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Showing papers in "Blood Pressure in 2007"


Journal ArticleDOI
TL;DR: Authors/Task Force Members: Giuseppe Mancia, co-Chairperson (Italy), Guy De Backer, Co-Chair person (Belgium), Anna Dominiczak (UK), Renata Cifkova (Czech Republic), Robert Fagard (Belgian), Giuseppo Germano (Italy) and Guido Grassi (Italy).
Abstract: Authors/Task Force Members: Giuseppe Mancia, Co-Chairperson (Italy), Guy De Backer, Co-Chairperson (Belgium), Anna Dominiczak (UK), Renata Cifkova (Czech Republic) Robert Fagard (Belgium), Giuseppe Germano (Italy), Guido Grassi (Italy), Anthony M. Heagerty (UK), Sverre E. Kjeldsen (Norway), Stephane Laurent (France), Krzysztof Narkiewicz (Poland), Luis Ruilope (Spain), Andrzej Rynkiewicz (Poland), Roland E. Schmieder (Germany), Harry A.J. Struijker Boudier (Netherlands), Alberto Zanchetti (Italy)

1,085 citations


Journal ArticleDOI
TL;DR: The ACCOMPLISH BP control rates are the highest of any multi‐national trial to date, and in this trial it is expedient and safe for both stage 1 and 2 hypertension.
Abstract: Background. ACCOMPLISH is a “new‐generation” hypertension trial assessing single‐tablet combination therapy for initial treatment of high‐risk hypertension. At baseline, 97% of subjects were treate...

117 citations


Journal ArticleDOI
TL;DR: It is noteworthy that the mean BMI of 31 in this cohort is clearly above the accepted diagnostic criterion of obesity and that 60% of patients are diabetic, possibly reflecting secular trends in clinical disease.
Abstract: ACCOMPLISH is the first trial designed to compare the effects on major fatal and non-fatal cardiovascular endpoints of two forms of antihypertensive combination therapy: benazepril plus hydrochlorothiazide and amlodipine plus benazepril in hypertensive patients at high cardiovascular risk. Enrollment for this trial is now complete and this report describes the clinical characteristics of the study cohort. Patients with hypertension and a previous history of cardiovascular events, strokes or diabetes mellitus were randomized to double-blind treatment with either of the two combination regimens. The data in this report detail the clinical history and demographic characteristics in patients immediately prior to randomization to study drugs. A total of 11,454 patients were randomized. Mean age (+/-SD) was 68.4+/-6.9 years, 60% were men, and 1360 (12%) were African American. Mean body mass index (BMI) was 31.0+/-6.3 kg/m(2). At study entry, 46% of patients had a history of acute coronary syndromes, coronary artery bypass grafts or percutaneous coronary interventions; 13% had a history of stroke. A history of diabetes mellitus was reported in 6928 (60%) of patients. Mean blood pressure at baseline (on prior hypertension therapy) was 145.4/80.0 mmHg; only 38% of patients had a BP less than 140/90 mmHg. Overall, 97% of patients had received previous antihypertensive treatment (74% on at least two drugs); 53% were on oral diabetes therapy or insulin, 68% on anti-lipid therapy and 63% on anti-platelet agents. In summary, the ACCOMPLISH trial has recruited hypertensive patients at high risk of cardiovascular morbidity and mortality. It is noteworthy that the mean BMI of 31 in this cohort is clearly above the accepted diagnostic criterion of obesity and that 60% of patients are diabetic, possibly reflecting secular trends in clinical disease.

63 citations


Journal ArticleDOI
TL;DR: It was shown that the risk of having non‐dipping hypertension, a risk factor for poor cardiovascular outcomes among hypertensive individuals, was tripled (odds ratios) among poor sleepers.
Abstract: Background. Sleep is a basic physiological process. Normal sleep yields decrease in sympathetic activity, blood pressure (BP) and heart rate. Those, who do not have expected decrease in their BP are considered “non‐dippers”. We aimed to determine if there was any association between the non‐dipping status and sleep quality, designed a cross‐sectional study, and enrolled and evaluated the sleep quality of relatively young patients with an initial diagnosis of hypertension. Methods. Seventy‐five consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients had newly diagnosed with stage 1 hypertension. Patients with a prior use of any anti‐hypertensive medication were not included. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI), which has an established role in evaluating sleep disturbances. All patients underwent ambulatory BP monitoring. Results. There were 42 non‐dipper patients (mean age = 47.5±11.9 years, 24 male/18...

