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Öğe Clinically additive effect between doxazosin and amlodipine in the treatment of essential hypertension(Elsevier Science Inc, 2000) Nalbantgil, S; Nalbantgil, I; Onder, RThe Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has reported that combinations of low doses of antihypertensive agents from different classes may provide additional antihypertensive efficacy and minimize the likelihood of dose-dependent adverse effects. Doxazosin and amlodipine, alone and in combination, were compared for efficacy in reducing blood pressure (BP) in 75 patients with predominantly moderate (Stage 2) hypertension. This was a double-blind, randomized, crossover study. After a 2-week washout period, patients in group A (n = 37) received amlodipine 10 mg and patients in group B (n = 38) received doxazosin 4 mg for 6 weeks. All patients then received reduced-dose combination therapy (amlodipine 5 mg and doxazosin 2 mg) for 6 weeks. Subsequently, patients received 6 weeks of monotherapy with the alternate medication (group A received doxazosin 4 mg and group B received amlodipine 10 mg). During both monotherapy periods, doxazosin and amlodipine significantly reduced systolic and diastolic BP (P < .001 v baseline). BP further decreased with combination therapy (P < .01 v monotherapy). The percentage of patients with Stage 2 hypertension who achieved a target BP of < 140/ < 90 mm Hg increased from 78% with monotherapy to 94% with combination therapy. Fewer adverse effects were observed during combination therapy. It is concluded that there is an additional fall in blood pressure when reduced doses of doxazosin and amlodipine are used in combination for the treatment of hypertension, suggesting that doxazosin should be considered as an effective add-on treatment to calcium-channel blockers. (C) 2000 American Journal of Hypertension, Ltd.Öğe Combination Therapy With Verapamil and Nitrendipine In Patients With Hypertension(Stockton Press, 1993) Nalbantgil, I; Onder, R; Kiliccioglu, B; Turkoglu, CForty patients with mild to moderate hypertension were divided into two groups, 20 patients (group A) received 240 mg verapamil and 20 patients (group 8) received 20 mg nitrendipine dally during the first six weeks. During the second six weeks, all 40 patients were given 10 mg nitrendipine plus 120 mg verapamil. After the combination therapy, group B received verapamil, 240 mg and group A nitrendipine 20 mg for a further period of six weeks. When verapamil and nitrendipine were used alone, BP decreased significantly in each group. However, BP decreased more when the combination therapy was used and increased when the treatment was changed to single drug therapy from the two-drug combination. In addition, side-effects were three to four times fewer during the combination therapy. It is concluded that the combination of two different calcium antagonists in the treatment of hypertension provides a new dimension to therapy.Öğe Comparison of candesartan and felodipine alone and combined in the treatment of hypertension: A single-center, double-blind, randomized, crossover trial(Excerpta Medica Inc, 2003) Nalbantgil, S; Zoghi, M; Ozerkan, F; Boydak, B; Nalbantgil, I; Onder, R; Akin, MBackground. In the past decade, many studies have indicated that the combination of low doses of different classes of antihypertensive agents may be more efficacious than monotherapy while minimizing the likelihood of dose-dependent adverse effects (AEs). Objective: The aim of this study was to determine whether combination therapy with lower doses of candesartan and a calcium antagonist, felodipine, would be more effective and tolerable in controlling mild to moderate hypertension compared with either drug used alone. Methods: In this 18-week, single-center, double-blind, crossover study, patients with mild to moderate essential hypertension were randomized to 1 of 2 treatment groups after a 2-week placebo washout period. Patients in group 1 received candesartan 16 mg once daily and patients in group 2 received felodipine 5 mg once daily, for 6 weeks. All patients then received half-dose combination therapy (candesartan 8 mg plus felodipine 2.5 mg, once daily) for 6 weeks. Finally, patients received 6 weeks of monotherapy with the alternate medication (group 1 received felodipine 5 mg once daily and group 2 received candesartan 16 mg once daily). Results: Thirty patients (18 men, 12 women; mean [SD] age, 54.0 [4.9] years; range, 39-62 years) were included in the study. During both monotherapy periods, candesartan and felodipine significantly reduced blood pressure (BP) (both P < 0.001). BP further decreased with combination therapy (P < 0.001 in both groups). Overall, 90.0% (27/30) of the patients achieved the target BP at the end of combination therapy. The incidence of AEs was similar with combination therapy compared with either monotherapy. Conclusions: In this study population, candesartan and felodipine had additive effects when used in combination, even at low doses, in the treatment of hypertension. Therefore, the combination of candesartan and felodipine is an effective alternative to that of candesartan and hydrochlorothiazide. Copyright (C) 2003 Excerpta Medica, Inc.Öğe Comparison of candesartan and felodipine alone and combined in the treatment of hypertension: A single-center, double-blind, randomized, crossover trial(Excerpta Medica Inc, 2003) Nalbantgil, S; Zoghi, M; Ozerkan, F; Boydak, B; Nalbantgil, I; Onder, R; Akin, MBackground. In the past decade, many studies have indicated that the combination of low doses of different classes of antihypertensive agents may be more efficacious than monotherapy while minimizing the likelihood of dose-dependent adverse effects (AEs). Objective: The aim of this study was to determine whether combination therapy with lower doses of candesartan and a calcium antagonist, felodipine, would be more effective and tolerable in controlling mild to moderate hypertension compared with either drug used alone. Methods: In this 18-week, single-center, double-blind, crossover study, patients with mild to moderate essential hypertension were randomized to 1 of 2 treatment groups after a 2-week placebo washout period. Patients in group 1 received candesartan 16 mg once daily and patients in group 2 received felodipine 5 mg once daily, for 6 weeks. All patients then received half-dose combination therapy (candesartan 8 mg plus felodipine 2.5 mg, once daily) for 6 weeks. Finally, patients received 6 weeks of monotherapy with the alternate medication (group 1 received felodipine 5 mg once daily and group 2 received candesartan 16 mg once daily). Results: Thirty patients (18 men, 12 women; mean [SD] age, 54.0 [4.9] years; range, 39-62 years) were included in the study. During both monotherapy periods, candesartan and felodipine significantly reduced blood pressure (BP) (both P < 0.001). BP further decreased with combination therapy (P < 0.001 in both groups). Overall, 90.0% (27/30) of the patients achieved the target BP at the end of combination therapy. The incidence of AEs was similar with combination therapy compared with either monotherapy. Conclusions: In this study population, candesartan and felodipine had additive effects when used in combination, even at low doses, in the treatment of hypertension. Therefore, the combination of candesartan and felodipine is an effective alternative to that of candesartan and hydrochlorothiazide. Copyright (C) 2003 Excerpta Medica, Inc.Öğe Effect of antihypertensive treatment on the prevalence of ventricular arrhythmias among patients with isolated systolic hypertension without left ventricular hypertrophy(Excerpta Medica Inc, 2002) Gurgun, C; Nalbantgil, S; Nalbantgil, I; Zoghi, M; Yilmaz, H; Boydak, B; Onder, RBackground: The high incidence of ventricular arrhythmias in patients with hypertension and left ventricular hypertrophy (LVH) is well documented. However, few studies have been conducted on the prevalence of ventricular arrhythmias in patients with isolated systolic hypertension without LVH. Objectives: The objectives of this study were to (1) determine the prevalence of ventricular arrhythmias in patients with systolic hypertension without LVH and (2) estimate the effect of a perindopril/indapamide combination, which does not have an antiarrhythmic effect, on the incidence of ventricular arrhythmias. Methods: Patients with newly diagnosed isolated systolic hypertension (systolic blood pressure [SBP] >160 mm Hg) and a control group of normotensive patients were enrolled. During the 2-week washout period, patients underwent physical examination (including blood pressure measurements), ambulatory electrocardiography monitoring, echocardiography, and laboratory urine and blood tests. Absence of LVH was confirmed by echocardiographic examination. The group of hypertensive patients received 1 tablet of 2 mg