Target BP Research Articles

EFFICACY AND SAFETY OF FIXED RAMIPRIL + FELODIPINE COMBINATION IN TREATMENT OF ARTERIAL HYPERTENSION: A RETROSPECTIVE STUDY-FORECAST

Approximately 30-50% of the world's adult population suffer from arterial hypertension, and only 30-35% is successfully treated. A large number of patients with arterial hypertension require a combination of antihypertensive medications to achieve target blood pressure. The ESH/ESC recommendations suggest the use of fixed dose combinations for treatment simplification and improved adherence to treatment. The aim of this study was to evaluate efficacy and safety of fixed ramipril + felodipine combination in therapy of essential arterial hypertension. This multicentric, cross-sectional, non-interventional study evaluated 1.341 adult patients with essential arterial hypertension, defined by systolic and diastolic blood pressure increase (BP≥140/90 mmHg), only systolic blood pressure increase or antihypertensive therapy usage. All patients were treated with fixed-dose combination therapy ramipril + felodipine (5+5mg and 2.5+2.5mg) (Triapin® and Triapin mite®) therapy for at least two months. Efficacy was evaluated by proportion of patients who achieved target blood pressure values (<140/90 mmHg and <130/80 mmHg in diabetics) or defined blood pressure reduction (≥15/10mmHg). Safety of ramipril + felodipine therapy was evaluated based on the incidence of adverse events (AE) and therapy discontinuation rate during observational period. Therapy prescription was based on physician decision according to everyday clinical practice and 15 consecutive eligible patients were enrolled by each physician from the cohort of hypertensive patients treated in ambulatory setting. Patient population consisted of 647 (48.4%) males and 690 (51.7%) females (mean age 60.15±11.84 and mean duration of hypertension 9.5±7.34 years). Males were significantly younger (58.74±15.5 vs. 61.45±11.04, p<0.01) without difference in body mass index. There were 47.5% of patients with stage II, 29.2% with stage I and 23.3% with stage III. There was a significant reduction of systolic/diastolic BP and heart rate in patients with ramipril + felodipine combination (162.6±17/97.2±9 mmHg and 79.4±12/min) compared to baseline values prior to treatment (136.9±17/84.2±9 mmHg and 73.2±10 /min, p<0.01). Group with Triapin mite had lower reduction of systolic/diastolic BP compared to Triapin 21.4±15.9/11.6±9.8 vs. 28.9±19.2/14.1±11.0 mmHg and lower reduction of heart rate 6.1 vs. 6.3 /min (p<0.01). In total, 39.3% of patients reached target BP with or without target BP reduction, 30.0% reached only BP reduction and 30.7% did not reach target values. More patients reached target BP (48.4 vs 32.%) and less achieved defined BP reduction (18.8 vs. 38.9%) on Triapin mite therapy compared to Triapin (p<0.01). The proportion of patients who failed to reach any of these endpoints is similar in both treatment modalities. AEs were present in 34 patients (2.5%): headache in 9 (0.7%), lower leg swelling in 8 (0.6%) and dry cough in 4 (0.2%) cases - these were reported as the most frequent. None of reported adverse events was serious. Therapy continuation was reported in 92.6% of patients. Reasons for therapy discontinuation were insufficient drug efficacy in 29 (2.2%) patients; AE in 28 (2.1%) patients and other reasons in 34 (2.6%) patients. Triapin therapy efficacy and safety evaluated by physicians were: excellent efficacy in 824 (61.4%) patients and excellent safety in 870 (64.9%) patients. Fixed dose combination of ramipril + felodipine was shown to be an effective antihypertensive therapy in patients with essential arterial hypertension and an alternative approach to monotherapy for the initial management of essential hypertension. Small proportion of patients discontinued from ramipril+felodipine therapy and rare AEs indicate excellent safety profile.

