Use of a sanitary sheath at artificial insemination by nonprofessional technicians does not markedly improve pregnancy rates to artificial insemination in pasture-based dairy cows.

Plastic sanitary sheaths over artificial insemination (AI) guns have been used at the time of AI to improve hygiene at AI and fertility in cattle, but fertility responses have been variable in studies when AI was performed by professional inseminators. The aims of this study were to investigate whether the use of a sanitary sheath at the time of AI carried out by nonprofessional (do-it-yourself, or DIY) inseminators improves pregnancy rates to AI in pasture-based dairy cows and whether effects of sheaths are greater in cows with contaminated vulvas and in cows at increased risk of extended calving to conception intervals. Lactating dairy cows located in 10 pasture-based herds in a subtropical region of northern Australia were inseminated by herd-based DIY inseminators and assigned to be inseminated with (n = 3,655) or without (n = 3,969) a sanitary sheath, with potential effects assessed using multivariable logistic regression. Overall, use of a sheath at the time of AI did not significantly affect pregnancy rates to AI (36.3% for those inseminated without a sheath vs. 36.8% for those inseminated with a sheath; odds ratio: 1.02; 95% confidence interval: 0.92-1.11). Effects of using a sheath on pregnancy rates to AI varied by herd, with lower pregnancy rates with the use of sheaths in 1 herd and some evidence of increases in 3 herds. Unexpectedly, there was evidence that the effect of sheath on pregnancy rates was less positive (or more negative) when the vulva was classified as dirty before any cleaning of the vulva before insemination compared with when the vulva was classified as clean (interaction odds ratio: 0.75; 95% CI: 0.56-1.00). Interactions between sheath and other explanatory variables that could affect fertility were not significant; thus, there was no compelling evidence that the effect of using a sheath was modified by any of these variables. We conclude that the use of sheaths during AI of pasture-based dairy cows by DIY inseminators does not, on average, markedly improve pregnancy rates to AI. However, responses may vary between herds, and the response to sheaths may be inferior (i.e., less positive or more negative) when a cow's vulva is contaminated with feces or discharge at the time of AI compared with when the vulva is clean.

Effect of equine chorionic gonadotropin on reproductive performance in a dairy herd in Northern Queensland, Australia.

This study evaluated the effect of equine chorionic gonadotropin (eCG) on reproductive performance, when incorporated into the first Ovsynch + P4 synchronization following planned start mating (PSM) in pasture-based lactating dairy cows. Two synchrony programs were compared in a randomized controlled trial in Queensland, Australia. Lactating cows from a single dairy herd (n = 782) were randomly allocated to Control and eCG groups. Control cows had their estrous cycles synchronized by treatment with 100 µg gonadotropin releasing hormone (GnRH; im) and insertion of a progesterone (P4) releasing intravaginal device that contained 1.0 g of P4 on Day 0; removal of P4 device and administration of 500 µg of an analogue of PGF2α on Day 7 (cloprostenol; im); 100 µg im of GnRH on Day 9, and fixed-time artificial insemination (FTAI) on Day 10. The eCG group were treated the same as the Control group except for the addition of 400 IU of eCG, im on Day 7 of the first synchronized estrous cycle. Following the first insemination, non-pregnant cows from both groups had their estrous cycles synchronized with the same treatment protocol without using eCG. The effects of eCG on 42d cumulative incidence of pregnancy and pregnancy per AI (P/AI) were determined using logistic regression models. The effect of eCG on time to pregnancy was determined using Kaplan-Meier survival analysis and Cox proportional hazards models. Adjusted 42 d cumulative incidence of pregnancy for eCG and control groups were 47.2 and 39.3% respectively (Odds ratio [OR] = 1.38, 95% CI: 1.01-1.88). Hazard of pregnancy tended to be higher in eCG cows overall (Hazard ratio [HR] = 1.18, 95% CI: 0.99-1.41) and was significantly higher when restricting to the first 42 days after PSM (HR = 1.31, 95% CI: 1.04-1.64). Hazards of pregnancy were not different between groups when restricting to > Day 42 post PSM (HR = 1.00, 95% CI: 0.77-1.31). P/AI tended to be higher in eCG treated cows at the first AI (44.0 vs 37.7%, OR = 1.30, 95% CI: 0.94-1.78). P/AI for second and third AIs were not significantly different between groups. In this herd, a single treatment of eCG at the first synchronized estrus after PSM improved reproductive performance in the short term, but not at subsequent inseminations.

