A PROSPECTIVE CONTROLLED TRIAL OF METOPROLOL‐HYDRALAZINE TREATMENT IN HYPERTENSION DURING PREGNANCY l-Arginine supplementation in women with chronic hypertension: impact on blood pressure and maternal and neonatal complications Patient Acceptance of Guanethidine as Therapy for Mild to Moderate Hypertension: A Comparison with Reserpine [Atenolol and bisoprolol in the treatment of mild and moderately severe hypertension]. Appropriate Blood Pressure Control in NIDDM (ABCD) Trial Severe hypertension in pregnancy: hydralazine or labetalol. A randomized clinical trial. Early blood pressure control improves pregnancy outcome in primigravid women with mild hypertension. A CONTROLLED STUDY OF THE EFFECTS OF AEROBIC EXERCISE ON ANTIHYPERTENSIVE DRUG REQUIREMENTS OF ESSENTIAL HYPERTENSIVE PATIENTS IN THE GENERAL PRACTICE SETTING Proteinuria in mild to moderate hypertension: results of the VA cooperative study of six antihypertensive agents and placebo. 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At equipotent doses, isradipine is better tolerated than amlodipine in patients with mild-to-moderate hypertension: a double-blind, randomized, parallel-group study. A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy. A randomized double-blind clinical trial of xipamid and hydrochlorothiazide in essential hypertension. Effect of various antihypertensive drugs on plasma fibrinogen levels in patients with essential hypertension. Combined Versus Single Effect of Fosinopril and Hydrochlorothiazide in Hypertensive Patients Effect of single-drug therapy on reduction of left ventricular mass in mild to moderate hypertension: comparison of six antihypertensive agents. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. A randomized comparison of early with conservative use of antihypertensive drugs in the management of pregnancy‐induced hypertension A randomised comparison of hydralazine and mini-bolus diazoxide for hypertensive emergencies in pregnancy: the PIVOT trial. Antihypertensive efficacy and tolerability of once daily losartan potassium compared with captopril in patients with mild to moderate essential hypertension Induction of labour versus expectant monitoring in women with pregnancy induced hypertension or mild preeclampsia at term: the HYPITAT trial Effect of telmisartan 80 mg once daily on 24-h blood pressure profile in patients with mild-to-moderate hypertension failing to respond to prior antihypertensive therapy. Clonidine versus Captopril for Severe Postpartum Hypertension: A Randomized Controlled Trial Labetalol and bendrofluazide: comparison of their antihypertensive effects. Effects of aerobic dance training on blood pressure in individuals with uncontrolled hypertension on two antihypertensive drugs: a randomized clinical trial. Monotherapy with amlodipine or hydrochlorothiazide in patients with mild to moderate hypertension: Comparison of their efficacy and effects on electrolytes A multifactorial trial design to assess combination therapy in hypertension. Treatment with bisoprolol and hydrochlorothiazide. Antihypertensive efficacy and safety of losartan alone and in combination with hydrochlorothiazide in adult African Americans with mild to moderate hypertension. Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension. A 12-month comparison of ACE inhibitor and CA antagonist therapy in mild to moderate essential hypertension--The GLANT Study. Study Group on Long-term Antihypertensive Therapy. Atenolol and fetal growth in pregnancies complicated by hypertension. An economic evaluation of the 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of mild-to-moderate hypertension in Greece. Artichoke Leaf Juice Contains Antihypertensive Effect in Patients With Mild Hypertension Comparison of the efficacy of nifedipine and hydralazine in hypertensive crisis in pregnancy. Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial. Comparative antihypertensive effects of losartan 50 mg and losartan 50 mg titrated to 100 mg in patients with essential hypertension. Nifedipine GITS and hydrochlorothiazide in essential hypertension. Evaluation of the antihypertensive effect of atenolol in fixed or free combination with chlorthalidone. 24‐hour blood pressure profiles in hypertensive patients administered ramipril or placebo once daily: Magnitude and duration of antihypertensive effects Randomised controlled trial of ketanserin and aspirin in prevention of pre-eclampsia Effect of single-drug therapy on reduction of left atrial size in mild to moderate hypertension: comparison of six antihypertensive agents. Relation between low dose of hydrochlorothiazide, antihypertensive effect and adverse effects. A randomized, double-blind comparison of the antihypertensive efficacy and safety of once-daily losartan compared to twice-daily captopril in mild to moderate essential hypertension. Reduction of blood pressure with oral magnesium supplementation in women with mild to moderate hypertension. [Acebutolol in the treatment of arterial hypertension in pregnancy--comparison with commonly used hypertensive agents]. Treatment of mild-to-moderate hypertension with calcium channel blockers: a multicentre comparison of once-daily nifedipine GITS with once-daily amlodipine Effect of allopurinol on blood pressure and aortic compliance in hypertensive patients The effect of antihypertensive agents on sleep apnea: protocol for a randomized controlled trial Antihypertensive effect of diet compared with drug treatment in obese men with mild hypertension. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): Practical Implications PLACEBO-CONTROLLED TRIAL OF ATENOLOL IN TREATMENT OF PREGNANCY-ASSOCIATED HYPERTENSION Patterns of antihypertensive medication use in hemodialysis patients. The Antihypertensive Action of Isradipine in Mild Essential Hypertension Antihypertensive efficacy and safety of olmesartan medoxomil compared with amlodipine for mild-to-moderate hypertension An assessment of diltiazem and hydrochlorothiazide in hypertension. Application of factorial trial design to a multicenter clinical trial of combination therapy. QUALITY OF LIFE BEFORE AND DURING ANTIHYPERTENSIVE TREATMENT: A COMPARATIVE STUDY OF CELIPROLOL AND ATENOLOL Rational Prescribing in Primary Care (RaPP-trial). A randomised trial of a tailored intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs in general practice [ISRCTN48751230] Effectiveness of antihypertensive medications in office and ambulatory settings: a placebo-controlled comparison of atenolol, metoprolol, chlorthalidone, verapamil, and an atenolol-chlorthalidone combination. The antihypertensive efficacy and tolerability of a low dose combination of ramipril and felodipine ER in mild to moderate essential hypertension. Antihypertensive efficacy of zofenopril compared with atenolol in patients with mild to moderate hypertension Antihypertensive treatment efficacy in type II diabetes mellitus. Dissociation between casual and 24-hour ambulatory blood pressure. Spanish Multicenter Study Group. Analysis of well-being and 24-hour blood pressure recording in a comparative study between indapamide and captopril. Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. Calcium Dobesilate Lowers the Blood Pressure in Mild to Moderate Midtrimester Hypertension Angiotensin-converting enzyme inhibitors and Alzheimer's disease progression in older adults: results from the Réseau sur la Maladie d'Alzheimer Français cohort. Prospective study on the treatment of mild hypertension in the aged. Indoramin in the treatment of pregnancy hypertension. A placebo-controlled trial comparing the efficacy of indoramin with alpha-methyldopa.
Abstract . in an open , controlled trial , treatment with a combination of metoprolol and hydralazine was compared with non‐pharmacological management of mild and moderate hypertension in pregnancy . One hundred and sixty‐one women participated in the study . the drug‐treated group showed significantly better blood pressure control than the group not given antihypertensives .  Induction of labor before term , because of maternal or fetal complications , was somewhat more frequent in the control group . Nine women in the treatment group and 5 in the control group developed albuminuria . Three infants in the drug‐treated group died perinatally , and one in the control group . the outcome for the newborns was similar in both groups concerning birth weight , head circumference and Apgar score and in the frequencies of respiratory distress , bradycardia and hypoglycemia . the better blood pressure control achieved with these drugs makes it possible to treat the patient at home and reduce the risk of emergency delivery , but treatment does not seem to be m and atory for a good outcome of the pregnancy in cases of mild and moderate hypertension during pregnancy Objective . To evaluate l-arginine ( l-Arg ) supplementation in pregnant women with chronic hypertension and its effects on blood pressure ( BP ) and maternal and neonatal complications . Methods . We enrolled 80 women affected by mild chronic hypertension referred to the High Risk Clinic of the Mother – Infant Department of the University of Modena and Reggio Emilia . Each woman after obtaining oral consent was r and omized to receive oral l-Arg versus placebo and thereafter su bmi tted to 24-h ambulatory BP monitoring . The primary outcome was BP change after 10–12 weeks of treatment . Secondary outcomes were as follows : percentage of women on antihypertensive treatment at delivery , maternal , and fetal outcome . Results . The BP changes after 10–12 weeks of treatment did not differ between groups . A lower percentage of women received antihypertensive drugs in the l-Arg group than the placebo group . The incidence of superimposed preeclampsia indicated delivery before the 34th weeks and certain neonatal complications tended to be higher in the placebo group . Conclusions . l-Arg supplementation in pregnant women with mild chronic hypertension does not significantly affect overall BP but is associated with less need for antihypertensive medications and a trend toward fewer maternal and neonatal complications . The results of the study were limited by the small sample size and by the exclusion of women with severe chronic hypertension . In our policy , these patients needed many hypertensive drugs and were normally managed by the cardiologist . Nevertheless , considering the promising results on maternal and fetal outcome , we believe that further studies should be performed to confirm such data and to clarify the role of l-Arg as a protective supplement in high-risk pregnancy The relative benefits and risks of reserpine and guanethidine were compared in patients with thiazide-treated mild to moderate hypertension ( diastolic pressure 95–115 mm Hg ) . Fortynine ambulant patients ( 30 men , 19 women ) were treated throughout the study with hydrochlorothiazide , 50 mg/day . In this double blind crossover study each drug was added in grade d increments until a predetermined therapeutic response was obtained , blood pressure measurements and side effect scores were evaluated biweekly . Major conclusions of the study were : 1 ) guanethidine , as well as reserpine , will reduce mild to moderate blood pressures to normal ; 2 ) in most cases , side effects which did occur while taking guanethidine or reserpine were well tolerated and neither drug was clearly superior . Side effects associated with larger doses of guanethidine employed in severe hypertension were absent or only slightly bothersome . Thus , guanethidine appears to have a good benefit-to-risk ratio in the therapy of mild to moderate hypertension and offers a number of advantages over drugs commonly used in this syndrome . This study refutes the common belief that guanethidine must be reserved only for the treatment of more severe degrees of hypertension Atenolol and bisoprolol , two beta-1-selective blockers , were compared in patients with mild and medium severe hypertension . Forty patients with a diastolic blood pressure of 95 - 115 mm Hg were two weeks after discontinuation of treatment divided at r and om into two groups treated with 50 mg atenolol and 5 mg bisoprolol . If the blood pressure was not affected by this dosage , the dose was raised to 100 mg atenolol and 10 mg bisoprolol . The blood pressure readings , heart rate , side effects of the drugs , laboratory and echocardiographic values were followed up for a period of three months . The authors recorded a marked decline of pressure and heart rate after the first week of therapy , the pressure readings in an upright position did not differ statistically from values in a sitting position , orthostatic hypotension was not recorded . The rate of success of bisoprolol was 85 % , of atenolol 75 % . During treatment no serious side-effects were observed . The biochemical parameters and echocardiographic values were not altered significantly by treatment . Atenolol and bisoprolol are two effective beta-1-selective blockers with a comparable effect in the treatment of mild and medium severe hypertension . They are useful in monotherapy as well as in combination with other antihypertensive drugs . In hypertension associated with diabetes mellitus , incipient bronchopulmonary disease and pregnancy they are also indicated . They are well tolerated also by elderly patients , an advantage of bisoprolol may be that it has a smaller impact on pressure and heart rate during the night Summary The ABCD ( Appropriate Blood Pressure Control in Diabetes ) Trial is a large , prospect i ve , r and omized clinical trial of 950 patients with non-insulin-dependent diabetes mellitus ( NIDDM ) design ed to compare the effects of intensive blood pressure control with moderate control on the prevention and progression of diabetic nephropathy , retinopathy , cardiovascular disease , and neuropathy in NIDDM . The secondary objective is to determine equivalency of the effects of a calcium channel blocker ( nisoldipine ) and an angiotensin-converting-enzyme inhibitor ( enalapril ) as a first-line antihypertensive agent in the prevention and /or progression of these diabetic vascular complications . The study consists of two study population s aged 40–74 years , 470 hypertensive patients ( diastolic blood pressure of ≥ 90.0 mmHg at time of r and omization ) and 480 normotensive patients ( diastolic blood pressure of 80.0 mmHg at time of r and omization ) . The study duration is 5 years and is scheduled to end in May of 1998 . Patients are r and omized to receive either intensive antihypertensive drug therapy or moderate antihypertensive drug therapy . Patients are also r and omized to nisoldipine or enalapril , with open-label medications added if further blood pressure control is necessary . The primary outcome measure is glomerular filtration rate as assessed by 24-h creatinine clearance . Secondary outcome measures are urinary albumin excretion , left ventricular hypertrophy , retinopathy , and neuropathy . Cardiovascular morbidity and mortality will also be evaluated . Given the data showing the impact of hypertension on complications in NIDDM , the ABCD Trial is design ed to determine if intensive antihypertensive therapy will be more efficacious than moderate antihypertensive therapy on the outcome of diabetic complications in NIDDM . [ Diabetologia ( 1996 ) 39 : 1646–1654 OBJECTIVE The objective was to compare the safety and efficacy of intravenous labetalol and intravenous hydralazine for acutely lowering blood pressure in pregnancy . STUDY DESIGN Two hundred women with severe hypertension in pregnancy were r and omized to receive hydralazine ( 5 mg as a slow bolus dose given intravenously , and repeated every 20 min up to a maximum of five doses ) or labetalol ( 20-mg intravenous bolus dose followed by 40 mg if not effective within 20 min , followed by 80 mg every 20 min up to a maximum dose of 300 mg ) . The primary