DOCSLIB.ORG

Study on Cognition and Prognosis in the Elderly (SCOPE)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Study on Cognition and Prognosis in the Elderly (SCOPE) BLOOD PRESSURE 1999; 8: 177±183 Study on COgnition and Prognosis in the Elderly (SCOPE) L. HANSSON1, H. LITHELL1, I. SKOOG2, F. BARO3,C.M.BA´NKI4, M. BRETELER5, P. U. CARBONIN6, A. CASTAIGNE7, M. CORREIA8, J.-P. DEGAUTE9, D. ELMFELDT10, K. ENGEDAL11, C. FARSANG12, J. FERRO8, V. HACHINSKI13, A. HOFMAN5, O. F. W. JAMES14, E. KRISIN10, M. LEEMAN9, P. W. DE LEEUW15, D. LEYS16, A. LOBO17, G. NORDBY11, B. OLOFSSON10, G. OPOLSKI18, M. PRINCE19, F. M. REISCHIES20, J. B. ROSENFELD21, L. RUILOPE22, J. SALERNO23, R. TILVIS24, P. TRENKWALDER25 AND A. ZANCHETTI26 From 1Uppsala, 2Go¨teborg, Sweden, 3Bierbeek, Belgium, 4Nagyka´llo´, Hungary, 5Rotterdam, The Netherlands, 6Roma, Italy, 7Cre´teil, France, 8Lisboa, Portugal, 9Bruxelles, Belgium, 10Mo¨lndal, Sweden, 11Oslo, Norway, 12Budapest, Hungary, 13London, Ontario, Canada, 14Newcastle upon Tyne, UK, 15Maastricht, The Netherlands, 16Lille, France, 17Zaragoza, Spain, 18Warsaw, Poland, 19London, UK, 20Berlin, Germany, 21Tel-Aviv, Israel, 22Madrid, Spain, 23Washington DC, USA, 24Helsinki, Finland, 25Starnberg, Germany, 26Milan, Italy Hansson L, Lithell H, Skoog I, Baro F, Ba´nki CM, Breteler M, Carbonin PU, Castaigne A, Correia M, Degaute J-P, Elmfeldt D, Engedal K, Farsang C, Ferro J, Hachinski V, Hofman A, James OFW, Krisin E, Leeman M, De Leeuw PW, Leys D, Lobo A, Nordby G, Olofsson B, Opolski G, Prince M, Reischies FM, Rosenfeld JB, Ruilope L, Salerno J, Tilvis R, Trenkwalder P, Zanchetti A. Study on cognition and prognosis in the elderly (SCOPE). Blood Pressure 1999; 8: 177–183. The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multicentre, prospective, randomized, double-blind, parallel-group study designed to compare the effects of candesartan cilexetil and placebo in elderly patients with mild hypertension. The primary objective of the study is to assess the effect of candesartan cilexetil on major cardiovascular events. The secondary objectives of the study are to assess the effect of candesartan cilexetil on cognitive function and on total mortality, cardiovascular mortality, myocardial infarction, stroke, renal function, hospitalization, quality of life and health economics. Male and female patients aged between 70 and 89 years, with a sitting systolic blood pressure (SBP) of 160– 179 mmHg and/or diastolic blood pressure (DBP) of 90–99 mmHg, and a Mini-Mental State Examination (MMSE) score of 24 or above, are eligible for the study. The overall target study population is 4000 patients, at least 1000 of whom are also to be assessed for quality of life and health economics data. After an open run-in period lasting 1–3 months, during which patients are assessed for eligibility and those who are already on antihypertensive therapy at enrolment are switched to hydrochlorothiazide 12.5 mg o.d., patients are randomized to receive either candesartan cilexetil 8 mg once daily (o.d.) or matching placebo o.d. At subsequent study visits, if SBP remains >160 mmHg, or has decreased by <10 mmHg since the randomization visit, or DBP is >85 mmHg, study treatment is doubled to candesartan cilexetil 16 mg o.d. or two placebo tablets o.d. Recruitment was completed in January 1999. At that time 4964 patients had been randomized. All randomized patients will be followed for an additional 2 years. If the event rate is lower than anticipated, the follow-up will be prolonged. Key words: mild hypertension, elderly, candesartan cilexetil, cardiovascular events, cognitive function. INTRODUCTION Hypertension is one of the major risk factors for both coronary heart disease and stroke, which have been shown The proportion of the elderly people in the general to increase by around five-fold and ten-fold, respectively, population, and particularly of very elderly people, is with increasing diastolic blood