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Medical research on cardura
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2007 Dec; 29(6): 792-6
Hua CX, Hua L, Li N, Wang L, Pang HM, Ming GH, Huang Y, Cheng XR, Liu H, Wu Y, Xu L, Kang J, Xu ZM, Li YS
OBJECTIVE: To evaluate the efficacy of the monotherapy of 15 agents in treating essential hypertension. METHODS: After 2-week wash-out, a total of 370 patients with seated diastolic blood pressure 95-114 mmHg and seated systolic blood pressure < 180 mmHg were randomized to different therapeutic groups. 24-hour ambulatory blood pressure monitoring was performed before medication and at the end of 8 weeks. RESULT: All the agents significantly reduced the 24 hour mean blood pressures after treatment except doxazosin, terazosin, and torasemide. CONCLUSION: The result suggested that the angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers and long-acting calcium antagonists were effective in treating essential hypertension, while the low-dose doxazosin, terazosin and torasemide can be used for combination therapy but not for monotherapy.
Zhonghua Nan Ke Xue. 2008 May; 14(5): 451-3
Zhang Y, Sun FL, Zang T
OBJECTIVE: To compare the effect of the combined therapy of medication with local hyperthermia with that of the simple local hyperthermia therapy in the treatment of pain symptoms of chronic prostatitis (CP). METHODS: Seventy-six CP patients aged 18-48 (mean 29.2 +/- 3.8) years, with the disease course of 3.5-180 (mean 8.0 +/- 1.2) months and NIH-CPSI pain score > or = 14, were equally randomized into a treatment group and a control. The former was treated by applying the CRS-2280E extraorgan short-wave capacitance field hyperthermia system to the prostate once an hour every other day for 7 times, combined with anal administration of 1 Qianliean suppository and oral doxazosin 4 mg before dedtime every night for 2 weeks, while the latter underwent simple local hyperthermia. All the patients were scored on NIH-CPSI and the therapeutic results were compared between the two groups. RESULTS: The pre- and post-treatment NIH-CPSI scores were (23.9 +/- 3.8) and (5.2 +/- 3.1) (P < 0.01) in the treatment goup and (24.5 +/- 4.3) and (11.6 +/- 3.4) (P < 0.01) in the control; the pre- and post-treatment scores on NIH-CPSI pain symptoms were (16.5 +/- 1.9) and (3.1 +/- 2.2) (P < 0.01) in the former and (15.9 +/- 1.7) and (8.2 +/- 2.0) (P < 0.01) in the latter. The total score on NIH-CPSI and that on NIH-CPSI pain symtoms were both significantly higher in the treatment group than in the control (P < 0.01). Within the treatment group, the score on NIH-CPSI pain symptoms was even more significantly improved in patients with the first attacks than in those already treated by other means (P < 0.01). No adverse effects were observed in either of the groups. CONCLUSION: Both the combined therapy of medication with local hyperthermia and simple local hyperthermia are effective, safe and tolerable in the treatment of CP pain symptoms, and the former is even more desirable, particularly for those with the first attacks of the symptoms.
5alpha-Reduktase-Inhibitoren - Benigne Prostatahyperplasie und vieles mehr. BPH, Alopezie und Co.
Pharm Unserer Zeit. 2008 Jun 23; 37(4): 310-314
Holzgrabe U, Bennack E
Die 5alpha-Reduktase-Inhibitoren Finasterid und Dutasterid können bei der BPH gleichwertig eingesetzt werden. Manche Leitlinien sehen allerdings alpha-Blocker den 5alpha-Reduktase-Inhibitoren überlegen. In der Studie von McConnell et al. gibt es Hinweise, dass eine Kombinationstherapie aus dem alpha-Blocker Doxazosin und dem 5alpha-Reduktase-Inhibitor Fina-sterid einer Einzeltherapie überlegen ist. Allerdings scheinen die Kosten deutlich höher als der Nutzen zu sein.