Age, anger regulation and well-being.

Emotion regulation has been argued to be an important factor in well-being. The current study investigated the effects of adult aging on emotional expression, emotional control and rumination about emotional events, focusing on an emotion which is particularly important in social interaction: anger. Measures of anger regulation and well-being were obtained in a sample of 286 adults aged between 18 and 88. Older adults expressed anger outwardly less often, and reported more inner control of anger using calming strategies compared to their younger counterparts. These age differences were not explained by variance in social desirability of responding. Age improvements in negative affect and anxiety were partly explained by age differences in anger regulation suggesting an important role for anger management in good mental health amongst older adults. Further, age improvements in quality of life were explained by variance in anger regulation indicating that improved management of emotions with age is an important factor in maintaining well-being in old age.

Knowledge of display rules in prelingually deaf and hearing children.

Deaf children of elementary and secondary school age participated in a study designed to examine their understanding of display rules, the principles governing the expression and concealment of emotion in social situations. The results showed that deaf children's knowledge of display rules, as measured by their reported concealment of emotion, was comparable to that of hearing children of the same age. However, deaf children were less likely to report that they would conceal happiness and anger. They were also less likely to produce reasons for concealing emotion and a smaller proportion of their reasons were prosocial, that is, relating to the feelings of others. The results suggest that the understanding of display rules (which function to protect the feelings of other people) may develop more gradually in deaf children raised in a spoken language environment than it does in hearing children.

The pharmacodynamic and pharmacokinetic profiles of controlled-release formulations of felodipine and metoprolol in free and fixed combinations in elderly hypertensive patients.

AIMS: The aims of this study were to study the efficacy and tolerability of felodipine extended release (ER) 5 mg and metoprolol controlled release (CR/ZOC) 50 mg given as a fixed combination (Logimax) or as a free combination in elderly (age greater than 60 years) hypertensive patients, using ambulatory blood pressure (BP) monitoring. A secondary aim was to relate the efficacy of the free and fixed combinations with pharmacokinetic profiles. METHODS: This was a double-blind, placebo-controlled randomised three-way crossover multi-centre study. BP was measured for 26 h using ambulatory blood pressure monitoring (ABPM), which was performed on the last day of the three treatment phases. RESULTS: Mean sitting BPs, measured during the trough period with ABPM, were significantly lower with both the free and fixed combinations of metoprolol and felodipine than placebo (141/83 mmHg free, 140/83 mmHg fixed, 156/93 mmHg placebo). The mean BPs measured over 24 h using ABPM were 143/82 mmHg, 140/82 mmHg and 158/93 mmHg for the free, fixed and placebo treatment arms, respectively. The trough-to-peak ratios (T:P) were 75% and 79% for the systolic BP and 70% and 70% for the diastolic BP for the free and fixed combinations, respectively. Pharmacokinetic evaluation revealed identical plasma concentration-time curves for felodipine given as the free or fixed combination. Comparison of the plasma concentration-time curves for metoprolol revealed a delay in the release rate from the fixed combination formulation. No significant differences in BP control between the active treatments were noted during this period. Of 26 patients entered into the study, 3 withdrew during active phase for non-drug-related reasons. No patient withdrew from active treatment due to treatment-related adverse events. The frequency of adverse event reporting for the fixed combination of felodipine and metoprolol was similar to that for placebo (60% and 58%, respectively). CONCLUSION: The results suggest that once-daily dosing with either the free or fixed combination of felodipine 5 mg and metoprolol 50 mg produces a significant sustained reduction in systolic and diastolic BP with similar plasma concentration profiles over a 24-h period.

