Drugs online research references
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AIMS: The aim of this study was to assess the prognostic importance of peripheral arterial disease (PAD) as evaluated by ankle blood pressure index (ABI), and the impact of ramipril on the prevention of major cardiovascular events in PAD patients included in the Heart Outcomes Prevention Evaluation (HOPE) study. METHODS AND RESULTS: Patients were randomized to treatment with ramipril or placebo and followed for 4.5 years. Ankle brachial blood pressure index was measured, mainly by digital palpation of the foot pulse, at baseline in 8986 patients. The ABI was subnormal (< or =0.9) in 3099 patients and normal in 5887 patients. A low ABI was a strong predictor of morbidity and mortality during the follow-up even in patients with no clinical symptoms of PAD (n=6769). This was so for the primary outcome of the study; ABI>0.9:13.1%, 0.6-0.9: 18.2% and <0.6: 18.0% (P<0.0001) and for mortality from all causes: in those with a normal ABI it was 8.5%, in those with ABI >0.6-0.9, 12.4% and 14.2% in those with an ABI lower than 0.6 (P<0.0001). Ramipril reduced the risk of clinical outcomes in those with a clinical history of PAD as well as in the patients with subclinical PAD. CONCLUSIONS: The ABI even if measured simply by palpation of the foot arteries is a strong predictor for future cardiovascular events and for all-cause mortality. Ramipril prevented major cardiovascular events in patients with clinical as well as subclinical PAD.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14683738&dopt=Abstract [PubMed - in process]
Am J Hypertens. 2003 Nov;16(11 Suppl):50-4.
Recommendations for the management of special populations: racial and ethnic populations.
Ferdinand KC.
Heartbeats Life Center, Xavier University College of Pharmacy, New Orleans, Louisiana, USA
One of the current challenges in the treatment of hypertension is the variation in the incidence and morbidity among ethnic populations. For example, in the recent Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), in which 35% of the patients were African American, the diuretic chlorthalidone was associated with greater reductions in blood pressure (BP) than the angiotensin-converting enzyme (ACE) inhibitor lisinopril and was also associated with a relative risk reduction in stroke compared with lisinopril. However, the increased stroke risk associated with lisinopril was experienced among African American but not non-African American patients. ALLHAT did not permit combination therapy with ACE inhibitors plus diuretics; therefore, the benefits of such regimens in this patient population could not be assessed. In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, in contrast to the overall study population, African American patients with left ventricular hypertrophy treated with atenolol were at lower risk of experiencing the primary composite end point (death, myocardial infarction, and stroke) than African Americans treated with losartan, with or without diuretics. On the other hand, in the African American Study of Kidney Disease and Hypertension, African American patients treated with the ACE inhibitor ramipril had a significantly lower incidence of the primary composite end point (glomerular filtration rate reduction, end-stage renal disease, or death) than African Americans treated with the calcium channel blocker amlodipine. Although the use of diuretics in African American patients may be a logical first-line choice for BP reduction, most patients will require combination therapy. African American patients with systolic BP >/=15 mm Hg above target level or a diastolic BP >/=10 mm Hg above target should be considered for first-line combination therapy. Although certain combinations have been shown to be effective in non-African American patients, the choice of drugs for combination therapy in African American patients may be different.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14693432&dopt=Abstract [PubMed - in process]
cs.com
Angiotensin-II receptor blockers (ARBs) have been shown to provide stroke, cardiac and renal protection in high-risk hypertensive patients. Telmisartan is a powerful and selective ARB that provides sustained blood pressure reduction for a full 24 h after a single dose and continues to protect against circadian blood pressure surges in the critical early morning hours. The objective of the Programme of Research tO show Telmisartan End-organ proteCTION (PROTECTION) is to measure the end-organ protective effects of telmisartan in patients at high risk of renal, cardiac and vascular damage. An extensive series of clinical trials is being conducted to compare telmisartan with valsartan, losartan, amlodipine and ramipril in patients at increased risk of end-organ damage. Nine clinical studies will examine the effects of telmisartan in about 5000 hypertensive patients with isolated systolic hypertension, type 2 diabetes, obesity, left ventricular hypertrophy or renal disease. All of the studies will be conducted using state-of-the-art technology, including such techniques as ambulatory blood pressure monitoring and magnetic resonance imaging. This programme will also investigate the effects of an ARB on key surrogate markers of organ tissue damage. This series of trials will characterize the end-organ protective effects of telmisartan in hypertensive patient populations at high risk of clinical events.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14694914&dopt=Abstract [PubMed - in process]
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