1.The Phase 4 Randomized, Public, Parallel, Comparative, Clinical Trial to Compare Efficacy and Safety of S-(-)-Amlodipine Nicotinate with Ramipril in Hypertensive Patients.
Min Suk KIM ; Myung Ho JEONG ; Min Goo LEE ; Doo Sun SIM ; Keun Ho PARK ; Nam Sik YOON ; Hyun Ju YOON ; Kye Hun KIM ; Young Joon HONG ; Ju Han KIM ; Young Keun AHN ; Jeong Gwan CHO ; Jong Chun PARK ; Jung Chaee KANG
Journal of the Korean Society of Hypertension 2011;17(3):103-113
BACKGROUND: The aim of this study was to compare the antihypertensive effect of S-(-)-amlodipine nicotinate with ramipril in patients with essential hypertension. METHODS: Total 138 patients (54.5 +/- 10.5 years, 69 males) were enrolled in this study between 2008 and 2010. Amlodipine 2.5 mg or ramipril 2.5 mg was treated once in a day for 8 weeks. Epidemiologic analysis was performed in intend-to-treat (ITT) group. Efficacy analysis was performed in the differences of diastolic blood pressure in study groups. Abnormal reactions were divided with severities and drug-relationship. RESULTS: The change of diastolic blood pressures were more prominent with -12.7 +/- 7.02 mm Hg in amlodipine group, and -9.6 +/- 7.38 mm Hg in ramipril group (p = 0.023). The change of systolic blood pressures was higher in amlodipine group with -18.1 +/- 7.91 mm Hg, and -14.3 +/- 11.96 mm Hg in ramipril group (p = 0.047). Blood pressure normalization rates were 81.3% (48 of 59 patients) in amlodipine group, and 61.4% (35 of 57 patients) in ramipril group (p = 0.017). Abnormal reaction occurred in 5.8% (4 of 68 patients) of amlodipine group and 14.2% (10 of 70 patients) of ramipril group (p = 0.102). The most frequent abnormal reaction was respiratory symptom. CONCLUSIONS: S-Amlodipine-Nicotinate was more effective than ramipril in hypertensive patients without significant abnormal reaction.
Amlodipine
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Blood Pressure
;
Humans
;
Hypertension
;
Niacin
;
Ramipril
2.Target Blood Pressure in Patients with Diabetes: Asian Perspective.
Sungha PARK ; Kazuomi KARIO ; Chang Gyu PARK ; Qi Fang HUANG ; Hao Min CHENG ; Satoshi HOSHIDE ; Ji Guang WANG ; Chen Huan CHEN
Yonsei Medical Journal 2016;57(6):1307-1311
Recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial enrolled 4733 participants with type 2 diabetes and randomized them to a target systolic blood pressure (SBP) of less than 120 mm Hg or 140 mm Hg. Despite the significant difference in the achieved SBP, there was no significant difference in the incidence of primary outcomes. Based on this evidence, the target SBP for diabetics has been revised in the majority of major guidelines. However, there is a steeper association between SBP and stroke in Asians than other ethnicities, with stroke being the leading cause of cardiovascular mortality. This suggests that target BP in the Asian region should be tailored towards prevention of stroke. In the ACCORD study, the intensive BP treatment was associated with significant reductions in both total stroke and non-fatal stroke. The results from the ACCORD study are supported by a subgroup analysis from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study, which showed that, in diabetic patients, the risk of stroke continues to decrease to a SBP value of 115 mm Hg with no evidence of J curve. As diabetes is highly associated with underlying coronary artery disease, there is a justified concern for adverse effects resulting from too much lowering of BP. In a post hoc analysis of 6400 diabetic subjects enrolled in the International Verapamil SR-Trandolapril (INVEST) study, subjects with SBP of less than 110 mm Hg were associated with a significant increase in all-cause mortality. In the ONTARGET study, at any levels of achieved SBP, diastolic blood pressure (DBP) below 67 mm Hg was associated with increased risk for cardiovascular outcomes. As such, a prudent approach would be to target a SBP of 130–140 mm Hg and DBP of above 60 mm Hg in diabetics with coronary artery disease. In conclusion, hypertension, in association with diabetes, has been found to be significantly correlated with an elevated risk for cardiovascular events. As the association between stroke and BP is stronger in Asians, compared to other ethnicities, consideration should be given for a target BP of 130/80 mm Hg in Asians.
Asian Continental Ancestry Group*
;
Blood Pressure*
;
Coronary Artery Disease
;
Humans
;
Hypertension
;
Incidence
;
Mortality
;
Ramipril
;
Stroke
;
Verapamil
3.Hypotensive Efficacy and Safety of Ramipril on the Patients with Essential Hypertension.
