Treatment of Hypertension in Patients With Coronary Artery Disease

Rosendorff, Clive; Lackland, Daniel T.; Allison, Matthew A.; Aronow, Wilbert S.; Black, Henry R.; Blumenthal, Roger S.; Cannon, Christopher P.; Lemos, James A. de; Elliott, W.J.; Findeiss, Laura; Gersh, Bernard J.; Gore, Joel M.; Levy, Daniel; Long, Janet B.; O’Connor, Christopher M.; O’Gara, Patrick T.; Ogedegbe, Gbenga; Oparil, Suzanne; White, William Β.

doi:10.1161/hyp.0000000000000018

Cited by 111 publications

(67 citation statements)

References 305 publications

(140 reference statements)

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“…Even though no significant differences in the risk of stroke recurrence according to the class of antihypertensive used among included RCTs were found, we detected a nonsignificant trend for lower risk of stroke recurrence in RCTs reporting the use of thiazide diuretics as monotherapy or in combination therapy for secondary stroke prevention. Our observation is consistent with previously published recommendations focusing on treatment intensity with a goal of SBP <140 mm Hg and expressing uncertainty about the potential disparities between different antihypertensive regimens, [33][34][35] suggesting thus that the degree of BP reduction may be more important than the class of the agent used to achieve it.…”

Section: Discussionsupporting

confidence: 91%

“…34 Our findings are also in accordance with the recent hypertension guidelines from the American Heart Association, American College of Cardiology, and American Society of Hypertension, which suggest that even though a BP target of 140/90 mm Hg is reasonable for the secondary prevention of cardiovascular events in patients with hypertension and coronary artery disease, more intensive BP reduction (<130/80 mm Hg) could be more appropriate in patients with coronary artery disease and a history of stroke or TIA. 35 However, it should be highlighted that even though intensive BP reduction seems to be associated with a lower risk of cardiovascular events and mortality, both the optimal BP target (below 140 mm Hg for SBP and below 90 mm Hg for DBP) and the most favorable timing for achieving this goal after the index event still remain unknown. These specific knowledge gaps need to be addressed in future RCTs in view of the recent evidence underscoring that intensive and acute BP control have also been associated with a higher risk for adverse events.…”

Section: Discussionmentioning

confidence: 99%

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Blood Pressure Reduction and Secondary Stroke Prevention

et al. 2017

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Evidence from randomized controlled trials (RCTs) supports the use of antihypertensive agents in the secondary prevention of patients with ischemic stroke (IS) or transient ischemic attack (TIA).1,2 However, since heterogeneity is present for several outcomes among these trials, current recommendations do not specifically address the intensity of blood pressure (BP) lowering for secondary stroke prevention. 1,2This heterogeneity has been attributed to both a potential class effect of antihypertensive drugs used (related also to the reduction of BP variability) 3 and differences in the degree of BP reduction using standard and aggressive antihypertensive strategies. 4 Moreover, the majority of RCTs of secondary stroke prevention did not specifically evaluate the association between the extent of BP reduction and long-term outcomes in patients with stroke or TIA, leading to increasing uncertainty about the optimal BP levels that should be aimed and achieved during secondary stroke prevention. 5,6 In view of the former considerations, we conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using available RCT data on secondary stroke prevention. Methods Trial Identification and Data AbstractionThis meta-analysis has adopted the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for systematic reviews and meta-analyses.7 Eligible RCTs of all antihypertensive treatments used in the secondary prevention of IS/TIA Abstract-Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Blood Pressure Reduction and Secondary Stroke Prevention

et al. 2017

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“…Az Európai Kardiológus Társaság (ESC) aktuális irányelvében a béta-blokkolókat elsővonalbeli szerként javasolt alkalmazni a frekvencia csökkentésére és a tünetek enyhítésére (I. osztályú A-evidenciaszint). A béta-blokkolók alkalmazhatók tünetmentes betegeknél is, ahol nagy kiterjedésű iszkémia detektálható, továb-bá mikrovaszkuláris angina esetén, a terhelés kiváltotta panaszok mérséklésére (5,6). A béta-blokkolók bizonyítottan növelik a beteg terhelhetőségét, megnyújtják az iszkémia kialakulásáig eltelt időt, valamint csökken-tik a panaszos és tünetmentes anginás epizódok szá-mát (7,8).…”

Section: Az Optimális Gyógyszeres Terápia Stabil Iszkémiás Szívbetegsunclassified

Revaszkularizáció vagy optimális gyógyszeres kezelés stabil koszorúér-betegségben. Melyik terápiás stratégia követendő?

