Abstract:
BACKGROUND:Type 2 diabetes mellitus is associated with an increased risk of hypertension, and cardiovascular and renal disease, and it has been recommended that management of hypertension should be more aggressive in presence than in absence of diabetes mellitus, but the matter is controversial at present. OBJECTIVES:Meta-analysing all available randomized controlled trials (RCTs) to compare the effects on cardiovascular and renal outcomes of blood pressure BP lowering to different systolic BP (SBP) and diastolic BP (DBP) levels or by different drug classes in patients with and without diabetes mellitus. METHODS:The database consisted of 72 BP-lowering RCTs (260 210 patients) and 50 head-to-head drug comparison RCTs (247 006). Among these two sets, RCTs or RCT subgroups separately reporting data from patients with and without diabetes mellitus were identified, and stratified by in-treatment achieved SBP and DBP, by drug class compared with placebo, and drug class compared with all other classes. Risk ratios and 95% confidence intervals, and absolute risk reductions of six fatal and non-fatal cardiovascular outcomes, all-cause death, and end-stage renal disease (ESRD) were calculated (random-effects model) separately for diabetes mellitus and no diabetes mellitus, and compared by interaction analysis. RESULTS:We identified 41 RCTs providing data on 61 772 patients with diabetes mellitus and 40 RCTs providing data on 191 353 patients without diabetes mellitus. For achieved SBP at least 140 mmHg, relative and absolute reductions of most cardiovascular outcomes were significantly greater in diabetes mellitus than no diabetes mellitus, whereas for achieved SBP below 130 mmHg, the difference disappeared or reversed (greater outcome reduction in no diabetes mellitus). Significant ESRD reduction was found only in diabetes mellitus, but it was greatest when achieved SBP was at least 140 mmHg, and no further effect was found at SBP below 140 mmHg. All antihypertensive drug classes reduced cardiovascular risk vs. placebo in diabetes mellitus and no diabetes mellitus, but angiotensin-converting enzyme inhibitors were the only class more effective in diabetes mellitus than in no diabetes mellitus. When compared to other classes, renin-angiotensin system blockers were equally effective in cardiovascular prevention in no diabetes mellitus, but moderately, though significantly, more effective in diabetes mellitus. CONCLUSION:BP-lowering treatment significantly and importantly reduces cardiovascular risk both in diabetes mellitus and no diabetes mellitus, but evidence for reduced ESRD risk is available only in diabetes. Contrary to past recommendations, in diabetes mellitus there is little or no further benefit in lowering SBP below 130 mmHg, whereas continuing benefit is seen in no diabetes mellitus also at SBP below 130 mmHg. Although all BP-lowering drugs can beneficially be prescribed in hypertensive patients with diabetes mellitus, the current recommendation to initiate or include a renin-angiotensin system blocker is supported by the evidence here presented.
journal_name
J Hypertensjournal_title
Journal of hypertensionauthors
Thomopoulos C,Parati G,Zanchetti Adoi
10.1097/HJH.0000000000001276subject
Has Abstractpub_date
2017-05-01 00:00:00pages
922-944issue
5eissn
0263-6352issn
1473-5598journal_volume
35pub_type
杂志文章,meta分析,评审abstract:OBJECTIVE:A number of potential interactions between angiotensin-converting enzyme inhibitors and lithium have been described in the literature. In the present study, we investigated the effects of a low-dose combination treatment with lithium and captopril on survival and stroke prevention in salt-loaded, stroke-prone...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/01.hjh.0000189868.48290.d8
更新日期:2005-12-01 00:00:00
abstract::Uptake of 45Ca was measured in rings of thoracic aorta from rabbits with hypertension, induced by cellophane perinephritis (Page hypertension: one-kidney, one wrap). Basal 45Ca uptake was increased significantly in the hypertensive group (sham: 100 +/- 3, hypertensive: 133 +/- 11 nmol/g wet weight, n = 6). 45Ca uptake...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-198712000-00013
更新日期:1987-12-01 00:00:00
abstract:OBJECTIVE:Currently, normative means and ranges of blood pressure (BP) and pulse rates in Japanese newborns are not available. The objective of the present study was to estimate BP, pulse rate, and their distribution among Japanese newborns. METHODS:Using oscillometric devices, arm or calf BP and pulse rate levels wer...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000000976
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To compare the prediction of mortality by ambulatory blood pressure monitoring and screening blood pressure measurements in a general population. DESIGN:A prospective cohort study. PATIENTS AND METHODS:We obtained blood pressure data for 1542 subjects (565 men and 977 women) aged > or = 40 years who were fo...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-199715040-00006
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVE:To assess the Accutracker II (version 30/23) ambulatory blood pressure monitor by nationally agreed protocols in order to resolve previous conflicting assessments, and to examine the feasibility of combining these protocols into one study. DESIGN:The protocols of the Association for the Advancement of Medica...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:
更新日期:1993-11-01 00:00:00
abstract:OBJECTIVES:Endothelial dysfunction is established in aged individuals; however, the mechanism(s) are not fully elucidated. We have previously identified l-arginine transport as a potential rate-limiting factor in nitric oxide (NO) production in heart-failure patients, characterized with endothelial dysfunction. We ther...
