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Qiao Y, Shin JI, Sang Y, Inker LA, Secora A, Luo S, Coresh J, Alexander GC, Jackson JW, Chang AR, Grams ME. Discontinuation of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Chronic Kidney Disease. Mayo Clin Proc 2019; 94:2220-2229. [PMID: 31619367 PMCID: PMC6858794 DOI: 10.1016/j.mayocp.2019.05.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/16/2019] [Accepted: 05/08/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the patterns of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACE-I/ARB) discontinuation in the setting of chronic kidney disease (CKD) progression in real-world clinical practice. PATIENTS AND METHODS We identified incident ACE-I/ARB users with a baseline estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m2 and without end-stage renal disease in the Geisinger Health System between January 1, 2004, and December 31, 2015. We investigated the associations of CKD stage, hospitalizations with and without acute kidney injury (AKI), serum potassium, bicarbonate level, thiazide, and loop diuretic use with ACE-I/ARB discontinuation. RESULTS Among the 53,912 ACE-I/ARB users, the mean age was 59.9 years, and 50.6% were female. More than half of users discontinued ACE-I/ARB within 5 years of therapy initiation. The risk of ACE-I/ARB discontinuation increased with more advanced CKD stage. For example, patients who initiated ACE-I/ARB with CKD stage G4 (eGFR: 15-29 mL/min/1.73 m2) were 2.09-fold (95% CI, 1.87-2.34) more likely to discontinue therapy than those with eGFR ≥ 90 mL/min/1.73 m2. Potassium level greater than 5.3 mEq/L, systolic blood pressure ≤ 90 mm Hg, bicarbonate level < 22 mmol/L, and intervening hospitalization-particularly AKI-related-were also strong risk factors for ACE-I/ARB discontinuation. Thiazide diuretic use was associated with lower risk, whereas loop diuretic use was associated with higher risk of discontinuation. CONCLUSION In a real-world cohort, discontinuation of ACE-I/ARB was common, particularly in patients with lower eGFR. Hyperkalemia, hypotension, low bicarbonate level, and hospitalization (AKI-related, in particular) were associated with a higher risk of ACE-I/ARB discontinuation. Additional studies are needed to evaluate the risk-benefit balance of discontinuing ACE-I/ARB in the setting of CKD progression.
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Affiliation(s)
- Yao Qiao
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Jung-Im Shin
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Yingying Sang
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Lesley A Inker
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Alex Secora
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Shengyuan Luo
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Josef Coresh
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - G Caleb Alexander
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - John W Jackson
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Alex R Chang
- Division of Nephrology, Geisinger Health System, Danville, PA
| | - Morgan E Grams
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Internal Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, MD.
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Dineva S, Uzunova K, Pavlova V, Filipova E, Kalinov K, Vekov T. Comparative efficacy and safety of chlorthalidone and hydrochlorothiazide-meta-analysis. J Hum Hypertens 2019; 33:766-774. [PMID: 31595024 PMCID: PMC6892412 DOI: 10.1038/s41371-019-0255-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/02/2019] [Accepted: 08/14/2019] [Indexed: 12/18/2022]
Abstract
Hypertension is a complex syndrome of multiple hemodynamic, neuroendocrine, and metabolic abnormalities. The goals of treatment in hypertension are to optimally control high blood pressure and to reduce associated cardiovascular morbidity and mortality using the most suitable therapy available. Hydrochlorothiazide (HCTZ) and chlorthalidone (CTLD) are with proven hypertensive effects. The topic of our meta-analysis is to compare the efficacy of HCTZ and CTLD therapy in patient with hypertension. A search of electronic databases PubMed, MEDLINE, Scopus, PsyInfo, eLIBRARY.ru was performed. We chose the random-effects method for the analysis and depicted the results as forest plots. Sensitivity analyses were performed in order to evaluate the degree of significance of each study. Of the 1289 identified sources, only nine trials directly compared HCTZ and CTLD and were included in the meta-analysis. Changes in SBP lead to WMD (95% CI) equal to -3.26 mmHg showing a slight but statistically significant prevalence of CTLD. Results from analyzed studies referring to DBP lead to WMD (95% CI) equal to -2.41 mmHg, which is also statistically significant. During our analysis, we found that there were not enough studies presenting enough data on the effect of CTLD and HCTZ on levels of serum potassium and serum sodium. Our meta-analysis has demonstrated a slight superiority for CTLD regarding blood pressure control. At the same time, the two medications do not show significant differences in their safety profile.
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Affiliation(s)
- Stela Dineva
- Science Department, Tchaikapharma High Quality Medicines, Inc, 1 G.M. Dimitrov Blvd, 1172, Sofia, Bulgaria.
| | - Katya Uzunova
- Science Department, Tchaikapharma High Quality Medicines, Inc, 1 G.M. Dimitrov Blvd, 1172, Sofia, Bulgaria
| | - Velichka Pavlova
- Science Department, Tchaikapharma High Quality Medicines, Inc, 1 G.M. Dimitrov Blvd, 1172, Sofia, Bulgaria
| | - Elena Filipova
- Science Department, Tchaikapharma High Quality Medicines, Inc, 1 G.M. Dimitrov Blvd, 1172, Sofia, Bulgaria
| | - Krassimir Kalinov
- Department of Informatics, New Bulgarian University, 21 Montevideo Str, 1618, Sofia, Bulgaria
| | - Toni Vekov
- Department of Pharmacy, Medical University, Pleven, Bulgaria
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53
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Affiliation(s)
- O. D. Ostroumova
- I.M. Sechenov First Moscow State Medical University; Russian Clinical and Research Center of Gerontology
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54
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Lorthioir A, Belmihoub I, Fouassier D, Azizi M, Amar L. [Spironolactone in resistant essential hypertension]. Presse Med 2019; 48:1431-1438. [PMID: 31473027 DOI: 10.1016/j.lpm.2019.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/23/2019] [Indexed: 11/26/2022] Open
Abstract
Resistant hypertension is defined as uncontrolled blood pressure (BP) despite three antihypertensive agents including a diuretic (thiazide diuretic if renal function is normal or loop diuretic in case of chronic kidney disease with eGFR<30mL/min), a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, at optimal doses. Resistance must be confirmed by out-of-office measurements (ambulatory blood pressure monitoring or home blood pressure monitoring) and patients should be asked about treatment compliance and excessive salt or alcohol intake. If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for secondary causes of hypertension as they are frequent in this context. If essential resistant hypertension is confirmed, the mineralocorticoid receptor antagonist, spironolactone, should be added (25 to 50mg daily). In the event of a contraindication to spironolactone, or if adverse effects occur, a beta-blocker, an alpha-blocker, or a centrally acting antihypertensive drug should be prescribed.
