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Rodgers A, Salam A, Cushman W, de Silva A, Di Tanna GL, Gnanenthiran SR, Grobbee D, Narkiewicz K, Ojji D, Oparil S, Poulter N, Schlaich MP, Schutte AE, Spiering W, Williams B, Wright JT, Whelton P. Rationale for a New Low-Dose Triple Single Pill Combination for the Treatment of Hypertension. Glob Heart 2024; 19:18. [PMID: 38371656 PMCID: PMC10870947 DOI: 10.5334/gh.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/04/2023] [Indexed: 02/20/2024] Open
Abstract
Two recent large trials showed the potential of single pill combinations (SPCs) with ≥3 low-dose components among people with hypertension who were untreated or receiving monotherapy. In both trials, these 'hypertension polypills' were superior to usual care, achieving >80% BP control without increasing withdrawal due to side effects. However, there are no such products available for prescribers. To address this unmet need, George Medicines developed GMRx2 with telmisartan/amlodipine/indapamide in three strengths (mg): 10/1.25/0.625, 20/2.5/1.25; 40/5/2.5. Two pivotal trials are ongoing to support FDA submission for the treatment of hypertension, including initial treatment. These assess efficacy and safety of GMRx2 compared to: placebo, and each of the three possible dual combinations. Regulatory submissions are planned for 2024, with the aim of providing access to GMRx2 in developed and developing regions. Wider implementation of GMRx2-based treatment strategies will be guided by further research to inform access and appropriate scale up.
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Affiliation(s)
- Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Australia
| | - Abdul Salam
- The George Institute for Global Health, University of New South Wales, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, India
| | | | | | - Gian Luca Di Tanna
- University of Applied Sciences and Arts of Southern Switzerland, Switzerland
| | | | - Diederick Grobbee
- University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | | | | | | | | | - Aletta E. Schutte
- The George Institute for Global Health, University of New South Wales, Australia
| | - Wilko Spiering
- University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | - Jackson T. Wright
- University Hospitals Cleveland Medical Center, Case Western Reserve University, USA
| | - Paul Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
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Green K, Hough A. Thiazide Diuretic Utilization Within the VA. Fed Pract 2023; 40:S6-S11. [PMID: 38812589 PMCID: PMC11132188 DOI: 10.12788/fp.0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Background The 2017 American College of Cardiology/American Heart Association blood pressure guideline recommends chlorthalidone as the preferred thiazide diuretic. We aimed to better understand thiazide prescribing patterns within the US Department of Veterans Affairs (VA). Methods A retrospective analysis was conducted of patients with a prescription for hydrochlorothiazide (HCTZ), chlorthalidone, indapamide, or any combination products containing these from January 1, 2016, to January 21, 2022. The primary objective was to determine the utilization rates of each thiazide in the active cohort, assessed via χ2 test with Bonferroni correction. Secondary objectives included concomitant potassium or magnesium supplementation, blood pressure rates and control, and thiazide use from January 1, 2016, to December 31, 2021. Results Of 628,994 active thiazide prescriptions, utilization rates differed significantly between thiazide groups (P < .001). Rates for HCTZ, chlorthalidone, and indapamide were 84.6%, 14.9%, and 0.5%, respectively. HCTZ use decreased from 90.2% to 83.5% (P < .001) and chlorthalidone use increased from 9.3% to 16.0% (P < .001). Between thiazide groups, rates of blood pressure control were not significantly different (P = .58). Potassium or magnesium supplementation was significantly different between groups (P < .001). The highest concomitant supplementation was with indapamide followed by chlorthalidone and HCTZ with rates of 27.1%, 22.6%, and 12.4%, respectively. Conclusions Despite guideline recommendations for chlorthalidone, HCTZ is the most prescribed thiazide diuretic within the VA. However, there was a significant trend toward increased chlorthalidone prescribing from 2016 to 2021. Application of these data may guide further research to increase guideline-recommended therapy.
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Affiliation(s)
- Kiana Green
- West Palm Beach Veterans Affairs Healthcare System, Florida
| | - Augustus Hough
- West Palm Beach Veterans Affairs Healthcare System, Florida
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Leung G, Grant A, Garas AN, Li G, Freeman EE. A Systematic Review and Meta-analysis of Systemic Antihypertensive Medications With Intraocular Pressure and Glaucoma. Am J Ophthalmol 2023; 255:7-17. [PMID: 36966883 DOI: 10.1016/j.ajo.2023.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/23/2023] [Accepted: 03/14/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE We synthesized the literature on the association between systemic antihypertensive medications with intraocular pressure (IOP) and glaucoma. Antihypertensive medications included β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. DESIGN Systematic review and meta-analysis. METHODS Databases were searched for relevant articles until December 5, 2022. Studies were eligible if they examined (1) the association between systemic antihypertensive medications with glaucoma or (2) the association between systemic antihypertensive medications with IOP in those without glaucoma or ocular hypertension. The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews; registration ID: CRD42022352028). RESULTS A total of 11 studies were included in the review and 10 studies in the meta-analysis. The 3 studies on IOP were cross-sectional, whereas the 8 studies on glaucoma were primarily longitudinal. In the meta-analysis, β-blockers were associated with a lower odds of glaucoma (odds ratio: 0.83, 95% CI: 0.75-0.92, 7 studies, n = 219,535) and lower IOP (β: -0.53, 95% CI: -1.05 to -0.02, 3 studies, n = 28,683). Calcium channel blockers were associated with a higher odds of glaucoma (odds ratio: 1.13, 95% CI: 1.03-1.24, 7 studies, n = 219,535) but not with IOP (β: -0.11, 95% CI: -0.25 to 0.03, 2 studies, n = 20,620). There were no consistent associations between angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or diuretics with glaucoma or IOP. CONCLUSIONS Systemic antihypertensive medications have heterogeneous effects on glaucoma and IOP. Clinicians should be aware that systemic antihypertensive medications may mask elevated IOP or positively or negatively affect the risk of glaucoma.
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Affiliation(s)
- Gareth Leung
- From the School of Epidemiology and Public Health, University of Ottawa, Ottawa (G. Leung, A.G., E.E.F.), Ontario, Canada
| | - Alyssa Grant
- From the School of Epidemiology and Public Health, University of Ottawa, Ottawa (G. Leung, A.G., E.E.F.), Ontario, Canada
| | - Andrew N Garas
- Faculty of Health Sciences, McMaster University, Hamilton (A.N.G.), Ontario, Canada
| | - Gisele Li
- Maisonneuve-Rosemont Hospital, Montréal, Québec (G. Li), Canada
| | - Ellen E Freeman
- From the School of Epidemiology and Public Health, University of Ottawa, Ottawa (G. Leung, A.G., E.E.F.), Ontario, Canada; Ottawa Hospital Research Institute (E.E.F.), Ottawa, Ontario, Canada; Bruyere Research Institute (E.E.F.), Ottawa, Ontario, Canada.
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Kumar L, Khuwaja S, Kumar A, Memon UA, Kumar M, Ashok A, Lohana M, Qudoos A, Kashif M, Khatri M, Kumar S, Sapna F, Dass A, Varrassi G. Exploring the Effectiveness and Safety of Azilsartan-Medoxomil/Chlorthalidone Versus Olmesartan-Medoxomil/Hydrochlorothiazide in Hypertensive Patients: A Meta-Analysis. Cureus 2023; 15:e41198. [PMID: 37525792 PMCID: PMC10387287 DOI: 10.7759/cureus.41198] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
This study aims to assess the effectiveness and safety of azilsartan-medoxomil/chlorthalidone (AZI-M/CT) compared to olmesartan-medoxomil/hydrochlorothiazide (OLM/HCTZ) in patients with hypertension. Systematic searches were conducted on PubMed, Google Scholar, and ClinicalTrials.gov, starting from their establishment until March 15, 2023. The purpose of these searches was to locate original reports that compare the effectiveness of AZI-M/CT and OLM/HCTZ in treating hypertension. Data on various characteristics at the beginning and end of the studies were gathered. The analyses were carried out using Review Manager 5.4.1 (The Nordic Cochrane Center, The Cochrane Collaboration, 2014, Odense, Denmark) and STATA 16.0 software (Stata Corp. LP, College Station, TX, USA). Risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated as part of the study. A total of 3,146 individuals from four separate investigations were included in the study, with 1,931 individuals receiving AZI-M/CT and 1,215 individuals receiving OLM/HCTZ. The combined analysis revealed that the average diastolic blood pressure (DBP) was significantly lower in the AZI-M/CT group compared to the OLM/HCTZ group (WMD -2.64 [-2.78, -2.51]; P = 0.00001; I2 = 1%). However, there were no significant differences in mean systolic blood pressure (SBP; WMD -2.95 [-6.64, 0.73]; P = 0). Furthermore, the AZI-M/CT group had a notably higher incidence of major adverse events (RR 1.58 [1.20, 2.08]; P = 0.001; I2 = 11%) and any treatment-emergent adverse events (RR 1.11 [1.03, 1.20]; P = 0.007; I2 = 51%). However, there was no significant difference in the mortality risk between the two groups (RR 0.74 [0.14, 3.91]; P = 0.72; I2 = 0%). Based on the results of our meta-analysis, AZI-M/CT is more effective than OLM/HCTZ at reducing blood pressure in elderly hypertensive patients. However, because of the small sample size, favorable results must be carefully reevaluated, and more studies are needed.
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Affiliation(s)
- Lakshya Kumar
- General Medicine, Pandit Dindayal Upadhyay (PDU) Medical College, Rajkot, IND
| | - Sundal Khuwaja
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Aanand Kumar
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Unaib Ahmed Memon
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Munesh Kumar
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Arpana Ashok
- Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Manisha Lohana
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Ahmed Qudoos
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Maham Kashif
- Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Fnu Sapna
- Internal Medicine, Detroit Medical Center, Detroit, USA
| | - Arjan Dass
- Internal Medicine, Willis-Knighton Health System, Shreveport, USA
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Jo W, Koh ES, Chung S. Therapeutic roles of thiazides and loop diuretics in blood pressure control and renal protection against chronic kidney disease. Clin Hypertens 2023; 29:14. [PMID: 37183259 PMCID: PMC10184374 DOI: 10.1186/s40885-023-00238-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/17/2023] [Indexed: 05/16/2023] Open
Abstract
Fluid overload secondary to loss of functional nephron mass can elevate blood pressure, which is characteristic of hypertension shown in chronic kidney disease (CKD). Therefore, it is logical to use diuretics at appropriate dose to lower blood pressure in patients with CKD and hypertension. Despite the theoretical background on the use of diuretics in CKD, there have been no definitive data on the effectiveness or safety of diuretics as first-line therapy for the management of hypertension in patients with CKD. Results from some clinical trials have demonstrated that diuretics would not lower blood pressure. They could even worsen electrolyte imbalance and kidney function when they are administered in patients with CKD. Major clinical practice guidelines on management of blood pressure or CKD have stated that evidence for benefits of thiazide diuretics is not conclusive yet in patients with advanced CKD, although loop diuretics are often effective for volume control at lower glomerular filtration rate. Recently, evidence for diuretics as effective blood pressure lowering agents in patients with advanced CKD is increasing. Renoprotective effect of thiazide or loop diuretics might represent a consequence of their influence on blood pressure or their ability to potentiate the effect of renin-angiotensin system blockade by making intraglomerular pressure more renin-angiotensin system-dependent, although their direct benefit on renal function remains controversial. This review summarizes recent data on the possible role of diuretics in lowering blood pressure, slowing the progression of kidney disease, and reducing cardiovascular risk in CKD patients.
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Affiliation(s)
- Wonji Jo
- Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Sil Koh
- Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungjin Chung
- Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Chalmers J, Mourad JJ, Brzozowska-Villatte R, De Champvallins M, Mancia G. Benefit of treatment based on indapamide mostly combined with perindopril on mortality and cardiovascular outcomes: a pooled analysis of four trials. J Hypertens 2023; 41:508-515. [PMID: 36633311 PMCID: PMC9894155 DOI: 10.1097/hjh.0000000000003368] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to assess the reduction in all-cause death and cardiovascular outcomes associated with the administration of the thiazide-like diuretic indapamide monotherapy or in combination with perindopril as a blood pressure lowering drug in randomized controlled trials (RCTs). METHOD Aggregate data from four published RCTs conducted versus matching placebo were pooled: PATS, a 2-year study (indapamide), and PROGRESS, a 4-year study (indapamide and perindopril), both in patients with a history of stroke or transient ischemic attack; ADVANCE, a 4-year study in patients with type 2 diabetes and cardiovascular risk factor (single-pill combination perindopril/indapamide) and HYVET, a 2-year study in very elderly hypertensive individuals (indapamide and an option of perindopril). The pooled effect (fixed and random) estimate (hazard ratio) was reported with corresponding 95% confidence intervals and P values. Treatment discontinuations were also analysed to assess the net benefit of the treatment. RESULTS The population involved 24 194 patients (active: 12 113, placebo: 12 081). The fixed-effects meta-analysis of the three mortality endpoints found low statistical heterogeneity ( I2 = 0). Statistically significant risk reductions in the indapamide with or without perindopril-treated patients as compared to placebo were observed for all-cause death (-15%), cardiovascular death (-21%), fatal stroke (-36%) and all strokes (-27%). Other cardiovascular outcomes were improved (risk reduction, 22 to 36%). As expected, discontinuation rates for safety (two studies) were higher in the active group (6.4 vs. 3.9%), while they were similar when discontinuation for any reason is concerned (18.4 vs. 18.0%). CONCLUSION Across medium to high cardiovascular risk population, long-term indapamide, mostly combined with perindopril-based treatment, provided evidence of benefit on mortality and morbidity.
