Long-term Antihypertensive Therapy Research Articles

The impact of long-term antihypertensive treatment on wound healing after major non-cardiac surgery in patients with cardiovascular diseases: A meta-analysis.

Hypertension is a prevalent condition that poses significant challenges in the perioperative management of patients undergoing major non-cardiac surgery, particularly concerning wound healing and scar formation. This meta-analysis assesses the impact of long-term antihypertensive treatment on postoperative wound healing, examining data from seven studies involving patients who received such treatments compared to untreated controls. Our findings reveal that long-term antihypertensive therapy is associated with significantly improved wound healing outcomes, as indicated by lower REEDA scores (I2 = 96%, SMD = -25.71, 95% CI: [-33.71, -17.70], p < 0.01) 1 week post-surgery and reduced scar formation, demonstrated by lower Manchester Scar Scale scores (I2 = 93%, SMD = -37.29, 95% CI: [-44.93, -29.64], p < 0.01) 2 months post-surgery. These results underscore the potential benefits of antihypertensive treatment in enhancing surgical recovery and offer insights into optimising perioperative care for hypertensive patients.

Target blood pressure level in patients in the pre- and post-stroke period: features of antihypertensive therapy depending on the stage of hypertension (literature review)

Today, the problem of managing patients in the pre- and post-stroke period is associated with the target level of blood pressure. However, it is difficult to determine, because patients differ in age, duration and stage of hypertension, and comorbidities. Instrumental studies of the brain reveal its various lesions, as well as damage to the heart, impaired autoregulation of cerebral circulation, atherosclerosis of the major vessels of the head and neck. All these factors are certainly crucial for planning the long-term antihypertensive therapy.

31. Evaluation of Hypertension Patient's Adherence to Treatment in Primary Healthcare Settings Across Multiple Centers in Indonesia

Background: Hypertension is a significant public health concern as it can lead to cardiovascular and cerebrovascular diseases. Many hypertension patients are unaware of their condition and do not take any medication. Riskesdas 2018 stated that the prevalence of hypertension in ages &gt;18 years old is 34,1%, 8,8% being diagnosed, 13,3% not taking medication, and 32,3% in poor compliance. Multiple factors contribute to poor compliance with long-term antihypertensive therapy. This study examines hypertensive therapy compliance in primary care and its major determinants. Method: We gather the data of patients with hypertension using the Electronic Medical Record in the Primary Healthcare Center (Puskesmas). We also included the National Health Insurance system data to determine when the patient went to Puskesmas from November 2021 to October 2022. The patient's gender and other comorbid conditions become the independent variable. The dependent variable is patient compliance which is associated with the number of patient visits in 1 year. Result: We Gather 44,293 data from patients visiting 5 Puskesmas. These are 1,493 unique patients diagnosed with hypertension. Only 493 male patients from 1,493 patients (33%) went to the Puskesmas for treatment. However, there was no difference in compliance between male and female patients (p = 0.136). Hypertensive patients with comorbid (diabetes) amounted to 225 out of 1,790 patients (13%). The independent t-test showed that patients with comorbidities were more likely to routinely control (p = 0.000). Conclusion: Compliance from hypertensive patients is often neglected. Gender and comorbidities are essential for planning appropriate public interventions to increase patient compliance.

Вплив поліморфізма гена рецепторів ангіотензина ii типу 1 на ефективність антигіпертензивної терапії у хворих із гіпертонічною хворобою, які перенесли інфаркт міокарда за результатами довготривалого спостереження

