Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs And Direct Renin Inhibitors For Treating Essential Hypertension
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Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs And Direct Renin Inhibitors For Treating Essential Hypertension
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Author :
language : en
Publisher:
Release Date : 2011
Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs And Direct Renin Inhibitors For Treating Essential Hypertension written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011 with categories.
OBJECTIVES: A 2007 comparative effectiveness review (CER) evaluated the long-term benefits and harms of angiotensin-converting enzyme inhibitors (ACEIs) versus angiotensin II receptor blockers/antagonists (ARBs) for treating essential hypertension in adults. Since then, significant additional research has been published comparing these agents, and direct renin inhibitors (DRIs) have been introduced to the market. We sought to update 2007 CER on ACEIs versus ARBs and expand this to include comparisons with DRIs. DATA SOURCES: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, a list of systematic reviews underway in the Cochrane Hypertension Review Group, and selected gray literature sources. REVIEW METHODS: We included studies that directly compared ACEIs, ARBs, and/or DRIs in at least 20 total adults with essential hypertension; had at least 12 weeks of followup; and reported at least one outcome of interest. Two investigators reviewed each article, and a standard protocol was used to extract data on study design, interventions, population characteristics, and outcomes; evaluate study quality; and summarize the evidence. When appropriate, quantitative meta-analysis was performed. RESULTS: We included 97 studies (36 new since 2007) directly comparing ACEIs versus ARBs and 3 studies directly comparing DRIs to ACEIs or ARBs. The strength of evidence remains high for equivalence between ACEIs and ARBs for blood pressure lowering and use of a single antihypertensive agent, and for superiority of ARBs over ACEIs for short-term adverse events (primarily due to cough). The new evidence did not strengthen our conclusions regarding long-term cardiovascular outcomes, quality of life, progression of renal disease, medication adherence or persistence, rates of angioedema, or differences in key patient subgroups: the strength of evidence for these outcomes remained low to moderate. For DRIs, we were not able to reach definitive conclusions for any of the outcomes of interest. Few studies involved a representative sample treated in a typical clinical setting over a long duration; treatment protocols had marked heterogeneity; and significant amounts of data about important outcomes and patient subgroups were missing. CONCLUSION: Evidence does not support a meaningful difference between ACEIs and ARBs for any outcome except short-term adverse events. Few, if any, of the questions that were not answered in the 2007 CER have been addressed by the 39 new studies. Future research in this area should consider areas of uncertainty and be prioritized accordingly.
Future Research Needs For Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs Or Direct Renin Inhibitors Dris For Treating Hypertension
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Author :
language : en
Publisher:
Release Date : 2012
Future Research Needs For Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs Or Direct Renin Inhibitors Dris For Treating Hypertension written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012 with categories.
Almost 75 million American adults have hypertension. Advances in antihypertensive therapy have dramatically reduced cardiovascular, cerebrovascular, and renal events. Among the effective pharmacotherapies are inhibitors of the renin-angiotensin-aldosterone system (RAS). In 2007, the Agency for Healthcare Research and Quality (AHRQ) sponsored a comparative effectiveness review (CER) of the two most common renin system inhibitors, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), to answer the following three Key Questions for adults with essential hypertension: do ACEIs and ARBs differ in their (1) blood pressure control, cardiovascular events, quality of life, and other outcomes; (2) safety, tolerability, persistence with therapy, or treatment adherence; and (3) effects within important subgroups of patients? This 2007 CER was updated in 2011 to incorporate the significant additional direct comparison research published in the interval and to include direct renin inhibitors (DRIs), which are the newest class of RAS inhibitors. The results of the updated CER included 97 studies (36 new since 2007) directly comparing ACEIs versus ARBs and 3 studies directly comparing DRIs to ACEIs or ARBs. The strength of evidence remained high for equivalence between ACEIs and ARBs for blood pressure lowering, and for superiority of ARBs over ACEIs for short-term adverse events (primarily cough). The new evidence did not strengthen the conclusions regarding long-term cardiovascular outcomes, quality of life, progression of renal disease, medication adherence or persistence, rates of angioedema, or differences in key patient subgroups; the strength of evidence for these outcomes remained low to moderate. Evidence on the comparative effectiveness of DRIs versus either ACEIs or ARBs was limited to 3 studies with 2,049 patients and did not allow definitive conclusions on any of the included outcomes. Few studies involved a representative patient sample treated in a typical clinical setting over a long duration; treatment protocols had marked heterogeneity; and significant amounts of data about important outcomes and patient subgroups were missing. Given the clinical and economic importance of these medications, the ongoing investment in research, and the remaining areas of uncertainty, we sought to create a prioritized research agenda representing the interests of diverse stakeholders in order to address the remaining areas of uncertainty.
Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs And Direct Renin Inhibitors For Treating Essential Hypertension
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Author : U. S. Department Human Services
language : en
Publisher: Createspace Independent Publishing Platform
Release Date : 2013-04-06
Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs And Direct Renin Inhibitors For Treating Essential Hypertension written by U. S. Department Human Services and has been published by Createspace Independent Publishing Platform this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-04-06 with categories.
Almost 75 million American adults-approximately one-third-have hypertension. The prevalence of hypertension increases with advancing age such that more than half of people 55 to 74 years old and approximately three-fourths of those age 75 years and older are affected. In addition to being the primary attributable risk factor for death throughout the world, hypertension results in substantial morbidity because of its impact on numerous target organs, including the brain, eyes, heart, arteries, and kidneys. Despite the high rates of morbidity and mortality attributable to hypertension, control of the condition remains suboptimal. In addition to several effective nonpharmacological interventions-including diet, exercise, and control of body weight-many people require antihypertensive medication to lower blood pressure. Among the many choices in antihypertensive therapy, some of the most common are those aimed at affecting the renin-angiotensin-aldosterone (renin) system. The renin system is an important mediator of blood volume, arterial pressure, and cardiac and vascular function. Components of this system can be identified in many tissues, but the primary site of renin release is the kidney. The renin system can be triggered by sympathetic stimulation, renal artery hypotension, and decreased sodium delivery to the distal tubule. Through proteolytic cleavage, renin acts on the oligopeptide substrate angiotensinogen to produce the decapeptide angiotensin I. In turn, two terminal peptide residues of angiotensin I are removed by the angiotensinconverting enzyme (ACE) to form the octapeptide angiotensin II. Angiotensin II acts directly on the resistance vessels to: increase systemic vascular resistance and arterial pressure; stimulate the adrenal cortex to release aldosterone, which leads to increased sodium and water reabsorption and potassium excretion; promote secretion of antidiuretic hormone, which leads to fluid retention; stimulate thirst; promote adrenergic function; and increase cardiac and vascular hypertrophy. Therapies aimed at modifying the renin system have been used extensively for treatment of hypertension, heart failure, myocardial infarction, diabetes, and renal disease. Currently, three classes of drugs that interact with this system are used to inhibit the effects of angiotensin II: the angiotensin-converting enzyme inhibitors (ACEIs), the angiotensin II receptor blockers/antagonists (ARBs), and the direct renin inhibitors. ACEIs block the conversion of angiotensin I into angiotensin II; ARBs selectively inhibit angiotensin II from activating the angiotensin-specific receptor (AT1); and direct renin inhibitors block the conversion of angiotensinogen into angiotensin I. This review summarizes the evidence on the comparative long-term benefits and harms of ACEIs, ARBs, and direct renin inhibitors, focusing on their use for treating essential hypertension in adults. In that analysis, investigators assessed the conclusions from the original comparative effectiveness review, performed a limited literature search of potentially new evidence, and solicited expert opinions concerning the state of the evidence and validity of the original report. Key Questions addressed are: Key Question 1. For adult patientsa with essential hypertension, how do ACEIs (angiotensin-converting enzyme inhibitors), ARBs (angiotensin II receptor antagonists), and direct renin inhibitorsb differ in blood pressure control, cardiovascular risk reduction, cardiovascular events, quality of life, and other outcomesc? Key Question 2. For adult patients with essential hypertension, how do ACEIs, ARBs, and direct renin inhibitors differ in safety, adverse events, tolerability, persistence with drug therapy, and treatment adherence
Future Research Needs For Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs Or Direct Renin Inhibitors Dris For Treating Hypertension
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Author : U. S. Department Human Services
language : en
Publisher: Createspace Independent Publishing Platform
Release Date : 2013-05-14
Future Research Needs For Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs Or Direct Renin Inhibitors Dris For Treating Hypertension written by U. S. Department Human Services and has been published by Createspace Independent Publishing Platform this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-05-14 with categories.