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Affiliation(s)
- John Chalmers
- The George Institute for Global Health, University of NSW, Sydney, New South Wales, Australia
| | - Jean-Jacques Mourad
- Department of Internal Medicine and ESH Excellence Center, Hôpital Saint-Joseph, Paris
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Pham NYT, Owen JG, Singh N, Shaffi SK. The Use of Thiazide Diuretics for the Treatment of Hypertension in Patients With Advanced Chronic Kidney Disease. Cardiol Rev 2023; 31:99-107. [PMID: 34224450 DOI: 10.1097/crd.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The use of thiazide diuretics for the treatment of hypertension in patients with advance chronic kidney disease. Thiazides have been recommended as the first-line for the treatment of hypertension, yet their use has been discouraged in advanced chronic kidney disease (CKD), as they are suggested to be ineffective in advanced CKD. Recent data suggest that thiazide diuretics may be beneficial blood pressure control in addition to natriuresis in existing CKD. This review discusses the commercially available thiazides with a focus on thiazide pharmacology, most common adverse effects, clinical uses of thiazide diuretic, and the evidence for efficacy of thiazide use in advanced CKD.
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Affiliation(s)
- Ngoc-Yen T Pham
- From the University of New Mexico Hospitals, Albuquerque, NM
| | - Jonathan G Owen
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Namita Singh
- University of New Mexico Health Sciences Center, Albuquerque, NM
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Patil T, Halsey E, Kaur A, Minchak J, Hobson J, Eppes D. CHAnges in Diuretic Medication Prescribing and Surrogate Laboratory Parameters After Initiating EmpagliflOziN in Veterans (CHAMPION Cohort Study). Clin Drug Investig 2023; 43:61-74. [PMID: 36515856 DOI: 10.1007/s40261-022-01226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Sodium-glucose cotransporter type 2 inhibitors have evolved into a novel drug class utilized for reductions in cardiovascular risk and heart failure hospitalization. We aimed to describe the impact of sodium-glucose cotransporter type 2 inhibitors on diuretic prescribing patterns and intermediate laboratory outcomes in patients with and without diuretic use. METHODS This retrospective cohort study included patients taking empagliflozin as of 1 July, 2021. Patients were assigned to the intervention group if prescribed a diuretic concomitantly or a control group otherwise. The primary outcome was the impact of empagliflozin on diuretic prescribing (i.e., no change, discontinuation, decrease, increase). Secondary outcomes were change in weight, hemoglobin A1c, estimated glomerular filtration rate, hemoglobin, hematocrit, blood pressure, and electrolytes at 90 and 180 days. Mean differences were compared using the t-test between groups or the paired t-test within groups. Patients without diuretic use were matched 1:1 to patients taking diuretics using propensity scores. RESULTS This study included 1189 patients: 750 in the control group and 439 in the intervention group. After propensity score matching, baseline characteristics were well balanced. Of the 439 patients in the intervention group, 118 had changes in the diuretic regimen. There were 131 changes: 109 (83.2%) discontinuations, 13 (9.92%) decreases, and nine (6.87%) increases. The mean furosemide equivalent loop dose was reduced after empagliflozin initiation (50.62 mg vs 43.13 mg; p < 0.001). Among all patients, there was a decrease in weight (p = 0.01), estimated glomerular filtration rate (p < 0.001), and hemoglobin A1c (p < 0.001). There was an increase in hemoglobin (p < 0.001), hematocrit (p < 0.001), and magnesium (p < 0.001). In the propensity score-matched cohort, there was a significant reduction from baseline in mean weight in the intervention group compared with the control group (p < 0.001). CONCLUSIONS This hypothesis-generating study suggests that sodium-glucose cotransporter type 2 inhibitors may lower diuretic requirements, further supported by a reduction in weight in the intervention cohort.
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Affiliation(s)
- Tanvi Patil
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA.
| | - Emily Halsey
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Alamdeep Kaur
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - John Minchak
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Jesse Hobson
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Davida Eppes
- Salem Veterans Affairs Healthcare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
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Nugroho P, Andrew H, Kohar K, Noor CA, Sutranto AL. Comparison between the world health organization (WHO) and international society of hypertension (ISH) guidelines for hypertension. Ann Med 2022; 54:837-845. [PMID: 35291891 PMCID: PMC8933011 DOI: 10.1080/07853890.2022.2044510] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
The global burden of hypertension remains an unsolved problem, especially in low- and middle-income countries (LMICs). For this reason, clinical practice guidelines containing the latest evidence-based recommendations are crucial in the management of hypertension. It is noteworthy that guidelines simply translated from those of high-income countries (HICs) are not the solution to the problem of hypertension in LMICs. Among the numerous guidelines available, those of the World Health Organisation and the International Society of Hypertension are the latest to be published as of the writing of this article. In this review, we conducted both general and specific comparisons between the recommendations supplied by both guidelines. Differences in aspects of hypertension management such as the timing of antihypertensive initiation, assessment of comorbidities and cardiovascular risk factors, pharmacological therapy selection, and blood pressure target and reassessment are explored. Lastly, the implications of the differences found between the two guidelines in both LMICs and HICs are discussed.Key messagesCurrently, with low treatment and control rates, hypertension remains a burden in low- and middle-income countries (LMICs).The lack of customised guidelines for LMICs cannot be solved simply by adopting guidelines from high-income countries.The World Health Organisation (WHO) recently published a clinical guideline for the pharmacological management of hypertension in LMICs. We compare select recommendations from the guidelines to those published by the International Society of Hypertension.
