Response to a Second Single Antihypertensive Agent Used as Monotherapy for Hypertension After Failure of the Initial Drug

Materson, Barry J.; Reda, Domenic J.; Preston, Richard A.; Cushman, William C.; Massie, Barry M.; Freis, Edward D.; Kochar, Mahendr S.; Hamburger, Robert J.; Fye, Carol L.; Lakshman, Raj; Gottdiener, John S.; Ramirez, Eli A.; Henderson, William G.; Asch, Joseph; Smith, Mary; Rainey, Clydie; Rowe, Jean; Tir, Shirley; Williams, David Wynne; Abdellatif, Mazen; Lizano, Barbara; Koontz, Dolly; Mackay, Barbara; Sather, Mike R.; Buchanan, Sandra L.; Foy, Claude; Chacon, Frances; Khatri, Ibrahim M.; Gregory, Barbara; Notargiacomo, Aldo; Sapp, Rhonda; Coutlakis, Peter; Cianchini, Jose L.; Jimenez, A. Villares; Juan, San; Tobin, M.; Pieczek, Ann; Talmers, Frederick N.; Grant, Chris K.; Neal, William W.; Henry, M; Mezey, Kalman C.; Luzniak, Barbara; Borreson, Richard E.; Stewart, Colleen; Srivastava, Narain; Cooper, Karen M.; Katz, Lois A.; Mannix, Rosemary; Nunn, S; McKnight, Anita; Trottier, Dee; Olzinski, Patricia; Perry, H. Mitchell; Berg, Deborah; Monahan, Larry; Politte, Judy; Tubau, Julio F.; Der, Elaine; Mukherji, Bangshi; Pannone, Marion; Arnold, Charlene; Fox, Keith A.A.; Kirkendall, Walter M.; Gaasch, William H.; Gifford, Ray W.; Woolson, Robert F.; Deykin, Daniel; Huang, Ping; Gold, Janet N.

doi:10.1001/archinte.1995.00430160089009

Cited by 43 publications

(16 citation statements)

References 13 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: 94%

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: 94%

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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“…1 When hypertensive patients are switched to another monotherapy, the response rate is similar (49.1%). 2 Therefore, patients with essential hypertension who do not respond to monotherapy are switched to combination therapy, which sometimes is used as firstline therapy.…”

Section: Introductionmentioning

confidence: 99%

Effects of Verapamil Slow Release Plus Trandolapril Combination Therapy on Essential Hypertension

Derici

Sindel

Arınsoy

et al. 2003

Current Therapeutic Research

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Background: Fixed-dose combination antihypertensive therapy has been recommended for patients with essential hypertension who are unresponsive to monotherapy or as a first-line treatment.Objective: We investigated the effects of a fixed-dose combination of the phenylalkylamine-type calcium channel blocker verapamil slow release (SR) plus the angiotensin-converting enzyme inhibitor trandolapril on blood pressure (BP), serum lipid profile, urinary albumin excretion (UAE), left ventricular mass (LVM), and LVM index (LVMI), as well as the adverse events associated with this treatment.Methods: Patients aged 30 to 65 years with mild to moderate essential hypertension were included in the study. All of the patients received capsules containing combination treatment with verapamil SR 180 mg plus trandolapril 2 mg orally, daily for 12 weeks. Mean arterial pressure (MAP), systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) were measured at baseline and at 4, 8, and 12 weeks of treatment. Serum lipid profile, UAE, LVM, LVMI, and body mass index (BMI) were determined at baseline and at the end of the study period. All patients underwent electrocardiography and echocardiography at baseline and week 12. The primary end point of the study was to achieve an SBP/DBP Յ140/Յ90 mm Hg (ie, normotensive) during week 12. All adverse events were assessed as mild, moderate, or severe at each visit. According to the response rate at week 12, patients were divided into 2 groups: those who became normotensive (responders) or those who remained hypertensive (SBP/ DBP Ͼ140/Ͼ90 mm Hg; nonresponders BMI, 29.4 [3.5] kg/m 2 ) were enrolled. The median duration of hypertension prior to enrollment was 5 months. Mean MAP, SBP, DBP, UAE, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C),

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“…These drugs, used either as monotherapy or in combination, enable the normalization of blood pressure in most patients [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Potential Cardioprotective Effect of Mibefradil in the Long-Term Treatment of Hypertension

Waeber

1998

Cardiology

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During the last 2 decades, remarkable progress has been made in the treatment of hypertension with the discovery of new drugs lowering blood pressure by various mechanisms, e.g. calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin II antagonists. These antihypertensive agents are now widely used as first-line therapy although there is still no definite proof that they have a cardioprotective effect and reduce the mortality rate in patients with coronary heart disease. Mibefradil is a new calcium antagonist with a novel mechanism of action since it is the only drug available so far able to block T channels. This compound might be particularly effective in preventing cardiac morbidity and mortality. It reduces heart rate when lowering blood pressure, has no negative inotropic effect, allows regression of cardiac hypertrophy and is effective in the treatment of angina. Mibefradil produces a sustained blood pressure reduction with a close to optimal trough:peak ratio. A major advantage of this novel compound is its excellent tolerability over the dose range recommended (50–100 mg/day). In particular, leg edema is seen clearly less often during mibefradil treatment than during therapy with dihydropyridines. Mibefradil has therefore an attractive profile in terms of both efficacy and safety and represents a promising first-line option to treat hypertensive patients.

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Response to a Second Single Antihypertensive Agent Used as Monotherapy for Hypertension After Failure of the Initial Drug

Abstract: We conclude that sequential single-drug therapy is a rational approach for treatment of hypertension in patients in whom initial drug therapy has failed.

Cited by 43 publications

References 13 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

Effects of Verapamil Slow Release Plus Trandolapril Combination Therapy on Essential Hypertension

Potential Cardioprotective Effect of Mibefradil in the Long-Term Treatment of Hypertension

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