Zofenopril plus hydrochlorothiazide fixed combination in the treatment of hypertension and associated clinical conditions.

Zofenopril, is a highly lipophilic ACE inhibitor, characterized by long-lasting tissue penetration and sustained cardiac ACE inhibition, indicated for the treatment of hypertension and myocardial infarction. Comparative studies with different antihypertensive drug classes have demonstrated the good efficacy and tolerability of this compound in the management of the patient with mild-moderate hypertension. Zofenopril may also be combined with hydrochlorothiazide, a combination which has proved to be effective and safe as compared with monotherapy with either agent in three studies, including more than 600 patients. In addition, recent post hoc analyses in high-risk patients, such as those with the metabolic syndrome, impaired fasting glucose or diabetes, atherogenic dyslipidemia, and impaired renal function, have confirmed the superiority of zofenopril 30 mg plus hydrochlorothiazide 12.5 mg once-daily combination as compared with zofenopril monotherapy also in these high-risk populations of patients with hypertension. These data suggest the usefulness of this fixed combination in the treatment of patients with hypertension requiring more prompt, intensive, and sustained blood pressure reduction, according to guidelines recommendation. © 2009 Blackwell Publishing Ltd

Nebivolol/Hydrochlorothiazide (HCTZ) combination in patients with essential hypertension: a pooled analysis from five non-interventional studies with a focus on diabetic and elderly patients

Abstract. -Background and Objectives: Nebivolol is a third-generation beta-blocker, characterized by unique pharmacological properties. The combination of nebivolol and hydrochlorothiazide (HCTZ) has been evaluated in large-scale clinical trials. This post-marketing surveillance analysis evaluated the effectiveness of the nebivolol/HCTZ combination in a "real-life" setting that included diabetic and elderly patients. Patients and Methods: The analysis was based on data from five non-interventional studies conducted in Germany, which lasted up to 12 weeks. Data from patients treated with nebivolol/HCTZ 5/12.5 mg/day in combination were pooled. The following parameters were calculated at the final visit, in the whole population and in elderly (>70 years) and diabetic subgroups: (1) difference from baseline in diastolic blood pressure (DBP) and in systolic blood pressure (SBP); (2) percentage of responder patients (reduction in DBP or SBP of 10 or 20 mmHg, respectively). Alterations in laboratory parameters were also monitored. Results: In total, 86 patients (mean age 58.9±10.8 years) were included in the analysis. Nebivolol/HCTZ significantly reduced both DBP (-11.8±7.9 mmHg; p<0.0001 vs baseline) and SBP (-22.5±13.5 mmHg; p<0.0001 vs baseline). In total, 81.4% of patients were responders (75% and 83.3% in elderly and diabetic patients, respectively). No clinically significant alterations in laboratory parameters were observed. Discussion: This study confirms that nebivolol/HCTZ is an effective and well tolerated therapeutic strategy in a real-life setting as well as in clinical trials. Therefore, this combination may represent a first-choice therapy in the management of hypertension

P-181: Fixed-dose valsartan + hydrochlorothiazide combination therapy compared with amlodipine monotherapy in hypertensive patients with additional cardiovascular risk factors: The vast study

