3651
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Lydakis C, Momen A, Blaha C, Gugoff S, Gray K, Herr M, Leuenberger UA, Sinoway LI. Changes of central haemodynamic parameters during mental stress and acute bouts of static and dynamic exercise. J Hum Hypertens 2008; 22:320-8. [DOI: 10.1038/jhh.2008.4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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3652
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Messerli FH, Pinto L, Tang SS, Thakker KM, Cappelleri JC, Sichrovsky T, Dubois RW. Impact of systemic hypertension on the cardiovascular benefits of statin therapy--a meta-analysis. Am J Cardiol 2008; 101:319-25. [PMID: 18237593 DOI: 10.1016/j.amjcard.2007.08.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 08/20/2007] [Accepted: 08/20/2007] [Indexed: 10/22/2022]
Abstract
The ASCOT-LLA and ALLHAT-LLT trials provide conflicting evidence of the efficacy of statins in decreasing cardiovascular (CV) morbidity and mortality in hypertensive patients. We performed a meta-analysis to compare the overall efficacy of statins in hypertensive and nonhypertensive patients enrolled in major randomized clinical trials. We systematically reviewed PubMed publications from 1985 onward for placebo-controlled randomized trials that examined the effect of statins on cardiac morbidity and mortality. Only trials that followed >or=1,000 patients for >or=2 years were included in the meta-analysis. Outcomes included cardiac or CV death, major coronary events, or major CV events. Pooled estimates of relative risk (RR) were calculated separately for hypertensive and nonhypertensive patients. The moderating effect of the percentage of hypertensive patients at baseline was tested using meta-regression. Besides the ASCOT-LLA and ALLHAT-LLT, 12 trials enrolling 69,984 patients met inclusion criteria. Overall, in these 12 trials, statin therapy decreased cardiac death by 24% (RR 0.76, 95% confidence interval [CI] 0.71 to 0.82). There was no evidence of difference in RR estimates for hypertensive (RR 0.78, 95% CI 0.72 to 0.84) and nonhypertensive (RR 0.76, 95% CI 0.72 to 0.80) patients. Similarly, meta-regression showed that the efficacy of statins was not moderated by the percentage of hypertensive patients at baseline (Q estimate 1.51, p=0.22). In conclusion, statin therapy effectively decreases CV morbidity and mortality to the same extent in hypertensive and nonhypertensive patients.
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3653
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3654
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Ambulatory arterial stiffness index: merits and limitations of a simple surrogate measure of arterial compliance. J Hypertens 2008; 26:182-5. [DOI: 10.1097/hjh.0b013e3282f52fb9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3655
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Choice of antihypertensive drugs in the European Society of Hypertension–European Society of Cardiology guidelines: specific indications rather than ranking for general usage. J Hypertens 2008; 26:164-8. [DOI: 10.1097/hjh.0b013e3282f52fa8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3656
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Protocolo local consensuado para un adecuado manejo de la enfermedad renal crónica en Atención Primaria. Semergen 2008. [DOI: 10.1016/s1138-3593(08)71858-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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3657
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Rodríguez Roca G, Barrios Alonso V, Llisterri Caro J, Alonso Moreno F. Réplica. Rev Clin Esp 2008. [DOI: 10.1157/13115215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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3658
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Ghiadoni L, Penno G, Giannarelli C, Plantinga Y, Bernardini M, Pucci L, Miccoli R, Taddei S, Salvetti A, Del Prato S. Metabolic Syndrome and Vascular Alterations in Normotensive Subjects at Risk of Diabetes Mellitus. Hypertension 2008; 51:440-5. [DOI: 10.1161/hypertensionaha.107.103093] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We evaluated the possible association between early vascular abnormalities and the metabolic syndrome (MS) in 77 normotensive subjects (mean age: 50 years) at risk of developing diabetes for family history of diabetes, obesity, or impaired fasting glucose. Fifty healthy subjects were recruited as controls. MS was defined according to the ATP III criteria. Brachial artery endothelium-dependent and -independent vasodilation were assessed as flow-mediated dilation (FMD) and response to glyceryl trinitrate (GTN, 25 μg sublingual), respectively, by automatic computerized edge detection system. Carotid-femoral pulse wave velocity (PWV) and radial augmentation index (AIx) were assessed by applanation tonometry. PWV was significantly (
P
<0.01) higher in subjects with MS (n=29, 9.0±1.9 m/s) as compared with those without MS (n=48, 7.7±1.2 m/s) and controls (7.2±1.5 m/s). FMD was significantly (
P
<0.05) reduced in both subjects with (5.8±2.7%) and without MS (6.1±3.7%) as compared with controls (6.9±2.5%). No significant differences were found for response to GTN and AIx. PWV and FMD were significantly (
P
