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Identifying treatment response to antihypertensives in patients with obesity-related hypertension.

ABSTRACT: BACKGROUND:In patients with obesity-related hypertension (ORH), reaction to antihypertensive medication is likely influenced by patientcharacteristics. METHODS:Effects of aliskiren, moxonidine and hydrochlorothiazide on 24-h blood pressure (BP) were compared to placebo. Linear mixed effect models were used to analyze the effect of patient characteristics on BP levels and treatment response. RESULTS:Systolic BP response to aliskiren was higher in patients with a BMI >?30.7 kg/m2 compared to patients with a BMI ??30.7 kg/m2 (-21 mmHg versus -4 mmHg). In patients with a hsCRP >?1.8 mg/L the systolic BP response to aliskiren was higher than in patients with a low hsCRP (-15 mmHg versus -7 mmHg). Hydrochlorothiazide (HCTZ) treatment effect on systolic BP was -13 mmHg when heart rate >?71 beats/min compared to -3 mmHg when heart rate was ??71 beats/min. CONCLUSION:In patients with ORH, BP response to aliskiren is positively related to BMI and hsCRP. Systolic BP response to HCTZ is positively related to heart rate and negatively to renin levels. TRIAL REGISTRATION:NCT01138423. Registered June 4th, 2010.

SUBMITTER: Schrover IM

PROVIDER: S-EPMC5654008 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Identifying treatment response to antihypertensives in patients with obesity-related hypertension.

Schrover Ilse M IM Dorresteijn Jannick A N JAN Smits Jodine E JE Danser A H Jan AHJ Visseren Frank L J FLJ Spiering Wilko W

Clinical hypertension 20171024

<h4>Background</h4>In patients with obesity-related hypertension (ORH), reaction to antihypertensive medication is likely influenced by patientcharacteristics.<h4>Methods</h4>Effects of aliskiren, moxonidine and hydrochlorothiazide on 24-h blood pressure (BP) were compared to placebo. Linear mixed effect models were used to analyze the effect of patient characteristics on BP levels and treatment response.<h4>Results</h4>Systolic BP response to aliskiren was higher in patients with a BMI > 30.7 k ...[more]

PMID: 29085669

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Project description:BACKGROUND:Multiple classes of oral therapy are available for the treatment of pulmonary arterial hypertension (PAH), but there is little to guide clinicians in choosing a specific regimen or therapeutic class. We aimed to investigate whether treatment-relevant blood biomarkers can predict therapy response in prevalent PAH patients. METHODS:This prospective cohort study longitudinally assessed biomarkers along the endothelin-1 (ET-1) and nitric oxide (cGMP, ADMA, SDMA, nitrite, and S-nitrosohemoglobin) pathways along with the cGMP/NT-proBNP ratio over 12 months in patients with WHO Group 1 PAH on oral PAH-specific therapies. The relationship between biomarkers and 6MWD at the same and future visits was examined using mixed linear regression models adjusted for age. As cGMP can be elevated when NT-proBNP is elevated, we also tested the relationship between 6MWD and the cGMP/NT-pro BNP ratio. Patients with PAH with concomitant heart or lung disease or chronic thromboembolic pulmonary hypertension (CTEPH) were included in a sensitivity analysis. RESULTS:The study cohort included 58 patients with PAH treated with either an endothelin receptor antagonist (27.6%), phosphodiesterase-5 inhibitor (25.9%) or a combination of the two (43.1%). Among biomarkers along the current therapeutic pathways, ET-1 and the cGMP/NT-proBNP ratio associated with same visit 6MWD (p?=?0.02 and p?=?0.03 respectively), and ET-1 predicted future 6MWD (p?=?0.02). ET-1 (p?=?0.01) and cGMP/NT-proBNP ratio (p?=?0.04) also predicted future 6MWD in the larger cohort (n?=?108) of PAH patients with concomitant left heart disease (n?=?17), lung disease (n?=?20), or CTEPH (n?=?13). Finally, in the larger cohort, SDMA associated with 6MWD at the same visit (p?=?0.01) in all subgroups and ADMA associated with 6MWD in PAH patients with concomitant lung disease (p?=?0.03) and PAH patients on ERA therapy (p?=?0.01). CONCLUSIONS:ET-1, cGMP/NTproBNP ratio, and dimethylarginines ADMA and SDMA are mediators along pathways targeted by oral PAH therapies that associate with or predict 6MWD.

Dataset Information

Identifying treatment response to antihypertensives in patients with obesity-related hypertension.

Publications

Identifying treatment response to antihypertensives in patients with obesity-related hypertension.

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