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Spironolactone for the treatment of isolated systolic hypertension
AJH–May 2004 –VOL. 17, NO. 5, PART 2
P-253 SPIRONOLACTONE FOR THE TREATMENT OF ISOLATED SYSTOLIC HYPERTENSION Steven A Yarows. Treatment of ISH is effective in the prevention of congestive heart failure and cerebrovascular accidents, however control of ISH usually requires combination therapy is often difficult with only 50% of patients controlled. Method: Escribe, (Lille Corp, Albany, New York), our electronic record company, provided a list of all patients in the practice that had spironolactone on their medication list. A retrospective chart review of these patients was performed and only data from patients that were on spironolactone for hypertension treatment was collected. Office blood pressures (BP) were averaged from 1-3 visits before treatment with spironolactone (pre-spiro) and after the addition of spironolactone (postspiro). The office BP reflected the usual clinical practice of BP measurement, however was not performed in a standard manner. Results: Forty-eight patients were identified, with an average age 71.6⫾10.1 years and a pre-spiro BP of 157.7⫾16.4/74.5⫾11.8mmHg. Post-spiro BP was 141.7⫾19.5/70.6⫾12.6mmHg (p⬍0.05 for both SBP and DBP). The addition of spironolactone decreased the BP by 15.9/ 3.8mmHg (p⬍0.05). This group was sub-divided into spironolactone responders (ⱖ10mmHg decrease in SBP) and non-responders (⬍10mmHg decrease in SBP). There were 33 responders (69%) and 15 non-responders (31%) with similar average ages in both groups. The addition of spironolactone decreased the BP by 25.3/8.1mmHg for the responders and 0.6/⫺0.1mmHg for the non-responders (P⬍0.05 for both SBP and DBP). There were no significant differences (p⬎0.05) between the responders and non-responders for the drugs before or after the addition of spironolactone, number of visits before or after spironolactone, or number of patients on ACE inhibitors, angioreceptor blockers, calcium channel blockers, beta-blockers, or other drug categories. Conclusions: Spironolactone may be effective for treatment of isolated systolic hypertension, however a randomized, controlled trial using spironolactone or eplerenone should be considered.
Key Words: Spironolactone, Isolated Systolic Hypertension,
P-254 SYMPATHOVAGAL BALANCE IN ESSENTIAL HYPERTENSIVES TREATED WITH ANGIOTENSIN RECEPTOR BLOCKERS FOR A LONG PERIOD OF TIME Ilias Zarkos, Irini Vrana, Eleftherios Thireos, Gerasimos Livieratos, Aikaterini Mitropoulou, Nearchos Nearchou, Vasilis Tolis. Cardiac Department, 3rd IKA Hospital, Athens, Greece; Lavrion Health Center, General Hospital of Athens, Athens, Greece; 1st Cardiac Department, Red Cross Hospital, Athens, Greece. Heart rate variability (HRV) is believed to reflect autonomic nervous activity. We studied the influence of antihypertensive therapy with the angiotensin receptor blocker losartan on HRV in essential hypertensives treated for 3 years.
POSTERS: Antihypertensive Drugs
125A
32 patients (16 male, 16 female, mean age 53 ⫾8.5yrs) with mild to moderate essential hypertension received daily 50mg losartan as monotherapy. In those, not achieved the goal of SBP⬍140mmHg and/or DBP⬍85mmHg in the first 6 weeks of therapy, chlorthalidone 25mg daily was added. Ambulatory 24-h ECG recordings were obtained at presentation and then at six weeks and every year till the 3rd year. The HRV parameters analyzed were: 1.The standard deviation of all NN intervals (SDNN), 2.The square root of the mean of the sum of the squares of the differences between adjacent NN intervals (RMSSD), 3.The ratio low frequency/high frequency (LF/HF). Hypertensives had at the baseline impaired HRV, when compared to 22 healthy subjects (11 male ,11 female, mean age 52⫾8yrs). Our findings are shown in the Table: During long term therapy with losartan alone or in combination with diuretics, despite the favorable effect on SBP and DBP, the initially observed augmentation on parasympathetic tone (SDNN, RMSSD) is diminished. The attenuation on sympathetic activity (LF/HF) remains unaffected during the observation period.