<0.05) affected by increasing number of MS components. Among the components of the MS, only blood pressure significantly affected PWV, whereas blood pressure and fasting glucose influenced FMD. Logistic regression analysis showed that MS was associated with increased risk of altered PVW (odd ratio: 7.95, confidence limits: 1.06 to 69.11), whereas only blood pressure component was significantly related with increased risk of impaired FMD (odd ratio: 3.60, confidence limits: 1.01 to 12.78). In conclusion, in normotensive subjects at risk of developing diabetes mellitus, the presence of MS is associated with a selective alteration of central PWV.
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Affiliation(s)
- Lorenzo Ghiadoni
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Giuseppe Penno
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Chiara Giannarelli
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Yvonne Plantinga
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Melania Bernardini
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Laura Pucci
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Roberto Miccoli
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Stefano Taddei
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Antonio Salvetti
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Stefano Del Prato
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
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3659
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3660
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Weir MR, Bakris GL. Combination Therapy With Renin-Angiotensin-Aldosterone Receptor Blockers for Hypertension: How Far Have We Come? J Clin Hypertens (Greenwich) 2008; 10:146-52. [PMID: 18256579 DOI: 10.1111/j.1751-7176.2008.07439.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Matthew R Weir
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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3661
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European guidelines on cardiovascular disease prevention in clinical practice: past, present, and future: a need for joint forces. J Hypertens 2008; 26:157-60. [DOI: 10.1097/hjh.0b013e3282f424f9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3662
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Glucometabolic state of in-hospital patients with primary hypertension in sub-population of partial regions in China. J Hum Hypertens 2008; 22:346-51. [DOI: 10.1038/sj.jhh.1002327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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3663
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Abstract
Hypertension is rare in the young, but its prevalence increases with aging. Currently, about 25% of the population has hypertension and this is expected to increase to up to about 29% in 2025. The overall risk of the hypertensive patient depends not only on blood pressure but also on the presence of other cardiovascular risk factors, target organ damage, and associated clinical conditions. The recommendations for preparticipation screening, sports participation, and follow-up depend on the cardiovascular risk profile of the individual athlete. When antihypertensive treatment is required, calcium channel blockers and blockers of the renin-angiotensin system are currently the drugs of choice.
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3664
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Savoia C, Touyz RM, Amiri F, Schiffrin EL. Selective mineralocorticoid receptor blocker eplerenone reduces resistance artery stiffness in hypertensive patients. Hypertension 2008; 51:432-9. [PMID: 18195160 DOI: 10.1161/hypertensionaha.107.103267] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Some antihypertensive agents may improve resistance artery remodeling in hypertensive patients whereas other agents may not, for similar blood pressure reduction. We questioned whether the selective mineralocorticoid receptor blocker eplerenone improves resistance artery remodeling in hypertensive patients versus the beta-blocker atenolol. Sixteen hypertensive patients were randomly assigned to double-blind daily treatment with eplerenone or atenolol. Resistance arteries from gluteal subcutaneous tissue were assessed on a pressurized myograph. After 1 year of treatment, systolic and diastolic blood pressures were similarly well controlled in both groups. Endothelial function did not change with treatment in either group. Media/lumen ratio and cross-sectional area were unchanged in either the atenolol or the eplerenone group. In atenolol-treated patients, the arterial wall became stiffer, whereas in the eplerenone-treated patients, it became less stiff and similar to that of a normotensive control group. The media collagen/elastin ratio was reduced only after eplerenone treatment. Circulating concentrations of osteopontin, monocyte chemoattractant protein-1, basic fibroblast growth factor, interleukin-8, and interleukin-10 were significantly reduced only by eplerenone. However, plasma interleukin-1 receptor a concentration was significantly reduced by both drugs. In conclusion, in hypertensive patients, blood pressure control for 1 year with atenolol was associated with increased wall stiffness of resistance arteries, whereas eplerenone treatment was associated with reduced stiffness, decreased collagen/elastin ratio, and a reduction in circulating inflammatory mediators. These data raise the possibility that eplerenone treatment of hypertensive patients when normalizing blood pressure could potentially be associated with better vascular protection and outcomes than the beta-blocker atenolol, which remains to be demonstrated.