60 citations


Journal ArticleDOI
TL;DR: Experimental studies indicate that there is a cause‐and‐effect type of relationship between the pulsatile component of blood pressure and atherosclerotic process, and the presence of a bidirectional link between atherosclerosis and PP is commonly postulated, meaning that an increased PP may be both a cause and an effect of Atherosclerosis.
Abstract: Pulse pressure (PP) is traditionally believed to increase cardiovascular risk because of an increase in afterload leading to left ventricular hypertrophy. It has also been emphasized that low diastolic blood pressure, being in part responsible for high PP, leads to an impairment of myocardial perfusion with all its adverse consequences. More recently, however, a direct role of pulsatile blood pressure changes in the pathogenesis of atherosclerosis and its complications has become better known. Experimental studies indicate that there is a cause-and-effect type of relationship between the pulsatile component of blood pressure and atherosclerotic process. A significant relationship between the parameters of the pulsatile blood pressure component and the extent of coronary atherosclerosis was also demonstrated. Currently the presence of a bidirectional link between atherosclerosis and PP is commonly postulated, meaning that an increased PP may be both a cause and an effect of atherosclerosis. This may result in a vicious circle wherein the pulsatile blood pressure component induces/enhances the development of atherosclerosis, which in its turn reduces the arterial compliance and enhances pulse wave reflection, thereby leading to an increase in PP. Currently new drug classes are being investigated, which might reduce the pulsatile blood pressure component without changing mean blood pressure level. Their clinical usefulness should become known over the next few years.

57 citations


Journal ArticleDOI
Paolo Verdecchia, Carlos Calvo, Volker Möckel1, Lucy Keeling1, Andrew Satlin1 
TL;DR: Aliskiren, a novel direct renin inhibitor, provides effective 24‐h BP lowering with no evidence of dose‐related increases in the incidence of adverse events in elderly patients with hypertension.
Abstract: Objectives. To evaluate the efficacy, safety and tolerability of aliskiren in elderly patients (⩾65 years old) with essential hypertension. Methods. In this double‐blind, multicenter study, 355 elderly patients with hypertension [office mean sitting systolic blood pressure (msSBP) ⩾145–<180 mmHg and mean 24‐h ambulatory systolic BP (ASBP) ⩾135 mmHg] were randomized to once‐daily treatment for 8 weeks with aliskiren 75 mg (n = 91), 150 mg (n = 84), 300 mg (n = 94) or the comparator lisinopril 10 mg (n = 86). The primary efficacy variable was change in mean 24‐h ASBP. Results. At endpoint, aliskiren 75 mg, 150 mg, 300 mg and lisinopril 10 mg lowered mean 24‐h ASBP (least‐squares mean±SEM) by 8.4±0.8, 7.1±0.8, 8.7±0.8 and 10.2±0.9 mmHg, and mean 24‐h ambulatory diastolic BP by 4.5±0.5, 3.6±0.5, 3.9±0.5 and 6.3±0.5 mmHg, respectively, with no significant difference between aliskiren doses. The trough‐to‐peak ratio for ASBP reduction with aliskiren 75 mg, 150 mg, 300 mg and lisinopril 10 mg was 0.77, 0.64, 0.7...

52 citations


Journal ArticleDOI
TL;DR: The results established a feasible link between arterial stiffness and seasonal BP variation, which may partly explain higher cardiovascular risk in patients with increased arterIAL stiffness.
Abstract: Background. Seasonal variation in blood pressure (BP), a usual tendency of both systolic (SBP) and diastolic BP (DBP) to rise during winter in hypertensive patients, may be related to the higher cardiovascular mortality in winter. However, it is not yet clear what factors are relevant to the seasonal BP changes. We hypothesized that arterial stiffness is related to the BP changes between summer and winter. Methods and results. Eighty‐five elderly (>55 years) patients with essential hypertension (33 males, 64±6.0 years) were enrolled. Seasonal BP profiles over at least 2 years were studied along with arterial stiffness and clinical variables (age, gender, smoking, duration of hypertension, anti‐hypertensive medications and body mass index). Both SBP and DBP were significantly higher during winter compared with three other seasons (spring 128±10.0/79±7.3 mmHg, summer 127±9.8/78±7.1 mmHg, autumn 127±10.3/78±8.0 mmHg, winter 136±12.5/81±7.6 mmHg; SBP changes; p<0.001, DBP changes; p<0.001). There were no sign...

