Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes

Williams, Bryan; Lacy, Peter; Thom, Simon; Cruickshank, Kennedy; Stanton, Alice; Collier, David; Hughes, Alun D.; Thurston, H.; O’Rourke, Michael

doi:10.1161/circulationaha.105.595496

Cited by 1,807 publications

(451 citation statements)

References 61 publications

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“…Calcium channel blockers (versus β-blockers) have been demonstrated to lower central aortic pressure in the Conduit Artery Functional Endpoint Study (nonpregnant hypertensive population). 17 The exact mechanism behind these hemodynamic differences is not clear, but this finding in combination with the Anglo Scandinavian Cardiac Outcomes Trial results (of which the Conduit Artery Functional Endpoint Study was a subgroup analysis) suggested a greater decrease in longterm cardiovascular risk with calcium channel blockers as first-line antihypertensive agent compared with β-blockers, perhaps mediated through reduction in central aortic pressure. 18 National guidance no longer recommends β-blockers as first-line antihypertensive treatment outside pregnancy; calcium channel blockers are recommended as first-line antihypertensive treatment in black women and angiotensin-converting enzyme inhibitors (avoided in pregnancy because of fetal risks) are recommended for women <55 years of age of other ethnic backgrounds.…”

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confidence: 99%

Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy

et al. 2017

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maternal morbidity in these women (post hoc analysis). 10 The study highlights the need to determine which antihypertensive agent(s) provides optimal control of chronic hypertension in pregnancy to ameliorate these risks.Choice of antihypertensive outside pregnancy depends on ethnicity with those of African/Caribbean family origin receiving calcium channel blockers as first-line agent 11 and is thought to relate to differences in the pathophysiology causing hypertension in those of differing ethnic backgrounds. 12Ethnic disparity in maternal and perinatal outcome in the general pregnant population is well described and likely to be multifactorial. 13 To our knowledge, no randomized controlled trials have investigated the impact of ethnicity on efficacy of antihypertensive treatment in pregnancy. The aims of the PANDA study (Pregnancy and Chronic Hypertension: Nifedipine Versus Labetalol as Antihypertensive Treatment) were 3-fold: to assess feasibility of such a randomized controlled trial, to evaluate mechanistic treatment effects, and to examine the impact of ethnicity on efficacy of nifedipine (a calcium channel blocker with a well-established safety profile in pregnancy) with labetalol (currently recommended as firstline by national UK guidance). MethodsThe study was an open-label, phase 4, randomized controlled clinical trial (EudraCT Number 2013-003144-23 +6 weeks (to allow for second trimester BP nadir), singleton pregnancies, aged >18 years, and the ability to provide written informed consent. Women were excluded if they had a contraindication (relative or absolute) to either antihypertensive agent, such as labetalol in women with asthma. Details of the randomization process, intervention, and outcome measures are contained in the online-only Data Supplement. Statistical AnalysisFor the primary analysis, the intention to treat principle was applied; women were analyzed in the groups into which they were randomly allocated regardless of allocation received. The statistical software Stata/SE version 14 for Windows was used for all analyses. The number and percentage were calculated for binary and categorical variables. The mean and SD or the median and interquartile range were calculated for continuous variables. Linear regression with robust SE was used for the primary and other continuous outcomes. Adjustment was made for baseline covariates, including ethnicity (black [determined by self-report of whether the woman had a parent or grandparent who was African or Caribbean] versus non-black [all other ethnicities]), gestational age at randomization, and center. For continuous measures, an adjustment was also made for corresponding baseline measurement (systolic BP at randomization for the primary clinical outcome). For binary outcomes, binary regression with a log link was used to calculate risk ratios (RR). Analysis of the primary clinical outcomes was repeated excluding women delivering their baby before 24 completed weeks of pregnancy because women who deliver before viability did not complete the inten...

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Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy

et al. 2017

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“…As reviewed elsewhere [77,78], antihypertensive drugs might also reduce arterial stiffness, especially calcium channel blockers and those targeting the renin-angiotensin system [79]. However, current non-invasive measures of arterial stiffness are BP-dependent, making it hard to distinguish the beneficial BP-lowering effects from those caused by de-stiffening of the arterial wall.…”

Section: Antihypertensive and De-stiffening Strategies For Heart Failmentioning

confidence: 99%

Sex-specific differences in cardiac maladaptation to hypertension and arterial stiffening

Cauwenberghs

Kuznetsova

2018

Kardiol Pol

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A b s t r a c tThe overall prevalence of symptomatic heart failure (HF) is similar in men and women and constitutes about a quarter of the first manifestation of cardiovascular disease in both sexes. However, there is an important difference between the sexes in the type of HF. Whereas men more frequently develop HF with reduced ejection fraction, HF with preserved ejection fraction is especially frequent in women. The major risk factors for symptomatic HF are high blood pressure and arterial stiffness, which evoke a complex network of functional and structural changes in the heart in both men and women. In this review, we will discuss the recent epidemiological data on sex discrepancies in cardiac maladaptation to hypertension and arterial stiffening.

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“…Предположительно, в ответ на это (и ввиду хронического медикаментозного подавления АПФ у 81% пациентов) с помощью ангио-тензинпревращающего фермента 2 (АПФ-2) происходит компенсаторная выработка ангиотензина 1-7 (АТ 1/7), являющегося эндогенным конкурентоспособным ин-гибитором нативного ангиотензина II. АТ 1/7 обладает вазодилатирующим, антипролиферативным, противо-аритмическим, противовоспалительным и инотропным действием, также обладает способностью уменьшать микроальбуминурию [62].…”

Section: гемодинамическая теорияunclassified

Empagliflozin as a new management strategy on outcomes in patients with type 2 diabetes mellitus

Салухов¹,

Demidova²

2016

Diabetes mellitus

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Диагностика, контроль, лечение Diagnosis, control, treatment здавна сахарный диабет рассматривался вра-чами древности как заболевание, связанное с нарушением мочеотделения в виде обильного мочеиспускания. Начало XX века ознаменовалось откры-тием особой роли бета-клеток поджелудочной железы в патогенезе сахарного диабета 2 типа (СД2), которые надолго стали основной мишенью лекарственных разра-боток. Вместе с тем исследования последних десятилетий снова актуализировали интерес к роли почек при нару-шениях углеводного обмена. Установлено, что реабсорб-ция глюкозы в почках представляет собой эволюционно сложившийся механизм, направленный на поддержание энергетического баланса и сохранение глюкозы, -ос-новного источника энергии. Примерно 180 г глюкозы

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Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes

Cited by 1,807 publications

References 61 publications

Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy

Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy

Sex-specific differences in cardiac maladaptation to hypertension and arterial stiffening

Empagliflozin as a new management strategy on outcomes in patients with type 2 diabetes mellitus

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