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Effects of Valsartan and Nebivolol Treatment on Blood Pressure Variability in Hypertensive Patients  [cached]
Stefania Negrea,Luminita Latea,Sorana Daniela Bolboac?
Australasian Medical Journal , 2010,
Abstract: BackgroundThe exploration of Blood Pressure (BP) variability and of theinfluence of different antihypertensive drugs on BP variabilitymay improve understanding of the mechanism involved in BPchanges induced by drugs. We therefore evaluated the longtermeffects of the angiotensin-receptor blocker Valsartan andof the ultraselective beta blocker Nebivolol.MethodsA prospective study was conducted at the regional outpatientDiagnosis and Treatment Center from Cluj-Napoca, Romania.The study included newly diagnosed adult hypertensives ofeither sex. All patients underwent 24 hour ambulatory bloodpressure monitoring (ABPM) and systolic and diastolic 24hour blood pressure variability was measured. A total of 80hypertensive patients were randomely assigned to receive 80mg of Valsartan or 5 mg of Nebivolol. Patients were dividedinto two groups according to antihypertensive medication:group A included 42 hypertensive patients treated withValsartan and group B included 38 hypertensive patientstreated with Nebivolol.ResultsBoth Valsartan and Nebivolol decreased 24h BP variability butlong-term treatment with Valsartan proved to be moreefficient in reducing SBP variability during the night timeperiod. Valsartan reduces more the systolic BP variabilityduring the night time period when compared to Nebivolol.Conclusions:Treatment with ARBs (Valsartan) and BBs (Nebivolol)efficiently reduced the BP variability during the day andnight period of time as first line antihypertensive agents.Valsartan reduces more the systolic BP variability duringthe night time period when compared to Nebivolol.Antihypertensive treatment using long acting agents likean angiotensin receptor blocker or an ultraselective betablocker could offer a better cardiovascular protection byreducing the BP variability.
Fixed combination of valsartan and amlodipine: effects on the left ventricular hypertrophy regression, albuminuria reduction and endothelium function in hypertensive patients with metabolic syndrome  [cached]
Ye.I. Tarlovskaya,N.S. Maksimchuk,I.Ye. Sapozhnikova,S.V. Malchikova
Rational Pharmacotherapy in Cardiology , 2010,
Abstract: Aim. To study effects of fixed combination of valsartan and amlodipine on of left ventricular hypertrophy (LVH) regression, microalbuminuria reduction and endothelium function in hypertensive patients with metabolic syndrome (MS).Materials and methods. 20 hypertensive patients (15 females and 5 males) with metabolic syndrome and a history of previous ineffective antihypertensive therapy were studied. Combined antihypertensive therapy was applied during 12-24 weeks. Amlodipine and valsartan dose was 5/160 or 10/160 mg/day depending on blood pressure level. Endothelial function, blood pressure level, urinary albumin excretion and LVH regression were estimated.Results. Blood pressure reduction to the target level was revealed. There was a significant reduction in microalbuminuria by -55.3±39.2% (р=0.022) in comparison with the baseline. Endothelium-dependent vasodilation increased in 3.6±7.2% (р=0.05) in comparison with baseline, LVH decreased by -9.1±12.4 g/m2 (р=0.021).Conclusion. Therapy with fixed combination of valsartan and amlodipine results in blood pressure and microalbuminuria reduction, endothelium-dependent vasodilation improvement, LVH regression in hypertensive patients with MS. These findings show that the fixed combination of these antihypertensives has a multifaceted impact on cardiovascular risk.
Simultaneous estimation of nebivolol hydrochloride and valsartan using RP HPLC  [cached]
Kokil S,Bhatia M
Indian Journal of Pharmaceutical Sciences , 2009,
Abstract: In this study, a rapid, precise, accurate, specific and sensitive ion-paired reverse phase liquid chromatographic method has been developed for the simultaneous estimation of nebivolol hydrochloride and valsartan in their capsule formulation. The chromatographic method was standardized using a HIQ sil C 18 column (250x4.6 mm i.d., 5 μm particle size) with UV detection at 289 nm and flow rate of 1 ml/min. The mobile phase consisting of methanol:water (80:20 v/v) with addition of 0.1 percent 1-hexanesulfonic acid monohydrate sodium salt as an ion-pairing reagent was selected. The method was validated and produced accurate and precise results for estimation of the two drugs.
