Antihypertensive Effect In Patients Research Articles

Indications for renal denervation in the treatment of hypertension.

Renal denervation (RDN) is a neuromodulation therapy performed using an intraarterial catheter in patients with hypertension. Recent randomized sham-operated controlled trials have shown that RDN has significant antihypertensive effects in patients with resistant, uncontrolled, and/or drug-naïve hypertension. Based on available evidence, the European Society of Hypertension 2023 guidelines include a Class II recommendation for the use of RDN in individuals with resistant and uncontrolled hypertension. The US Food and Drug Administration approved two devices, the ultrasound-based ReCor ParadiseTM RDN system and the radiofrequency-based Medtronic Symplicity SpyralTM RDN system, as adjunctive therapy for patients with resistant and uncontrolled hypertension. The indications for RDN and incorporation of RDN into clinical practice will grow as clinical evidence accumulates. This mini review summarizes latest findings focusing on the safety and effectiveness of RDN for treating hypertension in the absence and presence of antihypertensive drugs, and discusses the indications for RDN. This mini review focuses on the safety and effectiveness of RDN for treating hypertension in the absence and presence of antihypertensive drugs. The indications for RDN and incorporation of RDN into clinical practice will grow as clinical evidence accumulates and should be reviewed and updated.

Effectiveness of radiofrequency renal denervation in diseases with increased sympathetic nervous system activity

The article discusses the role of sympathetic nervous system hyperactivity in the pathogenesis of various pathologies (hypertension, heart failure, atrial fibrillation, metabolic syndrome, diabetes and systemic inflammatory response syndrome). On the example of large randomized clinical trials using catheter-based radiofrequency ablation, the antihypertensive effect in patients with uncontrolled hypertension has been proven. The first experimental and clinical studies on the effectiveness of renal denervation in reducing the activity of inflammatory markers, the incidence of atrial fibrillation and ventricular arrhythmia episodes, and improving the left ventricular contractility. The first clinical results of the favorable effect of renal denervation on carbohydrate metabolism (insulin resistance and glycemic level) in patients with metabolic syndrome and diabetes have been studied in detail.

Can Chlorthalidone Lower Blood Pressure in Patients with Advanced Kidney Disease

Literature published decades ago suggested that thiazide diuretics lose their antihypertensive effects in patients with advanced chronic kidney disease

Chronic Limb Remote Ischemic Conditioning may have an Antihypertensive Effect in Patients with Hypertension.

Hypertension is the leading preventable risk factor for all-cause morbidity and mortality worldwide. Despite antihypertensive medications have been available for decades, a big challenge we are facing is to increase the blood pressure (BP) control rate among the population. Therefore, it is necessary to search for new antihypertensive means to reduce the burden of disease caused by hypertension. Limb remote ischemic conditioning (LRIC) can trigger endogenous protective effects through transient and repeated ischemia on the limb to protect specific organs and tissues including the brain, heart, and kidney. The mechanisms of LRIC involve the regulation of the autonomic nervous system, releasing humoral factors, improvement of vascular endothelial function, and modulation of immune/inflammatory responses. These underlying mechanisms of LRIC may restrain the pathogenesis of hypertension through multiple pathways theoretically, leading to a potential decline in BP. Several existing studies have explored the impact of LRIC on BP, however, controversial findings were reported. To explore the potential antihypertensive effect of LRIC and the underlying mechanisms, we systematically reviewed the relevant articles to provide an insight into the novel therapy of hypertension.

Multicenter Clinical Study of the Efficacy and Safety of Levamlodipine Besylate in Treatment of Mild to Moderate Essential Hypertension (Randomized, Open, Positive Drug Parallel Control)

Objectives: To observe the antihypertensive effect, safety and economy of S-amlodipine versus extended release nifedine in patients with essential hypertension. Methods: From July to September 2017, 500 patients with mild to moderate essential hypertension managed by 5 hospitals in Tianjin were enrolled, and 490 patients were effective. The observation group were given S-amlodipine (2.5~5mg/d, n=247). The control group were given extended release nifedine (30~60 mg/d, n=243). According to blood pressure control, the drug was adjusted within 2 weeks until the optimal dose for 12 weeks. Blood pressure was measured at 0, 2, 8 and 12 weeks respectively. Routine indexes such as blood and urine were tested at baseline and 8 weeks respectively, and adverse reactions were recorded. If there was abnormal heart rate, electrocardiogram was examined. Results: There was no significant difference (Z= –1.89, P=0.59) in the total effective rate between the observation group and the control group, and the adverse reactions were less than those of the control group. 234 patients were treated with S-amlodipine 5 mg, and the utilization rate was 94.74%. Conclusions: S-amlodipine 5 mg has definite antihypertensive effect in patients with essential hypertension, which is more safe and economical than extended release nifedine.

