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Background: The national and international guidelines emphasize the importance of the effective treatment of arterial hypertension. Nevertheless, low levels of control are observed, as well as low attainment of the recommended goals, indicating that it is important to plan and implement better treatment strategies., Objective: To evaluate the efficacy of a based treatment algorithm with olmesartan medoxomil., Methods: This is an open, national, multicentric and prospective study of 144 patients with primary arterial hypertension, stages 1 and 2, naïve to treatment or after a 2-to-3 week washout period for those in whom treatment was ineffective. The use of olmesartan medoxomil was assessed in a treatment algorithm divided into 4 phases: (i) monotherapy (20 mg), (ii-iii) associated to à hydrochlorothiazide (20/12.5 mg and 40/25 mg) and (iv) addition of amlodipine besylate (40/25 mg + 5 mg)., Results: At the end of the phased-treatment, 86% of the study subjects attained the goal of BP < 130/85 mmHg. Maximum reductions in SAP and DAP were -44.4 mmHg and -20.0 mmHg, respectively. The rate of systolic responders (SAP >or= 20 mmHg) and of diastolic responders (DAP >or= 10 mmHg) was 87.5% and 92.4%, respectively., Conclusion: The study was based on a treatment regimen that was similar to the therapeutic approach in daily clinical practice and showed that the use of olmesartan medoxomil in monotherapy or in association with hydrochlorothiazide and amlodipine was effective in the attainment of the recommended goals for hypertension stage 1 and 2 hypertensive individuals.

Objective: Measure the systolic (SP), diastolic (DP) and pulse pressure (PP) using home blood pressure monitoring (HBPM) and correlate its values with the left ventricular mass index (LVMI)., Methods: In 2004, 127 individuals underwent HBPM in a private clinic. A total of 83 of these also underwent an echocardiographic study in a period shorter than 6 months. After excluding those with dilated or ischaemic cardiomyopathy and those with mitral or aortic valvopathies, 72 patients were evaluated for the correlation between SP, DP and PP (SP minus DP) and the LVMI., Results: The group's mean age was 51.9 +/- 17.3 years and the masculine gender represented 43% of their components. The mean body mass index (BMI) was 28.6 +/- 6 kg/m(2) and 53% of the patients were using antihypertensive drugs. The PS and PP correlated positively to the LVMI (r = 0.356; p = 0.002 e r = 0.429; p < 0.001, respectively). There was no correlation between DP and LVMI., Conclusion: The PS and the PP correlate positively to the LVMI.

Objective: To test a simplified blood pressure device called Rastreometro that could be used by the Health Agents., Methods: The Rastreometro has been developed from an ordinary aneroid sphygmomanometer, in which the numeric display is covered by an adhesive with a red zone, indicating pressures equal or above 140 mmHg and a yellow zone indicating pressures below 140 mmHg. The onset of oscillations of the aneroid needle is taken as an indication of the systolic pressure value. The measurements made by the Rastreometro were compared with those made by the auscultatory method, and were carried out in 268 patients, by two operators. The influence on the results of confounding variables such as age, gender, BMI, arm length, upper arm circumference, skin colour and antihypertensive treatment were taken into consideration, as well as intra and interobserver variation., Results: In the whole group, sensitivity was 95.1%, specificity was 63.1%, positive predictive value was 62.4% and negative predictive value was 95.3%. Hypertensive treatment significantly affected specificity, 32.7% as compared to 77.8% for the non-treated group. Both operators improved their results over time., Conclusion: This study suggests that the Rastreometro technique, as a screener for hypertension, has good sensitivity. Concerning specificity, it is acceptable, provided the patient is not on regular antihypertensive treatment. In this latter situation, it can be improved by a proper standardization of the method to read the systolic pressure by needle oscillations. Furthermore, the use of this technique requires well trained operators.