38 citations


Journal ArticleDOI
TL;DR: Aortic elastic properties are significantly and LV diastolic function is slightly impaired in subjects with PHT, and impairment of aorti elasticity is as severe as that in hypertension.
Abstract: Background. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (BP) provides guideline for the new category of BP levels as normal, prehypertension (PHT), and hypertension. Although PHT is associated with a markedly increased risk of developing hypertension within 4 years, its prognostic significance and predisposition to target‐organ damage is unknown. Accordingly, we evaluated the effects of normal BP, PHT and hypertension on left ventricular (LV) diastolic function and aortic elasticity, which are sensitive indicators of target‐organ damage. Methods. We evaluated LV diastolic function and aortic elastic properties of 60 subjects with PHT, 70 patients with hypertension and 50 normotensive healthy volunteers using transthoracic echocardiography. None of the subjects had any systemic disease. Results. LV diastolic function was more significantly impaired in the hypertension group than in the PHT group compared with controls, but it...

38 citations


Journal ArticleDOI
TL;DR: There is a high prevalence in Spain of obesity and AO in patients with hypertension and these conditions are associated with metabolic alterations and worse BP control.
Abstract: Objectives. The aim of this study was to determine the prevalence of obesity in patients with hypertension and to evaluate the relationship between obesity, metabolic syndrome (MetS) and blood pressure (BP) control. Materials and methods. We conducted an epidemiological survey in a sample of 19,039 patients with hypertension who consecutively attended a primary healthcare center. Patients were considered to have hypertension if the BP was ⩾140/90 mmHg or ⩾130/80 mmHg in diabetic patients or if they were undergoing pharmacological treatment for hypertension. The obesity was based on body mass index (BMI). Overweight was if the BMI was ⩾25 kg/m2, obese ⩾30 kg/m2 and severe obesity (SO) if BMI was ⩾40 kg/m2. Abdominal obesity (AO) was considered when the waist circumference was greater than 102 cm in men and 88 cm in women. Results. The prevalence of obesity in our hypertensive patients was 51.6% and among these 3.8% had SO. Furthermore, 38.7% were overweight. AO was observed in 66.1% of the whole. Both obes...

36 citations


Journal ArticleDOI
TL;DR: In this elderly non‐diabetic hypertensive population, the presence of MS was independently related to a greater prevalence of hypertensive TOD and established CVD, suggesting a role of MS as a cardiovascular risk marker in hypertension.
Abstract: The aim of this study is to assess the relationship among metabolic syndrome (MS), target organ damage (TOD) and established cardiovascular disease (CVD) in non‐diabetic hypertensive elderly patients. ERIC‐HTA is cross‐sectional, multicentre study carried out in primary care, on hypertensive patients aged 55 or older. MS was defined by the NCEP‐ATP III criteria, using body mass index (>28.8 kg/m2) instead of abdominal perimeter. In 8331 non‐diabetic hypertensive patients (3663 men and 4668 women, mean age 67.7 years), the prevalence of MS was 32.6% (men: 29.0%; women: 36.8%). A linear association was observed between a greater number of components of MS and a greater prevalence of left ventricle hypertrophy (LVH) on the electrocardiogram (p<0.001), impaired kidney function (p<0.001) and established CVD (p = 0.001). In a multivariate model, MS in non‐diabetic hypertensive patients was related to a greater prevalence of LVH (OR 1.31 [95% CI: 1.15–1.48]), impaired kidney function (OR 1.45 [95% CI: 1.29–1.63]...

32 citations


Journal ArticleDOI
TL;DR: There is a major gap between how hypertensive patients are managed in Denmark and the current treatment goals and recommendations of hypertension, and predictors for not being optimally treated are identified.
Abstract: Objective. We describe the current status of awareness, treatment and control of hypertension in Denmark and identify predictors for not being optimally treated. Methods. A population‐based sample, the Inter99 study, of 6784 individuals aged 30–60 years completed a questionnaire about lifestyle and risk factors for cardiovascular disease and had a physical examination including at least two blood pressure (BP) measurements. Hypertension was defined as BP⩾140/90 mmHg or receiving medical treatment for hypertension. Predictors for awareness, treatment and control were analysed in logistic regression models. Results. Nearly 40% were diagnosed with hypertension and more than 60% were not aware of the diagnosis. Half of those aware of the diagnosis did not receive medical treatment and among those who did, only 21% had their hypertension controlled. Only 10% of all persons aware of their hypertension had a BP below 140/90 mmHg. A higher degree of awareness and treatment of hypertension was positively associate...

