Effects Of Antihypertensive Therapy Research Articles

A “patient-tailored” treatment of hypertension with use of impedance cardiography: A randomized, prospective and controlled trial

BackgroundArterial hypertension might be caused by hemodynamic disturbances such as fluid retention, increased vascular resistance, and hyperdynamic function of the heart. The aim of this study was to estimate the effectiveness of antihypertensive therapy based on hemodynamic assessment by impedance cardiography in a randomized, prospective, controlled trial.Material/MethodsThis study involved 128 patients (average age: 42.9±11.1 years) with arterial hypertension, randomized into groups: (1) empiric, and (2) hemodynamic, in which treatment choice considered impedance cardiography results. Evaluation of treatment effects was performed after 12 weeks and included office blood pressure measurement and ambulatory blood pressure monitoring.ResultsAll final blood pressure values were lower in the hemodynamic group, significantly for office systolic blood pressure (empiric vs. hemodynamic: 136.1 vs. 131.6 mmHg; p=0.036) and diastolic blood pressure (87.0 vs. 83.7 mmHg; p=0.013), as well as night-time systolic blood pressure (121.3 vs. 117.2 mmHg; p=0.023) and diastolic blood pressure (71.9 vs. 68.4 mmHg; p=0.007). Therapy based on impedance cardiography significantly increased the reduction in office systolic blood pressure (11.0 vs. 17.3 mmHg; p=0.008) and diastolic blood pressure (7.7 vs. 12.2 mmHg; p=0.0008); as well as 24-h mean systolic blood pressure (9.8 vs. 14.2 mmHg; p=0.026), daytime systolic blood pressure (10.5 vs. 14.8 mmHg; p=0.040), and night-time systolic blood pressure (7.7 vs. 12.2 mmHg; p=0.032).ConclusionsAntihypertensive treatment based on impedance cardiography can significantly increase blood pressure reduction in hypertensive patients.

Experience of using a fixed-dose combination of perindopril and amlodipine in the clinical practice settings: a real-world opportunity to increase antihypertensive therapy effectiveness

The paper presents the results of the studies on effectiveness and safety of a fixeddose combination of perindopril A and amlodipine (Prestans) in the real-world clinical practice settings in Russia and other countries. The focus is on the evidence of fast and strong antihypertensive action of this medication, its excellent tolerability, and increased therapy compliance. The evidence presented justifies a wider use of this fixed-dose combination of perindopril A and amlodipine in order to improve blood pressure control in hypertensive patients.

Treatment of Arterial Remodeling in Essential Hypertension

Essential hypertension is associated with large and small vascular remodeling that impacts cardiovascular prognosis. Longitudinal follow-up of hypertensive patients has shown that large arterial stiffness decreases partly independently of blood pressure reduction, suggesting specific pharmacological effects of antihypertensive therapy. Inhibitors of the renin-angiotensin-aldosterone system are among the agents that have been shown to affect vascular remodeling to a greater degree. Lifestyle modifications, including exercise and weight reduction, also improve large and small vascular remodeling. New antihypertensive drugs, including neprilysin inhibitors associated with an angiotensin receptor blocker, aldosterone synthase inhibitors and new devices such as renal denervation and baroreceptor stimulation, may exert beneficial effects on vascular remodeling and are currently under evaluation.

Estimated Glomerular Filtration Rate Reversal by Blood Pressure Lowering in Chronic Kidney Disease: Japan Multicenter Investigation for Cardiovascular DiseaseB CKD Study