Felodipine-metoprolol combination tablet: a valuable option to initiate antihypertensive therapy?

The aim of the present study was to assess the efficacy and tolerability of a calcium antagonist/beta-blocker fixed combination tablet used as first-line antihypertesnive therapy in comparison with an angiotensin converting enzyme inhibitor and placebo. Patients with uncomplicated essential hypertension (diastolic blood pressure between 95 and 110 mm Hg at the end of a 4-week run-in period) were randomly allocated to a double-blind, 12-week treatment with either a combination tablet of felodipine and metoprolol (Logimax), 5/50 mg daily (n = 321), enalapril, 10 mg daily (n = 321), or placebo (n = 304), with the possibility of doubling the dose after 4 or 8 weeks of treatment if needed (diastolic blood pressure remaining >90 mm Hg). The combined felodipine-metoprolol treatment controlled blood pressure (diastolic < or =90 mm Hg 24 h after dose) in 72% of patients after 12 weeks, as compared with 49% for enalapril and 30% for placebo. A dose adjustment was required in 38% of patients receiving the combination, in 63% of patients allocated to placebo, and 61% of enalapril-treated patients. The overall incidence of adverse events was 54.5% during felodipine-metoprolol treatment; the corresponding values for enalapril and placebo were 51.7% and 47.4%, respectively. Withdrawal of treatment due to adverse events occurred in 18 patients treated with the combination, in 10 patients on enalapril, and 12 patients on placebo. No significant change in patients' well-being was observed in either of the three study groups. These results show that a fixed combination tablet of felodipine and metoprolol allows to normalize blood pressure in a substantially larger fraction of patients than enalapril given alone. This improved efficacy is obtained without impairing the tolerability. The fixed-dose combination of felodipine and metoprolol, therefore, may become a valuable option to initiate antihypertensive treatment.

Symptomatic gastro-oesophageal reflux disease: double blind controlled study of intermittent treatment with omeprazole or ranitidine. The European Study Group.

OBJECTIVE: To assess intermittent treatment over 12 months in patients with symptomatic gastro-oesophageal reflux disease. DESIGN: Randomised, multicentre, double blind, controlled study. Patients with heartburn and normal endoscopy results or mild erosive changes received omeprazole 10 mg or 20 mg daily or ranitidine 150 mg twice daily for 2 weeks. Patients remaining symptomatic had omeprazole 10 mg or ranitidine dose doubled for another 2 weeks while omeprazole 20 mg was continued for 2 weeks. Patients who were symptomatic or mildly symptomatic were followed up for 12 months. Recurrences of moderate or severe heartburn during follow up were treated with the dose which was successful for initial symptom control. SETTING: Hospitals and primary care practices between 1994 and 1996. SUBJECTS: 677 patients with gastro-oesophageal reflux disease. MAIN OUTCOME MEASURES: Total time off active treatment, time to failure of intermittent treatment, and outcomes ranked from best to worst. RESULTS: 704 patients were randomised, 677 were eligible for analyses; 318 reached the end of the study with intermittent treatment without recourse to maintenance antisecretory drugs. The median number of days off active treatment during follow up was 142 for the entire study (281 for the 526 patients who reached a treatment related end point). Thus, about half the patients did not require treatment for at least 6 months, and this was similar in all three treatment groups. According to outcome, 378 (72%) patients were in the best outcome ranks (no relapse or one (or more) relapse but in remission until 12 months); 630 (93%) had three or fewer relapses in the intermittent treatment phase. Omeprazole 20 mg provided faster relief of heartburn. The results were similar in patients with erosive and non-erosive disease. CONCLUSIONS: Intermittent treatment is effective in managing symptoms of heartburn in half of patients with uncomplicated gastro-oesophageal reflux disease. It is simple and applicable in general practice, where most patients are seen.

Cost effectiveness of omeprazole and ranitidine in intermittent treatment of symptomatic gastro-oesophageal reflux disease.

