High blood pressure. Causes, symptoms, treatments

Metformin vs insulin in the management of gestational diabetes: a meta-analysis.


A post-marketing clinical trial was carried out in ambulatory patients to assess the efficacy and toleration of atenolol (100 mg)/chlorthalidone (25 mg) tablets in the treatment of arterial hypertension. Data are reported on a cut-off at 2449 patients. Analysis of results in the different age groups has shown that after 4 weeks of treatment there was a mean fall of 16-17% in systolic and of 16-18% in diastolic blood pressure. Adequate blood pressure reduction was obtained for all age groups. The frequency of adverse reactions/events was low, these being reported in only 5.7% of cases. As discontinuation of treatment on account of adverse reactions/events occurred in 3.8% of patients, the risk-to-benefit relationship of atenolol/chlorthalidone tablets was very favourable.

The antihypertensive efficacy and tolerance of a new fixed combination of 50 mg atenolol and 12.5 mg chlorthalidone (Tenoretic Mite, TM) was studied in 37 patients with arterial hypertension, aged 61-80 years (mean, 70.2 years), who had been randomized to either 50 mg atenolol or 12.5 mg chlorthalidone for a 4-week period. At the end of this period, the fixed combination of atenolol and chlorthalidone was given to all patients for 6 months at a dose of one tablet daily in the morning. In both atenolol- and chlorthalidone-pretreated patients, treatment with the fixed combination resulted in a further significant drop in blood pressure, whereas the heart rate decreased only in the latter group. The mean blood pressure reduction achieved by the fixed combination was 30/15 mmHg in the standing position. Serum potassium levels significantly increased with the fixed combination compared with values on chlorthalidone alone. Unwanted effects were rare, and their frequency tended to decrease over time. In conclusion, the fixed combination of 50 mg atenolol plus 12.5 mg chlorthalidone tested in this study proved highly effective in lowering elevated blood pressure values in a population of elderly hypertensive patients treated over a 6-month period without noticeable unwanted effects.

A patient is presented who suffered for 3 years from increasing photosensitivity with chronic eczematous lesions in sun-exposed areas. He had taken one Neotri (triamterene, xipamide) tablet daily for 6 years. After discontinuation of the drug, phototesting and a photopatch test failed to reveal pathological reactions. Eczematous lesions, however, were induced in test areas upon systemic photochallenging with Neotri. One year later, after the antihypertensive medication had been changed from Adalat (nifedipine) to Teneretic (atenolol, chlortalidone) the eczematous photosensitive reaction recurred. Since both xipamide and chlortalidone have a chlorsulfamoyl-substituted aromatic ring in common, it seems that a photoallergic cross-reaction occurred.

Two hundred and ninety-two hypertensive patients from general practice who had previously been treated with a diuretic with insufficient effect participated in a randomised trial for a period of three months. A total of 115 patients completed treatment with 50 mg atenolol (Tanormin) and 121 were treated with the combined preparation consisting of 50 mg atenolol and 12.5 mg chlothalidone (Tenoretic Mite) while 56 patients defected from the trial. In both of the groups, the average blood pressure was reduced significantly already after treatment for one month. A significantly greater number of patients receiving combined treatment achieved satisfactory diastolic blood pressures (less than 90 mmHg), the proportions being 78% and 54%, respectively. Better effects from combined treatment were found particularly in patients over 60 years of age and in females. No significant differences were observed between the side-effects of the regimes nor in the laboratory values registered during treatment.

The pharmacological treatment, mainly based on diuretics, of isolated systolic hypertension (ISH) has recently been shown to reduce the risk of stroke and coronary heart disease in the elderly. The purpose of this study was to compare the antihypertensive effect and tolerability of different drug regimens in elderly subjects with ISH (systolic blood pressure--SBP-- > or = 160 mmHg and diastolic blood pressure--DBP-- < 90 mmHg). A multicentre, randomized, controlled open trial was planned in the general practice setting. Four widely used treatment schedules were tested: hydrochlorothiazide 25 mg plus amiloride 2.5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol 50 mg (At) and atenolol 25 mg plus chlorthalidone 6.25 mg (At+C). After a baseline evaluation, 308 patients (76.3% female, mean age 75.3 +/- 7.1 years) were randomized and followed up for 6 months. After 3 months the drug dosage was doubled if the systolic blood pressure goal (SBP < 160 mmHg and SBP reduction of at least 20 mmHg) had not been reached. Ninety-four subjects (30.5%) presented contraindications to beta-blockers. At the 3rd- and 6th-month visits all treatment groups, except At, showed a significant reduction in SBP compared to the control group; DBP showed no significant reduction in any group at any time. At the end of the follow-up the percentage of hypertensives who had reached the BP goal was 14.6% in the control group, 52.9% in H+Am, 54.8% in N, 28.6% in At and 52.2% in At+C.(ABSTRACT TRUNCATED AT 250 WORDS)