Showing papers in "Blood Pressure in 2008"

Blood pressure control during telemonitoring of home blood pressure. A randomized controlled trial during 6 months.

Abstract: Aim. To compare the effectiveness of antihypertensive treatment based on telemonitoring of home blood pressure (BP) and conventional monitoring of office BP. Methods. Hypertensive patients (n = 236) participated in a randomized, controlled study. In the intervention group, antihypertensive treatment was based on home BP monitoring. BP readings were registered by a PDA and automatically transmitted to a server, by which the patient and doctor could communicate. In the control group, patients received usual care with office visits to adjust antihypertensive treatment as needed. Primary outcome was difference in systolic daytime ambulatory BP monitoring (ABPM) change between baseline and 6 months. Results. In both groups, systolic daytime ABPM decreased significantly from baseline to follow‐up. The decrease in systolic daytime ABPM was −11.9 mmHg in the intervention group and −9.6 mmHg in the control group (mean difference −2.3 [95% CI −6.1 to −1.5], p = 0.225). The likelihood of daytime ABPM normalization w...

The molecular sources of reactive oxygen species in hypertension.

Abstract: In both animal models and humans, increased blood pressure has been associated with oxidative stress in the vasculature, i.e. an excessive endothelial production of reactive oxygen species (ROS), which may be both a cause and an effect of hypertension. In addition to NADPH oxidase, the best characterized source of ROS, several other enzymes may contribute to ROS generation, including nitric oxide synthase, lipoxygenases, cyclo-oxygenases, xanthine oxidase and cytochrome P450 enzymes. It has been suggested that also mitochondria could be considered a major source of ROS: in situations of metabolic perturbation, increased mitochondrial ROS generation might trigger endothelial dysfunction, possibly contributing to the development of hypertension. However, the use of antioxidants in the clinical setting induced only limited effects on human hypertension or cardiovascular endpoints. More clinical studies are needed to fully elucidate this so called "oxidative paradox" of hypertension.

The safety profile of telmisartan as monotherapy or combined with hydrochlorothiazide: A retrospective analysis of 50 studies

Abstract: Background To compare the tolerability and safety of telmisartan +/- hydrochlorothiazide (HCTZ). Methods This retrospective analysis was performed on all hypertensive patients that were enrolled in telmisartan studies. A total of 30 double-blind (n=8023) and 20 open-label (n=8393) studies were available at the time of this analysis, and were included. Treatments investigated were placebo, telmisartan 10-160 mg, or telmisartan 10-160 mg plus HCTZ 6.25-25 mg. The incidence and causality of all adverse events (AEs) and laboratory abnormalities occurring during treatment were recorded. Results The incidences of all-cause AEs in the double-blind studies were: 2.73 per patient-year (PY) (36.1%; placebo); 2.03/PY (37.4%; telmisartan monotherapy) and 2.09/PY (44.8%; telmisartan plus HCTZ). The respective numbers in the open-label studies were: 0.65/PY (49.6%; telmisartan monotherapy) and 0.70/PY (40.3%; telmisartan plus HCTZ). The most frequent suspected adverse reactions were dizziness and headache, which were comparable across groups and studies. The overall incidence of drug-related laboratory abnormalities was low in all treatment groups. Treatment-related hyperuricaemia and hypokalaemia occurred in less than 0.1% of patients, respectively, treated with telmisartan plus HCTZ. Incidences of discontinuation due to an AE were 4.6%, 4.5% and 4.7%, respectively, for the placebo, telmisartan and telmisartan plus HCTZ treatment groups. Conclusion The consolidated data show that telmisartan +/- HCTZ are well tolerated in patients of all ages and have placebo-like tolerabilities.

Predictors of blood pressure response to intensified and fixed combination treatment of hypertension: The ACCOMPLISH Study

Abstract: Background. Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension (ACCOMPLISH) is an outcome study investigating aggressive antihypertensive combination treatment. It has achieved a larger fraction of overall patients with blood pressure (BP) <140/90 mmHg (73.3%) and diabetic patients <130/80 mmHg (43.3%) at 12 months of follow‐up than any other large outcomes trial. We have analyzed baseline predictors of BPs and BP control at 12 months. Methods. Blinded baseline and 12‐month BP was available in 10 173 patients of whom 6132 had diabetes. Univariate and multivariate logistic regression models were used for BP control at 12 months; simple and multiple regression models were used for absolute BP value at 12 months. A stepwise procedure was used to select significant predictors in multivariate analyses. Results. Mean (SD) BP fell from 145.5/80.2 mmHg (18.2/10.7 mmHg) at randomization to 132.7/74.7 mmHg (16/9.6 mmHg) at 12 months. The main baseline predictors...

