Showing papers in "Journal of Hypertension in 2003"
TL;DR: There is evidence that specific agents have benefits for patients with particular compelling indications, and that monotherapy is inadequate for the majority of patients, and for patients without a compelling indication for a particular drug class, a low dose of diuretic should be considered for initiation of therapy.
Abstract: OBJECTIVE Hypertension is estimated to cause 4.5% of current global disease burden and is as prevalent in many developing countries, as in the developed world. Blood pressure-induced cardiovascular risk rises continuously across the whole blood pressure range. Countries vary widely in capacity for management of hypertension, but worldwide the majority of diagnosed hypertensives are inadequately controlled. This statement addresses the ascertainment of overall cardiovascular risk to establish thresholds for initiation and goals of treatment, appropriate treatment strategies for non-drug and drug therapies, and cost-effectiveness of treatment. CONCLUSIONS Since publication of the WHO/ISH Guidelines for the Management of Hypertension in 1999, more evidence has become available to support a systolic blood pressure threshold of 140 mmHg for even 'low-risk' patients. In high-risk patients there is evidence for lower thresholds. Lifestyle modification is recommended for all individuals. There is evidence that specific agents have benefits for patients with particular compelling indications, and that monotherapy is inadequate for the majority of patients. For patients without a compelling indication for a particular drug class, on the basis of comparative trial data, availability, and cost, a low dose of diuretic should be considered for initiation of therapy. In most places a thiazide diuretic is the cheapest option and thus most cost effective, but for compelling indications where other classes provide additional benefits, even if more expensive, they may be more cost effective. In high-risk patients who attain large benefits from treatment, expensive drugs may be cost effective, but in low-risk patients treatment may not be cost-effective unless the drugs are cheap.
2,591 citations
Royal College of Surgeons in Ireland1, Cardiovascular Institute of the South2, University of Western Australia3, Joseph Fourier University4, University of Bonn5, University of Toronto6, Western General Hospital7, University of Padua8, Icahn School of Medicine at Mount Sinai9, University of Valencia10, Katholieke Universiteit Leuven11, National and Kapodistrian University of Athens12
TL;DR: In this paper, the accuracy of the conventional Riva-Rocci/Korotkoff technique of blood pressure measurement has been questioned and efforts have been made to improve the technique with automated devices.
Abstract: IntroductionOver the past 20 years or so, the accuracy of the conventional Riva-Rocci/Korotkoff technique of blood pressure measurement has been questioned and efforts have been made to improve the technique with automated devices. In the same period, recognition of the phenomenon of white-coat hype
1,462 citations
TL;DR: In elderly hypertensive patients, a slightly more effective blood pressure reduction during candesartan-based therapy, compared with control therapy, was associated with a modest, statistically non-significant, reduction in major cardiovascular events and with a marked reduction in non-fatal stroke.
Abstract: BackgroundThe prognostic benefits of blood pressure lowering treatment in elderly hypertensive patients were established more than a decade ago, but are less clear in those with mildly to moderately elevated blood pressure.ObjectiveTo assess whether candesartan-based antihypertensive treatment in el
1,402 citations
TL;DR: Blood pressure was at least as strongly associated with cardiovascular events in Asian populations compared to Australasian populations and considerable potential benefit of blood pressure lowering down to levels of at least 115 mmHg systolic blood pressure is seen.
Abstract: Objectives To estimate age-, sex- and region-specific associations of blood pressure with cardiovascular diseases. Design Relative risk estimates and 95% confidence intervals were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk on individual participant data from 37 cohort studies. Repeat measurements of blood pressure were used to adjust for regression dilution bias. Setting Studies included in the Asia Pacific Cohort Studies Collaboration from Australia, mainland China, Hong Kong, Japan, New Zealand, Singapore, South Korea, and Taiwan. Participants A total of 425 325 study participants. Main outcomes measures Stroke, ischaemic heart disease, total cardiovascular death. Results During over 3 million person-years of follow-up, 5178 strokes, 3047 ischaemic heart disease events and 6899 cardiovascular deaths were observed. Continuous log-linear associations were seen between systolic blood pressure and the risks of all three endpoints down to at least 115 mmHg. In the age groups or = 70 years, a 10 mmHg lower usual systolic blood pressure was associated with 54% (95% CI 53-56%), 36% (34-38%) and 25% (22-28%) lower stroke risk, and 46% (43-49%), 24% (21-28%) and 16% (13-20%) lower ischaemic heart disease risk, respectively. All associations were similar in men and women. Blood pressure was at least as strongly associated with cardiovascular events in Asian populations compared to Australasian populations. Conclusions About half of the world's cardiovascular burden is predicted to occur in the Asia Pacific region. Blood pressure is an important determinant of this burden, with considerable potential benefit of blood pressure lowering down to levels of at least 115 mmHg systolic blood pressure.
