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Holinstat M, Lambert S, Yalavarthi P, Stanger L, Yamaguchi A, Dahlof B. CS585 IS A NOVEL ORALLY AVAILABLE PROSTACYCLIN RECEPTOR AGONIST WITH LONG-TERM IN VIVO INHIBITION OF PLATELETS AND THROMBOSIS FORMATION IN MOUSE WITHOUT INCREASED RISK OF BLEEDING. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Holinstat M, Adili R, Stanger L, Hoang T, Lambert S, Rhoads N, Dahlof B, Bergh N. CS014 is a novel HDAC inhibitor regulating the platelet activity, fibrinolysis and clot stability for prevention of thrombosis without increased risk of bleeding. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiovascular disease is the leading cause of morbidity and mortality. A major challenge with current antithrombotic treatments is the increased risk of bleeding associated with effective inhibition of clot formation. We have developed a novel histone deacetylase inhibitor (HDACi) that effectively prevents occlusive thrombosis following vascular injury without increasing bleeding diathesis commonly associated with antithrombotic drugs.
Purpose
Develop an HDACi and antiplatelet drug, CS014, with an improved efficacy/safety profile and reduced bleeding risk compared with current anticoagulant and antiplatelet therapeutic approaches used to prevent thrombosis.
Methods
We assessed thrombosis and bleeding in mouse models by labelling platelets and fibrin and measuring accumulation at the site of injury using intravital microscopy. Drug was administered IP for 5 days prior to the experiments. Degree of clot formation in the vessel was assessed in the 1) laser-induced cremaster thrombosis assay, 2) carotid artery FeCl3 thrombosis assay, and 3) saphenous vein rebleeding laser-induced puncture wound assay. Bleeding was assessed in the tail vein bleeding assay. Potential off-target effects were studied using thromboelastography (TEG).
Results
CS014 treatment significantly reduced clot formation and fibrin formation at the site of injury in the laser-induced cremaster arteriole thrombosis assay (Fig. 1). FeCl3-induced injury of the carotid artery resulted in full occlusion of the carotid artery within 12–15 minutes. Treatment with CS014 was able to prevent full occlusion of the carotid artery, supporting its benefit in arterial injury conditions. In the saphenous vein rebleeding assay, fibrin and platelet accumulation at the site of injury wound was significantly inhibited, suggesting that CS014 functions in both arterial and venous systems to attenuate clot and thrombosis. The tail vein bleeding assay confirmed that while the thrombus formation and stability was decreased based on the cremaster and carotid artery assays, no significant change was observed in bleeding time under these conditions. Finally, TEG experiments in mouse blood treated with or without CS014 demonstrated no delay or decrease in clot strength confirming the prevention of a bleeding diathesis observed in the tail vein bleeding assay experiments.
Conclusions
We have shown for the first time that the HDACi CS014 results in inhibition of mouse thrombosis and decreased time to clot resolution without an increased risk of bleeding. This discovery represents a new class of inhibitors for prevention of platelet activation and thrombosis with the potential to protect from myocardial infarction and stroke while increasing fibrinolytic ability in the blood to limit the risk of thromboembolism on the venous side, with no signs of increased bleeding risk.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Cereno Scientific
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Affiliation(s)
- M Holinstat
- University of Michigan , Ann Arbor , United States of America
| | - R Adili
- University of Michigan , Ann Arbor , United States of America
| | - L Stanger
- University of Michigan , Ann Arbor , United States of America
| | - T Hoang
- University of Michigan , Ann Arbor , United States of America
| | - S Lambert
- University of Michigan , Ann Arbor , United States of America
| | - N Rhoads
- University of Michigan , Ann Arbor , United States of America
| | - B Dahlof
- University of Gothenburg , Gothenburg , Sweden
| | - N Bergh
- University of Gothenburg , Gothenburg , Sweden
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Gupta A, Thompson D, Whitehouse A, Collier T, Dahlof B, Poulter N, Collins R, Sever P. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet 2017; 389:2473-2481. [PMID: 28476288 DOI: 10.1016/s0140-6736(17)31075-9] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/15/2017] [Accepted: 02/22/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND In blinded randomised controlled trials, statin therapy has been associated with few adverse events (AEs). By contrast, in observational studies, larger increases in many different AEs have been reported than in blinded trials. METHODS In the Lipid-Lowering Arm of the Anglo-Scandinavian Cardiac Outcomes Trial, patients aged 40-79 years with hypertension, at least three other cardiovascular risk factors, and fasting total cholesterol concentrations of 6·5 mmol/L or lower, and who were not taking a statin or fibrate, had no history of myocardial infarction, and were not being treated for angina were randomly assigned to atorvastatin 10 mg daily or matching placebo in a randomised double-blind placebo-controlled phase. In a subsequent non-randomised non-blind extension phase (initiated because of early termination of the trial because efficacy of atorvastatin was shown), all patients were offered atorvastatin 10 mg daily open label. We classified AEs using the Medical Dictionary for Regulatory Activities. We blindly adjudicated all reports of four prespecified AEs of interest-muscle-related, erectile dysfunction, sleep disturbance, and cognitive impairment-and analysed all remaining AEs grouped by system organ class. Rates of AEs are given as percentages per annum. RESULTS The blinded randomised phase was done between February, 1998, and December, 2002; we included 101 80 patients in this analysis (5101 [50%] in the atorvastatin group and 5079 [50%] in the placebo group), with a median follow-up of 3·3 years (IQR 2·7-3·7). The non-blinded non-randomised phase was done between December, 2002, and June, 2005; we included 9899 patients in this analysis (6409 [65%] atorvastatin users and 3490 [35%] non-users), with a median follow-up of 2·3 years (2·2-2·4). During the blinded phase, muscle-related AEs (298 [2·03% per annum] vs 283 [2·00% per annum]; hazard ratio 1·03 [95% CI 0·88-1·21]; p=0·72) and erectile dysfunction (272 [1·86% per annum] vs 302 [2·14% per annum]; 0·88 [0·75-1·04]; p=0·13) were reported at a similar rate by participants randomly assigned to atorvastatin or placebo. The rate of reports of sleep disturbance was significantly lower among participants assigned atorvastatin than assigned placebo (149 [1·00% per annum] vs 210 [1·46% per annum]; 0·69 [0·56-0·85]; p=0·0005). Too few cases of cognitive impairment were reported for a statistically reliable analysis (31 [0·20% per annum] vs 32 [0·22% per annum]; 0·94 [0·57-1·54]; p=0·81). We observed no significant differences in the rates of all other reported AEs, with the exception of an excess of renal and urinary AEs among patients assigned atorvastatin (481 [1·87%] per annum vs 392 [1·51%] per annum; 1·23 [1·08-1·41]; p=0·002). By contrast, during the non-blinded non-randomised phase, muscle-related AEs were reported at a significantly higher rate by participants taking statins than by those who were not (161 [1·26% per annum] vs 124 [1·00% per annum]; 1·41 [1·10-1·79]; p=0·006). We noted no significant differences between statin users and non-users in the rates of other AEs, with the exception of musculoskeletal and connective tissue disorders (992 [8·69% per annum] vs 831 [7·45% per annum]; 1·17 [1·06-1·29]; p=0·001) and blood and lymphatic system disorders (114 [0·88% per annum] vs 80 [0·64% per annum]; 1·40 [1·04-1·88]; p=0·03), which were reported more commonly by statin users than by non-users. INTERPRETATION These analyses illustrate the so-called nocebo effect, with an excess rate of muscle-related AE reports only when patients and their doctors were aware that statin therapy was being used and not when its use was blinded. These results will help assure both physicians and patients that most AEs associated with statins are not causally related to use of the drug and should help counter the adverse effect on public health of exaggerated claims about statin-related side-effects. FUNDING Pfizer, Servier Research Group, and Leo Laboratories.
