Trough to peak ratio: current status and applicability

Size: px
Start display at page:

Download "Trough to peak ratio: current status and applicability"

Transcription

1 Journal of Human Hypertension (1998) 12, Stockton Press. All rights reserved /98 $12.00 REVIEW ARTICLE Trough to peak ratio: current status and applicability Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT, UK Keywords: trough to peak ratio; antihypertensive drugs Introduction In concept, trough to peak (T:P) ratio is a simple and straightforward parameter which succinctly describes the consistency and duration of a drug s antihypertensive effectiveness across its recommended dosage interval. Additionally, it provides information about the suitability of the drug for its recommended dosage interval for which there is a clear current preference for once-daily dosing. Thus a T:P ratio approaching 100% informs the clinician that drug X in a dose of Y mg is well suited to its dosage interval and that the blood pressure (BP) reduction persisting at trough (which, by definition, is immediately prior to the administration of the next dose) is closely similar in magnitude to the BP reduction measured at peak (ie, at the time of maximal or peak pharmacological activity). By inference, and in terms of clinical reality, the trough BP measurement corresponds to the lowest level of pharmacological activity and, usually, the residual plasma drug concentration. It is implicit that the magnitude of the trough BP reduction is clinically useful and intellectual arguments about a drug with a T:P ratio of 100% which is achieved with a trough BP reduction of only 1 2 mm Hg are completely spurious. Unfortunately, this straightforward and useful parameter has been misconstrued, misunderstood and misrepresented in much of the published literature to such an extent that its meaning and usefulness have been significantly compromised. T:P ratio the FDA perspective It is not difficult to appreciate that a drug with a relatively short duration of action might deliberately be administered in a very high dose with the sole and specific intention of demonstrating that significant BP-lowering activity persists until the end of the dosage interval. In this way, the drug is entitled Correspondence:, Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT, UK Revised and accepted 10 August 1997 to be licensed as an effective antihypertensive agent (for once daily administration). Thus, an acceptable trough BP reduction has been generated via an unnecessarily large peak BP reduction. It is fundamental to the concept of T:P ratio that an unnecessarily large peak BP reduction is not appropriate when it constitutes a specific stratagem to avoid having to administer lower doses via a multiple daily dosing regimen. The essence of T:P ratio, therefore, is to identify the treatment regimen (dose and dosing frequency) which is the most effective (and safest) for routine use in an unselected hypertensive population. The trough BP reduction itself remains the critical index of antihypertensive efficacy for regulatory purposes. Figure 1 illustrates the BP reduction profiles for two different drug treatment regimens and it can be seen that the once-daily treatment produces a measurable effect at trough (sufficient for licensing as a once-a-day drug) and that this has been achieved in association with an obvious and pronounced peak BP reduction. In contrast, the twicedaily treatment regimen not only increases the magnitude of the trough BP reduction but also avoids an excessive peak reduction in BP. In summary, and with specific respect to the overall level of BP control, the twice daily regimen is superior and this is directly reflected in the high T:P ratio of greater than 70%. These BP reduction profiles are derived from treatment with enalapril 20 mg once daily (T:P ratio of 48%) and enalapril 10 mg b.d. (T:P ratio of 74%). 1 Methodological issues principles and problems a) Different studies, different results: Specific issues of methodology are discussed elsewhere in this issue but it is important to note that the FDA did not define the most appropriate methodology although they did make two specific and important recommendations: that the antihypertensive effect should be assessed under steady state dosing conditions and that it should be adjusted for placebo effects. In conventional clinical trials practice, therefore, a parallel group design comparing the achieved BPs under placebo and active treatment conditions

2 Trough to peak ratio: current status 56 Figure 1 A comparison of systolic BP reductions throughout 24 h during treatment with two different antihypertensive drug treatment regimens. would seem to be the simplest and most obvious approach. Alternatively, and in some ways preferably, a randomised crossover comparison of the achieved BPs following periods of placebo and active treatment. Because the FDA failed to detail the methodology a variety of approaches have been employed and many of these contain serious misrepresentations: for example, there are no grounds for calculating T:P ratios for the placebo effect itself, relative to the pre-treatment or baseline BP; there are no grounds for calculating T:P ratio via the offset of antihypertensive effect following temporary treatment withdrawal. These are examples of the different and often flawed approaches which have led to disparate published results and created confusion. The confusion created by the use of a variety of methodologies, allied to some fundamental misconceptions about the clinical pharmacology of antihypertensive drugs, makes it virtually impossible to compare T:P ratios for different competitor drugs on the basis of different studies, by different researchers, by different methodologies, etc. However, where the differing methodologies are sound and the studies well conducted, it may sometimes be possible to compare different study results and some degree of concordance would be expected 2 (Table 1). However, even in this illustrative metaanalysis (with its acknowledged limitations) there are discrepancies which, in most cases, reflect dosedependent differences in T:P ratio and/or different methodologies. b) Definition of the peak blood pressure reduction: The peak BP reduction constitutes the Table 1 T:P ratios with ACE inhibitor drugs Drug T:P ratio (%) Benazepril Captopril 0 40 Enalapril 40 or 50 or 70 or 80 Lisinopril 40 or 50 or 60 or 70 or 80 Perindopril 30 Quinapril 30 or 40 Ramipril 40 or 50 Trandolapril 50 or 100 maximum BP reduction attributable to the antihypertensive drug but it is not necessarily the lowest achieved BP (which is often attained during deep sleep). This is illustrated in Figure 2 with systolic BP profiles following placebo and following an antihypertensive drug (upper panel). This also highlights the importance of placebo rather than baseline correction for calculating the BP reduction directly attributable to the drug itself. In this illustration, although the lowest BP relative to baseline, occurs at approximately 6 h post-dose, this is not the peak antihypertensive effect which occurs at about 2 h post-dose, relative to placebo (lower panel). The maximum or peak BP reduction reflects the maximum pharmacological effect of the drug (which in turn is often related to the maximum plasma drug concentration) and across a range of, say, 2 3 h it will occur at about the same time in the great majority of patients. However, it will not occur at exactly the same time in every patient: this is an argument in favour of T:P studies in individual

