An update on the cardiovascular pleiotropic effects of milk and milk products.

Hypertension is a major risk factor in addition to atherosclerosis and type 2 diabetes mellitus for the development of coronary heart disease and strokes. Several prospective clinical studies have demonstrated a possible protective effect of milk and dairy product consumption on these conditions. The putative effects of milk and dairy products are possibly mediated through their mineral content of calcium, magnesium, potassium, and vitamin D.

New insights into the true nature of the obesity paradox and the lower cardiovascular risk.

Obesity is considered a major risk factor for cardiovascular disease, hypertension, and diabetes by National and International Committees. For this reason, they advocate weight loss and prevention of obesity. However, several studies in patients with established coronary artery disease (CAD), congestive heart failure, and hypertension have shown an inverse relationship between obesity and mortality, the so called "obesity paradox," whereas other studies have not shown such a relationship.

Olmesartan medoxomil-based antihypertensive therapy evaluated by ambulatory blood pressure monitoring: efficacy in high-risk patient subgroups.

Hypertension affects approximately 26% of the world's adult population and is a recognized major risk factor for morbidity and mortality associated with cardiovascular, cerebrovascular, and renal diseases. However, despite the availability of a range of effective antihypertensive agents and a growing awareness of the consequences of high blood pressure (BP), the treatment and control of hypertension remains suboptimal. A number of patient subgroups are categorized as 'high risk' and may have hypertension that is more difficult to treat, including obese individuals, patients with stage 2 hypertension, those with type 2 diabetes mellitus (T2DM), patients with coronary artery disease or a history of stroke, and Black patients.

The pleiotropic effects of phosphodiesterase 5 inhibitors on function and safety in patients with cardiovascular disease and hypertension.

Phosphodiesterase 5 (PDE-5) inhibitors are selective blockers of PDE-5, which catalyzes the hydrolysis of cyclic guanosine monophosphate (cGMP) to its corresponding monophosphates. cGMP is a potent vasodilator and nitric oxide donor. Since PDE-5 is widely distributed in the body, it was hypothesized that inhibition of its actions could lead to significant vasodilation, which could benefit patients with coronary artery disease.

Triple-Combination therapy with olmesartan, amlodipine, and hydrochlorothiazide in black and non-black study participants with hypertension: the TRINITY randomized, double-blind, 12-week, parallel-group study.

Background: Although awareness of hypertension in Black patients has increased, blood pressure (BP) is frequently inadequately controlled.

Objective: This prespecified subgroup analysis of the TRINITY study evaluated the efficacy and safety of olmesartan medoxomil (OM) 40 mg, amlodipine besylate (AML) 10 mg, and hydrochlorothiazide (HCTZ) 25 mg triple-combination treatment compared with the component dual-combination treatments in Black and non-Black study participants.

Study Design: TRINITY was a 12-week, randomized, double-blind, parallel-group evaluation.

Blood pressure effects of high-dose amlodipine-benazepril combination in Black and White hypertensive patients not controlled on monotherapy.

Background: Black hypertensive patients are more resistant to angiotensin-converting enzyme (ACE) inhibitor monotherapy than White patients. This resistance can be overcome with the combination of ACE inhibitors with diuretics or calcium-channel blockers (CCBs).

Objectives: The objective of this clinical investigation was to evaluate the antihypertensive effectiveness of monotherapy with the ACE inhibitor benazepril or the CCB amlodipine and their combination in Black and White hypertensive patients in two separate studies.

Single-pill triple-combination therapy: an alternative to multiple-drug treatment of hypertension.

Hypertension (HTN) affects an estimated 76.4 million US adults. Despite improvements in blood pressure (BP) control rates and the availability of effective antihypertensive agents, only 50% of these individuals achieve BP control.

Efficacy and safety of triple-combination therapy with olmesartan, amlodipine, and hydrochlorothiazide in study participants with hypertension and diabetes: a subpopulation analysis of the TRINITY study.

Background: Most patients with hypertension and diabetes require two or more antihypertensive agents to achieve the recommended blood pressure (BP) goal of <130/80 mm Hg. This prespecified subgroup analysis from the TRIple Therapy with Olmesartan Medoxomil, Amlodipine, and Hydrochlorothiazide in HyperteNsIve PatienTs StudY assessed the efficacy and safety of triple-combination treatment (olmesartan medoxomil 40/amlodipine besylate 10/hydrochlorothiazide 25 mg) versus the component dual-combination treatments according to diabetes status (diabetes; non-diabetes).

Methods: Participants received dual-combination treatment for 4 weeks or placebo for 2 weeks.

