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2. Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension.
- Author
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Stergiou G, Brunström M, MacDonald T, Kyriakoulis KG, Bursztyn M, Khan N, Bakris G, Kollias A, Menti A, Muntner P, Orias M, Poulter N, Shimbo D, Williams B, Adeoye AM, Damasceno A, Korostovtseva L, Li Y, Muxfeldt E, Zhang Y, Mancia G, Kreutz R, and Tomaszewski M
- Subjects
- Blood Pressure, Blood Pressure Monitoring, Ambulatory, Circadian Rhythm, Humans, Prospective Studies, Antihypertensive Agents pharmacology, Hypertension drug therapy
- Abstract
Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
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3. Cardiovascular risk management in type 2 diabetes mellitus: A joint position paper of the Italian Cardiology (SIC) and Italian Diabetes (SID) Societies.
- Author
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Avogaro A, Barillà F, Cavalot F, Consoli A, Federici M, Mancone M, Paolillo S, Pedrinelli R, Perseghin G, Perrone Filardi P, Scicali R, Sinagra G, Spaccarotella C, Indolfi C, and Purrello F
- Subjects
- Antihypertensive Agents adverse effects, Cardiovascular Diseases diagnosis, Cardiovascular Diseases epidemiology, Cardiovascular Diseases physiopathology, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 physiopathology, Dyslipidemias diagnosis, Dyslipidemias epidemiology, Dyslipidemias physiopathology, Heart Disease Risk Factors, Humans, Hypertension diagnosis, Hypertension epidemiology, Hypertension physiopathology, Hypoglycemic Agents adverse effects, Hypolipidemic Agents adverse effects, Platelet Aggregation Inhibitors therapeutic use, Prevalence, Risk Assessment, Treatment Outcome, Antihypertensive Agents therapeutic use, Cardiovascular Diseases prevention & control, Diabetes Mellitus, Type 2 drug therapy, Dyslipidemias drug therapy, Hypertension drug therapy, Hypoglycemic Agents therapeutic use, Hypolipidemic Agents therapeutic use
- Abstract
Aim: This review represents a joint effort of the Italian Societies of Cardiology (SIC) and Diabetes (SID) to define the state of the art in a field of great clinical and scientific interest which is experiencing a moment of major cultural advancements, the cardiovascular risk management in type 2 diabetes mellitus., Data Synthesis: Consists of six chapters that examine various aspects of pathophysiology, diagnosis and therapy which in recent months have seen numerous scientific innovations and several clinical studies that require extensive sharing., Conclusions: The continuous evolution of our knowledge in this field confirms the great cultural vitality of these two cultural spheres, which requires, under the leadership of the scientific Societies, an ever greater and effective collaboration., Competing Interests: Conflicts of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)
- Published
- 2021
- Full Text
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4. The Invisible Paper that Shook Ophthalmology.
- Author
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Alward WLM
- Subjects
- Academies and Institutes standards, Humans, Ophthalmology organization & administration, Practice Guidelines as Topic standards, United States, Antihypertensive Agents therapeutic use, Evidence-Based Medicine, Glaucoma, Open-Angle drug therapy, Intraocular Pressure drug effects, Quality of Health Care
- Published
- 2021
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5. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension.
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Cífková R, Johnson MR, Kahan T, Brguljan J, Williams B, Coca A, Manolis A, Thomopoulos C, Borghi C, Tsioufis C, Parati G, Sudano I, McManus RJ, van den Born BH, Regitz-Zagrosek V, and de Simone G
- Subjects
- Antihypertensive Agents adverse effects, Blood Pressure Determination standards, Consensus, Emergencies, Evidence-Based Medicine standards, Female, Humans, Hypertension, Pregnancy-Induced diagnosis, Hypertension, Pregnancy-Induced physiopathology, Peripartum Period, Pregnancy, Risk Factors, Severity of Illness Index, Treatment Outcome, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Hypertension, Pregnancy-Induced drug therapy, Maternal Health Services standards
- Abstract
Hypertensive disorders are the most common medical complications in the peripartum period associated with a substantial increase in morbidity and mortality. Hypertension in the peripartum period may be due to the continuation of pre-existing or gestational hypertension, de novo development of pre-eclampsia or it may be also induced by some drugs used for analgesia or suppression of postpartum haemorrhage. Women with severe hypertension and hypertensive emergencies are at high risk of life-threatening complications, therefore, despite the lack of evidence-based data, based on expert opinion, antihypertensive treatment is recommended. Labetalol intravenously and methyldopa orally are then the two most frequently used drugs. Short-acting oral nifedipine is suggested to be used only if other drugs or iv access are not available. Induction of labour is associated with improved maternal outcome and should be advised for women with gestational hypertension or mild pre-eclampsia at 37 weeks' gestation. This position paper provides the first interdisciplinary approach to the management of hypertension in the peripartum period based on the best available evidence and expert consensus., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
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6. Update of the position paper on arterial hypertension and erectile dysfunction.
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Viigimaa M, Vlachopoulos C, Doumas M, Wolf J, Imprialos K, Terentes-Printzios D, Ioakeimidis N, Kotsar A, Kiitam U, Stavropoulos K, Narkiewicz K, Manolis A, Jelakovic B, Lovic D, Kreutz R, Tsioufis K, and Mancia G
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- Adrenergic beta-Antagonists therapeutic use, Arteries physiopathology, Atherosclerosis complications, Cardiology standards, Cardiovascular Diseases complications, Cardiovascular Diseases epidemiology, Coronary Artery Disease physiopathology, Endothelium physiopathology, Erectile Dysfunction epidemiology, Erectile Dysfunction physiopathology, Humans, Hypertension epidemiology, Hypertension physiopathology, Impotence, Vasculogenic complications, Impotence, Vasculogenic epidemiology, Male, Nebivolol therapeutic use, Phosphodiesterase 5 Inhibitors therapeutic use, Risk Factors, Sexual Dysfunction, Physiological chemically induced, Societies, Medical, Testosterone therapeutic use, Antihypertensive Agents therapeutic use, Erectile Dysfunction complications, Hypertension complications, Penile Erection drug effects
- Abstract
: Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.
- Published
- 2020
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7. Roadmap for the treatment of heart failure patients after hospital discharge: an interdisciplinary consensus paper.
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Mueller C, Bally K, Buser M, Flammer AJ, Gaspoz JM, Mach F, Moschovitis G, Paul M, Zeller A, Heitlinger E, Fay B, and Rosemann T
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- Consensus, Heart Failure complications, Humans, Hypotension complications, Patient Discharge, Switzerland, Treatment Outcome, Antihypertensive Agents pharmacology, Heart Failure drug therapy, Interdisciplinary Communication, Transitional Care
- Abstract
The transition period from the hospital to the outpatient setting is a critical phase when managing heart failure. A well-structured transition is paramount and helps to ensure a tight follow-up schedule for the heart failure patient, thereby improving treatment outcomes. This article aims to provide guidance for the first three follow-up visits after hospital discharge, with a focus on monitoring heart failure patients and up-titrating their medication in primary care.
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- 2020
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8. Isolated systolic hypertension in the young: a position paper endorsed by the European Society of Hypertension.
