Document Detail


A selective endothelin-receptor antagonist to reduce blood pressure in patients with treatment-resistant hypertension: a randomised, double-blind, placebo-controlled trial.
MedLine Citation:
PMID:  19748665     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Hypertension cannot always be adequately controlled with available drugs. We investigated the blood-pressure-lowering effects of the new vasodilatory, selective endothelin type A antagonist, darusentan, in patients with treatment-resistant hypertension.
METHODS: This randomised, double-blind study was undertaken in 117 sites in North and South America, Europe, New Zealand, and Australia. 379 patients with systolic blood pressure of 140 mm Hg or more (>/=130 mm Hg if patient had diabetes or chronic kidney disease) who were receiving at least three blood-pressure-lowering drugs, including a diuretic, at full or maximum tolerated doses were randomly assigned to 14 weeks' treatment with placebo (n=132) or darusentan 50 mg (n=81), 100 mg (n=81), or 300 mg (n=85) taken once daily. Randomisation was made centrally via an automated telephone system, and patients and all investigators were masked to treatment assignments. The primary endpoints were changes in sitting systolic and diastolic blood pressures. Analysis was by intention to treat. The study is registered with ClinicalTrials.gov, number NCT00330369.
FINDINGS: All randomly assigned participants were analysed. The mean reductions in clinic systolic and diastolic blood pressures were 9/5 mm Hg (SD 14/8) with placebo, 17/10 mm Hg (15/9) with darusentan 50 mg, 18/10 mm Hg (16/9) with darusentan 100 mg, and 18/11 mm Hg (18/10) with darusentan 300 mg (p<0.0001 for all effects). The main adverse effects were related to fluid accumulation. Oedema or fluid retention occurred in 67 (27%) patients given darusentan compared with 19 (14%) given placebo. One patient in the placebo group died (sudden cardiac death), and five patients in the three darusentan dose groups combined had cardiac-related serious adverse events.
INTERPRETATION: Darusentan provides additional reduction in blood pressure in patients who have not attained their treatment goals with three or more antihypertensive drugs. As with other vasodilatory drugs, fluid management with effective diuretic therapy might be needed.
FUNDING: Gilead Sciences.
Authors:
Michael A Weber; Henry Black; George Bakris; Henry Krum; Stuart Linas; Robert Weiss; Jennifer V Linseman; Brian L Wiens; Marshelle S Warren; Lars H Lindholm
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-09-11
Journal Detail:
Title:  Lancet     Volume:  374     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-26     Completed Date:  2009-11-06     Revised Date:  2010-12-29    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1423-31     Citation Subset:  AIM; IM    
Affiliation:
State University of New York, Downstate College of Medicine, New York, NY 11203, USA. michaelwebermd@cs.com
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00330369
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Blood Pressure Monitoring, Ambulatory
Diastole / drug effects
Dose-Response Relationship, Drug
Double-Blind Method
Drug Therapy, Combination
Edema / chemically induced,  epidemiology
Female
Humans
Hypertension / diagnosis,  drug therapy*,  etiology,  metabolism
Male
Middle Aged
Phenylpropionates / adverse effects,  therapeutic use*
Pyrimidines / adverse effects,  therapeutic use*
Receptor, Endothelin A / antagonists & inhibitors,  physiology
Systole / drug effects
Treatment Outcome
Chemical
Reg. No./Substance:
0/LU 135252; 0/Phenylpropionates; 0/Pyrimidines; 0/Receptor, Endothelin A
Comments/Corrections
Comment In:
Curr Hypertens Rep. 2010 Feb;12(1):1-3   [PMID:  20425150 ]
Lancet. 2010 Feb 20;375(9715):635; author reply 636-7   [PMID:  20171390 ]
Lancet. 2010 Feb 20;375(9715):636; author reply 636-7   [PMID:  20171394 ]
Lancet. 2010 Feb 20;375(9715):636; author reply 636-7   [PMID:  20171393 ]
Lancet. 2010 Feb 20;375(9715):635; author reply 636-7   [PMID:  20171391 ]
Expert Opin Pharmacother. 2011 Jan;12(1):153-5   [PMID:  21043838 ]
Lancet. 2009 Oct 24;374(9699):1396-8   [PMID:  19748666 ]

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


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