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Maria Circelli,1 Gabriele Nicolini,1 Colin G Egan,2 Giovanni Cremonesi11Chiesi Farmaceutici, Direzione Medica, Parma, Italy; 2Primula Multimedia, Pisa, ItalyAbstract: The main objective of this meta-analysis was to compare the efficacy of the combination of delapril and indapamide (D+I) to different angiotensin-converting enzyme inhibitor (ACEi) plus hydrochlorothiazide (HCTZ) combinations for the treatment of mild-to-moderate hypertension. A secondary objective was to examine the safety of these two combinations. Studies comparing the efficacy of D+I to ACEi+HCTZ combinations in hypertensive patients and published on computerized databases (1974–2010) were considered. Endpoints included percentage of normalized patients, of responders, change in diastolic and systolic blood pressure (DBP/SBP) at different time-points, percentage of adverse events (AEs), and percentage of withdrawal. Four head-to-head randomized controlled trials (D+I-treated, n = 643; ACEi+HCTZ-treated, n = 629) were included. Meta-analysis indicated that D+I-treated patients had a higher proportion with normalized blood pressure (P = 0.024) or responders (P = 0.002) compared to ACEi+HCTZ-treated patients. No difference was observed between treatments on absolute values of DBP and SBP at different time-points. Although the rate of patients reporting at least one AE was similar in both groups (10.4% versus 9.9%), events leading to study withdrawal were lower in the D+I group versus the ACEi+HCTZ group (2.3% versus 4.8%, respectively; P = 0.018). This meta-analysis suggests that treatment with D+I could provide a higher proportion of normalized or responder patients with good tolerability compared to ACEi+HCTZ combinations.Keywords: meta-analysis, hypertension, ACE inhibitor, diuretic, delapril, indapamide

Human activities are affecting habitats and wildlife populations worldwide. Tropical forests are one of the most affected environments, mainly due to deforestation and poaching. Since high levels of anthropogenic pressure on forest ecosystems, including illegal logging and hunting, occur in southwest Myanmar (Rakhine State), we analyzed the effects of human disturbance on medium to large mammals in this region. We used camera‐trapping data collected over three consecutive years to investigate occurrence probabilities of 10 species: five common species exploited for bushmeat consumption, and five threatened species targeted by the illegal wildlife trade. We used a hierarchical single‐species multi‐season occupancy model implemented in a Bayesian framework to evaluate the effects of human disturbances and persistent habitat characteristics, such as the proportion of remaining pristine evergreen forest and the elevation, on occurrence probabilities. We found that occupancy probabilities of three out of five target species for the illegal wildlife trade were positively linked to forest habitats, whereas among common species hunted for bushmeat consumption the Northern red muntjak and the Malayan porcupine were negatively affected by human presence. The effects of human and habitat covariates were varied for other species of both groups. We confirmed results from previous studies that human disturbance is a driver of occurrence probabilities for some species in tropical areas. Our findings suggest that as protection of rainforest habitat is fundamental to the conservation of tropical ecosystems, law enforcement, patrolling, and local engagement activities are also recommended to mitigate forest and species exploitation. Finally, camera trapping could be a first step to identify areas where human presence affects species occupancy and help local authorities to develop more fine‐tuned conservation plans. [ABSTRACT FROM AUTHOR]

The calcium channel antagonists (CCAs) were originally introduced as vasodilators for the treatment of coronary heart disease, but are now also noted for their clinical efficacy in the management of hypertension. Data from large clinical studies have shown that CCAs are not associated with the undesirable metabolic effects (e.g. worsening of dyslipidemia and reduction of insulin sensitivity) seen with older agents such as thiazide diuretics and beta-adrenoceptor antagonists (beta-blockers) that are used to treat hypertension. Indeed, reductions in cardiovascular risk and rates of onset of new cases of diabetes mellitus have been reported in trials in patients with hypertension treated with CCAs. These beneficial effects extend beyond those expected to accompany reductions in BP. Until recently, the biochemical effects underlying these metabolic changes were only poorly understood, but pharmacologic studies have now started to shed more light on these issues. Of particular interest are studies with manidipine, some of which suggest that this agent may be associated with greater improvements in insulin sensitivity and may have better renal protective properties than other CCAs. Confirmation of potential differences among CCAs in terms of the relative magnitude of any beneficial metabolic effects requires further study. Ongoing research is expected to clarify further the action of these agents at the cellular level and to assist with the optimization of antihypertensive therapy, particularly in patients with elevated cardiovascular risk profiles. [ABSTRACT FROM AUTHOR]

Background: Several studies have shown that antihypertensive monotherapy is commonly insufficient to control blood pressure (BP) in hypertensive patients and that concomitant use of >/= 2 drugs is necessary in ~50% of these patients. The combination of an angiotensin-converting enzyme (ACE) inhibitor and a diuretic, delapril plus indapamide (D + I), has been shown to be effective and tolerable, with no interaction between the 2 components. Another widely used combination of ACE inhibitor and diuretic is lisinopril plus hydrochlorothiazide (L + H).Objectives: The aims of this study were to confirm the antihypertensive efficacy and tolerability of the fixed combination of D + I in mild to moderate hypertension, and to compare its therapeutic efficacy and tolerability with that of L + H.Methods: The antihypertensive efficacy and tolerability of a fixed combination of D + I (30-mg + 2.5-mg tablets once daily) or L + H (20-mg + 12.5-mg tablets once daily) in patients with mild to moderate hypertension were compared in a multinational, multicenter, randomized, 2-armed, parallel-group study. Eligible patients were aged 18 to 75 years and had a diastolic blood pressure (DBP) 95 to 115 mm Hg and a systolic blood pressure (SBP) /=10 mm Hg from baseline or had a DBP