Are Observational Studies More Informative Than Randomized Controlled Trials in Hypertension?

Simone, Giovanni de; Izzo, Raffaele; Verdecchia, Paolo

doi:10.1161/hypertensionaha.113.00727

Cited by 20 publications

(16 citation statements)

References 77 publications

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“…Recently, results from the Strong Heart Study, a population‐based cohort, including hypertensive patients with multiple cardiovascular risk factors and comorbidities, demonstrated an average increase in LV mass (LVM) during follow‐up, even in the subpopulation with optimal BP control . These findings suggest that in the real world, there might be problems in achieving effective LVH regression, which are not explored in clinical trials that are conducted in selected hypertensive populations …”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Hypertrophy Regression During Antihypertensive Treatment in an Outpatient Clinic (the Campania Salute Network)

Lønnebakken

Izzo

Mancusi

et al. 2017

JAHA

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100

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BackgroundRegression of left ventricular (LV) hypertrophy (LVH) has been a goal in clinical trials. This study tests the external validity of results of clinical trials on LVH regression using a large registry from a tertiary care center, to identify phenotypes less likely to achieve regression of LVH.Methods and ResultsPatients from the Campania Salute Network, free of prevalent cardiovascular disease, but with echocardiographic LVH (defined as LV mass index [LVMi] >47 g/m2.7 in women and >50 g/m2.7 in men) were included. During a median follow‐up of 67 months, clear‐cut regression of LVH was documented in 14% of patients (13±8% reduction of initial LVMi) or 23% when also considering those with a reduction of LVMi ≥5 g/m2.7. Patients with persistent LVH were older with longer duration of hypertension, suboptimal blood pressure (BP) control, larger body mass index, LV mass, and carotid intima‐media thickness and included more women and subjects with diabetes mellitus, isolated systolic hypertension, and metabolic syndrome (all P<0.05). Number and class of antihypertensive drugs during follow‐up did not differ between groups. In multiple logistic regression analysis, older age, female sex, obesity, higher baseline LVMi and carotid intima‐media thickness, and suboptimal BP control were significant covariates of persistent LVH (all P≤0.01), independent of diabetes, duration of hypertension, isolated systolic hypertension, follow‐up time and number and class of antihypertensive drugs.ConclusionsEarly initiation of antihypertensive treatment, aggressive BP control, and attention to metabolic aspects are critical to avoid irreversible LVH.

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Section: Introductionmentioning

confidence: 99%

Left Ventricular Hypertrophy Regression During Antihypertensive Treatment in an Outpatient Clinic (the Campania Salute Network)

Lønnebakken

Izzo

Mancusi

et al. 2017

JAHA

Self Cite

100

View full text Add to dashboard Cite

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“…Specifically, the interaction of CV risk factors with structural and hemodynamic alterations as combined promoters of incident AF is not yet well studied [1], especially in a real-word context. The relatively disappointing results of strategies for primary prevention [5] might be at least in part due to the lack of a real-word approach, weighing all possible confounders [10].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular ultrasound exploration contributes to predict incident atrial fibrillation in arterial hypertension: The Campania Salute Network

Losi¹,

Izzo²,

Marco³

et al. 2015

International Journal of Cardiology

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“…However, because such results are usually obtained from a restricted dosing regimen in selected patients, it is difficult to generalize the demonstrated efficacy and safety (9,10). Therefore, such results have to be complemented by observational or surveillance studies before they are put to practical use in the routine clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure control with cilnidipine treatment in Japanese post-stroke hypertensive patients: The CA-ATTEND study

Aoki

Hosomi

Nezu

et al. 2017

Clinical and Experimental Hypertension

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Blood pressure control is important in post-stroke hypertensive patients and antihypertensive treatment is recommended for such patients. Ca-channel blockers are recommended as the medications of choice for the treatment of post-stroke patients. Here, we report the results of a large-scale prospective postmarketing surveillance study of post-stroke hypertensive patients (n = 2667, male 60.4%, 69.0 ± 10.9 years) treated with cilnidipine, with regard to blood pressure control and adverse reactions. Cilnidipine treatment caused a decrease in both clinic and home blood pressures 2 months after the beginning of treatment, and the decreased blood pressure was maintained until the end of 12 months' observation. The proportion of patients in whom clinic blood pressure was well controlled (<140/90 mmHg) increased from 21.5% to 65.3% in cilnidipine treatment, with no differences in effectiveness among the various clinical subtypes of stroke. In total, 346 adverse events occurred, with an overall incidence of 8.9% (238 of 2667 patients). In the elderly group, specifically, a fall and a hip fracture each occurred in 1 (0.1%) patient. These results indicate that cilnidipine was effective in treating uncontrolled blood pressure and was well tolerated in Japanese post-stroke hypertensive patients in a real-world clinical setting. ARTICLE HISTORY

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Are Observational Studies More Informative Than Randomized Controlled Trials in Hypertension?

Cited by 20 publications

References 77 publications

Left Ventricular Hypertrophy Regression During Antihypertensive Treatment in an Outpatient Clinic (the Campania Salute Network)

Left Ventricular Hypertrophy Regression During Antihypertensive Treatment in an Outpatient Clinic (the Campania Salute Network)

Cardiovascular ultrasound exploration contributes to predict incident atrial fibrillation in arterial hypertension: The Campania Salute Network

Blood pressure control with cilnidipine treatment in Japanese post-stroke hypertensive patients: The CA-ATTEND study

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