Sequential comparison of therapy with beta-blockers and calcium channel blockers with celiprolol therapy in patients with angina pectoris, hypertension, or both

Unlike patients with either hypertension (HT) of angina pectoris (AP) alone, patients with both HT and AP usually have a reduced left ventricular compliance and may, therefore, have an impaired capability to cope with acute hemodynamic changes generated by standard beta-blockers or calcium channel blockers, Celiprolol has been documented to produce fewer adverse effects and equal efficacy compared with standard beta-blockers or calcium channel blockers. We carried out a 16-week open-lab, sequential comparison of standard monotherapy versus celiprolol in 172 patients,vith either HT alone, AP alone, or HT + AP. We compared the effects on symptoms and adverse effects, The recurrence of adverse effects from drug therapy was definitely more common in the HT + AP patients than in patients with AP alone or HT alone. Despite this imbalance In the groups, celiprolol overall produced fewer occurrences of fatigue, dizziness, and edema. Celiprolol controlled AP and HT to the same extent as did standard monotherapy, Our data, although preliminary, suggest that patients with both HT and AP are prone to adverse effects of standard drug therapy, and that celiprolol, while equally effective, is largely devoid of adverse effects as compared with standard therapy, particularly in patients with both HT aid AP.</p

Nonlinear and conventional biosignal analyses applied to tilt table test for evaluating autonomic nervous system and autoregulation

Copyright © Tseng et al.; Licensee Bentham Open. This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.Tilt table test (TTT) is a standard examination for patients with suspected autonomic nervous system (ANS) dysfunction or uncertain causes of syncope. Currently, the analytical method based on blood pressure (BP) or heart rate (HR) changes during the TTT is linear but normal physiological modulations of BP and HR are thought to be predominately nonlinear. Therefore, this study consists of two parts: the first part is analyzing the HR during TTT which is compared to three methods to distinguish normal controls and subjects with ANS dysfunction. The first method is power spectrum density (PSD), while the second method is detrended fluctuation analysis (DFA), and the third method is multiscale entropy (MSE) to calculate the complexity of system. The second part of the study is to analyze BP and cerebral blood flow velocity (CBFV) changes during TTT. Two measures were used to compare the results, namely correlation coefficient analysis (nMxa) and MSE. The first part of this study has concluded that the ratio of the low frequency power to total power of PSD, and MSE methods are better than DFA to distinguish the difference between normal controls and patients groups. While in the second part, the nMxa of the three stages moving average window is better than the nMxa with all three stages together. Furthermore the analysis of BP data using MSE is better than CBFV data.The Stroke Center and Department of Neurology, National Taiwan University, National Science Council in Taiwan, and the Center for Dynamical Biomarkers and Translational Medicine, National Central University, which is sponsored by National Science Council and Min-Sheng General Hospital Taoyuan

Quality of life before and during antihypertensive treatment:A comparative study of celiprolol and atenolol

Background: The well-being of hypertensive patients may be adversely affected by the disease itself, its complications, and other concomitant processes such as anxiety, sedation, and side effects of the prescribed drugs. Some recently developed antihypertensive agents have been suggested to be devoid of these deleterious effects on well-being expressed as quality of life. Object: We compared the effect on quality of life of a standard cardioselective beta-blocker atenolol to the effect of celiprolol as a representative of a new class of selective beta-blockers with vasodilatory properties. One-hundred-thirty-two patients with mild to moderate hypertension were eligible to enter a 28-week double-blind parallel-group study, consisting of a 4-week run-in period on placebo and a 24-week period on dosage-adjusted treatment with either atenolol or celiprolol. Results: Both systolic and diastolic blood pressure were assessed, as was quality of life perception by a selected test battery including the Quality of Life Questionnaire of Bulpitt and Fletcher [1990]. During celiprolol treatment, supine blood pressure fell from 167/101 (range 120 - 200/95 - 116) to 150/92 mm Hg (p <0.0001). This antihypertensive effect was at least as good with celiprolol as with atenolol. Quality of life perception was comparable for the 2 drugs, although some adverse effects were more frequent during atenolol than during celiprolol, particularly after prolonged treatment. Also patient compliance was better for celiprolol than for atenolol. Conclusions: Our results show that the selective beta-blocker with vasodilatory property celiprolol is at least as effective as atenolol and that it has additional advantage in terms of enhancement of some quality of life variables

Nitrate-induced headache in patients with stable angina pectoris: Beneficial effect of starting on a low dosage

Background: Nitrates, although important for the management of angina pectoris, cause significant headache in many patients. Methods: In a randomized, double-blind, crossover study, 89 patients with stable angina pectoris were studied to compare two different dosage strategies of isosorbide-5-mononitrate (5-ISMN). Patients were randomized to either 60 mg 5-ISMN once daily (ed) for two weeks or to 30 mg 5-ISMN od for one week followed by 60 mg 5-ISMN od for one week. Then, there was a two-week placebo washout, after which the alternative treatment was given. The authors assessed the occurrence of angina pectoris and headache by diary cards while taking into account the numbers of isosorbide dinitrate sublingual puffs and paracetamole tablets required. Data were assessed for carryover and time effects. Results: The two dosage regimens were equally efficient for the relief of angina pectoris without development of tolerance. Thirty percent of the patients never experienced headache from the given dosages. In the remainder of them there was a highly significant time effect: the overall numbers of headache attacks in the first period of active treatment versus the second were 2,380 vs 1,400 (P <0.003). Yet significantly fewer patients had headache on low dosage than oil high dosage (45 vs 57, P <0.02). Conclusions: (1) Starting on a low dosage-was associated with a reduced frequency and severity of headache and did not notably influence the beneficial effect on angina pectoris. (2) One in 3 patients never experienced headache from the given dosages. (3) The overall number of headache attacks in the first period of active treatment was significantly higher than in the second period irrespective of the dosages given