Therapeutic concordance improves blood pressure control in patients with resistant hypertension

Trimarco, Valentina; Izzo, Raffaele; Mone, Pasquale; Lembo, Maria; Manzi, Maria Virginia; Pacella, Daniela; Falco, Angela; Gallo, Paola; Esposito, Giovanni; Morisco, Carmine; Santulli, Gaetano; Trimarcö, Bruno

doi:10.1016/j.phrs.2022.106557

Cited by 16 publications

(15 citation statements)

References 74 publications

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“…The Campania Salute Network Registry represents an open electronic registry, characterized by networking to the Hypertension Research Center of the "Federico II" University Hospital in Naples both general practitioners and community hospital-based hypertension clinics. The database generation of the Campania Salute Network was formally approved by the "Federico II" University Hospital Ethic Committee (Izzo et al, 2011;Mancusi et al, 2022;Manzi et al, 2022;Trimarco et al, 2023c). All participants signed a written informed consent for the use of their clinical data for scientific aims (ClinicalTrials.gov Identifier: NCT02211365).…”

Section: Populationmentioning

confidence: 99%

“…No prevalent coronary/cerebrovascular disease and atrial fibrillation; (Izzo et al, 2015b;Trimarco et al, 2023a). Arterial blood pressure was measured using auscultatory or oscillometric semiautomatic sphygmomanometers, attended by physicians were, with appropriate-size cuffs (Trimarco et al, 2023b). According to current guidelines on hypertension (Williams et al, 2018), we measured systolic and diastolic BP after 5 min resting in the sitting position, 3 times at 1 minute interval.…”

Section: Populationmentioning

confidence: 99%

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Achieving a Systolic Blood Pressure Below 130 mmHg Reduces the Incidence of Cardiovascular Events in Hypertensive Patients with Echocardiographic Left Ventricular Hypertrophy

Lembo,

Trimarco,

Izzo

et al. 2023

J Pharmacol Exp Ther

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Background: Recent reports have evidenced an increased mortality rate in hypertensive patients with electrocardiographic left ventricular hypertrophy (ECG-LVH) achieving systolic blood pressure (SBP) <130mmHg. However, to the best of our knowledge, the actual effects of BP reduction to the ≤130/80mmHg target on the incidence of cardiovascular events in hypertensive patients with a diagnosis of LVH based on echocardiographic-criteria (Echo-LVH) have never been determined. Methods: In order to fill this long-standing knowledge gap, we harnessed a population of 9511 hypertensive patients, followed-up for 33.6 [IQR 7.9-72.7] months. The population was divided into six groups according to the average SBP achieved during the follow-up (≤130, 130-to-139, and ≥140mmHg) and absence/presence of Echo-LVH. The primary endpoint was a composite of fatal or non-fatal myocardial infarction and stroke, sudden cardiac death, heart failure requiring hospitalization, revascularization, and carotid stenting. Secondary endpoints included atrial fibrillation and transient ischemic attack. Results: During the follow-up, achieved SBP and diastolic BP (DBP) were comparable between patients with and without Echo-LVH. Strikingly, the rate of primary and secondary endpoints was significantly higher in patients with Echo-LVH and SBP>130mmHg, reaching the highest rate in the Echo-LVH group with SBP≥140mmHg. By separate Cox multivariable regressions, after adjusting for potential confounders, both primary and secondary endpoints were significantly associated with SBP≥140mmHg and Echo-LVH. Instead, DBP reduction ≤80mmHg was associated with a significant increased rate of secondary events. Conclusions:In hypertensive patients with Echo-LVH, achieving an average in-treatment SBP target ≤130mmHg has a beneficial prognostic impact on incidence of cardiovascular events.

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Section: Populationmentioning

confidence: 99%

Section: Populationmentioning

confidence: 99%

Achieving a Systolic Blood Pressure Below 130 mmHg Reduces the Incidence of Cardiovascular Events in Hypertensive Patients with Echocardiographic Left Ventricular Hypertrophy

Lembo,

Trimarco,

Izzo

et al. 2023

J Pharmacol Exp Ther

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“…Although hypertension is known to be associated with an increased risk of cardiovascular disease and death, BP control remains suboptimal [ 72 , 73 ]. Tirzepatide has been shown to favorably affect BP [ 33 ], and this result has been consistently confirmed in all trials.…”

Section: Tirzepatide and Hypertensionmentioning

confidence: 99%

Tirzepatide: A Systematic Update

Forzano

Varzideh

Avvisato

et al. 2022

IJMS

Self Cite

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Tirzepatide is a new molecule capable of controlling glucose blood levels by combining the dual agonism of Glucose-Dependent Insulinotropic Polypeptide (GIP) and Glucagon-Like Peptide-1 (GLP-1) receptors. GIP and GLP1 are incretin hormones: they are released in the intestine in response to nutrient intake and stimulate pancreatic beta cell activity secreting insulin. GIP and GLP1 also have other metabolic functions. GLP1, in particular, reduces food intake and delays gastric emptying. Moreover, Tirzepatide has been shown to improve blood pressure and to reduce Low-Density Lipoprotein (LDL) cholesterol and triglycerides. Tirzepatide efficacy and safety were assessed in a phase III SURPASS 1–5 clinical trial program. Recently, the Food and Drug Administration approved Tirzepatide subcutaneous injections as monotherapy or combination therapy, with diet and physical exercise, to achieve better glycemic blood levels in patients with diabetes. Other clinical trials are currently underway to evaluate its use in other diseases. The scientific interest toward this novel, first-in-class medication is rapidly increasing. In this comprehensive and systematic review, we summarize the main results of the clinical trials investigating Tirzepatide and the currently available meta-analyses, emphasizing novel insights into its adoption in clinical practice for diabetes and its future potential applications in cardiovascular medicine.

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“…Resistant hypertension is a condition observed in >10% of hypertensive patients, defined by blood pressure (BP) targets not achieved despite treatment with at least three anti-hypertensive medications of different classes, including a diuretic, a blocker of the renin-angiotensin system, and a long-acting calcium channel blocker ( 1 ). Current guidelines recommend the use of spironolactone as the preferred 4th line drug, with a better BP lowering efficacy compared to adrenergic α-blockers or β blockers.…”

mentioning

confidence: 99%

“…The PRECISION trial is not exempt from limitations, including the lack of a placebo control in the single-blind part 2 of the study; in this sense, we would also like to emphasize the substantial BP lowering effect of placebo in the double-blind part 1, which might be attributable to the attentive management of patients with resistant hypertension, as seen with the so-called therapeutic concordance ( 1 ), in the setting of a clinical trial. Moreover, a direct comparison with spironolactone is not provided, and the actual clinical relevance of the results of the PRECISION trial remains to be determined.…”

mentioning

confidence: 99%