Valsartan: long-term efficacy and tolerability compared to lisinopril in elderly patients with essential hypertension.

A total of 501 elderly patients with essential hypertension were randomized to receive valsartan or lisinopril in this one year multi-center, double-blind, parallel group trial. Patients received valsartan 40 mg (n = 334) or lisinopril 2.5 mg (n = 167) daily for 2 weeks with subsequent titration (alone or in combination with hydroclorothiazide), depending on response to treatment. The primary efficacy variable was the percentage of patients with a response, defined as sitting diastolic blood pressure < 90 mmHg or drop of > or = 10 mmHg from baseline. A high percentage of patients responded to treatment in both valsartan and lisinopril groups: 80% for both groups at 12 weeks and 81% and 87%, respectively, at 52 weeks with no statistically significant difference between treatments (12 weeks, p = 0.925; 52 weeks, p = 0.148). More patients on lisinopril experienced drug-related cough (7.5% on valsartan, 17.4% on lisinopril). In 5.4% of lisinopril treated patients, cough led to discontinuation of therapy compared to 0.6% on valsartan. Valsartan 80 mg daily provides comparable short and long-term antihypertensive efficacy to lisinopril in elderly patients with a lower incidence of drug-related cough.

Early side-effects of antihypertensive therapy: comparison of amlodipine and nifedipine retard.

In a multicentre crossover study of 97 patients with mild hypertension, the incidence and severity of adverse effects were observed during the first 14 days of treatment with amlodipine, nifedipine retard or placebo. Amlodipine (5 mg) once daily was equipotent to nifedipine retard (20 mg) twice daily. At these doses, the incidence of adverse effects was significantly greater during treatment with nifedipine retard (41%) than with amlodipine (27%, P < 0.05) or placebo (16%, P < 0.01). In particular, headache and flushing occurred significantly less frequently during the first 14 days of treatment with amlodipine than with nifedipine retard. The lower incidence and reduced severity of vasodilatory side-effects associated with amlodipine resulted in fewer withdrawals during initiation of therapy (2 on amlodipine compared with 7 on nifedipine retard).

Side effects of dihydropyridine therapy: comparison of amlodipine and nifedipine retard.

The efficacy and tolerability of amlodipine (5 mg, once daily), nifedipine retard (20 mg, twice daily), and placebo were compared in a multicenter, three-way, crossover study involving 97 patients with mild-to-moderate hypertension. Each patient underwent three, 2-week treatment periods separated by 2-week washout periods without therapy. Comparable and significant (p < 0.05) blood pressure reductions were observed after amlodipine and nifedipine retard when compared with placebo, except in the case of supine systolic blood pressure with nifedipine retard. A significantly greater incidence of treatment-related side effects was observed with nifedipine retard (41%) compared with amlodipine (27%, p < 0.05) or placebo (16%, p < 0.01). Amlodipine treatment was associated with significantly fewer reports of headache and flushing than nifedipine retard (p < 0.05). The lower incidence and reduced severity of vasodilator side effects associated with amlodipine resulted in fewer withdrawals and a better overall tolerability profile.

Comparison of early side effects with amlodipine and nifedipine retard in hypertension.

The frequency and severity of adverse effects during the first 14 days of treatment with amlodipine (5 mg once daily), nifedipine retard (20 mg twice daily) or placebo were compared in a multicentre, three-way, cross-over study involving 97 patients with mild-to-moderate hypertension. All three groups of patients were well matched for age, sex and baseline blood pressure. Amlodipine and nifedipine retard produced highly significant and comparable reductions in blood pressure, indicating that the doses were therapeutically equivalent. The incidence of adverse effects considered to be definitely or probably related to nifedipine retard treatment (41%) was significantly higher than for placebo (16%, p less than 0.01) or amlodipine (27%, p less than 0.05). There were no significant differences in the incidence of vasodilator-related adverse effects between amlodipine and placebo. In contrast, headache, flushing and dizziness were reported more frequently by patients while on nifedipine retard than on placebo or amlodipine. The convenience of once-daily dosing, together with a lower incidence of adverse effects, with consequently fewer withdrawals from therapy, suggests that amlodipine has clinical advantages over nifedipine retard in the treatment of hypertension.

The investigation and management of infertility in East Africa. A prospective study of 200 cases.

PIP: A prospective study of 200 patients complaining of infertility was conducted to determine the incidence of detectable lesions, in particular tubal occlusion, pelvic tuberculosis, and anovulation. These cases of primary and secondary infertility presented at the Gynecological Outpatient Department of the Kenyatta National Hospital in Nairobi. Tubal insufflation and endometrial biopsy were performed as outpatient procedures without general anesthesia. The 200 patients were divided into those with primary infertility who had never conceived, and those with secondary infertility who had conceived on at least 1 occasion. The Mantoux test was positive in 93 patients (46.5%) and negative in 107 (53.5%). The 4 cases of tuberculous endometritis diagnosed in the study had strongly positive results, but the Mantoux result bore no significant relationship to the incidence of tubal occlusion. Culture of the endometrium for M. tuberculosis in 200 cases yeilded 3 positive cultures (1.5%). These corresponded to the histological results and a definite diagnosis of tuberculosis endometritis was therefore established in 3 cases. In the 4th case, where the culture was negative, the histological evidence was very convincing, and it was considered justified to commence antituberculous therapy on this evidence alone. Tubal insufflation was performed in 3 out of these 4 cases and all showed blocked tubes. The menstrual cycles of 26 cases out of the 30 found to have proliferative phase endometrium were regular and unremarkable. The remaining 4 patients, where the histological pattern showed evidence of prolonged estrogen stimulation, had irregular menses suggestive of anovulatory menstruation. Of the 200 cases investigated, 98 patients (49%) had a demonstrable lesion preventing conception, 96 having blocked tubes, 1 having tuberculosis endometritis alone, and 1 having anovulation alone. 6 cases had 2 lesions preventing conception. No patients in the study became pregnant during the course of the investigation.^ieng

Tumoral calcinosis--an unrecognized disease.

Twenty-six cases of tumoral calcinosis are reported from Kenya. The disease, frequently misdiagnosed, is of unknown origin. It presents as calcified tumours, usually around the hips and buttocks, in muscle and subcutaneous tissue. The tumours are partly solid, partly multiloculated cysts which contain a chalky fluid. They may grow rapidly or very slowly, and are found in children and adults. Both sexes are affected and there is no obvious tribal or geographical localization.