Hiroyuki Daikuhara 1, Fumi Kikuchi 2 and Toshihiko Ishida 2. Introduction. Original Article

Size: px
Start display at page:

Download "Hiroyuki Daikuhara 1, Fumi Kikuchi 2 and Toshihiko Ishida 2. Introduction. Original Article"

Transcription

1 447310DVR / Daikuhara et al.diabetes and Vascular Disease Research 2012 Original Article The combination of OLmesartan and a CAlcium channel blocker (azelnidipine) or candesartan and a calcium channel blocker (amlodipine) in type 2 diabetic hypertensive patients: The OLCA study Diabetes & Vascular Disease Research 9(4) The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalspermissions.nav DOI: / dvr.sagepub.com Hiroyuki Daikuhara 1, Fumi Kikuchi 2 and Toshihiko Ishida 2 Abstract Angiotensin II receptor blockers (ARB) are often co-administered with a calcium channel blocker (CCB) for treating hypertension. In this open-label randomised study, untreated diabetic hypertensive patients were randomised to receive either olmesartan 20 mg/day or candesartan 8 mg/day for 12 weeks. Patients with blood pressure exceeding 130/80 mm Hg received add-on 16 mg/day azelnidipine to ongoing olmesartan (OL group) or 5 mg/day amlodipine to ongoing candesartan (CA group) for 24 weeks. Home-measured and clinic-measured blood pressure decreased in both groups. Fasting blood glucose, haemoglobin A1c (HbA1c) and urinary albumin levels decreased significantly in the OL group but not in the CA group. In conclusion, this study revealed clinically relevant differences between two combinations of an ARB+CCB in diabetic hypertensive patients. Olmesartan and azelnidipine had a more persistent early morning antihypertensive effect and produced greater decreases in heart rate, fasting blood glucose and HbA1c (National Glycohemoglobin Standardization Program values) levels, and microalbuminuria than did candesartan and amlodipine. Keywords Heart rate, morning blood pressure, urinary albumin, haemoglobin A1c, sympathetic nerve activity Introduction Hypertension is an important risk factor for cardiovascular and cerebrovascular diseases. The goal of antihypertensive treatment is to prevent the onset of these diseases by controlling blood pressure within appropriate levels. Hypertensive patients with diabetes mellitus are at even higher risk for cardiac and cerebrovascular disorders, as well as renal disorders. Therefore, more aggressive control of blood glucose and blood pressure is needed and the Japanese Society of Hypertension guidelines for the management of hypertension (JHS (2009)) have proposed target blood pressure values of 130/80 mm Hg. 1 However, many patients are unable to achieve such low blood pressure values. Therefore, for the management of blood pressure it is important that clinicians are aware of the rate of achievement of these antihypertensive targets and that they determine why many patients experience inadequate blood pressure lowering. In fact, in terms of antihypertensive drugs, blood pressure is often poorly controlled with one antihypertensive drug alone and at least two antihypertensive drugs may be required in many patients to achieve blood pressure targets. Inhibitory effects of antihypertensive drugs on cardiovascular and cerebral events have been reported in hypertensive patients complicated with diabetes mellitus and, considering the antihypertensive effects and the effect on glucose and lipid metabolism, renin angiotensin (RA) inhibitors are considered as first-line drugs in these patients. If RA inhibitors show inadequate efficacy, calcium channel blockers (CCB), and sometimes thiazide diuretics, are often used as secondline drugs. 1 3 It was recently reported in the large-scale ACCOMPLISH (Avoiding Cardiovascular events through COMbination therapy In Patients LIving with Systolic Hypertension) study that co-administration of a RA inhibitor and a CCB inhibited cardiovascular events in all nondiabetic patients, diabetic patients and chronic kidney disease 1 Department of Internal Medicine, Sakaide City Hospital, Japan 2 Department of Internal Medicine, Kagawa University, Japan Corresponding author: Hiroyuki Daikuhara, Department of Internal Medicine, Sakaide City Hospital, Bunkyo-cho, Sakaide, Kagawa , Japan. daikusan@r5.dion.ne.jp

2 Daikuhara et al. 281 Figure 1. Study design. A CCB was added at week 0 for patients who did not meet the JSH (2009) treatment targets for hypertension (130/80 mm Hg). CA: candesartan plus amlodipine; CCB: calcium channel blocker; JSH: Japanese Society of Hypertension; OL: olmesartan plus azelnidipine. patients, unlike the use of a RA inhibitor plus a diuretic. 4,5 It was also found that the combination of a RA inhibitor and a CCB confers greater organ protection. Since antihypertensive treatment is generally conducted for a long time, the tolerability of and long-term adherence to the treatment regimen are also important factors when selecting antihypertensive drugs. 6 Angiotensin II receptor blockers (ARB) are often coadministered with a CCB in clinical practice because of their relatively high tolerability. It has been found that the binding force to the angiotensin II type 1 receptor differs among ARBs. 7 Moreover, some CCBs stimulate the sympathetic nervous system while others inhibit it, and azelnidipine was reported to show renal protective effects by reducing proteinuria In Japan, combinations of ARBs and CCBs have been launched by various companies, but there are few reports comparing the clinical effects of different combinations of drugs. Therefore, the purpose of this study was to compare the effects of two combinations of an ARB and a CCB on early-morning blood pressure, heart rate, renal function and glucose/lipid metabolism in hypertensive patients with type 2 diabetes mellitus. Methods Patients Untreated hypertensive patients complicated with type 2 diabetes mellitus (with or without insulin treatment) who were attending the outpatient clinic for diabetes mellitus at Sakaide City Hospital were invited to participate in this two-arm, open-label, randomised controlled study. The study protocol was approved by the Institutional Ethical Committee at Sakaide City Hospital. All of the patients were given an explanation of the study and their written consent for participation and for the use of their data was obtained before enrolment. We also explained to the patients that no personal information would be disclosed during publication of the results. Patients meeting the following criteria were eligible for inclusion: (i) hypertension in the presence of type 2 diabetes mellitus and systolic pressure or diastolic pressure at medical examination exceeding 130 mm Hg or 80 mm Hg respectively; and (ii) no planned changes in antidiabetic therapy. Patients with secondary hypertension or Grade 3 hypertension were excluded from the study. Patients meeting any of the following criteria were also excluded: (i) contraindication for any of the test drugs; (ii) uncontrolled diabetes mellitus; (iii) diabetic nephropathy after the late stage of overt nephropathy (because blood insulin clearance may decrease after the late stage of overt nephropathy and may mask glucose metabolic status); (iv) history of acute coronary syndrome or cerebrovascular disorders within one year of enrolment; (v) severe infection, before or after surgery, or serious trauma; (vi) history of hypersensitivity to the study drugs; (vii) pregnant women or women with the possibility of being pregnant; and (viii) other reasons for ineligibility as determined by the investigator. Study design and treatments The study design is shown in Figure 1. Three-hundred hypertensive patients complicated with type 2 diabetes mellitus were randomly allocated (150 patients/group) to receive either olmesartan medoxomil (olmesartan) 20 mg/ day or candesartan cilexetil (candesartan) 8 mg/day for 12 weeks. Based on the JSH (2009) guidelines, patients who did not achieve blood pressure less than 130/80 mm Hg with olmesartan were also given azelnidipine once daily after breakfast at a dose of 16 mg/day (OL group). Meanwhile, 121 patients in the candesartan group who did not reach the antihypertensive target added amlodipine 5 mg/day once daily after breakfast (CA group). The doses used were chosen based on the doses commonly used in Japan, and were expected to achieve similar hypotensive effects. None of the patients dropped out after starting CCB

