scholarly journals Empagliflozin for Patients With Presumed Resistant Hypertension: A Post Hoc Analysis of the EMPA-REG OUTCOME Trial

2020 ◽  
Author(s):  
João Pedro Ferreira ◽  
David Fitchett ◽  
Anne Pernille Ofstad ◽  
Bettina Johanna Kraus ◽  
Christoph Wanner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Repeated Measures ◽  
Cox Regression ◽  
Antihypertensive Drugs ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Cardiac Events ◽  
Post Hoc Analysis ◽  
Post Hoc

Abstract BACKGROUND Type 2 diabetes (T2D) and resistant hypertension often coexist, greatly increasing risk of target-organ damage and death. We explored the effects of empagliflozin in patients with and without presumed resistant hypertension (prHT) in a post hoc analysis of EMPA-REG OUTCOME (NCT01131676). METHODS Overall, 7,020 patients received empagliflozin 10, 25 mg, or placebo with median follow-up of 3.1 years. We defined baseline prHT as ≥3 classes of antihypertensive drugs including a diuretic and uncontrolled blood pressure (BP; systolic blood pressure (SBP) ≥140 and/or diastolic blood pressure ≥90 mm Hg) or ≥4 classes of antihypertensive, including a diuretic, and controlled BP. We explored the effect of empagliflozin on cardiovascular (CV) death, heart failure (HF) hospitalization, 3-point major adverse cardiac events, all-cause death, and incident/worsening nephropathy by Cox regression and BP over time by a mixed-repeated-measures-model analysis. RESULTS 1,579 (22.5%) patients had prHT. The mean difference in change in SBP from baseline to week 12 vs. placebo was −4.5 (95% confidence interval, −5.9 to −3.1) mm Hg (P < 0.001) in prHT and −3.7 (−4.5, −2.9) mm Hg (P < 0.001) in patients without prHT. SBP was more frequently controlled (<130/80 mm Hg) with empagliflozin than with placebo. Patients with prHT had 1.5- to 2-fold greater risk of HF hospitalization, incident/worsening nephropathy, and CV death compared with those without prHT. Empagliflozin improved all outcomes in patients with and without prHT (interaction P > 0.1 for all outcomes). CONCLUSIONS Empagliflozin induced a clinically relevant reduction in SBP and consistently improved all outcomes regardless of prHT status. Due to these dual effects, empagliflozin should be considered for patients with hypertension and T2D.

Abstract 117: Preclinical Target Organ Damage Changes in Patients with Resistant Hypertension Randomized to Renal Denervation or Spironolactone as Add-on Therapy. Results From the DENERVHTA Study

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Anna Oliveras ◽  
Pedro Armario ◽  
Laia Sans ◽  
Albert Clarà ◽  
Susana Vázquez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Linear Models ◽  
Antihypertensive Drugs ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Group Differences

Objective: To compare the effect of renal denervation (RDN) and spironolactone, two proposed therapeutic strategies for the treatment of patients with resistant hypertension (RH), on preclinical target organ damage (pTOD). Methods: Patients with office systolic blood pressure (SBP) ≥150 mmHg and 24h-SBP ≥140 mmHg despite receiving ≥3 full-dose antihypertensive drugs, one a diuretic, but none aldosterone antagonist, were randomized to receive RDN or spironolactone (50mg), as add-on therapy. Changes (Δ) in 24h-BP, as well as Δ in urinary albumin excretion (ΔUAE), carotid-femoral pulse-wave velocity (ΔcfPWV), carotid intima-media thickness (ΔIMT), left ventricular mass index (ΔLVMI) and E/e’ (ΔE/e’), a marker of hypertension-induced diastolic dysfunction, were evaluated at 6 months. Between-group comparisons of ΔUAE (after log transformation), ΔcfPWV, ΔIMT, ΔLVMI and ΔE/e’ were carried out by generalized linear models before and after adjusting by Δ24h-SBP and the corresponding baseline value. Results: Twenty-four patients (mean age 64±8 yr) were included. Mean baseline-adjusted difference (95% CI) between the two groups (Spironolactone vs.RDN) at 6 months in 24h-SBP (mmHg) was of-17.9 (-30.9 to -4.9), p=0.01. As shown in the table, there were no statistically significant between-group differences in Δ on pTOD. Conclusion: Changes at 6 months on pTOD as assessed by UAE, cfPWV, IMT, LVMI and E/e’, were not associated with the therapeutic add-on strategy used to reduce high blood pressure in RH patients. We cannot discard that the high variability of some of these markers, especially UAE, could account for this lack of statistically significant between-group differences.

