Author
Suzanne Oparil
Other affiliations: Michigan State University, Oregon Health & Science University, National Institutes of Health ...read more
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.
Papers published on a yearly basis
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TL;DR: ABPM results support an intensive treatment approach in hypertensive patients (pts) unresponsive to ARB monotherapy using ambulatory blood pressure monitoring (ABPM), and home BP reductions were observed with intensive vs moderate treatment.
Abstract: Objective: To evaluate the efficacy of initiating treatment with an intensive dose of amlodipine/valsartan (A/V 5/320 to 10/320 mg) vs a moderate dose of A/V (5/160 mg) in hypertensive patients (pts) unresponsive to ARB monotherapy using ambulatory blood pressure monitoring (ABPM). Methods: This analysis presents data in a subset of pts (n=80) in a 12-wk study. Pts aged >=18 years on ARB (other than V) for >=28 d (with treatment-naive pts or those not controlled on agents other than an ARB treated with olmesartan 20 or 40 mg, respectively, for 28 d) and with uncontrolled MSSBP (>=150– 140 mmHg. ABPM was compared with home and clinic BP. Results: As with clinic BP, intensive treatment provided significant 24 h ABP reductions vs moderate treatment (table). Numerically greater home BP reductions were observed with intensive vs moderate treatment (p=NS). In the overall study, AEs were reported by a similar percentage of pts in both groups (36.3% intensive, 37.6% moderate); the most common AEs were peripheral edema (8.7%, 4.5%) and dizziness (5.1%, 3.9%). Conclusion: ABPM results support an intensive treatment approach in this pt population.
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TL;DR: Initiating treatment of hypertensive diabetic or stage 2 CKD pts with an intensive dose of A/V provided greater antihypertensive efficacy than moderate treatment.
Abstract: Objective: Hypertensive patients (pts) with diabetes (D) or CKD are at high risk and require > = 2 agents for BP control. In a 12-wk study of hypertensive pts unresponsive to ARB monotherapy, initial treatment with intensive dose of amlodipine/valsartan (A/V 5/320 to 10/320 mg) provided significantly greater BP efficacy than moderate dose (5/160 mg). Here we present data in D pts, stage-2 CKD pts (eGFR > = 60–<90 mL/min/1.73 m2), and stage-3 CKD pts (eGFR > = 30–<60 mL/min/1.73 m2). Methods: Pts aged > = 18 years on ARB (other than V) for > = 28 d (with treatment-naïve pts or pts not controlled on agents other than an ARB treated with olmesartan 20 or 40 mg, respectively, for 28 d) and with uncontrolled MSSBP (> = 150–<200 mmHg) were randomized to A/V 5/320 or 5/160 mg; increased to 10/320 mg in the intensive arm at Wk 2 and addition of HCTZ 12.5 mg to both arms at Wk 4; optional up-titration with HCTZ 12.5 mg at Wk 8 was allowed if MSSBP >140 mmHg. Results: Intensive treatment provided significant BP reductions vs moderate treatment by Wk 4 in D and stage 2 CKD pts (table). Overall, percent AEs were similar in both groups (36.3% intensive, 37.6% moderate); most common AEs were peripheral edema (8.7%, 4.5%) and dizziness (5.1%, 3.9%). Figure 1. No caption available. Conclusion: Initiating treatment of hypertensive diabetic or stage 2 CKD pts with an intensive dose of A/V provided greater antihypertensive efficacy than moderate treatment.
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1 citations
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TL;DR: According to current standards for initiation of treatment, 50% of patients did not need to resume medication up to 2 years after cessation of a 2year course of candesartan, and the authors of the letter note that the BP visit-to-visit variability is higher in treated compared with the untreated patients.
