High blood pressure. Causes, symptoms, treatments

Thorn-induced Alternaria flexor tenosynovitis of the hand.


Losartan, losartan carboxylic acid and hydrochlorothiazide were well tolerated by subjects in all periods of each study under fasted conditions. No serious adverse events were observed. The ratios of least square means for AUC0-t and Cmax and the affiliated 90% confidence intervals were within acceptance range recommended by PMDA. Marginal differences were observed in pharmacokinetic values of Asian Indian and Japanese volunteers.

Of 60 patients with a mean BP of 173.3 ± 1.7/98.4 ± 1.2 mmHg, 59 were randomized to losartan + HCTZ (n = 32) or bisoprolol + HCTZ (n = 27). Amlodipine was added if target BP was not achieved at 1 month, and doxazosin was added if target BP was not achieved after 3 months. Body mass index, office and 24-hour ambulatory BP, pulse wave velocity (carotid-femoral [PWVE] and radial [PWVM]), noninvasive central systolic BP, augmentation index (AIx), laboratory investigations, and electrocardiography were done at baseline and after 6 months of treatment.

Twenty four hour blood pressure (BP) monitoring was carried out and structural state of left ventricular myocardium assessed in 20 patients with mild and moderate hypertension before and after 24 weeks of therapy with Hyzaar - fixed dose combination of losartan (50 mg) and hydrochlorothiazide (12.5 mg). According to data of 24-hour BP monitoring the use of Hyzaar was associated with lowering of diurnal (by 26.9/17.2+/-3/2 mm Hg, p<0.001), nocturnal (by 32.6/18.9+/-3/2 mm Hg, p<0.001), pulse (p<0.001) BP, and rate of morning systolic BP rise (p<0.05), decrease of nocturnal systolic and diastolic BP variability, and improvement of 24-hour BP rhythm. Trough/peak coefficients for systolic and diastolic BP (70 and 76%, respectively) reflected sufficient and steady hypotensive effect throughout 24 hours after single dose of Hyzaar. Target BP level was achieved in 70% of patients. At the background of 24-week treatment with Hyzaar left ventricular myocardial mass index significantly decreased (from 120.1+/-3.5 to 108.6+/-3.1 g/m2, D=11.5+/-1.0, p<0.001) and became normal in 60% of patients. Correlation analysis revealed independence of cardioprotective action of therapy from its hypotensive activity. Thus therapy with Hyzaar produced hypotensive and cardioprotective effects which were independent from each other.

Baseline low-grade inflammation in patients with hypertension was associated with a poor ambulatory BP response, especially with losartan/HCTZ treatment. Initial measurement of hsCRP could be useful for selection of an appropriate antihypertensive drug.

A randomized, open-label, multicenter trial was performed in 88 hypertensive patients (mean age = 63.4 years) allocated to receive losartan 50 mg or amlodipine 5 mg for 4 weeks, and each treatment was changed to losartan 50 mg/hydrochlorothiazide (HCTZ) 12.5 mg in combination or amlodipine 10 mg for a further 4 weeks. Clinic and ambulatory BP were measured before and after 8 weeks of treatment, and hsCRP was measured at baseline.

Switching to LOS/HCTZ provides a greater reduction in clinic and home BP in patients with uncontrolled hypertension. This combination therapy may lead to cardio-, reno protection and improve UA metabolism.

In this study, 31 hypertensive patients after receiving 3 months of Preminent(®) (Stage A) were enrolled. We applied a changeover with switching from Preminent(®) to CodioMD(®) (Stage B). We then applied another changeover with switching from CodioMD(®) to Preminent(®) after 3 months (Stage C).

Low adherence to an antihypertensive-drug regimen was associated with poor BP control.

LOS + HCTZ did not influence UA metabolism as well as glucose metabolism, likely because of inhibitory action of losartan on URAT1, although TEL + HCTZ were accompanied with impairment of the UA metabolism and glucose metabolism.

Concerns about metabolic complications often disturb prolonged use of diuretics in Japan. We investigated 3-year safety and efficacy in Japanese patients with hypertension who were uncontrolled with angiotensin receptor blocker or angiotensin-converting enzyme inhibitor regimens and then switched to losartan (50 mg)/hydrochlorothiazide (12.5 mg; HCTZ) combinations. Blood pressure decreased favorably and maintained a steady state for 3 years (157 ± 16/88 ± 11 mm Hg to 132 ± 13/75 ± 9 mm Hg, P < .0001). Metabolic parameters maintained a limited range of changes after 3 years, and adverse events were markedly decreased after 1-year treatment. The losartan/HCTZ combination minimized diuretic-related adverse effects and thus may be useful for the treatment of Japanese patients with hypertension.

This multicentre, randomized, double-blind clinical trial studied 302 patients with mild or moderate hypertension in 1995. Of the 302, 97 also underwent ambulatory blood pressure monitoring (ABPM). After a 4-week placebo run-in period, the patients were randomly assigned to group A, B or C for 12 weeks. Those in groups A and B began treatment with losartan at 50mg/d, and those in group C began with amlodipine at 5 mg/d. If the blood pressure remained uncontrolled after 6 weeks, subjects in group A had their losartan dose doubled (to 100 mg/d), those in group B were given hydrochlorothiazide (12.5 mg/d) in addition to the losartan, which remained at 50 mg/d, and patients in group C had their amlodipine dose doubled (to 10 mg/d).