TCT-3 Cardiac Neuromodulation Therapy Reduces Systolic Blood Pressure and Pulse Pressure in Patients With Isolated Systolic Hypertension in a Randomized Double-Blind Study

Background: Chronic mitral valve regurgitation is the most common heart disease in dogs. It is caused by myxomatous mitral valve degeneration, an acquired degenerative disease that can lead to congestive heart failure. Pimobendan is a mixed action drug, with inotropic and vasodilator proprieties, widely used to treat such dogs. Amlodipine is a pure vasodilator drug used as an anti-hypertensive agent, with no inotropic effects. This study aimed to compare echocardiographic, electrocardiographic and blood pressure parameters between dogs with congestive heart failure treated with pimobendan and those treated with amlodipine in addition to conventional therapy.Materials, Methods & Results: A prospective, randomized, double-blind study was conducted in dogs with stage C chronic mitral valve regurgitation according to the 2009 American College of Veterinary Internal Medicine (ACVIM) guidelines, who weighed up to 15 kg. Randomization was performed using appropriate software and the sealed envelope technique. Blinding of the owner, the main researcher, and the person who performed the clinical analysis was guaranteed by the use of identical capsules and bottles for both pimobendan and amlodipine. Statistical analysis was performed using specialized software. Eligibility was determined by predefined inclusion and exclusion criteria. Dogs with cardiac disease other than mitral and/or tricuspid degeneration, patients already undergoing pharmacological treatment with drugs other than enalapril and furosemide, patients with systolic blood pressure below 100 mmHg, patients with chronic kidney disease in stages III or IV according to International Renal Interest Society staging system for chronic kidney disease (2009), and patients with other systemic debilitating diseases were excluded from the study. The animals were randomized into two groups based on the drug they received. Group A received pimobendan (n = 10) and group B received amlodipine (n = 11). All animals were also treated with furosemide and enalapril maleate and evaluated three times over a period of sixty days (T0, T30, T60). Changes in echodopplercardiographic and electrocardiographic parameters and systolic blood pressure were investigated. There were no significant differences in electrocardiographic parameters or systolic blood pressure between the groups at any time. Among the echocardiographic parameters, only early diastolic myocardial peak velocity (Em) and late diastolic myocardial peak velocity (Am) showed a significant difference between groups.Discussion: This was the first prospective randomized double-blind study comparing pimobendan and amlodipine in the treatment of dogs with stage C chronic mitral valve regurgitation according to the ACVIM consensus statement. The use of pimobendan in these patients has been debated because myocardial inotropism is generally preserved in them. Some authors argue that early use of the drug can even lead to deleterious effects on the heart. In the present study, the groups showed no statistically significant differences in systolic blood pressure or electrocardiographic parameters. Among the echocardiographic parameters, statistically significant differences were only observed in the speed of Em waves between groups at T0, in the speed of Em waves in the amlodipine group between T0 and T60 times, and in the speed of Am waves in the amlodipine group between T30 and T60 times. Both parameters are indices of diastolic function and may indicate a change in early myocardial relaxation. From the findings of this study, we could not conclude whether one drug was superior to the other.

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Abstract P482: Different Hemodynamic Phenotypes Of Isolated Systolic Hypertension In Adolescents

Hypertension ◽

10.1161/hyp.70.suppl_1.p482 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Lukasz Obrycki ◽

Anna Niemirska ◽

Jedrzej Sarnecki ◽

Zbigniew Kulaga ◽

Mieczyslaw Litwin

Keyword(s):