The purpose of the study was to evaluate the effectiveness of antihypertensive therapy based on the data of daily blood pressure monitoring in patients with hypertension and a history of myocardial infarction, taking into account the A1166C polymorphism of the angiotensin II type 1 receptor gene, based on the results of long-term follow-up. Materials and methods. The study included 36 men with arterial hypertension of the 1st to 3rd degree who had suffered a myocardial infarction. The average age was 57.0 (52.0; 64.0) years, the experience of arterial hypertension – 6.3 (4.0; 15.0) years, the period after a myocardial infarction – 48.0 (12.0; 144.0) months. When determining the A1166C polymorphism of the angiotensin II type 1 receptor gene, patients were divided into 3 groups: group 1 consisted of 18 (50%) patients with the AA genotype, group 2 included 12 (33.3%) patients with the AС genotype, and group 3 – 6 (16.7%) patients with СС genotype of angiotensin II type 1 receptor gene. Daily blood pressure monitoring was carried out at the beginning of the study and after 38 months. Results and discussion. At the beginning of the study, based on the results of daily blood pressure monitoring, it was found that in the group as a whole, the levels of systolic blood pressure and diastolic blood pressure, the pressure load index – the diastolic blood pressure time index corresponded to the target values according to the median, but the pressure load indices for systolic blood pressure exceeded the normal range. Against the background of long-term antihypertensive therapy, a reliable decrease in systolic blood pressure levels was established for all time periods of the day, especially during the daytime. A significant decrease in the values of the pressure load indices was established – the time index of systolic blood pressure at daytime (delta -10.49%, which was -27.9%) and the area index of systolic blood pressure at daytime (delta -34.89 mm Hg x h, which was -32.0%) (p &lt;0.05). When analyzing the effectiveness of long-term antihypertensive therapy depending on the A1166C polymorphism of the angiotensin II type 1 receptor gene, it was established that the highest percentage of achieving the target blood pressure level (66.7%) in combination with the normalization of the circadian blood pressure rhythm was determined in patients with the AA genotype of the AGTR1 gene. Among patients with AC genotype, 33.3% reached the target blood pressure levels, but it was not possible to achieve normalization of blood pressure variability and pathological patterns of the circadian rhythm of blood pressure persisted, which are signs of a prognostically unfavorable course of the disease. Among patients with CC genotype of the AGTR1 gene, against the background of long-term treatment, 33.3% achieved the target level of blood pressure, in general, the group normalized the degree of nocturnal decrease in blood pressure, but only a decrease in the levels of systolic blood pressure and diastolic blood pressure during the day in combination with increased values of pressure load indices was observed, which indicates insufficiently effective control of arterial hypertension. Conclusion. During the long-term observation of patients with hypertension and a history of myocardial infarction, an assessment of the effectiveness of antihypertensive therapy was carried out taking into account the A1166C polymorphism of the AGTR1 gene based on the results of daily blood pressure monitoring

The impact of different angiotensin II receptor blockers on the stiffness of the large arteries and effectiveness of therapy

In recent years, the method of determining the Cardio-Ankle Vascular Index (CAVI) has been introduced into clinical practice, which can be used to determine changes in the stiffness of the large arteries regardless of changes in blood pressure (BP). Aim. To compare the effect of 12-month angiotensin II receptor blocker (ARB) therapy with olmesartan, azilsartan and telmisartan on the large arteries stiffness based on the CAVI determination. Material and methods. The study included 126 patients (57 men, 69 women) with hypertension, who were selected to compare the effect of ARB drug therapy on the arterial stiffness by CAVI: olmesartan, azilsartan and telmisartan for 12 months. All patients had mild and moderate hypertension. The patients underwent the following examinations: office BP measurement, ambulatory BP monitoring (ABPM), biochemical blood test, echocardiogram, CAVI, registration of side effects. Results. The average office systolic BP (SBP) throughout the group was 152.56 ± 1.00 mm Hg, office diastolic BP (DBP) – 94.83 ± 0.58 mm Hg, heart rate (HR) – 72.46 ± 0.80 bpm, 24-hour SBP – 135.60 ± 0.96 mm Hg, 24-hour DBP – 82.41 ± 0.84 mm Hg, 24-hour HR – 71.88 ± 0.89 beats/min., CAVI on the right – 7.89 ± 0.27, CAVI on the left – 8.00 ± 0.31. Office and ambulatory BP indicators were decreased equally in all groups. In the olmesartan group, CAVI was significantly decreased by 7 % on the right (P &lt; 0.05) and 5 % on the left (P &lt; 0.05). In the telmisartan group, CAVI was decreased by 6 % on the right (P &lt; 0.05) and 5 % on the left (P &lt; 0.05). In the azilsartan group, CAVI was significantly decreased by 5 % both on the right (P &lt; 0.05) and left (P &lt; 0.05). Conclusions. Long-term antihypertensive therapy with three different AT II receptor blockers, olmesartan, azilsartan, and telmisartan has helped to reduce stiffness of the large arteries according to CAVI by 5–7 % from the initial level.

Effect of long-term antihypertensive therapy on myocardial strain: a meta-analysis.

