Goal Of Antihypertensive Therapy Research Articles

The Double Sequential Actions of the Angiotensin II Receptor Blockers and Mineralocorticoid Receptor Antagonists Therapy on the Renin Angiotensin Aldosterone System Produce a Better Reduction of Both Blood Pressure and Central Haemodynamic Parameters and Can Prevent the Appearance of the Atrial Fibrillation

Hypertension is a complex, multifactorial disease that has a significant positive association with adverse cardiovascular outcomes, such as myocardial infarction, stroke, kidney disease, and death. Research studies on hypertension have, so far, generally focused on vascular resistance and small arteries. The development of hypertension is usually accompanied by arterial structural remodelling, such as large artery stiffness, and increased both central systolic blood pressure and pulse pressure. Also, is well-established that hypertension is an important risk factor for atrial fibrillation. The goal of antihypertensive therapy is to prevent cardiovascular complications. Therefore, treatment with combination of antihypertensive agents acting on multiple targets is necessary for successful in the majority of patients. New therapeutics models are necessary to reduce both arterial stiffness and volume cardiovascular to ameliorate the stress of the arterial-ventricular-atrial dynamic coupling and the abnormal pulsatile system. The objective of the study was to assess the levels reached on both the systolic and diastolic blood pressure, and the central haemodynamic parameters into each one of the three groups of patients during the angiotensin II receptor blockers therapy alone, associated with hydrochlorothiazide or mineralocorticoid receptor antagonists, and observing the presence of episodes of atrial fibrillation during 24-hour Holter monitoring. The results suggest that the latter association of sequential double blockade on the renin angiotensin aldosterone system achieves the best haemodynamic conditions to avoid or reduce the presence of brief phases of atrial fibrillation on hypertensive patients with normal kidney function.

ASSESSMENT OF ANGIOTENSIN RECEPTOR BLOCKERS THERAPY WHEN ASSOCIATED TO MINERALOCORTICOID RECEPTOR ANTAGONISTS OR TO HYDROCHLOROTHIAZIDE ACCORDING CENTRAL HAEMODYNAMIC PARAMETERS

Objective: OBJECTIVE: The goal of antihypertensive therapy is to prevent complications. The harmful effects of aldosterone are innumerable: induced cardiac/renal fibrosis, sodium and water retention, inflammation, oxidative stress, among others, that are involved in arterial/myocardium stiffness, remodelling, heart failure and new onset atrial fibrillation. Thiazide diuretics can activate the neurohormonal system, impair glucose metabolism, increase new-onset diabetes, and are potentially arrhythmogenic. Protective effect of Angiotensin Receptor Blockers (ARBs) on major cardiovascular events might be partly independent of the degree of blood pressure reduction. Mineralocorticoid Receptor Antagonists (MRAs) therapy reduce arterial stiffness, plasma volume, collagen/elastin ratio and vascular/myocardial fibrosis. The objective is to assess the levels reached in central haemodynamic parameters (CHPs) when thiazide is replaced by MRA, and associated with ARBs, during the treatment of hypertensive patients with normal kidney function. Design and method: DESIGN AND METHOD: For this cross-sectional retrospective study, data were registered from 70 hypertensive patients, female/male: 39/31 (average age: 66/62), while being treated with hydrochlorothiazide (Hctz) combined to ARBs, and after changing to MRAs+ARBs therapy in the same patients. The average dose of Hctz among female/male were 14/15 mg and the duration of the Hctz+ARB therapy were 35/34 months, while the MRA+ARB therapy were 13/14 months. The CHPs (Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure, Pulse Pressure, Augmentation Pressure, Augmentation Index) were measured by the SphygmoCor System PVX (AtCor-Medical, Australia), according system's standard methods. Also was measured the difference between the normal levels, and the observed values of Augmentation Index (Diff-AIx) according age. Results: RESULTS: The results of CHPs, Diff-AIx, systolic and diastolic blood pressure during association of ARBs+MRAs therapy compared to ARBs+Hctz, both genders, showed the lowest values with a highly statistically significant difference, except augmentation pressure and pulse pressure among male. No hyperkalaemia was observed in this sample. Conclusions: CONCLUSIONS: These findings suggest that the dual block with MRA+ARB therapy giving better central haemodynamic parameters, reducing the stress to arterial-ventricular coupling, it could be helpful to prevent, in the short- and long-term, the harmful effects of angiotensin-aldosterone system such as the development of heart failure and atrial fibrillation.

