Hypertension Treatment and Control in Five European Countries, Canada, and the United States

Wolf-Maier, Katharina; Cooper, Richard S.; Kramer, Holly; Banegas, José R.; Giampaoli, Simona; Joffres, Michel; Poulter, Neil; Primatesta, Paola; Stegmayr, Birgitta; Thamm, Michael

doi:10.1161/01.hyp.0000103630.72812.10

Cited by 957 publications

(682 citation statements)

References 32 publications

(24 reference statements)

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“…Of these, 41% receive an antihypertensive treatment that results in 60% and 30% response rates at thresholds of 160/95 and 140/90 mmHg respectively. This leads to the most unfavourable situation that only 8% of all hypertensive individuals are controlled at guideline levels of <140/ 90 mmHg (Wolf-Maier et al 2004). Under these conditions, genetic abnormalities that markedly impact blood pressure variation should also materialize as stroke genes.…”

Section: Hypertension and Strokementioning

confidence: 99%

Genetics of arterial hypertension and hypotension

Rosskopf

Schürks

Rimmbach

et al. 2007

Naunyn-Schmied Arch Pharmacol

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Human hypertension affects affects more than 20% of the adult population in industrialized countries, and it is implicated in millions of deaths worldwide each year from stroke, heart failure and ischemic heart disease. Available evidence suggests a major genetic impact on blood pressure regulation. Studies in monogenic hypertension revealed that renal salt and volume regulation systems are predominantly involved in the genesis of these disorders. Mutations here affect the synthesis of mineralocorticoids, the function of the mineralocorticoid receptor, epithelial sodium channels and their regulation by a new class of kinases, termed WNK kinases. It has been learned from monogenic hypotension that almost all ion transporters involved in the renal uptake of Na + have a major impact on blood pressure regulation. For essential hypertension as a complex disease, many candidate genes have been analysed. These include components of the reninangiotensin-aldosterone system, adducin, β-adrenoceptors, G protein subunits, regulators of G protein signalling (RGS) proteins, Rho kinases and G protein receptor kinases. At present, the individual impact of common polymorphisms in these genes on the observed blood pressure variation, on risk for stroke and as predictors of antihypertensive responses remains small and clinically irrelevant. Nevertheless, these studies have greatly augmented our knowledge on the regulation of renal functions, cellular signal transduction and the integration of both. Together, this provides the basis for the identification of novel drug targets and, hopefully, innovative antihypertensive drugs.

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Section: Hypertension and Strokementioning

confidence: 99%

Genetics of arterial hypertension and hypotension

Rosskopf

Schürks

Rimmbach

et al. 2007

Naunyn-Schmied Arch Pharmacol

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“…2 However, data from national surveys and other sources suggest a high prevalence of uncontrolled hypertension, with up to two-thirds of individuals with hypertension being inadequately treated. 3 All current hypertension treatment guidelines agree that the major benefit of treatment is associated with improved BP control. The European guidelines (ESH/ESC, 2007) suggest that all five major classes of anti-hypertensive agents are suitable for the initiation and maintenance of antihypertensive treatment, and furthermore suggest that, because many patients require more than one drug, emphasis on identification of the first class of drugs to be used is often futile.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the efficacy of candesartan and losartan: a meta-analysis of trials in the treatment of hypertension

2009

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Informed by the findings from prospective observational studies and randomized outcome trials, guidelines for the management of hypertension acknowledge that the benefit of treatment can be attributed largely to blood pressure (BP) reduction. Therefore, quantification of differential BP lowering of different agents within classes of anti-hypertensives is of practical importance. The objective of this analysis was to compare the efficacy of candesartan and losartan with respect to reduction in systolic and diastolic BP (SBP and DBP). A systematic literature search of databases from 1980 to 1 October 2008 identified 13 studies in which candesartan and losartan were compared in randomized trials in hypertensive patients. Data from 4066 patients were included in the analysis using a random effect model. Mean changes in SBP and DBP were compared for each drug alone and after stratification for dose and for combination with hydrochlorothiazide (HCTZ). On the basis of all the data, the weighted mean difference favoured candesartan-3.22 mm Hg (95% confidence interval (CI) 2.16, 4.29) for SBP and 2.21 mm Hg (95% CI 1.34, 3.07) for DBP. These findings were consistent when analyses according to dose and combination with HCTZ were carried out. Thus, it can be concluded that at currently recommended doses, candesartan is more effective than losartan in lowering BP.