The Effects of Nebivolol Therapy on QT Dispersion in Patients with Congestive Heart Failure
Makbule Kutlu Karadag,Mehmet Akbulut,Ozbay Yilmaz
The Cardiology , 2011,
Abstract: Nebivolol results in a significant improvement in Left Ventricular (LV) systolic function and prognosis in patients with Congestive Heart Failure (CHF) but it is unknown whether nebivolol effects QT dispersion (QTd), which is related with sudden cardiac death. Aim of this study was to investigate the effects of nebivolol on QTd in heart failure patients. Fifty CHF patients (age 65 11 years, 31 male) with a LV ejection fraction 35% and in New York Heart Association (NYHA) class II-III were included in this study. After the 1 month standard heart failure therapy; nebivolol was added on standard therapy at an initial dose of 2.5 mg and up titrated to the maximum tolerated dose. At baseline and at the 3rd month of nebivolol treatment all patients were assessed by clinical, laboratory, electrocardiographic and echocardiographic examinations. From 12-lead standard ECG maximum and minimum QT intervals (QTmax, QTmin), QTd, corrected QT intervals (QTcmax, QTcmin) and corrected QTd (QTcd) values were calculated at baseline and at the end of follow-up period. Mean nebivolol dose was 4.5 0.49 mg. QTd and QTcd values significantly decreased with nebivolol therapy (QTd: 81 25 vs. 71 22 ms, p<0.0001; QTcd: 86 27 vs 70 16 ms, p<0.0001). While QTcmax decreased significantly (p<0.001), there was no statistically significant changes in QTcmin value. A significant reduction was noted in the resting heart rate (94 26 vs 75 12 bpm, p<0.0001), systolic and diastolic blood pressures (p<0.0001). Left ventricular systolic functions also had significant improvement that Ejection Fraction (EF) increased from 28.8 3.4-31.4 4%, (p<0.0001). As a conclusion, added-on nebivolol therapy for 3 months was associated with a significant decrease in QTd and QTcd values and improvement in systolic functions in heart failure patients. This effect of nebivolol, which is due to the improvement in myocardial repolarization properties and special vasodilatory effects, may contribute to a possible reduction in sudden cardiac death in congestive heart failure patients.
HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY
Mahboob Ahmad Wagan
The Professional Medical Journal , 2001,
Abstract: The left ventricular hypertrophy is sequlae of systemic hypertension. LVH leads to increasedarrhythmias, accelerated coronary atherosclerosis, and heart failure. The Framingham Heart Studyhas shown that LVH is powerful independent risk factor for cardiovascular morbidity andmortality. Therefore, the optimal anti-hypertensive therapy should provide the regression of LVH.Captropril causes regression of left ventricular hypertrophy. The study was done to calculate the thicknessof inter-ventricular septum, posterior wall and left ventricular internal diameter. M-mode echo-cardiographywas used in 20 patients of left ventricular hypertrophy. Captopril was given in the range of 25-150mg perday in patients of left ventricular hypertrophy with hypertension for a period of six weeks. Result on echocardiographyshows regression of IVST 12.45±0.15 to 11±0.24 and LVID (mm) 46.45±1.29 to 46.20±1.25.
Nebivolol And Quinapril Reduce P-Wave Duration And Dispersion In Hypertensive Patients  [cached]
Hasan Korkmaz,Orhan Onalan,Mehmet Akbulut,Y?lmaz Ozbay
Indian Pacing and Electrophysiology Journal , 2009,
Abstract: We aimed to investigate the effects of nebivolol and quinapril treatments on P-wave duration and dispersion in hypertensive patients. Hypertensive patients who were in sinus rhythm were assigned to the two treatment groups and received either 20 mg quinapril/day or 5 mg nebivolol/day. P-Wave dispersion (PWD) was measured at baseline and after four weeks of treatment and defined as the difference between the maximum (Pmax) and the minimum (Pmin) P-wave duration. The study group consisted of 54 patients (Mean age: 53 ± 9 years, 46% women) with 27 patients in each group. At 4-week follow up both treatment groups showed a significant reduction (p<0.001) in systolic (SBP) and diastolic blood pressure (DBP). Heart rate (HR) reduction was significant in patients receiving nebivolol (P=0.001). Both groups showed a similar (P=0.413 for PWD, p=0.651 for Pmax) but significant reduction in PWD (nebivolol: -16±14, P<0.0001 and quinapril: -13±11, P<0.0001) and Pmax (nebivolol: -10±11, P=0.001 and quinapril: -9±11, P=0.001). A 2 (Time) x 2 (Group) mixed-model repeated-measures analysis of variance revealed that the main effect of Time was significant for Pmax (P=0.002) and PWD (P=0.008) after controlling for changes in SBP, DBP and HR. However, the main effect of Group and Time x Group interaction was not significant for both variables (All p values >0.05). In conclusion, short-term treatment with nebivolol and quinapril produces a similar but significant reduction in Pmax and PWD in hypertensive patients. This effect is independent of blood pressure and heart rate changes.
