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Blood pressure-lowering treatment for preventing recurrent stroke, major vascular events, and dementia in patients with a history of stroke or transient ischaemic attack

Blood pressure-lowering treatment for preventing recurrent stroke, major vascular events, and dementia in patients with a history of stroke or transient ischaemic attack

Our results support the use of blood pressure-lowering drugs (BPLDs) in secondary prevention after transient ischaemic attack (TIA) or stroke. Current evidence is primarily derived from trials of treatment with an angiotensin-converting enzyme (ACE) in- hibitor or diuretic. BPLDs appeared to be most effective in people with high baseline blood pressure (> 140 mmHg); however, dif- ferences between these subgroups were not statistically significant. Only limited data comparing different systolic blood pressure tar- gets were available. Therefore, no conclusions can be drawn from current evidence regarding an optimal systolic blood pressure tar- get after TIA or stroke.
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Are the effects of blood pressure lowering treatment diminishing?: meta-regression analyses

Are the effects of blood pressure lowering treatment diminishing?: meta-regression analyses

Results of meta-regressions for all-cause mortality In Table 2, we reported the results of meta-regressions for all-cause mortality. The dependent variable was log RR of all-cause mortality. With the increase in RR, the effect of blood pressure lowering treatment is inter- preted to decrease. In the table, exponentiated coeffi- cients (exp(b)) instead of coefficients per se are reported. Exp(b) is the exponential of the unstandardized coeffi- cient and shows a proportional change in RR per unit change in each explanatory variable. This makes more straightforward interpretation possible by denoting the multiplicative effects upon RR. If exp(b) is greater than 1, when the explanatory variable rises by one unit, RR increases (effect of blood pressure lowering treatment on all-cause mortality diminishes) by the ratio of exp(b) minus one. If exp(b) is smaller than 1, when the explana- tory variable rises by one unit, RR falls (effect of blood pressure lowering treatment on all-cause mortality in- creases) by the ratio of one minus exp(b).
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Effect of blood pressure lowering medication on peripheral artery disease: a meta-analysis of randomised controlled trials

Effect of blood pressure lowering medication on peripheral artery disease: a meta-analysis of randomised controlled trials

Hypertension was identified by the global burden of disease study as the leading risk factor for mortality and disability-adjusted life years lost in 2010[7]. Hypertension is considered an important risk factor for PAD and its complications and approximately 50% of patients pre- senting with PAD are reported to have hypertension[8–12]. Clinical trials including PAD patients (in addition to those with other atherosclerosis-related diseases) have reported a rela- tive reduction in cardiovascular events in those receiving blood pressure lowering medications of 20–30%[13, 14]. Therefore current recommendations advise that PAD patients should receive anti-hypertensive medications if their blood pressure (BP) is >140/90[15–17]. How- ever, the use of some anti-hypertensives, particularly β blockers, has been traditionally contra- indicated in PAD patients due to concerns regarding reducing peripheral perfusion[18, 19]. This opinion has been challenged by others who have reported that BP lowering medications do not worsen leg ischemia[20–22]. Some previously published randomised trials in PAD patients have reported improvements in maximum walking distance (MWD), pain free walk- ing distance (PFWD), ankle brachial pressure index (ABPI) and calf blood flow (CBF) after commencing anti-hypertensive medications[23–30]. Other trials have reported no effect of anti-hypertensive medications on PAD patients[31, 32]. A previous Cochrane review con- cluded that there was lack of evidence on the efficacy of anti-hypertensive medication in patients with PAD, but did not perform a meta-analysis or meta-regression to definitely assess this[33]. In view of the current controversy regarding the effect of BP lowering medication on symptoms of PAD, we undertook a systematic review and meta-analysis to assess if anti-hyper- tensive medications worsen leg ischemia in PAD patients.
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Effectiveness of blood pressure lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study

Effectiveness of blood pressure lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study