Journal ArticleDOI
TL;DR: Bicuspid aortic valve and stenosis severity were independent predictors of ascending aorta dimensions, but not the history of hypertension and blood pressure, which was the aim of this study.
Abstract: Background/aims. Aortic stenosis (AS) and hypertension are associated with cardiac hypertrophy and aortic dilatation. The effect of their coincidence on the ascending aortic dimensions has not yet been evaluated, and therefore was the aim of our study. Methods. We performed cross‐sectional analysis of history, clinical, angiographic and echocardiographic data of consecutive patients evaluated before surgery for non‐rheumatic AS. Results. The study sample included 225 patients (age 68±9 years, 60% males), with mean transaortic gradient of 55±17 mmHg. Hypertension was present in 153 (68%) patients. The hypertensives had more severe dyspnea (NYHA class 2.2±0.9 vs 1.9±0.9, p = 0.05) and higher prevalence of coronary artery disease (57% vs 33%, p = 0.001), but did not differ from the normotensives in the ascending aortic dimensions, the left ventricular mass, ejection fraction and remodeling patterns. Wider ascending aortic dimensions were independently associated with bicuspid aortic valve (p<0.001), and with...

Journal ArticleDOI
TL;DR: It is demonstrated that an increase in LV mass and alterations in LV diastolic function are related to endothelial dysfunction.
Abstract: Objectives. We aimed to investigate left ventricular (LV) morphology and function in normotensive offspring of subjects with essential hypertension (familial trait – FT), and to determine the association between LV mass and determinants of LV diastolic function and endothelium‐dependent (NO‐mediated) dilation of the brachial artery (BA). Materials and methods. The study encompassed 76 volunteers of whom 44 were normotonics with FT aged 28–39 (mean 33) years and 32 age‐matched controls without FT. LV mass and LV diastolic function was measured using conventional echocardiography and tissue Doppler imaging (TDI). LV diastolic filling properties were assessed and reported as the peak E/A wave ratio, and peak septal annular velocities (Em and Em/Am ratio) on TDI. Using high‐resolution ultrasound, BA diameters at rest and during reactive hyperaemia (flow‐mediated dilation – FMD) were measured. Results. In subjects with FT, the LV mass index was higher than in controls (92.14±24.02 vs 70.08±20.58); p<0.001). Of...

Journal ArticleDOI
TL;DR: Non‐invasive assessment of central aortic pressures using PWA on a single occasion is highly repeatable in ambulant patients even when used by relatively inexperienced staff.
Abstract: Objective. To estimate the repeatability of radial pulse wave analysis (PWA) in measuring central systolic and diastolic blood pressures (cSBP/cDBP), pulse pressure (cPP), augmentation pressure (cAP) and pulse pressure amplification (PPA). Methods. After 15 min supine rest, 20 ambulant patients (aged 27–82 years; four female) underwent four SphygmoCor PWA measurements on a single occasion. Two nurses independently undertook two measurements in alternate order, blind to their colleague's measurements. Analysis was by Bland–Altman limits of agreement (LOA). Results. Heart rate and brachial blood pressure (BP) were stable during assessment. Based on the average of two PWA measurements between‐observer differences (LOA, mean difference±2SD) were small (cSBP 1.5±10.9 mmHg; cDBP 0.4±5.2 mmHg; cAP 0.5±4.5 mmHg; cPP 1.1±10.5 mmHg; PPA −0.5%±5.6%). Between‐observer differences were much greater for single/initial PWA measurement (cSBP 3.6±15.9 mmHg; cDBP 2.8±8.8 mmHg; cAP 0.7±5.8 mmHg; cPP 0.8±13.6 mmHg; PPA −1.2±...

Journal ArticleDOI
TL;DR: Recent evidence on renal protection in individuals with and without diabetes is reviewed, and the importance of offering a high standard of care also to those with the metabolic syndrome or prediabetes in order to prevent initial forms of renal, and as a consequence, cardiovascular damage is reviewed.
Abstract: Cardiovascular and renal diseases share many of the same risk factors. In fact, renal failure is usually accompanied by an increased global cardiovascular risk. Thus, preservation of kidney function might simultaneously protect the heart and the brain and, conversely, addressing cardiovascular risk factors might safeguard the kidney. This review considers the evidence supporting this approach, focusing on the protective effect of blood-pressure lowering and the ancillary actions of antihypertensive agents on renal protection. We review recent evidence on renal protection in individuals with and without diabetes, and the importance of offering a high standard of care also to those with the metabolic syndrome or prediabetes in order to prevent initial forms of renal, and as a consequence, cardiovascular damage. Intervention may be appropriate even in individuals with high-normal blood pressure, if they already have early renal and/or cardiovascular risk markers. As a consequence of these insights, thresholds for starting antihypertensive therapy are gradually falling, whereas awareness of the need for an early intervention in patients at high risk of developing renal damage and simultaneously cardiovascular disease is growing.