3 Trough to peak ratio: current status 57 Figure 3 Comparison of the drug concentration-time profiles for two different formulations of nifedipine. Figure 2 The systolic BP responses to placebo and an antihypertensive drug (upper panel) and the BP corrected for the baseline (pre-treatment) BP and for the corresponding placebo profile (lower panel). patients, rather than groups. Furthermore, it will often be difficult to identify the exact time of the maximum BP reduction and several different strategies have been advocated to permit the accurate definition of the peak BP response: multiple BP measurements in the controlled and reproducible environment of a clinical research unit, 3 for example, or the use of ambulatory BP measurement with a smoothing analytical approach and averaging of 2 3 h of BP measurements to eliminate rogue values and avoid undue reliance on single time points. 4 Not only are there difficulties in clearly identifying the peak BP response but there are also reproducibility problems with ambulatory BP measurement for repeat measurements in the same individual. Thus, although average values may be sufficiently reproducible to suggest that the ambulatory technique has no placebo effect, the consensus view now indicates that there is a significant placebo or acclimatisation effect, which is most obvious during the first few hours of measurement. 5 9 Whatever the technique of BP measurement, therefore, there is a clear requirement for an appropriate parallel group or crossover design to define the BP levels during a placebo treatment and to take account of circadian changes. clearly there will be different T:P ratios for the tablet and for the GITS formulation. The published results indicating differing T:P ratios, of respectively about 50% 10 and approximately 100%, 11 are entirely consistent with these differing pharmacokinetic profiles. b) Dose and concentration dependent effects: The impact of dose on the T:P ratio is fundamentally dependent on the underlying drug concentrationeffect relationship. In simplistic terms, the T:P ratio will not vary with dose when there is a linear concentration-effect relationship (and when there is a well-designed drug formulation with a consistent drug delivery system). This applies to calcium antagonist drugs in general: thus, for nifedipine delivered via the tablet formulation the T:P ratio falls in the range 48 50% for the twice-daily administration of 10 mg, 20 mg and 30 mg doses 10 (Figure 4). Similar results are obtained with the GITS formulation with reported T:P ratios of about 100% with both the 30 mg and 60 mg doses. 11 In contrast, drugs which have more complex concentration-effect characteristics such as those involving E max relationships, for example ACE inhibitors, have dose-dependent T:P ratios. This has The consistency of the T:P ratio a) Formulation dependent results: The plasma drug concentration-time profiles for two formulations of nifedipine are illustrated in Figure 3 and Figure 4 Effect of dose on the T:P ratio for nifedipine (tablet formulation).

4 58 Trough to peak ratio: current status been very well illustrated (Figure 5) in a study with lisinopril where the low dosages had low T:P ratios well below the minimum target of 50% and the higher dosages were just over 50%. 12 Quite clearly, therefore, low doses of lisinopril should probably be administered via a twice-daily dosing regimen whereas, at least arguably, the higher doses might be administered once daily. Trough:peak ratio implications for treatment The validity of T:P ratio as an index of duration of action, and of the drug s suitability for its recommended dosage interval, is largely but crucially dependent upon a satisfactory methodology. 13 From a practical point of view, however, if the T:P ratio is appropriately characterised then a ratio consistently in excess of 50% (ie, consistent between different individuals and consistent in the published literature) is indicative of a drug with a BP response whose magnitude will be relatively consistent throughout the nominated dosage interval. Thus, approximately the same level of BP control will be consistently maintained throughout the full 24-h period (assuming once-daily dosing), including an overnight BP reduction if the patient is a nondipper and including persisting antihypertensive efficacy in the waking and early working day. With particular reference to concerns about excessive reductions in nocturnal BP, when the levels might already be inherently low, there again appear to be misconceptions. The absolute magnitude of the BP reduction in response to an antihypertensive agent is, in general, determined not only by the prevailing drug concentrations but also by the level of the untreated BP. 14,15 This reflects a mathematical/statistical phenomenon whereby the higher the (untreated) pressure the greater the fall (in response to treatment). 16 Thus, if nocturnal BP is normal or low then there will be a relatively small further reduction in response to antihypertensive treatment. The vexed question of the ideal T:P ratio, however, is unanswerable. The basic message is that antihypertensive drugs with values less than 50% require to be administered more frequently: drugs with ratios in the range % are well suited to their recommended dosing frequencies, presumably once daily. For agents with ratios in the range 50 Figure 5 Effect of dose on the T:P ratio for lisinopril. 66% there clearly would be differences of opinion concerning their suitability for single or multiple dosing regimens and other factors, such as the range of T:P values, might influence the decision about once- or twice-daily dosing. Some of the practical issues are discussed in detail elsewhere. 17,18 Overall, although there is no definitive proof that an antihypertensive profile characterised by a high T:P ratio is preferable, it is interesting to note that thiazide diuretics which are arguably the most successful agents in the published clinical trials of antihypertensive drugs have, in general, high T:P ratios. Conclusions The T:P ratio is not a fixed and immutable single value which can be used to label each antihypertensive drug. It is probably best expressed as a mean value with some indication of inter-individual variability in order to provide some information about the consistency of the drug, and the appropriateness of its dosing regimen, within a hypertensive population. Furthermore, where there are dose-dependent differences it will be necessary to provide a series of values for each of the dosages recommended in routine clinical practice. Thus, T:P ratio is one of several parameters to be taken into account alongside, say, half-life and the concentration effect relationship, when dosage regimens are being determined. Ideally, the T:P ratio should be determined in early clinical development via two or three appropriately designed and well conducted studies. Thus, T:P ratio is a useful parameter and an important indicator of dose and dose frequency when it is quantified correctly and applied appropriately. It is not, and was never intended to be, the yardstick by which an antihypertensive drug is judged. Misconceptions and misrepresentations, allied to the application of sub-optimal methodology (in fact, sometimes wholly inappropriate methodology) has sullied an otherwise useful and clinically relevant measurement which contributes to our overall assessment of an antihypertensive drug. References 1 Meredith PA, Donnelly R, Elliott HL, Reid JL. Prediction of response to enalapril. J Hypertens 1990; 8: Zannad F. Trandolapril: how does it differ from other angiotensin converting enzyme inhibitors? Drugs 1993; 46 (Suppl 2): Elliott HL, Meredith PA. Calculation of trough-to-peak ratio in the Research Unit setting. Am J Hypertens 1996; 9: 71S 75S. 4 Omboni A et al. Calculation of trough-to-peak ratio of antihypertensive treatment from ambulatory blood pressure; methodological aspects. J Hypertens 1995; 13: Mutti E et al. Effect of placebo on 24-h non-invasive ambulatory blood pressure. J Hypertens 1991; 9: Mancia G et al. Limited reproducibility of hourly blood pressure values obtained by ambulatory blood pressure monitoring: implications for studies on antihypertensive drugs. J Hypertens 1992; 10:

5 7 Gerin W, Rosofsky M, Pieper C, Pickering TG. A test of reproducibility of blood pressure and heart rate variability using a controlled ambulatory procedure. J Hypertens 1993; 11: Prasad N, MacFadyen RJ, Ogston SA, MacDonald TM. Elevated blood pressure during the first two hours of ambulatory blood pressure monitoring: a study comparing consecutive twenty-four-hour monitoring periods. J Hypertens 1995; 13: Staessen JA et al (on behalf of the Syst-Eur Investigators). Ambulatory pressure decreases on longterm placebo treatment in older patients with isolated systolic hypertension. J Hypertens 1994; 12: Meredith PA, Donnelly R, Elliott HL. Prediction and optimisation of the antihypertensive response to nifedipine. Blood Press 1994; 3: Zanchetti A et al. Antihypertensive effects of nifedipine GITS on clinical and ambulatory blood pressures in essential hypertensives. J High Blood Press 1994; 3: Menard J, Bellet M, Brunner HR. Clinical development Trough to peak ratio: current status of antihypertensive drugs: can we perform better? In: Larach JH, Brenner BM (eds). Hypertension: Pathophysiology, Diagnosis and Management, 1st edn. Raven Press Limited: New York, 1990, pp Elliott HL, Meredith PA. Methodological considerations in calculation of the T:P ratio. J Hypertens 1994; 12 (Suppl 8): S3 S7. 14 Meredith PA, Donnelly R, Elliott HL. Prediction and optimisation of the antihypertensive response to nifedipine. Blood Press 1994; 3: Meredith PA et al. Age and the antihypertensive effect of verapamil: an integrated pharmacokineticpharmacodynamic approach. J Hypertens 1987; 5 (Suppl 5): S125 S Sumner DJ et al. Blood pressure and correlations. Lancet 1985; 1: Elliott HL, Meredith PA. Analysis of T:P ratio and the assessment of antihypertensive drug action. J Hum Hypertens 1995; 9: Elliott HL, Meredith PA. T:P ratio: clinically useful or practically irrelevant. J Hypertens 1995; 13:

Concentration-Effect Relationships and Implications for Trough-to-Peak Ratio

Concentration-Effect Relationships and Implications for Trough-to-Peak Ratio AJH 1996;9:66S-70S Concentration-Effect Relationships and Implications for Trough-to-Peak Ratio Peter A. Meredith and Henry L. Elliott The guidelines on trough-to-peak ratio identified an index of the

More information

Calculation of Trough-to-Peak Ratio in the Research Unit Setting

Calculation of Trough-to-Peak Ratio in the Research Unit Setting A]H 1996; 9:71S-75S Calculation of Trough-to-Peak Ratio in the Research Unit Setting Advantages and Disadvantages Henry L. Elliott and Peter A. Meredith The trough-to-peak ratio for the response to an

More information

BRIEF COMMUNICATIONS. KEY WORDS: Ambulatory blood pressure monitoring, placebo effect, antihypertensive drug trials.

BRIEF COMMUNICATIONS. KEY WORDS: Ambulatory blood pressure monitoring, placebo effect, antihypertensive drug trials. AJH 1995; 8:311-315 BRIEF COMMUNICATIONS Lack of Placebo Effect on Ambulatory Blood Pressure Giuseppe Mancia, Stefano Omboni, Gianfranco Parati, Antonella Ravogli, Alessandra Villani, and Alberto Zanchetti

More information

Slide notes: References:

Slide notes: References: 1 2 3 Cut-off values for the definition of hypertension are systolic blood pressure (SBP) 135 and/or diastolic blood pressure (DBP) 85 mmhg for home blood pressure monitoring (HBPM) and daytime ambulatory

More information

How well do office and exercise blood pressures predict sustained hypertension? A Dundee Step Test Study

How well do office and exercise blood pressures predict sustained hypertension? A Dundee Step Test Study (2000) 14, 429 433 2000 Macmillan Publishers Ltd All rights reserved 0950-9240/00 $15.00 www.nature.com/jhh ORIGINAL ARTICLE How well do office and exercise blood pressures predict sustained hypertension?