3 282 Diabetes & Vascular Disease Research 9(4) therapy. Antidiabetic drugs (including insulin) used at the start of the study were to be continued without any change in type or dosage during the study. In 236 patients in the two groups, blood pressure and heart rate were measured in the outpatient clinic and at home at weeks 4, 8, 16 and 24 after the start of combination therapy. Fasting blood glucose, haemoglobin A1c (HbA1c) (National Glycohemoglobin Standardization Program (NGSP)), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), serum uric acid, blood urea nitrogen (BUN), serum creatinine, and serum electrolyte (Na, K and Cl) levels, urinary albumin levels and the estimated glomerular filtration rate (egfr) were measured 24 weeks after starting combination therapy. The most common oral antidiabetic drugs used before starting the study were sulfonylureas (30%), biguanides (30%), α-glucosidase inhibitors (25%), dipeptidyl peptidase inhibitors (20%) and glinides (5%). Thirty-nine percent of patients were treated with insulin. Blood pressure was measured in the clinic multiple times at one- or two-minute intervals with the patient in the resting and sitting position. The mean of two values differing by less than 5 mm Hg was recorded. Blood pressure was also measured at home, after waking in the morning, using a pressure measurement device for the upper arm. The patient was instructed to measure blood pressure while in the sitting position, with a 1 2-minute rest, after urination but before administration of hypotensive drugs, as recommended by the JSH. 1 Additional parameters were determined using blood and urine samples. Changes in blood pressure and heart rate measured in the clinic, early morning blood pressure and heart rate measured at home, urine albumin, egfr, HbA1c (NGSP), fasting blood glucose, LDL-C, HDL-C and TG between the start and after 24 weeks of combination therapy were defined as endpoints in this study. HbA1c was measured by column chromatography at our institute. Urinary albumin levels were measured by a turbidimetric immunoassay (Shikoku Chuken Inc., Kagawa, Japan). Values are expressed for all patients as means ± standard deviation (SD), except for the urinary albumin level, which is expressed as the mean ± standard error (SE). Unpaired t-tests and paired t-tests were used to determine the significance of differences between the two groups and within each group, respectively. The number of urinary albuminpositive patients was compared using the χ 2 -test. The level of significance was set at 5%. Intention-to-treat analytical procedures were applied. Based on data from previous studies, 8,12 we assumed a difference in SBP of 4.8 mm Hg between the two groups. To achieve 90% power at a 5% significance level, and allowing for a 25% dropout rate, 150 patients were needed in each group. Results Comparing the clinical characteristics of 300 hypertensive patients complicated with diabetes mellitus, there were no differences between the two groups of patients (150 patients/group) randomised to either olmesartan 20 mg/day or candesartan 8 mg/day. Overall, 115 patients treated with olmesartan and 121 patients treated with candesartan did not achieve the antihypertensive goal within 12 weeks of treatment and received add-on CCB therapy. The characteristics of these patients before adding a CCB to ongoing ARB therapy (i.e. at week 0) are shown in Table 1. There were no significant differences between the OL and CA groups. Similar proportions of patients in both groups used insulin or oral antidiabetic drugs. There were no changes in antidiabetic therapy (type or dose) during the study. The changes in clinic-measured blood pressure and home-measured early morning blood pressure during the study period are shown in Figures 2 and 3. The changes in other parameters between weeks 0 and 24 of ARB and CCB combination therapy are shown in Figures 4 6. The mean change in clinic-measured blood pressure (systolic/diastolic) following 24 weeks of ARB and CCB combination therapy was 15.3 ± 4.8/ 7.1 ± 3.2 mm Hg (both p < 0.01) in the OL group and 14.5 ± 4.6/ 6.7 ± 3.1 mm Hg (both p < 0.01) in the CA group. The corresponding changes in home-measured early morning blood pressure were 16.7±5.0/ 8.8 ± 3.0 mm Hg (both p < 0.01) and 13.0 ± 4.6/ 6.4 ± 3.1 mm Hg (both p < 0.01). These results indicate that both OL and CA had significant antihypertensive effects, but that the lowering of home-measured early morning blood pressure was significantly greater in the OL group than in the CA group (p < 0.05) (see Figures 2 and 3). Clinic-measured heart rate tended to increase while homemeasured early morning heart rate increased significantly in the CA group. In contrast, these parameters decreased significantly in the OL group, with changes of 6.8 ± 2.7 beats/ minute (p < 0.01) and 5.0 ± 2.1 beats/minute (p < 0.01), respectively (see Figure 4.). In the OL group, the fasting blood glucose level decreased significantly from 127.4±10.3 mg/dl before the start of combination therapy to 123.0±9.9 mg/dl at week 24 (p < 0.05), as did the HbA1c (NGSP) level, which decreased from 7.1±0.8% to 6.8 ± 0.7% (p < 0.05) (see Figure 5). Although egfr was not significantly different between the two groups, the urinary albumin level decreased significantly in the OL group from ± mg/gcr to ± mg/gcr (p < 0.001) and a significant decrease in the number of urinary albumin-positive patients was observed (see Figure 6). Body weight increased very slightly in both groups, increasing from 62.2 ± 12.3 to 62.5 ± 12.7 kg in the OL group, and from 62.7 ± 12.6 to 63.0 ± 12.9 kg in the CA group. These changes were not significantly different between the two groups. Peripheral foot oedema was noted in one patient treated with OL and two patients treated with CA; however, the oedema was very mild and did not interfere with daily living. There were no significant changes in the levels of metabolic markers, such as LDL-C, HDL-C, TG, serum uric acid, BUN, serum creatinine, Na, K or Cl in either group.