Evidence on the impact of blood pressure (BP)-lowering drugs on left ventricular (LV) mechanics in hypertension is still limited. We performed a meta-analysis of speckle-tracking echocardiographic studies in order to provide a new piece of information on this topic. The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search for articles published from the inception up to 31 October 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'left ventricular hypertrophy', 'systemic hypertension', 'BP lowering drugs,' 'antihypertensive therapy'. A total of 1140 hypertensive patients (mean age 55.4 years, 50% men, follow-up 6-36 months) were included in eight studies. Pretreatment and posttreatment pooled SBP/DBPs were 148.4 ± 3.5/88.7 ± 2 vs. 127.4 ± 1.9/77.8 ± 0.9 mmHg. Corresponding values for ejection fraction (EF), LV mass (LVM) index, and global longitudinal strain (GLS) were 64 ± 2.3 vs. 65.9 ± 1.7% (SMD: 0.14 ± 0.03, CI 0.08- 0.20, P = 0.001); 108.4 ± 11.2 vs. 100.2 ± 11.0 g/m2 (SMD: -0.27 ± 0.10, CI -0.46 to -0.08, P < 0.01); -17.7 ± 0.6 vs. -19.6 ± 0.4%, (SMD 0.26 ± 0.03, CI 0.20-0.32, P < 0.0001), respectively. A meta-regression analysis showed a significant relation between GLS improvement and the extent of reduction of LVMI (P = 0.0003), but not of SBP (P = 0.27). Our meta-analysis suggests that antihypertensive treatment has a clear beneficial effect on LV mechanisms, and the improvement in GLS is mainly related to the reduction in LVMI rather than SBP.

INVERSE SEASONAL VARIATIONS OF AMBULATORY BLOOD PRESSURE ARE ASSOCIATED WITH CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS

Objective: The seasonal changes of blood pressure (BP) in hypertensive patients have been widely investigated and attracted an increasing scientific interest during the past two decades. However, it is unclear whether these BP variations are related to cardiovascular risk. Design and method: We included patients aged 40–79 years who visited ambulatory clinics for various reasons. The main inclusion criteria were office BP 130/85-139/89 mm Hg, hypertension stage 1, or long-term antihypertensive therapy. The ambulatory blood pressure monitoring (ABPM) was performed with the BPLab device (Nizhny Novgorod, Russia), twice in all patients: in winter (December-February 2012–2014) and in summer (June-August 2012–2014). The interval between ABPMs was 6 months ± 7 days. The selection criteria for ABPM records were: duration &gt;23.5 hours, absence of data gaps &gt;1 hour, and &gt;55 readings per 24 hours. We analyzed the individual ambulatory and office seasonal BP differences in each patient. The participants were followed up until October 31st 2019 (mean follow-up 76.8 ± 5.1 months). The composite primary endpoint included death, myocardial infarction, stroke, transient ischemic attack, angina pectoris, and development of heart failure. The preliminary analyses included ANOVA, sensitivity analysis, and descriptive statistics. Results: 770 patients completed both visits. The outcome information was available in 528 patients: 335 from Ivanovo and 193 from Saratov (mean age 55 ± 10 years, 220 men). The endpoints were registered in 50 patients. We found the inverse mean winter-summer BP difference in the group of patients with cardiovascular outcomes (see table). In contrast, this difference was positive in the other group (see table). The sensitivity analysis (the winter-summer BP difference classified into 4 groups: inverse (&lt;0), small (0–5 mm Hg), medium (5–10 mm Hg), and large (&gt;10 mm Hg) variation) confirmed the hypothesis for 24-hour diastolic BP. We found no significant associations for office BP. Conclusions: The inverse seasonal BP variability may be associated with a higher risk of cardiovascular events; compared to patients with standard BP variability (BP is higher in winter, than in summer). Our data provide the tentative argument in favor of additional ambulatory BP control. The problem of seasonal BP variability warrants further investigation.

