scholarly journals Topical Pressure Lowering Drug: Racial Respond Variation and Pharmacogenetics

10.5772/18552 ◽  
2011 ◽  
Author(s):  
Ahmad Tajudin
Keyword(s):  
Pressure Lowering ◽  
Lowering Drug

scholarly journals Efficacy and safety of triple versus dual combination blood pressure-lowering drug therapy

2019 ◽  
Vol 37 (8) ◽  
pp. 1567-1573 ◽  
Author(s):  
Abdul Salam ◽  
Emily R. Atkins ◽  
Benjumin Hsu ◽  
Ruth Webster ◽  
Anushka Patel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Drug Therapy ◽  
Efficacy And Safety ◽  
Blood Pressure Lowering ◽  
Pressure Lowering ◽  
Lowering Drug

scholarly journals Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e017723 ◽  
Author(s):  
Chau Le Bao Ho ◽  
Monique Breslin ◽  
Jenny Doust ◽  
Christopher M Reid ◽  
Mark R Nelson
Keyword(s):  
Blood Pressure ◽  
Drug Treatment ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Number Needed To Treat ◽  
Absolute Benefit ◽  
All Cause Mortality ◽  
Pressure Lowering ◽  
Lowering Drug ◽  
Post Hoc

ObjectivesIn many current guidelines, blood pressure (BP)-lowering drug treatment for primary prevention of cardiovascular disease (CVD) is based on absolute risk. However, in clinical practice, therapeutic decisions are often based on BP levels alone. We sought to investigate which approach was superior by conducting a post hoc analysis of the Australian National Blood Pressure (ANBP) cohort, a seminal study establishing the efficacy of BP lowering in ‘mild hypertensive’ persons.DesignA post hoc subgroup analysis of the ANBP trial results by baseline absolute risk tertile.Setting and participants3244 participants aged 35–69 years in a community-based randomised placebo controlled trial of blood pressure-lowering medication.InterventionsChlorothiazide500 mg versus placebo.Primary outcome measuresAll-cause mortality and non-fatal events (non-fatal CVD, congestive cardiac failure, renal failure, hypertensive retinopathy or encephalopathy).ResultsTreatment effects were assessed by HR, absolute risk reduction and number needed to treat. Participants had an average 5-year CVD risk in the intermediate range (10.5±6.5) with moderately elevated BP (mean 159/103 mmHg) and were middle aged (52±8 years). In a subgroup analysis, the relative effects (HR) and absolute effects (absolute risk reduction and number needed to treat) did not statistically differ across the three risk groups except for the absolute benefit in all-cause mortality (p for heterogeneity=0.04). With respect to absolute benefit, drug treatment significantly reduced the number of events in the high-risk group regarding any event with a number needed to treat of 18 (10 to 64), death from any cause with 45 (25 to 196) and major CVD events with 23 (12 to 193).ConclusionOur analysis confirms that the benefit of treatment was substantial only in the high-risk tertile, reaffirming the rationale of treating elevated blood pressure in the setting of all risk factors rather than in isolation.

Abstract 19263: Vasodilator Use and Wave Intensity Patterns in Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Julio A Chirinos ◽  
Payman Zamani ◽  
Deepa Rawath ◽  
Rushik Bhuva ◽  
Prithvi Shiva kumar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Drug Use ◽  
Wave Intensity ◽  
Intensity Analysis ◽  
Blood Pressure Lowering ◽  
Wave Intensity Analysis ◽  
Pressure Lowering ◽  
Lowering Drug ◽  
The Relationship

Background: Blood pressure is the result of interactions between the heart and the arteries. Although the effects of vasoactive blood pressure-lowering drugs on arteries has been widely investigated, their in vivo effects on ventricular-arterial interactions are not well understood. Hypothesis: We aimed to assess the relationship between antihypertensive drug use and ventricular arterial interactions assessed via wave intensity analysis (WIA), which quantifies the energy contained in waves generated by the heart and/or reflected from the periphery (figure). Methods: We studied 152 subjects with treated hypertension. We measured central pressure using carotid arterial tonometry. Ascending aortic flow was quantified with through-plane phase-contrast MRI. We performed WIA and assessed the relationship between specific classes of blood pressure lowering drug use and WIA patterns. Results: In models that adjusted for age, gender, body size, race, presence of diabetes and glomerular filtration rate, angiotensin receptor blocker (ARB) use was associated with a greater likelihood of a mid-systolic expansion (i.e., suction) wave (Hazard Ratio=31.1; P=0.005), whereas beta-blocker use was associated with a lower likelihood of such wave (HR=0.16; P=0.02). ARB use was also independently associated with a lower energy in the late systolic forward suction wave (Beta=-0.18; standardized beta=-0.24; P=0.007). This association persisted after adjustment for the forward compression wave (beta=-0.13; standardized beta=-0.16; P=0.008). No associations between WIA patterns and calcium channel blocker use, diuretic use, ACE inhibitor use or long-anting nitrate use were found. Conclusions: Wave intensity analysis is a useful tool to assess the effects of vasodilators on ventricular-arterial interactions. ARB use is selectively associated with systolic suction waves (from blood inertia), which may in turn unload the heart in mid and late systole.

What is next when the first blood pressure-lowering drug is not sufficient?

2007 ◽  
Vol 5 (3) ◽  
pp. 435-439 ◽  
Author(s):  
Flávio D Fuchs ◽  
Patrícia Guerrero ◽  
Miguel Gus
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Lowering ◽  
Pressure Lowering ◽  
Lowering Drug

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.

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