Blood Pressure Response Rates Research Articles

Antihypertensive Effect of Irbesartan and Predictors of Response in Obesity-Associated Hypertension

Obesity-associated hypertension is difficult to treat and puts patients at a substantially increased risk of cardiovascular events. Irbesartan has previously been shown to effectively lower blood pressure (BP) in high-risk groups including patients with type 2 diabetes mellitus or nephropathy, and may therefore also be suitable for the treatment of obesity-associated hypertension. In this study we aimed to: (a) assess the efficacy and tolerability of irbesartan alone and in combination with hydrochlorothiazide in patients with obesity-associated mild-to-moderate hypertension; and (b) investigate patient-associated determinants of poor BP control in this patient group. This was a 3-month, prospective, open-label, multicentre, phase IV study in 72 479 hypertensive patients in 6989 general practices across Germany. Main outcome measures were BP reduction (primary parameter of effectiveness) and BP response rates after 3 months, as well as adverse events (AEs). Independent predictors of poor control were identified in a multivariate proportional odds model. All of the patients were Caucasian, 50.5% were females, mean age was 62.1 +/- 11.1 years, mean bodyweight was 88.6 +/- 15.4kg, and mean body mass index (BMI) was 30.7 +/- 4.8 kg/m(2). Almost all the patients were overweight or obese (92.3%). From a baseline value of 162/94mm Hg, systolic and diastolic BP were reduced by a mean of -23/-12mm Hg after 3 months. 66.1% of the patients were responders (reduction of diastolic BP >/=10mm Hg), and 48.0% achieved BP normalisation (i.e. <140/90mm Hg). 79% of patients met their individual treatment goals as defined by the treating physician (mean 135/80mm Hg). AEs were reported in only 322 patients (0.4%). Factors requiring special attention in patients not achieving BP control were age (>55 years), high BMI category (>25 kg/m(2)), and increased waist circumference. Treatment with irbesartan (+/- hydrochlorothiazide) appeared to be effective and well tolerated in the study population of patients with obesity- associated hypertension. Easily recognisable characteristics allow physicians to identify patients whose BP is likely to be difficult to control.

A comparative analysis of the efficacy of olmesartan medoxomil (O)/hydrochlorothiazide (HCTZ), valsartan (V)/HCTZ, irbesartan (I)/HCTZ and telmisartan (T)/HCTZ combinations

P-243 Key Words: Olmesartan, ARB/HCTZ, Combination Therapy

Blood pressure responses to dose titration of the angiotensin receptor blocker olmesartan medoxomil in essential hypertension

Blood pressure (BP) control rates remain unacceptably low, in part because of clinicians’ tendencies to use very low doses of approved antihypertensive agents. With regard to angiotensin receptor blockers (ARBs), there is a poorly substantiated belief that the BP responses to dose titration are essentially flat across the usual dose range. This misconception has arisen largely from published drug development data that include pooled endpoint-limited dose titration studies performed in subjects with heterogeneous response patterns. In these pooled endpoint-limited antihypertensive drug studies, the apparent dose-response relationship is automatically flattened because the subgroup of individuals with heightened BP responses stop at the lowest dose while those intrinsically less responsive are titrated upward. The present analysis was therefore undertaken to identify whether the subgroup of individuals who respond less vigorously to the starting dose of olmesartan medoxomil (OLM) demonstrate a response to dose titration. A pooled analysis was performed based on the 3 BP studies in which OLM was titrated from the recommended starting dose of 20 mg/d to 40 mg/d. BP response rate was defined as achievement of seated diastolic BP (SeDBP) <90 mm or a reduction in SeDBP from baseline of ≥10 mm Hg. Two cohorts could be identified retrospectively: Group A (responders to OLM 20 mg/d) and Group B (those who were titrated to OLM 40 mg/d without the addition of other antihypertensive agents). Out of a total of 791 subjects, 404 (51%) were classified as Group A. Of the Group B subjects (n = 387 or 49%, mean baseline BP 162/102 mm Hg), titration to OLM 40 mg/d caused a further decrease in SeSBP/SeDBP of 5.7/4.7 mm Hg (P<0.001) and achieved an overall responder rate of 50%. We conclude that hypertensive individuals who do not respond adequately to low-dose OLM typically demonstrate a clinically significant dose-response relationship during titration from 20 to 40 mg OLM once daily. Present data, taken together with the excellent adverse effect profiles seen with ARBs, should encourage clinicians to use higher doses of these agents to achieve better BP control.

