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Hypertension, diabetes,nephropathy,stroke,outcome trials

Hao Xue, Zhuang Lu, Wen Lu Tang, Lu Wei Pang, Gan Mi Wang, Gavin W K Wong, James M Wright
BACKGROUND: Renin-angiotensin system (RAS) inhibitors are widely prescribed for treatment of hypertension, especially for diabetic patients on the basis of postulated advantages for the reduction of diabetic nephropathy and cardiovascular morbidity and mortality. Despite widespread use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for hypertension in both diabetic and non-diabetic patients, the efficacy and safety of RAS inhibitors compared to other antihypertensive drug classes remains unclear...
January 11, 2015: Cochrane Database of Systematic Reviews
Marcel Ruzicka, Robert R Quinn, Phil McFarlane, Brenda Hemmelgarn, G V Ramesh Prasad, Janusz Feber, Gihad Nesrallah, Martin MacKinnon, Navdeep Tangri, Brendan McCormick, Sheldon Tobe, Tom D Blydt-Hansen, Swapnil Hiremath
The KDIGO (Kidney Disease: Improving Global Outcomes) 2012 clinical practice guideline for the management of blood pressure (BP) in chronic kidney disease (CKD) provides the structural and evidence base for the Canadian Society of Nephrology (CSN) commentary on this guideline's relevancy and application to the Canadian health care system. While in general agreement, we provide commentary on 13 of the 21 KDIGO guideline statements. Specifically, we agreed that nonpharmacological interventions should play a significant role in the management of hypertension in patients with CKD...
June 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Patricio Lopez-Jaramillo, Jose Lopez-Lopez, Cristina Lopez-Lopez, Miguel I Rodriguez-Alvarez
The recent Latin American and European guidelines published this year has proposed as a goal for blood pressure control in patients with diabetes type 2 a value similar or inferior to 140/90 mmHg. High blood pressure is the leading cause of cardiovascular diseases and deaths globally. Although once hypertension is detected, 80% of individuals are on a pharmacologic therapy only a minority is controlled. Diabetes also is a risk factor for other serious chronic diseases, including cardiovascular disease. Whether specifically targeting lower fasting glucose levels can reduce cardiovascular outcomes remains unknown...
2014: Diabetology & Metabolic Syndrome
R V Seimon, D Espinoza, L Ivers, V Gebski, N Finer, U F Legler, A M Sharma, W P T James, W Coutinho, I D Caterson
BACKGROUND/OBJECTIVES: The Sibutramine Cardiovascular OUTcomes (SCOUT) trial showed a significantly increased relative risk of nonfatal cardiovascular events, but not mortality, in overweight and obese subjects receiving long-term sibutramine treatment with diet and exercise. We examined the relationship between early changes (both increases and decreases) in body weight and blood pressure, and the impact of these changes on subsequent cardiovascular outcome events. SUBJECTS/METHODS: A total of 9804 male and female subjects, aged 55 years or older, with a body mass index of 27-45 kg m(-2) were included in this current subanalysis of the SCOUT trial...
September 2014: International Journal of Obesity: Journal of the International Association for the Study of Obesity
Jun Hata, Hisatomi Arima, Sophia Zoungas, Greg Fulcher, Carol Pollock, Mark Adams, John Watson, Rohina Joshi, Andre Pascal Kengne, Toshiharu Ninomiya, Craig Anderson, Mark Woodward, Anushka Patel, Giuseppe Mancia, Neil Poulter, Stephen MacMahon, John Chalmers, Bruce Neal
BACKGROUND: Endpoint adjudication committees (EPAC) are widely used in clinical trials. The aim of the present analysis is to assess the effects of the endpoint adjudication process on the main findings of the ADVANCE trial (Trial registration: NCT00145925). METHODS AND FINDINGS: The ADVANCE trial was a multicentre, 2 × 2 factorial randomised controlled trial of blood pressure lowering and intensive blood glucose control in 11140 patients with type 2 diabetes...
2013: PloS One
Wim Terryn, Pierre Cochat, Roseline Froissart, Alberto Ortiz, Yves Pirson, Bruce Poppe, Andreas Serra, Wim Van Biesen, Raymond Vanholder, Christoph Wanner
Fabry disease (FD) is an X-linked disorder of glycosphingolipid catabolism resulting in the accumulation of glycolipids including globotriaosylceramide in cells of various tissues resulting in end-organ manifestations. Initially, FD is typically characterized by angiokeratoma and recurrent episodes of neuropathic pain in the extremities occurring during childhood or adolescence. Most affected patients also exhibit a decreased ability to sweat. Later in life, FD results in left ventricular hypertrophy, proteinuria, renal failure and stroke...
