Treatment of hypertension in the elderly: I. Blood pressure and clinical changes. Results of a Department of Veterans Affairs Cooperative Study.

Materson, Barry J.; Cushman, William C.; Goldstein, Gérald; Reda, Domenic J.; Freis, Edward D.; Ramirez, Eli A.; Talmers, Frederick N.; White, Thomas J.; Nunn, S; Chapman, Robert H.

doi:10.1161/01.hyp.15.4.348

Cited by 82 publications

(29 citation statements)

References 31 publications

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“…However, we and others have shown comparatively large reductions in SBP and higher SBP control rates with diuretics but also with clonidine and calcium channel blockers. [12][13][14]16,[22][23][24][25][26] Although calcium blockers usually lower SBP as well as diuretics do, as in the current trial, DBP is usually lowered more consistently, resulting in less reduction in PP with calcium blockers than with diuretics. It is not clear whether the differences in PP found in this study are related to differences in vascular compliance.…”

Section: Discussionmentioning

confidence: 95%

Pulse Pressure Changes With Six Classes of Antihypertensive Agents in a Randomized, Controlled Trial

Cushman¹,

Materson²,

Williams³

et al. 2001

Hypertension

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Abstract-Pulse pressure has been more strongly associated with cardiovascular outcomes, especially myocardial infarction and heart failure, than has systolic, diastolic, or mean arterial pressure in a variety of populations. Little is known, however, of the comparative effects of various classes of antihypertensive agents on pulse pressure. In retrospective analyses of the Veterans Affairs Single-Drug Therapy for Hypertension Study, we compared changes in pulse pressure with 6 classes of antihypertensive agents: 1292 men with diastolic blood pressure of 95 to 109 mm Hg on placebo were randomized to receive hydrochlorothiazide, atenolol, captopril, clonidine, diltiazem, prazosin, or placebo. Drug doses were titrated to achieve a goal diastolic blood pressure of Ͻ90 mm Hg during a 4-to 8-week medication titration phase. Pulse pressure change (placebo subtracted) was assessed from baseline to the end of the 3-month titration and 1-year maintenance. Mean baseline systolic, diastolic, and pulse pressures were 152, 99, and 53 mm Hg, respectively. Reductions in pulse pressure during titration were greater (PϽ0.001) with clonidine (6.7 mm Hg) and hydrochlorothiazide (6.2 mm Hg) than with captopril (2.5 mm Hg), diltiazem (1.6 mm Hg), and atenolol (1.4 mm Hg); reduction with prazosin (3.9 mm Hg) was similar to all but clonidine. After 1 year, pulse pressure was reduced significantly more (PϽ0.001) with hydrochlorothiazide (8.6 mm Hg) than with captopril and atenolol (4.1 mm Hg with both); clonidine (6.3 mm Hg), diltiazem (5.5 mm Hg), and prazosin (5.0 mm Hg) were intermediate. These data show that classes of antihypertensive agents differ in their ability to reduce pulse pressure. Whether these differences affect rates of cardiovascular events remains to be determined. Key Words: pulse pressure Ⅲ antihypertensive agents Ⅲ drug therapy Ⅲ human P ulse pressure (PP) has usually been found to be a stronger independent predictor of cardiovascular events, particularly in older populations, than has systolic (SBP), diastolic (DBP), or mean arterial pressure. 1-9 Although treatment of elevated DBP 10,11 or isolated SBP 10 -13 with antihypertensive agents has been shown to reduce cardiovascular events in prospective randomized controlled trials, clinical trials have not evaluated whether any reduction in cardiovascular events has been related to a reduction in PP. In fact, most studies assessing the antihypertensive efficacy of lifestyle interventions or drugs have addressed reductions in DBP and, to a limited extent, SBP. Studies have demonstrated differences in DBP and SBP antihypertensive efficacy between drug classes overall and in various demographic groups. 14 -16 Only very recently have studies begun to evaluate changes in PP, and almost no data have been published on the comparative effects of different classes of antihypertensive agents on PP. 7,17 Therefore, we compared the short-and long-term effects on changes in PP of a diuretic (hydrochlorothiazide), a ␤-blocker (atenolol), a calcium channel blocker (diltiazem sustai...

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Section: Discussionmentioning

confidence: 95%

Pulse Pressure Changes With Six Classes of Antihypertensive Agents in a Randomized, Controlled Trial

Cushman¹,

Materson²,

Williams³

et al. 2001

Hypertension

View full text Add to dashboard Cite

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“…It can be used with minimal adverse effects when prescribed at a low dose (0.10 to 0.25 mg/d). 4,168 The risk of rebound HTN is lower than with clonidine because of its long duration of action. Importantly, reserpine combines very effectively with diuretic agents.…”

