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Schmidt Salita Law Team

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Top rated (5 star client rating, AV), Award Winning (Super Lawyer, Million Dollar Roundtable, MTLA Distinguished Service Award), 70 years’ experience, over 10,000 successful cases-Free Consultation.

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Nationally Recognized Personal Injury Wrongful Death Law Firm | Millions Recovered For Our Clients | Experience - Integrity - Results | Free 45 minute Detailed Case Evaluation By ... Read more Nationally Recognized Trial Lawyer Emery Ledger 800-300-0001. Grace Jack Rogers ril5lK5t

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Nicolet Law Office, S.C.

Car Accident Lawyers at 724 Bielenberg Drive, Suite 126, Woodbury, MN 55125

A highly rated Law Firm practicing Automobile Accidents law.

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Sjoberg Tebelius, P.A.

Car Accident Lawyers at 2145 Woodlane Drive, Suite 101, Woodhill Office Park, Woodbury, MN 55125

Personalized estate and business planning, probate, real estate, family law, employment, and more in Minnesota and Western Wisconsin.

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Sjoberg Tebelius, P.A.

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Serving individuals, business and insurance companies in legal matters venued in Minnesota Wisconsin since 1991.

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The padded collar is double-foam padded and nylon reinforced to cushion a snug and comfy ankle The classic boot laces are made of 100% recycled nylon and have been re-engineered to stay tied 400 grams of PrimaLoft®

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The padded collar is double-foam padded and nylon reinforced to cushion a snug and comfy ankle The classic boot laces are made of 100% recycled nylon and have been re-engineered to stay tied 400 grams of PrimaLoft® insulation

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We’ve been using nubuck leather to craft our hard-wearing boots for decades – and our Earthkeepers® Newmarket 6-Inch Cupsole is the latest version of a classic style. A comfortable cupsole cradles your heel, linings made from recycled plastic bottles let your feet breathe, and the siped outsoles provide traction through eco-conscious recycled rubber.

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These boots have the recognizable styling of our original waterproof boots, but in colors and materials that are only available for a short time. Get one of these unique pairs before they're gone forever!

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The iconic Timberland® 6-inch boot has worked hard for almost 40 years to keep feet the world over looking fantastic – and feeling even better. Be a little unpredictable in your choice of men’s boot with this range where contrasting shades, tones and textures are the norm. Dry, warm and cosy feet all-day long are a given, however, with a seam sealed...

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Effects of high dose olmesartan medoxomil plus hydrochlorothiazide on blood pressure control in patients with grade 2 and grade 3 hypertension

Original Article | Published:

, pages 565 574 (2011) | Download Citation

High dose (40 mg) olmesartan medoxomil (OM) blocks the angiotensin II receptor, significantly reducing blood pressure (BP). Adding hydrochlorothiazide (HCTZ) to OM increases efficacy, but has not been evaluated in patients inadequately controlled by OM 40 mg. Patients with grade 2 and grade 3 hypertension with inadequately controlled BP (seated diastolic blood pressure [SeDBP] 90–115 mm Hg and seated systolic blood pressure [SeSBP] 140–180 mm Hg, plus ambulatory BP criteria) after 8 weeks of OM 40 mg open-label treatment were randomized to 8 weeks of double-blind treatment with OM/HCTZ 40/25 (=140), 40/12.5 (=278), 20/12.5 mg (=280) or OM 40 mg (=274). Treatment with OM/HCTZ 40/25 mg and 40/12.5 mg significantly reduced SeDBP (−5.3 and −3.4 mm Hg, respectively), and SeSBP (−7.4 and −5.2 mm Hg, respectively), vs OM 40 mg monotherapy (<0.0001 for each) in patients inadequately controlled on OM 40 mg alone. OM/HCTZ 40/12.5 mg reduced SeSBP significantly more than OM/HCTZ 20/12.5 mg (−2.6 mm Hg, =0.0255), and also produced a further reduction in SeDBP vs the lower dose. All treatments were well tolerated, with similar low proportions of patients reporting treatment-emergent adverse events in all treatment groups. In conclusion, adding HCTZ to OM 40 mg significantly improves BP reductions and target BP rates in harder-to-treat patients and a clear dose-response was observed for efficacy.

