Target Organ Protection Research Articles

Pharmacoeconomic analysis of the use of ramipril and candesartan in patients with arterial hypertension

Arterial hypertension (AH) is the most common cardiovascular disease in the world and is the cause of disability of the population of the developed countries of the world. A feature of hypertension pharmacotherapy is a lifelong intake of medications. Indicators of economic evaluation of the effectiveness of different methods of treatment contribute to the selection of pharmacotherapy, which will provide the patient with the highest effectiveness of treatment, taking into account the financial capabilities of a particular patient. The main objectives of antihypertensive therapy is to achieve the target level of blood pressure (BP), the protection of target organs and a positive impact on risk factors for cardiovascular complications. The cost-effectiveness method makes it possible to compare costs with the same therapeutic effectiveness, which was the purpose of our study.Materials and methods. 100 protocols of medical cards of inpatients were studied. Two groups of patients were isolated: the first group for the treatment of AH received candesartan, and the second group – ramipril. The parameters were taken into account: achievement of target blood pressure, as well as possible complications of drug therapy - hypotension, cough, angioedema. To assess the cost of treatment against the background of the use of ramipril and candesartan, a cost-effectiveness pharmaco-economic analysis was carried out.Results of the study. Using the cost-effectiveness method, an analysis of ramipril and candesartan was carried out. The minimum, average and maximum costs of a single, daily, and course dose were calculated and the cost of BP normalization was calculated. The data obtained by us indicate a lower cost of treatment with ramipril. Analysis of the effectiveness of the drugs showed that ramipril is more effective in achieving the target blood pressure, but the percentage of side effects among which heart failure and cough were significantly higher. The data obtained indicate a high therapeutic efficacy of candesartan and ramipril, which allows us to draw conclusions:Conclusions. The most effective in achieving target BP was ramipril than candesartan. Analysis of the efficacy of drugs has established that ramipril has side effects and causes cough and heart failure, and candesartan can cause angioedema and hypotension. In analyzing the direct costs of treating hypertension, based on current standards of medical care for patients with AH, it was found that the least expensive is the treatment with ramipril. The analysis cost-effectiveness, showed that ramipril possesses the greatest pharmaco-economic advantage

Optimization of Blood Pressure Control, Metabolic Parameters, and Target Organs Protection with Perindopril + Indapamide Fixed Combination in Hypertensive Patients with Obesity and Prediabetes

The study objective was to evaluate the ability of the fixed combination (FC) of perindopril + indapamide (P+I) to reduce insulin resistance and low intensive noninfectious inflammation as well as to improve arterial elasticity in patients with hypertension, obesity and prediabetes on previous successful antihypertensive therapy with losartan + hydrochlorothiazide (L+HTZ) 100/12.5 mg. A 12-week open-label study included 50 patients (age 54.8 ± 6.6 years, body mass index (BMI) 32.5 ± 3.2 kg/m2). All patients underwent a 24-hour ambulatory blood pressure monitoring, applanation tonometry (assessment of augmentation index (AI), central blood pressure (CBP)), pulse wave velocity (PWV) measurement and laboratory investigations (lipid profile, fasting glucose, the homeostatic model assessment (HOMA) index, homocysteine, leptin, adiponectin, high-sensitive C-reactive protein (hsCRP)). Results: The switch of patients from L+HTZ to a FC of P+I resulted in an additional decrease in systolic BP and diastolic BP by 3.9% and 5.4%, respectively (p <0.05). Significant decrease in the BP load and variability was observed. PWV, AI, central SBP, vascular age decreased by 2.2%, 9.4%, 2.1% and 6.0% (p <0.05 for all). Fasting glycemia, insulinemia, and HOMA index decreased by 4.9%, 6.0% and 10.3% (p <0.05 for all). Triglycerides (TG) decreased by 13.5% (p<0.05) and high density lipoproteins (HDL) increased by 9.6% (p <0.05). Leptin and hsCRP levels decreased by 14.4% and 11.0%, adiponectin increased by 9.9% (p <0.05 for all). Clinically significant results were obtained in weight and BMI reduction on 6,0% and 1,2%. Conclusions: FC of P+I is superior to the L+HTZ in BP control, improvement of arterial elasticity and promotes a decrease in BMI, suppression of insulin-resistance and low intensive noninfectious inflammation in patients with hypertension, associated obesity and prediabetes. Disclosure S.V. Nedogoda: None. I. Barykina: None. A. Salasyuk: None. V.O. Smirnova: None. E. Popova: None.