pressure (DBP) from increasing in most industrialized countries [1]. This trend 76 mmHg to 105 mmHg [3]. Cerebrovascular disease, as is expected to continue well beyond the year 2000, manifested by stroke and ischaemic white matter changes, leading to a greater prevalence of cardiovascular and results in varying degrees of brain dysfunction, including cerebrovascular disease, which increase considerably dementia, and represents a chronic health problem with with age. Recent data from a worldwide study show that important personal, social and economic implications. A cardiovascular and cerebrovascular disease are already history of atherosclerosis alone, excluding the effects of the leading causes of death and disability in the age and education, has also been shown to be associated industrialized world [2]. with decreased cognitive performance [4]. 1999 Scandinavian University Press on licence from Blood Pressure. ISSN 0803-7051 BLOOD PRESSURE 1999 178 L. Hansson et al. Prevention of cardiovascular and cerebrovascular Rationale for proposed study complications At the time of planning SCOPE, an analysis of nine The beneficial effects of treating hypertension have been prospective observational studies suggested that there was documented in a number of studies. In a meta-analysis of no apparent threshold DBP below which the risk of stroke several, prospective randomized intervention trials invol- was not continuously reduced [25]. The results of the ving nearly 48 000 patients, a DBP reduction of 5– recently completed Hypertension Optimal Treatment 6 mmHg was found to decrease the risk of stroke by 38% (HOT) Study indicated that the lowest risk of stroke and heart disease by 16% [5]. Four major studies have (fatal and non-fatal) was achieved at a DBP of also shown that stroke morbidity and mortality in the <85 mmHg [26]. However, HOT was not a study in the elderly can be significantly reduced with antihypertensive elderly, since in this cohort the mean age was 62 years therapy: the Systolic Hypertension in the Elderly Program and, furthermore, patients had a mean DBP of 105 mmHg (SHEP) [6] in the USA, the Swedish Trial in Old Patients (Æ3.4) at randomization. with Hypertension (STOP-Hypertension) [7], the British An as yet unanswered question, is whether antihyper- Medical Research Council (MRC) study in older adults tensive treatment provides protection against stroke in [8] and the Systolic Hypertension in Europe (Syst-Eur) patients with an initial DBP of 90–99 mmHg. In addition, study [9]. In all of these studies, the entry systolic blood although the term “preventable senility” has been used pressure (SBP) was relatively high. However, the value of [27], there is no definitive evidence to show that lowering antihypertensive treatment in elderly patients with DBP in of elevated blood pressure can reduce the incidence of the range 90–99 mmHg remains an open issue, since DBP dementia. However, a subgroup analysis from the Syst- at entry in both the STOP and MRC trials was above these Eur Study [28] showed that treatment of isolated systolic values, and the SHEP and Syst-Eur studies specifically hypertension with the long-acting calcium antagonist recruited patients with isolated systolic hypertension. nitrendipine reduced the incidence of dementia and AD by 50%. These results further emphasize that treatment of hypertension may be a potential way to prevent develop- ment of dementia and cognitive decline in the elderly. A clinical study to assess the effects of antihypertensive The impact of hypertension on cognitive function and drug treatment on major cardiovascular events and dementia cognitive function in elderly patients with mild hyperten- Hypertension is generally recognized to be a major risk sion is therefore warranted. factor for the development of ischaemic white matter There may be a considerable benefit of antihyperten- lesions [10, 11], as well as stroke [12]. Old age, and sive therapy