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Use of a long-acting loop diuretic to improve blood pressure control
118A
POSTERS: Antihypertensive Drugs
inpatient for accelerated HTN with BP of 230/130, rising liver enzymes, and jaundice. Upon admission all home meds were discontinued. Liver biopsy excluded neoplasm but revealed bridging hepatocyte necrosis. The blood pressure was controlled with oral nicardipine. The patients’ condition regressed to fulminant hepatic failure, hepatic encephalopathy, and acute renal failure. She required a liver transplant and now is stable eight months post liver transplant. Labetalol hepatotoxicity and hepatic necrosis is a potentially life threatening illness, which can result in hepatic failure and multi-organ failure necessitating liver transplantation. Routine surveillance of liver enzymes may become necessary for a subset of high risk patients on chronic labetalol therapy. Key Words: Labetalol, hepatic necrosis, liver transplantation
P-219 USE OF A LONG-ACTING LOOP DIURETIC TO IMPROVE BLOOD PRESSURE CONTROL Kimberly G. Harkins, Deborah S. King, George E. Habeeb, Jimmy L. Stewart, Sharon B. Wyatt, Marion R. Wofford. Division of Hypertension, University of Mississippi Medical Center, Jackson, MS. Patient non-adherence remains an etiology of uncontrolled hypertension. A recent meta-analysis demonstrated that once-daily dosing regimens are associated with higher rates of adherence than either twice-daily (BID) or multiple daily dosing (MDD). Diuretics are a mainstay of hypertension therapy, but short-acting loop diuretics may activate the renin-angiotensin-aldosterone system when dosed once daily. To evaluate the efficacy of once-daily long-acting diuretics, a retrospective chart analysis was performed on patients seen in the University of Mississippi Medical Center Hypertension Clinic within the last two years. Patients were identified who had been treated with torsemide, a long-acting loop diuretic. As one arm of a larger study, particular attention was given to those patients who had been changed from BID or MDD furosemide to once-daily torsemide. Of forty-nine charts reviewed, eighteen patients met entry criteria for the study. Average systolic blood pressure lowering associated with this change in medication was 12 mm Hg, with average diastolic blood pressure lowering of 7 mm Hg. Chart documentation supported improvement in adherence as a specific reason for the change in many cases. Torsemide was well tolerated by patients. Once-daily loop diuretics may improve blood pressure control by improving adherence and by achieving a more steady natriuresis and diuresis than multiple daily doses of short-acting loop diuretics. Key Words: Hypertension control, diuretics, patient adherence
P-220 EPROSARTAN EFFECT ON FIBRINOLYTIC/HEMOSTATIC VARIABLES IN ARTERIAL HYPERTENSION: A COMPARATIVE STUDY TO LOSARTAN Thomas K Makris, Panagiota G Krespi, Antonios N Hatzizacharias, Dimetrios Papadopoulos, Evangelos Batzoglou, Maria Kouli, Perseas Gioldasis, Vassilios V Votteas. Cardiology, Laikon Hospital of Athens, Athens, Greece; Cardiology, EVAGELISMOS Hospital of Athens, Athens, Greece. Background: Essential hypertension (EH) is often accompanied by abnormalities of coagulation/fibrinolysis predisposing to a procoagulant state. Recent studies indicate that many of these disturbances are predictors of future vascular events. Aim of our study was to compare the effect of eprosartan, a new highly selective, structurally distinct, non peptide AT1 receptor antagonist, to losartan on plasma levels of hemostatic/ fibrinolytic markers, in a cohort of previously untreated hypertensives.
