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Bakris GL, Yang YF, McCabe JM, Liu JR, Tan XJ, Benn VJ, Pitt B. Efficacy and Safety of Ocedurenone: Subgroup Analysis of the BLOCK-CKD Study. Am J Hypertens 2023; 36:612-618. [PMID: 37471468 PMCID: PMC10570658 DOI: 10.1093/ajh/hpad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Ocedurenone (KBP-5074), a nonsteroidal mineralocorticoid receptor antagonist, is documented to lower blood pressure in patients with stage 3b/4 chronic kidney disease (CKD) with uncontrolled or resistant hypertension (BLOCK-CKD study). However, the efficacy and safety of Ocedurenone in subgroups such as Hispanic patients or those with stage 4 CKD, diabetes, or very high albuminuria have not been reported. METHODS A total of 162 patients were enrolled in the BLOCK-CKD study. The primary endpoint of these analyses was change in systolic blood pressure (SBP) from baseline to day 84. Prespecified subgroup analysis of SBP focused on demographic (e.g., ethnicity, age) and medical (e.g., CKD stage, diabetes, albuminuria, baseline estimated glomerular filtration rate [eGFR]). The safety analysis focused on changes in serum potassium levels from baseline. RESULTS SBP reductions were consistent across subgroups compared with the overall study cohort. Placebo-adjusted SBP reductions were observed in Hispanic patients (-8.1 and -9.9 mm Hg for 0.25 and 0.5 mg, respectively, total n = 35) and patients with CKD stage 4 (-9.3 and -10.4 mm Hg for 0.25 and 0.5 mg, respectively, total n = 64), diabetes (-6.9 and -11.6 mm Hg for 0.25 and 0.5 mg, respectively, total n = 51), and very high albuminuria (-13.1 and -12.3 mm Hg for 0.25 and 0.5 mg, respectively, total n = 85). Changes in serum potassium were similar across all patient subgroups regardless of baseline eGFR, diabetes status, or degree of proteinuria. No cases of hyperkalemia required intervention or resulted in study discontinuation. CONCLUSIONS Ocedurenone consistently reduced in SBP in all patient subgroups. Moreover, while small elevations in serum potassium occurred, they were not associated with Ocedurenone or study discontinuation.
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Affiliation(s)
- George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Y Fred Yang
- Chief Development Officer, KBP BioSciences USA Inc., Princeton, New Jersey, USA
| | - James M McCabe
- Chief Development Officer, KBP BioSciences USA Inc., Princeton, New Jersey, USA
| | - Jin Rong Liu
- Chief Development Officer, KBP BioSciences USA Inc., Princeton, New Jersey, USA
| | - Xiaojuan J Tan
- Chief Development Officer, KBP BioSciences USA Inc., Princeton, New Jersey, USA
| | - Vincent J Benn
- Chief Development Officer, KBP BioSciences USA Inc., Princeton, New Jersey, USA
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
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Brant LCC, Passaglia LG, Pinto-Filho MM, de Castilho FM, Ribeiro ALP, Nascimento BR. The Burden of Resistant Hypertension Across the World. Curr Hypertens Rep 2022; 24:55-66. [PMID: 35118612 DOI: 10.1007/s11906-022-01173-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Resistant hypertension (R-HTN) is related to worse cardiovascular, renal outcomes, and death compared to non R-HTN. We aimed to review the burden of R-HTN across the world, focusing on its prevalence, associated factors and outcomes, and the impact of treatment. RECENT FINDINGS R-HTN prevalence among hypertensive individuals varies around 10-20%, depending on the population and definition applied. R-HTN consistently relates to older age, chronic kidney disease, obesity, and obstructive sleep apnea - which are increasing in prevalence with global population aging. As such, R-HTN prevalence is also expected to rise. Infrequent use of ambulatory blood pressure monitoring to identify at higher risk individuals and poor adherence to treatment are still barriers in the approach of R-HTN. Available evidence suggests that 10-20% of patients with hypertension have R-HTN. However, the prevalence of true R-HTN using contemporaneous standardized definitions is still unknown. Novel strategies to address clinicians, patients and health system barriers to treatment inertia and adherence are fundamental to reduce the burden of R-HTN.