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Affiliation(s)
- Pringgodigdo Nugroho
- Division of Nephrology and Hypertension, Department of Internal Medicine, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hubert Andrew
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kelvin Kohar
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Chairina Azkya Noor
- Division of Nephrology and Hypertension, Department of Internal Medicine, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Aida Lydia Sutranto
- Division of Nephrology and Hypertension, Department of Internal Medicine, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Ernst ME, Fravel MA. Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide. Am J Hypertens 2022; 35:573-586. [PMID: 35404993 DOI: 10.1093/ajh/hpac048] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/27/2023] Open
Abstract
The term thiazide is universally understood to refer to diuretics that exert their principal action in the distal tubule. The thiazide class is heterogenous and can be further subdivided into compounds containing the benzothiadiazine ring structure-the thiazide-type (e.g., hydrochlorothiazide)-and those lacking the benzothiadiazine ring-the thiazide-like (e.g., chlorthalidone and indapamide) drugs. Thiazide-like agents are longer acting and constitute the diuretics used in most of the cardiovascular outcome trials that established benefits of treatment with diuretics, but pragmatic aspects, such as lack of availability in convenient formulations, limit their use. Regardless of class heterogeneity, thiazides have retained importance in the management of hypertension for over 60 years. They are reliably effective as monotherapy in a majority of hypertensive patients, and augment the efficacy of other classes of antihypertensives when used in combination. Importantly, a thiazide-based treatment regimen lowers cardiovascular events, and their sturdy effect reinforces their place among the recommended first-line agents to treat hypertension in major domestic and international hypertension guidelines. There are few head-to-head comparisons within the class, but potential differences have been explored indirectly as well as in non-blood pressure mechanisms and potential pleiotropic properties. Until proven otherwise, the importance of these differences remains speculative, and clinicians should assume that cardiovascular events will be lowered similarly across agents when equivalent blood pressure reduction occurs. Thiazides remain underutilized, with only about one-third of hypertensive patients receiving them. For many patients, however, a thiazide is an indispensable component of their regimen to achieve adequate blood pressure control.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA.,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
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Adão JR, de Souza P, Boeing T, Mariano LN, Brandt AM, Hemmer JV, Bazani HA, de Andrade SF, Corrêa R, Klein-Júnior LC, Niero R. Synthesis and characterization of Schiff base derivatives and its effect on urinary parameters of Wistar rats: A comparative analysis with different classes of diuretics. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.132849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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The immunomodulatory effects of antihypertensive therapy: A review. Biomed Pharmacother 2022; 153:113287. [PMID: 35728352 DOI: 10.1016/j.biopha.2022.113287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Hypertension remains the leading preventable risk factor for stroke and coronary artery disease, significantly contributing to all-cause global mortality and predisposing patients to renal and heart failure, as well as peripheral vascular disease. Due to the widespread usage of antihypertensive drugs, global mean blood pressure has remained unchanged or even slightly decreased over the past four decades. However, considering the broad spectrum of mechanisms involved in the action of antihypertensive drugs and the prevalence of their target receptors on immune cells, possible immunomodulatory effects which may exert beneficial effects of lowering blood pressure but also potentially alter immune function should be considered. In this review, we attempt to assess the consequences to immune system function of administering the five most commonly prescribed groups of antihypertensive drugs and to explain the mechanisms behind those interactions. Finally, we show potential gaps in our understanding of the effects of antihypertensive drugs on patient health. With regard to the widespread use of these drugs in the adult population worldwide, the discussed results may be of vital importance to evidence-based decision-making in daily clinical practice.
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Carneiro DM, Jardim TV, Araújo YCL, Arantes AC, de Sousa AC, Barroso WKS, Sousa ALL, Cruz ADC, da Cunha LC, Jardim PCBV. Antihypertensive effect of Equisetum arvense L.: a double-blind, randomized efficacy and safety clinical trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 99:153955. [PMID: 35168030 DOI: 10.1016/j.phymed.2022.153955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Equisetum arvense L. (EA) is a traditional phytomedicine used as a diuretic agent worldwide and regulated strictly by European Medicine Agency (EMA) and Brazilian National Health Surveillance Agency (ANVISA). However, few studies evaluating its efficacy and safety have been published and no clinical trial assessing its antihypertensive effect has been reported to date. PURPOSE To assess antihypertensive effect, safety and tolerability of EA compared to hydrochlorothiazide (HCTZ). METHODS This is a double-blind randomized clinical trial, allocating 58 systemic arterial hypertension (SAH) stage I patients (both sexes, 25-65 years old) into two groups (EA and HCTZ). All patients underwent biochemical and cardiologic checkup prior to and during interventions. The EA standardized dry extract (900 mg/day) or HCTZ (25 mg/day) were administered for 3 months and follow-up visits were conducted every 30 days. Efficacy established goals were systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) decreases ≥ 10.0 mmHg and/or casual blood pressure (CBP) < 140/90 mmHg. RESULTS EA treatment demonstrated a significant antihypertensive effect, promoting a mean decrease of SBP and DBP by 12.6 and 8.1 mmHg, respectively, and resulting a CBP mean of 134.0/84.5 mmHg at the end of intervention on the SAH stage I patients (CBP mean of 148.5/95.7 mmHg). There were no significant statistical differences between EA and HCTZ interventions on blood pressure decrease, and before-after treatments regarding to biochemical tests and signs of acute toxicity, renal, hepatic and hematologic alterations. A slight trend but no significant difference were observed between adverse events from EA (3.58%) and HCTZ (4.68%) groups. CONCLUSION EA standardized dry extract was successfully applied to the SAH stage I patient treatment, decreasing effectively SBP ad DBP values to the reference normal ranges, and demonstrating a well-tolerability profile similar to HCTZ intervention.
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Affiliation(s)
- Danilo Maciel Carneiro
- Hypertension League, School of Medicine, Federal University of Goiás (UFG), Goiânia, Goiás, Brazil; Reference Center in Integrative and Complementary Medicine of the State Health Department of Goiás, Goiânia, Goiás, Brazil
| | - Thiago Veiga Jardim
- Hypertension League, School of Medicine, Federal University of Goiás (UFG), Goiânia, Goiás, Brazil
| | | | - Ana Carolina Arantes
- Hypertension League, School of Medicine, Federal University of Goiás (UFG), Goiânia, Goiás, Brazil
| | - Andrea Cristina de Sousa
- Hypertension League, School of Medicine, Federal University of Goiás (UFG), Goiânia, Goiás, Brazil
| | | | - Ana Luiza Lima Sousa
- Hypertension League, School of Medicine, Federal University of Goiás (UFG), Goiânia, Goiás, Brazil
| | - Alessandro de Carvalho Cruz
- NEPET-UFG - Nucleus of Toxicopharmacological Studies and Research, School of Pharmacy, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Luiz Carlos da Cunha
- NEPET-UFG - Nucleus of Toxicopharmacological Studies and Research, School of Pharmacy, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Paulo César Brandão Veiga Jardim
- Hypertension League, School of Medicine, Federal University of Goiás (UFG), Goiânia, Goiás, Brazil; School of Medicine of UFG. FM/HC/UFG Hypertension League. Goiânia, Goiás, Brazil
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Ostroumova OD, Polyakova OA, Listratova AI, Logunova NA, Gorohova TV. Thiazide and thiazide-like diuretics: how to make the right choice? KARDIOLOGIIA 2022; 62:89-97. [PMID: 35168538 DOI: 10.18087/cardio.2022.1.n1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023]
Abstract
Most patients with arterial hypertension (AH) require a combination treatment to achieve the goal blood pressure. According to Russian and international clinical guidelines on the treatment of AH patients, various antihypertensive drugs may be combined; however, not all combinations have similar profiles of safety and clinical efficacy. In this respect, special attention is given to combinations of renin-angiotensin-aldosterone system inhibitors and thiazide (hydrochlorothiazide) or thiazide-like (chlortalidone, indapamide) diuretics. Diuretics also differ in their mechanisms of action, presence of pleiotropic effects and organ-protective properties, effects on the prognosis, and in the evidence base. This review discusses the place of thiazide and thiazide-like diuretics in the treatment of patients with AH and provides an evaluation of major differences in pharmacological and clinical effects of drugs of the diuretic class.