Angiotensin receptor blockers and mineralocorticoid receptor antagonists therapy reaches better central haemodynamic parameters and avoid the episodes of atrial fibrillation

Abstract Introduction The goal of antihypertensive therapy is to prevent complications. The harmful effects of aldosterone are innumerable: induced cardiac/renal fibrosis, sodium and water retention, inflammation, oxidative stress, among others, that are involved in arterial/myocardium stiffness, remodelling, heart failure and new-onset atrial fibrillation (AF). Thiazide diuretics can activate the neurohormonal system, impair glucose metabolism, increase new-onset diabetes, and are potentially arrhythmogenic. Protective effect of Angiotensin Receptor Blockers (ARB) on major cardiovascular events might be partly independent of the degree of blood pressure reduction. Mineralocorticoid Receptor Antagonists (MRA) therapy reduce arterial stiffness, plasma volume, collagen/elastin ratio and vascular/myocardial fibrosis. Purpose The objective was to assess the levels reached in central haemodynamic parameters (CHP) and the presence of episodes of AF during ARB+hydrochlorothiazide (Hct) versus ARB+MRA therapy in hypertensive patients with normal kidney function. Methods For this cross-sectional retrospective study, data were entered from 108 hypertensive patients, female 62 (ARBs+MRA/ARB+Hctz average age 67/71), male 46 (average age ARB+MRA/ARB+Hctz 67/71), both p=ns). The average doses of Hct among female/male were 16/19 mg and the duration of the ARB+Hctz therapy were 37/47 months, while the ARB+MRA therapy were 36/49 months. 24-hours Holter monitoring was used in all patients. The group ARB+MRA before therapy had a history of AF episodes. The CHP (Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure, Pulse Pressure, Augmentation Pressure, Augmentation Index) were registered by the SphygmoCor System PVX (AtCor-Medical, Australia), according system's standard methods. Also was measured the difference between the normal levels, and the observed values of Augmentation Index (Diff-AIx) according age. Results The results of CHP, Diff-AIx, systolic and diastolic blood pressure during association of ARB+MRA therapy compared to ARB+Hct, both genders, showed the lowest values with a highly statistically significant difference. The episodes of AF during 24-hours Holter monitoring in the group ARB+Hct therapy in female/male were 55%/71%; instead, in the ARB+MRA treated they were not found. Conclusions These findings suggest that the dual block with ARB+MRA therapy giving better CHP, reducing the stress to arterial-ventricular coupling, it could be helpful to prevent, the harmful effects of angiotensin-aldosterone system such as the development of heart failure and atrial fibrillation. Funding Acknowledgement Type of funding source: None

The effect of preservative-free treatment of primary open-angle glaucoma on the state of ocular surface in combination therapy (intermediate results)

To assess the state of ocular surface in patients with POAG when switching to preservative-free carbonic anhydrase inhibitor (ICA) containing 0.18% sodium hyaluronate in combination with prostaglandin analogues and beta-adrenergic blocking agents. The study was conducted in 2019; according to selection criteria, it included 46 patients (80 eyes) with POAG and a control group of healthy persons. At the start of the study and one month later, after a change of treatment to uninterrupted ICA containing 0.18% sodium hyaluronate, the patients had state of their ocular surface examined: Norn's test (tear break-up time; TBUT), Schirmer's test, vital staining with lissamine green and an Ocular Surface Disease Index (OSDI) survey. Replacing the ICA with benzalkonium chloride in the combination therapy of glaucoma with a preservative-free ICA containing 0.18% sodium hyaluronate - Dorzolan Solo (Solopharm, Russia) - expectedly did not lead to additional decrease of IOP, but resulted in a decrease in the width of the confidence interval according to both Maklakov's and Icare tonometers, which may be associated with increased treatment adherence. At the same time, the state of ocular surface in the observation group was statistically significantly improved according to Norn's test - from 3.57±1.3; 3.0 (3.0; 5.0) to 4.9±2.5; 5.0 (3.0; 6.0) (V=16.5; p=0.0039). According to Schirmer's test and vital staining with lissamine green, no statistically significant changes have occurred. OSDI survey did not reveal changes in the study patients during 4 weeks of the follow-up, while the control group exhibited improvement.