AJH–May 2003–VOL. 16, NO. 5, PART 2
Methods: Eighty-six patients (pts) who controlled their hypertension (mild to moderate) by monotherapy, 45 pts (20M, 25F) under eprosartan and 41 pts (19M, 22F) under losartan were studied. SBP, DBP, and the plasma levels of plasminogen activator inhibitor-1 antigen (PAI-1), fibrinogen (F), tissue plasminogen activator antigen (tPA) and thrombomodulin (TM) were determined in the whole population, before and after six months of therapy. Age, gender distribution, body mass index, lipid profile and baseline markers of the measured values were similar in both groups. Results: The results were as shown below: Comparative Effects on the Measured Markers (% modifications) SBP (mmHg) DBP (mmHg) PAI-1 (ng/ml) F (mg/dl) tPA (ng/ml) TM (ng/ml)
Eprosartan
Losartan
p value
⫺11.93 ⫾ 4.2* ⫺13.54 ⫾ 5.17* ⫺30.95 ⫾ 11.37* ⫺9.46 ⫾ 3.85* 10.295 ⫾ 4.67* ⫺16.88 ⫾ 8.46*
⫺7.12 ⫾ 4.24* ⫺13.04 ⫾ 3.58* ⫺17.65 ⫾ 7.02* ⫺2.27 ⫾ 6.1** 6.27 ⫾ 4.32* ⫺5.59 ⫾ 6.68***
⬍0.00001 NS ⬍0.00001 ⬍0.0001 ⬍0.00008 ⬍0.00001
* p⬍0.00001 ** p⬍0.0027 *** p⬍0.00013 (p value between baseline and after treatment levels in each group)
Conclusions: The results suggest that eprosartan and losartan are effective in hypertension control but 6-month treatment with eprosartan was associated with a more significant decrease of SBP and a more favorable effect on hemostatic/fibrinolytic status than losartan. This is maybe due to its sympathyticolytic activity. Key Words: Antihypertensive drugs, hemostatic parameters
P-221 EFFECTS OF VALSARTAN ON LIPID AND GLUCOSE METABOLISM IN PATIENTS WITH ESSENTIAL HYPERTENSION Qi Hua, Dongbao Li, Hailing Chen. Cardiovascular Department of Xuan Wu Hospital, Capital University of Medical Sciences, Beijing, China. To investigate the effects of Valsartan on Lipid and glucose metabolism and its antihypertensive efficacy. the changes of fasting lipid and glucose and clinical blood pressure were observed before and after Valsartan was taken for 4 weeks in 89 patients with essential hypertension and 36 patients without drug therapy. After treatment of Valsartan, decreasing values of clinical systolic blood pressure and clinical diastolic blood pressure were 16.68⫾2.69 mmHg and 11.67⫾3.39 mmHg respectivesly P⬍0.001; TC, LDL-C and TG decreased significantly P⬍0.05, 0.001 and 0.05; blood glucose and HDL-c rised slightly after the therapy of Valsartan P⬎0.05. There were no any changes in control group. Valsartan can lower blood pressure effectively and improve lipid metabolism simultaneously. Key Words: Lipid metabolism
P-222 LOW RENIN ACTIVITY AND BLOOD PRESSURE MANAGEMENT Ajay K. Israni, Hatem Amer, Sandeep Jaglan, Tulsi Mehta, Raymond T. Townsend. Renal, University of Pennsylvania, Philadelphia, PA; Medicine, Abington Hospital, Abington, P.A.; Medicine, Medical College of Pennsylvania, Philadephia, PA. Clinical outcomes in patients with LRH referred to a hypertension program are unknown. To determine blood pressure (BP) outcomes in patients with LRH, we examined the records of a single practitioner (RRT) outpatient hypertension program at a University hospital, using a preset survey tool. Seated renin activity is routinely performed in new referrals to our program since 1998.
POSTERS: Antihypertensive Drugs
inpatient for accelerated HTN with BP of 230/130, rising liver enzymes, and jaundice. Upon admission all home meds were discontinued. Liver biopsy excluded neoplasm but revealed bridging hepatocyte necrosis. The blood pressure was controlled with oral nicardipine. The patients’ condition regressed to fulminant hepatic failure, hepatic encephalopathy, and acute renal failure. She required a liver transplant and now is stable eight months post liver transplant. Labetalol hepatotoxicity and hepatic necrosis is a potentially life threatening illness, which can result in hepatic failure and multi-organ failure necessitating liver transplantation. Routine surveillance of liver enzymes may become necessary for a subset of high risk patients on chronic labetalol therapy. Key Words: Labetalol, hepatic necrosis, liver transplantation
P-219 USE OF A LONG-ACTING LOOP DIURETIC TO IMPROVE BLOOD PRESSURE CONTROL Kimberly G. Harkins, Deborah S. King, George E. Habeeb, Jimmy L. Stewart, Sharon B. Wyatt, Marion R. Wofford. Division of Hypertension, University of Mississippi Medical Center, Jackson, MS. Patient non-adherence remains an etiology of uncontrolled hypertension. A recent meta-analysis demonstrated that once-daily dosing regimens are associated with higher rates of adherence than either twice-daily (BID) or multiple daily dosing (MDD). Diuretics are a mainstay of hypertension therapy, but short-acting loop diuretics may activate the renin-angiotensin-aldosterone system when dosed once daily. To evaluate the efficacy of once-daily long-acting diuretics, a retrospective chart analysis was performed on patients seen in the University of Mississippi Medical Center Hypertension Clinic within the last two years. Patients were identified who had been treated with torsemide, a long-acting loop diuretic. As one arm of a larger study, particular attention was given to those patients who had been changed from BID or MDD furosemide to once-daily torsemide. Of forty-nine charts reviewed, eighteen patients met entry criteria for the study. Average systolic blood pressure lowering associated with this change in medication was 12 mm Hg, with average diastolic blood pressure lowering of 7 mm Hg. Chart documentation supported improvement in adherence as a specific reason for the change in many cases. Torsemide was well tolerated by patients. Once-daily loop diuretics may improve blood pressure control by improving adherence and by achieving a more steady natriuresis and diuresis than multiple daily doses of short-acting loop diuretics. Key Words: Hypertension control, diuretics, patient adherence
P-220 EPROSARTAN EFFECT ON FIBRINOLYTIC/HEMOSTATIC VARIABLES IN ARTERIAL HYPERTENSION: A COMPARATIVE STUDY TO LOSARTAN Thomas K Makris, Panagiota G Krespi, Antonios N Hatzizacharias, Dimetrios Papadopoulos, Evangelos Batzoglou, Maria Kouli, Perseas Gioldasis, Vassilios V Votteas. Cardiology, Laikon Hospital of Athens, Athens, Greece; Cardiology, EVAGELISMOS Hospital of Athens, Athens, Greece. Background: Essential hypertension (EH) is often accompanied by abnormalities of coagulation/fibrinolysis predisposing to a procoagulant state. Recent studies indicate that many of these disturbances are predictors of future vascular events. Aim of our study was to compare the effect of eprosartan, a new highly selective, structurally distinct, non peptide AT1 receptor antagonist, to losartan on plasma levels of hemostatic/ fibrinolytic markers, in a cohort of previously untreated hypertensives.