Arterial stiffness indices in healthy volunteers using non-invasive digital photoplethysmography.

Abstract: Background. Increased arterial stiffness is a marker of cardiovascular damage, even in the absence of clinically apparent disease. It is likely to become an important clinical tool in cardiovascula...

End-digit preference in general practice: a comparison of the conventional auscultatory and electronic oscillometric methods.

Abstract: Introduction. In clinical practice, end‐digit preference is a common feature of blood pressure (BP) measurements. A wider use of electronic BP measuring machines could decrease this observer‐linked artefact. The purpose of this analysis was to investigate the frequency of end‐digit preference and to evaluate the impact of this observer bias on the assessment of the BP control induced in a large group of hypertensive patients treated with a calcium‐channel blocker in whom BP was measured either with an automatic device or with a conventional sphygmomanometer. Methods. Five hundred and four physicians participated in the study and 2199 patients were included. Treatment with lercanidipine was introduced at a dosage of 10 mg and titration to 20 mg was optional according to the physician's decision. BP was assessed at 4 and 8 weeks. To measure BP, physicians could use either a standard mercury sphygmomanometer or a pre‐defined validated semi‐automatic device (Microlife Average Mode, BP 3AC1‐1, Microlife Corpor...

Adiponectin--insulin and resistin plasma levels in young healthy offspring of patients with essential hypertension.

Abstract: Background. Accumulating epidemiological studies have shown that healthy offspring of hypertensive patients exhibit some metabolic disturbances such as hyperinsulinemia, insulin resistance, lipid disorders, elevated plasma leptin levels and reduced insulin receptor number, features that may be predictors of future cardiovascular events. The aim of this study was to determine insulin, adiponectin and resistin plasma levels in young healthy offspring of patients with essential hypertension, and to compare the findings to those of young healthy offspring of healthy normotensives matched for age, sex and body mass index (BMI). Methods. Forty‐six (24 male/22 female) healthy offspring of patients with essential hypertension–positive family history (FH+), mean age 18±3 years and BMI 22.4±1.4 kg/m2 (group A) and 50 (28 male/22 female) healthy offspring of healthy normotensives–negative family history (FH−) mean age 18±3.2 years and BMI 22.6±1.7 kg/m2 (group B) were studied. The two groups were matched for age, se...

Efficacy of aliskiren/hydrochlorothiazide single-pill combinations in aliskiren non-responders.

Abstract: Objectives. To evaluate the efficacy, safety and tolerability of a single-pill combination of the direct renin inhibitor aliskiren and hydrochlorothiazide (HCT) in patients with hypertension and an inadequate BP response to aliskiren monotherapy (mean sitting diastolic BP [msDBP] >90 and ≤110 mmHg following 4 weeks of aliskiren 300 mg). Methods. In this study, 880 patients with hypertension and an inadequate BP response to aliskiren monotherapy were randomized to once-daily, double-blind treatment with a single-pill combination of aliskiren/HCT 300/25 mg or 300/12.5 mg, or aliskiren 300 mg monotherapy. At the week 8 endpoint, least-squares mean changes in mean sitting systolic/diastolic BP (msSBP/DBP) from baseline were analyzed for the intent-to-treat population. Results. Aliskiren/HCT 300/25 mg and 300/12.5 mg provided significantly greater msSBP/DBP reductions from baseline (15.9/11.0 mmHg and 13.5/10.5 mmHg, respectively) than aliskiren 300 mg alone (8.0/7.4 mmHg; both p<0.001). Rates of BP control (<...