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Palatini P, Rosei EA, Avolio A, Bilo G, Casiglia E, Ghiadoni L, Giannattasio C, Grassi G, Jelakovich B, Julius S, Mancia G, McEniery CM, O'Rourke MF, Parati G, Pauletto P, Pucci G, Saladini F, Strazzullo P, Tsioufis K, Wilkinson IB, and Zanchetti A
- Subjects
- Adolescent, Adult, Blood Pressure drug effects, Blood Pressure Determination methods, Child, Europe epidemiology, Humans, Hypertension diagnosis, Life Style, Middle Aged, Obesity diagnosis, Practice Guidelines as Topic, Prevalence, Prognosis, Pulse Wave Analysis, Risk Factors, Societies, Medical, White Coat Hypertension diagnosis, Young Adult, Antihypertensive Agents therapeutic use, Hypertension epidemiology
- Abstract
: Whether isolated systolic hypertension in the young (ISHY) implies a worse outcome and needs antihypertensive treatment is still a matter for dispute. ISHY is thought to have different mechanisms than systolic hypertension in the elderly. However, findings from previous studies have provided inconsistent results. From the analysis of the literature, two main lines of research and conceptualization have emerged. Simultaneous assessment of peripheral and central blood pressure led to the identification of a condition called pseudo or spurious hypertension, which was considered an innocent condition. However, an increase in pulse wave velocity has been found by some authors in about 20% of the individuals with ISHY. In addition, obesity and metabolic disturbances have often been documented to be associated with ISHY both in children and young adults. The first aspect to consider whenever evaluating a person with ISHY is the possible presence of white-coat hypertension, which has been frequently found in this condition. In addition, assessment of central blood pressure is useful for identifying ISHY patients whose central blood pressure is normal. ISHY is infrequently mentioned in the guidelines on diagnosis and treatment of hypertension. According to the 2013 European Guidelines on the management of hypertension, people with ISHY should be followed carefully, modifying risk factors by lifestyle changes and avoiding antihypertensive drugs. Only future clinical trials will elucidate if a benefit can be achieved with pharmacological treatment in some subgroups of ISHY patients with associated risk factors and/or high central blood pressure.
- Published
- 2018
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9. [Blood Pressure Measurement and Treatment Targets: Position Paper of the DHL® Task Force Scientific Statements and Guidelines].
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Krämer BK, Hausberg M, Sanner B, Kusche-Vihrog K, Weil J, Weisser B, Wenzel U, and Trenkwalder P
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- Germany, Humans, Hypertension classification, Reference Values, Societies, Medical, Antihypertensive Agents therapeutic use, Blood Pressure Determination, Hypertension diagnosis, Hypertension drug therapy
- Abstract
Competing Interests: Interessenkonflikte: Die Autoren sind aktuelle, bzw. ehemalige Vorstandsmitglieder der Deutschen Hochdruckliga DHL.
- Published
- 2017
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10. The polypill in cardiovascular prevention: evidence, limitations and perspective - position paper of the European Society of Hypertension.
- Author
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Coca A, Agabiti-Rosei E, Cifkova R, Manolis AJ, Redón J, and Mancia G
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- Drug Combinations, Drug Compounding, Europe, Humans, Societies, Medical, Antihypertensive Agents administration & dosage, Cardiovascular Diseases prevention & control, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Hypoglycemic Agents administration & dosage, Platelet Aggregation Inhibitors administration & dosage
- Abstract
: Antihypertensive, lipid lowering, antidiabetic and antiplatelet treatments all substantially reduce the risk of cardiovascular morbid and fatal events. In real life, however, effective implementation of these treatments is rare, and thus their contribution to cardiovascular prevention is much less than it could be, based on research data. This article reviews the pros and cons of cardiovascular prevention by the polypill approach. It is argued that the high prevalence of individuals with a multifactorial risk profile provides a strong rationale for a therapeutic strategy based on the combination in a single tablet of drugs against different risk factors. It is further argued that other important favourable arguments exist. First, in real-life adherence to all above treatments is very low, leading to a major increase in the incidence and risk of cardiovascular outcomes. Second, although a large number of factors are involved, adherence is adversely affected by the complexity of the prescribed treatment regimen and can be considerably improved by treatment simplification. Third, recent studies in patients with a history of manifest cardiovascular disease have documented that different cardiovascular drugs can be combined in a single tablet with no loss of their individual efficacy or unexpected inconveniences and this does favour adherence to treatment and multiple risk factor control, supporting use of the polypill in secondary cardiovascular prevention. It is finally also mentioned, however, that the polypill may have some drawbacks and that at present no evidence is available that this approach reduces cardiovascular outcome to a greater degree than standard treatment strategies. Trials are under way to provide an answer to this question and thus allow the therapeutic value of this approach to be known.
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- 2017
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11. Are there any new pharmacologic therapies on the horizon to better treat hypertension? A state-of-the-art paper.
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Habib GB and Basra SS
- Subjects
- Animals, Drug Therapy, Combination, Humans, Hypertension complications, Hypertension diagnosis, Hypertension metabolism, Hypertension physiopathology, Molecular Targeted Therapy, Signal Transduction drug effects, Treatment Outcome, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Drug Discovery, Hypertension drug therapy
- Abstract
Hypertension is the most important cardiovascular risk factor. We have witnessed a significant improvement in hypertension treatment and control and an impressive growth in the pharmacologic options available to clinicians and hypertension specialists. With up to a third of patients with hypertension not at the recommended goal blood pressures, it is critically important to develop novel therapeutic approaches to better treat hypertension. This review will explore the ever-expanding horizon of antihypertensive treatment and will focus on 2 major areas of drug development. First, we will review novel targets for pharmacologic treatment and novel molecules and classes of drugs in various phases of development and recognize the limitations we face in their transition from research and development to clinical practice. Then, we will discuss an expanding array of combination strategies to better treat hypertension with the goal of minimizing the burden of cardiovascular and renal complications of hypertension., (© The Author(s) 2014.)
- Published
- 2014
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12. I brazilian position paper on antihypertensive drug combination.
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Póvoa R, Barroso WS, Brandão AA, Jardim PC, Barroso O, Passarelli O Jr, Gemelli JR, Feitosa A, Jardim TV, Carneiro SB, Amodeo C, Moreira Filho O, Nogueira Ada R, Morais NS, Scala LC, Gonzaga C, Souza Ddo S, Paiva AM, Malachias MV, Mion D Jr, Mota-Gomes MA, Barbosa EC, Sousa MG, Bianco HT, Fonseca FA, Kalil M, Miranda RD, Uehara CA, and Sanjuliani AF
- Subjects
- Blood Pressure drug effects, Brazil, Cerebrovascular Disorders complications, Coronary Disease complications, Drug Therapy, Combination methods, Humans, Renal Insufficiency, Chronic drug therapy, Risk Factors, Treatment Outcome, Antihypertensive Agents administration & dosage, Hypertension drug therapy, Practice Guidelines as Topic, Societies, Medical
- Published
- 2014
- Full Text
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13. Analysis of recent papers in hypertension treatment of hypertension in the setting of acute intracerebral hemorrhage: still no clear answer on the best BP level to intervene or what BP goal to achieve.