590 citations
TL;DR: Collagen cross-linking is a major mechanism that governs aging and diabetes-associated loss of vascular and cardiac compliance and the development of AGEs cross-link breakers may have important role for future therapy of isolated systolic hypertension and diastolic heart failure in these conditions.
Abstract: The normal aging process is often accompanied by arterial wall stiffening and by a decrease in myocardial compliance. These processes contribute to isolated systolic hypertension and diastolic heart failure, which lead to substantial morbidity and mortality among older individuals. Patients with diabetes manifest arterial stiffening and diastolic dysfunction at a younger age. This leads to the concept that the mechanism that underlies changes in vascular mechanical properties during aging is accelerated in diabetes. The Maillard reaction or advanced glycation of proteins occurs slowly in vivo with normal aging and at an accelerated rate in diabetes. Advanced glycation end-products (AGEs) that form during the Maillard reaction are implicated in the complications of aging and diabetes. The formation of AGEs on vascular wall and myocardial collagen causes cross-linking of collagen molecules to each other. This leads to the loss of collagen elasticity, and subsequently a reduction in arterial and myocardial compliance. Aminoguanidine, an inhibitor of AGE formation, is effective in slowing or preventing arterial stiffening and myocardial diastolic dysfunction in aging and diabetic animals. In aged and diabetic animals, agents that can chemically break pre-existing cross-linking of collagen molecules are capable of reverting indices of vascular and myocardial compliance to levels seen in younger or non-diabetic animals. These studies suggest that collagen cross-linking is a major mechanism that governs aging and diabetes-associated loss of vascular and cardiac compliance. The development of AGEs cross-link breakers may have important role for future therapy of isolated systolic hypertension and diastolic heart failure in these conditions.
588 citations
TL;DR: The hypothesis that new antihypertensive drugs, such as calcium-channel blockers, α-blockers, ACE inhibitors or AR1 blockers might influence cardiovascular prognosis over and beyond their antihyertensive effects remains unproven.
Abstract: BackgroundIn a meta-analysis published in October 2001, we reported that new and old classes of antihypertensive drugs had similar long-term efficacy and safety Furthermore, we observed that in clinical trials in hypertensive or high-risk patients gradients in systolic pressure accounted for most d
501 citations
TL;DR: In healthy humans, flavanol-rich cocoa induced vasodilation via activation of the nitric oxide system, providing a plausible mechanism for the protection that flavanols-rich foods induce against coronary events.
Abstract: BackgroundConsumption of flavonoid-rich beverages, including tea and red wine, has been associated with a reduction in coronary events, but the physiological mechanism remains obscure. Cocoa can contain extraordinary concentrations of flavanols, a flavonoid subclass shown to activate nitric oxide sy
486 citations
TL;DR: The 2016 European Wheelchair Rugby Championship finalists are: C.R. Cifkova (Czech Republic), S.M. Fagard (Belgium), C. Farsang (Hungary), L. Rodicio (Spain), and A. Zanchetti (Italy).
Abstract: R. Cifkova (Czech Republic) S. Erdine (Turkey) R. Fagard (Belgium) C. Farsang (Hungary) A.M. Heagerty (UK) W. Kiowski (Switzerland) S. Kjeldsen (Norway) T. Lüscher (Switzerland) J.M. Mallion (France) G. Mancia (Italy, Coordinator) N. Poulter (UK) K.H. Rahn (Germany) J.L. Rodicio (Spain) L.M. Ruilope (Spain) P. van Zwieten (Netherlands) B. Waeber (Switzerland) B. Williams (UK) A. Zanchetti (Italy, Coordinator)
407 citations
TL;DR: Antihypertensive treatment with a diuretic, if needed combined with a β-adrenoceptor blocker, was associated with an aggravated metabolic profile; this was not so for patients treated with an angiotensin-II-receptor blocker as well as in newly diagnosed patients with primary hypertension.
