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Your search keyword '"Isla S Mackenzie"' showing total 2 results
Start Over Author "Isla S Mackenzie" Journal journal of the american heart association: cardiovascular and cerebrovascular disease
2 results on '"Isla S Mackenzie"'

1. Reaching an ACCORD on Glycemia and Systolic Blood Pressure Targets in Type 2 Diabetes Mellitus

Author

Thomas M. MacDonald and Isla S. Mackenzie

Subjects
Blood Glucose, Male, medicine.medical_specialty, Simvastatin, type 2 diabetes mellitus, Blood Pressure, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Fenofibrate, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Antihypertensive Agents, Aged, Hypolipidemic Agents, Dose-Response Relationship, Drug, business.industry, Incidence, Editorials, Type 2 Diabetes Mellitus, Middle Aged, Prognosis, United States, glycemia, Survival Rate, macrovascular, Blood pressure, Editorial, Treatment Outcome, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Hypertension, Cardiology, targets, Drug Therapy, Combination, Female, microvascular, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiology and Cardiovascular Medicine, business
Abstract

Background Intensive systolic blood pressure ( SBP ) lowering significantly reduced cardiovascular disease ( CVD ) events in SPRINT (Systolic Blood Pressure Intervention Trial) but not in ACCORD BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure). Methods and Results SPRINT tested the effects of intensive (120 mm Hg) versus standard (140 mm Hg) SBP goals on CVD events and all-cause mortality. Using 2×2 factorial design, ACCORD BP tested the same SBP intervention in addition to an intensive versus standard glycemia intervention. We compared the effects of intensive SBP lowering on the composite CVD end point and all-cause mortality in SPRINT with its effects within each of the glycemia arms in ACCORD BP . Intensive SBP lowering decreased the hazard of the composite CVD end point similarly in SPRINT (hazard ratio: 0.75; 95% confidence interval, 0.64-0.89) and in the ACCORD BP standard glycemia arm (hazard ratio: 0.77; 95% confidence interval, 0.63-0.95; interaction P=0.87). However, the effect of intensive SBP lowering on the composite CVD end point in the ACCORD BP intensive glycemia arm (hazard ratio: 1.04; 95% confidence interval, 0.83-1.29) was significantly different from SPRINT (interaction P=0.023). Patterns were similar for all-cause mortality. Conclusions The effects of intensive SBP control on CVD events and all-cause mortality were similar in patients without diabetes mellitus and in those with diabetes mellitus on standard glycemic control. An interaction between intensive SBP lowering and intensive glycemic control may have masked beneficial effects of intensive SBP lowering in ACCORD BP . Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifiers: NCT 01206062, NCT 00000620.

Published
2018

2. Combination Therapy Is Superior to Sequential Monotherapy for the Initial Treatment of Hypertension: A Double‐Blind Randomized Controlled Trial

Author

Thomas M. MacDonald, Bryan Williams, David J. Webb, Steve Morant, Mark Caulfield, J. Kennedy Cruickshank, Ian Ford, Peter Sever, Isla S. Mackenzie, Sandosh Padmanabhan, Gerald P. McCann, Jackie Salsbury, Gordon McInnes, and Morris J. Brown

Subjects
angiotensin II receptor blocker, comparative effectiveness, diuretics, renin, treatment effectiveness, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundGuidelines for hypertension vary in their preference for initial combination therapy or initial monotherapy, stratified by patient profile; therefore, we compared the efficacy and tolerability of these approaches. Methods and ResultsWe performed a 1‐year, double‐blind, randomized controlled trial in 605 untreated patients aged 18 to 79 years with systolic blood pressure (BP) ≥150 mm Hg or diastolic BP ≥95 mm Hg. In phase 1 (weeks 0–16), patients were randomly assigned to initial monotherapy (losartan 50–100 mg or hydrochlorothiazide 12.5–25 mg crossing over at 8 weeks), or initial combination (losartan 50–100 mg plus hydrochlorothiazide 12.5–25 mg). In phase 2 (weeks 17–32), all patients received losartan 100 mg and hydrochlorothiazide 12.5 to 25 mg. In phase 3 (weeks 33–52), amlodipine with or without doxazosin could be added to achieve target BP. Hierarchical primary outcomes were the difference from baseline in home systolic BP, averaged over phases 1 and 2 and, if significant, at 32 weeks. Secondary outcomes included adverse events, and difference in home systolic BP responses between tertiles of plasma renin. Home systolic BP after initial monotherapy fell 4.9 mm Hg (range: 3.7–6.0 mm Hg) less over 32 weeks (P150/95 mm Hg. Clinical Trial RegistrationURL: http://www.ClinicalTrials.gov. Unique identifier: NCT00994617.

Published
2017
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