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Basile JN and Bloch MJ
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- Female, Humans, Male, Antihypertensive Agents therapeutic use, Cerebral Hemorrhage complications, Hypertension drug therapy
- Published
- 2014
- Full Text
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14. Japanese Society of Hypertension official comment on valsartan papers.
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- Clinical Trials as Topic, Humans, Retraction of Publication as Topic, Societies, Treatment Outcome, Valine therapeutic use, Valsartan, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Scientific Misconduct, Tetrazoles therapeutic use, Valine analogs & derivatives
- Published
- 2013
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15. Analysis of recent papers in hypertension. Initial combination therapy provides more prompt blood pressure control and reduces cardiovascular events but remains underutilized.
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Basile JN and Bloch MJ
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- Female, Humans, Male, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Cardiovascular Diseases etiology, Hypertension drug therapy
- Published
- 2013
- Full Text
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16. Most important outcomes research papers on hypertension.
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Chen R, Dharmarajan K, Kulkarni VT, Punnanithinont N, Gupta A, Bikdeli B, Mody PS, and Ranasinghe I
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- Animals, Comorbidity, Guideline Adherence, Humans, Hypertension diagnosis, Hypertension epidemiology, Hypertension physiopathology, Practice Guidelines as Topic, Risk Factors, Treatment Outcome, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Hypertension drug therapy
- Abstract
The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, which have published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes, as well as general cardiology audience. The studies included in this article represent the most significant research related to hypertension.
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- 2013
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17. [Economy, costs and drug choices in cardiology. A reflection on the 2012 position paper of the Italian Society of Hypertension].
- Author
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Camerini F and Palcic S
- Subjects
- Cardiology, Costs and Cost Analysis, Humans, Practice Guidelines as Topic, Antihypertensive Agents economics, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Hypertension economics
- Published
- 2013
- Full Text
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18. News update on withdrawal of Kyoto Heart Study research paper.
- Author
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Boersma E
- Subjects
- Female, Humans, Male, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Renin-Angiotensin System drug effects
- Published
- 2013
19. Analysis of recent papers in hypertension: nighttime administration of at least one antihypertensive medication is associated with better blood pressure control and cardiovascular outcomes in patients with type 2 diabetes or chronic kidney disease.
- Author
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Basile JN and Bloch MJ
- Subjects
- Blood Pressure drug effects, Blood Pressure physiology, Cardiovascular System drug effects, Cardiovascular System physiopathology, Humans, Antihypertensive Agents administration & dosage, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 physiopathology, Drug Chronotherapy, Hypertension drug therapy, Hypertension physiopathology, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic physiopathology
- Published
- 2013
- Full Text
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20. Reporting blood pressure effects of antihypertensive treatment in scientific papers: are guidelines needed?
- Author
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Mancia G
- Subjects
- Humans, Antihypertensive Agents therapeutic use, Blood Pressure, Hypertension drug therapy, Randomized Controlled Trials as Topic
- Published
- 2012
- Full Text
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21. ASH position paper: Adherence and persistence with taking medication to control high blood pressure.
- Author
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Hill MN, Miller NH, and DeGeest S
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- Blood Pressure, Health Policy, Humans, Risk Factors, Time Factors, United States, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Medication Adherence, Societies, Medical
- Abstract
Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now., (© 2010 Wiley Periodicals, Inc.)
- Published
- 2010
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22. Concerning the paper "estimated annual direct expenditures in the United States as a result of inappropriate hypertension treatment according to national treatment guidelines" by Dr. Sanjeev Balu.
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Finestone AJ
- Subjects
- Age Factors, Blood Pressure, Blood Pressure Determination, Humans, Hypertension physiopathology, Reference Values, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Practice Guidelines as Topic
- Published
- 2010
- Full Text
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23. Practical solutions to the challenges of uncontrolled hypertension: a white paper.
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Redon J, Brunner HR, Ferri C, Hilgers KF, Kolloch R, and van Montfrans G
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- Humans, Hypertension economics, Antihypertensive Agents therapeutic use, Hypertension epidemiology, Hypertension therapy, Needs Assessment
- Abstract
This white paper is an urgent call to action from an international group of physicians. The continued failure to control hypertension takes an unacceptable toll on patients, families and society and it must be addressed. Any patient with blood pressure of 140/90 mmHg or greater can be characterized as a 'challenging patient', is at significant risk, and requires persistent optimization of therapy until target blood pressure is achieved. Six key challenges in reaching this goal blood pressure are described: (1) inadequate primary prevention; (2) faulty awareness of risk; (3) lack of simplicity; (4) therapeutic inertia; (5) insufficient patient empowerment; and (6) unsupportive healthcare systems. This white paper identifies straightforward actions that will produce rapid improvements in the management of hypertension, with a simple aim: to treat all challenging patients effectively to goal blood pressure, preventing disability and saving lives.
- Published
- 2008
- Full Text
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24. ASH position paper: treatment of hypertension in patients with diabetes-an update.
- Author
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Bakris GL and Sowers JR
- Subjects
- Algorithms, Diabetes Complications complications, Humans, Hypertension complications, Renin-Angiotensin System drug effects, Antihypertensive Agents therapeutic use, Blood Pressure, Diabetes Complications drug therapy, Hypertension drug therapy
- Abstract
This report updates concepts on hypertension management in patients with diabetes. It focuses on clinical outcomes literature published within the last 3 years and incorporates these observations into modifications of established guidelines. While the fundamentals of treatment and goal blood pressures remain unchanged, approaches to specific patient-related issues has changed. This update focuses on questions such as what to do when a patient has an elevated potassium level when therapy is initiated and whether combinations of agents that block the renin-angiotensin system still be used. In addition, there are updates from trials, just published and in press, that focus on related management issues influencing cardiovascular outcomes in persons with diabetes. Last, an updated algorithm is provided that incorporates many of the new findings and is suggested as a starting point to achieve blood pressure goals.
- Published
- 2008
- Full Text
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25. Clinical evidence for drug treatments in obesity-associated hypertensive patients--a discussion paper.
- Author
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Doggrell SA
- Subjects
- Appetite Depressants therapeutic use, Cyclobutanes therapeutic use, Humans, Hypertension etiology, Insulin, Lactones therapeutic use, Lipids, Orlistat, Anti-Obesity Agents therapeutic use, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Obesity drug therapy
- Abstract
The association between obesity and hypertension is well known. The hemodynamic features of obesity-related hypertension are an expansion of extracellular volume inducing hypervolaemia and increased cardiac output, with activation of both the sympathetic nervous system and the renin--angiotensin system. It is suggested that obesity-related hypertension may be considered as a subset of essential hypertension, and treated as an identity. Orlistat and sibutramine both reduce body weight in the obese patients. The use of orlistat in obese hypertensive patients is associated with a small decrease in blood pressure, whereas sibutramine may increase the blood pressure. Thus, orlistat may be preferred in the obese hypertensive patients. Diuretics and beta-blockers decrease insulin sensitivity, which is an unwanted effect in obesity, and should be used with caution in obese hypertensive patients. The calcium channel blockers have no or minor effects on insulin sensitivity and may be considered for use in obese hypertensive patients. Inhibitors of the effects of angiotensin may be the antihypertensive drugs of choice for obese hypertensive patients, as in addition to reducing blood pressure, ACE inhibitors and AT(1) receptor antagonists have no effect or improve insulin sensitivity, and are renoprotective. More clinical trials are needed for the centrally acting antihypertensives (clonidine, rilmenidine) in obese hypertensive patients, as they inhibit the sympathetic nervous and renin--angiotensin systems, which are overactive in this population., (Copyright 2005 Prous Science. All rights reserved.)
