Showing papers by "Joseph L. Izzo published in 2014"

Reversibility of left ventricular mechanical dysfunction in patients with hypertensive heart disease.

Abstract: OBJECTIVE Prior studies indicate that hypertension is associated with mechanical systolic dysfunction, even in the presence of a normal ejection fraction, but whether this cardiac dysfunction may be ameliorated by antihypertensive treatment is unknown. METHODS To test the hypothesis that mechanical systolic dysfunction in hypertension may respond to blood pressure-lowering therapy, we studied 182 patients with uncontrolled hypertension who underwent a 24-week trial of intensive versus standard antihypertensive therapy (titrated to a goal SBP -15%). RESULTS Despite all patients having a preserved left ventricular ejection fraction (≥50%), almost a third (32%) had mechanical systolic dysfunction at baseline. In the total sample, GLS significantly improved in response to antihypertensive therapy (-16.8 ± 3.8 to -18.7 ± 3.4%; P < 0.0001), and this improvement was especially evident in patients with baseline dysfunction (13.1 ± 2.2 to -17.0 ± 2.9%; P < 0.0001). Improvement in GLS was associated with lower BMI (P = 0.015) and was greater in women than in men (P = 0.003). Although uncorrelated with blood pressure change, GLS improvement was related to having received high doses of antihypertensive therapy during the study (P = 0.040). CONCLUSION In patients with hypertensive heart disease and normal left ventricular ejection fraction, abnormalities in left ventricular mechanical systolic function can be ameliorated in the setting of targeted antihypertensive treatment.

Triple-Combination Treatment with Olmesartan Medoxomil/ Amlodipine/ Hydrochlorothiazide in Hispanic/Latino Patients with Hypertension: The TRINITY Study

Abstract: Objective(s): Evaluate efficacy/safety of olmesartan medoxomil (OM)/amlodipine (AML)/ hydrochlorothiazide (HCTZ) in Hispanic/Latino adults with hypertension. Design: Randomized, double-blind, 12-week, parallel-group study followed by a 40-week open-label extension phase. Setting: Clinical sites (317) in the United States and Puerto Rico. Patients or Participants: Individuals ≥18 years of age with mean seated blood pressure (BP) ≥140/100 or ≥160/90 mm Hg divided into Hispanic/Latino (369) and non-Hispanic/Latino (2122) subgroups. Interventions: Participants were randomized to OM 40/AML 10 mg, OM 40/HCTZ 25 mg, AML 10/HCTZ 25 mg, or OM 40/AML 10/HCTZ 25 mg during the double-blind phase. During the open-label extension, all participants received OM 40/AML 5/HCTZ 12.5 mg; participants not reaching BP goal within 2 weeks were randomly titrated to OM40/AML 10/HCTZ 12.5mg or OM 40/AML 5/HCTZ 25mg, then to OM40/AML 10/ HCTZ 25 mg after another 2 weeks. Main Outcome Measure: Change in mean seated diastolic BP (SeDBP) from baseline (double-blind phase). Results: Triple-drug therapy vs the dual therapies resulted in greater mean reduction in SeBP (Hispanic/Latino: 35.0/20.9 mm Hg vs 27.8– 30.9/15.3–17.7 mm Hg; non-Hispanic/Latino: 39.0/21.7 mm Hg vs 28.9–31.5/14.6–17.8 mm Hg) and enabled more participants to reach BP goal (Hispanic/Latino: 56.8% vs 40.6%–51.2%; non-Hispanic/Latino: 65.7% vs 33.8%–46.6%) irrespective of ethnicity. The efficacy of triple-drug therapy in achieving BP goal was sustained long-term(40-week open-label extension period) in Hispanic/Latino (63.3%) and non-Hispanic/ Latino (64.2%) participants. Triple-drug therapy was well tolerated in Hispanic/Latino and non- Hispanic/Latino participants. Conclusions: In this study, OM/AML/HCTZ was an effective treatment option in Hispanic/ Latino patients with hypertension. (Ethn Dis. 2014;24[1]:41–47)

Age and the effectiveness of anti-hypertensive therapy on improvement in diastolic function.

Abstract: Objective Diastolic dysfunction is associated with adverse outcomes and is highly prevalent among older adults with hypertension. Lowering SBP with antihypertensive therapy has been shown to improve diastolic function, but whether or not age influences this effect is unknown. Methods In the Exforge Intensive Control of Hypertension to Evaluate Efficacy in Diastolic Dysfunction trial, 189 patients (age range 45-93 years) with hypertension and diastolic dysfunction underwent echocardiography before and after 24 weeks of intensive versus standard antihypertensive therapy titrated to a goal SBP below 135 versus below 140 mmHg. We performed linear regression analyses to examine the association between age and improvement in diastolic function achieved with SBP reduction. Results Antihypertensive therapy reduced SBP by 28 ± 19 mmHg overall, and this was not significantly different across age strata. However, percentage improvement in diastolic relaxation velocity (lateral E' peak velocity) for every 10 mmHg reduction in SBP was lower in older compared to younger patients. In analyses adjusting for age stratum, sex, treatment arm, baseline relaxation velocity, and baseline blood pressure, older age was associated with reduced improvement in diastolic relaxation velocity per 10 mmHg of SBP reduction (β -1.64, P = 0.009). In contrast, the degree of change in left ventricular mass index per 10 mmHg reduction in SBP was not influenced by age (P = 0.89). Conclusions In our sample of individuals with hypertension and diastolic dysfunction, older compared to younger adults experienced less improvement in diastolic function in response to similar reductions in SBP.