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Affiliation(s)
- O D Ostroumova
- Russian Medical Academy of Continuous Professional Education, Moscow
| | - O A Polyakova
- Russian Medical Academy of Continuous Professional Education, Moscow
| | - A I Listratova
- Russian Medical Academy of Continuous Professional Education, Moscow
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Pulipati VP, Mares JW, Bakris GL. Optimizing Blood Pressure Control Without Adding Anti-Hypertensive Medications. Am J Med 2021; 134:1195-1198. [PMID: 34197786 DOI: 10.1016/j.amjmed.2021.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022]
Affiliation(s)
| | - Jon W Mares
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Ill
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Ill
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16
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Guide de Pratique Clinique. Prise en charge de l’hypertension artérielle chez l’adulte en Tunisie. LA TUNISIE MÉDICALE 2021. [PMCID: PMC9003593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ce document a été réalisé dans le cadre d'une collaboration entre l'Instance Nationale de l’Évaluation et de l'Accréditation en Santé (INEAS), la Société Tunisienne de Cardiologie et de Chirurgie Cardiovasculaire (STCCCV) et la Caisse Nationale d’Assurance Maladie (CNAM).
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Roush GC, Messerli FH. Chlorthalidone versus hydrochlorothiazide: major cardiovascular events, blood pressure, left ventricular mass, and adverse effects. J Hypertens 2021; 39:1254-1260. [PMID: 33470735 DOI: 10.1097/hjh.0000000000002771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is continuous debate whether chlorthalidone (CTD) and hydrochlorothiazide (HCTZ) differ in reducing major cardiovascular events (MACE). HCTZ is prescribed 10 times more commonly than CTD. METHOD A systematic literature search yielded 14 references, including two network meta-analyses of randomized trials with MACE and left ventricular mass as outcomes. RESULTS The network meta-analysis of randomized trials showed CTD reducing MACE more than HCTZ, hazard ratio = 0.79 (0.72-0.88), P < 0.0001, and an observational cohort study gave an identical point estimate: hazard ratio = 0.79 (0.68-0.92), P = 0.002. In contrast, two observational cohort studies reported no differences between CTD and HCTZ. However, in the studies showing the superiority of CTD median follow-up was 4.3 and 7.0 years, respectively, whereas in the latter studies showing no difference between the two drugs follow-up was only 0.95 and 0.25 years. As differences in outcomes for MACE in hypertension trials with various interventions only emerge after prolonged (>1 year) therapy, differences in follow-up explain these discrepant results. CTD also more effectively reduced left ventricular mass in observational data and network analysis of trials. These advantages of CTD over HCTZ are consistent with greater reductions in night-time blood pressure, greater reductions in oxidative stress and platelet aggregation, and greater improvements in endothelial function. CONCLUSION Over the short-term there were no differences in the net clinical benefit between HCTZ and CTD. However, long-term available data document CTD to be significantly more effective in reducing MACE than HCTZ. The Veterans Administration's trial in progress may provide definitive answer to these questions.
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Affiliation(s)
| | - Franz H Messerli
- Swiss Cardiovascular Center, Bern, Switzerland
- Mount Sinai Icahn School of Medicine, New York City, New York, USA
- Jagiellonian University Krakow, Poland
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Barletta PHAAS, Moreira JL, Almeida VFD, Machado MAB, Almeida BLD, Santos TSSD, Nascimento YM, Silva TA, Aras R, Macedo C. Drug Profile and Therapeutic Adherence of African-Brazilians with Apparent Resistant Hypertension. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pareek A, Ram CVS, Joshi S, Mehta RT. 2020 International Society of Hypertension Guidelines: preference of calcium channel blocker over thiazide-like diuretics lacks evidence. J Hypertens 2020; 38:2335-2336. [DOI: 10.1097/hjh.0000000000002601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Langford AT, Akinyelure OP, Moore TL, Howard G, Min YI, Hillegass WB, Bress AP, Tajeu GS, Butler M, Jaeger BC, Yano Y, Shimbo D, Ogedegbe G, Calhoun D, Booth JN, Muntner P. Underutilization of Treatment for Black Adults With Apparent Treatment-Resistant Hypertension: JHS and the REGARDS Study. Hypertension 2020; 76:1600-1607. [PMID: 32924633 PMCID: PMC7685176 DOI: 10.1161/hypertensionaha.120.14836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/20/2020] [Indexed: 01/26/2023]
Abstract
Resistant hypertension, defined as blood pressure levels above goal while taking ≥3 classes of antihypertensive medication or ≥4 classes regardless of blood pressure level, is associated with increased cardiovascular disease risk. The 2018 American Heart Association Scientific Statement on Resistant Hypertension recommends healthy lifestyle habits and thiazide-like diuretics and mineralocorticoid receptor antagonists for adults with resistant hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance cannot be excluded. We estimated the use of healthy lifestyle factors and recommended antihypertensive medication classes among US Black adults with aTRH. Data were pooled for Black participants in the JHS (Jackson Heart Study) in 2009 to 2013 (n=2496) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) in 2013 to 2016 (n=3786). Outcomes included lifestyle factors (not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index <25 kg/m2) and recommended antihypertensive medications (thiazide-like diuretics and mineralocorticoid receptor antagonists). Overall, 28.3% of participants who reported taking antihypertensive medication had aTRH. Among participants with aTRH, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. In conclusion, evidence-based lifestyle factors and recommended pharmacological treatment are underutilized in Black adults with aTRH. Increased use of lifestyle recommendations and antihypertensive medication classes specifically recommended for aTRH may improve blood pressure control and reduce cardiovascular disease-related morbidity and mortality among US Black adults. Graphic Abstract A graphic abstract is available for this article.
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Affiliation(s)
- Aisha T Langford
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Oluwasegun P Akinyelure
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Tony L Moore
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - George Howard
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Yuan-I Min
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - William B Hillegass
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Adam P Bress
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Gabriel S Tajeu
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Mark Butler
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Byron C Jaeger
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Yuichiro Yano
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Daichi Shimbo
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Gbenga Ogedegbe
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - David Calhoun
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - John N Booth
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
| | - Paul Muntner
- From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.)
- Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham
- Departments of Biostatistics (G.H., B.C.J.), University of Alabama at Birmingham
- Departments of Medicine (D.C.), University of Alabama at Birmingham
- Departments of Data Science (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Departments of Medicine (Y.-I.M., W.B.H.), University of Mississippi Medical Center, Jackson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.)
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
- and Department of Medicine, Columbia Hypertension Center, Columbia University Medical Center, New York, NY (D.S.)
- CTI Clinical Trials and Consulting Services, Inc., Covington, KY (J.N.B.)