Hypertension is the most common reason older adults visit the doctor and advances in antihypertensive therapy have dramatically reduced the associated cardiovascular, cerebrovascular, and renal events. Inhibitors of the renin-angiotensin system (RAS) are the most frequently used medications for blood pressure control and are highly efficacious for reducing hypertension-related outcomes. In 2007, a comparative effectiveness review (CER) sponsored by the Agency for Healthcare Research and Quality (AHRQ) evaluated the long-term benefits and harms of the two most common classes of RAS inhibitors for treating essential hypertension in adults: angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers/antagonists (ARBs). This 2007 CER was updated in 2011 to incorporate the significant additional direct comparison research published in the interval, and to include the direct renin inhibitors (DRIs), which are the newest class of RAS inhibitors. The 2011 CER addressed the three following Key Questions: KQ 1. For adult patients with essential hypertension, how do ACEIs, ARBs, and DRIs differ in blood pressure control, cardiovascular risk reduction, cardiovascular events, quality of life, and other outcomes? KQ 2. For adult patients with essential hypertension, how do ACEIs, ARBs, and DRIs differ in safety, adverse events, tolerability, persistence with drug therapy, and treatment adherence? KQ 3. Are there subgroups of patients-based on demographic and other characteristics (i.e., age, race, ethnicity, sex, comorbidities, concurrent use of other medications)-for whom ACEIs, ARBs, or DRIs are more effective, are associated with fewer adverse events, or are better tolerated? The results of the CER included 97 studies (36 new since 2007) directly comparing ACEIs versus ARBs and 3 studies directly comparing DRIs to ACEIs or ARBs. The strength of evidence remained high for equivalence between ACEIs and ARBs for blood pressure lowering, and for superiority of ARBs over ACEIs for short-term adverse events (primarily cough). The new evidence did not strengthen the conclusions regarding long-term cardiovascular outcomes, quality of life, progression of renal disease, medication adherence or persistence, rates of angioedema, or differences in key patient subgroups; the strength of evidence for these outcomes remained low to moderate. Evidence on the comparative effectiveness of DRIs versus either ACEIs or ARBs was limited to 3 studies with 2,049 patients and did not allow definitive conclusions on any of the included outcomes. Few studies involved a representative patient sample treated in a typical clinical setting over a long duration; treatment protocols had marked heterogeneity; and significant amounts of data about important outcomes and patient subgroups were missing. Our approach to identifying evidence gaps, prioritizing future research, and developing recommendations for stakeholders is outlined in the following steps. Further detail is provided below. 1. Develop an analytic framework from the original CER in order to understand the clinical and policy context of the review and its initial list of future research needs. 2. Create an initial list of evidence gaps based on the CER organized according to the population, interventions, comparators, and outcomes (PICO) framework. 3. Form a stakeholder group representing appropriate clinician, policymakers, and patient perspectives. 4. Expand the list of evidence gaps based on stakeholder input. 5. Perform an updated review of published literature since the last CER (search last updated in December 2010) and a horizon scan for recently published and ongoing studies that may address the evidence gaps, but which are not included in the current CER. 6. Solicit stakeholder prioritization of the identified research gaps based on the updated literature review. 7. Determine the most appropriate study designs for the highest priority research areas.
Future Research Needs For Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs Or Direct Renin Inhibitors Dris For Treating Hypertension Identification Of Future Research Needs From Comparative Effectiveness Re
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Author :
language : en
Publisher:
Release Date :
Future Research Needs For Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs Or Direct Renin Inhibitors Dris For Treating Hypertension Identification Of Future Research Needs From Comparative Effectiveness Re written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on with categories.
Future Research Needs For Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs Or Direct Renin Inhibitors Dris For Treating Hypertension Identification Of F
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Author :
language : en
Publisher:
Release Date : 2012
Future Research Needs For Angiotensin Converting Enzyme Inhibitors Aceis Angiotensin Ii Receptor Antagonists Arbs Or Direct Renin Inhibitors Dris For Treating Hypertension Identification Of F written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012 with categories.
Angiotensin Ii Receptor Blockade Physiological And Clinical Implications
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Author : Naranjan S. Dhalla
language : en
Publisher: Springer Science & Business Media
Release Date : 2012-12-06
Angiotensin Ii Receptor Blockade Physiological And Clinical Implications written by Naranjan S. Dhalla and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-12-06 with Medical categories.