A new paradigm in the treatment of the cardiovascular disease continuum: focus on prevention.

The cardiovascular disease continuum (CVDC) is a sequence of cardiovascular events, which begins from a cluster of cardiovascular risk factors consisting of diabetes mellitus, dyslipidemia, hypertension, smoking and visceral obesity. If these factors are not intervened with early, they will, inexorably, progress to atherosclerosis, coronary artery disease, myocardial infarction, left ventricular hypertrophy, left ventricular dilatation leading to left ventricular diastolic or systolic dysfunction and eventually end stage heart failure and death. For this concise review, a Medline search of the English language literature between the years 2000 and 2009 was conducted and 33 pertinent publications were selected.

Current status of aggressive blood pressure control.

The concept of treatment of hypertension has gone through wide swings over the years. From ignoring blood pressure (BP) treatment initially, to aggressive BP control recently. As newer and more effective drugs were developed, it was possible to lower BP to very low levels.

Triple-drug, fixed-dose combinations for the treatment of hypertension: focus on olmesartan/amlodipine/hydrochlorothiazide combination.

Hypertension is a major risk factor for cardiovascular, renal and stroke complications. Its incidence continues to rise worldwide, and it is projected that by the year 2025, 1 billion people will be hypertensive. Despite the enormity of the high blood pressure burden, its control to < 140/90 mmHg for uncomplicated hypertensives and < 130/80 mmHg for patients with diabetes mellitus, chronic kidney disease or coronary artery disease remains poor and currently stands at approximately 50%.

Current status of aggressive blood glucose and blood pressure control in diabetic hypertensive subjects.

Uncontrolled diabetes mellitus (DM) is associated with high cardiovascular morbidity and mortality. The coexistence of hypertension and DM multiplies the diabetic complications manifold. Earlier studies have shown that lowering blood glucose, blood pressure (BP), or both decreases the diabetic complications.

Stopping the cardiovascular disease continuum: Focus on prevention.

The cardiovascular disease continuum (CVDC) is a sequence of events, which begins from a host of cardiovascular risk factors that consists of diabetes mellitus, dyslipidemia, hypertension, smoking and visceral obesity. If it is not intervened with early, it inexorably progresses to atherosclerosis, coronary artery disease, myocardial infarction, left ventricular hypertrophy, and left ventricular dilatation, which lead to left ventricular diastolic or systolic dysfunction and eventually end-stage heart failure and death. Treatment intervention at any stage during its course will either arrest or delay its progress.

Current evidence on the hemodynamic and blood pressure effects of isometric exercise in normotensive and hypertensive persons.

Isometric exercise is associated with acute hemodynamic changes consisting of increases in systolic, diastolic, and mean arterial pressure and also an increase in heart rate and cardiac output. The peripheral vascular resistance is either not changed or decreased. These hemodynamic changes return to baseline values soon after the completion of exercise.

The role of Angiotensin receptor blocker and calcium channel blocker combination therapy in treating hypertension: focus on recent studies.

Hypertension remains a significant health problem, affecting approximately 30% of the US population. Of these, only 36.8% have BP controlled to recommended levels of <140/90 mmHg for uncomplicated hypertension and <130/80 mmHg for patients with diabetes mellitus or renal disease.

Effectiveness of lowering blood pressure to prevent stroke versus to prevent coronary events.

The concept of the J-curve effect has been around for a long time and is a subject of contention among various investigators. The J-curve effect describes an inverse relation between low blood pressure (BP) and cardiovascular complications. Because the coronary arteries are perfused during diastole, this effect is seen mostly with low diastolic BP in the range of 70 to 80 mm Hg, depending on preexisting coronary artery disease, hypertension, or left ventricular hypertrophy.

Safety and tolerability of an olmesartan medoxomil-based regimen in patients with stage 1 hypertension: a randomized, double-blind, placebo-controlled study.

Background: One of the reasons for suboptimal blood pressure (BP) control in patients with hypertension is poor adherence to treatment, which may be caused by treatment-emergent adverse events. Therefore, it is crucial for an antihypertensive agent to provide a high level of efficacy without compromising tolerability.

Objective: To evaluate the safety and tolerability of a titrate-to-goal, olmesartan medoxomil-based therapy in patients with stage 1 hypertension (seated systolic BP [SeSBP] of 140-159 mmHg or seated diastolic BP [SeDBP] of 90-99 mmHg).

The antihypertensive effectiveness and safety of dual RAAS blockade with aliskiren and valsartan.

