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Influence of tight blood pressure control on the variability of blood pressure in hypertensive and hypertensive diabetic patients
114A
POSTERS: Clinical Trials
(65.4⫾9.4 vs 59.0⫾89. mmHg). PP reductions were higher in elderly patients, with no differences between men and women. Torasemide achieved strict BP control (BP⬍ 140/90) in 53.6% of patients and the response rate (BP reduction ⬎ 10 mmHg) was 78.4%. At the end of the 6 month treatment period 63.3% were being treated with torasemide in monotherapy (75.5% with 10 mg) and 35.4% in combination (87.7% with 5 mg). Clinical adverse effects related to treatment were only reported in 20 patients, and 10 of them discontinued the study for this reason. We conclude that torasemide treatment 5-10 mg od in single therapy or associated to other antihypertensive drugs significantly reduced PP and cardiovascular risk of these patients. Key Words: Torasemide, Pulse Pressure, Essential Hypertension
P-232 CAROTID INTIMA-MEDIA THICKNESS AND ANTIHYPERTENSIVE TREATMENT: AN OVERVIEW OF THE RANDOMIZED CONTROLLED TRIALS
AJH–April 2002–VOL. 15, NO. 4, PART 2
P-233 INFLUENCE OF TIGHT BLOOD PRESSURE CONTROL ON THE VARIABILITY OF BLOOD PRESSURE IN HYPERTENSIVE AND HYPERTENSIVE DIABETIC PATIENTS B. Gontmacher, L. Neuman, E. Paran. Hypertension Unit, Soroka University Hospital; Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel. Ambulatory blood pressure monitoring (ABPM) became an important diagnostic tool in the recent years. Blood pressure variability (BPV) has been suggested as a risk factor for hypertension related target organ damage. BPV is measured as the standard deviation of BP values by noninvasive ambulatory blood pressure monitoring obtained every 15-20 minutes. The goal of our study is to determine whether tight blood pressure control with reduction of mean BP on ABPM influences the blood pressure variability in hypertensive and hypertensive diabetic patients. We performed 24 hours ABPM in 79 patients with hypertension and NIDDM and hypertension. The standard deviations from the mean pressure were taken as index of blood pressure variability. The mean age of patient was 60 years with range of 46-72 years Patients were treated with various combinations of ACE, beta-blockers, diuretics, CA channel blockers. Patients were divided to four groups: Variability with Tight blood pressure control
Ji-Guang Wang, Jan A. Staessen. Hypertension Unit, University of Leuven, Leuven, Belgium. In a meta-analysis, we investigated 1) whether antihypertensive drug treatment would reduce carotid intima-media thickness, 2) whether new antihypertensive drugs (angiotensin-converting enzyme inhibitors or calcium-channel blockers) would be more effective than old drug classes (diuretics or -blockers) in the prevention of carotid intima-media thickening, and 3) whether the angiotensin-converting enzyme inhibitors and calcium-channel blockers would have similar effects. We identified 15 randomized parallel-group trials, in which carotid intima-media thickness was the outcome measure, and in which a drug with blood pressure lowering action was tested versus placebo or another antihypertensive agent of a different class. We extracted summary statistics from published articles. After application of chi-squared test of heterogeneity, we computed pooled differences in yearly percentage changes from baseline between experimental and reference treatment. These calculations were weighted for the inverse of the variance in each trial. In 6 trials, 2617 patients with diabetes or coronary heart disease were randomized to placebo or active antihypertensive treatment started with an angiotensinconverting inhibitor, a -blocker, or a calcium-channel blocker. Compared with placebo, active antihypertensive treatment slightly but significantly reduced carotid intima-media thickness (difference in percentage changes per year: -0.5%, 95% CI -0.8% to -0.2%, p⫽0.001). In 3 trials, 1820 hypertensive patients were randomized to a calcium-channel blocker or a diuretic. Despite similar blood pressure reductions, calcium channel blockers reduced carotid intima-media thickness more than diuretics (-0.7%, 95% CI -1.2% to -0.2%, p⫽0.004). In only 2 trials with a total of 158 hypertensive patients, no significant difference was observed between angiotensin-converting inhibitors and old drug classes (diuretics or -blockers) (p⫽0.79). In 4 trials, 168 patients with hypertension or diabetes were randomized to an angiotensin-converting inhibitor or a calcium-channel blocker. Compared with angiotensin-converting inhibitors, calcium-channel blockers attenuated carotid intima-media thickening (-3.5%, 95% CI -6.6% to -0.4%, p⫽0.03). In conclusion, in general, calcium-channel blockers attenuated carotid intima-media thickening. Comparative trials with angiotensin-converting inhibitors suggest that blood pressure reduction may not be the only mechanism involved. Key Words: Antihypertensive Drugs, Meta-Analysis of Randomized Trials, Intima-Media Thickness