Abstract: ObjectiveThe aim of the Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evaluation study was to compare the long-term effect of the commonly used inexpensive medication with a low-dose diuretic (hydrochlorothiazide), alone or in combination with a β-adrenoceptor (atenolol)
346 citations
TL;DR: In the placebo group, but not the active treatment group, increased night-time systolic blood pressure variability on admission to the Syst-Eur trial was an independent risk factor for stroke during the trial.
Abstract: ObjectiveTo investigate whether baseline systolic blood pressure variability was a risk factor for stroke, cardiovascular mortality or cardiac events during the Syst-Eur trial.DesignThe Syst-Eur study was a randomized, double-blind, placebo-controlled trial, powered to detect differences in stroke r
333 citations
TL;DR: The preliminary results support the need for the continuing main HYVET trial and it is possible that treatment of 1000 patients for 1 year may reduce stroke events by 19 (nine non-fatal), but may be associated with 20 extra non-stroke deaths.
Abstract: BackgroundThe risks and benefits of treating hypertension in individuals older than 80 years are uncertain. A meta-analysis has suggested that a reduction in stroke events of 36% may have to be balanced against a 14% increase in total mortality.ObjectivesTo report the results of the pilot study of t
TL;DR: A critical review of the uses, potential uses, strengths and weaknesses of the technique of applanation tonometry for the assessment of augmentation index and pulse wave velocity concludes that several pertinent issues need to be addressed before it can be used reliably as a clinical or research tool.
Abstract: The study of the pulse using the technique of applanation tonometry is undergoing a resurgence with the development of new computerized equipment. We aim here to present a critical review of the uses, potential uses, strengths and weaknesses of the technique of applanation tonometry for the assessment of augmentation index and pulse wave velocity. We will review the technique of applanation tonometry, the physiological factors affecting pulse wave velocity and pulse wave analysis, the changes in pulse wave velocity and pulse wave analysis with pharmacological interventions, and the use of the technique of applanation tonometry as a prognostic tool. We conclude that, although the technique of applanation tonometry initially seems promising, several pertinent issues need to be addressed before it can be used reliably as a clinical or research tool. Importantly, use of the technique of applanation tonometry to derive the central waveform from non-invasively acquired peripheral data needs to be validated prospectively.
TL;DR: Measurement of the aldosterone : renin ratio in all hypertensive individuals, followed by fludrocortisone suppression testing to confirm or exclude primary aldosteronism and adrenal venous sampling to determine the subtype, can result in the detection of significant numbers of patients with specifically treatable or potentially curable hypertension.
Abstract: Background Wide testing of the aldosterone: renin ratio among hypertensive individuals has revealed primary aldosteronism to be common, with most patients normokalaemic. Some investigators, however, have reported aldosterone-producing adenoma to be rare among patients so detected. Objective To test the hypothesis that differences among reported studies in the rate of detection of aldosterone-producing adenoma (as opposed to bilateral adrenal hyperplasia) reflect differences in the procedures used for diagnosis of primary aldosteronism, and the methods used to identify aldosterone-producing adenomas. Methods In the newly established Princess Alexandra Hospital Hypertension Unit (PAHHU), we used procedures developed by Greenslopes Hospital Hypertension Unit (which reports that more than 30% of patients with primary aldosteronism have aldosterone-producing adenomas) to diagnose primary aldosteronism and determine the subtype. All patients with an increased aldosterone: renin ratio (measured after correction for hypokalaemia and while the patient was not receiving interfering medications) underwent fludrocortisone suppression testing to confirm or exclude primary aldosteronism; if they were positive, they underwent genetic testing to exclude glucocorticoid-remediable aldosteronism before adrenal venous sampling was used to differentiate lateralizing from bilateral primary aldosteronism. Results This approach allowed PAHHU to diagnose, within 2 years, 54 patients [only seven (13%) hypokalaemic] with primary aldosteronism. All tested negative for glucocorticoid-remediable aldosteronism. Aldosterone production was lateralized to one adrenal in 15 patients (31%; only six hypokalaemic) and was bilateral in 34 (69%; all normokalaemic) of 49 patients who underwent adrenal venous sampling. Among patients with lateralizing adrenal hyperplasia, computed tomography revealed an ipsilateral mass in only six and a contralateral lesion in one. Fourteen patients underwent unilateral adrenalectomy, which cured the hypertension in seven and improved it in the remainder. In patients with bilateral primary aldlosteronism, hypertension responded to spironolactone (112.5-50 mg/ day) or amiloride (2.5-10 mg/day). Conclusion When performed with careful regard to confounding factors, measurement of the aldosterone: renin ratio in all hypertensive individuals, followed by fludrocortisone suppression testing to confirm or exclude primary aldosteronism and adrenal venous sampling to determine the subtype, can result in the detection of significant numbers of patients with specifically treatable or potentially curable hypertension. (C) 2003 Lippincott Williams Wilkins.