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Affiliation(s)
- Ajay Gupta
- National Heart and Lung Institute, Imperial College London, London, UK; Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK; William Harvey Research Institute, Queen Mary University of London, London, UK
| | - David Thompson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Whitehouse
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Tim Collier
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Bjorn Dahlof
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Sever
- National Heart and Lung Institute, Imperial College London, London, UK.
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Sever P, Gupta A, Thompson D, Whitehouse A, Collier T, Dahlof B, Poulter N. LBOS 01-04 THE TRUE INCIDENCE OF STATIN -RELATED ADVERSE EVENTS IN HYPERTENSIVE PATIENTS REVEALED BY COMPARISON OF BLINDED AND UN-BLINDED USE OF STATIN IN THE ANGLO-SCANDINAVIAN CARDIAC OUTCOMES TRIAL (ASCOT). J Hypertens 2016. [DOI: 10.1097/01.hjh.0000501498.29676.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Weber MA, Bloch M, Bakris GL, Weir MR, Zappe DH, Dahlof B, Velazquez EJ, Pitt B, Basile JN, Jamerson K, Hua TA. Cardiovascular Outcomes According to Systolic Blood Pressure in Patients With and Without Diabetes: An ACCOMPLISH Substudy. J Clin Hypertens (Greenwich) 2016; 18:299-307. [PMID: 27060568 DOI: 10.1111/jch.12816] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 11/28/2022]
Abstract
To evaluate the effects of achieved systolic blood pressure (SBP) during treatment on cardiovascular (CV) outcomes, the authors measured event rates of a composite primary endpoint (CV death or nonfatal myocardial infarction or stroke) at on-treatment SBPs of ≥140 mm Hg and the 10 mm Hg intervals of <140 mm Hg, <130 mm Hg, and <120 mm Hg in 6459 patients with diabetes (mean age, 67) and 4246 patients without diabetes (mean age, 69) from the Avoiding Cardiovascular Events in Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) trial. In the diabetic cohort, the primary endpoint was 49% lower (P<.001) at <140 mm Hg than at ≥140 mm Hg, and the separate components of this endpoint were also significantly reduced. Further SBP reductions did not improve outcomes, and at <120 mm Hg they were no longer different (except for stroke) from ≥140 mm Hg. In contrast, in the nondiabetic cohort, the primary endpoint event rate fell steadily (although not significantly) through the decreasing SBP categories until it was reduced by 45% (P=.0413) at <120 mm Hg. Total stroke rates for both the diabetic (-56%, P=.0120) and nondiabetic (-68%, P=.0067) cohorts were lowest at <120 mm Hg, and adverse renal events (serum creatinine increase ≥50%) were significantly lowest in the range of 130 mm Hg to 139 mm Hg for both cohorts. Diabetic patients (<140 mm Hg or <130 mm Hg) and nondiabetic patients (<120 mm Hg) may require different SBP targets for optimal CV protection, although stroke and renal considerations should also influence the selection of blood pressure targets.
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Affiliation(s)
| | - Michael Bloch
- University of Nevada, Reno, NV.,School of Medicine, Renown Institute for Heart and Vascular Health, Reno, NV
| | | | | | | | - Bjorn Dahlof
- Sahlgrenska University Hospital, Goteborg, Sweden
| | | | | | - Jan N Basile
- Medical University of South Carolina, Charleston, SC
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Zivin JA, Sehra R, Shoshoo A, Albers GW, Bornstein NM, Dahlof B, Kasner SE, Howard G, Shuaib A, Streeter J, Richieri SP, Hacke W. NeuroThera® Efficacy and Safety Trial-3 (NEST-3): a double-blind, randomized, sham-controlled, parallel group, multicenter, pivotal study to assess the safety and efficacy of transcranial laser therapy with the NeuroThera® Laser System for the treatment of acute ischemic stroke within 24 h of stroke onset. Int J Stroke 2014. [PMID: 23013107 DOI: 10.1111/j.1747-4949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
RATIONALE Transcranial laser therapy is undergoing clinical trials in patients with acute ischemic stroke. The NeuroThera® Efficacy and Safety Trial-1 was strongly positive for 90-day functional benefit with transcranial laser therapy, and post hoc analyses of the subsequent NeuroThera® Efficacy and Safety Trial-2 trial suggested a meaningful beneficial effect in patients with moderate to moderately severe ischemic stroke within 24 h of onset. These served as the basis for the NeuroThera® Efficacy and Safety Trial-3 randomized controlled trial. AIM The purpose of this pivotal study was to demonstrate safety and efficacy of transcranial laser therapy with the NeuroThera® Laser System in the treatment of subjects diagnosed with acute ischemic stroke. DESIGN NeuroThera® Efficacy and Safety Trial-3 is a double-blind, randomized, sham-controlled, parallel group, multicenter, pivotal study that will enroll 1000 subjects at up to 50 sites. All subjects will receive standard medical management based on the American Stroke Association and European Stroke Organization Guidelines. In addition to standard medical management, both groups will undergo the transcranial laser therapy procedure between 4·5 and 24 h of stroke onset. The study population will be randomized into two arms: the sham control group will receive a sham transcranial laser therapy procedure and the transcranial laser therapy group will receive an active transcranial laser therapy procedure. The randomization ratio will be 1:1 and will be stratified to ensure a balanced subject distribution between study arms. STUDY OUTCOMES The primary efficacy end point is disability at 90 days (or the last rating), as assessed on the modified Rankin Scale, dichotomized as a success (a score of 0-2) or a failure (a score of 3 to 6).