Journal ArticleDOI
TL;DR: SBP as well as DBP were substantially reduced in mild to moderate hypertensive patients over 12 weeks treatment with zofenopril or amlodipine in monotherapy, and given the size of the BP reduction, such treatments are likely to produce beneficial cardiovascular outcome effects in patients with mild tomoderate hypertension.
Abstract: Angiotensin‐converting enzyme inhibitors (ACEIs) and calcium antagonists are today extensively used as first‐line monotherapy as well as appropriate combination therapy in mild to moderate hypertension. In a parallel‐group study, using clinically recommended doses, the ACEI zofenopril was compared with the calcium antagonist amlodipine in respect of their antihypertensive properties. In the study, 303 hypertensive patients, aged 18–75 years, were compared in terms of antihypertensive response and adverse effects after treatment with zofenopril, 30–60 mg once daily or amlodipine 5–10 mg od. After receiving the lower starting dose, up‐titration was optional at 4 weeks to the higher dose if diastolic pressure (DBP) was 90 mmHg or more or if a decrease from base line of <10 mmHg was present. After 4 weeks and appropriate up‐titration of dose in non‐responder patients, there were significant and similar reductions of sitting DBP by −10.0 and −9.9 mmHg and systolic blood pressure (SBP) by −13.0 and −13.2 mmHg t...

Journal ArticleDOI
TL;DR: Arterial stiffness and inflammation were increased in association with proteinuria in non‐diabetic essential hypertension and SI was significantly correlated with hsCRP.
Abstract: Objective. Both arterial stiffness and proteinuria are important markers for organ damage in hypertension. This study was planed to investigate the association between arterial stiffness and inflammation and to define the influences of proteinuria on arterial stiffness and inflammation in non‐diabetic hypertension. Methods. We enrolled 205 patients (mean age 41±8 years, 66 women) with essential hypertension noted for less than 5 years in this study. They did not have diabetes mellitus or any overt cardiac, vascular, or renal complications. Stiffness index (SI) derived from digital volume pulse was used for assessment of arterial stiffness. High‐sensitivity C‐reactive protein (hsCRP) was measured in each patient during enrollment. Left ventricular hypertrophy (LVH) was documented by electrocardiography and proteinuria was assessed by measuring 24‐h urine protein. Results. SI was significantly correlated with hsCRP (r = 0.166, p = 0.017). LVH was noted in 34 patients (17%). SI was significantly higher in pa...

Journal ArticleDOI
TL;DR: Assessment of the relation between central blood pressure‐derived indices and the presence and extent of coronary artery disease in patients with and without hypertension concluded that ascending aortic pulsatility is related to the extent of artery disease irrespectively of the presence of hypertension.
Abstract: Ascending aortic blood pressure‐derived indices were shown to be related to coronary atherosclerosis. However, no study so far has analyzed the relation between ascending aortic pulsatility and the extent of coronary atherosclerosis in normotensives. Therefore, the aim of the present analysis was to assess the relation between central blood pressure‐derived indices and the presence and extent of coronary artery disease in patients with and without hypertension. The study group consisted of 821 patients (590 men and 231 women; mean age: 57.3±10.0 years) with preserved left ventricular function (ejection fraction>50%) undergoing coronary angiography. Hypertension was diagnosed in 639 (77.8%) patients. Ascending aortic blood pressure during catheterization was measured. After multivariate stepwise adjustment the odds ratio (OR) and confidence interval (CI) of coronary artery disease was: pulsatility per standard deviation (SD) OR 1.36 (95% CI 1.01–1.82) in hypertensives and OR 3.96 (1.95–8.07) in normotensiv...