More information

Overview of the outcome trials in older patients with isolated systolic hypertension

Overview of the outcome trials in older patients with isolated systolic hypertension Journal of Human Hypertension (1999) 13, 859 863 1999 Stockton Press. All rights reserved 0950-9240/99 $15.00 http://www.stockton-press.co.uk/jhh Overview of the outcome trials in older patients with isolated

More information

Comparison of arbitrary definitions of circadian time periods with those determined by wrist actigraphy in analysis of ABPM data

Comparison of arbitrary definitions of circadian time periods with those determined by wrist actigraphy in analysis of ABPM data Journal of Human Hypertension (1999) 13, 449 453 1999 Stockton Press. All rights reserved 0950-9240/99 $12.00 http://www.stockton-press.co.uk/jhh ORIGINAL ARTICLE Comparison of arbitrary definitions of

More information

Antihypertensive efficacy of olmesartan compared with other antihypertensive drugs

Antihypertensive efficacy of olmesartan compared with other antihypertensive drugs (2002) 16 (Suppl 2), S24 S28 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh compared with other antihypertensive drugs University Clinic Bonn, Department of Internal

More information

The hypertensive effects of the renin-angiotensin

The hypertensive effects of the renin-angiotensin Comparison of Telmisartan vs. Valsartan in the Treatment of Mild to Moderate Hypertension Using Ambulatory Blood Pressure Monitoring George Bakris, MD A prospective, randomized, open-label, blinded end-point

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 7 January 2009

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 7 January 2009 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 7 January 2009 LERCAPRESS 10 mg/10 mg, film-coated tablets Pack of 30 (CIP code: 385 953-3) Pack of 90 (CIP code:

More information

Improving Medical Statistics and Interpretation of Clinical Trials

Improving Medical Statistics and Interpretation of Clinical Trials Improving Medical Statistics and Interpretation of Clinical Trials 1 ALLHAT Trial & ALLHAT Meta-Analysis Critique Table of Contents ALLHAT Trial Critique- Overview p 2-4 Critique Of The Flawed Meta-Analysis

More information

Executive Summary. Different antihypertensive drugs as first line therapy in patients with essential hypertension 1

Executive Summary. Different antihypertensive drugs as first line therapy in patients with essential hypertension 1 IQWiG Reports Commission No. A05-09 Different antihypertensive drugs as first line therapy in patients with essential hypertension 1 Executive Summary 1 Translation of the executive summary of the final

More information

Blood Pressure and Complications in Individuals with Type 2 Diabetes and No Previous Cardiovascular Disease. ID BMJ

Blood Pressure and Complications in Individuals with Type 2 Diabetes and No Previous Cardiovascular Disease. ID BMJ 1 Blood Pressure and Complications in Individuals with Type 2 Diabetes and No Previous Cardiovascular Disease. ID BMJ 2016.033440 Dear Editor, Editorial Committee and Reviewers Thank you for your appreciation

More information

Lisinopril 20 converting to losartan

Lisinopril 20 converting to losartan Search Lisinopril 20 converting to losartan Stop wasting your time with unanswered searches. lisinopril 40 mg to losartan conversion,cannot Find low price Best. Winds SSW at 10 to 20. Lisinopril 20 to

More information

STANDARD treatment algorithm mmHg

STANDARD treatment algorithm mmHg STANDARD treatment algorithm 130-140mmHg (i) At BASELINE, If AVERAGE SBP 1 > 140mmHg If on no antihypertensive drugs: Start 1 drug: If >55 years old / Afro-Caribbean: Calcium channel blocker (CCB) 2 If

More information

Verapamil SR and trandolapril combination therapy in hypertension a clinical trial of factorial design

Verapamil SR and trandolapril combination therapy in hypertension a clinical trial of factorial design Br J Clin Pharmacol 1998; 45: 491 495 Verapamil SR and trandolapril combination therapy in hypertension a clinical trial of factorial design Juergen Scholze, 1 Peter Zilles 2 & Daniele Compagnone 2 on

More information

Clinical Policy: ACEI and ARB Duplicate Therapy Reference Number: CP.PMN.61 Effective Date: Last Review Date: 05.18

Clinical Policy: ACEI and ARB Duplicate Therapy Reference Number: CP.PMN.61 Effective Date: Last Review Date: 05.18 Clinical Policy: Reference Number: CP.PMN.61 Effective Date: 08.01.14 Last Review Date: 05.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important regulatory

More information

DRUG UTILIZATION PATTERNS OF ANTIHYPERTENSIVES IN VARIOUS WARDS IN A TERTIARY CARE HOSPITAL IN TAMILNADU

DRUG UTILIZATION PATTERNS OF ANTIHYPERTENSIVES IN VARIOUS WARDS IN A TERTIARY CARE HOSPITAL IN TAMILNADU Original Article DRUG UTILIZATION PATTERNS OF ANTIHYPERTENSIVES IN VARIOUS WARDS IN A TERTIARY CARE HOSPITAL IN TAMILNADU V.Gowri 1, K.Punnagai, K.Vijaybabu 3, Dr.Darling Chellathai 4 1 Assistant Professor

More information

High-dose monotherapy vs low-dose combination therapy of calcium channel blockers and angiotensin receptor blockers in mild to moderate hypertension

High-dose monotherapy vs low-dose combination therapy of calcium channel blockers and angiotensin receptor blockers in mild to moderate hypertension (2005) 19, 491 496 & 2005 Nature Publishing Group All rights reserved 0950-9240/05 $30.00 www.nature.com/jhh ORIGINAL ARTICLE High-dose monotherapy vs low-dose combination therapy of calcium channel blockers

More information

Phase 3 investigation of aprocitentan for resistant hypertension management. Investor Webcast June 2018

Phase 3 investigation of aprocitentan for resistant hypertension management. Investor Webcast June 2018 Phase 3 investigation of aprocitentan for resistant hypertension management Investor Webcast June 2018 The following information contains certain forward-looking statements, relating to the company s business,

More information

Conversion of losartan to lisinopril

Conversion of losartan to lisinopril Cari untuk: Cari Cari Conversion of losartan to lisinopril Dania Alsammarae, Strategy Director and co-founder of Anglo Arabian Healthcare speaks with Neil Halligan of Arabian Business on what it takes

More information

Clinical cases with Coversyl 10 mg

Clinical cases with Coversyl 10 mg Clinical cases Coversyl 10 mg For upgraded benefits in hypertension A Editorial This brochure, Clinical cases Coversyl 10 mg for upgraded benefits in hypertension, illustrates a variety of hypertensive