Objectives: To determine whether the combination of valsartan 160 mg and hydrochlorothiazide (HCTZ) 25 mg once-daily (od) is more effective than amlodipine 10 mg od in reducing systolic blood pressure (BP) in patients suffering from moderate hypertension combined with at least one other cardiovascular risk factor or concomitant condition. Further, to study the effects of treatment on vascular markers. Methods: A multicenter, randomized, double-blind, active-controlled, three-arm study over 24 weeks. After a two-week single-blind placebo run-in period, 1088 stage-II hypertensive patients with additional risk factors were randomized to three groups, two receiving valsartan 160 mg od and one group receiving amlodipine 5 mg od. At Week 4, HCTZ 12.5 mg and 25 mg respectively, were added to the valsartan groups and the amlodipine dose was force-titrated to 10 mg od. Patients were followed-up for a total of 24 weeks. Results: The combination of valsartan 160 mg+HCTZ 25 mg reduced systolic BP significantly (p<0.05) more than amlodipine monotherapy (least-squares mean changes from baseline 29.7±0.7 mmHg and 27.6± 0.7 mmHg, respectively). For diastolic BP the values were 11.1±0.4 mmHg and 10.8±0.4 mmHg, respectively (differences not significant). Levels of IL-6, t-PA antigen and hs-CRP were reduced with both combination therapies at week 12 (figure). Significantly more patients discontinued because of adverse events in the amlodipine group (18.2%) than in the combination-therapy groups (4.2% and 3.5%) over the 6 months treatment period. Conclusions: Valsartan 160 mg+HCTZ 25 mg is an effective and well-tolerated therapy in this patient population with possible beneficial effects on vascular marker

Clinical Study Blood Pressure Response to Zofenopril or Irbesartan Each Combined with Hydrochlorothiazide in High-Risk Hypertensives Uncontrolled by Monotherapy: A Randomized, Double-Blind, Controlled, Parallel Group, Noninferiority Trial

In this randomized, double-blind, controlled, parallel group study (ZENITH), 434 essential hypertensives with additional cardiovascular risk factors, uncontrolled by a previous monotherapy, were treated for 18 weeks with zofenopril 30 or 60 mg plus hydrochlorothiazide (HCTZ) 12.5 mg or irbesartan 150 or 300 mg plus HCTZ. Rate of office blood pressure (BP) response (zofenopril: 68% versus irbesartan: 70%; = 0.778) and 24-hour BP response (zofenopril: 85% versus irbesartan: 84%; = 0.781) was similar between the two treatment groups. Cardiac and renal damage was equally reduced by both treatments, whereas the rate of carotid plaque regression was significantly larger with zofenopril. In conclusion, uncontrolled monotherapy treated hypertensives effectively respond to a combination of zofenopril or irbesartan plus a thiazide diuretic, in terms of either BP response or target organ damage progression

Entre Senegâmbia e Angola: comércio atlântico, protagonismo africano e dinâmicas regionais (séculos XVII e XIX)

Este artigo tem por intenção discutir o funcionamento do comércio de longa distância no interior de duas regiões que foram profundamente integradas às malhas do comércio atlântico, a Senegâmbia e a Angola Central, em dois momentos de reconfiguração econômica dessas macrorregiões: a intensificação do contato dos povos da Senegâmbia com o comércio atlântico nos séculos XVI e XVII e as novas demandas por gêneros coloniais de Angola em meados do XIX, após a proibição legal do tráfico de escravizados. Para isso, analisamos as dinâmicas sociais e econômicas pré-existentes nas regiões, os agentes comerciais envolvidos neste comércio, bem como a circulação de mercadorias atlânticas, debatendo por fim sobre as transformações políticas, sociais e econômicas causadas por esses processos históricos.Palavras-chave: comércio atlântico | agência | Senegâmbia | Planalto Central angolano.  Abstract:This article discusses the operation of long distance trade within two regions that have been deeply integrated into networks of Atlantic commerce, Senegambia and Central Angola, during two periods when these macro-regions were undergoing economic reconfiguration: the intensification of contact by Senegambian peoples with Atlantic trade in the 16th and 17th centuries, and the new demands for colonial goods from Angola in the mid-1800s, after the real prohibition of the slave trade. Thus, we analyze the preexisting social and economic dynamics in the regions, the commercial agents, and the circulation of Atlantic goods, debating the political, social and economic transformations caused by these historical processes.Keywords: atlantic commerce | agency | Senegambia | Angolan Central Highlands