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Affiliation(s)
- Aurélien Lorthioir
- AP-HP, hôpital européen Georges-Pompidou, hypertension unit, 20, rue Leblanc, 75015 Paris, France.
| | - Inès Belmihoub
- AP-HP, hôpital européen Georges-Pompidou, hypertension unit, 20, rue Leblanc, 75015 Paris, France; Paris-Descartes university, faculty of medicine, 75006 Paris, France
| | - David Fouassier
- Paris-Descartes university, faculty of medicine, 75006 Paris, France; AP-HP, hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, 20, rue Leblanc, 75015 Paris, France
| | - Michel Azizi
- AP-HP, hôpital européen Georges-Pompidou, hypertension unit, 20, rue Leblanc, 75015 Paris, France; Paris-Descartes university, faculty of medicine, 75006 Paris, France; AP-HP, hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, 20, rue Leblanc, 75015 Paris, France
| | - Laurence Amar
- AP-HP, hôpital européen Georges-Pompidou, hypertension unit, 20, rue Leblanc, 75015 Paris, France; Paris-Descartes university, faculty of medicine, 75006 Paris, France
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Lee HY, Shin J, Kim GH, Park S, Ihm SH, Kim HC, Kim KI, Kim JH, Lee JH, Park JM, Pyun WB, Chae SC. 2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension. Clin Hypertens 2019; 25:20. [PMID: 31388453 PMCID: PMC6670135 DOI: 10.1186/s40885-019-0124-x] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
The standardized techniques of blood pressure (BP) measurement in the clinic are emphasized and it is recommended to replace the mercury sphygmomanometer by a non-mercury sphygmomanometer. Out-of-office BP measurement using home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM) and even automated office BP (AOBP) are recommended to correctly measure the patient’s genuine BP. Hypertension (HTN) treatment should be individualized based on cardiovascular (CV) risk and the level of BP. Based on the recent clinical study data proving benefits of intensive BP lowering in the high risk patients, the revised guideline recommends the more intensive BP lowering in high risk patients including the elderly population. Lifestyle modifications, mostly low salt diet and weight reduction, are strongly recommended in the population with elevated BP and prehypertension and all hypertensive patients. In patients with BP higher than 160/100 mmHg or more than 20/10 mmHg above the target BP, two drugs can be prescribed in combination to maximize the antihypertensive effect and to achieve rapid BP control. Especially, single pill combination drugs have multiple benefits, including maximizing reduction of BP, minimizing adverse effects, increasing adherence, and preventing cardiovascular disease (CVD) and target organ damage.
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Affiliation(s)
- Hae-Young Lee
- 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jinho Shin
- 2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Gheun-Ho Kim
- 2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sungha Park
- 3Department of Internal Medicine, Yonsei University, Seoul, Korea
| | - Sang-Hyun Ihm
- 4Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Chang Kim
- 3Department of Internal Medicine, Yonsei University, Seoul, Korea
| | - Kwang-Il Kim
- 5Department of Internal Medicine, Seoul National University, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Han Kim
- Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Jang Hoon Lee
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Moo Park
- 8Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Wook Bum Pyun
- 9Cardiovascular Center, Seoul Hospital, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Shung Chull Chae
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Hydrochlorothiazide and alternative diuretics versus renin-angiotensin system inhibitors for the regression of left ventricular hypertrophy: a head-to-head meta-analysis. J Hypertens 2019; 36:1247-1255. [PMID: 29465713 DOI: 10.1097/hjh.0000000000001691] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Found in 36-41% of hypertension, elevated left ventricular mass (LVM) independently predicts cardiovascular events and total mortality. Conversely, drug-induced regression of LVM predicts improved outcomes. Previous studies have favored renin-angiotensin system inhibitors (RASIs) over other antihypertensives for reducing LVM but ignored differences among thiazide-type diuretics. From evidence regarding potency, cardiovascular events, and electrolytes, we hypothesized a priori that 'CHIP' diuretics [CHlorthalidone, Indapamide and Potassium-sparing Diuretic/hydrochlorothiazide (PSD/HCTZ)] would rival RASIs for reducing LVM. METHOD AND RESULTS Systematic review yielded 12 relevant double-blind randomized trials. CHIPs were more closely associated with reduced LVM than HCTZ (P = 0.004), indicating that RASIs must be compared with each diuretic separately. Publication bias favoring RASIs was corrected by cumulative analysis. For reducing LVM, HCTZ tended to be less effective than RASIs. However, the following surpassed RASIs: chlorthalidone Hedge's G: -0.37 (95% CI -0.72 to -0.02), P = 0.036; indapamide -0.20 (-0.39 to -0.01), P = 0.035; all CHIPs combined (with 61% of patients in one trial) -0.25 (-0.41to -0.09), P = 0.002. Statistical significance (P < 0.05) did not depend on any one trial. CHIPs reduction in LVM was 37% greater than that from RASIs. CHIPs superiority tended to increase with trial duration, from a negligible effect at 0.5 year to a maximal effect at 0.9-1.0 years: -0.26 (-0.43 to -0.09), P = 0.003. Fifty-eight percent of patients had information on echocardiographic components of LVM: relative to RASIs, CHIPs significantly reduced end-diastolic LV internal dimension (EDLVID): -0.18 (-0.36 to -0.00), P = 0.046. Strength of evidence favoring CHIPs over RASIs was at least moderate. CONCLUSION In these novel results in patients with hypertension, CHIPs surpassed RASIs for reducing LVM and EDLVID.
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Efficacy of a new single-pill combination of a thiazide-like diuretic and a calcium channel blocker (indapamide sustained release/amlodipine) in essential hypertension. J Hypertens 2019; 37:2280-2289. [PMID: 31246894 DOI: 10.1097/hjh.0000000000002177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The current international, 12-week, double-blind, randomized, controlled trial assessed the efficacy and safety of indapamide sustained release/amlodipine single-pill combination (SPC) in mild-to-moderate hypertensive patients. METHODS Following a 4-week run-in period on amlodipine 5 mg, patients (SBP 150-180 mmHg and/or DBP < 110 mmHg) were randomized to indapamide 1.5 mg sustained release/amlodipine 5 mg SPC or amlodipine 5 mg/valsartan 80 mg SPC with conditional uptitration at week 6. Office blood pressure (BP) was assessed at baseline, weeks 6 and 12; ambulatory and home blood pressure monitoring (ABPM/HBPM) at baseline and week 12. RESULTS Baseline characteristics were similar in both groups (57 years, 51% men, BP 160/92 mmHg). 233 patients were randomized to IndSR/Aml and 232 to amlodipine/valsartan, of whom 48 and 57% were uptitrated, respectively. After 12 weeks, office SBP/DBP decreased similarly with both treatments (-21/-8 vs. -20/-8 mmHg) leading to BP control in 50% and BP response in 70% of patients. Uptitration was effective (P < 0.001) with both regimens, in favour of IndSR/Aml (SBP/DBP -12/-6 vs. -7/-3 mmHg, respectively). ABPM (n = 273) and HBPM (n = 194) confirmed 24-h efficacy of both regimens. In the subgroup of patients with sustained uncontrolled hypertension assessed by ABPM (n = 216), office SBP/DBP decreased by -23/-13 vs. -18/-10 mmHg, respectively (P = 0.016/P = 0.135, post-hoc analysis). Both treatments were generally well tolerated. CONCLUSION Both regimens produced effective BP reductions confirmed by ABPM/HBPM. Both treatments were well tolerated, in accordance with the individual agents' safety profile. TRIAL REGISTRATION NUMBER EUDRA CT no. 2012-001690-84.
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Ojji DB, Mayosi B, Francis V, Badri M, Cornelius V, Smythe W, Kramer N, Barasa F, Damasceno A, Dzudie A, Jones E, Mondo C, Ogah O, Ogola E, Sani MU, Shedul GL, Shedul G, Rayner B, Okpechi IG, Sliwa K, Poulter N. Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans. N Engl J Med 2019; 380:2429-2439. [PMID: 30883050 DOI: 10.1056/nejmoa1901113] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood-pressure control in these patients has not been established. METHODS In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or was taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12.5 mg of hydrochlorothiazide, 5 mg of amlodipine plus 4 mg of perindopril, or 4 mg of perindopril plus 12.5 mg of hydrochlorothiazide for 2 months. Doses were then doubled (10 and 25 mg, 10 and 8 mg, and 8 and 25 mg, respectively) for an additional 4 months. The primary end point was the change in the 24-hour ambulatory systolic blood pressure between baseline and 6 months. RESULTS The mean age of the patients was 51 years, and 63% were women. Among the 621 patients who underwent 24-hour blood-pressure monitoring at baseline and at 6 months, those receiving amlodipine plus hydrochlorothiazide and those receiving amlodipine plus perindopril had a lower 24-hour ambulatory systolic blood pressure than those receiving perindopril plus hydrochlorothiazide (between-group difference in the change from baseline, -3.14 mm Hg; 95% confidence interval [CI], -5.90 to -0.38; P = 0.03; and -3.00 mm Hg; 95% CI, -5.8 to -0.20; P = 0.04, respectively). The difference between the group receiving amlodipine plus hydrochlorothiazide and the group receiving amlodipine plus perindopril was -0.14 mm Hg (95% CI, -2.90 to 2.61; P=0.92). Similar differential effects on office and ambulatory diastolic blood pressures, along with blood-pressure control and response rates, were apparent among the three groups. CONCLUSIONS These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months. (Funded by GlaxoSmithKline Africa Noncommunicable Disease Open Lab; CREOLE ClinicalTrials.gov number, NCT02742467.).