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Estol CJ, Bath PM, Gorelick PB, Cotton D, Martin RH, Weber MA, Dahlof B. Blood pressure measurement reliability among different racial-ethnic groups in a stroke prevention study. Blood Press Monit 2014; 19:256-62. [DOI: 10.1097/mbp.0000000000000045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Okin PM, Kjeldsen S, Dahlof B, Devereux R. LOWER ACHIEVED SYSTOLIC PRESSURE (≤130 MM HG) IS ASSOCIATED WITH WORSE RENAL FUNCTION BUT A SLOWER DECLINE IN GFR IN HYPERTENSIVE PATIENTS WITH ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY: THE LIFE STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Okin PM, Hille D, Wachtell K, Kjeldsen S, Dahlof B, Devereux R. RELATIONSHIP OF INCIDENT ATRIAL FIBRILLATION TO RENAL FUNCTION IN HYPERTENSIVE PATIENTS WITH ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY: THE LIFE STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61404-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mancusi C, Gerdts E, De Simone G, Abdelhai YM, Lonnebakken MT, Boman K, Wachtell K, Dahlof B, Devereux RB. Impact of isolated systolic hypertension on normalization of left ventricular structure during antihypertensive treatment in patients with electrocardiographic left ventricular hypertrophy (LIFE). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bakris G, Briasoulis A, Dahlof B, Jamerson K, Weber MA, Kelly RY, Hester A, Hua T, Zappe D, Pitt B. Comparison of benazepril plus amlodipine or hydrochlorothiazide in high-risk patients with hypertension and coronary artery disease. Am J Cardiol 2013; 112:255-9. [PMID: 23582626 DOI: 10.1016/j.amjcard.2013.03.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 10/26/2022]
Abstract
Combination therapy with benazepril 40 mg and amlodipine 10 mg (B+A) has been shown to be more effective than benazepril 40 mg and hydrochlorothiazide (HCTZ) 25 mg (B+H) in reducing cardiovascular (CV) events in high-risk patients with stage 2 hypertension with similar blood pressure reductions. In the present post hoc analysis, we evaluated whether B+A is more effective than B+H for reducing CV events in patients with known coronary artery disease (CAD) at baseline in a subgroup analysis of the Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension (ACCOMPLISH) study. The main trial randomized 11,506 patients. Of those, 5,744 received B+A and 5,762 received B+H. Of the 11,506 patients, 5,314 (46%) were classified as having CAD at baseline. The mean patient follow-up period was 35.7 months for the B+A group and 35.6 months for the B+H group. The primary end point was the interval to the first event of composite CV morbidity and mortality. At baseline, significant differences were present between the 5,314 with CAD and the 6,192 without CAD. The patients with CAD had a lower systolic blood pressure and heart rate, a lower incidence of diabetes, and greater incidence of dyslipidemia. However, no baseline differences were found between the randomized B+A and B+H groups. In the patients with CAD, an 18% reduction occurred in the hazard ratio for CV events (primary end point) with B+A versus B+H (p = 0.0016). In a prespecified secondary analysis of the composite end point, including only CV death, myocardial infarction, and stroke, the hazard ratio in the patients with CAD was reduced by 25% (p = 0.0033) in the B+A group compared with the B+H group. B+A was more effective than B+H at comparable blood pressure reductions for reducing CV events in patients, regardless of the presence of CAD. In conclusion, our findings suggest that the combination of B+A should be preferentially used for older patients with high-risk, stage 2 hypertension.
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Okin PM, Hille D, Wachtell K, Lindholm L, Dahlof B, Devereux R. STATIN USE AND RISK OF NEW DIABETES MELLITUS IN HYPERTENSivE PATIENTS: THE LIFE STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Okin PM, Hille D, Wachtell K, Kjeldsen S, Dahlof B, Devereux R. LOW IN-TREATMENT HDL CHOLESTEROL LEVELS STRONGLY PREDICT THE DEVELOPMENT OF NEW STROKE: THE LIFE STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Weber MA, Bakris G, Hester A, Weir M, Hua T, Zappe D, Dahlof B, Velazquez E, Pitt B, Jamerson K. RELATIONSHIPS BETWEEN SYSTOLIC BLOOD PRESSURE AND CARDIOVASCULAR OUTCOMES IN PATIENTS WITH HIGH RISK HYPERTENSION: AN ANALYSIS OF THE ACCOMPLISH TRIAL. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Weber MA, Jamerson K, Bakris GL, Weir MR, Zappe D, Zhang Y, Dahlof B, Velazquez EJ, Pitt B. Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trial. Lancet 2013; 381:537-45. [PMID: 23219284 DOI: 10.1016/s0140-6736(12)61343-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In previous clinical trials in high-risk hypertensive patients, paradoxically higher cardiovascular event rates have been reported in patients of normal weight compared with obese individuals. As a prespecified analysis of the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial, we aimed to investigate whether the type of hypertension treatment affects patients' cardiovascular outcomes according to their body size. METHODS On the basis of body-mass index (BMI), we divided the full ACCOMPLISH cohort into obese (BMI ≥30, n=5709), overweight (≥25 to <30, n=4157), or normal weight (<25, n=1616) categories. The ACCOMPLISH cohort had already been randomised to treatment with single-pill combinations of either benazepril and hydrochlorothiazide or benazepril and amlodipine. We compared event rates (adjusted for age, sex, diabetes, previous cardiovascular events, stroke, or chronic kidney disease) for the primary endpoint of cardiovascular death or non-fatal myocardial infarction or stroke. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00170950. FINDINGS In patients allocated benazepril and hydrochlorothiazide, the primary endpoint (per 1000 patient-years) was 30·7 in normal weight, 21·9 in overweight, and 18·2 in obese patients (overall p=0·0034). However, in those allocated benazepril and amlodipine, the primary endpoint did not differ between the three BMI groups (18·2, 16·9, and 16·5, respectively; overall p=0·9721). In obese individuals, primary event rates were similar with both benazepril and hydrochlorothiazide and benazepril and amlodipine, but rates were significantly lower with benazepril and amlodipine in overweight patients (hazard ratio 0·76, 95% CI 0·59-0·94; p=0·0369) and those of normal weight (0·57, 0·39-0·84; p=0·0037). INTERPRETATION Hypertension in normal weight and obese patients might be mediated by different mechanisms. Thiazide-based treatment gives less cardiovascular protection in normal weight than obese patients, but amlodipine-based therapy is equally effective across BMI subgroups and thus offers superior cardiovascular protection in non-obese hypertension. FUNDING Novartis Pharmaceuticals.
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Affiliation(s)
- Michael A Weber
- State University of New York, Downstate College of Medicine, Brooklyn, NY 11203, USA.