4 Daikuhara et al. 283 Table 1. Patient characteristics before starting combination therapy. Group OL (n=115) CA (n=121) p-value Age (years) 59.2 ± ± 9.9 NS Sex (male/female) 68/47 75/46 NS BMI (kg/m 2 ) 24.2 ± ± 4.2 NS Current antidiabetic therapy, n (%) 113 (98.2) 117 (96.7) Oral drugs 65 (56.5) 74 (61.2) Insulin 48 (41.7) 43 (35.5) Duration of diabetes mellitus (years) 8.8 ± ± 4.5 NS Clinic-measured SBP (mm Hg) ± ± 11.9 NS DBP (mm Hg) 85.1 ± ± 8.6 NS Heart rate (beats/min) 72.4 ± ± 9.8 NS Home-measured SBP (mm Hg) ± ± 11.2 NS DBP (mm Hg) 84.6 ± ± 8.7 NS Heart rate (beats/min) 69.8 ± ± 9.8 NS Serum creatinine (mg/dl) 0.8 ± ± 0.2 NS BUN (mg/dl) 14.0 ± ± 3.6 NS Uric acid (mg/dl) 5.7 ± ± 1.6 NS Serum Na (meq/l) ± ± 3.9 NS Serum K (meq/l) 4.4 ± ± 0.4 NS Serum Cl (meq/l) ± ± 4.1 NS FBG (mg/dl) ± ± 10.6 NS HbA1c (NGSP) (%) 7.1 ± ± 0.8 NS LDL-C (mg/dl) ± ± 27.3 NS HDL-C (mg/dl) 60.0 ± ± 12.7 NS TG (mg/dl) ± ± 42.2 NS Data are means ± standard deviation unless otherwise specified. BMI: body mass index; DBP: diastolic blood pressure; BUN: blood urea nitrogen; CA: candesartan plus amlodipine; FBG: fasting blood glucose; HbA1c: haemoglobin A1c; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; NGSP: National Glycohemoglobin Standardization Program; OL: olmesartan plus azelnidipine; SBP: systolic blood pressure; TG: triglyceride. Figure 2. Changes in clinic-measured blood pressure. Data are means ± standard deviation. *p<0.01 vs week 0. CA: candesartan plus amlodipine; OL: olmesartan plus azelnidipine. The horizontal dashed lines represent the Japanese Society of Hypertension (2009) treatment targets for hypertension (130/80 mm Hg). Figure 3. Changes in home-measured early morning blood pressure. Data are means ± standard deviation. *p<0.01 vs week 0. CA: candesartan plus amlodipine; OL: olmesartan plus azelnidipine. The horizontal dashed lines represent the Japanese Society of Hypertension (2009) treatment targets for hypertension (130/80 mm Hg). Furthermore, there were no significant changes in other parameters during the study, and we detected no changes in clinical symptoms resulting from discontinuation of the study. Similarly, we noted no adverse reactions caused by administration of the study drugs and none of the patients withdrew because of adverse events.

5 284 Diabetes & Vascular Disease Research 9(4) Figure 4. Changes in heart rate measured (A) in the clinic and (B) at home in the early morning. Data are means ± standard deviation. CA: candesartan plus amlodipine; OL: olmesartan plus azelnidipine. Figure 5. Changes in (A) fasting blood glucose (FBG) and (B) haemoglobin A1c (HbA1c) (NGSP) levels. Data are means ± standard deviation. CA: candesartan plus amlodipine; NGSP: National Glycohemoglobin Standardization Program; OL: olmesartan plus azelnidipine. Figure 6. Changes in (A) urinary albumin levels and (B) the number of urinary albumin-positive patients. Data are means ± SE. (A) includes patients whose urinary albumin level before and/or after combination therapy was 30 mg/g Cr. CA: candesartan plus amlodipine; Cr: creatinine; OL: olmesartan plus azelnidipine; SE: standard error.