ANTIHYPERTENSIVE THERAPY TACTICS IN HYPERTENSIVE CRISE COMPLICATED BY HAEMORRHAGIC STROKE

Aim. To identify the optimal tactics of antihypertensive therapy (AHT) in patients with hypertensive crise (HC), complicated by haemorrhagic stroke (HS).Material and methods. Forty patients aged 46–87 years, who were hospitalised with HC and HS as its complication.Results. All patients were divided into two groups, according to the median levels of systolic blood pressure (SBP) at 20 minutes after the start of the treatment: SBP &gt;161 mm Hg vs. SBP &lt;161 mm Hg. A significantly better survival was observed in patients with a higher degree of the 20-minute SBP eduction. In addition, patients were divided into tertiles of the 20-minute SBP levels. Participants with SBP 136–149 mm Hg demonstrated a significantly better survival. The degree of SBP reduction at 220 minutes was not significantly associated with survival. Furthermore, the patients were divided into two groups by the rate of SBP reduction. Faster rates were associated with a better survival (PGW=0,002). The second part of the study was focused on the assessment of effectiveness and safety of urapidil hydrochloride (Ebrantil). The patients were randomised into two groups: one group was administered Ebrantil, while another received the standard neuroresuscitation unit treatment. Ebrantil therapy demonstrated a fast and effective SBP reduction at 20 minutes, which was also associated with a better survival.Conclusion. We identified optimal, associated with a better survival, BP levels (136–149 mm Hg) for patients with HC complicated by HS. Target BP levels should be achieved within 20 minutes, as a slower BP reduction is linked to a worse prognosis. Ebrantil is an effective and safe antihypertensive medication.

Effects of antihypertensive therapy on glucose, insulin metabolism, left ventricular diastolic dysfunction and renin system in overweight and obese hypertensives

We attempted to test the hypothesis that the direct renin inhibitor aliskiren can improve diastolic dysfunction, glucose, and insulin metabolism (GIM) in overweight and obese hypertensive patients. Seventy-eight hypertensive patients were divided into two groups: 38 treated with aliskiren for six months, and 40 treated without aliskiren but with only traditional anti-hypertensive therapy, as controls. Doppler mitral flow velocity patterns were assessed before and after aliskiren during a six-month period. GIM (three-hour intravenous glucose tolerance test) was measured after four to six weeks of washout and six months of treatment. The mitral E/A ratio increased from 0.65 ± 0.11 to 0.75 ± 0.19. None of the indexes changed in the control group. In the control group, GIM parameters, fasting glucose levels (5.3 ± 0.9 to 6.0 ± 1.5 mmol/l; p = 0.003), fasting insulin levels (121 ± 121 to 189 ± 228 pmol/l; p = 0.03), and most other relevant metabolic measures (p < 0.05 for all) significantly worsened. Aliskiren did not affect GIM. In the control group LVM/height was not affected (119 ± 12 to 120 ± 17 g/m; p = 0.8), whereas aliskiren significantly reduced LVM/height (120 ± 13 to 111 ± 19 g/m; p = 0.04). Optimal target BP was achieved in the group as a whole and in both obese patient groups, while benefits to cardiac structure were of a smaller magnitude. In high-risk, overweight/obese patients with hypertension, traditional therapy provides significantly greater BP- versus aliskiren-lowering throughout the 24-hour dosing interval. Therefore in obese, hypertensive individuals, adequate and similar blood pressure control was achieved with aliskiren; however, the aliskiren group and not the control group was associated with a more favorable GIM profile and led to a significant regression of LVM; overall aliskiren-based treatment offers sustained control of PRA.

Сравнительная эффективность небиволола и бисопролола в плане влияния на центральное артериальное давление и упруго-эластические свойства артерий у пациентов с мягкой и умеренной артериальной гипертензией

