Efficacy and safety of 24 weeks of therapy with bendroflumethiazide 1.25 mg/day or 2.5 mg/day and potassium chloride compared with enalapril 10 mg/day and amlodipine 5 mg/day in patients with mild to moderate primary hypertension : a multicentre, randomised, open study.

BACKGROUND: The efficacy and safety of therapy with low-dose bendroflumethiazide 1.25 mg/day or 2.5 mg/day and potassium chloride was compared with that of enalapril 10 mg/day and amlodipine 5 mg/day in patients with mild to moderate primary hypertension. STUDY DESIGN: This was a multicentre study in general practice with patients randomised in a double-blind fashion and on open-label treatment. After a washout phase that lasted 4-6 weeks, 312 patients with a diastolic blood pressure of between 100 and 115 mm Hg were randomised in a double-blind fashion to treatment with either bendroflumethiazide 1.25 mg/day and potassium chloride (n = 117), bendroflumethiazide 2.5 mg/day and potassium chloride (n = 60), amlodipine 5 mg/day (n = 61) or enalapril 10 mg/day (n = 60), all given once daily (numbers in parentheses indicate the intention-to-treat population, with a total of 298 patients). The primary efficacy parameter was the reduction in diastolic blood pressure. Effects on systolic blood pressure, heart rate, biochemical variables, adverse events and quality of life were studied as secondary efficacy parameters. RESULTS: All treatments reduced diastolic blood pressure significantly; reductions were as follows: 6.8 mm Hg with bendroflumethiazide 1.25 mg/day, 9.1 mm Hg with bendroflumethiazide 2.5 mg/day, 10.8 mm Hg with amlodipine 5 mg/day and 6.8 mm Hg with enalapril 10 mg/day. The reduction in diastolic blood pressure on amlodipine was significantly greater than on bendroflumethiazide 1.25 mg/day and enalapril 10 mg/day (p = 0.013). The percentage of patients achieving a diastolic blood pressure of < 95 mm Hg was 34% (SD 4.4) with bendroflumethiazide 1.25 mg/day, 48% (SD 6.5) with bendroflumethiazide 2.5 mg/day (p = 0.075 vs bendroflumethiazide 1.25 mg/day), 57% (SD 6.3) with amlodipine 5 mg/day (p = 0.004 vs bendroflumethiazide 1.25 mg/day) and 41% (SD 6.4) with enalapril 10 mg/day (p = 0.41 vs bendroflumethiazide 1.25 mg/day) [mean reductions]. The effect on systolic blood pressure was similar with all treatments. No clinically significant changes occurred in heart rate, serum potassium, blood glucose, serum urate or serum cholesterol levels. The incidences of adverse events were similar in the low-dose bendroflumethiazide groups, with significantly higher incidences in the enalapril and amlodipine groups. Quality of life was similar in the different treatment groups, but the study had limited power to detect any difference in this parameter. CONCLUSION: The present study has confirmed, in a general practice population, that low-dose bendroflumethiazide (bendroflumethiazide 1.25-2.5 mg/day) in combination with potassium chloride is a well tolerated and efficacious first-line treatment for patients with mild to moderate essential hypertension.

Three days of pivmecillinam or norfloxacin for treatment of acute uncomplicated urinary infection in women.

Pivmecillinam is a unique beta-lactam antimicrobial that has been used for the treatment of acute uncomplicated urinary infection for > 20 y. Since this agent was introduced, the quinolone antimicrobials have become widely used for the same indication. This study compared the efficacy of a 3-d regimen of pivmecillinam 400 mg b.i.d. with norfloxacin 400 mg b.i.d. Women aged between 18 and 65 y presenting with symptoms of acute cystitis of < 7 d duration were eligible for enrollment; 483 were randomized to receive pivmecillinam and 471 to receive norfloxacin. In each group, 30% of women had negative urine cultures prior to therapy. Bacteriologic cure at early post-therapy follow-up was achieved in 222/298 (75%) pivmecillinam patients and 276/302 (91%) norfloxacin patients [p < 0.001; 95% confidence interval (CI) 12.0-21.8]. Clinical cure/improvement at Day 4 following initiation of therapy was observed in 434/457 (95%) women who received pivmecillinam and 425/442 (96%) who received norfloxacin (p = 0.39; 95% CI 1.5-3.9). Early post-therapy (11 +/- 2 d) clinical cure was achieved in 360/437 women (82%) who received pivmecillinam and 381/433 (88%) who received norfloxacin (p = 0.019; 95% CI 0.9-10.3). In women aged < or = 50 y, early clinical cure rates were 294/351 (84%) for pivmecillinam and 299/340 (88%) for norfloxacin (p = 0.11; 95% CI 1.0-9.4). Adverse effects were similar for both regimens, and there was no evidence of the emergence of organisms of increasing resistance with therapy. Short-course therapy with norfloxacin was superior to that with pivmecillinam in terms of bacteriologic outcome, although differences in clinical outcome were less marked. In conclusion, short-course therapy with pivmecillinam is an effective empirical treatment for pre-menopausal women.