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Affiliation(s)
- Carmine Savoia
- Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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3665
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Schrader J, Bramlage P, Lüders S, Thoenes M, Schirmer A, Paar DW. BP goal achievement in patients with uncontrolled hypertension : results of the treat-to-target post-marketing survey with irbesartan. Clin Drug Investig 2008; 27:783-96. [PMID: 17914897 DOI: 10.2165/00044011-200727110-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Despite the fact that high BP is a leading risk factor for cardiovascular morbidity and mortality, BP goals are achieved in less than 10-30% of hypertensive patients. Irbesartan alone or in combination with hydrochlorothiazide has been shown to control BP in >70% of hypertensive patients in clinical trials. We set out to investigate the role in clinical practice of irbesartan in improving BP in uncontrolled hypertensive patients with a particular focus on patients with the metabolic syndrome through analysis of data from a post-marketing surveillance study. METHODS A multicentre, prospective, post-marketing surveillance study was conducted over 9 months in 14 200 patients aged > or =18 years with previously uncontrolled hypertension (either receiving therapy or newly diagnosed), paying particular attention to a subgroup of patients receiving irbesartan/hydrochlorothiazide as first-line combination therapy. BP was measured by a sphygmomanometer. The main outcome measures were systolic BP (SBP) and diastolic BP (DBP) reduction, response rate (DBP reduction of > or =10mm Hg or to <90 mm Hg), and BP normalisation (SBP <140 and DBP <90 mm Hg) in patients treated with irbesartan alone or in combination with hydrochlorothiazide. Analyses per patient subgroup, previous medication and whether treatment was initiated by the treating physician as first-line combination therapy were conducted. The number and nature of adverse events were documented. RESULTS Use of irbesartan 300 mg/day as monotherapy in previously uncontrolled patients resulted in a significant reduction in SBP/DBP (-26.8/-13.3mm Hg, p < 0.0001), which was comparable to the subgroup of patients with the metabolic syndrome (-26.3/-13.0mm Hg, p < 0.0001 vs baseline). Combination therapy (irbesartan 300 mg/hydrochlorothiazide 12.5mg once daily) lowered BP by -27.9/-14.2mm Hg (p < 0.0001) in previously uncontrolled patients; again the subgroup of patients with the metabolic syndrome achieved a comparable BP reduction (-27.5/-14.1mm Hg, p < 0.0001 vs baseline). Overall, no linear dose-response relationship was observed. Use of irbesartan/hydrochlorothiazide as first-line combination therapy was effective (BP normalisation rates between 65.7% and 78.6%) and safe. The mean number of antihypertensive tablets taken was reduced and after a mean period of 9 months, 92% of patients were still taking irbesartan therapy. CONCLUSION The study demonstrates that treatment with an irbesartan-based regimen for 9 months results in a strong BP reduction and is feasible as first-line combination therapy. Similar BP reductions were observed in the subgroup of patients with the metabolic syndrome. Compliance with treatment is particularly good, with >90% of patients continuing with treatment after 9 months.
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Affiliation(s)
- Joachim Schrader
- Department of Internal Medicine, St Josefs-Hospital, Cloppenburg, Germany.