More information

ANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION*

ANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION* Progress in Clinical Medicine 1 ANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION* Keishi ABE** Asian Med. J. 44(2): 83 90, 2001 Abstract: J-MUBA was a large-scale clinical

More information

The problem of uncontrolled hypertension

The problem of uncontrolled hypertension (2002) 16, S3 S8 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh The problem of uncontrolled hypertension Department of Public Health and Clinical Medicine, Norrlands

More information

The Efficacy and Tolerability of Barnidipine Hydrochloride in Thai Patients with Hypertension

The Efficacy and Tolerability of Barnidipine Hydrochloride in Thai Patients with Hypertension The Journal of International Medical Research 2004; 32: 185 200 The Efficacy and Tolerability of Barnidipine Hydrochloride in Thai Patients with Hypertension P BURANAKITJAROEN 1, B KOANANTAKUL 2, M PHOOJAROENCHANACHAI

More information

Which antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017

Which antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017 Which antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017 The most important reason for treating hypertension in primary care is to prevent

More information

State of the art treatment of hypertension: established and new drugs. Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland

State of the art treatment of hypertension: established and new drugs. Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland State of the art treatment of hypertension: established and new drugs Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland First line therapies in hypertension ACE inhibitors AT

More information

The CARI Guidelines Caring for Australasians with Renal Impairment. Blood Pressure Control role of specific antihypertensives

The CARI Guidelines Caring for Australasians with Renal Impairment. Blood Pressure Control role of specific antihypertensives Blood Pressure Control role of specific antihypertensives Date written: May 2005 Final submission: October 2005 Author: Adrian Gillian GUIDELINES a. Regimens that include angiotensin-converting enzyme

More information

Combination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London

Combination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London Combination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email:

More information

Trandolapril to lisinopril

Trandolapril to lisinopril Trandolapril to lisinopril Lisinopril : learn about side effects, dosage, special precautions, and more on MedlinePlus. Tansiyon, hipertansiyon ilaçlarını; antihipertansif ilaçları içerir.. Tansiyon -

More information

Received 24 February 2015 Revised 29 April 2015 Accepted 20 May 2015

Received 24 February 2015 Revised 29 April 2015 Accepted 20 May 2015 Original article 1 Clinical practice of ambulatory versus home blood pressure monitoring in hypertensive patients Jorge A. Paolasso, Florencia Crespo, Viviana Arias, Eduardo A. Moreyra, Ariel Volmaro,

More information

Managing Hypertension in 2016

Managing Hypertension in 2016 Managing Hypertension in 2016: Where Do We Draw the Line? Disclosure No relevant financial relationships Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu

More information

The Evolution To Treatment Of Hypertension With Advanced Formulation

The Evolution To Treatment Of Hypertension With Advanced Formulation The Evolution To Treatment Of Hypertension With Advanced Formulation Dr. Donald Ang MBChB (UK) FRCP (Edin) MD (UK) CCST Cardiology (UK) FESC (Europe) Consultant Cardiologist Island Hospital Penang High

More information

Managing hypertension: a question of STRATHE

Managing hypertension: a question of STRATHE (2005) 19, S3 S7 & 2005 Nature Publishing Group All rights reserved 0950-9240/05 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Managing hypertension: a question of STRATHE Department of Cardiovascular Disease,

More information

Abbreviations Cardiology I

Abbreviations Cardiology I Cardiology I and Clinical Controversies Joseph J. Saseen, Pharm.D., FCCP, BCPS (AQ Cardiology) Reviewed by Stuart T. Haines, Pharm.D., FCCP, BCPS; and Michelle M. Richardson, Pharm.D., FCCP, BCPS Learning

More information

AT 1 -receptor blockers: differences that matter

AT 1 -receptor blockers: differences that matter (2002) 16, S9 S16 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh AT 1 -receptor blockers: differences that matter Division of Cardiovascular Diseases, The Western

More information

AJH 1999;12: Downloaded from by guest on 15 December 2018

AJH 1999;12: Downloaded from   by guest on 15 December 2018 AJH 1999;12:806 814 Differential Effects of Morning and Evening Dosing of Nisoldipine ER on Circadian Blood Pressure and Heart Rate William B. White, George A. Mansoor, Thomas G. Pickering, Donald G. Vidt,

More information

Int. J. Pharm. Sci. Rev. Res., 36(1), January February 2016; Article No. 06, Pages: JNC 8 versus JNC 7 Understanding the Evidences

Int. J. Pharm. Sci. Rev. Res., 36(1), January February 2016; Article No. 06, Pages: JNC 8 versus JNC 7 Understanding the Evidences Research Article JNC 8 versus JNC 7 Understanding the Evidences Anns Clara Joseph, Karthik MS, Sivasakthi R, Venkatanarayanan R, Sam Johnson Udaya Chander J* RVS College of Pharmaceutical Sciences, Coimbatore,

More information

Large therapeutic studies in elderly patients with hypertension

Large therapeutic studies in elderly patients with hypertension (2002) 16 (Suppl 1), S38 S43 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh Large therapeutic studies in elderly patients with hypertension Centro Clinico Profesional

More information

9/17/2015. Reference: Ruschitzka F. J Hypertens 2011;29(Suppl 1):S9-14.