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Zivin JA, Sehra R, Shoshoo A, Albers GW, Bornstein NM, Dahlof B, Kasner SE, Howard G, Shuaib A, Streeter J, Richieri SP, Hacke W. NeuroThera® Efficacy and Safety Trial-3 (NEST-3): a double-blind, randomized, sham-controlled, parallel group, multicenter, pivotal study to assess the safety and efficacy of transcranial laser therapy with the NeuroThera® Laser System for the treatment of acute ischemic stroke within 24 h of stroke onset. Int J Stroke 2012; 9:950-5. [PMID: 23013107 DOI: 10.1111/j.1747-4949.2012.00896.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 03/06/2012] [Indexed: 11/30/2022]
Abstract
RATIONALE Transcranial laser therapy is undergoing clinical trials in patients with acute ischemic stroke. The NeuroThera® Efficacy and Safety Trial-1 was strongly positive for 90-day functional benefit with transcranial laser therapy, and post hoc analyses of the subsequent NeuroThera® Efficacy and Safety Trial-2 trial suggested a meaningful beneficial effect in patients with moderate to moderately severe ischemic stroke within 24 h of onset. These served as the basis for the NeuroThera® Efficacy and Safety Trial-3 randomized controlled trial. AIM The purpose of this pivotal study was to demonstrate safety and efficacy of transcranial laser therapy with the NeuroThera® Laser System in the treatment of subjects diagnosed with acute ischemic stroke. DESIGN NeuroThera® Efficacy and Safety Trial-3 is a double-blind, randomized, sham-controlled, parallel group, multicenter, pivotal study that will enroll 1000 subjects at up to 50 sites. All subjects will receive standard medical management based on the American Stroke Association and European Stroke Organization Guidelines. In addition to standard medical management, both groups will undergo the transcranial laser therapy procedure between 4·5 and 24 h of stroke onset. The study population will be randomized into two arms: the sham control group will receive a sham transcranial laser therapy procedure and the transcranial laser therapy group will receive an active transcranial laser therapy procedure. The randomization ratio will be 1:1 and will be stratified to ensure a balanced subject distribution between study arms. STUDY OUTCOMES The primary efficacy end point is disability at 90 days (or the last rating), as assessed on the modified Rankin Scale, dichotomized as a success (a score of 0-2) or a failure (a score of 3 to 6).
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Vardeny O, Pouleur AC, Takeuchi M, Appelbaum E, Verma A, Prescott M, Smith B, Dahlof B, Solomon SD. Influence of diabetes on efficacy of aliskiren, losartan or both on left ventricular mass regression. J Renin Angiotensin Aldosterone Syst 2012; 13:265-72. [DOI: 10.1177/1470320312437893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Orly Vardeny
- University of Wisconsin School of Pharmacy, Madison, USA
| | | | | | | | - Anil Verma
- Brigham and Women’s Hospital, Boston, USA
| | | | | | - Bjorn Dahlof
- Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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Okin PM, Wachtell K, Kjeldsen S, Lindholm L, Dahlof B, Devereux R. ASSOCIATION OF HIGH SERUM GLUCOSE LEVELS WITH LOW HDL CHOLESTEROL LEVELS IN NON-DIABETIC HYPERTENSIVE PATIENTS: IMPLICATIONS FOR THE DEVELOPMENT OF NEW DIABETES. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Okin PM, Hille D, Wachtell K, Kjeldsen S, Lindholm L, Dahlof B, Devereux R. LOW IN-TREATMENT HDL CHOLESTEROL LEVELS STRONGLY PREDICT SUDDEN CARDIAC DEATH IN HYPERTENSIVE PATIENTS: THE LIFE STUDY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Weir MR, Bakris GL, Weber MA, Dahlof B, Devereux RB, Kjeldsen SE, Pitt B, Wright JT, Kelly RY, Hua TA, Hester RA, Velazquez E, Jamerson KA. Renal outcomes in hypertensive Black patients at high cardiovascular risk. Kidney Int 2011; 81:568-76. [PMID: 22189843 DOI: 10.1038/ki.2011.417] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The ACCOMPLISH trial (Avoiding Cardiovascular events through Combination therapy in Patients Living with Systolic Hypertension) was a 3-year multicenter, event-driven trial involving patients with high cardiovascular risk who were randomized in a double-blinded manner to benazepril plus either hydrochlorothiazide or amlodipine and titrated in parallel to reach recommended blood pressure goals. Of the 8125 participants in the United States, 1414 were of self-described Black ethnicity. The composite kidney disease end point, defined as a doubling in serum creatinine, end-stage renal disease, or death was not different between Black and non-Black patients, although the Blacks were significantly more likely to develop a greater than 50% increase in serum creatinine to a level above 2.6 mg/dl. We found important early differences in the estimated glomerular filtration rate (eGFR) due to acute hemodynamic effects, indicating that benazepril plus amlodipine was more effective in stabilizing eGFR compared to benazepril plus hydrochlorothiazide in non-Blacks. There was no difference in the mean eGFR loss in Blacks between therapies. Thus, benazepril coupled to amlodipine was a more effective antihypertensive treatment than when coupled to hydrochlorothiazide in non-Black patients to reduced kidney disease progression. Blacks have a modestly higher increased risk for more advanced increases in serum creatinine than non-Blacks.
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Affiliation(s)
- Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Gupta A, Chang CL, Collier D, Dahlof B, Poulter N, Sever P. 758 THE RELATIONSHIP BETWEEN STATIN THERAPY AND PROGRESSION OF RENAL DAMAGE AMONG 10305 HYPERTENSIVE PATIENTS RANDOMISED IN THE ASCOT-LIPID-LOWERING ARM (LLA). ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70759-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vardeny O, Pouleur AC, Appelbaum E, Verma A, Prescott MF, Dahlof B, Solomon SD. INFLUENCE OF DIABETES ON LEFT VENTRICULAR MASS REGRESSION WITH ALISKIREN, LOSARTAN OR BOTH. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wiik BP, Larstorp ACK, Hoieggen A, Kjeldsen SE, Olsen MH, Ibsen H, Lindholm L, Dahlof B, Devereux RB, Okin PM, Wachtell K. Serum uric acid is associated with new-onset diabetes in hypertensive patients with left ventricular hypertrophy: The LIFE Study. Am J Hypertens 2010; 23:845-51. [PMID: 20431530 DOI: 10.1038/ajh.2010.89] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND It is unclear whether serum uric acid (SUA) is associated with development of new-onset diabetes (NOD) in patients with hypertension and left ventricular hypertrophy (LVH). The aim of the present investigation was to test the hypothesis that SUA predicts development of NOD in these patients. METHODS In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, a double-masked, parallel-group design, 9,193 patients with hypertension and electrocardiographic LVH were randomized to losartan- or atenolol-based antihypertensive treatment and followed for a mean of 4.9 years. At baseline, 7,489 patients with available SUA measurements did not have diabetes mellitus and were thus at risk of its development during the study. We used Cox regression analyses to investigate whether SUA predicted development of NOD. RESULTS NOD developed in 522 of 7,489 patients. The association between baseline SUA and development of NOD was significant (hazard ratio (HR) 1.29 per s.d. (1.3 mg/dl), 95% confidence interval (CI) 1.18-1.42, P < 0.001) after adjustment for treatment with losartan vs. atenolol, baseline serum glucose, urinary albumin/creatinine ratio, estimated glomerular filtration rate and Framingham risk score, time-varying systolic and diastolic blood pressure, and time-varying LVH by Cornell voltage-duration product and Sokolow-Lyon voltage. In parallel analyses, baseline quartiles of SUA were significantly associated with increasing NOD (HR 1.28, 95% CI 1.18-1.40, P < 0.001). Time-varying SUA was also associated with NOD (HR 1.10 per s.d. [1.3 mg/dl], 95% CI 1.02-1.19, P = 0.015). CONCLUSION Our analysis suggests that SUA is an independent risk marker for NOD in hypertensive patients with LVH.