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3666
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Baguet JP, Legallicier B, Auquier P, Robitail S. Updated meta-analytical approach to the efficacy of antihypertensive drugs in reducing blood pressure. Clin Drug Investig 2008; 27:735-53. [PMID: 17914893 DOI: 10.2165/00044011-200727110-00001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Despite advances in the treatment of hypertension, control rates continue to be suboptimal in both Europe and the US. Strategies that improve hypertension control are therefore urgently needed. This study aimed to assess the relative efficacies of various antihypertensive drugs commonly used in France in reducing systolic and diastolic blood pressure (SBP and DBP) by using a meta-analytical approach. This update of a previously published meta-analytical approach extends the number of drugs evaluated from 13 to 19. METHODS A total of 80 randomised, controlled trials published between 1973 and 2007 involving 10 818 patients were selected for inclusion in the meta-analytical approach. Data were examined for 19 drugs, and 16 drugs were included in the analysis: hydrochlorothiazide, indapamide sustained-release (SR), atenolol, amlodipine, lercanidipine, manidipine, enalapril, ramipril, trandolapril, candesartan cilexetil, irbesartan, losartan, olmesartan medoxomil, telmisartan, valsartan and aliskiren. Weighted average reductions in SBP and DBP over a period of 8-12 weeks were calculated for each drug from information on both the mean and the variability in BP reduction. No trials evaluating furosemide, spironolactone or cicletanine satisfied the inclusion criteria for this analysis. RESULTS The average weighted reductions in SBP over 8-12 weeks were most marked with diuretics, and in particular indapamide SR 1.5 mg/day (mean change from baseline -22.2mm Hg), which reduced SBP to a greater extent than any of the other drugs evaluated (at any dosage considered). Average weighted reductions in DBP were generally similar with all classes of antihypertensives and ranged from -11.4mm Hg with the beta-adrenoceptor blocker atenolol and calcium channel antagonists to -10.3mm Hg with the angiotensin II type 1 receptor antagonists. CONCLUSION This new analysis supports the results of the earlier investigation, in that indapamide SR 1.5 mg/day appeared to be the most effective drug for producing significant reductions in SBP within 8-12 weeks, which is an essential element in optimising cardiovascular prevention among hypertensive patients. The clinical application of these results should take into consideration all the limitations discussed in this analysis.
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Affiliation(s)
- J P Baguet
- Cardiology and Hypertension Unit, Grenoble University Hospital, Grenoble, France.
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3667
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3668
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Weber MA, Wenger NK. Progress in treating hypertension. THE AMERICAN JOURNAL OF GERIATRIC CARDIOLOGY 2008; 17:5-6. [PMID: 18174753 DOI: 10.1111/j.1076-7460.2007.07783.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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3669
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Chrysant SG. Angiotensin II receptor blockers in the treatment of the cardiovascular disease continuum. Clin Ther 2008; 30 Pt 2:2181-90. [DOI: 10.1016/j.clinthera.2008.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2008] [Indexed: 11/16/2022]
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3670
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Gorostidia M, Segura J. Diabetes: nuevas aproximaciones a un problema clásico. HIPERTENSION Y RIESGO VASCULAR 2008. [DOI: 10.1016/s1889-1837(08)71748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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3671
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Gojanovic B, Feihl F, Liaudet L, Waeber B. Review: Concomitant calcium entry blockade and inhibition of the renin-angiotensin system: a rational and effective means for treating hypertension. J Renin Angiotensin Aldosterone Syst 2008; 9:1-9. [DOI: 10.3317/jraas.2008.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Pharmacological treatment of hypertension is effective in preventing cardiovascular and renal complications. Calcium antagonists (CAs) and blockers of the renin-angiotensin system [angiotensin-converting enzyme (ACE) inhibitors and angiotensin II antagonists (ARBs)] are widely used today to initiate antihypertensive treatment but, when given as monotherapy, do not suffice in most patients to normalise blood pressure (BP). Combining a CA and either an ACE-inhibitor or an ARB considerably increases the antihypertensive efficacy, but not at the expense of a deterioration of tolerability. Several fixed-dose combinations are available (CA + ACE-inhibitors: amlodipine + benazepril, felodipine + ramipril, verapamil + trandolapril; CA + ARB: amlodipine + valsartan). They are expected not only to improve BP control, but also to facilitate long-term adherence with ON antihypertensive therapy, thereby providing renal damage caused by high BP. maximal protection against the cardiovascular and renal damage caused by high BP.
