The influence of dose of angiotensin I-converting enzyme inhibitor on systolic blood pressure variability in heart failure: a substudy of the Assessment of Treatment with Lisinopril and Survival in heart failure (ATLAS) trial

Td, Giles; Ek, Kerut; Le, Roffidal; Jones, Roy; Mb, Given; Hutchinson, Howard G.; O, Tresznewsky

doi:10.1097/00126097-200104000-00003

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…Rats submitted to MI had a marked reduction on BPV. These results are in accordance with short or long-term observations in subjects with heart failure, in which BPV is also decreased (Caruana et al, 1988;Guzzetti et al, 1995;Giles et al, 2001). Our results also had shown a significant increase of normalized HF BPV component.…”

Section: Discussionsupporting

confidence: 93%

Carvedilol recovers normal blood pressure variability in rats with myocardial infarction

Dantas

Pimentel

Andreão

et al. 2013

Autonomic Neuroscience

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Section: Discussionsupporting

confidence: 93%

Carvedilol recovers normal blood pressure variability in rats with myocardial infarction

Dantas

Pimentel

Andreão

et al. 2013

Autonomic Neuroscience

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“…Different antihypertensive treatments appear to have differing effects on BPV. For instance, angiotensin‐converting enzyme inhibitors are associated with higher BPV in a dose‐dependent fashion . Limited data suggest that calcium channel blockers and higher doses of nonloop diuretics may be associated with less BPV .…”

Section: Discussionmentioning

confidence: 99%

Blood pressure variability predicts adverse events and cardiovascular outcomes in SPRINT

Mezue

Goyal

Pressman

et al. 2018

J of Clinical Hypertension

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SPRINT (Systolic Blood Pressure Intervention Trial) highlighted the benefits of intensive targeted antihypertensive therapy but resulted in higher rates of treatment-related adverse events. Blood pressure (BP) variability has emerged as a significant predictor of outcomes over and above levels of BP. Using the SPRINT data set, we aimed to determine the relationship of BP variability with cardiovascular outcomes and side effects of antihypertensive therapy. The analyses included all participants randomized in SPRINT who reached the target systolic BP (SBP) for their respective groups (intensive < 120 mm Hg; standard < 140 mm Hg). Coefficients of variation (CV) for SBP, diastolic BP (DBP), and PP for each patient characterized variability. Student t test was used to compare treatment arms for each CV metric. Cox proportional hazards regression was used to identify independent predictors of the SPRINT primary outcome and adverse events. P < .15 on univariate analysis was required to enter the model and P < .05 to remain in it. A total of 8884 patients (4561 standard group; 4323 intensive group) met inclusion criteria. DBP CV differed between the groups (9.12 ± 3.20 standard group; 9.47 ± 3.49 intensive group [P < .0001]). DBP CV predicted a greater hazard for the primary outcome (hazard ratio [HR], 1.14) in the overall model as well as separate analyses by treatment arms (standard group HR, 1.15; intensive group HR, 1.19), each P < .0001. DBP CV also independently predicted a greater hazard for acute kidney injury (HR, 1.12) and hypotensive events (HR, 1.12). Visit-to-visit DBP variability independently predicted worse cardiovascular outcomes and hypoperfusion-related adverse events in SPRINT.

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“…Several studies support the assertion that an appropriate dosage increment of ACE inhibitor will exert clinically relevant effects on blood pressure and outcome (21,22), effects that could equal the benefit of an additional blocking of the angiotensin II receptor. This has not been investigated until now because all previous studies have compared dual blockade with a placebo without a dosage increment of ACE inhibitor in the competing arm (1)(2)(3)23).…”

Section: Tolerabilitymentioning

confidence: 90%

Long-Term Dual Blockade With Candesartan and Lisinopril in Hypertensive Patients With Diabetes

et al. 2005

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OBJECTIVE -To assess and compare the long-term effects of the combination of candesartan and lisinopril with high-dose lisinopril on systolic blood pressure in patients with hypertension and diabetes.RESEARCH DESIGN AND METHODS -This was a prospective, randomized, parallel-group, double-blind, double-dummy study with a 12-month follow-up. Drug therapy was either lisinopril 40 mg once daily or dual-blockade treatment with candesartan 16 mg once daily and lisinopril 20 mg once daily. The study comprised 75 type 1 and type 2 diabetic patients aged 35-74 years. The main outcome measures were seated and 24-h ambulatory systolic blood pressure.RESULTS -Reduction in systolic blood pressure (24-h systolic blood pressure) reduction was obtained in both treatment arms (mean reduction at final follow-up: dual blockade 6 mmHg vs. lisinopril 2 mmHg), but no significant difference was found between dual-blockade and lisinopril 40 mg once daily (P ϭ 0.10). Both treatments were generally well tolerated, and similar low rates of side effects were found in the two groups.CONCLUSIONS -There was no statistically significant difference between lisinopril 40 mg once daily and lisinopril 20 mg in combination with candesartan 16 mg once daily in reducing systolic blood pressure in hypertensive patients with diabetes. Diabetes Care 28:273-277, 2005D ual blockade of the renin-angiotensin system was opted for based on the principle of obtaining the broadest and most efficient blockade of the effects of angiotensin II by using the combination of an ACE inhibitor and an angiotensin II receptor blocker (AIIA).By combining two different pharmacological principles and inhibiting both the ACE and the angiotensin II type 1 receptor, it seems possible to arrive at a treatment regimen that inhibits both the production and the action of angiotensin II and serves as an efficient antihypertensive therapy. The Candesartan and Lisinopril Microalbuminuria (CALM) study was among the first to show an additional effect from dual blockade on blood pressure in a population of type 2 diabetic patients with microalbuminuria over a 12-week follow-up period (1). Following the CALM study, several small-scale studies indicated that using dual blockade in treating type 1 and type 2 diabetic patients might produce additional clinical effects on both blood pressure and albumin excretion (2-4). Moreover, one large-scale study in nondiabetic patients with nephropathy has also shown that dual-blockade treatment has an effect in the long term (5).However, several important clinical questions remain unresolved: 1) What are the clinical effects of dual blockade compared with an efficient dosage titration of an ACE inhibitor? 2) Does the effect of dual blockade persist over a longer period of time? 3) What are the long-term safety and tolerability characteristics of the two treatment regimes?Thus, the primary objective of the CALM II study was to compare over a 12-month period the results of adding either candesartan cilexetil 16 mg or lisinopril 20 mg to concomitant antihy...

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The influence of dose of angiotensin I-converting enzyme inhibitor on systolic blood pressure variability in heart failure: a substudy of the Assessment of Treatment with Lisinopril and Survival in heart failure (ATLAS) trial

Abstract: Variation in circadian systolic blood pressure is useful in reflecting the influence of the magnitude of dose of the ACE inhibitor lisinopril on the pharmacodynamics of patients with heart failure.

Cited by 7 publications

References 10 publications

Carvedilol recovers normal blood pressure variability in rats with myocardial infarction

Carvedilol recovers normal blood pressure variability in rats with myocardial infarction

Blood pressure variability predicts adverse events and cardiovascular outcomes in SPRINT

Long-Term Dual Blockade With Candesartan and Lisinopril in Hypertensive Patients With Diabetes

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