Terapia szyta na miarę czyli jak poprawić skuteczność leczenia i rokowanie chorego. Intensyfikacja leczenia hipotensyjnego krok po kroku — od monoterapii do leków złożonych

The goal of antihypertensive therapy is to reduce the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular end points including stroke, myocardial infarction, and heart failure. For patients with stage 1 hypertension, it is often reasonable to start with monotherapy. Recent data, however, suggest that the advantages of initial combination treatment may extend to stage 1 hypertension. Available data suggest that about 70–80% of patients will require combination therapy to achieve contemporary blood pressure targets. Rational combination therapy is based on the co-administration at least two antihypertensive agents. Perindopril-based single-pill combinations are associated with a significant improvement in compliance, effective blood pressure-lowering, and reduction long-term incidence of cardiovascular events.

A descriptive study on drug prescribing pattern in hypertensive patients in a tertiary care teaching hospital

Background: Hypertension is highly prevalent and the goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points including stroke, myocardial infarction, and heart failure. Not many studies are conducted in this part of world regarding drug utilization of antihypertensive drugs and hence this study was planned.Methods: A descriptive cross-sectional study was conducted for a period 6 month in outpatient department of a tertiary care centre of Government Medical College, Srinagar, Jammu and Kashmir. The prescriptions containing antihypertensive drugs were collected from the patients attending the outpatient department.Results: During the study period a total of 230 prescriptions were collected, out of which 196 were included for the final analysis. Mean age was found to be 62.42±7.77 years. In majority of cases (44.89%), a combination of two drugs was prescribed and among the two-drug combination, Angiotensin Receptor Blockers (ARBs) and Calcium Channel Blockers (CCBs) were used most commonly (40.90%). Angiotension receptor blockers were used as single drug in most number of patients (41.66%). Proton pump inhibitors were the most common (35.71%) co-prescribed drug, followed by Anti platelet drugs (27.55%), Anti diabetics (16.32%) and Statins (16.32).Conclusions: Present study represents the current prescribing trend for antihypertensive agents. It implies that ARBs are the leading group of antihypertensive agents both when used singly and in combination. Further studies focused on the rationale for choice of drugs based on demographic data, economic status, associated comorbid conditions and complications would give additional insights into prescribing patterns in hypertension in India.

Medication Adherence and Blood Pressure Control Among Hypertensive Patients With Coexisting Long-Term Conditions in Primary Care Settings: A Cross-Sectional Analysis.