AJH–May 2003–VOL. 16, NO. 5, PART 2
Methods: Eighty-six patients (pts) who controlled their hypertension (mild to moderate) by monotherapy, 45 pts (20M, 25F) under eprosartan and 41 pts (19M, 22F) under losartan were studied. SBP, DBP, and the plasma levels of plasminogen activator inhibitor-1 antigen (PAI-1), fibrinogen (F), tissue plasminogen activator antigen (tPA) and thrombomodulin (TM) were determined in the whole population, before and after six months of therapy. Age, gender distribution, body mass index, lipid profile and baseline markers of the measured values were similar in both groups. Results: The results were as shown below: Comparative Effects on the Measured Markers (% modifications) SBP (mmHg) DBP (mmHg) PAI-1 (ng/ml) F (mg/dl) tPA (ng/ml) TM (ng/ml)
Eprosartan
Losartan
p value
⫺11.93 ⫾ 4.2* ⫺13.54 ⫾ 5.17* ⫺30.95 ⫾ 11.37* ⫺9.46 ⫾ 3.85* 10.295 ⫾ 4.67* ⫺16.88 ⫾ 8.46*
⫺7.12 ⫾ 4.24* ⫺13.04 ⫾ 3.58* ⫺17.65 ⫾ 7.02* ⫺2.27 ⫾ 6.1** 6.27 ⫾ 4.32* ⫺5.59 ⫾ 6.68***
⬍0.00001 NS ⬍0.00001 ⬍0.0001 ⬍0.00008 ⬍0.00001
* p⬍0.00001 ** p⬍0.0027 *** p⬍0.00013 (p value between baseline and after treatment levels in each group)
Conclusions: The results suggest that eprosartan and losartan are effective in hypertension control but 6-month treatment with eprosartan was associated with a more significant decrease of SBP and a more favorable effect on hemostatic/fibrinolytic status than losartan. This is maybe due to its sympathyticolytic activity. Key Words: Antihypertensive drugs, hemostatic parameters
P-221 EFFECTS OF VALSARTAN ON LIPID AND GLUCOSE METABOLISM IN PATIENTS WITH ESSENTIAL HYPERTENSION Qi Hua, Dongbao Li, Hailing Chen. Cardiovascular Department of Xuan Wu Hospital, Capital University of Medical Sciences, Beijing, China. To investigate the effects of Valsartan on Lipid and glucose metabolism and its antihypertensive efficacy. the changes of fasting lipid and glucose and clinical blood pressure were observed before and after Valsartan was taken for 4 weeks in 89 patients with essential hypertension and 36 patients without drug therapy. After treatment of Valsartan, decreasing values of clinical systolic blood pressure and clinical diastolic blood pressure were 16.68⫾2.69 mmHg and 11.67⫾3.39 mmHg respectivesly P⬍0.001; TC, LDL-C and TG decreased significantly P⬍0.05, 0.001 and 0.05; blood glucose and HDL-c rised slightly after the therapy of Valsartan P⬎0.05. There were no any changes in control group. Valsartan can lower blood pressure effectively and improve lipid metabolism simultaneously. Key Words: Lipid metabolism
P-222 LOW RENIN ACTIVITY AND BLOOD PRESSURE MANAGEMENT Ajay K. Israni, Hatem Amer, Sandeep Jaglan, Tulsi Mehta, Raymond T. Townsend. Renal, University of Pennsylvania, Philadelphia, PA; Medicine, Abington Hospital, Abington, P.A.; Medicine, Medical College of Pennsylvania, Philadephia, PA. Clinical outcomes in patients with LRH referred to a hypertension program are unknown. To determine blood pressure (BP) outcomes in patients with LRH, we examined the records of a single practitioner (RRT) outpatient hypertension program at a University hospital, using a preset survey tool. Seated renin activity is routinely performed in new referrals to our program since 1998.