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Affiliation(s)
- Luisa Campos Caldeira Brant
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil.
| | - Luiz Guilherme Passaglia
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Marcelo Martins Pinto-Filho
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Fabio Morato de Castilho
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Bruno Ramos Nascimento
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil. .,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil.
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Ribó-Coll M, Lassale C, Sacanella E, Ros E, Toledo E, Sorlí JV, Babio N, Lapetra J, Gómez-Gracia E, Alonso-Gómez ÁM, Fiol M, Serra-Majem L, Pinto X, Castañer O, Díez-Espino J, González JI, Becerra-Tomás N, Cofán M, Díaz-López A, Estruch R, Hernáez Á. Mediterranean diet and antihypertensive drug use: a randomized controlled trial. J Hypertens 2021; 39:1230-1237. [PMID: 33496530 DOI: 10.1097/hjh.0000000000002765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine in older individuals at high cardiovascular risk whether following a Mediterranean diet decreased the necessity of antihypertensive drugs and modulated their associated cardiovascular risk. METHODS In the PREvención con DIeta MEDiterránea study, we assessed whether volunteers randomly allocated to an intervention with a Mediterranean diet enriched with extra-virgin olive oil or nuts (relative to a low-fat control diet) disclosed differences in the risk of: initiating antihypertensive medication in nonusers at baseline (n = 2188); and escalating therapy in participants using one, two, or three drugs at baseline (n = 2361, n = 1579, and n = 554, respectively). We also assessed whether allocation to Mediterranean diet modified the association between antihypertensive drug use and incident cardiovascular events. RESULTS Participants allocated to Mediterranean diet interventions were associated with lower risk of initiating antihypertensive therapy [5-year incidence rates: 47.1% in the control diet, 43.0% in MedDiets; hazard ratio = 0.84, 95% CI (0.74--0.97), in a model adjusted for age, sex, and recruitment site]. Volunteers using two drugs at baseline in the Mediterranean diet intervention enriched with extra-virgin olive oil decreased their risk of therapy escalation [5-year incidence rates: 22.9% in the control diet, 20.1% in the MedDiet; hazard ratio = 0.77, 95% CI (0.60--0.99)]. Allocation to Mediterranean diet interventions attenuated the association between antihypertensive therapy at baseline and incidence of major adverse cardiovascular events (P interaction = 0.003). CONCLUSION In an older population at high cardiovascular risk, following a Mediterranean diet reduced the risk of initiating or escalating antihypertensive medication and attenuated cardiovascular risk in antihypertensive drug users.
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Affiliation(s)
- Margarita Ribó-Coll
- Cardiovascular Risk, Nutrition, and Aging Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
- PhD program in Food Science and Nutrition, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona
| | - Camille Lassale
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM)
| | - Emilio Sacanella
- Cardiovascular Risk, Nutrition, and Aging Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Internal Medicine Service, Hospital Clínic
| | - Emilio Ros
- Cardiovascular Risk, Nutrition, and Aging Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clínic, Barcelona
| | - Estefanía Toledo
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona
| | - José V Sorlí
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Department of Preventive Medicine and Public Health, Universidad de Valencia, Valencia
| | - Nancy Babio
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Unitat de Nutrició Humana, Departament de Bioquimica i Biotecnologia, Universitat Rovira i Virgili
- Institut d'Investigació Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Reus
| | - José Lapetra
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla
| | - Enrique Gómez-Gracia
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Department of Preventive Medicine and Public Health, Universidad de Málaga, Málaga
| | - Ángel M Alonso-Gómez
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz
| | - Miquel Fiol
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Health Research Institute of the Balearic Islands (IdISBa). Hospital Son Espases. Palma de Mallorca
| | - Lluis Serra-Majem
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Instituto de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria
- Centro Hospitalario Universitario Insular Materno Infantil, Servicio Canario de Salud, Las Palmas