Prevalence of left ventricular hypertrophy detected by Cornell voltage-duration product in a hypertensive population

Abstract: Introduction. Detection and treatment of left ventricular hypertrophy (LVH) in hypertension is important in order to reduce cardiovascular risk. The product of QRS voltage and duration (e.g. Cornell voltage‐duration product; CorP), is a good marker of LVH and the current study was designed to determine the prevalence of LVH in patients with essential hypertension treated in general practice. Methods. This study was a multicenter, cross‐sectional survey in outpatient hypertensive patients attending clinics across Spain. The primary endpoint for detection of LVH was a CorP >2.440 mm·ms on ECG recordings, which were independently assessed. Results. Seven hundred and eighty‐two patients were evaluated (66.1±10.4 years; 50.6% males; body mass index 28.2±6.1 kg/m2) with a mean baseline blood pressure (BP) of 155.7±17.7/90.8±10.6 mmHg. Only 13.2% of the study population had BP that was adequately controlled. LVH was detected in 23.4% of patients using the CorP method. Predictors of LVH were prior history of LVH,...

Comparison of hypertension and its risk factors between the Guangxi Bai Ku Yao and Han populations.

Abstract: Objective. Little is known about the prevalence of hypertension in Bai Ku Yao, an isolated subgroup of the Yao minority in China. The aim of this study was to compare the difference in the prevalence of hypertension and its risk factors between the Guangxi Bai Ku Yao and Han populations. Methods. A cross‐sectional study of hypertension in 1170 subjects of Bai Ku Yao and 1173 participants of Han Chinese aged 15–89 was conducted by a stratified randomized cluster sampling. Information on diet and lifestyle was collected with standardized questionnaires. Blood pressure, serum lipids and several anthropometric parameters were obtained in all subjects. Results. Systolic, diastolic and pulse pressure levels and hypertension prevalence (10.85% vs 16.45%, p<0.001) were lower in Bai Ku Yao than in Han. Hypertension was positively correlated with male, age, physical activity, body mass index, waist circumference, total energy, total fat and sodium intakes, and negatively associated with education level and total di...

Managing hypertension in the elderly in light of the changes during aging.

Abstract: The natural rise in systolic blood pressure with age is often complicated by other co-morbidities. Pharmacokinetics and pharmacodynamics of antihypertensive drugs are altered during aging, resulting in decrease in absorption and function of the kidney and liver, as well as interactions and adverse reactions of antihypertensives with the often large number of medications taken by the elderly. The problem of compliance in the elderly that may be disrupted by depression, loss of memory, vascular dementia and other conditions that compromise cognition is also of concern. Despite the many issues facing healthcare providers in managing hypertension in the elderly, the benefits are extensively documented and warrant overcoming therapeutic inertia, especially in view of current access to well documented therapeutic options.

Health-related quality of life (SF-36) during telemonitoring of home blood pressure in hypertensive patients: a randomized, controlled study.

Abstract: Telemonitoring of home blood pressure (BP) is a new advance in home BP monitoring (HBPM) and has proved effective in improving BP control. The impact of telemedical HBPM on health-related quality of life (HRQOL) has not yet been studied. The purpose of this study is to compare HRQOL using a generic scale (SF-36) in patients with antihypertensive treatment based on telemedical HBPM and in patients with antihypertensive treatment based on conventional monitoring of office BP. Hypertensive patients (n = 223) recruited by general practitioners participated in the study. In the intervention group, antihypertensive treatment was based on telemedical HBPM. In the control group, patients (n = 118) received usual care with office visits to monitor BP. After 6 months, participants filled out SF-36 questionnaires. Patients in the telemonitoring group (T) had higher mean scores in the bodily pain domain than patients in the control group (C), indicating less pain and interference with activities among telemonitored patients [T: 85.3(20.2), C: 78.3(26.4), p = 0.026)]. Patients were more likely to feel their general health had worsened during the last year if antihypertensive treatment was based on conventional office measurements. In the bodily pain domain and health transition scale, scores were slightly better among telemonitored patients compared with control patients.

The ‐2548G/A LEP polymorphism is associated with blood pressure in Tunisian obese patients

Abstract: Objective. To examine the association of a common ‐2548G/A (rs7799039) promoter variant of the human leptin gene (LEP) with obesity or body mass index (BMI) and its associated phenotypes such as blood pressure variability and the prevalence of hypertension in a sample of the Tunisian population. Design and methods. Two hundred and twenty‐nine obese patients were screened and compared with 251 normal weight subjects. The ‐2548G/A LEP polymorphism was analysed by PCR‐RFLP procedure. Results. No significant association was found between the ‐2548G/A polymorphism and obesity or BMI. However, in obese patients subjects with AA genotype had significantly higher systolic (p = 0.003) and diastolic (p = 0.002) blood pressure compared with those with GA or GG genotypes. Stratified analysis by gender revealed that male patients but not female homozygous for ‐2548A allele exhibited significantly increased systolic (p = 0.01) and diastolic (p<0.001) blood pressure than did carriers of ‐2548G allele. Multiple linear re...

