The combination valsartan plus hydroclorothiazide could be a good choice. Peer review The paper is well written and the conclusions are clear. during exercise ( 0.001), and 85% of patients achieved BP normalization ( 130/85 mmHg). Doppler echocardiography showed a significant reduction of LV mass ( 0.005). LV hypertrophy was identified in 70% of subjects at baseline and in 5% after 3 mo of treatment. The ratio alpha-Boswellic acid of early (E) to late (A) trans-mitral diastolic flow velocity increased, ( 0.05), the relative wall thickness decreased ( 0.05) and the left ventricular relaxation time shortened ( 0.005). The left atrial diameter ( 0.05) and the aortic diameter ( 0.05) and stiffness ( 0.005) also decreased. CONCLUSION: The full-dose combination of valsartan plus hydrochlorothiazide produced optimal BP control with regression of target organ damage, already after 3 mo, without relevant side effects. patients with BP 120/80 mmHg[6-8]. Furthermore, it has been reported that about 50% of pre-hypertensive individuals (SBP 120-139 mmHg, DBP 80-89 mmHg) have an excessive BP increase during exercise compared with normotensive subjects and echocardiographic evidence of structural and functional abnormalities of the left ventricle (LV)[9]. It is essential to identify these patients because, as with patients affected by mild hypertension, they are often under-treated despite their high cardiovascular risk and because they easily develop target organ damage and cardiovascular events in the mid to long term[10]. According to the most recent European Guidelines, the treatment of elevated BP in the pre-hypertensive-first degree range depends not only on the values of BP but also on the presence of other risk factors such as age, smoking, diabetes, sedentary lifestyle and, particularly, the presence of target organ damage. In addition to lifestyle recommendations (i.e. low sodium diet, weight loss, limited alcohol intake, smoking Rabbit Polyclonal to SHC3 cessation and aerobic exercise)[11], there are now a wide range of drugs (i.e. diuretics, -blockers, calcium-antagonists, ACE-inhibitors, and especially sartans) that may be used to treat arterial hypertension[1]. However, despite the more stringent guidelines and the rich therapeutic arsenal, it is estimated that only 58% of hypertensive individuals receive treatment and among these only 31% maintain good BP control[12]. This limited success is due to several factors, among which are the lack of diagnosis in many candidates in whom a pharmacologic treatment should be advised, inadequate treatment and poor compliance to pharmacologic therapies. Consequently, there is high incidence of cardiovascular events, morbidity, mortality and disability within the population, with significant increases in public spending. Hypertension may be underrated also because it is not always possible to identify hypertensive subjects from the measurement of BP at rest alone. Indeed, many subjects may have normal BP at rest, but their pressure increases excessively during the psycho-physical stresses of everyday life[13,14]. Furthermore, poor compliance of some patients may be due to unpleasant side effects of prescribed drugs. Among these, erectile dysfunction is one of the most frequent causes of therapy discontinuity in male subjects[15]. On these premises, the aim of this study was to demonstrate the efficacy and safety of a prompt pharmacologic treatment with the combination of valsartan plus hydroclorothiazide in young-middle aged male subjects with slight hypertension and the presence of target organ damage. MATERIALS AND METHODS Patients Twenty young or middle-aged males with first-degree hypertension or high-normal BP, and with echocardiographic evidence of LV concentric remodeling and/or high vascular stiffness, na?ve for antihypertensive treatment, were selected from our outpatient department and enrolled in this prospective, not controlled, 12-wk study. Each patient provided written informed consent to the study. The protocol was approved by the Ethics Committee of our Medical School, and the study was carried out according to the principles outlined in the Declaration of Helsinki. Inclusion criteria for recruitment were age between 18 and.Indeed, many subjects may have normal BP at rest, but their pressure increases excessively during the psycho-physical stresses of everyday life[13,14]. to late (A) trans-mitral diastolic flow velocity increased, ( 0.05), the relative wall thickness decreased ( 0.05) and the left ventricular relaxation time shortened ( 0.005). The left atrial diameter ( 0.05) and the aortic diameter ( 0.05) and stiffness ( 0.005) also decreased. CONCLUSION: The full-dose combination of valsartan plus hydrochlorothiazide produced optimal BP control with regression