TL;DR: In this article, the authors showed that Dahl rats exhibit many phenotypic traits associated with salt-sensitive hypertension in man, such as salt sensitivity, insulin resistance, and hyperlipidemic.
Abstract: BackgroundDahl salt-sensitive (Dahl S) rats exhibit many phenotypic traits associated with salt-sensitive hypertension in man. Specifically, they are salt-sensitive, insulin-resistant and hyperlipidemic. They also develop endothelial dysfunction, cardiac injury and glomerulosclerosis. Insulin resist
TL;DR: Dysfunction of the vascular H2S synthase/H2S pathway was found in l-NAME-induced hypertensive rats, and exogenous H1N1 effectively prevented the development of hypertension induced by l- NAME.
Abstract: ObjectiveThe present study intended to investigate whether the impaired H2S synthase/H2S pathway is associated with hypertension.MethodsHypertension in Wistar rats was induced by the oral administration of the l-arginine analog, NG-nitro-l-arginine methyl ester (l-NAME) in their drinking water for a
TL;DR: It is shown that hypertension is frequent in HIV patients on HAART and that hypertension appears to be linked to insulin resistance; in particular, hypertension seems to be a part of the metabolic syndrome.
Abstract: OBJECTIVES Metabolic syndrome is a cluster of risk factors, such as central obesity, dyslipidemia, glucose intolerance, hypertension, related to insulin resistance. In HIV patients insulin resistance and several metabolic abnormalities of the metabolic syndrome have been described, but few and conflicting studies have investigated the behaviour of blood pressure. The aims of the present study were to evaluate the prevalence of hypertension in a large group of HIV-patients on highly active antiretroviral therapy (HAART) and to investigate the relationship between hypertension, metabolic syndrome and insulin resistance. DESIGN Case control study. METHODS We enrolled 287 HIV-positive patients on HAART (mean age 41.1 +/- 7.5 years) and 287 age- and sex-matched controls. Insulin resistance was estimated by the homeostasis model insulin resistance assessment (HOMA) index. Metabolic syndrome was defined according to the European Group for the Study of Insulin Resistance. RESULTS HIV patients showed a prevalence of subjects with hypertension (34.2 versus 11.9%; P < 0.0001) and metabolic syndrome (33.1 versus 2.4%; P < 0.0001) higher than controls. HOMA was higher in HIV-patients than controls (3.3 +/- 1.2 versus 2.0 +/- 0.9; P < 0.0001). HOMA (3.7 +/- 1.0 versus 3.1 +/- 1.2; P < 0.001) and the prevalence of subjects with the metabolic syndrome (64.3 versus 16.9%; P < 0.0001) were greater in HIV-patients with than in those without hypertension. Multiple logistic regression analysis showed that family history of hypertension (odds ratio [(OR): 8.73; 95% confidence interval (CI): 4.31-17.70; P < 0.0001], metabolic syndrome (OR: 6.79; 95% CI: 3.27-14.10; P < 0.0001), lipodystrophy (OR: 4.80; 95% CI: 2.43-9.85; P < 0.0001) and HOMA (OR: 4.13; 95% CI: 1.14-14.91; P < 0.05) were predictors of hypertension in HIV-patients. CONCLUSIONS The present study shows that hypertension is frequent in HIV patients on HAART and that hypertension appears to be linked to insulin resistance; in particular, hypertension seems to be a part of the metabolic syndrome.