Введение. В настоящее время широко обсуждается поиск новейших методов снижения сердечно-сосудистого риска в популяции. Во многих рандомизированных исследованиях было доказано значение жесткости артериальной стенки в ухудшении прогноза кардиологических больных. Поэтому, исходя из таких соображений, терапия, в состав которой входят бета-блокаторы с вазодилатирующими свойствами, возможно, обладает более выраженным эффектом в профилактике основных кардиоваскулярных событий.Однако подобные свойства основных представителей группы бета-блокаторов были изучены недостаточно. С одной стороны, это связано с тем, что большая часть контролируемых исследований была проведена с использованием низкоселективного бета-блокатора атенолола. С другой — существует мало исследований, в которых бы проводили сравнение эффективности бета-блокаторов между собой.Цель. Данное исследование ставило перед собой целью сравнить эффективность бисопролола и небивoлола в улучшении упруго-эластических свойств артерий.Материалы и методы. Мы проводили наблюдения с участием 40 больных с мягкой и умеренной артериальной гипертензией (24 мужчины, 16 женщин). Все пациенты были разделены на 2 группы терапии небивололом (n = 20) и бисопрололом (n = 20). Если не удавалось достичь целевого уровня АД, добавляли гидрохлортиазид. Процедура обследования в начале исследования и через 6 месяцев включала в себя измерение офисного систолического (САД) и диастолического (ДАД) артериального давления, суточное мониторирование артериального давления, измерение центрального артериального давления, определение скорости распространения пульсовой волны (СРПВ), частоты сердечных сокращений (ЧСС) и оценку уровня липидов.Результаты. После анализа всех данных было установлено, что показатели офисного САД и ДАД значительно снизились у больных как с мягкой, так и с умеренной гипертензией в группе небиволола. В конце периода наблюдения произошло значительное снижение офисного САД и ДАД в обеих группах (30,5/15,95 мм рт.ст. в группе небиволола и 30,35/17,65 мм рт.ст. в группе бисопролола). Офисная ЧСС снизилась на 10,40 и 7,85 уд/мин соответственно. Такое выраженное снижение офисного АД можно объяснить тем, что в случае недостижения целевого уровня АД через 1 месяц терапии к монотерапии добавляли второй препарат — гидрохлортиазид.Уровень центрального САД достоверно снизился в обеих группах, однако в группе небиволола это снижение было достоверно большим по сравнению с бисопрололом — на 17,55 ± 3,86 и 8,67 ± 1,57 мм рт.ст. соответственно. Разница в достижении центрального САД — 8,88 мм рт.ст. (р &lt; 0,05). Нами отмечено также улучшение упруго-эластических свойств артерий за счет снижения СРПВ в обеих группах по артериям как эластического типа, так и мышечного. Однако наблюдалась разница в динамике СРПВ при анализе групп отдельно. Так, в группе небиволола выявлено достоверное снижение СРПВ по артериям эластического типа на 1,61 м/с. В группе бисопролола также наблюдалось снижение СРПВэ на 1 м/с, но оно было недостоверным (вероятно, в связи с небольшим числом наблюдений).Вывод. При одинаковом снижении офисного и амбулаторного АД в группе небиволола центральное аортальное давление в группе небиволола снизилось достоверно более выражено по сравнению с группой бисопролола. Это, возможно, связано с вазодилатирующими свойствами небиволола. Скорость распространения пульсовой волны достоверно снизилась только в группе небиволола.

Postmarketing study of efficacy and safety of losartan during the treatment of patients with mild and moderate hypertension: Lothar study

Losartan, the angiotensin type 1 receptor blocker (ARB) exercises its main antihypertensive effect by vasodilatation of peripheral arteries. The aim of this study was to evaluate the antihypertensive effect and safety of losartan in patients with mild and moderate arterial hypertension (AH). This was an open post-marketing study with losartan as monotherapy in previously treated or untreated patients with AH. Primary efficacy parameter was the percentage of patients that achieved target blood pressure after 8-week treatment with a single daily dose of losartan of 50-100 mg. Safety parameters were assessed according to the percentage of adverse events and metabolic effects of therapy. The study included 550 patients with AH (59% female and 41% male), mean age 56.8 +/-11.4 years, BMI = 27 +/- 4 kg/m2. Losartan was applied in 31% of untreated and 69% of previously treatment-resistant patients After 8 weeks target blood pressure was achieved in 67.8% (SBP) and in 81.1% (DBP) of patients, respectively. The mean decrease was 21.8% for SBP and 21.1% for DBP (p < 0.001). Out of all, 65% of patients achieved both target SBP and DBP values. Hydrochlorothiazide was added to the therapy in 11.6% of patients. There were no significant differences in drug efficacy between the entire group and subgroups of patients with diabetes mellitus and impaired renal function (p = ns). Adverse events were rare and metabolic effect was favorable. Monotherapy with losartan in a dosage of 50-100 mg applied during 8 weeks resulted in achieving target values of blood pressure in 65% of patient with mild and moderate hypertension, also including the patients with diabetes mellitus and impaired renal function. Losartan is a safe and metabolically neutral medication.

Amelioration of Albuminuria in Japanese Type 2 Diabetic Patients by Maximal Dose of Candesartan

Introduction: It was recently reported that candesartan, an angiotensin II receptor blocker, had a protective effect against cardiovascular events, comparable to that of calcium channel antagonists. Moreover, a renoprotective effect and anti-diabetic action of candesartan had also been demonstrated. However, whether the renoprotective effect of candesartan, especially in diabetes, was dose-dependent or not remain to be fully elucidated. The present study attempted to clarify the dose effect of renoprotection by candesartan in Japanese type 2 diabetic patients. Subjects and Method: In this case series study, we recruited 26 type 2 diabetic patients with albuminuria whose blood pressure did not reach the target BP level ( were increased to the maximal dose in Japan, 12 mg/day. Clinical parameters were examined before, at 6 and 12 months after the increase in dose. Results: An ameliorating effect of the increased dose of candesartan on albuminuria and hypertension was distinctly observed. No severe adverse effect was observed. Conclusion: It was highly possible that the maximal dose of candesartan provided more effective renoprotection in hypertensive type 2 diabetic patients initially treated with lower doses of candesartan.