Won Sang YOO ; Sung Woon KWON ; Chang Young LIM ; Sang Hyun PARK ; Suck Koo CHOI ; Dong Chul LEE
Korean Circulation Journal 1991;21(4):774-780
Thirty three patients with mild to moderate essential hypertension were administered ramipril, a new ACe inhibitor, 2.5-5mg once daily for 6 weeks to evaluate the hypotensive efficacy and safety. The results were as follows : 1) The patients consisted of 18 males, 15 females, aged 54 on average and classified as mild in 19 and moderate in 14 patients. 2) At the end of 6 weeks trial, blood pressure dropped 13/6mmHg on average, rewarding 70% effectiveness and normalized below 150/90mmHg in 39%. 3) The most frequent side reaction was dry cough in 5 patients(15%) followed by asthenia, GI trouble, dizziness, edema, eye injection and one case of GPT elevation which normalized after completion of trial. 4) The rating of safety of safety was 79% and of overall usefulness was 73%. In conclusion, ramipril 5mg once daily regimen is well tolerated and effective in the treatment of mild to moderated essential hypertension.
Asthenia
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Blood Pressure
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Cough
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Dizziness
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Edema
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Female
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Humans
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Hypertension*
;
Male
;
Ramipril*
;
Reward
4.J-curve Phenomenon Might Be Inherent: How to Know If It Is Treatment Induced?
Korean Circulation Journal 2018;48(1):80-81
No abstract available.
Antihypertensive Agents
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Hypertension
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Blood Pressure
;
Myocardial Ischemia
;
telmisartan
;
Ramipril
;
Risk Factors
5.Musical murmur in a dog with acute chordae tendineae rupture.
Sa Hee MIN ; Min Hee KANG ; Hee Myung PARK
Korean Journal of Veterinary Research 2013;53(4):263-264
A 6 year-old, spayed female, Maltese dog was presented with precordial thrill and mild coughing. Thoracic auscultation revealed a grade V/VI systolic murmur with maximal intensity over the left apex characterized by musical murmur. Echocardiography revealed mild myxomatous degeneration of mitral valve and ruptured chordae tendineae. Musical murmur was produced due to the vibration of ruptured piece of chordae tendineae along with regurgitant flow. After treatment with furosemide and ramipril, clinical signs resolved and precordial thrill reduced. This case report describes typical clinical signs and phonocardiogram of musical murmur in a dog with acute chordae tendineae rupture.
Animals
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Auscultation
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Child
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Chordae Tendineae*
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Cough
;
Dogs*
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Echocardiography
;
Female
;
Furosemide
;
Humans
;
Mitral Valve
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Music*
;
Ramipril
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Rupture*
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Systolic Murmurs
;
Vibration
6.Effects of Simvastatin Alone or Combined With Ramipril on Nitric Oxide Bioactivity and Inflammation Markers in Hypercholesterolemic Patients.
Ji Won SON ; Kwang Kon KOH ; Seung Min YOU ; Woun Seok RYU ; Jeong Yeal AHN ; Han Gyu KIM ; Dae Sung KIM ; Hyung Sik KIM ; Kyu Jin OH ; Eak Kyun SHIN
Korean Circulation Journal 2003;33(11):1053-1059
BACKGROUND AND OBJECTIVES: Because the mechanisms of the biological effects of statin and antiotensin converting enzyme inhibitor therapies differ, the vascular responses to these therapies were studied in hypercholesterolemic patients. MATERIALS AND METHODS: Simvastatin, 20 mg, placebo or ramipril, 10 mg, were administered daily for 2 months, with a 2 month washout, to 32 hypercholesterolemic patients. This was a randomized, double-blind, placebo-controlled, crossover in design study. RESULTS: Simvastatin alone, or in combination with ramipril, significantly changed the lipoproteins, and improved the percentage of the flow-mediated dilator response to hyperemia by 46+/-48% and by 59+/-66%, respectively, relative to the baseline measurements (both p<0.001). The plasma malondialdehyde levels were reduced, relative to baseline measurements, by 6+/-57% (p=0.045) and 13+/-47% (p=0.045 and p<0.001, respectively) and plasma levels of monocyte chemoattractant protein-1 by 3+/-27% and by 9+/-16%, respectively (p=0.113 and p=0.001, respectively). The C-reactive protein were also reduced, relative to baseline measurements, by 17+/-75% and by 17+/-37%, respectively (p=0.003 and p=0.001, respectively). However, simvastatin combined with ramipril changed, to a greater extent, but was statistically insignificant, the percentage of the flow-mediated dilator response to hyperemia, and the plasma monocyte chemoattractant protein-1 levels, than simvastatin alone. CONCLUSION: Compared with simvastatin alone, the addition of ramipril improved the endothelial function to greater extent, but was statistically insignificant, in hypercholes-terolemic patients.