Antihypertensive Effect Of Amlodipine In Co-Administration With Omeprazole In Patients With Hypertension And Acid-Related Disorders: Cytochrome P450-Associated Aspects.

BackgroundCYP2C19 and CYP3A are the main enzymes involved in omeprazole metabolism, while CYP3A is the principal enzyme family for amlodipine biotransformation. Concomitant use of these drugs in patients with hypertension and acid-related disorders (ARD) might lead to drug–drug interaction.PurposeThe aim of the study was to find if adding omeprazole for treating ARD to amlodipine long-term therapy of hypertension influenced blood pressure of CYP2C19 polymorphism carriers.Patients and methodsFifty-one patients diagnosed with hypertension and ARD were enrolled in the study. Evaluation of antihypertensive therapy was performed by office (OBPM) and ambulatory (ABPM) blood pressure monitoring. Peripheral venous blood was collected for DNA extraction and real-time polymerase chain reaction was performed for CYP2C19*2G681A (rs4244285), CYP2C19*3G636A (rs4986893) and CYP2C19*17C−806T (rs12248560) polymorphisms analysis.ResultsOf 51 patients there were 21 extensive metabolizers (EMs), 18 ultrarapid metabolizers (UMs) and 12 intermediate metabolizers (IMs). The results of OBPM showed that antihypertensive effect was significantly more pronounced in IMs compared to EMs or UMs and the average group value in the following parameters: average office systolic blood pressure (BP), dynamics of the average office systolic BP. According to dynamics of diastolic BP, the antihypertensive effect was also significantly higher in IMs than in UMs and the average group value. The results of ABPM revealed that there was a significantly more pronounced antihypertensive effect in IMs compared to all other analyzed groups according to the dynamics of both daytime systolic and 24 hr diastolic BP. The average daytime diastolic BP and its dynamics, the average 24 hr systolic BP and its dynamics were higher in IMs compared to EMs and UMs.ConclusionAdding omeprazole to long-term amlodipine therapy in patients with hypertension and ARD may lead to a significantly more pronounced antihypertensive effect in patients genotyped CYP2C19 IMs.

Cardioprotection by intermittent hypoxia conditioning: evidence, mechanisms, and therapeutic potential.

The calibrated application of limited-duration, cyclic, moderately intense hypoxia-reoxygenation increases cardiac resistance to ischemia-reperfusion stress. These intermittent hypoxic conditioning (IHC) programs consistently produce striking reductions in myocardial infarction and ventricular tachyarrhythmias after coronary artery occlusion and reperfusion and, in many cases, improve contractile function and coronary blood flow. These IHC protocols are fundamentally different from those used to simulate sleep apnea, a recognized cardiovascular risk factor. In clinical studies, IHC improved exercise capacity and decreased arrhythmias in patients with coronary artery or pulmonary disease and produced robust, persistent, antihypertensive effects in patients with essential hypertension. The protection afforded by IHC develops gradually and depends on β-adrenergic, δ-opioidergic, and reactive oxygen-nitrogen signaling pathways that use protein kinases and adaptive transcription factors. In summary, adaptation to intermittent hypoxia offers a practical, largely unrecognized means of protecting myocardium from impending ischemia. The myocardial and perhaps broader systemic protection provided by IHC clearly merits further evaluation as a discrete intervention and as a potential complement to conventional pharmaceutical and surgical interventions.

Effect of Onopordon acanthium L. as Add on Antihypertensive Therapy in Patients with Primary Hypertension Taking Losartan: a Pilot Study.