OBJECTIVE: This 1-year study compared the cost effectiveness of omeprazole and ranitidine when used as initial therapy in an intermittent treatment strategy for the management of patients with symptomatic gastro-oesophageal reflux disease with or without erosive oesophagitis. DESIGN AND SETTING: A prospective health economic analysis was conducted alongside an international multicentre randomised, double-blind clinical study. The economic analysis was performed from a societal perspective. PATIENTS: A total of 704 patients in the UK, the Republic of Ireland, Germany, France, Italy and Spain were randomised to 1 of the 3 treatment groups. INTERVENTIONS: Patients were randomised to receive either omeprazole 20 mg once daily, omeprazole 10 mg once daily or ranitidine 150 mg twice daily. Initial treatment failure resulted in dose titration and drug switching from ranitidine to omeprazole, and subsequently open maintenance treatment. MAIN OUTCOME MEASURES AND RESULTS: The estimated mean direct medical costs (medication and number of visits and endoscopies) were found to be lower for both dosages of omeprazole than for ranitidine in all countries except Germany. However, none of the differences were statistically significant. The differences between omeprazole 10 mg and omeprazole 20 mg were small and nonsignificant. With regard to numbers of symptom-free days, both omeprazole 20 mg and omeprazole 10 mg were found to be more effective than ranitidine. However, none of the differences were statistically significant. CONCLUSIONS: Following a pragmatic interpretation, incorporating intermediate short term results, the results in this study give no support to the notion that a step-up approach, either as dose titration from omeprazole 10 mg to omeprazole 20 mg or as drug switching from ranitidine to omeprazole, will result in cost savings and thereby be cost effective.

The development of theory of mind in deaf children.

Deaf children aged 4 to 16 years were given a false-belief test of theory of mind. Although the children experienced difficulty with the test, relative to hearing children, confirming a report by Peterson and Siegal (1995), performance was age-related, with a significantly higher proportion of 13- to 16-year-olds passing the test. It was concluded that deaf children raised in a spoken language environment show a developmental delay in theory of mind acquisition. This delay is consistent with the assumption that their early opportunities for learning about mental states are relatively restricted and that the normal development of theory of mind is dependent upon such opportunities.

Quality of life during acute and intermittent treatment of gastro-oesophageal reflux disease with omeprazole compared with ranitidine. Results from a multicentre clinical trial. The European Study Group.

AIMS: To investigate quality of life in patients with gastro-oesophageal reflux disease. PATIENTS: A series of 704 patients were randomised to treatment with ranitidine 150 mg bd, omeprazole 10 mg om or omeprazole 20 mg om for 2 weeks. Asymptomatic/mildly symptomatic patients were followed for 12 months. METHODS: The Psychological General Well-Being index and the Gastrointestinal Symptom Rating Scale were completed before and during short-term and intermittent treatment. RESULTS: The quality of life response rate was > 80%. The majority of the patients receiving omeprazole 20 mg om (55%) had symptom relief after 2 weeks despite the fact that more patients on ranitidine required 4 weeks' treatment and an increased dose. There was no difference in the reflux dimension of Gastrointestinal Symptom Rating Scale between treatments in the initial treatment phase, but the total Gastrointestinal Symptom Rating Scale score improved significantly more on omeprazole 10 mg om than on ranitidine 150 mg bd (p = 0.006). Both doses of omeprazole improved the total Psychological General Well-Being score more than ranitidine (omeprazole 10 mg om versus ranitidine 150 mg bd, p = 0.005, omeprazole 20 mg om versus ranitidine 150 mg bd, p = 0.031). During follow-up, relapsing patients returned to pre-treatment symptom and well-being scores, but these dimensions were restored after treatment. CONCLUSION: The quality of life is impaired in patients presenting with reflux symptoms. Irrespective of whether the patients presented with endoscopy positive or endoscopy negative reflux disease, treatment on demand improved the quality of life.

Sparfloxacin for the treatment of community-acquired pneumonia: a pooled data analysis of two studies.