| | - Xavier Pinto
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat
| | - Olga Castañer
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM)
| | - Javier Díez-Espino
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona
- Centro de Salud de Tafalla, Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Tafalla
- Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona
| | - José I González
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Department of Preventive Medicine and Public Health, Universidad de Valencia, Valencia
| | - Nerea Becerra-Tomás
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Department of Preventive Medicine and Public Health, Universidad de Valencia, Valencia
- Unitat de Nutrició Humana, Departament de Bioquimica i Biotecnologia, Universitat Rovira i Virgili
- Institut d'Investigació Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Reus
| | - Montserrat Cofán
- Cardiovascular Risk, Nutrition, and Aging Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clínic, Barcelona
| | - Andrés Díaz-López
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Unitat de Nutrició Humana, Departament de Bioquimica i Biotecnologia, Universitat Rovira i Virgili
- Institut d'Investigació Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Reus
| | - Ramón Estruch
- Cardiovascular Risk, Nutrition, and Aging Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Internal Medicine Service, Hospital Clínic
| | - Álvaro Hernáez
- Cardiovascular Risk, Nutrition, and Aging Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid
- Blanquerna School of Health Sciences, Universitat Ramon Llull, Barcelona, Spain
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Agarwal R, Rossignol P, Budden J, Mayo MR, Arthur S, Williams B, White WB. Patiromer and Spironolactone in Resistant Hypertension and Advanced CKD: Analysis of the Randomized AMBER Trial. KIDNEY360 2021; 2:425-434. [PMID: 35369022 PMCID: PMC8785994 DOI: 10.34067/kid.0006782020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/14/2021] [Indexed: 02/04/2023]
Abstract
Background Mineralocorticoid receptor antagonists reduce mortality in patients with heart failure with reduced ejection fraction and have become a standard of care in those with resistant hypertension (rHTN). Yet, their use is limited among patients with CKD, primarily due to hyperkalemia. Methods AMBER was a multicenter, randomized, double-blind, placebo-controlled, parallel-group study that reported that the use of the potassium-binding drug patiromer allowed a more persistent use of spironolactone in patients with CKD and rHTN. In this report, we compare the safety and efficacy of patiromer in advanced CKD as a prespecified analysis. Results Of the 295 patients randomized, 66 fell into the eGFR 25 to <30 subgroup. In this subgroup, persistent use of spironolactone was seen in 19 of 34 (56%) in the placebo group and 27 of 32 (84%) in the patiromer group (absolute difference 29%; P<0.02). In the eGFR 30-45 subgroup, persistent use of spironolactone was seen in 79 of 114 (69%) in the placebo group and 99 of 115 (86%) in the patiromer group (absolute difference 17%; P=0.003). There was no significant interaction between eGFR subgroups (P=0.46). Systolic BP reduction with spironolactone in the eGFR 25 to <30 subgroup was 6-7 mm Hg; in the eGFR 30-45 subgroup, it was 12-13 mm Hg. There was no significant interaction between eGFR subgroups on BP reduction (P=0.79). Similar proportions of patients reported adverse events (59% in the eGFR 25 to <30 subgroup; 53% in the eGFR 30-45 subgroup). Conclusions Patiromer facilitates the use of spironolactone among patients with rHTN, and its efficacy and safety are comparable in those with eGFR 25 to <30 and 30-45 ml/min per 1.73 m2. Clinical Trial registry name and registration number Clinicaltrials.gov, NCT03071263.
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Affiliation(s)
- Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Patrick Rossignol
- University of Lorraine, Inserm 1433 CIC-P CHRU de Nancy, Inserm U1116 and FCRIN INI-CRCT, Nancy, France
| | - Jeffrey Budden
- Medical Affairs, Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, California
| | - Martha R. Mayo
- Biostatistics, Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, California
| | - Susan Arthur
- Clinical Development, Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, California
| | - Bryan Williams
- Department of Medicine, Institute of Cardiovascular Sciences University College London and National Institute for Health Research University College London/University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - William B. White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut
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