Hypertension is closely associated with an increased risk of cardiovascular disease events. In order to reduce the risk of cardiovascular disease associated with hypertension, health authorities have published guidelines that set maximum levels of acceptable blood pressure (BP), typically 140/90 or 130/80 mm Hg in patients with diabetes or at high cardiovascular risk, and have recently recommended that it may be prudent to consider lowering BP to values within the range 130–139/80–85 mm Hg in all hypertensive patients. However, population-based surveys show a high prevalence of hypertension in many countries, with 38% of men and 32% of women affected across both developed and developing countries. Moreover, the frequency of uncontrolled BP in patients with hypertension who are receiving treatment is high. Estimates show that across all countries, only 11% of male and 17% of female patients receiving treatment for hypertension are controlled, and this underlines the need for improved patient management and more effective treatments.

The efficacy of antihypertensive therapy can be increased by combining agents from different classes, and studies have consistently shown that the majority of patients will require 2 antihypertensive agents in order to achieve target BP. Treatment guidelines increasingly stress the role of combination therapy in the treatment of hypertension, especially for patients at increased CV risk and have highlighted the use of fixed dose combinations, on the basis that they improve compliance by simplifying therapy. The European Society of Hypertension-European Society of Cardiology (ESH-ESC) guidelines recommend that agents used in combination therapy should have complementary mechanisms of action that provide greater efficacy than either monotherapy component together with a favourable tolerability profile. Several classes of antihypertensive agents are listed by the ESH-ESC guidelines as suitable for use in combination therapy, and these include thiazide diuretics and angiotensin II receptor blockers (ARBs).

The ESH-ESC guidelines do not provide recommendations on the individual members of drug classes, but recently a meta-analysis of ambulatory BP studies involving ARBs has shown that the drug used and its dose level are determinants of BP reduction. However, differences in angiotensin II (AT) receptor blockade observed with the various ARBs have been explained mainly by differences in dosing. It can also be seen in the meta-analysis of Fabia that the ARB olmesartan medoxomil (OM) provides effective BP reductions over 24-h, which are maintained during the night-time and last few hours of the dosing interval. Pharmacodynamic studies support this notion and treating patients with the high (40 mg) dose of olmesartan should provide a high level of AT-receptor blockade leading to increased BP reductions and control.

The addition of hydrochlorothiazide (HCTZ) 12.5 and 25 mg to OM 20 mg has been shown to deliver increased BP-lowering efficacy compared with continuation of OM 20 mg monotherapy in patients whose BP was inadequately controlled on OM 20 mg monotherapy. However, the combination of HCTZ with the 40 mg dose of OM has not been evaluated in such a setting. Furthermore, relatively little data is available on the efficacy of OM 40 mg combined with HCTZ in patients with more severe hypertension. Such patients provide an important insight into efficacy as these patients often fail to achieve target BP, as illustrated by an analysis which found that in studies involving patients with high initial BP levels, the majority remained above or only slightly below SBP 140 mm Hg after treatment.

The present randomized study was designed to assess the antihypertensive efficacy and tolerability of HCTZ (12.5 and 25 mg) when used in combination with OM 40 mg in patients with grade 2 and grade 3 hypertension who had failed to achieve an adequate level of BP control following 8 weeks of treatment with open-label OM 40 mg. The study also assessed the efficacy of the combination of OM/HCTZ 40/12.5 mg compared with OM/HCTZ 20/12.5 mg.

This was a two-phase, randomized, double-blind, multi-national, parallel group Phase III study that was conducted at 78 sites in Europe (Bulgaria, Czech Republic, France, Germany, Poland, Spain, Ukraine). The study was designed and conducted in accordance with the ethical principles of the International Conference on Harmonisation guidelines for Good Clinical Practice and the Declaration of Helsinki. The study was approved by the relevant Independent Ethical Committee in each participating country, and each patient provided written informed consent before entering the study.

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