Global Impact of 2017 American Heart Association/American College of Cardiology Hypertension Guidelines: A Perspective From Japan.

The 2017 American Heart Association/American College of Cardiology (AHA/ACC) guidelines for the prevention, detection, evaluation, and management of high blood pressure (BP) in adults were recently released.1 The core concept in these guidelines is earlier and tighter BP control over 24 hours, with the aim of providing more sustained target organ protection and cardiovascular disease prevention. These guidelines lower the threshold of hypertension diagnosis and target BP levels to 130/80 mm Hg. This direction of strict BP control with a new definition and universal target goal for hypertension will be the topic of debate among the guideline developing committee members of the Japanese Society of Hypertension.2 Evidence in support of this change to a lower threshold (130/80 mm Hg) has been provided by recent publications, including SPRINT (Systolic Blood Pressure Intervention Trial) and The Lancet 2016 meta-analysis of randomized controlled trials of antihypertensive medications.3,4 In The Lancet meta-analysis, a BP reduction of ≈25% was shown to be of benefit in preventing cardiovascular events, especially stroke and heart failure, among people with a baseline systolic BP of ≥130 mm Hg. In SPRINT, automated office BP measurement without study personnel present in the room with the patient was conducted in some centers, which could yield BP values 10 to 15 mm Hg lower than BPs taken by routine clinical measurement. Thus, the achievement of strict systolic BP control of 120 mm Hg is postulated to be comparable to 130 to 135 mm Hg by routine clinical assessment. Accordingly, …

Immune Response of A Novel ATR-AP205-001 Conjugate Anti-hypertensive Vaccine

We developed a virus-like particle (VLP)-based therapeutic vaccine against angiotensin II receptor type 1, ATR-AP205-001, which could significantly reduce the blood pressure and protect target organs of hypertensive animals. In this study, we focused on the immunological effect and safety of the VLP-based vaccine. By comparing to the depolymerized dimeric vaccine ATR-Dimer-001, we found that ATR-AP205-001 reached subcapsular sinus of lymph node shortly after administration, followed by accumulation on follicle dendritic cells via follicle B cell transportation, while ATR-Dimer-001 vaccine showed no association with FDCs. ATR-AP205-001 vaccine strongly activated dendritic cells, which promoted T cells differentiation to follicular helper T cells. ATR-AP205-001 vaccine induced powerful germinal center reaction, which was translated to a boost of specific antibody production and long-lasting B cell memory, far superior to ATR-Dimer-001 vaccine. Moreover, neither cytotoxic T cells, nor Th1/Th17 cell-mediated inflammation was observed in ATR-AP205-001 vaccine, similar to ATR-Dimer-001 vaccine. We concluded that ATR-AP205-001 vaccine quickly induced potent humoral immunity through collaboration of B cells, follicular dendritic cells and follicular helper T cells, providing an effective and safe intervention for hypertension in the future clinical application.

Research progress on the treatment of needling Renying for hypertension

This paper reviewed the domestic and foreign progress of needling Renying (ST 9) for hypertentsion in clinical and experimental researches. It has been confirmed that needling Renying showed the remarkable clinical effects, with bi-directional benign regulative action, protecting target organs, improving quality of life and so on. Based on the review, the author looks forward to offer the direction for the future researches. Key words: Acupuncture therapy; Point ST9(Renying); Hypertension; Review

ARTERIAL HYPERTENSION IN THE PRESENCE OF OVERWEIGHT AND OBESITY. THE CAPABILITIES OF AMLODIPINE AND LISINOPRIL COMBINATION. Part 2. Antihypertensive and Organoprotective Effects of Amlodipine/Lisinopril Fixed-Dose Combination in Patients with Arterial Hypertension in the Presence of Overweight and Obesity

Advantages of amlodipine, lisinopril and their fixed-dose combination are presented regarding to antihypertensive effect and target-organs protection in patients with arterial hypertension in the presence of obesity. Abnormalities in myocardial strain, increased stiffness of the left heart chambers, left ventricular hypertrophy are considered as new risk factors in hypertensive patients along with disturbances in some parameters of blood pressure and its daily profile. Current data about various pathophysiological mechanisms of the favorable impact of calcium channel blockers, as well as angiotensin-converting enzyme inhibitors, are described, in particular, lisinopril-mediated beneficial effects on myocardial stiffness and regression of myocardial hypertrophy.