Arterial hypertension: the accent on the target organs’ protection

Background. Prolonged untreated arterial hypertension (AH) is accompanied by the damage of target organs (brain, eyes, kidneys, heart and large vessels). This problem can be prevented by the stable control of blood pressure (BP).&#x0D; Objective. To identify the main strategies for the target organs protection in AH.&#x0D; Materials and methods. Analysis of the available guidelines and literature data; the own study of L-arginine (Tivortin, “Yuria-Pharm”) administration.&#x0D; Results and discussion. BP lowering is an integral part of improving the outcome in patients with AH. Reduction of systolic BP by 10 mm Hg leads to the reduction of stroke risk by 27 %, heart failure risk – by 28 %, coronary heart disease risk – by 17 %. The primary goal of treatment of all patients with AH is to achieve the BP level &lt;140/90 mm Hg, in case of good tolerability – &lt;130/80 mm Hg. More intensive treatment with the achievement of BP &lt;130/80 mm Hg provides a more pronounced reduction of the risk of cardiovascular events. Reduction of systolic BP &lt;120 mm Hg is not reasonable. In patients with AH and chronic kidney disease, the target systolic BP should be 130-140 mm Hg. It is important to achieve normalization of BP quickly (within 3 months of treatment), as an early control of this parameter provides a better prognosis (VALUE study). The treatment strategy for uncomplicated AH involves initial therapy with a two-component combination in a single tablet (angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) + calcium channel blocker (CCB) or diuretic). At the next stage, a triple combination (ACEI/ARB + CCB + diuretic) is prescribed. According to the indications, β-blockers can be added at any stage. It is necessary to use drugs with proven organoprotective properties based on the target organs affection and concomitant nosological conditions of each individual patient. Even in patients with resistant AH long-term antihypertensive therapy improves renal function and reduces left ventricular hypertrophy. Additional ways of organoprotection in hypertension include the influence on the vascular endothelium condition. According to the results of our own study, the inclusion of L-arginine (Tivortin, “Yuria-Pharm”) into the basic therapy of AH can significantly reduce albuminuria compared with the control group (basic therapy without L-arginine), as well as improve the flow-dependent vasodilation (from 6.7 to 13.6 %, whereas in the control group this parameter has changed from 6.5 to 9.8 %; p&lt;0.001). In the L-arginine group, the glomerular filtration rate also increased significantly, while in the control group this indicator decreased. The renal artery resistance index also decreased (from 0.68 to 0.65 units; no changes were recorded in the control group).&#x0D; Conclusions. 1. To prevent the damage of target organs, it is necessary to quickly and stably reduce BP to the target values. 2. It is advisable to prescribe antihypertensive drugs with proven organoprotective properties. 3. L-arginine (Tivortin) improves the condition of the endothelium, thereby promoting vasodilation and improving renal function.

52-Year-Old Woman With Fever, Diaphoresis, and Abdominal Pain

52-Year-Old Woman With Fever, Diaphoresis, and Abdominal Pain

New approaches to managing patients with hypertensive crisis (sudden increase in blood pressure)

The article discusses management tactics for patients with hypertensive crisis – a sudden increase in blood pressure, which is based on the assessment of end-organ damage. In the presence of acute end-organ damage, condition is defined as hypertensive crisis and requires immediate intensive care. In this case, intravenous administration of drug is necessary, the choice of which depends on the type of end-organ damage. Gradual decrease in blood pressure and selection of long-term antihypertensive therapy on an outpatient basis is recommended for patients with hypertensive crisis without acute end-organ damage.

Is the medical treatment for arterial hypertension after primary aortic coarctation repair related to age at surgery? A retrospective cohort study.

Hypertension following primary coarctation repair affects up to a third of subjects. A number of studies suggest that future hypertension risk is reduced if primary repair is performed at a younger age. The objective of this study was to evaluate the risk of future medical treatment for hypertension depending on age of primary coarctation repair. This study was carried out at a tertiary paediatric cardiology referral centre. Retrospective database evaluation of children aged 28 days and ⩽12 months), and children (>12 months). Main outcome measure is the need for long-term anti-hypertensive medication. The risk for re-coarctation was also evaluated. A total of 87 patients were analysed: 60 neonates, 17 infants, 10 children. Among them, 6.7% neonates, 29.4% infants, and 40% children required long-term anti-hypertensive medications. Group differences were statistically significant (p=0.004). After adjustment for type of repair, the risk of long-term anti-hypertensive therapy was 4.5 (95% confidence interval 1.2-16.9, p=0.025) and 10.5 times (95% confidence interval 2.6-42.3, p=0.001) higher if primary repair was carried out in infancy and childhood, respectively, compared with neonates. Among all, 13 patients developed re-coarctation: 21.7% in the neonatal group, 5.9% in the infant group, and 20% in the child group. We could not demonstrate a significant difference between these proportions or calculate a reliable risk for developing re-coarctation. Risk of medical treatment for hypertension was lowest when primary repair was carried out during the neonatal period, rising 10-fold if first operated on as a child. Knowing the likelihood of hypertension development depending on age of primary repair is useful for long-term surveillance and counselling.

