Principal Results of the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS)

Group, JATOS Study

doi:10.1291/hypres.31.2115

Cited by 349 publications

(230 citation statements)

References 35 publications

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“…We observed lower prevalence and odds of treatment intensification in older adults; this may result from a relative lack of evidence supporting a goal SBP less than 150 mm Hg in the elderly28, 29 until the recent SPRINT results 15, 16. In contrast, for people with diabetes mellitus, a goal SBP/DBP of 130/80 mm Hg was recommended in 2003,12 and yet treatment intensification from 2005 to 2012 among diabetic adults remained low even compared to those without diabetes mellitus.…”

Section: Discussionmentioning

confidence: 64%

Treatment Intensification for Hypertension in US Ambulatory Medical Care

Lin

Mukamal

2016

JAHA

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BackgroundHypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care.Methods and ResultsUsing the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time.ConclusionsUS hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.

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Section: Discussionmentioning

confidence: 64%

Treatment Intensification for Hypertension in US Ambulatory Medical Care

Lin

Mukamal

2016

JAHA

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“…This first recommendation is based on several RCTs evaluating treatment of SBP to <140 mm Hg versus a more liberal target (140–160 mm Hg) in patients >65 years of age 9, 10. In the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS), 4418 patients between the ages of 65 and 85 were randomized to SBP treatment goal <140 mm Hg versus 140 to <160 mm Hg.…”

Section: Jnc 8 Recommendationmentioning

confidence: 99%

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

Kovell

Ahmed

Misra

et al. 2015

JAHA

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“…Taken together with our findings, T-type calcium channel blockers such as efonidipine may be useful for the management of hypertension in patients with CHF. Indeed, our findings may help to explain why the mortality rate was markedly lower in the JATOS study 37 than in other similar clinical trials.…”

Section: Effect Of Efonidipine On Aldosterone and Lvmi T Tsutamoto Et Almentioning

confidence: 54%

Long-term effect of efonidipine therapy on plasma aldosterone and left ventricular mass index in patients with essential hypertension

et al. 2009

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A certain percentage of aldosterone (ALD) breakthrough generally occurs in patients with hypertension and chronic heart failure and is an important issue during long-term treatment with angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB). It has been reported that efonidipine decreases the plasma levels of ALD. However, the long-term effects of efonidipine on the plasma levels of ALD and the left ventricular mass index (LVMI) remain unknown in patients with hypertension. Sixty stable outpatients with essential hypertension who had received amlodipine and ACE-I or ARB for more than 1 year were randomized into two groups (amlodipine group (n¼30): continuous amlodipine treatment at a stable dose; efonidipine group (n¼30): amlodipine (5 mg day À1 ) was changed to efonidipine at a dose of 40 mg day À1 ). There was no difference in their baseline characteristics including the LVMI and plasma levels of ALD. In the amlodipine group, there were no significant changes in blood pressure, LVMI or plasma levels of ALD for 18 months. In the efonidipine group, blood pressure did not change after replacement of amlodipine with efonidipine, although there was a significant decrease in the plasma levels of ALD after 6 months. The decrease in ALD was sustained for 18 months and LVMI was significantly decreased after 18 months (121 ± 25 vs. 114 ± 21 g m À2 , Po0.05). There was a significant correlation between the changes in LVMI and % changes of ALD in the efonidipine group. These findings indicate that the effect of efonidipine on the suppression of plasma ALD was sustained for at least 18 months and that long-term efonidipine therapy decreases LVMI in patients with essential hypertension. INTRODUCTIONRecent clinical trials have shown that inhibiting the biological actions of aldosterone (ALD) using an ALD blocker alone or in combination with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) is reported to be a useful add-on therapy in hypertensive patients, reducing the incidence of cardiovascular events among patients with chronic heart failure (CHF). 1,2 Therefore, to prevent cardiovascular disease, targeting ALD synthesis and release may be clinically important. One of the major incentives for implementing the RALES and EPHESUS trial was the investigation of the ALD breakthrough phenomenon 3,4 in which ACE-I does not reliably induce significant decreases in plasma ALD levels. Therefore, in a certain percentage of patients with hypertension or CHF, ALD breakthrough generally occurs. This phenomenon is an important issue during a long-term treatment with ACE-I and ARB. 1,[5][6][7][8][9][10][11] Although the mechanisms of ALD breakthrough remain obscure, there was no apparent reduction of the left ventricular mass index (LVMI) in patients with ALD breakthrough(+) during the administration of ACE-I. 8 Aldosterone production in the adrenal gland is mediated mainly by the T-type calcium channel in vitro. 12 Recently, it has been reported that efonidipine, a...

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Principal Results of the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS)

Cited by 349 publications

References 35 publications

Treatment Intensification for Hypertension in US Ambulatory Medical Care

Treatment Intensification for Hypertension in US Ambulatory Medical Care

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

Long-term effect of efonidipine therapy on plasma aldosterone and left ventricular mass index in patients with essential hypertension

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