Sex-specific effects of LiCl treatment on preservation of renal function and extended life-span in murine models of SLE: perspective on insights into the potential basis for survivorship in NZB/W female mice.

Considerable research effort has been invested in attempting to understand immune dysregulation leading to autoimmunity and target organ damage. In systemic lupus erythematosus (SLE), patients can develop a systemic disease with a number of organs involved. One of the major target organs is the kidney, but patients vary in the progression of the end-organ targeting of this organ. Some patients develop glomerulonephritis only, while others develop rapidly progressive end organ failure. In murine models of SLE, renal involvement can also occur. Studies performed over the past several years have indicated that treatment with LiCl of females, but not males of the NZB/W model, at an early age during the onset of disease, can prevent development of end-stage renal disease in a significant percentage of the animals. While on Li treatment, up to 80 % of the females can exhibit long-term survival with evidence of mild glomerulonephritis which does not progress to renal failure in spite of on-going autoimmunity. Stopping the treatment led to a reactivation of the disease and renal failure. Li treatment of other murine models of SLE was less effective and decreased survivorship in male BxSB mice, exhibited little effect on male MRL-lpr mice, and only modestly improved survivorship in female MRL-lpr mice. This perspective piece discusses the findings of several related studies which support the concept that protecting target organs such as the kidney, even in the face of continued immune insults and some inflammation, can lead to prolonged survival with retention of organ function. Some possible mechanisms for the effectiveness of Li treatment in this context are also discussed. However, the detailed mechanistic basis for the sex-specific effects of LiCl treatment particularly in the NZB/W model remains to be elucidated. Elucidating such details may provide important clues for development of effective treatment for patients with SLE, ~90 % of which are females.

Beta-blockers in treatment of cardiovascular diseases: current position of carvedilol

The article is devoted to the role of beta-blockers in treatment of cardiovascular diseases. Based on the results of numerous large clinical trials, the author demonstrates the effectiveness of this group of drugs that can affect not only sympathetic activity, which results into reduction of hypersympathicotonia symptoms, but also the prognosis of patients with cardiovascular diseases. Positive clinical effects of drugs of this group are shown on the example of beta-blocking agent carvedilol: it exerts β- and α-blocking effects and has antioxidant, anti-inflammatory, antiapoptopic activity, is metabolically neutral, therefore it can be administered to patients with hypertension and diabetes, as well as patients with metabolic syndrome, which is of paramount importance in treatment of the elderly. Beta-blocking agents have positive effect on CVD risk factors and provide protection of target organs in hypertensive patients, patients with chronic heart failure, atrial fibrillation and after myocardial infarction. The choice of beta-blocking agents, the knowledge of indications and contraindications to their administration, the opportunity to prevent the negative effects of these drugs expand medical potential for use of beta-blocking agents in clinical practice.

Diverse combination therapies of Chinese Medicine in treating Hypertension.

There are more than 300 million patients with hypertension in China, and at least 1 in 5 is using or has ever used Chinese Medicine (CM) treatment. This article reviews the efficacy and safety of CM as monotherapy and in combination with western medicine (WM) to explore its potential role in the clinical management of hypertension. Relevant articles were identified through PubMed, Chinese National Knowledge Infrastructure (CNKI) Database, VIP Chinese Journal Database, Wanfang Database, and China Biological Medicine Database (CBM-disc) search (up to 31 March, 2013). A total of 27 RCTs and 7 systematic reviews (including meta-analyses) were identified. These articles suggested that although as monotherapy, CM has limited effect for hypertension, while combined with WM, it does have a favorable effect of antihypertension. The combination therapy could not only improve the quality of life and the symptoms of hypertensive patients, such as dizziness and headache, but also stabilize blood pressure variability (BP). Moreover, the combined treatment of CM and WM may further reduce BP to the target levels for patients failed with hypertension control. Besides, the combination therapy also has more favorable effects than any WM monotherapy in protecting target organs as well as avoiding adverse reactions. When combined with WM, CM as a complementary treatment approach has certain effects for the control of hypertension and protection of target organs. However, more well-designed studies should be conducted to make a solid conclusion.

Differing Effects of Aliskiren/Amlodipine Combination and High-Dose Amlodipine Monotherapy on Ambulatory Blood Pressure and Target Organ Protection.