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Okin PM, Kjeldsen SE, Julius S, Hille DA, Dahlof B, Edelman JM, Devereux RB. All-cause and cardiovascular mortality in relation to changing heart rate during treatment of hypertensive patients with electrocardiographic left ventricular hypertrophy. Eur Heart J 2010; 31:2271-9. [DOI: 10.1093/eurheartj/ehq225] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Gupta AK, Dahlof B, Sever PS, Poulter NR. Metabolic syndrome, independent of its components, is a risk factor for stroke and death but not for coronary heart disease among hypertensive patients in the ASCOT-BPLA. Diabetes Care 2010; 33:1647-51. [PMID: 20413525 PMCID: PMC2890375 DOI: 10.2337/dc09-2208] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate whether in hypertensive patients the risk of cardiovascular disease is greater in association with the metabolic syndrome (MetS) or the sum of its individual components. RESEARCH DESIGN AND METHODS Cox regression analysis models were developed to assess the influence of age, sex, ethnicity, and the individual components of MetS on risk associated with the MetS (using several definitions) of coronary outcomes, stroke, and all-cause mortality. RESULTS MetS was significantly associated with coronary outcomes, stroke, and all-cause mortality after adjusting for age, sex, and ethnicity. However, when the model was further adjusted for the individual components, MetS was associated with significantly increased risk of stroke (hazard ratio 1.34 [95% CI 1.07-1.68]) and all-cause mortality (1.35 [1.16-1.58]) but not coronary outcomes (fatal coronary heart disease plus nonfatal myocardial infarction 1.16 [0.95-1.43] and total coronary events 1.06 [0.91-1.24]). CONCLUSIONS MetS, independent of its individual components, is associated with increased risk of stroke and all-cause mortality but not coronary outcomes.
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Affiliation(s)
- Ajay K Gupta
- International Centre for Circulatory Health, National Heart & Lung Institute, Imperial College London, London, U.K.
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Sever PS, Poulter NR, Mastorantonakis S, Chang CL, Dahlof B, Wedel H. Coronary heart disease benefits from blood pressure and lipid-lowering. Int J Cardiol 2009; 135:218-22. [PMID: 19232755 DOI: 10.1016/j.ijcard.2009.01.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 01/09/2009] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND We have reported the benefits of atorvastatin and of an amlodipine-based regimen on coronary heart disease (CHD) events in hypertensive patients in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). We report further analyses on the combined benefits of these interventions. METHODS 19,342 hypertensive patients were randomised to either an amlodipine or an atenolol-based regimen in the ASCOT Blood Pressure-Lowering Arm (BPLA). 10,305 subjects with total cholesterol <or=6.5 mmol/L were further randomised to atorvastatin 10 mg or placebo in the Lipid-Lowering Arm (LLA). Estimates of CHD risk at baseline based on the Framingham algorithm were compared with observed and predicted event rates throughout ASCOT-LLA. RESULTS Estimated baseline Framingham risk of CHD events was 22.8 per 1000 patient years. After 3.3 years, when the LLA was stopped, the actual CHD event rate had fallen to 4.8 per 1000 patient years--a reduction of 79% in those assigned amlodipine-based treatment and atorvastatin. CONCLUSIONS CHD benefits associated with BP and lipid lowering were larger than predicted by previous observational and trial data. We estimate that compared with pre-trial treatment, treating about 55 patients with the amlodipine-based regimen and atorvastatin would prevent one CHD event per year.
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Affiliation(s)
- Peter S Sever
- Clinical Pharmacology and Therapeutics, Imperial College London, International Centre for Circulatory Health, London, UK.
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Zivin JA, Albers GW, Bornstein N, Chippendale T, Dahlof B, Devlin T, Fisher M, Hacke W, Holt W, Ilic S, Kasner S, Lew R, Nash M, Perez J, Rymer M, Schellinger P, Schneider D, Schwab S, Veltkamp R, Walker M, Streeter J. Effectiveness and safety of transcranial laser therapy for acute ischemic stroke. Stroke 2009; 40:1359-64. [PMID: 19233936 DOI: 10.1161/strokeaha.109.547547] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE We hypothesized that transcranial laser therapy (TLT) can use near-infrared laser technology to treat acute ischemic stroke. The NeuroThera Effectiveness and Safety Trial-2 (NEST-2) tested the safety and efficacy of TLT in acute ischemic stroke. METHODS This double-blind, randomized study compared TLT treatment to sham control. Patients receiving tissue plasminogen activator and patients with evidence of hemorrhagic infarct were excluded. The primary efficacy end point was a favorable 90-day score of 0 to 2 assessed by the modified Rankin Scale. Other 90-day end points included the overall shift in modified Rankin Scale and assessments of change in the National Institutes of Health Stroke Scale score. RESULTS We randomized 660 patients: 331 received TLT and 327 received sham; 120 (36.3%) in the TLT group achieved favorable outcome versus 101 (30.9%), in the sham group (P=0.094), odds ratio 1.38 (95% CI, 0.95 to 2.00). Comparable results were seen for the other outcome measures. Although no prespecified test achieved significance, a post hoc analysis of patients with a baseline National Institutes of Health Stroke Scale score of <16 showed a favorable outcome at 90 days on the primary end point (P<0.044). Mortality rates and serious adverse events did not differ between groups with 17.5% and 17.4% mortality, 37.8% and 41.8% serious adverse events for TLT and sham, respectively. CONCLUSIONS TLT within 24 hours from stroke onset demonstrated safety but did not meet formal statistical significance for efficacy. However, all predefined analyses showed a favorable trend, consistent with the previous clinical trial (NEST-1). Both studies indicate that mortality and adverse event rates were not adversely affected by TLT. A definitive trial with refined baseline National Institutes of Health Stroke Scale exclusion criteria is planned.
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Affiliation(s)
- Justin A Zivin
- Department of Neurosciences, University of California San Diego, San Diego, CA 92161, USA.