Circulation. 2008 Jul 1; 118(1): 42-8
Chapman N, Chang CL, Dahlöf B, Sever PS, Wedel H, Poulter NR,
BACKGROUND: The role of doxazosin in treatment of hypertension remains controversial. METHODS AND RESULTS: We evaluated the effects on blood pressure (BP) and biochemical parameters of doxazosin GITS (gastrointestinal therapeutic system) as a third-line antihypertensive agent among 10,069 participants in the Anglo-Scandinavian Cardiac Outcomes Trial--Blood Pressure Lowering Arm (ASCOT-BPLA) whose BP remained above 140/90 mm Hg (130/80 mm Hg in those with diabetes mellitus). Among those who received doxazosin, mean age was 63 years (SD 9 years), 79% were male, and 32% had diabetes. Doxazosin was initiated a median of 8 months (interquartile range 3 to 24 months) after randomization and was added to a mean of 2.0 (SD 0.3) other antihypertensive drugs; the mean starting and final doses were 4.1 (SD 0.6) and 7.0 (SD 3.1) mg, respectively. During a median of 12 months (interquartile range 4 to 31 months) of uninterrupted doxazosin treatment, during which other antihypertensive treatments remained unchanged, mean BP fell 11.7/6.9 mm Hg (SD 18.8/9.6 mm Hg, P
J Hypertens. 2008 Jul; 26(7): 1463-1471
Matsui Y, Eguchi K, Shibasaki S, Ishikawa J, Hoshide S, Pickering TG, Shimada K, Kario K,
OBJECTIVES: Doxazosin is reported to increase the incidence of congestive heart failure. The benefits of doxazosin, for controlling morning blood pressure as well as its effect on the left ventricular structure and function, are herein examined. METHODS: In this study, 223 morning hypertensive patients were randomized into either the doxazosin group, with a once-daily bedtime dose of doxazosin, or the control group, who continued their current medication. Atenolol was added to the doxazosin group when needed. The effect of doxazosin was evaluated by measurement of echocardiographic parameters and B-type natriuretic peptide. RESULTS: The left ventricular wall thickness decreased, but the left ventricular diastolic diameter in the doxazosin group increased from the baseline. The changes in the left ventricular mass index were similar between the groups, whereas the relative wall thickness in the doxazosin group decreased more than that in the control group. The left ventricular diastolic function could deteriorate in the doxazosin group. In the doxazosin group, an increase in the left ventricular diameter was only seen in the patient who did not take diuretics throughout the study. The office and home blood pressure in the doxazosin group decreased more than that in the control group, whereas the B-type natriuretic peptide increased in the doxazosin group. Three cases of congestive heart failure were observed in the doxazosin group, but none in the control group. CONCLUSION: Although a bedtime dose of doxazosin can significantly lower the blood pressure, it can also increase left ventricular diameter, thus increasing the risk of congestive heart failure. However, the prior use of diuretics can prevent the unfavorable effects of doxazosin on the left ventricular structure.
Hypertens Res. 2008 Mar; 31(3): 443-53
Guzik P, Wykretowicz A, Krauze T, Piskorski J, Adamska K, Milewska A, Wesseling KH, Wysocki H
This study was designed to determine whether or not the addition of a single nighttime dose of doxazosin in extended-release form (GITS; gastrointestinal therapeutic system) would affect the autonomic modulation of the cardiovascular system in patients with uncontrolled hypertension treated with a multi-drug regimen. Resting 5-min noninvasive finger blood pressure and ECG signals, as well as 24-h Holter ECGs, were recorded in 30 patients with uncontrolled hypertension on multi-drug treatment before and after 16-week add-on therapy with doxazosin GITS. Cardiovascular autonomic modulation was evaluated by spectral analysis of heart rate variability (HRV) and a cross-correlation method for spontaneous baroreflex sensitivity (BRS) in 5-min resting recordings, and by the analysis of Poincaré plots and phase-rectified signal averaging of the duration of cardiac cycles in 24-h ECG recordings. This combined therapy significantly reduced systolic pressure (19.4+/-3.5 mmHg; p
J Hypertens. 2008 Jun; 26(6): 1257-65
Kario K, Matsui Y, Shibasaki S, Eguchi K, Ishikawa J, Hoshide S, Ishikawa S, Kabutoya T, Schwartz JE, Pickering TG, Shimada K,
BACKGROUND: The impact on microalbuminuria of strict treatment aimed at lowering of self-measured morning blood pressure using an adrenergic blockade is unclear. METHODS: We conducted an open-label multicenter trial, the Japan Morning Surge-1 Study, that enrolled 611 hypertensive patients, whose self-measured morning systolic blood pressure levels were more than 135 mmHg while taking antihypertensive drugs. These were randomly allocated to an experimental group, whose members received bedtime administration of 1-4 mg doxazosin (doxazosin group) or a control group whose members continued without any add-on medication (control group). The urinary albumin/creatinine ratio was investigated at the baseline and 6 months after the randomization. RESULTS: Both the morning and evening blood pressures and urinary albumin/creatinine ratio (-3.4 vs. 0.0 mg/gCr for urinary albumin/creatinine ratio; P < 0.001) were more markedly reduced in the doxazosin group than in the control group. This difference in the urinary albumin/creatinine ratio between the two groups was more marked in the patients with microalbuminuria (n = 238, -27.9 vs. -8.1 mg/gCr, P < 0.001). The reduction of urinary albumin/creatinine ratio was significantly associated with the use of doxazosin, and the change in all self-measured blood pressures (morning, evening, the average morning-evening), and these associations were independent of each other (P < 0.001). CONCLUSION: Adding a bedtime dose of an alpha-adrenergic blocker titrated by self-measured morning blood pressure in treated hypertensive patients with uncontrolled morning hypertension significantly reduced blood pressure and urinary albumin excretion rate, particularly in those with microalbuminuria.