end point was successful lowering of blood pressure and maternal hypotension . RESULTS Women were similar with respect to characteristics at r and omization . No significant differences were observed for maternal hypotension or persistent severe hypertension ; only two patients in the hydralazine group presented with hypotension . Palpitations ( p=0.01 ) and maternal tachycardia ( p=0.05 ) occurred significantly more often in patients treated with hydralazine . The main neonatal outcomes were very similar per group ; however , hypotension and bradycardia were significantly more frequent in the labetalol group . There were two neonatal deaths per antihypertensive drug group . CONCLUSIONS This r and omized clinical trial shows that labetalol and hydralazine fulfill the criteria required for an antihypertensive drug to treat severe hypertension in pregnancy OBJECTIVE AND DESIGN The aim of this study was to evaluate treatment of mild to moderate hypertension ( less than 170/110 mmHg ) in pregnancy in a prospect i ve , r and omised , double-blind trial . SETTING AND PATIENTS Pregnancy outcome was studied for 52 primigravid women , managed in hospital from early in the third trimester . INTERVENTIONS Patients were r and omly allocated either to placebo or to active treatment ( clonidine plus hydralazine ) . MAIN OUTCOME MEASURES AND RESULTS Maternal deterioration dictated withdrawal from trial therapy for eight patients receiving placebo , but for only one receiving active treatment . Maternal proteinuria occurred only in the placebo group . Intention-to-treat analysis showed a significant increase in premature delivery for complications in the placebo group ( P less than 0.05 ) , despite active blood pressure treatment for those withdrawn from the group because of severe hypertension ( 170/110 mmHg or higher ) . Neonatal respiratory distress requiring intensive care occurred only in babies born to women in the placebo group . There were no perinatal deaths and no adverse effects of treatment in the neonates . CONCLUSIONS The study indicates that early control of mild hypertension in pregnancy can prevent progression to emergency premature delivery 1 . To investigate the effect of an exercise training programme on antihypertensive drug requirements , 19 sedentary subjects ( 14 men and five women ) with mild essential hypertension ( systolic blood pressure greater than 140 mmHg but less than 180 mmHg ) , aged 29–55 years , were r and omly assigned to 16 weeks of moderate intensity exercise or light intensity exercise ( control ) , and titrated on antihypertensive drug therapy ( captopril and hydrochlorothiazide ) until  resting systolic blood pressure  ( sitting ) of less than 140 mmHg was achieved The prevalence and natural history of severe proteinuria in mild to moderate hypertension are not completely defined . We screened 1635 men with a history of hypertension and r and omized 1292 with untreated diastolic blood pressure ( DBP ) 95 - 109 mmHg to single-drug treatment with either hydrochlorothiazide , atenolol , captopril , clonidine , diltiazem-SR , prazosin , or placebo in a double-blind prospect i ve trial . Twenty-seven of 1635 patients ( 1.7 % ) satisfying clinical criteria for primary hypertension were found to have developed proteinuria > 1000 mg/24 hours and were removed from the study . Follow-up data were obtained on 19 of these 27 patients . One patient was found to have focal segmental sclerosis and progressed to end-stage renal disease . Three other patients developed severe ( serum creatinine > 3.5 mg/dl ) chronic renal failure ( one with diabetic nephropathy ) , one progressed from serum creatinine 1.4 to 2.2 mg/dl , but 14 of the 19 remained with stable serum creatinine < 2.0 mg/dl on follow-up for 6 - 9 years . Data were available for 1076 of 1155 ( 93 % ) treated study patients at end titration , 522/600 ( 87 % ) at one year and 322/444 ( 73 % ) at two years . There were significant associations for proteinuria with obesity and higher systolic blood pressure . There was a trend toward significant difference in mean 24-hour protein excretion rates at baseline between black ( 127 mg ) and white ( 139 mg ) patients ( p = 0.07 ) . There were no statistically significant changes in urinary protein excretion/24 hours between or within the different treatment groups ( including placebo ) . Eighteen patients were removed from the study during the active treatment phase for proteinuria > 1000 mg/24 hours : hydrochlorothiazide 4 , placebo 3 , diltiazem 3 , prazosin 3 , atenolol 2 , clonidine 2 , and captopril 1 . We conclude : ( 1 ) the prevalence of severe ( > 1 g/24 hours ) proteinuria in the hypertensive population is significant but does not necessarily imply a poor prognosis ; ( 2 ) mean 24-hour urinary protein excretion rates did not vary in response to the different classes of antihypertensive drugs ; and ( 3 ) there was no drug-specific increase in proteinuria detected in this study BACKGROUND Hypertension is associated with increased maternal and fetal mortality and morbidity . While there is consensus that severe hypertension should be treated , antihypertensive treatment for mild chronic hypertension during pregnancy remains controversial . OBJECTIVE To evaluate clinical course , and maternal and perinatal outcomes of pregnant women with mild chronic hypertension without other disease , under strict control of maternal hypertension ( target dBP of 85 - 89 mmHg ) . PATIENTS AND METHODS We conducted a prospect i ve cohort study of 110 pregnant women with mild chronic hypertension without other disease ; clinical course was classified in three groups : stable condition , exacerbation of hypertension and superimposed preeclampsia . We compare maternal and perinatal outcomes ; statistical comparisons were performed by ANOVA test . Relative risk ( RR ) was calculated for adverse perinatal outcomes . RESULTS Atotal of 110 women were included , mean maternal age was 33 + /- 5.8 years . There were 78 ( 71 % ) women with stable condition , 26 ( 24 % ) with exacerbation of hypertension and 6 ( 5 % ) with superimposed preeclampsia ( PE ) . Women with superimposed PE and exacerbation of hypertension delivered earlier and had more small for gestational age ( SGA ) babies than women with stable condition and exacerbation . Delivery route was vaginal in 45 patients ( 40 % ) while 65 patients ( 60 % ) underwent cesarean section in order to avoid fetal distress . CONCLUSIONS Results demonstrated that fetuses in the stable condition group ( strict control ) did not have worst outcomes than those in the other groups . This cohort study shows efficacy and safety of treating mild chronic hypertension during pregnancy OBJECTIVE The primary objective of the ABCD ( Appropriate Blood Pressure Control in Diabetes ) Trial is to determine the efficacy of intensive versus moderate antihypertensive control on the outcome of type II diabetic end-organ complications in normotensive and hypertensive population s. The secondary objective is to determine whether any differential effect on end-organ complications exists between an angiotensin converting enzyme inhibitor ( enalapril ) and a calcium channel blocker ( nisoldipine ) . DESIGN The ABCD Trial is a prospect i ve , controlled , r and omized , double-blind trial , with a planned follow-up of 5 years . SETTING All patients are seen at the Colorado Prevention Center , site of the ABCD Trial , for follow-up visits . PATIENTS Patients are type II diabetic males and females between the ages of 40 and 74 years with entry diastolic blood pressures > or = 80 mmHg . Patients were recruited from University of Colorado-affiliated hospitals , several health maintenance organizations , and mailing lists from the Colorado affiliate of the American Diabetes Association . INTERVENTIONS Patients were r and omized to intensive antihypertensive drug therapy or moderate antihypertensive drug therapy . Patients were also r and omized to nisoldipine or enalapril , with open-label medications added if further blood pressure control was necessary . MAIN OUTCOME MEASURES The primary outcome measure is glomerular filtration rate as assessed by 24-hour creatinine clearance . Secondary outcome measures are microalbumin urinary excretion , left ventricular hypertrophy , retinopathy , and neuropathy . Cardiovascular morbidity and mortality will also be evaluated . CONCLUSION Given the data showing the impact of hypertension on diabetic complications , the ABCD Trial was design ed to determine if intensive antihypertensive therapy will be more efficacious than moderate antihypertensive therapy on the outcome of these complications . Results from the ABCD Trial are expected to lend interpretable and clinical ly relevant findings with regards to the treatment of hypertension in type II diabetes OBJECTIVE Determine the definitive position of ketanserin and dihydralazine for treatment of  severe hypertension in pregnancy . STUDY DESIGN A single centre double blind r and omized controlled trial was performed at the obstetrical tertiary high care unit of the University Medical Centre in Rotterdam , the Netherl and s. Women with severe hypertension in pregnancy ( diastolic blood pressure (DBP)≥110mmHg ) , and significant proteinuria ( ≥300mg/24h ) , and gestational age≤32 weeks were eligible for the study . All patients ( n=30 ) received two infusions ( double dummy technique ) : one contained the active ingredient ( ketanserin or dihydralazine ) , the other was used for placebo . Nicardipine was used as rescue medication . The main outcome measures were persistent severe hypertension ( DBP>100mmHg>120min ) despite maximum dosage of study medication and prolongation of pregnancy . RESULTS Dihydralazine was significantly more effective in lowering blood pressure than ketanserin . No significant difference in prolongation of pregnancy was seen between the two groups . After 30 inclusion s , the study was stopped because of the high rate of persistent hypertension using ketanserin and the high rate of maternal side effects using dihydralazine and the apparent succesful use of the rescue drug nicardipine . CONCLUSIONS Our results do not support the use of either dihydralazine or ketanserin for the treatment of severe hypertension in pregnancy . Future research is needed to compare nicardipine with other antihypertensive drugs currently in use for treatment of severe hypertension in pregnancy In a double-blind , parallel , 12-week trial , antihypertensive effects of diltiazem and reserpine were compared in 107 patients with essential hypertension .  Diltiazem reduced blood pressure from 176/100 mmHg to 154/86 mmHg after 12 weeks , and reserpine reduced blood pressure from 171/96 mmHg to 155/85 mmHg . The difference between diltiazem and reserpine was not statistically significant . However , among a subset of patients given 180 mg/day of diltiazem , a significantly better antihypertensive effect was achieved than among a subset given 0.3 mg of reserpine . The incidence of side effects and complications in the diltiazem group was about one half that in the reserpine group ( 12.3 % and 27.1 % , respectively ) . Side effects of diltiazem were mild , and the drug was extremely well tolerated . These results show that diltiazem is an effective antihypertensive drug for the treatment of mild to moderate essential hypertension Objectives To compare the antihypertensive efficacy and tolerability of the imidazoline I1 receptor agonist moxonidine , a central ly acting antihypertensive , with the angiotensin converting enzyme inhibitor enalapril . Design An 8-week , double-blind , r and omized , placebo- controlled study involving 140 out patients with mild-to- moderate essential hypertension . Methods Out patients with WHO stage I or II hypertension were enrolled in the study . After a 4-week placebo-controlled stabilization phase patients were allocated r and omly to placebo , 0.2 mg moxonidine once a day or 5 mg enalapril once a day for 2 weeks . Dosages were then doubled to 0.4 mg moxonidine once a day or 10 mg enalapril once a day for a further 6 weeks . Blood pressure responses to therapy were measured by conventional office techniques and by 24 h ambulatory blood pressure monitoring . Results The mean reduction in sitting blood pressure  with moxonidine was similar to that with enalapril ( 19.5 ± 16.0/12.3 ± 8.7 versus 18.9 ± 13.7/11.8 ± 8.0 mmHg ) and significantly superior to that with placebo ( -4.6 ± 12.3/-4.7 ± 6.8 mmHg , P < 0.001 ) . In addition to reducing blood pressure during conventional measurements , moxonidine administration reduced blood pressure throughout 24 h ambulatory measurements . The trough : peak ratio for moxonidine was 0.7 . Both moxonidine and enalapril were tolerated well . Conclusions Moxonidine is an effective and well- tolerated antihypertensive , at least as good as other established forms of antihypertensive medication . The trough : peak ratio of 0.7 indicates that the drug will be effective administered once a day OBJECTIVES To compare the antihypertensive efficacy and tolerability of the imidazoline I1 receptor agonist moxonidine , a central ly acting antihypertensive , with the angiotensin converting enzyme inhibitor enalapril . DESIGN An 8-week , double-blind , r and omized , placebo-controlled study involving 140 out patients with mild-to-moderate essential hypertension . METHODS Out patients with WHO stage I or II hypertension were enrolled in the study . After a 4-week placebo-controlled stabilization phase patients were allocated r and omly to placebo , 0.2 mg moxonidine once a day or 5 mg enalapril once a day for 2 weeks . Dosages were then doubled to 0.4 mg moxonidine once a day or 10 mg enalapril once a day for a further 6 weeks . Blood pressure responses to therapy were measured by conventional office techniques and by 24 h ambulatory blood pressure monitoring . RESULTS The mean reduction in sitting blood pressure with moxonidine was similar to that with enalapril ( 19.5 + /- 16.0/12.3 + /- 8.7 versus 18.9 + /- 13.7/11.8 + /- 8.0 mmHg ) and significantly superior to that with placebo ( -4.6 + /- 12.3/-4.7 + /- 6.8 mmHg , P < 0.001 ) . In addition to reducing blood pressure during conventional measurements , moxonidine administration reduced blood pressure throughout 24 h ambulatory measurements . The trough : peak ratio for moxonidine was 0.7 . Both moxonidine and enalapril were tolerated well . CONCLUSIONS Moxonidine is an effective and well-tolerated antihypertensive , at least as good as other established forms of antihypertensive medication . The trough : peak ratio of 0.7 indicates that the drug will be effective administered once a day 1 . The objective of this double-blind parallel-group study was to compare the tolerability of isradipine and amlodipine , specifically , the side-effects known to be related to the use of dihydropyridine calcium antagonists . 2 . A total of 205 patients with mild-to-moderate essential hypertension were r and omized to receive either the sustained-release ( SRO ) formulation of isradipine ( n = 103 ) or amlodipine ( n = 102 ) , both at dosages of 5 mg once daily . Blood pressure measurements were taken at the end of the dosing interval to assess the antihypertensive efficacy of the two drugs . 3 . Adverse reactions were assessed in two ways : a ) spontaneously reported adverse events were recorded and investigated in depth for severity , duration , relation to the study drug , and outcome ; b ) a question naire was used to elicit specific adverse reactions known to be related to the use of dihydropyridine calcium antagonists which were evaluated for severity , duration , relation to the study drug , and outcome . 