Document Detail


Effect of intensive versus standard blood pressure lowering on diastolic function in patients with uncontrolled hypertension and diastolic dysfunction.
MedLine Citation:
PMID:  19996069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Diastolic dysfunction may precede development of heart failure in hypertensive patients. We randomized 228 patients with uncontrolled hypertension, preserved ejection fraction, and diastolic dysfunction to 2 targeted treatment strategies: intensive, with a systolic blood pressure target of <130 mm Hg, or standard, with a systolic blood pressure target of <140 mm Hg, using a combination of valsartan, either 160 or 320 mg, plus amlodipine, either 5 or 10 mg, with other antihypertensive medications as needed. Echocardiographic assessment of diastolic function was performed at baseline and after 24 weeks in a prospective, open-label, blinded end point design. Blood pressure was reduced significantly in both groups, from 161.2+/-13.9/90.1+/-12.0 to 130.8+/-12.3/74.9+/-9.1 mm Hg (P<0.0001) in the intensive arm and from 162.1+/-13.2/93.7+/-12.2 to 137.0+/-12.9/79.6+/-11.0 mm Hg (P<0.0001) in the standard arm (P<0.003 for between-group comparisons). Myocardial relaxation velocity improved from 7.6+/-1.1 to 9.2+/-1.7 cm/s (Delta 1.54+/-1.4 cm/s; P<0.0001) in the intensive arm and from 7.5+/-1.3 to 9.0+/-1.9 cm/s (Delta 1.48+/-1.6 cm/s; P<0.0001) in the standard arm, with no difference between the 2 strategies in the achieved improvement (P=0.58). The degree of improvement in annular relaxation velocity was associated with the extent of systolic blood pressure reduction, and patients with the lowest achieved systolic blood pressure had the highest final diastolic relaxation velocities.
Authors:
Scott D Solomon; Anil Verma; Akshay Desai; Amira Hassanein; Joseph Izzo; Suzanne Oparil; Yves Lacourciere; Joleen Lee; Yodit Seifu; Robert J Hilkert; Ricardo Rocha; Bertram Pitt;
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-12-07
Journal Detail:
Title:  Hypertension     Volume:  55     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-21     Completed Date:  2010-02-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  241-8     Citation Subset:  IM    
Affiliation:
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. Ssolomon@rics.bwh.harvard.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00523549
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Antihypertensive Agents / administration & dosage*
Blood Pressure Determination
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Echocardiography, Doppler
Female
Follow-Up Studies
Heart Failure, Diastolic / prevention & control*,  ultrasonography*
Humans
Hypertension / diagnosis,  drug therapy*
Hypertrophy, Left Ventricular / prevention & control,  ultrasonography
Linear Models
Male
Middle Aged
Multivariate Analysis
Probability
Risk Assessment
Severity of Illness Index
Sex Factors
Statistics, Nonparametric
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections
Comment In:
Hypertension. 2010 Feb;55(2):224-5   [PMID:  19996064 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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