We performed a post hoc analysis of the ANBP study 26 . The study was conducted between 1973 and 1979 and was a multicentre, single-blind randomised controlled trial of 3427 patients that compared the effects of BP-lowering drug therapy between individuals who initially received active treatment (chlorothiazide) and those who received delayed active treatment or no active treatment (placebo). The study intervention remains applicable to current prac- tice as thiazide diuretics (eg, hydrochlorothiazide) are still first-line BP-lowering agents. 5–9 The ANBP study enrolled participants who had not been on treatment for hyperten- sion in the past 3 months and had no history of CVD or diabetes. In the 1970s, ‘mild hypertension’ was defined as a screening diastolic BP of 95–109 mmHg with a systolic BP lower than 200 mmHg. A total of 3931 eligible partic- ipants were initially randomised, then 504 participants were excluded because their BP throughout the study did not meet the criteria for starting drug treatment (entry or follow-up diastolic BP higher than 95 mmHg and/or entry or follow-up systolic BP higher than 200 mmHg). The primary endpoints were all-cause mortality and non-fatal events (non-fatal CVD, congestive cardiac failure, renal failure, hypertensive retinopathy or encephalopathy). 26
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Blood pressure lowering effect of Shinrin yoku (Forest bathing): a systematic review and meta analysis

Blood pressure lowering effect of Shinrin yoku (Forest bathing): a systematic review and meta analysis

Shinrin-yoku (experiencing the forest atmosphere or for- est bathing) has received increasing attention from the perspective of preventive medicine in recent years [1 – 4]. Observational studies have suggested an association of exposure to nature and green vegetation with various health outcomes, including cardiovascular diseases [5]. Some experimental studies have reported the physio- logical effects of the forest environment (walking in, sitting in, and/or viewing the forest). They reported that the forest environment decreases levels of stress hormones [6 – 11], blood pressure [6, 12 – 14], and heart rate (HR) [15, 16], and induce relaxation effects. Changes in urinary adrenaline and noradrenaline
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Blood Pressure Lowering Effect Of The Ethanol Extract From The Stembark Of Cinnamomum Zeylanicum (Lauraceae) In Rats

Blood Pressure Lowering Effect Of The Ethanol Extract From The Stembark Of Cinnamomum Zeylanicum (Lauraceae) In Rats

The rats were anaesthetized by the intraperitoneal injection of 0.1 ml/100 g body weight of Thiopental at a dose of 50 mg/kg. The femoral vein was canulated for the administration of plant extract and reference drugs while the carotid artery was also canulated for the blood pressure measurement using a blood pressure transducer model Ugo Basile PRC 21k-10. The preparations were allowed to stabilise for at least 30 min before administration of a test substance. Blood pressure variation was detected and recorded on an Ugo Basile Unirecord model 7050.
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Impact of baseline blood pressure on the magnitude of blood pressure lowering by nifedipine gastrointestinal therapeutic system: refreshing the Wilder’s principle

Impact of baseline blood pressure on the magnitude of blood pressure lowering by nifedipine gastrointestinal therapeutic system: refreshing the Wilder’s principle

SBP, DBP, and pulse pressure (PP) were significantly lower at 2, 4, 8, 12, and 24 weeks after treatment with NGTS compared with baseline (p0.01), while nonsignificant changes were observed in SBP, DBP, and PP between values after 4, 12, and 24 weeks of treatment (p0.05), indicating that NGTS has reached its maximal antihypertensive effect in 4 weeks after treatment (Figure 1). There was no significant change in heart rate before and after antihypertensive therapy (p0.05).

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Comparative review of the blood pressure-lowering and cardiovascular benefits of telmisartan and perindopril

Comparative review of the blood pressure-lowering and cardiovascular benefits of telmisartan and perindopril

The evidence for CV benefits with perindopril has been mainly demonstrated in patients with hypertension, with combination therapy, and in placebo-controlled trials. The large reductions in BP observed in these trials and the lack of an active control makes it difficult to conclude whether the CV benefits were due to the reduction in BP or were beyond-BP-lowering benefits. Even the EUROPA trial was compromised by differences in achieved BP. Although these differences can be statistically adjusted, they reduce confi- dence in whether the effect is genuinely beyond BP lowering. Furthermore, perindopril monotherapy did not prevent stroke, despite BP reduction in EUROPA and PROGRESS, and did not reduce the incidence of revascularization in EUROPA. A review of the results from ASCOT-BPLA, PROGRESS, and EUROPA 62 also suggested that the reduction of CV
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Blood pressure lowering by pioglitazone  Evidence for a direct vascular effect