A pooled data analysis of two double-blind studies encompassing 1137 episodes of community-acquired pneumonia in hospitalised adults, of which 560 were treated with sparfloxacin and 577 were randomised to comparator antibacterial agents (amoxycillin/clavulanic acid, erythromycin or amoxycillin administered at reference dosages), was performed. The global efficacy rate at the end of treatment in evaluable patients treated with sparfloxacin was 88.3% compared with 84.1% in those who received comparator antibacterial agents. This analysis verified the efficacy of this new aminofluoroquinolone, given orally once daily, in the treatment of community acquired pneumonia. The overall outcome favoured sparfloxacin for use in the empirical treatment of community-acquired pneumonia.

Comparative safety and efficacy of sparfloxacin in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a double-blind, randomised, parallel, multicentre study.

In a double-blind, placebo-controlled trial, patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) were randomly allocated to oral treatment with sparfloxacin (200 mg loading dose followed by 100 mg once daily) or amoxycillin/clavulanic acid (500 mg/125 mg tds) for a total treatment duration of 7 to 14 days. Patients were evaluable if they had a FEV1/FVC ratio of less than 70% at stable state and presented with a suspected infectious exacerbation defined as increases in dyspnoea, sputum volume and sputum purulence. The primary efficacy variable was the overall success (defined as disappearance or improvement of dyspnoea and reductions in sputum volume and purulence) at end of treatment and follow-up. Overall efficacy was assessed in both the intent-to-treat (728 patients) and the evaluable (351 patients) populations. At the end of treatment and follow-up, success rates were identical for the sparfloxacin (87.3% and 78.7%) and amoxycillin-clavulanic acid (88.8% and 79.8%) treatment groups. Similar figures were found for the intent-to-treat population. The analysis of drug safety was similar for both treatment groups. The most frequently encountered pathogens were Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Sparfloxacin appeared superior for bacteriological eradication of Haemophilus influenzae, and Moraxella catarrhalis. Sparfloxacin in a single daily dose appears at least as effective as amoxycillin/clavulanic acid in the treatment of patients with acute exacerbations of COPD.

Meloxicam in osteoarthritis: a 6-month, double-blind comparison with diclofenac sodium.

A multicentre, double-blind, randomized study was conducted in patients with osteoarthritis (OA) of the hip or knee in order to compare the efficacy and safety of the new cyclooxygenase-2 (COX-2) inhibitor, meloxicam, with diclofenac sodium, a conventional treatment for this condition. Three hundred and thirty-six patients were treated with oral meloxicam 7.5 mg once daily or diclofenac 100 mg slow release once daily for 6 months. There were no significant differences between the treatment groups with respect to overall pain, pain on movement, global efficacy or quality of life scores at the end of treatment, all of which showed good levels of improvement. Sixty-six patients were withdrawn after the start of the double-blind phase due to adverse events (n = 21, meloxicam; n = 31, diclofenac) or to lack of efficacy (seven in each group). The median of dose paracetamol taken concomitantly was statistically significantly lower in the meloxicam group than in the diclofenac group (185 vs 245 mg/day; P = 0.0123) with a comparable proportion of patients taking concomitant paracetamol therapy in both groups. Both drugs were well tolerated, although severe adverse events, treatment withdrawal and clinically significant laboratory abnormalities were more common with diclofenac than with meloxicam. Thus, meloxicam 7.5 mg is a safe and effective treatment for OA of the hip and knee which demonstrates a trend towards an improved safety profile compared with diclofenac.

The effect of experimental design on memory for typical and distinctive faces.

The effect of experimental design on memory for typical and distinctive faces was investigated in three experiments. In Experiments 1 and 2, a between-subjects, between-lists (distinctive-only faces, or typical-only faces) manipulation of distinctiveness was compared with a within-subjects mixed-list design. The results demonstrated an interaction between design type and distinctiveness, indicating an increase in the rate of misidentifications and a decrease in the response criterion to distinctive faces in the distinctive-only set relative to distinctive faces in the mixed-list condition. Experiment 3 addressed the locus of this effect by comparing the standard mixed-list within-subjects design with two sets of faces in which the target images were different in type from the distractor images, i.e. a typical target-distinctive distractor set and a distinctive target-typical distractor set. The results of this experiment demonstrated that distinctive distractor faces were more readily rejected as new faces when typical target faces were included in the same set. The relative sensitivity of memory for typical and distinctive faces to manipulations of experimental design are discussed with reference to current models of facial distinctiveness.