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Affiliation(s)
- Dike B Ojji
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Bongani Mayosi
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Veronica Francis
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Motasim Badri
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Victoria Cornelius
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Wynand Smythe
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Nicky Kramer
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Felix Barasa
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Albertino Damasceno
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Anastase Dzudie
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Erika Jones
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Charles Mondo
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Okechukwu Ogah
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Elijah Ogola
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Mahmoud U Sani
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Gabriel L Shedul
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Grace Shedul
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Brian Rayner
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Ikechi G Okpechi
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Karen Sliwa
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Neil Poulter
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
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Delucchi A, Marín M, Páez O, Bendersky M, Rodríguez P. Principales conclusiones del Consenso Argentino de Hipertensión Arterial. HIPERTENSION Y RIESGO VASCULAR 2019; 36:96-109. [DOI: 10.1016/j.hipert.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/28/2018] [Accepted: 01/07/2019] [Indexed: 01/13/2023]
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Victor RG, Blyler CA, Li N, Lynch K, Moy NB, Rashid M, Chang LC, Handler J, Brettler J, Rader F, Elashoff RM. Sustainability of Blood Pressure Reduction in Black Barbershops. Circulation 2019; 139:10-19. [PMID: 30592662 PMCID: PMC6917481 DOI: 10.1161/circulationaha.118.038165] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND We developed a new model of hypertension care for non-Hispanic black men that links health promotion by barbers to medication management by American Society of Hypertension-certified pharmacists and demonstrated efficacy in a 6-month cluster-randomized trial. The marked reduction in systolic blood pressure (BP) seen at 6 months warranted continuing the trial through 12 months to test sustainability, a necessary precondition for implementation research. METHODS We enrolled a cohort of 319 black male patrons with systolic BP ≥140 mm Hg at baseline. Fifty-two Los Angeles County barbershops were assigned to either a pharmacist-led intervention or an active control group. In the intervention group, barbers promoted follow-up with pharmacists who prescribed BP medication under a collaborative practice agreement with patrons' primary care providers. In the control group, barbers promoted follow-up with primary care providers and lifestyle modification. After BP assessment at 6 months, the intervention continued with fewer in-person pharmacist visits to test whether the intervention effect could be sustained safely for 1 year while reducing pharmacist travel time. Final BP and safety outcomes were assessed in both groups at 12 months. RESULTS At baseline, mean systolic BP was 152.4 mm Hg in the intervention group and 154.6 mm Hg in the control group. At 12 months, mean systolic BP fell by 28.6 mm Hg (to 123.8 mm Hg) in the intervention group and by 7.2 mm Hg (to 147.4 mm Hg) in the control group. The mean reduction was 20.8 mm Hg greater in the intervention (95% CI, 13.9-27.7; P<0.0001). A BP <130/80 mm Hg was achieved by 68.0% of the intervention group versus 11.0% of the control group ( P<0.02). These new 12-month efficacy data are statistically indistinguishable from our previously reported 6-month data. No treatment-related serious adverse events occurred in either group over 12 months. Cohort retention at 12 months was 90% in both groups. CONCLUSIONS Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in large and sustained BP reduction over 12 months when coupled with medication management by American Society of Hypertension-certified pharmacists. Broad-scale implementation research is both justified and warranted. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT 02321618.
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Affiliation(s)
| | | | - Ning Li
- Department of Biomathematics at the David Geffen School of Medicine at UCLA
| | | | | | | | - L. Cindy Chang
- Department of Biomathematics at the David Geffen School of Medicine at UCLA
| | | | | | | | - Robert M. Elashoff
- Department of Biomathematics at the David Geffen School of Medicine at UCLA
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Favretto D, Visentin S, Scrivano S, Roselli E, Mattiazzi F, Pertile R, Vogliardi S, Tucci M, Montisci M. Multiple incidence of the prescription diuretic hydrochlorothiazide in compounded nutritional supplements. Drug Test Anal 2018; 11:512-522. [DOI: 10.1002/dta.2499] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Donata Favretto
- Department of Cardiac Thoracic and Vascular Sciences and Public HealthUniversity of Padova Padova Italy
- University Hospital of Padova via Falloppio 50 35121 Padova Italy
| | - Sindi Visentin
- Department of Cardiac Thoracic and Vascular Sciences and Public HealthUniversity of Padova Padova Italy
- University Hospital of Padova via Falloppio 50 35121 Padova Italy
| | - Salvatore Scrivano
- Department of Cardiac Thoracic and Vascular Sciences and Public HealthUniversity of Padova Padova Italy
- University Hospital of Padova via Falloppio 50 35121 Padova Italy
| | - Emanuele Roselli
- Department of Cardiac Thoracic and Vascular Sciences and Public HealthUniversity of Padova Padova Italy
- University Hospital of Padova via Falloppio 50 35121 Padova Italy
| | - Fabio Mattiazzi
- Department of Cardiac Thoracic and Vascular Sciences and Public HealthUniversity of Padova Padova Italy
- University Hospital of Padova via Falloppio 50 35121 Padova Italy
| | - Roberto Pertile
- University Hospital of Padova via Falloppio 50 35121 Padova Italy
| | - Susanna Vogliardi
- Department of Cardiac Thoracic and Vascular Sciences and Public HealthUniversity of Padova Padova Italy
| | - Marianna Tucci
- Department of Cardiac Thoracic and Vascular Sciences and Public HealthUniversity of Padova Padova Italy
| | - Massimo Montisci
- Department of Cardiac Thoracic and Vascular Sciences and Public HealthUniversity of Padova Padova Italy
- University Hospital of Padova via Falloppio 50 35121 Padova Italy
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2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953-2041. [PMID: 30234752 DOI: 10.1097/hjh.0000000000001940] [Citation(s) in RCA: 1809] [Impact Index Per Article: 301.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
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Moya L, Moreno J, Lombo M, Guerrero C, Aristizábal D, Vera A, Melgarejo E, Conta J, Gómez C, Valenzuela D, Ángel M, Achury H, Duque R, Triana Á, Gelves J, Pinzón A, Caicedo A, Cuéllar C, Sandoval J, Pérez J, Rico-Mendoza A, Porras-Ramírez A. Consenso de expertos sobre el manejo clínico de la hipertensión arterial en Colombia. Sociedad Colombiana de Cardiología y Cirugía. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Tadic M, Cuspidi C. Diuretics and left ventricular hypertrophy regression: The relationship that we commonly forget. J Clin Hypertens (Greenwich) 2018; 20:1516-1518. [PMID: 30251479 DOI: 10.1111/jch.13381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
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Roush GC, Abdelfattah R, Song S, Ernst ME, Sica DA, Kostis JB. Hydrochlorothiazide vs chlorthalidone, indapamide, and potassium-sparing/hydrochlorothiazide diuretics for reducing left ventricular hypertrophy: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2018; 20:1507-1515. [PMID: 30251403 DOI: 10.1111/jch.13386] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
Left ventricular hypertrophy develops in 36%-41% of hypertensive patients and independently predicts cardiovascular events and total mortality. Moreover, drug-induced reduction in left ventricular mass (LVM) correlates with improved prognosis. The optimal thiazide-type diuretic for reducing LVM is unknown. Evidence regarding potency, cardiovascular events, sodium, and potassium suggested the hypothesis that "CHIP" diuretics (CHlorthalidone, Indapamide, and Potassium-sparing diuretic/hydrochlorothiazide [PSD/HCTZ]) would reduce LVM more than HCTZ. Systematic searches of five databases were conducted. Among the 38 randomized trials, a 1% reduction in systolic blood pressure (SBP) predicted a 1% reduction in LVM, P = 0.00001. CHIP-HCTZ differences in reducing LVM differed across trials (ie, heterogeneity), making interpretation uncertain. However, among the 28 double-blind trials, heterogeneity was undetectable, and HCTZ reduced LVM (percent reduction [95% CI]) by -7.3 (-10.4, -4.2), P < 0.0001. CHIP diuretics surpassed HCTZ in reducing LVM: chlorthalidone -8.2 (-14.7, -1.6), P = 0.015; indapamide -7.5 (-12.7, -2.3), P = 0.005; and all CHIP diuretics combined -7.7 (-12.2, -3.1), P < 0.001. The comparison of PSD/HCTZ with HCTZ had low statistical power but favored PSD/HCTZ: -6.0 (-14.1, +2.1), P = 0.149. Thus, compared to HCTZ, CHIP diuretics had twice the effect on LVM. CHIP diuretics did not surpass HCTZ in reducing systolic or diastolic blood pressure: -0.3 (-5.0, +4.3) and -1.6 (-5.6, +2.4), respectively. The strength of evidence that CHIP diuretics surpass HCTZ for reducing LVM was high (GRADE criteria). In conclusion, these novel results have demonstrated that CHIP diuretics reduce LVM 2-fold more than HCTZ among hypertensive patients. Although generally related to LVM, blood pressure fails to explain the superiority of CHIP diuretics for reducing LVM.