Ágoston¹

2017

Cardiologia Hungarica

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Az optimális gyógyszeres terápia helye stabil iszkémiás szívbetegségben továbbra is vitatott terület. Iszkémiás szív-betegségben minden beteg gyógyszeres terápiában részesül, azonban a stabil koronáriabetegek többségénél további terápiás beavatkozás, koronária-intervenció vagy bypass-műtét is történik. Az optimális gyógyszeres terápián lévő betegek revaszkularizációja számos bizonytalanságot vet fel és nem definiálható egyértelműen annak prognosztikai jelentősége. A jelen összefoglalóban röviden ismertetjük az optimális gyógyszeres terápia jellemzőit, valamint a témában született legfontosabb multicentrikus, randomizált tanulmányok eredményeit. Következtetésként leszögezhető, hogy az optimális gyógyszeres terápia és revaszkularizáció egyaránt alkalmazható terápiás stratégia. Hogy melyik stratégia követendő? -a kérdés megválaszolásában reményeink szerint segíteni fog a jelenleg is folyamatban lévő ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) vizsgálat, ahol a fő célkitűzés a stabil koronáriabetegek optimális kezelési stratégiájának meghatározása. Revascularizationoroptimalmedicaltherapyinstablecoronaryarterydisease.Whichstrategytofollow?Defining optimal management of patients with stable, ischemic heart disease is still a central area of debate. All patients with coronary artery disease should at least be managed with optimal medical therapy, many patients with stable coronary artery disease continue to be treated with revascularization, whether by percutaneous coronary intervention or coronary artery bypass grafting. It remains unclear is whether revascularization further improves prognosis when added to optimal medical therapy. In the present summary we start by reviewing the definition and details of optimal medical therapy and then to review the results of randomized trials comparing both revascularization strategies with optimal medical therapy. We conclude that revascularization and medical therapy should be used as complementary strategies. Which strategy to follow? Hopefully the ongoing ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial will bring us closer to the answer which seeks to determine optimal management for patients with stable ischemic heart disease. ischaemic heart disease, stable angina, optimal medical therapy Keywords:iszkémiás szívbetegség, stabil angina pectoris, optimális gyógyszeres kezelés Kulcsszavak: BevezetőA kardiovaszkuláris betegségek továbbra is vezető haláloki tényezők, ezen belül az iszkémiás szívbetegség a mortalitás fő oka. A koronáriabetegség az életkor elő-rehaladtával egyre gyakoribbá válik, a betegek kezelé-se egyre nagyobb terhet ró az egészségügyre, ezért a stabil koszorúér-betegség optimális kezelési stratégi-ájának kérdése napjainkban egyre nagyobb hangsúlyt kap. A stabil koszorúér-betegség kezelésében számos módszert alkalmaznak és hasonlítottak össze. Ilyen a perkután transzluminális koronária-angioplasztika (PTCA), a perkután koronária-intervenció...

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“…В 2015 г. американские кардиологи (American Heart Association/American College of Cardiology/American Society of Hypertension) стали первыми в мире, кто выпустил специальные рекомендации по лечению АГ у пациентов с ИБС [3]. Этот документ интересен своей хорошей структурированностью, и тем, что отвечает на многие вопросы о том, как целесообразно лечить дан-ную когорту пациентов.…”

Section: Management Of Hypertensive Patients With Ischemic Heart Diseaseunclassified

Features of Management of Patients With Hypertension in Combination With Ischemic Heart Disease: Modern Approaches

Napalkov

2017

Racionalʹnaâ farmakoterapiâ v kardiologii

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Treatment of Hypertension in Patients With Coronary Artery Disease

Cited by 111 publications

References 305 publications

Blood Pressure Reduction and Secondary Stroke Prevention

Blood Pressure Reduction and Secondary Stroke Prevention

Revaszkularizáció vagy optimális gyógyszeres kezelés stabil koszorúér-betegségben. Melyik terápiás stratégia követendő?

Features of Management of Patients With Hypertension in Combination With Ischemic Heart Disease: Modern Approaches

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