The renin-angiotensin-aldosterone system (RAAS) is a major factor for the development and maintenance of hypertension and a major cause for cardiovascular remodeling and cardiovascular complications through its active peptide angiotensin (Ang) II. Blockade of RAAS with ACE inhibitors (ACEIs) results in suppression of Ang II levels, which eventually return to baseline levels after prolonged ACEI administration. This leads to an escape phenomenon through generation of Ang II from enzymes other than ACE and led to the hypothesis that dual blockade of RAAS with an ACEI/Ang receptor blocker (ARB) combination could lead to total blockade of RAAS, since ARBs block the action of Ang II at the AT1 receptor level, irrespective of the mechanism of Ang II generation and will have an additive blood pressure (BP)-lowering effect.

Current status of dual Renin Angiotensin aldosterone system blockade for the treatment of cardiovascular diseases.

Clinical and experimental studies have shown that the initial suppression of angiotensin II after the administration of angiotensin-converting enzyme (ACE) inhibitors is later reversed and returns almost to pretreatment levels. This raised the hypothesis of the "escape phenomenon," which was strengthened by the discovery that angiotensin II can also be generated through non-ACEs. Therefore, the addition of angiotensin receptor blockers to ACE inhibitors would produce additional benefits by blocking all angiotensin II at the angiotensin II receptor type 1 level and in addition allowing angiotensin II to stimulate the unoccupied angiotensin II receptor type 2, causing additional vasodilation and antiremodeling effects.

Efficacy and tolerability of amlodipine plus olmesartan medoxomil in patients with difficult-to-treat hypertension.

Hypertension is particularly prevalent in patients aged ≥65 years, those with a body mass index ≥30 kg m(-2), Blacks and those with type II diabetes. Here we report a prespecified secondary analysis of the efficacy of amlodipine (10 mg day(-1)), olmesartan medoxomil (40 mg day(-1)), a combination of the two and placebo in these subgroups. Patients were randomized to treatment for 8 weeks.

The treatment of cardiovascular disease continuum: focus on prevention and RAS blockade.

The cardiovascular disease continuum is a sequence of events, which begins with a host of risk factors consisting of diabetes mellitus, dyslipidemia, hypertension, smoking and visceral obesity. If left untreated, it will inexorably progress to atherosclerosis, CAD, myocardial infarction, left ventricular remodeling, LVH, left ventricular enlargement, and eventually end-stage heart failure and death. Treatment intervention at any stage of its course will prevent or delay its further progression.

Efficacy and safety of long-term treatment with the combination of amlodipine besylate and olmesartan medoxomil in patients with hypertension.

J Clin Hypertens (Greenwich). 2009;11:475-482. (c) 2009 Wiley Periodicals, Inc.

Amlodipine besylate/olmesartan medoximil fixed combination for the treatment of hypertension.

National and international guidelines recommend the use of combination drugs as a first-line therapy for persons with stage 2 hypertension (blood pressure > or =160/100 mmHg). Although hypertension is common (30% of adults in the USA), its control to recommended blood pressure levels of under 140/90 mmHg remains low, at 36.8%.

Combination therapy with olmesartan medoxomil and hydrochlorothiazide: secondary analysis of the proportion of patients achieving recommended blood pressure goals from a randomized, double-blind, factorial study.

Background: The combination of olmesartan medoxomil and hydrochlorothiazide (HCTZ) [olmesartan medoxomil/HCTZ] has previously been shown to produce significantly greater SBP/DBP reductions than monotherapy with either agent alone in a randomized, double-blind, factorial study in patients with stage 2 hypertension. Compared with the evaluation of a single mean BP reduction in a patient population, determining the efficacy of an antihypertensive agent in achieving multiple BP targets provides additional information about the range of BP reductions attainable within this study population.

Objective: To conduct a secondary analysis of this study to evaluate the proportion of patients achieving combined SBP/DBP targets recommended in current hypertension treatment guidelines as well as individual SBP and DBP targets.

Irbesartan/hydrochlorothiazide for the treatment of isolated systolic hypertension: a subgroup analysis of the INCLUSIVE trial.

This post hoc analysis of the Irbesartan/Hydrochlorothiazide (HCTZ) Blood Pressure Reductions in Diverse Patient Populations (INCLUSIVE) trial evaluated the efficacy and safety of fixed-dose irbesartan/HCTZ in patients with isolated systolic hypertension. Adults with uncontrolled systolic blood pressure (SBP) (140-179 mm Hg; 130-179 mm Hg in type 2 diabetes) after 4 weeks or more of antihypertensive monotherapy once-daily treatment with placebo for 4-5 weeks, followed by HCTZ 12.5 mg for 2 weeks, irbesartan/HCTZ 150/12.