Reversal of left ventricular hypertrophy by propranolol in hypertensive rats
Charles I Maina, Maurice Ogunde
African Health Sciences , 2005,
Abstract: Background: Hypertension contributes significantly to the development of left ventricular hypertrophy. Left ventricular hypertrophy is associated with increased incidence of sudden cardiac death. Recognition and management of hypertension is, therefore, imperative. Objective: To establish whether propranolol can reverse left ventricular hypertrophy in hypertensive rats. Methods: Hypertension was induced in male albino rats by giving them 1% NaCl solution as their only drink for four weeks. Propranolol was then administered orally to one of the four groups of rats used in this study. Systolic blood pressure of each rat was measured twice a week using a modified tail-cuff method. Each rat was then sacrificed, its heart excised from the chest cavity and geometric studies carried on the left ventricle. Results: Excessive intake of sodium salt by the rats caused an increase in their systolic blood pressure which was accompanied by left ventricular hypertrophy. The elevated blood pressure (139.4 ± 0.5 mm Hg) was, however, brought back to normal (108.4 ± 0.2 mm Hg) by propranolol. Data on weight, thickness, and volume of the left ventricle strongly indicated that propranolol can reverse ventricular hypertrophy. Conclusion: Propranolol reverses left ventricular hypertrophy besides lowering elevated systolic blood pressure in rats. African Journal of Health Sciences Vol.5(1) 2005: 29-32
Valsartan addition to amlodipine is more effective than losartan addition in hypertensive patients inadequately controlled by amlodipine  [cached]
Roberto Fogari,Amedeo Mugellini,Paola Preti,et al
Vascular Health and Risk Management , 2010,
Abstract: Roberto Fogari, Amedeo Mugellini, Paola Preti, Annalisa Zoppi, Giuseppe DerosaDepartment of Internal Medicine and Therapeutics, Centro Ipertensione e Fisiopatologia Cardiovascolare, University of Pavia, Pavia, ItalyIntroduction: This study evaluated the effects on blood pressure (BP) of valsartan 160 mg or losartan 100 mg addition to amlodipine 5 mg in hypertensive patients.Methods: 221 patients with inadequately controlled BP (DBP ≥ 90 mmHg) after 4 weeks of treatment with amlodipine 5 mg were randomized to receive losartan/amlodipine combination therapy or valsartan/amlodipine combination therapy for 4 weeks in a cross-over study design. At the end of the wash-out period and of each treatment period, clinic and ambulatory BP measurements were recorded.Results: 166 patients completed the study. Both combination treatments induced a greater ambulatory BP reduction than did monotherapy. However, the further mean reductions in BP versus monotherapy were significantly greater with the valsartan/amlodipine combination (SBP/DBP: –7.9 ± 3.4/–6.5 ± 2.6 mmHg for 24-hour, –8.0 ± 3.4/–6.6 ± 2.7 mmHg for daytime; –7.7 ± 3.3/–6.4 ± 2.7 mmHg for nighttime) than with the losartan/amlodipine combination (SBP/DBP: –5.5 ± 2.8/–4.2 ± 2.1 mmHg for 24-hour, –5.7 ± 2.9/–4.4 ± 2.2 mmHg for daytime; –4.8 ± 2.8/–3.7 ± 2.2 mmHg for nighttime; P < 0.01 vs valsartan/amlodipine). The incidence of adverse events with valsartan/amlodipine (8%) and losartan/amlodipine (9%) was lower than that observed with amlodipine monotherapy (17%; P < 0.05 vs combinations).Conclusion: Valsartan 160 mg plus amlodipine 5 mg produced greater BP reductions than losartan 100 mg plus amlodipine 5 mg.Keywords: angiotensin receptor blocker, ambulatory blood pressure monitoring, valsartan, losartan, amlodipine, combination therapy
Anti-hypertensive drugs have different effects on ventricular hypertrophy regression
