There were no trials of triple quarter-dose combination versus placebo, but one quadruple quarter-dose study observed a blood pressure reduction of −22.4/−13.1 mm Hg versus placebo (P<0.001). Figure 3A from the paper by Chou et al. More than a quarter of deaths were attributable to indirect causes. use prohibited. The variables extracted included study design, sample size, mean age, percentage of female patients, randomization, blinding, intervention, dose(s), follow-up, percent lost to follow-up, and study outcomes. ACEI indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-blocker; CCB, calcium channel blocker; CI, confidence interval; and TZ, thiazide diuretic. Prevention and treatment information (HHS). Table 4 compares the mean difference from baseline to follow-up in biochemical measures, for placebo, single quarter-dose, dual quarter-dose, and standard-dose therapy. Chou KJ, Lee PT, Chen CL, et al. Uptitration studies must have had blood pressure or safety data for at least the first 2 weeks before titration occurred. (2012) Uric acid concentration as a risk marker for blood pressure progression and incident hypertension: a Chinese cohort … The review also has some limitations. High blood pressure is the leading cause of preventable morbidity and mortality globally.1 Yet control of blood pressure is poor, with only 1 in 3 people on treatment achieving blood pressure targets.2–5 The largest global survey of hypertension practice showed that while 88% of those aware of hypertension receive some pharmacological treatment, only 34% of those treated were controlled. Rockville, MD: Agency for Healthcare Research and Quality; 2015. A third reviewer (A.R.) Hong S, Ferraro CS, Hamilton BK, Majhail NS. Systemic hypertension is common in chronic renal failure, and may contribute to the progression of glomerular injury (Del Greco et al. Most studies were dose–response trials testing 3 to 4 doses of one agent versus placebo. Effects of calcitriol on (A) glucose and (B) blood glucose curves following intra-peritoneal…. Le chou est un légume aux multiples variétés que l’on retrouve souvent dans nos salades. Male Wistar-Kyoto rats were divided into 4 groups (n = 6 per group). High- and low-dose calcitriol reduced modestly systolic blood pressure, increased endothelium-dependent aortic relaxation, ameliorated glucose intolerance, reduced the weight and adipose size of visceral fat pads, and lowered adipose angiotensin II expressions in the fructose-fed rats. No individual-patient data were used, and data were not checked with original trialists because most trials were completed more than 17 years ago. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Data presented as difference in means (lower confidence limit, upper confidence limit). Overall, there were 20 284 participants with a mean age of 54 years, 61% were men, and mean baseline blood pressure was 154/101 mm Hg. Journal of Hypertension. Altman D, Carroli G, Duley L, et al; Magpie Trial Collaboration Group. B. Neal reports grants for a clinical trial from Abbvie, Dr Reddy’s Laboratories, Jannsen, Merck Schering-Plough, and Roche; speaking fees from Abbott, Novartis, Pfizer, Roche, and Servier; travel fees from Janssen, Roche, and Servier; fees for advisory board membership from Janssen; is Chair of the Steering Committee for 2 ongoing large-scale trials of an SGLT2 inhibitor and member of the Steering Committee for a third. Table S1 details the characteristics of included studies. Hypertens Res. Introduction. The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Binary outcomes were analyzed using the Mantel–Haenszel approach and summarized as risk ratios with 95% confidence intervals (CIs). 2016;387(10017):462–74. Standard-dose TZ resulted in greater uric acid concentration versus single quarter-dose TZ, versus dual quarter angiotensin receptor II antagonists+quarter TZ and versus dual quarter β-blockers+quarter TZ. In the absence of detailed study protocols, it was not possible to assess whether outcomes were selective. This estimates the risk based on sequence generation, allocation concealment, selective outcome reporting, potential threats to validity, blinding of participants, personnel and outcome assessors, and incomplete data. It was conducted in line with recommended systematic review methodology and included a relatively large number of studies, doubling the number of trials of quarter-dose therapy included in a previous systematic review.9 Several studies were identified in regulatory