Prevalence, Biochemical and Clinical Characteristics of Resistant Hypertension

2018 ◽  
Vol 69 (10) ◽  
pp. 2845-2849
Author(s):  
Daniela Gurgus ◽  
Elena Ardeleanu ◽  
Carmen Gadau ◽  
Roxana Folescu ◽  
Ioan Tilea ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Resistant Hypertension ◽  
Clinical Characteristics ◽  
Salt Intake ◽  
Target Organ Damage ◽  
Multivariate Logistic Regression Analysis ◽  
Organ Damage ◽  
Left Ventricular ◽  
High Salt Intake

The objectives of the present study were to evaluate the prevalence of resistant hypertension (RH) in primary care setting and to analyse its biochemical and clinical characteristics. After 3 months of treatment and evaluation, 721 (14.01%) of 5,146 patients with hypertension did not reach target office blood pressure of [ 140/90 mmHg. After exclusion of �white-coat effect� with ambulatory blood pressure, of secondary and pseudo- resistant hypertension, prevalence of RH was 6.74%. Lifestyle factors associated with RH were physical inactivity, obesity, high salt intake, smoking and excessive alcohol ingestion. Compared to controlled hypertension, RH patients presented higher incidence of family history of cardiovascular disease (38.90% vs 25.94%), diabetes mellitus (34.87% vs 19.01%), impaired fasting glucose (21.91% vs 19.07%), target organ damage (29.1% vs 15.95%), and cardiovascular disease (27.09% vs 17.06%). Dyslipidaemia (52.90% vs 42.03%), fasting plasma glucose (116.10�38.9 vs 107.80�37.2), HbA1c (6.41�1.42 vs 5.96�0.94), serum creatinine (1.09�0.27 vs 1.03�0.24) and microalbuminuria (21.90% vs 10.95%) were significantly higher in RH. Predictors of RH, determined by a multivariate logistic regression analysis were left ventricular hypertrophy (OD 2.14, 95% CI 1.32-3.69), renal impairment expressed as eGFR [ 60 ml/min/1.73m2 (OD 1.62, 95% CI 1.21-2.21) and the presence of cardiovascular disease (OD 1.48, 95% CI 1.02-2.16).

scholarly journals Effect of the Nonsteroidal Mineralocorticoid Receptor Blocker, Esaxerenone, on Nocturnal Hypertension: A Post Hoc Analysis of the ESAX-HTN Study

2020 ◽  
Author(s):  
Kazuomi Kario ◽  
Sadayoshi Ito ◽  
Hiroshi Itoh ◽  
Hiromi Rakugi ◽  
Yasuyuki Okuda ◽  
...  
Keyword(s):  
Older Patients ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Effective Treatment Option ◽  
Double Blind ◽  
Nocturnal Hypertension ◽  
Post Hoc Analysis ◽  
Nocturnal Dipping ◽  
Parallel Group ◽  
Post Hoc