March 2013: Nephrology, Dialysis, Transplantation
W Rathmann, K Kostev
AIMS: Insulin aspart has a higher ability to treat postprandial glucose than regular human insulin, which may have favourable cardiovascular effects. The aim was to collect and compare the incidence of recorded macro- and microvascular events in patients with type 2 diabetes with insulin aspart or regular human insulin in general practices. METHODS: Computerized data from 3154 aspart and 3154 regular insulin users throughout Germany (Disease Analyzer, January 2000 to July 2011) were analysed after matching for age (60 ± 10 years), sex (men: 57%), health insurance (private: 5...
April 2013: Diabetes, Obesity & Metabolism
Bernard Waeber, Corina Rotaru, François Feihl
INTRODUCTION: Diuretics play a pivotal role in the management of hypertension. A large experience has been accumulated with indapamide , a long-acting thiazide-like diuretic that lowers blood pressure (BP) primarily through its natriuretic diuretic effect. Some of its long-term antihypertensive efficacy may be due to calcium antagonist-like vasorelaxant activities. Indapamide has protecting effects in a variety of conditions associated with high cardiovascular risk, such as diabetes, left ventricular hypertrophy, nephropathy and stroke...
July 2012: Expert Opinion on Pharmacotherapy
E Imai, J C N Chan, S Ito, T Yamasaki, F Kobayashi, M Haneda, H Makino
AIMS/HYPOTHESIS: The renal and cardiovascular protective effects of angiotensin receptor blocker (ARB) remain controversial in type 2 diabetic patients treated with a contemporary regimen including an angiotensin converting enzyme inhibitor (ACEI). METHODS: We examined the effects of olmesartan, an ARB, on primary composite outcome of doubling of serum creatinine, endstage renal disease and death in type 2 diabetic patients with overt nephropathy. Secondary outcome included composite cardiovascular outcomes, changes in renal function and proteinuria...
December 2011: Diabetologia
Zemin Cao, Mark E Cooper
Cardiovascular disease is the predominant cause of morbidity in people with type 2 diabetes. Hypertension frequently coexists with diabetes and substantially increases the risk of developing end-organ damage. Controlling hypertension in patients with diabetes is therefore critical to reducing microvascular and macrovascular complications. Agents that block the renin-angiotensin system are increasingly used in patients with diabetes based on their cardiovascular and renoprotective effects, in addition to their direct effects on reducing blood pressure...
August 2012: Acta Diabetologica
Frank A Holtkamp, Dick de Zeeuw, Pieter A de Graeff, Gozewijn D Laverman, Tom Berl, Giuseppe Remuzzi, David Packham, Julia B Lewis, Hans-Henrik Parving, Hiddo J Lambers Heerspink
AIMS: The long-term cardioprotective effect of angiotensin receptor blockers (ARBs) is associated with the short-term lowering of its primary target blood pressure, but also with the lowering of albuminuria. Since the individual blood pressure and albuminuria response to an ARB varies between and within an individual, we tested whether the variability and discordance in systolic blood pressure (SBP) and albuminuria response to ARB therapy are associated with its long-term effect on cardiovascular outcomes...
June 2011: European Heart Journal
Hiddo J Lambers Heerspink, Toshiharu Ninomiya, Vlado Perkovic, Mark Woodward, Sophia Zoungas, Alan Cass, Mark Cooper, Diederick E Grobbee, Giuseppe Mancia, Carl Eric Mogensen, Bruce Neal, John Chalmers
AIMS: Individuals with diabetes and chronic kidney disease (CKD) are at high risk for cardiovascular disease. In these analyses of the ADVANCE trial, we assessed the effects of a fixed combination of perindopril-indapamide on renal and cardiovascular outcomes in patients with type 2 diabetes according to baseline CKD stage. METHODS AND RESULTS: Patients with type 2 diabetes were randomized to perindopril-indapamide (4 mg/1.25 mg) or placebo. Treatment effects on cardiovascular (cardiovascular death, myocardial infarction, or stroke) and renal outcomes were compared in subgroups defined by baseline Kidney Disease Outcome Quality Initiative CKD stage...
December 2010: European Heart Journal
Paolo Verdecchia, Fabio Angeli, Giovanni Mazzotta, Giuseppe Ambrosio, Gianpaolo Reboldi
Angiotensin II receptor blockers (ARBs) are widely used in the treatment of patients with hypertension, heart failure, diabetic nephropathy and other clinical conditions. Several intervention trials and systematic overviews showed that both angiotensin-converting enzyme inhibitors and ARBs effectively reduce the risk of stroke, myocardial infarction and congestive heart failure in hypertensive patients. Two recent intervention trials conducted in Japan (JIKEI and Kyoto studies) suggested that the protective effect of ARBs on major cardiovascular events might be partly independent from the degree of blood pressure (BP) reduction...