Patients are diagnosed as having chronic kidney disease (CKD) if estimated glomerular filtration rate (eGFR) is <60 mL/min/1.73 m(2) . Low eGFR is likely to increase the incidence of cardiovascular events and lead to dialysis. Therefore, it is important to prevent eGFR from decreasing eGFR. However, it still remains unknown whether antihypertensive therapy can prevent low eGFR from becoming even lower and improve eGFR in hypertensive patients with CKD. The authors analyzed the results of the Japan Multicenter Investigation for Cardiovascular DiseaseB (JMIC-B) and investigated the effects of antihypertensive therapy on eGFR. In hypertensive patients with CKD (eGFR <60), eGFR was significantly increased from 51.87±6.21 (n=98) to 57.55±19.00 (P<.001) after 3 years of antihypertensive therapy. In patients without CKD (eGFR ≥60), eGFR was significantly decreased from 91.84±23.27 (n=682) to 88.95±23.67 (P<.001). Regardless of the type of antihypertensive drugs used, eGFR was significantly increased in patients with CKD and was significantly decreased in patients without CKD. This paper shows that antihypertensive therapy can improve eGFR in hypertensive patients with CKD. J Clin Hypertens (Greenwich). 2012;00:00-00. ©2012 Wiley Periodicals, Inc.

Effectiveness of antihypertensive therapy in HIV‐positive patients: evaluation to 144 weeks

Hypertension is more prevalent among HIV‐infected subjects than in the general population, contributing to increased cardiovascular risk in HIV+ patients. The angiotensin II receptor blocker telmisartan is also a partial peroxisome proliferator activated receptor (PPAR)‐γ agonist, with documented effects on improving hypertension, lipid metabolism and renal function. Therefore telmisartan was found to be the first choice for treatment of HIV+ hypertensive patients. Aim of this study was to evaluate the durability on 144 weeks of treatment with telmisartan in HIV+ patients. 13 HIV+ Caucasian male patients treated with combined antiretroviral therapy (cART) and discovered to be naïve hypertensive, were given 80 mg telmisartan daily. Systolic (SBP) and diastolic (DBP) blood pressure, viro‐immunological, lipid and metabolic parameters, including triglycerides, cholesterol, insulin resistance (HOMA‐IR), inflammatory markers, C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), indexes of renal function and cardiovascular risk, microalbuminuria, cystatin C, were measured at baseline (T0), and after 24 (T24), 48 (T48), 72 (T72), 96 (T96), 120 (T120) and 144 (T144) weeks. Treatment with telmisartan decreased SBP and DBP levels during the 144 weeks of observation. We also observed improved HDL‐cholesterol, HOMA‐IR, microalbuminuria and cystatin C at the end of study. Triglycerides and total cholesterol significantly decreased and HDL‐cholesterol significantly increased. Total cholesterol/HDL cholesterol ratio improved significantly. Throughout in the course of the trial our patients showed a significant improvement of the percentage of CD4+ and CD8+. Eventually in all 144 weeks of therapy with telmisartan 80 mg/day have not observed adverse events or dropouts. Telmisartan was effective in improving hypertension, lipid metabolism and renal function in 144 weeks of evaluation. It determines the improvement of cystatin C and microalbuminuria, markers of renal function and cardiovascular risk. Telmisartan doesn't interfere with cART, not interfering with the recovery of immunological HIV patients. Telmisartan has confirmed durability and effectiveness, excellent tolerability and an high persistance with a good blood pressure control. Therefore telmisartan reveals the first choice in the treatment of hypertension in HIV+ because of significant morbidity in this group of patients.

Assessment of the effectiveness of antihypertensive therapy in early postoperative period in patients with kidney tumors after nephrectomy

Objective. To analyze the dynamics of blood pressure in the early postoperative period in hypertensive patients with kidney tumor after nephrectomy. Design and methods. We examined 96 patients with cardiovascular diseases and kidney tumors, at the age from 41 up to 75 years (mean age — 57 ± 6,3 years), who were planned for nephrectomy (I group). Group II included 53 patients aged 37-65 years (mean age — 49 ± of 7,2 years) who underwent laparoscopic nephrectomy. Daily monitoring of blood pressure MECG-DS-HC-01 («LCA Advanced technologies», Russia) was performed in all subjects. Results. Young hypertensive patients (from 40 to 48 years, mean age — 43,7 ± 4,6 years) demonstrated blood pressure elevation in the early postoperative period after nephrectomy even when antihypertensive medication was taken. At the same time elderly patients (from 56 to 85 years of age, mean age — 65,3 ± 7,5 years) develop hypotension episodes. Calcium channel blockers appeared to be highly effective in young patients who also demonstrated higher blood pressure levels in the postoperative period after laparoscopic nephrectomy, as compared with patients after open surgery. On the second day after the open nephrectomy 22,9 % (22 of 96) patients required antihypertensive treatment correction, and on the tenth only 1 % (1 patient out of 96) required treatment enhancement, whereas in group II on the second day after the intervention 100 % patients required therapy enhancement, and on the tenth day 60,4 % (32 out of 53) patients needed some correction of the treatment. Conclusions. Hypertensive patients with kidney tumors require precise control of blood pressure before the operation and correction of antihypertensive therapy, as almost one third of the patients develop increase of blood pressure in postoperative period. Calcium channel antagonists should be considered as a drug of choice in the young patietnts (mean age — 44 years) as they allow to achieve target blood pressure, that is necessary to improve renal blood flow and protects the kidney. At the same time 20 % of elderly patients (age 66) develop hypotension episodes requiring lower doses of antihypertensive drugs.

Effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency

To investigate the effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency in early-stage hypertension. We studied 527 participants from two clinical trials assessing the effect of blood pressure lowering on diastolic function. Participants were aged ≥45 years with early-stage hypertension, no heart failure, ejection fraction (EF) ≥50%, and diastolic dysfunction using Doppler echocardiography. Effective arterial afterload and its components were assessed along with measures of left ventricular (LV) structure and function prior to and after 24-38 weeks of antihypertensive therapy. Systolic blood pressure decreased from 154 ± 18 to 137 ± 15 mmHg at follow-up. Blood pressure reduction was associated with decreases in ventricular and arterial stiffness, improvements in systemic arterial compliance and resistance, enhanced LV ejection, and reduction in cardiac work (all P < 0.001). Changes in Ea/Ees ratio were inversely correlated with those in EF (r = -0.25; P < 0.001), stroke work index (r = -0.13; P = 0.007), and LV efficiency (r = -0.98; P < 0.001); and directly related to changes in mitral E/e' (r = 0.12; P = 0.01). Adjusting for age and blood pressure change, women and obese individuals had less enhancement in ventricular-arterial coupling and efficiency compared with men and non-obese individuals (P = 0.04 and 0.007, respectively). Antihypertensive therapy reduces arterial and ventricular stiffness, enhances ventricular-arterial coupling, reduces cardiac work, and improves LV efficiency, systolic, and diastolic function. Attenuated responses in women and among obese subjects suggest that structure-function changes may be less reversible in these groups, possibly explaining their greater susceptibility to ultimately develop heart failure.

OP21.10: Effect of antihypertensive therapy on uterine artery and fetal Dopplers: systematic review and meta‐analysis

OP21.10: Effect of antihypertensive therapy on uterine artery and fetal Dopplers: systematic review and meta‐analysis

Effect of antihypertensive therapy on cognitive function in hypertensive patients with obesity

Objective. To assess and compare efficacy of perindopril, eprosartan and amlodipine according to their effects on cognitive function in patients with arterial hypertension and obesity. Design and methods. This open clinical trial included 78 patients (mean age — 46,8 ± 5,5 years), 26 of them received perindopril, 26 — eprosartan, and 26 — amlodipine. Monotherapy has lasted for 12 months. At baseline and 12 months later, all participants underwent 24-hour blood pressure monitoring, neuropsychological testing and cognitive evoked potential (P300) to assess cognitive function. Results. Twelve-month monotherapy with eprosartan and amlodipine significantly improved cognitive function (neuropsychological testing and P300) in patients with obesity and arterial hypertension.

Pharmacotherapy for mild hypertension.

