Urapidil 60mg capsules

Aims: To evaluate the efficacy of different pharmacologic treatment for severe hypertension during pregnancy. Methods: Two reviewers searched Ovid MEDLINE, Ovid EMbase, and the Cochrane Library for randomized clinical trials from the establishment of the database to 15 July 2021 that were eligible for inclusion and analyzed the pharmaceuticals used for severe hypertension in pregnancy. Results: 29 relevant trials with 2,521 participants were involved. Compared with diazoxide in rate of achieving target blood pressure, other pharmaceuticals, including epoprostenol (RR:1.58, 95%CI:1.01–2.47), hydralazine\dihydralazine (RR:1.57, 95%CI:1.07–2.31), ketanserin (RR:1.67, 95%CI:1.09–2.55), labetalol (RR:1.54, 95%CI:1.04–2.28), nifedipine (RR:1.54, 95%CI:1.04–2.29), and urapidil (RR:1.57, 95%CI:1.00–2.47), were statistically significant in the rate of achieving target blood pressure. According to the SUCRA, diazoxide showed the best therapeutic effect, followed by nicardipine, nifedipine, labetalol, and nitroglycerine. The three pharmaceuticals with the worst therapeutic effect were ketanserin, hydralazine, and urapidil. It is worth noting that the high ranking of the top two pharmaceuticals, including diazoxide and nicardipine, comes from extremely low sample sizes. Other outcomes were reported in the main text. Conclusion: This comprehensive network meta-analysis demonstrated that the nifedipine should be recommended as a strategy for blood pressure management in pregnant women with severe hypertension. Moreover, the conventional pharmaceuticals, including labetalol and hydralazine, showed limited efficacy. However, it was important to note that the instability of hydralazine reducing blood pressure and the high benefit of labetalol with high dosages intakes should also be of concern to clinicians.

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Objectives: The application of urapidil for treating hypertensive patients with acute heart failure in the emergency department remains controversial. Our objective was to organize the relevant articles and assess the clinical indexes between urapidil and nitroglycerin. Materials and methods: PubMed, EMBASE, the Cochrane Library and China National Knowledge Infrastructure were searched for randomized studies that compared urapidil treatment with nitroglycerin treatment for hypertensive patients with acute heart failure. The risk ratio, with 95% CI, was calculated by using a corresponding effects model, according to the value of I 2 . Results: Seven randomized controlled trials were identified, in order to compare the clinical indexes. On comparing the clinical indexes, the urapidil group was found to be better than the nitroglycerin group in regard to left ventricular ejection fraction, systolic blood pressure, N-terminal prohormone of brain natriuretic peptide, left ventricular end-diastolic volume, cardiac index, ALT, AST and health complications ( P <0.05), but the indexes of creatinine were worse in the urapidil group. Furthermore, the two methods of treatment were comparable in diastolic blood pressure, left ventricular end-systolic volume, left ventricular end-systolic dimension, heart rate, fasting plasma glucose and total cholesterol levels ( P >0.05). Conclusion: Based on the current evidence, urapidil treatment had better clinical safety features than the traditional pharmaceutical treatment with nitroglycerin. For those indicators with a small amount of data, a greater number of randomized, high-quality controlled trials should be conducted in order to further verify the findings, which could give researchers a more comprehensive evaluation of urapidil treatment. Keywords: urapidil, nitroglycerin, acute heart failure, meta-analysis