Antihypertensive efficacy and tolerability of candesartan–hydrochlorothiazide 32/12.5 mg and 32/25 mg in patients not optimally controlled with candesartan monotherapy

Abstract: Aim. To evaluate the efficacy and tolerability of candesartan cilexetil 32 mg in combination with hydrochlorothiazide (HCT) 12.5 mg or 25 mg in hypertensive patients not optimally controlled with candesartan monotherapy. Patients and methods. A total of 3521 patients with treated or untreated hypertension and sitting diastolic blood pressure (DBP) 90– 114 mmHg, entered a single-blind run-in phase with candesartan (16 mg for 2 weeks, followed by 32 mg for 6 weeks). At the end of the run-in phase, 1975 patients who still had DBP 90–114 mmHg were randomized to 8 weeks' double-blind treatment with either candesartan 32 mg (n=654), or candesartan–HCT 32/12.5 mg (n=656), or candesartan–HCT 32/ 25 mg (n=665). Principal results. At randomization, the mean blood pressure was similar in the three treatment groups (approximately 153/97 mmHg). It was reduced during the double-blind treatment phase by 6.1/5.6 mmHg in the candesartan 32 mg group, by 13.0/8.8 mmHg in the candesartan–HCT 32/12.5 mg group, and by 15.5/10....

Modification of the association of alcohol drinking with blood pressure by cigarette smoking.

Abstract: The purpose of this study was to investigate whether the association of alcohol drinking with blood pressure was modified by cigarette smoking. The subjects were healthy male workers aged 40-59 years and were divided into three different groups by average daily consumption of alcohol (non-drinkers; light drinkers, less than 30 g ethanol per day; heavy drinkers, 30 g or more ethanol per day) and cigarettes (non-smokers; light smokers, less than 20 cigarettes per day; heavy smokers, 20 cigarettes or more per day). The mean levels of both systolic and diastolic blood pressures were significantly lower in the light and heavy smoker groups than in the non-smoker group. In the light and heavy smoker groups, systolic blood pressure was higher in the light drinker subgroup than in the non-drinker subgroup, while there was no significant difference between systolic blood pressures in the non- and light drinker subgroups of non-smokers. In the non-, light and heavy smoker groups, systolic and diastolic blood pressures were significantly higher in the heavy drinker subgroup than in the non-drinker subgroup, and these differences tended to be greater in light and heavy smokers than in non-smokers. The above differences in the relationships of alcohol drinking with blood pressure in non-, light and heavy smokers were also observed when age and body mass index were adjusted and when alcohol intake-matched groups were used. These results suggest that the association of alcohol drinking with blood pressure is stronger in smokers than in non-smokers, independently of age, body mass index and alcohol intake.

Self-measurement of blood pressure at home: is it reliable?

Abstract: Self-measurement of blood pressure (BP) at home is more common than 10 years ago and encouraged by current guidelines to increase patient adherence to treatment and reach the goal of target BP. The aims of this study are to evaluate the accuracy of home sphygmomanometers and to investigate behavior/knowledge of the sphygmomanometer owners. A campaign was planned to determine the accuracy of home sphygmomanometers in 2006. Seven hundred and twenty-three home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic within 1 year and 693 (96%) of the devices were in adequate working condition and suitable for analysis. Four hundred and thirty-nine (63%) of the sphygmomanometers were automatic. Four hundred and eleven (59.3%) of the 693 sphygmomanometer were inaccurate. About 80% (256/320) of the wrist devices were inaccurate. Most studies evaluating the accuracy of sphygmomanometers are conducted in hospital or primary care settings; studies investigating home sphygmomanometers are rare. High frequency of inaccurate home devices is a major public health problem. In conclusion, inaccurate devices have been used in home BP measurements frequently and frequency of device-related errors can be decreased by awareness and training of the patients. Physicians and healthcare providers should advise the patients to check the accuracy of their home sphygmomanometers regularly.

