The cumulative dose response effect of eicosapentaenoic and docosahexaenoic acid on blood pressure, plasma lipid profile and diet pattern in mild to moderate essential hypertensive black patients.

In this study eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were given in a cumulative manner, every 6 weeks, starting with 10 mg, then 100 mg, 1000 mg and 10,000 mg EPA daily to mild to moderate essential hypertensive black patients. The corresponding DHA doses were 3, 33, 333 and 3333 mg. A control group was given olive oil as placebo for the entire 24 weeks. The placebo group had lower diastolic and systolic blood pressures after 24 weeks than the EPA and DHA group. No effect was seen on plasma triglycerides, cholesterol, HDL-cholesterol and gamma-glutamyltranspeptidase at any stage of the trial. In the EPA group plasma free-EPA increased significantly from 1000 mg onwards and plasma free-arachidonic acid (AA) decreased after 1000 mg EPA. No other plasma free essential fatty acid changed during the trial, although the HDL:cholesterol increased slightly but non-significantly with an increase in EPA and DHA. No significant changes in diet pattern or body mass was observed. It is therefore concluded that EPA and DHA supplementation had no beneficial effects in mild to moderate essential hypertensive black patients except for a lowering of plasma AA.

[The effect of enalapril and prazosin on mild to moderate hypertension in black South Africans]. / Die effekte van enalapril en prasosien op geringe tot matige hipertensie in swart Suid-Afrikaners. Resultate van 'n kliniese proef.

A double-blind, placebo-controlled clinical trial with a parallel design was conducted on 35 black patients with mild to moderate hypertension. After a 4-week run-in on placebo, baseline values were recorded and only patients with diastolic pressures of 95 - 115 mmHg were admitted to the trial, which lasted 10 weeks. These patients were randomised in three groups, receiving daily initially either 5 mg enalapril, 2 mg prazosin or placebo. Blood pressures and heart rates were measured once every week and in poor responders dosages were increased on a 2-weekly basis. Enalapril was increased to 10, 20 and 40 mg during the last 4 weeks, and prazosin was respectively increased to 4, 10 and 20 mg. The only statistically significant difference between baseline and post-treatment values (week 10) was a reduction in heart rate in the prazosin group, but no differences in either systolic or diastolic pressure could be detected in this group or between any of the three measurements in the other two groups. When the mean values of 3 groups were compared on a weekly basis it transpired that there were no statistically significant differences between any of the baseline values but that the mean heart rate at week 2 and the mean diastolic pressure at week 9 in the prazosin group and the mean systolic pressures in the enalapril group at weeks 6, 8 and 10 were significantly lower than the corresponding placebo values. Cumulative sum techniques were used to measure the course of the effects of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Compliance in black patients with non-insulin-dependent diabetes mellitus receiving oral hypoglycaemic therapy.

Poor compliance with drug therapy is an important cause of therapeutic failure. Sixty-eight black patients with non-insulin-dependent diabetes mellitus receiving oral hypoglycaemic agents were interviewed and various factors, such as age, sex, degree of control and type of therapy, were recorded by means of a questionnaire. Compliance was determined by qualitatively assessing urine for the presence of the drugs. An alarmingly high incidence of non-compliance of 65% was found, which could still be an under-estimation because of the long half-life of one of the drugs involved--chlorpropamide. Although interesting trends were noted, no statistically significant differences between compliant and non-compliant patients were found. In the light of the high incidence of non-compliance, a larger and more detailed study seems to be warranted to identify problem areas and to plan appropriate interventions.

The effect of miglitol and acarbose after an oral glucose load: a novel hypoglycaemic mechanism?

1. Alpha-glucosidase inhibitors such as miglitol and acarbose lower blood glucose after a starch load in healthy volunteers and diabetic patients by interfering with the conversion of disaccharide to monosaccharide in the gastrointestinal tract. 2. The effect of placebo, 100 mg miglitol and 100 mg acarbose given 30 min prior to a 75 g oral glucose load was investigated in nine healthy Caucasian volunteers. 3. Miglitol produced a statistically significant fall in post-peak blood glucose levels when compared with placebo and acarbose. Serum insulin did not change significantly. 4. As miglitol is well absorbed and acarbose is not, it is suggested that miglitol has a systemic hypoglycaemic effect, probably related to its close structural similarity to glucose, which warrants further investigation.

Penbutolol in the treatment of mild to moderate essential hypertension in black South Africans.

The antihypertensive effects of penbutolol, a nonselective beta-adrenoceptor antagonist with intrinsic sympathomimetic activity, was assessed in nonobese black South Africans aged 25 to 65 years with uncomplicated mild to moderate essential hypertension. After a 4-week placebo run-in period 50 patients entered a randomized placebo-controlled study with a crossover design. For 8 weeks they received a once daily dose of 40 mg penbutolol (or placebo) which was increased to 80 mg per day for the next 4 weeks in poor responders. This was followed by a 4-week placebo washout period after which a crossover of treatment was achieved and a second 12-week period of treatment initiated. Thirty-five patients completed the whole study and in 15 patients diastolic blood pressure was reduced below 95 mm Hg. The mean systolic pressures of these patients decreased by 21 mm Hg and their mean diastolic pressure decreased by 11 mm Hg during treatment with penbutolol. These results suggest that penbutolol monotherapy is an alternative therapeutic approach to hypertension in black South Africans.