Introducing candesartan 32 mg plus hydrochlorothiazide 25 mg in previously untreated patients with severe essential hypertension

Purpose

To investigate the efficacy of candesartan 32 mg and hydrochlorothiazide (HCTZ) 25 mg combination in patients with severe essential hypertension.

Patients and methods

In this prospective, open-label, single-group study, 106 previously untreated patients with a baseline systolic blood pressure (SBP) of 150–200 mmHg, and a diastolic blood pressure (DBP) of 110 to 120 mmHg, started with candesartan 16 mg during the first week. HCTZ 12.5 mg was added at week 2 and from fourth week onwards candesartan 32 mg plus HCTZ 25 mg was given over 6 weeks. The primary efficacy endpoint was mean reduction in SBP and DBP after 9 weeks. Response was defined as a decrease in SBP to <140 mmHg and/or by ≥20 mmHg and in DBP to <90 mmHg and/or by ≥10 mmHg. A second response criterion defined blood pressure reduction below 140/90 mmHg.

Results

Blood pressure was lowered from 180.0 ± 11.7/114.7 ± 3.1 mmHg by SBP 44.4 ± 16.8 and DBP 32.0 ± 11.3 mmHg (P < 0.0001). Response was 92.4% and 64.8% achieved <140/90 mmHg. Each titration step produced a statistically significant and clinically relevant decrease in SBP and DBP, but a level below 140/90 mmHg was achieved by >50% of the patients only after the third titration step. Adverse reactions were reported by 3.8% of the patients. The disorders were in line with the known safety profile of the study drugs.

Conclusion

A stepped treatment approach with candesartan/HCTZ combinations is effective and safe to achieve a swift blood pressure reduction in newly diagnosed, severe hypertension. The target of <140/90 mmHg was reached by >50% of the patients only after taking the full dose of candesartan 32 mg and HCTZ 25 mg.

Evaluation of the effect of candesartan cilexetil on the steady-state pharmacokinetics of tacrolimus in renal transplant patients

BACKGROUND

Candesartan cilexetil is a possible treatment for hypertension in renal allograft recipients. Tacrolimus is widely used as an immunosuppressant following renal transplantation. The aim of this study was to evaluate the effect of multiple doses of candesartan cilexetil on the steady-state pharmacokinetics of tacrolimus.

METHODS

Twelve patients received oral doses of tacrolimus twice daily for 12 days from study day -2 until day 10, single oral doses of candesartan cilexetil placebo on study days -2 to -1, single oral doses of 2 mg candesartan cilexetil once daily on study days 1 to 3, oral doses of 4 mg candesartan cilexetil once daily on study days 4 to 6, and oral doses of 16 mg candesartan cilexetil once daily on study days 7 to 9. Serial blood samples were collected on days -1, 6 and 9 and were analysed for tacrolimus using microparticle enzyme immunoassay.

RESULTS

Mean C(max,ss) and AUC(tau,ss) values for tacrolimus on day 6 (4 mg candesartan) and day 9 (16 mg candesartan cilexetil) were similar to those on day -1 (tacrolimus alone). Renal function did not change under treatment with candesartan cilexetil compared with baseline. The co-administration of multiple oral doses of cardesartan cilexetil with oral doses of tacrolimus was well tolerated.

CONCLUSIONS

Concomitant administration of multiple doses of candesartan cilexetil does not alter the steady-state pharmacokinetics of tacrolimus.

Variants of the CYP11B2 gene predict response to therapy with candesartan

In a prospective trial, patients with an elevated diastolic blood pressure (above 95 mm Hg) received high-dose (16 mg) or low-dose (8 mg) candesartan in addition to standardised medication. A positive response to treatment was defined as a diastolic blood pressure <85 mm Hg at follow-up. Genotyping for two candidate genes was performed in 116 patients. Genotypes of the CYP11B2 promotor polymorphism significantly predicted a positive response to treatment (CC: 67%; TC: 34%; TT: 21%; p=0.005).

Effect of 7-day therapy with different doses of the proton pump inhibitor lansoprazole on the intragastric pH in healthy human subjects

BACKGROUND

Systematic, randomized, and controlled studies on the effect of low to high doses of the proton pump inhibitor lansoprazole on intragastric acidity and plasma gastrin levels have not previously been performed.

METHODS

We investigated the effect of 7-day therapy with different doses of lansoprazole (15 mg once or twice daily, 30 mg once or twice daily, and 15 mg three times daily) on intragastric acidity and meal-stimulated daytime plasma gastrin levels in 12 healthy Helicobacter pylori-negative human subjects in a randomized, double-blind, placebo-controlled, 6-way crossover study. On days 1, 2, and 7 of the study 24-h intragastric pH-metry and 12-h integrated daytime plasma gastrin determinations were done.

RESULTS

Lansoprazole in a dose regimen of 1 x 30 mg/day, 3 x 15 mg/daily, and 2 x 30 mg/day significantly (P < 0.05) increased the intragastric 24-h median pH on days 1, 2, and 7 of therapy as compared with placebo. Lansoprazole in doses of 1 x 15 mg/day and 2 x 15 mg/day significantly increased the intragastric 24-h median pH on days 2 and 7 but not on day 1 of therapy. Doses of 3 x 15 mg and 2 x 30 mg lansoprazole daily significantly increased the intragastric 24-h median pH on days 2 and 7 of treatment as compared with 1 x 30 mg lansoprazole daily. Except for 1 x 15 mg lansoprazole on day 1 of therapy, all given dose regimens of lansoprazole (15-60 mg/day) significantly (P < 0.05) stimulated the 12-h integrated meal-stimulated daytime plasma gastrin response (pM x min) on days 1, 2, and 7 of therapy as compared with placebo.