- Published
- 2005
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26. Analysis of recent papers in hypertension.
- Author
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Basile JN
- Subjects
- Angiotensin-Converting Enzyme Inhibitors therapeutic use, Blood Pressure Monitoring, Ambulatory, Cardiovascular Diseases mortality, Combined Modality Therapy, Exercise, Female, Humans, Hypertension diagnosis, Hypertension epidemiology, Life Style, Male, Prognosis, Randomized Controlled Trials as Topic, Risk Assessment, Survival Analysis, Antihypertensive Agents therapeutic use, Cardiovascular Diseases prevention & control, Diet, Hypertension drug therapy
- Published
- 2004
- Full Text
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27. Discussion of papers on basic observations of new psychopharmacological agents.
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HIMWICH HE
- Subjects
- Humans, Antihypertensive Agents, Central Nervous System drug effects, Chlorpromazine pharmacology, Paper, Psychopharmacology, Secologanin Tryptamine Alkaloids pharmacology
- Published
- 1956
28. Paper chromatography of some guanidine derivatives.
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PANT R and DUBEY SS
- Subjects
- Amidines chemistry, Antihypertensive Agents, Chromatography, Paper, Guanidines
- Published
- 1960
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29. [Characterization of guanidine derivatives of biological origin by electrophoresis and paper chromatography (chromatoelectrophoresis)].
- Author
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LISSITZKY S, GARCIA I, and ROCHE J
- Subjects
- Amidines analysis, Antihypertensive Agents, Chromatography, Chromatography, Paper, Electrophoresis, Guanidines
- Published
- 1954
- Full Text
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30. [Experiments on the separation of Rauwolfia alkaloids by means of paper electrophoresis].
- Author
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SAHLI M
- Subjects
- Antihypertensive Agents, Electrophoresis, Paper, Retinal Detachment, Secologanin Tryptamine Alkaloids analysis
- Published
- 1958
31. [Paper chromatography of monosubstituted guanidine derivatives].
- Author
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ROCHE J, FELIX W, ROBIN Y, and NGUYEN VAN THOAI
- Subjects
- Amidines, Antihypertensive Agents, Chromatography, Chromatography, Paper, Guanidines
- Published
- 1951
32. Paper chromatographic evaluation Rauwolfia species.
- Author
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KORZUN BP, ST ANDRE AF, and ULSHAFER PR
- Subjects
- Alkaloids, Antihypertensive Agents, Chromatography, Paper, Hypnotics and Sedatives, Rauwolfia, Secologanin Tryptamine Alkaloids analysis
- Published
- 1957
33. Paper chromatographic and biological properties of reserpine and related compounds.
- Author
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BOSCOTT RJ and KAR AB
- Subjects
- Antihypertensive Agents, Chromatography, Paper, Reserpine, Secologanin Tryptamine Alkaloids
- Published
- 1955
- Full Text
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34. Antihypertensive drugs in the morning or the evening? A complicated question with no clear answer.
- Author
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Reboldi G, Angeli F, and Verdecchia P
- Subjects
- Humans, Circadian Rhythm, Blood Pressure drug effects, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Hypertension physiopathology
- Published
- 2024
- Full Text
- View/download PDF
35. Use of fixed-dose combinations for cardiovascular indications from 2018 to 2023: a nationwide population-based study.
- Author
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Götzinger F, Kieble M, Daudí AE, Kunz M, Lauder L, Böhm M, Laufs U, Mahfoud F, and Schulz M
- Subjects
- Humans, Germany, Middle Aged, Male, Female, Aged, Adult, Cardiovascular Diseases drug therapy, Cardiovascular Diseases prevention & control, Antihypertensive Agents administration & dosage, Antihypertensive Agents therapeutic use, Drug Combinations
- Abstract
Aims: Clinical guidelines support the use of fixed-dose combinations (FDC) for prevention of cardiovascular disease. Implementation of FDC into clinical care remains challenging, and current population-based data are scarce., Methods and Results: Claims data on dispensed drugs in an outpatient care setting of approximately 87% of the German population were analysed regarding the use of FDC according to time, age of the insured persons, and active ingredients. The overarching trend for all FDC revealed a decrease from 77.3 defined daily doses per 1000 statutory health-insured (SHI) persons per day (DID) in the second half-year of 2018 (2018HY02) to 60.8 DID in the first half-year of 2023 (2023HY01) (Spearman ρ = -0.988; P < 0.001). The total DID for all antihypertensives (AHT) increased from 590.6 in 2018HY02 to 624.8 in 2023HY01 (ρ = 0.855; P = 0.002), but the DID for fixed-dose AHT (AHT-FDC) declined from 74.1 in 2018HY02 to 55.0 in 2023HY01 (ρ = -0.988; P < 0.001). Conversely, the use of all lipid-lowering agents (LLA) and LLA-FDC continuously increased: The total DID of all LLA rose from 92.5 in 2018HY02 to 134.4 in 2023HY01 (ρ = 1.000; P = 0.000), and for LLA-FDC from 3.1 in 2018HY02 to 5.5 DID in 2023HY01 (ρ = 0.915; P < 0.001). AHT-FDC and LLA-FDC were less frequently dispensed to patients at least 80 years than to patients less than 80 years. Dispensing of multiple purpose FDC increased from 2018HY02 to 2023HY01 from 0.11 DID to 0.26 DID (ρ = 1.000; P = 0.000) but remained negligible., Conclusion: Use of AHT-FDC in Germany is declining. In contrast, FDC containing LLA are increasingly prescribed. Dispensing of multiple purpose FDC is very low. Strategies are needed to facilitate the use of FDC as recommended by current guidelines., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
- Full Text
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36. Blood pressure variability assessed by office, home, and ambulatory measurements before and during antihypertensive drug treatment: a sub-analysis of the REVERENT randomized trial.
