The American journal of medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of terazosin as an antihypertensive agent.
A total of 713 patients with hypertension were evaluated in eight randomized, double-blind, placebo-controlled trials of terazosin administered in single daily doses ranging from 1 to 40 mg. In three of these studies, terazosin or placebo was added to ongoing antihypertensive drug therapy. Patient response was categorized (from excellent to inadequate) according to the change in supine diastolic blood pressure from baseline and the value at the final visit. ⋯ Overall, 52 percent of terazosin-treated patients in these eight studies, compared with 30 percent of placebo-treated patients, had good to excellent responses. Subgroup analysis revealed that blood pressure response was not dependent on sex or age, although white patients appeared to achieve better responses to terazosin in comparison with placebo than did black patients. These studies demonstrate that terazosin administered once daily, either as monotherapy or in combination with other antihypertensive agents, effectively controls blood pressure in patients with mild to moderate hypertension.
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A group of 2,122 healthy men in the Honolulu Heart Program who participated in the Cooperative Lipoprotein Phenotyping Study, 1970 to 1972, were followed for 10 years by repeated examinations and surveillance of hospital discharge and mortality records in order to diagnose new cases of coronary heart disease, stroke, cancer, and other deaths. Total cholesterol and low-density lipoprotein cholesterol were significantly associated with all clinical types of coronary heart disease in multivariate analyses, whereas high-density lipoprotein cholesterol was inversely associated with nonfatal myocardial infarction and total coronary heart disease, but not with fatal coronary heart disease nor angina. ⋯ Thus, for total disease (coronary heart disease, stroke, cancer, and other deaths), the optimal range for lowest disease incidence was about 200 to 220 mg/dl for total cholesterol and 120 to 140 mg/dl for low-density lipoprotein cholesterol. A strong inverse pattern of total disease with high-density lipoprotein cholesterol indicated that the highest levels were the optimal levels.
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The relation of blood pressure to fasting (basal) insulin and glycosylated hemoglobin (hemoglobin A1) was examined in 248 nondiabetic subjects (137 women and 111 men). None of the subjects was taking antihypertensive medication. ⋯ In a multiple regression analysis, the association between blood pressure and insulin level was diminished with an allowance for adiposity; however, it remained statistically significant. These data indicate that blood pressure is related to insulin levels in nondiabetic subjects and suggest that insulin may be a physiologic determinant of blood pressure.