6 Daikuhara et al. 285 Discussion In this study, we found that the administration of a CCB in combination with an ARB elicited significant antihypertensive effects in hypertensive patients complicated with diabetes mellitus who did not achieve the antihypertensive targets despite usual doses of an ARB. Clinic-measured blood pressure showed similar antihypertensive effects in the OL and CA groups. However, the clinic-measured heart rate tended to increase in the CA group and it decreased significantly in the OL group. Meanwhile, patients in the OL group showed significant and persistent improvements in home-measured early morning blood pressure, compared with the CA group. Furthermore, home-measured early morning heart rate decreased significantly in the OL group. It is known that home-measured early morning blood pressure is more strongly associated with cardiovascular events than is clinic-measured blood pressure. 13 Accordingly, antihypertensive drugs showing antihypertensive effects that persist until the early morning are desirable. In the REZALT study, the use of an automatic blood pressure meter (ABPM) showed that the effects of olmesartan in combination with azelnidipine persisted for 24 hours. 14 In other studies using an APBM, differences in blood pressure control were reported between ARBs and between CCBs. For example, in double-blind comparative studies, the 24-hour persistence of olmesartan was significantly longer than that of candesartan 12 while the persistence of azelnidipine was longer than that of amlodipine. 8 Based on these findings, it is likely that the reduction in early morning blood pressure was significantly greater in the OL group than in the CA group because of concomitant use of olmesartan and azelnidipine, which show excellent persistency. Since the type and dosage of antidiabetic medications were not changed during the study period, the decreases in fasting blood glucose and HbA1c (NGSP) in the OL group were likely due to the effects of azelnidipine. This is because azelnidipine has been reported to improve insulin resistance 15 possibly by inhibiting sympathetic nerve activity. Palatini and Julius reported that tachycardia in hypertension results in sympathetic hyperactivity and that the heart rate itself influences cardiovascular risk factors such as hyperinsulinaemia and hyperglycaemia. 16 Moreover, an increased heart rate is considered a risk factor for type 2 diabetes mellitus because a high resting heart rate is significantly associated with obesity and diabetes mellitus. 17 The results of the present study suggest that inhibition of sympathetic nerve activity may positively influence glucose metabolism. Notably, there were no differences in clinicmeasured blood pressure and heart rate, home-measured early morning blood pressure, blood glucose, HbA1c, urinary albumin, lipid or electrolytes between patients treated with or without insulin (data not shown). It has also been reported that azelnidipine elicits significantly greater decreases in urinary protein compared with amlodipine. 10 In this study, we detected a significant decrease in the number of urinary albumin-positive patients in the OL group and renal function improved in the OL group but not in the CA group. These findings suggest that the renal disorders regressed from stage II to stage I because of the renal protective effects of OL, which normalised renal function. Since it was reported that the rate of cerebrovascular, cardiovascular and renal events decreases in patients with type 2 diabetes mellitus showing improvements in microalbuminuria, 18 the combination of olmesartan and azelnidipine is particularly appropriate for hypertensive patients complicated with diabetes mellitus in terms of cardiovascular and renal function protection. In Japan, tablets combining olmesartan with azelnidipine are now commercially available and are considered useful in terms of long-term adherence. Conclusions Two combinations of a CCB with an ARB elicited antihypertensive effects in hypertensive patients complicated with type 2 diabetes mellitus who did not achieve sufficient antihypertensive effects with the ARB at the usual dose. Our results suggest that the effects on the metabolic system may differ according to the combination of ARB and CCB. We observed persistent antihypertensive effects in terms of early morning hypertension in patients treated with olmesartan plus azelnidipine, in addition to decreases in heart rate, fasting blood glucose and HbA1c (NGSP), and a significant decrease in microalbuminuria. Taken together, these results indicate that, in hypertensive patients complicated with diabetes mellitus, olmesartan in combination with azelnidipine has beneficial effects in terms of blood pressure, glucose metabolism and renal protection. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflicts of interest statement None declared. References 1. Ogihara T, Kikuchi K, Matsuoka H, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2009). Hypertens Res 2009; 32: Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: Mancia G, De Backer G, Dominiczak A, et al Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28:

7 286 Diabetes & Vascular Disease Research 9(4) 4. Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in highrisk patients. N Engl J Med 2008; 359: Weber MA, Bakris GL, Jamerson K, et al. Cardiovascular events during differing hypertension therapies in patients with diabetes. J Am Coll Cardiol 2010; 56: Gupta AK, Arshad S and Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension 2010; 55: Koike H, Konse T, Sada T, et al. Olmesartan medoxomil, a novel potent angiotensin II blocker. Annu Rep Sankyo Res Lab 2003; 55: Kuramoto K, Ichikawa S, Hirai A, et al. Azelnidipine and amlodipine: a comparison of their pharmacokinetics and effects on ambulatory blood pressure. Hypertens Res 2003; 26: Nada T, Nomura M, Koshiba K, et al. Clinical study with azelnidipine in patients with essential hypertension. Antiarteriosclerotic and cardiac hypertrophy-inhibitory effects and influence on autonomic nervous activity. Arzneimittelforschung 2007; 57: Nakamura T, Sugaya T, Kawagoe Y, et al. Azelnidipine reduces urinary protein excretion and urinary liver-type fatty acid binding protein in patients with hypertensive chronic kidney disease. Am J Med Sci 2007; 333: Ogawa S, Mori T, Nako K, et al. Combination therapy with renin-angiotensin system inhibitors and the calcium channel blocker azelnidipine decreases plasma inflammatory markers and urinary oxidative stress markers in patients with diabetic nephropathy. Hypertens Res 2008; 31: Brunner HR, Stumpe KO and Januszewicz A. Antihypertensive efficacy of olmesartan medoxomil and candesartan cilexetil assessed by 24-hour ambulatory blood pressure monitoring in patients with essential hypertension. Clin Drug Investig 2003; 23: Sega R, Facchetti R, Bombelli M, et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 2005; 111: Ogihara T, Saruta T, Shimada K, et al. A randomized, double-blind, four-arm parallel-group study of the efficacy and safety of azelnidipine and olmesartan medoxomil combination therapy compared with each monotherapy in Japanese patients with essential hypertension: the REZALT study. Hypertens Res 2009; 32: Iwai M, Li HS, Chen R, et al. Calcium channel blocker azelnidipine reduces glucose intolerance in diabetic mice via different mechanism than angiotensin receptor blocker olmesartan. J Pharmacol Exp Ther 2006; 319: Palatini P and Julius S. Heart rate and the cardiovascular risk. J Hypertens 1997; 15: Nagaya T, Yoshida H, Takahashi H, et al. Resting heart rate and blood pressure, independent of each other, proportionally raise the risk for type-2 diabetes mellitus. Int J Epidemiol 2010; 39: Araki S, Haneda M, Koya D, et al. Reduction in microalbuminuria as an integrated indicator for renal and cardiovascular risk reduction in patients with type 2 diabetes. Diabetes 2007; 56:

Effectiveness of Add-On Low-Dose Diuretics in Combination Therapy for Hypertension: Losartan/Hydrochlorothiazide vs. Candesartan/Amlodipine

Effectiveness of Add-On Low-Dose Diuretics in Combination Therapy for Hypertension: Losartan/Hydrochlorothiazide vs. Candesartan/Amlodipine 831 Original Article Hypertens Res Vol.3 (27) No.9 p.831-837 Effectiveness of Add-On Low-Dose Diuretics in Combination Therapy for Hypertension: Losartan/Hydrochlorothiazide vs. Candesartan/Amlodipine

More information

Efficacy and Safety of a Single-Pill Fixed-Dose Combination of Azilsartan and Amlodipine

Efficacy and Safety of a Single-Pill Fixed-Dose Combination of Azilsartan and Amlodipine Elmer ress Original Article J Clin Med Res. 2016;8(12):888-892 Efficacy and Safety of a Single-Pill Fixed-Dose Combination of Azilsartan and Amlodipine Kota Motozato a, b, Shin-ichiro Miura a, c, d, Yuhei

More information

VA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005

VA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005 VA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005 1 Any adult in the health care system 2 Obtain blood pressure (BP) (Reliable,

More information

Inhibitory Effects of Azelnidipine Tablets on Morning Hypertension

Inhibitory Effects of Azelnidipine Tablets on Morning Hypertension Drugs R D (2013) 13:63 73 DOI 10.1007/s40268-013-0006-8 ORIGINAL RESEARCH ARTICLE Inhibitory Effects of Azelnidipine Tablets on Morning Hypertension Kazuomi Kario Yuki Sato Masayuki Shirayama Megumi Takahashi

More information

Hypertension and Cardiovascular Disease

Hypertension and Cardiovascular Disease Hypertension and Cardiovascular Disease Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic,

More information

Methods. Study design

Methods. Study design Elmer ress Original Article J Clin Med Res. 2017;9(2):98-103 Efficacy and Safety of Combination Therapy Consisting of Angiotensin II Type 1 Receptor Blocker, Calcium Channel Blocker and Hydrochlorothiazide

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

New Hypertension Guideline Recommendations for Adults July 7, :45-9:30am

New Hypertension Guideline Recommendations for Adults July 7, :45-9:30am Advances in Cardiovascular Disease 30 th Annual Convention and Reunion UERM-CMAA, Inc. Annual Convention and Scientific Meeting July 5-8, 2018 New Hypertension Guideline Recommendations for Adults July

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

Diabetes and Hypertension

Diabetes and Hypertension Diabetes and Hypertension M.Nakhjvani,M.D Tehran University of Medical Sciences 20-8-96 Hypertension Common DM comorbidity Prevalence depends on diabetes type, age, BMI, ethnicity Major risk factor for

More information

DISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE

DISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE DISCLOSURES Editor-in-Chief- Nephrology- UpToDate- (Wolters Klewer) Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA 1 st Annual Internal

More information

Blood Pressure Goal in Elderly Hypertensive Patients with Diabetes Mellitus: A Subanalysis of the CASE-J Trial

Blood Pressure Goal in Elderly Hypertensive Patients with Diabetes Mellitus: A Subanalysis of the CASE-J Trial Blood Pressure Goal in Elderly Hypertensive Patients with Diabetes Mellitus: A Subanalysis of the CASE-J Trial Kenji Ueshima 1, Shinji Yasuno 1, Sachiko Tanaka 1, Akira Fujimoto 1, Toshio Ogihara 2, Takao

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

Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) Trial of Cardiovascular Events in High-Risk Hypertensive Patients

Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) Trial of Cardiovascular Events in High-Risk Hypertensive Patients 1/5 This site became the new ClinicalTrials.gov on June 19th. Learn more. We will be updating this site in phases. This allows us to move faster and to deliver better services. Show less IMPORTANT: Listing

More information

Supplementary Table 1. Baseline Characteristics by Quintiles of Systolic and Diastolic Blood Pressures

Supplementary Table 1. Baseline Characteristics by Quintiles of Systolic and Diastolic Blood Pressures Supplementary Data Supplementary Table 1. Baseline Characteristics by Quintiles of Systolic and Diastolic Blood Pressures Quintiles of Systolic Blood Pressure Quintiles of Diastolic Blood Pressure Q1 Q2

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

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and

More information

Jared Moore, MD, FACP

Jared Moore, MD, FACP Hypertension 101 Jared Moore, MD, FACP Assistant Program Director, Internal Medicine Residency Clinical Assistant Professor of Internal Medicine Division of General Medicine The Ohio State University Wexner

More information

The Open Hypertension Journal, 2015, 7, 1-6 1

The Open Hypertension Journal, 2015, 7, 1-6 1 Send Orders for Reprints to reprints@benthamscience.ae The Open Hypertension Journal, 2015, 7, 1-6 1 Open Access Home Blood Pressure Measurement in the Morning Related to Cancer in Patients with Type 2

More information

Cardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003

Cardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003 Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,

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

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Heart Failure Clin 2 (2006) 101 105 Index Note: Page numbers of article titles are in boldface type. A ACE inhibitors, in diabetic hypertension, 30 31 Adipokines, cardiovascular events related to, 6 Advanced

More information

Hypertension Putting the Guidelines into Practice

Hypertension Putting the Guidelines into Practice Hypertension 2017 Putting the Guidelines into Practice Disclosures Relationships with commercial interests: Grants/Research Support: Speakers Bureau/Honoraria: Consulting Fees: Data Safety and Monitoring:

More information

CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES

CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES C. Liakos, 1 G. Vyssoulis, 1 E. Karpanou, 2 S-M. Kyvelou, 1 V. Tzamou, 1 A. Michaelides, 1 A. Triantafyllou, 1 P. Spanos, 1 C. Stefanadis