journal_title:Journal of hypertension
pub_type: 临床试验,杂志文章
doi:10.1097/00004872-200402000-00016
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:Increased BP-variability predicts cardiovascular morbidity and mortality in hypertensives. This study aimed to examine short-term BP-variability according to renal function stage. METHODS:We included 16 546 patients [10 270 (62.1%) without/6276 (38.9%) with CKD Stage 1-5] from the Spanish Ambulatory-Blood-Pr...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000001670
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVE:To investigate the role of an activated endothelin system in the renal dysfunction observed in chronic heart failure after myocardial infarction. METHODS:In rats with heart failure after myocardial infarction and in sham-operated animals (Sham), we investigated the effect on renal function of long-term oral ...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-200018100-00020
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVE:Arterial hypertension is recurrently associated with inflammation of the endothelium as an effect of the upregulation of functional molecules, including cytokines, adhesion molecules and chemokines. However, the role of monocyte chemoattractant protein-1 (MCP-1) in maintaining the inflammatory state of endoth...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/01.hjh.0000234111.31239.c3
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the mean levels of blood pressure and hypertension (> or = 140 mmHg systolic or > or = 90 mmHg diastolic pressure or on treatment for hypertension) in the adult English population, and to evaluate any changes in the efficacy of hypertension management between 1994 and 2003. DESIGN/METHODS:Cross-s...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/01.hjh.0000226210.95936.bc
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:The present study was performed to examine the role of superoxide (O2*) and its interaction with nitric oxide (NO) in the regulation of renal function in prehypertensive heterozygous Ren-2 transgenic rats (TGR). METHODS:Renal responses to the O2* scavenger, tempol (150 microg/min per 100 g), and/or the NO sy...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0b013e3282efb195
更新日期:2007-11-01 00:00:00
abstract::The effects of essential fatty acid deficiency (EFAD) on vascular reactivity to vasoconstrictor stimuli were studied in rat autoperfused hindquarters. Weanling male Sprague-Dawley rats (aged 21 days) were fed diets containing 8% (weight/weight) of stearax plus 2% safflower oil (control diet) or 10% stearax (EFAD diet)...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:
更新日期:1988-02-01 00:00:00
abstract:OBJECTIVE:To compare the effects of a cardioselective beta-blocker (nebivolol) with those of an angiotensin-converting enzyme inhibitor (enalapril) on parameters of insulin sensitivity, peripheral blood flow and arterial stiffness during one extended glucose clamp experiment. DESIGN:A randomized, double-blind crossove...
journal_title:Journal of hypertension
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.hjh.0000234121.48272.67
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVE:Although several studies have reported an association between microalbuminuria and pulse wave velocity in patients with hypertension or diabetes, there have been no reports of their significance in apparently healthy individuals. METHODS:Microalbuminuria and brachial-ankle PWV (baPWV) were investigated in a ...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0b013e32834b5627
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVES:To explore the association of different types of blood pressure (BP) variability measures estimated from either short-term ambulatory reading-to-reading or long-term clinic visit-to-visit BP records with long-term survival in an elderly treated hypertensive population. METHODS:A subset of patients (n = 508)...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000001652
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:The effects of salt intake on renal regulation have been investigated for decades. To find new pathways and to demonstrate the utility of oligonucleotide expression arrays, we studied whole kidneys. METHODS:Eight Sprague-Dawley rats were divided into two groups. One group received a 6% salt (by weight) diet...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-200206000-00022
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the association between stroke risk and blood pressure (BP) levels with regard to the usage of antihypertensive medications. METHODS:From the Japan arteriosclerosis longitudinal study, 11,371 participants from the four population-based cohort studies (aged 40-89) were followed up for a mean of 9....
