BACKGROUNDAtrial fibrillation (AF) is the most frequent tachyarrhythmia in patients with a permanent pacemaker. Angiotensin II receptor antagonists have a protective effect against the occurrence of AF in patients with heart diseases. This study aimed to assess the effectiveness of olmesartan in the prevention of new-onset AF and AF burden in atrioventricular block (AVB) patients with dual-chamber (DDD) pacemaker implantation.

METHODSThis was a single-center, prospective, randomized, single-blind, controlled clinical study. A total of 116 AVB patients, who received DDD pacemakers implantation with the percentage of ventricular pacing (VP%) ≥40% from April 22, 2011 to December 24, 2012, were prospectively randomized to olmesartan group (20 mg per day; n = 57) or control group (n = 59). Patients were followed up using pacemaker programming, 12-lead electrocardiography in the intrinsic sinus rhythm, laboratory examinations, and transthoracic echocardiography at 24 months. Atrial high rate events (AHREs) were defined as 180 beats/min over a minimum of 5 min. AF burden was calculated by the number of hours with AHREs divided by the number of measurement hours.

RESULTSTen (17.5%) patients in the olmesartan group and 24 patients (40.7%) in the control group occurred new-onset AF, and the difference between two groups was statistically significant (P = 0.04). AF burden was lower in olmesartan group than that in control group (8.02 ± 3.10% vs. 13.66 ± 6.14%, P = 0.04). There were no significant differences in mean days to the first occurrence of AHREs and mean cumulative numbers of AHREs between two groups (P = 0.89 and P = 0.42, respectively). Moreover, olmesartan group had smaller values of maximal P-wave durations and P-wave dispersion (PD) after 24 months follow-up compared with the control group (109.5 ± 7.4 ms vs. 113.4 ± 7.1 ms, P = 0.00; and 40.6 ± 4.5 ms vs. 43.3 ± 4.4 ms, P = 0.02, respectively). Left ventricular end-diastolic diameter and left ventricular ejection fraction were not significantly different between two groups (both P > 0.05).

CONCLUSIONThis study suggested that 24-month of olmesartan therapy could reduce new-onset AF and AF burden in patients with DDD pacemakers.

CLINICAL TRIAL REGISTRATIONChiCTR-TRC-12004443; http://www.chictrdb.org.

Aged ; Angiotensin Receptor Antagonists ; therapeutic use ; Atrial Fibrillation ; drug therapy ; Atrioventricular Block ; drug therapy ; Female ; Humans ; Imidazoles ; therapeutic use ; Male ; Middle Aged ; Single-Blind Method ; Tetrazoles ; therapeutic use

OBJECTIVETo observe therapeutic effects of qi supplementing, yin nourishing, blood stasis dispersing, collateral dredging recipe (QYBCR) on early diabetic nephropathy (DN).

METHODSSeventy-eight early DN patients were randomly assigned to the treatment group (39 cases, treated by QYBCR) and the control group (39 cases, treated by irbesartan). The changes of the therapeutic efficacy, Chinese medicine syndrome scores, urine albumin excretion rate (UAER), serum creatinine (SCr), blood urine nitrogen (BUN), fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), and the occurrence of end-point events were observed after one-year treatment.

RESULTSThe total effective rate in treatment group was 83.8% (31/37 cases), which was obviously higher than that in control group (60.5%, 23/38 cases) (P < 0.05). After treatment the Chinese medicine syndrome scores were reduced significantly in the treatment group (P < 0.05, P < 0.01), and showed significant difference when compared with those in the control group (P < 0.05, P < 0.01). Levels of UAER, SCr, BUN, FBG, TC, and TG were (65. 78 +/- 9.67) microg/min, (93.20 +/- 12.99) micromol/L, (5.69 +/- 1.21) mmol/L, (6.14 +/- 1.47) mmol/L, (4. 85 +/- 0. 83) mmol/L, (1.46 +/- 0.81) mmol/L after treatment in treatment group. All of them decreased more significantly than before treatment [(161.03 +/- 20.01) microg/min, (101.11 +/- 14.33) micromol/L, (6.54 +/- 1.12) mmol/L, (9.27 +/- 2.32) mmol/L, (6. 19 +/- 2.13) mmol/L, (2. 70 +/- 1.86) mmol/L] (P < 0.05, P < 0.01). The aforesaid indices were also improved in the control group after treatment (P < 0.05, P < 0.01). The reduction of TC and TG after treatment in the treatment group was more significant [(5.58 +/- 1.57) mmol/L, (1.99 +/- 1.22) mmol/L] (P < 0.05). Besides, the incidence rate of end-point events (5.4%, 2/37) (1 year after the development of clinical DN) of the treatment group was slightly lower than that of the control group (10.5%, 4/38), but with no statistical difference.

