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

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

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

Transcription

1 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 Web:

2 Disclosures I have no conflicts of interest for this talk Travel and accommodation provided by Les Laboratories Servier

3 Global Variations in Mortality among Patients with Heart Failure The INTER-CHF Study Clinical Variables Overall N=5823 Africa N=1294 India N=858 SE Asia N=811 M. East N=1000 China N=991 S Amer. N=869 Age (years, SD) 59 (15) 53 (14) 56 (15) 57 (14) 56 (16) 66 (16) 67 (15) Male Sex (%) Reduced LVEF + (<40%) (%) Valve disease + (%) NYHA class III/IV (%) HF cause: Ischemic heart disease (%) Hypertensive heart disease (%) Dilated cardiomyopathy (%) Valvular heart disease (%) INTER-CHF Investigators, HFA Congress 2017

4 Unadjusted mortality rates within one year, by region and cause Death rate at 1 year (%) Cardiac death Non-Cardiac Death Unknown Cause of Death Region INTER-CHF Investigators, HFA Congress 2017

5 Lowering systolic blood pressure reduces mortality SPRINT study (2015) 1 Targeting systolic BP <120 mm Hg vs <140 mm Hg in older patients further improves CV outcomes 1. SPRINT Research Group. N Engl J Med. 2015;373:

6 NICE guidelines recommendations for the management of arterial hypertension A: Renin Angiotensin System Antagonist, C: Calcium Channel Blocker; D: Diuretic 1. NICE guidelines. Hypertension: Clinical management of primary hypertension in adults [CG127]. Published August Accessed September 28,

7 Indapamide is more potent than HCTZ at reducing systolic blood pressure Roush meta-analysis (2015) 1 Indapamide is significantly more potent than HCTZ at reducing systolic blood pressure, which is not the case with chlorthalidone Systematic review and metaanalysis; head-to-head RCTs comparing HCTZ vs indapamide (10 RCTS, n=813) and HCTZ vs chlorthalidone (3 RCTS, n=70). 1. Roush et al. Hypertension. 2015;65:

8 Unlike all other diuretics, Indapamide is metabolically neutral Indapamide SR preserves lipid and glucose metabolism in the short and long term 1 1. Ambrosioni E et al. J Hypertens. 1998;16:

9 Indapamide reduces left ventricular hypertrophy Indapamide SR significantly reduces left ventricular hypertrophy LIVE study (2000) 1 1. Gosse P et al. J Hypertens. 2000;18:

10 Thiazide-like diuretics are better than thiazide-type diuretics in reducing stroke Chen meta-analysis (2007) 1 Stroke reduction with thiazide diuretics is mainly driven by thiazide-like diuretics and not thiazidetype diuretics 1. Chen P et al. Am J Hypertension. 2015;28:

11 Thiazide-like diuretics have strong evidence of cardiac protection Olde Engberink meta-analysis (2015) 1 1. Olde Engberink RH et al. Hypertension. 2015;65:

12 Indapamide provides effective protection on mortality, stroke and heart failure Protection against stroke with indapamide Indapamide reduces the risk of heart failure Indapamide based treatment reduces the risk of death from cardiovascular causes HYVET study (2008) 1 1. Beckett N et al. N Engl J Med. 2008;358:

13 NICE guidelines recommendations for the management of arterial hypertension A: Renin Angiotensin System Antagonist, C: Calcium Channel Blocker; D: Diuretic 1. NICE guidelines. Hypertension: Clinical management of primary hypertension in adults [CG127]. Published August Accessed September 28,

14 CCBs are still one of the best classes for reducing strokes Mukete meta-analysis (2015) 1 Risk ratios for stroke comparing treatment with calcium channel blockers versus other antihypertensive agents(ace) inhibitors 1. Mukete B et al. Am J Cardiovasc Drugs. 2015;15:

15 Amlodipine provides effective protection against stroke Wang meta-analysis (2007) 1 Protection against stroke with amlodipine vs placebo, angiotensin receptor blockers (ARBs), or angiotensin- converting enzyme (ACE) inhibitors Effects of antihypertensive treatment on stroke in trials comparing amlodipine with placebo or other classes of antihypertensive drugs, including angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors. 1. Wang et al. Hypertension. 2007;50:

16 Amlodipine effectively reduces myocardial infarction Wang study (2007) 1 Effects of antihypertensive treatment on myocardial infarction in trials comparing amlodipine with placebo or other classes of antihypertensive drugs, including angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors 1. Wang JG et al. Hypertension. 2007;50:

17 Amlodipine reduces mortality Kaplan-Meier curves for time to first primary composite end point in ACCOMPLISH ACCOMPLISH study (2008) 1 1. Jamerson K et al. N Engl J Med. 2008;359:

18 CCB/thiazide-like diuretic combinations are more effective at reducing stroke than other combinations Rimoldi meta-analysis (2015) 1 Risk ratios for stroke comparing treatment with combination CCB/thiazide-like diuretic vs other combinations CCB, calcium channel blocker; CI, confidence interval, Diu, diuretic; RR, risk ratio. 1. Rimoldi SF et al. J Clin Hypertens (Greenwich). 2015;17:

19 JNC8 guidelines for the treatment of arterial hypertension JNC8 guidelines recommend a CCB or a diuretic, alone or in combination for patients over James PA et al. JAMA. 2014;311(5):

20 South African hypertension practice guideline 2014 In black hypertensive patients a diuretic and/or a CCB is recommended. [ ] Compared to whites, blacks respond poorly to ACEI and β-blockers as monotherapy 20

21 Two complementary modes of action Two complementary effects: renal and vascular Waeber B et al. Expert Opin Pharmacother. 2012;13: Leenen FH et al. Curr Med Res Opin. 1983;8 (suppl 3): Hamet P et al. J Hypertens.32(e-suppl 1):e269-e Cappuccio FP et al. J Hum Hypertens. 1991;5:

22 Two of the most effective drugs at lowering systolic blood pressure Indapamide SR and amlodipine effectively reduce systolic BP. Baguet meta-analysis (2007) 1 1. Baguet et al. Clin Drug Invest. 2007;27:

23 Two drugs providing full 24-hour BP control and reduce BP variability Trough-to-peak ratio for different antihypertensive drugs. 1-7 Comparisons of 24-hour systolic blood pressure variability 1. Lacourciere Y et al. Am J Hypertens. 1995;8: Oparil MD et al. Clin Ther. 2010;32: Staessen JA et et al. Hypertension. 1995;26: Yusoff K et al. Int J Clin Pract. 1999;53: Zannad F et al. J Hypertens. 1999;17: Hermida RC et al. Hypertension. 2003;42: Mallion JM et al. Arch Mal Coeur. 1996;89;

24 Amlodipine/Indapamide (Natrixam) further reduces Systolic blood pressure versus placebo EFFICIENT study (2014) 1 Efficient and rapid blood pressure (BP) decrease (global population). Blood pressure (BP) lowering efficacy of Natrixam in grade 3 hypertensive patients. BP, blood pressure. 1. Jadhav U et al. PLoS One. 2014;9:e

25 Amlodipine/indapamide (Natrixam) further reduces systolic blood pressure versus ARB/CCB combination 006 study (2016) 1 Reduction in office SBP at week 12 in 216 patients with sustained hypertension (baseline ambulatory blood pressure monitoring >130/80 mm Hg 1. Dominiczak A, Asmar R et al. Abstract ESH

26 Amlodipine/Indapamide (Natrixam) further reduces systolic blood pressure versus ACEI/CCB combination Long-term efficacy of indapamide SR + amlodipine 10 mg vs enalapril + amlodipine 10 mg >130/80 mm Hg NESTOR CCB sub-study (2015) 1 BP, blood pressure. 1. Hanon O et al. Am J Hypertens. 2015;28:

27 Safety profile of Amlodipine/Indapamide (Natrixam) NESTOR CCB over 65 years old substudy (2016) 1 Superiority of indapamide + amlodipine over enalapril + amlodipine in reducing edema 1. Hanon O et al. Am J Hypertens. 2015;28:

28 Compensatory mechanisms of action of CCBs, diuretics and RAAS-blockers on vascular and renal function, sympathetic and Renin-Angiotensin-Aldosterone activity Natriuresis Vasodilation CCB Diuretic RAAS-blocker RAAS SNS RAAS SNS Adapted from Sever P S et al. European Heart Journal 2011

29 The PIANIST Study: antihypertensive effect of the triple combination Perindopril/Indapamide/Amlodipine Tòth K, on behalf of PIANIST Investigators. Am J Cardiovasc Drugs. 2014

30 The PIANIST Study: antihypertensive effect of the triple combination Perindopril/Indapamide/Amlodipine ABPM Tòth K, on behalf of PIANIST Investigators. Am J Cardiovasc Drugs. 2014

31 PIANIST Study: side effects Ankle edema 0.2% Hypotension 0.1% Cough 0.08% Dizziness 0.08% Tòth K, on behalf of PIANIST Investigators. Am J Cardiovasc Drugs. 2014

32 Conclusion Arterial hypertension is one of the major noncommunicable causes of mortality and morbidity in sub-saharian Africa The therapeutic approach of arterial hypertension in patients of sub-saharian origin should include a diuretic and a calcium-channel blocker either alone or in association Amlodipine/indapamide (Natrixam) is effective and safe in all hypertensive patients and should represent the treatment of choice for sub-saharian patients with arterial hypertension 32

33 33

34 Systolic blood pressure is the best predictor of stroke risk in hypertensive patients Stroke mortality rate in each decade of age vs. usual systolic blood pressure at the start of the decade Rahimi K et al. Circ Res. 2015;116:

35 Systolic blood pressure is the most difficult BP parameter to control Mean BP results for treated patients 1 Clinic blood pressure levels in hypertensive patients included in observational studies or clinical surveys on hypertension between 2005 and 2011 in Italy. Histograms represent average systolic BP and diastolic BP levels in each study included in the analysis. Data are expressed as mean standard deviation. 1. Tocci G et al. J Hypertens. 2012;30:

36 Indapamide is metabolically neutral Frequency of hypokalemia with indapamide SR in the 6th week of treatment 1 1. Ambrosioni E et al. J Hypertens. 1998;16:

37 Indapamide provides effective renal protection Madkour study (1996) 1 Effects of long-term therapy with indapamide SR or hydrochlorothiazide on creatinine clearance in patients with impaired renal function and hypertension 1. Madkour et al. Am J Cardiol. 1996;77:23B-25B. 39

38 Amlodipine effectively reduces myocardial infarction End points (first occurrence in each category). VALUE trial (2004) 1 1. Julius S et al. Lancet. 2004;363:

39 Two drugs providing full 24-hour blood pressure control Trough-to-peak ratio: high for both indapamide SR and amlodipine 43

40 Natrixam further reduces systolic blood pressure in older patients NESTOR CCB over 65 years old substudy (2016) 1 Reduction in systolic blood pressure from baseline to 52 weeks in patients aged 65 years 1. Hanon O. NESTOR CCB over 65. Accepted Abstract. 26e Journées Européenes de la Société Française de Cardiologie (JESFC)

41 Natrixam is recommended for older hypertensive patients ESH/ESC guidelines suggest a CCB or a diuretic may be particularly useful for elderly patients 1 1. Mancia G et al. Eur Heart J. 2013;34:

42 Hypertension is the biggest contributor to the global burden of disease and mortality Deaths attributable to individual risk factors 1 1. Ezzati M, Riboli E. N Engl J Med. 2013;369:

43 Amlodipine effectively reduces myocardial infarction Wang study (2007) 1 Protection against myocardial infarction with amlodipine vs placebo, angiotensin receptor blockers (ARBs), or angiotensinconverting enzyme (ACE) inhibitors 1. Wang JG et al. Hypertension. 2007;50:

44 Amlodipine effectively reduces myocardial infarction VALUE trial (2004) 1 Reduction in myocardial infarction with an amlodipine-based regimen vs a valsartan-based regimen CI, confidence interval, HR, hazard ratio. 1. Julius S et al. Lancet. 2004;363:

45 Natrixam further reduces systolic blood pressure versus placebo Systolic blood pressure (BP) decrease for 10 mm Hg decrease of diastolic BP 1 BP, blood pressure. 1. Jadhav U et al. PLoS One. 2014;9:e92955.

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

Hypertension Update Clinical Controversies Regarding Age and Race

Hypertension Update Clinical Controversies Regarding Age and Race Hypertension Update Clinical Controversies Regarding Age and Race Allison Helmer, PharmD, BCACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 22, 2017 DISCLOSURE/CONFLICT

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

Valsartan Amlodipine HCT Combination: Control To Goal. Dr. Sameh Shaheen M.B.B.Ch, MSc, MD, FESC, FSCAI. Prof of cardiology Ain Shams University

Valsartan Amlodipine HCT Combination: Control To Goal. Dr. Sameh Shaheen M.B.B.Ch, MSc, MD, FESC, FSCAI. Prof of cardiology Ain Shams University Valsartan Amlodipine HCT Combination: Control To Goal Dr. Sameh Shaheen M.B.B.Ch, MSc, MD, FESC, FSCAI Prof of cardiology Ain Shams University Sonesta Hotel Cairo Egypt December 4 th 5 th ; 213 Hypertension

More information

2/10/2014. Hypertension: Highlights of Hypertension Guidelines: Making the Most of Limited Evidence. Issues with contemporary guidelines

2/10/2014. Hypertension: Highlights of Hypertension Guidelines: Making the Most of Limited Evidence. Issues with contemporary guidelines Hypertension: 214 Highlights of Hypertension Guidelines: Making the Most of Limited Evidence Michael A, Weber, MD Editor-in-Chief, The Journal of Clinical Hypertension, Professor of Medicine, Division

More information

Objectives. Describe results and implications of recent landmark hypertension trials

Objectives. Describe results and implications of recent landmark hypertension trials Hypertension Update Daniel Schwartz, MD Assistant Professor of Medicine Associate Medical Director of Heart Transplantation Temple University School of Medicine Disclosures I currently have no relationships

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

Hypertension Pharmacotherapy: A Practical Approach

Hypertension Pharmacotherapy: A Practical Approach Hypertension Pharmacotherapy: A Practical Approach Ronald Victor, MD Burns & Allen Chair in Cardiology Director, The Hypertension Center Associate Director, The Heart Institute Hypertension Center 1. 2.