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21
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Demidova TY, Kislyak OA. The Peculiarity of Process and Treatment of Arterial Hypertension in Patients with Type 2 Diabetes Mellitus. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-08-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Arterial hypertension (AH) is powerful and modifying factor of developing macrovascular and microvascular complications of diabetes. Patients with AH and diabetes belong to group with high and very high levels risk of developing cardiovascular complications and chronic kidney disease. The combination of type 2 diabetes mellitus and AH dramatically increases the risk of developing terminal stages of microvascular and macrovascular diabetic complications: blindness, end-stage chronic kidney disease, amputation of the lower extremities, myocardial infarction, cerebral stroke, worsens the patients prognosis and quality of life. There is ample evidence that blood pressure control in diabetic patients may be critical for improving long-term prognosis. This observation does not lose its relevance even with the emergence of new antidiabetic drugs with proven cardio- and nephroprotective effects. Modern clinical researchers and meta-analysis show the priority of combined antihypertensive therapy, which increases the efficacy of blood pressure correction and prophylaxis of long-term complications in patients with type 2 diabetes. In this article we want to pay attention to features of AH in patients with diabetes, to bi-directional pathogenic mechanisms, to discuss the new algorithms of the treatment and therapeutic needs of these patients. It is important to accent the understanding of the integrity and unity of pathogenic mechanisms which are needed in correction. Innovative antihyperglycemic therapy demonstrates the ability of blood pressure decrease. The synergy of effects let us successfully realize the strategy of multi-factor control and reduce a risk of micro- and macrovascular complications.
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Affiliation(s)
| | - O. A. Kislyak
- Pirogov Russian National Research Medical University
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22
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Tsujimoto T, Kajio H. Thiazide Use and Decreased Risk of Heart Failure in Nondiabetic Patients Receiving Intensive Blood Pressure Treatment. Hypertension 2020; 76:432-441. [PMID: 32639892 PMCID: PMC7340223 DOI: 10.1161/hypertensionaha.120.15154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Supplemental Digital Content is available in the text. The SPRINT (Systolic Blood Pressure Intervention Trial) study reported that intensive blood pressure (BP) treatment with a systolic BP target of <120 mm Hg decreased the risks of cardiovascular events. However, it remains unknown whether specific medications can further improve cardiovascular outcome in patients receiving intensive BP treatment. This study examined whether thiazide use improves cardiovascular outcome in patients receiving intensive BP treatment. We used data of nondiabetic patients receiving intensive BP treatment in the SPRINT study. The primary outcome was a composite end point of myocardial infarction, acute coronary syndrome, stroke, heart failure, or cardiovascular death. We analyzed hazard ratios for outcomes with 95% CIs in patients taking thiazides compared with those not taking thiazides using Cox proportional hazard models. This study included 2847 patients and the mean follow-up period was 3.3 years. The risk of primary outcome events was significantly lower in patients taking thiazides than in those not taking thiazides in both entire and propensity score-matched cohorts. Particularly, heart failure risk was significantly lower in those taking thiazides. These associations were also observed in various subgroups. In addition, thiazide use was associated with decreased risk of all-cause mortality. Hypokalemia occurred more frequently in patients taking thiazides than in those not taking thiazides. Thiazide use decreased risk of cardiovascular events, particularly heart failure, in nondiabetic high-risk patients receiving intensive BP treatment.
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Affiliation(s)
- Tetsuro Tsujimoto
- From the Department of Diabetes and Endocrinology, Toranomon Hospital Kajigaya, Kanagawa, Japan (T.T.).,Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan (T.T., H.K.)
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan (T.T., H.K.)
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23
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The effect of Ramadan fasting on ambulatory blood pressure in treated hypertensive patients using diuretics. Blood Press Monit 2020; 25:195-200. [DOI: 10.1097/mbp.0000000000000451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Abstract
Hypertension is still the number one global killer. No matter what causes are, lowering blood pressure can significantly reduce cardiovascular complications, cardiovascular death, and total death. Unfortunately, some hypertensive individuals simply do not know having hypertension. Some knew it but either not being treated or treated but blood pressure does not achieve goal. The reasons for inadequate control of blood pressure are many. One important reason is that we are not very familiar with antihypertensive agents and less attention has been paid to comorbidities, complications as well as the hypertension-modified target organ damage in patients with hypertension. The right antihypertensive drug was not given to the right hypertensive patients at right time. This reviewer studied comprehensively the literature, hopefully that the review will help improve antihypertensive drug selection and antihypertensive therapy.
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Affiliation(s)
- Rutai Hui
- Chinese Academy of Medical Sciences FUWAI Hospital Hypertension Division, 167 Beilishilu West City District, 100037, Beijing People's Republic of China, China.
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25
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Kuzmin OB, Buchneva NN, Zhezha VV, Serdyuk SV. Uncontrolled Arterial Hypertension: Kidney, Neurohormonal Imbalance, and Approaches to Antihypertensive Drug Therapy. ACTA ACUST UNITED AC 2019; 59:64-71. [DOI: 10.18087/cardio.2019.12.n547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/29/2019] [Indexed: 11/18/2022]
Abstract
Resistant and refractory arterial hypertensions are two distinct clinical phenotypes of uncontrolled arterial hypertension (AH), which differ in their sensitivity to antihypertensive drug therapy. The review presents data obtained in clinical studies devoted to elucidating the involvement of disorders of neurohormonal status and renal function in the formation of resistant and refractory arterial hypertension, to and the development of new approaches to increasing the effectiveness of antihypertensive therapy in these patient’s populations. The results of these studies have shown that in patients with uncontrolled arterial hypertension, despite prolonged intake ≥ 3 antihypertensive drugs with different mechanisms of action, including a diuretic, excess sodium reabsorption persists in the distal segments of nephron due to increased aldosterone activity and sympathetic nervous system hyperactivity. In this regard, special attention has been paid to the data of PATHWAY-2, PATHWAY-3 and ReHOT trials that in patients with resistant AH tested the clinical efficacy of spironolactone, amiloride, and antiadrenergic drugs bisoprolol, doxazosin and clonidine, suppressing activity of the sympathetic nervous system.
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26
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Abstract
ZusammenfassungErhöhter Blutdruck bleibt eine Hauptursache von kardiovaskulären Erkrankungen, Behinderung und frühzeitiger Sterblichkeit in Österreich, wobei die Raten an Diagnose, Behandlung und Kontrolle auch in rezenten Studien suboptimal sind. Das Management von Bluthochdruck ist eine häufige Herausforderung für Ärztinnen und Ärzte vieler Fachrichtungen. In einem Versuch, diagnostische und therapeutische Strategien zu standardisieren und letztendlich die Rate an gut kontrollierten Hypertoniker/innen zu erhöhen und dadurch kardiovaskuläre Erkrankungen zu verhindern, haben 13 österreichische medizinische Fachgesellschaften die vorhandene Evidenz zur Prävention, Diagnose, Abklärung, Therapie und Konsequenzen erhöhten Blutdrucks gesichtet. Das hier vorgestellte Ergebnis ist der erste Österreichische Blutdruckkonsens. Die Autoren und die beteiligten Fachgesellschaften sind davon überzeugt, daß es einer gemeinsamen nationalen Anstrengung bedarf, die Blutdruck-assoziierte Morbidität und Mortalität in unserem Land zu verringern.
