Systolic vs Diastolic Blood Pressure Control in the Hypertensive Patients of the PAMELA Population

Mancia, Giuseppe; Bombelli, Michele; Lanzarotti, Arturo; Grassı, Guıdo; Cesana, Giancarlo; Zanchetti, Alberto; Sega, Roberto

doi:10.1001/archinte.162.5.582

Cited by 97 publications

(52 citation statements)

References 25 publications

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“…26 -28 Despite the development of strict treatment guidelines, BP is still inadequately controlled in a large proportion of treated hypertensives. 29,30 The present study confirms a high prevalence of mild hypertension in the elderly and additionally illustrates the risk associated with a moderately elevated BP (mean BP in the sustained hypertensive group, 155/87 mm Hg).…”

Section: Discussionsupporting

confidence: 84%

Isolated Ambulatory Hypertension Predicts Cardiovascular Morbidity in Elderly Men

et al. 2003

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Background-Little is known about isolated ambulatory hypertension, a state with elevated ambulatory but normal office blood pressure (BP). This study aimed to investigate the prognostic significance of isolated ambulatory hypertension for cardiovascular morbidity in a population of elderly men. Methods and Results-At baseline, 24-hour ambulatory BP and metabolic and cardiac risk profiles were evaluated in 578 untreated 70-year-old men, participants of a population-based cohort. Subjects with isolated ambulatory hypertension (office BP Ͻ140/90 and daytime BP Ն135/85) and sustained hypertension (office BP Ն140/90 and daytime BP Ն135/85) had increased plasma glucose, body mass index, and echocardiographically determined left ventricular relative wall thickness compared with normotensive subjects (office BP Ͻ140/90 and daytime BP Ͻ135/85). Seventy-two cardiovascular morbid events (2.37 per 100 person-years at risk) occurred over 8.

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Section: Discussionsupporting

confidence: 84%

Isolated Ambulatory Hypertension Predicts Cardiovascular Morbidity in Elderly Men

et al. 2003

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“…Some studies have suggested that discrepancies in cardiovascular risk between males and females may involve genderrelated differences in response to antihypertensive therapy. [18][19][20] For example, a large registry study involving 29 148 essential hypertensive patients receiving antihypertensive treatment found that a greater proportion of women achieved BP control, measured by ambulatory BP monitoring, compared with men. 31 However, a meta-analysis of data from 31 trials involving more than 100 000 male and nearly 90 000 female patients with hypertension found no evidence of a difference in the effects of BP-lowering treatment regimens between men and women.…”

Section: Discussionmentioning

confidence: 99%

“…The study also provides an opportunity to ascertain whether the combination is effective in specific patient groups. For example, certain BP-lowering treatment regimens have been reported to differ between men and women, [18][19][20] whereas others have shown no evidence of a gender difference. 21 Also, BP is known to increase with advancing age and it is important to determine that antihypertensive therapies are effective in older patients.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of olmesartan medoxomil plus amlodipine in age, gender and hypertension severity defined subgroups of hypertensive patients

Schmieder

Böhm

2010

J Hum Hypertens

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Effective antihypertensive therapy is crucial for preventing cardiovascular events; however, blood pressure (BP) control rates remain poor. The objective of this analysis was to determine the efficacy of olmesartan/ amlodipine in age, severity and gender-based subgroups of patients with moderate-to-severe hypertension uncontrolled by amlodipine monotherapy. Patients with uncontrolled BP after 8 weeks' amlodipine 5 mg monotherapy (n ¼ 755) were randomized to continue amlodipine 5 mg or receive olmesartan (10-40 mg) plus amlodipine 5 mg for 8 weeks. Patients whose BP remained suboptimal were uptitrated to olmesartan/ amlodipine 20/5, 40/5 or 40/10 mg. Changes in BP and numbers of controlled patients were calculated separately to assess efficacy in patients aged o65 or X65 years, in those with moderate or severe hypertension, and in males and females. The antihypertensive effects of olmesartan/amlodipine were similar in patients aged o65 and X65 years of age. Compared with patients with moderate hypertension at baseline, those with severe hypertension tended to show higher decreases in BP, but achieved lower goal rates despite this. Females showed larger mean reductions in diastolic (1.61 mm Hg; P ¼ 0.003) and systolic BP (1.72 mm Hg; P ¼ 0.053) than males, independent of age and dose. This gender difference appeared to be higher and more consistent across dose groups for patients o50 years of age, but the difference in the pattern between both age groups was not statistically significant (P ¼ 0.1526). These results suggest that olmesartan/amlodipine is effective and safe in a wide range of patients, regardless of age or hypertension severity. Small differences in responsiveness between females and males may exist, which require further investigation.

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“…46 Similarly, PAMELA, a study conducted in Northern Italy, reported a similar poor SBP response rate, with SBP control occurring in 8.9% of treated hypertensives, compared with 15.4% for DBP. 47 Indeed, even in the recently completed ALLHAT study, SBP control occurred in 60% of hypertensive patients vs 90% for DBP control. According to a recent review of 10 antihypertensive drug trials, DBP was invariably below 90 mmHg in most trials, whereas SBP remained above or slightly below 140 mgHg-approximately 90% of patients attained goal DBP values but only 50% attained SBP goal.…”

Section: Overview Of Managing Systolic Hypertensionmentioning

confidence: 99%

Treatment of systolic hypertension: spotlight on recent studies with angiotensin II antagonists

Volpe

2004

J Hum Hypertens

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Systolic blood pressure has a continuous, graded, strong, independent, and aetiologically significant relationship to mortality from coronary heart disease, stroke, and all cardiovascular diseases, as well as to all-cause mortality and life expectancy. Angiotensin II (AII) may be intimately involved in the pathogenesis of systolic hypertension through multiple mechanisms, including decreasing the elastin content and increasing the collagen content of the arterial wall, thickening and fibrotic remodelling of the vascular intima, and proliferating smooth muscle cells in the arterial wall, resulting in increased thickness, stiffening, and partial loss of contractility. AII antagonists may therefore offer hitherto unrecognized benefits ( independent of blood pressure) on age-related vascular damage and provide particular benefits in patients with systolic hypertension. Recent evidence has demonstrated that losartan offers cardiovascular outcomes benefits in isolated systolic hypertension ( ISH) associated with an excellent tolerability profile. This, in patients with ISH, AII antagonists more facilitate systolic BP control, providing cardiovascular protection and offering an excellent risk-benefit profile

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Systolic vs Diastolic Blood Pressure Control in the Hypertensive Patients of the PAMELA Population

Cited by 97 publications

References 25 publications

Isolated Ambulatory Hypertension Predicts Cardiovascular Morbidity in Elderly Men

Isolated Ambulatory Hypertension Predicts Cardiovascular Morbidity in Elderly Men

Efficacy and safety of olmesartan medoxomil plus amlodipine in age, gender and hypertension severity defined subgroups of hypertensive patients

Treatment of systolic hypertension: spotlight on recent studies with angiotensin II antagonists

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