scholarly journals Blood Pressure Lowering May Decrease Cognitive Decline; But Are We Ready to Lower Blood Pressure in the Real World?

2021 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Blood Pressure ◽  
Cognitive Decline ◽  
Real World ◽  
Lower Blood Pressure ◽  
Blood Pressure Lowering ◽  
The Real ◽  
Lower Blood ◽  
Pressure Lowering

Oral Antihypertensives for Hypertensive Urgencies

1994 ◽  
Vol 28 (3) ◽  
pp. 352-358 ◽  
Author(s):  
Mark A. Gales
Keyword(s):  
Blood Pressure ◽  
Adverse Effects ◽  
Antihypertensive Agents ◽  
Lower Blood Pressure ◽  
Blood Pressure Lowering ◽  
Oral Agents ◽  
Lower Blood ◽  
Pressure Lowering ◽  
Hypertensive Urgencies ◽  
Comparative Trials

OBJECTIVE: To review the data describing the use of oral antihypertensive agents in the treatment of hypertensive urgencies (HU). DATA SOURCES: A MEDLINE search of the English-language literature and fan searches of papers evaluating oral antihypertensives in HUs and emergencies were conducted. STUDY SELECTION: Controlled and uncontrolled studies in humans are reviewed. Emphasis was placed on recent trials evaluating individual agents and comparative trials. DATA SYNTHESIS: Comparative trials have demonstrated that four currently available oral agents can lower blood pressure rapidly and predictably. Nifedipine, the most extensively studied, and clonidine have served traditionally as the oral agents of choice for the treatment of HUs. All the agents can lower blood pressure effectively within the first few hours after dosing, but their use also has been associated with adverse effects. Nifedipine and captopril are the two agents with the most rapid onset, within 0.5–1 hour, and may treat hypertensive emergencies as well as urgencies. Clonidine and labetalol have maximal blood pressure lowering effects at 2–4 hours. CONCLUSIONS: Captopril, clonidine, labetalol, and nifedipine are all effective agents for the treatment of HUs. Agent selection should be based on the perceived need for urgent blood pressure control, the cause of HU, and concomitant conditions. A definite benefit from acute blood pressure lowering in HUs has yet to be demonstrated, especially in asymptomatic patients. More controlled trials with less aggressive dosing regimens and placebo controls need to be performed to assess the most appropriate treatments for HUs with the fewest adverse effects.

External applicability of blood pressure-lowering drug trials to real-world patients with manifest cardiovascular disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N.E Bonekamp ◽  
W Spiering ◽  
H.M Nathoe ◽  
L.J Kappelle ◽  
G.J De Borst ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cerebrovascular Disease ◽  
Real World ◽  
Blood Pressure Lowering ◽  
Peripheral Artery ◽  
Eligibility Criteria ◽  
Pressure Lowering ◽  
Artery Disease

Abstract Background Randomised controlled trials (RCTs) are the main source of evidence for clinical treatment guidelines. However, there are concerns that strict eligibility criteria for participant selection may limit applicability of trial results to real-world patients. Purpose To assess the applicability of blood pressure-lowering drug trials in real-world secondary preventive care in stable coronary artery disease, peripheral artery disease and cerebrovascular disease. Methods Eligibility criteria from the largest guideline-informing RCTs on blood pressure-lowering drugs, the EUROPA, PEACE, HOPE-PAD, PRoFESS and PROGRESS trials, were applied to three subcohorts within the UCC-SMART study with coronary artery disease (n=5155), peripheral artery disease (n=1487) and cerebrovascular disease (n=2515). Baseline differences between would-be trial eligible and ineligible patients were estimated. Differences in all-cause mortality and a composite major adverse cardiovascular event (MACE) outcome of cardiovascular death, myocardial infarction and stroke were calculated and adjusted for age, sex and cardiovascular risk factors using Cox proportional hazard models. Results Seventy-five percent of UCC-SMART patients with the appropriate cardiovascular disease were eligible for EUROPA, 84% for PEACE, 59% for HOPE-PAD, 17% for PRoFESS and 100% for PROGRESS. Across trials, the main reasons for UCC-SMART patients' ineligibility were age younger than 50 or 55 years and cardiovascular history. On average, eligible patients were older (range 1.4–14.6 years across trials). Incidence rates for all-cause mortality and MACE were higher for trial eligible patients (Figure 1). After adjustment for age and sex, EUROPA and PEACE eligible patients had a lower risk of mortality (EUROPA: hazard ratio (HR) 0.68 95% confidence interval (CI) 0.59–0.77, PEACE: HR 0.52 95% CI 0.43–0.64) and MACE (EUROPA: HR 0.88 95% CI 0.76–1.01, PEACE: 0.56 95% CI 0.46–0.69), while differences between HOPE-PAD and PRoFESS eligible and ineligible patients were not statistically significant. Conclusion The results from the landmark trials on blood pressure-lowering drugs, specifically RAASi, in patients with peripheral artery and cerebrovascular disease are widely applicable to real-world patient populations. Although the majority of coronary artery disease patients is eligible for the EUROPA and PEACE trial, the results of these trials should be applied to trial ineligible patients with caution. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): UMC Utrecht