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Bakris G, Hester A, Weber M, Dahlof B, Pitt B, Velasquez E, Staikos-Byrne L, Shi V, Jamerson K. The Diabetes Subgroup Baseline Characteristics of the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) Trial. ACTA ACUST UNITED AC 2008; 3:229-33. [DOI: 10.1111/j.1559-4572.2008.00023.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Palmieri V, Bella JN, Gerdts E, Wachtell K, Papademetriou V, Nieminen MS, Dahlof B, Devereux RB. Change in pulse pressure/stroke index in response to sustained blood pressure reduction and its impact on left ventricular mass and geometry changes: the life study. Am J Hypertens 2008; 21:701-7. [PMID: 18437127 DOI: 10.1038/ajh.2008.162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In cross-sectional data in hypertensive subjects, brachial pulse pressure (PP)/Doppler stroke index (SVi), (PP/SVi) correlates weakly but significantly with left ventricular (LV) mass and relative wall thickness (RWT). METHODS In the Losartan Intervention For End-point reduction in hypertension (LIFE) study, we evaluated the impact of antihypertensive treatment on change of PP/SVi as raw indicator of systemic arterial stiffness, and further explored the impact of the change in PP/SVi on the change in LV mass and RWT. RESULTS Compared to baseline, mean PP/SVi reduction was -13% at year 1, -15% at year 2, and -16% at year 3 follow-up, and was sustained through year 4 and year 5 follow-ups; change in PP/SVi was related to increased SVi and decreased PP during the annual follow-ups, but not to LV mass change. Restricting analyses to the first two follow-ups to ensure highest statistical power, age >65 and diabetes were associated with higher PP/SVi at baseline and throughout follow-ups; black participants and women had baseline PP/SVi mean values comparable with those of their counterparts, showed blunted PP/SVi reduction after 1 year, but differences became smaller and not statistically significant at year 2 follow-up. Losartan- or atenolol-based treatments were associated with comparable reduction of PP/SVi. At year 2 follow-up, reduced PP/SVi was associated with greater reductions in mean blood pressure (BP) and heart rate and greater increase in SVi, but not with lower LV mass; RWT was lower with lower PP/SVi at year 2 follow-up. CONCLUSIONS Reduction in PP/SVi by long-term antihypertensive treatment did not have significant impact on change in LV mass index, but correlated with LV remodeling toward eccentric geometry.
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Gerdts E, Cramariuc D, de Simone G, Wachtell K, Dahlof B, Devereux RB. Impact of left ventricular geometry on prognosis in hypertensive patients with left ventricular hypertrophy (the LIFE study). European Journal of Echocardiography 2008; 9:809-15. [DOI: 10.1093/ejechocard/jen155] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gupta AK, Dahlof B, Dobson J, Sever PS, Wedel H, Poulter NR. Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial--Blood Pressure Lowering Arm and the relative influence of antihypertensive medication. Diabetes Care 2008; 31:982-8. [PMID: 18235048 DOI: 10.2337/dc07-1768] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the baseline predictors of new-onset diabetes (NOD) in hypertensive patients and to develop a risk score to identify those at high risk of NOD. RESEARCH DESIGN AND METHODS Among 19,257 hypertensive patients in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) who were randomly assigned to receive one of two antihypertensive regimens (atenolol +/- thiazide or amlodipine +/- perindopril), 14,120 were at risk of developing diabetes at baseline. Of these, 1,366 (9.7%) subsequently developed NOD during median follow-up of 5.5 years. A multivariate Cox model was developed to identify the independent predictors of NOD and individual risk scores. RESULTS NOD was significantly associated with an increase in baseline fasting plasma glucose (FPG), BMI, serum triglycerides, and systolic blood pressure. In contrast, amlodipine +/- perindopril in comparison with atenolol +/- thiazide treatment (hazard ratio 0.66 [95% CI 0.59-0.74]), high HDL cholesterol, alcohol use, and age >55 years were found to be significantly protective factors. FPG was the most powerful predictor with risk increasing by 5.8 times (95% CI 5.23-6.43) for each millimole per liter rise >5 mmol/l. The risk of NOD increased steadily with increasing quartile of risk score, with a 19-fold increase (95% CI 14.3-25.4) among those in the highest compared with those in the lowest quartile. The model showed excellent internal validity and discriminative ability. CONCLUSIONS Baseline FPG >5 mmol/l, BMI, and use of an atenolol +/- diuretic regimen were among the major determinants of NOD in hypertensive patients. The model developed from these data allows accurate prediction of NOD among hypertensive subjects.
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Affiliation(s)
- Ajay K Gupta
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, UK
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Okin PM, Wachtell K, Devereux RB, Nieminen MS, Oikarinen L, Viitasalo M, Toivonen L, Ibsen H, Olsen MH, Borch-Johnsen K, Lindholm LH, Kjeldsen SE, Julius S, Dahlof B. Combination of the electrocardiographic strain pattern and albuminuria for the prediction of new-onset heart failure in hypertensive patients: the LIFE study. Am J Hypertens 2008; 21:273-9. [PMID: 18219298 DOI: 10.1038/ajh.2007.66] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although albuminuria and the electrocardiographic (ECG) strain pattern each predict development of heart failure (HF), whether combining albuminuria and strain improves prediction of new HF is unclear. METHODS The relation of ECG strain and albuminuria to new-onset HF was examined in 7,786 hypertensive patients with no history of HF, who were randomly assigned to treatment with losartan or atenolol. Albuminuria was defined by a urine albumin/creatinine ratio >30.94 mg/g. RESULTS During a mean follow-up of 4.7 +/- 1.1 years, new-onset HF occurred in 231 patients (3.0%). Five-year HF rate was highest when both strain and albuminuria were present (10.4%), intermediate when only ECG strain (8.0%) or albuminuria (4.9%) was present, and lowest when neither strain nor albuminuria was present at baseline (1.8%, P < 0.0001). In Cox multivariable analyses, controlling for HF risk factors, treatment assignment and baseline severity of ECG left ventricular hypertrophy (LVH) by both Sokolow-Lyon voltage and Cornell product, ECG strain and albuminuria remained significant predictors of incident HF, with the presence of both strain and albuminuria associated with the highest risk (HR 2.8, 95% CI 1.8-4.4) and the presence of only strain (HR 2.6, 95% CI 1.7-4.0) or albuminuria (HR 2.1, 95% CI 1.5-2.8) with intermediate risk of new HF compared with the absence of both strain and albuminuria. CONCLUSIONS The combination of albuminuria and ECG strain identifies hypertensive patients at an increased risk of developing HF in the setting of aggressive blood pressure lowering, independent of treatment modality and of other risk factors for HF.
