients received prazosin hydrochloride SR during 4 weeks in an initial dose of 1 mg, adjusted to a maximum of 6 mg in order to decrease the diastolic blood pressure (DBP) to 90 mmHg or less. RESULTS: The mean daily dose was 2.08 mg. At the end of the study, 1274 (91.46%) patients had DBP less than or equal to 90 mmHg or less. 624 patients were in the mild hypertension group and 650 patients were in the moderate hypertension group. The number of patients under DBP control in the first three weeks was 426 (first week), 844 (second week) and 1147 (third week). The DBP decreased from the mean value of 104 +/- 5 mmHg to 88 +/- 8 mmHg (p less than 0.05). The mean heart rate ranged from 82 +/- 9 beats/min (pre-treatment) to 80 +/- 8 beats/min (fourth week). Adverse effects were identified in 377 (27.06%) patients, total of 444 episodes, the more frequent being dizziness. Only 8 (2.12%) patients had to reduce the doses of prazosin hydrochloride SR and 5 (1.32%) had to discontinue the treatment on account of the adverse effects of the drug. CONCLUSION: Prazosin hydrochloride SR in a single daily dose seems to be an advance in the treatment of patients with mild and moderate hypertension.

[24-hour antihypertensive efficacy of nitrendipine]. / Eficácia anti-hipertensiva da nitrendipina por 24 horas.

PURPOSE: To evaluate the efficacy of nitrendipine 20 mg OD in mild to moderate hypertensive subjects. PATIENTS AND METHODS: Twenty patients followed for 90 days. The protocol was a double blind placebo control trial using 24 hours ambulatory blood pressure monitoring system for pressure and heart rate observations. After 15 days without any drug patients were randomly assigned to the study divided into two subgroups: one remained 30 days using placebo and the other nitrendipine. After a new 15 days washout period there was a cross over of the study groups and then other 30 days of follow-up. RESULTS: The 24 hours mean systolic blood pressure decreased (p less than 0.0001) with nitrendipine (127.7 +/- 8 mmHg) in relation to placebo (139.2 +/- 8 mmHg); the mean diastolic blood pressure decreased (p less than 0.0001) with nitrendipine (84.6 +/- 4 mmHg) in relation to placebo (90.7 +/- 5 mmHg). There were no significant changes on heart rate and body weight. CONCLUSION: Nitrendipine seems to be a safe and efficient antihypertensive agent for 24 hours blood pressure control. The drug can decrease blood pressure levels without significant changes over the circadian pattern of the 24 hours blood pressure curve and without unwanted drop of blood pressure levels.

Treatment of resistant hypertension: 3 years of follow-up with the combination of verapamil and methyldopa.

A combination of verapamil (V), methyldopa (M), and hydrochlorothiazide (H) was tried in hypertensive patients resistant to the usual stepped-care therapy. After at least 60 days with a third-step regimen, placebo was added during the last 2 weeks. Twenty patients whose diastolic blood pressure (DBP) remained greater than 100 mm Hg were assigned to the study. During the initial titration period patients received increasing doses of V (240-480 mg) and M (500-1,500 mg). H was kept at 50 mg/day. Other previously administered drugs were gradually withdrawn. Goal pressure was DBP less than or equal to 95 mm Hg. Follow-up lasted 3 years. Sixteen patients participated in the investigation until the end and all but one reached the goal DBP. Mean systolic BP dropped from 187 +/- 17 to 150 +/- 15 mm Hg (p less than 0.05) and DBP from 118 +/- 12 to 90 +/- 9 mm Hg (p less than 0.01). Adverse effects were rare and mild. Other control measurements did not show any change except improvement of the electrocardiogram of 11 patients, and of the optic fundus of 10 patients. The number of drug unities to be taken dropped from 10 +/- 4 to 7 +/- 2 (p less than 0.05). The abovementioned combination seems to be useful in the control of resistant hypertension. Efficacy was sustained and tolerability was excellent. A potential to reverse target organ damage, namely of the heart and optic fundus, is suggested.

Captopril na hipertensão arterial sistêmica leve ou moderada / Captopril in mild or moderate systemic arterial hypertension

Treze pacientes portadores de hipertensao arterial essencial de leve a moderada apos um periodo inicial de duas semanas com placebo, foram tratados com captopril isolado ou associado a hidroclorotiazida por um periodo de dez semanas. Oito pacientes (61%) obtiveram normalizacao dos valores tensionais com captopril isolado na dose de 50 mg/dia. Os demais necessitaram da dose de 75 mg/dia. Destes ultimos, apenas dois tiveram necessidade da associacao de hidroclorotiazida para normalizacao dos valores tensionais.Os exames laboratoriais realizados nao evidenciaram variacoes significativas durante todo o periodo de estudo. A tolerancia do medicamento foi satisfatoria. Observou-se apenas leve cefaleia em dois casos e zumbido em um caso.Os resultados obtidos sugerem que o captopril em baixas doses, associado ou nao a um diuretico, tem indicacao no tratamento de pacientes portadores de hipertensao leve a moderada