Prevalence, awareness, and treatment of hypertension in patients with type 1 diabetes: a nationwide multicenter study in Brazil.

Objective. This study evaluated the prevalence, awareness, and type of treatment for hypertension in Brazil in patients with type 1 diabetes (T1D). Methods. This was a cross-sectional, multicenter study that was conducted from December 2008 to December 2010 in 28 public clinics located in 20 Brazilian cities. Results. A total of 3,591 patients were studied, 56% female, average age 21.2 ± 11.7 years, with a median duration of diabetes 9.6 ± 8.1 years. Blood pressure levels were available for a total of 3,323 patients and 689 (19.2%) patients were hypertensive. Hypertensive patients were older, exhibited longer duration of diabetes, and had higher body mass index (BMI), total cholesterol, triglycerides, and LDL-C values (P < 0.001, for all comparisons), but only 370 (53.7%) received treatment. Patient awareness of hypertension was documented in 453 (65.5%) patients. However, only 76 (22.9%) of the treated patients attained the target systolic (sBP) and diastolic blood pressures (dBP). Conclusions. Our results demonstrate that a large number of T1D patients with hypertension do not receive appropriate treatment; few of the treated T1D patients achieved the target sBP and dBP values. Greater attention should be paid to blood pressure evaluation, hypertension diagnosis, and treatment of T1D patients in Brazil.

Improvement and influencing factors of blood pressure control by nephrologist referral in chronic kidney disease patients in China: a cohort study

Hypertension is an independent risk factor for mortality in chronic kidney disease (CKD) and is suboptimally controlled worldwide. Therefore, this study aimed to examine the rate of BP control and the main barriers to achieving target BP, according to K/DOQI guidelines, in China. We performed a single-center, prospective cohort study. Two hundred and sixty CKD patients were referred by general physicians to nephrologists, and their BP was treated in accordance with K/DOQI guidelines for a 1-year follow-up. We evaluated improvement of BP target achievement and factors affecting BP control. We defined "not-at-goal" as persistence of systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg after 1 year. The BP decreased from 138 ± 12/84 ± 7 mmHg at baseline to 124 ± 13/73 ± 7 mmHg after 1 year. The rate of achieving the BP goal (<130/80 mmHg) increased from 25.4 to 61.5 %. The decrease in BP was associated with a significant reduction of proteinuria (median, 0.14 vs 0.06 g/24 h; P < 0.05). Logistic regression analysis identified proteinuria levels ≥1.0 g/24 h (odds ratio [OR]: 5.21; 95 % confidence interval [CI]: 1.37-19.77) and high basal systolic BP (OR: 2.17; 95 % CI: 1.25-3.77) and diastolic BP (OR: 6.62; 95 % CI: 2.03-21.60) as independent predictors of not-at-goal BP. Higher educational level was independently associated with at-goal BP (OR: 0.21; 95 % CI: 0.06-0.78). In CKD patients, BP control is poor when managed by general physicians and may be improved after nephrologist referral. High basal BP and proteinuria levels ≥1.0 g/24 h are the main barriers that preclude the optimal control of BP.

Abstract 8903: Six-year Target Systolic Blood Pressure Less Than 120 mmHg For More Than 65 Aged Hypertension Patients With Chronic Renal Disease

Background: Three year target SBP≦120 mmHg in elderly hypertension patients with chronic kidney disease(CKD) was safety and efficacy was reported in 2009 AHA meeting by us.The six year safety and efficacy of SBP≦120 mmHg in these patient is not reported. Methods: In a prospective, controlled open-label studies, the authors have evaluated the safety and efficacy of six-year treatment on progress of renal disease and risk of development of cardiovascular disease in 122 &gt;65 aged hypertension patients with chronic renal disease III to IV stage and macroproteinuria. Before randomization, all patients have already been treated for one-year with angiotensin converting enzyme inhibitors(ACEI) or angiotensin AT1 receptor blockade(ARBs) and other antihypertensive drugs, but their SBP are above 140 mmHg,less than 150 mmHg. Blood pressure , serum creatinine(Cr) and potassium were monitored every 14 days in the period of follow-up by physician and healthcare nurse and more frequent patient-physician encounters will be improve that patients monitored their BP every day at home and adjusted their own medication according to pre-agreed rules. Results: By the end of six year,medication possession ratio between two groups was similar(94% vs 94%), mean BP in treatment group was 116/66±6/3 mmHg and in control was 146/78±13/9 mmHg, Cr clearance increased from 51±2.0 to 63±3.0 ml/min (p&lt;0.001)in the group of strict control of SBP,by contrast, Cr clearance decreased significantly from 52±1.9 to 34±2.4 ml/min( P&lt;0.01)in the controls. During this time, urine protein excretion decreased from 1.4±0.5 to 0.2±0.4g/24 hours(P0.05)in the controls. Ten patients had got ACS ,17 patients stroke.21 patients had got pneumonia , 10 patients renal dialysis and eight patient died (5 in SCD and 3 in heart failure) in controls, and three patients had got ACS, six patient had stroke ,nine pneumonia, 1 patient renal dialysis and four patients died in non-cardiac causes in the treatment group.Incidence of hyperkalaemia was similar between two groups. Conclusions: SBP≦120 mmHg is safe and was more apparently in decreasing proteinuria, slowing the progress of renal disease and reducing the risk of development of cardiovascular events and pneumonia in elderly hypertensive patients with CKD