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Sever PS, Poulter NR, Dahlof B, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes G, Mehlsen J, Nieminen MS, O'Brien ET, Ostergren J. The Anglo-Scandinavian Cardiac Outcomes Trial lipid lowering arm: extended observations 2 years after trial closure. Eur Heart J 2008; 29:499-508. [DOI: 10.1093/eurheartj/ehm583] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lampl Y, Zivin JA, Fisher M, Lew R, Welin L, Dahlof B, Borenstein P, Andersson B, Perez J, Caparo C, Ilic S, Oron U. Infrared laser therapy for ischemic stroke: a new treatment strategy: results of the NeuroThera Effectiveness and Safety Trial-1 (NEST-1). Stroke 2007; 38:1843-9. [PMID: 17463313 DOI: 10.1161/strokeaha.106.478230] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE The NeuroThera Effectiveness and Safety Trial-1 (NEST-1) study evaluated the safety and preliminary effectiveness of the NeuroThera Laser System in the ability to improve 90-day outcomes in ischemic stroke patients treated within 24 hours from stroke onset. The NeuroThera Laser System therapeutic approach involves use of infrared laser technology and has shown significant and sustained beneficial effects in animal models of ischemic stroke. METHODS This was a prospective, intention-to-treat, multicenter, international, double-blind, trial involving 120 ischemic stroke patients treated, randomized 2:1 ratio, with 79 patients in the active treatment group and 41 in the sham (placebo) control group. Only patients with baseline stroke severity measured by National Institutes of Health Stroke Scale (NIHSS) scores of 7 to 22 were included. Patients who received tissue plasminogen activator were excluded. Outcome measures were the patients' scores on the NIHSS, modified Rankin Scale (mRS), Barthel Index, and Glasgow Outcome Scale at 90 days after treatment. The primary outcome measure, prospectively identified, was successful treatment, documented by NIHSS. This was defined as a complete recovery at day 90 (NIHSS 0 to 1), or a decrease in NIHSS score of at least 9 points (day 90 versus baseline), and was tested as a binary measure (bNIH). Secondary outcome measures included mRS, Barthel Index, and Glasgow Outcome Scale. Primary statistical analyses were performed with the Cochran-Mantel-Haenszel rank test, stratified by baseline NIHSS score or by time to treatment for the bNIH and mRS. Logistic regression analyses were conducted to confirm the results. RESULTS Mean time to treatment was >16 hours (median time to treatment 18 hours for active and 17 hours for control). Time to treatment ranged from 2 to 24 hours. More patients (70%) in the active treatment group had successful outcomes than did controls (51%), as measured prospectively on the bNIH (P=0.035 stratified by severity and time to treatment; P=0.048 stratified only by severity). Similarly, more patients (59%) had successful outcomes than did controls (44%) as measured at 90 days as a binary mRS score of 0 to 2 (P=0.034 stratified by severity and time to treatment; P=0.043 stratified only by severity). Also, more patients in the active treatment group had successful outcomes than controls as measured by the change in mean NIHSS score from baseline to 90 days (P=0.021 stratified by time to treatment) and the full mRS ("shift in Rankin") score (P=0.020 stratified by severity and time to treatment; P=0.026 stratified only by severity). The prevalence odds ratio for bNIH was 1.40 (95% CI, 1.01 to 1.93) and for binary mRS was 1.38 (95% CI, 1.03 to 1.83), controlling for baseline severity. Similar results held for the Barthel Index and Glasgow Outcome Scale. Mortality rates and serious adverse events (SAEs) did not differ significantly (8.9% and 25.3% for active 9.8% and 36.6% for control, respectively, for mortality and SAEs). CONCLUSIONS The NEST-1 study indicates that infrared laser therapy has shown initial safety and effectiveness for the treatment of ischemic stroke in humans when initiated within 24 hours of stroke onset. A larger confirmatory trial to demonstrate safety and effectiveness is warranted.
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Affiliation(s)
- Yair Lampl
- Wolfson Medical Center, Department of Neurology, Holon, Israel
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Kizer JR, Hoieggen A, Alderman MH, Kjeldsen SE, Dahlof B, Julius S, Beevers G, de Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H, Edelman JM, Snapinn SM, Devereux RB. 812-4 Serum uric acid and ischemic stroke risk among hypertensive patients with left ventricular hypertrophy: The losartan intervention for endpoint reduction in hypertension (LIFE) study. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)92011-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sever PS, Dahlof B, Poulter N, Wedel H. 882-1 Anglo-scandinavian cardiac outcomes trial — lipid-lowering arm (ASCOT-LLA): Results in the subgroup of patients with diabetes. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)92243-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gerdts E, Papademetriou V, Wachtell K, Nieminen M, Bjornstad H, Franklin S, Dahlof B, Devereux RB. 1009-166 Pulse pressure as cardiovascular risk marker during losartan or atenolol based therapy in hypertensive patients with electrocardiographic left ventricular hypertrophy (the LIFE trial). J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kjeldsen SE, Dahlof B, Devereux RB, Julius S, Aurup P, Edelman J, Beevers G, de Faire U, Fyhrquist F, Ibsen H, Kristianson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Snapinn SM, Wedel H, Lyle PA. 1085-170 Benefits of losartan on preventing stroke in patients with isolated systolic hypertension: A LIFE substudy. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)92040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Devereux R, Brenner B, Carr A, Dahlof B, Dickson T, Edelman J, Lindholm L, Shahinfar S, Snapinn S. Losartan reduces hospitalization for heart failure in patients with diabetes and no prior history of heart failure. J Card Fail 2003. [DOI: 10.1016/s1071-9164(03)00243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, Snapinn S, Harris KE, Aurup P, Edelman JM, Dahlof B. Regression of electrocardiographic left ventricular hypertrophy by losartan versus atenolol: The Losartan Intervention for Endpoint reduction in Hypertension (LIFE) Study. Circulation 2003; 108:684-90. [PMID: 12885747 DOI: 10.1161/01.cir.0000083724.28630.c3] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Electrocardiographic left ventricular hypertrophy (LVH) predicts cardiovascular morbidity and mortality, and regression of ECG LVH may predict improved prognosis in hypertensive patients. However, uncertainty persists as to how best to regress ECG LVH. METHODS AND RESULTS Regression of ECG LVH with losartan versus atenolol therapy was assessed in 9193 hypertensive patients with ECG LVH by Sokolow-Lyon voltage or Cornell voltage-duration product criteria enrolled in the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study. Patients had ECGs at study baseline and after 6 months, 1, 2, 3, 4, and 5 years of blinded losartan-based or atenolol-based therapy. After 6 months' follow-up, adjusting for baseline ECG LVH levels, baseline and in-treatment systolic and diastolic pressures, and for diuretic therapy, losartan-based therapy was associated with greater regression of both Cornell product (adjusted means, -200 versus -69 mm. ms, P<0.001) and Sokolow-Lyon voltage (-2.5 versus -0.7 mm, P<0.001) than was atenolol-based therapy. Greater regression of ECG LVH persisted at each subsequent annual evaluation in the losartan-treated group, with between 140 and 164 mm. ms greater mean reductions in Cornell product and from 1.7 to 2.2 mm greater mean reductions in Sokolow-Lyon voltage (all P<0.001). The effect of losartan was consistent across subgroups defined by gender, age, ethnicity, and diabetes. CONCLUSIONS After adjusting for baseline and in-treatment blood pressure and baseline severity of ECG LVH, losartan-based antihypertensive therapy resulted in greater regression of ECG LVH by Cornell voltage-duration product and Sokolow-Lyon voltage criteria than did atenolol-based therapy. These findings support the value of angiotensin receptor blockade with losartan for reversing ECG LVH.
