Search

The effects of nisoldipine and slow release nifedipine on mild to moderate hypertension and glycaemic control were studied in 28 diabetic hypertensives, all except one of whom were non-insulin dependent. After two weeks placebo treatment patients were randomised to receive either nisoldipine 5 mg twice daily or nifedipine 10 mg twice daily. If, after four weeks of treatment, diastolic blood pressures (DBP) were 95 mmHg or more, the doses were doubled. On the 'optimum' dose patients were reviewed at weeks 4, 8, 12 and 24. At each visit blood was taken for haematology, biochemistry, glucose and glycosylated haemoglobin (GHb). Twenty-four hour home blood glucose (HBG) profiles were done at the end of the placebo period, and at weeks 8, 12, and 24, when on 'optimum' treatment. Mean sitting blood pressure fell from 173/99 to 161/92 (nisoldipine) and 158/86 mmHg (nifedipine) on the lower doses. Responses to higher doses were less marked. Changes in post breakfast blood glucose and GHb were not statistically significant. There were no significant changes in 24 hr HBG profiles on nisoldipine 5 mg and only minor decreases on 10 mg. On nifedipine 10 mg there was a similar change but on 20 mg an increase in HBG was seen at all points.

Platelet reactivity was studied immediately after and throughout the first 6 months following myocardial infarction. Its modification by sulphinpyrazone was observed. Out of 65 consecutive patients admitted to the coronary care unit, ten did not meet the protocol criteria. Fifty five received either placebo or sulphinpyrazone in a double-blind trial for 6 months, treatment being started within 6 days of infarction. Forty four patients completed the study (19 on placebo and 25 on sulphinpyrazone). An additional ten patients commenced treatment within one day of infarction and were studied daily for one week. Platelet hyper-reactivity was demonstrable in all patients at presentation and persisted throughout the 6 months in the control group. This effect was reversed by sulphinpyrazone, the modification of reactivity being established by the third day of treatment.

A study was carried out in 44 patients with mild to moderate essential hypertension attending a hypertension clinic in a general hospital. Treatment was administered using fixed-dose combination tablets of timolol maleate (10 mg) and bendrofluazide (2.5 mg) taken twice daily for 16 weeks, in order to assess the efficacy and side-effects of this combination and to monitor changes in serum electrolytes and other biochemical indices. Blood pressure control (supine diastolic blood pressure less than or equal to 95 mmHg) was achieved in 38 (86%) patients on a mean dose of 2.6 tablets daily (range 1 to 4 tablets). Adverse effects were uncommon, 3 (6%) patients being withdrawn at an early stage. In a complementary investigation, 14 patients who completed the 16-weeks' treatment were changed onto a regimen in which the drug dosage remained unchanged but was taken on a once-daily basis for a further 16 weeks to assess the efficacy of once-daily dosing and to monitor any further long-term changes in biochemistry. The trend of changes in biochemical indices which were observed in the 16-week study tended to reverse during the second 16 weeks so that, overall, changes in biochemistry were minimal. The combination of timolol maleate and bendrofluazide was effective in controlling blood pressure in most mild to moderate hypertensives and the dose range allowed accurate titration of dosing for each patient. The effect was equal on a once-daily or a twice-daily dosage.

In a double blind, within patient investigation of twenty-four patients (nineteen males and five females) with a mean age of 46.3 years (SD 10.9 years) with mild to moderate essential hypertension a comparison between equipotent beta-blocking doses of propranolol, metoprolol and labetalol was carried out. Blood pressure and pulse rate were measured in lying, sitting and standing positions and before, during and after isometric and dynamic exercise. Peak expiratory flow was recorded before and during dynamic exercise. All the active treatments were better than placebo in reducing blood pressure and heart rate. Comparing the effects of treatment, labetalol lowered sitting diastolic pressure significantly more than propranolol and standing diastolic pressure than both propranolol and metoprolol. Metoprolol and propranolol were more effective in reducing heart rate. Propranolol significantly reduced peak flow rate compared to labetalol. During the exercise, both isometric and dynamic, the heart rate and the blood pressure, both systolic and diastolic, of the treated patients were lower than those on placebo. There was little difference between the drugs in the influence on blood pressure, but metoprolol and propranolol were significantly more effective than labetalol in lowering the heart rate.

Penbutolol is a potent long-acting non-cardioselective beta-adrenergic blocker with partial agonist activity. A double-blind cross-over comparison of penbutolol given in a single daily dose and propranolol given twice daily in the treatment of ambulant patients with moderate hypertension is described. Fourteen patients completed the study and were treated with each drug for 12 weeks. Penbutolol in daily doses of 20-120 mg and propranolol in daily doses of 80-400 mg produced similar significant reductions in both supine and erect blood pressure. Penbutolol did not reduce heart rate to the same extent as propranolol, in equivalent doses. Penbutolol appears to produce adequate control of moderate hypertension when administered once a day, and this effect appears to be equivalent to divided doses of propranolol. No serious adverse effects were reported, although one patient receiving penbutolol experienced severe eye pains at a dose of 40 mg which resolved on crossing over to treatment with propranolol.

The effects on blood pressure and heart rate of 200 mg metoprolol and 2.5 mg indapamide given separately and together as a single daily dose were compared in 27 patients suffering from moderate hypertension. The blood pressure and heart rate were measured in the lying and standing position, before, during and after exercise. Both indapamide and metoprolol in a single daily dose reduced the blood pressure. The best results were achieved by a combination of the two.

Eighty nine adults with asthma who were receiving inhaled corticosteroid and bronchodilator treatment took part in a double blind, randomised, placebo controlled trial of nedocromil sodium, 4 mg four times daily by inhalation. During a run in period of two to four weeks corticosteroid treatment was reduced when possible to produce a comparable level of symptoms across the trial population. The test treatment was then taken for four weeks, with the severity of asthma recorded daily by patients and assessed at two weekly hospital visits. There was an improvement in symptoms in the patients taking nedocromil sodium by comparison with those having the placebo, the differences being significant for diary card PEF readings, asthma symptom scores, and bronchodilator usage at night. The mean difference between the two groups was 18 l/min for PEF, 0.42 for daytime asthma score, and 1.73 puffs in 24 hours for bronchodilator usage. These results suggest that asthmatic patients who require inhaled steroids show better control of their asthma with the addition of nedocromil sodium than of placebo over a four week period after reduction of the dosage of their inhaled steroids.

The comparative anti-arrhythmic effect of equivalent daily doses of conventional propranolol ('Inderal') and long-acting propranolol ('Inderal' LA) was assessed in a double-blind, crossover study lasting 6 weeks in 13 patients with cardiac arrhythmias. Patients were investigated using 24-hour ambulatory monitoring. Both formulations of propranolol significantly reduced the heart rate, together with the number of ventricular premature beats and ventricular couplets, with no significant difference between treatments. The two formulations also produced similar plasma concentrations of propranolol. The long-acting formulation of propranolol proved an effective anti-arrhythmic treatment which, with once-daily dosage, may improve patient compliance with treatment.

A patient presented with a pneumococcal lobar pneumonia and later developed a subphrenic abscess. Peritonitis and intra-abdominal abscess formation should be remembered as a rare cause of delayed recovery from lobar pneumonia.