Good knowledge about hypertension is linked to better control of hypertension; A multicentre cross sectional study in Karachi, Pakistan

BackgroundAccording to the National Health survey only 3% of the population has controlled hypertension. This study was designed to elucidate the knowledge about hypertension in hypertensive patients at three tertiary care centers in Karachi. Secondly we sought to compare the knowledge of those with uncontrolled hypertension and controlled hypertension.MethodsIt was a cross-sectional study conducted at The Aga Khan University hospital (AKUH), Ziauddin Hospital (ZH) and Civil hospital, Karachi (CHK. All diagnosed Hypertensive patients (both inpatients and outpatients) coming to a tertiary care hospital in Pakistan aged > 18 years were included. Patients were categorized into 2 groups: controlled and uncontrolled hypertension based on their initial BP readings on presentation Uncontrolled Hypertension was defined as average BP ≥ 140/90 mm Hg in patients on treatment. Controlled Hypertension (HTN) was defined as average BP <140/90 mm Hg in patients on treatment. Standardized methods were used to record BP in the sitting position. Knowledge was recorded as a15 item question. Primary outcome was knowledge about hypertension.ResultsA total of 650 participants were approached and consented 447 were found eligible. 284(63.5%) were from Aga Khan University, 101(22.6) from Dow University of health sciences and 62(13.9) were from Ziauddin University. Mean (SD) age of participants was 57.7(12) years, 50.1(224) were men. Controlled hypertension was present in 323(72.3) and uncontrolled hypertension was present in 124(27.4). The total mean (SD) Knowledge score was 20.97(4.93) out of a maximum score of 38. On comparison of questions related to knowledge between uncontrolled and controlled hypertension, there was statistically significant different in; meaning of hypertension (p <0.001), target SBP(p0.001), target DBP(p 0.001), importance of SBP versus DBP, improvement of health with lowering of blood pressure (p 0.002), high blood pressure being asymptomatic (p <0.001), changing lifestyle improves blood pressure(p 0.003),hypertension being a lifelong disease (<0.001), lifelong treatment with antihypertensives(<0.001) and high blood pressure being part of aging(<0.001). On comparison of knowledge as a composite score between uncontrolled and controlled hypertensive; Mean (SD) score was 21.85(4.74) v18.67 (4.70) (p value: < 0.001). On multivariate analysis; gender β (95% CI) 1.67(0.75, 2.59) p <0.001, uncontrolled blood pressure; -2.70(−3.76,-1.67) p <0.001, Sindhi ethnicity; -1.79(−3.25,-3.27) p 0.01 and pukhtoon ethnicity; -2.72(−4.13,-1.32) p <0.001 were significantly associated with knowledge score.ConclusionKnowledge about hypertension in hypertensive patients is not adequate and is alarmingly poor in patients with uncontrolled hypertension. More emphasis needs to be made on target blood pressure and need for taking antihypertensives for life to patients by physicians.

