I. Lotensin-HCT Fact file

Lotensin-HCT was introduced by Novartis pharmaceuticals.

Novartis Pharmaceuticals Corporation is the U.S. affiliate of Novartis AG (NYSE:NVS), a world leader in healthcare.

Novartis has core businesses in pharmaceuticals, consumer health, generics, eye care, and animal health. In the U.S., Novartis has quickly achieved a reputation as an industry leader.

II. Lotensin-HCT Medication

Lotensin-HCT medication (Benazepril-hydrochlorothiazide) is a combination of two drugs used to lower blood pressure.

Lotensin (Benazepril) is an ACE inhibitor that controls high blood pressure (hypertension) by relaxing blood vessels. Hydrochlorothiazide is a diuretic.

High blood pressure can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. By lowering blood pressure, Lotensin-HCT medication can help reduce your risk of having damage to your kidneys, heart, or other organs. Lotensin-HCT medication does not cure high blood pressure.

Antihypertensives: Information

Antihypertensives include:

• Diuretics ("water pills")
• Beta Blockers
• Alpha Blockers
• Alpha-Beta Blockers
• Sympathetic Nerve Inhibitors
• Angiotensin Converting Enzyme (ACE) Inhibitors
• Calcium Channel Blockers
• Angiotensin Receptor Blockers (formal medical name angiotensin-2-receptor antagonists, known as "sartans" for short). These agents are sometimes prescribed together, for instance an ACE inhibitor along with a calcium channel blocker.

In general, antihypertensives work through one or more of the following mechanisms:

• By Decreasing Blood Volume
• By Opening Up Blood Vessels, either by
  • Inhibiting Constriction (narrowing) or
  • Stimulating Dilation (widening), to make it easier for blood to flow through the arteries
• By Decreasing Rate and/or Force of Contraction of the Heart, thus decreasing the amount of blood pumped through the arteries

Diuretics counteract high blood pressure by removing excess salts and water from the body in the form of urine.

• The removal of excess water decreases blood volume.
• The removal of excess salt helps to flush sodium from the walls of the blood vessels, allowing the blood vessels to dilate.

Some common diuretics include:

• Amiloride (brand name Midamor)
• Bumetanide (Bumex)
• Chlorothiazide (Diuril)
• Chlorthalidone (Hygroton)
• Furosemide (Lasix)
• Hyrdochlorothiazide (HydroDIURIL)
• Indapamide (Lozol)
• Methyclothiazide (Enduron)
• Metolazone (Zaroxolyn)
• Spironolactone (Aldactone)
• Triamterene (Dyrenium)

ACE inhibitors block the body's production of angiotensin, a vasoconstrictor (chemical which stimulates constriction of blood vessels), thereby decreasing constriction of blood vessels.

Some common ACE inhibitors include:

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Prinivil, Zestril)
• Quinapril (Accupril)
• Ramipril (Altace)

Hypertension (High Blood Pressure): Information

Approximately 50 million Americans aged 6 and older have elevated blood pressure (hypertension). In approximately 15% of these patients, a specific cause (i.e., Cushing's disease) can be identified: the remainder are said to have primary (essential) hypertension.

Diagram: Blood Pressure

Diagram: Hypertension

High blood pressure, sometimes called hypertension, means high pressure (tension) in the arteries. It does not mean excess emotional stress, though doctors' believe that stress might contribute to high blood pressure over a longer period of time.

Your blood pressure rises and falls with each heartbeat, even normal blood pressure does this. These levels can change with everyday activity, for example, during exercise or when you are asleep and this is also normal.

However, in some people, and as we get older, these changes in blood pressure start to happen at higher pressure levels than normal and this is what high blood pressure means.

Your blood pressure is usually measured with a blood pressure cuff placed around the upper arm that registers the pressure in units called millimeters of mercury (or mm Hg).

Your blood pressure is usually considered to be high when it is at a level exceeding 140/90 mm Hg ("140 over 90") on several readings under various conditions. However, defining normal and abnormal is not always so clear-cut and your doctor or healthcare professional will make the necessary recommendations.

Blood pressure rises and falls with each heartbeat. Systolic blood pressure, the higher number, represents the pressure in the arteries as the heart contracts and sends blood into the circulation.

Diastolic pressure, the lower number, occurs as the heart relaxes following a beat. It represents the lowest pressure to which the arteries are exposed between heartbeats.

High blood pressure may be present for several years before it is detected and is often found during a routine check-up, for example, for insurance purposes. Usually there are no symptoms and consequences may only become apparent after many years.