- Author
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Kyriakoulis KG, Kollias A, Bilo G, Soranna D, Liu CY, Pengo MF, Zambon A, Zhang W, Destounis A, Wang JG, Stergiou GS, and Parati G
- Subjects
- Humans, Male, Middle Aged, Female, Adult, Ramipril therapeutic use, Aged, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Nifedipine therapeutic use, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Hypertension drug therapy, Hypertension physiopathology, Blood Pressure Monitoring, Ambulatory methods
- Abstract
Objectives: Blood pressure (BP) variability (BPV) can be assessed using office (OBP), home (HBP), or ambulatory BP (ABP) measurements. This analysis investigated the association and agreement between OBP, HBP, and ABP measurements for BPV assessment at baseline and 10 weeks after initiating antihypertensive drug therapy., Methods: Untreated hypertensive patients with elevated BPV were randomized to receive an angiotensin-converting enzyme inhibitor (ramipril) or a calcium channel blocker (nifedipine GITS) in a 10-week, open-label, blinded-end point study. BPV was assessed using standard deviation (SD) and coefficient of variation (CV) (reading-to-reading analyses)., Results: Data from 146 participants from three research centers (Athens/Greece; Milan/Italy; Shanghai/China) were analyzed [mean age 53 ± 10 (SD) years, male individuals 60%, baseline systolic OBP, HBP, and 24 h ABP 144 ± 9, 138 ± 10, and 143 ± 10 mmHg, respectively]. Post-treatment minus pre-treatment systolic CV difference was: OBP: 0.3%, P = 0.28; HBP: -0.2%, P = 0.20; 24 h ABP: 1.1%, P < 0.001. Home and ambulatory (not office) BPV indices presented weak-to-moderate correlation, both before and during treatment (range of coefficients 0.04-0.33). The correlation coefficient between systolic HBP and awake ABP CV was 0.21 and 0.28 before and during treatment, respectively ( P < 0.05/< 0.001, respectively). Home and ambulatory (not office) BPV indices presented slight-to-fair agreement (range 64-73%) in detecting participants with high systolic BPV (top quartile of respective distributions) both before and during treatment (kappa range 0.04-0.27)., Conclusion: These data showed a weak-to-moderate association between out-of-office (but not office) BPV indices both before and during BP-lowering treatment, with reasonable agreement in detecting individuals with high BPV. Out-of-office BP measurements provide more similar and consistent BPV information than office measurements., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
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37. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension.
- Author
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Mancia G, Cappuccio FP, Burnier M, Coca A, Persu A, Borghi C, Kreutz R, and Sanner B
- Subjects
- Humans, Blood Pressure, Financial Stress, Drug Therapy, Combination, Antihypertensive Agents therapeutic use, Hypertension diagnosis, Hypertension prevention & control
- Abstract
The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems., (© 2023 The Association for the Publication of the Journal of Internal Medicine.)
- Published
- 2023
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38. Current insights and future perspectives of flavonoids: A promising antihypertensive approach.
- Author
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Harahap U, Syahputra RA, Ahmed A, Nasution A, Wisely W, Sirait ML, Dalimunthe A, Zainalabidin S, Taslim NA, Nurkolis F, and Kim B
- Subjects
- Humans, Animals, Antioxidants pharmacology, Nitric Oxide metabolism, NG-Nitroarginine Methyl Ester pharmacology, Oxidative Stress drug effects, Blood Pressure drug effects, Antihypertensive Agents pharmacology, Antihypertensive Agents chemistry, Flavonoids pharmacology, Flavonoids chemistry, Hypertension drug therapy, Hypertension chemically induced
- Abstract
Hypertension, or high blood pressure (BP), is a complex disease influenced by various risk factors. It is characterized by persistent elevation of BP levels, typically exceeding 140/90 mmHg. Endothelial dysfunction and reduced nitric oxide (NO) bioavailability play crucial roles in hypertension development. L-NG-nitro arginine methyl ester (L-NAME), an analog of L-arginine, inhibits endothelial NO synthase (eNOS) enzymes, leading to decreased NO production and increased BP. Animal models exposed to L-NAME manifest hypertension, making it a useful design for studying the hypertension condition. Natural products have gained interest as alternative approaches for managing hypertension. Flavonoids, abundant in fruits, vegetables, and other plant sources, have potential cardiovascular benefits, including antihypertensive effects. Flavonoids have been extensively studied in cell cultures, animal models, and, to lesser extent, in human trials to evaluate their effectiveness against L-NAME-induced hypertension. This comprehensive review summarizes the antihypertensive activity of specific flavonoids, including quercetin, luteolin, rutin, troxerutin, apigenin, and chrysin, in L-NAME-induced hypertension models. Flavonoids possess antioxidant properties that mitigate oxidative stress, a major contributor to endothelial dysfunction and hypertension. They enhance endothelial function by promoting NO bioavailability, vasodilation, and the preservation of vascular homeostasis. Flavonoids also modulate vasoactive factors involved in BP regulation, such as angiotensin-converting enzyme (ACE) and endothelin-1. Moreover, they exhibit anti-inflammatory effects, attenuating inflammation-mediated hypertension. This review provides compelling evidence for the antihypertensive potential of flavonoids against L-NAME-induced hypertension. Their multifaceted mechanisms of action suggest their ability to target multiple pathways involved in hypertension development. Nonetheless, the reviewed studies contribute to the evidence supporting the useful of flavonoids for hypertension prevention and treatment. In conclusion, flavonoids represent a promising class of natural compounds for combating hypertension. This comprehensive review serves as a valuable resource summarizing the current knowledge on the antihypertensive effects of specific flavonoids, facilitating further investigation and guiding the development of novel therapeutic strategies for hypertension management., (© 2024 John Wiley & Sons Ltd.)
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- 2024
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39. European Society of Hypertension position paper on renal denervation 2021
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Schmieder, Roland E, Mahfoud, Felix, Mancia, Giuseppe, Azizi, Michael, Böhm, Michael, Dimitriadis, Kyriakos, Kario, Kazuomi, Kroon, Abraham A, D Lobo, Melvin, Ott, Christian, Pathak, Atul, Persu, Alexandre, Scalise, Filippo, Schlaich, Markus, Kreutz, Reinhold, Tsioufis, Costas, members of the ESH Working Group on Device-Based Treatment of Hypertension, RS: Carim - V02 Hypertension and target organ damage, MUMC+: MA Alg Interne Geneeskunde (9), Interne Geneeskunde, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, and UCL - (SLuc) Service de cardiologie
- Subjects
medicine.medical_specialty ,Physiology ,MEDLINE ,Blood Pressure ,CONTROLLED-TRIAL ,Kidney ,law.invention ,Randomized controlled trial ,law ,Internal Medicine ,Medicine ,Humans ,Sympathectomy ,Intensive care medicine ,Adverse effect ,renal denervation ,Antihypertensive Agents ,Denervation ,sympathetic nervous system ,business.industry ,DENERHTN ,Blood pressure ,Treatment Outcome ,CATHETER ,Concomitant ,SAFETY ,Ambulatory ,Hypertension ,Position paper ,Cardiology and Cardiovascular Medicine ,business ,position paper ,SYSTEM - Abstract
This ESH Position Paper 2021 with updated proposed recommendations was deemed necessary after the publication of a set of new pivotal sham-controlled randomized clinical trials (RCTs), which provided important information about the efficacy and safety of endovascular device-based renal denervation (RDN) for hypertension treatment. RDN is effective in reducing or interrupting the sympathetic signals to the kidneys and decreasing whole body sympathetic activity. Five independent, fully completed, sham-controlled RCTs provide conclusive evidence that RDN lowers ambulatory and office blood pressure (BP) to a significantly greater extent than sham treatment. BP-lowering efficacy is evident both in patients with and without concomitant antihypertensive medication. The average decrease of 10mmHg in office BP is estimated to lower the incidence of cardiovascular events by 25-30%, based on meta-analyses of RCTs using pharmacological treatment. Neither peri-procedural, nor short-term or long-term adverse events or safety signals (available up to 3 years) have been observed. Implementing RDN as an innovative third option in the armamentarium of antihypertensive treatment requires a structured process that ensures the appropriate performance of the endovascular RDN procedure and adequate selection of hypertensive patients. The latter should also incorporate patients' perspective and preference that needs to be respected in a shared decision-making process.