People with no previous cardiovascular events or cardiovascular disease represent a primary prevention population. The benefits and harms of treating mild hypertension in primary prevention patients are not known at present. This review examines the existing randomised controlled trial (RCT) evidence. To quantify the effects of antihypertensive drug therapy on mortality and morbidity in adults with mild hypertension (systolic blood pressure (BP) 140-159 mmHg and/or diastolic BP 90-99 mmHg) and without cardiovascular disease. We searched CENTRAL (2011, Issue 1), MEDLINE (1948 to May 2011), EMBASE (1980 to May 2011) and reference lists of articles. The Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE) were searched for previous reviews and meta-analyses of anti-hypertensive drug treatment compared to placebo or no treatment trials up until the end of 2011. RCTs of at least 1 year duration. The outcomes assessed were mortality, stroke, coronary heart disease (CHD), total cardiovascular events (CVS), and withdrawals due to adverse effects. Of 11 RCTs identified 4 were included in this review, with 8,912 participants. Treatment for 4 to 5 years with antihypertensive drugs as compared to placebo did not reduce total mortality (RR 0.85, 95% CI 0.63, 1.15). In 7,080 participants treatment with antihypertensive drugs as compared to placebo did not reduce coronary heart disease (RR 1.12, 95% CI 0.80, 1.57), stroke (RR 0.51, 95% CI 0.24, 1.08), or total cardiovascular events (RR 0.97, 95% CI 0.72, 1.32). Withdrawals due to adverse effects were increased by drug therapy (RR 4.80, 95%CI 4.14, 5.57), ARR 9%. Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms.

Effects of antihypertensive therapy on female sexual dysfunction

Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Greece Correspondence to Michael Doumas, MD, Aristotle University of Thessaloniki, Hippokration General Hospital, 49, Konstantinoupoleos street, 54643 Thessaloniki, Greece. Tel: +30 6947 006 001; fax: +30 2310 992834; e-mail: [email protected]

Effects of antihypertensive therapy on female sexual dysfunction

Ma, Ruixin; Yu, Jing; Zhao, Feng; Xu, Dian; Yang, Longquan; Lin, Xin; Bai, Feng Author Information

Angiotensin Receptor Blockers and Tumorigenesis: Something To Be (or Not To Be) Concerned About?

The possibility of carcinogenic side effects of antihypertensive therapies due to their chronic administration has been raised multiple times in the past. Recently, the issue has again drawn attention, this time in relation to angiotensin receptor blockers (ARBs). This, among others, caused both American and European drug regulation authorities to review the underlying evidence concerning the relationship between this class of medications and potential adverse carcinogenic outcome. A plethora of both basic science and preclinical evidence has been generated, and three meta-analyses and one nationwide cohort have focused on this specific question. The current review aims to summarize the contemporary multidisciplinary evidence on whether ARBs may be associated with an increased risk of tumorigenesis.

Effect of Antihypertensive Therapy on Cognitive Function in Early Executive Cognitive Impairment: A Double-blind Randomized Clinical Trial

Approximately 50% of older hypertensive individuals have difficulties in executive function, the cognitive domain that controls complex tasks.1 Hypertensive individuals with executive dysfunction have a high rate of conversion to dementia.2 To date, no study has investigated therapeutic options for executive dysfunction. Recent evidence suggest that the renin angiotensin system plays a central role in linking hypertension to cognitive function offering new therapeutic options for cognitive protection.3 In the brain, angiotensin receptor blockers (ARB) block the type 1 but not type 2 whereas angiotensin converting enzyme inhibitors (ACEI) decrease activation of both receptors. Activating the type 2 receptor may provide cognitive protection.4 We therefore hypothesized that an ARB-based regimen would be superior to other antihypertensive regimens in cognitive protection, especially executive function, and conducted a 12-month double blind randomized clinical trial comparing candesartan, lisinopril, and HCTZ in hypertensives with early executive dysfunction.

Common and less common adverse effects of antihypertensives: a general practitioner's perspective

About 35% of hypertensive patients will discontinue their medication within six months, 1 and in at least 50% of cases, the reason for discontinuation relates to adverse effects and patient dissatisfaction. 2 Therefore, it is imperative that hypertension practitioners are fully cognisant of the adverse effects of antihypertensive drugs. The focus in this article will be on the six major classes of drugs, namely diuretics, angiotensin-converting (ACE) inhibitors, angiotensinreceptor blockers (ARBs), calcium-channel blockers, beta blockers and alpha blockers. 3 The most universal adverse effect of antihypertensive therapy is hypotension, due to overtreatment. This can be subtle, and includes vague symptoms of dizziness, fatigue, tiredness, and anxiety. This is often not detected in the consulting room because of counter-regulatory measures to restore the blood pressure (BP), white-coating (especially in the elderly), and failure to perform a standing BP. Another clue to overtreatment is an unexplained increase in creatinine. Home and 24-hour ambulatory BP monitoring are useful in detecting this.