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

Explore the Rationale for the Dual Mechanism CCB/ARB Approach in Hypertension Management

Explore the Rationale for the Dual Mechanism CCB/ARB Approach in Hypertension Management Explore the Rationale for the Dual Mechanism CCB/ARB Approach in Hypertension Management Jeong Bae Park, MD,PhD Dept of Med/Cardiology, Cheil General Hospital, Kwandong University College of Medicine Apr

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

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 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

Prevention of Heart Failure: What s New with Hypertension

Prevention of Heart Failure: What s New with Hypertension Prevention of Heart Failure: What s New with Hypertension Ali AlMasood Prince Sultan Cardiac Center Riyadh 3ed Saudi Heart Failure conference, Jeddah, 13 December 2014 Background 20-30% of Saudi adults

More information

Hypertension Management Controversies in the Elderly Patient

Hypertension Management Controversies in the Elderly Patient Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No

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

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

HYPERTENSION IN THE ELDERLY A BALANCED APPROACH. Barry Goldlist October 31, 2014

HYPERTENSION IN THE ELDERLY A BALANCED APPROACH. Barry Goldlist October 31, 2014 HYPERTENSION IN THE ELDERLY A BALANCED APPROACH Barry Goldlist October 31, 2014 DISCLOSURE I have not accepted any money for myself from any pharmaceutical company in the 21 st century I have accepted

More information

Treating Hypertension in Individuals with Diabetes

Treating Hypertension in Individuals with Diabetes Treating Hypertension in Individuals with Diabetes 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

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

Update on pharmacological treatment of heart failure. Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy

Update on pharmacological treatment of heart failure. Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Update on pharmacological treatment of heart failure Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Presenter Disclosures Dr. Maggioni : Serving in Committees of studies sponsored

More information

Metoprolol Succinate SelokenZOC

Metoprolol Succinate SelokenZOC Metoprolol Succinate SelokenZOC Blood Pressure Control and Far Beyond Mohamed Abdel Ghany World Health Organization - Noncommunicable Diseases (NCD) Country Profiles, 2014. 1 Death Rates From Ischemic

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

The Road to Renin System Optimization: Renin Inhibitor

The Road to Renin System Optimization: Renin Inhibitor The Road to Renin System Optimization: Renin Inhibitor A New Perspective on the Renin-Angiotensin System (RAS) Yong-Jin Kim, MD Seoul National University Hospital Human and Economic Costs of Hypertension

More information

Amlodipine/Valsartan (Exforge ) Changing the Landscape of BP Management

Amlodipine/Valsartan (Exforge ) Changing the Landscape of BP Management Amlodipine/Valsartan (Exforge ) Changing the Landscape of BP Management Bum-Kee Hong Yongdong Severance Hospital Yonsei University College of Medicine Rationale for Multiple-Mechanism Therapy Inadequacy

More information

Drugs acting on the reninangiotensin-aldosterone

Drugs acting on the reninangiotensin-aldosterone Drugs acting on the reninangiotensin-aldosterone system John McMurray Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham and Women s Hospital, Boston & Visiting Professor, Harvard Medical School

More information

Hypertension Management Focus on new RAAS blocker. Disclosure

Hypertension Management Focus on new RAAS blocker. Disclosure Hypertension Management Focus on new RAAS blocker Rameshkumar Raman M.D Endocrine Associates of The Quad Cities Disclosure Speaker bureau Abbott, Eli Lilly, Novo Nordisk, Novartis, Takeda, Merck, Solvay

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

Hypertension Update. Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016

Hypertension Update. Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016 Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016 Hypertension Update Vincent J. Canzanello, M.D. Consultant, Division of Nephrology and Hypertension Professor or Medicine College

More information

Combination of renin-angiotensinaldosterone. how to choose?

Combination of renin-angiotensinaldosterone. how to choose? Combination of renin-angiotensinaldosterone system inhibitors how to choose? Karl Swedberg Professor of Medicine Sahlgrenska Academy University of Gothenburg karl.swedberg@gu.se Disclosures Research grants

More information

SPRINT trial: quoi de neuf en hypertension? Approche pratique du patient cardiaque en médecine. générale

SPRINT trial: quoi de neuf en hypertension? Approche pratique du patient cardiaque en médecine. générale SPRINT trial: quoi de neuf en hypertension? Approche pratique du patient cardiaque en médecine 17 ème édition du Congrès de la Ligue Cardiologique Belge 21 mai 2016 générale Philippe van de Borne Service

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

COMPLEX HYPERTENSION. Anita Ralstin, FNP-BC Next Step Health Consultant, LLC

COMPLEX HYPERTENSION. Anita Ralstin, FNP-BC Next Step Health Consultant, LLC COMPLEX HYPERTENSION Anita Ralstin, FNP-BC Next Step Health Consultant, LLC Incidence Of Hypertension About 70 million American adults have high blood pressure. About 33% of the population Only 52% have