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

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

5.2 Key priorities for implementation

5.2 Key priorities for implementation 5.2 Key priorities for implementation From the full set of recommendations, the GDG selected ten key priorities for implementation. The criteria used for selecting these recommendations are listed in detail

More information

Reframe the Paradigm of Hypertension treatment Focus on Diabetes

Reframe the Paradigm of Hypertension treatment Focus on Diabetes Reframe the Paradigm of Hypertension treatment Focus on Diabetes Paola Atallah, MD Lecturer of Clinical Medicine SGUMC EDL monthly meeting October 25,2016 Overview Physiopathology of hypertension Classification

More information

Clinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8. Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital

Clinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8. Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital Clinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8 Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital Objectives Review the Eighth Joint National Committee (JNC

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

Difficult to Treat Hypertension

Difficult to Treat Hypertension Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic

More information

IJRPC 2011, 1(3) Patel et al. ISSN: INTERNATIONAL JOURNAL OF RESEARCH IN PHARMACY AND CHEMISTRY

IJRPC 2011, 1(3) Patel et al. ISSN: INTERNATIONAL JOURNAL OF RESEARCH IN PHARMACY AND CHEMISTRY INTERNATIONAL JOURNAL OF RESEARCH IN PHARMACY AND CHEMISTRY Available online at www.ijrpc.com Research Article EVALUATION OF COMPLIANCE AND BLOOD PRESSURE REDUCTION IN PATIENTS TREATED WITH AMLODIPINE

More information

Low-Dose Candesartan Cilexetil Prevents Early Kidney Damage in Type 2 Diabetic Patients with Mildly Elevated Blood Pressure

Low-Dose Candesartan Cilexetil Prevents Early Kidney Damage in Type 2 Diabetic Patients with Mildly Elevated Blood Pressure 453 Original Article Low-Dose Candesartan Cilexetil Prevents Early Kidney Damage in Type 2 Diabetic Patients with Mildly Elevated Blood Pressure Satoru MURAYAMA, Tsutomu HIRANO, Taro SAKAUE, Kenta OKADA,

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

Hypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital

Hypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital Hypertension Update 2008 Warwick Jaffe Interventional Cardiologist Ascot Hospital Definition of Hypertension Continuous variable At some point the risk becomes high enough to justify treatment Treatment

More information

EFFICACY & SAFETY OF ORAL TRIPLE DRUG COMBINATION OF TELMISARTAN, AMLODIPINE AND HYDROCHLOROTHIAZIDE IN THE MANAGEMENT OF NON-DIABETIC HYPERTENSION

EFFICACY & SAFETY OF ORAL TRIPLE DRUG COMBINATION OF TELMISARTAN, AMLODIPINE AND HYDROCHLOROTHIAZIDE IN THE MANAGEMENT OF NON-DIABETIC HYPERTENSION EFFICACY & SAFETY OF ORAL TRIPLE DRUG COMBINATION OF TELMISARTAN, AMLODIPINE AND HYDROCHLOROTHIAZIDE IN THE MANAGEMENT OF NON-DIABETIC HYPERTENSION Khemchandani D. 1 and * Arif A. Faruqui 2 1 Bairagarh,

More information

Module 2. Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension

Module 2. Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension Module 2 Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension 1 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,

More information

DISCLOSURE PHARMACIST OBJECTIVES 9/30/2014 JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES. I have nothing to disclose.

DISCLOSURE PHARMACIST OBJECTIVES 9/30/2014 JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES. I have nothing to disclose. JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES Tiffany Dickey, PharmD Assistant Professor, UAMS COP Clinical Pharmacy Specialist, Mercy Hospital Northwest AR DISCLOSURE I

More information

The Hypertension Clinic is a part of the Internal Medicine

The Hypertension Clinic is a part of the Internal Medicine Original Article Hypertension Registry at the Bangkok Hospital Medical Center: The First 7 Months Experience OBJECTIVE: The Hypertension Registry at the Bangkok Hospital Medical Center was established

More information

Cedars Sinai Diabetes. Michael A. Weber

Cedars Sinai Diabetes. Michael A. Weber Cedars Sinai Diabetes Michael A. Weber Speaker Disclosures I disclose that I am a Consultant for: Ablative Solutions, Boston Scientific, Boehringer Ingelheim, Eli Lilly, Forest, Medtronics, Novartis, ReCor

More information

Hypertension Putting the Guidelines into Practice

Hypertension Putting the Guidelines into Practice Hypertension 2017 Putting the Guidelines into Practice Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or

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

The Indian Polycap Study 1 & 2 (TIPS 1 & 2) and The International Polycap Study 3 & 4 (TIPS 3 & 4)

The Indian Polycap Study 1 & 2 (TIPS 1 & 2) and The International Polycap Study 3 & 4 (TIPS 3 & 4) The Indian Polycap Study 1 & 2 (TIPS 1 & 2) and The International Polycap Study 3 & 4 (TIPS 3 & 4) Denis Xavier MD, MSc Professor and Head, Pharmacology, St. John's Medical College Coordinator, Division

More information

Management of Hypertension. M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine

Management of Hypertension. M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine Management of Hypertension M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine Disturbing Trends in Hypertension HTN awareness, treatment and control rates are decreasing

More information

PFIZER INC. THERAPEUTIC AREA AND FDA APPROVED INDICATIONS: See USPI.

PFIZER INC. THERAPEUTIC AREA AND FDA APPROVED INDICATIONS: See USPI. PFIZER INC. These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert. For publications based on this study, see associated bibliography.