Abstract BACKGROUND Nocturnal hypertension is an important phenotype of abnormal diurnal blood pressure (BP) variability and a known risk marker for target organ damage and cardiovascular events. This study aimed to assess the differential BP-lowering effects of esaxerenone vs. eplerenone on nocturnal BP in hypertensive patients with different nocturnal dipping patterns. METHODS This was a post hoc analysis of the “Esaxerenone (CS-3150) Compared to Eplerenone in Patients with Essential Hypertension” study (NCT02890173), which was a phase 3, multicenter, randomized, controlled, double-blind, parallel-group clinical study conducted in Japan. Ambulatory BP monitoring data were collected. RESULTS Patients (n = 1,001) were randomized to esaxerenone 2.5 mg/day (n = 331) or 5 mg/day (n = 338), or eplerenone 50 mg/day (n = 332). Reductions in nighttime systolic BP (95% confidence interval) were significantly greater with 2.5 and 5 mg/day esaxerenone vs. eplerenone (−2.6 [−5.0, −0.2] and −6.4 mm Hg [−8.8, −4.0], respectively). Esaxerenone significantly reduced nighttime BP from baseline compared with eplerenone in non-dippers with previously uncontrolled BP. In addition, esaxerenone did not markedly alter nighttime BP in extreme dipper patients. In the esaxerenone 5 mg/day group, esaxerenone-induced decreases in nighttime BP were greater than eplerenone-induced decreases in older patients. CONCLUSIONS Esaxerenone may be an effective treatment option for nocturnal hypertension, especially in older patients and those with a non-dipper pattern of nocturnal BP.

scholarly journals The Clinical Significance of Circadian Rhythm and Blood Pressure Variability

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Rafidah Hanim Mokhtar ◽  
Maizatul Azma Masri ◽  
Hanis Hidayu Kasim ◽  
Azizi Ayob
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Circadian Variation ◽  
Biological Clock ◽  
Organ Damage ◽  
Time Of Day ◽  
Cardiac Events ◽  
Factors Affecting

— Sleep-wake cycle is the most evident 24 hour rhythms observed in humans. This circadian variation is a normal biological clock. The physiological phenomenon, however has been able to explain the onset of cardiac events that also tend to occur during certain time of day. It has been known that there is a tendency for major cardiovascular episodes to occur during the mid-morning hours. With the advent of ambulatory blood pressure monitoring, the fluctuations of blood pressure throughout the day are able to be captured. This is called blood pressure variability (BPV). The factors affecting BPV include age, sex, physical activity, mental activity, behavioural and environmental. Recent studies have shown that high BPV is associated with target organ damage, in particular cardiovascular and coronary artery diseases. In the effort to explain the mechanisms related to these complications out of excessive BPV, several studies explored the role of history of family with hypertension, hyperglycaemia and hyperlipidemia towards developing pre-existing condition that lead to high BPV.

scholarly journals Association of Hypertension and Hypertriglyceridemia on Incident Hyperuricemia: An 8-year Prospective Cohort Study

2020 ◽  
Author(s):  
Yuan Zhang ◽  
Miaomiao Zhang ◽  
Xiawen Yu ◽  
Fengjiang Wei ◽  
Chen Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Survival Analysis ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Combined Effect ◽  
Kaplan Meier

Abstract BackgroundHypertension and high triglyceride are two of the most important risk factors for hyperuricemia. Epidemiological records show that hypertension and dyslipidemia often coexist and may significantly increase the risk of target organ damage. However, their combined effect on incident hyperuricemia is poorly understood. Thus, we aimed to investigate the separate and combined effect of hypertension and hypertriglyceridemia on the incidence of hyperuricemia.MethodsA prospective cohort study of 6424 hyperuricemia-free participants aged 20 to 94 years between August 2009 and October 2017 was performed at Tianjin General Hospital of China. Participants were categorized into four groups by combining hypertension and hypertriglyceridemia status at baseline. The restricted cubic spline fitting Cox regression model was used to evaluate the relationship between blood pressure and triglyceride and hyperuricemia. Cox regression models were performed to calculate hazard ratios (HRs) and 95% confident intervals (CIs) to estimate baseline factors and their association with the incidence of hyperuricemia. A Kaplan–Meier survival analysis was performed to compare the incidence of hyperuricemia among subjects in each separate and combined hypertension and hypertriglyceridemia group.ResultsDuring the 8-year follow-up period, 1,259 subjects developed hyperuricemia (20.6%). There existed positive relationships between blood pressure and triglyceride levels and hyperuricemia. This risk factor arising from a combination of the two (HR, 3.02; 95% CI: 2.60-3.50) is greater than that from hypertension (HR, 1.48; 95% CI: 1.28-1.71) or hypertriglyceridemia (HR, 1.84; 95% CI: 1.55-2.18) separately. The Kaplan–Meier survival analysis indicated that combined effect of hypertension and hypertriglyceridemia may predict higher onset of hyperuricemia.ConclusionThe combined effect of hypertension and hypertriglyceridemia on the risk of hyperuricemia is much stronger than that by hypertension or hypertriglyceridemia separately. Hypertension combined with hypertriglyceridemia may be an independent and powerful predictor for hyperuricemia.