scholarly journals Applicability of Blood Pressure–Lowering Drug Trials to Real-World Patients With Cardiovascular Disease

Hypertension ◽  
2020 ◽  
Author(s):  
Nadia E. Bonekamp ◽  
Wilko Spiering ◽  
Hendrik M. Nathoe ◽  
L. Jaap Kappelle ◽  
Gert J. de Borst ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cerebrovascular Disease ◽  
Cardiovascular Event ◽  
Real World ◽  
Major Adverse Cardiovascular Event ◽  
Drug Trials ◽  
Blood Pressure Lowering ◽  
Adverse Cardiovascular Event ◽  
Pressure Lowering ◽  
Lowering Drug

This study aimed to assess applicability of blood pressure–lowering drug trials to real-world secondary preventive care. We applied the eligibility criteria of the landmark blood pressure–lowering drug trials (EUROPA, PEACE, HOPE-peripheral arterial disease [PAD], PRoFESS, and PROGRESS) to patients with coronary artery disease (CAD; n=5155), peripheral arterial disease (PAD; n=1487), and cerebrovascular disease (n=2515) participating in the UCC-SMART cohort. Baseline differences according to trial eligibility were assessed. Differences in risk of all-cause mortality and a composite of cardiovascular death, myocardial infarction, and stroke (major adverse cardiovascular event) were calculated using Cox proportional hazard models, adjusted for age, sex, and cardiovascular risk factors. Seventy-five percent of UCC-SMART patients with CAD would have been eligible for EUROPA, 84% for PEACE, 59% of patients with PAD for HOPE-PAD, 17% of patients with cerebrovascular disease for PRoFESS, and 100% for PROGRESS. Eligible patients were older (average difference ranging 1.4–14.6 years across trials). Eligible patients with CAD were at lower risk of major adverse cardiovascular event after adjustment for age, sex, and cardiovascular risk factors in PEACE (hazard ratio, 0.65 [95% CI, 0.53–0.79]) and of mortality in both EUROPA (hazard ratio, 0.72 [95% CI, 0.62–0.82]) and PEACE (0.63 [95% CI, 0.51–0.78]). Adjusted mortality and major adverse cardiovascular event risks were not different between eligible and ineligible patients with PAD and cerebrovascular disease in HOPE-PAD, PRoFESS, and PROGRESS. The majority of real-world patients with CAD, PAD, or cerebrovascular disease would be eligible for landmark trials on blood pressure–lowering drugs. Patients with CAD ineligible for the EUROPA and PEACE trials are at higher adjusted mortality and major adverse cardiovascular event risks, which may limit applicability of their results to ineligible patients.

Blood Pressure Lowering for the Prevention of Cognitive Decline in Patients with Cerebrovascular Disease

1997 ◽  
Vol 19 (5-6) ◽  
pp. 843-855 ◽  
Author(s):  
Gary Whitlock ◽  
Stephen Macmahon ◽  
Craig Anderson ◽  
Bruce Neal ◽  
Anthony Rodgers ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cerebrovascular Disease ◽  
Cognitive Decline ◽  
Blood Pressure Lowering ◽  
Pressure Lowering
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