The aim of this study was to compare an aliskiren/amlodipine combination with high-dose amlodipine monotherapy on ambulatory blood pressure monitoring (ABPM) and organ protection. The study was a prospective, randomized, multicenter, open-label trial in elderly essential hypertensive patients. A total of 105 patients with clinic BP (CBP) ≥140/90 mm Hg with amlodipine 5 mg were randomly allocated to aliskiren (150-300 mg)/amlodipine (5 mg) (ALI/AML group, n=53) or high-dose amlodipine (10 mg) (h-dAML group, n=52) and treated for 16 weeks. Each patient's CBP, ABPM, urine albumin-to-creatinine ratio (UACR), and brachial-ankle pulse wave velocity (baPWV) were measured at baseline and at the end of the study. The ALI/AML and h-dAML groups showed similarly reduced mean 24-hour SBP, daytime SBP, nighttime SBP, and baPWV. However, UACR reduction was significantly greater in the ALI/AML group (P=.02). ALI/AML was significantly less effective in reducing early-morning BP (P=.002) and morning BP surge (P=.001) compared with h-dAML.

Optimal Control Strategy Allies in Blood Pressure

to review the available results of clinical trials on the efficacy and safety of a fixed combination of an angiotensin-converting enzyme (ACE) inhibitor lisinopril and the calcium antagonist amlodipine, including an analysis of the actual antihypertensive effect and organoprotective action in the russian population of patients. The main objectives of the treatment of hypertension is to achieve target blood pressure level and protection of target organs. According to the available evidence base these properties to a greater extent have only ACE inhibitors and calcium antagonists. When analyzing the results of clinical studies using a fixed combination of lisinopril and amlodipine revealed high levels of efficacy and safety in patients suffering from hypertension and related to different groups at risk of developing cardiovascular complications. The combination of lisinopril and amlodipine is a key for effective, safe control of blood pressure, organoprotection and high adherence to the treatment of patients with hypertension.

What is new in the diagnostics and treatment of acute heart failure?

Acute heart failure (AHF) is the term used to describe a rapid onset or changes in the symptoms and signs of heart failure. It is a life-threatening condition that requires immediate attention and medical care and usually leads to an emergency hospital admission. In most cases, AHF is a result of deterioration of health in patients with previously diagnosed chronic heart failure (CHF) whether with reduced (HF-REF) or preserved (HF-PEF) left ventricular ejection fraction (EF). Heart failure is defined as an abnormality of cardiac structure or function, which leads to the inability of the heart to deliver oxygen at a rate which is adequate to the requirements of metabolism in tissues, despite normal cardiac filling pressure (or only at the cost of increased filling pressure). The most common causes of AHF are myocardial diseases which lead to ventricular dysfunction and a reduction in cardiac ejection fraction but also the abnormality of diastolic function or heart valve disease, pericardium, endocardium and heart rhythm disorders. In suspected AHF there are two approaches for exact diagnosis: through the use of rapid essay of BNP hormones or by echocardiographic examination with measurement of ejection fraction or diastolic anomalies and myocardial hypertrophy. Acuteness may vary, from the situation that within a few days there occurs a deterioration (dyspnea or edema) in some patients, while others develop AHF within a few minutes or hours (e.g., in acute myocardial infarction). The patient may have a range of conditions, from life-threatening pulmonary edema or cardiogenic shock, to the clinical picture that is primarily characterized by worsening of peripheral edema. Diagnosis and treatment are carried out concurrently, especially in seriously ill patients and all measures must be applied quickly. Continuous monitoring of the patient's vital functions is essential during the initial evaluation and treatment and certain patients are best treated in the intensive or coronary care unit like patients with acute coronary syndromes. Long-term goals of the treatment are the prevention of recurrent AHF and improvement of prognosis. 5 aspects are evaluated simultaneously: adequacy of ventilation, presence of threatening arrhythmias, state of tension (hypotension, shock), presence of acute coronary syndrome and acute mechanical reasons. All these evaluations should lead to a rapid response to the presence of a threatening condition, such as, for example, urgent revascularization and so on. Changes in the treatment strategy are early administration of vasodilatators and diuretics therapy for target organs protection(heart, liver and kidnies) in relation to mortality reduction. Key medications in AHF are the same as in the CHF: oxygen therapy, diuretics and vasodilators. Opiates and inotropic drugs are used more selectively and mechanical circulatory support devices only rarely. Non-invasive ventilation becomes a common practice, while invasive ventilation is required in a small number of cases. Systolic pressure, heart rate and frequency, and peripheral blood saturation and diuresis should be measured and often repeated until the patient becomes stable. All aspects are summarized in the algorithm AHF of the European Society of Cardiology (ESC).