C-Reactive Protein
;
Chemokine CCL2
;
Humans
;
Hydroxymethylglutaryl-CoA Reductase Inhibitors
;
Hyperemia
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Inflammation*
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Lipoproteins
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Malondialdehyde
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Nitric Oxide*
;
Plasma
;
Ramipril*
;
Simvastatin*
7.Antihypertensive Effect of Ramipril in Patients with Essential Hypertension.
Jung Sang SONG ; Yang Soo KIM ; Hye Jeon CHEONG ; Heung Sun KANG ; Chung Whee CHOUE ; Kwon Sam KIM ; Myung Shick KIM ; Jong Hoa BAE
Korean Circulation Journal 1993;23(4):597-602
BACKGROUND: Angiotensin converting enzyme(ACE) inhibition as a means of controlling blood pressure began in the 1970s. This increasing knowledge of ACE inhibitors has resulted in their being used with confidence in a antihyertensive therapy, combining high efficacy with very low levels of side effects. METHOD: In this study, the antihyertensive effect of ramipril was assessed in 28 patients(9 males and 19 females with mean age of 52 years)with mild-to-moderate hypertension. After a placebo run-in phase, patients received ramipril as monotherapy in a dose 2.5 to 5 mg daily for 6 weeks. RESULTS: 1) At the end of 6 weeks, ramipril induced clinically significant reduction in supine(30.1mmHg in systole, 17mmHg in diastole) and sitting(33.4mmHg in systole, 18.5mmHg in diatole)blood pressure. 2) The heart rate was similar after 6 weeks. 3) The most frequent side effect was dry cough in 6 patients(5.6%) followed by dizziness. CONCLUSION: This study indicate that ramipril is effective in the treatment of mild to moderate essential hypertension.
Angiotensin-Converting Enzyme Inhibitors
;
Angiotensins
;
Blood Pressure
;
Cough
;
Dizziness
;
Female
;
Heart Rate
;
Humans
;
Hypertension*
;
Male
;
Ramipril*
;
Systole
8.Study on ultrastructure of cardioprotection of ramipril against ischemia/reperfusion injury in diabetic rats.
Yan-Na WU ; Yan CHEN ; Zhe ZHANG ; Ya-Li DONG ; Xue-Kuan YU ; Jian-Jie JIAO ; Yi KANG ; Wei-Zhen GAO ; Jian-Shi LOU ; Yan-Xia LIU
Chinese Journal of Applied Physiology 2009;25(4):485-489
AIMTo investigate the effects of ramipril on myocardial ischemia/reperfusion injury in diabetic rats, and to explore its mechanism according to the observation on myocardial ultrastructure.
METHODSStreptozotocin induced diabetic rats were divided randomly into three groups (n = 16): ischemia/reperfusion (I/R), ischemic preconditioning (IPC) and ramipril (RAM) group. Rats in RAM group were administered by RAM(1 mg x kg(-1) x d(-1)) orally for 4 weeks, the others were administered by normal saline. Then all rats were subjected to myocardial ischemia/ reperfusion injury. Rats in IPC group were preconditioned before ischemia. The ECG and the infarct size were examined. The changes of myocardial morphology were examined by light and electron microscopes.
RESULTSCompared with I/R group, the elevation of ST segment and the incidence of ventricular tachycardia and ventricular fibrillation during ischemia were significantly decreased, the infarct size at the end of reperfusion was remarkably reduced, the myocardial morphology were significantly improved, special structure of myofilaments and mitochondria remained clearly, blood vessels were unobstructed, injury of endothelium were decreased in PC and RAM groups.
CONCLUSIONRamipril administered for 4 weeks induces myocardial protection in diabetic rats, which is similar to that of IPC. The mechanism may be involved in protection of cardiocytes and mitochondria, and improvement of endothelial function.
Animals ; Cardiotonic Agents ; pharmacology ; Diabetes Mellitus, Experimental ; complications ; Ischemic Preconditioning, Myocardial ; methods ; Myocardial Reperfusion Injury ; pathology ; prevention & control ; Myocardium ; ultrastructure ; Ramipril ; pharmacology ; Rats
9.The Study of the Dry Cough Incidence Rate about Imidapril, the Angiotensin Converting Enzyme Inhibitor.