Blood Pressure ◽

Pulse Pressure ◽

Systolic Hypertension ◽

Target Organ Damage ◽

Intima Media Thickness ◽

Left Ventricular ◽

White Coat Hypertension ◽

Control Group ◽

Isolated Systolic Hypertension ◽

Dominant Form

Objective: Isolated systolic hypertension (ISH) is a dominant form of primary hypertension (PH) in adolescents. Some of them present with normal central systolic blood pressure (cSBP), a phenomenon called spurious hypertension (sHT). The study was aimed to describe hemodynamics of PH in relation to cSBP, central pulse pressure (cPP) and target organ damage (TOD) in adolescents referred because of PH. Patients and Methods: In 267 children (59 girls; 14.9 ±2.6 years) referred with arterial hypertension, in whom secondary hypertension was excluded, 24 hour ABPM, left ventricular mass index (LVMi), carotid intima-media thickness (cIMT), pulse wave velocity (PWV), cSBP, cPP, cardiac index (CI) and stroke volume (SV) was assessed. 64 age and sex matched normotensive control children were control group. Results: 145 subjects had white coat hypertension (WCH) including 24 with ambulatory prehypertension (ambpreHT). Of 122 hypertensive pts, 39 had ambulatory hypertension (ambHT) and 83 severe ambulatory hypertension (severeHT). Normal cSBP was found in all WCH subject and 23 with ambpreHT. 39 of 122 (32%) hypertensive pts had sHT - 47.4% in those with ambHT and 26.5% with severeHT (p=0.0001). cIMT, LVMi, PWV, cSBP and cPP increased across blood pressure strata from normotension, through sHT to PH with elevated cSBP (all p<0.05). LVMi and cIMT correlated with cSBP (r = 0.220; p = 0.0007; r = 0.14; p = 0.04, respectively) and cPP (r = 0.274; p = 0.0001; r=0.202; p=0.002, respectively). 36 pts with left ventricular hypertrophy (LVH) had greater cPP (52 ±10 mmHg) in comparison with subjects without LVH (47 ±8 mmHg; p = 0.027). Regression analysis revealed cPP as the only predictor of LVMi (r 2 = 0.09, β = 0.143, p = 0.03). ROC area for predictors of LVH revealed similar area under curve for cSBP (0.585), cPP (0.618) and 24h systolic ABPM (0.612). Patients with sHT had greater amplification of pulse pressure than normotensive ones. CI and SV was lowest in normotensive controls, intermediate in sHT patients and highest in patients with elevated cSBP (p<0.05). Conclusions: sHT present with intermediate hemodynamic phenotype between normotension and sustained PH. cSBP and cPP differentiates patients with severeHT and TOD from patients with WCH, ambpreHT and ambHT without TOD

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Flunarizine (10 and 20 mg) i.v. Versus Placebo in the Treatment of Acute Migraine Attacks: A Multi-Centre Double-Blind Study

Cephalalgia ◽

10.1046/j.1468-2982.1990.1002077.x ◽

1990 ◽

Vol 10 (2) ◽

pp. 77-81 ◽

Cited By ~ 12

Author(s):

Volker Pfaffenrath ◽

Wolfgang Oestreich ◽

Wolfgang Haase

Keyword(s):

Blood Pressure ◽

Visual Analogue Scale ◽

Drug Administration ◽

Analogue Scale ◽

Blind Study ◽

Response To Treatment ◽

Double Blind Study ◽

Acute Migraine ◽

Double Blind ◽

Suitable Alternative

In a multi-centre, randomized double-blind study, the effect and tolerance of 10 and 20 mg flunarizine i.v. versus placebo was tested on 102 migraineurs with acute migraine attacks with and/or without aura. Thirty-seven patients received 10 mg flunarizine, 32 received 20 mg and 33 received placebo. The groups were comparable. Response to treatment was defined as pain reduction of at least 50% within 60 min on a visual analogue scale after i.v. drug administration. This effect was noted on 59.4% with 20 mg flunarizine, on 24.3% with 10 mg flunarizine and on 30.3% with placebo. The tolerance of flunarizine i.v. was similar to placebo. Blood pressure and pulse rate were not affected by flunarizine. All in all, 20 mg flunarizine i.v. appeared to be a suitable alternative for treatment of acute migraine attacks.

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Arterial stiffness: from isolated systolic hypertension to syncope

ESC CardioMed ◽

10.1093/med/9780198784906.003.0718 ◽

2018 ◽

pp. 2971-2976

Author(s):

Jerzy Gąsowski ◽

Chirag Bavishi ◽

Franz H Messerli

Keyword(s):

Blood Pressure ◽

Pulse Pressure ◽

Systolic Hypertension ◽

Pulse Wave ◽

Angiotensin Receptor Blockers ◽

The Elderly ◽

Channel Blockers ◽

Isolated Systolic Hypertension ◽

Converting Enzyme Inhibitors ◽

European Guidelines

Isolated systolic hypertension (ISH) is the predominant form of hypertension in the elderly. The pathophysiology includes a plethora of factors; however, the stiffening of large arteries, leading to wider pulse pressure and faster propagation of the pressure pulse wave, are at the core of the disease. It has been shown that higher systolic blood pressure (SBP), pulse pressure, and pulse wave velocity are associated with a greater risk of cardiovascular complications, including a greater risk of dementia. In elderly patients, the relationship between SBP and the risk of mortality starts increasing at about 160 mmHg. A number of clinical trials were performed in populations of patients which included the elderly, however only four trials were specifically dedicated to answer the question of whether the active treatment of ISH (SHEP, Syst-Eur, Syst-China) or treatment of octogenarian hypertensive patients (HYVET) lowers cardiovascular risk in the elderly patient. They all showed that regimens based on thiazide-like diuretics, dihydropyridine calcium channel blockers, or angiotensin-converting enzyme inhibitors are capable of reducing the risk along with the appropriate reduction of SBP. This is widely reflected in the current European guidelines, with the addition of angiotensin receptor blockers. Nevertheless, the debate on the appropriate blood pressure goal is ongoing. However, none of the trials in the elderly had an average SBP lowered to less than 140 mmHg, and the overwhelming evidence suggests that in patients above the age of 70 with overt cardiovascular disease, a SBP less than 130 mmHg may be associated with an increase in risk.

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