BHS Annual Meeting, Cambridge
14 th September 2011
Adrian J.B. Brady MD, FRCP(Glasg), FRCPE, FAHA
Associate Professor, University of Glasgow
Consultant Cardiologist
Glasgow Royal Infirmary
Glasgow, UK
Secretary, British Hypertension Society
Chairman, Guidelines Committee, British Cardiovascular Society
European Society of Cardiology Guidelines Development Group
Disclosures:
Research grants from: AstraZeneca, Bayer,
Boehringer Ingelheim, Merck, Schering Plough,
Roche, Servier

Baroreflex Activation Therapy Lowers Blood
Pressure in Patients With Resistant Hypertension:
Results From the Double-Blind, Randomized,
Placebo-Controlled Rheos Pivotal Trial

Baroreceptor Activation Therapy

Average 5.2 antihypertensive drugs

Baroreflex Activation Therapy Lowers Blood Pressure in Patients With Resistant
Hypertension : : Results From the Double-Blind, Randomized, Placebo-Controlled
Rheos Pivotal Trial

Ter Arkh.
2011;83(4):52-5.
[Efficacy and safety of the first made in Russia alpha, beta long-acting adrenoblocker proxodolol in patients with arterial hypertension of the second degree].
[Article in Russian]
Beliaeva SA .
Abstract
AIM:
To study efficacy and safety of a new dose and dosage form of proxodolol--a betaadrenoblocker with alpha1-adrenoblocking activity--in patients with moderate arterial hypertension (AH).
MATERIAL AND METHODS:
A total of 60 patients with verified diagnosis of essential AH of the second degree were randomized into two groups: group 1 (n=40) received proxodolol, group 2 (n=20) was given carvedilol. The trial lasted for 89 days.
RESULTS:
The trial demonstrates that proxodolol is highly effective and safe in the treatment of AH.
CONCLUSION:
Proxodolol is effective and safe in hypertension, in a dose 120 mg its activity is the same as carvedilol in a dose 25 mg.
PMID:
21675275
[PubMed - indexed for MEDLINE]

BMJ. 2011; 342: d2234

BMJ. 2011; 342: d2234.

• What is already known on this topic
• Angiotensin receptor blockers are important in the treatment of cardiovascular conditions
• Previous studies have shown an increased risk of myocardial infarction with these drugs and have raised concern among physicians and patients
• What this study adds
• There is firm evidence to refute the hypothesis of angiotensin receptor blockers increasing the risk of myocardial infarction (ruling out even a
0.3% absolute increase)
• Compared with controls (active treatment or placebo), angiotensin receptor blockers reduce the risk of stroke, heart failure, and new onset diabetes.
• Despite lower blood pressure with angiotensin receptor blockers when compared with placebo, there also was no detectable beneficial effect for the outcome of myocardial infarction or cardiovascular mortality
BMJ. 2011; 342: d2234

Ischemic Heart Disease Mortality Rate in Each Decade of Age vs Usual BP at the Start of that Decade
256
32
Age at Risk:
80-89
256
70-79
60-69
32
50-59
Age at Risk:
80-89
70-79
60-69
50-59
40-49
4
4
40-49
0
120 140 160
Usual SBP (mmHg)
180
Prospective Studies Collaboration, Lancet, v.360, Dec. 14, 2002
0
70 80 90 100 110
Usual DBP (mmHg)

Ischemic Heart Disease Mortality Rate in Each Decade of Age vs Usual BP at the Start of that Decade
256
32
Age at Risk:
80-89
256
70-79
60-69
32
50-59
Age at Risk:
80-89
70-79
60-69
50-59
40-49
4
4
40-49
0
120 140 160
Usual SBP (mmHg)
180
Prospective Studies Collaboration, Lancet, v.360, Dec. 14, 2002
0
70 80 90 100 110
Usual DBP (mmHg)

10
9
8
7
6
5
4
3
2
1
0
< 80
Non-Ischemic
Ischemic
< 85 < 90 DBP (mmHg)
CruickshankJM, Hannson L,CV Drugs Therapy
2000;14,373.

International trial in 22,576 patients with CAD and hypertension
Randomized to multi-drug treatment strategies
• verapamil SR + trandolapril + HCTZ
• atenolol + HCTZ + trandolapril
• Trandolapril recommended for all patients with diabetes
Primary Outcome: First occurrence of all-cause mortality, nonfatal MI or nonfatal stroke
Secondary Outcomes: All-cause mortality, nonfatal MI, nonfatal stroke, total MI and total stroke
Main finding: risk for CV adverse outcomes was equivalent comparing the strategies
Pepine et al. JAMA. 2003:290:2805-2816

INVEST Subanalysis: BP and Risk
50
Nadir = 84.1 mm Hg
Primary Outcome
Hazard Ratio
40
10
0
30
20
Total patients 176 2239
DBP (mm Hg)
11306 7376 1230 248

INVEST Subanalysis: BP and Risk
6 6
Nadir =
119.2
mm Hg
Nadir =
84.1
mm Hg
4 4
2 2
0
105 115 125 135 145 155 165
SBP (mm Hg)
0
55 65 75 85 95 105
DBP (mm Hg)

INVEST Subanalysis: BP and Risk
50
40
Nadir = 85.8 mm Hg
All-Cause Death Hazard Ratio
30
20
10
0
Total patients 176 2253
DBP (mm Hg)
11339 7367 1201 240
5
3
1

INVEST Subanalysis: BP and Risk
20
MI Stroke
15
10
5
0
DBP (mm Hg)

V alsartan A ntihypertensive L ong-Term U se E valuation
15,313 randomised at 942 sites in 31 countries
Average follow up 4.2 years
Julius S et al. Lancet . June 2004;363.

BMJ 2011;342:d643 doi:10.1136/bmj.d643

BRADY AJB, ESC SEPT 2010
Conclusions
• Different guidelines have many similarities
• Blood pressure lowering is fundamental
• Therapeutic drug choices are showing global concordance