Fixed low-dose combination therapy for hypertension.

Despite the availability of various classes of antihypertensive agents that lower blood pressure by different primary actions, the treatment of hypertension remains a difficult task. Essential hypertension has a highly heterogeneous character, so that monotherapies are often not sufficient to normalize blood pressure. This is especially true since the goal of treatment is currently to normalize both systolic and diastolic blood pressure. By combining medications acting by different mechanisms, it is possible to gain considerably in terms of antihypertensive efficacy because of synergistic impacts on the cardiovascular system. Furthermore, low doses of antihypertensive agents are generally sufficient when used in combination, which accounts for the excellent tolerability of combination products. Fixed low-dose combinations are very useful tools for treating hypertensive patients. Because of their simplicity of use, and the fact that they improve the blood pressure response rate while minimizing the incidence of adverse effects, such combinations are increasingly being considered as suitable for both second-line and first-line therapy.

Eprosartan versus enalapril in hypertensive patients with angiotensin-converting enzyme inhibitor-induced cough

This multicenter, double-masked, double-dummy, randomized study was undertaken to compare the incidence of persistent, nonproductive cough during eprosartan or enalapril treatment or when receiving placebo in patients with mild-to-moderate hypertension and a history of angiotensin-converting enzyme inhibitor-induced cough. Patients were administered eprosartan 300 mg twice daily, enalapril 20 mg once daily, or placebo for 6 weeks. The primary efficacy variable was the incidence of persistent, nonproductive cough; secondary outcome measures included cough severity, changes in vital signs, response to antihypertensive therapy, and incidence of adverse events. Eprosartan significantly reduced the risk of nonproductive cough by 88% ( P = 0.008) and maximum cough by 57% ( P = 0.0085) compared with enalapril. Both the incidence and severity of cough end points in the eprosartan and placebo groups were comparable. The blood pressure response rate to treatment was 53% in the eprosartan group compared with 42% and 25% in the enalapril and placebo groups, respectively. Adverse events occurred more frequently in patients treated with enalapril than in those who received eprosartan or placebo. The incidence of cough of any nature or severity in the eprosartan group was comparable to that seen in the placebo group. Overall, persistent, nonproductive cough was clinically and statistically less in eprosartanthan in enalapril-treated patients. Eprosartan was at least as effective as enalapril at lowering blood pressure, and treatment with eprosartan was safe and well tolerated.

A study on the primary prevention of essential hypertension (1). Evaluation of blood pressure response during exercise and effect of habitual exercise

Hypertension is one of the risk factors of cardiovascular diseases, which are widely prevalent maladies that result in burdensome medical expenditures. Therefore, it is important to explore primary preventive measures for hypertension. Until recently, it was thought that exercise was a risk factor for hypertension, but recent reports have suggested that low-intensity physical training actually lowers blood pressure. However, habitual physical exercise has still not been clearly proven to prevent the development of hypertension. To clarify this point, one must first establish a method for predicting hypertension and second examine the possibility of preventing the development of hypertension by changing the subject's environment. In this study we have investigated a method for predicting hypertension by classifying blood pressure responses to increasing exercise intensity and the effect of habitual exercise on blood pressure response. This study was composed of three experiments. Experiment one involved female students (n = 42) and experiment two, male students (n = 38), in whom blood pressure response rates during exercise were recorded. In experiment three, the same group of female students (n = 23) was subjected to training in order to chart its effects on blood pressure response, both while exercising and while at rest. The exercises were performed with a bicycle ergometer in an upright position. There were four different degrees of work intensity. Blood pressure was measured using the auscultation method, with Riva-Rocci mercury measured by the same investigator. High blood pressure responses at rest were noted among some normotensive female and male students. The systolic blood pressure responses during the peddling exercise showed significant individual differences at the lowest work load; the distribution of the increment of the systolic blood pressure ratio at the lowest work load against the increment while resting showed two peaks. This result suggests that this increment ratio is an important variable related to the prediction of hypertension. The increment ratio showed no significant change in female students after three months of aerobic exercise. The high-response group showed high readings of the TPR indicator (MBP/VO2). Aerobic training was shown to be effective in significantly lowering the TPR indicator both at rest and during exercise. This result suggests that habitual exercise may contribute to preventing the development of hypertension.