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27
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McNally RJ, Morselli F, Farukh B, Chowienczyk PJ, Faconti L. A review of the prescribing trend of thiazide-type and thiazide-like diuretics in hypertension: A UK perspective. Br J Clin Pharmacol 2019; 85:2707-2713. [PMID: 31471972 PMCID: PMC6955404 DOI: 10.1111/bcp.14109] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/07/2019] [Accepted: 08/24/2019] [Indexed: 01/02/2023] Open
Abstract
Thiazide diuretics have been the cornerstone of hypertension treatment for >5 decades. Most recent European and American guidelines recommend both thiazide-type and thiazide-like diuretics as first-line drugs for all patients with hypertension. In contrast, diuretics are not regarded as first-line treatment in the UK and in patients who are to be initiated on a diuretic treatment, thiazide-like molecules, such as chlortalidone and indapamide are the preferred option. This review examines the prescribing trend of the 4 most commonly prescribed thiazide diuretics for the treatment of hypertension in the UK. Prescription cost analysis data were obtained for both 2010 and 2016/2017 for each region of the UK to analyse the impact of the 2011 National Institute for Health and Care Excellence hypertension guidelines on the trend in thiazide diuretic prescribing. Overall, the prescriptions of thiazide diuretics declined over the years. Bendroflumethiazide is the most commonly prescribed diuretic in the UK and despite some geographical differences, thiazide-type diuretics are more widely used than thiazide-like. The use of indapamide increased significantly between 2010 and 2016/2017 while chlortalidone was rarely employed. Of the many factors affecting trends in prescriptions, clinical inertia, treatment adherence, availability of the products and the lack of fixed dose combinations may play a role.
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Affiliation(s)
- Ryan J. McNally
- British Heart Foundation CentreKing's College LondonLondonUK
| | - Franca Morselli
- British Heart Foundation CentreKing's College LondonLondonUK
| | - Bushra Farukh
- British Heart Foundation CentreKing's College LondonLondonUK
| | | | - Luca Faconti
- British Heart Foundation CentreKing's College LondonLondonUK
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28
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Podzolkov VI, Tarzimanova AI, Georgadze ZO. Modern Principles of Treatment of Uncontrolled Hypertension. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-5-736-741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Despite the current possibilities of using different classes of antihypertensive drugs that effectively reduce blood pressure and significantly improve the long-term prognosis of patients, the problem of uncontrolled arterial hypertension has not lost its importance and its solution in a particular clinical situation often remains very difficult. The term "uncontrolled arterial hypertension" can be used in all cases where arterial pressure has not been achieved. The true prevalence of uncontrolled arterial hypertension has not been established, and its study is hampered primarily by the fact that not all patients initially receive antihypertensive therapy that meets generally accepted standards. Currently, the tactics of management of patients with uncontrolled hypertension involves the use of combinations of antihypertensive drugs. Rational combinations, according to the new recommendations for the diagnosis and treatment of arterial hypertension in 2018, remain a combination of blockers of the renin-angiotensin-aldosterone system – angiotensin-converting enzyme inhibitors or receptor blockers to angiotensin with a calcium antagonist or diuretic, preferably in one tablet. With the ineffectiveness of dual therapy needs to be assigned to a third antihypertensive drug. Among the most modern antihypertensive drugs can be considered a triple fixed combination of lisinopril, amlodipine and indapamide. All the components included in the composition of the drug, has proved its high efficiency and safety. Uncontrolled arterial hypertension remains one of the most urgent problems of modern cardiology. Many aspects of it are far from unambiguously interpreted solutions and standards. Until the end, the mechanisms of the formation of uncontrolled course of hypertension remain unexplored, which, in turn, leads to a restriction of the use of drug and non-drug methods in the treatment of this pathology. Rational choice of antihypertensive therapy regimens can significantly improve the quality of treatment of this category of patients.
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Affiliation(s)
- V. I. Podzolkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. I Tarzimanova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Z. O. Georgadze
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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29
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Tsujimoto T, Kajio H. Thiazide Use and Cardiovascular Events in Type 2 Diabetic Patients With Well-Controlled Blood Pressure. Hypertension 2019; 74:1541-1550. [PMID: 31679424 PMCID: PMC7069392 DOI: 10.1161/hypertensionaha.119.13886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Evidence regarding the efficacy and safety of thiazides in patients with well-controlled and relatively low blood pressure (BP) is lacking. This study aimed to assess whether thiazide use is effective and safe in type 2 diabetic patients with well-controlled BP and whether intensive BP control leads to decreased risk of cardiovascular events depending on thiazide use. We performed an observational cohort study using data from the ACCORD study (Action to Control Cardiovascular Risk in Diabetes). The primary outcome was major adverse cardiovascular events (MACE), which was a composite end point including cardiovascular death, myocardial infarction, and stroke. Hazard ratios for primary and secondary outcomes with 95% CIs were calculated using Cox proportional hazards models. We included 10 011 type 2 diabetic patients. The overall mean follow-up period was 7.7 years, and 1776 patients experienced MACE. Mean systolic BP at baseline in patients taking and not taking thiazides was 137.2 and 135.7 mm Hg, respectively. Thiazide use was associated with increased risk of MACE, particularly stroke (hazard ratio, 1.49 [95% CI, 1.18-1.88]). In addition, thiazide use was significantly associated with higher risks of MACE and stroke in patients receiving intensive BP control but not in those receiving standard BP control. Similar associations were observed in analyses using propensity score matching. Intensive BP control reduced the risks of MACE and stroke in patients not taking thiazides but not in patients taking thiazides. Thiazide use may be harmful in type 2 diabetic patients with relatively low BP.
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Affiliation(s)
- Tetsuro Tsujimoto
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kajio
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
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30
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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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31
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Affiliation(s)
- Teck K Khong
- Clinical Pharmacology Unit, St George's University of London, London, UK
| | - Elizabeth Adeyeye
- Clinical Pharmacology Unit, St George's University of London, London, UK
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32
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Boban M, Bulj N, Kolačević Zeljković M, Radeljić V, Krcmar T, Trbusic M, Delić-Brkljačić D, Alebic T, Vcev A. Nutritional Considerations of Cardiovascular Diseases and Treatments. Nutr Metab Insights 2019; 12:1178638819833705. [PMID: 30923440 PMCID: PMC6431763 DOI: 10.1177/1178638819833705] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 01/28/2019] [Indexed: 12/16/2022] Open
Abstract
Nutritional considerations of many chronic diseases are not fully understood or taken into consideration in everyday clinical practice. Therefore, it is not surprising that high proportion of hospitalized patients with cardiovascular diseases remains underdiagnosed with malnutrition. Malnourished patients have increased risk of poor clinical outcomes, complications rate, prolonged hospital stay, more frequent rehospitalizations, and lower quality of life. The purpose of this review is to recapitulate recent data on nutritional considerations in cardiovascular medicine.