Doctors know that there is a benefit from treating high blood pressure at any age, even in older patients of 65 years and over. Depending on the level of the blood pressure, different things are recommended. In some people with only mild elevations in blood pressure a change in diet and adopting a healthier lifestyle may reduce the blood pressure to normal. Your healthcare professional will provide you with the right diet for you. Its not just lowering the amount of salt you eat, although this is important: there are other things you can change in your diet that can help.

Also, if you are overweight, getting slimmer may help.

If necessary, high blood pressure can be treated with a range of different medicines, including:

• Beta-blockers, which make the heart beat more slowly and less strongly. They work by blocking the action of nerves supplying the heart that release a chemical called noradrenaline. This helps to control the rhythm and force of heart muscle movement. They also block a hormone called adrenaline (a chemical carried in the blood), which is similar to noradrenaline.
• Diuretics, which work in the kidneys to make you pass urine more often and get rid of excess fluid.
• Calcium-channel blockers, which relax arterial blood vessels making them less narrow. These lower the resistance to blood flow, allowing blood to flow more easily. They work by preventing calcium from entering the muscles in blood vessels because calcium is important in narrowing down blood vessels.
• ACE inhibitors and angiotensin II antagonists, which in general relax the blood vessels. They do this by preventing a hormone called angiotensin II from working, either by preventing its production or blocking its action. Like other hormones, angiotensin II is an active chemical signal in the blood. It controls the function of many organs or systems including the narrowing of blood vessels and prevents the kidneys from getting rid of excess fluid. Doctors believe that angiotensin II is involved as one of the causes of high blood pressure.

It is also important to follow any lifestyle instructions that your doctor has given to you, like trying to give up smoking, reducing your weight, doing more exercise and eating a healthy diet. When these and other risk factors are present together with high blood pressure, then this means there is even higher risk of serious disease.

It is also important to continue taking any medications you have been given, even if you feel normal.

No specific cause is found in 95% of patients with hypertension - this is called primary hypertension or sometimes essential-hypertension.

Most patients have primary, or essential hypertension. Most cases of primary hypertension are due to increased stiffness and narrowing of the smaller (peripheral) arteries.

This results in increased resistance to the flow of blood and is what makes the blood pressure go up.

Increased peripheral artery resistance is associated with genetics (family history), obesity, lack of exercise, over use of salt, and the natural ageing process.

A few patients have high blood pressure with a known cause (secondary hypertension). Long-lasting (chronic) kidney disease accounts for most of these patients where there is excessive fluid accumulation in the body that raises blood pressure. Hypertension can also occur during some pregnancies.

Diuretics: Information

Diuretics are sometimes called "water pills." Diuretics are medicines that help reduce the amount of water in the body.

Diuretics are used for the following conditions:

• High blood pressure: Diuretics lower blood pressure, which substantially reduces the risk of stroke and heart attack.
• Heart failure: Diuretics reduce the swelling and water build-up caused by heart failure.
• Kidney problems: Diuretics reduce water-retention.
• Liver problems: Diuretics reduce the amount of fluid build-up associated with cirrhosis (disease of the liver).
• Glaucoma: Diuretics reduce the pressure in the eye associated with this disease

Diuretics act on the kidneys to increase urine output. This reduces the amount of fluid in the bloodstream, which in turn lowers blood pressure.

There are several types of diuretics, also called water pills:

1. Loop diuretics , such as bumetanide (Bumex) and furosemide (Lasix), get their name from the loop-shaped part of the kidneys where they have their effect. Loop-acting diuretics cause the kidneys to increase the flow of urine. This helps reduce the amount of water in your body and lower your blood pressure. They tend to act faster than thiazides and have a great diuretic effect. It is important, therefore, to control the medication to avoid dehydration and excessive loss of potassium.
2. Thiazide diuretics include such commonly used diuretics as hydrochlorothiazide (Hydrodiuril, Esidrix), chlorothiazide (Diuril), and chlorthalidone (Hygroton). Thiazide diuretics are used to treat high blood pressure by blocking the sodium absorption from the kidney back into the blood.. Thiazides are the only type of diuretic that dilates (widens) the blood vessels, which also helps to lower blood pressure.
3. Potassium-sparing diuretics prevent the loss of potassium, which is a problem with other types of diuretics. These block the action of aldosterone, so that more potassium is left in the blood, and more sodium and water are excreted in the urine. Examples of potassium-sparing diuretics are amiloride (Midamor) and triamterene (Dyrenium). Unlike the other diuretic medicines, these medicines do not cause your body to lose potassium.

