Henry R. Black

Effects of Controlled-Onset Extended-Release Verapamil on Nocturnal Blood Pressure (Dippers Versus Nondippers)

Approximately 1 in 4 patients with systemic hypertension have a 24-hour blood pressure (BP) profile characterized by a blunted or absent nocturnal decline in pressure. We evaluated the effects of a chronotherapeutic delivery system of controlled-onset extended-release (COER) verapamil hydrochloride and placebo in 257 hypertensive patients according to their circadian BP pattern in an 8-week prospective, multicenter, randomized, and double-blind clinical trial. Patients were stratified into 193 dippers (>10% decline in BP during the period of 10 P.M. to 5 A.M. compared with the hours of 5 A.M. to 10 P.M.) and 64 nondippers (<10% decline in BP during nighttime). During daytime, placebo-subtracted BP was similarly decreased in dippers and nondippers by COER verapamil. During nighttime, the placebo increased nocturnal BP in dippers (baseline nocturnal BP, 133/78 mm Hg) by 3/3 +/- 2/2 mm Hg and reduced BP by -5/-3 +/- 2/2 mm Hg in nondippers (baseline nocturnal BP, 152/94 mm Hg) (p = NS between groups). After controlling for age, gender, ethnicity, and the regression to the mean observed on placebo for all doses, COER verapamil reduced nocturnal BP more in nondippers than dippers -5.8/-2.4 mm Hg, p <0.0001 for systolic BP and p = 0.09 for diastolic BP). Additionally, a significant dose-related reduction in systolic and diastolic nocturnal BP (r = 0.56, p <0.0001 for systolic BP and r = 0.62, p <0.0001 for diastolic BP) was observed with COER verapamil after controlling for baseline covariates. These data demonstrate that nocturnal BP is decreased by a greater extent in nondipper hypertensives than in dipper hypertensives following treatment with COER verapamil HCL.

Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension

Note: Authors from the National Institutes of Health/National Heart, Lung, and Blood Institute represent themselves and not the opinions of the National Institutes of Health/National Heart, Lung, and Blood Institute. The American Heart Association, the American College of Cardiology, and American Society of Hypertension make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This document was approved by the American Heart Association Science Advisory and Coordinating Committee on September 22, 2014, by the American College of Cardiology on October 10, 2014, and by the American Society of Hypertension on September 30, 2014. The American Heart Association requests that this document be cited as follows: Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O’Connor CM, O’Gara PT, Ogedegbe G, Oparil S, White WB; on behalf of the American Heart Association, American College of Cardiology, and American Society of Hypertension. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Hypertension. 2015;65:1372–1407. This article has been copublished in Circulation, the Journal of the American College of Cardiology, and the Journal of the American Society of Hypertension. Copies: This document is available on the World Wide Web sites of the American Heart Association (my.americanheart.org), the American College of Cardiology (www.cardiosource.org), and the American Society of Hypertension (http://www.ash-us.org/). A copy of the document is available at http:// my.americanheart.org/statements by selecting either the “By Topic” link or the “By Publication Date” link. To purchase additional reprints, call 843-2162533 or e-mail kelle.ramsay@wolterskluwer.com. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the “Policies and Development” link. Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/CopyrightPermission-Guidelines_UCM_300404_Article.jsp. A link to the “Copyright Permissions Request Form” appears on the right side of the page. (Hypertension. 2015;65:1372-1407. DOI: 10.1161/HYP.0000000000000018.)

Age-related issues in the treatment of hypertension.

The highest prevalence of hypertension is now recognized to exist in the elderly segment of the population. With the completion of several large-scale studies, several of our assumptions regarding elderly hypertensive patients have changed. It is now clear that the elderly have shown the greatest benefit from antihypertensive therapy. This favorable risk-benefit ratio extends to even the very elderly; treatment for hypertension is appropriate for healthy elderly individuals, regardless of age. It also extends to elderly individuals who have already experienced the consequences of elevated blood pressure. Attitudes toward antihypertensive agents have also evolved. Diuretics are appropriate monotherapy in many patients, when the dose is kept low. The usefulness of calcium antagonists has been confirmed, whereas beta blocker use appears to be indicated only in certain subgroups. Recently, angiotensin-converting enzyme inhibitors have also been shown to be effective in elderly patients, despite earlier studies whose results describe low plasma renin activity in the elderly.

P-65: Prevalence of ACE-inhibitor use in diabetic hypertensives in hypertension speciality clinic: a quality assurance review

tinued due to AEs during OL. There were no SAEs. Sildenafil was well tolerated among men with ED who were taking multiple anti-HTNs. The incidence of AEs was similar in men taking 2 (n 307) and 3 (n 222) anti-HTNs and consistent with that previously reported. Less than 2% of patients discontinued because of AEs. Thus, men who are taking multiple anti-HTNs are not at increased risk for more frequent or severe AEs while taking sildenafil for ED.