579 Single-pill combination of telmisartan 80 mg/amlodipine 5 mg provides sustainable 24 hours blood pressure reduction

Objectives: The majority of patients with hypertension may require combination therapy to achieve BP targets. This study was conducted to evaluate the 24 hours antihypertensive efficacy of telmisartan 80 mg (T80) plus amlopipine 5 mg (A5) as a single-pill combination (SPC) by 24 h ambulatory blood pressure monitoring (ABPM). Methods: In an open-label, single center, phase III trial, 40 chinese adult patients with mean seated trough cuff diastolic blood pressure [DBP] ≥ 100 mmHg or 24 hour mean DBP ≥ 85 mmHg at baseline were screened to be treated with T80/A5 SPC for 8 weeks. Primary efficacy measures were the changes from baseline in the 24-hour ABPM mean (relative to dose time) for both DBP and SBP after 8 weeks of treatment with T80/A5 SPC. Results: 27 patients (mean age, 52 years; male, 66.8%; mean SBP and DBP in baseline by ABPM, 150.24 ± 17.30mmHg and 95.79 ± 7.74 mmHg repectively) received treatment;. 24 hours mean BP reductions (mmHg) with T80/A5 from baseline to Week 8 were -23.8 ± 14.5 for SBP and -12.8 ± 7.4 for DBP. The median trough-to-peak(T/P) ratios for SBP and DBP using 24-hour ABPM were 0.98 and 1.13, respectively. T80/A5 SPC had a low rate of patients with overall adverse events (AEs) (14.8% and AEs leading to discontinuation (3.7%). Conclusions: In Chinese patients with hypertension, 8 weeks treatment with T80/A5 SPC resulted in a clinically meaningful decrease in both SBP and DBP with a low T/P ratio of about 1. T80/A5 SPC was safe and well tolerated in this population. Appendix

Discrepancy Between Tonometric Ambulatory and Cuff‐Based Office Blood Pressure Measurements in Patients With Type 1 Diabetes

The aim of the current study was to compare ambulatory blood pressure (ABP) with office blood pressure (OBP) in diagnosing hypertension (HTN) in type 1 diabetes. The cross-sectional study included 569 type 1 diabetes patients, with a mean ± standard deviation (SD) age of 55 ± 13 years and diabetes duration of 33 ± 16 years, and 315 (55%) men. Blood pressure ≥ 130/80 mm Hg defined HTN. ABP was measured by tonometry and OBP by sphygmomanometry. Elevated ABP with normal OBP defined masked uncontrolled HTN, and normal ABP with elevated OBP defined isolated uncontrolled clinic HTN. Mean ± SD 24-hour ABP, daytime ABP, and OBP was 128 ± 16/75 ± 10 mm Hg, 133 ± 16/77 ± 11 mm Hg, and 136 ± 14/76 ± 8 mm Hg, respectively (P<.001). With 24-hour and daytime ABP, HTN was present in 256 (45%) and 304 (53%) patients; normal BP in 102 (18%) and 88 (15%) patients; isolated uncontrolled clinic HTN in 154 (27%) and 104 (%) patients; and masked uncontrolled HTN in 57 (10%) and 73 (13%) patients. Twenty-four-hour ABP and OBP showed disagreement in diagnosing HTN in 211 (37%) patients. Daytime ABP and OBP disagreed in 177 (31%) patients. HTN by 24-hour and daytime ABP was present in 313 (55%) and 377 (66%) patients. ABP measurements were well-tolerated and successful in 98%. A total of 92% would volunteer for repeat measurements and 83% preferred the tonometry to conventional cuff-based devices. In patients with type 1 diabetes, tonometric ABP measurements are feasible. ABP and OBP disagree in diagnosing HTN in 31% to 37% of patients. Furthermore, 55% to 66% of patients do not reach target BP of <130/80 mm Hg despite regular follow-up.

Hypertension and Kidney Disease: What Do the Data Really Show?

Hypertension is the most common co-morbidity in chronic kidney disease (CKD) and the optimal target BP to prevent CKD progression has been hotly debated. Prior recommendations by various groups for BP targets for CKD in the range of less than 130/80mm Hg have been based on the assumed benefits of lower BP in this population with exceedingly high risk for cardiovascular disease (CVD). Although there is suggestive data that lower BP may be helpful in patients with proteinuria and CKD, studies not directly link a treatment-related reduction in proteinuria to a benefit in kidney outcomes. There are ongoing studies which will provide more data on BP targets in CKD. Based on the currently available data we recommend a BP goal of less than 140/90mm Hg in all patients with CKD.

