NEWSLETTER 7 - MAGGIO 2009
Ipertensione e diabetePrevention of diabetes and cardiovascular disease in patients with impaired glucose tolerance: rationale and design of the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) Trial.
Am Heart J 2008 Oct;156(4):623-32 (ISSN: 1097-6744)
Califf RM; Boolell M; Haffner SM; Bethel MA; McMurray J; Duggal A; Holman RR
Duke Transitional Medicine Institute, Durham, NC 27715, USA; Collective Name: NAVIGATOR Study Group.
Patients with impaired glucose tolerance (IGT) have increased risk for developing type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Lifestyle modification and medication can prevent or delay progression to diabetes (PD), but whether such interventions also reduce the risk of CVD has not been rigorously tested. The Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial is a multinational, randomized, double-blind, 2 x 2 factorial trial in subjects with IGT (on a screening oral glucose tolerance test [OGTT]) aged > or = 50 years with known CVD or aged > or = 55 years with > or = 1 CVD risk factor. Enrollment began in January 2002 and was completed January 2004, with 9,518 patients randomized to receive 1 of 4 possible treatment combinations as follows: nateglinide with valsartan, nateglinide with valsartan-placebo, nateglinide-placebo with valsartan, or nateglinide-placebo with valsartan-placebo. All subjects are participating in a clinic-based and telephone-based lifestyle intervention aimed at reducing weight and dietary fat and increasing ... [Continua]
Valsartan improves arterial stiffness in type 2 diabetes independently of blood pressure lowering.
Hypertension 2008 Jun;51(6):1617-23 (ISSN: 1524-4563)
Karalliedde J; Smith A; De Angelis L; Mirenda V; Kandra A; Botha J; Ferber P; Viberti G
Cardiovascular Division, King's College London School of Medicine, United Kingdom. j.karalliedde@kcl.ac.uk.
Increased arterial stiffness, as estimated from aortic pulse wave velocity (Ao-PWV), and albuminuria are independent predictors for cardiovascular disease in type 2 diabetes mellitus (T2DM). Whether angiotensin receptor blockers (ARBs), drugs with cardio-renal protective effects, improve Ao-PWV to a greater extent than other equipotent antihypertensive medications remains unclear. After a 4-week washout phase, we compared the effects of valsartan (n=66), an ARB, with that of amlodipine (n=65), a calcium channel blocker on Ao-PWV in 131 T2DM patients with pulse pressure (PP) >or=60 mm Hg and raised albumin excretion rate (AER) in a 24-week randomized, double-blind, parallel group study. Hydrochlorothiazide (HCTZ) 25 mg/d was added to valsartan 160 mg and amlodipine 5 mg/od uptitrated to 10 mg/od after 4 weeks to ensure equivalent BP control. After 24 weeks brachial and central aortic PP had fallen to a similar extent with attained mean (SD) brachial and ... [Continua]
Development of heart failure in recent hypertension trials.
J Hypertens 2008 Jul;26(7):1477-86 (ISSN: 0263-6352)
Tocci G; Sciarretta S; Volpe M
Division of Cardiology, II Faculty of Medicine, University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.
BACKGROUND: Heart failure represents a major cause of disease burden worldwide and is expected to further rise in the coming decades. Hypertension is the clinical condition most frequently associated to heart failure. OBJECTIVE: To systematically review the incidence of heart failure compared to coronary heart diseases and stroke in recent hypertension trials. METHODS: We identified 23 trials concluded within the last decade including 193,424 patients with hypertension or at 'high' cardiovascular risk with a predominant presence of hypertensive patients, and reported incidence of major cardiovascular events, including heart failure, coronary heart disease and stroke. RESULTS: A total of 24 837 major cardiovascular events were recorded in trials performed between 1997 and 2007, of which 7171 (28.9%) were cases of heart failure, 10,223 (41.1%) of coronary heart disease and 7443 (30.0%) of stroke. The rate of heart failure was comparable with that of stroke, accounting for 8.5 and 9.1 events per 1000 patients (P = NS), respectively. Heart failure development was more prevalent in older sub ... [Continua]
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