More information

LCZ696 A First-in-Class Angiotensin Receptor Neprilysin Inhibitor

LCZ696 A First-in-Class Angiotensin Receptor Neprilysin Inhibitor The Angiotensin Receptor Neprilysin Inhibitor LCZ696 in Heart Failure with Preserved Ejection Fraction The Prospective comparison of ARNI with ARB on Management Of heart failure with preserved ejection

More information

Disclosures. Hypertension: Nationwide Dilemma. Learning Objectives. What s Currently Recommended? Specific Concerns 3/9/2012

Disclosures. Hypertension: Nationwide Dilemma. Learning Objectives. What s Currently Recommended? Specific Concerns 3/9/2012 How Should We ACCOMPLISH Good Blood Pressure Control In Our VETS? Disclosures No conflicts of interest to disclose Updates in the Management of HypertensionIn the Elderly Antoine T. Jenkins, Pharm.D.,

More information

Hypertension Controversies: SPRINTing to New Goals

Hypertension Controversies: SPRINTing to New Goals Hypertension Controversies: SPRINTing to New Goals Diana Isaacs, PharmD, BCPS, BC-ADM, CDE Clinical Pharmacy Specialist Cleveland Clinic Lauren Wolfe, PharmD Primary Care Clinical Specialist Cleveland

More information

Managing HTN in the Elderly: How Low to Go

Managing HTN in the Elderly: How Low to Go Managing HTN in the Elderly: How Low to Go Laxmi S. Mehta, MD, FACC The Ohio State University Medical Center Assistant Professor of Clinical Internal Medicine Clinical Director of the Women s Cardiovascular

More information

Blood Pressure Monitoring in Chronic Kidney Disease

Blood Pressure Monitoring in Chronic Kidney Disease Blood Pressure Monitoring in Chronic Kidney Disease Aldo J. Peixoto, MD FASN FASH Associate Professor of Medicine (Nephrology), YSM Associate Chief of Medicine, VACT Director of Hypertension, VACT American

More information

CADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION

CADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION CADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION PERINDOPRIL ARGININE/AMLODIPINE (Viacoram Servier Canada Inc.) Indication: Mild to Moderate Essential Hypertension Recommendation: The Canadian

More information

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Dipak Kotecha, MD PhD on behalf of the Selection of slides presented at the European

More information

Talking about blood pressure

Talking about blood pressure Talking about blood pressure Mrs Khan 56 BP 158/99 BMI 32 Total cholesterol 5.4 (HDL 0.8) HbA1c 43 She has been promising to do more exercise and eat more healthily for the last 2 years but her weight

More information

Pre-ALLHAT Drug Use. Diuretics. ß-Blockers. ACE Inhibitors. CCBs. Year. % of Treated Patients on Medication. CCBs. Beta Blockers.

Pre-ALLHAT Drug Use. Diuretics. ß-Blockers. ACE Inhibitors. CCBs. Year. % of Treated Patients on Medication. CCBs. Beta Blockers. Pre- Drug Use % of Treated Patients on Medication 60 50 40 30 20 10 0 1978 Diuretics ß-Blockers ACE Inhibitors Year CCBs CCBs Beta Blockers Diuretics ACE Inhibitors 1980 1982 1984 1986 1988 1990 1992 IMS

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

JNC-8. (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines

JNC-8. (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines JNC-8 (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines Derrick Sorweide, DO Assistant Professor of Family Medicine,

More information

RAS Blockade Across the CV Continuum

RAS Blockade Across the CV Continuum A Summary of Recent International Meetings RAS Blockade Across the CV Continuum Copyright New Evidence Presented at the 2009 Congress of the European Society of Cardiology (August 29-September 2, Barcelona)

More information

Antihypertensive Combinations

Antihypertensive Combinations This Professional Resource gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER October 2016 ~ Resource #321047 Antihypertensive Combinations

More information

Management of Hypertension in special groups. DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University

Management of Hypertension in special groups. DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University Management of Hypertension in special groups BY DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University AGENDA SPECIAL GROUPS SPECIFIC DRUDS FOR SPECIAL GROUPS TARGET BP FOR SPECIAL GROUPS:

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

THE SOUTHERN AFRICAN HYPERTENSION GUIDELINE. Brian Rayner, Division of Hypertension, University of Cape Town

THE SOUTHERN AFRICAN HYPERTENSION GUIDELINE. Brian Rayner, Division of Hypertension, University of Cape Town THE SOUTHERN AFRICAN HYPERTENSION GUIDELINE Brian Rayner, Division of Hypertension, University of Cape Town Scope of Problem Deaths attributable to high blood pressure in males, South Africa 2000 7000

More information

Hypertension Guidelines Michael A. Weber, MD Division of Cardiovascular Medicine State University of New York Downstate Medical Center

Hypertension Guidelines Michael A. Weber, MD Division of Cardiovascular Medicine State University of New York Downstate Medical Center Hypertension Guidelines 2016 Michael A. Weber, MD Division of Cardiovascular Medicine State University of New York Downstate Medical Center Speaker Disclosures I disclose that I am a Consultant for: Ablative

More information

Hypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD?

Hypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD? Hypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD? Suzanne Oparil, MD Distinguished Professor of Medicine, Professor of Cell, Developmental and Integrative Biology Director, Vascular

More information

Management of chronic heart failure: pharmacology. Giuseppe M.C. Rosano, MD, PhD, FHFA

Management of chronic heart failure: pharmacology. Giuseppe M.C. Rosano, MD, PhD, FHFA Management of chronic heart failure: pharmacology. Giuseppe M.C. Rosano, MD, PhD, FHFA Declaration of potential conflict of interests Type of job or financial support Salary Ordinary funds Position in

More information

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

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

Causes of Poor BP control Rates

Causes of Poor BP control Rates Goals Of Hypertension Management in Clinical Practice World Hypertension League (WHL) Meeting Adel E. Berbari, MD, FAHA, FACP Professor of Medicine and Physiology Head, Division of Hypertension and Vascular

More information

Challenges in Hypertension: Incorporating Evolving Clinical Data Into Practice

Challenges in Hypertension: Incorporating Evolving Clinical Data Into Practice Challenges in Hypertension: Incorporating Evolving Clinical Data Into Practice Faculty Jan Basile, MD Professor of Medicine Seinsheimer Cardiovascular Health Program Division of General Internal Medicine

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

Lowering blood pressure in 2003

Lowering blood pressure in 2003 UPDATE CLINICAL UPDATE Lowering blood pressure in 2003 John P Chalmers and Leonard F Arnolda Institute for International Health, University of Sydney, Sydney, NSW. John P Chalmers, MD, FRACP, Professor

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

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

LXIV: DRUGS: 4. RAS BLOCKADE

LXIV: DRUGS: 4. RAS BLOCKADE LXIV: DRUGS: 4. RAS BLOCKADE ACE Inhibitors Components of RAS Actions of Angiotensin i II Indications for ACEIs Contraindications RAS blockade in hypertension RAS blockade in CAD RAS blockade in HF Limitations

More information

Chapter 10 Worksheet Blood Pressure and Antithrombotic Agents

Chapter 10 Worksheet Blood Pressure and Antithrombotic Agents Complete the following. 1. A layer of cells lines each vessel in the vascular system. This layer is a passive barrier that keeps cells and proteins from going into tissues; it also contains substances

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

Saudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière

Saudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière Prevention of Cardiovascular events with Ivabradine: The SHIFT Study Saudi Arabia February 2011 Pr Michel KOMAJDA Université Pierre et Marie Curie Hospital Pitié Salpétrière Paris FRANCE Declaration Of

More information

Are Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Especially Useful for Cardiovascular Protection?

Are Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Especially Useful for Cardiovascular Protection? EVIDENCE-BASED CLINICAL MEDICINE Are Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Especially Useful for Cardiovascular Protection? Hean Teik Ong, FRCP, FACC, FESC Purpose:

More information

Chapter 10. Learning Objectives. Learning Objectives 9/11/2012. Congestive Heart Failure

Chapter 10. Learning Objectives. Learning Objectives 9/11/2012. Congestive Heart Failure Chapter 10 Congestive Heart Failure Learning Objectives Explain concept of polypharmacy in treatment of congestive heart failure Explain function of diuretics Learning Objectives Discuss drugs used for

More information

Patient persistence with antihypertensive drugs in France, Germany and the UK

Patient persistence with antihypertensive drugs in France, Germany and the UK Patient persistence with antihypertensive drugs in France, Germany and the UK B. Ehlken (1), K. Kostev (1), A. Sandberg (2), B. Holz (1), A. M. S. Oberdiek (2) (1) IMS Health Frankfurt / Munich, Germany

More information

Short-term antihypertensive efficacy of perindopril according to clinical profile of 3,188 patients: A meta-analysis

Short-term antihypertensive efficacy of perindopril according to clinical profile of 3,188 patients: A meta-analysis ORIGINAL ARTICLE Cardiology Journal 2010, Vol. 17, No. X, pp. 1 XX Copyright 2010 Via Medica ISSN 1897 5593 Short-term antihypertensive efficacy of perindopril according to clinical profile of 3,188 patients:

More information

Hypertension Management in Diabetic Patients

Hypertension Management in Diabetic Patients Hypertension Management in Diabetic Patients Park, Chang G, MD, PhD Cardiovascular Center, Guro Hospital, Korea University Medical School Contents (Treatment of 2 Cases) Type 2 Diabetes Mellitus Hypertension

