Showing papers by "Joseph L. Izzo published in 2007"

Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention

Abstract: Epidemiological studies have established a strong association between hypertension and coronary artery disease (CAD). Hypertension is a major independent risk factor for the development of CAD, stroke, and renal failure. The optimal choice of antihypertensive agents remains controversial, and there are only partial answers to important questions in the treatment of hypertension in the prevention and management of ischemic heart disease (IHD), such as: ● What are the appropriate systolic blood pressure (SBP) and diastolic blood pressure (DBP) targets in patients at high risk of developing CAD or in those with established CAD? ● Are the beneficial effects of treatment simply a function of blood pressure (BP) lowering, or do particular classes of drugs have uniquely protective actions in addition to lowering BP? ● Are there antihypertensive drugs that have shown particular efficacy in the primary and secondary prevention of IHD? ● Which antihypertensive drugs should be used in patients who have established CAD with stable or unstable angina pectoris, in those with non–ST-elevation myocardial infarction (NSTEMI), and in those with ST-elevation myocardial infarction (STEMI)?

Efficacy and Safety of Treating Stage 2 Systolic Hypertension With Olmesartan and Olmesartan/HCTZ: Results of an Open-Label Titration Study

Abstract: This study investigated an aggressive treatment program for stage 2 systolic hypertension (pretreatment systolic blood pressure [SBP] ≥160 mm Hg) using the angiotensin receptor blocker olmesartan medoxomil (OM) and hydrochlorothiazide (HCTZ). In this open-label, 16-week trial, 170 subjects received OM 20 mg/d for 3 weeks. If seated SBP/diastolic BP remained ≥120/80 mm Hg, subjects were advanced to successive 3-week courses of OM 40 mg/d, OM/HCTZ 40/12.5 mg/d, and OM/HCTZ 40/25 mg/d. OM 20 mg/d reduced mean SBP by 16.9 mm Hg (P<.001), and there were further dose-dependent decreases in mean SBP to a maximum of 34.5 mm Hg with OM/HCTZ 40/25 mg/d. At study end, 75.1% of subjects achieved SBP goal (<140 mm Hg) and 16.0% achieved SBP normalization (<120 mm Hg). Treatment was well tolerated at all doses. The addition of HCTZ did not change serum potassium levels but resulted in a dose-independent but not symptomatic increase in serum glucose and uric acid. The authors conclude that an OM-based regimen, with or without HCTZ in conventional doses, is effective in controlling and normalizing BP in stage 2 systolic hypertension.

Aging and arterial structure-function relations.

Abstract: Aging and hypertension interact and are associated with long-term changes in arterial structure and function. Systolic BP is not constant along the arterial tree due to different proportional contributions of forward and reflected pressure waves. Brachial cuff BP values are inadequate to detect these changes. Increased PP is the result of an imbalance between arterial flow and arterial impedance, which can be due to increased effective arterial wall stiffness or to a smaller proportional arterial diameter. After middle age, there is both dilation and stiffening of large arteries, along with increased effective stiffness caused by the corresponding changes in content of collagen, elastin, and VSM in the vascular wall. Intermediate conduit arteries also dilate with age but their functional characteristics remain relatively preserved. In the microcirculation, vasoconstriction, VSM hypertrophy and rarefaction accompany and may contribute to changes in organ function.

REPRINT Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention

Abstract: Epidemiological studies have established a strong association between hypertension and coronary artery disease (CAD). Hypertension is a major independent risk factor for the development of CAD, stroke, and renal failure. The optimal choice of antihypertensive agents remains controversial, and there are only partial answers to important questions in the treatment of hypertension in the prevention and management of ischemic heart disease (IHD), such as: This scientific statement summarizes the published data relating to the treatment of hypertension in the context of CAD prevention and management and attempts, on the basis of the best available evidence, to develop recommendations that will be appropriate for both BP reduction and the management of CAD in its various manifestations. Where data are meager or lacking, the writing group has proposed consensus recommendations, with all of the reservations that that term implies and with the hope that large gaps in our knowledge base will be filled in the near future by data from well-designed prospective clinical trials. All of the discussion and recommendations refer to adults. The writing committee has not addressed hypertension or IHD in the pediatric age group. Also, there is no discussion of the different …