CONCLUSIONQYBCR combined with Western medicine-based treatment showed better therapeutic efficacy on early DN.

Adult ; Aged ; Biphenyl Compounds ; therapeutic use ; Diabetic Nephropathies ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Qi ; Tetrazoles ; therapeutic use

OBJECTIVETo compare the renal protective effects between calcium channel blocker benidipine and angiotensin II receptor blocker valsartan in primary hypertension patients with proteinuria.

METHODSA total of 236 patients were divided to low (< 1 g/24 h) and high (1 - 3 g/24 h) proteinuria groups and treated with benidipine (8 mg/d) or valsartan (80 mg/d) for 48 weeks. Blood pressure, glomerular filtration rate (GFR) and 24 h protein were measured at baseline, 12, 24 and 48 weeks.

RESULTSBlood pressure was significantly and equally reduced in all treated groups (all P < 0.05 vs. baseline). GFR was also significantly and equally improved in all treated groups after 24 weeks treatments (all P < 0.05 at 24 weeks and 48 weeks). Proteinuria reduction at 24 and 48 weeks was more significant in patients treated with valsartan compared to patients treated with benidipine in low proteinuria group [24 weeks: (0.27 +/- 0.07) g/24 h vs. (0.39 +/- 0.06) g/24 h, P < 0.01; 48 weeks: (0.18 +/- 0.01) g/24 h vs. (0.30 +/- 0.05) g/24 h, P < 0.01].

CONCLUSIONThe renal protection efficacy of valsartan and benidipine was similar in primary hypertensive patients with proteinuria.

Adult ; Aged ; Angiotensin Receptor Antagonists ; therapeutic use ; Calcium Channel Blockers ; therapeutic use ; Dihydropyridines ; therapeutic use ; Female ; Glomerular Filtration Rate ; Humans ; Hypertension ; complications ; drug therapy ; Male ; Middle Aged ; Proteinuria ; complications ; drug therapy ; Tetrazoles ; therapeutic use ; Valine ; analogs & derivatives ; therapeutic use ; Valsartan

OBJECTIVETo compare the effects between felodipine plus irbesartan and felodipine plus metoprolol regimen on blood pressure and the sexual function in young and middle-aged hypertensive women.

METHODSIn this prospective, randomized, parallelized, controlled and fixed combined therapy trial, 99 female patients (aged 18 to 60) with grade 1 and grade 2 hypertension (BP ≥ 140/90 mm Hg and < 179/109 mm Hg, 1 mm Hg = 0.133 kPa) were assigned to felodipine 5 mg q.d + irbesartan 150 mg q.d (F + I group, n = 49) and felodipine 5 mg q.d + metoprolol 47.5 mg q.d (F + M group, n = 50) group. Target blood pressure was < 140/90 mm Hg. The female sexual function index (FSFI) questionnaire, levels of serum estradiol and testosterone were assessed. Female sexual dysfunction was defined as a FSFI score of less than 25.5. Patients were followed up for 24 weeks.

RESULTSThe rate of achieving blood pressure goal between 2 groups was similar at the 4th, 8th, 12th and 24th weeks respectively (42.9% vs. 62.0% at 4th week, 89.8% vs. 90.0% at 8th week, 93.9% vs. 94.0% at 12th week, 98.0% vs. 96.0% at 24th week, P > 0.05). Compared to baseline, scores for the items related to "desire" and "arousal" were significantly improved (P < 0.05), the level of the serum estradiol was significantly elevated [(50.3 ± 37.4) pg/L vs. (54.4 ± 10.8) pg/L before menopause, (18.4 ± 2.9) pg/L vs. (20.2 ± 3.1)pg/L after menopause, P < 0.05] and the level of the serum testosterone was significantly decreased [(722.8 ± 277.1) ng/L vs. (650.0 ± 156.0) ng/L before menopause, (841.2 ± 279.3) ng/L vs. (761.9 ± 197.8) ng/L after menopause, P < 0.05] in the F + I group, while scores for the items related to "sexual desire" and "lubrication" were statistically reduced (P < 0.01), the concentration of the serum estradiol was significantly reduced [(57.4 ± 9.7) pg/L vs. (51.1 ± 12.1) pg/L before menopause, (19.8 ± 2.3) pg/L vs. (17.8 ± 3.3) pg/L after menopause, P < 0.01] and the level of the serum testosterone was significantly increased [(775.6 ± 217.8) ng/L vs. (886.0 ± 186.4) ng/L before menopause, (812.5 ± 311.3) ng/L vs. (914.4 ± 300.2) ng/L after menopause, P < 0.01] in the F + M group. FSFI score was negatively correlated with age and systolic blood pressure levels.

CONCLUSIONfelodipine plus irbesartan or metoprolol for 24 weeks equally reduced blood pressure and the former regimen is superior to the latter on sexual function improvement in this patient cohort.

Adolescent ; Adult ; Antihypertensive Agents ; therapeutic use ; Biphenyl Compounds ; pharmacology ; therapeutic use ; Felodipine ; pharmacology ; therapeutic use ; Female ; Humans ; Hypertension ; drug therapy ; Metoprolol ; pharmacology ; therapeutic use ; Middle Aged ; Prospective Studies ; Sexual Dysfunction, Physiological ; Tetrazoles ; pharmacology ; therapeutic use ; Young Adult

OBJECTIVETo investigate the curative effects of irbesartan, amiodarone and Wenxin Granule (WG), applied alone or in combination, on sinus rhythm maintenance in patients with auricular fibrillation (AF) after conversion.

METHODSForty-one patients of persistent AF, after their fibrillation being converted, were divided into three groups randomly, and treated with amiodarone (group A, n=14), irbesartan and amiodarone (group B, n=15), and WG plus irbesartan and amiodarone (group C, n=12) respectively for 6 months.

RESULTSCompared with that before treatment, the inner diameter of atria sinistrum reduced in group B and C, and the reduction in the latter was superior to that in the former (P < 0.05); the diameter of left ventricle also reduced in group C (P < 0.05); and the maintenance rate of sinus rhythm was higher in group C than that in group A (P < 0.05).

CONCLUSIONCombined therapy of Chinese and Western medicines shows synergistic effect of anti-arrhythmia.

Aged ; Amiodarone ; therapeutic use ; Anti-Arrhythmia Agents ; therapeutic use ; Atrial Fibrillation ; drug therapy ; Biphenyl Compounds ; therapeutic use ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Tetrazoles ; therapeutic use

Albuminuria ; drug therapy ; Diabetes Mellitus, Type 2 ; complications ; drug therapy ; Diabetic Nephropathies ; drug therapy ; Humans ; Tetrazoles ; therapeutic use

Female ; Humans ; Hypertension, Portal ; drug therapy ; etiology ; Liver Cirrhosis ; complications ; drug therapy ; Male ; Tetrazoles ; therapeutic use ; Valine ; analogs & derivatives ; therapeutic use ; Valsartan

OBJECTIVETo compare the effects of valsartan combined with amlodipine or hydrochlorothiazide regimen on blood pressure variation and plasma nitric oxide (NO) and endothelin (ET) in elderly hypertensive patients.

METHODSA total of 61 elderly patients with grade 2 or 3 hypertension were randomized into valsartan + amlodipine (the amlodipine group, n = 31) or valsartan + hydrochlorothiazide (the hydrochlorothiazide group, n = 30) group. Blood lipids, fasting plasma glucose and uric acid were determined before the treatment. 24-hour dynamic blood pressure, NO and ET were monitored at baseline, 8 and 16 weeks after treatment.

