|
||||||
|
|
|
|
|||||||||||
|
|||||||||||||
| ||||||||||||||||||||||||||||||||||||
A large, multicenter trial shows that treating prehypertension with anangiotensin-receptor blocker (ARB) disrupts disease progression, reducing therisk of incipient hypertension by more than 15% over a 4-yearperiod.
President of the American Society of Hypertension (ASH), Thomas J. Giles,MD, urges his colleagues to consider hypertension a progressive cardiovascularsyndrome. The condition can be postponed or perhaps even prevented, he saidduring remarks at ASH's 21st Annual Scientific Meeting held May 16–20 inNew York.
Proof of concept of pharmacologic treatment of prehypertension was shown inthe Trial of Preventing Hypertension (TROPHY). Lead investigator Stevo Julius,MD, ScD, of the University of Michigan, Ann Arbor, announced the TROPHYresults at ASH 2006.
TROPHY researchers followed 772 adults with prehypertension, defined as asystolic pressure of 130–139 mmHg and a diastolic pressure of85–89 mmHg, for 4 years. Patients were randomized to 16 mg a day ofcandesartan cilexetil (Atacand, AstraZeneca) or placebo for 2 years, then allpatients received placebo for another 2 years. Treatment withantihypertensives was initiated when subjects reached stage 1 hypertension.Both the candesartan and placebo groups were instructed to make lifestylechanges to lower blood pressure.
At the 2-year visit, hypertension had developed in 13.6% of patients onactive treatment and in 40.4% of patients on placebo, Julius reports. At the4-year visit, after all patients had been on placebo, hypertension haddeveloped in 53.2% of those who received candesartan compared with 63% ofplacebo patients. The relative risk reduction for hypertension was 15.6%.Candesartan was well tolerated with no serious adverse events, according toJulius.
The full study report was published in the April 20 issue of The NewEngland Journal ofMedicine.1
"The exciting finding from TROPHY is that the effect of reducing theprogression to hypertension is sustained... beyond the discontinuation oftreatment," co-investigator Shawna Nesbitt, MD, of the University ofTexas Southwestern Medical School in Dallas, tells DOC News."This study is the opening of the door to the concept of earlytreatment, which clearly needs additionalresearch."
The Hypertension Writing Group has proposed new definitions ofhypertension2 thatinclude a constellation of symptoms—of which hypertension is justone—that arise for complex reasons. These symptoms result in bothfunctional and structural progressive changes to the heart, kidneys, brain,vasculature, and other organs, which often lead to premature morbidity anddeath, according to Giles, a writing group member.
"Physicians should address those risk factors before the cuff readingshows signs of high blood pressure," Giles says. 
References
2. Giles TD, Berk BC, Black HR, et al., for the Hypertension WritingGroup: Expanding the definition and classification of hypertension.J Clin Hypertens 7:505–512, 2005.
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||
|
||||||
|
| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