in this group of patients, since there is a especially very old age, is associated with an increased continuum between dementia and cognitive impairment risk of dementia [13]. More than 60 diseases are in the elderly population [29]. Hence, even if treatment of associated with the syndrome of dementia, the most vascular risk factors results in only a small improvement common being Alzheimer’s disease (AD) and vascular in the whole distribution of cognitive ability, it may lead dementia (VAD) [14]. In a recent study, VAD was found to a substantial reduction in the prevalence of overt to be more common than previously assumed [15]. dementia [4, 29]. Furthermore, since hypertension and Although all the risk factors for VAD have yet to be other cardiovascular disorders are common in the elderly, identified, it is obvious that arterial hypertension plays an they may make a much greater contribution to the number important role [10]. In a longitudinal study of nearly 1000 of cases of dementia than more infrequent disorders elderly Swedish men, there was an inverse relationship associated with a higher risk [4, 29]. between DBP at 50 years of age and cognitive function at 70 years of age [16], as determined by psychometric testing and use of the Mini-Mental State Examination Rationale for using candesartan cilexetil (MMSE) [17, 18]. In a further Swedish study, a significant Angiotensin II type 1 (AT1) receptor blockers represent a link was found between the presence of high SBP and new class of antihypertensive agents. Unlike ACE- DBP at age 70 years and the development of dementia inhibitors, AT1-receptor blockers do not inhibit the break- 10–15 years later [19]. down of bradykinin or other kinins, and this novel class of The risk of developing dementia increases at least nine- drugs is not associated with a dry cough [30]. The excellent fold after a stroke [20, 21]. Furthermore, ischaemic white tolerability and relative lack of contraindications of these matter lesions have also been linked to AD and to VAD agents make them highly suitable for the treatment of [10]. Other cardiovascular disorders, such as myocardial hypertension in the elderly. Moreover, AT1-receptor infarction [22, 23] and generalized atherosclerosis [24], blockers may help to maintain or even improve cognitive may also increase the risk of developing dementia.
Load more

Recommended publications
  • Angiotensin-Converting Enzyme (ACE) Inhibitors Single Entity Agents
    Therapeutic Class Overview Angiotensin-Converting Enzyme (ACE) Inhibitors Single Entity Agents Therapeutic Class Overview/Summary: The renin-angiotensin-aldosterone system (RAAS) is the most important component in the homeostatic regulation of blood pressure.1,2 Excessive activity of the RAAS may lead to hypertension and disorders of fluid and electrolyte imbalance.3 Renin catalyzes the conversion of angiotensinogen to angiotensin I. Angiotensin I is then cleaved to angiotensin II by angiotensin- converting enzyme (ACE). Angiotensin II may also be generated through other pathways (angiotensin I convertase).1 Angiotensin II can increase blood pressure by direct vasoconstriction and through actions on the brain and autonomic nervous system.1,3 In addition, angiotensin II stimulates aldosterone synthesis from the adrenal cortex, leading to sodium and water reabsorption. Angiotensin II exerts other detrimental cardiovascular effects including ventricular hypertrophy, remodeling and myocyte apoptosis.1,2 The ACE inhibitors block the conversion of angiotensin I to angiotensin II, and also inhibit the breakdown of bradykinin, a potent vasodilator.4 Evidence-based guidelines recognize the important role that ACE inhibitors play in the treatment of hypertension and other cardiovascular and renal diseases. With the exception of Epaned® (enalapril solution) and Qbrelis® (lisinopril solution), all of the ACE inhibitors are available generically. Table 1. Current Medications Available in Therapeutic Class5-19 Generic Food and Drug Administration