Hypertension Hypertension and NIDDM
Day Night Day Night
Variability with Poor blood pressure control
SBP
DBP
SBP
DBP
12.9 10.3 14.4 12.7
10.2 8.0 10.4 9.0
15.3 12.9 17.1 12.14
10.6 9.5 11.1 9.2
Conclusions: Diabetic hypertensives compared to hypertensives without diabetes had higher variability both in tight controlled and poor controlled patients. However, tight blood pressure control decreased the variability of blood pressure in hypertensive and in hypertensive diabetic patients. These results support the higher cardiovascular risk of diabetic hypertensive patients, however tight control improves the prognosis. Key Words: Blood Pressure Variability, Tight Blood Pressure Control, Poor Blood Pressure Control
P-234 THERAPEUTICAL EFFECTS OF FOLIC ACID ON SERUM HOMOCYSTEINE IN HYPERTENSIVE PATIENTS Haylhe Moreno, Nelson Croce, Jose Kuffaty, Elias Chuki, Martha Berbesi, Francisco Fragachan. Unidad de Hipertension Arterial, Hospital Universitario de Caracas/ Facultad de Medicina, Caracas, DF, Venezuela. High levels of Homocysteine (Hcys), an end product of metionine metabolism, has been pointed out as an independent risk factor associated with Primary Hypertension; they are influenced by diet, folic acid, B6 and B 12 vitamins. Studies have shown that a high intake of fortificated folic acid could lower Hcys level. The present study considerated the therapeutical effects of Folic Acid on Homocysteinemia in patients with High Blood Pressure grade 1 and/or 2 according to the World Health Organization (WHO-1999). We enrolled forty four patient; 23 women (52,3 %), 21 men (47,7%) between 35 and 60 years of age in a prospective, open-labeled, descriptive and comparative study. A medical history, physical examination and laboratory studies were done on all the patients and previous medications withheld (antioxidants, vitamins, antihiperten-
POSTERS: Clinical Trials
(65.4⫾9.4 vs 59.0⫾89. mmHg). PP reductions were higher in elderly patients, with no differences between men and women. Torasemide achieved strict BP control (BP⬍ 140/90) in 53.6% of patients and the response rate (BP reduction ⬎ 10 mmHg) was 78.4%. At the end of the 6 month treatment period 63.3% were being treated with torasemide in monotherapy (75.5% with 10 mg) and 35.4% in combination (87.7% with 5 mg). Clinical adverse effects related to treatment were only reported in 20 patients, and 10 of them discontinued the study for this reason. We conclude that torasemide treatment 5-10 mg od in single therapy or associated to other antihypertensive drugs significantly reduced PP and cardiovascular risk of these patients. Key Words: Torasemide, Pulse Pressure, Essential Hypertension
P-232 CAROTID INTIMA-MEDIA THICKNESS AND ANTIHYPERTENSIVE TREATMENT: AN OVERVIEW OF THE RANDOMIZED CONTROLLED TRIALS
AJH–April 2002–VOL. 15, NO. 4, PART 2
P-233 INFLUENCE OF TIGHT BLOOD PRESSURE CONTROL ON THE VARIABILITY OF BLOOD PRESSURE IN HYPERTENSIVE AND HYPERTENSIVE DIABETIC PATIENTS B. Gontmacher, L. Neuman, E. Paran. Hypertension Unit, Soroka University Hospital; Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel. Ambulatory blood pressure monitoring (ABPM) became an important diagnostic tool in the recent years. Blood pressure variability (BPV) has been suggested as a risk factor for hypertension related target organ damage. BPV is measured as the standard deviation of BP values by noninvasive ambulatory blood pressure monitoring obtained every 15-20 minutes. The goal of our study is to determine whether tight blood pressure control with reduction of mean BP on ABPM influences the blood pressure variability in hypertensive and hypertensive diabetic patients. We performed 24 hours ABPM in 79 patients with hypertension and NIDDM and hypertension. The standard deviations from the mean pressure were taken as index of blood pressure variability. The mean age of patient was 60 years with range of 46-72 years Patients were treated with various combinations of ACE, beta-blockers, diuretics, CA channel blockers. Patients were divided to four groups: Variability with Tight blood pressure control
