The evolution of systolic blood pressure as a strong predictor of cardiovascular risk and the effectiveness of fixed-dose ARB/CCB combinations in lowering levels of this preferential target

Abstract

Elevated blood pressure is an important cardiovascular risk factor. Although targets for both diastolic blood pressure (DBP) and systolic blood pressure (SBP) are defined by current guidelines, DBP has historically taken precedence in hypertension management. However, there is strong evidence that SBP is superior to DBP as a predictor of cardiovascular events. Moreover, achieving control of SBP is assuming greater importance amongst an aging population. In spite of the growing recognition of the importance of SBP in reducing cardiovascular risk and the emphasis by current guidelines on SBP control, a substantial proportion of patients still fail to achieve SBP targets, and SBP control is achieved much less frequently than DBP control. Thus, new approaches to the management of hypertension are required in order to control SBP and minimize cardiovascular risk. Fixed-dose combination (FDC) therapy is an approach that offers the advantages of multiple drug administration and a reduction in regimen complexity that favors compliance. We have reviewed the latest evidence demonstrating the efficacy in targeting SBP of the most recent FDC products; combinations of the calcium channel blocker (CCB), amlodipine, with angiotensin receptor blockers (ARBs), valsartan or olmesartan. In addition, results from studies with new classes of agent are outlined.

Multiple Points Change in the Association of Blood Pressure Subtypes with Anthropometric Indices of Adiposity among Children in a Rural Population

“…The reason for the lack of a significant association of BMI with SBP is thought to be the influence of potential confounders, such as diet and physical inactivity, which were not adjusted for [19,20]. Furthermore, DBP did not show any association with the adiposity indices, which affirm the results of the previous study [21], suggesting that SBP may be a better guide than DBP to evaluate cardiovascular and all mortality [22].…”

Drug synergism of antihypertensive action in combination of telmisartan with lercanidipine in spontaneous hypertensive rats

“…This effect was greater than that (31.8 mmHg) for lisinopril plus hydrochlorothiazide administered in combination (Poldermans et al, 2007). In another clinical trial involving patients with less severe hypertension at a baseline BP level of 156.7/99.1 mmHg), the combination therapy of valsartan (160 mg/day) and amlodipine (10 mg/day) for 8 weeks resulted in a mean SBP reduction of 27.8 mmHg, and this dose was equivalent to the maximal marketed dose of the drug when administered as a fixed-dose combination in Europe (Philipp et al, 2007;Mourad, 2008). Thus, the results of these recent clinical trials with ARB/CCB combination therapy suggest that this therapeutic strategy potentially lowers BP, especially SBP, and provides a useful tool in the management of hypertension and hypertension-related cardiovascular risk.…”

Cardiovascular Consequences of Binge Drinking: An Integrative Review with Implications for Advocacy, Policy, and Research

“…Importantly, the results of Wellman and colleagues () support that binge drinking in young adulthood gives rise to increased SBP. Given that SBP is a strong predictor of future CV risk and outcomes (Mourad, ), the binge drinking‐associated increases in BP may have important long‐term clinical consequences.…”