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Emptiness is wide. Like the bird that spontaneously sings and is identified with the universe. Chang-tzu IN THE PRE-MODERN ERA, EVERYTHING ACHIEVED THROUGHOUT fire's tame was enclosed by a magic [...]

The safety and antihypertensive effectiveness of a fixed-dose combination form of spironolactone + altizide (S/A) were compared with those of enalapril, an angiotensin-converting enzyme inhibitor in a randomized, double-blind, parallel-group study of 186 patients with moderate essential hypertension. The 2 treatment groups were comparable in terms of age, gender, duration and severity of hypertension, diastolic blood pressure (BP), serum potassium and creatinine, and 24-hour urinary sodium excretion after a 4-week washout phase. After 8 weeks of treatment, both S/A and enalapril decreased BP significantly and to about the same extent. Enalapril, however, was more effective in decreasing supine diastolic BP in patients younger than age 50, whereas S/A yielded better results in those older than SO. Laboratory values were similar after both drugs were administered, and there were no clinically significant changes. The study demonstrated that S/A safely reduces elevated BP, particularly in older patients. (Am J Cardiol 1990;65:28K-32K), Thiazide diuretics increase the excretion of water through effects on sodium and chloride transport within the kidneys, and are used to treat hypertension. However, thiazides have been shown to cause disorders of lipid and carbohydrate metabolism, as well as potassium and magnesium losses. The drug spironolactone antagonizes or prevents the action of the adrenal hormone aldosterone, which regulates the metabolism of sodium, potassium, and chloride. Spironolactone reduces the loss of potassium and has a blood pressure-lowering effect, and may be combined with altizide, a thiazide diuretic, to provide an antihypertensive effect without causing potassium loss. Another type of antihypertensive agent, the angiotensin-converting enzyme (ACE) inhibitor, prevents the formation of angiotensin II, which constricts blood vessels and increases the production and release of aldosterone. The antihypertensive effectiveness and safety of a fixed-dose combination form of spironolactone and altizide were compared with that of the ACE inhibitor enalapril in 186 patients with moderate hypertension. After eight weeks of drug treatment, both the combination therapy and enalapril decreased blood pressure to the same extent. However, enalapril was more effective in decreasing blood pressure in patients younger than 50 years, whereas the combination therapy was more effective in patients older than 50 years. Neither drug regimen affected laboratory values. These results demonstrate that the combination of spironolactone and altizide is safe and effective in treating hypertension in older patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

In a double-blind, randomized, multicenter study of 194 patients with moderate hypertension, spironolactone and nifedipine were found to reduce blood pressure (BP) to about the same extent and in the same percentage of patients after 45 days of treatment (47 and 50%, respectively). At that point, the patients controlled by either drug continued on their regimen for another 45 days, while patients whose BP was still elevated diastolic BP >90 mm Hg), received the other drug in addition. After 45 days of combination therapy, 63% of the patients had normal BP, whereas those receiving monotherapy largely remained normotensive 96% in the spironolactone group and 88% in the nifedipine group). The adverse effects were not severe with either group, but the incidence was markedly higher in the nifedipine group. (Am J Cardiol 1990;65:36K-38K), The drug spironolactone antagonizes or prevents the actions of the adrenal hormone aldosterone, which regulates the metabolism of sodium, potassium, and chloride. Spironolactone causes a slight increase in sodium excretion, but does not cause the loss of potassium and magnesium from the kidney. This aldosterone antagonist is effective in treating hypertension when give alone or in combination with other antihypertensive agents. The effectiveness and safety of spironolactone were compared with those of the calcium channel blocker nifedipine, another type of antihypertensive agent. Calcium channel blockers prevent the entry of calcium into the cell by way of the calcium channels, which are pore-like structures in the cell membrane. The safety and effectiveness of spironolactone combined with nifedipine was also assessed. Among 194 hypertensive patients, spironolactone and nifedipine reduced blood pressure to the same extent and in a similar percentage of patients after 45 days of treatment. Patients with elevated blood pressure after 45 days of treatment with one of the antihypertensive agents were then switched to combined treatment with spironolactone and nifedipine. Blood pressure recovered to normal levels in 63 percent of the patients after 45 days of combination therapy. Blood pressures remained at normal levels in 96 percent of the patients receiving only spironolactone and 88 percent of the patients receiving only nifedipine. Although adverse effects were not severe, their incidence was greater in the group treated with nifedipine. (Consumer Summary produced by Reliance Medical Information, Inc.)