Influence of Prevalent and Incident Atrial Fibrillation on Post-Trial Major Events in ALLHAT

AimsLimited information is available on long-term antihypertensive and lipid-lowering therapy effects on hypertensive patients with atrial fibrillation/flutter (AF/AFL) compared to those without. AF/AFL at baseline or during the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (mean follow-up 4.9 years) markedly increased risk of stroke, heart failure, CHD, and all-cause mortality. We aimed to determine if AF/AFL continued to impact outcomes during post-trial follow-up (mean 3.8 years). MethodsPatients were randomized to chlorthalidone, amlodipine, or lisinopril, and to pravastatin vs. usual care in the lipid-lowering trial (LLT). Of 31,473 available subjects, AF/AFL occurred in 854; 383/14,371 chlorthalidone (2.7%), 247/8565 amlodipine (2.9%), and 224/8537 lisinopril (2.6%). Post-hoc analyses utilized administrative databases for post-trial data. Individuals with AF/AFL were compared to those without during post-trial. Outcomes were analyzed by treatment groups for the antihypertensive and LLT trials. ResultsAmong 854 AF/AFL participants, 491 (57.5%) died: 220 in-trial, 271 post-trial. Ten-year all-cause mortality rates for those with in-trial AF/AFL were similar for chlorthalidone and lisinopril, but lower for amlodipine (68, 66, and 49 per 100 persons, respectively); adjusted HR for amlodipine vs. chlorthalidone was 0.68 (95% CI, 0.54–0.87). Ten-year all-cause mortality rates were 57 vs. 65 per 100 persons (pravastatin vs. usual care); non-CVD mortality rates, 18 vs. 39 per 100 persons (pravastatin vs. usual care) (adjusted HR = 0.46, 95% CI, 0.24–0.86). ConclusionPost-trial follow-up revealed continued deleterious AF/AFL effects. The amlodipine (ALLHAT) and pravastatin (ALLHAT-LLT) treatment groups showed lower all-cause and non-CVD mortality compared to the chlorthalidone and usual-care groups, respectively.

Diagnostic value of the different schedules for the home blood pressure measurement for assessment of the efficiency of algorithmic anti-hypertensive therapy at the long-term observation over hypertensive patients

Aim. The assessment of diagnostic possibilities of the protocols of the home arterial pressure (AP) measurement for the control of efficacy of anti-hypertensive therapy.Methods. The data of home AP of 236 patients as to its value, frequency of attainment of recommended level and determination of phenotype of arterial hypertension (AH), received for 3-5-7 of measurement taking into account of the results of 1 day or without it, were compared. The coefficients: Cohen’s kappa and Lin’s coordination of correlation were determined.Results. Taking into account of the data of the 1 day of measurement worsened the coordination of the mean AP values in 7 days of treatment not depending on the duration of measurement and did not influence in further. The coordination of data as to attainment of recommended level of home AT and AH phenotypes in the case of 7-days and 5-days measurement did not depend on taking into account of the data of 1 day, but worsened at 3-days one.Concision. Taking into account of the data of 1 day of home AT measurement influences the diagnostic possibilities of the measurement protocols of the different term as to the control of efficacy of the long-term anti-hypertensive therapy at the beginning of treatment and in the case of 3-days period of measurement and is less essential at the long-term observation

Nimodipine, an L-type calcium channel blocker attenuates mitochondrial dysfunctions to protect against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinsonism in mice

Parkinson’s disease (PD), the most common progressive neurodegenerative movement disorder, results from loss of dopaminergic neurons of substantia nigra pars compacta. These neurons exhibit Cav1.3 channel-dependent pacemaking activity. Epidemiological studies suggest reduced risk for PD in population under long-term antihypertensive therapy with L-type calcium channel antagonists. These prompted us to investigate nimodipine, an L-type calcium channel blocker for neuroprotective effect in cellular and animal models of PD. Nimodipine (0.1–10 μM) significantly attenuated 1-methyl-4-phenyl pyridinium ion-induced loss in mitochondrial morphology, mitochondrial membrane potential and increases in intracellular calcium levels in SH-SY5Y neuroblastoma cell line as measured respectively employing Mitotracker green staining, TMRM, and Fura-2 fluorescence, but only a feeble neuroprotective effect was observed in MTT assay. Nimodipine dose-dependently reduced 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonian syndromes (akinesia and catalepsy) and loss in swimming ability in Balb/c mice. It attenuated MPTP-induced loss of dopaminergic tyrosine hydroxylase positive neurons in substantia nigra, improved mitochondrial oxygen consumption and inhibited reactive oxygen species production in the striatal mitochondria measured using dichlorodihydrofluorescein fluorescence, but failed to block striatal dopamine depletion. These results point to an involvement of L-type calcium channels in MPTP-induced dopaminergic neuronal death in experimental parkinsonism and more importantly provide evidences for nimodipine to improve mitochondrial integrity and function.