More information

Byvalson. (nebivolol, valsartan) New Product Slideshow

Byvalson. (nebivolol, valsartan) New Product Slideshow Byvalson (nebivolol, valsartan) New Product Slideshow Introduction Brand name: Byvalson Generic name: Nebivolol, valsartan Pharmacological class: Beta-blocker + angiotensin II receptor blocker (ARB) Strength

More information

The Journal of International Medical Research 2005; 33:

The Journal of International Medical Research 2005; 33: The Journal of International Medical Research 2005; 33: 620 631 Ambulatory Blood Pressure Comparison of the Anti-hypertensive Efficacy of Fixed Combinations of Irbesartan/hydrochlorothiazide and Losartan/hydrochlorothiazide

More information

Heart Failure. Dr. William Vosik. January, 2012

Heart Failure. Dr. William Vosik. January, 2012 Heart Failure Dr. William Vosik January, 2012 Questions for clinicians to ask Is this heart failure? What is the underlying cause? What are the associated disease processes? Which evidence-based treatment

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

Ejection Fraction in Patients With Chronic Heart Failure. Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction

Ejection Fraction in Patients With Chronic Heart Failure. Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction Keith Miller MD Diastolic Heart Failure Risk Factors Common Risk Factors Aging Female gender Obesity Hypertension Diabetes mellitus

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

Hypertension and the JNC-8 guidelines

Hypertension and the JNC-8 guidelines What goes up must come down: Hypertension and the JNC-8 guidelines What you need to know about the new treatment guidelines By Terri Townsend, MA, RN, CCRN-CMC, CVRN-BC, and Pamela Anderson, MS, RN, ANP-BC,

More information

Disclosure Statement. Heart Failure: Refreshers and Updates. Objectives. CHF: Chronic Heart Failure. Definitions. Definitions 2/19/2018

Disclosure Statement. Heart Failure: Refreshers and Updates. Objectives. CHF: Chronic Heart Failure. Definitions. Definitions 2/19/2018 Disclosure Statement Heart Failure: Refreshers and Updates Tracy K. Pettinger, PharmD Clinical Associate Professor College of Pharmacy The planners and presenter of this presentation have disclosed no

More information

Objectives. JNC 7 Is Nice But What s Up With JNC 8? Why Do We Care? Hypertension Background: Prevalence

Objectives. JNC 7 Is Nice But What s Up With JNC 8? Why Do We Care? Hypertension Background: Prevalence JNC 7 Is Nice But What s Up With JNC 8? 37 th Annual CAPA Conference October 4 th 2013 Ignacio de Artola, Jr. M.D. Assistant Professor of Clinical Family Medicine Medical Director, Primary Care Physician

More information

Creative blood pressure management: whys and the tricks

Creative blood pressure management: whys and the tricks Creative blood pressure management: whys and the tricks Cynthia D. Caraballo-Hunt, MD Kaiser/OHSU Family Medicine Faculty Beaverton Medical Office NW Permanente, Portland, OR Objectives 1. Describe current

More information

Val-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions in hs-crp

Val-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions in hs-crp Página 1 de 5 Return to Medscape coverage of: American Society of Hypertension 21st Annual Scientific Meeting and Exposition Val-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions

More information

Should beta blockers remain first-line drugs for hypertension?

Should beta blockers remain first-line drugs for hypertension? 1 de 6 03/11/2008 13:23 Should beta blockers remain first-line drugs for hypertension? Maros Elsik, Cardiologist, Department of Epidemiology and Preventive Medicine, Monash University and The Alfred Hospital,

More information

Best Therapy for Resistant Hypertension: The PATHWAY-2 2 Study

Best Therapy for Resistant Hypertension: The PATHWAY-2 2 Study Best Therapy for Resistant Hypertension: The PATHWAY-2 2 Study Antonio Coca MD, PhD, FRCP, FESC Council on Hypertension. European Society of Cardiology Hypertension and Vascular Risk Unit. Department of

More information

DISCLOSURES ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION NONE

DISCLOSURES ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION NONE ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION Lori M. Tam, MD Providence Heart Institute DISCLOSURES NONE 1 OUTLINE Systolic vs. Diastolic Heart Failure New

More information

Estrogens vs Testosterone for cardiovascular health and longevity

Estrogens vs Testosterone for cardiovascular health and longevity Estrogens vs Testosterone for cardiovascular health and longevity Panagiota Pietri, MD, PhD, FESC Director of Hypertension Unit Athens Medical Center Athens, Greece Women vs Men Is there a difference in

More information

How to Manage Resistant Hypertension Min Su Hyon, MD

How to Manage Resistant Hypertension Min Su Hyon, MD How to Manage Resistant Hypertension Min Su Hyon, MD Cardiovascular Medicine, Internal Medicine Soonchunhyang University College of Medicine Definition Resistant to conventional medical therapy Definition