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“…To obtain adequate BP reduction, in particular over the entire 24-h period, a combination of two or more antihypertensive drugs is required in most patients. [1][2][3]5,18 Combinations involving a CCB with a blocker of the renin-angiotensin-aldosterone system (RAAS), for example, an ARB or ACE-I, are among those recommended by the guidelines 19,20 and are becoming increasingly used in clinical practice. Their usefulness is based on a favorable pharmacodynamic profile (different mechanisms of antihypertensive action favor efficacy, while RAAS blockade counteracts edema formation caused by dihydropyridines), which translates into clinical benefits in terms of effectiveness in achieving BP control and tolerability.…”

Section: Discussionmentioning

confidence: 99%

“…1-3 However, most patients do not achieve target BP levels, and the majority of them require combination therapy with two or more drugs in order to obtain an adequate BP reduction. [1][2][3][4][5] The ACCOMPLISH (Avoiding Cardiovascular events through COMbination therapy in Patients Living with Systolic Hypertension) study has shown that treatment with the combination of an angiotensin-converting enzyme inhibitor (ACE-I) and a calcium channel blocker (CCB) may not only be effective in achieving BP control and well tolerated, but may also reduce cardiovascular event rates to a larger extent than an ACE-I plus diuretic combination. 6 Single-pill combinations of CCBs and angiotensin II receptor blockers (ARBs) are now available and have been reported to be widely used, well tolerated and effective treatments for controlling BP.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of olmesartan/amlodipine combination therapy in reducing ambulatory blood pressure in moderate-to-severe hypertensive patients not controlled by amlodipine alone

Bilo

Koch²,

Hoshide

et al. 2014

Hypertens Res

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This previously unpublished, preplanned analysis investigated the efficacy of the olmesartan/amlodipine combination at different doses on 24-h blood pressure (BP) control, as well as assessed trough estimation of trough-to-peak ratio (TPR) and smoothness index (SI). Ambulatory BP monitoring was performed in patients with moderate-to-severe hypertension whose BP was inadequately controlled after 8 weeks' treatment with amlodipine 5 mg. Patients were randomized to continue with amlodipine 5 mg or to receive olmesartan/amlodipine 10/5, 20/5 or 40/5 mg for 8 weeks (Period II). Patients not achieving BP control were uptitrated to a more powerful regimen for another 8 weeks (Period III). During Period II, each olmesartan/ amlodipine combination reduced 24-h systolic and diastolic BP (SBP/DBP), as well as morning and early morning SBP/DBP, significantly more than amlodipine 5 mg (Po0.001 for all). TPRs were higher in each olmesartan/amlodipine group than with amlodipine 5 mg, and SI values showed dose-related increases; olmesartan/amlodipine 40/5 mg produced a significantly higher SI for SBP and DBP (1.55 and 1.33, respectively) than amlodipine 5 mg (0.96 and 0.77, respectively, Po0.0001 for each). During Period III, uptitrated patients showed further BP reductions, which were largest in those on olmesartan/amlodipine 40/10 mg. SI values increased in uptitrated patients and were highest with olmesartan/amlodipine 40/10 mg (SBP 1.62/DBP 1.41). The olmesartan/amlodipine combination effectively reduces BP over 24 h, including the morning hours, in a dose-related manner. Compared with amlodipine alone, the olmesartan/amlodipine combination has a better 24-h coverage (TPR) and a dose-related improvement in BP lowering homogeneity (SI).

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Hypertension Treatment and Control in Five European Countries, Canada, and the United States

Abstract: Abstract-Levels

Cited by 957 publications

References 32 publications

Genetics of arterial hypertension and hypotension

Genetics of arterial hypertension and hypotension

Comparison of the efficacy of candesartan and losartan: a meta-analysis of trials in the treatment of hypertension

Efficacy of olmesartan/amlodipine combination therapy in reducing ambulatory blood pressure in moderate-to-severe hypertensive patients not controlled by amlodipine alone

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