Putative endothelial progenitor cells are associated with flow‐mediated dilation in refractory hypertensives

Abstract: Background. Hypertension has been related to endothelial dysfunction. Patients with refractory hypertension (RH) have a reduced number of endothelial progenitor cells (EPCs). Aim. To evaluate if blood EPC levels relate to endotheliumdependent vasodilation (ED-VD) in RH. Methods. We analyzed 29 RH confirmed by 24-h ambulatory blood pressure monitoring and assessed complete clinical and laboratory evaluation. EPCs were isolated from peripheral mononuclear cells (MNC) by flow cytometry. ED-VD was determined measuring flow-mediated dilation (FMD) by venous occlusion plethysmography. Results. Circulating EPCs/10 5 MNC (median [Q1–Q3]): 23.0 [4.5–53.8]. FMD (median [Q1–Q3]): 211.7 [79.5–365.8]%. Significant correlations with log-FMD: EPCs (r50.469; p50.018) and homocysteine (r520.414; p50.045). There was no collinearity between EPCs and homocysteine. FMD did not correlate with age, gender, office BP, 24-h systolic blood pressure or 24-h diastolic blood pressure, laboratory parameters, C-reactive-protein, left ventricularmass index, dyslipidaemia, smoking habit and statin or angiotensin system blockers treatment. Multiple linear regression analysis showed that after age-adjustment, EPC (p50.027) and homocysteine (p50.004) were the only variables that predicted FMD (R50.740). After dividing patients according to EPC number, patients in the lower tertile showed a significantly reduced FMD compared with those in the group of the two upper tertiles of EPC: log-FMD (meaniSD): 4.7i0.9 vs 5.6i0.8, respectively (p50.031). Conclusions. ED-VD independently correlates with circulating EPCs in RH. Homocysteine is also an independent predictor of lower FMD in such patients.

Regulation of blood pressure, natriuresis and renal thiazide/amiloride sensitivity in PPARα null mice

Abstract: This study evaluated the role of PPARalpha in renal function and whether PPARalpha knockout (KO) mice are hypertensive or salt-sensitive. We hypothesize that PPARalpha modulation of ion transport defines the capacity for sodium excretion (U(Na)V). PPARalpha KO and wild-type (WT) mice were placed on a normal salt (NS, 0.5% NaCl) or high salt (8% NaCl, HS) diet for 28 days and mean arterial blood pressure (MABP) and heart rate (HR) determined. In a group of anesthetized animals on NS diet, pressure natriuresis (P/N) was determined and in another group, acute sodium load (0.9% NaCl) was administered and U(Na)V compared in mice pretreated with amiloride (200 microg/kg) or hydrochlorothiazide (3 mg/kg), in vivo measurements of sodium hydrogen exchanger or Na-Cl-cotransporter activity, respectively. MABP and HR were similar in PPARalpha KO and WT mice placed on a NS diet (116+/-6 mmHg, 587+/-40 beats/min, KO; 116+/-4 mmHg, 551+/-20 beats/min, WT). HS diet increased MABP to a greater extent in KO mice (Delta = 29+/-3 vs 14+/-3 mmHg, p<0.05) as did proteinuria (8- vs 2.5-fold, p<0.05). P/N was blunted in untreated KO mice. In response to an acute NaCl-load, U(Na)V was faster in PPARalpha KO mice (4.31+/-1.11 vs 0.77+/-0.31 micromol, p<0.05). However, U(Na)V was unchanged in hydrochlorothiazide-treated KO mice but increased 6.9-fold in WT mice. Similarly, U(Na)V was less in amiloride-treated KO mice (3.4- vs 15.5-fold). These data suggest that PPARalpha participates in pressure natriuresis and affects Na transport via amiloride- and thiazide-sensitive mechanisms. Thus, despite defective fatty acid oxidation, PPARalpha null mice are not hypertensive but develop salt-sensitive hypertension.

Metabolic syndrome and multiple organ damage in essential hypertension

Abstract: Aim. We investigated the prevalence of the metabolic syndrome (MS) in hypertensive patients categorized according to the number of markers of organ damage (OD) in order to assess the value of a sys...

The clinical significance of abnormal diurnal blood pressure variation in healthy late middle-aged and older adults.

