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Background: Although insulin resistance (IR) is present in non-diabetic subjects, it is

SummaryCurrently there is no consensus regarding which add-on therapy to use in resistant hypertension. We have conducted an open observational study of the use of aliskiren in resistant hypertensive patients. Forty-three patients with resistant hypertension were included in the study. The inclusion criteria were as follows: 1) office blood pressure (BP) > 140/90 mmHg despite treatment with at least three or more antihypertensive drugs; 2) no prior therapy with aliskiren; and 3) no renal insufficiency. Follow-up BP was determined at 1 and 3 months. Baseline BP was 153 ± 12/79 ± 12 mmHg. After 3 months, systolic BP (SBP) and diastolic BP (DBP) dropped significantly: 140 ± 19/73 ± 13 mmHg (P < 0.0001). Twenty-one patients (49%) had an office BP < 140/90 mmHg, and these patients were assigned to the good BP control group. Another 22 were placed into the poor BP control group. BP reductions from baseline in the good BP control group (SBP/ DBP: 19 ± 11/8 ± 7 mmHg) were larger than those in the poor BP control group (5 ± 15/3 ± 9 mmHg, P < 0.05). Mean BP (MBP) values at baseline, 1, and 3 months were higher in the poor BP control group. There was no significant difference in pulse pressure at baseline between the 2 groups. In multivariate analysis, only MBP at baseline correlated with lack of BP control. Aliskiren administration to resistant hypertensive patients was effective in reducing BP. The present findings suggest aliskiren may be useful as a fourth-line or fifth-line treatment added to other drugs in the treatment of resistant hypertension. (Int Heart J 2013; 54: 88-92) Key words: Uncontrolled hypertension, Pulse pressure, Mean blood pressure A lthough various authors use different definitions, resistant hypertension is defined as blood pressure (BP) that requires the use of four or more antihypertensive agents, whether controlled or uncontrolled. 1) Approximately 30% of adults who have hypertension are unaware of their condition, and about half of patients receiving treatment in Japan do not achieve the modest goal of < 140 / 90 mmHg. 2) In the absence of a definitive study, clinical trials have been largely relied upon as surrogate opportunities to estimate the prevalence of resistant hypertension. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is likely the most relevant, in that it included a large and diverse cohort, and, per protocol, subjects were to have continued escalation of their treatment regimen as long as the BP remained elevated. At the end of the 5-year treatment period, uncontrolled hypertension was common in ALLHAT, with 34% of subjects never having achieved BP control and with 27% of subjects receiving ≥ 3 antihypertensive medications. 3) Data from a large, community-based study indicated that 12.7% of hypertensive patients were uncontrolled on three or more medications. 4) Recently, de la Sierra, et al presented analysis of data from their large registry of Spanish patients who had 24-hour ambulatory BP monitoring performed. 5) They gathered dat...

SUMMARYFew studies have examined predictors of poor blood pressure (BP) control. The aim of this study was to observe the relationship between the pulsatility of brachial artery pressure characterized as pulse pressure/diastolic pressure (PP/DP), suggesting aortic input impedance, and poor BP control.We obtained office BP measurements for 94 patients aged 40-75 years with either office systolic BP (SBP) ≧ 140 mmHg or diastolic BP (DBP) ≧ 90 mmHg. Patients were given a single antihypertensive agent or were untreated at baseline. The angiotensin II receptor blocker valsartan (80 mg) was administered to all patients. Patients were treated with 1 to 2 antihypertensive drugs (valsartan only or valsartan + Ca antagonist) for 6 months to achieve an office BP of less than 140/90 mmHg.At follow-up, 32 patients were taking a single drug (valsartan) with good BP control, 24 were receiving two drugs with good BP control, and 38 were on two drugs with poor BP control. SBP and DBP at baseline were similar in the 3 groups. PP/DP at baseline differed in the 3 groups (P < 0.01). In multivariate analysis, only PP/DP at baseline correlated with lack of BP control.The pulsatility of brachial artery pressure is associated with achieving adequate BP control. (Int Heart J 2008; 49: 295-302) Key words: Angiotensin II receptor blocker, Pulsatility index, Pulse pressure EPIDEMIOLOGIC studies have shown that people with high blood pressure (BP) are at greater risk for cardiovascular or cerebrovascular events. [1][2][3][4] The goal in the management of hypertension is to reduce the incidence of morbidity and mortality from cardiovascular events. Although the importance of reducing BP is well known, only one quarter of hypertensive patients are adequately controlled to a BP of 140/90 mmHg or less.5) Fewer than 30% in the USA, and only 6% in the UK had attained BP values < 140/90 mmHg. 5,6) In addition, recent clinical trials suggest that resistant hypertension is increasingly common.5) Therefore,