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Affiliation(s)
- Boris Gojanovic
- Division of Clinical Pathophysiology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
| | - François Feihl
- Division of Clinical Pathophysiology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
| | - Lucas Liaudet
- Service of Adult Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
| | - Bernard Waeber
- Division of Clinical Pathophysiology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland, Bernard.Waeber @chuv.ch
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3672
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de la Sierra A. The Clinical Significance of Metabolic Syndrome in Hypertension: Metabolic Syndrome Increases Cardiovascular Risk. High Blood Press Cardiovasc Prev 2008; 15:53-7. [DOI: 10.2165/00151642-200815020-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Accepted: 04/23/2008] [Indexed: 01/28/2023] Open
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3673
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Affiliation(s)
- Steven G Chrysant
- University of Oklahoma College of Medicine, Oklahoma Cardiovascular Hypertension Center, Oklahoma City, Oklahoma 73132-4904, USA.
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3674
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McConnell KJ, Denham AM, Olson KL. Pharmacist-Led Interventions for the Management of Cardiovascular Disease. ACTA ACUST UNITED AC 2008. [DOI: 10.2165/00115677-200816030-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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3675
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Affiliation(s)
- Chang Gyu Park
- Division of Cardiology, College of Medicine, Korea University, Seoul, Korea
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3676
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Affiliation(s)
- Josep Redon
- From the Hypertension Clinic (J.R.), Internal Medicine, Hospital Clinico, University of Valencia, Pediatric Department (E.L.), Consorcio Hospital General, University of Valencia, CIBER Fisiopatología Obesidad y Nutrición (CB06/03) (J.R., E.L.), Instituto de Salud Carlos III, Spain
| | - Empar Lurbe
- From the Hypertension Clinic (J.R.), Internal Medicine, Hospital Clinico, University of Valencia, Pediatric Department (E.L.), Consorcio Hospital General, University of Valencia, CIBER Fisiopatología Obesidad y Nutrición (CB06/03) (J.R., E.L.), Instituto de Salud Carlos III, Spain
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3677
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Seki S, Tsurusaki T, Kasai T, Taniguchi I, Mochizuki S, Yoshimura M. Clinical Significance of B-Type Natriuretic Peptide in the Assessment of Untreated Hypertension. Circ J 2008; 72:770-7. [DOI: 10.1253/circj.72.770] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shingo Seki
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Tetsuji Tsurusaki
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Tokuo Kasai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Ikuo Taniguchi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Seibu Mochizuki
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
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3678
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3679
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Abstract
INTRODUCTION Correlations between renal and cardiovascular (CV) pathologies in advanced kidney or heart disease are well characterised, but less clearly defined in the early stages. Microalbuminuria, in addition to being an early sign of kidney damage, is often found in patients with essential hypertension, suggesting that it may reflect early vascular abnormalities. EVIDENCE FROM LITERATURE Studies have shown that even very low levels of microalbuminuria strongly correlate with CV risk: albumin excretion rates as low as 4.8 microg/min, well below the microalbuminuria thresholds stated in current clinical guidelines, are associated with increased risk of CV and cerebrovascular disease, independent of the presence of other risk factors. Increased microalbuminuria indicates endothelial dysfunction or developing atherosclerosis and predicts end-organ damage, major cardio or cerebrovascular events and death. CLINICAL ASPECTS Available tests for screening microalbuminuria are sensitive, reliable and accessible; current European and US guidelines advocate annual screening in patients with diabetes and wherever possible in non-diabetic patients with hypertension. Early identification of high-risk patients through detection of microalbuminuria allows selection of aggressive treatment to slow disease progression. THERAPEUTIC IMPLICATIONS Antihypertensive agents providing angiotensin II blockade are recommended for the treatment of hypertensive patients with microalbuminuria, regardless of diabetes and/or early or overt nephropathy. Treatment with angiotensin II receptor blockers provides effective reduction of microalbuminuria and blood pressure, and long-term prevention of CV events beyond blood pressure reduction. In addition, pharmacoeconomic studies have shown that these long-term benefits translate into a substantially reduced burden on healthcare resources.