RESULTS24 hours blood pressure and daytime blood pressure were similar between two groups at all 3 time points. At 16 weeks, morning systolic blood pressure surge was significantly lower in amlodipine group than in hydrochlorothiazide group [(22.6 ± 8.8) mm Hg (1 mm Hg = 0.133 kPa) vs. (26.3 ± 13.7) mm Hg, P < 0.05]. 24 hours systolic blood pressure variability (SBPV) decreased progressively in both groups [the amlodipine group: (12.5 ± 2.8) mm Hg vs. (10.2 ± 2.2) mm Hg vs. (8.8 ± 1.6) mm Hg, P < 0.01; the hydrochlorothiazide group: (12.5 ± 2.5) mm Hg vs. (10.7 ± 2.2) mm Hg vs. (9.6 ± 2.0) mm Hg, P < 0.01]. Daytime SBPV also decreased progressively in both groups [the amlodipine group: (12.2 ± 3.0) mm Hg vs. (10.1 ± 2.3) mm Hg vs. (8.4 ± 1.9) mm Hg, P < 0.01; the hydrochlorothiazide group: (11.8 ± 2.7) mm Hg vs. (10.4 ± 1.9) mm Hg vs. (9.6 ± 2.2) mm Hg, P < 0.01]. 24 hours diastolic blood pressure variability (DBPV) was significantly reduced post therapy in the amlodipine group [(15.5 ± 3.4) mm Hg vs. (13.0 ± 3.5) mm Hg vs. (12.3 ± 2.5), P < 0.01] but not in the hydrochlorothiazide group. NO increased progressively [(27.3 ± 13.6) µmol/L vs. (47.2 ± 16.3) µmol/L vs. (69.5 ± 18.9) µmol/L in the amlodipine group, P < 0.01; (33.5 ± 13.9) µmol/L vs. (49.7 ± 21.9) µmol/L vs. (66.7 ± 24.7) µmol/L in the hydrochlorothiazide group, P < 0.01] and ET decreased progressively [(45.3 ± 8.0) ng/L vs. (37.4 ± 3.9) ng/L vs. (34.2 ± 4.4) ng/L in the amlodipine group, P < 0.01; (46.6 ± 10.4) ng/L vs. (37.0 ± 5.4) ng/L vs. (36.1 ± 8.2) ng/L in the hydrochlorothiazide group, P < 0.01] in both groups.

CONCLUSIONValsartan in combination with amlodipine or hydrochlorothiazide can both effectively lower BPV in elderly hypertensive patients and improve the vascular endothelial function and the former regimen is more suitable for elderly hypertensive patients.

Aged ; Amlodipine ; therapeutic use ; Blood Pressure ; drug effects ; Drug Therapy, Combination ; Female ; Humans ; Hydrochlorothiazide ; therapeutic use ; Hypertension ; drug therapy ; physiopathology ; Male ; Middle Aged ; Tetrazoles ; therapeutic use ; Treatment Outcome ; Valine ; analogs & derivatives ; therapeutic use ; Valsartan

OBJECTIVESTo analyse the control rate of irbesartan/hydrochlorothiazide (HCTZ) combination tablets (COAPROVEL) in the treatment of patients with mild to moderate primary hypertension.

METHODSIn this multi-center, open, single therapy trial, the enrolled patients aged 18-75 were treated with irbesartan/HCTZ combination tablets for 8 weeks. The initial dose comprised one tablet of irbesartan (150 mg)/HCTZ (12.5 mg) once a day during the first 2 weeks. If diastolic blood pressure was greater than 85 mm Hg at the end of the second or fourth weeks, irbesartan (300 mg)/HCTZ (12.5 mg) once a day or irbesartan (300 mg)/HCTZ (25 mg) once a day were added respectively.