OS014. Which first-line drug to control severe hypertension in pregnancy? A pilot study

Severe hypertension is a common complication in pregnancy-associated hypertensive disorders and there is no clear consensus on which first-line antihypertensive drug to use in this setting. To determine the efficacy and safety of four antihypertensive drugs (two intravenous and two oral) in pregnant women with severe hypertension. Pilot prospective randomised study. pregnant women with a gestational age >24weeks and admitted in the Obstetrics Department with severe hypertension defined as systolic blood pressure (SBP) ⩾165mmHg and/or diastolic blood pressure (DBP) ⩾105mmHg. The women were randomised in 4 groups to receive:-20mg intravenous labetalol;-5mg intravenous hydralazine;-10mg oral nifedipine tablets ;-10mg sublingual nifedipine. Treatment was repeated every 20mn until target SBP and DBP were reached (⩽150/⩽95mmHg). The primary endpoint was the time needed to achieve effective blood pressure control. Treatment failure was defined as the unability to reach the target BP within one hour. After giving informed consent, 41 pregnant women admitted with severe hypertension were randomised. Mean age was 35 years (SD 3.5), 65% were nulliparous and mean SBP and DBP at admission were 176 (SD 16) and 105 (SD 12)mmHg, respectively. Success to achieve target BP was reached in all patients within the oral 10mg nifedipine group (11 patients), in all but one patients with the 10mg sublingual group (12 patients), and only in 5 out of 9 patients and 6 out of 9 patients within the labetalol and hydralazine groups. They were only one hypotension (defined as SBP <120mmHg) in the two groups with intravenous drugs and 3 and 5 in the oral and sublingual nifedipine groups. These results indicate that oral nifedipine seems more effective than intravenous labetalol or hydralazine to reach BP control in pregnant patients with severe hypertension. A large scale randomized trial comparing oral nifedipine versus these commonly used intravenous antihypertensive drugs should be implemented in order to determine whether oral nifedipine is a more effective treatment in this population.

Predictors of lowering SBP to assigned targets at 12 months in the Secondary Prevention of Small Subcortical Strokes study.

Lowering blood pressure for secondary stroke prevention remains a challenge. These analyses were conducted to identify factors predicting achievement of SBP targets in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. SPS3 is a randomized trial assigning patients with lacunar stroke to two targets of SBP control (130-149 mmHg or <130 mmHg). Logistic regression models were used to identify patient and SPS3 site characteristics predictive of lowering SBP to target at the 12-month study visit. Of those above target at baseline (n = 1041), 69% were within their assigned target at 12 months. In the model with baseline characteristics only, those receiving treatment for hypertension at baseline were 68% less likely to achieve target [odds ratio (OR) = 0.32; 95% confidence interval (CI) = 0.17-0.60], whereas those of Hispanic ethnicity were 1.49 times more likely (95% CI = 1.09-2.03) to achieve SBP target. When clinical site characteristics were added to the model, only treated hypertension at baseline remained significant. In addition, management at a larger site (OR = 1.51; 95% CI = 1.03-2.20), SBP in target at 6 months (OR = 2.39; 95% CI = 1.79-3.19), and medication adherence (OR = 2.73; 95% CI = 1.51-4.95) were positively associated with achieving target SBP. Missed appointments (OR = 0.55; 95% CI = 0.41-0.73) were negatively associated with lowering SBP to target at 12 months. These results demonstrate that it is feasible to achieve targets of SBP control in this multiethnic stroke cohort across multiple sites and countries. The results highlight the important variables reflecting clinical site management.

Resistant hypertension in visceral obesity

BackgroundVisceral obesity increases the risk of arterial hypertension (78% of cases of hypertension in men and 65% of cases in women). The aim of the study is to assess the role of visceral obesity in causing resistant hypertension (RH). MethodsThe survey was performed on 5065 hypertensive patients with visceral obesity. BP control was analyzed on the basis of office and home BP measurements. Patients reporting non-compliance were excluded from the study. ResultsThe percentage of RH after excluding undertreated patients (receiving less than 3 drugs or on at least 3-drug regimen without diuretic and without reaching target BP goal) was 13.9%. RH was more frequent only in obese with BMI≥35 and <40kg/m2 (16.2%) and in morbidly obese individuals (26.5%). Patients with BMI≥35 and <40kg/m2 and with morbid obesity were receiving three-drug therapy more frequently than patients with visceral obesity and BMI<30kg/m2. A multiple regression analysis revealed that obesity was associated with RH independent from longer than 5-year period of antihypertensive therapy, diabetes, smoking cigarettes, cardiovascular disease and heart failure. The analysis of home BP measurement revealed that in 11.1% of patients RH was in fact “white coat” hypertension. ConclusionsUndertreatment, underuse of diuretics in multidrug regimens, and the “white-coat” effect are the most common reasons for over-diagnosing resistant hypertension in patients with visceral obesity. Obesity is an independent risk factor for the occurrence of RH.

