New Vascular Registry Study Central blood pressure lowering
New Vascular Registry Study : Central blood pressure lowering effect of doubling antihypertensive dose in isolated systolic hypertension - Isolated systolic hypertension registry 이해영 서울대학병원 순환기 내과
Systolic BP increases with age in Asian patients ANZ: Australia and New Zealand Asia Pacific Cohort Studies Collaboration. Int J Epidemiol 2006; 35: 1025– 1033.
Systolic HT becomes predominant phenotype with increasing age l ISH prevalence in Asians, which is reported to be 3. 9 -12. 5%, is age dependent. l Increased ISH prevalence is noticeable in elderly > 60 yrs Kim JA, Choi KM, et al. The prevalence and risk factors associated with isolated untreated systolic hypertension in Korea: the Korean National Health and Nutrition Survey 2001. J Hum Hypertens 2007; 21: 107– 113.
Young normal aorta Old stiff aorta
Young normal aorta Resistance artery Old stiff aorta Resistance artery
Young normal aorta Resistance artery
Old stiff aorta Resistance artery
Young normal aorta Old stiff aorta
Pressure during systole is a major determinant of myocardial O 2 requirement Efficient arterial system Pressure during diastole is a major determinant of coronary blood flow Inefficient arterial system
Study objectives Primary: To evaluate non-inferiority of irbesartan (and/or hydrochlorothiazide fixed combination) to amlodipine (and/or hydrochlorothiazide) in reducing the office seated SBP in elderly patients with ISH Secondary: To evaluate non-inferiority of irbesartan-base regimen to amlodipine-based regimen in PP reduction and tolerability
AMISH: evolution of seated BP (ITT population)
Blood pressure reduction from combining drugs 2 different classes >> doubling the dose of 1 drug 5 times greater [Ratio of observed to expected incremental blood pressure-lowering effects of adding a drug or doubling the dose according to the class of drug] Am J Med 2009; 122: 290 -300
Modest addictive BP lowering effect with dose doubling
3 mm. Hg further BP lowering resulting in > 10% more achieving target goal Candesartan 16 -> 32 mg for further 3 mm. Hg BP reduction Data from CAESAR study performed in Korean 2 nd stage hypertension
High Dose ARB might be more effective in central blood pressure reduction Hypertension. 2006; 48: 80 -86
치료법에 따른 동맥경화도, 중심동맥압 변화 속도 l 치료에 따른 변화의 경우 소형 동맥(muscular artery) 이 대형 동맥(elastic artery)에 비해 용이할 것이다. l 중재에 따른 동맥경화지표의 변화 기전 및 소요 시간 – Distension BP and flow modifications: 수시간-수주 – Arterial wall muscular fibers affecting the vasomotion function (constriction and dilation): > 4 -6개월 – Arterial wall structure by affecting the elastin/collagen fibers content and organization: > 4 -6개월
24 -h ambulatory recording of aortic PWV and central systolic augmentation l Oscillometric Mobil-O-Graph 24 h PWA Monitor monitors (I. E. M. Germany) l ARCSolver software computes aortic PWV from the reconstructed central pulse wave, characteristic impedance and age based on the concept that the ejection work of the left ventricle is subject to an optimization principle and assuming a 3 -element Windkessel model Hypertension Research 2012; 35: 980– 987
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