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Affiliation(s)
- M Volpe
- Division of Cardiology, II Faculty of Medicine, University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.
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3680
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Vómitos persistentes en mujer hipertensa. HIPERTENSION Y RIESGO VASCULAR 2008. [DOI: 10.1016/s1889-1837(08)71873-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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3681
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Grassi G, Borghi C. Central blood pressure as estimate of cardiovascular risk: potentials and limitations. J Hypertens 2008; 26:16-7. [DOI: 10.1097/hjh.0b013e3282f465e3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3682
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Rahn KH. ACE inhibition after renal transplantation: the effect on persistent left ventricular hypertrophy. NATURE CLINICAL PRACTICE. NEPHROLOGY 2008; 4:22-23. [PMID: 17971798 DOI: 10.1038/ncpneph0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 10/01/2007] [Indexed: 05/25/2023]
Affiliation(s)
- Karl H Rahn
- Medizinischen Klinik und Poliklinik D, Albert-Schweitzer-Strasse 33, Münster, 48149Germany.
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3683
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Relationship between the metabolic syndrome and the development of hypertension in the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS2). Am J Hypertens 2008; 21:17-22. [PMID: 18091739 DOI: 10.1038/ajh.2007.19] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The metabolic syndrome is a predictor of diabetes and coronary events. We hypothesized that it also predicts hypertension. METHODS A total of 1,944 subjects (901 men and 1,043 women; age 46 +/- 12 years) from the Hong Kong Cardiovascular Risk Factor Prevalence Survey were recruited in 1995-1996 and restudied in 2000-2004. The prevalence of hypertension and factors predicting its development were determined. RESULTS In 2000-2004, hypertension was found in 23.2% of the men and 17.2% of the women. Of the 1,602 subjects who were normotensive at baseline, 258 subjects developed hypertension after a median interval of 6.4 years. According to the National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria, the hazard ratios associated with the metabolic syndrome were 1.89 (95% confidence interval (CI): 1.41-2.54) and 1.72 (95% CI: 1.24-2.39), respectively. The positive and negative predictive values of the metabolic syndrome for identifying subjects who will develop hypertension in this population were 34.7 and 85.4% (NCEP criteria), and 33.1 and 85.5% (IDF criteria), respectively. The development of hypertension was related to the number of components of the metabolic syndrome (other than raised blood pressure), present in men (P = 0.003) and in women (P = 0.001). Using multivariate analysis, age, baseline systolic blood pressure (SBP), body mass index (BMI), and the triglycerides/high-density lipoprotein (HDL) ratio were found to be significant predictors of the development of hypertension. Compared with optimal blood pressure, the hazards of developing hypertension associated with normal or high-normal blood pressure were 2.31 (95% CI: 1.68-3.17) and 3.48 (95% CI: 2.52-4.81), respectively. CONCLUSIONS Blood pressure, when not optimal, is the predominant predictor of hypertension. The metabolic syndrome contributes to the risk, especially when blood pressure is optimal.
