Classes of antihypertensive medications and blood pressure control in relation to metabolic risk factors

Marco, Marina De; Simone, Giovanni de; Izzo, Raffaele; Mancusi, Costantino; Sforza, Antonio; Giudice, Renata Del; Trimarco, Bruno; Luca, Nicola De

doi:10.1097/hjh.0b013e32834e1eda

Cited by 26 publications

(21 citation statements)

References 35 publications

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“…25 Taken altogether, these findings strongly suggest that aggressive antihypertensive management should be adopted as soon as possible to optimally control BP and prevent development of target organ damage 26 because once hypertensive target organ damage is advanced, slowing down progression might be difficult, 27 especially in a real-world context, where coexistent risk factors are likely to be present.…”

Section: Discussionmentioning

confidence: 99%

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

et al. 2017

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L eft ventricular (LV) hypertrophy (LVH) is a marker of target organ damage in hypertension and helps stratifying cardiovascular risk.1,2 The effect of LVH on incident cardiovascular events is independent of conventional risk factors and of coronary artery disease. [3][4][5] In selected subsets of nondiabetic patients, LVH also precedes new onset of diabetes mellitus, 6 suggesting that hypertensive target organ damage might be also a marker of complex metabolic changes associated with the evolution of arterial hypertension.Prevention of the development of target organ damage should be, therefore, the main goal of management of arterial hypertension. 7,8 The most modifiable parameter to achieve this goal is the effective control of blood pressure (BP) using appropriate antihypertensive medications. There is no information on whether LVH could develop during antihypertensive regimen. However, we recently demonstrated that carotid plaque can develop in a specific patient phenotype, independently of optimal BP control. 10 In that study, we found that risk of incident carotid plaque was higher in older diabetic or smoker patients with chronic renal failure and higher initial intima-media thickness complex, suggesting that earlier antihypertensive management might be more beneficial to reduce and prevent target organ damage.In the present analysis, we evaluate whether LVH occurs during antihypertensive therapy and whether a specific phenotype can be identified at risk of incident LVH, in a large treated hypertensive population from a regional Italian registry. Methods Study PopulationHypertensive patients were selected from the Campania Salute Network (CSN) Registry. The CSN is an open registry collecting information from general practitioners and community hospitals networked with the Hypertension Research Center of the Federico Abstract-There is little information on left ventricular (LV) hypertrophy (LVH) development during antihypertensive treatment. We evaluate incident LVH in a treated hypertensive cohort, the Campania Salute Network registry. We analyzed prospectively 4290 hypertensives (aged 50.3±11.1 years, 40% women) with at least 1-year follow-up, without LVH at baseline. Incident LVH was defined as the first detection of echocardiographic LV mass index ≥47 in women or ≥50 g/m 2.7 in men. During a median 48-month follow-up, 915 patients (21.3%) developed LVH. They were older, more frequently women, and obese (P<0.0001), with initial higher fasting glucose, diastolic and systolic blood pressure, LV mass index, lower heart rate and glomerular filtration rate, longer hypertension history and follow-up, and higher average systolic blood pressure during follow-up (all P<0.05), despite a more frequent treatment with Ca ++ -channel blockers and diuretics (both P<0.02). At multivariable Cox regression, incident LVH was independently associated with older age, female sex, obesity, higher average systolic blood pressure during follow-up, and initial greater LV mass index (all P<0.02). By categorizing patients a...

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Section: Discussionmentioning

confidence: 99%

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

et al. 2017

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“…68 in the Campania salute network, 69 an open electronic registry generated from a network of 23 community hospitals and 60 general practitioners in the Campania District, the underuse of diuretics was one of the independent correlates of insufficient Bp control. 70 table 2 shows the complexity of hypertensive participants of the Campania salute network, making evident the variety of clinical presentations of an open outpatient clinic, as compared with the selections operated in rCts. in the Campania salute network, at presentation in the outpatient clinic, 6% of hypertensive patients had prevalent coronary heart disease; 60% had chronic kidney disease of whom 10% were with stage 3 or greater; 33% exhibited carotid atherosclerosis; and 32% had LvH.…”

Section: The Real Worldmentioning

confidence: 99%

“…Comparing these features with the selection criteria required by the major trials, only a minority of these patients could have been enrolled. epidemiological studies also indicate that the association of arterial hypertension with other Cv risk factors or metabolic syndrome makes effective control of Bp much more difficult even if aggressive therapy is used, [70][71][72] paralleling the less effective reduction of LvH, as shown in the Losartan intervention for endpoint reduction in Hypertension (LiFe) study. 73 in the American indian cohort of the strong Heart study, left ventricular mass index tended to increase in treated hypertensive participants, over 4 years of follow-up.…”

Section: The Real Worldmentioning

confidence: 99%

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

2013

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“…As for the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III), MS represents the combination of at least three CRFs in an adult: abdominal obesity, increased triglycerides (TG), glucose intolerance, HDL-cholesterol (HDL-c) and increased blood pressure (BP) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Comparing the Diagnostic Criteria of Metabolic Syndrome in Schoolchildren: Cross-sectional Study

Cirino¹,

Silva²,

Oliveira³

et al. 2017

int arch med

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Introduction: The Metabolic Syndrome has been highlighted by being the result of the meeting of several cardiovascular risk factors. However, there is still no consensus for the determination of MS in children and adolescents, since the diagnostic criteria and its cut-off points considered at risk are not established and, depending on the criteria used, the prevalence of MS found in the literature may vary. Objective:To compare the diagnostic criteria for metabolic syndrome in adolescents in the private school system.Method: This is a cross-sectional study of 325 adolescents from private schools in the urban area of a city in northeastern Brazil. The analysis was performed through the descriptive statistics, and the verification of the agreement between the results was given by the calculation of the Kappa index. The study was approved by the Ethics Committee (opinion 352.372). Results:In only 7 adolescents, the diagnosis was like the three definitions of metabolic syndrome. Regarding the number of components of metabolic syndrome, a large percentage of adolescents presented 02 or more altered parameters. Regarding the comparison of the diagnostic criteria, the criteria established by De Ferranti presented a higher positive proportion for the syndrome.Conclusion: There were differences between the proportions obtained through the three diagnostic criteria, which may impair the diagnosis of the metabolic syndrome in adolescents.

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Classes of antihypertensive medications and blood pressure control in relation to metabolic risk factors

Abstract: Despite the use of increased number of medications, hypertensive patients with MetS are at higher risk of uncontrolled BP. Among classes of antihypertensive medications, increased prescriptions of DRTs, RAS-blockers and also statins decrease the probability of poor BP control.

Cited by 26 publications

References 35 publications

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

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

Comparing the Diagnostic Criteria of Metabolic Syndrome in Schoolchildren: Cross-sectional Study

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