Evidence-Based Medicine ; Humans ; Hypertension ; drug therapy ; prevention & control

To briefly introduce the updated principles for treatment of hypertension by reviewing foreign literatures in point of this aspect and its progress. The strategies of hypertension treatment in our country experienced the development from "non-principles (NP)", "partial principles (PP)" to "full principles (FP)", and already realized five conversions, i.e. the conversion from simply depress the blood pressure to multi-drugs, multi-targets and multi-pathways comprehensive therapy, and put stress on both prevention and treatment. The authors emphasized that NP should be rejected completely, and population proportion of PP, especially FP used should be elevated in hypertension treatment in the future.
Antihypertensive Agents ; therapeutic use ; Blood Pressure ; drug effects ; China ; Drug Therapy, Combination ; Humans ; Hypertension ; drug therapy ; physiopathology ; prevention & control

Aged ; Aged, 80 and over ; Humans ; Hypertension ; complications ; drug therapy ; Randomized Controlled Trials as Topic ; Stroke ; prevention & control

Gastrointestinal Hemorrhage ; drug therapy ; etiology ; prevention & control ; Humans ; Hypertension, Portal ; complications

OBJECTIVETo study the role of baseline risk factors in predicting the onset of diabetes among essential hypertensive patients with metabolic syndrome (MS) and to evaluate an ideal therapeutic regime that could reduce the risk factors and risk of onset of diabetes.

METHODSA randomized parallel clinical trial in essential hypertensive patients of grade 1 or 2 was conducted. Two of the three components (1) increased waist circumference and/or BMI; (2) increased triglycerides (TG) and/or decreased high-density lipoprotein cholesterol; (3) impaired glucose tolerance (IGT) were present define the MS. The three intervention therapy groups were: indapamide + fosinopril (I + F, n = 151); atenolol + nitrendipine (A + N, n = 160); atenolol + nitrendipine + metformin (A + N + M, n = 152). Each case was followed-up monthly and the dosage of medicine taken be adjusted according to their BP level. The plasma glucose during fasting and two hours after taking 75 g glucose orally was also measured every six months. The new onset of diabetes was diagnosed according to the criteria. OGTT, insulin release test, lipid analysis, body weight and waist circumference were measured again at the last follow-up.

RESULTS(1) The lowering of BP was similar among the three groups (P > 0.05). 23 new diabetes onsets occurred, being 10 in group I + F and 8 in group A + N and 5 in group A + N + M, respectively (P > 0.05); (2) Proportions of patients' risk factors decreased significantly in group A + N or A + N + M, e.g. the proportions of high TG in each group reduced by 14.7% and 9.3% respectively (P < 0.05), the central fat distribution reduced by 16.7% and 15.9% respectively (P < 0.05) and the IGT reduced by 6.6% and 29.6% respectively (P < 0.05). However no changes were found in group I + F; (3) After 1 year and 5 months' follow-up, the proportions of main risk factors (high TG, central fat distribution and IGT) in the three groups were 91%, 96%, 83% and 90%, 88%, 47%, respectively. The difference of IGT was significant between two groups (P < 0.01) and the proportions of having three risk factors were 70% and 31% in the two groups (P < 0.01); (4) I + F group was better than A + N group in reduction of TG and central fat distribution. And A + N + M group improved in all risk factors.

CONCLUSIONSIGT alone or combined with increased TG plus abdominal obesity are the most important risk factors in predicting a new onset of diabetes among essential hypertensive patients with MS. Metformin in combination with atenolol plus nitrendipine can significantly prevent the onset of diabetes as well as improve patients' metabolic abnormality.

Adult ; Diabetes Mellitus, Type 2 ; prevention & control ; Drug Therapy, Combination ; Female ; Glucose Intolerance ; Humans ; Hypertension ; complications ; drug therapy ; Male ; Metabolic Syndrome ; complications ; drug therapy ; Middle Aged ; Risk Factors

The nuclear hormone receptor PPARgamma is activated by several agonists, including members of the thiazolidinedione group of insulin sensitizers. Pleiotropic beneficial effects of these agonists, independent of their blood glucose-lowering effects, have recently been demonstrated in the vasculature. PPARgamma agonists have been shown to lower blood pressure in animals and humans, perhaps by suppressing the renin-angiotensin (Ang)-aldosterone system (RAAS), including the inhibition of Ang II type 1 receptor expression, Ang-II-mediated signaling pathways, and Ang-II-induced adrenal aldosterone synthesis/secretion. PPARgamma agonists also inhibit the progression of atherosclerosis in animals and humans, possibly through a pathway involving the suppression of RAAS and the thromboxane A2 system, as well as the protection of endothelial function. Moreover, PPARgamma-agonist-mediated renal protection, especially the reduction of albuminuria, has been observed in diabetic nephropathy, including animal models of the disease, and in non-diabetic renal dysfunction. The renal protective activities may reflect, at least in part, the ability of PPARgamma agonists to lower blood pressure, protect endothelial function, and cause vasodilation of the glomerular efferent arterioles. Additionally, anti-neoplastic effects of PPARgamma agonists have recently been described. Based on the multiple therapeutic actions of PPARgamma agonists, they will no doubt lead to novel approaches in the treatment of lifestyle-related and other diseases.
Animals ; Atherosclerosis/prevention & control ; Humans ; Hypertension/drug therapy ; Hypoglycemic Agents/*pharmacology ; Kidney Diseases/etiology ; PPAR gamma/*agonists ; PPAR-beta/agonists