Abstract: Objective. A fall in nocturnal blood pressure (BP) is generally observed in normotensive subjects as well as in those with mild to moderate essential hypertension, regardless of the level of daytime BP. Among elderly hypertensive subjects, extreme-dippers with a marked nocturnal fall in BP as well as non-dippers with nocturnal fall absence are at increased risk for cardiovascular and cerebrovascular complications. However, the relationship between these abnormal diurnal BP variation patterns in normotensive elderly subjects has not been investigated. Methods. We classified 45 healthy late middle-aged and older adults into three groups according to the nocturnal systolic BP fall pattern examined by 24-h ambulatory BP monitoring (dipper, non-dipper and extreme-dipper), and compared the parameters of initial atherosclerosis, endothelial function and autonomic function. As a parameter of atherosclerotic factors, the intima-media thickness (IMT) of the carotid artery was examined, and as a parameter of endothelial function, brachial artery endothelium-dependent flow-mediated dilation (FMD) was ultrasonographyically measured. Autonomic function was assessed by power spectral analysis of heart rate variability (HRV). Results. No difference was observed in the severity of IMT between the three groups. The percent change of FMD in subjects in the extreme-dipper group was significantly lower than that of subjects in the dipper group, indicating that extreme-dippers in healthy elderly subjects may be associated with endothelial dysfunction. Also, HRV due to sympathetic modulation of subjects in the extreme-dipper group was significantly higher than that of subjects in the dipper and non-dipper groups, suggesting the activation of sympathetic tone. Conclusion. In healthy elderly subjects, the extreme-dipper type may reflect a decrease in endothelial function, i.e. initial stage atherosclerosis, rather than the dipper type.

Blood pressure in the initial phase of acute ischaemic stroke: evolution and its role as an independent prognosis factor at discharge and after 3 months of follow-up.

Abstract: Background. A prospective observational study was aimed at assessing the role of blood pressure (BP) during the first 24 h from stroke onset on the outcome of acute ischaemic stroke. Methods. Subjects admitted within the first 3 h from stroke onset were included. Stroke severity was evaluated with the Canadian Stroke Scale (CSS). Functional recovery was defined as a modified Rankin Scale score ⩽2. Results. One hundred subjects were included. In a logistic regression model, the independent predictors of poor functional recovery at discharge were: age (OR = 1.12; 95% CI 1.04–1.21; p = 0.0033), non‐lacunar stroke subtype (OR = 4.31; 95% CI 1.07–17.31; p = 0.0395), diabetes mellitus (OR = 8.38; 95% CI 1.67–41.95; p = 0.0097), a CSS score at admission ⩽8 (OR = 28.64; 95% CI 5.59–146.68; p<0.0001), an average systolic BP during the first 6 h ⩾180 mmHg (OR = 13.34; 95% CI 1.34–133.10; p = 0.0272) and a lower diastolic BP average from 6 to 24 h (OR for 5 mmHg increase: 0.57; CI 95% 0.36–0.88; p = 0.0115). Similar...

Determinants of increasing pulse pressure during 23 years' follow-up as a marker of arterial stiffness and vascular ageing.

Abstract: The aim was to investigate clinical characteristics of increased brachial pulse pressure (PP) during long-term follow-up (23 years) as a marker of arterial stiffness in 9704 healthy subjects. The association of baseline variables with an increasing PP burden during the study period was analysed by univariate analysis. In addition, the association between different biological variables at baseline and increasing PP at follow-up, as well as the cross-sectional association with PP at follow-up, were examined by multiple regression analysis. The prospective analysis showed in men that the following baseline variables predicted (p<0.05) increased PP at follow-up: age, fasting glucose, triglycerides, heart rate, smoking, family history of hypertension and cholesterol. Among women, the same predictors were established (p<0.05), except for smoking and triglycerides, but in addition body mass index (BMI). The cross-sectional analysis obtained at the last survey, showed that the following variables (p<0.05) were associated with increased PP in men: fasting glucose, age, BMI, cholesterol and family history of hypertension. In females, similar findings were noted (p<0.05), but in addition there was a negative correlation with smoking. In conclusion, several well-known cardiovascular risk factors, such as glucose, BMI, heart rate, family history of hypertension and cholesterol in particular, are long-term predictors of increased PP in both genders.