Objective: The LOTHAR study evaluated medium and long term (one year) efficacy, tolerability and metabolic effects of the fixed combination of amlodipine and losartan compared to amlodipine or losartan alone., Methods: Brazilian multicenter, randomized, double-blind and comparative trial performed with 198 patients in stage 1 and 2 essential hypertension., Results: The fixed combination has a high antihypertensive efficacy that is sustained in the long term with very low percentage of loss of blood pressure control. This percentage is incidentally lower than that of the two monotherapy comparative regimens. In the long term, more than 60% of the patients treated with the fixed combination remained with DBP < or = 85 mmHg, and the antihypertensive effect, when assessed by ABPM persisted for 24 hours with a trough-to-peak ratio of 76.7%. The frequency of adverse events was quite low in this group, and the long-term incidence of leg edema was approximately four-fold lower than that observed with amlodipine alone. The fixed combination did not change glucose and lipid metabolism in the medium or in the long term., Conclusion: Based on these results, we can say that the combination of amlodipine and losartan--the first fixed combination of a calcium channel blocker and an angiotensin II receptor blocker available in the pharmaceutical market, is an excellent option for the treatment of a wide range of hypertensive patients.

Background: Cyclodextrins are suitable drug delivery systems because of their ability to subtly modify the physical, chemical, and biological properties of guest molecules through labile interactions by formation of inclusion and/or association complexes. Plant cysteine proteinases from Caricaceae and Bromeliaceae are the subject of therapeutic interest, because of their anti-inflammatory, antitumoral, immunogenic, and wound-healing properties., Methods: In this study, we analyzed the association between beta-cyclodextrin (betaCD) and fraction P1G10 containing the bioactive proteinases from Carica candamarcensis, and described the physicochemical nature of the solid-state self-assembled complexes by Fourier transform infrared (FTIR) spectroscopy, thermogravimetry (TG), differential scanning calorimetry (DSC), X-ray powder diffraction (XRD), and nuclear magnetic resonance (NMR), as well as in solution by circular dichroism (CD), isothermal titration calorimetry (ITC), and amidase activity., Results and Discussion: The physicochemical analyses suggest the formation of a complex between P1G10 and betaCD. Higher secondary interactions, namely hydrophobic interactions, hydrogen bonding and van der Waals forces were observed at higher P1G10 : betaCD mass ratios. These results provide evidence of the occurrence of strong solid-state supramolecular non-covalent interactions between P1G10 and betaCD. Microcalorimetric analysis demonstrates that complexation results in a favorable enthalpic contribution, as has already been described during formation of similar betaCD inclusion compounds. The amidase activity of the complex shows that the enzyme activity is not readily available at 24 hours after dissolution of the complex in aqueous buffer; the proteinase becomes biologically active by the second day and remains stable until day 16, when a gradual decrease occurs, with basal activity attained by day 29., Conclusion: The reported results underscore the potential for betaCDs as candidates for complexing cysteine proteinases, resulting in supramolecular arrays with sustained proteolytic activity.

Objectives: The use of low-dose amlodipine has not yet been well established in the elderly. This study therefore aimed to evaluate the efficacy and tolerability of low-dose amlodipine in elderly patients with Joint National Committee VI stage I or II hypertension., Patients and Methods: Sixty-five hypertensive individuals (aged 66.3 +/- 5.3 years) received amlodipine 2.5 mg per day for 12 weeks before and after two periods of 4 weeks of placebo. At weeks 0, 12 and 16, patients were submitted to office, 24 h ambulatory blood pressure monitoring and home blood pressure measurement., Results: Office systolic and diastolic blood pressure showed decreases at weeks 8 (153 +/- 17, 90 +/- 9 mmHg) and 12 (152 +/- 16, 90 +/- 9 mmHg) compared with weeks 0 (164 +/- 16, 99 +/- 6 mmHg) and 16 (162 +/- 19, 95 +/- 9 mmHg). During ambulatory monitoring, a decrease was observed in the average 24 h systolic and diastolic pressure at week 12 (143 +/- 13, 86 +/- 7 mmHg) compared with weeks 0 (155 +/- 15, 93 +/- 6 mmHg) and 16 (152 +/- 16, 92 +/- 8 mmHg). A daytime and night-time reduction in systolic and diastolic pressure was observed on home blood pressure monitoring at week 12 (146 +/- 16/88 +/- 8, 144 +/- 16/93 +/- 8 mmHg) compared with weeks 0 (159 +/- 17/94 +/- 8, 161 +/- 19/93 +/- 8 mmHg) and 16 (153 +/- 16/93 +/- 8, 154 +/- 17/92 +/- 8 mmHg). Adverse reactions were infrequent., Conclusions: Amlodipine at a dose of 2.5 mg per day showed efficacy and good tolerability in elderly hypertensives.