9/17/2015. Reference: Ruschitzka F. J Hypertens 2011;29(Suppl 1):S9-14. 0 1 2 Reference: Ruschitzka F. J Hypertens 2011;29(Suppl 1):S9-14. 3 Slide notes: Large trials such as ALLHAT, LIFE and ASCOT show that the majority of patients with hypertension will require multiple

More information

The magnitude and duration of ambulatory blood pressure reduction following acute exercise

The magnitude and duration of ambulatory blood pressure reduction following acute exercise Journal of Human Hypertension (1999) 13, 361 366 1999 Stockton Press. All rights reserved 0950-9240/99 $12.00 http://www.stockton-press.co.uk/jhh ORIGINAL ARTICLE The magnitude and duration of ambulatory

More information

Clinical Study Synopsis for Public Disclosure

Clinical Study Synopsis for Public Disclosure abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis - which is part of

More information

Factors Involved in Poor Control of Risk Factors

Factors Involved in Poor Control of Risk Factors Factors Involved in Poor Control of Risk Factors Patient compliance Clinical inertia Health Care System structure 14781 M Limitations of Formal Studies Selection of patients Recruitment and follow-up alter

More information

Scientific conclusions and detailed explanation of the scientific grounds for the differences from the PRAC recommendation

Scientific conclusions and detailed explanation of the scientific grounds for the differences from the PRAC recommendation Annex I Scientific conclusions, grounds for variation to the terms of the marketing authorisations and detailed explanation of the scientific grounds for the differences from the PRAC recommendation 1

More information

Pharmacodynarnic modeling of the antihypertensive response to amlodipine

Pharmacodynarnic modeling of the antihypertensive response to amlodipine Pharmacodynarnic modeling of the antihypertensive response to amlodipine The distinctive pharmacokinetic characteristics of amlodipine, particularly the long half-life, are presumed to translate directly

More information

Lisinopril losartan conversion dose

Lisinopril losartan conversion dose P ford residence southampton, ny Lisinopril losartan conversion dose Deep in-house technology, streaming expertise, and partnerships with the widest range of digital platforms secures our position as the

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 27 May 2009

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 27 May 2009 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 27 May 2009 RASILEZ HCT 150 mg/12.5 mg, film-coated tablets B/30 (CIP code: 392 151-6) RASILEZ HCT 150 mg/25 mg, film-coated

More information

Primary hypertension in adults

Primary hypertension in adults Primary hypertension in adults NICE provided the content for this booklet which is independent of any company or product advertised Hypertension Welcome NICE published an updated guideline on the diagnosis

More information

JNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults

JNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults JNC 8 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults Table of Contents Why Do We Treat Hypertension? Blood Pressure Treatment Goals Initial Therapy Strength of Recommendation

More information

Clinical Study Synopsis for Public Disclosure

Clinical Study Synopsis for Public Disclosure abcd Clinical Study for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis - which is part of the clinical

More information

Peer Review Report. [Fixed Dose Combination Lisinopril + Hydrochlothiazide]

Peer Review Report. [Fixed Dose Combination Lisinopril + Hydrochlothiazide] 21 st Expert Committee on Selection and Use of Essential Medicines Peer Review Report [Fixed Dose Combination Lisinopril + Hydrochlothiazide] (1) Does the application adequately address the issue of the

More information

HEART FAILURE SUMMARY. and is associated with significant morbidity and mortality. the cornerstone of heart failure treatment.

HEART FAILURE SUMMARY. and is associated with significant morbidity and mortality. the cornerstone of heart failure treatment. HEART FAILURE SUMMARY + Heart Failure is a condition affecting a large number of Irish people and is associated with significant morbidity and mortality. + ACE inhibitors, in combination with diuretics,

More information

JNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH

JNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH JNC 8 -Controversies Sagren Naidoo Nephrologist CMJAH Joint National Committee (JNC) Panel appointed by the National Heart, Lung, and Blood Institute (NHLBI) First guidelines (JNC-1) published in 1977

More information

ADVANCES IN MANAGEMENT OF HYPERTENSION

ADVANCES IN MANAGEMENT OF HYPERTENSION Prevalence 29%; Blacks 33.5% About 72.5% treated; 53.5% uncontrolled (>140/90) Risk for poor control: Latinos, Blacks, age 18-44 and 80,

More information

PROSTRAKAN v SHIRE. Calcichew-D 3 Forte journal advertisement CASE AUTH/1825/4/06

PROSTRAKAN v SHIRE. Calcichew-D 3 Forte journal advertisement CASE AUTH/1825/4/06 CASE AUTH/1825/4/06 PROSTRAKAN v SHIRE Calcichew-D 3 Forte journal advertisement ProStrakan complained about a journal advertisement for Calcichew-D 3 Forte (calcium carbonate, colecalciferol) issued by

More information

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION Dr Catherine BESEME Paris 6 th December 2005 6 th International Congress of Bangladesh Society of Medicine Hypertension is a risk factor at the source, with

More information

Long-Term Care Updates

Long-Term Care Updates Long-Term Care Updates August 2015 By Darren Hein, PharmD Hypertension is a clinical condition in which the force of blood pushing on the arteries is higher than normal. This increases the risk for heart

More information

Clinical Study Synopsis for Public Disclosure

Clinical Study Synopsis for Public Disclosure abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis - which is part of

More information

AGING, BLOOD PRESSURE & CARDIOVASCULAR DISEASE EVENT RISK. Michael Smolensky, Ph.D. The University of Texas Austin & Houston

AGING, BLOOD PRESSURE & CARDIOVASCULAR DISEASE EVENT RISK. Michael Smolensky, Ph.D. The University of Texas Austin & Houston AGING, BLOOD PRESSURE & CARDIOVASCULAR DISEASE EVENT RISK Michael Smolensky, Ph.D. The University of Texas Austin & Houston Disclosures Partner: Circadian Ambulatory Diagnostics Consultant: Spot On Sciences

More information

Management of Hypertensive Chronic Kidney Disease: Role of Calcium Channel Blockers. Robert D. Toto, MD

Management of Hypertensive Chronic Kidney Disease: Role of Calcium Channel Blockers. Robert D. Toto, MD R e v i e w P a p e r Management of Hypertensive Chronic Kidney Disease: Role of Calcium Channel Blockers Robert D. Toto, MD Both the prevalence and incidence of end-stage renal disease have been increasing

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 9 March 2011

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 9 March 2011 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 9 March 2011 TAREG 3 mg/ml oral solution B/1 160 ml (CIP code: 491 474-8) Applicant: NOVARTIS PHARMA SAS valsartan

More information

Management of Hypertension

Management of Hypertension Clinical Practice Guidelines Management of Hypertension Definition and classification of blood pressure levels (mmhg) Category Systolic Diastolic Normal

More information

MODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure. No relevant financial relationships. Blood Pressure and Risk

MODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure. No relevant financial relationships. Blood Pressure and Risk MODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure No relevant financial relationships Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu

More information

Metabolic Consequences of Anti Hypertensives: Is It Clinically Important?