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Affiliation(s)
| | | | - Steven Song
- SUNY Downstate Medical Center, New York, New York
| | | | - Domenic A Sica
- Department of Medicine and Pharmacology, Virginia Commonwealth University, Richmond, Virginia
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5688] [Impact Index Per Article: 948.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Jordan J, Kurschat C, Reuter H. Arterial Hypertension. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:557-568. [PMID: 30189978 PMCID: PMC6156553 DOI: 10.3238/arztebl.2018.0557] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 11/28/2017] [Accepted: 07/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Essential arterial hypertension is one of the main treatable cardiovascular risk factors. In Germany, approximately 13% of women and 18% of men have uncontrolled high blood pressure (≥ 140/90 mmHg). METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed. RESULTS Arterial hypertension is diagnosed when repeated measurements in a doctor's office yield values of 140/90 mmHg or higher. The diagnosis should be confirmed by 24-hour ambulatory blood pressure monitoring or by home measurement. Further risk factors and end-organ damage should be considered as well. According to the current European guidelines, the target blood pressure for all patients, including those with diabetes mellitus or renal failure, is <140/90 mmHg. If the treatment is well tolerated, further lowering of blood pressure, with a defined lower limit, is recommended for most patients. The main non-pharmacological measures against high blood pressure are reduction of salt in the diet, avoidance of excessive alcohol consumption, smoking cessation, a balanced diet, physical exercise, and weight loss. The first-line drugs for arterial hypertension include long-acting dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and thiazide-like diuretics. Mineralocorticoid-receptor blockers are effective in patients whose blood pressure cannot be brought into acceptable range with first-line drugs. CONCLUSION In most patients with essential hypertension, the blood pressure can be well controlled and the cardiovascular risk reduced through a combination of lifestyle interventions and first-line antihypertensive drugs.
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Affiliation(s)
- Jens Jordan
- Institute of Aerospace Medicine (DLR) and Chair of Clinical Aerospace Medicine, University of Cologne, Germany
- University Hypertension Center, University of Cologne, Germany
| | - Christine Kurschat
- Department II of Internal Medicine, Divisions of Nephrology, Rheumatology, Diabetes and General Internal Medicine, University Hospital of Cologne, Germany
- University Hypertension Center, University of Cologne, Germany
| | - Hannes Reuter
- Department of Internal Medicine and Cardiology, Evangelisches Klinikum Köln Weyertal, Cologne
- University Hypertension Center, University of Cologne, Germany
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Victor RG, Lynch K, Li N, Blyler C, Muhammad E, Handler J, Brettler J, Rashid M, Hsu B, Foxx-Drew D, Moy N, Reid AE, Elashoff RM. A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. N Engl J Med 2018; 378. [PMID: 29527973 PMCID: PMC6018053 DOI: 10.1056/nejmoa1717250] [Citation(s) in RCA: 355] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings. METHODS We enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg or more from 52 black-owned barbershops (nontraditional health care setting) in a cluster-randomized trial in which barbershops were assigned to a pharmacist-led intervention (in which barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors) or to an active control approach (in which barbers encouraged lifestyle modification and doctor appointments). The primary outcome was reduction in systolic blood pressure at 6 months. RESULTS At baseline, the mean systolic blood pressure was 152.8 mm Hg in the intervention group and 154.6 mm Hg in the control group. At 6 months, the mean systolic blood pressure fell by 27.0 mm Hg (to 125.8 mm Hg) in the intervention group and by 9.3 mm Hg (to 145.4 mm Hg) in the control group; the mean reduction was 21.6 mm Hg greater with the intervention (95% confidence interval, 14.7 to 28.4; P<0.001). A blood-pressure level of less than 130/80 mm Hg was achieved among 63.6% of the participants in the intervention group versus 11.7% of the participants in the control group (P<0.001). In the intervention group, the rate of cohort retention was 95%, and there were few adverse events (three cases of acute kidney injury). CONCLUSIONS Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT02321618 .).
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Affiliation(s)
- Ronald G Victor
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Kathleen Lynch
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Ning Li
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Ciantel Blyler
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Eric Muhammad
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Joel Handler
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Jeffrey Brettler
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Mohamad Rashid
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Brent Hsu
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Davontae Foxx-Drew
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Norma Moy
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Anthony E Reid
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Robert M Elashoff
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
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Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, Grassi G, Jordan J, Poulter NR, Rodgers A, Whelton PK. Hypertension. Nat Rev Dis Primers 2018; 4:18014. [PMID: 29565029 PMCID: PMC6477925 DOI: 10.1038/nrdp.2018.14] [Citation(s) in RCA: 562] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Systemic arterial hypertension is the most important modifiable risk factor for all-cause morbidity and mortality worldwide and is associated with an increased risk of cardiovascular disease (CVD). Fewer than half of those with hypertension are aware of their condition, and many others are aware but not treated or inadequately treated, although successful treatment of hypertension reduces the global burden of disease and mortality. The aetiology of hypertension involves the complex interplay of environmental and pathophysiological factors that affect multiple systems, as well as genetic predisposition. The evaluation of patients with hypertension includes accurate standardized blood pressure (BP) measurement, assessment of the patients' predicted risk of atherosclerotic CVD and evidence of target-organ damage, and detection of secondary causes of hypertension and presence of comorbidities (such as CVD and kidney disease). Lifestyle changes, including dietary modifications and increased physical activity, are effective in lowering BP and preventing hypertension and its CVD sequelae. Pharmacological therapy is very effective in lowering BP and in preventing CVD outcomes in most patients; first-line antihypertensive medications include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, dihydropyridine calcium-channel blockers and thiazide diuretics.