Purpose: Onopordon acanthium L. is known for its medicinal properties. Our recent study showed that its seed extract is a novel natura angiotensin-converting-enzyme inhibitor (ACEI). This study was carried out to investigate its possible antihypertensive effects in patients receiving losartan.Methods: This uncontrolled clinical trial was carried out among 20 patients (30-60y) with uncontrolled hypertension despite receiving 50 mg losartan (stage I & II) in two hospitals in Iran. After completing informed consent, patients were treated by 2 capsules [each 1g of Onopordon acanthium seed extract (OSE)] as add-on therapy, two times per day.Results: 18 patients completed the study (50.94 ±8.37y). Mean systolic blood pressure (SBP) at the baseline was 151.9 ± 13.74mmHg and at the end of the study, it was 134.6 ± 18.25 mmHg and mean diastolic blood pressure (DBP) was 97.41 ± 10.36 at the baseline and was 85.71 ± 7.481 after 8 weeks. OSE significantly reduced SBP and DBP at the end of 8 weeks (P=0.003, 95% CI: -19.7, -15.1; P=0.0006, 95% CI: -10.23, -13.15; respectively). No evidence of hepatic or renal toxicity was detected.Conclusion: Based on the results of this study OSE has antihypertensive property with no significant adverse effects. However, because of the low number of samples, this medication may be not safely administered. The results of this study could be the basis for further studies with larger sample size. IRCT registration number: IRCT2013020712391N.

THE FREQUENCY OF USE OF COMBINATIONS OF ANTIHYPERTENSIVE DRUGS IN PATIENTS WITH DIFFICULT-TO-CONTROL HYPERTENSION ON THE BACKGROUND OF BIOFEEDBACK AND PACED BREATHING AND HEART RATE VARIABILITY

The frequency of administration of combinations of antihypertensive drugs and its changes at different stages of observation was studied in 60 patients with difficult-to-control arterial hypertension (DTCAH) (32 men and 28 women) aged 59.0 ± 9.4. All patients were randomly divided into two subgroups: biofeedback (BFB) in the loop of paced breathing (PB) and heart rate variability (HRV) (33 patients) – basic subgroup, subgroup of comparisons (27 patients). Determined that patients with DTCAH in the subgroup of patients with the BFB in the loop of PB there has been a reduction of four-component antihypertensive therapy to three-component and in the subgroup of comparisons the frequency of the appointment of a four-component therapy was increased. At the same time, it was found that the addition of drug therapy with regular BFB sessions in the loop of PB contributed to the potentiation of the antihypertensive effect in patients with DTCAH. It is concluded that the BFB in the loop of PB and HRV can be used as a technology to improve the efficiency of control of blood pressure in patients with DTCAH.

DUAL NEPRILYSIN AND AT1-ANGIOTENSIN RECEPTOR BLOCKADE: A NOVEL APPROACH FOR ANTIHYPERTENSIVE AND NEPHROPROTECTIVE THERAPY

The review presents data on the role of natriuretic peptides in the pharmacodynamics of LCZ696 (sacubitril/valsartan) and the results of clinical studies evaluating its clinical efficacy in patients with arterial hypertension (HTN), including those with impaired renal function. LCZ696 when administered as monotherapy at doses 200–400 mg/day for 8 weeks causes a clinically significant antihypertensive effect in patients with essential HTN 1–2 degree, as well as when used in combination therapy in HTN 3 degree. Short-term use of the drug is not accompanied by angioedema occurrence or other side effects. These results apply mainly to patients with primary HTN with relatively preserved kidney function and without diabetes mellitus, as subjects with serum creatinine > 133 micromole/L and patients with type 1 and 2 diabetes mellitus were excluded. Available data show that LCZ696 at doses 200–400 mg/day for 8 weeks also provides obvious antihypertensive effect and a moderate decrease in albuminuria in patients with HTN 1–2 degree and chronic kidney disease 3–4 stage. The long-term, large-scale clinical trials are needed for a more complete assessment of the clinical efficacy and safety of LCZ696 in hypertensive patients, including patients with impaired renal function.

Antihypertensive effect of an enzymatic hydrolysate from Styela clava flesh tissue in type 2 diabetic patients with hypertension.