J Physiol Pharmacol. 2008 Mar; 59(1): 189-201
Kasacka I, Majewski M
We have previously shown that the endocrine cells in the stomach increase in number in spontaneously hypertensive rats (SHR) that suggests that the hypertension has an influence on the intrinsic regulatory system by endocrine cells control in the stomach of rats. The aim of the present study is to find differences in the density of neuroendocrine (NE) cells of stomach rats and composition in doxazosin treated SHR compared to untreated animals. Fragments of the pyloric region were collected at 12 weeks of age. Paraffin-embedded sections were stained with H+E and by silver impregnation. To identify NE cells, immunohistochemical reaction (IR) was performed with the use of a specific antibody against somatostatin, gastrin, serotonin and chromogranin. It was revealed that the distribution density of IR-endocrine cells all searched types was considerable lower in the pyloric mucosa of hypertension animals treated with doxazosin compared to SHR untreated and was on level healthy rats. The present study demonstrated that doxazosin inhibit the hypertension-induced changes of endocrine cells in the stomach of SHR.
Comparison of the cardiac electrophysiological effects between doxazosin and bunazosin.
J Biomed Sci. 2008 Jul; 15(4): 519-28
Lee AS, Chen WP, Su MJ
In Langendorff-perfused adult rat heart with constant pressure at 80 mmHg, we found doxazosin, an alpha(1) adrenoceptor blocker, at 10 muM prolonged PR interval and induced occasional arrhythmia followed by complete inhibition of the sinus rhythm, whereas bunazosin, another alpha(1)-blocker, at same concentration did not. The results of voltage-clamp study showed that, at the concentration of 10 muM, doxazosin inhibited I (Na), I ( (Ca,L) ), I (to), and Iss without changing I (k1) but bunazosin only inhibited I ( (Ca,L) ) about 30%. Doxazosin also caused markedly negative shift of the I (Na) inactivation curve. In current-clamp study, doxazosin prolonged action potential duration in association with the decreased action potential amplitude and upstroke velocity, whereas bunazosin did not. We hypothesize that doxazosin-induced arrhythmia may result from the heterogeneous or different level of I ( (Ca,L) ) blockade of AV nodal tissue. In conclusion, the present study suggests that bunazosin is safer than doxazosin for long-term treatment in view of electrophysiological effect. However, the underlying mechanism of doxazosin induced nodal arrhythmia is still needed to be determined.
Clin Ther. 2008 Mar; 30(3): 482-98
Esnault VL, Brown EA, Apetrei E, Bagon J, Calvo C, DeChatel R, Holdaas H, Krcmery S, Kobalava Z,
BACKGROUND: Placebo-controlled trials have found that angiotensin-converting enzyme inhibitors (ACEIs) decrease proteinuria and slow the progression of nondiabetic nephropathies. However, head-to-head comparisons of ACEIs and calcium channel blockers (CCBs) have shown conflicting results. Indeed, a recent metaanalysis concluded that there is still uncertainty about the greater renoprotection seen with ACEIs or angiotensin II receptor blockers in nondiabetic patients with renal disease, particularly when using true glomerular filtration rate (GFR) as the primary outcome. OBJECTIVE: The objective of this 3-year, randomized, multicenter, double-blind, placebo-controlled study was to compare true GFR decline (measured by yearly 51Cr-EDTA blood clearance) in nondiabetic, nonnephrotic adult hypertensive patients with estimated creatinine clearance of 20 to 60 mL/min.1.73 m(2), when randomized to a CCB (amlodipine, 5-10 mg/d) or an ACEI (enalapril, 5-20 mg/d). METHODS: Patients (aged 18-80 years) entered a 4-week placebo run-in washout period and previous antihypertensive drugs were tapered off over 2 weeks. Add-on treatments were atenolol (50-100 mg/d), loop diuretics (furosemide, 20-500 mg/d or torsemide, 5-200 mg/d), alpha-blockers (prazosin, 2.5-5 mg/d or doxazosin, 1-16 mg/d), and centrally acting drugs (rilmenidine, 1-2 mg/d or methyldopa, 250-500 mg/d). The primary end point was true GFR measured by yearly (51)Cr-EDTA blood clearance. Secondary end points included a clinical composite of renal events and tolerability collected by a full clinical and laboratory evaluation at each study visit. Post hoc analyses for the change in GFR, proteinuria, and time to clinical events were also planned on baseline proteinuria subgroups (or=1 g/d) before unblinding the database. RESULTS: Three hundred eighteen patients entered the run-in period and 263 patients (156 men/107 women; mean age, 58 years) were randomized to receive either amlodipine (5 mg/d, n=132) or enalapril (5 mg/d, n=131). Blood pressure declined from 165/102 mm Hg to 138/84 mm Hg and 138/85 mm Hg with amlodipine and enalapril, respectively (no between-group significance). Only 20.8% of the patients randomized to ACEI treatment received diuretics at the last observation. No statistically significant difference was found between amlodipine and enalapril in GFR decline (-4.92 and -3.98 mL/min.1.73 m(2), respectively, at last observation) and composite secondary end point after a median follow-up of 2.9 years, including in the subgroup of patients with proteinuria >1 g/d at baseline. Protein excretion rate decreased significantly from baseline in patients taking enalapril plus diuretics (median -270 mg/d; P1 g/d.