    [Show full text]
  • Interaction of the Sympathetic Nervous System with Other Pressor Systems in Antihypertensive Therapy
    Journal of Clinical and Basic Cardiology An Independent International Scientific Journal Journal of Clinical and Basic Cardiology 2001; 4 (3), 185-192 Interaction of the Sympathetic Nervous System with other Pressor Systems in Antihypertensive Therapy Wenzel RR, Baumgart D, Bruck H, Erbel R, Heemann U Mitchell A, Philipp Th, Schaefers RF Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Indexed in Chemical Abstracts EMBASE/Excerpta Medica Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria FOCUS ON SYMPATHETIC TONE Interaction of SNS J Clin Basic Cardiol 2001; 4: 185 Interaction of the Sympathetic Nervous System with Other Pressor Systems in Antihypertensive Therapy R. R. Wenzel1, H. Bruck1, A. Mitchell1, R. F. Schaefers1, D. Baumgart2, R. Erbel2, U. Heemann1, Th. Philipp1 Regulation of blood pressure homeostasis and cardiac function is importantly regulated by the sympathetic nervous system (SNS) and other pressor systems including the renin-angiotensin system (RAS) and the vascular endothelium. Increases in SNS activity increase mortality in patients with hypertension, coronary artery disease and congestive heart failure. This review summarizes some of the interactions between the main pressor systems, ie, the SNS, the RAS and the vascular endothelium including the endothelin-system. Different classes of cardiovascular drugs interfere differently with the SNS and the other pressor systems. Beta-blockers, ACE-inhibitors and diuretics have no major effect on central SNS activity. Pure vasodilators including nitrates, alpha-blockers and DHP-calcium channel blockers increase SNS activity. In contrast, central sympatholytic drugs including moxonidine re- duce SNS activity. The effects of angiotensin-II receptor antagonist on SNS activity in humans are not clear, experimental data are discussed in this review.
    [Show full text]
  • Beta-Blockers for Hypertension: Time to Call a Halt
    Journal of Human Hypertension (1998) 12, 807–810 1998 Stockton Press. All rights reserved 0950-9240/98 $12.00 http://www.stockton-press.co.uk/jhh FOR DEBATE Beta-blockers for hypertension: time to call a halt DG Beevers University Department of Medicine, City Hospital, Birmingham B18 7QH, UK Beta-blockers are not very effective at lowering blood the endorsement of beta-blockers by the British Hyper- pressure in elderly hypertensive patients or in Afro- tension Society and other guidelines committees, Caribbeans and these two groups represent a large pro- except possibly for severe resistant hypertension, high portion of people with raised blood pressure. Further- risk post-infarct patients and those with angina pectoris. more they do not prevent more heart attacks than the The time has come to move across to newer, safer, more thiazide diuretics. Beta-blockers can also be dangerous tolerable and more effective antihypertensive agents in many hypertensive patients and even when these whilst continuing to use thiazide diuretics in low doses drugs are not contraindicated, they cause subtle and in the elderly as first choice, providing there are no depressing side effects which should preclude their contraindications. usefulness. The time has come therefore to reconsider Keywords: beta-blockers; hypertension Introduction Safety and tolerability Beta-adrenergic blockers were first introduced in the There is little doubt that the beta-blockers are the early 1960s for the treatment of angina pectoris. most unsafe of all antihypertensive drugs. They can Their antihypertensive properties were not fully precipitate or worsen heart failure in patients with recognised until the celebrated paper by Pritchard myocardial damage and they are contraindicated in and Gillam in 1964.1 They rapidly became popular patients with asthma.