Abstract: To the Editor: We are glad to see that 6 years after publication of the Trial of Preventing Hypertension (TROPHY), the results are still being debated. Only truly new and important findings can elicit such an interest. TROPHY reported more robust results in the first 2 than in the second 2 years of the study. Two years of treatment with candesartan produced a 66.3% relative risk reduction (RRR) of hypertension, and the treatment was well tolerated. At the end of year 4, the RRR in the group that had been switched from candesartan to placebo at year 2 was highly significant but clinically modest (15.6%). We stated that “we do not advocate treatment of 25 million people with prehypertension and that further studies are needed.” This call for action was a smashing success. The Short Treatment with the Angiotensin Receptor Blocker Candesartan Surveyed by Telemedicine (STAR CAST) study in Japan will analyze the reversal from stage 1 to prehypertension and is nearly completed. The CHINON study in China recruited 10,000 patients and will compare cardiovascular outcomes in active treatment and placebo groups. In Brazil the Hypertension Prevention in Pre-Hypertensive Individuals (PREVER) study evaluates the effect of diuretic treatment in patients with prehypertension who failed to respond to lifestyle modification. In the meantime, we responded to an early critique of TROPHY by reanalyzing data according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) definition of hypertension. In the reanalysis, all original findings were confirmed and the median time to hypertension as defined by JNC 7 was 4.0 years in the group previously randomized to candesartan. Thus, according to current standards for initiation of treatment, 50% of patients did not need to resume medication up to 2 years after cessation of a 2year course of candesartan. We are disappointed that this body of work had escaped Dr Schalkwyk’s and Turner’s attention. We have recently published a paper in this Journal on the measurement of visit-to-visit variability of blood pressure (BP) using data from the placebo arm of the TROPHY trial. This work was intended to investigate different approaches to the estimation of visit-to-visit variability, an active area of BP research. The authors of the letter note that the BP visit-to-visit variability is higher in treated compared with the untreated patients, referring to the results in Figure 1 of the article. Their observation is what one would expect when BP is treated; that is, the visit-to-visit variability for patients initiating treatment for hypertension will be higher than those not initiating treatment because of the effect of treatment. For example, if a patient has systolic BP readings of 143, 139, 145, and 146 mmHg at visits 1 through 4 without antihypertensive medication use (pretreatment: standard deviation=3.1 mm Hg) and 134, 128, 135, and 132 mm Hg at visits 5 through 8 following antihypertensive medication initiation (posttreatment: standard deviation=3.1 mm Hg), the overall standard deviation will be 6.5 mm Hg, which more than doubles from the actual value due to treatment effect. When the effect of treatment is excluded, that is, the post-treatment BP measures were censored, the variability in patients who initiated treatment vs patients always untreated was similar (Figure 1). TROPHY produced a rich set of data that we will continue to analyze according to our sense of priorities. We anticipate that ongoing trials will clarify many questions that TROPHY could not resolve. However, there is a need for additional studies. None of the ongoing trials of prehypertension will discontinue active treatment and thereafter evaluate incident hypertension. We invite Drs Schalkwyk and Turner to join the international community and design an AustralianNew Zealand study that could provide new insights and verify or disprove their assumptions.
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TL;DR: Initiating treatment in hypertensive MetS pts with an intensive dose of A/V provided significantly greater antihypertensive efficacy than moderate treatment.
Abstract: Hypertensive patients (pts) with cardiometabolic syndrome (MetS) are at high-risk and require >=2 agents for BP control. Previously in a 12-week study, initial treatment with an intensive dose of amlodipine/valsartan (A/V 5/320 to 10/320 mg) provided significantly greater BP lowering and control than moderate dose (5/160 mg) in hypertensive patients (pts) unresponsive to ARB monotherapy. Here we present the data in a subset of MetS pts by ATP III criteria.
Pts aged >=18 years on ARB (other than V) for >=28 days (with treatment-naive pts or those not controlled on agents other than ARB treated with open-label olmesartan 20 or 40 mg, respectively, for 28 days) and with uncontrolled mean sitting systolic BP (MSSBP; >=150- 140 mmHg.
In the subset of 345 MetS pts (mean age 56 years, 51% women), baseline MSSBP was similar between groups (table). Intensive treatment provided significantly greater BP reductions vs moderate treatment from Week 4 (primary endpoint) to Week 12. At Weeks 4 and 8, significantly more pts in the intensive vs moderate arm achieved BP goal (<140/90 mmHg). In the overall study, percent adverse events (AEs) were similar in both groups (36.3% intensive, 37.6% moderate); most common AEs were peripheral edema (8.7%, 4.5%) and dizziness (5.1%, 3.9%).
Initiating treatment in hypertensive MetS pts with an intensive dose of A/V provided significantly greater antihypertensive efficacy than moderate treatment.
1 citations
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TL;DR: There is, I think, something ethereal about i —the square root of minus one, which seems an odd beast at that time—an intruder hovering on the edge of reality.
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 …
33,785 citations
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Boston University1, Rush University Medical Center2, University of Tennessee Health Science Center3, University of Michigan4, University at Buffalo5, University of Mississippi6, University of Miami7, University of Alabama at Birmingham8, Case Western Reserve University9, National Institutes of Health10
TL;DR: The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated, and empathy builds trust and is a potent motivator.
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.
24,988 citations
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TL;DR: In those older than age 50, systolic blood pressure of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP, and hypertension will be controlled only if patients are motivated to stay on their treatment plan.
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.
14,975 citations
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TL;DR: In this article, a randomized controlled trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly people was presented. But the authors did not discuss the effect of the combination therapy in patients living with systolic hypertension.
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 …
14,173 citations
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TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
13,400 citations