Association between difference in blood pressure reduction and risk of cardiovascular events in a type 2 diabetes population: A meta-regression analysis.

AIM: Recent US recommendations indicate a target blood pressure (BP) of 130/80mmHg for patients with type 2 diabetes (T2D). Our aim was to characterize the association between risk of cardiovascular events and differences in BP decreases in randomized trials of a T2D population. METHODS: A systematic search was made for randomized clinical trials assessing the effects of antihypertensive treatments in T2D patients on mortality, and fatal and non-fatal cardiovascular events, using a meta-regression technique to explore the influence of BP decreases on treatment effects. RESULTS: A total of 88,503 patients from 44 randomized trials were included. There was no significant association between BP decreases and risk of all-cause or cardiovascular mortality, cardiovascular events or myocardial infarction. However, stroke risk was influenced by BP decreases: compared with no reduction, a 10-mmHg reduction in systolic BP was associated with a relative odds ratio (OR) decrease of 33% (OR: 0.67, 95% CI: 0.54-0.82), and a 5-mmHg diastolic BP reduction was associated with a relative OR decrease of 38% (OR: 0.62, 95% CI: 0.50-0.76). Restricting the analysis to double-blind studies did not change the results for diastolic BP. CONCLUSION: A reduction in BP lowers the risk of stroke, but does not appear to affect the risk of other cardiovascular events in a T2D population.

Can we identify response markers to antihypertensive drugs? First results from the IDEAL Trial.

Current antihypertensive strategies do not take into account that individual characteristics may influence the magnitude of blood pressure (BP) reduction. Guidelines promote trial-and-error approaches with many different drugs. We conducted the Identification of the Determinants of the Efficacy of Arterial blood pressure Lowering drugs (IDEAL) Trial to identify factors associated with BP responses to perindopril and indapamide. IDEAL was a cross-over, double-blind, placebo-controlled trial, involving four 4-week periods: indapamide, perindopril and two placebo. Eligible patients were untreated, hypertensive and aged 25-70 years. The main outcome was systolic BP (SBP) response to drugs. The 112 participants with good compliance had a mean age of 52. One in every three participants was a woman. In middle-aged women, the SBP reduction from drugs was -11.5 mm Hg (indapamide) and -8.3 mm Hg (perindopril). In men, the response was significantly smaller: -4.8 mm Hg (indapamide) and -4.3 (perindopril) (P for sex differences 0.001 and 0.015, respectively). SBP response to perindopril decreased by 2 mm Hg every 10 years of age in both sexes (P=0.01). The response to indapamide increased by 3 mm Hg every 10 years of age gradient in women (P=0.02). Age and sex were important determinants of BP response for antihypertensive drugs in the IDEAL population. This should be taken into account when choosing drugs a priori.

[Value and role of echo-Doppler in the screening of renovascular hypertension. A prospective study of 144 arteries with reference to angiography]. / Intérêt et place de l'écho-Doppler dans le dépistage des hypertensions réno-vasculaires. Une étude prospective portant sur 144 artères, en référence à l'angiographie.

The purpose of the study is a rigorous validation of different ultrasonic criteria of renal artery stenosis, and the presentation of the performances of duplex sonography in renal artery stenosis screening. Sixty seven patients have been investigated by ultrasonic techniques, and the results of duplex compared with intraarterial or intravenous digital subtraction angiography. Two kinds of ultrasonic investigations have been defined: complete explorations when the renal artery ostium is accessible, incomplete explorations in other cases. The main difficulty preventing the exploration from being complete is obesity: all patient with an overweight of more than 20% of their theoretical weight have an incomplete exploration of at least one of their renal arteries. Furthermore, duplex sonography was not able to demonstrate polar artery in any case. When the exploration is complete, maximum systolic frequency (F max) recorded on the renal artery course, and the systolic frequency ratio of renal and aortic recordings (RAR) are two valuable criteria of significant stenosis (> 50%): mean difference between normal and stenosed arteries for these two variables is statistically significant (p < 0.01). To obtain a good specificity, pathological threshold have been fixed at F max > 3,500 Hz and RRA > 2.5. When the exploration in incomplete, ascending time (asc. T) and resistance index (RI) of doppler recording obtained in the renal hilum are two valuable criteria for severe stenosis (> 80%), or occlusion: the mean between stenosed and non stenosed arteries is statistically different (p < 0.001 and p < 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)