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Affiliation(s)
- Suzanne Oparil
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, School of Medicine, The University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, Birmingham, AL, 35294-0007, USA
| | | | | | - Dan R Berlowitz
- Center for Healthcare Organization and Implementation Research, Bedford Veteran Affairs Medical Center, Bedford, MA, USA
- Schools of Medicine and Public Health, Boston University, Boston, MA, USA
| | - Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Science, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Milan, Italy
- IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), University of Cologne, Cologne, Germany
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony Rodgers
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Impact of long-term potassium supplementation on thiazide diuretic-induced abnormalities of glucose and uric acid metabolisms. J Hum Hypertens 2018; 32:301-310. [PMID: 29497150 DOI: 10.1038/s41371-018-0036-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/05/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022]
Abstract
Treatment of hypertension with thiazide diuretics may trigger hypokalemia, hyperglycemia, and hyperuricemia. Some studies suggest simultaneous potassium supplementation in hypertensive patients using thiazide diuretics. However, few clinical studies have reported the impact of long-term potassium supplementation on thiazide diuretic-induced abnormalities in blood glucose and uric acid (UA) metabolisms. One hundred hypertensive patients meeting the inclusion criteria were equally randomized to two groups: IND group receiving indapamide (1.25-2.5 mg daily) alone, and IND/KCI group receiving IND (1.25-2.5 mg daily) plus potassium chloride (40 mmol daily), both for 24 weeks. At the end of 24-week follow-up, serum K+ level in IND group decreased from 4.27 ± 0.28 to 3.98 ± 0.46 mmol/L (P < 0.001), and fasting plasma glucose (FPG) and UA increased from 5.11 ± 0.52 to 5.31 ± 0.57 mmol/L (P < 0.05), and from 0.404 ± 0.078 to 0.433 ± 0.072 mmol/L (P < 0.05), respectively. Serum K+ level in IND/KCl group decreased from 4.27 ± 0.36 to 3.89 ± 0.28 mmol/L (P < 0.001), and FPB and UA increased from 5.10 ± 0.41 to 5.35 ± 0.55 mmol/L (P < 0.01), and from 0.391 ± 0.073 to 0.457 ± 0.128 mmol/L (P < 0.001), respectively. The difference value between the serum K+ level and FPG before and after treatment was not statistically significant between the two groups. However, the difference value in UA in IND/KCl group was significantly higher than that in IND group (0.066 (95% confidence interval (CI): 0.041-0.090) mmol/L vs. 0.029 (95% CI: 0.006-0.058) mmol/L, P < 0.05). The results showed that long-term routine potassium supplementation could not prevent or attenuate thiazide diuretic-induced abnormalities of glucose metabolism in hypertensive patients; rather, it may aggravate the UA metabolic abnormality.
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Abstract
PURPOSE OF REVIEW In patients with prediabetes or type 2 diabetes, the use of thiazides as antihypertensive agents has been challenged because associated metabolic adverse events, including new-onset diabetes. RECENT FINDINGS These metabolic disturbances are less marked with low-dose thiazides and, in most but not all studies, with thiazide-like diuretics (chlorthalidone, indapamide) than with thiazide-type diuretics (hydrochlorothiazide). In post hoc analyses of subgroups of patients with hypertension and type 2 diabetes, thiazides resulted in a significant reduction in cardiovascular events, all-cause mortality, and hospitalization for heart failure compared to placebo and generally were shown to be non-inferior to other antihypertensive agents. Benefits attributed to thiazide diuretics in terms of cardiovascular event reduction outweigh the risk of worsening glucose control in type 2 diabetes and of new-onset diabetes in non-diabetic patients. Thiazides still play a key role in the management of patients with type 2 diabetes and hypertension.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, University of Liège, CHU Sart Tilman (B35), B-4000, Liege, Belgium.
- Clinical Pharmacology Unit, CHU Liège, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
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Lamb SA, Al Hamarneh YN, Houle SKD, Leung AA, Tsuyuki RT. Hypertension Canada's 2017 guidelines for diagnosis, risk assessment, prevention and treatment of hypertension in adults for pharmacists: An update. Can Pharm J (Ott) 2018; 151:33-42. [PMID: 29317935 PMCID: PMC5755821 DOI: 10.1177/1715163517743525] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Sarah A. Lamb
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
| | - Yazid N. Al Hamarneh
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
| | - Sherilyn K. D. Houle
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
| | - Alexander A. Leung
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
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Dasgupta K, Sapir-Pichhadze R, Khan N. Powerful diuretics: A common denominator in landmark hypertension and type 2 diabetes mellitus trials. J Clin Hypertens (Greenwich) 2017; 20:136-142. [PMID: 29265730 DOI: 10.1111/jch.13151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Kaberi Dasgupta
- Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Nadia Khan
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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AI Dhaybi O, Bakris GL. Renal Targeted Therapies of Antihypertensive and Cardiovascular Drugs for Patients With Stages 3 Through 5d Kidney Disease. Clin Pharmacol Ther 2017; 102:450-458. [DOI: 10.1002/cpt.758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/03/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Affiliation(s)
- O AI Dhaybi
- Department of Medicine; ASH Comprehensive Hypertension Center, University of Chicago Medicine; Chicago Illinois USA
| | - GL Bakris
- Department of Medicine; ASH Comprehensive Hypertension Center, University of Chicago Medicine; Chicago Illinois USA
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Comparison between the effects of hydrochlorothiazide and indapamide on the kidney in hypertensive patients inadequately controlled with losartan. J Hum Hypertens 2017; 31:848-854. [PMID: 28703124 DOI: 10.1038/jhh.2017.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/25/2017] [Accepted: 06/02/2017] [Indexed: 02/05/2023]
Abstract
The aim of the study is to compare the effects of hydrochlorothiazide and indapamide on the kidney in patients with hypertension inadequately controlled with losartan. A total of 140 patients who met the criteria and inadequately controlled with losartan 50 mg per day for 2 weeks were randomized in two groups and administered either hydrochlorothiazide 12.5 mg per day (n=70) or indapamide (sustained release) 1.5 mg per day (n=70) in combination with losartan 50 mg per day. Office blood pressure (BP) were collected at baseline and upon each follow-up visit. Creatinine, urine albumin-creatinine ratio (ACR), urine neutrophil gelatinase-associated lipocalin (NGAL) and renal resistive index (RRI) were also collected at baseline and at the 24-week follow-up. None of the baseline characteristics was statistically significantly different between the two groups. After excluding those patients with office BP uncontrolled, 46 patients in the hydrochlorothiazide group (45.7% males, 58.8±10.8 years) and 44 patients in the indapamide group (38.4% males, 61.5±10.9 years) were analysed. There were insignificant changes in creatinine and significant decreases in ACR, NGAL and RRI compared to baseline levels in the two groups. The decrease in ACR (3.8 (0, 28.7) vs 4.2 (0.4, 64.8) mg g-1, P=0.485) was not significantly different between the two groups, while the decrease in NGAL (16.07±7.07 vs 28.77±7.64 ng ml-1, P<0.001) and RRI (0.04±0.02 vs 0.07±0.04, P<0.001) was more significant in the indapamide group than in the hydrochlorothiazide group. In conclusion, indapamide is superior to hydrochlorothiazide to improve renal tubular injury and renal haemodynamics in combination with losartan in hypertensive patients with controlled BP.
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76
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Blood pressure-lowering efficacy and safety of perindopril/indapamide/amlodipine single-pill combination in patients with uncontrolled essential hypertension. J Hypertens 2017; 35:1481-1495. [DOI: 10.1097/hjh.0000000000001359] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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77
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Spoladore R, Maranta F, Fragasso G. Pathophysiological mechanisms should be taken into account and guide the treatment of essential arterial hypertension. Indian Heart J 2017. [PMID: 28648446 PMCID: PMC5485400 DOI: 10.1016/j.ihj.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Roberto Spoladore
- Heart Failure Clinic, Istituto Scientifico San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Francesco Maranta
- Heart Failure Clinic, Istituto Scientifico San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Gabriele Fragasso
- Heart Failure Clinic, Istituto Scientifico San Raffaele, Via Olgettina 60, 20132 Milano, Italy.
