KDOQI US Commentary on the 2017 ACC/AHA Hypertension Guideline

Hypertension is a modifiable risk factor for cardiovascular morbidity and mortality and reduction of elevated blood pressure (BP) remains an important intervention for slowing kidney disease progression. Over the past decade, the most appropriate BP target for initiation and titration of BP-lowering medications has been an area of intense research and debate within the clinical community. In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) in conjunction with several other professional societies released new hypertension guidelines based on data from a systematic review of clinical trials and observational data. While many of the recommendations in the ACC/AHA hypertension guideline are relevant to nephrology practice, BP targets and management strategies for patients receiving dialysis are not discussed. This Kidney Disease Outcomes Quality Initiative (KDOQI) commentary focuses largely on recommendations from the ACC/AHA hypertension guidelines that are pertinent to individuals at risk of chronic kidney disease or with non-dialysis-dependent chronic kidney disease. This KDOQI commentary also includes a brief discussion of the consensus statement regarding hypertension diagnosis and management for adults receiving maintenance dialysis published by the European Renal and Cardiovascular Medicine Working Group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension. Overall, we support the vast majority of the ACC/AHA recommendations and highlight select areas in which best diagnosis and treatment options remain controversial.

A phase III, open-label, multicenter study to evaluate the safety and efficacy of long-term triple combination therapy with azilsartan, amlodipine, and hydrochlorothiazide in patients with essential hypertension

PURPOSE

Patients with essential hypertension who are receiving treatment with an angiotensin II receptor blocker and a calcium channel blocker often develop inadequate blood pressure (BP) control and require the addition of a diuretic. This study aimed to evaluate the long-term safety and efficacy of a triple combination therapy with 20 mg azilsartan (AZL), 5 mg amlodipine (AML) and 12.5 mg hydrochlorothiazide (HCTZ).

MATERIALS AND METHODS

The phase III, open-label, multicenter study (NCT02277691) comprised a 4-week run-in period and 52-week treatment period. Patients with inadequate BP control despite AZL/AML therapy (n = 341) received 4 weeks' treatment with AZL/AML (combination tablet) + HCTZ (tablet) and 4 weeks' treatment with AZL/AML/HCTZ (combination tablet) in a crossover manner, followed by AZL/AML/HCTZ (combination tablet) from Week 8 of the treatment period up to Week 52. The primary and secondary endpoints were long-term safety and BP (office and home), respectively.

RESULTS

Most adverse events (AEs) were mild or moderate in intensity, and no deaths or treatment-related serious AEs were reported. The triple therapy provided consistent BP-lowering effects in both office and home measurements.

CONCLUSIONS

The triple combination therapy with AZL/AML/HCTZ was well tolerated and effective for 52 weeks in Japanese patients with essential hypertension.

Eighth Joint National Committee (JNC-8) Guidelines and the Outpatient Management of Hypertension in the African-American Population

Background:

Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8) guidelines, there have been major changes in blood pressure management in the various subgroups.

Aim:

Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens.

Materials and Methods:

African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI), age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows — Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB) only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed.

Results:

In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6%) were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage.

Conclusion:

Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents.