A patient on haemodialysis with bowel ischemia was given vancomycin 500 mg orally every 6 h for superimposed Clostridium difficile colitis resulting in a high vancomycin serum concentration. When treating C. difficile colitis in patients with significant renal impairment and bowel injury, we recommend administering the lower dose of oral vancomycin.

We compared treatment with an angiotensin II receptor antagonist (ARB) and a calcium channel blocker (CCB) combination and a fixed-dose ARB and thiazide diuretic in 18 chronic kidney disease (CKD) patients. A randomized crossover study was performed using a fixed-dose combination of losartan-hydrochlorothiazide or losartan combined with controlled-release nifedipine. Both systolic blood pressure (SBP) and diastolic blood pressures (DBPs) were lower during the nifedipine period than during the diuretic period. No significant difference was observed in urinary albumin excretion, but the estimated glomerular filtration rate was higher in the nifedipine than in the diuretic period. Serum uric acid and low-density lipoprotein cholesterol were higher in the diuretic than in the nifedipine period. A significantly low cardio-ankle vascular index, an index of arterial wall stiffness, was observed in the nifedipine period. A combination of ARB and a controlled-release nifedipine at 20-40 mg used showed a superior antihypertensive effect in CKD patients compared to a fixed-dose combination of losartan 50 mg-hydrochlorothiazide 12.5 mg in terms of blood control. The former combination is considered advantageous for maintaining renal function and artery wall elasticity without influencing uric acid or lipid metabolism.

SummaryMost previous studies have examined the effects of antihypertensive drugs in hypertensive animals for only a few months, and little information has been provided as to the protective effects of lifetime antihypertensive medication against cardiovascular organ injury. In this study, spontaneously hypertensive rats (SHR) were treated for 1 year with an angiotensin-II receptor antagonist (ARB) and the development of hypertensive organ injury was evaluated. Male 15-week-old SHR (n = 9) were given 25 mg/L candesartan (CS) in their drinking water for 1 year. Twelve SHR and 9 normotensive Wistar-Kyoto rats (WKY) were given normal tap water. Tail-cuff blood pressure was almost normalized by CS throughout 1 year (at 12-months: WKY 132 ± 3, SHR 229 ± 3, CS 137 ± 4 mmHg). After 1 year, cardiac ventricular weight (SHR +33%, CS -2% versus WKY) and aortic thickness (SHR +34%, CS +4% versus WKY) in the CStreated SHR rats were not different than those of WKY. Echocardiographic midwall fractional shortening (SHR -18%, CS -1% versus WKY) and left ventricular hydroxyproline content (SHR +47%, CS +11% versus WKY) were also improved by CS to the WKY level. With respect to kidney function, GFR (SHR -24%, CS +9% versus WKY) was preserved, proteinuria (SHR +312%, CS +12% versus WKY) was reduced, and the histological glomerular injury rate (SHR +186%, CS +6% versus WKY) was reduced by CS. These results suggest that long-term antihypertensive therapy with CS can completely prevent hypertensive cardiovascular and renal injuries in SHR. (Int Heart J 2010; 51: 359-364)

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SummaryAmong angiotensin receptor blockers (ARBs), telmisartan is suggested to function as a partial agonist of peroxisome proliferator-activated receptor-γ (PPAR γ) and to improve lipid and glucose metabolism. Clinical benefits of telmisartan over other ARBs may be apparent in combination with diuretics, which have harmful influences on lipid and glucose metabolism. In the present study, 21 patients treated with mild to moderate hypertension (13 women and 8 men aged 63.1 ± 11.6 years) underwent a 24-week treatment period with telmisartan 40 mg and HCTZ 12.5 mg once daily, or a 24-week treatment period with losartan 50 mg and HCTZ 12.5 mg once daily, without a wash-out period, in a quasi-randomized cross-over manner. Their ambulatory blood pressure and metabolic parameters were measured after the 2 treatment periods. Ambulatory systolic and diastolic blood pressures did not differ significantly between the 2 treatment periods during 24 hours, daytime, night-time, and early-morning hours (06:00-08:00). Serum uric acid was insignificantly higher in the treatment period with telmisartan/HCTZ than in the treatment period with losartan/HCTZ (P = 0.086). Although serum total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol did not differ significantly, serum triglycerides were slightly higher in the treatment period with telmisartan/HCTZ than in the treatment period with losartan/HCTZ (P = 0.060). Parameters of glucose metabolism did not differ significantly between the 2 treatment periods. In conclusion, antihypertensive efficacy was similar between the 2 regimens throughout 24 hours, despite different elimination half-lives of telmisartan and losartan. Although telmisartan is suggested to function as a partial agonist of PPARγ, no clinical benefit was found in combination with HCTZ with respect to lipid and glucose metabolism. (Int Heart J 2009; 50: 85-93)