Effect of treatment on cardiac small resistance arteries in hypertension and diabetes

Effect of treatment on cardiac small resistance arteries in hypertension and diabetes

Effect of Antihypertensive Drug Therapy on the Blood Pressure Control among Hypertensive Patients Attending Campus’ Teaching Hospital of Lome, Togo, West Africa

High blood pressure (HBP) is a health problem world—wide. In Togo, that affection constitutes a more and more pre-occupying cause of morbidity and mortality. This study is a prospective one which intended to identify the antihypertensive regimens prescribed and evaluate their effect on patients’ blood pressure (BP) control. Out of the 204 patients enrolled (mean: 55.01 ± 12.55 years; sex ratio: 1.3), 112/176 placed on antihypertensive therapy have controlled their BP (38.39% outpatients vs 61.61% inpatients). Related to the sex factor, we didn’t observe any significant difference in the BP control. Whereas, the mean median value of BP reduction of outpatients (30.00/15.00 mmHg) (p = 0.001) was half lower than that of inpatients (60.00/30.00 mmHg (p = 0.004)). Thirty five outpatients (81.40%) vs 64 inpatients (92.75%) were placed on combination therapy. The bitherapy was prescribed to 23 outpatients (53.49%) against 27 inpatients (39.13%) while the quadritherapy and more than 4 drugs combination were prescribed exclusively to inpatients (20.29%, n = 14). That quadritherapy induced a significant mean reduction of inpatients’ SBP compared to monotherapy (p = 0.043) and to bitherapy (p = 0.004). The favorite combinations were D + CCA, D + ACEI, D + CCA + ACEI and D + CCA + ACEI + CAAD of which the quadruple therapy showed a significant inpatients’ DBP control (p = 0.015) compared to D + CCA combination. The combinations including at least one diuretic induced a significant difference between outpatients (median value: 30.000/10.000 mmHg) (p ＜ 0.001) and inpatients (median value: 60.000 mmHg/30 mmHg) (p ＜ 0.001). The first-line molecules and fixe combinations prescribed in decreasing frequency were among others: hydrochlorothiazide + captopril, nicardipine, α methyldopa for outpatients; furosemide, nicardipine, captopril, α methyldopa, hydrochlorothiazide + captopril for inpatients. Diuretics, CCAs and ACEIs were the 3 favorite pharmacological groups for essential hypertension management in our African resource limited context. Combined to CAAD, they represented the best quadruple combination among inpatients having showed a significant difference in DBP control compared to D + CCA combination.

Masked inefficacy of arterial hypertension treatment: prevalence and predictors

Aim.To assess the prevalence of masked inefficacy of arterial hypertension treatment (AH MTI) and its predictors in various clinical groups and for various blood pressure (BP) control strategies, in order to evaluate the true effectiveness of antihypertensive therapy (AHT).Material and methods.AHT effectiveness was assessed in two groups of the patients with Stage I-II AH (n=219 and n=39), by comparing the ratios of clinical (cl) to ambulatory (a) BP parameters. AH MTI was defined as elevated aBP and target clBP levels during AHT. The potential predictors of AH MTI included gender, age, body mass index (BMI), anamnestic data, frequency of the clinical visits to measure BP, quality of life (QoL) parameters (GWBQ questionnaire), circadian BP profile, orthostatic BP, and ECG signs of left ventricular hypertrophy (LVH).Results.AH MTI prevalence in Groups I and II was 11,0-15,7 % and 22,6-58,1 %, respectively, depending on the definition used. The groups were significantly different in terms of age, BMI, and QoL questionnaire III and VI domains. According to the regression analysis results, in Group I AH MTI was associated with QoL questionnaire II, V, and VI domains, baseline parameters of 24-hour BP monitoring, 24-hour systolic BP (SBP) variability, minimal daytime levels of mean BP, and metoprolol and atenolol therapy. In Group II, AH MTI was predicted by age, BMI, previously administered AHT, alcohol consumption, orthostatic SBP levels, Sokolow-Lyon index, Cornell voltage and Cornell product, Gubner index, and QoL questionnaire I, IV, and VI domains.Conclusion.AH MTI prevalence is associated with some baseline characteristics of the patients and the character of AHT. Due to regression to the mean, AH MTI prevalence could increase substantially when clBP parameters are measured more often.