Metabolic Consequences of Anti Hypertensives: Is It Clinically Important? Metabolic Consequences of Anti Hypertensives: Is It Clinically Important?,FACA,FICA,MASH,FVBWG,MISCP CONSULTANT OF CARDIOLOGY DIRECTOR OF PORT-FOUAD HOSPITAL CCU Consideration of antihypertensive agents

More information

AJH 2000;13: by the American Journal of Hypertension, Ltd /00/$20.00

AJH 2000;13: by the American Journal of Hypertension, Ltd /00/$20.00 AJH 2000;13:632 639 Comparison of Three Blood Pressure Measurement Methods for the Evaluation of Two Antihypertensive Drugs: Feasibility, Agreement, and Reproducibility of Blood Pressure Response Stéphanie

More information

Adapted d from Federation of Health Regulatory Colleges of Ontario Template Last Updated September 18, 2017

Adapted d from Federation of Health Regulatory Colleges of Ontario Template Last Updated September 18, 2017 Insert Logo or Org Name Here Primary Care Medical Directive for Hypertension Management Adapted d from Federation of Health Regulatory Colleges of Ontario Template Last Updated September 18, 2017 Title:

More information

APPENDIX D: PHARMACOTYHERAPY EVIDENCE

APPENDIX D: PHARMACOTYHERAPY EVIDENCE Página 1 de 7 APPENDIX D: PHARMACOTYHERAPY EVIDENCE Table D1. Outcome Trials of Antihypertensive Agents Study Drug Regimen N Duration Primary Outcomes Remarks Antihypertensive Therapy vs Placebo SHEP 1991

More information

By Prof. Khaled El-Rabat

By Prof. Khaled El-Rabat What is The Optimum? By Prof. Khaled El-Rabat Professor of Cardiology - Benha Faculty of Medicine HT. Introduction Despite major worldwide efforts over recent decades directed at diagnosing and treating

More information

In the Literature 1001 BP of 1.1 mm Hg). The trial was stopped early based on prespecified stopping rules because of a significant difference in cardi

In the Literature 1001 BP of 1.1 mm Hg). The trial was stopped early based on prespecified stopping rules because of a significant difference in cardi Is Choice of Antihypertensive Agent Important in Improving Cardiovascular Outcomes in High-Risk Hypertensive Patients? Commentary on Jamerson K, Weber MA, Bakris GL, et al; ACCOMPLISH Trial Investigators.

More information

ASTRAZENECA v GLAXOSMITHKLINE

ASTRAZENECA v GLAXOSMITHKLINE CASE AUTH/1833/5/06 ASTRAZENECA v GLAXOSMITHKLINE CONCEPT study leavepiece AstraZeneca complained that a leavepiece issued by Allen & Hanburys, part of GlaxoSmithKline, did not present a fair and balanced

More information

POPULATION PHARMACOKINETICS RAYMOND MILLER, D.Sc. Daiichi Sankyo Pharma Development

POPULATION PHARMACOKINETICS RAYMOND MILLER, D.Sc. Daiichi Sankyo Pharma Development POPULATION PHARMACOKINETICS RAYMOND MILLER, D.Sc. Daiichi Sankyo Pharma Development Definition Population Pharmacokinetics Advantages/Disadvantages Objectives of Population Analyses Impact in Drug Development

More information

Review article: pharmacology of esomeprazole and comparisons with omeprazole

Review article: pharmacology of esomeprazole and comparisons with omeprazole Aliment Pharmacol Ther 2003; 17 (Suppl. 1): 5 9. Review article: pharmacology of esomeprazole and comparisons with omeprazole J. DENT Department of Gastroenterology, Hepatology and General Medicine, Royal

More information

New Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets

New Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets New Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets Sidney C. Smith, Jr. MD, FACC, FAHA Professor of Medicine/Cardiology University of

More information

Evidence based advertising. in 2018

Evidence based advertising. in 2018 Evidence based advertising in 2018 Channel your inner evidence ninja Speaker: Karen Rizwan, Reviewer, PAAB Acceptable Sources of Evidence: The Terms of Market Authorization (TMA) (e.g. product monograph,

More information

New Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.

New Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant

More information

Is Traditional Clinic Blood Pressure Dead?

Is Traditional Clinic Blood Pressure Dead? Royal College of Physicans May 16 th 2017 Is Traditional Clinic Blood Pressure Dead? Professor Bryan Williams MD FRCP FAHA FESC Chair of Medicine UCL Director National Institute for Health Research Biomedical

More information

Clinical Trials A Practical Guide to Design, Analysis, and Reporting

Clinical Trials A Practical Guide to Design, Analysis, and Reporting Clinical Trials A Practical Guide to Design, Analysis, and Reporting Duolao Wang, PhD Ameet Bakhai, MBBS, MRCP Statistician Cardiologist Clinical Trials A Practical Guide to Design, Analysis, and Reporting

More information

ANGIOTENSIN RECEPTOR BLOCKERS ARE FIRST LINE TREATMENT : PRO

ANGIOTENSIN RECEPTOR BLOCKERS ARE FIRST LINE TREATMENT : PRO ANGIOTENSIN RECEPTOR BLOCKERS ARE FIRST LINE TREATMENT : PRO Prof Xavier Girerd M.D., Ph.D., F.E.S.C. Endocrinology Department Cardiovascular Prevention Unit Groupe Hospitalier Pitié-Salpêtrière Faculté

More information

Volume 6; Number 1 January 2012 NICE CLINICAL GUIDELINE 127: HYPERTENSION CLINICAL MANAGEMENT OF PRIMARY HYPERTENSION IN ADULTS (AUGUST 2011)

