Reduction In Mean SBP Research Articles

Valsartan vs. other angiotensin II receptor blockers in the treatment of hypertension: a meta-analytical approach

Objective:To compare the efficacy of valsartan in systolic (SBP) and diastolic blood pressure (DBP) reduction with other angiotensin II receptor blockers (ARBs) in essential hypertension.Methods:Systematic literature search of databases between October 1997 and May 2008. Meta-analysis of short-term, double-blind, parallel group, randomised controlled trials (RCTs) for treatment of adult hypertension (DBP: 90–115 mmHg). Random-effects meta-regression adjusting for baseline blood pressure (BP) was used to analyse the data. Mean change in SBP and DBP was estimated for each individual drug and dose combination.Results:In all, 31 RCTs (n = 13,110 patients) were included in the analysis. Six studies include trial arms with candesartan, six irbesartan, 13 losartan, two olmesartan, five telmisartan and 12 valsartan. The weighted average reduction in mean SBP and DBP for valsartan 160 mg was −15.32 mmHg (95% CI: −17.09, −13.63) and −11.3 mmHg (95% CI: −12.15, −10.52) and for 320 mg was −15.85 mmHg (95% CI: −17.60, −14.12) and −11.97 mmHg (95% CI: −12.81, −11.16); these are statistically significantly greater reductions compared with losartan 100 mg, which was −12.01 mmHg (95% CI: −13.78, −10.25) and −9.37 mmHg (95% CI: −10.18, −8.54) for SBP and DBP respectively. There is evidence that valsartan 160 mg reduces SBP and DBP more than irbesartan 150 mg and reduced DBP more than candesartan 16 mg. No other statistically significant difference in efficacy is demonstrated.Conclusion:Valsartan administered at 160 or 320 mg is more effective at lowering BP than losartan 100 mg and shows comparable efficacy to other ARBs in patients with essential hypertension.

Is the Magnitude of Post-Exercise Hypotension Mediated by Exercise Intensity or Total Work Done?

It is unclear whether exercise intensity per se or the total work done is the most important factor that influences the magnitude of post-exercise hypotension (PEH). As well as being important for prescribing exercise to hypertensive patients, such knowledge might help unravel the mechanisms of PEH. PURPOSE: To compare post-exercise hemodynamic changes between bouts of exercise which differ in intensity and total work completed. METHODS: Seven normotensive males, aged 28±6 years (mean±SD), completed four trials, which began at 08:00 hours; (i) Control – resting for 30 min on a semi-recumbent cycle ergometer, (ii) Intense – 30-min of semi-recumbent cycling at 70% VO2peak, (iii) Moderate-short; cycling at 40% VO2 ± for 30 min and (iv) Moderate-long; cycling at 40% VO2peak for a time (mean±SD =50±8 min) that corresponded to the same total work done as in the Intense trial. Blood pressure (Portapres, Holland), heart rate, stroke volume, cardiac output, total peripheral resistance, core body temperature and forearm blood flow were measured every min for 5 min before, and for 20 min after, exercise. Data were analysed using repeated measures analysis of summary statistics and are described as mean±SD. RESULTS: Post-exercise hypotension relative to Control was observed in all three exercise trials with the minimum SBP occurring approximately 8 min after cessation of exercise in all trials. The mean reduction in SBP was different to control after Intense (−19± 11 mmHg, P=0.014) and Moderate-long (−15±15 mmHg. P=0.032) but not after Mo derate-short (−9±15 mmHg, P=0.123). Mean arterial pressure followed the same pattern, with Intense (−7±6 mmHg, P=0.057) and Moderate-long (−8±10 mmHg, P=0.048) mediating lower post-exercise MAP than Moderate-short (−5±8 mmHg, P=0.122). No significant differences were observed between the Intense and Moderate-long trials in terms of SBP (P=0.529) and MAP (P=0.727). Increases in HR, CO and FBF were greatest after the Intense trial (35±7 beat.min−1, 1.7±0.8 l.min−1 and 13.6±8.7 PU respectively, p<0.0005). Reductions in SV and TPR were also greatest after Intense (−21.7±16.1 ml and-4.2±2.2mmHg.L−1 min−1, respectively, p<0.001). Core temperature increased by 0.5–0.7 °C, but this change did not differ between the three exercise trials. CONCLUSION: Exercise bouts that differed in intensity but not total work completed induced similar post-exercise responses in SBP and MAP. These similar blood pressure responses were evident despite the changes in HR, CO, SV, TPR and FBF being greatest after the more intense but shorter bout of exercise.

