Abstract:
OBJECTIVE:The increase in blood pressure that accompanies the obese state is almost invariably associated with alterations in metabolism (insulin resistance and dyslipidaemia) and the neurohumoral profile (activation of the renin-angiotensin system, sympathetic overactivity), which potentiate the cardiovascular risk associated with hypertension. However, debate remains as to the antihypertensive drug on which treatment of obesity-related hypertension should be based. The CROSS (Candesartan Role on Obesity and on Sympathetic System) study was undertaken to examine the antihypertensive, neuroadrenergic, and metabolic effects of an angiotensin II receptor blocker in comparison with a diuretic in obese hypertensive individuals. METHODS:In 127 obese hypertensive individuals aged 50.7 +/- 5.1 years (mean +/- SD), we measured clinic blood pressure, heart rate, plasma glucose, and insulin at rest and during an oral glucose load before and 12 weeks after treatment with either candesartan cilexetil (8-16 mg once daily) or hydrochlorothiazide (HCTZ, 25-50 mg once daily), administered orally in accordance with a double-blind, randomized, placebo-controlled, two-parallel-groups study design. Insulin sensitivity was expressed as insulin resistance index (IRI), calculated as the ratio of the area under the curve (AUC) for glucose to that for insulin. In a subgroup of patients, measurements also included direct microneurographic recording of muscle sympathetic nerve activity (MSNA) in the peroneal nerve. RESULTS:Candesartan cilexetil caused a significant (P < 0.01) reduction in both mean blood pressure (from 114.2 +/- 5.1 to 99.6 +/- 6.0 mmHg) and MSNA (from 51.0 +/- 12.3 to 40.4 +/- 12.5 bursts per 100 heart beats), and a significant (P < 0.02) increase in insulin sensitivity (AUC IRI: from -23.2 +/- 22.1 to -17.6 +/- 12.2). In contrast, HCTZ did not significantly affect MSNA and worsened insulin sensitivity, while achieving blood pressure reductions similar to those produced by candesartan cilexetil. CONCLUSIONS:These data provide evidence that, in obese hypertensive individuals, treatment with candesartan cilexetil has an antihypertensive effect similar to that of HCTZ. Unlike diuretic treatment, however, treatment with candesartan cilexetil improves insulin sensitivity and exerts sympathoinhibitory effects.
journal_name
J Hypertensjournal_title
Journal of hypertensionauthors
Grassi G,Seravalle G,Dell'Oro R,Trevano FQ,Bombelli M,Scopelliti F,Facchini A,Mancia G,CROSS Study.doi
10.1097/00004872-200309000-00027subject
Has Abstractpub_date
2003-09-01 00:00:00pages
1761-9issue
9eissn
0263-6352issn
1473-5598journal_volume
21pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVE:The objective is to evaluate the relationship between cholesterolemia, serum apolipoprotein B (apoB) level and blood pressure in a large sample of general population. METHODS:The Brisighella Heart Study (BHS) is a prospective, population-based longitudinal epidemiological investigation. For this study, we an...
journal_title:Journal of hypertension
pub_type: 杂志文章
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000000518
更新日期:2015-05-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract:BACKGROUND:Besides its capacity to regulate organ and tissue growth, the insulin-like growth factor I exerts biologic actions that resemble those of insulin. Tissue access of the factor depends on the distribution of the circulating bound factor between its binding protein 3 that remains within the intravascular space ...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-199715100-00014
更新日期:1997-10-01 00:00:00
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journal_title:Journal of hypertension
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doi:10.1097/HJH.0000000000000822
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journal_title:Journal of hypertension
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doi:10.1097/01.hjh.0000239283.35562.15
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journal_title:Journal of hypertension
pub_type: 杂志文章,多中心研究
doi:10.1097/HJH.0000000000001844
更新日期:2019-01-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000001748
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0b013e3282f3e39d
更新日期:2008-03-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-198502000-00007
更新日期:1985-02-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 临床试验,杂志文章
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更新日期:2017-06-01 00:00:00
abstract:OBJECTIVE:Treating hypertension in those aged at least 80 years is now recommended; however, the best antihypertensive to choose remains unexplored. Calcium channel blocker (CCB) use has been associated with a decreased risk of incident dementia in a younger hypertensive group but with an increased risk of cognitive de...
journal_title:Journal of hypertension
pub_type: 杂志文章,评审
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更新日期:2014-10-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-200110000-00004
更新日期:2001-10-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0b013e32830a4a3b
更新日期:2008-10-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/01.hjh.0000222768.15100.00
更新日期:2006-05-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-200105000-00007
更新日期:2001-05-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
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更新日期:2004-05-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00004872-200204000-00032
更新日期:2002-04-01 00:00:00
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journal_title:Journal of hypertension
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doi:10.1097/HJH.0000000000002155
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-199511000-00004
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更新日期:2005-08-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-199510000-00013
更新日期:1995-10-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000002171
更新日期:2019-12-01 00:00:00
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journal_title:Journal of hypertension
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doi:10.1097/HJH.0000000000002536
更新日期:2020-11-01 00:00:00
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journal_title:Journal of hypertension
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doi:10.1097/00004872-199917110-00010
更新日期:1999-11-01 00:00:00
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journal_title:Journal of hypertension
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doi:10.1097/HJH.0b013e3280108e6f
更新日期:2007-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/00004872-199308000-00013
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journal_title:Journal of hypertension
pub_type: 杂志文章,随机对照试验
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更新日期:2009-04-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:
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