Status of the globally threatened forest birds of northeast Brazil

The Atlantic Forest of northeast Brazil hosts a unique biota which is among the most threatened in the Neotropics. Near-total conversion of forest habitat to sugar cane monocultures has left the region's endemic forest-dependent avifauna marooned in a few highly-fragmented and degraded forest remnants. Here we summarise the current status of 16 globally threatened species based on surveys conducted over the last 11 years. We found a bleak situation for most of these species and consider that three endemics: Glaucidium mooreorum (Pernambuco Pygmy-owl), Cichlocolaptes mazarbarnetti (Cryptic Treehunter) and Philydor novaesi (Alagoas Foliage-gleaner) are most likely globally extinct. Some positive news can, however, be reported for both Leptodon forbesi (White-collared Kite) and Synallaxis infuscata (Pinto's Spinetail) which may warrant re-evaluation of their respective red list statuses. We outline a road map to prioritise conservation interventions in the region directed at preventing the extinction of this suite of threatened bird species and their companion biota.A Floresta Atlântica do Nordeste do Brasil abriga uma biota única que está entre as mais ameaçadas na região Neotropical. A quase total conversão dos habitats florestais em áreas de plantação de cana-de-açúcar deixou a avifauna florestal endêmica da região isolada em poucos remanescentes florestais altamente fragmentados e degradados. Aqui, resumimos o status atual de 16 espécies globalmente ameaçadas baseado em pesquisas conduzidas nos últimos 11 anos. Encontramos uma situação desanimadora para a maioria dessas espécies e consideramos que três espécies endêmicas: Glaucidium mooreorum (caburé-de-pernambuco), Cichlocolaptes mazarbarnetti (gritador-do-nordeste) e Philydor novaesi (limpa-folha-do-nordeste) estejam provavelmente extintas. Algumas notícias positivas podem, no entanto, ser reportadas para Leptodon forbesi (gavião-de-pescoço-branco) e Synallaxis infuscata (tatac), do qual necessitam de uma reavaliação de seus respectivos status na lista vermelha. Descrevemos em linhas gerais um planejamento para priorizar as intervenções conservacionistas na região direcionadas na prevenção da extinção do conjunto das espécies de aves ameaçadas e sua biota associada

Relationship between feed efficiency indexes and performance, body measurements, digestibility, energy partitioning, and nitrogen partitioning in pre-weaning dairy heifers.

Abstract The objectives of this study were: 1) to classify animals into groups of high and low feed efficiency using two feed efficiency indexes (Residual feed intake (RFI) and residual feed intake and body weight gain (RIG)), and 2) to evaluate if pre-weaning heifer calves divergent for feed efficiency indexes exhibit differences in performance, body measurements, digestibility, energy partitioning, and nitrogen partitioning. A total of 32 Gyr heifer calves were enrolled in a 63-d trial and classified into two feed efficiency (FE) groups based on RFI and RIG (mean ± 0.5 SD). The groups were classified as high efficiency (HE) RFI (HE RFI, n = 9; HE RIG, n = 10), and low efficiency (LE) RFI (LE RFI, n = 10; LE RIG, n = 11). The remaining animals were classified as intermediate (n = 13 (RFI) and n = 11 (RIG)). HE and LE calves had RFI values of?0.052 and 0.049 kg/d (P < 0.05), respectively. The HE RFI group consumed 8.9% less solid diet than the LE RFI group. HE RFI animals exhibited an increased digestibility of crude protein and ether extract and tended to have greater total dry and organic matter digestibility. LE RFI animals had greater gross energy and nitrogen intake, though greater fecal losses resulted in a tendency to reduce energy and nitrogen use efficiency. HE and LE calves had RIG values of 0.080 and -0.077kg/d (P ? 0.01), respectively. HE RIG animals exhibited greater average daily gain (9.4%), body weight (BW), and heart girth, though HE RIG group exhibited narrower hip width. HE RIG animals tended to have greater ether extract digestibility but greater methane losses (% of gross energy). HE RFI in pre-weaning heifers seems to be related to differences in digestibility. Divergent animals for RIG during the assessed phase appear to differ in body measurements, which may be related to differences in the composition of the gain