perindopril/0.625 mg indapamide per day for a total of 4 weeks. Physical examinations and ambulatory electrocardiographic monitoring were repeated after treatment. Results: A total of 60 hypertensive (mean age, 63.1 years; mean SBP, 176.8 +/- 3.1 mm Hg; mean diastolic blood pressure, 82.6 +/- 2.9 mm Hg) and 60 normotensive patients were enrolled. Ambulatory electrocardiographic monitoring indicated that 18 of the 60 hypertensive patients (30%) had ventricular arrhythmias: 17 had ventricular premature contractions (>100/24 h) and 1 had ventricular tachycardia plus ventricular premature contractions. In the control group, 7 of 60 subjects (11.7%) had ventricular premature contractions. The difference between the 2 groups in incidence of ventricular arrhythmias was significant (P < 0.01). After treatment, mean SBP decreased to 136.1 +/- 3.2 mm Hg, and ventricular premature contractions were found in 9 of 60 hypertensive patients (15%) (P < 0.02 vs pretreatment). Conclusions: The results of this study suggest that in patients with isolated systolic hypertension without LVH, (1) the prevalence of ventricular arrhythmia is higher than in normotensive patients and (2) treatment with perindopril/ indapamide decreases the incidence of ventricular arrhythmias.Öğe Effect of irbesartan monotherapy compared with ACE inhibitors and calcium channel blockers on patient compliance in patients with essential hypertension: A multicenter, randomized, open-cohort study(Lippincott Williams & Wilkins, 2003) Koylan, N; Acarturk, E; Caglar, N; Caglar, S; Erdine, S; Guneri, S; Ilerigelen, B; Kabakci, G; Onder, R; Sagkan, OÖğe Effect of irbesartan monotherapy compared with ACE inhibitors and calcium channel blockers on patient compliance in patients with essential hypertension: A multicenter, randomized, open-cohort study(Lippincott Williams & Wilkins, 2003) Koylan, N; Acarturk, E; Caglar, N; Caglar, S; Erdine, S; Guneri, S; Ilerigelen, B; Kabakci, G; Onder, R; Sagkan, OÖğe Effect of irbesartan monotherapy compared with ACE inhibitors and calcium-channel blockers on patient compliance in essential hypertension patients: A multicenter, open-labeled, three-armed study(Taylor & Francis Ltd, 2005) Koylan, N; Acarturk, E; Canberk, A; Caglar, N; Caglar, S; Erdine, S; Guneri, S; Ilerigelen, B; Kabakci, G; Onder, R; Sagkan, O; Buyukozturk, KObjectives. This multicenter, three-armed, open-labeled study investigated patient compliance of patients receiving irbesartan, angiotensin-converting enzyme (ACE) inhibitors or calcium-channel blockers (CCB) for essential hypertension for a 6-month period. Patients were either newly diagnosed or switched from existing antiltypertensive medication due to lack of efficacy or side-effects. Methods. Patients were started monotherapy with irbesartan (n=377), ACE inhibitors (n=298) or CCB (n=308) and were reevaluated on 1st, 3rd, and 6th months of the treatment. The primary endpoint was patient compliance, assessed by proportion of patients who had taken their study medication every day. Efficacy was recorded as mean reductions in blood pressure and the proportion of patients whose blood pressure normalized. Tolerability was assessed by reported adverse events. Results. Significantly more patients receiving irbesartan had complied with study medication after 3 and 6 months of treatment than ACE inhibitors or CCB. Significantly fewer patients receiving irbesartan needed to change their antihypertensive medication. All three study treatments exhibited similar efficacy profiles, but irbesartan had significantly less adverse events. Conclusions. This study demonstrated that patient compliance to irbesartan was significantly superior to other study treatments. Irbesartan is therefore a suitable first-line therapy for essential hypertension in everyday clinical practice.