Seung Bai LEE ; Tae Young KO ; Kyung Suk OH ; Jae Sik KWAG ; Byung Sun CHUNG ; Kyu Rak YI ; Nam Ho CHOI ; Jae Yong LEE ; Chong Soon KIM
Korean Circulation Journal 1998;28(7):1154-1160
BACKGROUND AND OBJECTIVES: Imidapril, one of the ACE inhibitor, has been used to treate hypertension, congestive heart failure, diabetes mellitus and renal disease. ACE inhibitor, however often causes dry cough and this adverse effect affects the compliance rate negatively. This report aimed to examine the incidence rate of coughing caused by Imidapril treat-ment. And we compared the results with the incidence and tendency of dry cough caused by the other ACE inhibitors. MATERIALS AND METHOD: This study enrolled 38 patients who followed up at internal medicine and took Imidapril from the period of May 9, 1997 to December 17, 1997. We tested its effectiveness, safety and tolerance. The initial dosage of it was 5mg/day and the maximum dosage according to blood pressure was 10mg/day for 8 weeks. The tendency and the incidence of dry cough have been analyzed and compared with recently published Korean reports. RESULTS: The 5 mg dosage of Imidapril showed 68.1% in lowering blood pressure rate and it went up to 81.8% during the 8 weeks treatment perriod. The blood pressure regularity rate was 36.3% after the 8 weeks treatment. The overall rate of adverse effect occurrence was 26.1% (6/23) and 8.7% of them were likely to cough. One of the patients who showed nausea stopped medication. The recent articles reported that the incidence of dry cough had been reduced: Enalapril (33.8%), Fosinopril (16%), Ramipril (15%), Imidapril (7.8 - 8.7%), Losartan (4.3%). CONCLUSION: Imidapril is as safe and effective as other ACE inhibitors. Various ACE inhibitors that were newly developed show their effectiveness in lessening incidence rate of dry cough, and Imidapril is thought to be an excellent drug for this matter. Even though Losartan shows the lowest incidence rate of dry cough, it needs to more regular usages since it is still on the stage of its medical adaptation.
Angiotensin-Converting Enzyme Inhibitors
;
Angiotensins*
;
Blood Pressure
;
Compliance
;
Cough*
;
Diabetes Mellitus
;
Enalapril
;
Fosinopril
;
Heart Failure
;
Humans
;
Hypertension
;
Incidence*
;
Internal Medicine
;
Losartan
;
Nausea
;
Peptidyl-Dipeptidase A*
;
Ramipril
10.The Additive Beneficial Effects of Ramipril Combined with Candesartan in Hypertensive Patients on Insulin Resistance, Plasma Adiponectin.
Seung Hwan HAN ; Sang Jin LEE ; Byung Chun OH ; Kwang Kon KOH ; Eak Kyun SHIN
Korean Circulation Journal 2007;37(4):173-179
BACKGROUND AND OBJECTIVES: Ramipril and candesartan have decreased the incidence of new onset diabetes in large scale randomized clinical studies. Because ramipril and candesartan have distinct mechanisms of action in the renin angiotensin aldosterone system, we hypothesized that combination therapy would have additive beneficial metabolic effects in patients with hypertension. SUBJECTS AND METHODS: Thirty-four patients were given ramipril 10 mg and placebo, ramipril 10 mg and candesartan 16 mg, or candesartan 16 mg and placebo daily in a randomized, double-blind, placebo-controlled cross-over trial with three treatment arms and two washout periods (each being 2 months). RESULTS: Ramipril, combination therapy or candesartan significantly increased the plasma adiponectin levels relative to the baseline measurements by 17+/-6% (p=0.038), 25+/-5% (p<0.001), and 14+/-6% (p=0.016), respectively. Combination therapy significantly increased the plasma adiponectin levels more than either ramipril or candesartan alone (p=0.020 by ANOVA). Only combination therapy significantly increased the QUICKI level relative to the baseline measurements (p=0.002). There were no significant correlations between these changes of the metabolic parameters and reduction of the systolic blood pressure (-0.288< or =r< or =0.284) and reduction of the diastolic blood pressure (-0.282< or =r< or =0.190). On multivariate analysis, only the change of adiponectin levels was an independent predictor of the changes in the QUICKI levels (beta=1.549, p=0.040) following combination therapy. CONCLUSION: Ramipril in combination with candesartan increases the plasma adiponectin levels to a greater extent than monotherapy with either drug alone. Only combination therapy significantly improves insulin sensitivity relative to the baseline measurements. The only predictor for the improvement of insulin sensitivity is the increase of plasma adiponectin levels by combination therapy.
Adiponectin*
;
Angiotensin-Converting Enzyme Inhibitors
;
Arm
;
Blood Pressure
;
Humans
;
Hypertension
;
Incidence
;
Insulin Resistance*
;
Insulin*
;
Multivariate Analysis
;
Plasma*
;
Ramipril*
;
Renin-Angiotensin System