BACKGROUND/OBJECTIVESIn this randomized, placebo-controlled, double-blind study, we evaluated the antihypertensive effects of enzymatic hydrolysate from Styela clava flesh tissue in patients with type 2 diabetes mellitus (T2DM) and hypertension.SUBJECTS/METHODSS. clava flesh tissue hydrolysate (SFTH) (n = 34) and placebo (n = 22) were randomly allocated to the study subjects. Each subject ingested two test capsules (500 mg) containing powdered SFTH (SFTH group) or placebo capsules (placebo group) during four weeks.RESULTSIn the SFTH group, systolic and diastolic blood pressure decreased significantly 4 weeks after ingestion by 9.9 mmHg (P < 0.01) and 7.8 mmHg (P < 0.01), respectively. In addition, the SFTH group exhibited a significant decrease in hemoglobin A1c with a tendency toward improvement in homeostasis model assessment of insulin resistance, triglyceride, apolipoprotein B and plasma insulin levels after 4 weeks. No adverse effects were observed in other indexes, including biochemical and hematological parameters in both groups.CONCLUSIONThe results of our study suggested that SFTH exerts a regulatory, antihypertensive effect in patients with T2DM and hypertension.

Clinical use of azelnidipine in the treatment of hypertension in Chinese patients.

BackgroundHypertension is the most common chronic disease and the calcium channel antagonist is the most popularly used antihypertensive drug in Chinese patients. Azelnidipine is a third generation and long-acting dihydropyridine calcium channel antagonist. A series of research has demonstrated that azelnidipine produced an effective antihypertensive effect in patients with essential hypertension. Now it is need to summarize clinical use of azelnidipine in the treatment of hypertension in Chinese patients.MethodsRelevant literature was identified by performing searches in PubMed and CNKI (China National Knowledge Infrastructure), covering the period from January 2003 (the year azelnidipine was launched) to July 2014. We included studies that described pharmacology of azelnidipine, especially the pharmacokinetics, clinical efficacy, and safety and tolerability of azelnidipine in a Chinese population. The full text of each article was strictly reviewed, and data interpretation was performed.ResultsIn Chinese healthy volunteers, a single-dose oral administration of azelnidipine 8–16 mg had a peak plasma concentration of 1.66–23.06 ng/mL and time to peak plasma concentration was 2.6–4.0 hours and the area under the plasma concentration versus time curve from time 0 hour to 96 hours was 17.9–429 ng/mL·h and elimination half-life was 16.0–28.0 hours. A number of clinical trials have demonstrated that azelnidipine produced a significant reduction in blood pressure in Chinese patients with mild-to-moderate hypertension, which was similar to that of other effective antihypertensive drugs such as amlodipine, zofenopril, and nifedipine. In addition to its antihypertensive effect, azelnidipine had other cardiovascular protective effects as well, like anti-oxidative action, decreasing heart rate, and improving systolic and diastolic function. Azelnidipine was generally well tolerated in Chinese patients and no severe adverse events were observed.ConclusionAzelnidipine is effective and safe in the treatment of hypertension in Chinese patients.

Flaxseed consumption reduces blood pressure in patients with hypertension by altering circulating oxylipins via an α-linolenic acid-induced inhibition of soluble epoxide hydrolase.

In a randomized, double-blinded, controlled clinical trial, participants with peripheral arterial disease (75% hypertensive) consumed 30 g of milled flaxseed/d for 6 months. The flaxseed group exhibited significant reductions in systolic (-10 mm Hg) and diastolic (-7 mm Hg) blood pressure. Flaxseed contains the n3 fatty acid α-linolenic acid. Plasma α-linolenic acid increased with ingestion of flaxseed and was inversely associated with blood pressure. However, the antihypertensive mechanism was unclear. Oxylipins derived from polyunsaturated fatty acids regulate vascular tone. Therefore, the objective was to examine whether flaxseed consumption altered plasma oxylipins in a manner that influenced blood pressure. Plasma of FlaxPAD (Flaxseed for Peripheral Arterial Disease) participants underwent solid phase extraction and high-performance liquid chromatography-mass spectrometry/mass spectrometry analysis. The flaxseed group exhibited significant decreases in 8 plasma oxylipins versus control. Six of these (5,6-, 8,9-, 11,12-, 14,15-dihydroxyeicosatrienoic acid and 9,10- and 12,13-dihydroxyoctadecenoic acid) were products of soluble epoxide hydrolase, a pharmacological target for antihypertensive treatment. Patients exhibiting a decrease in total plasma soluble epoxide hydrolase-derived oxylipins, exhibited a significant decrease in systolic blood pressure (mean [95% confidence interval], -7.97 [-14.4 to -1.50] mm Hg) versus those who exhibited increased plasma soluble epoxide hydrolase-derived oxylipins (+3.17 [-4.78 to 11.13] mm Hg). These data suggest that a flaxseed bioactive may have decreased blood pressure via soluble epoxide hydrolase inhibition. Using a soluble epoxide hydrolase inhibitor screening assay, increasing concentrations of α-linolenic acid decreased soluble epoxide hydrolase activity (P=0.0048; ρ=-0.94). In conclusion, α-linolenic acid in flaxseed may have inhibited soluble epoxide hydrolase, which altered oxylipin concentrations that contributed to the antihypertensive effects in patients with peripheral arterial disease. http://www.clinicaltrials.gov. Unique identifier: NCT00781950.

