Showing papers by "Joseph L. Izzo published in 2004"

Arterial stiffness and the systolic hypertension syndrome.

Abstract: Purpose of reviewThis review is intended to provide the background for a new comprehensive hemodynamic view of the syndrome of systolic or wide pulse pressure hypertension and its hallmark abnormality: increased central arterial stiffness.Recent findingsStudies of the pathogenesis of systolic hypert

Antihypertensive efficacy of candesartan-lisinopril in combination vs. up-titration of lisinopril: the AMAZE trials.

Abstract: The AMAZE (A Multicenter Trial Using Atacand and Zestril vs. Zestril to Evaluate the Effects on Lowering Blood Pressure) program included two identical studies sponsored by AstraZeneca LP. The oral form of candesartan is candesartan cilexetil; for simplicity, the term "candesartan" is used throughout this manuscript. Two identical multicenter, randomized, double-blind studies were performed to determine if addition of the angiotensin receptor blocker candesartan was more effective in lowering blood pressure than up-titration of lisinopril. Hypertensive patients (N=1,096) who were uncontrolled on lisinopril 20 mg daily were randomized (1:1) to receive either 8 weeks of high-dose lisinopril (40 mg) or the addition of candesartan (16 mg) for 2 weeks followed by 32 mg for 6 weeks. Study 1 (n=538) demonstrated decreases in trough sitting systolic/diastolic blood pressures at Week 8 by 6.2/5.9 mm Hg, respectively, for the lisinopril up-titration treatment group and by 11.6/8.3 mm Hg, respectively, for the lisinopril plus candesartan treatment group (p<0.01 in comparing both blood pressures reductions between the two treatment groups). Corresponding results for Study 2 (n=558) are reductions of 8.7/6.2 mm Hg and 9.5/7.4 mm Hg, respectively, for each of the two treatment groups. For Study 2, comparisons of systolic/diastolic blood pressures between the two treatment groups were not statistically significantly different (p=0.51/p=0.08, respectively). Post hoc pooled analysis (N=1,096) demonstrated a slightly greater blood pressure reduction with lisinopril plus candesartan compared with lisinopril (3.1/1.7 mm Hg). A 95% confidence interval limit for the difference in least squares mean change from baseline in systolic blood pressure between the two treatment groups is -4.8 to -1.5 and is -2.8 to -0.7 in mm Hg for diastolic blood pressure. The blood pressure control rates (<140/<90 mm Hg) were 42.7% and 36.9%, respectively. Both treatment regimens were well tolerated in all groups. In conclusion, for hypertensive patients not controlled by lisinopril 20 mg once daily, addition of candesartan (32 mg once daily) or doubling the dose of lisinopril provides safe, additional reduction of blood pressure.

Blood Pressure Goal Attainment: Meeting the Challenge of the JNC 7's Blood Pressure Goals and the Role of Renin‐Angiotensin‐Aldosterone System Blockade

Abstract: This roundtable discussion, held in December 2003, was convened to discuss the impact of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure's (JNC 7) challenging blood pressure goal objectives for the clinical management of hypertensive patients. The discussion was moderated by Michael Weber, MD, of the State University of New York Downstate College of Medicine in New York City. Participants included leading experts in the field Joseph Izzo, Jr., MD, of the School of Medicine and Biomedical Sciences at the State University of New York at Buffalo; Suzanne Oparil, MD, of the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham; and Jan Basile, MD, of the Ralph H. Johnson VA Medical Center and Department of General Internal Medicine/Geriatrics, Medical University of South Carolina in Charleston. The primary intention of this roundtable is to educate physicians about the importance of achieving the blood pressure goals agreed upon by the JNC 7 Committee and to present practical ways for the attainment of such goals in clinical practice.

62 – Biochemical Assessment of Sympathoadrenal Activity

Abstract: Publisher Summary This chapter discusses the major biochemical techniques for the assessment of sympathoadrenal system (SAS) activity. Because of the complex pattern, no single measurement of catecholamine or its metabolites can provide full assessment of SAS activity at any given time. Full assessment of SAS activation requires integration of information from several diverse analytic approaches that are generally more complementary than redundant. Plasma norepinephrine (NE) remains the most durable and widely used biochemical index to assess physiologic and pathologic increases in sympathetic activity. Total or fractionated urinary catecholamines are used occasionally in the determination of 24-hour sympathetic nervous activity and are still quite commonly used in the diagnosis of pheochromocytoma. Under usual conditions, the bulk of urinary NE is derived from circulatory rather than renal sources. Normal total urinary catecholamine values are usually 100 mcg or less per day. Metanephrines, the primary O-methylated metabolites of catecholamines, have limited usefulness in the physiologic assessment of sympathetic tone.