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78
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Nedogoda SV, Stojanov VJ. Single-Pill Combination of Perindopril/Indapamide/Amlodipine in Patients with Uncontrolled Hypertension: A Randomized Controlled Trial. Cardiol Ther 2017; 6:91-104. [PMID: 28181192 PMCID: PMC5446818 DOI: 10.1007/s40119-017-0085-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Patients with hypertension often require a combination of three antihypertensive agents to achieve blood pressure control, but very few single-pill triple combinations are available. The aim of this study was to determine whether a single-pill triple combination of perindopril, indapamide, and amlodipine was as effective as a dual-pill combination of perindopril/indapamide plus separate amlodipine at reducing blood pressure in patients with uncontrolled, essential hypertension. METHODS This international, multicenter, open-label, randomized controlled trial was conducted in men or women aged ≥18 years old with confirmed essential hypertension (SBP ≥140 and <160 mmHg and DBP ≥90 and <100 mmHg), uncontrolled on maximal dose antihypertensive monotherapy or with a single dose of dual therapy. Patients were randomly assigned to: single-pill triple combination of perindopril 5 mg/indapamide 1.25 mg/amlodipine 5 mg (Per/Ind/Aml) or dual-pill combination perindopril 5 mg/indapamide 1.25 mg + amlodipine 5 mg (Per/Ind + Aml) once daily for 12 weeks. The primary endpoint was change in office supine SBP and DBP from baseline to week 12. The proportion of responders defined as those with normalized BP (SBP <140 mmHg and DBP <90 mmHg), and/or decrease of SBP ≥20 mmHg, and/or decrease of DBP ≥10 mmHg at week 12 (W12) compared with baseline was also assessed. Secondary efficacy endpoints included change in office supine SBP and DBP, response, and BP control at weeks 4 and 8. The tolerability of the treatments was also assessed. RESULTS A total of 148 patients were randomized: 75 to Per/Ind/Aml and 73 to Per/Ind + Aml. Mean supine SBP and DBP were 149.1 ± 4.7 and 94.1 ± 3.1 mmHg, respectively, with no relevant between-group difference. At week 12, both triple-therapy regimens were associated with clinically significant reductions in SBP compared with baseline (-21.5 ± 11.7 and -20.0 ± 12.9 mmHg, respectively). Reductions in office supine DBP were also clinically significant (-15.3 ± 7.8 and -14.8 ± 9.0 mmHg, respectively). The proportion of treatment responders was high in both groups: 89.2 and 87.1%, respectively. The reduction in office supine SBP/DBP was already evident at week 4 and maintained for the duration of the study in both groups. The majority of patients were treatment responders at week 4 (89.2 and 82.9%, respectively) and had achieved BP control (87.8 vs. 78.6%, respectively), which was maintained until week 12 in both treatment groups. Both treatments were well tolerated with no between-group differences. CONCLUSIONS In adult patients with uncontrolled essential hypertension on treatment, single-pill triple-combination therapy with Per/Ind/Aml is as effective as the same dose dual-pill combination of Per/Ind + Aml. Both treatments were associated with clinically significant BP reductions compared with baseline and were well tolerated. Clinical trials number: http://www.controlled-trials.com ISRCTN: 16442558. FUNDING Les Laboratoires Servier.
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Affiliation(s)
| | - Vesna J Stojanov
- Center for Hypertension, Clinical Center of Serbia, Medical School University of Belgrade, Belgrade, Serbia
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79
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Telmisartan and hydrochlorothiazide antihypertensive treatment in high sodium intake population: a randomized double-blind trial. J Hypertens 2017; 35:2077-2085. [PMID: 28509725 DOI: 10.1097/hjh.0000000000001407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the blood pressure (BP)-lowering effects of telmisartan 40 mg/day and hydrochlorothiazide (HCTZ) 25 mg/day in high sodium intake patients with mild-to-moderate hypertension in China. METHODS In this randomized, double-blind trial, eligible patients were randomly divided into telmisartan and HCTZ groups with three follow-ups scheduled on days 15, 30, and 60 after enrollment to compare BP decrease, hypokalemia, and other adverse events after intervention. RESULTS A total of 1333 mild-to-moderate hypertensive patients with average sodium intake of 5909 mg/day were enrolled from 14 county hospitals in China. Baseline characteristics were well balanced. At 15, 30, and 60 days of follow-up, average SBP/DBP reduction in telmisartan and HCTZ group was 12.5/8.0, 14.3/9.1, 12.8/7.2, 11.0/5.8, 13.6/7.1, and 11.5/5.3 mmHg, respectively. Telmisartan showed greater BP response than HCTZ at three visits, with statistical significance for DBP (P < 0.001) regardless of the adjustment for baseline BP, sodium excretion, and pulse pressure (PP). SBP reduction was positively related to increasing urinary sodium and PP levels for patients in both groups but increased faster with increasing PP in HCTZ than in telmisartan (P = 0.0238 for group × PP). Compared with telmisartan, HCTZ showed more hypokalemia (0.4 vs. 4.5%, P < 0.001). CONCLUSION Both telmisartan and HCTZ were effective for the treatment of hypertensive patients with high sodium intake. Telmisartan showed better DBP-lowering effect and less hypokalemia than HCTZ among high sodium intake patients. Further studies are needed to evaluate the plausible superiority effect of hydrochlorothiazide among patients with large PP.
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Pande A. Renoprotection with indapamide, additional feature to look for. Indian Heart J 2017; 69:284-285. [PMID: 28460782 PMCID: PMC5414977 DOI: 10.1016/j.ihj.2017.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/22/2017] [Indexed: 12/03/2022] Open
Affiliation(s)
- Arindam Pande
- Department of Cardiology, Apollo Gleneagles Hospital, 58, Canal Circular Road, Kolkata, 700054, India.
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81
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Boukhris M, Abcha F, Elhadj ZI, Kachboura S. Which diuretic for which hypertensive patient? Indian Heart J 2017; 69:282-283. [PMID: 28460779 PMCID: PMC5414937 DOI: 10.1016/j.ihj.2017.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/20/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marouane Boukhris
- Cardiology Department of Abderrahmen Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Ariana, Tunisia.
| | - Farouk Abcha
- Cardiology Department of Abderrahmen Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Ariana, Tunisia
| | - Zied Ibn Elhadj
- Cardiology Department of Abderrahmen Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Ariana, Tunisia
| | - Salem Kachboura
- Cardiology Department of Abderrahmen Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Ariana, Tunisia
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82
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Gupta R. Letter - Diuretics in primary hypertension - Reloaded. Indian Heart J 2017; 69:283-284. [PMID: 28460780 PMCID: PMC5414952 DOI: 10.1016/j.ihj.2017.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rahul Gupta
- Apollo Hospital, Plot No. 13, Parsik Hill Road, Sec-23, CBD Belapur, Navi Mumbai, 400614, India.
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83
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Tani S, Asayama K, Oiwa K, Harasawa S, Okubo K, Takahashi A, Tanabe A, Ohkubo T, Hirayama A, Kushiro T. The effects of increasing calcium channel blocker dose vs. adding a diuretic to treatment regimens for patients with uncontrolled hypertension. Hypertens Res 2017; 40:892-898. [PMID: 28446804 DOI: 10.1038/hr.2017.56] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/13/2017] [Accepted: 02/21/2017] [Indexed: 12/15/2022]
Abstract
In patients with insufficient blood pressure (BP) control, despite using a combination regimen containing an angiotensin receptor blocker and a calcium channel blocker (CCB), whether a greater dose of CCB or adding a diuretic is more effective at lowering BP remains unclear. We conducted a multicenter randomized clinical trial to compare the efficacy of switching from the daily administration of a single-pill fixed-dose combination of irbesartan (100 mg) and amlodipine (5 mg) to irbesartan (100 mg) with an increased dose of amlodipine (10 mg) (HD group, n=62) or irbesartan (100 mg) and amlodipine (5 mg) with 1 mg of indapamide (D group, n=63) in patients with poorly controlled hypertension. BP measured at home was monitored by a physician using a telemonitoring system. Between the HD and D groups, no significant differences were observed in morning home BP changes (mean reduction of systolic/diastolic BP, 1.7/0.9 mmHg; 95% confidence intervals, -2.4 to 5.7/-1.4 to 3.2; P=0.19/0.37), achievement rate of target BP (45.2% vs. 42.9%, P=0.80), BP variability independent of the mean (P⩾0.74), other variability indices (P⩾0.55) and time to stabilization, which was calculated using a fitted analysis (13.1 days vs. 11.4 days, P=0.99). Although a significant increase in serum uric acid was observed in the D group (P<0.0001), neither clinically relevant abnormal laboratory test results nor critical BP changes were observed throughout the trial period. Both antihypertensive drug combination strategies were effective treatment options. Further investigation is required to determine the appropriate use of both therapies based on the various pathologies associated with hypertension.
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Affiliation(s)
- Shigemasa Tani
- Department of Cardiovascular Center, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Department of Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Koji Oiwa
- Japan Community Health Care Organization, Yokohama Chuo Hospital, Yokohama, Japan
| | - Shinsuke Harasawa
- Department of Cardiovascular Center, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Katsuaki Okubo
- Department of Cardiovascular Center, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsuhiko Takahashi
- Department of Cardiovascular Center, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ayumi Tanabe
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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84
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Fixed-Dose Triple Combination of Antihypertensive Drugs Improves Blood Pressure Control: From Clinical Trials to Clinical Practice. Adv Ther 2017; 34:975-985. [PMID: 28299716 DOI: 10.1007/s12325-017-0511-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Blood pressure (BP) control is the main clinical goal in the management of hypertensive patients; however, BP in most of these patients remains uncontrolled, despite the widespread availability of antihypertensive drugs as free-combination therapy. This study compared the efficacy of a fixed-dose triple combination (FDTC) of antihypertensive drugs with that of a free combination of three antihypertensives in patients with uncontrolled hypertension. METHODS Ninety-two patients (mean age 60.8 ± 12.1, 58.0% male) with uncontrolled essential hypertension (office systolic BP ≥ 140 or diastolic BP ≥ 90 mmHg) previously treated with a renin-angiotensin-aldosterone system (RAAS) inhibitor plus hydrochlorothiazide were switched to once-daily FDTC therapy with perindopril/indapamide/amlodipine (5-10/1.25-2.5/5-10 mg). Patients were age- and sex-matched with a control group of hypertensive patients receiving free-combination therapy with three drugs including a RAAS inhibitor, a diuretic, and a calcium channel blocker. Office BP and 24-h ambulatory BP monitoring (ABPM) were evaluated at baseline and after 1 and 4 months. RESULTS Significant reductions in ambulatory 24-h, daytime, and nighttime systolic BP, and pulse pressure (PP) were found in the FDTC group relative to reductions seen with free-combination therapy, after the first month only of follow-up. Target BP values (mean 24-h ambulatory systolic/diastolic BP < 130/80 mmHg) were reached by more recipients of FDTC than free-combination therapy (64.8% vs. 46.9%, p < 0.05) at month 4 of follow-up, despite reductions in 24-h ABPM values from baseline being similar in both groups at this time point. CONCLUSION FDTC of perindopril/indapamide/amlodipine was effective at reducing SBP and PP in previously treated patients with uncontrolled hypertension, and well tolerated, providing support for clinicians in choosing a fixed-dose triple combination over the free-combination of a RAAS inhibitor, a diuretic, and a calcium antagonist.
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85
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Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, Nerenberg K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Tran KC, Tobe SW, Ruzicka M, Burns KD, Vallée M, Prasad GVR, Gryn SE, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Penner SB, Burgess E, Sivapalan P, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell NRC, Moe GW, Howlett JG, Boulanger JM, Prebtani A, Kline G, Leiter LA, Jones C, Côté AM, Woo V, Kaczorowski J, Trudeau L, Tsuyuki RT, Hiremath S, Drouin D, Lavoie KL, Hamet P, Grégoire JC, Lewanczuk R, Dresser GK, Sharma M, Reid D, Lear SA, Moullec G, Gupta M, Magee LA, Logan AG, Dionne J, Fournier A, Benoit G, Feber J, Poirier L, Padwal RS, Rabi DM. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. Can J Cardiol 2017; 33:557-576. [PMID: 28449828 DOI: 10.1016/j.cjca.2017.03.005] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 01/29/2023] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Stella S Daskalopoulou
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute of Alberta, O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kelly B Zarnke
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara Nerenberg
- Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada
| | - Maxime Lamarre-Cliche
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | | | - Steven E Gryn
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Ross D Feldman
- Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Milan Khara
- Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas W Wilson
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Brian Penner
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ellen Burgess
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Praveena Sivapalan
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert J Herman
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Steven Grover
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada
| | - George Honos
- University of Montreal, Montreal, Quebec, Canada
| | - Patrice Lindsay
- Stroke, Heart and Stroke Foundation of Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gord Gubitz
- Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norman R C Campbell
- Medicine, Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Martin Boulanger
- Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Gregory Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Jones
- University of British Columbia, Southern Medical Program, Kelowna, British Columbia, Canada
| | | | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janusz Kaczorowski
- Université de Montréal and Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, McGill University, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Swapnil Hiremath
- Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Drouin
- Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | | | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mukul Sharma
- McMaster University, Hamilton Health Sciences Population Health Research Institute, Hamilton, Ontario, Canada
| | - Debra Reid
- Centre intégré de santé et de services sociaux (CISSS) de l'Outaouais, Groupes de médecine de famille (GMF) de Wakefield, Wakefield, Quebec, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Gregory Moullec
- Research Center, Hôpital du Sacré-Coeur de Montréal, Public Health School, University of Montréal, Montréal, Quebec, Canada
| | - Milan Gupta
- McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Laura A Magee
- St George's, University of London and the St George's Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Poirier
- Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Quebec, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Doreen M Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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86
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Karpov YA. Full-dose Perindopril/Indapamide in the Treatment of Difficult-to-Control Hypertension: The FORTISSIMO Study. Clin Drug Investig 2017; 37:207-217. [PMID: 27878562 DOI: 10.1007/s40261-016-0479-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Blood pressure (BP) control in hypertensive patients remains poor worldwide, particularly in high-risk patients with hypertension and diabetes. Guidelines recommend that such patients receive prompt pharmacological therapy at maximal doses to rapidly control BP. We aimed to evaluate efficacy and safety of single-pill combination (SPC) perindopril/indapamide (PER/IND) at full dose (10/2.5 mg) in hypertensive patients, including diabetics, with BP uncontrolled by previous medication. METHODS Twelve-week prospective, observational study in patients with uncontrolled hypertension (≥160-200 mmHg systolic BP [SBP] and <110 mmHg diastolic BP [DBP]) on a previous SPC or free-dose combination of renin-angiotensin system blocker plus thiazide diuretic, substituted with PER/IND 10/2.5 mg. Office BP, quality of life, and blood parameters were evaluated in the whole cohort and patients with type 2 diabetes mellitus. RESULTS 2120 ambulatory hypertensive patients were enrolled, including 307 with type 2 diabetes. Two weeks after substitution, SBP significantly decreased from 171.0 ± 13.3 to 148.6 ± 13.4 mmHg, and DBP from 98.6 ± 8.3 to 88.8 ± 7.9 mmHg (both p < 0.00001). A similar rapid decrease was noted in the diabetes subgroup. After 12 weeks, BP had reduced by 42/19 mmHg in the whole cohort (diabetes subgroup: 41/18 mmHg). Most (84%; diabetes subgroup: 77%) patients reached BP target (<140/90 mmHg). Laboratory tests and quality of life improved in the whole cohort and the diabetic subgroup. CONCLUSIONS Switching to PER/IND at full dose (10/2.5 mg) was well tolerated, leading to fast BP reduction and control in the majority of patients with uncontrolled hypertension, including difficult-to-treat patients with diabetes.