Effect of Antihypertensive Therapy on Incident Stroke in Cohorts With Prehypertensive Blood Pressure Levels

Compared with normotensive individuals, there is a higher incidence of stroke in patients with hypertensive, as well as prehypertensive, blood pressure levels (ie, 120-139/80-89 mm Hg). Although several studies have shown that blood pressure reduction in hypertensive patients reduces the incidence of cardiovascular events, including stroke, it is still unknown whether treatment of prehypertensive blood pressure levels has a similar effect. We sought to determine whether reduction in blood pressure in the prehypertensive range reduces the incidence of stroke by performing a meta-analysis of randomized trials comparing an antihypertensive drug against placebo in cohorts with prehypertensive baseline blood pressure levels. Randomized controlled trials performed with the 95 different antihypertensive agents available in the market were identified using MEDLINE, returning a total of 2852 results. Exclusion criteria included: average blood pressure of ≥ 140/90 mm Hg at baseline, crossover studies, and lack of a control group receiving placebo. A total of 16 trials involving 70 664 patients were included. Patients randomized to the active treatment arm had a statistically significant 22% reduction in the risk of stroke compared with placebo, with little heterogeneity among the trials (I(2), 18.0%; RR, 0.78 [95% CI, 0.71-0.86]; P<0.000001). To prevent 1 stroke, 169 patients had to be treated with a blood-pressure-lowering medication for an average of 4.3 years. The risk of stroke is significantly reduced with antihypertensive therapy in cohorts with prehypertensive blood pressure levels. These findings can have important clinical implications.

Abstract 9358: Time-Course of Left Ventricular Geometry in Arterial Hypertension: The Strong Heart Study

Background: The natural history of hypertensive heart disease is postulated to evolve from concentric LV geometry (LVG) to eccentric and eventually dilated LVG. However, there is no evidence of this evolution, likely due to effect of antihypertensive therapy, and there is no information on whether changes of LVG can be predictable. Methods: We examined echocardiograms in 850 hypertensive participants of the 4th phase of the Strong Heart Study (SHS) cohort (50±14 yrs, 486 women), who repeated echo exam after 4 years. LVG was assessed by relative wall thickness. Results: LVG remained normal (NN) in 55% of men (M) and 45% of women (W), remained concentric (CC) in 19% M and 30% W, changed from concentric to normal (CN) in 22% M and 19% W, and from normal to concentric (NC) in 4% M and 6% W (p&lt;0.001). Between exams, acute myocardial infarction occurred in 4 participants (0.5%). Participants with concentric LVG at the second exam (NC and CC) were older than the other groups (p&lt;0.001). At the time of initial exam, systolic blood pressure (BP) was slightly higher in participants developing concentric LVG (NC p=0.056), whereas diastolic BP and GFR were lower in those with persistent concentric LVG than in the other groups (both p&lt;0.001). Initial LV mass was higher and ejection fraction (EF) lower in CN and CC than in NN (p&lt;0.0001). Compared to NN, systolic BP increased over time in participants with concentric LVG at the second exam (NC and CC; both p&lt;0.03). On average, EF decreased over time, with the greatest decrease in participants changing LVG from concentric to normal and the minimum decrease in those developing concentric LVG (all p&lt;0.001). No effect of body size, fat distribution and prescription of classes of antihypertensive meds and statins could be detected, but the number of antihypertensive meds used at the time of the initial exam was significantly higher with persistent concentric LVG and lower with evolution from concentric to normal LVG (p&lt;0.001). Conclusions: Changes in LV geometry in treated SHS hypertensive participants are not related to type of antihypertensive meds. Persistent concentric LV geometry is related to older age, and increasing systolic BP over time despite greater intensity of anti-hypertensive therapy.