Journal ArticleDOI
TL;DR: The present study demonstrates the role of correcting for differences in baseline diameter during measurements of FMD and a non‐linear relationship between flow velocity and FMD in the brachial artery and suggests different effects of antihypertensive treatment on endothelial function in large and small arteries.
Abstract: Hypertension has been associated with changes in endothelial function in both large muscular arteries and small resistance arteries. We evaluated the relationship between blood flow velocity and dilatation of the brachial artery following transient forearm ischemia and acetylcholine‐induced relaxation in subcutaneous small arteries and the influence of antihypertensive therapy on both in patients with essential hypertension. Thirty‐one previously untreated hypertensive patients were randomized in a double‐blind fashion to treatment with either the angiotensin‐converting enzyme (ACE) inhibitor perindopril or the beta‐blocker atenolol and compared with 17 healthy normotensive controls. Before and after 1 year of treatment, while still on active medication, flow‐mediated dilatation (FMD) was measured in the brachial artery using ultrasound while relaxation to acetylcholine in small arteries was tested in vitro in a myograph. FMD correlated inversely to resting brachial artery diameter (r = −0.38, p<0.05). FM...

Journal ArticleDOI
Peter M. Nilsson1
TL;DR: It is concluded that zofenopril as well as atenolol induces substantial reductions of diastolic BP in middle‐aged to elderly patients with hypertension, however, the control rate when initiating antihypertensive therapy with zofinopril is higher than that for atenoliol.
Abstract: Two first‐line antihypertensive therapies for initiating treatment in hypertension were compared, the angiotensin‐converting enzyme inhibitor (ACEI) zofenopril and the beta‐blocker atenolol. The study was multi‐centre and double‐blind, and included 304 middle‐aged to elderly patients with mild to moderate hypertension who were randomized to receive either zofenopril 30–60 mg once daily (od) or atenolol 50–100 mg od for 4 weeks with the possibility to an up‐titration in non‐responding patients. The higher dose level was then administered until 12 weeks after randomization. Blood pressures (BPs) were substantially reduced by either treatment, but after 4 weeks, the systolic and diastolic BP reductions were significantly greater (p<0.05) with zofenopril (−15.6/−13.5 mmHg) compared with atenolol (−13.1/−11.8 mmHg). After 12 weeks and the possibility of dose up‐titration, BP differences between treatments were no longer significant. However, control rates (sitting diastolic BP <90 mmHg) for zofenopril remained...

Journal ArticleDOI
TL;DR: It is demonstrated that zofenopril in clinically recommended doses is at least therapeutically equivalent to losartan treatment, when assessed by conventional sphygmomanometry at the doctor's office or at home by self‐measured BP assessments by the patients.
Abstract: In a parallel double-blind multicentre study, 375 hypertensive patients were enrolled and treated with either the angiotensin-converting enzyme inhibitor (ACEI) zofenopril 30 mg once daily (titration 60 mg od) or the angiotensin II type 1 receptor (AT1) antagonist losartan 50 mg od (titration 100 mg od). Patients with mild to moderate hypertension, defined as a diastolic blood pressure (DBP) between 95 and 110 mmHg in the sitting position without other signs of cardiovascular disease were enrolled and treated for 12 weeks. BP was assessed in the clinic, and self-measured by the patients at home during a working day and a holiday, as well as before and at the clinic follow-ups. Systolic (SBP) and DBP were significantly reduced in both treatment groups to a similar extent at the end of the 12-week study. However, the immediate or early reduction of DBP as well as DBP reduction over the first month was significantly greater with zofenopril (p= 0 .01 and p= 0 .003, respectively) compared with losartan treatment. After 3 months of treatment and dose up-titration, clinic BP reductions were similar in both groups. However, more subjects with losartan had used a higher dose step (42.1%) compared with zofenopril (33.1%). Home BP assessments demonstrated that systolic and diastolic pressures were substantially lower than the BP measurements made by sphygmomanometer in the clinic. In particular, assessments 2-3 days before the clinic visits during working days and holidays were characteristically lower, while the measurements during the clinic visits were largely similar to the conventional BP measurements by the doctor. The number and the severity of adverse events, related to the study medications, were largely benign and similar in both groups. The present study demonstrates that zofenopril in clinically recommended doses is at least therapeutically equivalent to losartan treatment, when assessed by conventional sphygmomanometry at the doctor's office or at home by self-measured BP assessments by the patients. Zofenopril however, induces a more rapid initial lowering of BP over the first month of therapy.