Treatment of community-acquired pneumonia: a randomized comparison of sparfloxacin, amoxycillin-clavulanic acid and erythromycin.

The treatment of community-acquired pneumonia is empirical in most cases and must cover a wide range of potential pathogens, such as Streptococcus pneumoniae, including penicillin-resistant strains, Haemophilus influenzae and intracellular microorganisms. The objective of this double-blind, randomized, parallel group study was to compare the efficacy and safety of sparfloxacin (400 mg loading dose, followed by 200 mg o.d.) with that of oral amoxycillin-clavulanic acid (500/125 mg t.i.d.) or oral erythromycin (1 g b.i.d.), during 7-14 days in 808 patients with confirmed community-acquired pneumonia. The overall success rates for sparfloxacin (87%), amoxycillin-clavulanic acid (80%) and erythromycin (85%) were similar in evaluable patients, and the equivalence hypothesis used for the statistical analysis showed at least an equivalent efficacy for the three antibiotics tested. The analysis of microbiologically documented infections (40% of the patients) showed that overall success rates were similar for S. pneumoniae and H. influenzae infections. Treatment withdrawal was necessary in 3.5, 2.5 and 7.7% of the patients treated with sparfloxacin, amoxycillin-clavulanic acid and erythromycin, respectively. This study indicates that sparfloxacin was at least as effective as amoxycillin-clavulanic acid or erythromycin in the treatment of mild-to-moderate community-acquired pneumonia and that the adverse effects were similar in the three groups.

A comparison of 5 days of dirithromycin and 7 days of clarithromycin in acute bacterial exacerbation of chronic bronchitis.

The safety and efficacy of dirithromycin and clarithromycin were compared in a single-blind, multicentre study of patients with acute bacterial exacerbation of chronic bronchitis (AECB). Patients received either dirithromycin, 500 mg once daily for 5 days, or clarithromycin, 250 mg twice daily for 7 days. A total of 212 patients entered the study, of whom 191 qualified for efficacy analysis. Favourable post-therapy clinical and bacteriological response rates for qualified patients (95 dirithromycin and 96 clarithromycin) were similar: 89.5% and 68.8% for dirithromycin vs 94.8% and 71.9% for clarithromycin. At late post-therapy evaluation, favourable clinical and bacteriological response rates were achieved in 98.8% and 96.2% of dirithromycin patients and 95.3% and 93.3% of clarithromycin patients, respectively. These differences were neither statistically nor clinically significantly different. Both drugs had similar efficacy against Haemophilus influenzae and both were well tolerated. Dirithromycin, administered as a single daily dose for just 5 days resulted in complete compliance in all but four patients. In clarithromycin-treated patients, requiring a 7-day course of twice-daily treatment, compliance was less satisfactory, with 12 patients failing to comply, though the between-group difference was not statistically significant. It can be concluded that 5 days of dirithromycin, 500 mg once daily is as safe and effective as 7 days of clarithromycin, 250 mg, twice daily in the treatment of AECB.

Managing hypertension in general practice: can we do better?

Two surveys of hypertension treatment in Europe have revealed major differences between doctor perception, patient belief and the reality of BP control. The first survey (part of the Cardiomonitor Study) investigated 23,339 cardiovascular patients treated by 1471 doctors in Italy, Spain, France, the UK and Germany. The second survey researched attitudes to treatment among 301 general practitioners and 300 patients in Italy, France and the UK. Cardiomonitor revealed that hypertension was poorly controlled, with only 37% of patients achieving target BP. In contrast, the second survey revealed that doctors believed that target BP was reached in the majority (76%) of their treated patients with hypertension, while an even higher percentage of patients (95%) believed their BP to be well controlled. There were significant discrepancies in the perceived reasons for treatment failure between doctors and patients. Most doctors considered poor compliance with therapy to be the main reason for failure to achieve target BP. In contrast, most patients reported good compliance, blaming poor efficacy or side-effects for treatment failure. Objective studies suggest that compliance is lower than patients report and can be reduced by factors that affect quality of life, such as side-effects of treatment, complex dosing regimens, changes in therapy and concern about poorly controlled disease. This argues for effective, well-tolerated antihypertensive drugs that can be taken once daily, enabling quality of life to be maintained throughout treatment.