The effects of radio-frequency ablation on blood pressure control in patients with atrial fibrillation and hypertension

The effects of radio-frequency ablation (RFA) on blood pressure (BP) regulation in patients with atrial fibrillation (AF) and hypertension remain unknown. We hypothesized that patients with successful ablation had a lower BP and/or lesser utilization of antihypertensive drug therapy during follow-up when compared to patients with failed ablation. This was a retrospective evaluation of patients with AF and hypertension treated with ablation at the University of Utah between July 2006 and June 2010. BP and use of antihypertensive medications were assessed at baseline and 1 year follow-up. A total of 167 patients were identified. Eight patients were excluded due to the need for AAD therapy beyond the blanking period thus leaving 80 patients in the success group and 79 patients in the failure group. The mean BP and HR at baseline were not significant between the groups. In the success group, the mean systolic BP decreased from a baseline value of 129 ± 17 to 125 ± 14 mmHg at 1 year (p = 0.075). In contrast, in the failure group, the mean systolic BP increased from a baseline value of 124 ± 16 to 127 ± 14 mmHg at 1 year (p = 0.176). Between-group comparison revealed a p value of 0.026. Minimal changes in diastolic BP were noted in both groups. No significant changes in antihypertensive therapy were noted. We have shown that successful catheter ablation in patients with AF and hypertension is associated with a decrease in systolic BP when compared to an increase in patients with failed ablation. Our findings suggest that restoring sinus rhythm could have an antihypertensive effect in patients with AF and hypertension.

Telmisartan/Hydrochlorothiazide Single-Pill Combination in the Treatment of Hypertension in Elderly Patients

Telmisartan is an angiotensin II receptor blocker that differs from others in its class owing to its unique pharmacologic properties, such as high lipophilicity and a long elimination half-life. It is the only angiotensin II receptor blocker indicated for the prevention of cardiovascular morbidity (such as myocardial infarction or stroke in patients with atherothrombotic disease or diabetes with end-organ damage), as well as hypertension. It provides sustained 24-h blood pressure control with once-daily dosing. Combination with hydrochlorothiazide provides additional antihypertensive effect in patients who are unable to achieve target blood pressure with either monotherapy. A single-pill combination simplifies dosing, is well tolerated, encourages adherence and is proportionally cheaper, thus providing an effective therapeutic option for the treatment of elderly hypertensive patients.

Effect of allopurinol on blood pressure and aortic compliance in hypertensive patients

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 randomized 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.

Comparison of Effects of Low Dose of Spironolactone and a Thiazide Diuretic in Patients with Hypertension Treated with an Angiotensin-Converting Enzyme Inhibitor or an Angiotensin Type 1 Receptor Blocker

This study was performed to investigate the additional anti-hypertensive effects and safety of low-dose thiazide diuretic, trichlormethiazide (TCTZ), and a mineralocorticoid receptor blocker, spironolactone (SPI), as add-on therapy in 64 patients whose blood pressure (BP) at office were over 140/90 mmHg, while receiving anti-hypertensive medication including an angiotensin-converting enzyme inhibitor or angiotensin II type I receptor antagonist. After 6 months, we observed a decrease of office and home BP. Moreover, urinary albumin excretion (UAE) was reduced in SPI-treated group, but not in the TCTZ-treated group. No significant change in serum potassium, lipids, glucose, or uric acid was observed. In conclusion, low-dose thiazide diuretic or SPI provided a significant additional anti-hypertensive effect in patients in whom hypertension was not controlled by medication, and SPI-reduced UAE.