CONCLUSION

A dose of 1 x 30 mg/day is nearly as potent as higher dose regimens of lansoprazole. Thus it most likely is the optimum dose for therapy of gastric and duodenal peptic lesions. A dose of 1 x 15 mg lansoprazole daily is a potent inhibitor of gastric acid output and could be a therapeutic dose for prevention of peptic lesions (that is, reflux oesophagitis or ulcers).

Changes in Helicobacter pylori-induced gastritis in the antrum and corpus during and after 12 months of treatment with ranitidine and lansoprazole in patients with duodenal ulcer disease

BACKGROUND

Several studies have shown that acid-suppressing treatment leads to aggravation of Helicobacter pylori gastritis in the corpus. It remains unclear whether this augmentation of the inflammation reverts to baseline after termination of treatment.

METHODS

In 114 H. pylori-infected duodenal ulcer patients we investigated the gastritis parameters in antral and corpus mucosa before treatment, after 6 and 12 months of therapy, and 6 months after termination of treatment with 15 mg lansoprazole or 150 mg ranitidine/day.

RESULTS

Lansoprazole and ranitidine led to a significant aggravation of gastritis in the corpus after 6 and 12 months of treatment. However, while there was no change in gastritis in the antrum with ranitidine, treatment with lansoprazole led to partial elimination of H. pylori with improvement of the inflammation in this part of the stomach. Following termination of therapy, the observed changes reverted to baseline. No increase in intestinal metaplasia and/or atrophy in the antrum or corpus was observed.

CONCLUSION

Both substances are associated with an aggravation of H. pylori gastritis in the corpus. However, only lansoprazole leads to a partial elimination of H. pylori with improvement of the inflammation in the antrum. The changes provoked by acid-suppressing treatment revert to baseline after termination of therapy.

Congenital malformation and maternal occupational exposure to glycol ethers. Occupational Exposure and Congenital Malformations Working Group

Glycol ethers are found in a wide range of domestic and industrial products, many of which are used in women's work environments. Motivated by concern about their potential reproductive toxicity, we have evaluated the risk of congenital malformations related to glycol ether exposure during pregnancy as part of a multicenter case-control study, conducted in six regions in Europe. The study comprised 984 cases of major congenital malformations and 1,134 controls matched for place and date of birth. Interviews of the mothers provided information about occupation during pregnancy, sociodemographic variables, and other potential risk factors (medical history, tobacco, alcohol, drugs). A chemist specializing in glycol ethers evaluated exposure during pregnancy, using the job description given by the mother, without knowledge of case or control status. We classified malformations into 22 subgroups. The overall odds ratio (OR) of congenital malformation associated with glycol ether exposure was 1.44 [95% confidence interval (CI) = 1.10-1.90], after adjustment for several potential confounders. The association with exposure to glycol ethers appeared particularly strong in three subgroups: neural tube defects (OR = 1.94; 95% CI = 1.16-3.24), multiple anomalies (OR = 2.00; 95% CI = 1.24-3.23), and cleft lip (OR = 2.03; 95% CI = 1.11-3.73). In this last subgroup, risk, especially of an isolated defect, tended to increase with level of exposure.

Molecular and crystal structure of flutropium bromide

(8r)-8-(2-Fluoroethyl)-3 alpha-hydroxy-1 alpha H, 5 alpha H-tropanium bromide benzilic acid ester (flutropium bromide, Ba 598 BR) crystallizes in the monoclinic space group P 2(1)/n and shows disorder. Nevertheless the averaged crystal structure could be solved and refined to R = 0.113.

[Pohl's track screw for the surgical treatment of femoral neck fracture. Reliable surgical principle or obsolete method?]

Pohl's hip screw--the classic form of a dynamic osteosynthesis--is an approved method in the treatment of the fracture of the femoral neck (lateral and pertrochanteric fractures). Between 1963 and 1983 over 200 patients were treated with Pohl's hip screw. At an averaged stay of 29 days in hospital half of them were rehabilitated. The mortality rate was 9.3%. More recent methods--e.g. the dynamic hip screw, propagated by AO--present more technical improvements but they are only variations of an old therapeutic principle proved over a generation.

[Is surgical treatment of small cell bronchial carcinoma still indicated?]

Based on own results, general negation of operation in small cell carcinoma of the lung does not appear warranted. Surgical treatment is indicated when a non-metastasizing tumour is present. Small cell bronchial carcinoma operated in tumour stage I has a clearly better prognosis than a carcinoma of the same stage treated by chemo- or radiotherapy. A certain response of these carcinomas to cytostatic or radiotherapy has not been established. Should tumour metastases be demonstrable, i.e. lymph node metastases in the mediastinum or distant metastases, as is the case in the majority of these rapidly metastasizing carcinomas, chemo- or radiotherapy has been shown to be superior to operative treatment.