Abstract:
BACKGROUND:Uncontrolled treatment-resistant hypertension (TRH), i.e., blood pressure (BP, mm Hg) ≥140/≥90mm Hg in and out of office on ≥3 different BP medications at optimal doses, is common and has a poor prognosis. Aldosterone antagonist (AA) and renin-guided therapy (RGT) are effective strategies for improving BP control in TRH but have not been compared. METHODS:A comparative effectiveness TRH pilot study of AA vs. RGT was conducted in 4 primary care clinics with 2 each randomized to AA or RGT. The primary outcome was change in clinic BP defined by means of 5 automated office BP values. Eighty-nine patients with apparent TRH were screened and 44 met criteria for true TRH. RESULTS:Baseline characteristics of 20 patients in the AA (70% Black, 45% female, mean age: 57.4 years) and 24 patients in RGT (79% Black, 50% female, 57.8 years) arms were similar with baseline BP 162±5/90±3 vs. 153±3/84±3, respectively, P = 0.11/0.20. BP declined to 144±5/86±4 in AA vs. 132±4/75±3 in RGT, P = 0.07/0.01; BP was controlled to JNC7 (Seventh Joint National Committee Report) goal in 25% vs. 62.5%, respectively, P < 0.01. Although BP changes from baseline, the primary outcome, were not different (-17.6±5.1/-4.0±3.0 AA vs. -20.4±3.8/-9.7±2.0 RGT, P = 0.65/0.10.), more BP medications were added with AA than RGT (+0.9±0.1 vs. +0.4±0.1 per patient, P < 0.01). CONCLUSIONS:In this TRH pilot study, AA and RGT lowered BP similarly, although fewer additional medications were required with RGT. A larger comparative effectiveness study could establish the utility of these treatment strategies for lowering BP of uncontrolled TRH patients in primary care.
journal_name
Am J Hypertensjournal_title
American journal of hypertensionauthors
Egan BM,Laken MA,Sutherland SE,Qanungo S,Fleming DO,Cook AG,Hester WH,Jones KW,Jebaily GC,Valainis GT,Way CF,Wright MB,Davis RAdoi
10.1093/ajh/hpw016subject
Has Abstractpub_date
2016-08-01 00:00:00pages
976-83issue
8eissn
0895-7061issn
1941-7225pii
hpw016journal_volume
29pub_type
杂志文章abstract::To evaluate the reactivity to psychological stress in patients with essential hypertension we investigated hemodynamic and endocrinologic changes during a mental arithmetic task (MAT) and a mirror drawing test (MDT) in 10 hypertensive subjects. Hemodynamic changes were assessed continuously using an ambulatory radionu...
journal_title:American journal of hypertension
pub_type: 临床试验,杂志文章
doi:10.1016/s0895-7061(96)00382-2
更新日期:1997-03-01 00:00:00
abstract:AIMS:Several studies have indicated that low physical activity is associated with increased risk of cardiovascular disease (CVD) and all-cause mortality among patients with diabetes. The association between physical activity and subclinical cardiovascular changes preceding clinical events remains to be elucidated. We i...
journal_title:American journal of hypertension
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更新日期:2004-09-01 00:00:00
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journal_title:American journal of hypertension
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doi:10.1016/s0895-7061(99)00223-x
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journal_title:American journal of hypertension
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journal_title:American journal of hypertension
pub_type: 杂志文章,随机对照试验
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更新日期:2013-05-01 00:00:00
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journal_title:American journal of hypertension
pub_type: 杂志文章,多中心研究
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journal_title:American journal of hypertension
pub_type: 杂志文章
doi:10.1016/0895-7061(95)00018-K
更新日期:1995-05-01 00:00:00
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journal_title:American journal of hypertension
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pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章,评审
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journal_title:American journal of hypertension
pub_type: 杂志文章
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journal_title:American journal of hypertension
pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:1997-12-01 00:00:00
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更新日期:2013-03-01 00:00:00
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journal_title:American journal of hypertension
pub_type: 杂志文章
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更新日期:1997-09-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2003-12-01 00:00:00
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journal_title:American journal of hypertension
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doi:
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