Long-term evaluation of cilazapril in severe hypertension

Article Abstract:

The effects of cilazapril with or without hydrochlorothiazide were examined in 30 patients with severe hypertension, or abnormally high blood pressure. The patient group was comprised of 23 men and seven women, aged 38 to 68 years. Sitting systolic blood pressure is the pressure during the contraction phase of the heart cycle recorded while sitting. The sitting diastolic blood pressure, which is the blood pressure during the relaxation phase of the heart cycle recorded while sitting, was 115 millimeters of mercury (mm Hg) in 23 patients. Fifteen patients had hypertrophy or enlargement of the left ventricle. An average dose of 10 milligrams (mg) of cilazapril with 12.5 to 25 mg of hydrochlorothiazide was effective in 90 percent of patients. Sitting systolic blood pressure was reduced from about 176 mm Hg to 143 mm Hg, while sitting diastolic blood pressure was reduced from 117 mm Hg to 88 mm Hg. Heart rate was unchanged. In 19 patients treated for 48 weeks, blood pressure remained lowered for a long-term period. Cilazapril decreased the mass of the left ventricle in nine patients with hypertrophy; this was correlated with the decrease in systolic blood pressure. Cilazapril improved the rate at which the ventricle fills with blood, but had no effect on blood flow in the kidney. The results demonstrate that the new antihypertensive agent cilazapril, combined with the currently used antihypertensive drug hydrochlorothiazide, is effective in treating patients with severe hypertension. In addition, the improvement of left ventricle hypertrophy was associated with improved left ventricle function. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, ACE inhibitors, Angiotensin converting enzyme inhibitors, Hydrochlorothiazide, Drug synergism, Cilazapril

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Metabolic considerations in the approach to diabetic hypertensive patients

Article Abstract:

There is a strong association between diabetes and high blood pressure. When blood pressure-lowering agents are required to treat hypertension in diabetic patients, drugs that do not alter the balance of glucose, a simple sugar, should be chosen. Drugs act to lower blood pressure through a variety of pharmacological mechanisms. Antihypertensive drugs may also affect other processes which will aggravate the diabetic condition. Diuretics and beta-blockers tend to increase glucose in the blood. Central agonists, alpha blockers, and vasodilators do not affect glucose metabolism. Angiotensin-converting enzyme inhibitors have little effect on glucose balance. In addition to evaluating drug effects on glucose metabolism, the effects of the drug on the balance of fluid in the body, hormones, calcium metabolism, magnesium metabolism and fat metabolism, already compromised in diabetic patients, must be considered. Angiotensin-converting-enzyme inhibitors and calcium channel blockers seem to have the least negative effect on glucose metabolism while lowering blood pressures in diabetic patients.

Physiological aspects, Control, Glucose metabolism

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General considerations in selecting antihypertensive agents in patients with type II diabetes mellitus and hypertension

Article Abstract:

Many patients with diabetes mellitus also have high blood pressure. Since many blood pressure-lowering agents can alter the balance of glucose in the body, careful selection of antihypertensive agents in diabetic patients is required. Drugs that adversely affect glucose control should not be used in the treatment of high blood pressure in diabetic patients. In addition, some drugs may alter fat metabolism, already compromised in diabetic patients, which can further promote the development of high blood pressure. Nondrug blood pressure control measures such as salt and fat restriction, weight control, and moderate alcohol consumption in combination with blood pressure lowering drugs will offer the best blood pressure control. Diuretics, known to alter glucose control, can be replaced by salt restriction and calcium-channel blocker antihypertensive drugs. Angiotensin-converting-enzyme inhibitors and prazosin hydrochloride do not have negative effects on glucose metabolism and they are the drugs of choice for treating high blood pressure in non-insulin-dependent diabetics.

Care and treatment

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