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

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Xu X, Qin X, Li Y, et al. Efficacy of folic acid therapy on the progression of chronic kidney disease: the Renal Substudy of the China Stroke Primary Prevention Trial. JAMA

More information

Target Blood Pressure Attainment in Diabetic Hypertensive Patients: Need for more Diuretics? Waleed M. Sweileh, PhD

Target Blood Pressure Attainment in Diabetic Hypertensive Patients: Need for more Diuretics? Waleed M. Sweileh, PhD Target Blood Pressure Attainment in Diabetic Hypertensive Patients: Need for more Diuretics? Waleed M. Sweileh, PhD Associate Professor, Clinical Pharmacology Corresponding author Waleed M. Sweileh, PhD

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

hypertension Head of prevention and control of CVD disease office Ministry of heath

hypertension Head of prevention and control of CVD disease office Ministry of heath hypertension t. Samavat MD,Cadiologist,MPH Head of prevention and control of CVD disease office Ministry of heath RECOMMENDATIONS FOR HYPERTENSION DIAGNOSIS, ASSESSMENT, AND TREATMENT Definition of hypertension

More information

Combination Therapy for Hypertension

Combination Therapy for Hypertension Combination Therapy for Hypertension Se-Joong Rim, MD Cardiology Division, Yonsei University College of Medicine, Seoul, Korea Goals of Therapy Reduce CVD and renal morbidity and mortality. Treat to BP

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

Metformin should be considered in all patients with type 2 diabetes unless contra-indicated

Metformin should be considered in all patients with type 2 diabetes unless contra-indicated November 2001 N P S National Prescribing Service Limited PPR fifteen Prescribing Practice Review PPR Managing type 2 diabetes For General Practice Key messages Metformin should be considered in all patients

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

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

Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension)

Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension) Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension) Janice P. Lea, MD, MSc, FASN Professor of Medicine Chief Medical Director of Emory Dialysis ASH Clinical Specialist

More information

Efficacy and safety of Olmesartan,Losartan, Valsartan, and Irbesartan in the Control of Essential Hypertension

Efficacy and safety of Olmesartan,Losartan, Valsartan, and Irbesartan in the Control of Essential Hypertension Efficacy and safety of Olmesartan,Losartan, Valsartan, and Irbesartan in the Control of Essential Hypertension Done by :Meznah zaid Al-mutairi Pharm.D Candidate Princess Nora Bint Abdul Rahman University

More information

Adult Diabetes Clinician Guide NOVEMBER 2017

Adult Diabetes Clinician Guide NOVEMBER 2017 Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Diabetes Clinician Guide Introduction NOVEMBER 2017 This evidence-based guideline summary is based on the 2017 KP National Diabetes Guideline.

More information

ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ. Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH

ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ. Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH Hypertension Co-Morbidities HTN Commonly Clusters with Other Risk

More information

TRIple pill vs. Usual care Management for Patients with mild-to-moderate Hypertension

TRIple pill vs. Usual care Management for Patients with mild-to-moderate Hypertension TRIple pill vs. Usual care Management for Patients with mild-to-moderate Hypertension The TRIUMPH study Dr Ruth Webster, PhD, MBBS, MIPH, BMedSc Global control rates for hypertension BP < 140/90 among

More information

Hypertension and obesity. Dr Wilson Sugut Moi teaching and referral hospital

Hypertension and obesity. Dr Wilson Sugut Moi teaching and referral hospital Hypertension and obesity Dr Wilson Sugut Moi teaching and referral hospital No conflict of interests to declare Obesity Definition: excessive weight that may impair health BMI Categories Underweight BMI

More information

Younger adults with a family history of premature artherosclerotic disease should have their cardiovascular risk factors measured.

Younger adults with a family history of premature artherosclerotic disease should have their cardiovascular risk factors measured. Appendix 2A - Guidance on Management of Hypertension Measurement of blood pressure All adults from 40 years should have blood pressure measured as part of opportunistic cardiovascular risk assessment.

More information

Received: / Revised: / Accepted: / Published:

Received: / Revised: / Accepted: / Published: World Journal of Pharmaceutical Sciences ISSN (Print): 2321-3310; ISSN (Online): 2321-3086 Published by Atom and Cell Publishers All Rights Reserved Available online at: http://www.wjpsonline.org/ Original

More information

Clinical Recommendations: Patients with Periodontitis

Clinical Recommendations: Patients with Periodontitis The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Friedewald VE, Kornman KS, Beck JD, et al. J Periodontol 2009;

More information

Hypertension. Risk of cardiovascular disease beginning at 115/75 mmhg doubles with every 20/10mm Hg increase. (Grade B)

Hypertension. Risk of cardiovascular disease beginning at 115/75 mmhg doubles with every 20/10mm Hg increase. (Grade B) Practice Guidelines and Principles: Guidelines and principles are intended to be flexible. They serve as reference points or recommendations, not rigid criteria. Guidelines and principles should be followed

More information

Egyptian Hypertension Guidelines

Egyptian Hypertension Guidelines Egyptian Hypertension Guidelines 2014 Egyptian Hypertension Guidelines Dalia R. ElRemissy, MD Lecturer of Cardiovascular Medicine Cairo University Why Egyptian Guidelines? Guidelines developed for rich

More information

Antihypertensive Trial Design ALLHAT

Antihypertensive Trial Design ALLHAT 1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes

More information

Risk Assessment of developing type 2 diabetes mellitus in patient on antihypertensive medication

Risk Assessment of developing type 2 diabetes mellitus in patient on antihypertensive medication 41 Research Article Risk Assessment of developing type 2 diabetes mellitus in patient on antihypertensive medication Amarjeet Singh*, Sudeep bhardwaj, Ashutosh aggarwal Department of Pharmacology, Seth

More information

Blood Pressure Targets: Where are We Now?