The addition of enalapril or acebutolol to a regimen of altizide + spironolactone in patients with moderate hypotension was investigated in a multicenter study of 53 patients. The patients underwent semiambulatory 24-hour blood pressure monitoring, especially to observe hypotensive episodes. in the 25 patients uncontrolled with altizide + spironolactone alone, enalapril and acebutolol were about equally effective in reducing blood pressure. The incidence of hypotension was low and comparable for both treatment groups, provided that the initial dose of angiotensin-converting enzyme inhibitor was low (5 mg). (Am J Cardiol 1990;65:33K-35K), Although diuretics, such as spironolactone and altizide, are considered safe, effective, and well-tolerated for treating hypertension, they may not be sufficient to control blood pressure. Diuretics can be combined with another type of antihypertensive agent, the angiotensin-converting enzyme inhibitors, which prevent the formation of angiotensin II (AII). AII constricts blood vessels and increases the production and release of the adrenal hormone aldosterone, which regulates sodium, potassium, and chloride metabolism. Diuretics increase the activity of the renin-angiotensin system, the enzyme system involved in the formation of AII, which counteracts the antihypertensive effects of the diuretics. Thus, ACE inhibitors, which block the renin-angiotensin system, may enhance the antihypertensive effect of diuretics. However, the combination of ACE inhibitors and diuretics may also cause hypotension, an abnormal drop in blood pressure. Diuretics may also be combined with yet another type of antihypertensive agent, the beta blockers. The safety and effectiveness of adding the beta blocker acebutolol or the ACE inhibitor enalapril to the diuretic combination of altizide and spironolactone (A/S) were compared in 53 hypertensive patients. When added to a combined drug regimen of A/S, acebutolol and enalapril were equally effective in reducing blood pressure. Both drug regimens were also associated with a low incidence of hypotension, if the dose of ACE inhibitor was kept low, at five milligrams. (Consumer Summary produced by Reliance Medical Information, Inc.)

The safety and efficacy of a thiazide/potassium-sparing diuretic and an angiotensin-converting enzyme inhibitor used concomitantly was evaluated in a large, multicenter study. Aldactazine[TM] was administered alone for 2 months, after which time captopril was added in those whose blood pressure had not normalized (332 patients). At the end of the 6-month study, control of blood pressure was achieved in 88% of the patients with one or the other regimen. No clinically significant changes were recorded for a number of biologic parameters. Specifically, there was 1 case of hyperkalemia (6 mmol/liter), a very low incidence of hypotension (1.6%), and a low rate of adverse effects. Therefore, such a combination could provide important therapeutic benefits in hypertensive patients. (Am J Cardiol 1990;65:4K-6K), Diuretics, such as thiazides, are agents that increase the excretion of water and are used to treat hypertension or high blood pressure. However, these antihypertensive agents may also cause decreased levels of potassium and magnesium, and lead to the development of arrhythmias or abnormal heart rhythms. Aldactazine is a combination of the potassium-retaining agent spironolactone and the thiazide diuretic, altizide, and was shown to reduce blood pressure without causing losses in potassium and magnesium. Another antihypertensive agent, captopril, prevents the formation of angiotensin, which constricts blood vessels and increases the secretion of the adrenal hormone aldosterone. This hormone increases the retention of sodium and the loss of potassium. Captopril is effective in treating mild hypertension, while maintaining or increasing potassium levels. However, if aldactazine and captopril were combined to treat hypertension, they may cause hyperkalemia or abnormally high levels of potassium, impaired kidney function, and hypotension (an abnormal drop in blood pressure). The effectiveness and safety of the combined drug regimen of aldactazine and captopril were assessed over a six-month period in 967 patients with hypertension. Aldactazine was given alone for the first two months and captopril was added only to the therapeutic regimen of 332 patients, whose blood pressures had not recovered to normal levels. At the end of the study, 88 percent of patients had well-controlled blood pressure with either drug regimen. There was one case of hyperkalemia, a very low incidence of hypertension, and few adverse drug effects. The results show that the combined regimen of aldactazine and captopril is both effective and safe in treating patients with hypertension. (Consumer Summary produced by Reliance Medical Information, Inc.)