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Background: Takayasu's arteritis (TA) is an autoimmune disease that invades large arteries and mostly occurs in women of childbearing age. It leads to thickening and loss of elasticity of the arterial wall, and eventually vascular occlusion, aneurysm or dissection formation. Type B aortic dissection (TBAD) during pregnancy is a rare disease, which is mostly caused by the increase of blood volume in circulation during pregnancy, the effect of estrogen and progesterone on the aorta, or congenital diseases. TBAD in TA pregnant women is very rare, and the condition is often complicated. It is necessary to make a multidisciplinary treatment plan and determine the timing and method of operation to save the life of mother and fetus. Case description: We report a pregnant woman at 35 weeks of gestation who presented to the emergency department with sudden and continuously unrelieved chest pain. She had TA for five years. Thoracoabdominal aortic computed tomography with angiography (CTA) showed acute TBAD. Her blood pressure was 209/73 mmHg and could not be lowered with Urapidil, therefore she was diagnosed with complex Stanford type B aortic dissection. She underwent cesarean section under general anesthesia, and the tracheal tube was not removed after surgery. Thoracic endovascular aortic repair (TEVAR) was administered under anesthesia 8 h after cesarean section. Intraoperative aortography showed that the stent blocked the tear of the intima of the aorta, and the false cavity was reduced. Her blood pressure was reduced to the normal range (140/90 mmHg or less), and the baby's vital signs were stable. They were discharged five days later. Use steroids to control TA throughout treatment. One year after the operation, the mother was healthy and the baby developed well. Conclusion: Early identification and accurate diagnosis should be made for acute TBAD in late pregnancy. Under the premise of stable hemodynamics, the fetus is delivered by cesarean section first and then TEVAR is the preferred treatment. The diagnosis and treatment plan of AD during pregnancy should be developed and implemented by multiple disciplines according to the vital signs of mother and fetus. TA pregnant women should take steroids during pregnancy, closely detect inflammatory indicators, and avoid pathogenic microbial infection, inflammatory state and complications. At the same time, the necessary follow-up is also the key to ensure the treatment effect.

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PURPOSE: To evaluate the neuroprotective effect of resveratrol, urapidil, and a combined administration of these drugs against middle cerebral artery occlusion (MCAO) induced ischemia/reperfusion (IR) injury model in rats. METHODS: Thirty-five rats were divided into five groups of seven animals each. Animals in IR, IR resveratrol (IRr), IR urapidil (IRu), and IR + combination of resveratrol and urapidil (IRc) were exposed to MCAO induced cerebral ischemia reperfusion injury model. Rats in IRr and IRu groups received 30-mg/kg resveratrol and 5-mg/kg urapidil respectively. Animals in IRc received a combined treatment of both drugs. At the end of the study, brain tissues were used for oxidative stress (malondialdehyde, glutathione, and superoxide dismutase), pro-apoptotic caspase-3, anti-apoptotic Bcl-2, and pro-inflammatory tumor necrosis factor-α cytokine level measurements. RESULTS: The MCAO model successfully replicated IR injury with significant histopathological changes, elevated tissue oxidative stress, and upregulated apoptotic and inflammatory protein expression in IR group compared to control group (p < 0.001). All parameters were significantly alleviated in IRr group compared to IR group (all p < 0.05). In IRu group, all parameters except for caspase-3 and Bcl-2 were also significantly different than IR group (all p < 0.05). The IRc group showed the biggest difference compared to IR group in all parameters (all p < 0.001). The IRc had higher superoxide dismutase and Bcl-2 levels, and lower caspase-3 levels compared to both IRr and IRu groups (all p < 0.05). Also, the IRc group had lower MDA and TNF-α levels compared to IRu group (all p < 0.05). CONCLUSIONS: The results indicate that combined treatment of resveratrol and urapidil may be a novel strategy to downregulate neurodegeneration in cerebral IR injury.

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PURPOSE: One of the important causes of morbidity and mortality in the world is traumatic brain injury (TBI), which is a process that triggers damaging mechanisms such as inflammation, oxidative stress, and apoptosis. The results of current pharmaceutical methods are not enough, and researches into new therapy modalities are needed. This study aimed to evaluate the neuroprotective effects of Urapidil (Ura), which is an alpha-1 adrenergic receptor antagonist with serotonergic activity, in a TBI model and investigating signaling pathways like high mobility group box 1 (HMGB1), BCL2-interacting protein 3-like (BNIP3L), and hypoxia-inducible factor-1 alpha (HIF1α). METHODS: (5 mg/kg) groups. Tissue integrity and expressions of tumor necrosis factor-alpha (TNF-α), caspase-3 (Cas-3), tyrosine hydroxylase (TH), HIF1α, BNIP3L, and HMGB1 were assessed. Ura's biochemical oxidative stress indicators were also assessed. RESULTS: Ura treatment at both doses, significantly decreased histopathological findings, BNIP3L, HMGB1, and HIF1α expressions, TNF-α, Cas-3, TH immunexpressions, and TOS and OSI levels, and elevated TAS levels compared to TBI group. These results show that Ura regulates molecular pathways related to TBI, including neuroinflammation, mitochondrial dysfunction, and hypoxia. CONCLUSION: Ura shows promising tissue-protective effects in TBI by targeting inflammation, oxidative stress, and apoptosis. This study provides a new perspective on the need for further development of Ura for therapeutic use.