Systolic BP Diastolic BP SDNN RMSSD LF/HF
Baseline-6 weeks 2p ⬍ 0,001 2p ⬍ 0,001 1NS 1NS 2p ⬍ 0,01
Baseline-1 year 2p ⬍ 0,001 2p ⬍ 0,01 1NS 1p ⬍ 0,04 2p ⬍ 0,001
Baseline-3 years 2p ⬍ 0,001 2p ⬍ 0,001 1NS 1NS 2p ⬍ 0,01
Key Words: Essential Hypertension, Angiotensin Receptor Blocker, Autonomic Nervous Activity
P-255 ANGIOTENSIN RECEPTORS BLOCKADE IMPROVES BLOOD PRESSURE RESPONSE, EXERCISE CAPACITY AND HEART RATE RECOVERY IN NORMOTENSIVES WITH EXCESSIVE BLOOD PRESSURE ELEVATION DURING EXERCISE Ilias Zarkos, Irini Vrana, Eleftherios Thireos, Gerasimos Livieratos, Aikaterini Mitropoulou, Nearchos Nearchou, Vasiliki Golfinopoulou, Vasilis Tolis. Cardiac Department, 3rd IKA Hospital, Athens, Greece; Lavrion Health Center, General Hospital of Athens, Athens, Greece; 1st Cardiac Department, Red Cross Hospital, Athens, Greece. Excessive hypertensive response to exercise is accompanied also by reduced exercise tolerance and delayed heart rate recovery. We studied the influence of the angiotensin receptor blocker irbesartan on all these test parameters associated with impairment of autonomic function. 48 subjects (group A: 48 subjects,36 male, 12 female, mean age 58,42⫾11,29yrs), free from known cardiovascular diseases and negative for myocardial ischemia, undergoing exercise testing for various reasons, with exaggerated blood pressure response at exercise ( systolic blood pressure ⱖ220mmHg and/or diastolic blood pressure ⱖ105mmHg during peak exercise) received daily 300mg irbesartan for 40 days. Thereafter they repeated the symptoms limited exercise test according the Bruce protocol using a 2000 Marquette treadmill. Control group (group C) consisted of 38 subjects, 19 male, 19 female, mean age 51.58⫾10,32yrs, with normal blood pressure response to exercise .The parameters studied were: peak systolic blood pressure (PSBP), peak diastolic blood pressure (PDBP), exercise time (ET), heart rate recovery (HRR). As compared to group C, group A had at the baseline exaggerated blood pressure response, reduced exercise time and delayed heart rate recovery. PSBP(mmHg) PDBP(mmHg) ET(sec) HRR(b.p.m.) Baseline-40 days 2p ⬍ 0,001 2p ⬍ 0,001 1p ⬍ 0,01 1p ⬍ 0,001
Our results are shown in the Table: Administration of angiotensin receptor blocker irbesartan in normotensives with hypertensive response during exercise test has rapidly beneficial effects in exercise test parameters associated with impaired autonomic function Key Words: Angiotensin Receptors Blockade, Exercise Capacity, Heart Rate Recovery
P-253 SPIRONOLACTONE FOR THE TREATMENT OF ISOLATED SYSTOLIC HYPERTENSION Steven A Yarows. Treatment of ISH is effective in the prevention of congestive heart failure and cerebrovascular accidents, however control of ISH usually requires combination therapy is often difficult with only 50% of patients controlled. Method: Escribe, (Lille Corp, Albany, New York), our electronic record company, provided a list of all patients in the practice that had spironolactone on their medication list. A retrospective chart review of these patients was performed and only data from patients that were on spironolactone for hypertension treatment was collected. Office blood pressures (BP) were averaged from 1-3 visits before treatment with spironolactone (pre-spiro) and after the addition of spironolactone (postspiro). The office BP reflected the usual clinical practice of BP measurement, however was not performed in a standard manner. Results: Forty-eight patients were identified, with an average age 71.6⫾10.1 years and a pre-spiro BP of 157.7⫾16.4/74.5⫾11.8mmHg. Post-spiro BP was 141.7⫾19.5/70.6⫾12.6mmHg (p⬍0.05 for both SBP and DBP). The addition of spironolactone decreased the BP by 15.9/ 3.8mmHg (p⬍0.05). This group was sub-divided into spironolactone responders (ⱖ10mmHg decrease in SBP) and non-responders (⬍10mmHg decrease in SBP). There were 33 responders (69%) and 15 non-responders (31%) with similar average ages in both groups. The addition of spironolactone decreased the BP by 25.3/8.1mmHg for the responders and 0.6/⫺0.1mmHg for the non-responders (P⬍0.05 for both SBP and DBP). There were no significant differences (p⬎0.05) between the responders and non-responders for the drugs before or after the addition of spironolactone, number of visits before or after spironolactone, or number of patients on ACE inhibitors, angioreceptor blockers, calcium channel blockers, beta-blockers, or other drug categories. Conclusions: Spironolactone may be effective for treatment of isolated systolic hypertension, however a randomized, controlled trial using spironolactone or eplerenone should be considered.