Patients' experiences of antihypertensive drugs in routine use: results of a Danish general practice survey.

A questionnaire-based survey of 1843 patients with hypertension was conducted in Denmark to profile patients' experiences of antihypertensive therapy. A high proportion of patients were found to have experienced adverse effects attributable to antihypertensive drug therapy. The pattern of adverse event reporting was consistent with the known pharmacology of the drugs prescribed. Thus, cold extremities were reported most often with beta-blockers and peripheral oedema was associated with calcium channel blockers. Patients' experiences with losartan indicated that this drug was tolerated better than other types of medication, but this finding was based on a relatively small dataset. It is concluded that adverse experiences attributable to antihypertensive medications may be a significant obstacle to the implementation of effective treatment of hypertension and that greater physician awareness of the problems patients experience may help provide hypertension therapy that is well tolerated as well as effective.

[Diagnosis of sore throat. A multipractice study of 3 different ways of antigenic determination for detection of group A streptococci in throat swabs]. / Diagnostik af halsbetaendelse. En multipraksisundersøgelse af tre antigendetektionssoet til påvisning af gruppe a-streptokokker i svoelgpodninger.

During five months in the winter of 1992/1993, 34 general practitioners (GPs) from 18 offices participated in a clinical testing of three group A streptococcal antigen detection test (ADT) kits (Abbott TestPack Strep A Plus (Abbott), Concise Strep A, Hybritech (Concise) and Kodak SureCell Strep A (Kodak)). The GPs obtained duplicate throat swabs, one for processing with the ADT kit, the other for culture reference at The Streptococcus Laboratory (Bacteriological Department, Statens Seruminstitut, Copenhagen). A total of 1389 patients were enrolled in the study, thirty percent of whom were infected by group A streptococci. The following results were obtained: Abbott: Sensitivity: 76%, specificity: 99%, positive predictive value: 97%, negative predictive value: 91%. Concise: Sensitivity: 82%, specificity: 95%, positive predictive value: 86%, negative predictive value: 92%. Kodak: Sensitivity: 84%, specificity: 87%, positive predictive value: 73%, negative predictive value: 93%. As a follow-up to the main study, each GP filled in a questionnaire, stating his opinion about the investigated ADT kit. Considering the practical handiness, Concise scored higher than Abbott, which in turn scored higher than Kodak. In conclusion, Abbott and Concise are recommended for the diagnosis of group A streptococcal pharyngotonsillitis in general practice.

Relation between low dose of hydrochlorothiazide, antihypertensive effect and adverse effects.

Thiazide diuretics are widely used in the drug treatment of hypertension but their dose-response curves for the antihypertensive and adverse metabolic effects differ. To characterize the lower end of the dose-response curve a double-blind, parallel group trial was performed as multicentre study in Scandinavia. One hundred and eleven patients with newly diagnosed or previously treated mild to moderate hypertension (untreated diastolic blood pressure of 95-115 mmHg after 4 weeks placebo) were randomly allocated to various doses of hydrochlorothiazide (3, 6, 12.5 or 25 mg) or placebo for 6 weeks. Blood pressure and biochemical variables (plasma renin activity, serum potassium, magnesium, urate, fasting glucose, total cholesterol, HDL-cholesterol, triglycerides and apolipoproteins A1 and B were measured. 12.5 mg hydrochlorothiazide had a borderline effect on blood pressure whilst 25 mg had a definite antihypertensive effect. Biochemical changes were seen in plasma renin activity, serum potassium and urate after the 12.5 and 25 mg dose. Three and 6 mg had no effect on blood pressure or metabolic parameters.

An evaluation of a commercial co-agglutination test for the diagnosis of group A streptococcal tonsillitis in a family practice.

The result of a rapid co-agglutination test was compared with the clinical diagnosis of group A streptococcal tonsillitis, a laboratory culture from the throat serving as the correct result. The study was carried out in a family practice, with two GPs partaking: it included 105 consecutive patients. The outcome of the rapid test was significantly correlated to the degree of growth determined by throat culture, and it was superior to the clinical judgement. The statistical analysis of the results of the rapid test revealed (95% confidence limits in brackets) a specificity of 97% (91-100), sensitivity of 68% (48-84), a positive predictive value of 90% (70-99), and a negative predictive value of 89% (81-95). Although the co-agglutination test was superior to the clinical diagnosis, the sensitivity of this test is rather low when compared with other recently evaluated rapid tests for use in family practice.