May 2010: Hypertension Research: Official Journal of the Japanese Society of Hypertension
Suresh G Vijan
Blockade of the renin-angiotensin system (RAS) plays an important role in the prevention and correction of cardiovascular diseases. Agents that block the RAS such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are major in this league. There have been numerous clinical trials looking at the use of ACEIs and ARBs in hypertension, heart failure (HF), and other special population who remain at high risk for cardiovascular and cardiometabolic abnormalities. Overall, ACEIs are the first line agents, recommended for high cardiovascular risk patients and are supported suitably by worldwide therapeutic guidelines including class IA recommendation from American College of Cardiology (ACC)/American Heart Association...
March 2009: Journal of the Indian Medical Association
Sanne de Vogel, Ewout J Hoorn, Vasilios Papademetriou
Hypertension is a major risk factor for the development of cardiovascular disease. Numerous placebo-controlled trials have demonstrated that treatment of hypertension results in substantial reduction of hypertension-related vascular events. The benefit of specific therapies beyond their effect on blood pressure is well established. Losartan is an orally-active, selective, nonpeptide, angiotensin II type 1-receptor antagonist (ARB), and it was the first in this class to be marketed. Several large-scale clinical trials have demonstrated that losartan and other ARBs have benefits in preventing cardiovascular disease...
July 2005: Future Cardiology
Alan H Gradman
Systolic blood pressure (SBP) increases with age, and hypertension affects approximately two-thirds of adults in the US aged >60 years. Blood pressure (BP) increases as a consequence of age-related structural changes in large arteries, which lead to loss of elasticity and reduced vascular compliance. Increased pulse wave velocity augments SBP, resulting in a high prevalence of isolated systolic hypertension. Because age itself elevates cardiovascular risk, effective treatment of hypertension in an older (aged >or=65 years) patient population prevents many more events per 1000 patients treated than treatment of younger hypertensive patients...
2009: Drugs & Aging
Gianpaolo Reboldi, Giorgio Gentile, Fabio Angeli, Paolo Verdecchia
The diabetes epidemic continues to grow unabated, with a staggering toll in micro- and macrovascular complications, disability, and death. Diabetes causes a two- to fourfold increase in the risk of cardiovascular disease, and represents the first cause of dialysis treatment both in the UK and the US. Concomitant hypertension doubles total mortality and stroke risk, triples the risk of coronary heart disease and significantly hastens the progression of microvascular complications, including diabetic nephropathy...
2009: Vascular Health and Risk Management
Simona de Portu, Lorenzo G Mantovani
OBJECTIVES: To review the pharmacoeconomic impact of the use of amlodipine in coronary artery disease (CAD) patients. METHODS: A review of the available outcome trials evaluating the clinical effectiveness of amlodipine in hypertensive patients or in patients with CAD or diabetic nephropathy was carried out to identify pharmacoeconomic studies that quantified the economic impact of using amlodipine instead of another treatment. RESULTS: A combined analysis of two trials comparing angiotensin receptor blockers (ARBs) with a calcium channel blocker amlodipine suggested that amlodipine provided more protection against stroke and myocardial infarction than ARBs...
March 2009: Journal of Medical Economics
Julio Pascual, Javier Zamora, John D Pirsch
BACKGROUND: During the past few years, there has been renewed interest in the use of expanded criteria donors (ECD) for kidney transplantation to increase the numbers of deceased donor kidneys available. More kidney transplants would result in shorter waiting times and limit the morbidity and mortality associated with long-term dialysis therapy. STUDY DESIGN: Systematic review of the literature. SETTING & POPULATION: Kidney transplantation population...
September 2008: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Samy Hadjadj, Frédéric Fumeron, Ronan Roussel, Pierre-Jean Saulnier, Yves Gallois, Amos Ankotche, Florence Travert, Charbel Abi Khalil, Aurélie Miot, François Alhenc-Gelas, Michel Lievre, Michel Marre
OBJECTIVE: We tested whether determination of the ACE insertion/deletion polymorphism is useful for renal and cardiovascular prognoses of type 2 diabetic subjects. RESEARCH DESIGN AND METHODS: The French participants (3,126 of 4,912) in the Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) trial were studied for their prognosis over 4 years according to their ACE insertion/deletion polymorphism...
September 2008: Diabetes Care
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