Blood pressure lowering by pioglitazone Evidence for a direct vascular effect

thiazolidinedione compound, pioglitazone (PIO), we studied the effects of the drug on blood pressure and insulin action in vivo and on vascular tissue in vitro. In vivo, PIO lowered blood pressure in fructose-fed and chow-fed rats to an extent that could not be explained by alterations in fasting plasma insulin or free magnesium concentrations or by alterations in whole-body insulin sensitivity. In vitro, PIO caused significant blunting of the contractile responses of aortic rings to NE, arginine vasopressin (AVP), and potassium chloride; the blunting of responses to NE was maintained after removal of the endothelium. To assess the potential importance of extracellular calcium to the vasodepressor effect of PIO, we measured contractile responses to NE in the absence of calcium, and then after acute restoration of calcium in the presence of NE. PIO had no effect on the contractile response in the absence of calcium. By contrast, PIO blunted by 42% the contractile response that occurred when the extracellular calcium supply was acutely restored in the presence of NE, suggesting that the blunting was mediated by blockade of calcium uptake by vascular smooth muscle. Such an effect was confirmed in cultured a7r5 vascular smooth muscle cells, which exhibited a brisk increase in intracellular calcium in response to AVP that […]
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Research Article Blood Pressure-Lowering Mechanisms of the DASH Dietary Pattern

Research Article Blood Pressure-Lowering Mechanisms of the DASH Dietary Pattern

acute hyperlipidemia induced by intralipid infusion among obese hypertensives [29]. The authors attributed the vascular protection e ff ect to the rich antioxidants in the DASH dietary pattern. In our study we did not observe an increase in BAFMD following the DASH diet. This may be related to the limited sample size in each group and relatively short assessment period. Another trial also did not observe an impact of consuming the DASH diet for 30 days on vascular function including measurement of FMD [30]. However, dietary adherence of these participants to the DASH pattern was not reported. A recent study, nevertheless, show- ed that consuming the DASH diet for 3 weeks improved en- dothelial function as indicated by small artery elasticity [31]. The changes in plasma nitrite (the primary metabolite of vascular NO production) suggest an increase in NO bio- availability and may change prior to the physiological res- ponse. It is possible that the BP-lowering effect of DASH could be mediated through its e ff ects of antioxidants on NO consumption. In a high antioxidant environment, it is possible that more NO produced would be oxidized to nitrite rather than nitrate and peroxynitrite. In addition, e ff ects of DASH on NO bioavailability and metabolism may have implications for cardiovascular health aside from just BP control. Future studies should examine the direct impact of the DASH dietary pattern on vascular health.
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VALIDATION OF HPLC AND UV VISIBLE METHODS FOR FEW SELECTED BLOOD PRESSURE LOWERING DRUGS AND THEIR FORMULATIONS

VALIDATION OF HPLC AND UV VISIBLE METHODS FOR FEW SELECTED BLOOD PRESSURE LOWERING DRUGS AND THEIR FORMULATIONS

The present study describes the soundness indicating RP-HPLC technique for synchronous estimation of Aliskiren hemifumarate and Nicardipine besylate in pharmaceutical dose form[r]

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Study on Fixed Dose Combination (Polypill) for CVD Prevention

Study on Fixed Dose Combination (Polypill) for CVD Prevention

A cross sectional survey of approximately 1,100 residents of two areas in Urban South India found that of the 47 individuals with Definite Coronary Artery Disease only 23.4% of these were on therapy with blood pressure lowering drugs (with only half receiving β–blockers) and (2%) was on a lipid lowering drugs. 5 Comparison of 71 tertiary and secondary centers over India with data over 4,000 acute coronary syndrome patients found that at 30 days nearly all were receiving antiplatelet agents but less than half were prescribed β –blockers(60% and 51%). 28 similarly a study of acute myocardial infarction (MI) showed that Thrombolysis, β-blockers and Angiotensin-converting enzyme-I(ACE-I)inhibitors, were used in 674(63%), 596(47%) and 413(38%) respectively of 1072 patients. 27
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A COMPLETE GUIDE ON THE PHARMACOLOGIC AND PHARMACOTHERAPEUTIC ASPECTS OF CALCIUM CHANNEL BLOCKERS: AN EXTENSIVE REVIEW