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PURPOSE: In patients with pheochromocytoma current guidelines recommend preoperative alpha-adrenoceptor blockade with selective or nonselective antagonists for at least 7-14 days. To date, no information exists about orally administered urapidil retard, a short-acting selective antagonist. METHODS: The medical records of consecutive patients with pheochromocytoma between 2010 and 2023 were reviewed. Patients received phenoxybenzamine between 2010 and 2017, intravenous urapidil was given between 2017 and 2019. Orally administered urapidil retard has been used from 2019 until present. RESULTS: Forty-nine patients with pheochromocytomas were included. Twenty-six patients received orally administered long-acting phenoxybenzamine and 23 patients were pretreated with short-acting intravenous (n = 8) or orally administered urapidil (n = 15). Treatment prior to surgery was significantly shorter with intravenously (3 days (IQR, 3-4), p = 0.015) or orally administered urapidil (2 days (IQR 2-3), p = 0.003) compared to phenoxybenzamine (7 days (IQR, 4-10)). Side effects were more often in the phenoxybenzamine group (17/26 vs 6/23, p = 0.02). The modified hemodynamic instability (HI) score was low and there was no significant difference between patients treated with phenoxybenzamine and those treated with intravenous or oral urapidil (29 (IQR 18.5-38); 26 (IQR 18-42); 31 (IQR 15-36) ns). No 30-day postoperative mortality or cardiovascular complications occurred in any of the three groups. The postoperative hospital stay was significantly shorter in the orally administered urapidil group compared to the phenoxybenzamine group (3 days (IQR 3-5)) vs 4 days (IQR 4-5)), p = 0.04). CONCLUSION: Oral pretreatment with urapidil retard is well tolerated for patients with pheochromocytoma, enabling a safe intra- and postoperative course.

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Background: The aim of this study was to determine whether dexmedetomidine can reduce the circulatory response in laparoscopic uterine fibroids (UF) surgery. Our purpose was to investigate the effect of dexmedetomidine on the circulatory response in laparoscopic UF surgery. Methods: This was a randomized controlled study of 214 patients age range of 40–60 years, American Society of Anesthesiologists (ASA) 1–2 grade, undergoing elective laparoscopic UF surgery at Fuxing Hospital, Capital Medical University from January 2020 to October 2023. Patients were randomly allocated to the non-dexmedetomidine group (Group1) and dexmedetomidine group (Group2). The mean arterial pressure (MAP) and heart rate (HR) were measured: when entering the operation room (MAP1, HR1), immediately at the time of local pituitrin injection (MAP2, HR2), and at 5 minutes after injection of pituitrin (MAP3, HR3). The medications and dosages (propofol, urapidil hydrochloride, fluid) used during the operation were recorded as well as the recovery (drowsiness, chills, nausea, vomiting, dysphoria) after the operation. Total mean time from the beginning of the operation to pituitrin injection (Time1) and recovery time after peaking blood pressure with pituitrin injection (Time2) were also recorded. Results: There were no significant differences in age, height, weight, size and number of UFs, and the location of uterine fibroids between the two groups. There were no differences between the groups for MAP1, MAP2, HR1, HR2, HR3, and Time1 (all p &gt; 0.05), but the dexmedetomidine group was smaller in MAP3 (p = 0.041) and Time2 (p = 0.000) than the non-dexmedetomidine group. There were significant differences in MAP3-MAP1 (p = 0.025), propofol (p = 0.011), and urapidil hydrochloride (p = 0.000) between the two groups. The dexmedetomidine group was smaller in chills (p = 0.002), nausea (p = 0.000), vomiting (p = 0.04), and dysphoria (p = 0.024) than the non-dexmedetomidine group. Conclusions: Dexmedetomidine maintains a stable hemodynamic response and is beneficial to postoperative recovery in laparoscopic UF surgery. Clinical Trial Registration: The study has been registered on https://classic.clinicaltrials.gov/ (registration number: NCT03524950).

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