TL;DR: Evidence is provided that, in obese hypertensive individuals, treatment with candesartan cilexetil has an antihypertensive effect similar to that of HCTZ, which improves insulin sensitivity and exerts sympathoinhibitory effects.
Abstract: ObjectiveThe increase in blood pressure that accompanies the obese state is almost invariably associated with alterations in metabolism (insulin resistance and dyslipidaemia) and the neurohumoral profile (activation of the renin–angiotensin system, sympathetic overactivity), which potentiate the car
TL;DR: The prevalence of cardiovascular risk factors was high in Morocco and it is necessary to increase action against the cardiovascular diseases and their risk factors.
Abstract: ObjectiveThe aim of this study was to determine the prevalence of the main cardiovascular risk factors in Morocco and their distribution according to age, sex and residential area.MethodsThe study was conducted during the year 2000 on a Moroccan representative sample aged 20 years and over, consider
TL;DR: Patients with known hypertension presented a poorer HRQOL, and deterioration of the subjective state of health was not observed in patients who had not yet been diagnosed, which suggests it is due, above all, to the labeling effect and/or to the treatment more than to the hypertension per se.
Abstract: ObjectiveAnalyze the impact of known and unknown hypertension on health-related quality of life (HRQOL).Design and settingA descriptive cross-sectional study in the health coverage area of the Rio Hortega University Hospital, in north-western Spain, on a simple random sample of 33 022 individuals.Pa
TL;DR: The evidence concerning the cardiovascular prognostic value and the potential direct involvement of CRP and IL-6 in atherogenesis is reviewed.
Abstract: Recent advances in basic science have shown that atherosclerosis should be considered as a chronic inflammatory process, and that a pivotal role of inflammation is evident from initiation through progression and complication of atherosclerosis. In the past few years many studies have examined the potential for biochemical markers of inflammation to act as predictors of coronary heart disease (CHD) risk in a variety of clinical settings. Several large, prospective epidemiological studies have shown consistently that C-reactive protein (CRP) and interleukin-6 (IL-6) plasma levels are strong independent predictors of risk of future cardiovascular events, both in patients with a history of CHD and in apparently healthy subjects. These molecules could be useful to complement traditional risk factors, as well as to identify new categories of subjects prone to atherosclerosis development. An intriguing question is whether these inflammatory molecules simply represent sensitive markers of systemic inflammation or if they actively contribute to atherosclerotic lesion formation and instability. In this paper we will review the evidence concerning the cardiovascular prognostic value and the potential direct involvement of CRP and IL-6 in atherogenesis.
TL;DR: The ISH statement on the management of blood pressure in acute stroke was finalized after presentation and discussion at the World Health Organization and International Society of Hypertension Meeting on Stroke and Blood Pressure, held in Melbourne, Australia, 5-7 December 2002.
Abstract: The ISH statement on the management of blood pressure in acute stroke was finalized after presentation and discussion at the World Health Organization and International Society of Hypertension (WHO-ISH) Meeting on Stroke and Blood Pressure, held in Melbourne, Australia, 5-7 December 2002. The meeting was conducted under the auspices of the Austin Hospital Medical Research Foundation, Melbourne.
TL;DR: The results are consistent with the hypothesis of a generalized remodelling of small arteries in the body, including the coronary circulation; this remodelling may play an important role in the reduction of coronary vasodilator capacity in patients with mild to moderate essential hypertension.
Abstract: Background Arterial hypertension is frequently associated with the presence of structural alterations in small arteries. Moreover, a reduced coronary flow reserve and vasodilator capacity has been observed in essential hypertensive patients, possibly due, at least in part, to microangiopathy of small coronary vessels. The aim of the present study was to evaluate a possible relationship between subcutaneous small artery structure and coronary flow reserve or vasodilator capacity in patients with essential hypertension. Methods and results A total of 20 patients with mild to moderate essential hypertension were included in the study, and underwent a biopsy of the subcutaneous fat from the gluteal region. Small arteries were dissected and mounted on a micromyograph. The media thickness, the normalized internal diameter and the media:lumen ratio (M/L) were then calculated. In addition, a transesophageal Doppler echocardiographic study, which allows the measurement of coronary flow velocity before and during maximal pharmacological vasodilatation, was performed. Coronary flow reserve (CFR) was measured as the ratio of coronary flow velocity assessed during adenosine infusion and that measured in basal conditions. From blood pressure and coronary flow velocity during adenosine infusion, minimum coronary resistance was calculated. CFR as well as minimum coronary resistance were significantly correlated to both M/L and to normalized internal diameter of subcutaneous small arteries. Conclusions Our results are consistent with the hypothesis of a generalized remodelling of small arteries in the body, including the coronary circulation; this remodelling may play an important role in the reduction of coronary vasodilator capacity in patients with mild to moderate essential hypertension.
TL;DR: Transfer functions may be valid for the derivation of some central aortic waveform characteristics, but in providing neither improved reproducibility nor data on parameters not obtainable from the radial waveform, transfer function techniques may offer no additional clinical benefit.
Abstract: ObjectiveTo investigate the utility and accuracy of radial-aortic arterial transfer functions for the derivation of central blood pressure waveforms.DesignProspective measurement of central and peripheral waveforms in patients undergoing coronary angiography or percutaneous coronary intervention.Met
TL;DR: A threefold difference in prevalence of hypertension exists between people of South Asian descent, which, unlike the urban/rural difference, cannot be accounted for by measured risk factors.
Abstract: ObjectiveCardiovascular risks are globally elevated in South Asians, but this masks important ethnic subgroup differences in risk factors, such as hypertension, which have not been fully explored. We conducted this study to explore the variations in hypertension within ethnic subgroups among South A
TL;DR: Systolic blood pressure and pulse pressure are predictors of plasma C-reactive protein concentrations in patients with newly diagnosed, never-treated hypertension, irrespective of the potential proinflammatory action of traditional cardiovascular risk factors.
Abstract: ObjectiveTo test whether the plasma concentration of C-reactive protein (CRP), a sensitive marker of systemic inflammation, is increased in patients with newly diagnosed, never-treated hypertension and whether blood pressure and its pulsatile component, pulse pressure, are correlated with plasma CRP
TL;DR: Consumption of a Mediterranean type of diet seems to reduce rates of hypertension in the population, and may contribute to the control of hypertension at the population level.
Abstract: ObjectiveTo evaluate the prevalence, awareness, treatment, and control of hypertension, in a random sample of adults free of cardiovascular disease, in Greece. A secondary goal was to evaluate the association between hypertension status and adoption of the Mediterranean diet.DesignCross-sectional su
TL;DR: This study documents a marked north–south gradient in the prevalence of hypertension in China, with residents in north China having higher percentages of awareness but lower percentages of control compared with their counterparts in south China.
Abstract: OBJECTIVE To compare the prevalence, awareness, treatment and control of hypertension in north and south, and urban and rural residents of China. DESIGN A cross-sectional survey conducted in 2000-2001. SETTING AND PARTICIPANTS A multistage cluster sampling method was used to select a nationally representative sample of 15 540 men and women aged 35-74 years from the general Chinese population. MAIN OUTCOME MEASURES Three blood pressure measurements were obtained by trained observers using a standardized mercury sphygmomanometer. Information on history of hypertension and use of antihypertensive medications was obtained by use of a standard questionnaire. Hypertension was defined as a mean systolic blood pressure >or= 140 mmHg and/or diastolic blood pressure >or= 90 mmHg and/or use of antihypertensive medications. RESULTS The age-standardized prevalence of hypertension was significantly higher among residents living in north than in south China (33.8 versus 23.3%, P < 0.001), but similar in those living in urban and rural areas (29.0 versus 28.1%, P = 0.3). Average systolic and diastolic blood pressure levels were consistently higher in north than in south residents. Residents in north China had higher percentages of awareness but lower percentages of control compared with their counterparts in south China. Percentages of awareness, treatment and control of hypertension were significantly higher in urban than in rural residents. CONCLUSIONS Our study documents a marked north-south gradient in the prevalence of hypertension in China. The previously reported urban-rural difference in the prevalence of hypertension was not noted, perhaps due to a rapid increase in the prevalence of hypertension in rural China.