    [Show full text]
  • 3. Diuretics for Hypertension-A Review and Update
    REVIEW Diuretics for Hypertension: A Review and Update George C. Roush1 and Domenic A. Sica2 Downloaded from https://academic.oup.com/ajh/article-abstract/29/10/1130/2622231 by Xenia Agorogianni user on 17 July 2019 This review and update focuses on the clinical features of hydrochlo- ectopy and reduce the risk for sudden cardiac death relative to thi- rothiazide (HCTZ), the thiazide-like agents chlorthalidone (CTDN) and azide-type diuretics used alone. A recent synthesis of 44 trials has indapamide (INDAP), potassium-sparing ENaC inhibitors and aldos- shown that the relative potencies in milligrams among spironolac- terone receptor antagonists, and loop diuretics. Diuretics are the sec- tone (SPIR), amiloride, and eplerenone (EPLER) are approximately ond most commonly prescribed class of antihypertensive medication, from 25 to 10 to 100, respectively, which may be important when SPIR and thiazide-related diuretics have increased at a rate greater than is poorly tolerated. SPIR reduces proteinuria beyond that provided by that of antihypertensive medications as a whole. The latest hyper- other renin angiotensin aldosterone inhibitors. EPLER also reduces tension guidelines have underscored the importance of diuretics for proteinuria and has beneficial effects on endothelial function. While all patients, but particularly for those with salt-sensitive and resist- guidelines often do not differentiate among specific diuretics, this ant hypertension. HCTZ is 4.2–6.2 systolic mm Hg less potent than review demonstrates that these distinctions are important for man- CTDN, angiotensin-converting enzyme inhibitors, beta blockers, and aging hypertension. calcium channel blockers by 24-hour measurements and 5.1 mm Hg systolic less potent than INDAP by office measurements.
    [Show full text]
  • Calcium Channel Blockers
    Calcium Channel Blockers Summary In general, calcium channel blockers (CCBs) are used most often for the management of hypertension and angina. There are 2 classes of CCBs: the dihydropyridines (DHPs), which have greater selectivity for vascular smooth muscle cells than for cardiac myocytes, and the non-DHPs, which have greater selectivity for cardiac myocytes and are used for cardiac arrhythmias. The DHPs cause peripheral edema, headaches, and postural hypotension most commonly, all of which are due to the peripheral vasodilatory effects of the drugs in this class of CCBs. The non-DHPs are negative inotropes and chronotropes; they can cause bradycardia and depress AV node conduction, increasing the risk of heart failure exacerbation, bradycardia, and AV block. Clevidipine is a DHP calcium channel blocker administered via continuous IV infusion and used for rapid blood pressure reductions. All CCBs are substrates of CYP3A4, but both diltiazem and verapamil are also inhibitors of 3A4 and have an increased risk of drug interactions. Verapamil also inhibits CYP2C9, CYP2C19, and CYP1A2. Pharmacology CCBs selectively inhibit the voltage-gated L-type calcium channels on cardiac myocytes, vascular smooth muscle cells, and cells within the sinoatrial (SA) and atrioventricular (AV) nodes, preventing influx of extracellular calcium. CCBs act by either deforming the channels, inhibiting ion-control gating mechanisms, and/or interfering with the release of calcium from the major cellular calcium store, the endoplasmic reticulum. Calcium influx via these channels serves for excitation-contraction coupling and electrical discharge in the heart and vasculature. A decrease in intracellular calcium will result in inhibition of the contractile process of the myocardial smooth muscle cells, resulting in dilation of the coronary and peripheral arterial vasculature.
