Management of hypertension with fixed dose combinations of candesartan cilexetil and hydrochlorothiazide: patient perspectives and clinical utility

Hypertension treatment and control is largely unsatisfactory when guideline-defined blood pressure goal achievement and maintenance are considered. Patient- and physician-related factors leading to non-adherence interfere in this respect with the efficacy, tolerability, and convenient use of pharmacological treatment options. Blockers of the renin–angiotensin system (RAS) are an important component of antihypertensive combination therapy. Thiazide-type diuretics are usually added to increase the blood pressure lowering efficacy. Fixed drug–drug combinations of both principles like candesartan/hydrochlorothiazide (HCTZ) are highly effective in lowering blood pressure while providing improved compliance, a good tolerability, and largely neutral metabolic profile. Comparative studies with losartan/HCTZ have consistently shown a higher clinical efficacy with the candesartan/HCTZ combination. Data on the reduction of cardiovascular endpoints with fixed dose combinations of antihypertensive drugs are however scarce, as are the data for candesartan/HCTZ. But many trials have tested candesartan versus a non-RAS blocking comparator based on a standard therapy including thiazide diuretics. The indications tested were heart failure and stroke and particular emphasis was put on elderly patients or those with diabetes. In patients with heart failure, for example, the fixed dose combination might be applied in patients in whom individual titration resulted in a dose of 32 mg candesartan and 25 mg HCTZ which can then be combined into one tablet to increase compliance with treatment. Also in patients with stroke the fixed dose combination might be used in patients in whom maintenance therapy with both components is considered. Taken together candesartan/HCTZ assist both physicians and patients in achieving long-term blood pressure goal achievement and maintenance

Office and ambulatory blood pressure control with a fixed-dose combination of candesartan and hydrochlorothiazide in previously uncontrolled hypertensive patients: results of CHILI CU Soon

Thomas Mengden1, Reinhold Hübner2, Peter Bramlage31Kerckhoff-Klinik GmbH, Bad Nauheim, 2Takeda Pharma GmbH, Aachen, 3Institut für Kardiovaskuläre Pharmakologie und Epidemiologie, Mahlow, GermanyBackground: Fixed-dose combinations of candesartan 32 mg and hydrochlorothiazide (HCTZ) have been shown to be effective in clinical trials. Upon market entry we conducted a noninterventional study to document the safety and effectiveness of this fixed-dose combination in an unselected population in primary care and to compare blood pressure (BP) values obtained during office measurement (OBPM) with ambulatory blood pressure measurement (ABPM).Methods: CHILI CU Soon was a prospective, noninterventional, noncontrolled, open-label, multicenter study with a follow-up of at least 10 weeks. High-risk patients aged ≥18 years with previously uncontrolled hypertension were started on candesartan 32 mg in a fixed-dose combination with either 12.5 mg or 25 mg HCTZ. OBPM and ABPM reduction and adverse events were documented.Results: A total of 4131 patients (52.8% male) with a mean age of 63.0 ± 11.0 years were included. BP was 162.1 ± 14.8/94.7 ± 9.2 mmHg during office visits at baseline. After 10 weeks of candesartan 32 mg/12.5 mg or 25 mg HCTZ, mean BP had lowered to 131.7 ± 10.5/80.0 ± 6.6 mmHg (P < 0.0001 for both comparisons). BP reduction was comparable irrespective of prior or concomitant medication. In patients for whom physicians regarded an ABPM to be necessary (because of suspected noncontrol over 24 hours), ABP at baseline was 158.2/93.7 mmHg during the day and 141.8/85.2 mmHg during the night. At the last visit, BP had significantly reduced to 133.6/80.0 mmHg and 121.0/72.3 mmHg, respectively, resulting in 20.8% being normotensive over 24 hours (<130/80 mmHg). The correlation between OBPM and ABPM was good (r = 0.589 for systolic BP and r = 0.389 for diastolic BP during the day). Of those who were normotensive upon OBPM, 35.1% had high ABPM during the day, 49.3% were nondippers, and 3.4% were inverted dippers. Forty-nine adverse events (1.19%) were reported, of which seven (0.17%) were regarded as serious.Conclusion: Candesartan 32 mg in a fixed-dose combination with either 12.5 mg or 25 mg HCTZ is safe and effective for further BP lowering irrespective of prior antihypertensive drug class not being able to control BP.Keywords: ambulatory blood pressure, office blood pressure, normalization, respons