A Rapid, Cost-Effective Method of Assembly and Purification of Synthetic DNA Probes &gt;100 bp

Here we introduce a rapid, cost-effective method of generating molecular DNA probes in just under 15 minutes without the need for expensive, time-consuming gel-extraction steps. As an example, we enzymatically concatenated six variable strands (50 bp) with a common strand sequence (51 bp) in a single pool using Fast-Link DNA ligase to produce 101 bp targets (10 min). Unincorporated species were then filtered out by passing the crude reaction through a size-exclusion column (<5 min). We then compared full-length product yield of crude and purified samples using HPLC analysis; the results of which clearly show our method yields three-quarters that of the crude sample (50% higher than by gel-extraction). And while we substantially reduced the amount of unligated product with our filtration process, higher purity and yield, with an increase in number of stands per reaction (>12) could be achieved with further optimization. Moreover, for large-scale assays, we envision this method to be fully automated with the use of robotics such as the Biomek FX; here, potentially thousands of samples could be pooled, ligated and purified in either a 96, 384 or 1536-well platform in just minutes.

Combination therapy for hypertension in the elderly: a sub-analysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial

The Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) trial demonstrated that the calcium-channel blocker benidipine-based combination therapies with an angiotensin-receptor blocker (ARB), a β-blocker, or a thiazide diuretic (thiazide) were similarly effective in preventing cardiovascular events and achieving the target blood pressure (BP; <140/90 mm Hg). We further evaluated the efficacy and safety of these combination therapies in older (65 years) and younger (<65 years) hypertensive patients. In this sub-analysis of the COPE trial 3293 patients (153365 years old and 1760 <65 years old) were randomly assigned to receive benidipine-based therapy with an ARB, a β-blocker or a thiazide. In each group, the average BP did not differ among the three treatment groups. The incidence of the primary cardiovascular composite end point in the older group was higher than in the younger group (12.7 vs. 8.3 per 1000 person-years, P=0.023). The primary composite cardiovascular end point, achievement (%) of target BP, and cardiovascular hard composite end points were similar among the three treatment groups. However, the hazard ratios and 95% confidence intervals in older patients were 2.74 (1.08-6.96; β-blocker vs. thiazide, P=0.022) for fatal and non-fatal stroke, and 2.47 (1.03-5.91; β-blocker vs. ARB, P=0.043) for new-onset diabetes. Thus, benidipine combined with an ARB, a β-blocker, or a thiazide was similarly effective in preventing cardiovascular events and achieving the target BP in both older and younger hypertensive patients. Further studies will be necessary to evaluate the usefulness of benidipine combined with a β-blocker in terms of the incidence of stroke and new-onset diabetes in older patients.

Efficacy and Safety of the Losartan-Hydrochlorothiazide Combination Tablet in Patients with Hypertension Uncontrolled by Angiotensin II Receptor Antagonist Therapy: The Aichi Research on Combination Therapy for Hypertension (ARCH) Study

The guidelines recommend combination therapy for patients who are unable to achieve target BP with monotherapy; some fixed dose therapies including an angiotensin II receptor blocker (ARB) and diuretics are available in Japan. However, to date there have been few reports on this long-term treatment and the patient profiles suited for this combination remain ambiguous. The Aichi Research on Combination therapy for Hypertension Study was a multicenter, open-label, prospective observational study that investigated the efficacy and safety of 1-year treatment with the losartan-hydrochlorothiazide (HCTZ) combination tablet in patients with hypertension uncontrolled by either ARB monotherapy or combination therapy with a calcium channel blocker (CCB). An ARB was switched to a losartan-HCTZ tablet after a pre-observation period. A total of 614 of 648 patients were evaluable (mean age, 66.3 years; 52.8% men; mean baseline blood pressure, BP, 157.7/87.9 mmHg). The BP had decreased significantly to 138.0/78.2 mmHg by month 3 (p<0.001, t-test), and 36.2% of the patients had achieved their target BP. The hypotensive effect lasted for 1 year and was found equally in the losartan-HCTZ arm and the losartan-HCTZ plus CCB arm. A stratified analysis showed significant hypotensive effects in patients with higher baseline BP, women, and patients who did not drink alcohol (p<0.001, unpaired t-test). The losartan-HCTZ combination tablet was found to have an early hypotensive effect, good tolerability, and stable long-term benefits in patients with hypertension uncontrolled by ARB monotherapy or combination therapy with a CCB.

Intensive and Standard BP Targets in Patients with Longstanding Type 2 Diabetes

The ACCORD blood pressure trial showed that intensive blood pressure control (target systolic BP, <120 mm Hg), compared with standard BP control (target SBP, <140 mm Hg), was not associated with lower risk for fatal and nonfatal cardiovascular events in patients with longstanding type 2 diabetes (JW Cardiol Mar 14 2010). In this meta-analysis, investigators evaluated outcomes …