Developments in Strategies for Treating High-risk Hypertension

2009 ◽  
Vol 5 (1) ◽  
pp. 56
Author(s):  
Cristina Sierra ◽  
Antonio Coca ◽  
◽  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Antihypertensive Drugs ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Current Evidence ◽  
Global Risk ◽  
Raas Blockade

On the basis of current evidence provided by various studies, the most recent international guidelines recommend reducing blood pressure levels to below 140/90mmHg for all hypertensive patients over 18 years of age, including the elderly, when this is clinically tolerated, as a necessary measure to reduce the global cardiovascular risk, which is the fundamental objective of treatment. For high-risk hypertensives, such as patients with diabetes, patients with silent target organ damage or established clinical cardiovascular disease, levels below 130/80mmHg should be reached and maintained, with even lower levels for patients with established renal disease and proteinuria within the nephrotic range. Blood pressure control in high-risk patients should be achieved as rapidly as possible using initial strategies that include combinations of antihypertensive drugs, and also the best drugs and drug combinations with proven capacity to regress silent organ damage and to interrupt the progression of cardiovascular disease. This must be accompanied by the additional lifestyle measures and drugs necessary to control other associated cardiovascular risk factors. In clinical practice this means that, together with renin–angiotensin–aldosterone system (RAAS) blockade, often associated with calcium-channel blockade, statins and antiplatelet drugs should routinely be administered in most patients, particularly those over 55 years of age, as they provide the only possibility of global risk prevention leading to greater survival.

scholarly journals A case of primary aldosteronism with a negative aldosterone-to-renin ratio

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fengyi Liu ◽  
Liang Wang ◽  
Yanchun Ding
Keyword(s):  
Blood Pressure ◽  
Primary Aldosteronism ◽  
Antihypertensive Drugs ◽  
Target Organ Damage ◽  
Screening Method ◽  
Organ Damage ◽  
Secondary Hypertension ◽  
Cardiovascular Damage ◽  
Aldosterone To Renin Ratio ◽  
Clinical Conditions

Abstract Background Primary aldosteronism (PA), as a cause of secondary hypertension, can cause more serious cardiovascular damage than essential hypertension. The aldosterone-to-renin ratio (ARR) is recommended as the most reliable screening method for PA, but ARR screening is often influenced by many factors. PA cannot be easily excluded when negative ARR. Case presentation We report the case of a 45-year-old Chinese man with resistant hypertension. Three years ago, he underwent a comprehensive screening for secondary hypertension, including the ARR, and the result was negative. After that, the patient's blood pressure was still poorly controlled with four kinds of antihypertensive drugs, the target organ damage of hypertension progressed, and hypokalaemia was difficult to correct. When the patient was hospitalized again for comprehensive examination, we found that aldosterone levels had significantly increased, although the ARR was negative. An inhibitory test with saline was further carried out, and the results suggested that aldosterone was not inhibited; therefore, PA was diagnosed. We performed a unilateral adenoma resection for this patient, and spironolactone was continued to control blood pressure. After the operation, blood pressure is well controlled, and hypokalaemia is corrected. Conclusion When the ARR is negative, PA cannot be easily excluded. Comprehensive analysis and diagnosis should be based on the medication and clinical conditions of patients.

scholarly journals Association of hypertension and hypertriglyceridemia on incident hyperuricemia: An 8-year prospective cohort study