Hypertension is a typical example of long-term disease posing formidable challenges to health care. One goal of antihypertensive therapy is to achieve optimal blood pressure (BP) control and reduce co-occurring chronic conditions (multimorbidity). This study aimed to assess the influence of multimorbidity on medication adherence, and to explore the association between poor BP control and multimorbidity, with implications for hypertension management.A cross-sectional design with multistage sampling was adopted to recruit Chinese hypertensive patients attending general out-patient clinics from 3 geographic regions in Hong Kong. A modified systemic sampling methodology with 1 patient as a sampling unit was used to recruit consecutive samples in each general out-patient clinic. Data were collected by face-to-face interviews using a standardized protocol. Poor BP control was defined as having systolic BP/diastolic BP ≥130/80 mm Hg for those with diabetes or chronic kidney disease; and ≥140/90 mm Hg for others. Medication adherence was assessed by a validated Chinese version of the Morisky Medication Adherence Scale. A simple unweighted enumeration was adopted to measure the combinations of coexisting long-term conditions. Binary logistic regression analysis was conducted with medication adherence and multimorbidity as outcome variables, respectively, after controlling for effects of patient-level covariates.The prevalence of multimorbidity was 47.4% (95% confidence interval [CI] 45.4%–49.4%) among a total of 2445 hypertensive patients. The proportion of subjects having 0, 1, and ≥2 additional long-term conditions was 52.6%, 29.1%, and 18.3%, respectively. The overall rate of poor adherence to medication was 46.6%, whereas the rate of suboptimal BP control was 48.7%. Albeit the influence of multimorbidity on medication adherence was not found to be statistically significant, patients with poorly controlled BP were more likely to have multimorbidity (adjusted odds ratio 2.07, 95% CI 1.70–2.53, P < 0.001). Diabetes was the most prevalent concomitant long-term condition among hypertensive patients with poor BP control (38.6%, 95% CI 35.8–41.4 vs 19.7%, 95% CI 17.5–21.9 for patients with good BP control, P < 0.001).Multimorbidity was common among hypertensive patients, and was associated with poor BP control. Subjects with coexisting diabetes, heart disease, or chronic kidney disorder should receive more clinical attention to achieve better clinical outcomes.

Pharmacological Interactions on Blood Pressure Control in Arterial Hypertension, An Issue not to be Overlooked.

Our vision of long-term treatment strategies for the prevention of target organ damage and eventually cardiovascular morbidity and mortality in essential arterial hypertension needs to be continually monitored and updated for at least three issues: 1--the achievement of target pressure required to obtain the expected benefit needs continuous monitoring, a dose adjustment of the drug and, often, the use of combination therapies; 2--the chronic use of certain drugs, even in combination, is associated with the possible onset of side effects; 3--increasing of population life expectancy is inevitably associated with in an increase in drugs use with the unavoidable occurrence of adverse drug reactions, some of which can interfere with blood pressure control. These issues, still poorly studied, pose considerable problems in applying proper strategies for prevention. In this review, we will evaluate the goals of antihypertensive therapy, and its weak spots, such as the frequent side effects, that lead to poor therapy compliance. Moreover, we will review the interactions between antihypertensive and drugs used for other common disease, and their importance in not achieving the expected blood pressure reduction.

GW24-e1911 Co-morbidity, treatment, and control of hypertension among hypertensive outpatients in China

ObjectivesTo investigate the prevalence of co-morbidities, the use of antihypertensive drugs and the status of blood pressure control among hypertensive outpatients in China.MethodsA multi-centre cross-sectional study in hypertensive outpatients was...

Blood pressure control and favourable pleiotropic effects of aliskiren

Hypertension and its acute and chronic complications are one of the most important risk factors associated with significant morbidity and mortality worldwide and will increase in importance as a public health problem by 2020.1 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) establishes that the goal of antihypertensive therapy is to reduce cardiovascular and renal morbidity and mortality. Despite the wide range of antihypertensive agents available, less than one third of patients with hypertension have their blood pressure (BP) controlled.

Therapierefraktäre Hypertonie

Sympathetic overexpression can be found in a majority of hypertensive patients. Resistant arterial hypertension requires a targeted diagnostic procedure in order to exclude secondary causes of hypertension which can be treated specifically with established therapies. If secondary reasons are not identified, the antihypertensive medication is already optimal and lifestyle changes have been realized, but still the goal of antihypertensive therapy cannot be achieved, alternative invasive therapy strategies such as renal sympathetic denervation and baroreflex activation have been developed to achieve blood pressure control. These therapies are restricted to specialized centers which treat well-defined patients with therapy-resistant hypertension. Little long-term data concerning safety and efficacy are available for the two strategies. However, they should preferably be used as an ultima-ratio and add-on pathway to conservative procedures when established medication fails to achieve blood pressure control. To date, the effectiveness of the interventional antihypertensive therapies has only been shown on patients with systolic blood pressure over 160mmHg and a mean oral medication of five drugs.