More information

Preventing the cardiovascular complications of hypertension

Preventing the cardiovascular complications of hypertension European Heart Journal Supplements (2004) 6 (Supplement H), H37 H42 Preventing the cardiovascular complications of hypertension Peter Trenkwalder* Department of Internal Medicine, Starnberg Hospital, Ludwig

More information

A Comparative Study of the Management of Stage 2 hypertension by Combined therapy with Losartan, Amlodipine and Hydrochlorothiazide

A Comparative Study of the Management of Stage 2 hypertension by Combined therapy with Losartan, Amlodipine and Hydrochlorothiazide Int Cardiovasc Res J.2012;6(3):79-83. icrj:1726 A Comparative Study of the Management of Stage 2 hypertension by Combined therapy with Losartan, Amlodipine and Hydrochlorothiazide Reza Jafarzadeh Esfehani

More information

The importance of early antihypertensive efficacy: the role of angiotensin II receptor blocker therapy

The importance of early antihypertensive efficacy: the role of angiotensin II receptor blocker therapy (2006) 20, 169 175 & 2006 Nature Publishing Group All rights reserved 0950-9240/06 $30.00 www.nature.com/jhh REVIEW The importance of early antihypertensive efficacy: the role of angiotensin II receptor

More information

Isolated Systolic Hypertension in the elderly. Daniel Hayoz Clinique de Médecine Interne HFR-Hôpital Cantonal Fribourg

Isolated Systolic Hypertension in the elderly. Daniel Hayoz Clinique de Médecine Interne HFR-Hôpital Cantonal Fribourg Isolated Systolic Hypertension in the elderly Daniel Hayoz Clinique de Médecine Interne HFR-Hôpital Cantonal Fribourg Case no 1 Man aged 75, from Kosovo, in CH since 1.5 years Former smoker (45 PY) BP:

More information

New Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD

New Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD New Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD None Disclosures Objectives Understand trend in blood pressure clinical practice guidelines

More information

Recent Hypertension Guidelines

Recent Hypertension Guidelines Recent Hypertension Guidelines Lawrence J. Fine, MD, DrPH, FAHA Division of Cardiovascular Sciences NHLBI/NIH February 19, 2014 Disclosures: Member of Panel Appointed to the Eighth Joint National Committee

More information

Randomized Design of ALLHAT BP Trial

Randomized Design of ALLHAT BP Trial Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Lisinopril* *Wright JT, Dunn JK, Cutler JA et al. JAMA 2005:293:1595-1608. 42,418 High-risk hypertensive

More information

ANTI- HYPERTENSIVE AGENTS

ANTI- HYPERTENSIVE AGENTS CLINICAL ANTI- HYPERTENSIVE AGENTS Jacqueline van Schoor, MPharm, BSc (Hons) Amayeza Info Centre Hypertension represents a major public health concern. It affects about a billion people worldwide and is

More information

Beta-blockers: Now what? Annemarie Thompson, MD Assistant Professor of Anesthesia and Medicine Vanderbilt University Medical Center

Beta-blockers: Now what? Annemarie Thompson, MD Assistant Professor of Anesthesia and Medicine Vanderbilt University Medical Center Beta-blockers: Now what? Annemarie Thompson, MD Assistant Professor of Anesthesia and Medicine Vanderbilt University Medical Center Beta-blockers: What s known 30 Years 30 Careers Physician clarity regarding

More information

CANADIAN STROKE BEST PRACTICE RECOMMENDATIONS. Prevention of Stroke Evidence Tables Blood Pressure Management

CANADIAN STROKE BEST PRACTICE RECOMMENDATIONS. Prevention of Stroke Evidence Tables Blood Pressure Management CANADIAN STROKE BEST PRACTICE RECOMMENDATIONS Blood Pressure Management Wein T, Gladstone D (Writing Group Chairs) on Behalf of the PREVENTION of STROKE Writing Group 2017 Heart and Stroke Foundation September

More information

Blood Pressure Lowering in Type 2 Diabetes A Systematic Review and Meta-analysis

Blood Pressure Lowering in Type 2 Diabetes A Systematic Review and Meta-analysis Research Original Investigation A Systematic Review and Meta-analysis Connor A. Emdin, HBSc; Kazem Rahimi, DM, MSc; Bruce Neal, PhD; Thomas Callender, MBChB; Vlado Perkovic, PhD; Anushka Patel, PhD IMPORTANCE

More information

Combination therapy in the treatment of arterial hypertension. Franco Veglio SIIIA. UNIVERSITA degli STUDI di TORINO

Combination therapy in the treatment of arterial hypertension. Franco Veglio SIIIA. UNIVERSITA degli STUDI di TORINO SIIIA UNIVERSITA degli STUDI di TORINO FACOLTA DI MEDICINA E CHIRURGIA DIPARTIMENTO DI MEDICINA ED ONCOLOGIA SPERIMENTALE SCU MEDICINA INTERNA CENTRO IPERTENSIONE ARTERIOSA AOU S.GIOVANNI BATTISTA TORINO

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