Section: Indigent Patients With Htnmentioning

confidence: 99%

Management of High Blood Pressure in Blacks

et al. 2010

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Abstract-Since the first International Society on Hypertension in Blacks consensus statement on the "Management of HighBlood Pressure in African American" in 2003, data from additional clinical trials have become available. We reviewed hypertension and cardiovascular disease prevention and treatment guidelines, pharmacological hypertension clinical end point trials, and blood pressure-lowering trials in blacks. Selected trials without significant black representation were considered. In this update, blacks with hypertension are divided into 2 risk strata, primary prevention, where elevated blood pressure without target organ damage, preclinical cardiovascular disease, or overt cardiovascular disease for whom blood pressure consistently Ͻ135/85 mm Hg is recommended, and secondary prevention, where elevated blood pressure with target organ damage, preclinical cardiovascular disease, and/or a history of cardiovascular disease, for whom blood pressure consistently Ͻ130/80 mm Hg is recommended. If blood pressure is Յ10 mm Hg above target levels, monotherapy with a diuretic or calcium channel blocker is preferred. When blood pressure is Ͼ15/10 mm Hg above target, 2-drug therapy is recommended, with either a calcium channel blocker plus a renin-angiotensin system blocker or, alternatively, in edematous and/or volume-overload states, with a thiazide diuretic plus a renin-angiotensin system blocker. Effective multidrug therapeutic combinations through 4 drugs are described. Comprehensive lifestyle modifications should be initiated in blacks when blood pressure is Ն115/75 mm Hg. The updated International Society on Hypertension in Blacks consensus statement on hypertension management in blacks lowers the minimum target blood pressure level for the lowest-risk blacks, emphasizes effective multidrug regimens, and de-emphasizes monotherapy. (Hypertension. 2010;56:780-800.)Key Words: antihypertensive therapy Ⅲ blood pressure Ⅲ essential hypertension Ⅲ ethnic groups Ⅲ hypertension detection and control Ⅲ obesity Ⅲ race

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“…To this end: (1) people need to be aware of their blood pressure levels; (2) patients with a diagnosis of hypertension need to be informed about the risk of untreated hypertension, the benefits of lifestyle changes, and the potential benefits and harms of treatment; (3) treated hypertensive patients need to know how to play an active role in therapy; and (4) physicians need to reconsider any preconceptions about antihypertensive agents.…”

Section: Discussionmentioning

confidence: 99%

“…1 Whereas initially these results were in most cases achieved with high-dose thiazide diuretics, subsequent research demonstrated that dose reduction, including combination with potassium-sparing agents, is effective and decreases the risk of adverse effects. 2,3 Since then, several new antihypertensive agents have been developed, but meta-analyses have not indicated a superior beneficial effect of these agents over conventional ones. 4,5 However, many hypertension experts do not recommend thiazide diuretics as first-line treatment for hypertension, and guidelines are inconsistent.…”

mentioning

confidence: 99%

Have ALLHAT, ANBP2, ASCOT-BPLA, and So Forth Improved Our Knowledge About Better Hypertension Care?

Sawicki

McGauran

2006

Hypertension

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O ne of the major milestones in medicine during the last 40 years has been strong evidence from well-designed clinical trials showing that blood pressure-lowering interventions reduce hypertension-related morbidity and mortality. 1 Whereas initially these results were in most cases achieved with high-dose thiazide diuretics, subsequent research demonstrated that dose reduction, including combination with potassium-sparing agents, is effective and decreases the risk of adverse effects. 2,3 Since then, several new antihypertensive agents have been developed, but meta-analyses have not indicated a superior beneficial effect of these agents over conventional ones. 4,5 However, many hypertension experts do not recommend thiazide diuretics as first-line treatment for hypertension, and guidelines are inconsistent. 6 -8 There were 2 major reasons for this failure to transform sound scientific evidence into practice. Firstly, potential thiazideinduced metabolic effects (eg, a transient increase in serum cholesterol and a serum potassium-dependent slight increase in blood glucose levels) were thought to be responsible for the so-called shortfall in the reduction in cardiovascular events (the gap between the epidemiologically estimated decrease in the risk of hypertension-related events and the magnitude of the decrease actually achieved in intervention trials). 9 Second, protective effects beyond the blood pressurelowering effect were attributed to newer agents, which include ␣-blockers, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), and, more recently, angiotensin receptor blockers. Despite the fact that this theory was not confirmed in head-to-head trials, the vigorous marketing of these agents, combined with a campaign against the use of diuretics, changed prescription habits worldwide. 10 This controversy was the reason for the largest hypertension study ever conducted: the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). The results and implications of ALLHAT and 2 other controversially discussed studies, namely, the Second Australian National Blood Pressure Study (ANBP2) and the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA), are discussed here. It should be noted that their comparability is limited by different study designs and by marked differences in baseline blood pressures and risk profiles. An overview of these studies is presented in Tables 1 and 2. The ALLHAT, ANBP2, and ASCOT-BPLA Hypertension TrialsALLHAT was sponsored by the US National Heart, Lung, and Blood Institute in conjunction with the Department of Veterans Affairs. The National Heart, Lung, and Blood Institute received financial support from Pfizer Inc, USA, and its responsibilities included the collection, interpretation, and analysis of data, and the decision to submit the article for publication. Study medications were supplied by Pfizer Inc and AstraZeneca, USA. 11,12 This randomized, double-blind, controlled trial included 42 418 h...

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Treatment of hypertension in the elderly: I. Blood pressure and clinical changes. Results of a Department of Veterans Affairs Cooperative Study.

Cited by 82 publications

References 31 publications

Pulse Pressure Changes With Six Classes of Antihypertensive Agents in a Randomized, Controlled Trial

Pulse Pressure Changes With Six Classes of Antihypertensive Agents in a Randomized, Controlled Trial

Management of High Blood Pressure in Blacks

Have ALLHAT, ANBP2, ASCOT-BPLA, and So Forth Improved Our Knowledge About Better Hypertension Care?

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