Volume 6; Number 1 January 2012 NICE CLINICAL GUIDELINE 127: HYPERTENSION CLINICAL MANAGEMENT OF PRIMARY HYPERTENSION IN ADULTS (AUGUST 2011) Volume 6; Number 1 January 2012 NICE CLINICAL GUIDELINE 127: HYPERTENSION CLINICAL MANAGEMENT OF PRIMARY HYPERTENSION IN ADULTS (AUGUST 2011) What s new in hypertension? NICE has issued an updated Clinical

More information

Choice of therapy in esse... http://www.uptodate.co... Page 1 of 28 Official reprint from UpToDate www.uptodate.com Print Back Choice of therapy in essential hypertension: Recommendations Authors Norman

More information

Several studies have demonstrated that reducing

Several studies have demonstrated that reducing AJH 2000;13:921 926 Clinically Additive Effect Between Doxazosin and Amlodipine in the Treatment of Essential Hypertension Sanem Nalbantgil, Istemi Nalbantgil, and Remzi Önder The Joint National Committee

More information

Reducing proteinuria

Reducing proteinuria Date written: May 2005 Final submission: October 2005 Author: Adrian Gillin Reducing proteinuria GUIDELINES a. The beneficial effect of treatment regimens that include angiotensinconverting enzyme inhibitors

More information

Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension

Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension Prof. Massimo Volpe, MD, FAHA, FESC, Chair of Cardiology, Department of Clinical and Molecular Medicine

More information

...SELECTED ABSTRACTS...

...SELECTED ABSTRACTS... The following abstracts, from peer-reviewed journals containing literature on vascular compliance and hypertension, were selected for their relevance to this conference and to a managed care perspective.

More information

*NOTE: When submitting CPT code and 99239, it is recommended the measure be submitted each time the code is submitted for hospital discharge.

*NOTE: When submitting CPT code and 99239, it is recommended the measure be submitted each time the code is submitted for hospital discharge. Quality ID #5 (NQF 0081): Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) National Quality

More information

Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM

Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Faculty Disclosure I have no financial interest to disclose No off-label use of medications will be discussed FIFTH ANNUAL SYMPOSIUM Recognize changes between

More information

Preventing and Treating High Blood Pressure

Preventing and Treating High Blood Pressure Preventing and Treating High Blood Pressure: Finding the Right Balance of Integrative and Pharmacologic Approaches Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Blood Pressure

More information

Hypertension: What s new since JNC 7. Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF

Hypertension: What s new since JNC 7. Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF Hypertension: What s new since JNC 7 Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF Disclosures Spectral Diagnostics Site investigator Eli Lilly Site investigator ACP IM ITE writing committee NBME Step

More information

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. The synopsis

More information

The CARI Guidelines Caring for Australasians with Renal Impairment. ACE Inhibitor and Angiotensin II Antagonist Combination Treatment GUIDELINES

The CARI Guidelines Caring for Australasians with Renal Impairment. ACE Inhibitor and Angiotensin II Antagonist Combination Treatment GUIDELINES ACE Inhibitor and Angiotensin II Antagonist Combination Treatment Date written: September 2004 Final submission: September 2005 Author: Kathy Nicholls GUIDELINES No recommendations possible based on Level

More information

The CARI Guidelines Caring for Australians with Renal Impairment. Specific effects of calcium channel blockers in diabetic nephropathy GUIDELINES

The CARI Guidelines Caring for Australians with Renal Impairment. Specific effects of calcium channel blockers in diabetic nephropathy GUIDELINES Specific effects of calcium channel blockers in diabetic nephropathy Date written: September 2004 Final submission: September 2005 Author: Kathy Nicholls GUIDELINES a. Non-dihydropyridine calcium channel

More information

Quality ID #122: Adult Kidney Disease: Blood Pressure Management National Quality Strategy Domain: Effective Clinical Care

Quality ID #122: Adult Kidney Disease: Blood Pressure Management National Quality Strategy Domain: Effective Clinical Care Quality ID #122: Adult Kidney Disease: Blood Pressure Management National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Intermediate

More information

ASTRAZENECA v GLAXOSMITHKLINE

ASTRAZENECA v GLAXOSMITHKLINE CASE AUTH/1986/4/07 ASTRAZENECA v GLAXOSMITHKLINE Symbicort and Seretide cost comparisons AstraZeneca complained about cost comparisons made by GlaxoSmithKline between AstraZeneca s Symbicort (budesonide/formoterol)

More information

Modern Management of Hypertension

Modern Management of Hypertension Modern Management of Hypertension Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Hypertension Prevalence

More information

Evaluation of the Extent and Duration of the ABPM Effect in Hypertensive Patients

Evaluation of the Extent and Duration of the ABPM Effect in Hypertensive Patients Journal of the American College of Cardiology Vol. 40, No. 4, 2002 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)02011-9

More information

Modern Management of Hypertension: Where Do We Draw the Line?

Modern Management of Hypertension: Where Do We Draw the Line? Modern Management of Hypertension: Where Do We Draw the Line? Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Blood Pressure

More information

ADVANCES IN MANAGEMENT OF HYPERTENSION

ADVANCES IN MANAGEMENT OF HYPERTENSION Advances in Management of Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Prevalence 29%; Blacks 33.5%

More information

Revised Cochrane risk of bias tool for randomized trials (RoB 2.0) Additional considerations for cross-over trials

Revised Cochrane risk of bias tool for randomized trials (RoB 2.0) Additional considerations for cross-over trials Revised Cochrane risk of bias tool for randomized trials (RoB 2.0) Additional considerations for cross-over trials Edited by Julian PT Higgins on behalf of the RoB 2.0 working group on cross-over trials

More information

Hypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, Financial Disclosures

Hypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, Financial Disclosures Hypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, 2015 William C. Cushman, MD Professor, Preventive Medicine, Medicine, and Physiology University

More information