4 . After 6 weeks of active treatment , both isradipine and amlodipine reduced mean sitting systolic/diastolic blood pressure : from 165.1/100.1 to 145.2/89.7 mm Hg with isradipine ; and from 164.1/100.6 to 145.7/90.5 mm Hg with amlodipine . There was no difference in antihypertensive effect between isradipine and amlodipine ( 95 % CI : -3.73 to 4.73 and -1.89 to 3.49 for differences in systolic and diastolic blood pressure , respectively ) . 5 . The number of patients spontaneously reporting adverse events was significantly higher ( P = 0.02 ; 95 % CI : 3.1 to 26.7 % ) with amlodipine ( 33.3 % ) than with isradipine ( 18.4 % ) . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To compare the antihypertensive effects of epoprostenol sodium ( prostacyclin ) with that of dihydralazine in acute hypertensive crises of pregnancy . DESIGN A prospect i ve r and omized study . A minimum of 20 patients per group was considered statistically acceptable ( alpha = 0.05 , power = 0.9 ) . SETTING A large urban tertiary hospital . SUBJECTS Forty-seven pregnant patients with diastolic blood pressures of > 100 mmHg were studied . INTERVENTION Lowering of high blood pressure with either dihydralazine ( n = 25 ) , the st and ard drug for this purpose , or epoprostenol ( n = 22 ) . MAIN OUTCOME MEASURE A significant drop in high blood pressure was regarded as a fall of 15 mmHg diastolic and 30 mmHg systolic blood pressure . RESULTS There were no statistically significant differences in the antihypertensive effects between the two treatment groups . Epoprostenol infusion caused less tachycardia ; the mean pulse rate changed from 81.77 beats/min , before treatment to 88.36 at stabilization , compared with a change from 80.96 beats/min to 102.68 in the group treated with dihydralazine ( P = 0.0024 ) . CONCLUSION The place of epoprostenol in pregnancy might be in patients with severe hypertension and tachycardia and in those requiring acute control of severe hypertension on the operating table before general anaesthesia Seventeen patients with mild to moderate essential hypertension and controlled with antihypertensive drugs were treated with xipamid ( 40 mg ) or hydrochlorothiazide ( 50 mg ) in a double-blind cross-over r and omized trial design . After a run-in-period of 2 weeks with placebo , all of them received either of the two drugs . Placebo treatment for 2 weeks decreased both supine as well as st and ing blood pressure , but it was not statistically significant . Xipamid produced a somewhat greater decrease in blood pressure than hydrochlorothiazide , but the difference was not statistically significant . Similar results were obtained in 12 newly diagnosed cases of mild to moderate essential hypertension treated with xipamid ( 80 mg ) or hydrochlorothiazide ( 100 mg ) daily as single drug treatment in a r and omized , double-blind parallel design trial . The side effects produced by both drugs were only mild in nature . No significant changes were produced in serum electrolytes , uric acid and fasting blood glucose in this short term study with either of the drugs In recent years , substantial evidence has accumulated to unambiguously implicate high plasma fibrinogen levels as a major cardiovascular risk factor . An open prospect i ve and r and omised pilot study was therefore undertaken in mild to moderate hypertensives to evaluate the effect of various antihypertensive drugs viz enalapril , felodipine and prazosin on the blood pressure and plasma fibrinogen levels . The systolic and diastolic blood pressures were determined at 0 , 4 and 8 weeks whereas plasma fibrinogen assays were done at baseline and at the end of the 8th week of treatment in all the drug-treated groups . It was observed that although all the three drugs effectively controlled blood pressure , only enalapril significantly reduced plasma fibrinogen levels . Due to this additional effect , enalapril has potential to control two major cardiovascular risk factors -- hypertension and high plasma fibrinogen levels -- simultaneously The antihypertensive effect and safety of fosinopril and hydrochlorothiazide combined were compared with each drug singly and placebo in a controlled manner . After a 4- to 5-week placebo lead-in period , 67 mild to moderate essential hypertensive patients ( seated diastolic blood pressure £ 95 and £ 110 mm Hg ) were r and omized in a double-blind fashion into four parallel treatment groups : 20 mg fosinopril plus 12.5 mg hydrochlorothiazide , 20 mg fosinopril , 12.5 mg hydrochlorothiazide , and placebo during 8 weeks . Patients were seen biweekly . Sitting diastolic blood pressure was the outcome variable defining therapeutic response . The efficacy  of fosinopril plus hydrochlorothiazide as a combined therapy was superior to any single drug ( P<.05 ) and placebo ( P<.01 ) in the treatment of mild to moderate essential hypertension . Mean adjusted systolic/diastolic blood pressure decrements at week 8 were −18.8/−13.7 , −12.9/−11.8 , −8.5/−9.3 , and −2.11−6.9 mm Hg for the fosinopril plus hydrochlorothiazide , fosinopril , hydrochlorothiazide , and placebo groups , respectively . Clinical adverse events and laboratory changes documented throughout the study were similar to placebo and were mild in severity in all groups BACKGROUND Antihypertensive drugs may differ in their ability to reduce LV mass . Covariates other than drug selection , such as pretreatment LV mass , body weight , the magnitude of blood pressure reduction , race , and age may modify the response of LV mass to therapy . METHODS AND RESULTS Patients with mild to moderate hypertension ( diastolic blood pressure , 95 to 109 mm Hg ) were r and omly allocated to treatment with atenolol , captopril , clonidine , diltiazem , hydrochlorothiazide , or prazosin in a double-masked trial . Patients achieving the goal diastolic blood pressure of < 90 mm Hg during drug titration entered a 1-year maintenance period . Longitudinal analysis examined changes from baseline echocardiogram in LV mass at 8 weeks and at 1 year , statistically adjusted for pretreatment LV mass , systolic blood pressure , body weight , sodium excretion , physical activity , race , and age . Significant reductions at 1 year in adjusted LV mass were seen for patients in the highest tertile of pretreatment LV mass treated with hydrochlorothiazide ( mean , -42.9 ; 95 % confidence limits , -65.5 , -20.2 g ) , captopril ( mean , -38.7 ; 95 % confidence limits , -61.0 , -16.4 g ) , and atenolol ( mean , -28.1 ; 95 % confidence limits , -50.9 , -5.3 g ) . These treatment effects differed from those of prazosin , diltiazem , or clonidine . CONCLUSIONS Antihypertensive drugs have disparate effects on LV mass independent of the magnitude of blood pressure reduction . Patients with adequate blood pressure control on captopril , hydrochlorothiazide , and atenolol show a reduction of LV mass after 1 year of treatment , whereas patients on diltiazem , clonidine , or prazosin do not Summary . Two treatment strategies were compared in 155 women with pregnancy‐induced hypertension who were also given comprehensive non‐pharmacological care . The mean gestation at entry was 28 weeks . As long as the diastolic blood pressure ( DBP ) remained below 106 mmHg , oxprenolol , or oxprenolol plus dihydralazine , were given to the early treatment group , and matching placebos to the control group . Open antihypertensive treatment was provided for patients whose DBP rose above 105 mmHg . Proteinuria occurred in seven women in each group . In the early treatment group , 13 of the 78 women were delivered by caesarean section ; the corresponding numbers in the control group were 27 of 76 ( 17 vs 36 % , 95 % confidence interval ( CI ) of difference : 5‐33 % ) ; the sections included seven and 16 in the early treatment and control groups , respectively , for severe hypertension and /or fetal distress . There were five perinatal deaths , two in the early treatment group and three in the control group . Early treatment did not influence gestational age at birth or birthweight . Respiratory distress syndrome occurred in four infants in the early treated group and in 10 in the control group ; 14 infants in the former group and 26 in the latter were in hospital for more than 10 days ( 18 vs 35 % ; 95 % CI of difference 4.32 % ) . These results indicate that early antihypertensive treatment with oxprenolol  is safe for the fetus and newborn in pregnancy‐induced hypertension , but has no advantage over non‐pharmacological care in terms of fetal growth . However , it may prevent acute hypertension in late pregnancy and associated fetal distress , and thus reduce the number of caesarean sections AIMS Diazoxide is one of few available agents for treatment of hypertensive emergencies in pregnancy . From previous studies , there is a question concerning safety after moderate-dose administration caused episodes of hypotension . Rapid control of severe hypertension is necessary to reduce maternal morbidity , for example , stroke and placental abruption . This study was design ed to compare the efficacy of mini-bolus diazoxide with intravenous ( i.v . ) hydralazine . DESIGN A r and omised controlled trial . SETTING Tertiary referral maternity hospital , Royal Prince Alfred Women and Babies , Sydney Australia . POPULATION Antenatal and postnatal women with severe hypertension . METHODS One hundred and twenty-four hypertensive women were r and omised to either i.v . hydralazine ( 5 mg doses ) or  mini-bolus diazoxide  ( 15 mg doses ) . PRIMARY OUTCOME MEASURE Achievement of target blood pressure reduction ; secondary measures included requirement for Caesarean section because of fetal deterioration as determined by non-reassuring cardiotocograph ( CTG ) . RESULTS Reduction in systolic and diastolic blood pressure was 34 min for hydralazine and 19 min for diazoxide ( P < 0.001 ) . There were no episodes of hypotension after diazoxide and one after hydralazine ( after epidural ) . Episodes of persistent severe hypertension were more common with hydralazine ( 38 % ) than with diazoxide ( 16 % ) , P < 0.01 . The Caesarean section rate for no-reassuring CTG was no different between the two groups . Neonatal outcomes were similar . CONCLUSION Diazoxide and hydralazine are safe and effective antihypertensives , showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy . The mini-bolus doses of 15 mg of diazoxide did not precipitate maternal hypotension as previously described and reduces episodes of persistent severe hypertension Introduction : Losartan potassium , an orally active , highly selective AT1 angiotensin II receptor inhibitor , effectively reduces blood pressure by direct receptor blockade , thereby lessening the likelihood of angiotensin converting enzyme ( ACE ) inhibitorassociated side effects such as dry cough or possibly angioedema Study design : In this multinational , double-blind , r and omized , parallel study , the efficacy and tolerability of once-daily losartan ( 50 mg ) versus once-daily ACE inhibitor ( captopril ; 50 mg ) was evaluated in 163 patients with mild to moderate hypertension . Non-responders after a 6-week treatment period had the dosage doubled for both study drugs until the end of study ( week 12 ) Results : Mean reductions in trough sitting diastolic blood pressure were significantly greater in the losartan group at week 6 ( 7.8 mmHg ) and week 12 ( 9.1 mmHg ) than in the captopril group ( 5.2 and 5.7 mmHg , respectively ) . Losartan and captopril were well tolerated . Headache was the most common adverse event reported in both groups Conclusions : It was concluded that a once-daily administration of losartan was significantly more effective in this study in lowering sitting diastolic blood pressure than once-daily administration of captopril in patients with mild to moderate essential hypertension . Both losartan and captopril regimes were well Background Hypertensive disorders , i.e. pregnancy induced hypertension and preeclampsia , complicate 10 to15 % of all pregnancies at term and are a major cause of maternal and perinatal morbidity and mortality . The only causal treatment is delivery . In case of preterm pregnancies conservative management is advocated if the risks for mother and child remain acceptable . In contrast , there is no consensus on how to manage mild hypertensive disease in pregnancies at term . Induction of labour might prevent maternal and neonatal complications at the expense of increased instrumental vaginal delivery rates and caesarean section rates . Methods / Design Women with a pregnancy complicated by pregnancy induced hypertension or mild preeclampsia at a gestational age between 36 + 0 and 41 + 0 weeks will be asked to participate in a multi-centre r and omised controlled trial . Women will be r and omised to either induction of labour or expectant management for spontaneous delivery . The primary outcome of this study is severe maternal morbidity , which can be complicated by maternal mortality in rare cases . Secondary outcome measures are neonatal mortality and morbidity , caesarean and vaginal instrumental delivery rates , maternal quality of life and costs . Analysis will be by intention to treat . In total , 720 pregnant women have to be r and omised to show a reduction in severe maternal complications of hypertensive disease from 12 to 6 % . Discussion This trial will provide evidence as to whether or not induction of labour in women with pregnancy induced hypertension or mild preeclampsia ( nearly ) at term is an effective treatment to prevent severe maternal complications . Trial Registration The protocol is registered in the clinical trial register number IS RCT N08132825 Blood pressure is not adequately controlled in almost 50 % of patients with hypertension who are in receipt of antihypertensive therapy . This multicentre , prospect i ve , open-label trial was design ed to determine whether or not once-daily telmisartan 80 mg reduced blood pressure during the last 6 h of the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive therapy . The study comprised 100 patients ( 47 males , 53 females ) who had failed to respond satisfactorily to prior treatment given for a minimum of 3 months . At screening ,  24-h ambulatory blood pressure monitoring ( ABPM )  was conducted after the patient had been treated with the currently prescribed antihypertensive medication . Following 5 weeks of telmisartan 80 mg treatment , ABPM was repeated . Telmisartan significantly reduced mean systolic blood pressure , diastolic blood pressure ( DBP ) and pulse pressure compared with previous antihypertensive therapy over each time interval ( 24-h , morning , night-time and the last 6 h of the dosing interval [ 2.00 a.m.-8.00 a.m. ] ) analysed . In addition , more than 90 % of patients responded successfully ( clinic DBP < 90 mmHg or a > 10 mmHg reduction in clinic DBP ) at the end of telmisartan treatment . In conclusion , telmisartan provides effective blood pressure control throughout the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive medication Background Changes during the puerperium are still unclear , particularly in women with hypertension . The choice of antihypertensives , both to control very high blood pressure episodes and to keep blood pressure stable , also requires further elucidation . Currently , there are no clear data to guide the decision for the choice of postpartum antihypertensives . Captopril plays an important role in the treatment of very high blood pressure episodes and may be used postpartum . Clonidine has been used as an alternative in pregnant or postpartum women with contraindications to  captopril , with satisfactory effect . The objective of the present study was to evaluate the effectiveness and safety of clonidine compared to captopril for treating severe postpartum hypertension . Methods and findings A r and omized , drug-controlled , triple-blind clinical trial evaluating postpartum women  receiving captopril or clonidine . Inclusion criteria consisted of : women with hypertensive disorders of pregnancy systolic blood pressure ( SBP ) ≥180 mmHg and /or diastolic blood pressure ( DBP ) ≥110 mmHg ] , requiring magnesium sulfate . Exclusion criteria were : heart disease , smoking , illicit drug use , contraindications to captopril , clonidine or oral medication , and having used captopril/clonidine previously . The primary outcome was the frequency of very high blood pressure episodes while in the obstetric intensive care unit .  