Key Words: Spironolactone, Isolated Systolic Hypertension,
P-254 SYMPATHOVAGAL BALANCE IN ESSENTIAL HYPERTENSIVES TREATED WITH ANGIOTENSIN RECEPTOR BLOCKERS FOR A LONG PERIOD OF TIME Ilias Zarkos, Irini Vrana, Eleftherios Thireos, Gerasimos Livieratos, Aikaterini Mitropoulou, Nearchos Nearchou, Vasilis Tolis. Cardiac Department, 3rd IKA Hospital, Athens, Greece; Lavrion Health Center, General Hospital of Athens, Athens, Greece; 1st Cardiac Department, Red Cross Hospital, Athens, Greece. Heart rate variability (HRV) is believed to reflect autonomic nervous activity. We studied the influence of antihypertensive therapy with the angiotensin receptor blocker losartan on HRV in essential hypertensives treated for 3 years.
POSTERS: Antihypertensive Drugs
125A
32 patients (16 male, 16 female, mean age 53 ⫾8.5yrs) with mild to moderate essential hypertension received daily 50mg losartan as monotherapy. In those, not achieved the goal of SBP⬍140mmHg and/or DBP⬍85mmHg in the first 6 weeks of therapy, chlorthalidone 25mg daily was added. Ambulatory 24-h ECG recordings were obtained at presentation and then at six weeks and every year till the 3rd year. The HRV parameters analyzed were: 1.The standard deviation of all NN intervals (SDNN), 2.The square root of the mean of the sum of the squares of the differences between adjacent NN intervals (RMSSD), 3.The ratio low frequency/high frequency (LF/HF). Hypertensives had at the baseline impaired HRV, when compared to 22 healthy subjects (11 male ,11 female, mean age 52⫾8yrs). Our findings are shown in the Table: During long term therapy with losartan alone or in combination with diuretics, despite the favorable effect on SBP and DBP, the initially observed augmentation on parasympathetic tone (SDNN, RMSSD) is diminished. The attenuation on sympathetic activity (LF/HF) remains unaffected during the observation period.
Systolic BP Diastolic BP SDNN RMSSD LF/HF
Baseline-6 weeks 2p ⬍ 0,001 2p ⬍ 0,001 1NS 1NS 2p ⬍ 0,01
Baseline-1 year 2p ⬍ 0,001 2p ⬍ 0,01 1NS 1p ⬍ 0,04 2p ⬍ 0,001
Baseline-3 years 2p ⬍ 0,001 2p ⬍ 0,001 1NS 1NS 2p ⬍ 0,01
Key Words: Essential Hypertension, Angiotensin Receptor Blocker, Autonomic Nervous Activity
P-255 ANGIOTENSIN RECEPTORS BLOCKADE IMPROVES BLOOD PRESSURE RESPONSE, EXERCISE CAPACITY AND HEART RATE RECOVERY IN NORMOTENSIVES WITH EXCESSIVE BLOOD PRESSURE ELEVATION DURING EXERCISE Ilias Zarkos, Irini Vrana, Eleftherios Thireos, Gerasimos Livieratos, Aikaterini Mitropoulou, Nearchos Nearchou, Vasiliki Golfinopoulou, Vasilis Tolis. Cardiac Department, 3rd IKA Hospital, Athens, Greece; Lavrion Health Center, General Hospital of Athens, Athens, Greece; 1st Cardiac Department, Red Cross Hospital, Athens, Greece. Excessive hypertensive response to exercise is accompanied also by reduced exercise tolerance and delayed heart rate recovery. We studied the influence of the angiotensin receptor blocker irbesartan on all these test parameters associated with impairment of autonomic function. 48 subjects (group A: 48 subjects,36 male, 12 female, mean age 58,42⫾11,29yrs), free from known cardiovascular diseases and negative for myocardial ischemia, undergoing exercise testing for various reasons, with exaggerated blood pressure response at exercise ( systolic blood pressure ⱖ220mmHg and/or diastolic blood pressure ⱖ105mmHg during peak exercise) received daily 300mg irbesartan for 40 days. Thereafter they repeated the symptoms limited exercise test according the Bruce protocol using a 2000 Marquette treadmill. Control group (group C) consisted of 38 subjects, 19 male, 19 female, mean age 51.58⫾10,32yrs, with normal blood pressure response to exercise .The parameters studied were: peak systolic blood pressure (PSBP), peak diastolic blood pressure (PDBP), exercise time (ET), heart rate recovery (HRR). As compared to group C, group A had at the baseline exaggerated blood pressure response, reduced exercise time and delayed heart rate recovery. PSBP(mmHg) PDBP(mmHg) ET(sec) HRR(b.p.m.) Baseline-40 days 2p ⬍ 0,001 2p ⬍ 0,001 1p ⬍ 0,01 1p ⬍ 0,001
Our results are shown in the Table: Administration of angiotensin receptor blocker irbesartan in normotensives with hypertensive response during exercise test has rapidly beneficial effects in exercise test parameters associated with impaired autonomic function Key Words: Angiotensin Receptors Blockade, Exercise Capacity, Heart Rate Recovery