Ji-Guang Wang, Jan A. Staessen. Hypertension Unit, University of Leuven, Leuven, Belgium. In a meta-analysis, we investigated 1) whether antihypertensive drug treatment would reduce carotid intima-media thickness, 2) whether new antihypertensive drugs (angiotensin-converting enzyme inhibitors or calcium-channel blockers) would be more effective than old drug classes (diuretics or -blockers) in the prevention of carotid intima-media thickening, and 3) whether the angiotensin-converting enzyme inhibitors and calcium-channel blockers would have similar effects. We identified 15 randomized parallel-group trials, in which carotid intima-media thickness was the outcome measure, and in which a drug with blood pressure lowering action was tested versus placebo or another antihypertensive agent of a different class. We extracted summary statistics from published articles. After application of chi-squared test of heterogeneity, we computed pooled differences in yearly percentage changes from baseline between experimental and reference treatment. These calculations were weighted for the inverse of the variance in each trial. In 6 trials, 2617 patients with diabetes or coronary heart disease were randomized to placebo or active antihypertensive treatment started with an angiotensinconverting inhibitor, a -blocker, or a calcium-channel blocker. Compared with placebo, active antihypertensive treatment slightly but significantly reduced carotid intima-media thickness (difference in percentage changes per year: -0.5%, 95% CI -0.8% to -0.2%, p⫽0.001). In 3 trials, 1820 hypertensive patients were randomized to a calcium-channel blocker or a diuretic. Despite similar blood pressure reductions, calcium channel blockers reduced carotid intima-media thickness more than diuretics (-0.7%, 95% CI -1.2% to -0.2%, p⫽0.004). In only 2 trials with a total of 158 hypertensive patients, no significant difference was observed between angiotensin-converting inhibitors and old drug classes (diuretics or -blockers) (p⫽0.79). In 4 trials, 168 patients with hypertension or diabetes were randomized to an angiotensin-converting inhibitor or a calcium-channel blocker. Compared with angiotensin-converting inhibitors, calcium-channel blockers attenuated carotid intima-media thickening (-3.5%, 95% CI -6.6% to -0.4%, p⫽0.03). In conclusion, in general, calcium-channel blockers attenuated carotid intima-media thickening. Comparative trials with angiotensin-converting inhibitors suggest that blood pressure reduction may not be the only mechanism involved. Key Words: Antihypertensive Drugs, Meta-Analysis of Randomized Trials, Intima-Media Thickness
Hypertension Hypertension and NIDDM
Day Night Day Night
Variability with Poor blood pressure control
SBP
DBP
SBP
DBP
12.9 10.3 14.4 12.7
10.2 8.0 10.4 9.0
15.3 12.9 17.1 12.14
10.6 9.5 11.1 9.2
Conclusions: Diabetic hypertensives compared to hypertensives without diabetes had higher variability both in tight controlled and poor controlled patients. However, tight blood pressure control decreased the variability of blood pressure in hypertensive and in hypertensive diabetic patients. These results support the higher cardiovascular risk of diabetic hypertensive patients, however tight control improves the prognosis. Key Words: Blood Pressure Variability, Tight Blood Pressure Control, Poor Blood Pressure Control
P-234 THERAPEUTICAL EFFECTS OF FOLIC ACID ON SERUM HOMOCYSTEINE IN HYPERTENSIVE PATIENTS Haylhe Moreno, Nelson Croce, Jose Kuffaty, Elias Chuki, Martha Berbesi, Francisco Fragachan. Unidad de Hipertension Arterial, Hospital Universitario de Caracas/ Facultad de Medicina, Caracas, DF, Venezuela. High levels of Homocysteine (Hcys), an end product of metionine metabolism, has been pointed out as an independent risk factor associated with Primary Hypertension; they are influenced by diet, folic acid, B6 and B 12 vitamins. Studies have shown that a high intake of fortificated folic acid could lower Hcys level. The present study considerated the therapeutical effects of Folic Acid on Homocysteinemia in patients with High Blood Pressure grade 1 and/or 2 according to the World Health Organization (WHO-1999). We enrolled forty four patient; 23 women (52,3 %), 21 men (47,7%) between 35 and 60 years of age in a prospective, open-labeled, descriptive and comparative study. A medical history, physical examination and laboratory studies were done on all the patients and previous medications withheld (antioxidants, vitamins, antihiperten-