Suzanne Oparil

Bio: Suzanne Oparil is an academic researcher from University of Alabama at Birmingham. The author has contributed to research in topics: Blood pressure & Angiotensin II. The author has an hindex of 106, co-authored 885 publications receiving 113983 citations. Previous affiliations of Suzanne Oparil include Michigan State University & Oregon Health & Science University.

Spironolactone improves blood pressure and left ventricular hypertrophy in patients with resistant hypertension

Abstract: Background: Hyperaldosteronism is being recognized to be increasingly prevalent particularly in patients with resistant hypertension and is believed in addition to raising blood pressure (BP) to induce cardiac fibrosis and LVH. We hypothesize that spironolactone a mineralocorticoid receptor antagonist, could improve blood pressure control and LVH in this high risk population. Methods: Patients with resistant hypertension (defined as requiring 4 or more antihypertensive agents) were treated with spironolactone 25mg once daily and up titrated to 50mg daily. Clinic BP, 24-hr ambulatory BP, cardiac MRI, plasma renin activity (PRA), brain natriuretic peptide (BNP) were measured before and 6 months after treatment with spironolactone. Results: Eleven subjects with a mean age 54.5_7.2 years and BMI 36.1_6.2 kg/m2 were evaluated. Ten of 11 subjects were receiving optimal doses of a thiazide diuretic as part of their treatment regimen. Clinic BP (134_13/81_7 vs. 120_11/76_7 mm Hg; p _ 0.015, p_ns), ambulatory daytime BP (142_15/83_10 vs. 132_16/76_12 mm Hg; p_ns), nighttime BP (132_16/ 74_14 vs. 121_14/65_11 mm Hg; p_0.05), 24-hr ABPM (139_15/80_11 vs. 129_15/ 73_12 mm Hg; p_ns), BNP (44.1_52.0 vs. 16.1_18.1 pg/ml; p _ 0.02), left ventricular (LV) end diastolic volume (170.0_43.9 vs. 160.9_46.4 ml; p_ns), end diastolic LV mass (178.4_48.6 vs. 148.5_33.4 gm; p _ 0.006), end systolic LV mass (195.2_55.6 vs. 155.5_34.6 gm; p _ 0.003), mean LV mass (186.8_51.9 vs. 151.9_33.8 gm; p _ 0.004), LV posterior wall thickness (10_1.9 vs. 9_1.8 mm; p_ns), interventricular septal thickness (11.3_2.4 vs. 9.6_2.2 mm; p _ 0.008) were lower at the end of six months following spiranolactone treatment compared to baseline. Serum potassium (3.7_0.4 vs. 4.3_0.5 mEq/L; p _ 0.006), serum creatinine (0.99_0.2 vs. 1.2_0.3 mg/dl; p_0.02) and PRA (1.7_2.2 vs. 12.2_16.1 ng/ml/hr; p_0.002) were higher. Conclusion: Our findings demonstrate for the first time in humans that spironolactone improves BP control and reduces LVH in patients with resistant hypertension who are receiving optimal doses of thiazide diuretics. These results suggest that mineralocorticoid receptor blockade specifically benefits patients with resistant hypertension beyond conventional diuretic therapy.

HOPE-3 and SPRINT: two landmark trials with different outcomes?

Abstract: clinical trials beginning with the landmark VA trial. 1 In this trial, 143 men with a diastolic pressure 115‐129 mm Hg were randomized to active treatment with hydrochlorothiazide (HCTZ) plus reserpine plus hydralazine or placebo. Dramatic reductions in cardiovascular disease (CVD) outcomes (two cases of cerebrovascular thrombosis and multiple drug toxicity) occurred in the active treatment group compared to 27 CVD outcomes (hypertensive retinopathy, congestive heart failure, increasing azotemia, cerebrovascular thrombosis, transient ischemic attacks, cerebral hemorrhage, myocardial infarction, and severely elevated blood pressure (BP)) and four deaths in the placebo group. This study soundly refuted that the then prevailing hypothesis that ‘‘hypertension may be an important compensation mechanism which should not be tampered with.’’ 2 Many subsequent controlled clinical trials have shown the CVD benefit of lowering BP in patients with various forms of hypertension, diastolic and isolated systolic, severe and less severe, among different racial/ethnic and age groups and associated with a variety of comorbid

Update on Clinical Guidelines for Treatment of Hypertension

Abstract: The 2014 US Hypertension Guideline (JNC 8) differs from many other contemporary guidelines. It is focused on the 3 most important questions in hypertension management: (1) When to initiate treatment? (2) How low should you go? (3) How do you get there? It takes a rigorous approach, based on evidence from randomized controlled trials (RCTs) with important health outcomes, the gold standard for determining efficacy and effectiveness of medical treatments. To facilitate implementation, treatment goals are simplified. The goal (BP <140/90 mm Hg) is the same for all hypertensive adults except when RCT evidence supports different goals for a particular subpopulation, ie, <150/90 mm Hg for those over age 60 without chronic kidney disease (CKD) or diabetes. Four medication classes, ACEI, ARB, CCB, or thiazide-type diuretic, alone or in combination, are recommended as initial therapy, except when evidence indicates a preference for a specific class, as in racial and CKD subgroups.

Conflicting and confusing data from the hypertension treatment trials: whom and what should you believe?

Abstract: Following a hypertension symposium in Atlanta, GA on March 30, 2005, a roundtable was convened to discuss a confusing topic: "Conflicting Information from the Hypertension Treatment Trials: Whom and What Should You Believe?" Dr. Marvin Moser, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT, moderated the panel discussion. Participants included Dr. Thomas Giles, Professor of Medicine at Louisiana State University Health Sciences Center, New Orleans, LA and President of the American Society of Hypertension, and Dr. Suzanne Oparil, Professor of Medicine at the University of Alabama at Birmingham, Birmingham, AL.

I and i

Abstract: There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality. Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

Abstract: "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, β-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Abstract: The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …