Journal ArticleDOI
Your Drug, My Drug, or Our Drugs: How Aggressive Should We Be With Antihypertensive Therapy?
TLDR
Why would an astute clinician (or informed patient) be satisfied with the relatively limited effects of any single class of antihypertensive agents when better overall protection is possible?Abstract:
In the prevention of hypertensive complications, especially stroke and kidney disease, “lower is better” because for each decrease of 20 mm Hg systolic or 10 mm Hg diastolic pressure in the population, cardiovascular risk is halved. Ideally, the goal for each patient should be to reach the lowest blood pressure that is well tolerated, a value that may be well below the arbitrary threshold value of 140/90 mm Hg. For the majority of “uncomplicated hypertensives,” the question of single-drug therapy is essentially moot, because more than one agent is almost always required to optimally control blood pressure. In individuals who already have heart or kidney disease, there are compelling indications for the use of drugs that block the renin-angiotensin system, but the large outcome studies that spawned these recommendations are themselves combination trials. Thus, in virtually all patients, more than one drug is indicated. The best combinations take advantage of long durations of action and complementary mechanisms of action of the component and are not only able to effectively lower blood pressure, but also to favorably affect the natural history of hypertensive complications. Regimens—including fixed-dose combination products—that combine a thiazide diuretic or calcium antagonist with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are most efficient. In summary, why would an astute clinician (or informed patient) be satisfied with the relatively limited effects of any single class of antihypertensive agents when better overall protection is possible?read more
Citations
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Journal ArticleDOI
EXCEED: Exforge®-intensive control of hypertension to evaluate efficacy in diastolic dysfunction: study rationale, design, and participant characteristics:
Amira H Hassanein,Akshay S. Desai,Anil Verma,Suzanne Oparil,Joseph Izzo,Richardo Rocha,Robert Hilkert,Youdit Seifu,Bertrand Pitt,Scott D. Solomon +9 more
TL;DR: ExCEED will determine whether intensive BP lowering will further improve diastolic dysfunction and vascular stiffness among patients with uncontrolled hypertension.
Journal ArticleDOI
Inhibiteurs de l'enzyme de conversion et antagonistes calciques : une synergie d'action pour une meilleure prévention des événements cardiovasculaires
TL;DR: Plusieurs essais cliniques de grande taille ont permis de valider cette strategie therapeutique, debouchant sur le developpement de nouvelles associations fixes.
References
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Journal ArticleDOI
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.
Aram V. Chobanian,George L. Bakris,Henry R. Black,William C. Cushman,Lee A. Green,Joseph L. Izzo,Daniel W. Jones,Barry J. Materson,Suzanne Oparil,Jackson T. Wright,Edward J. Roccella +10 more
TL;DR: The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated, and empathy builds trust and is a potent motivator.
Journal ArticleDOI
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
TL;DR: Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
Journal ArticleDOI
Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT)
Curt D. Furberg,Jackson T. Wright,Barry R. Davis,Jeffrey A. Cutler,Michael H. Alderman,Henry R. Black,William C. Cushman,Richard H. Grimm,L. Julian Haywood,Frans H. H. Leenen,Suzanne Oparil,Jeffrey L. Probstfield,Paul K. Whelton,Chuke Nwachuku,David Gordon,Michael A. Proschan,Paula Einhom,Charles E. Ford,Linda B. Piller,I. Kay Dunn,David C. Goff,Sara L. Pressel,Judy Bettencourt,Barbara DeLeon,Lara M. Simpson,Joe Blanton,Therese S. Geraci,Sandra M. Walsh,Christine Nelson,Mahboob Rahman,Anne Juratovac,Robert Pospisil,Lillian Carroll,Sheila Sullivan,Jeanne Russo,Gail Barone,Rudy Christian,Sharon Feldman,Tracy Lucente,David A. Calhoun,Kim Jenkins,Peggy McDowell,Janice Johnson,Connie Kingry,Juan Alzate,Karen L. Margolis,Leslie Ann Holland-Klemme,Brenda Jaeger,Jeff D. Williamson,Gail T. Louis,Pamela Ragusa,Angela Williard,R. L Sue Ferguson,Joanna Tanner,John H. Eckfeldt,Richard S. Crow,John Pelosi +56 more
TL;DR: Thiazide-type diuretics are superior in preventing 1 or more major forms of CVD and are less expensive and should be preferred for first-step antihypertensive therapy.
Journal ArticleDOI
Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial
Stevo Julius,Sverre E. Kjeldsen,Michael A. Weber,Hans R. Brunner,Steffan Ekman,Lennart Hansson,Tsushung Hua,John H. Laragh,Gordon T. McInnes,Lada Mitchell,Francis Plat,Anthony Schork,Beverly Smith,Alberto Zanchetti +13 more
TL;DR: Blood pressure was reduced by both treatments, but the effects of the amlodipine-based regimen were more pronounced, especially in the early period, which emphasise the importance of prompt blood-pressure control in hypertensive patients at high cardiovascular risk.
Journal ArticleDOI
A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Treatment Strategy for Patients With Coronary Artery Disease The International Verapamil-Trandolapril Study (INVEST): A Randomized Controlled Trial
Carl J. Pepine,Eileen M. Handberg,Rhonda M. Cooper-DeHoff,Ronald G. Marks,Peter R. Kowey,Franz H. Messerli,Giuseppe Mancia,Jose L. Cangiano,David Garcia-Barreto,Matyas Keltai,Serap Erdine,Heather A. Bristol,H Robert Kolb,George L. Bakris,Jerome D. Cohen,William W. Parmley +15 more
TL;DR: The verapamil-trandolapril- based strategy was as clinically effective as the atenolol-hydrochlorothiazide-based strategy in hypertensive CAD patients, and was also recommended for patients with heart failure, diabetes, or renal impairment.