A COMPLETE GUIDE ON THE PHARMACOLOGIC AND PHARMACOTHERAPEUTIC ASPECTS OF CALCIUM CHANNEL BLOCKERS: AN EXTENSIVE REVIEW

ABSTRACT: The calcium channel blockers, a diverse group of cardiovascular drugs, exert their action by inhibiting the L-type calcium channels and cause vasodilatation in the heart and the smooth muscles. They also block the action potential at the SA and AV node, thus prolonging the duration of the action potential (Verapamil and Diltiazem). Although, the calcium channel blockers have the same anti-hypertensive actions, they have a vast difference in their pharmacological actions, pharmacokinetic profile, and adverse reactions. The main aim was to review, compare, and understand the complete pharmacological profile of all the calcium channel blockers and understand their place in pharmacotherapy. Numerous articles and studies showed that amlodipine remains to be the safe and effective drug of choice in chronic hypertension due to its slow, prolonged duration of action and lesser incidence of reflux tachycardia. The newer calcium channel blockers, although similar to amlodipine in blood pressure lowering effect, have several pharmacological advantages. Felodipine was found to be slightly better than amlodipine in the treatment of ischemia/angina due to its high pre-load reducing the effect. Lercanidipine was found to be a better reno-protective agent than amlodipine due to its actions in the kidney. Benidipine was found to be an excellent, anti- atherosclerotic, and reno-protective agent. The incidence of baroreceptor activation and pedal edema was also found to be lower in the newer calcium channel blockers. Hence, the new generation calcium channel blockers could be preferred for various cardiovascular problems.
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Antihypertensive Therapy in Non Diabetic Chronic Kidney Disease Associated with Proteinuria in Adults

Antihypertensive Therapy in Non Diabetic Chronic Kidney Disease Associated with Proteinuria in Adults

Aliskiren, being the first oral direct renin inhibitor (DRI) became available in the United States in March 2007. A number of studies have evaluated the blood pressure lowering effect of aliskiren in combination with other antihypertensive drugs [23-26]. Its novel mechanism of action, inhibition of catalytic activity of renin, the most proximal and rate-limiting step in RAS activation, makes it of particular interest. In the AVOID trial, aliskiren plus losartan was associated with a 20 percent greater reduc- tion in proteinuria compared with losartan alone in pa- tients with type-2 diabetes and nephropathy in the ab- sence of a significantly greater effect on blood pressure [27]. However, this effect on proteinuria did not translate into a clinical benefit.
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RATIONALITY OF THE FIXED DOSE COMBINATION OF TELMISARTAN AND AMLODIPINE IN MANAGEMENT OF MILD TO MODERATE HYPERTENSION UNRESPONSIVE TO LOW DOSE MONOTHERAPY

RATIONALITY OF THE FIXED DOSE COMBINATION OF TELMISARTAN AND AMLODIPINE IN MANAGEMENT OF MILD TO MODERATE HYPERTENSION UNRESPONSIVE TO LOW DOSE MONOTHERAPY

According to the Seventh report of the Joint National Committee in 2003 (Chobanian AV et al 2003) and the European guidelines 2007 (Mancia G et al 2007) and 2009 (Mancia G et al 2009), the first step in hypertension control is lifestyle modification which includes dietary changes, physical exercise and weight loss (Siebenhofer et al 2007) followed by medical management. Several classes of antihypertensive drugs are available for the treatment of hypertension. However, there is no consensus over the best first line agent for hypertension (Klarenbach SW et al 2010). Based on pooling results from clinical trials, meta analyses of the efficacy of different classes of antihypertensive agents suggest essentially equivalent blood pressure lowering effects of the following six major classes of anti hypertensive agents when used as monotherapy: thiazide diuretics, beta blockers, ACEIs, ARBs, calcium antagonists, and alpha-1 blockers. (Harrison 19 th ed).
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Lessons from a pilot and feasibility randomised trial in depression (Blood pressure Rapid Intensive Lowering And Normal Treatment for Mood and cognition in persistent depression (BRILiANT mood study))

Lessons from a pilot and feasibility randomised trial in depression (Blood pressure Rapid Intensive Lowering And Normal Treatment for Mood and cognition in persistent depression (BRILiANT mood study))