VASCULAR REMODELING AND HEART RATE VARIABILITY IN DIFFERENT ANTIHYPERTENSIVE THERAPIES

Aim. To study the effect of the long-term antihypertensive monotherapy with indapamide (Arifon Retard, 1,5 mg/d), metoprolol tartrate (Egilok Retard, 50 mg/d) and combined therapy with indapamide and perindopril (Noliprel Forte, 1 tab/d: perindopril 4 mg and indapamide 1,25 mg) on pulse wave velocity (PWV), cardio-ankle vascular index (CAVI) and the sympathetic system activity. Material and methods. 88 patients, aged 30-59 y.o. (32 normotensive patients, 56 with arterial hypertension [HT] of 1-2 grades) were examined. Biological age (BA) was determined by the linear regression and the vascular wall age (VWA) was estimated with the use of volume sphygmography (“VaSera-1000”, “Fucuda Denshi”, Japan). 39 patients with HT were randomized into 3 parallel groups with studied therapies lasted for 6 months. PWV, CAVI of the vessels of elastic, muscular and mixed types, blood pressure, measured in upper and lower extremities and heart rate variability (HRV) were determined before and at the end of the therapies. Results. BA and VWA were elevated in all of patients with HT as compared with normotensive patients. The reduction in PWV and CAVI of the vessels of elastic and mixed types, HRV increase were found in patients with Arifon Retard monotherapy. Monotherapy with metoprolol significantly improved HVR without any influence on the vascular remodeling. Noliprel Forte significantly decreased in blood pressure in the upper and lower extremities, PWV and CAVI of the vessels of all types, decreased in VWA and increased in parasympathetic drive. Conclusion. Long-term therapy with Arifon Retard and Noliprel Forte resulted in decrease in vascular remodeling and increase in HRV simultaneously with significant antihypertensive effect in patients with HT. Metoprolol low doses therapy resulted in normalization of autonomic drive independently on antihypertensive action.

Aldosterone and magnesium

Magnesium ion (Mg) directly inhibits aldosterone production in rat adrenal glomerulosa cells, while potassium ion directly stimulates aldosterone production. It is reported that Mg shows antihypertensive effect in patients with essential hypertension. Secondary hyperaldosteronism induced by diuretic treatment in patients with congestive heart failure accelerates potassium and magnesium ions' excretion in urine. Diuretic-induced falls in potassium and magnesium ions and aldosterone-induced cardiac fibrosis and remodelling are associated with fatal ventricular arrhythmia. Aldosterone antagonists, such as spironolactone and eplerenone, correct not only potassium deficiency but also magnesium deficiency induced by diuretics. Mg supplementation also may be useful procedure to correct potassium and magnesium deficiency, because Mg itself inhibits aldosterone release from the adrenal glands.

Effects of the long-acting calcium channel blocker barnidipine hydrochloride on 24-h ambulatory blood pressure

The effect of the long acting calcium channel blocker, barnidipine hydrochloride (barnidipine) on 24-h ambulatory blood pressure (ABP) was evaluated in J-MUBA (Japanese Multicentre Study on Barnidipine with Ambulatory Blood Pressure Monitoring). Following an observation period of two weeks, antihypertensive treatment with barnidipine was continued for at least six months. At the end of each period, ABP were measured. The patients were divided into high- and low-range groups based on ABP measurement. Throughout the 24 h, barnidipine exerted an excellent antihypertensive effect in the high-range group, but not in the low-range group. Barnidipine had comparable effects in the daytime and nighttime in inverted dippers and non-dippers, but it was more effective on daytime ABP than on nighttime ABP in dippers and in extreme dippers. Morning blood pressure before and after waking was evaluated before and after barnidipine administration in 233 patients. Barnidipine inhibited increases in blood pressure before and after waking, especially in surge-type patients whose blood pressure increased rapidly after waking. A positive correlation among 24-h ABP, daytime and night time ABP, morning blood pressure, and clinic blood pressure during the observation period and the antihypertensive effect of barnidipine was observed, with barnidipine exhibiting stronger antihypertensive effects in patients with persistently high blood pressure. It was concluded that the antihypertensive effects of barnidipine are maintained for 24 h but it has no excessive hypotensive effects on lower blood pressure and is thus a safe antihypertensive agent.