Topomer CoMFA and Virtual Screening Studies of Azaindole Class Renin Inhibitors

Direct renin inhibitors (DRIs) have increasingly shown a significant advantage in the treatment of hypertension and protection of target organs. In this paper, a series of azaindole class renin inhibitors were subjected to 3D-QSAR study using Topomer CoMFA. Five kinds of splitting mode for different fragment cutting and 6 different training and test sets grouping were attempted to build consensus models. The results indicated that 6 consensus models had similar predictability (q(2) and r(2) pred) and stability (r(2)). The best model showed good stability and predictability (q(2) of 0.616, r(2) of 0.908). The r(2) pred value of the external test set was 0.70, which means that the model had an excellent external predictive ability, and the robustness of the developed model was assessed by the Y-randomization test. This study also adopted the methodology of fragment-based drug design (FBDD) to virtual screen new renin inhibitors by using Topomer Search technology. The R1-group of the compound No. 13 with the highest activity was chosen as the basic scaffold, and its remaining R2-group acted as a query to screen 142,025 molecules of ZINC database for similar fragments. The obtained 30 fragments with the highest R2-group contribution values were added to the basic scaffold respectively. Finally 30 new azaindole compounds with potent high activities were obtained. Further the binding modes were studied by using Surflex- Dock. The docking results showed good binding interactions of the designed compounds with the renin protein, thus the rationality of this design was further verified from the perspective of the renin receptor.

Protective effect of a pomace olive oil concentrated in triterpenic acids in alterations related to hypertension in rats: Mechanisms involved

Despite the amount of information and research on the effects of virgin olive oil and its components in cardiovascular disease, little attention has been paid to the effects of pomace olive oil, an olive oil subproduct traditionally used in Spain. The aim of the present study was to evaluate the potential effects of a pomace olive oil concentrated in triterpenic acids (POCTA) on blood pressure, cardiac hemodynamics, and functional and molecular vascular alterations associated with hypertension in spontaneously hypertensive rats (SHR). The study showed that POCTA attenuated the increase of blood pressure in SHR. This effect was associated with an improvement in endothelium-dependent relaxation, enhancement of vascular expression of endothelial nitric oxide synthase, and reduction of tumor necrosis factor alpha, transforming growth factor beta, and collagen I. Furthermore, POCTA improved cardiac hemodynamics (left ventricular systolic pressure and left ventricular end-diastolic pressure) and decreased relative kidney and lung weights. POCTA exerts antihypertensive effects together with vascular and hypertension target organ protection in SHR. Since interest in pomace olive oil has been low, the results of this study contribute to increasing awareness of its biological and nutritional values.

Olmesartan-based therapies

The main purpose in hypertension treatment is the reduction of cardiovascular disease burden. Among different first-line antihypertensive drug classes, angiotensin-receptor blockers are characterized by their both good effectiveness and tolerability. Furthermore, the interruption of the renin-angiotensin cascade is related with several benefits in target organ protection and cardiovascular prevention. Among different angiotensin-receptor blockers, olmesartan has been examined in several trial of organ protection, showing improvements in several disease markers, such as microinflammation, regression of both plaque volume and vascular hypertrophy, as well as microalbuminuria prevention. Olmesartan has been also widely examined in combination of either hydrochlorothiazide or amlodipine, as well as with both drugs in a single-pill triple combination, showing improvements in antihypertensive efficacy without significant effects on tolerability. This treatment strategy based on a drug with such characteristics and the availability of different types of combinations with other first-line drug classes may represent an effective way for achieving blood pressure control in a majority of hypertensive patients and this could also be related with a better cardiovascular disease prevention.