2020 ◽  
Author(s):  
Yuan Zhang ◽  
Miaomiao Zhang ◽  
Xiawen Yu ◽  
Fengjiang Wei ◽  
Chen Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Survival Analysis ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Combined Effect ◽  
Kaplan Meier

Abstract Background Hypertension and high triglyceride are two of the most important risk factors for hyperuricemia. Epidemiological records show that hypertension and dyslipidemia often coexist and may significantly increase the risk of target organ damage. However, their combined effect on incident hyperuricemia is poorly understood. Thus, we aimed to investigate the separate and combined effect of hypertension and hypertriglyceridemia on the incidence of hyperuricemia. Methods A prospective cohort study of 6424 hyperuricemia-free participants aged 20 to 94 years between August 2009 and October 2017 was performed at Tianjin General Hospital of China. Participants were categorized into four groups by combining hypertension and hypertriglyceridemia status at baseline. The restricted cubic spline fitting Cox regression model was used to evaluate the relationship between blood pressure and triglyceride and hyperuricemia. Cox regression models were performed to calculate hazard ratios (HRs) and 95% confident intervals (CIs) to estimate baseline factors and their association with the incidence of hyperuricemia. A Kaplan–Meier survival analysis was performed to compare the incidence of hyperuricemia among subjects in each separate and combined hypertension and hypertriglyceridemia group. Results During the 8-year follow-up period, 1,259 subjects developed hyperuricemia (20.6%). There existed positive relationships between blood pressure and triglyceride levels and hyperuricemia. This risk factor arising from a combination of the two (HR, 3.02; 95% CI: 2.60-3.50) is greater than that from hypertension (HR, 1.48; 95% CI: 1.28-1.71) or hypertriglyceridemia (HR, 1.84; 95% CI: 1.55-2.18) separately. The Kaplan–Meier survival analysis indicated that combined effect of hypertension and hypertriglyceridemia may predict higher onset of hyperuricemia. Conclusion The combined effect of hypertension and hypertriglyceridemia on the risk of hyperuricemia is much stronger than that by hypertension or hypertriglyceridemia separately. Hypertension combined with hypertriglyceridemia may be an independent and powerful predictor for hyperuricemia.

scholarly journals High Blood Pressure Variability is an Additional Cardiovascular Risk Factor

2020 ◽  
Vol 16 (1) ◽  
pp. 94-98
Author(s):  
A. V. Rodionov
Keyword(s):  
Blood Pressure ◽  
Calcium Antagonists ◽  
Antihypertensive Drugs ◽  
Meta Analysis ◽  
Cardiovascular Complications ◽  
Cardiac Events ◽  
Important Indicator ◽  
Adverse Cardiac Events ◽  
Post Hoc

Blood pressure (BP) is a highly variable physiological indicator. Most people have BP changes within 40-50 mmHg during the day. Various external factors (from the patient’s position during BP measurement to poor adherence to therapy and abuse of short-acting antihypertensive drugs) affect the assessed indicators. Evaluation of the average daily, intra-visit, as well as long-term ("from visit to visit") BP variability is used in clinical practice. In the past twenty years a number of major studies demonstrated that increased BP variability is an independent prognostic factor that increases the risk of cardiovascular complications. The largest meta-analysis of 41 studies showed that an increase in long-term BP variability was associated with 15% and 18% increase in total and cardiovascular mortality, respectively. According to the IDHOCO project, the threshold coefficient of variation for day-today variability is >11.0/12.8. Different groups of antihypertensive drugs have an uneven effect on BP variability. Consistent data from ASCOT-BPLA, X-CELLENT and ACCOMPLISH studies indicate that among the main groups of antihypertensive drugs, calcium antagonists, mainly amlodipine, have the greatest potential for the variability reduction. A decrease in BP variability, as shown in a post-hoc analysis of CAMELOT and PREVENT studies, has a positive effect on the incidence of major adverse cardiac events (MACE). Thus, the BP variability is an important indicator that reflects the prognosis in hypertensive patients. BP variability reduction can be considered as one of the independent goals of therapy. Calcium antagonists can be considered as first-line drugs for patients with high BP variability.

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