NEUROLOGICAL DISORDERS IN PATIENTS WITH HYPERTENSION AND THEIR CORRECTION

Neurological disorders in hypertensive patients can be caused by both brain injury and concomitant diseases. The elucidation of the causes of neurological disorders and their effective treatment contribute to hypertensive patients’ better adherence to long-term antihypertensive therapy, which normalizes blood pressure (BP) and reduces the risk of cerebral complications Objective: to study of the causes of neurological disorders in hypertensive patients and the efficiency of their correction using a new dispersible vinpocetine formulation (Cavinton® Comforte) in combined therapy. Patients and methods. A total of 80 patients (men (20%) and women (80%); mean age 63±12.3 years) with neurological complaints in the presence of hypertension were examined. All the patients were diagnosed with dyscirculatory encephalopathy or chronic brain ischemia, whether they had vascular cognitive impairment. The examination of patients revealed that the neurological complaints were mainly due to concomitant diseases, such as migraine (12%), tension-type headache (66%), and the latter concurrent with migraine (4%). Results and discussion. The effective treatment of concomitant diseases in combination with antihypertensive therapy contributed to normalization of BP and regression of complaints. The most pronounced effect was noted in 40 patients whose combination therapy included Vinpocetine (Cavinton® Comforte) 10 mg thrice daily. Conclusion. The therapy resulted in the less severity of both the symptoms of cerebrovascular disease (vascular cognitive impairment) and comorbid neurological disorders (headache, dizziness, etc.).

Long-Term Anti-Hypertensive Therapy and Stroke Prevention: A Meta-Analysis.

Stroke causes approximately 6.7million deaths worldwide per year and is the second leading cause of death. Pharmacotherapy for hypertension, an independent risk factor for stroke, significantly reduces the incidence of stroke. Although prior meta-analyses demonstrate various antihypertensive classes are superior to placebo in reducing stroke risk, which class is most effective is unclear. We conducted a systematic MEDLINE search including only randomized controlled trials (RCT) of antihypertensive medications published between 1999 and 2014 in adults with stroke as a primary or secondary outcome. Five classes compared against all others were angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-adrenoceptor antagonists (β-blockers), calcium channel blockers (CCBs), and thiazide or thiazide-like diuretics (T-TLDs). Among 17 RCTs with 31 comparative arms, risk ratio was used to assess effect size, and a fixed- and random-effect model was used to calculate summary effect size, utilizing comprehensive meta-analysis statistical software version 2.0. The 251,853 subjects (46±11.4% female; mean age 67.2±6.8years), were grouped as follows: ACEI 52,887; ARB 7278; ACEI/ARB 60,165; β-blocker 24,099; CCB 98,950; and T-TLD 68,639. The mean follow-up was 42.9±15months. A random-effect model was used to assess for summary effect size in ACEI, ACEI/ARB, ARB, and T-TLD groups. The summary risk ratio for stroke occurrence in the different antihypertensive drug classes were as follows: ACEIs 1.01 (95% confidence interval [CI] 0.81-1.27; p=0.92); ACEIs/ARBs 0.94 (95% CI 0.78-1.13; p=0.51); T-TLDs 0.90 (95% CI 0.75-1.08; p=0.25); ARBs 0.83 (95% CI 0.59-1.18; p=0.30); β-blockers 1.42 (95% CI 1.26-1.61; p<0.01); and CCBs 0.83 (95% CI 0.79-0.89; p<0.01). Among the antihypertensive classes, CCBs were most effective in reducing the long-term incidence of stroke, whereas β-blockers were associated with significantly increased risk.