submissions that had not been published in the medical literature. Several studies suggest that low-dose combinations may provide the best ratio of side effects to blood pressure reduction, because at low doses most side effects are avoided and most benefit is realized.7 Given that blood pressure dose–response gradients are typically shallow above quarter standard dose,7 combinations containing quarter doses of several antihypertensive agents may be of particular benefit. Blood was examined for serum ionized calcium, phosphate, creatinine, glucose, triglycerides, and total cholesterol. independently performed the searches assessing titles and abstracts, excluding any studies that did not qualify. All but one trial used a TZ diuretic in the dual quarter-dose combination. Values are means ± SD. Bone Marrow Transplant. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Dietary supplementation of vitamin D prevents the development of western diet-induced metabolic, hepatic and cardiovascular abnormalities in rats. Hayag-Barin et al 19 described the case of a 30 year old man with hereditary spherocytosis who presented 29 years after splenectomy with recurrent pulmonary emboli resulting in severe pulmonary hypertension. Heterogeneity (Q value, P value, and I2 statistic) observed for single quarter dose vs standard dose, DBP: 37, 0.5, and 0. High circulating angiotensin II has been shown to cause both salt‐independent and dependent forms of hypertension. 2015 Jul 7;21:1960-8. doi: 10.12659/MSM.894793. Heterogeneity was quantified by Q test, I2, and τ statistics14,15 (Table S2). Mills KT, Bundy JD, Kelly TN, et al. Causes de l'hypertension Lhypertension doit être pris au sérieux. ... Ren L, Shi M, Wu Y, Ni J, Bai L, Lu H, et al. As with the current review, Law et al did not find any clear evidence that one drug class was more effective than any other. Vitamin D Deficiency in Uygurs and Kazaks Is Associated with Polymorphisms in CYP2R1 and DHCR7/NADSYN1 Genes. Physiological changes during hemodialysis in patients with intradialysis hypertension. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-blocker; CCB, calcium channel blocker; and CI, confidence interval. showed that patients with primary aldosteronism also displayed higher plasma IL-6 levels, left ventricular mass index, degree of myocardial fibrosis, and more impaired diastolic function than patients with essential hypertension. Fig 1. Ankumah NA, Cantu J, Jauk V, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. Change in Biochemical Measures From Baseline to Follow-Up With Single and Dual Quarter-Dose Therapy, Compared With Placebo and Standard-Dose Monotherapy. 10.1097/MNH.0b013e3283557bf0 Magnolol ameliorates pneumonectomy and monocrotaline-induced pulmonary arterial hypertension in rats through inhibition of angiotensin II and endothelin-1 expression Author: Chou , Ching - Yu , et al. This review discusses the management of pregnant patients with preexisting resistant hypertension and also of those who develop severe hypertension in gestation and puerperium. * denotes. Sherwood MB(1), Craven ER, Chou C, DuBiner HB, Batoosingh AL, Schiffman RM, Whitcup SM. 2017 Jul 10;12(7):e0180712. The biochemical effects of calcitriol…, Fig 2. Sherwood MB(1), Craven ER, Chou C, DuBiner HB, Batoosingh AL, Schiffman RM, Whitcup SM. The impact of vitamin D deficiency on diabetes and cardiovascular risk. In the context of other low-dose combination therapy trials, the most relevant compared triple half-dose therapy (amlodipine 2.5 mg, losartan 25 mg, hydrochlorothiazide 12.5 mg) with placebo and also observed a large blood pressure reduction, of −17.9/−9.8 mm Hg.26. Fig 5. Six comparisons were of dual quarter-dose therapy versus placebo, observing a −6.7/ −4.4 mm Hg (P<0.001) blood pressure reduction. Background: General obesity and its progression are major predictors of future hypertension. COVID-19 is an emerging, rapidly evolving situation. The concept of resistant hypertension may be changed during pregnancy by the physiological hemodynamic changes and the particularities of therapy choices in this period. Obstet Gynecol. However, there were 2 exceptions. Prognostic N = 5433 Zager et al Kidney Int 1998. Int J Food Sci Nutr. Con: control rats with normal chow diet; Fru: rats were fed a high-fructose diet for 8 weeks; Fru-HVD: rats were treated as Group Fru, and high-dose calcitriol (20 ng / 100 g body weight per day) was administered 4 weeks later; Fru-LVD: rats were treated as Group Fru, and low-dose calcitriol (10 ng / 100 g body weight per day) was administered 4 weeks later. De plus, les patients atteints d’hypertension sont souvent résistants à l’insuline et sont plus susceptibles de souffrir de diabète que les personnes normotendues. Direct renin inhibitor prevents and ameliorates insulin resistance, aortic endothelial dysfunction and vascular remodeling in fructose-fed hypertensive rats. Dual quarter-dose therapy showed an equivalent blood pressure–lowering effect compared with standard-dose monotherapy. ... Roberton T, Carter ED, Chou VB, et al. Intradialytic hypertension and its association with endothelial cell dysfunction. Statin Use for the Prevention of Cardiovascular Disease in Adults: A Systematic Review for the US Preventive Services Task Force: Evidence Synthesis No. There was broad consistency in treatment effect across the 5 major treatment classes (I2 SBP: 3, DBP: 0), and each was separately significant except for calcium channel blockers. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. E-mail. We would like to acknowledge the contributions of Professor Henry Krum who passed away in 2015. Metabolic profile of indapamide sustained-release in patients with hypertension: data from three randomised double-blind studies. independently extracted data using a standard extraction form. 37:e18, July 2019. Besides regulating calcium homeostasis, the effects of vitamin D on vascular tone and metabolic disturbances remain scarce in the literature despite an increase intake with high-fructose corn syrup worldwide. Yang CH, Lin YC, Chou PH, Chen HC, Chan CH. Kidney Int 2006; 69:1833. J Hypertens.  |  Kidney Int 2006; 69:1833. Chou et al , Kidney Int, 2006. Six trials measured the efficacy of dual quarter-dose therapy compared with placebo (Figure 2). A. Patel was supported by a Senior Research Fellowship and Program Grant from NHMRC. The other authors report no conflicts. resolved any differences. Inrig JK, Van Buren P, Kim C, et al. Alternatively, addition of a single quarter-dose agent to existing therapy is likely to confer an extra 3 to 4 mm Hg systolic blood pressure reduction without additional side effects and thus could be preferable to doubling the dose of the existing agent, which on average confers only about a 1–2 mm Hg extra systolic blood pressure reduction at the expense of increased side effects.7,27 Currently, there are a few low-dose combinations available to clinicians: for example, a bisoprolol–hydrochlorothiazide combination is on the market in the United States (Ziac), with a dual quarter-dose version indicated for initial treatment of hypertension; a perindopril–indapamide combination is available that includes half dose and quarter dose, supported by clinical trial data showing improved rates of adverse event-free blood pressure control compared with sequential monotherapy or stepped care.28 Quarter doses are available for many β-blockers and are obtainable for other classes from halving existing half-doses. Edward Mellanby. 37:e18, July 2019. Quantifying heterogeneity in a meta-analysis. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. Fig 4. Mellanby E. Nutrition Classics. This involved a 0.1 mm Hg reduction in a given study’s SBP change score for each mm Hg baseline SBP over 150 mm Hg, and a 0.1 mm Hg increase for each mm Hg baseline SBP below 150 mm Hg. N Engl J Med. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, Con: control rats with normal chow diet; Fru: rats were fed a high-fructose diet for 8 weeks; Fru-HVD: rats were treated as Group Fru, and high-dose calcitriol (20 ng / 100 g body weight per day) was administered 4 weeks later; Fru-LVD: rats were treated as Group Fru, and low-dose calcitriol (10 ng / 100 g body weight per day) was administered 4 weeks later. 7. There are few data on the efficacy or tolerability of ultralow-dose blood pressure combinations. Epub 2018 Jun 12. Standard dose was defined as the most reported usual maintenance dose recorded by the BNF, Martindale, and MIMS. Original magnification × 40. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Sildenafil, an oral phosphodiesterase Type 5 inhibitor, has vasodilatory effects through a cGMP-dependent mechanism. 2 Nevertheless, awareness about and treatment adherence for hypertension remain suboptimal, particularly among people under 65 years of age. Of the 42 studies, 38 reported quarter-dose monotherapy, 7 reported dual quarter-dose combination therapy, and 2 reported quadruple quarter-dose therapy compared with either placebo or each component at a standard dose. Studies were only considered if at least one arm was allocated quarter-dose therapy (with one or multiple agents) and at least one arm allocated placebo or standard-dose monotherapy (to allow comparison with the 2007 trial8). Effects of calcitriol on adipose angiotensin II (Ang II) concentration in (A) retroperitoneal…, NLM Relation between low dose of hydrochlorothiazide, antihypertensive effect and adverse effects. One study (included trial 40, for more details, please see online-only Data Supplement) measured efficacy of quadruple quarter-dose therapy versus placebo and showed an office blood pressure reduction of −22.4 (−28.3 to −16.5)/−13.1 (−17.3 to −8.8; Figure 2). Finally, there is a pearl potentially hidden in the article—not hypotension, but intradialytic hypertension. the usefulness of computer tests from battery of psychology experiment building language (pebl) for the detection of mild cognitive impairment (mci) in patients with hypertension Wolska-Bulach, A. Yang T, Chu CH, Bai CH, You SL, Chou YC, et al. CI indicates confidence interval; DBP, diastolic blood pressure; and SBP, systolic blood pressure. These cells contributed to the different analyses as shown in Table 3. (A) Endothelium-dependent vascular relaxation in response to acetylcholine and (B) endothelium-independent vascular relaxation in response to sodium nitroprusside in thoracic aortic segments. There is a critical need for blood pressure–lowering strategies that have greater efficacy and minimal side effects. The online-only Data Supplement is available with this article at http://hyper.ahajournals.org/lookup/suppl/doi:10.1161/HYPERTENSIONAHA.117.09202/-/DC1. Inrig JK, Patel UD, Toto RD, Szczech LA. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Nat Rev Cardiol. One small trial reported in 2007 a large blood pressure reduction from quadruple quarter-dose combination therapy compared with monotherapy,8 and a small trial recently completed also showed large reductions compared with placebo.9 We, therefore, conducted a systematic review of randomized trials of quarter-dose blood pressure–lowering agent(s) to place these trials in the context of all evidence concerning quarter-dose therapy and to assess the potential clinical role of quarter-dose monotherapy and combination therapy. We did not review non–English language trials. Heterogeneity (Q value; P value, and I2 statistic) observed for single quarter dose vs placebo: 6, 0.8, and 0 observed for single quarter vs standard dose: 17, 0.11, and 35 observed for dual quarter vs standard dose: 0.4, 0.52, and 0. AHRQ publication 14-05206-EF-2. Quinapril and hydrochlorothiazide combination for control of hypertension: assessment by factorial design. Quarter-dose combinations could provide improvements in efficacy and tolerability of blood pressure–lowering therapy. See this image and copyright information in PMC. Figure 3. NCHS Data Brief 2015;(220):1–8. Similar trends were seen in 2 trials reporting the proportion of patients below a certain potassium level (<3.5 mmol/L)22 or the number of participants who developed a >0.05 mmol change in potassium concentration.23, Table 4. 2004 Jan;37(1):1-9. doi: 10.1016/j.clinbiochem.2003.09.003. Table 2. 1-800-242-8721 No study was excluded on the basis of baseline blood pressure, presence or absence of disease, or year performed. https://doi.org/10.1161/HYPERTENSIONAHA.117.09202, National Center Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. -, Tamez H, Thadhani RI. 1 Yet control of blood pressure is poor, with only 1 in 3 people on treatment achieving blood pressure targets. M. Chou contributed to the literature search, trial identification, data abstraction, and data checking as second reviewer and to review of data analyses and the article. Vitamin D and hypertension: an update and review. Follow-up ranged from 4 to 12 weeks, averaging 7 weeks. Fifty-eight studies with extractable data met the inclusion criteria, and 16 studies were excluded after full-text evaluation. Inrig JK, Patel UD, Toto RD, Szczech LA. Ankumah NA, Cantu J, Jauk V, et al. There was some evidence of heterogeneity present across the different dual combinations (I2 SBP: 18, DBP: 37). Aim . Con: control rats with normal chow diet; Fru: rats were fed a high-fructose diet for 8 weeks; Fru-HVD: rats were treated as Group Fru, and high-dose calcitriol (20 ng / 100 g body weight per day) was administered 4 weeks later; Fru-LVD: rats were treated as Group Fru, and low-dose calcitriol (10 