Prehypertension: Demographics, pathophysiology, and treatment

Abstract: The term prehypertension, which first appeared in the Seventh Report of the Joint National Committee (JNC 7) in 2003, has sparked controversy in the field of hypertension. Systolic blood pressure (BP) rises with age in industrialized societies, but an individual's rate of rise of systolic BP and the age at which BP crosses the arbitrary threshold of hypertension depends on prior BP levels (hence "prehypertension"). Obesity, another major factor in prehypertension, activates neurohumoral systems (renin-angiotensin and sympathetic nervous) and contributes to age-related BP increases. The JNC 7 recommendation for prehypertension management with optimal weight control (largely through diet and exercise) remains the mainstay, especially in the elderly. The Trial of Prevention of Hypertension demonstrated that angiotensin receptor blockade (ARB) retards age-related BP increases in prehypertensive patients. Associated elevated risk conditions (prediabetes, hypercholesterolemia, microalbuminuria) may justify early use of ARB therapy (in men and in women without childbearing potential) if weight control fails.

Titration of HCTZ to 50 mg Daily in Individuals With Stage 2 Systolic Hypertension Pretreated With an Angiotensin Receptor Blocker

Abstract: The authors studied the combination of hydrochlorothiazide (HCTZ) 50 mg/d plus olmesartan medoxomil (OM) 40 mg/d in stage 2 systolic hypertension during an extension phase of an open-label 12-week dose titration study. Subjects whose blood pressure remained above 120/80 mm Hg (n=105) on OM 40/HCTZ 25 mg/d subsequently received OM 40/HCTZ 50 mg/d for 4 weeks. Increasing HCTZ from 25 mg/d to 50 mg/d decreased systolic blood pressure by 3.6 mm Hg, increased BP control rates (<140/90 mm Hg) from 70.4% to 77.5%, and increased BP normalization rates (<120/80 mm Hg) from 15.4% to 27.8%. The combination was well tolerated. Compared with OM 40 mg/d monotherapy, neither dose of HCTZ affected serum potassium, but both increased serum glucose by about 5%. There was a dose-dependent increase in uric acid but no acute gout attacks. OM 40/HCTZ 50 mg/d is an effective strategy for managing stage 2 systolic hypertension.

The role of therapeutic inertia and the use of fixed-dose combination therapy in the management of hypertension.

Abstract: On April 9, 2007, a panel discussion was held to discuss the role of therapeutic inertia and the value of using fixed-dose combination therapy in the management of hypertension. The panel was moderated by Jan Basile, MD, Professor of Medicine, Ralph H. Johnson VA Medical Center, Charleston, SC. Discussants included Henry R. Black, MD, Clinical Professor Internal Medicine, New York University School of Medicine, New York, NY, John A. Flack, MD, MPH, Professor and Interim Chair and Chief, Division of Translational Research and Epidemiology, Department of Medicine, Wayne State University, Detroit, MI, and Joseph L. Izzo, Professor and Vice Chair, State University of New York at Buffalo, Buffalo, NY. This expert panel discussion was supported by Novartis and each author received an honorarium from Novartis for time and effort spent participating in the discussion and reviewing the transcript for important intellectual content prior to publication. The authors maintained full control of the discussion and the resulting content of this article.

The use of renin inhibitors in the management of hypertension.

Abstract: During a meeting of the American Society of Hypertension, an expert panel was convened to discuss the use of renin inhibitors in the management of hypertension. Marvin Moser, MD, of the Yale University School of Medicine, New Haven, CT, moderated the panel, which included Domenic A. Sica, MD, Virginia Commonwealth University Health System, Richmond, VA, and Joseph L. Izzo Jr, MD, State University of New York, Buffalo, NY. This expert panel discussion was supported by Novartis and each author received an honorarium from Novartis for time and effort spent participating in the discussion and reviewing the transcript for important intellectual content prior to publication. The authors maintained full control of the discussion and the resulting content of this article; Novartis had no input in the choice of topic, speakers, or content.

First-step use of fixed-dose combination treatment in stage 2 hypertensive patients: has the time come?

Abstract: A panel discussion was convened on February 14, 2007, to discuss the use of fixed-dose combination therapy for stage 2 hypertensive patients. The panel was moderated by Michael A. Weber, MD, Professor of Medicine, SUNY Downstate College of Medicine, New York, NY. Participants included Luis Ruilope, MD, Chief, Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain, Thomas D. Giles, MD, Professor of Medicine, Tulane University School of Medicine, Metairie, LA, and Joseph L. Izzo, Jr, MD, Professor of Medicine, Department of Medicine, State University of New York at Buffalo, Buffalo, NY.