- Published
- 2021
40. Medication adherence and associated factors in newly diagnosed hypertensive patients in Japan: the LIFE study.
- Author
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Sagara K, Goto K, Maeda M, Murata F, and Fukuda H
- Subjects
- Adult, Humans, Male, Aged, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Japan epidemiology, Angiotensin Receptor Antagonists therapeutic use, Medication Adherence, Retrospective Studies, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Hypertension epidemiology
- Abstract
Hypertension is the leading cardiovascular risk factor worldwide. However, in Japan, only 30% of patients have their blood pressure controlled under 140/90 mmHg, and nonadherence to antihypertensives is thought to be a reason for the poor control of hypertension. We therefore sought to assess the adherence to hypertension treatment and to evaluate factors influencing patients' adherence in a large, representative sample of the Japanese population. To this end, we analyzed claims data from the LIFE Study database, which includes 112 506 Japanese adults with newly diagnosed hypertension. Medication adherence was measured for a year postdiagnosis using the proportion of days covered (PDC) method. Factors associated with adherence to antihypertensives were also assessed. Among the total 112 506 hypertensive patients, the nonadherence rate (PDC ≤ 80%) for antihypertensives during the first year after initiation of the treatment was 26.2%. Younger age [31-35 years: odds ratio (OR), 0.15; 95% confidence interval (95% CI), 0.12-0.19 compared with 71-74-year-old patients], male gender, monotherapy, and diuretics use [OR, 0.87; 95% CI, 0.82-0.91 compared with angiotensin II receptor blockers (ARBs)] were associated with poor adherence in the present study. Cancer comorbidity (OR, 0.84; 95% CI, 0.79-0.91 compared with no comorbidity), prescription at a hospital, and living in a medium-sized to regional city were also associated with poor adherence. Our present findings showing the current status of adherence to antihypertensive medications and its associated factors using claims data in Japan should help to improve adherence to antihypertensives and blood pressure control., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
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41. Impact of timing of antihypertensive treatment on mortality: an observational study from the Spanish Ambulatory Blood Pressure Monitoring Registry.
- Author
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de la Sierra A, Ruilope LM, Martínez-Camblor P, Vinyoles E, Gorostidi M, Segura J, and Williams B
- Subjects
- Humans, Male, Middle Aged, Female, Blood Pressure Monitoring, Ambulatory methods, Blood Pressure physiology, Registries, Circadian Rhythm physiology, Antihypertensive Agents pharmacology, Hypertension drug therapy
- Abstract
Background and Aims: Whether bedtime versus morning administration of antihypertensive therapy is beneficial on outcomes is controversial. We evaluated the risk of total and cardiovascular mortality in a very large observational cohort of treated hypertensive patients, according to the timing of their usual treatment administration (morning versus evening)., Methods: Vital status and cause of death were obtained from death certificates of 28 406 treated hypertensive patients (mean age 62 years, 53% male individuals), enrolled in the Spanish Ambulatory Blood Pressure Monitoring (ABPM) Registry between 2004 and 2014. Among the 28 406 patients, most (86%) received their medication exclusively in the morning; whilst 13% were treated exclusively in the evening or at bedtime. Follow-up was for a median of 9.7 years and 4345 deaths occurred, of which 1478 were cardiovascular deaths., Results: Using Cox-models adjusted for clinical confounders and 24-h SBP, and compared with patients treated in the morning (reference group), all-cause mortality [hazard ratio 1.01; 95% CI 0.93-1.09) and cardiovascular mortality (hazard ratio 1.04; 95% CI 0.91-1.19) was not significantly different in those receiving evening medication dosing. The results were consistent in all the subgroups of patients analysed., Conclusion: In this very large observational study, morning versus bedtime dosing of antihypertensive medication made no difference to the subsequent risk of all-cause or cardiovascular mortality. These findings are in accordance with results from a recent randomized controlled trial and do not support the hypothesis of a specific beneficial effect of night-time antihypertensive treatment dosing on risk of all-cause or cardiovascular death., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
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42. The first software as medical device of evidence-based hypertension digital therapeutics for clinical practice.
- Author
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Kario K, Harada N, and Okura A
- Subjects
- Humans, Blood Pressure physiology, Blood Pressure Monitoring, Ambulatory methods, Software, Antihypertensive Agents therapeutic use, Hypertension drug therapy
- Abstract
In 2021, the open-label randomized HERB-Digital Hypertension 1 (HERB-DH1) trial showed for the first time that hypertension digital therapeutics (a hypertension treatment app) successfully reduced blood pressure (BP) in patients with hypertension. Patients in the digital therapeutics group who used the app and home BP monitoring (HBPM) showed significant and persistent decreases in office, home and ambulatory BP values compared with the control group (who were under physician management using HBPM and lifestyle modifications). The results of the pivotal study led to the first global approval of this app for the treatment of hypertension in Japan in 2022, including medical insurance reimbursement. As a result, this hypertension app is expected to become widely used in the clinical management of all stages of hypertension. The most important remaining research issues include the identification of patients likely to respond to this therapeutic approach and the development of clinical efficacy indices. In addition, guidelines for the appropriate use of hypertension apps in the treatment of hypertension are needed. Next steps include the development and research of digital tools to facilitate the behavioral modifications required to prevent hypertension., (© 2022. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)
- Published
- 2022
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43. Italian Society of Arterial Hypertension (SIIA) Position Paper on the Role of Renal Denervation in the Management of the Difficult-to-Treat Hypertensive Patient
- Author
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Guido Grassi, Rosa Maria Bruno, Roberto Pontremoli, Stefano Taddei, Maria Lorenza Muiesan, Bruno Trimarco, Giovambattista Desideri, Massimo Volpe, Gianfranco Parati, Alberto Mazza, Claudio Borghi, Furio Colivicchi, Claudio Ferri, Bruno RM, Taddei S, Borghi C, Colivicchi F, Desideri G, Grassi G, Mazza A, Muiesan ML, Parati G, Pontremoli R, Trimarco B, Volpe M, Ferri C, Bruno, R, Taddei, S, Borghi, C, Colivicchi, F, Desideri, G, Grassi, G, Mazza, A, Muiesan, M, Parati, G, Pontremoli, R, Trimarco, B, Volpe, M, and Ferri, C
- Subjects
0301 basic medicine ,Ablation Techniques ,medicine.medical_specialty ,Clinical Decision-Making ,Drug Resistance ,Kidney ,Decision Support Techniques ,Medication Adherence ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Pharmacotherapy ,Renal Artery ,Patient selection ,Risk Factors ,Internal Medicine ,Medicine ,Humans ,Arterial Pressure ,Patient preference ,Sympathectomy ,Intensive care medicine ,Antihypertensive Agents ,Denervation ,business.industry ,Patient preferences ,Adherence ,Hypertension ,Renal denervation ,Patient Safety ,Patient Selection ,Treatment Outcome ,Clinical trial ,030104 developmental biology ,Blood pressure ,Tolerability ,Position paper ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Renal denervation is a device-based procedure for hypertension for which safety and efficacy has been demonstrated. At present, its clinical use is still matter of debate, despite the most recent clinical trials have shown promising results with new-generation devices in various hypertensive populations. This position paper was deemed necessary by the Italian Society of Arterial Hypertension, in order to provide indications about the applications of renal denervation in the clinical setting. A state-of-the art review of the literature, focusing on safety and efficacy data, is provided. Furthermore, based on current evidence and expert consensus, clinical profiles of possible candidates for renal denervation are proposed. The selection process should take into account not only blood pressure values, global cardiovascular risk profile, but also drug adherence and tolerability and patient preferences. This position paper also defines minimum requirements for renal denervation selection centers and a flowchart for the difficult-to-treat hypertensive patient. Further studies are needed to support these preliminary indications, which are based on expert-consensus only.