ng / 100 g body weight per day) was administered 4 weeks later. N = 6 for each group. Publication bias was assessed and reported using a funnel plot (Figure S6). Both reviewers independently estimated the difference, with the average of the 2 being used. Competing Interests: The authors have declared that no competing interests exist. No studies measured triple quarter-dose therapy versus placebo. Overall, 8 studies described the method of sequence generation; 7 described the method of concealment and 28 described and dealt with missing data. Hypertension affects the majority of haemodialysis (HD) patients. resolved any disagreement on the included articles. Imputing missing standard deviations in meta-analyses can provide accurate results. 2018 Aug;41(8):589-597. doi: 10.1038/s41440-018-0058-9. TZ vs standard dose 0.17, 0.98, and 0; uric acid: TZ vs placebo: 0.15, 0.93, and 0. The initial search identified 1730 studies, with 1554 screened after exclusion of duplicate citations (Figure 1). 2014;123(5):966–972. -. Physiological changes during hemodialysis in patients with intradialysis hypertension. organization. 3 A. Bennett drafted the protocol and data collection forms and conducted search, data abstraction, and data checking as first reviewer; led statistical analysis; and drafted and revised the article. et al. The large number of trials allowed precise estimates of treatment effects, at least for single and dual combinations, and assessment of consistency of results across major drug classes. the usefulness of computer tests from battery of psychology experiment building language (pebl) for the detection of mild cognitive impairment (mci) in patients with hypertension Wolska-Bulach, A. The Trim and Fill approach did not suggest evidence of publication bias (Figure S6). J. Chalmers reports research grants and honoraria from Servier for the ADVANCE trial, outside the submitted work. Likewise, the control rate of hypertension in South Korea was 28.9% compared with 46.5% in the United States and was significantly lower among Korean adults aged 19–44 years (Guo, He, Zhang, & Walton, 2012; Moon et al., 2013). SBP: 4, 0.69, and 0. Methods: A community-based study population of 2377 normotensive nondiabetic Chinese adults aged >or=30 years were re-examined 10 years after their baseline examination. Yang T, Chu CH, Bai CH, You SL, Chou YC, et al. Exclusion of studies with missing data on variability also did not substantially affect this estimate (−5.0 [−5.7 to −4.2]/−2.4 [−2.9 to −1.8] mm Hg). and M.C.) and M.C.) In the 312 participants assessed, the effect of the dual quarter-dose combination was an overall blood pressure drop of −6.7 (−8.6 to −4.8)/−4.4 (−5.5 to −3.3) mm Hg. This site needs JavaScript to work properly. Trial and participant numbers represent single quarter dose vs placebo DBP analysis. doi: 10.1371/journal.pone.0180712. Chou et al. Changes in systolic blood pressure…, Fig 1. A. Rodgers is the guarantor. The review methods are detailed in the protocol (online-only Data Supplement) and were written in accordance with the preferred Cochrane Collaboration–reporting items for systematic reviews and meta-analyses. On ges- tures of pulmonary hypertension include right ventricle hypertrophy, tation days 20 and 21, the rats received an intraperitoneal injection muscularization of small pulmonary arteries, increased cardiomyocyte of LPS (0.5 mg/kg per day), which was obtained from Escherichia coli Chou et … Chou YT, Cheng HJ, Wu JS, Yang YC, Chou CY, Chang CJ, et al. entered the data into Microsoft Excel and then into the Comprehensive Meta-analysis Software.13 A second reviewer (H.-M.D.) This was also observed in 6 dual quarter-dose comparisons (0.93 [0.29–2.9]) and in a solitary quadruple (2.0 [0.2–20.2]) quarter-dose placebo comparison (Figure 4). ACEI indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-blocker; CCB, calcium channel blocker; CI, confidence interval; DBP, diastolic blood pressure; SBP, systolic blood pressure; and TZ, thiazide diuretic. Physiological changes during hemodialysis in patients with intradialysis hypertension. The biochemical effects of calcitriol treatment on the fructose-fed rats: (A) total cholesterol,…, Fig 3. The results showed that the fructose-fed rats significantly developed hypertension, impaired glucose tolerance, heavier weight and larger adipose size of visceral fat pads, and raised adipose angiotensin II expressions compared with the control rats.
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