Blood Pressure Targets: Where are We Now? Blood Pressure Targets: Where are We Now? Diana Cao, PharmD, BCPS-AQ Cardiology Assistant Professor Department of Clinical & Administrative Sciences California Northstate University College of Pharmacy

More information

The role of physical activity in the prevention and management of hypertension and obesity

The role of physical activity in the prevention and management of hypertension and obesity The 1 st World Congress on Controversies in Obesity, Diabetes and Hypertension (CODHy) Berlin, October 26-29 2005 The role of physical activity in the prevention and management of hypertension and obesity

More information

Prevention And Treatment of Diabetic Nephropathy. MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan

Prevention And Treatment of Diabetic Nephropathy. MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan Prevention And Treatment of Diabetic Nephropathy MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan Prevention Tight glucose control reduces the development of diabetic nephropathy Progression

More information

Diabetes in Renal Patients. Contents. Understanding Diabetic Nephropathy

Diabetes in Renal Patients. Contents. Understanding Diabetic Nephropathy Diabetes in Renal Patients Contents Understanding Diabetic Nephropathy What effect does CKD have on a patient s diabetic control? Diabetic Drugs in CKD and Dialysis Patients Hyper and Hypoglycaemia in

More information

A fixed-dose combination of bisoprolol and amlodipine in daily practice treatment of hypertension: Results of a noninvestigational

A fixed-dose combination of bisoprolol and amlodipine in daily practice treatment of hypertension: Results of a noninvestigational Hostalek U et al. Medical Research Archives, vol. 5, issue 11, November 2017 issue Page 1 of 11 RESEARCH ARTICLE A fixed-dose combination of bisoprolol and amlodipine in daily practice treatment of hypertension:

More information

Don t let the pressure get to you:

Don t let the pressure get to you: Balanced information for better care Don t let the pressure get to you: Current evidence-based goals for treating hypertension A cornerstone of primary care: Lowering high blood pressure prevents cardiovascular

More information

Management of Lipid Disorders and Hypertension: Implications of the New Guidelines

Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Management of Lipid Disorders and Hypertension Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine

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

ALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic

ALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic 1 U.S. Department of Health and Human Services National Institutes of Health Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker

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

1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria

1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria 1. Albuminuria an early sign of glomerular damage and renal disease albuminuria Cardio-renal continuum REGRESS Target organ damage Asymptomatic CKD New risk factors Atherosclerosis Target organ damage

More information

The New Hypertension Guidelines

The New Hypertension Guidelines The New Hypertension Guidelines Joseph Saseen, PharmD Professor and Vice Chair, Department of Clinical Pharmacy University of Colorado Anschutz Medical Campus Disclosure Joseph Saseen reports no conflicts

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

Hypertension Update Background

Hypertension Update Background Hypertension Update Background Overview Aaron J. Friedberg, MD Assistant Professor, Clinical Division of General Internal Medicine The Ohio State University Wexner Medical Center Management Guideline Comparison

More information

Ezetimibe Reduces Urinary Albumin Excretion in Hypercholesterolaemic Type 2 Diabetes Patients with Microalbuminuria

Ezetimibe Reduces Urinary Albumin Excretion in Hypercholesterolaemic Type 2 Diabetes Patients with Microalbuminuria The Journal of International Medical Research 2012; 40: 798 803 Ezetimibe Reduces Urinary Albumin Excretion in Hypercholesterolaemic Type 2 Diabetes Patients with Microalbuminuria T NAKAMURA 1, E SATO

More information

Supplementary Table 1. Criteria for selection of normal control individuals among healthy volunteers

Supplementary Table 1. Criteria for selection of normal control individuals among healthy volunteers Supplementary Table 1. Criteria for selection of normal control individuals among healthy volunteers Medical parameters Cut-off values BMI (kg/m 2 ) 25.0 Waist (cm) (Men and Women) (Men) 85, (Women) 90

More information

Renal Protection Staying on Target

Renal Protection Staying on Target Update Staying on Target James Barton, MD, FRCPC As presented at the University of Saskatchewan's Management of Diabetes & Its Complications (May 2004) Gwen s case Gwen, 49, asks you to take on her primary

More information

Clinical Study Synopsis

Clinical Study Synopsis Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace

More information

Update on Current Trends in Hypertension Management

Update on Current Trends in Hypertension Management Friday General Session Update on Current Trends in Hypertension Management Shawna Nesbitt, MD Associate Dean, Minority Student Affairs Associate Professor, Department of Internal Medicine Office of Student

More information

New Treatment Options for Diabetic Nephropathy patients. Prof. M. Burnier, Service of Nephrology and Hypertension CHUV, Lausanne, Switzerland

New Treatment Options for Diabetic Nephropathy patients. Prof. M. Burnier, Service of Nephrology and Hypertension CHUV, Lausanne, Switzerland New Treatment Options for Diabetic Nephropathy patients Prof. M. Burnier, Service of Nephrology and Hypertension CHUV, Lausanne, Switzerland Diabetes and nephropathy Diabetic nephropathy is the most common

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

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

What s In the New Hypertension Guidelines?

What s In the New Hypertension Guidelines? American College of Physicians Ohio/Air Force Chapters 2018 Scientific Meeting Columbus, OH October 5, 2018 What s In the New Hypertension Guidelines? Max C. Reif, MD, FACP Objectives: At the end of the

More information

Hypertension Update 2009

Hypertension Update 2009 Hypertension Update 2009 New Drugs, New Goals, New Approaches, New Lessons from Clinical Trials Timothy C Fagan, MD, FACP Professor Emeritus University of Arizona New Drugs Direct Renin Inhibitors Endothelin

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

Metabolic Syndrome and Chronic Kidney Disease

Metabolic Syndrome and Chronic Kidney Disease Metabolic Syndrome and Chronic Kidney Disease Definition of Metabolic Syndrome National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Abdominal obesity, defined as a waist circumference

More information

Clinical Trial Synopsis TL-OPI-525, NCT#

Clinical Trial Synopsis TL-OPI-525, NCT# Clinical Trial Synopsis, NCT#00762736 Title of Study: A Phase II, Double-Blind, Randomized, Placebo-Controlled, Proof-of-Concept Study of the Efficacy, Safety, and Tolerability of Pioglitazone HCl (ACTOS

More information

Hypertension Update. Aaron J. Friedberg, MD

Hypertension Update. Aaron J. Friedberg, MD Hypertension Update Aaron J. Friedberg, MD Assistant Professor, Clinical Division of General Internal Medicine The Ohio State University Wexner Medical Center Background Diagnosis Management Overview Guideline

More information

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures

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

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 s Policy on Transparency and Publication of Clinical Study Data. The synopsis which is part of the

More information