- Published
- 2020
44. Cardiovascular risk management in type 2 diabetes mellitus: A joint position paper of the Italian Cardiology (SIC) and Italian Diabetes (SID) Societies
- Author
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Roberto Pedrinelli, Agostino Consoli, Gianfranco Sinagra, Angelo Avogaro, Pasquale Perrone Filardi, Franco Cavalot, Francesco Purrello, Ciro Indolfi, F. Barilla, Gianluca Perseghin, Carmen Spaccarotella, Stefania Paolillo, Massimo Mancone, Roberto Scicali, Massimo Federici, Avogaro, A, Barillà, F, Cavalot, F, Consoli, A, Federici, M, Mancone, M, Paolillo, S, Pedrinelli, R, Perseghin, G, Filardi, P, Scicali, R, Sinagra, G, Spaccarotella, C, Indolfi, C, Purrello, F, Avogaro, A., Barilla, F., Cavalot, F., Consoli, A., Federici, M., Mancone, M., Paolillo, S., Pedrinelli, R., Perseghin, G., Perrone Filardi, P., Scicali, R., Sinagra, G., Spaccarotella, C., Indolfi, C., and Purrello, F.
- Subjects
Endocrinology, Diabetes and Metabolism ,Medicine (miscellaneous) ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Vitality ,Type 2 diabete ,Settore MED/11 ,0302 clinical medicine ,Cardiovascular Disease ,Prevalence ,Risk management ,Hypolipidemic Agents ,Hypolipidemic Agent ,Nutrition and Dietetics ,Heart Disease Risk Factor ,Antihypertensive Agent ,Treatment Outcome ,Cardiovascular Diseases ,Hypertension ,Cardiology ,Platelet aggregation inhibitor ,Cardiology and Cardiovascular Medicine ,Psychology ,Risk assessment ,Type 2 ,Human ,medicine.medical_specialty ,030209 endocrinology & metabolism ,Heart failure ,Risk Assessment ,03 medical and health sciences ,Type 2 diabetes, Cardiovascular risk, Heart failure ,Internal medicine ,Diabetes mellitus ,medicine ,Diabetes Mellitus ,Humans ,Hypoglycemic Agents ,Cardiovascular risk ,Antihypertensive Agents ,Diabetes Mellitus, Type 2 ,Dyslipidemias ,Heart Disease Risk Factors ,Platelet Aggregation Inhibitors ,MED/13 - ENDOCRINOLOGIA ,Hypoglycemic Agent ,business.industry ,Platelet Aggregation Inhibitor ,Type 2 Diabetes Mellitus ,medicine.disease ,Dyslipidemia ,Position paper ,business - Abstract
Aim This review represents a joint effort of the Italian Societies of Cardiology (SIC) and Diabetes (SID) to define the state of the art in a field of great clinical and scientific interest which is experiencing a moment of major cultural advancements, the cardiovascular risk management in type 2 diabetes mellitus. Data synthesis Consists of six chapters that examine various aspects of pathophysiology, diagnosis and therapy which in recent months have seen numerous scientific innovations and several clinical studies that require extensive sharing. Conclusions The continuous evolution of our knowledge in this field confirms the great cultural vitality of these two cultural spheres, which requires, under the leadership of the scientific Societies, an ever greater and effective collaboration.
- Published
- 2021
45. Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension
- Author
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George Stergiou, Mattias Brunström, Thomas MacDonald, Konstantinos G. Kyriakoulis, Michael Bursztyn, Nadia Khan, George Bakris, Anastasios Kollias, Ariadni Menti, Paul Muntner, Marcelo Orias, Neil Poulter, Daichi Shimbo, Bryan Williams, Abiodun Moshood Adeoye, Albertino Damasceno, Lyudmila Korostovtseva, Yan Li, Elizabeth Muxfeldt, Yuqing Zhang, Giuseppe Mancia, Reinhold Kreutz, and Maciej Tomaszewski
- Subjects
Physiology ,Hypertension ,Internal Medicine ,Humans ,Blood Pressure ,Prospective Studies ,Blood Pressure Monitoring, Ambulatory ,Cardiology and Cardiovascular Medicine ,Antihypertensive Agents ,Circadian Rhythm - Abstract
Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.
- Published
- 2022
46. PEDOT Decorated with PtIr Nanoclusters on Carbon Fiber Paper toward Electrocatalytic Reduction of a Hypertensive Drug Olmesartan Medoxomil.
- Author
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Akshaya, K. B., Vinod, T. P., Nidhin, M., Varghese, Anitha, and George, Louis
- Subjects
ELECTROCHEMICAL sensors ,CARBON fibers ,ANTIHYPERTENSIVE agents - Abstract
A facile electrochemical sensor was developed by electrochemical deposition of PtIr nanoparticles on poly(3,4- ethylenedioxythiophene) (PEDOT) modified carbon fiber paper electrode (CFP). The modified electrodes were characterized by Field emission scanning electron microscopy (FESEM) with energy-dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), RAMAN spectroscopy, Fourier transform infrared spectroscopy (FTIR) and electroanalytical techniques. PtIr-PEDOT modified CFP electrode was used successfully in the determination of an anti-hypertensive prodrug Olmesartan medoxomil (OM) at femtomolar (fM) level for the first time. Under optimal conditions, the prepared electrochemical sensor has shown broad linear range between 0.001 pM and 0.220 pM and superior detection limit of 3.42 fM was observed based on Differential pulse voltammetric (DPV) study. In addition, the designed electrochemical sensor was successfully demonstrated as a novel platform in the electrochemical determination of OM in human urine and pharmaceutical samples. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
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47. Update of the position paper on arterial hypertension and erectile dysfunction
- Author
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Nikolaos Ioakeimidis, Konstantinos Tsioufis, Jacek Wolf, Margus Viigimaa, Konstantinos Stavropoulos, Athanasios J. Manolis, Charalambos Vlachopoulos, Andres Kotsar, Dimitios Terentes-Printzios, Michael Doumas, Giuseppe Mancia, Urmo Kiitam, Reinhold Kreutz, Dragan Lovic, Konstantinos Imprialos, Krzysztof Narkiewicz, and Bojan Jelaković
- Subjects
Male ,medicine.medical_specialty ,Physiology ,Adrenergic beta-Antagonists ,Cardiology ,Coronary Artery Disease ,Disease ,030204 cardiovascular system & hematology ,Nebivolol ,Impotence, Vasculogenic ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Erectile Dysfunction ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Testosterone ,Endothelium ,030212 general & internal medicine ,Endothelial dysfunction ,Antihypertensive Agents ,Societies, Medical ,business.industry ,Penile Erection ,Arteries ,Phosphodiesterase 5 Inhibitors ,Atherosclerosis ,medicine.disease ,Sexual Dysfunction, Physiological ,Sexual dysfunction ,Erectile dysfunction ,Cardiovascular Diseases ,Hypertension ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Dyslipidemia ,medicine.drug - Abstract
Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.