A total of 90 postpartum women met the study inclusion criteria , with 45 r and omized to each group . There were fewer very high blood pressure episodes during hospitalization ( 2.1 ± 2.1 vs. 3.5 ± 4.7 , p = 0.08 ) , greater percentage reduction in SBP ( 14.0 % ± 8.6 % vs. 10.8 % ± 8.8 % , p = 0.08 ) and fewer women requiring sodium nitroprusside ( 2.3 % vs. 13.3 % ; RR : 0.17 ; 95%CI : 0.02–1.39 ; p = 0.06 ) in the clonidine group compared to the captopril group ; however , these differences were not significant . The groups were similar regarding daily mean SBP or DBP ; however , on the third postpartum day , mean SBP was lower in the clonidine compared to the captopril group ( 151.9 ± 11.8 mmHg vs. 158.1 ± 13.6 mmHg , p = 0.02 ) . Although not statistically significant , adverse reactions were more common in the captopril group ( 28.8 % ) compared to the clonidine group ( 18.6 % ) . Conclusion Clonidine and captopril represent safe , effective treatments for severe postpartum hypertension . Trial registration clinical trials.gov : www . clinical trial.gov , NCT01761916 A r and omized double-blind crossover trial of labetalol , bendrofluazide and placebo was carried out in 18 patients with mild to moderate hypertension . The reduction in blood pressure observed with labetalol and bendrofluazide was similar . The plasma levels of labetalol  showed a significant correlation with changes in blood pressure ( r = 0.07 ; P less than 0.021 ) ; and plasma level determinations of this drug may be of value in the management of patients who receive antihypertensive agents There is a dearth of reports on possible additive blood pressure (BP)-reducing effect of aerobic exercise on antihypertensive drug in humans . This study investigated the additive BP-reducing effect of aerobic exercise on BP in individuals with uncontrolled hypertension . In this 12-week double-blind study , 120 new-diagnosed individuals with mild-to-moderate hypertension were r and omized to receive coamilozide + 5/10 mg of amlodipine + aerobic dance or coamilozide + 5/10 mg of amlodipine alone . Forty-five and 43 participants in exercise and control groups , respectively , completed the 12-week intervention . Addition of aerobic exercise to antihypertensive drug therapy significantly reduced systolic BP ( 7.1 mm Hg [ 95 % confidence interval : 5.0 , 9.3 ] ; P < .001 ) and diastolic BP ( 1.7 mm Hg [ 95 % confidence interval : 0.4 , 3.0 ] ; P = .009 ) at 12 weeks . BP control rate differed significantly between exercise ( 53.9 % ) and control ( 35.3 % ) groups , P < .001 . Postintervention , proportion of participants in exercise group who had their number of antihypertensive drug reduced to one ( 20.3 % ) differed from that in control group ( 11.1 % ) ; ( χ(2 ) = 11.0 ; P = .001 ) . Combination of aerobic dance and antihypertensive drugs  reduces number of antihypertensive drugs needed to achieve BP control and enhances BP control in individuals with hypertension on two antihypertensive drugs Background Amlodipine and hydrochlorothiazide ( HCTZ ) are commonly prescribed in Nigeria either as a monotherapy or in combination with other drugs . The present study was design ed to investigate the antihypertensive efficacy of monotherapy with amlodipine or HCTZ and their effects on electrolyte profile in patients with mild to moderate hypertension . Methods A single-blind r and omized clinical study was used ; fifty patients newly diagnosed with mild to moderate hypertension ( aged 33 to 60 years ) were recruited and divided into two groups : amlodipine or hydrochlorothiazide each comprising of 25 subjects . The subjects received 5 mg of amlodipine or 25 mg of hydrochlorothiazide in their respective group once daily for 4 weeks . Blood pressure , serum and urine electrolytes were measured at baseline and weekly throughout the experiment . Results At the end of follow up , amlodipine reduced systolic and diastolic blood pressure significantly more ( p<0.001 ) than HCTZ . At the end of follow up , blood pressure was reduced to normal in 80 % of the subjects in amlodipine group compared to 50 % in HCTZ . Amlodipine had no significant effect on electrolyte profile of subjects unlike HCTZ which significantly changed both their serum and urine electrolytes . Conclusions Monotherapy with amlodipine was more effective than HCTZ in black patients with mild to moderate hypertension and in addition maintained electrolyte balance BACKGROUND The safety and effectiveness of different dosages and combinations of antihypertensive agents can be efficiently studied using a multifactorial trial design . In consultation with the Cardio-Renal Division of the Food and Drug Administration , we conducted a r and omized , double-blind , placebo-controlled , 3 x 4 factorial trial of bisoprolol , a beta 1-selective adrenergic blocking agent , and hydrochlorothiazide . METHODS A total of 512 patients with mild to moderate essential hypertension were r and omized to once-daily treatment with bisoprolol ( 0 , 2.5 , 10 , or 40 mg ) , hydrochlorothiazide ( 0 , 6.25 , or 25 mg ) , and all possible combinations .  Diastolic and systolic blood pressures were monitored during this 12-week trial . RESULTS The effects of bisoprolol and hydrochlorothiazide were additive with respect to reductions in diastolic and systolic blood pressures over the dosage ranges studied . The addition of hydrochlorothiazide ( or bisoprolol ) to therapy with bisoprolol ( or hydrochlorothiazide ) produced an incremental reduction in blood pressure . Dosages of hydrochlorothiazide as low as 6.25 mg/d contributed a significant antihypertensive effect . A hydrochlorothiazide dosage of 6.25 mg/d produced significantly less hypokalemia and less of an increase in uric acid levels than a dosage of 25 mg/d . The low-dose combination of bisoprolol , 2.5 mg/d , and hydrochlorothiazide , 6.25 mg/d , reduced diastolic blood pressure to lower than 90 mm Hg in 61 % of patients and demonstrated a safety profile that compared favorably with that of placebo . CONCLUSIONS The utility of factorial design trials to characterize dose-response relationships and to test the potential interactions between various antihypertensive agents has been demonstrated . The combination of low dosages of bisoprolol and hydrochlorothiazide may be a rational alternative to conventional stepped-care therapy for the initial treatment of patients with mild to moderate hypertension BACKGROUND African Americans with hypertension , particularly those with more severe blood pressure elevations , are generally less responsive to monotherapy from any antihypertensive class . These patients usually require treatment with drugs from > or = 2 antihypertensive classes to achieve adequate blood pressure control . OBJECTIVE The purpose of this study was to assess the antihypertensive efficacy and safety of losartan alone and in combination with hydrochlorothiazide ( HCTZ ) in African American adults with mild to moderate hypertension . METHODS In this 12-week , multicenter , double-blind , r and omized , parallel-group , placebo-controlled study , African American patients were r and omized in a 3:3:1 ratio to I of 3 treatment groups : placebo , losartan monotherapy ( 50 to 150 mg ) , or losartan plus HCTZ ( 50/0 to 50/12.5 to 100/25 mg ) . Doses were titrated at weeks 4 and 8 if  sitting diastolic blood pressure ( SiDBP ) was > or = 90 mm Hg . Safety was assessed by determining the incidence of clinical and laboratory Adverse events and evaluating mean changes in pulse , body weight , electrocardiographic parameters , and laboratory test results . RESULTS A total of 440 patients were r and omized-188 to placebo , 193 to losartan monotherapy , and 59 to losartan/HCTZ ; 391 completed the study . At week 12 , the response rate with losartan monotherapy was 45.8 % , with a significant ( P < or = 0.01 ) lowering in mean SiDBP by 6.6 mm Hg compared with placebo ; the response rate with placebo was 27.2 % , with a mean SiDBP reduction of 3.9 mm Hg . Sitting systolic blood pressure ( SiSBP ) was significantly lowered with losartan monotherapy , by 6.4 mm Hg , compared with placebo ( reduction of 2.3 mm Hg ) . The response rate with losartan/ HCTZ was 62.7 % , with reductions in SiSBP and SiDBP of 16.8 mm Hg and 10.8 mm Hg , respectively ( P < or = 0.01 vs placebo and losartan monotherapy ) . The incidence of clinical adverse events was comparable in the 3 treatment groups . CONCLUSIONS The results of this study suggest that in African American patients , losartan monotherapy was significantly more effective than placebo in lowering SiSBP and SiDBP . Moreover , the losartan/ HCTZ combination regimen result ed in significant and clinical ly meaningful additional reductions in SiSBP and SiDBP compared with losartan monotherapy or placebo . Losartan monotherapy and the losartan/HCTZ regimens were generally as well tolerated as placebo The efficacy and safety of Iosartan and valsartan were evaluated in a multicenter , double-blind , r and omized trial in patients with mild to moderate essential hypertension .  Blood pressure responses to once-daily treatment with either losartan 50 mg ( n = 93 ) or valsartan 80 mg ( n = 94 ) for 6 weeks were assessed through measurements taken in the clinic and by 24-hour ambulatory blood pressure monitoring ( ABPM ) . Both drugs significantly reduced clinic sitting systolic ( SiSBP ) and diastolic blood pressure ( SiDBP ) at 2 , 4 , and 6 weeks . Maximum reductions from baseline in SiSBP and SiDBP on 24hour ABPM were also significant with the two treatments . The reduction in blood pressure was more consistent across patients in the losartan group , as indicated by a numerically smaller variability in change from baseline on all ABPM measures , which achieved significance at peak ( P = .017 ) and during the day ( P = .002 ) . In addition , the numerically larger smoothness index with losartan suggested a more homogeneous antihypertensive effect throughout the 24-hour dosing interval . The anti hypertensive response rate was 54 % with losartan and 46 % with valsartan . Three days after discontinuation of therapy , SiDBP remained below baseline in 73 % of losartan and 63 % of valsartan patients . Both agents were generally well tolerated .  Losartan , but not valsartan , significantly decreased serum uric acid an average 0.4 mg/dL at week 6 . In conclusion , once-daily losartan 50 mg and valsartan 80 mg had similar anti hypertensive effects in patients with mild to moderate essential hypertension .  Losartan produced a more consistent blood pressure-lowering response and significantly lowered uric acid , suggesting potentially meaningful differences between these two A II receptor antagonists BACKGROUND The prevalence of hypertension and its cardiovascular complications is higher in African Americans than in whites . Interventions to control blood pressure in this population are particularly important . Regular exercise lowers blood pressure in patients with mild-to-moderate hypertension , but its effects in patients with severe hypertension have not been studied . We examined the effects of moderately intense exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension . METHODS We r and omly assigned 46 men 35 to 76 years of age to exercise plus antihypertensive medication ( 23 men ) or antihypertensive medication alone ( 23 men ) . A total of 18 men in the exercise group completed 16 weeks of exercise , and 14 completed 32 weeks of exercise , which was performed three times per week at 60 to 80 percent of the maximal heart rate . RESULTS After 16 weeks , mean ( + /- SD ) diastolic blood pressure had decreased from 88 + /- 7 to 83 + /- 8 mm Hg in the patients who exercised , whereas it had increased slightly , from 88 + /- 6 to 90 + /- 7 mm Hg , in those who did not exercise ( P = 0.002 ) . Diastolic blood pressure remained significantly lower after 32 weeks of exercise , even with substantial reductions in the dose of antihypertensive medication . In addition , the thickness of the interventricular septum ( P = 0.03 ) , the left ventricular mass ( P = 0.02 ) , and the mass index ( P = 0.04 ) had decreased significantly after 16 weeks in the patients who exercised , whereas there was no significant change in the nonexercisers . CONCLUSIONS Regular exercise reduced blood pressure and left ventricular hypertrophy in African-American men with severe hypertension Patients with mild to moderate essential hypertension were treated mainly with an ACE inhibitor ( delapril , n = 980 ) or a Ca antagonist ( n = 956 ) for 12 months , and the incidence of cerebrovascular and cardiovascular events as well as drug-related side effects were compared between the two groups . There were no significant differences between the clinical background s of the two groups . In both groups , the blood pressure was decreased significantly from 1 month of treatment onwards , with the degree of reduction being greater in the Ca antagonist group throughout the study period ( p < 0.001 ) . Cerebrovascular or cardiovascular events occurred in 11 out of 980 patients in the delapril group and 18 out of 956 patients in the Ca antagonist group ( p = NS ) . Cerebrovascular disease developed in 5 delapril-treated patients and 11 Ca antagonist-treated patients , and heart disease developed in 5 and 7 patients , respectively ( both p = NS ) . Discontinuation of treatment due to side effects was significantly more common in the delapril group than in the Ca antagonist group ( p < 0.001 ) . There was no significant difference in the incidence of cerebrovascular and cardiovascular events between the two groups , and the results suggested that blood pressure reduction per se did not necessarily lead to a parallel decrease in cerebrovascular and cardiovascular complications Atenolol use may be associated with growth retardation when given in pregnancy , although the relationship to trimester of initiation , duration of treatment , and its use as monotherapy is still uncertain . To compare the obstetric and fetal outcome between women receiving atenolol ( as monotherapy ) and other antihypertensive drug monotherapies , and also to investigate the effect of duration of treatment on fetal growth , we performed a retrospective cohort study of 312 pregnancies in 223 women attending an Antenatal Hypertension Clinic .  