Ferreira Filho, Celso;Abreu, Luiz Carlos de;Valenti, Vitor E.;Ferreira, Marcelo;Meneghini, Adriano;Silveira, José Alexandre;Riera, Andrés R. Pérez;Colombari, Eduardo;Murad, Neif;Santos-Silva, Paulo Roberto;Silva, Lovian José Henrique Pereira da;Vanderlei, Luiz Carlos Marques;Carvalho, Tatiana D.;Ferreira, Celso;
Clinics , 2010, DOI: 10.1590/S1807-59322010000700012
Abstract: objectives: there is a direct relationship between the regression of left ventricular hypertrophy (lvh) and a decreased risk of mortality. this investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. methods: the medline (via pubmed), lilacs and scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. we aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. results: the main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. these drugs are usually used in follow up programs, however, the studies we investigated used different protocols. enalapril (angiotensin-converting enzyme inhibitor) and verapamil (ca++ channel blocker) caused hypertrophy to regress in lvh rats. the effects of enalapril and nifedipine (ca++ channel blocker) were similar. indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin ii receptor type 1 (at1) receptor antagonist) produced better results than atenolol (selective β1 receptor antagonist) with respect to lvh regression. conclusion: the anti-hypertensive drugs induced various degrees of hypertrophic regression.
Valsartan addition to amlodipine is more effective than losartan addition in hypertensive patients inadequately controlled by amlodipine
Roberto Fogari, Amedeo Mugellini, Paola Preti, et al
Vascular Health and Risk Management , 2010, DOI: http://dx.doi.org/10.2147/VHRM.S9404
Abstract: lsartan addition to amlodipine is more effective than losartan addition in hypertensive patients inadequately controlled by amlodipine Review (9375) Total Article Views Authors: Roberto Fogari, Amedeo Mugellini, Paola Preti, et al Published Date February 2010 Volume 2010:6 Pages 87 - 93 DOI: http://dx.doi.org/10.2147/VHRM.S9404 Roberto Fogari, Amedeo Mugellini, Paola Preti, Annalisa Zoppi, Giuseppe Derosa Department of Internal Medicine and Therapeutics, Centro Ipertensione e Fisiopatologia Cardiovascolare, University of Pavia, Pavia, Italy Introduction: This study evaluated the effects on blood pressure (BP) of valsartan 160 mg or losartan 100 mg addition to amlodipine 5 mg in hypertensive patients. Methods: 221 patients with inadequately controlled BP (DBP ≥ 90 mmHg) after 4 weeks of treatment with amlodipine 5 mg were randomized to receive losartan/amlodipine combination therapy or valsartan/amlodipine combination therapy for 4 weeks in a cross-over study design. At the end of the wash-out period and of each treatment period, clinic and ambulatory BP measurements were recorded. Results: 166 patients completed the study. Both combination treatments induced a greater ambulatory BP reduction than did monotherapy. However, the further mean reductions in BP versus monotherapy were significantly greater with the valsartan/amlodipine combination (SBP/DBP: –7.9 ± 3.4/–6.5 ± 2.6 mmHg for 24-hour, –8.0 ± 3.4/–6.6 ± 2.7 mmHg for daytime; –7.7 ± 3.3/–6.4 ± 2.7 mmHg for nighttime) than with the losartan/amlodipine combination (SBP/DBP: –5.5 ± 2.8/–4.2 ± 2.1 mmHg for 24-hour, –5.7 ± 2.9/–4.4 ± 2.2 mmHg for daytime; –4.8 ± 2.8/–3.7 ± 2.2 mmHg for nighttime; P < 0.01 vs valsartan/amlodipine). The incidence of adverse events with valsartan/amlodipine (8%) and losartan/amlodipine (9%) was lower than that observed with amlodipine monotherapy (17%; P < 0.05 vs combinations). Conclusion: Valsartan 160 mg plus amlodipine 5 mg produced greater BP reductions than losartan 100 mg plus amlodipine 5 mg.
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