- Published
- 2020
48. Prognostic value of home blood pressure monitoring in patients under antihypertensive treatment.
- Author
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Barochiner J, Aparicio LS, Martínez R, and Boggia J
- Subjects
- Male, Humans, Aged, Female, Prognosis, Blood Pressure Monitoring, Ambulatory, Reproducibility of Results, Antihypertensive Agents adverse effects, Hypertension diagnosis, Hypertension drug therapy
- Abstract
The prognostic value of home blood pressure monitoring (HBPM) has been investigated in several studies in the general population, demonstrating its independent association with cardiovascular events. However, in the case of treated hypertensive subjects, evidence is controversial. Our purpose was to evaluate the prognostic value of HBPM in this population. Medicated hypertensive patients who performed a 4-day HBPM (Omron® HEM-705CP-II) between 2008 and 2015 were followed up for a median of 5.9 years, registering the occurrence of a composite primary outcome of fatal and non-fatal cardiovascular events. Cox regression models were used to analyze the prognostic value of HBPM, considering 4-day measurements, discarding the first day, and analyzing morning, afternoon and evening periods separately. We included 1582 patients in the analysis (33.4% men, median age 70.8 years, on an average of 2.1 antihypertensive drugs). During follow-up, 273 events occurred. HBPM was significantly associated with cardiovascular events in all five scenarios in the unadjusted models. When adjusting for office BP and other cardiovascular risk factors, the association remained marginally significant for the 4-day period, discarding first-day measurements HBPM (HR 1.04 [95% CI 1-1.1] and 1.04 [95% CI 1-1.1], respectively) and statistically significant for all separate periods of measurement: HR 1.32 (95% CI 1.01-1.72); 1.33 (95% CI 1.02-1.72); and 1.30 (95% CI 1.01-1.67), for morning, afternoon and evening, respectively. When analyzing separately fatal and non-fatal events, statistical significance was held for the former only. In conclusion, HBPM is an independent predictor of cardiovascular events in hypertensives under treatment., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)
- Published
- 2023
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49. Sex and gender in hypertension guidelines.
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Meinert F, Thomopoulos C, and Kreutz R
- Subjects
- Humans, Male, Female, Guidelines as Topic, Sex Factors, Blood Pressure, Hypertension diagnosis, Hypertension drug therapy, Hypertension epidemiology, Antihypertensive Agents therapeutic use
- Abstract
This paper reviews 11 current and previous international and some selected national hypertension guidelines regarding sex and gender-related differences. Those differences can be attributed to biological sex and to gender differences that are determined by socially constructed norms. All reviewed guidelines agree on a higher hypertension prevalence in men than in women. They also concur that evidence does not support different blood pressure thresholds and targets for treatment between men and women. Differences refer in addition to the differences in epidemiological aspects to differences in some morphometric diagnostic indices, e.g., left ventricular mass or the limits for daily alcohol intake. Concerning practical management, there are hardly any clear statements on different procedures that go beyond the consensus that blockers of the renin-angiotensin system should not be used in women of childbearing age wishing to become pregnant. Some further sex-specific aspects are related to differences in tolerability or drug-specific side effects of BP-lowering drugs. There is also a consensus about the need for blood pressure monitoring before and during the use of contraceptive pills. For management of pregnancy, several guidelines still recommend no active treatment in pregnant women without severe forms of hypertension, despite a wide consensus about the definition of hypertension in pregnancy. A disparity in treatment targets when treating severe and non-severe hypertension in pregnancy is also observed. Overall, sex-specific aspects are only very sparsely considered or documented in the evaluated guidelines highlighting an unmet need for future clinical research on this topic., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
50. Population pharmacokinetic modelling to quantify the magnitude of drug-drug interactions between amlodipine and antiretroviral drugs.
- Author
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Courlet P, Guidi M, Alves Saldanha S, Cavassini M, Stoeckle M, Buclin T, Marzolini C, Decosterd LA, and Csajka C
- Subjects
- Aged, Area Under Curve, Cytochrome P-450 CYP3A Inducers, Drug Interactions, Female, Humans, Male, Middle Aged, Socioeconomic Factors, Amlodipine pharmacokinetics, Anti-Retroviral Agents pharmacology, Antihypertensive Agents pharmacokinetics, Cytochrome P-450 CYP3A pharmacology, Cytochrome P-450 CYP3A Inhibitors pharmacology, Models, Biological
- Abstract
Purpose: Drug-drug interactions (DDIs) with antiretroviral drugs (ARVs) represent an important issue in elderly people living with HIV (PLWH). Amlodipine is a commonly prescribed antihypertensive drug metabolized by CYP3A4, thus predisposed to a risk of DDIs. Guidance on the management of DDIs is mostly based on theoretical considerations derived from coadministration with other CYP3A4 inhibitors. This study aimed at characterizing the magnitude of DDIs between amlodipine and ARV drugs in order to establish dosing recommendations., Methods: A population pharmacokinetic analysis was developed using non-linear mixed effect modelling (NONMEM) and included 163 amlodipine concentrations from 55 PLWH. Various structural and error models were compared to characterize optimally the concentration-time profile of amlodipine. Demographic and clinical characteristics as well as comedications were tested as potential influential covariates. Model-based simulations were performed to compare amlodipine exposure (i.e. area under the curve, AUC) between coadministered ARV drugs., Results: Amlodipine concentration-time profile was best described using a one-compartment model with first-order absorption and a lag-time. Amlodipine apparent clearance was influenced by both CYP3A4 inhibitors and efavirenz (CYP3A4 inducer). Model-based simulations revealed that amlodipine AUC increased by 96% when coadministered with CYP3A4 inhibitors, while efavirenz decreased drug exposure by 59%., Conclusion: Coadministered ARV drugs significantly impact amlodipine disposition in PLWH. Clinicians should adjust amlodipine dosage accordingly, by halving the dosage in PLWH receiving ARV with inhibitory properties (mainly ritonavir-boosted darunavir), whereas they should double amlodipine doses when coadministering it with efavirenz, under appropriate monitoring of clinical response and tolerance.
- Published
- 2021
- Full Text
- View/download PDF
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