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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five antihypertensive trials launched outside of the United States have been designed to address one of two vital issues. The first is whether or not there is an optimal level of blood pressure that clinicians should aim for to minimize the risk of cardiovascular disease. This has been addressed by the Swedish Behandla Blodtryck Battre (BBB) Trial and the international Hypertension Optimal Treatment (HOT) Study. The BBB Trial revealed interesting trends, but no definitive conclusions. The ongoing HOT Study will have to be completed before this particular issue can be adequately addressed. However, preliminary analysis of a subgroup study has revealed that the HOT treatment regimens are as effective in the elderly as in younger patients. The second important issue, which is the question of whether traditional antihypertensive agents are more effective than the newer agents in reducing cardiovascular risk, is the current focus of three ongoing studies. Investigators in the Captopril Prevention Project (CAPPP) are comparing captopril to beta-blocker and diuretic regimens. The purpose of the Nordic Diltiazem Study (NORDIL) is to determine if diltiazem is more effective than conventional therapy in reducing cardiovascular risk. The Swedish Trial in Old Patients with Hypertension-2 (STOP-Hypertension-2) has been designed to compare therapy with beta-blockers and diuretics to therapy with calcium antagonists and angiotension converting enzyme inhibitors. All ongoing trials should be completed in the next few years and are expected to yield valuable information that will improve current strategies for the treatment of hypertension.
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PMID:Major antihypertensive intervention trials conducted outside the United States. 886 36

A substudy of the Hypertension Optimal Treatment study, conducted in the Jackson Mississippi Center, set out to determine the link between obesity and hypertension and to determine the effects of weight loss in hypertensive individuals. An analysis of the relationship between body mass index and diastolic blood pressure for another study showed that increasing body mass indices were associated with increases in blood pressure. This indicates that not only is there a strong relationship between obesity and hypertension, but that there is also a close association between the continuous variables of body mass index and blood pressure. The purpose of the present study was to determine the effectiveness of a weight loss regimen in reducing the amount of medication required to achieve the target blood pressure in 228 patients at the Jackson center. Subjects were randomized to a dietary intervention group or to a control group. Preliminary 3 month observational data showed that subjects who lost the appropriate amount of weight were three times more likely to achieve their target blood pressure at 3 months. These observations suggest that weight reduction regimens can reduce elevated blood pressure and can probably promote further blood pressure reductions when combined with drug therapy in the treatment of hypertension.
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PMID:Body weight and blood pressure. Effects of weight reduction on hypertension. 886 37

The Hypertension Optimal Treatment study is a prospective, randomized, clinical trial designed to challenge the J curve phenomenon in hypertension. A subpopulation of 665 patients from seven participating centers in the United States were enrolled to evaluate the prevalence of left ventricular mass and its relationship to systolic and diastolic function, as assessed by Doppler echocardiography, and to clinical events during the length of the study. Echocardiographic measurements followed stringent criteria and were rechecked in a core laboratory for accuracy. Baseline data revealed left ventricular hypertrophy in 62% of the patients. Left ventricular hypertrophy was more prevalent in women than in men (72% v 57%, P < .0001). The hypertrophy was further characterized according to left ventricular geometry and found the concentric pattern as the predominant form of hypertrophy (46%). Indices of left ventricular systolic function, including fractional shortening, cardiac index, and ejection fraction, were normal or above-normal. Doppler interrogation of the mitral inflow demonstrated left ventricular diastolic dysfunction in 81% of patients. The constrictive physiology (inversion of the E/A ratio) was the most prevalent mitral flow pattern (79%). Regression of left ventricular hypertrophy, modification of mass index geometry, and alterations in mitral flow characteristics under optimal blood pressure control will be specifically compared with subsequent examinations.
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PMID:Left ventricular mass and function in primary hypertension. 886 38

In the past 20 years, clinicians have clearly demonstrated that antihypertensive therapy is very effective in reducing the incidence of myocardial infarction and stroke. However, little is known about the effects of blood pressure reduction on end stage renal disease (ESRD). Data from major clinical studies has clearly shown that patients with hypertension have an increased risk of developing ESRD. Black men and women with hypertension are at the greatest risk; however, the incidence of ESRD is increasing in all racial groups. Because patients with hypertensive ESRD often require dialysis, the cost of treating this increasing common disorder has the potential to deplete the Medicare system. The primary effect of blood pressure reduction in patients with ESRD has not been adequately addressed in any trial that has been completed to date. Results from some studies suggest that blood pressure reduction may improve renal function and that angiotensin converting enzyme inhibitors and calcium channel blockers may have renoprotective effects. Currently in progress are two large scale clinical trials that may provide more information on the effects on antihypertensive therapy on preventing ESRD in hypertensive patients. These are the African American Study of Kidney Disease and Hypertension (AASK), and a substudy of the Hypertension Optimal Treatment (HOT) Study. Data from the HOT study is expected to be available 5 years prior to that of the ASK Study, which is expected to be completed by the Year 2002.
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PMID:The effect of blood pressure reduction on end stage renal disease. 886 39

A total of 411 patients were recruited in the Israeli cohort of the Hypertension Optimal Treatment (HOT) Study, a multinational study conducted to assess the effect on cardiovascular morbidity and mortality in hypertensive patients of three levels of target diastolic blood pressure: < 90, < 85, and < 80 mm Hg. Initial treatment with felodipine in all patients was supplemented with other drugs as needed. When compared to the subjects in the rest of the world, the percentage of Israeli patients getting previous antihypertensive treatment was higher, reflecting a higher proportion of hospital-recruited patients. This accounted for the lower percentage of Israeli patients ending up with low-dose felodipine: 50% vs 56% in other countries. The percentage of patients getting high-dose felodipine plus additional drugs was also higher: 3.8% vs 2.9% for other countries. Felodipine was remarkably well tolerated, and most of the patients were able to continue this drug regimen.
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PMID:Hypertension optimal treatment: the Israeli HOT Study Group. Hypertension Optimal Treatment. 887 51

OPTIMAL BLOOD PRESSURE REDUCTION: The optimal blood pressure reduction when treating arterial hypertension is obviously the one which causes the maximum achievable prevention of hypertension-associated cardiovascular morbidity and mortality. This goal has not yet been reached by present approaches to antihypertensive treatment. Several large intervention trials in hypertension have shown that treated hypertensive patients still have an increased risk of cardiovascular morbidity and mortality in spite of receiving antihypertensive treatment. One possible explanation for this is that treated blood pressure is rarely, if ever, reduced to strictly normotensive levels. Another explanation, favored by proponents of the J-curve argument, is that excessive lowering of blood pressure may increase cardiovascular risks. DATA AVAILABLE FROM INTERVENTION TRIALS: So far, two prospective intervention trials have addressed this problem, the Swedish BBB (Treat Blood Pressure Better) study, for which results have been published, and the much larger Hypertension Optimal Treatment (HOT) study, which is still under way. Moreover, new epidemiological data from the Framingham Heart Study and the study of 50-year-old men in Gothenburg suggest that active intervention against arterial hypertension may change the pattern of blood pressure distribution in the population towards lower levels, also in untreated subjects, suggesting an additional and unexpected benefit from antihypertensive treatment.
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PMID:The optimal blood pressure reduction. 893 79

Epilepsy in elderly patients is a growing worldwide challenge; as the population ages, the prevalence of epilepsy increases. Management of epilepsy in elderly patients requires an understanding of their unique medical and pharmacologic characteristics. Accurate assessment of seizures, thorough neurologic assessment to define etiology, and evaluation of concomitant illnesses and living situations are necessary for comprehensive treatment planning and informed management. Expect elderly patients to present challenges to treatment that include concomitant diseases, obligatory polypharmacy with accompanying drug interactions, and age-related changes in renal and hepatic physiology that alter drug metabolism and elimination. Elderly patients have declining intellectual function, motor impairment, or altered special sensory function that make them susceptible to dose-related CNS side effects of antiepileptic drugs (AEDs). When AEDs are added to the medical regimen of an elderly patient, the physician must review all prescribed drugs. Drugs prescribed for concomitant illnesses such as behavioral problems, cardiovascular disease, hypertension, and infection may alter the distribution and metabolism of AEDs, with an impact on efficacy and occurrence of adverse effects. AEDs tend to induce metabolism of other drugs, leading to a decline in target response. Optimal care of elderly patients with epilepsy includes use of free levels to monitor AED concentrations, careful dose selection, and physician sensitivity to patients' social problems.
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PMID:Management of epilepsy in the elderly. 894 Oct 39

Recent publications purporting to show that calcium antagonists, when used for the treatment of hypertension or in the post myocardial infarction patient, would paradoxically increase the rate of heart attack and mortality have cast doubts on the safety and efficacy of this drug class. All three studies are retrospective, and have various drawbacks. Specifically, the metaanalysis of Furberg et al is fraught with mistakes, of borderline significance, and based on old data pertaining to short-acting nifedipine only (which should not be given in patients who have suffered an acute heart attack). The case control study of Psaty et al suggested that hypertensive patients who were treated with short-acting verapamil, diltiazem, and nifedipine had an excessive rate of myocardial infarction when compared with patients who were treated with diuretics. Two out of the three calcium antagonists that were used in this study were not approved for the treatment of hypertension by the US Food and Drug Administration. Some patients were taking these drugs only once a day whereas, because of their short duration of action, at least a three or four times daily regimen would be required to achieve an acceptable blood pressure control throughout a 24-h period. The cohort study of Pahor et al suggested distinct differences among various calcium antagonists with regard to survival. Blood pressure was controlled in < 40% of all patients, and in some patients blood pressure was never even measured. Recent studies, such as the Prospective Randomized Amlodipine Survival Evaluation (PRAISE), the third Vasodilator-Heart Failure Trial (VHeFT-III), the second Doppler Flow and Echocardiography in Functional Cardiac Insufficiency Assessment of Nisoldipine Therapy (DEFIANT II), the Angina Prognosis Study in Stockholm (APSIS), and the Shanghai Trial of Nifedipine in the Elderly (STONE), attest to the safety and efficacy of the newer long-acting calcium antagonists in patients with a wide spectrum of heart disease. Several ongoing trials including the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) with amlodipine, the International Nifedipine-GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT) with nifedipine, the Hypertension Optimal Treatment study (HOT) with felodipine, the Systolic Hypertension in the Elderly in Europe Trial (SYST-EUR) with nicardipine, the Second Swedish Trial in Old Patients with Hypertension (STOP II) with felodipine, and Nordic Diltiazem Study (NORDIL) with diltiazem, will give us morbidity and mortality data in patients with high blood pressure within the next few years. Until these results are available, we can be confident that the lowering of blood pressure and providing relief of patients with symptomatic angina can be achieved safely and efficiently with the presently available long-acting calcium antagonists.
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PMID:What, if anything, is controversial about calcium antagonists? 896 30

In order to evaluate the disturbances in circadian rhythms of blood pressure in 10 patients with chronic renal failure treated with CAPD, we performed blood pressure monitoring during the two following twenty-four hour periods. 40 healthy young male volunteers were included as a control group. They were divided into two subgroups: men whose parents have or have not hypertension. We used Oxford Medilog ABP equipment. Optimal CAPD parameters were confirmed by calculation Kt/V and pcr. To evaluate circadian rhythms in blood pressure we used Cosinor analysis, and to calculate the day-night blood pressure differences we used Student's t-test. In our study we did not find circadian rhythms of systolic, diastolic and mean arterial pressure in CAPD patients. There were also no statistically significant day-night blood pressure differences. The lack of circadian rhythms in blood pressure and statistically significant day-night differences can be explained in patients as the result of volume expansion and other abnormalities such as the lack of diurnal rhythm in atrial natriuretic peptide, rHuEpo therapy, sympathetic overactivation and others.
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PMID:[Circadian rhythm of blood pressure in patients with chronic kidney failure in the course of diabetes treated with peritoneal dialysis]. 908 41

The Hypertension Optimal Treatment (HOT) Study is an ongoing prospective randomized, multicentre trial conducted in 26 countries. There are two main aims of the study. The first is to evaluate the relationship between three levels of target diastolic blood pressure (< or = 90, < or = 85 or < or = 80 mmHg) and the incidence of cardiovascular morbidity and mortality in hypertensive patients. The second is to determine the effect on morbidity and mortality of a low dose, 75 mg daily, of acetylsalicylic acid (ASA, aspirin) compared with placebo. Altogether 18,790 patients have been recruited and randomized, and two-year data are now available for all patients. This is a report on the blood pressures achieved, the tolerability, and other available data after 24 months of follow-up of all patients. Special emphasis is given to the subgroup of elderly patients (> or = 65 years, n = 5988) compared with young patients (< 65 years, n = 12 802). On average, patients in the < or = 90 mmHg diastolic blood pressure target group have reached 85 mmHg, in the < or = 85 mmHg target group patients have reached 83 mmHg and in the < or = 80 mmHg target group patients have reached 81 mmHg. The percentage of those achieving target blood pressure in each target group at 24 months of follow-up is 85% in the < or = 90 mmHg target group, 75% in the < or = 85 mmHg target group and 57% in the < or = 80 mmHg target group. In the elderly subgroup (> or = 65 years of age), the percentage of patients achieving target at 24 months is higher for all target groups, namely 89% in the < or = 90 mmHg group, 80% in the 85 mmHg group and 62% in the 80 mmHg group. Antihypertensive treatment was initiated with a calcium antagonist, felodipine, at a dose of 5 mg once daily. If target blood pressure was not reached, additional antihypertensive therapy, with either an angiotensin converting enzyme (ACE) inhibitor or a beta-adrenoceptor blocking agent, was given. Further dose adjustments were made in accordance with a set protocol. As a fifth, and final, step, a diuretic could be added. There have been relatively few side effects in this large, multinational study of hypertensive patients. Only ankle oedema and coughing exceed a frequency of 0.5% (ankle oedema 1.3% in young and 1.7% in elderly; coughing 0.5% in young and elderly). After two years, 84% of all patients are still taking their baseline therapy, felodipine. The 24-month data presented here indicate that it should be possible to fulfil the primary aims of the HOT Study.
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PMID:The Hypertension Optimal Treatment (HOT) Study: 24-month data on blood pressure and tolerability. 936 3


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