We investigated morning home blood pressure (BP)- and heart rate (HR)-lowering effects of 2.5/5 mg bisoprolol in 70 patients with essential hypertension. After 4 weeks of treatment, mean home systolic/diastolic BP and HR significantly decreased by 2.6/5.2 mm Hg and by 8.1 bpm, respectively (all P < .05). The time required to reach 95% of the maximum lowering effect of bisoprolol (stabilizing time) was 5.1 days for home systolic BP (P = .2), 5.1 days for home diastolic BP (P = .0007), and 4.3 days for home HR (P < .0001). We demonstrated that the administration of low-dose bisoprolol significantly and rapidly decreased home BP and HR.
[Show abstract][Hide abstract] ABSTRACT: The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial was designed to test the hypothesis that for the same blood-pressure control, valsartan would reduce cardiac morbidity and mortality more than amlodipine in hypertensive patients at high cardiovascular risk.
15?245 patients, aged 50 years or older with treated or untreated hypertension and high risk of cardiac events participated in a randomised, double-blind, parallel-group comparison of therapy based on valsartan or amlodipine. Duration of treatment was event-driven and the trial lasted until at least 1450 patients had reached a primary endpoint, defined as a composite of cardiac mortality and morbidity. Patients from 31 countries were followed up for a mean of 4.2 years.
Blood pressure was reduced by both treatments, but the effects of the amlodipine-based regimen were more pronounced, especially in the early period (blood pressure 4.0/2.1 mm Hg lower in amlodipine than valsartan group after 1 month; 1.5/1.3 mm Hg after 1 year; p<0.001 between groups). The primary composite endpoint occurred in 810 patients in the valsartan group (10.6%, 25.5 per 1000 patient-years) and 789 in the amlodipine group (10.4%, 24.7 per 1000 patient-years; hazard ratio 1.04, 95% CI 0.94-1.15, p=0.49).
The main outcome of cardiac disease did not differ between the treatment groups. Unequal reductions in blood pressure might account for differences between the groups in cause-specific outcomes. The findings emphasise the importance of prompt blood-pressure control in hypertensive patients at high cardiovascular risk.
The Lancet 06/2004; 363(9426):2022-31. DOI:10.1016/S0140-6736(04)16451-9 · 45.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Only a minority of hypertensive individuals is adequately controlled for their hypertension, partially because reliable predictors for efficient antihypertensive drug therapy are lacking.
In a prospective, randomized, double-blind, cross-over, placebo-controlled study (The GENRES Study), 208 moderately hypertensive Finnish men (aged 35 to 60 years) were treated for 4 weeks with antihypertensive drugs from four different classes: amlodipine (5 mg), bisoprolol (5 mg), hydrochlorothiazide (25 mg), or losartan (50 mg) daily. Each individual received each of the four monotherapies in a randomized order. Four-week placebo periods were included before and between drug treatment periods. Antihypertensive responses were assessed with 24-h ambulatory and office measurements and analyzed according to age, body mass index, triceps skin fold thickness, waist-to-hip ratio, duration of hypertension, number of previous antihypertensive drugs, number of affected parents, and blood pressure (BP) levels, and profiles during placebo periods.
The median BP responses in 24-h ambulatory recordings (systolic/diastolic) were 11/8 mm Hg for bisoprolol, 9/6 mm Hg for losartan, 7/5 mm Hg for amlodipine, and 5/2 mm Hg for hydrochlorothiazide. The highest pairwise within-subject correlations in BP responses were seen for the combinations of bisoprolol-losartan and amlodipine-hydrochlorothiazide. The BP responses to bisoprolol and losartan did not vary according to the variables. Amlodipine and hydrochlorothiazide responses were positively correlated with age, placebo BP level, and lower night-time dipping on placebo.
Baseline clinical and BP parameters may be used to predict the efficacy of antihypertensive therapies. The GENRES Study material should provide an excellent platform for future pharmacogenetic analyses of antihypertensive drug responsiveness.
American Journal of Hypertension 04/2007; 20(3):311-8. DOI:10.1016/j.amjhyper.2006.09.006 · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recently, it was found that resting heart rate (HR) measured at home (home HR), as well as self-measured blood pressure (BP) at home (home BP), was a strong predictor of the risk of cardiovascular disease mortality in the general Japanese population. It was also reported that home BP levels were not adequately controlled in hypertensive patients. Little information, however, is available on the current status of home HR control in treated patients with hypertension. The objective of this study was to examine the current status of home HR control and home BP control among treated patients with hypertension.
Home HR and BP were measured using a self-monitored BP measuring device. Morning home HR and BP were obtained in 3183 patients and evening home HR and BP were obtained in 3106 patients. On the basis of an earlier study, we defined a home HR value of >or=70 beats/min as 'high home HR'.
The mean home HR value was 67.2+/-9.1 beats/min in the morning and 69.6+/-9.2 beats/min in the evening. Of the 3183 patients, 35.7% had a high home HR in the morning and 46.7% of the 3106 patients had a high home HR in the evening. The prevalence of patients with a high home HR and a controlled home BP (<135/85 mmHg) was 11.3% in the morning and 24.2% in the evening.
Resting home HR control and home BP control were inadequate.
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