Public health value of fixed‐dose combinations in hypertension

Abstract: It is well documented that reducing blood pressure (BP) in hypertensive individuals reduces the risk of cardiovascular (CV) events. Despite this, many patients with hypertension remain untreated or inadequately treated, and fail to reach the recommended BP goals. Suboptimal BP control, whilst arising from multiple causes, is often due to poor patient compliance and/or persistence, and results in a significant health and economic burden on society. The use of fixed-dose combinations (FDCs) for the treatment of hypertension has the potential to increase patient compliance and persistence. When compared with antihypertensive monotherapies, FDCs may also offer equivalent or better efficacy, and the same or improved tolerability. As a result, FDCs have the potential to reduce both the CV event rates and the non-drug healthcare costs associated with hypertension. When FDCs are adopted for the treatment of hypertension, issues relating to copayment, formulary restrictions and therapeutic reference pricing must be addressed.

Combination of amlodipine 10 mg and valsartan 160 mg lowers blood pressure in patients with hypertension not controlled by an ACE inhibitor/CCB combination.

Abstract: Aims. This multicenter, open-label, single-arm trial assessed the efficacy of the combination of amlodipine 10 mg and valsartan 160 mg to provide additional blood pressure reduction and tolerability in patients with moderate hypertension not adequately responding to the combination of ramipril 5 mg and felodipine 5 mg. Results. Of 133 patients treated for 5 weeks with ramipril 5 mg and felodipine 5 mg, 105 failed to achieve mean sitting systolic blood pressure <140 mmHg. These non-responders were then treated for an additional 5 weeks with amlodipine 10 mg and valsartan 160 mg, which resulted in clinically and statistically significant additional reductions in mean sitting systolic blood pressure of 15.4 mmHg (p<0.0001) and mean sitting diastolic blood pressure of 7.0 mmHg (p<0.0001). Adverse event rates were low with both treatment regimens. Conclusions. In hypertensive patients not controlled at 5 weeks by ramipril 5 mg and felodipine 5 mg, significant additional blood pressure reductions were observed ...

Combination therapy with valsartan/hydrochlorothiazide at doses up to 320/25 mg improves blood pressure levels in patients with hypertension inadequately controlled by valsartan 320 mg monotherapy

Abstract: Objectives. To investigate the efficacy and tolerability of valsartan (Val) 320 mg once daily (o.d.), Val/hydrochlorothiazide (HCTZ) 320/12.5 mg o.d. and Val/HCTZ 320/25 mg o.d. in patients with hypertension not adequately controlled by Val monotherapy. Methods. This double‐blind, active‐controlled, parallel‐group, randomized trial recruited patients ⩾18 years with mild‐to‐moderate essential hypertension, defined as mean sitting diastolic blood pressure (MSDBP) of ⩾95 mmHg and <110 mmHg without treatment. After washout, 3805 eligible patients received Val 320 mg o.d. single‐blind for 4 weeks. Subsequently, patients with MSDBP ⩾90 and <110 mmHg (n = 2702) were randomized to double‐blind treatment with Val 320 mg, Val/HCTZ 320/12.5 mg or Val/HCTZ 320/25 mg for 8 weeks. Mean changes in MSDBP and mean sitting systolic BP (MSSBP) from the start of the single‐blind period were analysed, as well as the proportion of responders (MSDBP <90 mmHg or ⩾10 mmHg decrease from the start of the double‐blind period). Toler...

Association of adiponectin with procollagen type I carboxyterminal propeptide in non-diabetic essential hypertension.

Abstract: Objective. The serum concentration of procollagen type I carboxyterminal propeptide (PICP) is a good marker for collagen deposition in hypertension. Increased collagen deposition was associated with myocardial fibrosis and increased arterial stiffness. A decreased adiponectin level is associated with increased atherosclerosis. The role of adiponectin and its relation to PICP in essential hypertension have rarely been studied before. Methods. We recruited 188 non‐diabetic uncomplicated hypertensive patients (mean age: 41±7 years; 128 men). No patient had vascular complications or renal or liver diseases. Overnight fasting blood samples were collected to assess patient lipid profiles, blood sugar, insulin, high‐sensitivity C‐reactive protein (hsCRP), PICP and adiponectin. Carotid to radial pulse wave velocity (PWV) measured using tonometry was used as an index of arterial stiffness. Results. Adiponectin (r = −0.216, p = 0.003) and male gender (p<0.001) were independent determinants of PICP. Diastolic blood ...