The BRILiANT mood study was developed as a pilot and feasibility randomised controlled trial (RCT) to investigate using rapid blood pressure lowering to allevi- ate persistent mood and cognitive symptoms in major depressive disorder in older adults. Despite the expecta- tions of an available population (Table 1) based on the then current NICE Clinical Guideline [24], difficulties were experienced in the process of recruitment at several stages. The study team and TSC identified recruitment difficulties and throughout the recruitment period implemented several new strategies to try and improve recruitment. Attempts by the study team to improve recruitment had mixed results. Expanding recruitment areas geographically had little impact on the numbers of eligible participants identified, but the use of direct recruitment via the advert yielded a good response rate. The responses from the surveys suggested that
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Lercanidipine/enalapril combination in the management of obesity-related hypertension

Lercanidipine/enalapril combination in the management of obesity-related hypertension

percent of the study population showed concomitant dis- eases, including about one-third of the recruited patients being obese. Although no separate analysis of the results was made in the obese or in the normoweight subgroups, the data confirmed the marked blood pressure lowering effects of the drug combination in the study population, independent of the presence or absence of obesity. On average, the clinic systolic and diastolic blood pressure reduction detected at the end of the study period amounted to 28.4 and 13.5 mmHg, respec- tively, with target blood pressure below 140/90 mmHg being achieved in 79% of the patients. Similar figures of efficacy were reported in another study that recruited patients with an average body mass index amounting to 29 kg/m 2 , with about
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The metabolic cost of lowering blood pressure with hydrochlorothiazide

The metabolic cost of lowering blood pressure with hydrochlorothiazide

Primum non nocere - our treatment choices should not only improve the primary condition for which they are prescribed, but we must ensure that our patients suf- fer no harm. The ultimate goal of any antihypertensive therapy is to prevent cardiovascular events. The use of an antihypertensive agent that worsens hepatic steatosis and insulin resistance, both of which promote cardiovas- cular disease, negates the ultimate cardiovascular- preventive goal of the treatment. Hypertension clusters with metabolic syndrome, diabetes, and hepatic steatosis, and requires life-long pharmacologic treatment. When all aspects are balanced i.e. the blood pressure lowering effect and the worsening metabolic profile the use of HCTZ as a first line therapeutic choice should be questioned.
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Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

We first identified potential causes for differences in specific drug responses based on ethno-geographic ori- gin (Table 2). As we sought to explain differential blood pressure lowering responses to different types of antihy- pertensive drugs, we excluded general factors such as ac- cess to care and differences in socio-economic status. To answer the clinical question, why there was a difference in response between people of African vs European an- cestry, we considered pharmacokinetic variations in- cluding polymorphisms in cytochrome P450 family of enzymes involved in phase I drug metabolism, and po- lymorphisms in genes encoding enzymes involved in phase II drug metabolism. Furthermore, we considered genetic polymorphisms that may influence pharmaco- dynamics including alpha-adducin ( ADD1 ), subunits of G-proteins ( GNB3 and GNAS1 ), the β-1-adrenergic recep- tor ( ADRB1 ), endothelial nitric oxide synthase ( NOS3 ),
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EFFECTS OF COCONUT NEERA (Cocos nucifera,L.) ON BLOOD PRESSURE AMONG HYPERTENSIVE ADULT WOMEN

EFFECTS OF COCONUT NEERA (Cocos nucifera,L.) ON BLOOD PRESSURE AMONG HYPERTENSIVE ADULT WOMEN

Figure II depicts the DBP changes in coconut neera. The DBP was significantly decreased form third week onwards in hypertensive treated group from 96 ±3 mmHg to 81±2mm Hg. The DBP of hypertensive treated group was significantly different from hypertensive group. The blood pressure lowering effects of coconut neera may be due to the various biological constituents in coconut neera viz calcium, magnesium, vitamin C, Polyphenol content, growth hormones, flavonoids and the sodium potassium ratio in coconut neera (1:4). The hypocholesterolaemic effects of coconut neera mediated by L-arginine and the favourable potassium- sodium ratiowhich helps in restoring electrolyte balance may be the reason for its antihypertensive effects. The population-based International Study of Macro/Micro-nutrients and Blood Pressure (INTERMAP) was designed to elucidate relations of multiple dietary factors to BP[31, 32].
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