of target organ damage, already after 3 mo, without relevant side effects. patients with BP 120/80 mmHg[6-8]. Furthermore, it has been reported that about 50% of pre-hypertensive individuals (SBP 120-139 mmHg, DBP 80-89 mmHg) have an excessive BP increase during exercise compared with normotensive subjects and echocardiographic evidence of structural and functional abnormalities of the left ventricle (LV)[9]. It is essential to identify these patients because, as with patients affected by mild hypertension, they are often under-treated alpha-Boswellic acid despite their high cardiovascular risk and because they easily develop target organ damage and cardiovascular events in the mid to long term[10]. According to the most recent European Guidelines, the treatment of elevated BP in the pre-hypertensive-first degree range depends not only on the values of BP but also on the presence of other risk factors such as age, smoking, diabetes, sedentary lifestyle and, particularly, the presence of target organ damage. In alpha-Boswellic acid addition to lifestyle recommendations (i.e. low sodium diet, weight loss, limited alcohol intake, smoking cessation and aerobic exercise)[11], there are now a wide range of drugs (i.e. diuretics, -blockers, calcium-antagonists, ACE-inhibitors, and especially sartans) that may be used to treat arterial hypertension[1]. However, despite the more stringent guidelines and the rich therapeutic arsenal, it is estimated that only 58% of hypertensive individuals receive treatment and among these only 31% maintain good BP control[12]. This limited success is due to several factors, among which are the lack of diagnosis in many candidates in whom a pharmacologic treatment should be advised, inadequate treatment and poor compliance to pharmacologic therapies. Consequently, there is high incidence of cardiovascular events, morbidity, mortality and disability within the population, with significant increases in public spending. Hypertension may be underrated also because it is not always possible to identify hypertensive subjects from the measurement of BP at rest alone. Indeed, many subjects may have normal BP at rest, but their pressure increases excessively during the psycho-physical stresses of everyday life[13,14]. Furthermore, poor compliance of some patients may be due to unpleasant side effects of prescribed drugs. Among these, erectile dysfunction is one of the most frequent causes of therapy discontinuity in male subjects[15]. On these premises, the aim of this study was to demonstrate the efficacy and safety of a prompt pharmacologic treatment with the combination of valsartan plus hydroclorothiazide in young-middle aged male subjects with slight hypertension and the presence of target organ damage. MATERIALS AND METHODS Patients Twenty young or middle-aged males with first-degree hypertension or high-normal BP, and with echocardiographic evidence of LV concentric remodeling and/or high vascular tightness, na?ve for antihypertensive treatment, were selected from our outpatient division and enrolled in this prospective, not controlled, 12-wk study. Each patient offered written knowledgeable consent to the study. The protocol was authorized by the Ethics Committee of our Medical School, and the study was carried out according to the principles defined in the Declaration of Helsinki. Inclusion criteria for recruitment were age between 18 and 60 years, high-normal BP (130-139/85-89 mmHg), essential first-degree hypertension (BP 140-159/90-99 mmHg), and echocardiographic evidence of remaining ventricular concentric redesigning and/or improved aortic tightness. Exclusion criteria were documented presence of ischemic heart disease, kidney or endocrine failure, inability to perform the bicycle-ergometer test, diabetes mellitus and valvular heart disease or arrhythmias. The characteristics of the study human population are reported in Table ?Table11. Table 1 Characteristics of the study population Individuals20Age (yr)51 9Weight (kg)77 10.9Body surface area (m2)1.8 0.15Body mass index (kg/m2)26.47 2.9Systolic blood pressure (mmHg)141 7Diastolic blood pressure (mmHg)89 5.3Left ventricular hypertrophy (%)70 Open in a separate window Individuals consumed alpha-Boswellic acid one tablet of the combination valsartan 160 mg plus hydroclorothiazide 25 mg every morning for 3 mo. Evaluations At baseline (T0) and after 3 mo of treatment (T1) we measured individuals BP at rest inside a sitting position and after a bicycle-ergometer test. This was performed by means of the version 5 CardioSoft software (General Electric, Freiburg, Germany), according to the Bruce Protocol. Each stage.
The combination valsartan plus hydroclorothiazide could be a good choice
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