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3684
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Mancia G. Dihydropiridinic Calcium-Channel Antagonists in the 2007 ESH/ESC Hypertension Guidelines. High Blood Press Cardiovasc Prev 2008; 15:85-90. [DOI: 10.2165/00151642-200815020-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 06/05/2008] [Indexed: 11/02/2022] Open
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3685
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Snider ME, Nuzum DS, Veverka A. Long-acting nifedipine in the management of the hypertensive patient. Vasc Health Risk Manag 2008; 4:1249-57. [PMID: 19337538 PMCID: PMC2663456 DOI: 10.2147/vhrm.s3661] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Hypertension is a global condition affecting billions worldwide. It is a significant contributor to cardiovascular events, cardiac death and kidney disease. A number of medication classes exist to aid healthcare providers and their patients in controlling hypertension. Nifedipine, a dihydropyridine calcium channel blocker, was once one of the most widely used medications for hypertension, but safety and tolerability concerns along with the introduction of new classes of antihypertensive medications and an increasing pool of data showing mortality benefit of other classes caused nifedipine to fall out of favor. More recently, long-acting formulations were developed and made available to clinicians. These newer formulations were designed to address many of the concerns raised by earlier formulations of nifedipine. Numerous clinical trials have been conducted comparing long-acting nifedipine to many of the more commonly prescribed antihypertensive medications. This review will address the pharmacology, pharmacokinetics and the available clinical trial data on long-acting nifedipine and summarize its role in the management of hypertension.
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Affiliation(s)
- Morgan E Snider
- Virginia Commonwealth University Health Systems Richmond, VA USA
| | | | - Angie Veverka
- Wingate University School of Pharmacy Wingate, NC USA
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3686
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Handler J. The Newly Identified Hypertensive Patient: Cost-Effective Laboratory Investigation. J Clin Hypertens (Greenwich) 2008; 10:77-80. [DOI: 10.1111/j.1524-6175.2007.07655.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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3687
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Marín R, Gorostidi M, Baltar J. Prevención de la preeclampsia con Aspirina®. HIPERTENSION Y RIESGO VASCULAR 2008. [DOI: 10.1016/s1889-1837(08)71735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3688
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Elliott W. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0145-4145(08)05031-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3689
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Affiliation(s)
- Roland E. Schmieder
- From the Department of Nephrology and Hypertension, University Hospital, Erlangen, Germany
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3690
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Van Bortel LM, Fici F, Mascagni F. Efficacy and tolerability of nebivolol compared with other antihypertensive drugs: a meta-analysis. Am J Cardiovasc Drugs 2008; 8:35-44. [PMID: 18303936 DOI: 10.2165/00129784-200808010-00005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Lowering BP to normal levels without quality of life deterioration is the most important means of reducing cardiovascular risk. Recent studies have challenged the position of beta-adrenoceptor antagonists (beta-blockers) as first-line antihypertensive drugs. Nebivolol is a third-generation, highly selective beta(1)-blocker that causes vasodilation through nitric oxide (NO) release. This meta-analysis investigates the efficacy and tolerability of nebivolol compared with other antihypertensive drugs and placebo in patients with hypertension. METHODS Twelve randomized controlled studies were included in which nebivolol 5 mg once daily was compared with the recommended clinical doses of other antihypertensive drugs (n = 9), placebo (n = 2), and both (n = 1). The clinical studies were selected after a MEDLINE search up to 2007 using the key words 'nebivolol' and 'hypertension.' RESULTS Antihypertensive response rates (the percentage of patients achieving target BP levels or a defined DBP reduction) were higher with nebivolol than with ACE inhibitors (odds ratio [OR] 1.92; p = 0.001) and all antihypertensive drugs combined (OR 1.41; p = 0.001) and similar to beta-blockers, calcium channel antagonists (CCAs) and the angiotensin receptor antagonist (ARA) losartan. Moreover, a higher percentage of patients receiving nebivolol achieved target BP levels compared with patients treated with losartan (OR 1.98; p = 0.004), CCAs (OR 1.44; p = 0.024), and all antihypertensive drugs combined (OR 1.35; p = 0.012). The percentage of patients experiencing adverse events did not differ between nebivolol and placebo; adverse event rates were significantly lower with nebivolol than losartan (OR 0.52; p = 0.016), other beta-blockers (OR 0.56; p = 0.007), nifedipine (OR 0.49; p < 0.001), and all antihypertensive drugs combined (OR 0.59; p < 0.001). CONCLUSION Results of previous pharmacokinetic studies suggest that nebivolol 5 mg may not conform completely to the definition of a classic beta-blocker demonstrating additional antihypertensive effect due to endothelial NO release-mediated vasodilation. This meta-analysis showed that nebivolol 5 mg achieved similar or better rates of treatment response and BP normalization than other drug classes and other antihypertensive drugs combined, with similar tolerability to placebo and significantly better tolerability than losartan, CCAs, other beta-blockers, and all antihypertensive drugs combined. Although not definitive, this meta-analysis suggests that nebivolol 5 mg is likely to have advantages over existing antihypertensives and may have a role in the first-line treatment of hypertension.