Combination Therapy in Hypertension

The goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points, including stroke, myocardial infarction, and heart failure. Although the choice of initial drug therapy exerts some effect on long-term outcomes, it is evident that BP reduction per se is the primary determinant of CV risk reduction. Available data suggest that at least 75% of patients will require combination therapy to achieve contemporary BP targets, and increasing emphasis is being placed on the practical tasks involved in consistently achieving and maintaining goal BP in clinical practice. It is within this context that the American Society of Hypertension presents this Position Paper on Combination Therapy for Hypertension. It will address the scientific basis of combination therapy, present the pharmacologic rationale for choosing specific drug combinations, and review patient selection criteria for initial and secondary use. The advantages and disadvantages of single-pill (fixed) drug combinations and the implications of recent clinical trials involving specific combination strategies will also be discussed.

INVESTing in Hypertension

Hypertension is a common risk factor for peripheral arterial disease (PAD), and the majority of patients with PAD are hypertensive. Recent consensus-based recommendations from the American Heart Association [1] indicate that the goal of antihypertensive therapy in patients with PAD should be to achieve a blood pressure (BP) less than 130/80 mm Hg. However, evidence from clinical trials for the optimal level of BP control in patients with PAD is lacking.

Combination therapy in hypertension

The goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points including stroke, myocardial infarction, and heart failure. Although the choice of initial drug therapy exerts some effect on long-term outcomes, it is evident that BP reduction per se is the primary determinant of CV risk reduction. Available data suggest that at least 75% of patients will require combination therapy to achieve contemporary BP targets, and increasing emphasis is being placed on the practical tasks involved in consistently achieving and maintaining goal BP in clinical practice. It is within this context that the American Society of Hypertension presents this Position Paper on Combination Therapy for Hypertension. It will address the scientific basis of combination therapy, present the pharmacologic rationale for choosing specific drug combinations, and review patient selection criteria for initial and secondary use. The advantages and disadvantages of single pill (fixed) drug combinations, and the implications of recent clinical trials involving specific combination strategies will also be discussed.

Combination therapy in hypertension

The goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points including stroke, myocardial infarction, and heart failure. Although the choice of initial drug therapy exerts some effect on long-term outcomes, it is evident that BP reduction per se is the primary determinant of CV risk reduction. Available data suggest that at least 75% of patients will require combination therapy to achieve contemporary BP targets, and increasing emphasis is being placed on the practical tasks involved in consistently achieving and maintaining goal BP in clinical practice. It is within this context that the American Society of Hypertension presents this Position Paper on Combination Therapy for Hypertension. It will address the scientific basis of combination therapy, present the pharmacologic rationale for choosing specific drug combinations, and review patient selection criteria for initial and secondary use. The advantages and disadvantages of single pill (fixed) drug combinations, and the implications of recent clinical trials involving specific combination strategies will also be discussed.

Leitliniengerechte Differenzialtherapie der Hypertonie

The goal of antihypertensive therapy is to lower blood pressure and, by doing so, to decrease cardiovascular risk. Life style changes and drugs are available for the treatment of hypertensive patients. In order to reach the target blood pressure, most patients with hypertension need drug treatment in addition to life style changes. In all hypertensive patients, the target blood pressure is <140/90 mmHg. In patients with diabetes mellitus, with chronic renal failure as well as in patients with complications of hypertension and, thereby a very high cardiovascular risk, the target blood pressure is <130/80 mmHg. Diuretics, beta-blockers, calcium antagonists, ACE-inhibitors and angiotensin receptor blockers are the drugs of first choice in the treatment of hypertension. The selection among these drug classes has to consider probable side effects as well as accompanying diseases and complications of hypertension. One should also take into account that most of the beneficial effects of antihypertensive therapy is due to the decrease of blood pressure per se and that the majority of hypertensive patients require the combination of two or more antihypertensive drugs in order to reach the target blood pressure.