Atenolol ( as monotherapy ) was given in 78 pregnancies ( 25.0 % ) , other types of antihypertensive drugs as monotherapy were given in 53 pregnancies ( 17.0 % ) , and multiple drug combinations were given in 90 pregnancies ( 28.8 % ) . In 91 pregnancies ( 29.2 % ) no antihypertensive drugs were given . Atenolol was found to be associated with lower birth weight and ponderal index values , with a trend toward a higher prevalence of preterm ( < 37 weeks ) delivery and small-for-gestational-age babies when compared to other antihypertensive drugs as monotherapy , or to no treatment . The adverse effect of atenolol  was more pronounced in women receiving the drug earlier in their pregnancy , and continuing the drug for a longer duration . In conclusion , atenolol should be avoided in the early stages of pregnancy and given with caution at the later stages , as it is associated with fetal growth retardation , which is related to duration of treatment BACKGROUND In the 2003 European Society of Hypertension-European Society of Cardiology ( ESH-ESC ) guidelines , it is concluded that the major classes of antihypertensive agents are suitable for the initiation and maintenance of antihypertensive therapy . The aim of this study was to compare the cost-effectiveness of each one of the major antihypertensive agents as monotherapy in the management of mild-to-moderate hypertension in Greece , when following the 2003 ESH-ESC guidelines . METHODS We performed a cost-effectiveness analysis based on numbers needed to treat . A decision analysis model was developed to compare chlorthalidone , propranolol , amlodipine , enalapril and losartan . Clinical inputs were derived from a meta- analysis and r and omized controlled trials and cost data from public sources . The evaluation of the cost of managing hypertension includes the cost of drug therapy , monitoring , treating side effects , poor compliance and switching . All costs were calculated from a public insurance system perspective , in 2004 Euros . Future costs and clinical benefits were discounted at 5 % . The time frame was 5 years . Extensive sensitivity analyses were also performed . RESULTS The cost ( in Euros ) of uncomplicated hypertension treatment for 5 years was 485.87 , 567.66 , 851.44 , 607.45 , and 1279.88 for chlorthalidone , propranolol , amlodipine , enalapril , and losartan , respectively . The estimated total cost ( in Euros ) to prevent one death was 60230.71 , 70369.96 , 105596.72 , 75301.40 , and 158659.35 , respectively . CONCLUSIONS In mild-to-moderate uncomplicated hypertension chlorthalidone is the most cost-effective agent . If it was the drug of choice to initiate treatment of uncomplicated hypertension , it would probably save the public insurance system organizations a great amount of expenses for benefit of the insured patients ABSTRACT . Lifestyle modifications are effective for the management and prevention of hypertension . We conducted a r and omized , placebo-controlled trial to evaluate the efficacy of an oral concentrated leaf juice of artichoke ( Cynara scolymus L. ; CS ) in patients with mild hypertension ( systolic blood pressure [SBP]/diastolic blood pressure [ DBP ] , 140–159/90−99 mmHg ) . Subjects were r and omized into a placebo and two drug groups that received 50 and 100 mg of artichoke juice concentrate . After 12 weeks , SBP significantly reduced as compared with the baseline data in case groups and DBP was significantly lower from the baseline as compared with the placebo group . It is concluded that the use of artichoke juice concentrate may have a blood pressure-lowering effect in mild hypertension Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancy . Oral nifedipine is an alternative in management of these patients . In this study the efficacy of nifedipine and hydralazine in pregnancy was compared in a group of Iranian patients . Fifty hypertensive pregnant women were enrolled in the study . A r and omized clinical trial was performed , in which patients in two groups received intravenus hydralazine or oral nifedipine to achieve target blood pressure reduction . The primary outcomes measured were the time and doses required for desired blood pressure achievement . Secondary measures included urinary output and maternal and neonatal side effects . The time required for reduction in systolic and diastolic blood pressure was shorter for oral nifedipine group ( 24.0 ± 10.0 min ) than intravenus Hydralazine group ( 34.8 ± 18.8 min ) ( P ≤ 0.016 ) . Less frequent doses were required with oral nifedipine ( 1.2 ± 0.5 ) compared to intravenus hydralazine ( 2.1 ± 1.0 ) ( P ≤ 0.0005 ) . There were no episodes of hypotension after hydralazine and one after nifedipine . Nifedipine and hydralazine are safe and effective antihypertensive drugs , showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy . Both drugs reduce episodes of persistent severe hypertension . Considering pharmacokinetic properties of nifedipine such as rapid onset and long duration of action , the good oral bioavailability and less frequent side effects , it looks more preferable in hypertension emergencies of pregnancy than hydralazine Men aged 40 - 64 years with mild to moderate hypertension [ diastolic blood pressure ( DBP ) 100 - 130 mmHg ] were r and omized to treatment with a  diuretic ( n = 3272 ) or a  beta-blocker ( n = 3297 ) , with additional drugs if necessary , to determine whether a beta-blocker based treatment differs from thiazide diuretic based treatment with regard to the prevention of coronary heart disease ( CHD ) events and death .  Patients with previous CHD , stroke or other serious diseases , or with contraindications to diuretics or beta-blockers were excluded . If normotension ( DBP less than 95 mmHg ) was not achieved by monotherapy , other antihypertensive drugs were added , but the two basic drugs were not crossed over . Patients were assessed at 6-monthly intervals . The mean follow-up for end-points was 45.1 months . Blood pressure ( BP ) side effects and end-points were recorded in a st and ardized manner . Entry characteristics and the BP reduction achieved were very similar in both treatment groups . All analyses were made on an intention-to-treat basis . The incidence of CHD did not differ between the two treatment groups . The incidence of fatal stroke tended to be lower in the beta-blocker treated group than in the diuretic treated group . Total mortality and the total number of end-points were similar in both groups . The percentage of patients withdrawn due to side effects was similar , whereas the number of reported symptoms , according to a question naire , was higher for patients on beta-blockers . The incidence of diabetes did not differ between the two groups . Subgroup analyses did not detect a difference in the effect of beta-blockers compared with diuretics in smokers as opposed to non-smokers , and beta-blockers also had the same effects as diuretics in the quartile with the highest predicted risk for CHD . Beta-blockers and thiazide diuretics were approximately equally well tolerated . The two drugs had a similar BP reducing effect although additional drugs had to be given more often in the diuretic group . Antihypertensive treatment based on a beta-blocker or on a thiazide diuretic could not be shown to affect the prevention of hypertensive complications , including CHD , to a different extent The antihypertensive activity of losartan potassium ( losartan , Cozaar ) , an angiotensin II receptor antagonist , was evaluated in a parallel 12-week , double-blind , placebo-controlled trial in hypertensive patients with mild-to-moderate hypertension . After a 4-week , single-blind , placebo lead-in period , which included monitoring of baseline variables , 366 patients with a group mean sitting diastolic blood pressure of 101 + /- 5 ( s.d . ) mmHg were assigned r and omly to one of three treatment groups : placebo , losartan 50 mg , or losartan 50 mg with the option to titrate to 100 mg after the first 6 weeks if the target sitting diastolic blood pressure ( < 90 mmHg ) was not reached . To assess the potential blood pressure response associated with the act of titration , patients in the placebo and losartan 50 mg treatment groups with a sitting diastolic blood pressure of > or = 90 mmHg at week 6 were mock titrated ( changed to a new tablet containing the same study medication and dose ) . Sitting diastolic blood pressure was also evaluated at the end of the trial during a 1-week off-drug period to assess for rebound hypertension . At week 6 , patients in the active-drug-treatment arms experienced significantly greater peak ( 6 h post-dose ) and trough ( 24 h post-dose ) reduction in systolic and diastolic sitting blood pressures compared with placebo ( p < or = 0.01 ) . Based on trough blood pressures at week 12 , active drug ( both arms ) was more effective than placebo in lowering sitting diastolic blood pressure , with a very small additional benefit associated with increasing the dose of losartan to 100 mg in patients who did not reach the target blood pressure after the first 6 weeks on losartan 50 mg . There was no evidence of rebound hypertension during 1 week after withdrawal of losartan . The correlation between baseline plasma renin activity and reduction in peak and trough blood pressure at week 12 , although statistically significant , was generally poor in the active treatment groups . In this trial , losartan was efficacious and well tolerated , and was similar to placebo with regard to adverse-experience profile . Adverse experiences that could reasonably be related to excessive lowering of blood pressure were not common and there was no evidence of rebound hypertension Twenty-nine subjects with mild to moderate essential hypertension completed this 13 week r and omized , double-blind , placebo-controlled study comparing the antihypertensive effects of nifedipine GITS ( N ) ( 30 - 60 mg/day ) , hydrochlorothiazide ( H ) ( 25 - 50 mg/day ) and placebo ( P ) . Nifedipine GITS is a new formulation design ed for once daily administration . N lowered blood pressure 15/10 mmHg ( p less than 0.0005/p less than 0.0001 ) , H 15/8 mmHg ( p less than 0.0005/p 0.05 ) , and P 4/0 mmHg ( p = NS ) . All patients required the larger dose of active drug to control BP . No drug affected the heart rate . For N , but not H , there was a positive correlation between age and the magnitude in reduction of SBP ( r = 0.79 ; p less than 0.005 ) , but not for DPB . N drug levels did not correlate with its antihypertensive effect . Epinephrine , norepinephrine , aldosterone , and plasma renin activity were not affected by N. No patients on N experienced immediate vasodilator side effects . N is a well tolerated and effective antihypertensive drug that can be given once daily . It does not cause reflex stimulation of the sympathetic nervous system A double-blind , within-patient study was carried out in 23 newly diagnosed patients with mild to moderate hypertension ( diastolic blood pressure of at least 100 mmHg ) to compare the antihypertensive effects of atenolol ( 100 mg ) and chlorthalidone ( 25 mg ) given in free and fixed combination . After a 4-week placebo run-in period , patients received each of the two active treatments and also placebo for periods of 4 weeks , the treatment sequence being r and omized . A single daily drug dose was taken 24 to 28 hours before each blood pressure measurement at 2-weekly intervals . The results showed that both active drug combinations lowered lying , st and ing and post-exercise blood pressure significantly and there was no statistical difference between the two forms of treatment . Two-thirds of the patients were adequately controlled with the single daily dose regimen and few side-effects were reported Ramipril is a new , potent nonsulfhydryl inhibitor of angiotensin converting enzyme . The magnitude and duration of its antihypertensive effect were evaluated in a multicenter , placebo‐controlled , r and omized clinical trial conducted in 100 patients with mild to moderate essential hypertension .  Ramipril significantly reduced both supine and st and ing blood pressures measured 24 h after dosing . Automated blood pressure monitoring showed that ramipril significantly reduced systolic and diastolic pressures for 24 h after dosing . The peak effect occurred between 3 and 6 h after dosing , with approximately 50 % of this effect retained after 24 h. Ramipril was well tolerated ; there was no significant difference between active drug and placebo in the overall incidence of side effects . Ramipril is an effective and well‐tolerated antihypertensive agent , which reduces both supine and st and ing blood pressure over the entire 24‐h period after dosing BACKGROUND Pre-eclampsia is associated with extensive endothelial-cell damage and platelet activation , result ing in lower production of vasodilator prostagl and ins and increased release of the vasoconstrictors thromboxane A2 and serotonin . Damage to endothelial-cell serotonin-1 receptors leaves vasoconstriction and platelet aggregation mediated by serotonin-2 receptors unopposed . We investigated the role of ketanserin , a selective serotonin-2-receptor antagonist , in lowering the rate of pre-eclampsia among pregnant women with mild to moderate hypertension . METHODS We recruited 138 pregnant women into a double-blind , r and omised , placebo-controlled trial . They had diastolic blood pressure persistently more than 80 mm Hg before 20 weeks ' gestation . 69 women received ketanserin  and 69 received placebo . Both groups also received aspirin . Patients were initially given two tablets daily , increased to four tablets daily in diastolic blood pressure was more than 90 mm Hg . Primary outcomes were the development of pre-eclampsia and severe hypertension , and perinatal mortality . FINDINGS There were significantly fewer cases of pre-eclampsia ( two vs 13 ; relative risk 0.15 [ 95 % CI 0.04 - 0.66 ] , p = 0.006 ) and severe hypertension ( six vs 17 ; p = 0.02 ) in the ketanserin than in the placebo group . There was also a trend towards less perinatal mortality ( one vs six deaths ) but this was not significant ( p = 0.28 ) . Rates of abruptio placentae and pre-eclampsia before 34 weeks ' gestation were lower in the ketanserin group , and mean birthweight was significantly higher . INTERPRETATION We found an association between the addition of ketanserin to aspirin and a decrease in the number of cases of pre-eclampsia and severe hypertension , as well as improved pregnancy outcome among patients with mild to moderate midtrimester hypertension BACKGROUND Cardiac effects of hypertension include increased left ventricular ( LV ) mass and LV hypertrophy , as well as increased left atrial size , a predictor of stroke and atrial fibrillation . Although literature on reduction of LV mass with antihypertensive therapy is extensive , little information is available on effects of treatment on left atrial size . METHODS AND RESULTS Patients with mild to moderate hypertension ( diastolic blood pressure 95 to 109 mm Hg ) were r and omly allocated to treatment with atenolol , captopril , clonidine , diltiazem , hydrochlorothiazide , or prazosin in a double-masked trial . Two-dimensional targeted M-mode echocardiography was used to assess left atrial size and LV mass at baseline , 8 weeks , and 1 and 2 years . Longitudinal analysis examined changes in left atrial size from the baseline study , statistically adjusting for age , race , pretreatment left atrial size and LV mass , and serial measurements of systolic blood pressure , body weight , urinary sodium excretion , and physical activity score . Without adjustment for covariates , only hydrochlorothiazide was associated with decreases in left atrial size from baseline at 8 weeks ( -1.0 + /- 5.2 mm ; P=0.052 ) , 1 year ( -2.0 + /- 5.1 mm ; P=0.02 ) , and 2 years ( 4.6+/-7.2 mm ; P=0.002 ) . After adjustment for effects of covariates , patients with normal left atrial size had greater reduction ( -3.3 mm ) in left atrial size at 2 years with hydrochlorothiazide than with any other drug . For patients with left atrial enlargement , left atrial size decreased significantly with hydrochlorothiazide , atenolol , clonidine , and diltiazem at 1 year and with all treatments at 2 years . However , reduction at 2 years was greater with hydrochlorothiazide than with captopril or prazosin . CONCLUSIONS Antihypertensive drugs differ in their effects on left atrial size .  