Antihypertensive Use and Breast Cancer Risk in the Sister Study

Background: Treatment of hypertension frequently requires long-term antihypertensive (AHT) drug therapy. Recent case-control studies suggest that long-term use of calcium channel blockers is associ...

Что такое рациональная комбинированная антигипертензивная терапия и остается ли таковой комбинация ингибитора АПФ и диуретика?

Данная статья является обзором литературы о преимуществах комбинированной антигипертензивной терапии как стартовой. Разъясняется понятие рациональной комбинации. Детально рассматриваются вопросы о том, является ли комбинация ингибитора ангиотензинпревращающего фермента (АПФ) и диуретика рациональной и какие диуретики и ингибиторы АПФ лучше использовать для длительной антигипертензивной терапии.

ENDOTHELIAL-TROPIC AND NEPHROPROTECTIVE EFFECTS OF COMBINED ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Aim. To assess the effect of the 24-week antihypertensive therapy with fixed-dose drug combination (lisinopril plus amlodipine) on endothelial dysfunction and renal function in patients with arterial hypertension (HT) and diabetes mellitus (DM) type 2. Material and methods. 30 hypertensive patients with DM type 2 (aged 40-65 years) were included into the study. Endothelial function (plasma and vascular components) and renal function were studied. Results. Combined antihypertensive therapy significantly improved parameters of endothelial function in patients with HT and DM type 2: production of nitric oxide (NO) in blood serum and urine increased by 122.8% and 65.8%, respectively. Along with these secretion of endothelin (ET-1) in serum and urine decreased by 26.1% and by 76.1%, respectively, p&lt;0.05. A statistically significant redistribution of patients by type of microcirculation was established: the share of patients with normal type of microcirculation increased by 73.4%. There was a statistically significant reduction of proteinuria and albuminuria by 58% and 43.6%, respectively. The share of patients with chronic kidney disease with an estimated GFR 30-60 ml/min/1.73 m2 decreased by 16.7%. Conclusions. It has been shown that the prescription of a long-term antihypertensive therapy with dose-fixed combination (lisinopril plus amlodipine) is safe and effective for endothelial function improvement, including renal endothelium, with no negative effect on glucose and lipid metabolism in patients with HT and DM type 2.

Left Ventricle Hypertrophy is Common in Patients with Cerebral Amyloid Angiopathy-Related Intracerebral Hemorrhage and Is Independently Associated with Long-Term Mortality.

Background: A post-hoc analysis of the PROGRESS trial suggested that long-term anti-hypertensive therapy prevents intracerebral hemorrhage (ICH) in patients with cerebral amyloid angiopathy (CAA). However, the burden of underlying hypertension in patients with CAA is unclear, and it is also unclear whether this hypertensive burden contributes to long-term outcome in survivors of CAA-related ICH. Left ventricle (LV) hypertrophy is a measure of the chronicity and severity of hypertension and could be used to assess hypertensive end-organ damage in patients with CAA. Objective: To test the hypothesis that LV hypertrophy is common in patients with CAA-related ICH and is associated with increased long-term mortality and shorter survival in those patients. Methods: This was a retrospective analysis of a prospectively collected cohort of consecutive patients with primary ICH presenting to a single academic center. We included patients presenting between January/2000 to December/2010, age &gt; 55 years, who received a transthoracic echocardiogram (echo) during follow-up and were diagnosed with definitive, probable or possible CAA according to the Boston criteria. LV mass index (10g/m2) was calculated according to Penn convention. Ninety-day survivors were followed prospectively for long-term mortality or censoring at January/2012. Cox proportional hazards models were used to identify predictors of mortality as time-dependent variables adjusting for potential confounders. Results: Among 211 patients who met inclusion criteria, the mean time to follow-up was 4.28 ± 2.7 years; the median time to echocardiogram was 3 days (IQR:49). The mean age was 75.7 ± 9.1 years; 103 (49%) were male. LV hypertrophy was present in 55 (31.8%) patients and 152 (72%) patients survived more than 90 days. In multivariate analysis, after adjusting for baseline characteristics, LV mass index (10g/m2) was associated with higher long-term mortality (HR: 1.20; 95%CI: 1.01-1.4; p=0.039). On Cox-regression, LV hypertrophy was independently associated with shorter long-term survival (HR 1.91; 95%CI 1.05-3.47; p=0.034). Conclusions: LV hypertrophy is common in patients with CAA-related ICH and is associated with increased risk of subsequent mortality among 90-day survivors.