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Affiliation(s)
- Peter M Okin
- Department of Medicine, Cornell University Medical Center, 525 East 68th St, New York, NY 10021, USA.
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Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen M, Papademetriou V, Rokkedal J, Snapinn S, Aurup P, Dahlof B. Prognostic significance of left ventricular hypertrophy during treatment of hypertension: The LIFE study. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81645-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Palmieri V, Bella JN, DeQuattro V, Roman MJ, Hahn RT, Dahlof B, Sharpe N, Lau CP, Chen WC, Paran E, de Simone G, Devereux RB. Relations of diastolic left ventricular filling to systolic chamber and myocardial contractility in hypertensive patients with left ventricular hypertrophy (The PRESERVE Study). Am J Cardiol 1999; 84:558-62. [PMID: 10482155 DOI: 10.1016/s0002-9149(99)00377-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abnormalities of left ventricular (LV) diastolic filling and stress-corrected midwall shortening (MWS) have been described in hypertensive patients with normal ejection fraction (EF). However, whether stress-corrected MWS parallels LV diastolic filling better than EF does remains uncertain. Blood pressure, body mass index, echocardiographic LV mass and LV geometry, EF and stress-corrected MWS, LV diastolic filling (peak E- and A-wave velocities, E-wave deceleration time, and atrial filling fraction) were evaluated in 212 hypertensive patients with LV hypertrophy enrolled in the Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement study. LV structure, geometry, as well as LV diastolic filling, were compared between patients with reduced EF (<55%, n = 39, 18%) and those with normal EF (>55%) as well as between patients with reduced stress-corrected MWS (<89.2%, n = 31, 15%) and those with normal stress-corrected MWS (>89.2%). Patients with reduced EF had higher LV mass, eccentric LV geometry, and higher heart rate than those with normal EF, although they did not differ in age, blood pressure, or body mass index. LV filling pattern was also similar in those 2 groups. Patients with reduced stress-corrected MWS had higher atrial filling fraction, body mass index, heart rate, LV mass, and concentric geometry than those with normal stress-corrected MWS. Atrial filling fraction was negatively associated with stress-corrected MWS, but not with EF in multivariate models, independently of age, gender, heart rate, and body mass index. Thus, in hypertensive patients with LV hypertrophy, abnormal LV diastolic filling is more closely related to impaired myocardial contractility than to LV chamber EF.
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Affiliation(s)
- V Palmieri
- Department of Medicine, The New York Presbyterian Hospital-Joan and Sanford I. Weill Medical College of Cornell University, New York 10021, USA
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Devereux RB, Dahlof B, Levy D, Pfeffer MA. Comparison of enalapril versus nifedipine to decrease left ventricular hypertrophy in systemic hypertension (the PRESERVE trial). Am J Cardiol 1996; 78:61-5. [PMID: 8712120 DOI: 10.1016/s0002-9149(96)00228-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The PRESERVE (Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement) study is designed to provide a definitive test of the ability of enalapril to achieve greater left ventricular (LV) mass reduction than nifedipine GITs (gastrointestinal treatment system) by a degree that would be prognostically meaningful on a population basis (10 g/m2). To achieve this goal, an ethnically diverse population of 480 men and women with essential hypertension and increased LV mass of screening echocardiography will be enrolled at clinical centers on 4 continents and studied by echocardiography at baseline and after 6 and 12 months' randomized therapy. Blinded readings of echocardiograms at a central laboratory will provide systematic information about treatment effects on LV structure, wall motion, and Doppler blood flow. The study power is at least 90% to test the primary hypotheses that enalapril will induce greater normalization of LV mass and diastolic filling than nifedipine. After the 1-year echocardiographic trial, the study population will be followed 3 more years to test the hypothesis that a reduction in LV mass, independent of blood pressure lowering, is associated with a reduction in the risk of morbid and fatal cardiovascular events.
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Affiliation(s)
- R B Devereux
- Department of Medicine, The New York Hospital-Cornell Medical Center, New York 10021, USA
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Devereux RB, Dahlof B. Criteria for an informative trial of left ventricular hypertrophy regression. J Hum Hypertens 1994; 8:735-9. [PMID: 7837209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although many studies have been made of hypertensive left ventricular (LV) hypertrophy regression, most have been marred by small numbers of subjects, unrepresentative populations, short study duration, lack of comparison between agents, unblinded echocardiographic readings and inappropriate statistical methods. Meta-analysis and critical reviews of this flawed literature suggest, but do not prove, that some antihypertensive drug classes may reverse LV hypertrophy more effectively than others. Eagerly awaited multicentre trials have not provided definitive answers because of pre-emptive success of concomitant nonpharmacological therapy in reversing both hypertension and LV hypertrophy or excessive drop-out of study participants. Future studies that avoid the above limitations are needed to address three sets of questions: relatively small ones (n > or = 40 to 60) to investigate pathophysiology in detail or explore the effects of new agents; medium-sized ones (n > or = 300-400, time > or = 1 year) to determine definitively whether inter-agent differences in reduction of LV mass exist; and large long-term trials (n > or = 1200, time > or = 4 years) to determine whether LV hypertrophy reversal improves prognosis over and above blood pressure reduction and the type of treatment used.
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Affiliation(s)
- R B Devereux
- Department of Medicine, New York Hospital-Cornell Medical Center, NY 10021
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Abstract
Preliminary results of a randomized, double-blind, placebo-controlled trial of PN 200-110 (isradipine) are reported. The study involves 5 centers and 61 patients with essential hypertension. Either PN 200-110 or placebo was added to an ongoing daily regimen of 10 mg of pindolol to determine if this agent would enhance the effect of the beta-adrenoreceptor blocking agent. PN 200-110 was given twice daily, starting with a dose of 2.5 mg or 5 mg, which could be doubled after 4 weeks. The average final dose was 6.3 mg given twice daily. Supine blood pressure was significantly reduced from a mean of 162/103 mm Hg to 144/88 mm Hg (p less than 0.001) in the patients who received the combination therapy. Heart rate did not change significantly. In 3 patients therapy was withdrawn, 1 during placebo and 2 during active treatment, owing to definite or suspected side effects.
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