journal_title:Journal of hypertension
pub_type: 杂志文章,meta分析
doi:10.1097/HJH.0b013e32831967ca
更新日期:2009-02-01 00:00:00
abstract::The effects of low-dose endothelin on systemic haemodynamics and vasoactive hormones were examined in conscious dogs. In addition, we examined the effects of endothelin on pressor responses to noradrenaline and angiotensin II and the baroreflex regulation of heart rate in conscious dogs. Continuous infusion of 40 fmol...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-199104000-00005
更新日期:1991-04-01 00:00:00
abstract:PURPOSE:Cardiovascular reactivity to mental stress has been used as a tool to predict short-term hypertension risk in adults but the impact of cardiovascular reactivity in childhood on hypertension in adulthood is unknown. Using the 1970 British Cohort study, we examined the association between pulse rate reactivity in...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000001023
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:To determine plasma aldosterone concentration (PAC) and plasma renin concentration (PRC) and aldosterone-to-renin ratio (ARR) values in a population attending a Clinic for Cardiovascular Risk Assessment in Children. METHODS:We assessed ARR and associated factors in a cohort of 287 children (137 female, 4-18 ...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000001571
更新日期:2018-02-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:
更新日期:1988-05-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000000075
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:Optimal medication use obscures the impact of physical activity on traditional cardiometabolic risk factors. We evaluated the relationship between step counts and carotid-femoral pulse wave velocity (cfPWV), a summative risk indicator, in patients with type 2 diabetes and/or hypertension. RESEARCH DESIGN AND...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000001277
更新日期:2017-05-01 00:00:00
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journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0b013e3282f06428
更新日期:2007-12-01 00:00:00
abstract::Noradrenergic activity was measured in the brainstem, hypothalamus and thoracic spinal cord of male and female spontaneously hypertensive (SHR) and Wistar-Kyoto (WKY) rats at 6 and 28-36 weeks of age. Two techniques were used, measurement of a major noradrenaline (NA) metabolite, free 3,4-dihydroxyphenylethyleneglycol...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-198506000-00007
更新日期:1985-06-01 00:00:00
abstract:OBJECTIVE:Metabolic syndrome (MetS) is associated with uncontrolled blood pressure (BP), despite use of aggressive therapy. This study was performed to assess whether the use of different classes of antihypertensive drugs might influence this association. METHODS:We evaluated risk of uncontrolled BP (BP ≥ 140/90 mmHg ...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0b013e32834e1eda
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:The oral contraceptive pill (OCP) is widely prescribed throughout the world. Although it is associated with a small but significant increase in blood pressure, the influence of the OCP on large artery stiffness and wave reflection is unclear. The aim of this study was to determine the relationship between us...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0b013e328346a5af
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:Visceral artery fibromuscular dysplasia (VA FMD) manifestations range from asymptomatic to life-threatening. The aim of the study is to evaluate the prevalence and clinical characteristics of VA FMD. METHODS:A total of 232 FMD patients enrolled into ongoing ARCADIA-POL study were included in this analysis. A...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/HJH.0000000000002327
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Epidemiological investigations have demonstrated a close association between heavy alcohol consumption and hypertension. The mechanisms of this association, however, remain elusive. We studied the effects of alcohol withdrawal on blood pressure, hormonal parameters, and circulating markers of endothelial act...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/01.hjh.0000239283.35562.15
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to define the relationship between physical activity and the magnitude of the percentage fall in blood pressure at night (nocturnal dip). METHODS:We simultaneously monitored 24-h ambulatory blood pressure and measured physical activity by actigraphy in 434 patients. Blood pressure w...
journal_title:Journal of hypertension
pub_type: 杂志文章
doi:10.1097/00004872-200018040-00008
更新日期:2000-04-01 00:00:00