The journal of clinical hypertension
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The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized placebo-controlled trial which clearly demonstrated that perindopril-based blood pressure (BP)-lowering treatment is one of the most effective and generalizable strategies for secondary prevention of stroke. Beneficial effects of BP lowering were observed on recurrent stroke, other cardiovascular events, disability, dependency, and cognitive function across a variety of subgroups defined by age, sex, geographical region, body mass index, diabetes, atrial fibrillation, chronic kidney disease, and baseline BP levels. Once patients with stroke have stabilized, all patients should receive BP-lowering therapy irrespective of their BP levels. On the basis of recommendations from current international guidelines, BP should be lowered to <140/90 mm Hg in all patients with cerebrovascular disease and to <130/80 mm Hg if therapy is well tolerated.
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J Clin Hypertens (Greenwich) · Aug 2011
Randomized Controlled Trial Multicenter StudyCombination angiotensin-receptor blocker (ARB)/calcium channel blocker with HCTZ vs the maximal recommended dose of an ARB with HCTZ in patients with stage 2 hypertension: the exforge as compared to losartan treatment in stage 2 systolic hypertension (EXALT) study.
This study compared the efficacy and safety of combination angiotensin-receptor blocker (ARB)/calcium-channel blocker (CCB) with hydrochlorothiazide (valsartan/amlodipine/HCTZ 160/5/2mg) vs maximal available combination doses of an ARB with HCTZ (losartan/HCTZ 100/25 mg) in the management of stage 2 hypertension. After 1 to 2 weeks of antihypertensive drug washout, patients with a mean sitting systolic blood pressure (MSSBP) of ≥ 160 mm Hg and <200 mm Hg were randomized to valsartan/amlodipine 160/5 mg (n = 241) or losartan 100 mg (n = 247). At week 3, HCTZ 25 mg was added to both treatments. ⋯ Achievement of blood pressure <140/90 mm Hg also favored the valsartan/amlodipine group. Dizziness was the only adverse event reported in >5% of patients (5.4% valsartan/amlodipine group, 3.6% losartan group). Moderate doses of an ARB/CCB combination with HCTZ reduced blood pressure more effectively than the maximal dose of an ARB with HCTZ.
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J Clin Hypertens (Greenwich) · Dec 2010
Associations among cardiometabolic risk factor clustering, weight status, and cardiovascular disease in an Appalachian population.
It has been suggested that within the traditional body mass index (BMI) categories there is a heterogeneous pattern of cardiometabolic risk factor clustering. The objective of this research was to determine the associations among obesity, cardiometabolic abnormalities, and cardiovascular disease (CVD) in a large population-based study of Appalachian adults. The study comprised a cross-sectional survey of Appalachian adults residing in 6 communities in Ohio and West Virginia, who were aged 18 years and older (n=14,783, 50.9% women). ⋯ They found that 25.6% of normal-weight adults displayed clustering of ≥2 cardiometabolic abnormalities; in contrast, 36.8% of overweight/obese adults displayed no clustering. Compared with normal-weight persons without clustering of cardiometabolic abnormalities (referent), the odds ratio of CVD was 1.06 (95% confidence interval [CI], 0.84-1.34) among overweight/obese individuals without cardiometabolic clustering, 2.21 (95% CI, 1.74-2.81) among normal-weight individuals with cardiometabolic clustering, and 2.45 (95% CI, 2.02-2.97) among overweight/obese individuals with cardiometabolic clustering. These results suggest that within the traditional BMI categories, there may be heterogeneity of CVD risk depending on whether there is underlying clustering of cardiometabolic abnormalities.