Hydrochlorothiazide was associated with greater overall reduction of left atrial size than other drugs effective for the treatment of hypertension . Reduction of left atrial size with therapy is in part independent of factors known to influence left atrial size , including LV mass and reduction of LV mass with treatment . The clinical benefit of reducing left atrial size with antihypertensive treatment remains to be determined Thiazide diuretics are widely used in the drug treatment of hypertension but their dose-response curves for the antihypertensive and adverse metabolic effects differ . To characterize the lower end of the dose-response curve a double-blind , parallel group trial was performed as multicentre study in Sc and inavia . One hundred and eleven patients with newly diagnosed or previously treated mild to moderate hypertension ( untreated diastolic blood pressure of 95 - 115 mmHg after 4 weeks placebo ) were r and omly allocated to various doses of hydrochlorothiazide ( 3 , 6 , 12.5 or 25 mg ) or placebo for 6 weeks . Blood pressure and biochemical variables ( plasma renin activity , serum potassium , magnesium , urate , fasting glucose , total cholesterol , HDL-cholesterol , triglycerides and apolipoproteins A1 and B were measured . 12.5 mg hydrochlorothiazide had a borderline effect on blood pressure whilst 25 mg had a definite antihypertensive effect . Biochemical changes were seen in plasma renin activity , serum potassium and urate after the 12.5 and 25 mg dose . Three and 6 mg had no effect on blood pressure or metabolic parameters INTRODUCTION The antihypertensive efficacy and safety of losartan , a specific and selective angiotensin II ( AII ) receptor antagonist , was compared to captopril in patients with mild or moderate essential hypertension . DESIGN This multinational , r and omized trial consisted of a 4-week single-blind , placebo baseline period followed by a 12-week double-blind , parallel comparison of once-daily administration of losartan 50 mg or twice-daily administration of captopril 25 mg . After 6 weeks of treatment , the daily dosage was doubled in patients whose sitting diastolic blood pressure ( SiDBP ) remained > or = 90 mm Hg . PATIENTS Patients with essential hypertension having a mean trough SiDBP of 95 - 115 mm Hg after the placebo baseline period were r and omized to losartan ( N = 192 ) or captopril ( N = 204 ) treatment . MAIN OUTCOME MEASURES The primary efficacy variable was the mean change from baseline to Week 12 in trough SiDBP . Safety was assessed by recording spontaneously reported or observed adverse experiences and clinical laboratory measurements . RESULTS After 12 weeks , both treatments produced clinical ly important reductions in trough SiDBP and sitting systolic blood pressure ( SiSBP ) . These mean reductions ( SiDBP , SiSBP ) were significantly greater in the losartan group ( -11.5 and -15.4 mm Hg , respectively ) than in the captopril group ( -9.3 and -12.2 mm Hg , respectively ) ( p = 0.010 for diastolic and p = 0.023 for systolic ) . The percentage of patients exhibiting an excellent ( trough SiDBP < 90 mm Hg ) or good ( trough SiDBP > 90 mm Hg , with decrease of > or = 10 mm Hg ) antihypertensive response to losartan and captopril therapy at Week 12 was comparable ( 60.0 % and 54.7 % , respectively ) . The percentage of patients reporting a clinical adverse experience considered drug-related by the investigator was 13 % in the captopril group and 10 % in the losartan group . The incidence of drug-related cough was 2.6 % in the losartan group and 4.4 % in the captopril group . CONCLUSION Once daily administration of losartan 50 to 100 mg is an effective treatment for patients with essential mild to moderate hypertension . The antihypertensive efficacy of losartan 50/100 mg is significantly greater than that of twice daily captopril 25/50 mg . Both treatments were generally well-tolerated . The number of patients with the side effect of cough was higher following captopril In a double-blind controlled trial , 91 middle-aged and elderly women with mild to moderate hypertension who were not on antihypertensive medication were r and omly assigned to treatment with magnesium aspartate-HCl ( 20 mmol Mg/d ) or placebo for 6 mo . Magnesium aspartate-HCl in the given dose was well-tolerated and was not associated with an increased frequency of diarrhea compared with placebo . At the end of the study , systolic blood pressure had fallen by 2.7 mm Hg ( 95 % CI -1.2 , 6.7 ; P = 0.18 ) and diastolic blood pressure by 3.4 mm Hg ( 1.3 , 5.6 ; P = 0.003 ) more in the magnesium group than in the placebo group . Blood pressure response was not associated with baseline magnesium status , as measured by dietary magnesium intake and urinary magnesium excretion . Urinary magnesium excretion in the magnesium group increased by 50 % during the intervention period . No changes were seen in other biochemical indexes , including serum concentrations of total and high-density-lipoprotein cholesterol . The findings suggest that oral supplementation with magnesium aspartate-HCl may lower blood pressure in subjects with mild to moderate hypertension OBJECTIVE The main purpose of our study was to analyse efficacy and safety of acebutolol ( Sectral ) in the treatment of hypertension in pregnancy . DESIGN Cohort clinical study comparing efficacy and safety of acebutolol with other antihypertensive drugs by 77 patients and their 81 newborns . The number of 48 patients were treated by acebutolol .  SETTING Internal Medicine and Clinical Pharmacology Department , Regional Hospital , Nitra and The Faculty of Health Service and Social Work , University of Trnava ; Department of Gynaecology and Obstetrics , Regional Hospital Nitra and The Faculty of Health Service and Social Work , University of Trnava ; Institute of Pharmacology , The Faculty of Medicine , Komenského University , Bratislava ; Environment , a.s . Nitra . METHODS During the period of 6 years our patients were divided into subgroups according to the type of hypertension in pregnancy and the severity of the illness which was the basis for used antihypertensive drugs . One of the topics of the study was to provide monitoring of adverse events by mother and possible drug influence on their new-born has been evaluated by investigating the week of birth , weight and length of the new-born and evaluating of Apgar score . RESULTS In the subgroup of 48 women treated by acebutolol we have confirmed the efficacy and safety of this antihypertensive drug without any clinical ly significant effect on the quality of life of their new-born and evaluating of Apgar score . CONCLUSION With regard to the results of our clinical study we can consider acebutolol to be effective and safe antihypertensive drug in the treatment of hypertension in pregnancy SUMMARY Background : Hypertension is one of the most important causes of cardiovascular disease , and treatment of hypertension leads to a significant reduction in cardiovascular mortality and morbidity . Although calcium channel blockers are regarded as an important part of the therapeutic armamentarium against cardiovascular diseases , and are among the most frequently prescribed antihypertensive medications , concern has been aroused about these drugs , particularly the short-acting dihydropyridine derivatives . However , the value of nifedipine GITS ( Adalat-Crono * ) , the long-acting dihydropyridine , is in need of being re-established . * Adalat-Crono is a registered tradename of Bayer AG , Leverkusen , Germany Objective : To compare the effectiveness , safety and tolerability of once-daily nifedipine and amlodipine treatment in patients with mild-to-moderate essential hypertension . Design : R and omised multicentre trial with an open comparison of treatments for 12 weeks , with a preceding placebo run-in period of 2 weeks ( patients on beta-blockers at the time of enrolment entered a m and atory 2-week wash-out period before being allowed in the placebo run-in period ; this wash-out period was one week for patients using any antihypertensive medication other than beta-blockers ) . Setting : Nine centres ( all university hospitals ) in Turkey . Patients : 155 patients with essential hypertension ( diastolicblood pressure 95 - 109 mmHg ) . Interventions : Initial treatment ( step 1 ) consisted of 30 mg nifedipine GITS ( n = 76 ; ( Adalat-Crono tablets ) , or 5 mg amlodipine ( n = 79 ; Norvasc * 5-mg tablets ) , either administered once daily , as a morning dose , or if the blood pressure was not below 140/90 mmHg , or the reduction in diastolic blood pressure was lower than 10 mmHg after a treatment period of 6 weeks , the dose was increased ( Step 2 ) to 60 mg once daily in the nifedipine group , or 10 mg once daily in the amlodipine group . Main efficacy parameter : Diastolic blood pressure at trough after 12 weeks of active compound therapy adjusted to baseline . Results : After 12 weeks of treatment , the mean diastolic blood pressure was 83.1 and 81.9 mmHg , in the nifedipine and amlodipine groups , respectively ( p = 0.436 ) . The mean decrease in systolic blood pressure ( 28.5 ± 11.9 and 28.2 ± 11.2 mmHg in the nifedipine and amlodipine groups , respectively ) and the mean decrease in diastolic blood pressure ( 16.4 ± 7.0 and 17.5 ± 6.9 mmHg in the nifedipine and amlodipine groups , respectively ) , as well as the responder rates ( 88.1 % and 92.1 % , in the nifedipine and amlodipine groups , respectively ) were comparable at the end of the study . No significant differences between groups were detected in the efficacy parameters assessed in this study . Both drugs were well tolerated . The overall incidence of adverse events was 7.9 % in the nifedipine group and 10.1 % in the amlodipine group . However , more patients discontinued treatment prematurely in the amlodipine group ( 13 patients ; 19.7 % ) , than in the nifedipine group ( four patients ; 5.6 % ) . Conclusions : The results of this study demonstrated that once-daily nifedipine in GITS formulation and amlodipine are comparably safe and effective treatment options in patients with mild-to-moderate essential hypertensi on Abstract Background . Arterial hypertension is commonly associated with hyperuricemia . Several studies have shown that allopurinol reduces arterial blood pressure in animal models and in adolescent patients with newly diagnosed hypertension . Moreover , allopurinol has shown beneficial effects on endothelial function and arterial wave reflection in contrast to uricosuric agents . Antihypertensive drugs produce different effects on serum uric acid levels . Objective . The aim of the study was to evaluate the influence of allopurinol on blood pressure and aortic compliance in patients with arterial hypertension depending on hypotensive therapy with angiotensin-converting enzyme inhibitor ( ACE-I ) or thiazide diuretic , hypotensive drugs with distinct effects on serum uric acid levels and conversely , a positive influence on pulse wave velocity ( PWV ) in the aorta . Material and Methods . Sixty-six patients aged 25–70 ( mean age 46.17 ± 10.89 ) with mild and moderate arterial hypertension diagnosed on the basis of office blood pressure , were studied . They were r and omized to antihypertensive therapy on either perindopril ( n = 35 ) or hydrochlorothiazide ( n = 31 ) . After 8 weeks of antihypertensive therapy , 150 mg of allopurinol daily was added for the next 8 weeks . Measurement of the serum uric acid level , PWV and 24-h ambulatory blood pressure monitoring ( ABPM ) were performed at baseline , after 8 weeks antihypertensive therapy and again after the final 8 weeks with the additional allopurinol . Results . No significant changes in systolic ( SBP ) and diastolic blood pressure ( DBP ) or ABPM were observed after allopurinol treatment in either of the subgroups receiving ACE-I or thiazide-based antihypertensive therapy . The mean PWV decreased from 10.7 ± 1.4 m/s to 10.0 ± 1.2 m/s ( p = 0.00008 ) in the ACE-I-based therapy subgroup and from 11.5 ±1.7 m/s to 10.4 ± 1.5 m/s ( p = 0.00002 ) in the thiazide-based therapy subgroup after treatment with allopurinol . However , significant correlations were found between PWV changes and the basic PWV ( r = −0.52 ; p < 0.001 ) or SBP changes ( r = 0.29 ; p < 0.019 ) after allopurinol treatment . Conclusions . Allopurinol does not produce additional antihypertensive effects in patients with treated arterial hypertension . Allopurinol increases aortic compliance independently of ACE-I or thiazide-based , antihypertensive therapy . However , this effect is significantly dependent on the initial PWV in the aorta and on SBP changes during allopurinol therapy Background Obstructive sleep apnea ( OSA ) and hypertension are well-known cardiovascular risk factors . Their control could reduce the burden of heart disease across population s. Several drugs are used to control hypertension , but the only consistently effective treatment of OSA is continuous positive airway pressure . The identification of a drug capable of improving OSA and hypertension simultaneously would provide a novel approach in the treatment of both diseases . Methods / Design This is a r and omized double-blind clinical trial , comparing the use of chlorthalidone with amiloride versus amlodipine as a first drug option in patients older than 40 years of age with stage I hypertension ( 140 to 159/90 to 99 mmHg ) and moderate OSA ( 15 to 30 apneas/hour of sleep ) . The primary outcomes are the variation of the number of apneas per hour and blood pressure measured by ambulatory blood pressure monitoring . The secondary outcomes are adverse events , somnolence scale ( Epworth ) , ventilatory parameters and C reactive protein levels . The follow-up will last 8 weeks . There will be 29 participants per group . The project has been approved by the ethics committee of our institution . Discussion The role of fluid retention in OSA has been known for several decades . The use of diuretics are well established in treating hypertension but have never been appropriately tested for sleep apnea . As well as testing the efficacy of these drugs , this study will help to underst and the mechanisms that link hypertension and sleep apnea and their treatment . Trial registration Clinical Trials.gov : OBJECTIVE --To determine whether dietary treatment has a similar antihypertensive effect to conventional drug treatment while being superior to drugs in improving serum lipid concentrations in obese men with mild hypertension . DESIGN --Six week run in period followed by r and omisation to either diet or drug treatment groups for one year . SETTING --Outpatient clinic in city hospital . PATIENTS --61 Men aged 40 - 69 years , body mass index greater than or equal to 26 , diastolic blood pressure 90 - 104 mm Hg when untreated . Exclusion criteria were signs of organ damage secondary to hypertension and diseases that might have interfered with compliance or with interpretation of results . INTERVENTIONS --Dietary treatment was based on weight reduction , restriction of sodium , and decrease of excess alcohol intake ( defined as greater than or equal to 250 g alcohol per week ) . Drug treatment used a stepped care approach with atenolol as drug of first choice . MAIN OUTCOME MEASURES --Diastolic blood pressure less than 90 mm Hg ; absolute reductions in blood pressure and serum lipid concentrations . RESULTS --Mean body weight decreased 7.6 kg in the diet group and increased 0.9 kg in the drug treatment group ( p less than 0.0001 ) , and mean sodium excretion decreased 42 and 10 mmol/24 h respectively ( p = 0.019 ) . There was no difference in reported alcohol intake . Mean systolic blood pressure decreased 4 mm Hg in the diet group and 16 mm Hg in the drug group ( p = 0.003 ) and diastolic blood pressure 3 and 11 mm Hg respectively ( p = 0.002 ) . Diastolic blood pressure of 90 mm Hg was attained by 29 % of the diet group ( nine men ) and 73 % ( 22 ) of those receiving drug treatment ( mean difference 44 % , 95 % confidence interval 21 to 67 % , p = 0.001 ) . Dietary treatment produced decreases in mean serum concentrations of total and low density lipoprotein cholesterol as well as triglycerides and an increase in high density lipoprotein cholesterol concentration . In the drug treatment group the changes were in the opposite direction , and the groups differed significantly in all but total cholesterol . CONCLUSIONS --Dietary treatment was inferior to conventional drug treatment in controlling mild hypertension but superior in lowering serum concentrations of lipids The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ) , sponsored by the National Heart , Lung , and Blood Institute ( NHLBI ) , is the largest outcome trial of antihypertensive treatment ever carried out and the only large blood pressure ( BP ) trial to be carried out in a US population in the past decade.1 The rationale for ALLHAT , which was design ed in the early 1990s , was the urgent need to determine which of the several classes of antihypertensive drugs that had been developed and released for clinical use was most effective in preventing coronary heart disease ( CHD ) , defined as fatal CHD and nonfatal myocardial infa rct ion.2 The only r and omized trials that had previously compared representatives of the antihypertensive drug classes , the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents3 and the Treatment of Mild Hypertension Study (TOMHS),4 showed BP reductions with all classes but were not powered to evaluate CHD outcomes . Further , prior outcome trials had shown that the reduction in CHD event rates with antihypertensive treatment was less than expected based on epidemiologic data .5 Adverse effects of study drugs , particularly diuretics , including hypokalemia , hypomagnesemia , hyperuricemia , hyperlipidemia , insulin resistance , and ventricular ectopic activity , had been adduced to account for the disappointing outcomes of earlier trials by off setting the beneficial effects of BP reduction.6,7 To further complicate the picture , benefits beyond BP reduction had been attributed to some antihypertensive drug classes , ie , improved survival and reduced morbidity in persons with heart failure or left ventricular dysfunction treated with angiotensin-converting enzyme ( ACE ) inhibitors8–10 and improved insulin sensitivity and lipid profiles with α-blocker treatment.11 In contrast , another antihypertensive drug class , the dihydropyridine calcium channel blockers ( CCBs ) , had been associated with unfavorable outcomes in patients with acute myocardial infa rct ion or unstable angina.12 There were no data Atenolol was compared with placebo in a r and omised and double-blind prospect i ve study of 120 women with mild to moderate pregnancy-associated hypertension who were also initially managed conventionally by bed rest .  