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Affiliation(s)
- Marko Boban
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice," Zagreb, Croatia.,Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Internal Medicine, Medical Faculty, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Internal Medicine and Physiology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Nikola Bulj
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice," Zagreb, Croatia.,Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Vjekoslav Radeljić
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice," Zagreb, Croatia
| | - Tomislav Krcmar
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice," Zagreb, Croatia
| | - Matias Trbusic
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice," Zagreb, Croatia
| | - Diana Delić-Brkljačić
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice," Zagreb, Croatia.,Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tamara Alebic
- Department of Internal Medicine, Medical Faculty, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Aleksandar Vcev
- Department of Internal Medicine, Medical Faculty, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Internal Medicine and Physiology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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33
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Macfarlane TV, Pigazzani F, Flynn RW, MacDonald TM. The effect of indapamide vs. bendroflumethiazide for primary hypertension: a systematic review. Br J Clin Pharmacol 2019; 85:285-303. [PMID: 30312512 PMCID: PMC6339968 DOI: 10.1111/bcp.13787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/25/2018] [Accepted: 09/21/2018] [Indexed: 12/28/2022] Open
Abstract
The aims of the current review were to compare the efficacy of monotherapy with bendroflumethiazide vs. indapamide on mortality, cardiovascular outcomes, blood pressure, need for intensification of treatment and treatment withdrawal. Two authors independently screened the results of a literature search, assessed the risk of bias and extracted relevant data. Randomized clinical trials of hypertensive patients of at least a 1-year duration were included. When there was disagreement, a third reviewer was consulted. Risk ratio (RR) and mean differences were used as measures of effect. Two trials comparing bendroflumethiazide against placebo, one comparing indapamide with placebo and three of short duration directly comparing indapamide and Bendroflumethiazide, were included. No statistically significant difference was found between indapamide and bendroflumethiazide for all deaths [RR 0.82; 95% confidence interval (CI) 0.57, 1.18], cardiovascular deaths (RR 0.82; 95% CI 0.55, 1.20), noncardiovascular deaths (0.81; 95% CI 0.54, 1.22), coronary events (RR 0.73; 95% CI 0.30, 1.79) or all cardiovascular events (RR 0.89; 95% CI 0.67, 1.18). Indapamide performed worse for stroke (RR 2.21; 95% CI 1.19, 4.11), even though a reduction in RR compared with placebo was observed in both groups. There was no statistically or clinically significant difference between indapamide and bendroflumethiazide in blood pressure reduction (mean absolute difference <1 mmHg). The present review highlights a lack of studies to answer the review question but also a lack of evidence of superiority of one drug over the other. Therefore, there is a clear need for new studies directly comparing the effect of these drugs on the outcomes of interest.
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Affiliation(s)
| | - Filippo Pigazzani
- Medicines Monitoring Unit (MEMO), School of MedicineUniversity of DundeeDundeeUK
| | - Robert W.V. Flynn
- Medicines Monitoring Unit (MEMO), School of MedicineUniversity of DundeeDundeeUK
| | - Thomas M. MacDonald
- Medicines Monitoring Unit (MEMO), School of MedicineUniversity of DundeeDundeeUK
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34
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Waldron M, Patterson SD, Tallent J, Jeffries O. The Effects of Oral Taurine on Resting Blood Pressure in Humans: a Meta-Analysis. Curr Hypertens Rep 2018; 20:81. [DOI: 10.1007/s11906-018-0881-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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35
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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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36
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MacDonald TM, Williams B, Webb DJ, Morant S, Caulfield M, Cruickshank JK, Ford I, Sever P, Mackenzie IS, Padmanabhan S, McCann GP, Salsbury J, McInnes G, Brown MJ. Combination Therapy Is Superior to Sequential Monotherapy for the Initial Treatment of Hypertension: A Double-Blind Randomized Controlled Trial. J Am Heart Assoc 2017; 6:e006986. [PMID: 29151036 PMCID: PMC5721778 DOI: 10.1161/jaha.117.006986] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Guidelines for hypertension vary in their preference for initial combination therapy or initial monotherapy, stratified by patient profile; therefore, we compared the efficacy and tolerability of these approaches. METHODS AND RESULTS We performed a 1-year, double-blind, randomized controlled trial in 605 untreated patients aged 18 to 79 years with systolic blood pressure (BP) ≥150 mm Hg or diastolic BP ≥95 mm Hg. In phase 1 (weeks 0-16), patients were randomly assigned to initial monotherapy (losartan 50-100 mg or hydrochlorothiazide 12.5-25 mg crossing over at 8 weeks), or initial combination (losartan 50-100 mg plus hydrochlorothiazide 12.5-25 mg). In phase 2 (weeks 17-32), all patients received losartan 100 mg and hydrochlorothiazide 12.5 to 25 mg. In phase 3 (weeks 33-52), amlodipine with or without doxazosin could be added to achieve target BP. Hierarchical primary outcomes were the difference from baseline in home systolic BP, averaged over phases 1 and 2 and, if significant, at 32 weeks. Secondary outcomes included adverse events, and difference in home systolic BP responses between tertiles of plasma renin. Home systolic BP after initial monotherapy fell 4.9 mm Hg (range: 3.7-6.0 mm Hg) less over 32 weeks (P<0.001) than after initial combination but caught up at 32 weeks (difference 1.2 mm Hg [range: -0.4 to 2.8 mm Hg], P=0.13). In phase 1, home systolic BP response to each monotherapy differed substantially between renin tertiles, whereas response to combination therapy was uniform and at least 5 mm Hg more than to monotherapy. There were no differences in withdrawals due to adverse events. CONCLUSIONS Initial combination therapy can be recommended for patients with BP >150/95 mm Hg. CLINICAL TRIAL REGISTRATION URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00994617.
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Affiliation(s)
- Thomas M MacDonald
- Medicines Monitoring Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, United Kingdom
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London (UCL), London, United Kingdom
- National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, London, United Kingdom
| | - David J Webb
- Clinical Pharmacology Unit, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Steve Morant
- Medicines Monitoring Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, United Kingdom
| | - Mark Caulfield
- Research Nurse William Harvey Institute, QMUL, London, United Kingdom
| | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom
| | - Peter Sever
- International Institute for Circulatory Health, Imperial College London, London, United Kingdom
| | - Isla S Mackenzie
- Medicines Monitoring Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, United Kingdom
| | - Sandosh Padmanabhan
- Institute of Cardiovascular Medical Sciences, University of Glasgow, United Kingdom
| | - Gerald P McCann
- NIHR Leicester Cardiovascular Biomedical Research Centre Glenfield Hospital, Leicester, United Kingdom
| | - Jackie Salsbury
- Research Nurse William Harvey Institute, QMUL, London, United Kingdom
| | - Gordon McInnes
- Institute of Cardiovascular Medical Sciences, University of Glasgow, United Kingdom
| | - Morris J Brown
- Research Nurse William Harvey Institute, QMUL, London, United Kingdom
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