Age at Risk - British Hypertension Society

Report
A Year in Hypertension Research
BHS Annual Meeting, Cambridge
14th September 2011
Adrian J.B. Brady MD, FRCP(Glasg), FRCPE, FAHA
Associate Professor, University of Glasgow
Consultant Cardiologist
Glasgow Royal Infirmary
Glasgow, UK
Secretary, British Hypertension Society
Chairman, Guidelines Committee, British Cardiovascular Society
European Society of Cardiology Guidelines Development Group
Disclosures:
Research grants from: AstraZeneca, Bayer,
Boehringer Ingelheim, Merck, Schering Plough,
Roche, Servier
September 2010
• Nurses join as full members of
BHS
Baroreflex Activation Therapy Lowers Blood
Pressure in Patients With Resistant Hypertension:
Results From the Double-Blind, Randomized,
Placebo-Controlled Rheos Pivotal Trial
Baroreceptor Activation Therapy
Average 5.2 antihypertensive drugs
Baroreflex Activation Therapy Lowers Blood Pressure in Patients With Resistant
Hypertension : : Results From the Double-Blind, Randomized, Placebo-Controlled
Rheos Pivotal Trial
Ter Arkh. 2011;83(4):52-5.
[Efficacy and safety of the first made in Russia alpha, beta long-acting
adrenoblocker proxodolol in patients with arterial hypertension of the second
degree].
[Article in Russian]
Beliaeva SA.
Abstract
AIM:
To study efficacy and safety of a new dose and dosage form of proxodolol--a betaadrenoblocker with alpha1-adrenoblocking activity--in patients with moderate arterial
hypertension (AH).
MATERIAL AND METHODS:
A total of 60 patients with verified diagnosis of essential AH of the second degree were
randomized into two groups: group 1 (n=40) received proxodolol, group 2 (n=20) was
given carvedilol. The trial lasted for 89 days.
RESULTS:
The trial demonstrates that proxodolol is highly effective and safe in the treatment of AH.
CONCLUSION:
Proxodolol is effective and safe in hypertension, in a dose 120 mg its activity is the same
as carvedilol in a dose 25 mg.
PMID:
21675275
[PubMed - indexed for MEDLINE]
BMJ. 2011; 342: d2234
BMJ. 2011; 342: d2234.
ARBs and the risk of MI
•
•
•
•
•
•
•
What is already known on this topic
Angiotensin receptor blockers are important in the treatment of
cardiovascular conditions
Previous studies have shown an increased risk of myocardial
infarction with these drugs and have raised concern among
physicians and patients
What this study adds
There is firm evidence to refute the hypothesis of angiotensin receptor
blockers increasing the risk of myocardial infarction (ruling out even a
0.3% absolute increase)
Compared with controls (active treatment or placebo), angiotensin
receptor blockers reduce the risk of stroke, heart failure, and new
onset diabetes.
Despite lower blood pressure with angiotensin receptor blockers when
compared with placebo, there also was no detectable beneficial effect
for the outcome of myocardial infarction or cardiovascular mortality
BMJ. 2011; 342: d2234
DALCETRAPIB CETP INHIBITOR
TRIALS
• DAL-VESSEL,
presented ESC Aug
2011
• DAL-PLAQUE,
presented ESC Aug
2011
(floating absolute risk and 95% CI)
IHD Mortality
Ischemic Heart Disease Mortality Rate in Each Decade
of Age vs Usual BP at the Start of that Decade
Age at Risk:
80-89
256
Age at Risk:
256
80-89
70-79
70-79
60-69
32
32
60-69
50-59
50-59
40-49
4
4
0
0
120
140
160
Usual SBP (mmHg)
Prospective Studies Collaboration, Lancet, v.360, Dec. 14, 2002
180
40-49
70
80
90
100
Usual DBP (mmHg)
110
(floating absolute risk and 95% CI)
IHD Mortality
Ischemic Heart Disease Mortality Rate in Each Decade
of Age vs Usual BP at the Start of that Decade
Age at Risk:
80-89
256
Age at Risk:
256
80-89
70-79
70-79
60-69
32
32
60-69
50-59
50-59
40-49
4
4
0
0
120
140
160
Usual SBP (mmHg)
Prospective Studies Collaboration, Lancet, v.360, Dec. 14, 2002
180
40-49
70
80
90
100
Usual DBP (mmHg)
110
J-Curve HOT Study
Non-Ischemic
MI per 1000 Patient Years
10
Ischemic
9
8
7
6
5
4
3
2
1
0
< 80
< 85
< 90
DBP (mmHg)
CruickshankJM, Hannson L,CV Drugs Therapy
2000;14,373.
INVEST Trial Design
International trial in 22,576 patients with CAD
and hypertension
Randomized to multi-drug treatment strategies
• verapamil SR + trandolapril + HCTZ
• atenolol + HCTZ + trandolapril
• Trandolapril recommended for all patients with diabetes
Primary Outcome: First occurrence of all-cause
mortality, nonfatal MI or nonfatal stroke
Secondary Outcomes: All-cause mortality,
nonfatal MI, nonfatal stroke, total MI and total
stroke
Main finding: risk for CV adverse outcomes
was equivalent comparing the strategies
Pepine et al. JAMA. 2003:290:2805-2816
INVEST Subanalysis: BP and Risk
DBP: Risk for Primary Outcome
6
Nadir = 84.1 mm Hg
Hazard Ratio
Primary Outcome
40
5
4
30
3
20
2
10
1
0
0
DBP (mm Hg)
Total patients
176
2239
11306
7376
1230
248
Estimated
Ratio
Hazard Ratio
Estimated Hazard
Incidence (%) of Primary Outcome
50
INVEST Subanalysis: BP and Risk
SBP/DBP: Risk for Primary Outcome
6
6
Nadir = 84.1 mm Hg
Nadir = 119.2 mm Hg
4
2
2
0
0
Hazard Ratio
4
105
115 125 135
145 155 165
SBP (mm Hg)
55
65
75
85
DBP (mm Hg)
95
105
INVEST Subanalysis: BP and Risk
DBP: Risk for All-Cause Death
Nadir = 85.8 mm Hg
All-Cause Death
Mortality (%)
40
66
Hazard Ratio
5
44
30
3
20
22
10
1
0
00
DBP (mm Hg)
Total patients
176
2253
11339
7367
1201
240
Hazard Ratio
EstimatedHazard
Estimated
Ratio
50
INVEST Subanalysis: BP and Risk
Stroke / MI and DBP Strata
20
Incidence (%) of MI/Stroke
MI
Stroke
15
10
5
0
DBP (mm Hg)
Valsartan Antihypertensive Long-Term Use Evaluation
15,313 randomised at 942 sites in 31 countries
Average follow up 4.2 years
Julius S et al. Lancet. June 2004;363.
BMJ 2011;342:d643 doi:10.1136/bmj.d643
BRADY AJB, ESC SEPT 2010
Conclusions
• Different guidelines have
many similarities
• Blood pressure lowering
is fundamental
• Therapeutic drug choices
are showing global
concordance

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