An open-label, uncontrolled, 8-week clinical trial of barnidipine hydrochloride, a once-daily calcium channel blocker, in Korean patients with essential hypertension

The efficacy and tolerability of barnidipine hydrochloride, a once-daily calcium channel blocker, was investigated in 31 Korean patients (19 women and 12 men; mean age, 53 ± 8 years; mean body weight, 65.8 ± 9.1 kg) with essential hypertension (mean systolic blood pressure [SBP] and diastolic blood pressure [DBP] in the sitting position, 154.5 ± 15.9 mm Hg and 101.0 ± 8.2 mm Hg, respectively). This study used an increasing-dose method with daily doses of 5 to 15 mg in an open-label, uncontrolled manner for 8 weeks. Mean reductions in SBP and DBP after 8 weeks of treatment with barnidipine were 28.5 mm Hg (mean reduction, 18.4%) and 16.5 mm Hg (mean reduction, 16.3%) in the sitting position, respectively, and the mean dose was 9.7 mg/d. Heart rate in the sitting position was not changed by the administration of barnidipine (mean ± SD, 70.0 ± 6.6 beats/min and 71.9 ± 6.8 beats/min before and after treatment, respectively). Barnidipine was well tolerated, with only mild adverse events such as headache (appearance rate, 6.5%), facial flushing (6.5%), dizziness, nausea, and vomiting (each, 3.2%). These results suggest that barnidipine is a once-daily calcium channel blocker that shows sufficient hypotensive effect and good tolerability in Korean patients with essential hypertension.

Efficacy, Safety and Tolerability Of Valsartan Plus HCTZ in Patients With Essential Hypertension: A Multicentre Observational Study in Bangladesh

Background: Valsartan is an established drug for treatment of essential hypertension. It blocks the action of Angiotensin II irrespective of its sources. A large proportion of patients need additional treatment with two or more drugs of different pharmacological classes for achieving target blood pressure. Published evidence demonstrated synergistic effect of Thiazides with ARB. Coadministration of valsartan and Hydrochlorothiazide has the potential to reverse the untoward effect of each other. Current study aimed at evaluating the efficacy, safety and tolerability of Valsartan plus Hydrochlorothiazide combination, and thus validating the regimen in the treatment of essential hypertension in Bangladeshi population, a population significantly different from Caucasian population where most studies were done. Methods: Current study is a prospective interventional study involving 404 Adult, patients, with Stage I (SBP 140-159 mmHg/DBP 90-99 mmHg) or Stage II (SBP≥160 mmHg/DBP ≥100 mmHg) essential hypertension or patients uncontrolled on current mono-therapy or other combination therapy. Valsartan plus HCTZ 80/12.5 mg once daily tablet were prescribed to continue till the following visit or for the remainder of the study. In case of inadequate control increment in dose was made on the following visit. Patients were assessed at baseline, at 4th weeks, 12th week and 24th week. One of the major outcome parameter set for the study was the percentage of participant having BP controlled that is a SBP &lt;140 mmHg and DBP &lt;90 mmHg or a reduction &gt;10 mmHg for DBP and/ or &gt;20 mmHg SBP versus baseline values at 24 weeks. At final follow-up, in addition to repetition of the baseline measurements and examinations, data on Safety of the drug was collected by enquiring and recording all adverse events or serious adverse events. Global assessment of efficacy and tolerability of treatment was also done by both the physicians and patients on a 4-point scale. Result: The percentage of participant having BP controlled at the end of the trial was 91%. Besides, Significant reduction in mean SBP and mean DBP was also evident (P&lt;.001) through paired comparison from baseline to end of the study. Average reduction of 32.4 ± 19.5 mmHg was seen in systolic BP and 17.4 ± 9.3 mmHg in diastolic BP. Global assessment based on both physician and patients reported greater satisfaction with the efficacy of treatment modality. Total adverse event reported by only six (1.5%) participants. Of the six cases three of the adverse effect was reported at 3rd visit and another three were reported at 4th visit. Total five dropouts (1.24%) were reported of which 1 in 3rd visit and 4 in 4th visit. Among the dropout patient three were withdrawn from the study and two didn’t attend the final follow-up. Global assessment of safety and tolerability based on both physician and patient’s opinion reveals greater satisfaction level with the safety and tolerability of combination treatment. Conclusion: The combination of valsartan and hydrochlorothiazide is an effective treatment for patients with essential hypertension. The combination is also effective in patients not responding to monotherapy with either agent. The drug is found to be well tolerated with minimal adverse event during the course of treatment. Key words: Valsartan; Hydrochlorothiazide; Hypertension. DOI: 10.3329/cardio.v3i1.6425Cardiovasc. j. 2010; 3(1): 37-44