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Follow-Up of the Hypertensive Patient
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Michael Doumas, Konstantinos Stavropoulos, Gemma Currie, Christian Delles
A recent study simulated the impact of three intervention strategies on BP control using national survey data and validated the findings in two large clinical trials (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial [ALLHAT] and VALUE) (26). Enhanced treatment intensification had the greatest impact on BP control followed by increased visit frequency and increased adherence. When all three interventions were optimised, appropriate BP control was predicted to be achieved in 95% of hypertensive patients, highlighting the importance of follow-up frequency in hypertension treatment strategies.
Cardiomyopathies in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
John Arthur McClung, Srihari S. Naidu, Wilbert S. Aronow
The past 3 decades have witnessed a significant improvement in the prognosis for elderly patients presenting with dilated cardiomyopathy, much of it driven by the increased use of ACE inhibitors and beta-blockers (89,90). Congestive heart failure in these patients should be treated with salt restriction, diuretics, and ACE inhibitor therapy. Of interest is the observation that elderly hypertensive patients enrolled in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) who were treated with a thiazide diuretic were less likely to develop heart failure than patients treated with an ACE inhibitor (91).
Hypertension in Indo-Asians
Published in Partha Ghosh, Shahid Anis Khan, Transcultural Geriatrics, 2018
Partha Ghosh, Shahid Anis Khan
The largest randomised trial of treatment, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), confirms the recommendation that a thiazide diuretic is at least as effective as more expensive medications in older people. The trial suggests that most patients would require two or more drugs to control blood pressure but that control is more difficult in older patients.
Fixed-dose combination amlodipine–celecoxib for treatment of hypertension and osteoarthritis pain: an up-to-date evaluation
Published in Expert Opinion on Pharmacotherapy, 2021
Christopher R. Piszczatoski, Steven M. Smith
Amlodipine, a dihydropyridine calcium channel blocker (DHP-CCB), is among the most commonly used antihypertensives due to its effectiveness in lowering blood pressure, relative tolerability, and low cost. Amlodipine does not cause reflex stimulation of the sympathetic nervous system nor does it have negative inotropic effects inherent to other DHP-CCBs [6–8]. Landmark trials, such as the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), have demonstrated that amlodipine is at least as effective as other first-line agents, including angiotensin converting enzyme (ACE) inhibitors and thiazide diuretics, at reducing risk of major adverse cardiovascular events and death and is thus a reasonable choice for hypertensive patients[9]. Additional studies have demonstrated that amlodipine combined with an ACE inhibitor may be superior to a thiazide diuretic (specifically, hydrochlorothiazide) combined with an ACE inhibitor for reducing the risk of cardiovascular death[10].
α1-Adrenergic receptors increase glucose oxidation under normal and ischemic conditions in adult mouse cardiomyocytes
Published in Journal of Receptors and Signal Transduction, 2021
Robert S. Papay, Dianne M. Perez
There are several previous studies indicating that the α1A-AR subtype can impart beneficial effects during ischemia and heart failure. α1-ARs were first indicated to confer protection in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) trial [32,33]. An α1-AR antagonist increased adverse cardiovascular incidents which stopped the trial early. α1-AR stimulation also prevented a maladaptive heart response during pressure overload [34]. Transgenic mice using the endogenous promoter for the α1-AR subtype and overexpressing the α1A- but not α1B-AR preconditioned the ischemic heart [35] and prevented damage through glucose uptake utilizing the PKCδ and GLUT1/4 pathways [14]. A cardiac-targeted α1A-AR transgenic model also limited post-infarct remodeling [36] and cardiac dysfunction [37]. Our results suggest that α1A-AR mediated glucose uptake and glucose oxidation may also play a role in this cardioprotection.
Current and emerging drug treatment strategies for peripheral arterial disease
Published in Expert Opinion on Pharmacotherapy, 2020
Hani Essa, Francesco Torella, Gregory Y. H. Lip
Nevertheless, the evidence for ACEI/ARBs is not all positive. A post-hoc subanalysis of the 2014 ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) [76] and a subgroup analysis of VALUE (Valsartan Antihypertensive Long-Term Use Evaluation) [77] did not show a significant reduction in primary endpoints of MACE, respectively, with ACE inhibitor or ARB over other antihypertensive classes in subgroup analysis of patients with symptomatic PAD. This suggests that a predominant if not all of the effect of ACEI/ARBs is linked to blood pressure control. Data by Mehler et al. from 2003 looking at antihypertensive medication in diabetic patients demonstrated no difference in outcomes between patients randomized to ACEI or nisoldipine (calcium channel blocker) [78]. The 2017 ESC guidelines recommended ACEI/ARBs as first-line therapy for patients with PAD and hypertension on this basis [30].