An Evaluation of Self-Measured Blood Pressure in a Study With a Calcium-Channel Antagonist Versus a β-Blocker

In recent years self-measurement of blood pressure at home has gained increasing importance but there have been only a few studies comparing casual, ambulatory, and self-measured blood pressure determinations during a single clinical trial. We therefore compared treatment-induced blood pressure-reductions in a double-blind, placebo-controlled, parallel study design with a single morning dose of either 10 mg bisoprolol (n = 26) or 20 mg nitrendi-pine (n = 27) with casual blood pressure readings in the morning before the dose, ambulatory 24-h monitoring, and self-recorded measurements in the morning before the dose and in the evening. Mean reductions for systolic and diastolic blood pressure after 4 weeks of therapy were significantly greater for bisoprolol than for nitrendipine. The treatment-induced blood pressure reductions were most pronounced as assessed by casual readings but showed good agreement between casual, ambulatory, and self-measured blood pressure for group comparisons. In some patients, however, marked individual differences between the three methods were observed. Correlation coefficients between ambulatory and self-measured blood pressure were 0.4 for systolic blood pressure (P < .05) and 0.6 for diastolic blood pressure (P < .0005). Under the conditions of this parallel study design and the usual statistical risks, a difference of 5 mm Hg in diastolic blood pressure can be detected in 118 patients at the clinic, in 70 patients if ambulatory blood pressure is used, or in 56 patients if self-measured blood pressure is used. In conclusion, bisoprolol was more effective over 24 h than nitrendipine at the doses studied. Furthermore, self-measured blood pressure was suitable for monitoring 24-h efficacy of the two antihypertensive drugs under investigation. Finally, self-measured blood pressure can substantially improve the sensitivity of hypertension trials in comparison to casual readings and therefore reduce the number of patients included. Am J Hypertens 1992;5:154-16

Marital stability : a qualitative psychological study of Mexican American couples

Thesis advisor: Bernard O'BrienThis study investigated factors which influenced stable marriages among twelve Mexican American, working class, Catholic couples from central Texas who had been married at least twenty years, spoke English, and whose youngest child was a minimum of 18 years of age. Each participant was interviewed separately in a retrospective, semi-structured interview that covered selected factors from three different marital stages: 1) initial attraction, early marriage and birth of first child, 2) child-rearing years, and 3) post child-rearing years. The influences of culture, religion, values, finances, and the family of origin were explored to determine their impact on marital stability.Thesis (PhD) — Boston College, 1994.Submitted to: Boston College. Graduate School of Arts and Sciences.Discipline: Education

Normal values of blood pressure self-measurement in view of the 1999 World Health Organization-International Society of Hypertension guidelines

New guidelines for the management of hypertension have been published in 1999 by the World Health Organization (WHO) and the International Society of Hypertension (ISH). The WHO/ISH Committee has adopted in principle the definition and classification of hypertension provided by the JNC VI (1997). The new classification defines a blood pressure of 120/80 mm Hg as optimal and of 130/85 mm Hg as the limit between normal and high-normal blood pressure. It is unclear which self-measured home blood pressure values correspond to these office blood pressure limits. In this study we reevaluated data from our Dübendorf study to determine self-measured blood pressure values corresponding to optimal and normal office blood pressure using the percentiles of the (office and home) blood pressure distributions of 503 individuals (age, 20 to 90 years; mean age, 46.5 years; 265 men, 238 women). Self-measured blood pressure values corresponding to office values of 130/85 mm Hg and 120/80 mm Hg were 124.1/79.9 mm Hg and 114.3/75.1 mm Hg. Thus, we propose 125/80 mm Hg as a home blood pressure corresponding to an office blood pressure of 130/85 mm Hg (WHO 1999: normal) and 115/75 mm Hg corresponding to 120/80 mm Hg (optimal). Am J Hypertens 2000;13:940-943 © 2000 American Journal of Hypertension, Lt

36 Chorale [Noot] : aus den Schriften des livländischen Landraths Gustav Freiherrn von Mengden 1627-1688

http://tartu.ester.ee/record=b1582315~S1*es

Espetáculo de consternações – Os conflitos jurisdicionais na administração do cotidiano cemiterial na Piratini da segunda metade do século XIX.