Staging of Hypertension and Total Cardiovascular Risk Assessment: Related but Not the Same—Challenge for the Hypertension Specialist

Staging of Hypertension and Total Cardiovascular Risk Assessment: Related but Not the Same—Challenge for the Hypertension Specialist

Association between Pulse Pressure and Mortality in Patients Undergoing Peritoneal Dialysis

Pulse pressure has been shown to be associated with adverse outcomes in the general population and in patients on hemodialysis (HD). However, the significance of pulse pressure has not been studied in peritoneal dialysis (PD) patients. This study examined the association between pulse pressure and mortality in patients undergoing chronic PD. All patients aged 18 years or older that commenced PD between 1 January 2000 and 31 December 2005 at the University Health Network, Toronto, were included. The association between pulse pressure and mortality was assessed using the Cox proportional hazards model. A total of 306 patients were included in the study. Mean pulse pressure of the study cohort was 56.8 +/- 17.8 mmHg. Age and diabetes were significant predictors of elevated pulse pressure (p < 0.001). After adjusting for the level of systolic blood pressure and other demographic and clinical parameters, multivariable Cox proportional hazards modeling showed a direct and consistent association between pulse pressure and death risk. Each increment of 1 mmHg in pulse pressure was associated with a 2.7% increased hazard of all-cause death [95% confidence interval (CI) 1.001 - 1.054, p = 0.039] and a 4.1% increase in risk for cardiovascular mortality (hazard ratio 1.041, 95% CI 1.003 - 1.081; p = 0.035). Elevated pulse pressure is associated with an increased risk of all-cause and cardiovascular death in patients on PD. Recognition of this characteristic as an important predictor of mortality suggests that one goal of antihypertensive therapy in PD patients should be to decrease elevated pulse pressure.

Management of hypertension in patients with left ventricular hypertrophy

Left ventricular hypertrophy (LVH) is a cardinal manifestation of organ damage in patients with arterial hypertension. Identifying LVH is a fundamental step in evaluating hypertensive patients, because clinical and epidemiologic studies have shown this condition has a strong independent adverse prognostic significance. LVH is an integrated marker of cardiovascular risk, reflecting hypertension's hemodynamic and nonhemodynamic effects on the heart. Reversing LVH is an intermediate goal of antihypertensive therapy. Pharmacologic strategies to reverse LVH should be based on combining two or more drugs: a renin-angiotensin system blocker (ie, angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist), and a calcium antagonist or low-dose diuretic. Successful therapeutic plans should also include nonpharmacologic interventions to promote LVH regression.

ESSENTIAL HYPERTENSION

Background: Hypertension and type 2 diabetes mellitus also tend to coexist.The goal of antihypertensive therapy should consist of reducing cardiovascular morbidity and mortality associated withhypertension by a strategy focused on lowering blood pressure while minimizing the impact on other associatedcardiovascular risk factors like diabetes mellitus. Objectives: To observe and compare any change in serum glucosein patients with newly diagnosed essential hypertension with Atenolol and Amlodipine. Setting: Department ofPharmacology and Therapeutics, Basic Medical Science Institute (BMSI), Jinnah Post Graduate Medical Centre(JPMC), Karachi. Period: 12 weeks (90 days) Methods: Patients with newly diagnosed essential hypertension (N=70)were enrolled in this study and were divided into two groups, each comprised of 35 patients and were given tabletAtenolol 50/100mg once daily and tablet Amlodipine 5/10 mg once daily respectively for 90 days. Fasting Blood glucosewas measured on day of inclusion i.e. day 0, day 45 and day 90. At each fortnightly visit, blood pressure was recorded.Results: Atenolol raised mean blood glucose levels from baseline levels of 91.82±1.34 mg/dl to 99.73±1.33 mg/dl onday 90 (P&lt;0.001) while Amlodipine had no significant effect on blood glucose level (P= N.S). Conclusion: Atenololmay not be a good choice for essential hypertensive patient with type 2 diabetes mellitus as it is found to impair the normal glucose metabolism. Long term clinical trials in diabetic patients are needed to confirm the observation of thepresent study.