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Affiliation(s)
- Luc M Van Bortel
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
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3691
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Comparación entre la actuación hospitalaria y la de Atención Primaria ante las crisis hipertensivas. HIPERTENSION Y RIESGO VASCULAR 2008. [DOI: 10.1016/s1889-1837(08)71754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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3692
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Gómez Marcos M, García Ortiz L, Sánchez Rodríguez Á, Parra Sánchez J, García García Á, González Elena L. Control de la presión arterial, concordancias y discrepancias entre diferentes métodos de medida utilizados. HIPERTENSION Y RIESGO VASCULAR 2008. [DOI: 10.1016/s1889-1837(08)71774-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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3693
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Guías de práctica clínica sobre prevención de la enfermedad cardiovascular: versión resumida. Rev Esp Cardiol 2008. [DOI: 10.1157/13114961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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3694
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Sarzani R. The Clinical Significance of Metabolic Syndrome in Hypertension: Metabolic Syndrome Increases Cardiovascular Risk. High Blood Press Cardiovasc Prev 2008; 15:59-62. [DOI: 10.2165/00151642-200815020-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 06/10/2008] [Indexed: 11/02/2022] Open
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3695
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Ruilope LM. The Clinical Significance of Blood Pressure Lowering Treatment: First-Line Drug Choice is Important. High Blood Press Cardiovasc Prev 2008. [DOI: 10.2165/0151642-200815030-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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3696
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de la Sierra A. Aplicaciones del estudio ONTARGET a la práctica clínica. HIPERTENSION Y RIESGO VASCULAR 2008. [DOI: 10.1016/s1889-1837(08)71868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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3697
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Fiedler GM. [Arterial hypertension--what's new?]. PHARMAZIE IN UNSERER ZEIT 2008; 37:296-304. [PMID: 18570284 DOI: 10.1002/pauz.200700272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Georg Martin Fiedler
- Leitender Oberarzt, Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Liebigstrasse 27, 04103 Leipzig, Germany.
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3698
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Kiyomoto H, Rafiq K, Mostofa M, Nishiyama A. Possible Underlying Mechanisms Responsible for Aldosterone and Mineralocorticoid Receptor–Dependent Renal Injury. J Pharmacol Sci 2008; 108:399-405. [DOI: 10.1254/jphs.08r02cr] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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3699
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Affiliation(s)
- Moo-Yong Rhee
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong Bae Park
- 3Department of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
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3700
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Pimenta E, Oparil S. Fixed combinations in the management of hypertension: patient perspectives and rationale for development and utility of the olmesartan-amlodipine combination. Vasc Health Risk Manag 2008; 4:653-64. [PMID: 18827915 PMCID: PMC2515425 DOI: 10.2147/vhrm.s2586] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Although the awareness and control of hypertension has increased, only 37% of hypertensive patients in the US achieve the conservative goal of <140/90 mmHg. Achieving optimal blood pressure (BP) control is the most important single issue in the management of hypertension, and in most hypertensive patients, it is difficult or impossible to control BP with one drug. Blocking two or more BP regulatory systems provides a more effective and more physiologic reduction in BP, and current guidelines have recommended the use of combination therapy as first-line treatment, or early in the management of hypertension. Fixed combination therapy is an efficacious, relatively safe, and may be cost-effective method of decreasing BP in most patients with essential hypertension. Similar to other combinations, fixed-dose combination tablets containing the dihydropyridine calcium channel blocker amlodipine and the angiotensin II receptor blocker olmesartan bring together two distinct and complementary mechanisms of action, resulting in improved BP control and potential for improved target organ protection relative to either class of agent alone.
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Affiliation(s)
- Eduardo Pimenta
- Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, Sao Paulo, SP, Brazil.
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