The Hyper‐Pract Study: A multicentre survey on the accuracy of the echocardiographic assessment of hypertensive left ventricular hypertrophy in clinical practice

Abstract: Left ventricular hypertrophy (LVH) assessed by echocardiography has a relevant impact in clinical decision making in hypertensive patients. We investigated the precision and accuracy of hypertensive LVH determination in current clinical practice by a regional-based survey. The study included 211 patients with essential hypertension consecutively attending six hospital outpatient hypertension clinics in the northern Italian region of Lombardy; all subjects had undergone an echocardiographic examination for hypertension-related problems in a non-academic or research ultrasound laboratory within 2 years. The original echocardiographic report was examined to ascertain whether the diagnosis of LVH was based on calculation of left ventricular (LV) mass according to validated formulae and indexed to body size (primary outcome) and whether LV geometrical patterns and indices of diastolic function were provided (secondary outcome). A total of 211 echocardiograms performed by 120 physicians operating in 73 different hospital and out-of-hospital ultrasound laboratories were collected. Absolute LV mass, LV mass index and relative wall thickness were calculated in 45.5%, 24.6% and 12.3% of the cases, respectively. Parameters of LV diastolic filling were measured in two-thirds of the cases and estimation of E/A ratio was provided by less than 20% of the examinations. This study shows that a large majority of echocardiographic examinations, routinely performed in hypertensive subjects in order to detect cardiac damage, do not report qualifying data on LV mass, LV geometry and diastolic function. These results indicate that a quantitative assessment of LVH and LV function is rarely provided in clinical practice.

Heightened acute circulatory responses to smoking in women

Abstract: Objective. Smoking, a major risk factor for cardiovascular morbidity and mortality, may be particularly harmful to women. Sympathetic and hemodynamic responses to cigarette smoking may be implicated in the link between smoking and acute cardiovascular events. We tested the hypothesis that acute effects of smoking on cardiovascular function are potentiated in women compared with men. Methods. We examined the effects of cigarette smoking and sham smoking on muscle sympathetic nerve activity, blood pressure and heart rate in 20 female and 20 male middle‐aged healthy habitual smokers. Results. Sham smoking had no effect on muscle sympathetic nerve activity, blood pressure, or heart rate. Although cigarette smoking increased average systolic blood pressure and heart rate in both females and males, systolic blood pressure increased more in women (12±2 mmHg) than in men (6±2 mmHg; p = 0.02), as did heart rate (16±2 beats/min in women vs 9±2 beats/min in men; p = 0.002). Female smokers also had greater smoking‐re...

Transforming growth factor β1 T29C gene polymorphism and hypertension: Relationship with cardiovascular and renal damage

Abstract: Distribution of T29C TGFβ1 gene polymorphism was analysed in 260 hypertensive and 134 normotensive subjects. Circulating TGFβ1 and procollagen type III levels, microalbuminuria, left ventricular geometry and function were evaluated in all the hypertensives subgrouped according to T29C TGFβ1 gene polymorphism. Circulating TGFβ1 by ELISA technique, procollagen type III by a specific radioimmunoassay, microalbuminuria by radioimmunoassay, left ventricular geometry and function by echocardiography were determined. All groups were comparable for gender, age and sex. Regarding T29C TGFβ1 gene polymorphism, prevalence of TC or CC genotypes was significantly (p<0.05) higher in hypertensives than normotensives. TC and CC hypertensives were characterized by a higher prevalence of subjects with microalbuminuria (p<0.001 TC vs TT; p<0.05 CC vs TT), left ventricular hypertrophy (p<0.01 TC and CC vs TT), and by increased levels of procollagen type III (p<0.05 TC and CC vs TT). TC hypertensives were also characterized b...

Do screening blood pressure and plasma catecholamines predict development of hypertension? Twenty-year follow-up of middle-aged men.

Abstract: Objectives. The sympathetic nervous system is implicated in the development and maintenance of hypertension. However, the predictive impact of arterial plasma catecholamines has never been reported. We investigated arterial catecholamines and blood pressures (BPs) prospectively over 20 years in a group of well‐characterized middle‐aged men. Methods. Fifty‐six of original 79 men were available for the follow‐up. Multiple regression analysis was done with mean BP at follow‐up as a dependent variable, and arterial plasma catecholamines and BP at baseline as independent variables. Results. Half of the originally normotensive men developed hypertension during follow‐up. There were significant differences in the screening BP values measured at baseline between the new hypertensives and the sustained normotensives. Multiple regression analysis revealed arterial adrenaline at baseline as an independent predictor of mean BP at follow‐up in the new hypertensives (β = 0.646, R2 = 0.42, p = 0.007). Furthermore, arter...