Atenolol given once daily significantly reduced blood-pressure , prevented proteinuria , and reduced the number of hospital admissions . Loss of blood-pressure control leading to withdrawal from the study was commoner among the placebo group , whose babies had a high morbidity . Respiratory distress syndrome occurred only in the placebo group . Intrauterine growth retardation , neonatal hypoglycaemia , and hyperbilirubinaemia occurred with the same frequency in the two groups . Neonatal bradycardia was more common after atenolol but the systolic blood-pressure of the babies was the same in both groups . There was no difference between the groups in maternal symptoms which could have been attributed to beta-blocker therapy . Thus atenolol is more effective than conventional obstetric management in this form of hypertension and does not adversely affect mother or baby PURPOSE Patterns of antihypertensive drug use in patients undergoing long-term hemodialysis therapy were studied . METHODS Patients attending seven outpatient hemodialysis units in Ohio were eligible for the study if they had been receiving the treatment for at least three months . Demographic and clinical data were obtained from patient interviews and computerized data bases , and blood pressure ( BP ) measurements were obtained before dialysis . Labeled names and dosages of antihypertensive drugs were recorded from containers the patients brought with them . Patients were asked to describe their adherence to the medications , their ability to afford the drugs , and their knowledge and beliefs about hypertension . Physical impairments in taking medication were also evaluated . RESULTS The frequency of hypertension was 89 % in the 270 participants . Antihypertensive drugs were prescribed for 76 % of the patients ; 25 % required three or more drugs . Hypertensive patients who were not receiving antihypertensive drugs ( 14 % ) had significantly higher BP than patients who were . Calcium-channel blockers were prescribed for 60 % of patients , angiotensin-converting-enzyme inhibitors for 33 % , and beta-blockers for 34 % . Eighty-three percent said the cost of drugs was never a problem , and 23 % said they sometimes forgot to take their medication . Almost all patients said they would not stop taking antihypertensive drugs if they were feeling better and agreed that monitoring BP was important . Twenty-two percent could not read the warning on a st and ard tablet container , and 12 % could not remove one tablet from the container . CONCLUSION Multidrug antihypertensive therapy was common among hemodialysis patients and was associated with significantly lower BP ; calcium-channel blockers were the most frequently prescribed agents . Most patients said they could afford drugs and reported good adherence to antihypertensive drug therapy The antihypertensive effect of isradipine compared with placebo was assessed in 28 male patients ( aged 40–64 years ) with mild-to-moderate essential hypertension . After withdrawal of all previous antihypertensive treatment , these patients were entered into a 4-week placebo period followed by r and omization to receive double-blind , for 8 weeks , either placebo ( n = 14 ) or isradipine at 1.25–2.5 mg twice daily ( n = 14 ) . Twenty-four-hour ambulatory blood pressure was measured by Accutracker at the end of the placebo period and at the end of active treatment . In the isradipine  group . both systolic and diastolic blood pressures decreased significantly ( p < 0.0001 ) whereas blood pressure increased in those taking placebo . In addition , isradipine as monotherapy con-trolled blood pressure throughout the day and night , and especially during the early morning , in these patients The antihypertensive efficacy of the angiotensin II receptor blocker olmesartan medoxomil has been shown to compare favourably with that of other antihypertensive agents . This r and omized , double-blind study compared the antihypertensive efficacy of the starting dose of olmesartan medoxomil with that of the calcium channel blocker amlodipine besylate ( amlodipine ) in subjects with mild-to-moderate hypertension . Following a 4-week , single-blind , placebo run-in period , 440 subjects aged ⩾18 years were r and omized to the starting dose of olmesartan medoxomil ( 20 mg/day ) , amlodipine ( 5 mg/day ) , or placebo for 8 weeks . Subjects were evaluated by  24-h ambulatory blood pressure monitoring ( ABPM ) and by seated cuff blood pressure ( BP ) measurements at trough . The primary end point was the change from baseline in mean 24-h diastolic blood pressure ( DBP ) by ABPM at Week 8 . Secondary end points included change from baseline in mean 24-h ambulatory systolic blood pressure ( SBP ) at 8 weeks , change from baseline in mean seated trough cuff DBP and SBP measurements , and response and control rates for DBP < 90 and < 85 mmHg . Control rates for SBP < 140 and < 130 mmHg were also calculated . Olmesartan medoxomil and amlodipine produced significantly greater reductions in ambulatory and seated DBP and SBP compared with placebo . Mean reductions in ambulatory and seated BP were similar between the two active agents ; however , in the olmesartan medoxomil group , significantly more patients achieved the SBP goal of < 130 mmHg and the DBP goal of < 85 mmHg . Both drugs were well tolerated at the recommended starting dose . Although amlodipine was associated with a higher incidence of oedema , this did not reach statistical significance . Olmesartan medoxomil is an effective antihypertensive agent , with BP-lowering efficacy at the starting dose similar to that of amlodipine , and is associated with more patients achieving the rigorous BP goals of SBP < 130 mmHg and DBP < 85 mmHg This multicenter , factorial- design trial assessed the safety and additive antihypertensive efficacy of a slow-release ( SR ) formulation of diltiazem hydrochloride given alone or in combination with hydrochlorothiazide for treatment of mild to moderate hypertension . After a 4- to 6-week placebo run-in period , 297 qualifying patients were r and omized to receive placebo , 1 of 4 doses of diltiazem SR monotherapy , 1 of 3 doses of hydrochlorothiazide monotherapy , or 1 of 12 possible combinations of diltiazem SR and hydrochlorothiazide for 6 weeks . A dose-related reduction in blood pressure was demonstrated for each drug as monotherapy and for the two drugs in combination . Absolute blood pressures of patients who received combination therapy were lower by an overall mean of 3.0 mm Hg diastolic and 8.0 mm Hg systolic vs diltiazem SR used alone and 3.5 mm Hg diastolic and 4.0 mm Hg systolic vs hydrochlorothiazide used alone . At the largest doses used , 50 % of patients achieved goal blood pressure while taking hydrochlorothiazide , 57 % while taking diltiazem SR , and 75 % while taking combination therapy . Combination therapy was well tolerated . This trial clearly demonstrates that diltiazem SR and hydrochlorothiazide have additive antihypertensive effects Hypertensive patients may be adversely affected by complications and other concomitant processes such as anxiety , sedation , and drug side effects . It has been suggested that some recently developed antihypertensive agents do not affect quality of life by causing adverse effects . We compared the effects of two antihypertensive drugs on quality of life : atenolol , a st and ard cardioselective β-blocker , and celiprolol , one of a new class of selective β-blockers with vasodilatory properties . One hundred thirty-two patients with mild-to-moderate hypertension were eligible to enter a 28-week , double-blind , parallel-group study . The study protocol consisted of a 4-week period on placebo and a 24-week period of dosage-adjusted treatment with either atenolol or celiprolol . We assessed both systolic and diastolic blood pressure and quality of life perception by a selected test battery that included the Bulpitt and Fletcher Quality of Life Question naire . Supine blood pressure fell from 167/101 ( range 120/95 to 200/116 ) to 150/92 mm Hg ( p < 0.0001 ) during celiprolol treatment . This antihypertensive effect was at least as good with celiprolol as with atenolol  . Quality of life perception was comparable for the two drugs although adverse effects were seen more frequently with atenolol than with celiprolol , particularly after prolonged treatment . Patient compliance was better for celiprolol than for atenolol . Our results show that the selective β-blocker with vasodilatory property celiprolol is at least as effective as atenolol and that it is more advantageous in terms of some quality of life variables Background The underlying reasons for differences between clinical practice and systematic ally developed guidelines vary from one clinical problem to another . It is therefore logical to tailor strategies to support the implementation of guidelines to address identified barriers to change . The objective of this trial is to evaluate the effects of a tailored intervention to support the implementation of systematic ally developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease . Methods / Design Unblinded , cluster-r and omised trial . 150 general practice s will be recruited from two geographical areas in Norway , and r and omised to the intervention or control group ( passive dissemination of guidelines )  . Outcomes will be measured for all eligible patients seen in the participating practice s during one year after the intervention . A multifaceted intervention has been tailored to address identified barriers to change . Key components are an educational outreach visit with audit and feedback , and computerised reminders . Pharmacists will conduct the visits . During the outreach visit the main recommendations will be presented and software will be installed that links to the electronic medical record systems used in the participating practice s. The software will perform an audit that will be fed back during the visit , present pop-up reminders for patients with high blood pressure or cholesterol , and provide a cardiovascular risk calculator and patient education material . The main outcomes are the proportions of 1 ) first time prescriptions for hypertension where thiazides are not prescribed , 2 ) patients not assessed for cardiovascular risk before prescribing antihypertensive or cholesterol-lowering drugs , and 3 ) patients treated for hypertension or high cholesterol for three months or more who have not achieved recommended treatment goals In a double-blind , crossover study , five white men with mild-to-moderate hypertension received placebo and fixed doses of atenolol , metoprolol , chlorthalidone , verapamil , and the combination of atenolol and chlorthalidone in a quasi-r and om order . Daily dosages were : atenolol , 100 mg ; metoprolol , 200 mg ; chlorthalidone , 50 mg ; verapamil , 240 mg ; and the same doses of atenolol and chlorthalidone in combination .  St and ard office and daytime ambulatory blood pressures were assessed at the end of each month-long trial . Atenolol , metoprolol , chlorthalidone , and verapamil  controlled office blood pressure with similar reductions . Verapamil did not lower ambulatory blood pressure at this dose ( which is lower than is now commonly used ) , but reductions in ambulatory blood pressure were similar for atenolol , metoprolol , and chlorthalidone . The combination of atenolol and chlorthalidone maintained blood pressure control more effectively than the single drug treatments in both office and ambulatory setting s , and the combined hypotensive effects were additive . However , reductions in the office due to the combination appeared to overestimate hypotensive effectiveness in the ambulatory setting . This study suggests that the effectiveness of commonly prescribed antihypertensive regimens varies according to setting as well as drug , and that assessment of treatment effectiveness can be improved by automated ambulatory blood pressure monitoring 1 . The antihypertensive efficacy and tolerability of a low dose combination of the angiotensin converting enzyme inhibitor ramipril ( 2.5 mg ) and the extended release formulation of the dihydropyridine calcium channel antagonist felodipine ( 5 mg ) were assessed in a double-blind , double dummy placebo controlled , r and omised , crossover study in 20 patients ( mean age 55.4 years ; range 46 - 69 ) with uncomplicated mild to moderate hypertension ( supine diastolic > 90 mmHg < 115 mmHg after 4 weeks of single-blind wash-out on placebo ) . The four r and omised , double-blind , crossover study phases evaluated the response to 4 weeks of once daily treatment with placebo , monotherapy with each drug and the combination .  Noninvasive ambulatory blood pressure monitoring ( Spacelabs 90207 ) was performed for 24 h at the end of each phase . 2 . The mean 24 h ambulatory blood pressure ( mmHg ) was 147.9/92.0 following placebo , 141.3/87.8 following monotherapy with ramipril 2.5 mg , 136.8/85.8 following monotherapy with felodipine ER 5 mg and 131.1/82.6 following the combination of ramipril 2.5 mg and felodipine ER 5 mg . All active treatment phases significantly reduced mean 24 h ambulatory diastolic pressure by comparison with placebo . The antihypertensive efficacy of the combination was additive . 