TL;DR: Add-on treatment with 0.3 mg/day moxonidine in hypertensive patients with renal failure is well tolerated and not inferior to 20mg/day nitrendipine with respect to the incidence of specific adverse events and the idea of a sympatholytic drug to be renoprotective is appealing.
Abstract: Objectives To compare safety and tolerability of moxonidine versus nitrendipine in hypertensive patients with renal failure. A secondary endpoint was to test whether the sympatholytic drug moxonidine slows decline of renal function when added to standard therapy with an angiotensin-converting enzyme inhibitor or AT(1) receptor antagonist plus loop diuretic. Design This prospective, randomized, double-blind, multicenter study recruited 177 patients with advanced renal failure receiving antihypertensive standard therapy at outpatient clinics in Germany and Hungary. Following a 2 week run-in, patients were randomized to 24 weeks of add-on treatment with 0.3 mg/day moxonidine or 20 mg/day nitrendipine. Results The incidence of pre-defined specific adverse events was 42% in the moxonidine (37/89 patients) and 46% in the nitrendipine group (38/82 patients) in intention-to-treat analysis. Intensity and multiplicity were comparable. The dropout rate due to adverse events was 12.4% in the moxonidine and 9.8% in the nitrendipine group. Creatinine clearance according to Cockcroft and Gault decreased by 0.5 +/- 4.3 ml/min (mean +/- standard deviation) in the moxonidine group and 2.3 +/- 4.0 ml/min in the nitrendipine group. Serum creatinine increased by 12.7 +/- 49.2 micromol/l in the moxonidine group and by 43.4 +/- 71.3 micromol/l in the nitrendipine group. These differences were statistically significant (P Conclusion Add-on treatment with 0.3 mg/day moxonidine in hypertensive patients with renal failure is well tolerated and not inferior to 20 mg/day nitrendipine with respect to the incidence of specific adverse events. The idea of a sympatholytic drug to be renoprotective is appealing but needs further evaluation.
TL;DR: Results from the SAMPLE trial show the superiority of mean 24-h, daytime and night-time blood pressures over clinic readings in predicting the regression of left ventricular mass index in treated hypertensive patients and a direct, positive relationship has been established between 24-H blood pressure variability and the severity and rate of progression of end-organ damage.
Abstract: The ultimate goal when treating high blood pressure is to reduce the incidence of end-organ damage and prevent cardiovascular disease, and thus reduce the incidence of premature death. Cuff blood pressure measurements have some prognostic value and have traditionally been used to predict the risk of end-organ damage. Such measurements, however, do not reflect accurately the 24-h mean blood pressure and hourly variations. For any value of cuff blood pressure, a lower 24-h mean blood pressure was associated with a lower prevalence and severity of end-organ damage. In the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, data from 24-h ambulatory blood pressure monitoring (ABPM) were more strongly associated with prognosis than other blood pressure data. Longitudinal evidence of the clinical relevance of 24-h ABPM data in predicting cardiovascular risk is less extensive. However, results from the Study on Ambulatory Monitoring of Pressure and Lisinopril Evaluation (SAMPLE) trial show the superiority of mean 24-h, daytime and night-time blood pressures over clinic readings in predicting the regression of left ventricular mass index in treated hypertensive patients. Furthermore, a direct, positive relationship has been established between 24-h blood pressure variability and the severity and rate of progression of end-organ damage. In addition, ABPM data demonstrate that hypertensive patients who do not exhibit a nocturnal reduction in blood pressure have a higher incidence of end-organ damage. Future directions for research and treatment of hypertension will need to consider the circadian cycle of blood pressure, the effect of treatment on blood pressure variability, and the magnitude of blood pressure changes in daily life.
TL;DR: The findings are in line with the recommendations of the ASH Ad Hoc Panel that recommends HBP for screening while ABP has a better prognostic accuracy.
Abstract: ObjectiveWe examined to what extent self-measurement of blood pressure at home (HBP) can be an alternative to ambulatory monitoring (ABP) to diagnose white-coat hypertension.MethodsIn 247 untreated patients, we compared the white-coat effects obtained by HBP and ABP. The thresholds to diagnose hyper