In addition, some medicines contain combinations of two diuretics. The brands Dyazide and Maxzide, for example, contain the thiazide diuretic hydrochlorothiazide with the potassium-sparing diuretic triamterene.

Side Effects of Antihypertensives

• Antihypertensives have in common that they can overcompensate for high blood pressure, leading to dangerously low blood pressure.
• Lightheadedness, Dizziness, or Fainting would be an initial indication of inadequate blood pressure levels.

Note: Decreased blood pressure in a mother also has the potential to harm her developing baby. Since blood volume determines the amount of blood filtered/urine processed by the kidneys, antihypertensives have effects on that organ as well. Although in general blood-pressure-lowering medicines reduce strain on the kidney, some antihypertensives like sartans can nevertheless worsen kidney disease.

• Another major concern with hypertensives is that they can aggravate congestive heart failure.
  As with most any drug, blood-pressure-lowering medications can have milder side-effects as well. While on an antihypertensive, report any changes in your condition to your health care provider.

Side effects of Diuretics

• Frequent urination: This may last for up to six hours after a dose. If you are taking two diuretic doses each day, take the second dose in the late afternoon so you can sleep through the night.
• Arrhythmia (abnormal heart rhythm)
• Extreme tiredness or weakness: These effects should decrease as your body adjusts to the medication. Call your doctor if these symptoms persist.
• Muscle cramps or weakness. Be sure that you are taking your potassium supplement correctly, if prescribed. Contact your doctor if these symptoms persist.
• Dizziness, lightheadedness: Try rising more slowly when getting up from a lying or sitting position.
• Blurred vision, confusion, headache, increased perspiration (sweating), restlessness. If these effects are persistent or severe, contact your doctor.
• Dehydration: Signs include dizziness, extreme thirst, excessive dryness of the mouth, decreased urine output, dark-colored urine or constipation. If these symptoms occur, don't assume you need more fluids, call your doctor.
• Fever, sore throat, cough, ringing in the ears, unusual bleeding or bruising, rapid and excessive weight loss. Contact your doctor right away.
• Skin rash: Stop taking the medication and contact your doctor right away.
• Loss of appetite, nausea, vomiting or muscle cramps. Be sure that you are taking your potassium supplement correctly, if prescribed.
• Rarely, potassium-sparing diuretics like Aldactone can cause breast enlargement in men and women, deepening of the voice, increased hair growth and irregular menstrual cycles.

Uses of Diuretics

Diuretics prevent, treat or improve symptoms in a variety of conditions, such as:

• High blood pressure
• Congestive heart failure
• Edema
• Polycystic ovary syndrome
• Certain kidney disorders, such as kidney stones
• Diabetes insipidus
• Female hirsutism
• Osteoporosis

Other uses of diuretics:
Diuretics may be used to treat certain other conditions.

• Loop diuretics:
  • Hypercalcemia (too much calcium in the blood)
  • Diagnostic aid for kidney disease
• Spironolactone:
  • Polycystic ovary syndrome
  • Hirsutism in women (excessive body and facial hair growth)
• Thiazide diuretics:
  • Diabetes insipidus (water diabetes)
  • Kidney stones (calcium containing)

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III. Useful links

http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/cder/ogd/

http://www.nih.gov/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

http://www.health.gov.on.ca/

National Library of Medicine

World Health Organization

http://www.mayoclinic.com/index.cfm

MedicineNet.com

Drugdigest.org

Healthsquare.com

http://www.pharma.us.novartis.com/novartis/index.jsp

http://www.drugdigest.org/DD/DVH/Uses/0,3915,68%7CLotensin+HCT,00.html

http://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/cardiovascular/antihypertensives.html

http://lysine.pharm.utah.edu/netpharm/netpharm_00/notes/antihypertensives.html#Introduction

http://www.patienthealthinternational.com/article/501305.aspx

http://www.tmc.edu/thi/diurmeds.html

http://my.webmd.com/content/pages/9/1675_57798.htm

http://www.umm.edu/careguides/hbp/hbp_diuretics.html

http://www.swedish.org/16716.cfm

Pharmacy sites

http://www.roche.com/home/company/com_hist.htm

http://www.healthdigest.org/Bactrim-DS(Oral)_2006_PRO.php

http://www.hsforum.com/stories/storyReader$1509

http://www.hsforum.com/stories/storyReader$1516

http://www.hsforum.com/stories/storyReader$1504

http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting

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