OBJECTIVETo study the effect of Zhenzhu Qishi Wan on blood pressure(BP), body weight(BW), stroke and survival rate of stroke-prone spontaneously hypertension rats(SHRsp).

METHOD8-week-old SHRsp was randomly divided into three groups: control group, Zhenzhu Qishi Wan prevention group and therapy group (n = 10). SHRsp of prevention group were treated with Zhenzhu Qishi Wan by ig 150 mg.kg-1 per day for 6 weeks, and therapy group were given the same treatment two weeks later. Behavior and stroke were observed everyday; BW were weighted every week; BP were estimated every 2 weeks. Time of the first cerebral seizure of SHRsp was recorded.

RESULTZhenzhu Qishi Wan had obvious preventive and therapeutic effect on genetic hypertension. The BP of prevention and therapy groups were significantly lower than that of control group (P < 0.05 [symbol: see text] P < 0.01). The drug ameliorated general behavior of SHRsp, BW of prevention group increased faster than that of control group(P < 0.05 or P < 0.01), and BW of therapy group were also heavier than that of control group at the age of 14 weeks(P < 0.05). When the experiment ended, 60% SHRsp of control group showed stroke and 20% of them were dead, while only 20% SHRsp in each of Zhenzhu Qishi Wan-treated groups showed stroke and none of them died.

CONCLUSIONZhenzhu Qishi Wan had significant hypotensive effect, and some protective effect on the stroke caused by hypertension.

Animals ; Antihypertensive Agents ; therapeutic use ; Blood Pressure ; drug effects ; Drug Combinations ; Drugs, Chinese Herbal ; therapeutic use ; Hypertension ; drug therapy ; prevention & control ; Male ; Materia Medica ; therapeutic use ; Phytotherapy ; Random Allocation ; Rats ; Rats, Inbred SHR ; Stroke ; drug therapy ; prevention & control

No abstract available.
Amlodipine/*therapeutic use ; Antihypertensive Agents/*therapeutic use ; Blood Pressure/*drug effects ; Calcium Channel Blockers/*therapeutic use ; Heart Failure/*prevention & control ; Humans ; Hypertension/*drug therapy ; Myocardial Infarction/*prevention & control ; Stroke/*prevention & control

Proliferation and migration of vascular smooth muscle cells (VSMC) are common pathological features of diabetic vascular complications,such as atherosclerosis and hypertension. Phenotypic modulation of VSMC is the basis for VSMC proliferation and migration. Therefore, studies on VSMC phenotypic modulation and its mechanisms in diabetes mellitus were of important significance to the prevention and therapy of diabetic vascular complications. This paper introduces VSMC phenotypic modulation and the underlying mechanisms in diabetes mellitus, and summarizes advance of studies on traditional Chinese medicine intervention upon VSMC phenotypic modulation, so as to provide reference for preventing and treating diabetic vascular complications with traditional Chinese medicines.
Atherosclerosis ; drug therapy ; prevention & control ; Cell Movement ; drug effects ; Cell Proliferation ; drug effects ; Diabetes Mellitus ; drug therapy ; pathology ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Hypertension ; drug therapy ; prevention & control ; Medicine, Chinese Traditional ; Muscle, Smooth, Vascular ; drug effects ; Myocytes, Smooth Muscle ; drug effects ; Phenotype

The 'vascular depression' hypothesis is supported by the high incidence of depression among patients with hypertension, diabetes mellitus, coronary artery disease or stroke, and the association of geriatric depression with silent stroke or white matter hyperintensity on neuroimaging scans. The vascular depression might be a valid new concept, making it worthwhile to be a new subtype of depression with different etiology, clinical manifestation, treatment method, and prognosis. Additionally, it can be suggested that the primary and secondary prevention of depression related with cerebrovascular disease can be possible by reducing the risk factors of cerebrovascular disease. The further study should be carried out to verify the diagnostic criteria of vascular depression and to develop pharmacotherapy for prevention and treatment. The more effort to understand and investigate vascular depression should be made in Korea where the cerebrovascular disease ranks first in cause of death and there may have been many untreated vascular depression patients.
Cause of Death ; Coronary Artery Disease ; Depression* ; Diabetes Mellitus ; Drug Therapy ; Humans ; Hypertension ; Incidence ; Korea ; Neuroimaging ; Prognosis ; Risk Factors ; Secondary Prevention ; Stroke