Abstract:
BACKGROUND:The efficacy and safety of angiotensin receptor blockers (ARBs) in the older population is unclear. OBJECTIVES:To determine the efficacy and safety of ARBs in older patients. METHODS:Randomized trials that compared ARBs to control and reported clinical outcomes in patients with a mean age of 65 years or older were included. Random-effects summary risk ratios (RRs) were constructed. RESULTS:A total of 16 trials met our selection criteria, which yielded 113,386 patients. ARBs were associated with a marginal increased risk of all-cause mortality (RR: 1.03, 95% confidence interval (CI): 1.00-1.06, P = 0.05), a nonsignificant increased risk of myocardial infarction (RR: 1.04, 95% CI: 0.96-1.12, P = 0.36), a marginal reduction in heart failure hospitalization (RR: 0.86, 95% CI: 0.74-1.00, P = 0.06), and a significant reduction in the risk of stroke (RR: 0.93, 95% CI: 0.87-0.99, P = 0.03). ARBs were associated with an increased risk of acute kidney injury (RR: 1.48, 95% CI: 1.24-1.77, P < 0.001), hypotension (RR: 1.56, 95% CI: 1.24-1.97, P < 0.001), and hyperkalemia (RR: 1.57, 95% CI: 1.13-2.19, P = 0.008). On the sensitivity analysis including placebo-controlled trials, the risk of all-cause mortality was no longer significant (P = 0.2), while the remainder of the outcomes did not change. CONCLUSION:In older patients, the benefit of ARBs compared with control was strongest for stroke reduction, with no (or weak) associations for all-cause mortality, myocardial infarction, and heart failure hospitalization. Benefit was offset by an increased risk of acute kidney injury, hypotension, and hyperkalemia. Thus, ARBs should be used with caution in older patients when clinically indicated.
journal_name
Am J Hypertensjournal_title
American journal of hypertensionauthors
Elgendy IY,Huo T,Chik V,Pepine CJ,Bavry AAdoi
10.1093/ajh/hpu209subject
Has Abstractpub_date
2015-05-01 00:00:00pages
576-85issue
5eissn
0895-7061issn
1941-7225pii
hpu209journal_volume
28pub_type
杂志文章,meta分析,评审abstract::Primary investigators of randomized drug trials in hypertension were invited to rate quality of such trials. The intention of the survey was to ask if antihypertensive drug therapy reduces incidence of coronary heart disease (CHD) in hypertensive patients. Response was obtained for 7 of the 11 invited investigators, c...
journal_title:American journal of hypertension
pub_type: 杂志文章,meta分析
doi:10.1093/ajh/7.8.703
更新日期:1994-08-01 00:00:00
abstract:BACKGROUND:The GTPase Rac1 has been implicated in hypertension as a modulator of mineralocorticoid receptor activity. Our aim is to investigate the frequency of polymorphisms rs10951982 (intron 1, G>A) and rs836478 (intron 3, T>C) in the RAC1 gene and perform association studies with clinical and biochemical parameters...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpt277
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:The role of C825T polymorphism of the candidate GNB3 gene in predicting cerebrovascular outcome has been poorly explored in longitudinal setting at a population level. METHODS:In an epidemiological setting, 1,678 men and women from general population were genotyped for C825T polymorphism of GNB3 gene and fo...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1038/ajh.2011.257
更新日期:2012-04-01 00:00:00
abstract::After nephrectomy, the level of arterial pressure is determined by the permitted degree of fluid volume expansion. With kidneys present, the fundamental requirement for fluid volume homeostasis is met by maintaining the balance between sodium and water intake and output. When one-kidney, one-clip (1-K,1-C) hypertensio...
journal_title:American journal of hypertension
pub_type: 杂志文章,评审
doi:10.1093/ajh/4.10.534s
更新日期:1991-10-01 00:00:00
abstract:BACKGROUND:Different methods of normalizing left ventricular (LV) mass for body size identify generally similar relative risks of adverse cardiovascular outcome but with variable prevalences of LV hypertrophy (H). Preliminary results from a population with high prevalence of obesity suggest that the population attribut...
