Evaluation of amlodipine dosing for conversion of nifedipine extended-release to amlodipine in the treatment of hypertension.

OBJECTIVE: To evaluate the appropriate dosing of amlodipine when converting patients from nifedipine extended-release (nifedipine ER) to amlodipine in the treatment of hypertension. METHODS: Patients of the Outpatient Clinic of Cheyenne Veterans Affairs Medical Center, Wyoming, receiving nifedipine ER for the management of hypertension (systolic BP or SBP > 140 mm Hg and diastolic BP or DBP > 90 mm Hg), participated in this study. Nifedipine ER was changed to amlodipine on entry into this study. An inclusion criterion was the BP had to be under control (SBP < 140 mm Hg and DBP < 90 mm Hg) before the switch. The BP in each study patient was monitored once weekly (once every 2 wk in some patients) for a total of six clinic visits or until BP was under control. Dosing titration of amlodipine was required in 16 of 27 patients after the switch. To assess the adequacy of the conversion, the statistical significance of the difference of the mean BP values before and at the end of the monitoring period was estimated by using the t-test for paired data. RESULTS: Twenty-seven male patients completed this study. BP in all study patients was adequately controlled after nifedipine ER was switched to amlodipine. The SBP and DBP values before and after the switch were similar (SBP: 124 +/- 12 vs. 126 +/- 9 mm Hg, CI of the mean difference -6.10 to 1.80; DBP: 76 +/- 8 vs. 76 +/- 7 mm Hg, CI of the mean difference -2.45 to 3.63). Initial amlodipine dose of 5 or 10 mg once daily was used in our study. No serious adverse effects were observed in any of the study patients after the drug switch. CONCLUSIONS: This study indicates the amlodipine dosage of 5 or 10 mg once daily can be used when nifedipine ER is converted to amlodipine in the treatment of hypertension. Dosage titration of amlodipine may be required to obtain adequate control of BP.

The effectiveness of neuromuscular release massage therapy in five individuals with chronic obstructive lung disease.

The purpose was to examine neuromuscular release massage therapy (NRMT) as an intervention for individuals with chronic obstructive lung disease (COLD) to improve pulmonary function, respiratory muscle strength, and quality of life. Variables measured were thoracic gas volume, peak flow, oxygen saturation, blood pressure, heart rate, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, and quality of life to determine if improvement occurred with 24 weekly treatments of NRMT. Four of five participants had an increase in thoracic gas volume, peak flow, and FVC. Paired differences t test resulted in significant changes in heart rate, oxygen saturation, and time of breath hold. Repeated measured analysis of variance indicated a significant interaction between participant and time for heart rate, oxygen saturation, and systolic blood pressure. The results suggest that individuals with COLD do benefit from NRMT, but the exact physiological mechanism for the changes warrants additional study.