    [Show full text]
  • Information Presse an Antihypertensive Drug Improves Corticosteroid-Based Skin Treatments
    Paris, le 18 mars 2015 Information presse An antihypertensive drug improves corticosteroid-based skin treatments Basic research on blood pressure has led researchers from Inserm (Inserm Unit 1138, “Cordeliers Research Centre”) to obtain unexpected results: drugs used to treat hypertension (high blood pressure) reduce side effects from corticosteroid-based creams used to treat certain skin diseases. This work is published in the Journal of Investigative Dermatology. Corticosteroid-based dermatological creams are indicated for the symptomatic treatment of inflammatory skin conditions, such as atopic dermatitis and psoriasis, for example. However, they have frequent side effects, such as a slight burning sensation, and very often end by inducing skin atrophy (thinning of the skin, which becomes fragile), which is inconvenient for the patient, and for which there is presently no treatment. The researchers from Inserm formulated a hypothesis whereby this harmful effect might be related to the inappropriate activation by these creams of mineralocorticoid receptors located in the epidermis. These receptors, which are present in the kidney, heart, eye, and certain neurons in particular, reacted with aldosterone, a hormone that regulates the blood pressure. Moreover, previous studies also showed them to be highly sensitive to corticosteroids. Application of corticosteroids to cultured skin causes it to become thinner: in 6 days, the thickness of the epidermis was reduced by one-third. The researchers then induced a pharmacological blockade of the receptors by adding specific antagonists to the corticosteroid treatment. The inability of the corticosteroid to bind to the mineralocorticoid receptors restores proliferation of the epidermal cells, and partially corrects epidermal atrophy. From the clinical point of view, it turns out that spironolactone, a drug used for a very long time as an antihypertensive drug (and which has marketing authorisation), is an antagonist of the mineralocorticoid receptor.
    [Show full text]
  • Report of the Third Working Party of the British Hypertension Society
    Journal of Human Hypertension (1999) 13, 569–592 1999 Stockton Press. All rights reserved 0950-9240/99 $15.00 http://www.stockton-press.co.uk/jhh BHS GUIDELINES Guidelines for management of hypertension: report of the third working party of the British Hypertension Society LE Ramsay, B Williams, GD Johnston, GA MacGregor, L Poston, JF Potter, NR Poulter and G Russell for the British Hypertension Society ¼ Use non-pharmacological measures in all hyperten- as first-line therapy for the majority of hypertensive sive and borderline hypertensive people. people. In the absence of compelling indications for ¼ Initiate antihypertensive drug therapy in people with beta-blockade, diuretics or long acting dihydropyrid- sustained systolic blood pressures (BP) у160 mm Hg ine calcium antagonists are preferred to beta-blockers or sustained diastolic BP у100 mm Hg. in older subjects. Compelling indications and contra- ¼ Decide on treatment in people with sustained systolic indications for all antihypertensive drug classes are BP between 140 and 159 mm Hg or sustained diastolic specified. BP between 90 and 99 mm Hg according to the pres- ¼ For most hypertensives, a combination of antihyper- ence or absence of target organ damage, cardio- tensive drugs will be required to achieve the rec- vascular disease or a 10-year coronary heart disease ommended targets for blood pressure control. у (CHD) risk of 15% according to the Joint British ¼ Other drugs that reduce cardiovascular risk must also Societies CHD risk assessment programme/risk chart. be considered. These include aspirin for secondary ¼ In people with diabetes mellitus, initiate antihyperten- у prevention of cardiovascular disease, and primary sive drug therapy if systolic BP is sustained 140 prevention in treated hypertensive subjects over the mm Hg or diastolic BP is sustained у90 mm Hg.
    [Show full text]
  • Antihypertensive Treatment in Kidney Transplant Recipients—A Current Single Center Experience
    Journal of Clinical Medicine Article Antihypertensive Treatment in Kidney Transplant Recipients—A Current Single Center Experience Ulrich Jehn 1 , Katharina Schütte-Nütgen 1, Markus Strauss 2, Jan Kunert 1, Hermann Pavenstädt 1, Gerold Thölking 1 , Barbara Suwelack 1 and Stefan Reuter 1,* 1 Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; [email protected] (U.J.); [email protected] (K.S.-N.); [email protected] (J.K.); [email protected] (H.P.); [email protected] (G.T.); [email protected] (B.S.) 2 Department of Medicine C, Division of Cardiology and Angiology, University Hospital of Münster, 48149 Münster, Germany; [email protected] * Correspondence: [email protected]; Tel.: +49-251-83-47540; Fax: +49-251-83-56973 Received: 16 October 2020; Accepted: 3 December 2020; Published: 7 December 2020 Abstract: Arterial hypertension affects the survival of the kidney graft and the cardiovascular morbidity and mortality of the recipient after kidney transplantation (KTx). Thus, antihypertensive treatment is necessary for a vast majority of these patients. Long-term data on antihypertensive drugs and their effects on allograft function after KTx is still limited, and further investigation is required. We retrospectively analyzed a cohort of 854 recipients who received a kidney transplant at our transplant center between 2007 and 2015 with regard to antihypertensive treatment and its influence on graft function and survival. 1-y after KTx, 95.3% patients were treated with antihypertensive therapy. Of these, 38.6% received mono- or dual-drug therapy, 38.0% received three to four drugs and 8.1% were on a regimen of 5 drugs.