Este artigo aborda os conflitos ocorridos na cidade de Piratini, Rio Grande do Sul, em 1872, envolvendo autoridades civis e eclesiásticas, tendo como pano de fundo o antigo cemitério da localidade. Inserido em um contexto pós-Reforma Cemiterial, este conflito ajuda a delimitar tanto a nebulosa administrativa na qual estavam inseridos os cemitérios naquele século, quanto os diferentes embates travados pela Igreja em um período de secularização da sociedade. A análise dos documentos feita neste trabalho permitiu traçar as redes de poder que envolviam a Câmara Municipal de Piratini, a igreja local e provincial, as autoridades de saúde pública, a elite e a maçonaria, interligando diversos autores e poderes envolvidos no gerenciamento da sociedade na época

Os Filhos da Mãe Santíssima : os Terceiros das Dores e os Irmãos da Misericórdia na Porto Alegre do século XIX (1800-1850)

Esta tese versa sobre duas irmandades leigas surgidas na cidade de Porto Alegre/RS no início do século XIX, a irmandade (e posteriormente ordem terceira) de Nossa Senhora das Dores, e a confraria da Santa Casa da Misericórdia. Uma história comparada entre as duas é feita de modo a compreender as intenções por trás de suas fundações e o sucesso que cada uma atingiu passadas cinco décadas desde a sua instituição. Para se atingir esses objetivos foram estudadas a história e a formação da população de Porto Alegre em suas primeiras décadas; a formação das mesas dirigentes e dos irmãos de cada irmandade, e vasta documentação primária oriunda dos arquivos particulares das duas confrarias. Objetivei com isso demonstrar que um certo anacronismo ocorrido com a fundação de uma Ordem 3ª em pleno século XIX levou ao fracasso dessa confraria, e que as modificações feitas pela irmandade da Misericórdia em renovarem as suas atribuições fizeram com que esta angariasse ainda mais poder social e econômico a partir de 1850.This thesis deals with two lay brotherhoods that emerged in the city of Porto Alegre/RS in the early 19th century, the brotherhood (and later third order) of Nossa Senhora das Dores, and the brotherhood of Santa Casa da Misericórdia. A comparative history between the two is made in order to understand the intentions behind their foundations and the success that each has achieved in the five decades since their inception. To achieve these goals, I’ve research the history and formation of the population of Porto Alegre in its first decades and the formation of the presiding boards and the brothers of each brotherhood. I’ve also analysed vast primary documentation from the private archives of the two confraternities. With this I aimed to demonstrate that a certain anachronism occurred with the foundation of a 3rd Order in the middle of the 19th century led to the failure of this brotherhood, and that the changes made by the confrary of Misericórdia in renewing its attributions made it gain even more social and economic power from 1850

Escavando um cemitério oitocentista em Porto Alegre, Rio Grande do Sul, Brasil

Este relato aborda o trabalho arqueológico realizado nos terrenos do antigo cemitério paroquial da cidade de Porto Alegre, Rio Grande do Sul, entre 2011 e 2012, como parte do restauro do edifício da Cúria Metropolitana. Participei da primeira parte dos trabalhos como auxiliar de campo e de laboratório, sendo  responsável tanto pelas escavações quanto pelo levantamento histórico do local. Os objetivos da atividade eram o resgate de remanescentes ósseos humanos que pudessem ser encontrados durante as obras de restauro, bem como a redescoberta do antigo cemitério, parcialmente esquecido pela memória urbana da cidade. Foram encontradas dezesseis sepulturas in situ, além de  algumas centenas  de ossos dispersos, que seguem sob análise genética e antropobiométrica. A escavação serviu para trazer novamente à luz um espaço que foi importantíssimo para a cidade durante oitenta anos, mas que há mais de um século encontrava- se completamente esquecido. Serviu, igualmente, para estimular novas pesquisas, que buscaram uma análise mais crítica do pouco que existia escrito sobre este espaço