Öğe Effect of statins on plasma fibrinogen levels in hypertensive hyperlipidemic patients(Lippincott Williams & Wilkins, 2002) Nalbantgil, S; Nalbantgil, I; Boydak, B; Ozerkan, F; Gurgun, C; Zoghi, M; Aytimur, M; Onder, RÖğe Effects of valsartan and enalapril on regression of left ventricular hypertrophy in patients with mild to moderate hypertension: A randomized, double-blind study(Excerpta Medica Inc, 2000) Nalbantgil, S; Yilmaz, K; Gurun, C; Ozerkan, F; Nalbantgil, I; Onder, RObjective: This study was undertaken to compare the effects of valsartan with those of enalapril on regression of left ventricular hypertrophy in patients with mild to moderate hypertension. Background: The effect of angiotensin II receptor antagonists on regression of left ventricular hypertrophy in patients with hypertension has been established in several studies. The effects of these agents have also been compared with those of other antihypertensive drugs such as diuretics or beta-receptor blocking agents. However, no study has compared angiotensin II receptor antagonists with angiotensin-converting-enzyme (ACE) inhibitors. The effect of ACE inhibitors on regression of left ventricular hypertrophy is superior to that of other antihypertensive drugs. Methods: Forty patients with mild to moderate hypertension and left ventricular hypertrophy were included in this randomized, double-blind study. Patients were divided into 2 groups. No between-group differences were noted with regard to age, systolic and diastolic blood pressures, duration of hypertension, and left ventricular mass index, which was measured by M-mode echocardiography. Twenty patients received enalapril 20 mg/d, and 20 patients received valsartan 80 mg/d. Echocardiographic measurements were repeated at 3 and 6 months, and blood pressure was measured every 15 days. Results: Systolic and diastolic blood pressures decreased significantly at 3 and 6 months in both groups (P < 0.001), as did left; ventricular mass index (P < 0.02 and P < 0.01, respectively). Cough and fatigue occurred in 3 (15%) and 2 (10%) patients in the enalapril group. No adverse effects were reported in the valsartan group. Conclusions.. In patients with left ventricular hypertrophy caused by hypertension, valsartan is as effective as enalapril in reducing left ventricular hypertrophy.Öğe Evaluation of the Antihypertensive Effect of Amlodipine Using 24-Hour Ambulatory Blood-Pressure Measurement(Excerpta Medica Inc, 1993) Nalbantgil, I; Kiliccioglu, B; Onder, R; Isler, MThe antihypertensive effect of amlodipine was investigated in 20 patients (11 men and nine women) with essential hypertension using 24-hour monitoring of ambulatory blood pressure. The patients received placebo initially for 1 week followed by amlodipine 5 mg/day for 8 weeks. In three patients whose diastolic blood pressure did not fall below 90 mmHg after 4 weeks, the dosage was raised to 10 mg/day. All patients underwent ambulatory blood pressure monitoring at the end of the placebo period and at the end of 8 weeks of active treatment. Blood pressures and heart rate were measured and a physical examination was performed every 2 weeks during the treatment period. By the second week of treatment, systolic and diastolic blood pressures were significantly reduced with amlodipine therapy (P < 0.01). The reduction was more pronounced in the fourth week (P < 0.001). There were no significant changes in heart rate. Ambulatory investigations revealed a significant decrease in both systolic and diastolic blood pressures every hour of the day (P < 0.001). On the other hand, heart rate was significantly reduced only between 8 AM and 12 noon (P < 0.05). Changes at other hours of the day were not significant. Drug-related side effects disappeared quickly without the need for tapering off or discontinuing the drug. Amlodipine is an effective and well-tolerated drug for the treatment of hypertension.Öğe Myocardial infarction following a bee sting(Elsevier Sci Ireland Ltd, 2001) Ceyhan, C; Ercan, E; Tekten, T; Kirilmaz, B; Onder, RWe described here a patient envenomated by a bee sting that caused myocardial damage compatible with non-ST elevation acute myocardial infarction. She developed a typical course of myocardial infarction; the ECG changes were reversed to almost all normal limits. She had normal coronary angiography and reversible wall motion abnormalities. Myocardial damage following prolonged spasm in the coronary arteries may be the underlying factor. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.