journal_title:American journal of hypertension
pub_type: 杂志文章,多中心研究
doi:10.1016/j.amjhyper.2005.05.027
更新日期:2005-10-01 00:00:00
abstract:BACKGROUND:This study was designed to evaluate whether plasma asymmetric dimethylarginine (ADMA) has any role in predicting hemodynamic responses in clinically healthy young subjects. ADMA, as an endogenous nitric oxide (NO) synthase inhibitor, has been demonstrated to associate with hypertension and vascular reactivit...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1038/ajh.2008.215
更新日期:2008-08-01 00:00:00
abstract::To elucidate whether postprandial hypotension (PPH) is associated with any diurnal change of blood pressure, ambulatory blood pressure monitoring was performed on 121 hospitalized essential hypertensive patients who received standardized meals. Postprandial change in blood pressure was defined as the difference betwee...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/s0895-7061(98)00161-7
更新日期:1998-11-01 00:00:00
abstract:BACKGROUND:Elastin microfibril interfacer 1 (EMILIN-1) is a negative regulator of the transforming growth factor-beta (TGF-beta) signaling, which is involved in blood pressure (BP) homeostasis. Emilin1 knockout mice display elevated BP. The aim of the present study was to assess the association between the human EMILIN...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1038/ajh.2010.16
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:The morbidity and mortality benefits of blood pressure (BP) control for the elderly is well documented. The cognitive consequences of hypertension control in this population, however, are still under debate. We aim to study the association between BP and cognitive performance in the elderly. Specifically, we...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/s0895-7061(03)01005-7
更新日期:2003-10-01 00:00:00
abstract::We studied the role of the sympathetic nervous system and the renin angiotensin system for pressure induced left ventricular hypertrophy (LVH) in 135 rats with experimental supravalvular aortic stenosis (AS). We induced this condition by a silver clip on the ascending aorta, when body weight (BW) was 90 to 100 g. Symp...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/4.6.521
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Differences between the antihypertensive responses to drug therapy measured by office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) techniques have been noted but rarely analyzed. We studied whether the OBP and 24-h ABPM responses to hydrochlorothiazide differ and, if so, the relevance...
journal_title:American journal of hypertension
pub_type: 临床试验,杂志文章
doi:10.1016/j.amjhyper.2004.10.021
更新日期:2005-03-01 00:00:00
abstract::Thromboembolic complications such as ischemic stroke and myocardial infarction are significantly more frequent in patients with arterial hypertension. From the available intervention studies, it appears that pharmacologic treatment of hypertension-at least with diuretics and beta-blockers-may more effectively protect ...
journal_title:American journal of hypertension
pub_type: 杂志文章,评审
doi:10.1016/s0895-7061(97)00496-2
更新日期:1998-03-01 00:00:00
abstract::Changes in the lipid composition of the membrane affect its fluidity and function. These variables are altered in various forms of hypertension. Our hypothesis was that the rapid increase in blood pressure (BP) caused by inhibition of nitric oxide production would lead to alterations in membrane fluidity similar to th...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/s0895-7061(00)01184-5
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:Strong associations between blood pressure (BP) and overweight raise the question whether overweight children (body mass index (BMI) ≥85th percentile) should be included in the normative database. METHODS:Using the LMS (Lamda-Mu-Sigma) method, we developed age-, gender-, and height-adjusted percentile curve...
journal_title:American journal of hypertension
pub_type: 杂志文章,多中心研究
doi:10.1093/ajh/hpu208
更新日期:2015-05-01 00:00:00
abstract::Using a new ion selective electrode (ISE) to measure ionized magnesium (IMg2+), we compared levels of IMg2+ with total magnesium (TMg) and serum ionized calcium levels (ICa2+) in umbilical arterial and venous serum of 13 parturients who developed transient hypertension in labor with levels in 38 who remained normotens...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/6.6.542
更新日期:1993-06-01 00:00:00
abstract::This study found that pigs in the early stages of perinephritic hypertension had enhanced plasma norepinephrine (NE) and heart rate (HR) responses to behaviorally arousing stimuli (lifting in a canvas sling) and exercise. In the hypertensive animals, the increase in plasma NE in response to behavioral arousal caused b...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/6.10.844
更新日期:1993-10-01 00:00:00
abstract::Insulin resistance, the most important factor in metabolic syndrome X, has been considered to raise blood pressure. Recently it was reported that insulin resistance was related to an elevated plasma level of leptin, which is an adipocyte-specific ob gene product and which plays a role in food intake suppression, therm...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/s0895-7061(97)00310-5
更新日期:1997-10-01 00:00:00
abstract::This double-blind placebo controlled study investigated the antihypertensive and humoral effects of nifedipine capsules in patients with essential hypertension inadequately controlled (seated diastolic blood pressure greater than or equal to 95 mm Hg) by hydrochlorothiazide (HCTZ) alone. Nifedipine acutely (first dose...