The relationship between angiotensin II and hypertension was established in 1898 when angiotensin II was shown to modulate systemic blood pressure. Over the intervening decades, a complete characterization of the renin-angiotensin system (RAS) has been achieved, and our understanding of its biochemistry and physiology has led to the directed development of agents such ·as ACE inhibitors and receptor antagonists capable of controlling hypertension. More recently, it was shown that angiotensin II is secreted within certain tissues and that these tissue-specific systems operate independently of the systemic RAS. The novel concept that angiotensin II regulates a number of cardiovascular processes that are unrelated to blood pressure has renewed the interest of both basic and clinical scientists in angiotensin II. The association between angiotensin II and cardiac growth, in particular, has indicated that therapies currently in use for hypertension may have direct application to the treatment of heart failure. The Manitoba Cardiovascular Forum on Angiotensin Receptor Blockade in Winnipeg was convened October 18-20, 1996 to examine the clinical and basic aspects of angiotensin receptor biology as they apply to hypertension and heart failure. In addition, the potential treatment of these conditions using specific angio tensin receptor antagonists was addressed within the context of their immediate therapeutic application and future potential.
Encyclopedia Of Heart Diseases
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Author : M. Gabriel Khan
language : en
Publisher: Elsevier
Release Date : 2005-12-14
Encyclopedia Of Heart Diseases written by M. Gabriel Khan and has been published by Elsevier this book supported file pdf, txt, epub, kindle and other format this book has been release on 2005-12-14 with Medical categories.
The Encyclopedia of Heart Diseases is an accurate and reliable source of in-depth information on the diseases that kill more than 12 million individuals worldwide each year. In fact, cardiovascular diseases are more prevalent than the combined incidence of all forms of cancer, diabetes, asthma and leukemia. In one volume, this Encylopedia thoroughly covers these ailments and also includes in-depth analysis of less common and rare heart conditions to round out the volume's scope. Researchers, clinicians, and students alike will all find this resource an invaluable tool for quick reference before approaching the primary literature. * Coverage of more than 200 topics, including: applied pharmacology of current and experimental cardiac drugs, gene therapy, MRI, electron-beam CT, PET scan put in perspective, cardiac tests costs and justification, and new frontiers in cardiovascular research* More than 150 helpful figures and illustrations!* Dr. Khan is a well-published and respected expert in heart and heart diseases
Angiotensin Ii Receptor Antagonists
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Author : Mancia Giuseppe
language : en
Publisher: CRC Press
Release Date : 2000-07-03
Angiotensin Ii Receptor Antagonists written by Mancia Giuseppe and has been published by CRC Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2000-07-03 with Medical categories.
Since angiotensin II is one of the most potent vasoconstrictors and an important stimulus for the secretion of aldosterone from the adrenal gland, the development of angiotensin II inhibitors is an important step in regulating blood pressure. This class of drug is well-tolerated by patients and these drugs have the added advantage over ACE inhibitors in that they are not associated with cough. Because most drugs can be given once daily and, like ACE inhibitors, they have a useful additive hypotensive effect in combination with diuretics, they are a welcome therapeutic tool in the treatment of hypertension.
Diabetes And Hypertension
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Author : Samy I. McFarlane
language : en
Publisher: Springer Science & Business Media
Release Date : 2012-10-19
Diabetes And Hypertension written by Samy I. McFarlane and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-10-19 with Medical categories.
Diabetes and hypertension have evolved as two of the modern day epidemics affecting millions of people around the world. These two common co-morbidities lead to substantial increase in cardiovascular disease, the major cause of morbidity and mortality of adults around the world. In Diabetes and Hypertension: Evaluation and Management, a panel of renowned experts address a range of critical topics -- from basic concepts in evaluation and management of diabetes and hypertension, such as dietary interventions, to evaluation and management of secondary hypertension in clinical practice. Other chapters focus on high cardiovascular risk populations such as those with coronary heart disease, chronic kidney disease and minority patients. In addition, evolving concepts and new developments in the field are presented in other chapters, such as prevention of type 2 diabetes and the epidemic of sleep apnea and its implication for diabetes and hypertension evaluation and management. An important title covering two of the most troubling disorders of our time, Diabetes and Hypertension: Evaluation and Management will provide the busy practitioner with cutting edge knowledge in the field as well as practical information that can translate into better care provided to the high-risk population of diabetics and hypertensive patients.