RESULTSIn 968 patients with mild to moderate hypertension enrolled, 920 patients were followed up for 8 weeks. (1) After 1 week of treatment, irbesartan/HCTZ combination tablets lowered systolic blood pressure by 11.87 mm Hg and diastolic blood pressure by 8.54 mm Hg (P < 0.01). After 8 weeks of treatment, the corresponding decreases were 21.97 mm Hg and 16.08 mm Hg, respectively (P < 0.01). (2) After 2, 4 and 8 weeks of treatment, 526, 703 and 769 patients reached blood pressure target (diastolic blood pressure less than 85 mm Hg). The control rates were 57.17%, 76.41% and 83.59%, respectively. (3) Among the 920 patients who completed the trial, 637 patients took irbesartan (150 mg)/HCTZ (12.5mg) once a day (69.24%), 211 patients took irbesartan (300 mg)/HCTZ (12.5 mg) once a day (22.93%), and 72 patients took irbesartan (300 mg)/HCTZ (25 mg) once a day (7.82%). (4) In the intention-to-treat analysis, no adverse reaction was observed in 903 patients (93.29% of the patients enrolled).

CONCLUSIONSWhen irbesartan/HCTZ combination regimen are used in the treatment of patients with mild to moderate primary hypertension, the proportion of patients reaching blood pressure target is high and adverse reactions are rare.

Adolescent ; Adult ; Aged ; Antihypertensive Agents ; adverse effects ; therapeutic use ; Biphenyl Compounds ; adverse effects ; therapeutic use ; China ; Drug Combinations ; Humans ; Hydrochlorothiazide ; adverse effects ; therapeutic use ; Hypertension ; drug therapy ; Middle Aged ; Tablets ; Tetrazoles ; adverse effects ; therapeutic use ; Young Adult

OBJECTIVETo investigate the effect and mechanism of valsartan and felodipine extended release tablets (Plendil) on a novel salt-sensitive hypertensive rat induced by sensory denervation.

METHODSNewborn Wistar rats were given 50 mg/kg capsaicin subcutaneously on the 1st and 2nd day of life. Control rats were treated with vehicle solution (10%ethanol, 10%Tween 80 in saline). After weanling period (3 weeks), male rats were divided into 5 groups and subject to the following treatment for 4 weeks: control + high salt diet (4%, CON-HS), capsaicin + normal salt diet (0.5%, CAP-NS), capsaicin + high salt diet (CAP-HS), capsaicin + high salt diet + Valsartan (30 mg/kg per day, by orally) (CAP-HS-VAL), capsaicin + high salt diet + Plendil (30 mg/kg per day, by orally) (CAP-HS-PLE). Tail-cuff systolic blood pressure, body weight, intralymphocytic [Ca(2+)](i), plasma calcitonin gene-related peptide concentration ([CGRP]), angiotensin II concentration ([AngII]) and 24 hour water intake, urinary volume, urinary Na(+) and K(+) concentrations were examined.

RESULTSTail-cuff systolic blood pressure and intralymphocytic [Ca(2+)](i) were lower in CAP-HS-VAL or CAP-HS-PLE group than those in CAP-HS group. Plasma [AngII] were higher in CAP-HS-VAL group than that in other groups. Tail-cuff systolic blood pressure were lower in CAP-HS-VAL group than that in CAP-HS-PLE group. Intralymphocytic [Ca(2+)](i) were lower in CAP-HS-PLE group than that in CAP-HS-VAL group. The 24 hour urine sodium excretion was higher in CAP-HS-PLE group than that in CAP-HS or CAP-HS-VAL group.

CONCLUSIONValsartan or Plendil could prevent the development of salt-sensitive hypertension induced by sensory denervation and the overloading of intracellular [Ca(2+)](i), which indicated that salt-sensitive hypertension induced by sensory nerve degeneration might be related to renin-angiotensin-aldosterone system (RAAS) and the over loading intracellular [Ca(2+)](i), and might be more closely to RAAS.

Animals ; Antihypertensive Agents ; therapeutic use ; Blood Pressure ; Felodipine ; therapeutic use ; Hypertension ; chemically induced ; drug therapy ; physiopathology ; Male ; Rats ; Rats, Wistar ; Sodium Chloride, Dietary ; Tetrazoles ; therapeutic use ; Valine ; analogs & derivatives ; therapeutic use ; Valsartan