journal_title:American journal of hypertension
pub_type: 临床试验,杂志文章
doi:10.1093/ajh/2.11.828
更新日期:1989-11-01 00:00:00
abstract::In normal coronary arteries, increased flow velocity induces endothelium-dependent dilation, and dilation in response to sympathetic stimulation evoked by the cold pressor test is partly due to increased flow velocity. In arterial hypertension, angiographically normal coronary arteries were constricted by acetylcholin...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/0895-7061(95)00028-n
更新日期:1995-05-01 00:00:00
abstract::It has been speculated for some time that various antihypertensive medications may have a deleterious effect on respiration during sleep and thereby enhance the apparent association between hypertension and sleep apnea/hypopnea (SAH). However, there are few data to support this contention. The present study used a dou...
journal_title:American journal of hypertension
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0895-7061(96)00507-9
更新日期:1997-06-01 00:00:00
abstract::Hypertension is a common condition that is often seen in patients with diabetes. Both diseases increase the risk of morbidity and mortality from CV events and kidney disease progression. Factors that influence blood pressure (BP) control in diabetes include the persons' genetic background for hypertension and kidney d...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpaa067
更新日期:2020-10-21 00:00:00
abstract:BACKGROUND:Inadequately treated hypertension (HTN) leads to considerable morbidity and mortality. Despite many treatment options, blood pressure (BP) control is suboptimal. Missed opportunities due to the growing complexity of primary care office visits contribute. Electronic health records (EHRs) offer best practice a...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpy155
更新日期:2019-01-01 00:00:00
abstract::The purpose of this study was to determine plasma and tissue endothelin-1 (ET-1)-like immunoreactivity in a new rodent model of spontaneous hypertension. Plasma and tissues were procured from pentobarbital-anesthetized 16- to 18-week-old male hamsters with spontaneous hypertension and genetically/age-matched normotens...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/s0895-7061(98)00047-8
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:Matrix Gla protein (MGP) is a vascular calcification inhibitor dependent upon vitamin K for activation. Evidence suggests that elevated plasma inactive MGP levels (desphospho-uncarboxylated MGP, dp-ucMGP; indicating poorer vascular vitamin K status) are associated with greater cardiovascular disease (CVD) ri...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpy049
更新日期:2018-05-07 00:00:00
abstract:BACKGROUND:Isolated systolic hypertension (ISH), more so than any other hypertension subtype, increases the risk for stroke and coronary heart disease. The prevalence of ISH versus other hypertension subtypes in the general Chinese adult population is not known. METHODS:The prevalence of isolated systolic and isolated...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/j.amjhyper.2004.06.007
更新日期:2004-10-01 00:00:00
abstract::Most antihypertensive drugs act by counteracting vasoconstrictor mechanisms and lower blood pressure by lowering vascular resistance. The beta-blockers, which have the unique feature of counteracting cardiac sympathetic drive, seem to be a major exception to this generalization. Moreover, their degree of cardiodepress...
journal_title:American journal of hypertension
pub_type: 杂志文章,评审
doi:10.1093/ajh/1.1.91
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND:Ascending aortic fractional pulse pressure and fractional systolic pressure (FSP) were demonstrated to differentiate patients with and without coronary artery disease. However, no study so far has analyzed the relationship between FSP and fractional diastolic pressure (FDP) and the extent of coronary artery ...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/j.amjhyper.2004.01.009
更新日期:2004-08-01 00:00:00
abstract:BACKGROUND:The angiotensin II type 1 receptor A1166C polymorphism has been associated with increased risks of hypertension and myocardial infarction in several small studies. We examined the association between this polymorphism and new-onset hypertension, blood pressure (BP) control, and incident cardiovascular events...
journal_title:American journal of hypertension
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0895-7061(02)03063-7
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:This study examines the interrelationship between gestational weight gain, pre-pregnancy body mass index (BMI), race/ethnicity, and their association with hypertensive disorders during pregnancy (HDP). METHODS:Data from the 2004-2011 national Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/hpv184
更新日期:2016-06-01 00:00:00
abstract::The effects of increased dietary calcium intake on blood pressure and arterial function were investigated in one-kidney deoxycorticosterone-salt hypertensive Wistar rats. The calcium content of the control diet was 1.1%, and that of the high calcium diet, 2.5%. During the 10-week study calcium supplementation markedly...
journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1093/ajh/7.6.520
更新日期:1994-06-01 00:00:00