The science and clinical translation of remote postconditioning

The treatment of reperfusion injury requires measures beyond timely reperfusion. Conventional postconditioning (PostC) of ischemic tissues offers a strategy to reduce reperfusion injury, but its adoption is challenged by requiring access and imposing additional ischemia to the ischemic organ. Generating protective signals by PostC in a tissue remote from the target organ such as the limb, i.e. remote PostC (rPostC), may present an alternative approach to exerting endogenous tissue protection. Because rPostC is only recently reported, the fundamental biology of rPostC is not well understood, and studies to date are largely observational. rPostC has been observed to reduce ischemia-reperfusion injury experimentally in heart, kidney, brain and skeletal muscle in multiple species, including rat, rabbit and pig. Both necrosis and apoptosis are reduced. As in remote ischemic preconditioning, rPostC requires a transfer or communication of protective factors or signals through humoral and/or neural pathways. Triggers of target organ protection include G-protein-coupled receptor ligands, metabolites of ischemia, or small thermolabile molecules. Some evidence suggests that reperfusion injury salvage kinases may be involved in rPostC, in agreement with both preconditioning and conventional PostC. Clinical studies investigating improvements in clinical outcomes or biomarkers with rPostC are encouraging.

Effects of moxonidine on sympathetic nervous system activity: An update on metabolism, cardio, and other target-organ protection

Moxonidine is the newest, second-generation, centrally acting antihypertensive agent. It has selective agonist activity at imidazoline I1 receptors and less adverse effects than the other centrally acting drugs. This fact authorizes the frequent use of moxonidine in clinical practice, as monotherapy or in combination with other antihypertensive agents. Also, moxonidine has beneficial effects in obese and metabolic syndrome and in target-organs, such as heart and kidneys.

Achievement of Cardiometabolic Goals in Aware Hypertensive Patients in Spain

See related article, pp 898–905 The article by Banegas et al1 published in the present issue of Hypertension provides important population-based data for improving cardiovascular health. The data from a population-based sample of adults in Spain during 2008-2010 include the clinical epidemiology of hypertension and concomitant cardiovascular risk factors, evidence-based pharmacotherapy for cardiovascular risk factor reduction and target organ protection, medical advice, and lifestyle factors. This commentary addresses 3 aspects of their comprehensive report, including a comparison of data in Spain and the United States with regard to the following: (1) clinical epidemiology of hypertension; (2) prevalence of concomitant risk factors, risk factor values, and/or control levels among hypertensive patients; and (3) lifestyle factors. The commentary concludes with a discussion of strategies for improving cardiovascular health in the population. The authors note the higher stroke incidence in Spain than in the United States probably reflects differences between the 2 countries in the clinical epidemiology of hypertension (Table 1).1-3 More specifically, the prevalence of hypertension is marginally higher in Spain than in the United States, whereas awareness, treatment, and control of hypertension are much lower in Spain than in the United States. Hypertension prevalence, awareness, and control were defined similarly in both countries (Table 1), although blood pressure was measured in triplicate in 2 sets of measurements separated by 90 minutes in the Spain cohort and in triplicate in only 1 set of readings in the US cohort. Blood …

Differential effects of strict blood pressure lowering by losartan/hydrochlorothiazide combination therapy and high-dose amlodipine monotherapy on microalbuminuria: the ALPHABET study

We investigated the effects of losartan/hydrochlorothiazide (HCTZ) fixed combination therapy and high-dose amlodipine monotherapy on BP measurements and target organ protection. In this open-label multicenter trial, hypertensive patients were randomly allocated to receive losartan 50 mg or amlodipine 5 mg for 4 weeks, and the treatments were changed to combination of losartan 50 mg/HCTZ 12.5 mg or amlodipine 10 mg for a further 4 weeks. A total of 91 hypertensive patients (age 63.6 years), 47 in the losartan/HCTZ group and 44 in amlodipine group, were enrolled. After 8 weeks, the clinic BP, home BP, and 24-hour ambulatory BP were successfully controlled to the same level in both treatment groups ( P < .001). Furthermore, both groups showed the same degree of BP reduction in the 24-hour, daytime, and nighttime ( P < .001). B-type natriuretic peptide (BNP) also significantly decreased to the same level in both groups, whereas the reduction of urinary albumin/creatinine ratio (UACR) was greater in the losartan/HCTZ group than in the high-dose amlodipine group (–47.6% vs 2.4%, P < .001). Losartan/HCTZ combination and high-dose amlodipine have similar effects on clinic, home, and ambulatory BP control and BNP reduction, whereas losartan/HCTZ has superior effect on UACR reduction when compared with high-dose amlodipine.

The impact of circadian rhythm of blood pressure on carotid artery intima-media thickness and left ventricular hypertrophy and clinical research for drug intervention in primary hypertension patients

BackgroundThe results by the 24 h ambulatory blood pressure monitoring show the change rules of normal blood pressure are double peaks and one valley long ‘dipper’ type. The blood pressure...