    [Show full text]
  • JNC 7 Express the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
    National High Blood Pressure Education Program JNC 7 Express The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute JNC 7 Express The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure This work was supported entirely by the National Heart, Lung, and Blood Institute. The Executive Committee, writing teams, and reviewers served as volunteers without remuneration. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute National High Blood Pressure Education Program NIH Publication No. 03-5233 December 2003 Chair Aram V. Chobanian, M.D. (Boston University Medical Center, Boston, MA) Executive Committee George L. Bakris, M.D. (Rush Presbyterian-St. Luke’s Medical Center, Chicago, IL); Henry R. Black, M.D. (Rush Presbyterian-St. Luke’s Medical Center, Chicago, IL); William C. Cushman, M.D. (Veterans Affairs Medical Center, Memphis, TN); Lee A. Green, M.D., M.P.H. (University of Michigan, Ann Arbor, MI); Joseph L. Izzo, Jr., M.D. (State University of New York at Buffalo School of Medicine, Buffalo, NY); Daniel W. Jones, M.D. (University of Mississippi Medical Center, Jackson, MS); Barry J. Materson, M.D., M.B.A. (University of Miami, Miami, FL); Suzanne Oparil, M.D. (University of Alabama at Birmingham, Birmingham, AL); Jackson T. Wright, Jr., M.D., Ph.D. (Case Western Reserve University, Cleveland, OH) Executive Secretary Edward J.
    [Show full text]
  • Effects of a New Calcium Channel Blocker, Azelnidipine, on Systemic Hemodynamics and Renal Sympathetic Nerve Activity in Spontaneously Hypertensive Rats
    1017 Hypertens Res Vol.28 (2005) No.12 p.1017-1023 Original Article Effects of a New Calcium Channel Blocker, Azelnidipine, on Systemic Hemodynamics and Renal Sympathetic Nerve Activity in Spontaneously Hypertensive Rats Takatomi SHOKOJI*, Yoshihide FUJISAWA**, Hideyasu KIYOMOTO***, Matlubur RAHMAN*,***, Guang-Ping SUN***, Yu-Yan FAN*, Shoji KIMURA*, Masakazu KOHNO***, Youichi ABE*, and Akira NISHIYAMA* Antihypertensive treatment with dihydropyridine calcium channel blockers elicits sympathetic nerve activa- tion, which may contribute to cardiovascular events. However, recent clinical studies showed that treatment with azelnidipine, a new dihydropyridine calcium channel blocker, significantly reduced blood pressure in hypertensive patients while either maintaining or actually decreasing heart rate (HR). In this study, we exam- ined the effects of azelnidipine and amlodipine on systemic hemodynamics and renal sympathetic nerve activity (RSNA) in anesthetized spontaneously hypertensive rats (SHR). We also examined the effects of these agents on baroreflex functions by infusing phenylephrine (30 µg/kg/min, i.v.) and sodium nitroprus- side (10 µg/kg/min, i.v.) into azelnidipine- or amlodipine-treated SHR. Fifty min after administration of azelni- dipine (10 µg/kg/min for 10 min, i.v.), mean arterial pressure (MAP) significantly decreased from 153±5 to 122±5 mmHg; however, HR and integrated RSNA did not change significantly (from 352±9 to 353±10 beats/ min and 115±5% of baseline, respectively). Infusion of amlodipine (50 µg/kg/min for 10 min) elicited similar effects on MAP (from 152±5 to 120±4 mmHg). However, amlodipine significantly increased HR (from 351±9 to 375±11 beats/min) and integrated RSNA (165±5% of baseline).