Journal ArticleDOI
TL;DR: Cystatin C concentration seems to be a useful indicator of renal function impairment associated with carotid intima‐media thickening and the effect of age was stronger in older patients.
Abstract: The aim of the study was to evaluate of the association between renal function and the intima‐media thickness of common carotid artery (CCA‐IMT) in treated hypertensive patients. Eighty‐seven hypertensives (51.7% diabetic), aged >45 years, were examined. Renal function was evaluated by plasma concentration of creatinine, cystatin C (in 64 patients) and creatinine clearance, calculated according to the Cockcroft–Gault formula. HbA1c measurement and blood pressure monitoring were performed. CCA‐IMT was measured at near and far wall of the CCA and of the bulb on both sides and averaged. In 63 hypertensives (72.4%) IMT was over 0.9 mm. These subjects were older (71.17±9.72 vs 57.75±7.76 years; p<0.0001), had higher pulse pressure (57.45±11.73 vs 49.35±8.35, p = 0.004), cystatin C concentration (1.25±0.34 vs 0.99±0.17 mg/l; p = 0.002), higher HbA1c (7.24±1.59 vs 6.25±1.28, p = 0.01), and lower creatinine clearance (71.28±28.32 vs 93.86±25.04; p<0.0001) in comparison to patients with IMT <0.9 mm. Groups did not...

Journal ArticleDOI
TL;DR: In mild to moderate hypertensive patients, zofenopril treatment results in a more pronounced lowering of BP compared with enalapril at recommended dose levels, at clinical and comparative antihypertensive doses.
Abstract: Angiotensin‐converting enzyme inhibitors (ACEIs) are used in the management of a range of cardiovascular disorders and are well established in primary as well as secondary cardiovascular prevention programmes. Over the years, several second‐ and third‐generation ACEIs have been introduced into the clinic. In a comparative study in patients with mild to moderate hypertension, the efficacy and safety of zofenopril 30 mg od (with an up‐titration to 60 mg od after 4 weeks in non‐responder patients) was compared with enalapril 20 mg od (with an up‐titration to 40 mg od after 4 weeks in non‐responders) during 12 weeks of treatment. Both treatments significantly reduced systolic (SBP) and diastolic blood pressure (DBP). BP reduction was significantly greater with zofenopril (30 mg/day) during the initial 4 weeks of treatment compared with enalapril (20 mg/day). A larger proportion of patients needed dose up‐titration with enalapril compared with zofenopril to reach preset BP goals. After 12 weeks of treatment an...

Journal ArticleDOI
TL;DR: Amlodipine/benazepril combinations were well tolerated and resulted in significant BP reductions and better BP responder rates than amlodipines monotherapy.
Abstract: Background. This study compared the efficacy and safety of amlodipine/benazepril (10/40 mg/day and 10/20 mg/day) with amlodipine 10 mg/day in patients whose blood pressure (BP) was not adequately c...

Journal ArticleDOI
TL;DR: RSG treatment for 1 year was associated with a small but significant decrease in diastolic 24‐h ambulatory diastolics BP, and both systolic anddiastolic office BPs in non‐diabetic people with insulin resistance.
Abstract: Objective. Rosiglitazone (RSG) has been reported to reduce blood pressure (BP) in patients with type‐2 diabetes, but similar effects in non‐diabetic people with insulin resistance is less clear. Our aim was to test the long‐term BP‐lowering effects of RSG compared with placebo. Methods. We recruited participants for BP evaluation of RSG treatment from a larger intervention trial. Office BP was recorded in 355 non‐diabetic subjects with insulin resistance randomized to receive either RSG or placebo for 52 weeks. Ambulatory BP monitoring (ABPM; Spacelab 90207) was performed in a subgroup of 24 subjects (RSG: n = 11; placebo n = 13). Results. After 1 year, the office BP decreased by −3.1 mmHg systolic (p<0.05) and −3.8 mmHg diastolic (p<0.001) in the RSG group versus placebo. In patients treated with RSG, at 1 year there was a trend for a reduction from baseline for mean 24‐h diastolic BP (DBP), daytime DBP and night‐time DBP (−4.39, −5.26 and −2.93 mmHg, respectively). However, only daytime DBP was signific...