The effect of tenidap on the anti-hypertensive efficacy of ACE inhibitors in patients treated for mild to moderate hypertension.

1. A randomised, placebo controlled, double-blind, parallel group study was conducted to assess the effect of tenidap sodium, a novel cytokine modulating drug, on the stable hypotensive response to the angiotension converting enzyme (ACE) inhibitor enalapril in subjects with mild to moderate, uncomplicated, essential hypertension. 2. Twenty-four male and female hypertensives, aged 33-77 years, received either 120 mg tenidap sodium or matched placebo daily for 22 days concomitantly with enalapril. 3. Mean endpoint supine and standing, systolic and diastolic pressures remained within 10% of baseline in each treatment group. However, the endpoint values were marginally above baseline during double-blind treatment with tenidap and marginally below baseline in the group receiving placebo. The increases in supine and standing systolic pressures in the tenidap group differed significantly from the changes in the placebo group. There were no significant differences between groups in changes in pulse rate. 4. Gastrointestinal side effects of mild to moderate severity attributed to treatment with tenidap were experienced by five subjects, one of whom was withdrawn during the third week of treatment. One subject receiving placebo was withdrawn because of a moderate headache attributed to study treatment. 5. The results of this study suggest that treatment with tenidap may interfere with the anti-hypertensive efficacy of ACE inhibitors. It is recommended that blood pressure should be monitored when tenidap is administered concomitantly with an ACE inhibitor.

Eficacia e tolerabilidade da felodipina em dose unica diaria e nifedipina, duas vezes ao dia, como monoterapia na hipertensao arterial leve / Effectiveness and tolerability of felodipine once daily and nifedipine twice daily as monotherapies for mild hypertension

Esse estudo foi projetado para comparar a felodipina de liberacao prolongada com a nifedipina retard em termos de seu efeito anti-hipertensivo,telerabilidade e impacto na qualidade de vida.Setenta e sete pacientes com hipertensao arterial primaria e pressao diastolica de 95-110 mmHg,na posicao supina,foram randomizados para quatro semanas de tratamento duplo-cego com felodipina,na dose de 5mg,uma vez por dia,ou nifedipina,na dose de 20mg,duas vezes por dia.A pressao arterial foi medida no termino do intervalo posologico,isto e,24 e 12 horas depois da administracao da felodipina e nifedipina,respectivamente.Foram registrados os efeitos adversos relatados espontaneamente ou em resposta a uma pergunta aberta e a qualidade de vida foi avaliada,usando-se dois questionarios auto-administrados.Depois de quatro semans de tratamento a pressao arterial media,na posicao supina,diminuiu de 165/104 mmHg para 154/91mmHg no grupo tratado com a felodipina e de 169/102mmHg para 155/90mmHg no grupo tratado com a nifedipina.Nao huve diferencas sisgnificativas na reducao da pressao arterial na posicao supina ou em pe entre os grupos.A qualidade de vida pareceu ser semelhante entreos tratamentos,mas foram relatadoa mais reacoes adversas,em particular,edema maleolar e rubor,com a nifedipinado que com a felodipina.As reacoes adversas exigiam a interrupcao do tratamanto em 5 de 40 pacientes do grupo da nifedipina,em comparacao com 1 de 37 pacientes do grupo da felodipina.Em conclusao,a felodipina na dose de 5mg,uma vez por dia,e anifedipina,na dose de 20mg,duas vezes por dia foram igualmente eficazes como tratamento anti-hipertensivo,mas a felodipina foi melhor tolerada