Managing hypertension: state of the science

A pilot study on level of blood vasoactive factors in prehypertensive and hypertensive patients

A pilot study was conducted to investigate blood pressure level and vasoactive factors (VFs) among age- and sex-matched normotensive (NT), prehypertensive (PH), and hypertensive (EH) subjects. The results showed that angiotensin, arginine vasopressin, and endothelin were significantly higher, while adrenomedullin and calcitonin gene-related peptide were lower in the EH group than in the PH and NT groups. Nitric oxide synthase was not different among the three groups. There was a dose-response relationship between VFs and BP status. The results suggested that changes in blood VFs might be early warning signs of the development of prehypertension to hypertension, and important biomarkers for the early prevention of prehypertension.

Characteristics of patients prescribed angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or the combination at an urban medical center

BACKGROUND

The realization that angiotensin-converting enzyme (ACE) inhibitors do not provide complete blockade of angiotensin II synthesis has resulted in an increased use of combinations of ACE inhibitors and angiotensin receptor blockers (ARBs). This study examines the characteristics of patients in whom this combination was prescribed.

METHODS

Seventy-two patients diagnosed with primary hypertension and receiving an ACE inhibitor, an ARB, or their combinations were included. A retrospective review using outcome variables of mean arterial pressure (MAP), and changes between pretreatment MAP and post-treatment MAP were compared between groups. Statistical analysis was performed with SPSS statistical software. Analysis of variance (ANOVA) with Tukey's post hoc analysis was performed on continuous variables. Chi-square analysis was performed on categorical variables. Multivariate linear regression was performed to determine the best predictors of post-treatment MAP.

RESULTS

There were no significant differences between the groups in pre- or post-treatment MAP. Patients on combination therapy with an ACE and ARB agent tended to be on more antihypertensive medications and tended to be diabetic.

CONCLUSION

All treatment groups had similar blood pressure control and changes in MAP regardless of treatment. These findings suggest that combination ARB and ACE inhibitor therapy is a strategy being used for diabetics with difficult-to-control hypertension, although we cannot determine from our study whether this is primarily for blood pressure control or for renal protection. Whether combining an ACE inhibitor and ARB for blood pressure control alone is supported by the literature may be debatable. Further studies should evaluate the efficacy of such intervention to control hypertension.

KEY POINTS

1. Antihypertensive therapies using ACE inhibitors with ARBs are gaining popularity. 2. This retrospective chart review was completed to examine the characteristics of patients on monotherapy and of patients on combination therapy with ACE inhibitors and ARB agents. 3. This study suggests a tendency toward combined ARB and ACE inhibitor therapy in patients with diabetes who are on multiple antihypertensive medications.