Journal ArticleDOI
TL;DR: There were no differences in 24‐h BP burden and HR that could explain the difference in outcome in favor of losartan vs atenolol in the LIFE study.
Abstract: Objective. The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study showed that losartan‐based treatment reduced risk of the composite endpoint of cardiovascular death, stroke and myocardial infarction compared with atenolol‐based treatment in patients with hypertension and left ventricular hypertrophy with similar office blood pressure (BP) reduction. Our aim was to investigate the effect of losartan‐ and atenolol‐based treatment on 24‐h ambulatory BP and heart rate (HR) in LIFE. Methods: In 110 patients, 24‐h ambulatory BP and heart rate were recorded at baseline and 1 year after randomization. Results: Ambulatory BP was comparably reduced throughout the 24‐h period after 1 year of losartan‐ vs atenolol‐based antihypertensive treatment. Office and ambulatory BP were comparably reduced in the follow‐up period. Early morning surge in BP was similar between groups. Non‐dipping status was more frequent in the losartan group (p = 0.01). From baseline to Year 1 the 24‐h HR profile for the...

Journal ArticleDOI
TL;DR: As the results of the LIFE study and other recent trials demonstrate superiority of newer agents over atenolol, this agent is not an appropriate reference drug for future trials of cardiovascular risk in hypertension.
Abstract: Objective. Twelve years after the design of the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, which showed superiority of losartan‐ vs atenolol‐based therapy for cardio...

Journal ArticleDOI
TL;DR: Commonly used ECG criteria of LVH have low discrimination ability in middle-aged subjects and ECG LVH alone should not be used as a marker of target organ damage in middle‐aged, never treated and apparently healthy hypertensives.
Abstract: Objective. To evaluate the usefulness of electrocardiographic left ventricular hypertrophy (ECG LVH) as a marker of LVH in middle‐aged subjects. Methods. LVH was determined by cardiovascular magnetic resonance imaging (MRI) in 188 apparently healthy middle‐aged [97 men (45±7 years) and 91 women (47±6 years)]. Receiver operating characteristic (ROC) curves, test sensitivity, specificity, positive and negative predictive values for identifying LVH at different ECG criteria were calculated. Results. Systolic and diastolic blood pressures were 142±13 mmHg and 90±8 mmHg in men and 139±10 mmHg and 90±8 mmHg in women, respectively. LVMI was 78±17 g/m2 in men and 67±12 g/m2 in women, and 14% of men and 22% of women had LVH in cardiac MRI. Only Sokolow–Lyon and Sokolow–Lyon product had the area under the ROC curve over 0.70. Sokolow–Lyon product had the highest sensitivity (47%). All ECG criteria had high negative predictive values, but the positive predictive values were below 46%. Conclusions. Commonly used ECG ...

Journal ArticleDOI
TL;DR: It is demonstrated that physical activity is not a determinant of PBP, and the previously observed reduction in PBP is not explained by a change in the population physical activity habits.
Abstract: Objective. Population blood pressure (PBP) is the average BP shared by all members of a population. In PBP research, the main focus is on the great majority of individuals who are healthy in respect to blood pressure. From previous studies, we know that PBP decreased 2 mmHg during 15 years of follow‐up. This decrease leads to significant reductions in cardiovascular (CV) and cerebrovascular risk. The major aim of the present study was to evaluate the effect of habitual physical activity on PBP. Design. Copenhagen City Heart Study is a longitudinal epidemiological study of CV risk in a random population sample. Three surveys were performed with 15 years of follow‐up. Methods. BP was measured under standardized circumstances. A questionnaire concerning physical exercise was completed. Two scales were used, describing physical activity at work and during leisure‐time, respectively. Results. Most of the subjects belonged to the sedentary or low physical activity categories. The population did not change physi...

Journal ArticleDOI
TL;DR: The results support a role for SUA level as an independent marker of target organ damage in hypertension and a good predictor of low CFR at the receiver‐operating characteristic curve.
Abstract: Background. Hyperuricemia is associated with hypertension, vascular disease and cardiovascular (CV) disease. However, the role of serum uric acid (SUA) level as an independent risk factor for CV and renal morbidity in hypertension remains controversial. Accordingly, we aimed to determine whether SUA levels are independently and specifically associated with coronary flow reserve (CFR) impairment in hypertensive patients. Methods. We examined 80 never treated and newly diagnosed hypertensive individuals. The hypertensive individuals were divided into two groups based on CFR values. Results. Subjects with altered CFR (<2) had significantly higher SUA levels compared with those with normal CFR (⩾2) (346.0±98.1 vs 260.7±75.6 µmol/l, p<0.0001). After adjusting for potential confounders, including age, sex, body mass index, blood pressure, lipids and creatinine, we found that SUA levels were independently associated with CFR impairment (β = −0.417, p<0.0001). We also found that SUA levels were a good predictor o...