    [Show full text]
  • Calcium Channel Blockers in Hypertension: the Debate Reawakens
    Journal of Human Hypertension (2001) 15, 85–87 2001 Nature Publishing Group All rights reserved 0950-9240/01 $15.00 www.nature.com/jhh COMMENTARY Calcium channel blockers in hypertension: the debate reawakens GYH Lip and DG Beevers University Department of Medicine, City Hospital, Birmingham B18 7QH, UK Keywords: calcium channel blockers; meta-analysis; mortality; morbidity Ever since the publication of the Puget Sound phar- the confidence of any one study to be sure of these macosurveillance study in 1995,1 there has been a such differences.7,8 continuing debate on the effectiveness or safety of Then as the millennium year ground to its sodden the calcium channel blockers (CCBs) in the treat- halt (in England at least) came a ‘rush’ of meta- ment of hypertension and heart disease. Various analyses. To highlight a few, The Lancet published retrospective case-control studies had raised the two papers on 9 December9,10 and a ‘mini’ meta- possibility that these drugs may cause haemorrhage, analysis in their correspondence columns on 2nd suicide, cancer and excess cardiovascular morbidity December.11 Another appeared in the British Journal and mortality.2 Several observational studies and of Cardiology in November.12 There probably have some individual randomised trials in hypertension been many others. Perhaps meta-analyses begat have even suggested that, compared with other further meta-analyses. drugs, CCBs may be associated with a higher risk of The Blood Pressure Lowering Treatment Trialists’ coronary events, despite similar blood pressure
    [Show full text]
  • Antihypertensive Drug Use During Pregnancy: a Population Based Study
    236 Ann Ist Super Sanità 2015 | Vol. 51, No. 3: 236-243 DOI: 10.4415/ANN_15_03_12 Antihypertensive drug use during pregnancy: a population based study Carmen D’Amore1, Francesco Trotta2, Roberto Da Cas1, Carlo Zocchetti3, Alfredo Cocci4 1 REVIEWS and Giuseppe Traversa 1Reparto di Farmacoepidemiologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della AND Salute, Istituto Superiore di Sanità, Rome, Italy 2Ufficio di Farmacovigilanza, Agenzia Italiana del Farmaco, Rome, Italy 3Unità di Programmazione Sanitaria, Direzione Generale Salute, Regione Lombardia, Milan, Italy 4Centro Regionale di Farmacovigilanza, Regione Lombardia, Milan, Italy ARTICLES RIGINAL Abstract Key words O Purpose. The study aimed at assessing if the European guideline on the use of antihyper- • antihypertensive drugs tensive drugs (AD) in pregnancy are followed in clinical practice. We also evaluated the • pregnancy association between the use of non-recommended drugs and individual characteristics. • clinical guidelines Methods. This study analyzed a cohort of 86 171 singleton deliveries occurring between 2009-2010 in the Lombardy region, Italy. Women with first prescription of AD during pregnancy were considered as incident users. Methyldopa, labetalol and nifedipine were considered as “recommended drugs”; all other AD were considered as “non-recommend- ed”. Odds Ratio and 95% confidence intervals were estimated. Results. Among the 1009 patients (1.2%) exposed to AD during pregnancy, 675 (66.9%) were incident users. Among the incident users, 31% received non-recommended drugs; this proportion decreased to 18% among women who started treatment in the third tri- mester. Women with at least four concomitant diseases had an elevated risk of receiving non-recommended drugs in pregnancy (OR 2.68; 95% CI 1.10-6.73).
    [Show full text]