3 . The coadministration of ramipril did not attenuate the incidence of headache attributable to felodipine ER Two first‐line antihypertensive therapies for initiating treatment in hypertension were compared , the angiotensin‐converting enzyme inhibitor ( ACEI ) zofenopril and the beta‐blocker atenolol . The study was multi‐centre and double‐blind , and included 304 middle‐aged to elderly patients with mild to moderate hypertension who were r and omized to receive either zofenopril 30–60 mg once daily ( od ) or atenolol 50–100 mg od for 4 weeks with the possibility to an up‐titration in non‐responding patients . The higher dose level was then administered until 12 weeks after r and omization . Blood pressures ( BPs ) were substantially reduced by either treatment , but after 4 weeks , the systolic and diastolic BP reductions were significantly greater ( p<0.05 ) with zofenopril ( −15.6/−13.5 mmHg ) compared with atenolol ( −13.1/−11.8 mmHg ) . After 12 weeks and the possibility of dose up‐titration , BP differences between treatments were no longer significant . However , control rates ( sitting diastolic BP < 90 mmHg ) for zofenopril remained significantly higher compared with atenolol .  The number of subjects with adverse drug reactions possibly or probably related to the study medication was 14 ( 9.1 % ) in the zofenopril group and 30 ( 20.8 % ) in the atenolol group ( p = 0.008 ) . It is concluded that zofenopril as well as atenolol induces substantial reductions of diastolic BP in middle‐aged to elderly patients with hypertension . However , the control rate when initiating antihypertensive therapy with zofenopril is higher than that for atenolol Whole-day ambulatory blood pressure monitoring is used to confirm the diagnosis of hypertension and assess the response to antihypertensive therapy .  Neither of these has been applied to patients with type II diabetes mellitus , in whom it has been proposed that the desirable blood pressure should be lower than in nondiabetics . This multicenter study was design ed to examine whether there are differences in the efficacy of a first-line antihypertensive drug when assessed by casual and ambulatory blood pressure determinations in patients with type II diabetes mellitus in whom 24-hour ambulatory monitoring confirms or fails to confirm the diagnosis of hypertension . Forty-three patients ( mean age , 57.7 years ) with stable type II diabetes mellitus and mild hypertension ( casual diastolic pressure , 90 to 104 mm Hg on at least two visits ) were treated with an angiotensin-converting enzyme inhibitor ( benazepril , 10 to 20 mg , once a day ) for 8 weeks . Antihypertensive drug efficacy was assessed by casual ( trough ) and 24-hour ambulatory blood pressure monitoring . Diabetic patients were classified as nonconfirmed hypertensive if the mean 24-hour ambulatory diastolic pressure was below 85 mm Hg . Antihypertensive treatment significantly decreased both systolic and diastolic pressures when determined by either casual measurement ( from a mean of 162.7/98.0 to 153.9/89.2 mm Hg ; P < .001 ) or ambulatory monitoring ( from a mean of 143.1/84.4 to 137.0/81.5 mm Hg ; P < .05 ) . Twenty-one patients ( 49 % ) were classified as confirmed hypertensive and 22 as nonconfirmed hypertensive . In confirmed hypertensive patients benazepril significantly reduced systolic and diastolic pressures when assessed by either casual or 24-hour ambulatory monitoring . ( ABSTRACT TRUNCATED AT 250 WORDS The effects of indapamide and captopril on office and ambulatory blood pressure control and on general well-being were investigated in 30 active , r and omly selected patients from 25 to 68 years old , with mild to moderate essential hypertension ( diastolic blood pressure , 92 to 114 mm Hg ) . Twenty-four-hour ambulatory blood pressure monitoring using an ICR model 5200 portable recorder and evaluation of general well-being were performed prior to and at the end of three months of therapy with indapamide 2.5 mg given once daily , or captopril 12.5 to 50 mg given twice daily . Indapamide and captopril were equally effective in controlling blood pressures in clinic and during 24-hour activities . Although general well-being and subjective symptomatology improved with both treatments , the only significant difference between the two drugs was improvement in the sleep dysfunction scale with indapamide ( p less than 0.02 ) . The results shown in this study suggest that both indapamide ( 2.5 mg ) once daily and captopril ( 12.5 to 50 mg ) twice daily are suitable drugs for initial therapy of active patients with mild to moderate hypertension . A fixed once-daily dosage of an antihypertensive agent may , however , increase patient compliance and convenience CONTEXT Blood pressure control ( < 140/90 mm Hg ) rates for hypertension fall far short of the US national goal of 50 % or more . Achievable control rates in varied practice setting s and geographic regions and factors that predict improved blood pressure control are not well identified . OBJECTIVE To determine the success and predictors of blood pressure control in a large hypertension trial involving a multiethnic population in diverse practice setting s. DESIGN The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial is a r and omized , double-blind , active-controlled clinical trial with a mean follow-up of 4.9 years . Participant enrollment began in February 1994 and follow-up was completed in March 2002 . SETTING A total of 623 centers in the United States , Canada , and the Caribbean . PARTICIPANTS A total of 33,357 participants ( aged > or = 55 years ) with hypertension and at least one other coronary heart disease risk factor . INTERVENTIONS Participants were r and omly assigned to receive ( double-blind ) chlorthalidone , 12.5 - 25 mg/d ( n=15,255 ) , amlodipine 2.5 - 10 mg/d ( n=9048 ) , or lisinopril 10 - 40 mg/d ( n=9054 ) after other medication was discontinued . Doses were increased within these ranges and additional drugs from other classes were added as needed to achieve blood pressure control ( < 140/90 mm Hg ) . MAIN OUTCOME MEASURES The outcome measures for this report are systolic and diastolic blood pressure , the proportion of participants achieving blood pressure control ( < 140/90 mm Hg ) , and the number of drugs required to achieve control in all three groups combined . RESULTS Mean age was 67 years , 47 % were women , 35 % black , 36 % diabetic ; 90 % were on antihypertensive drug treatment at entry . At the first of two pre-r and omization visits , blood pressure was < 140/90 mm Hg in only 27.4 % of participants . After 5 years of follow-up , the percent controlled improved to 66 % . Systolic blood pressure was < 140 mm Hg in 67 % of participants , diastolic blood pressure was < 90 mm Hg in 92 % , the mean number of drugs prescribed was 2.0+/-1.0 , and the percent on > or = 2 drugs was 63 % . Blood pressure control varied by geographic regions , practice setting s , and demographic and clinical characteristics of participants . CONCLUSIONS These data demonstrate that blood pressure may be controlled in two thirds of a multiethnic hypertensive population in diverse practice setting s. Systolic blood pressure is more difficult to control than diastolic blood pressure , and at least two antihypertensive medications are required for most patients to achieve blood pressure control . It is likely that the majority of people with hypertension could achieve a blood pressure < 140/90 mm Hg with the antihypertensive medications available today OBJECTIVE To compare six antihypertensive interventions for the treatment of mild hypertension . DESIGN R and omized , double-blind , placebo-controlled clinical trial . SETTING Four hypertension screening and treatment centers in the United States . PARTICIPANTS Hypertensive men and women , aged 45 to 69 years , with diastolic blood pressure less than 100 mm Hg . INTERVENTION Sustained nutritional-hygienic advice to all participants to reduce weight , dietary sodium intake , and alcohol intake , and increase physical activity . Participants were r and omly allocated to take ( 1 ) placebo ( n = 234 ) ; ( 2 ) chlorthalidone ( n = 136 ) ; ( 3 ) acebutolol ( n = 132 ) ; ( 4 ) doxazosin mesylate ( n = 134 ) ; ( 5 ) amlodipine maleate ( n = 131 ) ; or ( 6 ) enalapril maleate ( n = 135 ) . MAIN OUTCOME MEASURES Blood pressure , quality of life , side effects , blood lipid levels and analysis of other serum components , echocardiographic and electrocardiographic changes , and incidence of cardiovascular events over an average of 4.4 years of follow-up . RESULTS Blood pressure reductions were sizable in all six groups , and were significantly greater for participants assigned to drug treatment than placebo ( -15.9 vs -9.1 mm Hg for systolic blood pressure and -12.3 vs -8.6 mm Hg for diastolic blood pressure ; P < .0001 ) . After 4 years , 59 % of participants assigned to placebo and 72 % of participants given drug treatment continued on their initial medication as monotherapy . A smaller percentage of participants assigned to the drug-treatment groups died or experienced a major nonfatal cardiovascular event than those assigned to the placebo group ( 5.1 % vs 7.3 % ; P = .21 ) . After including other clinical events , the percentage of participants affected was 11.1 % for those in the drug-treatment groups and 16.2 % for those in the placebo group ( P = .03 ) . Incidence rates of most resting electrocardiographic abnormalities were lower and quality of life was improved more for those assigned to drug-treatment groups rather than the placebo group . Differences among the five drug treatments did not consistently favor one group in terms of regression of left ventricular mass , blood lipid levels , and other outcome measures . CONCLUSIONS As an initial regimen , drug treatment in combination with nutritional-hygienic intervention was more effective in preventing cardiovascular and other clinical events than was nutritional-hygienic treatment alone . Drug-treatment group differences were minimal . Pending results from large-scale clinical trials to evaluate drug treatments for their effect on cardiovascular clinical events , these findings support the recommendations of the new fifth Joint National Committee report regarding treatment choices for people with stage 1 ( " mild " ) hypertension To test the effects of calcium dobesilate ( Doxium ) in pregnancies complicated with pregnancy-induced hypertension or mild/moderate pre-eclampsia a double-blind , placebo-controlled pilot study was carried out . Primigravida patients ( gestational age ≤34 weeks ) daily took 2 g Doxium or placebo until delivery . Twelve patients received placebo for 53 days , and 11 patients took the drug for 57 days on average . At the start of the study 2 patients in the placebo group ( PG ) and 8 in the Doxium group ( DG ) had pre-eclampsia . The mean arterial pressure ( mean ± SD ) significantly decreased from 118 ± 7 to 99 ± 9 mm Hg in the DG ( p = 0.003 ) , while in the PG it had slightly increased by the end of the study . Proteinuria was higher in the DG at the start but not at the end ; however , significant changes of this parameter were detected in neither of the groups throughout the study . Fibronectin decreased significantly in both groups but it was more pronounced in the DG ( 23.8 vs. 9.4 % ) . Changes of platelet count , plasma and blood viscosity , and erythrocyte deformability were favourable in the DG but in the PG these parameters had deteriorated although the alterations were not significant . No marked differences were found between the two groups regarding fetal well-being , courses of deliveries , and the neonatal period . Neither maternal nor fetal/neonatal side effects were noticed . It seems that Doxium favourably influences the blood pressure and consequently decreases the requirement for medication and hospitalisation in cases of mild to moderate midtrimester hypertension OBJECTIVES To assess whether angiotensin-converting enzyme inhibitor ( ACE-I ) treatment is associated with less cognitive decline in older adults with Alzheimer 's disease ( AD ) than in those using other hypertensive or no drugs . DESIGN Four-year prospect i ve multicenter cohort study with a biannual assessment . SETTING Memory clinics from 16 university hospitals in France . PARTICIPANTS Community-dwelling older adults with mild to moderate AD ( N = 616 ) . MEASUREMENTS Participants were stratified into four groups according to type and duration of antihypertensive drug treatment .  Cognitive decline was assessed using the  Mini-Mental State Examination ( MMSE ) . Linear mixed-effects models were used to assess differences in decline in MMSE score between the four groups . Hypertension at each visit was included in the model . RESULTS Sixty-one participants had used ACE-Is continuously , 57 had used them intermittently , 189 had used other antihypertensive drugs , and 309 never used any antihypertensive drugs . Continuous ACE-Is users had a 4-year decline in MMSE of 6.4 ± 1.6 points ( P < .001 ) , intermittent ACE-Is users of 7.9 ± 1.1 points ( P < .001 ) , continuous or intermittent users of other antihypertensive drugs of 8.8 ± 0.7 points ( P < .001 ) , and never-users of 10.2 ± 0.6 points ( P < .001 ) . MMSE decline between the four groups was significantly different ( adjusted P = .02 ) . In subgroup analysis , the 118 ( 19.2 % ) participants who had continuously or intermittently used ACE-Is had a significant difference in 4-year MMSE decline from the 498 ( 80.8 % ) who had never used ACE-Is ( 7.5 ± 0.9 vs 9.7 ± 0.4 ; P = .03 ) . CONCLUSION The use of ACE-Is in older adults with AD is associated with a slower rate of cognitive decline independent of hypertension . Future research is needed to explore the role of ACE-Is in long-term AD progression The 4 year prospect i ve trial on the effectiveness of the antihypertensive treatment was performed in 100 mild hypertensive patients of the aged , the average age being 76.1 years . Dropouts during the drug-off control period were 9 cases . The matched pair group was selected by the age , sex , and blood pressure . Forty-four drug treated cases and 47 placebo treated cases were comparable in blood pressure as well as in laboratory data . Cerebrovascular and cardiac complications were observed in 4 cases or 10.5 % in the drug group , and in 9 cases or 22.0 % in the placebo group . When 8 cases of blood pressure elevation over 200/110 mmHg in the placebo group were added to the cardiovascular complications , dropouts in placebo group reached 41.5 % , and this showed the significant difference . Other complications were observed in 12 cases or 31.6 % in the drug group and in 17 cases or 41.5 % in the placebo group . Major complications were cancers , infections , and bone or joint diseases . Blood pressure was decreased from 171/87 to 151/80 in the drug group , and the average decrease was 20/7 mmHg in 4 year period . No significant changes in hematocrit , serum protein , urea nitrogen , uric acid , sodium , and potassium were observed during the trial period . The present study suggested that antihypertensive treatment was effective in the aged with mild hypertension , and that careful follow up was needed not only for cardiovascular complications but also for general health condition A placebo-controlled trial was used to assess the antihypertensive efficacy of indoramin in the management of  pregnancy hypertension . Sixty patients were recruited into the study and only 17 attained satisfactory blood pressure control .  In the doses of drugs administered indoramin was not shown to be more effective than alpha-methyldopa
REVIEW ER 'S CONCLUSIONS It remains unclear whether antihypertensive drug therapy for mild-moderate hypertension during pregnancy is worthwhile
BACKGROUND Mild-moderate hypertension during pregnancy is common .
Antihypertensive drugs are often used in the belief that lowering blood pressure will prevent progression to more severe disease , and thereby improve outcome .
OBJECTIVES To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during pregnancy .