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Affiliation(s)
- Yuri Aleksandrovich Karpov
- Russian Cardiological Research and Production Complex, 3rd Cherepkovskaya st. 15A, Moscow, 121552, Russia.
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87
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Affiliation(s)
- Anna F. Dominiczak
- From the College of Medical, Veterinary and Life Science, University of Glasgow, United Kingdom
| | - Denise Kuo
- From the College of Medical, Veterinary and Life Science, University of Glasgow, United Kingdom
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88
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Affiliation(s)
- Walter Zidek
- Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, D-12203, Berlin, Deutschland.
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89
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Rosa J, Zelinka T, Petrák O, Štrauch B, Holaj R, Widimský J. Should All Patients with Resistant Hypertension Receive Spironolactone? Curr Hypertens Rep 2016; 18:81. [PMID: 27787836 DOI: 10.1007/s11906-016-0690-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Ján Rosa
- 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
- Cardiocenter, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Tomáš Zelinka
- 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondřej Petrák
- 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Branislav Štrauch
- 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Robert Holaj
- 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Widimský
- 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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90
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Prado JC, Ruilope LM, Segura J. [Benefits of spironolactone as the optimal treatment for drug resistant hypertension. Pathway-2 trial review]. HIPERTENSION Y RIESGO VASCULAR 2016; 33:150-154. [PMID: 27363610 DOI: 10.1016/j.hipert.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/25/2016] [Accepted: 05/27/2016] [Indexed: 11/25/2022]
Abstract
Pathway-2 is the first randomised, double-blind and crossover trial that compares spironolactone as a fourth drug with alfa-blocker, beta-blocker and placebo. This study shows that spironolactone is the drug with more possibilities of success for the management of patients with difficult-to-treat hypertension in patients with a combination of three drugs and poor control. The results validate the widespread treatment with mineralocorticoid receptor antagonists in resistant hypertension.
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Affiliation(s)
- J C Prado
- Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - L M Ruilope
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Segura
- Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
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91
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Scheen A. Reappraisal of the diuretic effect of empagliflozin in the EMPA-REG OUTCOME trial: Comparison with classic diuretics. DIABETES & METABOLISM 2016; 42:224-33. [DOI: 10.1016/j.diabet.2016.05.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 12/23/2022]
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92
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Current prescription status of antihypertensive drugs with special reference to the use of diuretics in Japan. Hypertens Res 2016; 40:203-206. [PMID: 27581534 DOI: 10.1038/hr.2016.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/27/2016] [Accepted: 07/28/2016] [Indexed: 01/04/2023]
Abstract
The guidelines for the management of hypertension recommend the inclusion of diuretics, especially when three or more antihypertensive drugs are used. The present study investigated the current prescription status of antihypertensive drugs with a particular focus on the use of diuretics in a local district in Japan. Prescriptions, including antihypertensive drugs, were collected from a dispensing pharmacy of the Yahata Pharmacist Association, located in Kitakyushu City, in October 2014. Of the 10 585 prescriptions, calcium channel blockers (CCBs) were prescribed in 73.5%, followed by angiotensin II receptor blockers (ARB, 62.7%), diuretics (16.5%) and β-blockers (13.6%). The average number of drugs used was 1.80. The rates of prescription of diuretics for patients with one, two, three and four drugs were 0.6%, 13.1%, 55.2% and 82.6%, respectively. Diuretics were more frequently prescribed in elderly patients, and the prescription rate of doctors in hospitals was significantly higher than that of general practitioners (19.1% vs. 15.7%, P<0.01). In addition, 40% of patients with thiazide diuretics were prescribed combination tablets of hydrochlorothiazide with ARB, whereas trichlormethiazide (34.9%) and indapamide (19.8%) were used in other patients. Based on these findings, the use of diuretics remains limited, even among patients taking multiple antihypertensive drugs.
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93
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Quantifying intermolecular interactions in solid state indapamide and other popular diuretic drugs: Insights from Hirshfeld surface study. J Mol Struct 2016. [DOI: 10.1016/j.molstruc.2016.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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94
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Modern Management and Diagnosis of Hypertension in the United Kingdom: Home Care and Self-care. Ann Glob Health 2016; 82:274-87. [DOI: 10.1016/j.aogh.2016.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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95
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Wani P, Blanco-Garcia C. A Round-Up on Cost-Effectiveness of Hypertension Therapy Based on the 2014 Guidelines. Curr Cardiol Rep 2016; 18:24. [DOI: 10.1007/s11886-016-0703-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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96
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Turgut F, Yaprak M, Abdel-Rahman E. Management of hypertension: Current state of the art and challenges. World J Hypertens 2016; 6:53-59. [DOI: 10.5494/wjh.v6.i1.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/04/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023] Open
Abstract
Hypertension is a major modifiable cardiovascular risk factor. Hypertension is also recognized as the most important risk factor for global disease burden. It is well established that a sustained reduction in blood pressure by drugs reduces the incidence of cardiovascular morbidity and mortality. In recent years, studies and new guidelines published for the management of hypertension. Awareness, treatment and control of hypertension are very poor, despite the new guidelines. We highlighted the management of hypertension in the light of current literature.
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97
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Efficacy of Low-Dose Chlorthalidone and Hydrochlorothiazide as Assessed by 24-h Ambulatory Blood Pressure Monitoring. J Am Coll Cardiol 2016; 67:379-389. [DOI: 10.1016/j.jacc.2015.10.083] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 12/31/2022]
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98
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Not just chlorthalidone: evidence-based, single tablet, diuretic alternatives to hydrochlorothiazide for hypertension. Curr Hypertens Rep 2016; 17:540. [PMID: 25821163 DOI: 10.1007/s11906-015-0540-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Accounting for 15 % of deaths worldwide, hypertension is often treated with hydrochlorothiazide (HCTZ) (50 million prescriptions annually). HCTZ has a <24-h duration of action, is less potent than chlorthalidone and all major antihypertensive drug classes, and is inferior to four antihypertensive drugs for cardiovascular event (CVE) reduction. If there were alternative diuretics, why prescribe HCTZ? Chlorthalidone is often offered as an alternative to HCTZ, but has limited pharmaceutical formulations. However, there are seven evidence-based, single-tablet, alternative diuretics. For reducing CVE, the following are superior to their comparators: chlorthalidone versus four antihypertensives in multiple hypertensive populations; indapamide versus placebo in elderly Chinese (and versus enalapril for left ventricular hypertrophy), triamterene-HCTZ versus placebo in elderly Europeans, amiloride-HCTZ versus three antihypertensives, and indapamide-perindopril versus placebo in three populations. Additionally, chlorthalidone-azilsartan and spironolactone-HCTZ are potent combinations The aldosterone antagonist component of the latter combination has been shown to reduce total mortality by 30 % in heart failure. Five of these seven have multiple dose formulations. Six cost $4-$77 monthly. In conclusion, based on both scientific and practical grounds, new prescriptions for HCTZ are rarely justified.
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99
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Affiliation(s)
- Norman M. Kaplan
- From the Department of Medicine, University of Texas Southwestern Medical School, Dallas
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