Öğe The prevalence of silent myocardial ischaemia in patients with white-coat hypertension(Stockton Press, 1998) Nalbantgil, I; Onder, R; Nalbantgil, S; Yilmaz, H; Boydak, BThe aim of this study was to estimate the incidence of silent myocardial ischaemia in patients with mild to moderate hypertension, white-coat hypertension (WCH) and those with normal blood pressure, Ambulatory electrocardiographic (ECG) monitoring was carried out in 272 cases with normal blood pressure, 164 cases with mild to moderate hypertension (diastolic blood pressure >95 and <114 mm Hg), and 106 cases with white-coat hypertension who were diagnosed with ambulatory blood pressure monitoring. The ages of the patients of all groups were between 42-61 years, There were no differences between the groups according to age, gender and other parameters, There were no anginal symptoms, and resting ECGs were in normal limits in all cases. The diagnosis of silent ischaemia was considered to be present if there was ST depression >2 mm/at least 120 sec in ambulatory ECG examination without angina or its equivalent cardiac symptoms. The incidence of silent ischaemia was 6.4%, 18.8%, and 26.2% in cases with normal blood pressure, WCH, and hypertension, respectively. The differences between groups were significant. It was concluded that WCH is not a benign condition, but shares some characteristics with essential hypertension.Öğe The prevalence of silent myocardial ischemia in patients with white coat, dipper and non-dipper hypertension(Lippincott Williams & Wilkins, 2002) Nalbantgil, S; Nalbantgil, I; Yilmaz, H; Ozerkan, F; Boydak, B; Gurgun, C; Zoghi, M; Onder, RÖğe Smoking and diabetes mellitus are independent risk factors of silent myocardial ischemia in normotensive healthy persons(Lippincott Williams & Wilkins, 2002) Nalbantgil, I; Yilmaz, H; Nalbantgil, S; Boydak, B; Gurgun, C; Zoghi, M; Ozerkan, F; Onder, RÖğe Sustained-release verapamil and trandolapril, alone and in combination, in the treatment of obese hypertensive patients: A double-blind pilot study(Excerpta Medica Inc, 1996) Nalbantgil, I; Onder, R; Nalbantgil, SThe purpose of this pilot study was to compare the ability of sustained-release verapamil (verapamil SR) and trandolapril, both alone and combined in half doses, to reduce blood pressure in obese patients with mild-to-moderate essential hypertension. Twenty patients (13 men and 7 women) took part in the study. Ten (group A) received verapamil SR 240 mg/d, and 10 (group B) received trandolapril 2 mg/d for 6 weeks. All patients were then given both drugs in half-doses for 6 weeks. After combination therapy, group B received verapamil SR 240 mg/d, and group A received trandolapril 2 mg/d for 6 weeks. When verapamil and trandolapril were used alone, systolic and diastolic blood pressures decreased significantly in each group. However, systolic and diastolic blood pressures fell further when combination therapy was used and rose slightly when the treatment was changed again to single-drug therapy. Side effects were fewer during the combination therapy. Thus the combination of half doses of verapamil SR and trandolapril was more effective in reducing blood pressure in obese patients with mild-to-moderate essential hypertension than a full dose of either drug given alone.Öğe Therapeutic benefits of cilazapril in patients with syndrome X(Karger, 1998) Nalbantgil, I; Onder, R; Altintig, A; Nalbantgil, S; Kiliccioglu, B; Boydak, B; Yilmaz, HObjectives: Although the pathophysiology of syndrome X (angina pectoris, positive ECG test findings and normal coronary arteriogram) is unclear, it is generally accepted that intracellular metabolic changes resulting from abnormal constriction of prearteriolar vessels due to endothelium-dependent vasodilation abnormalities may play a role in the pathogenesis. We established the effect of long-term treatment with cilazapril, an angiotensin-converting enzyme inhibitor, which prevents the effect of angiotensin II in the tonic control of vascular resistance. Methods: 18 patients (15 women and 3 men, mean age 43.2 +/- 4.6 years) with syndrome X were included in this study. A randomized double-blind crossover placebo-controlled trial was done. After a 1-week washout period, patients received either cilazapril 2 x 2.5 mg or placebo for 3 weeks, followed by 3 weeks of the other therapy. At the end of two periods, an exercise ECG test (modified Bruce protocol) was employed. Results: The magnitude of ST segment depression was significantly decreased during treatment with cilazapril compared with placebo. On the other hand, total exercise time and time to 1 mm ST segment depression were significantly prolonged by cilazapril. However, rate pressure products were not significantly different at peak exercise at or at 1 mm of ST segment depression during both therapies. Conclusion: Cilazapril exerted a beneficial therapeutic effect in cases with syndrome X. The possible mechanism of this effect may be a modulation of coronary tone at the microcirculation level.
