scholarly journals Use of angiotensin II receptor blockers alone and in combination with other drugs: a large clinical experience trial

2001 ◽  
Vol 2 (1_suppl) ◽  
pp. S217-S222
Author(s):  
Matthew R Weir ◽  
Rebecca Y Wang
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Systolic Hypertension ◽  
Large Scale ◽  
Candesartan Cilexetil ◽  
Antihypertensive Drugs ◽  
Isolated Systolic Hypertension ◽  
Open Label ◽  
Background Therapy ◽  
Receptor Blockers

Angiotensin II (Ang II) receptor blockers are the newest class of antihypertensive drugs to be developed. No large-scale clinical trials have been performed to evaluate their efficacy alone, or in combination with other drugs. A large-scale, eight week, open-label, non-placebo-controlled, single-arm trial evaluated the efficacy, tolerability and dose-response of candesartan cilexetil, 16—32 mg once-daily, either as monotherapy or as part of combination therapy, in a diverse hypertensive population in actual practice settings. 6465 patients with high blood pressure, of whom 52% were female and 16% African American, with a mean age of 58 years, were included. 5446 patients had essential hypertension and 1014 patients had isolated systolic hypertension. In order to be included in this study, patients had either untreated or uncontrolled hypertension (systolic blood pressure (SBP) 140—179 mmHg and/or diastolic blood pressure (DBP) 90—109 mmHg inclusive at baseline), despite a variety of other antihypertensive drugs. Of the 5156 patients with essential hypertension and at least one post baseline efficacy measurement, the mean pretreatment blood pressure (BP) was 156/97 mmHg. Candesartan cilexetil monotherapy reduced mean SBP/DBP by 18.0/12.2 mmHg. Similarly, in the 964 patients with isolated systolic hypertension and at least one post baseline efficacy measurement, candesartan cilexetil monotherapy reduced SBP/DBP from 158/81 by 16.5/4.5 mmHg. Candesartan cilexetil was similarly effective when employed as add-on therapy. When added to baseline antihypertensive medication in 51% of the patients with essential hypertension not achieving BP control, additional reduction in BP was achieved regardless of the background therapy, including diuretics (17.8/11.7 mmHg) calcium antagonists (16.6/11.2 mmHg), beta-blockers (16.5/10.4 mmHg), angiotensin-converting enzyme inhibitors (ACE-I) (15.3/10.0 mmHg), and alpha blockers (16.4/10.4 mmHg). Likewise, when candesartan cilexetil was used as add-on therapy in patients with isolated systolic hypertension, there was a consistent further reduction of mean SBP/DBP, regardless of the background therapy. Moreover, these monotherapeutic or add-on efficacy benefits were seen regardless of age (<65 or >65 years), gender, or race. Despite the open-label design of the study which enhances efficacy owing to the placebo effect, the Ang II receptor blocker, candesartan cilexetil either alone, or as an add-on therapy, is highly effective for assisting in the control of systolic and diastolic hypertension.

scholarly journals Assessing the impact of antihypertensive therapy on ambulatory blood pressure monitoring in patients with isolated systolic hypertension

2014 ◽  
Vol 5 (1) ◽  
pp. 5-9
Author(s):  
V. A Aydarova ◽  
Z. T Astahova ◽  
F. U Kanukova ◽  
M. M Besaeva
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Therapy ◽  
Systolic Hypertension ◽  
Fixed Combination ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Isolated Systolic Hypertension ◽  
Pressure Monitoring ◽  
Group 2 ◽  
The Impact

The study examined the effectiveness of drug correction of high numbers of blood pressure (BP) by means of modern groups of antihypertensive drugs, the effect of a fixed combination of perindopril and indapamide on circadian blood pressure monitoring, and a commitment to patients of antihypertensive therapy, based on the opened simple randomization three groupswere formed: 1st comprised of 21 patients with isolated systolic hypertension (ISAH) and 22 patients with systolic-diastolic hypertension (SDAH) - they all received monotherapy with calcium antagonists (amlodipine 10 mg/day); Group 2 - of 16 ISAH patients and 24 SDAH patients - who received monotherapy with perindopril (2 mg/day) and the third group - of 17 patients with ISAH and 14 patients with SDAH - who received combination therapy with the drug noliprel (Servier) with a fixed combination of perindopril (2 mg) and indapamide of 0,625 mg. Treatment efficacy was assessed primarily to reduce the absolute numbers of blood pressure, and taken into account as a reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP), uncontrolled drop of which, according to the literature, in elderly patients can have fatal consequences

Abstract 13281: Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared to Combined Hypertension

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Christian Ott ◽  
Mel D Lobo ◽  
Paul A Sobotka ◽  
Felix Mahfoud ◽  
Roland Schmieder ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Hypertension ◽  
Antihypertensive Drugs ◽  
Blood Pressure Reduction ◽  
Treatment Resistant ◽  
Isolated Systolic Hypertension ◽  
Arteriovenous Anastomosis ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Post Hoc

Background: Several interventional therapeutic options for blood pressure (BP) lowering in patients with treatment-resistant hypertension (TRH) were introduced, such as renal denervation (RDN) and creation of an arteriovenous (AV) anastomosis using the ROX coupler. It was shown that BP response after RDN is greater in patients with combined hypertension (CH) compared to patients with isolated systolic hypertension (ISH). We analyzed now the effect of ROX coupler implantation in the subgroups with CH and ISH. Methods: The randomized, controlled, ROX CONTROL HTN study included patients with true TRH (office systolic BP ≥140mmHg, and average daytime ambulatory BP ≥135/85mmHg, despite treatment with at least 3 antihypertensive drugs including a diuretic). In our post-hoc analysis we have stratified the patients of the ROX coupler group (n=42) according CH (n=31) versus ISH (n=11). Results: Baseline systolic office (177±18 versus 169±17 mmHg, p=0.163) and ambulatory BP (159±16 versus 154±11 mmHg, p=0.463) did not differ between CH and ISH. Creation of an AV anastomosis resulted in a significant reduction in systolic office (CH: -28±22 versus ISH: -22±31 mmHg, p=0.572) as well as ambulatory BP (CH: -14±20 versus ISH: -13±15 mmHg, p=0.672), but without significant differences between the two subgroups. The non-responder rate (systolic office BP reduction < 10 mmHg) after 6 months was not different between the subgroups (CH: 18 % versus ISH: 23 %, p=0.844). Conclusions: Thus, our data suggest that creation of an AV anastomosis using the ROX coupler reduces systolic office and ambulatory BP, without any significant difference between CH and ISH. In contrast to RDN, creation of an AV anastomosis reduced BP to similar extent in both subtypes of TRH.

ABPM Comparison of the Anti-Hypertensive Profiles of Telmisartan and Enalapril in Patients with Mild-to-Moderate Essential Hypertension

2002 ◽  
Vol 30 (6) ◽  
pp. 543-552 ◽  
Author(s):  
J Amerena ◽  
S Pappas ◽  
J-P Ouellet ◽  
L Williams ◽  
D O'Shaughnessy
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Blood Pressure Monitoring ◽  
Study Drug ◽  
Pressure Control ◽  
Moderate Essential Hypertension ◽  
Open Label ◽  
Night Time ◽  
Once Daily

In this multicentre, prospective, randomized, open-label, blinded-endpoint (PROBE) study, the efficacy of 12 weeks' treatment with once-daily telmisartan 40–80 mg and enalapril 10–20 mg was evaluated using ambulatory blood pressure monitoring (ABPM) in 522 patients with mild-to-moderate essential hypertension. Patients were titrated to the higher dose of study drug at week 6 if mean seated diastolic blood pressure (DBP) was ≥ 90 mmHg. The primary endpoint was the change from baseline in ambulatory DBP in the last 6 h of the 24-h dosing interval after 12 weeks' treatment. Telmisartan and enalapril produced similar reductions from baseline in DBP and systolic blood pressure (SBP) over all ABPM periods evaluated (last 6 h, 24-h, daytime and night-time). Telmisartan produced a significantly greater reduction in mean seated trough DBP, measured unblinded with an automated ABPM device in the clinic, amounting to a difference of −2.02 mmHg ( P < 0.01). A significantly greater proportion of patients achieved a seated diastolic response with telmisartan than enalapril (59% versus 50%; P < 0.05), also measured with the same ABPM device. Both treatments were well tolerated. Compared with telmisartan, enalapril was associated with a higher incidence of cough (8.9% versus 0.8%) and hypotension (3.9% versus 1.1%). Therefore, telmisartan may provide better long-term compliance and, consequently, better blood pressure control than enalapril.

Arterial hypertension + past stroke – a case report

2021 ◽  
Vol 14 (3) ◽  
pp. 324-326
Author(s):  
Maria Łukasiewicz ◽  
Marta Swarowska-Skuza
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Chronic Disease ◽  
Side Effects ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Systolic Hypertension ◽  
The Elderly ◽  
Isolated Systolic Hypertension ◽  
Special Group

Arterial hypertension, as a very widespread chronic disease, and thus differing in both pathomechanism and course in patients, requires a significant individualization of pharmacotherapy. One such special group is the elderly. Both the low-renin pathomechanism of arterial hypertension and its phenotype (isolated systolic hypertension) imply the choice of a specific pharmacotherapy. Additionally, in this group, side effects should be observed much more vigilantly, while target blood pressure values should be treated more liberally. An example of antihypertensive therapy in a patient belonging to the group described is presented in the following case.

scholarly journals Blood Pressure Control: Stroke and Stroke Prevention

2005 ◽  
Vol 6 (1_suppl) ◽  
pp. S8-S11
Author(s):  
Hans-Christoph Diener
Keyword(s):  
Blood Pressure ◽  
Stroke Prevention ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Angiotensin Receptor ◽  
Risk Of Death ◽  
Pressure Lowering ◽  
Receptor Blockers

Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention. All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention. Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP) increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences. The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

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