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Roland Asmar - One of the best experts on this subject based on the ideXlab platform.

George L Bakris - One of the best experts on this subject based on the ideXlab platform.

  • redefining Diuretics use in hypertension why select a thiazide like Diuretic
    Journal of Hypertension, 2019
    Co-Authors: Michel Burnier, George L Bakris, Bryan Williams
    Abstract:

    : Diuretics are listed in hypertension guidelines as one of three equally weighted first-line treatment options. In order to differentiate between antihypertensives, a lot of discussion has been directed at side effect profiles and as a result, has created a perhaps disproportionate fear of the metabolic effects that can be associated with Diuretics. Data, however, show that the risk of a clinically meaningful change in laboratory parameters is very low, whereas the benefits of volume control and natriuresis are high and the reductions in morbidity and mortality are clinically significant. Moreover, as clinically significant differences in safety and efficacy profiles exist among Diuretics, several international guidelines have started making a distinction between thiazides (hydrochlorothiazide) and Thiazide-Like (chlorthalidone, indapamide) Diuretics; and some of them now recommend longer acting Thiazide-Like Diuretics. In time, pending more data, chlorthalidone and indapamide may need to be subdivided further into separate classifications.

  • The Contribution of the ACCOMPLISH Trial to the Treatment of Stage 2 Hypertension
    Current Hypertension Reports, 2014
    Co-Authors: James Brian Byrd, George L Bakris, Kenneth Jamerson
    Abstract:

    The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommended a Thiazide-Like Diuretic, alone or in combination with other antihypertensive drug classes, as initial therapy for hypertension. JNC 7, however, did not specify preferred combinations. The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial was completed five years after the JNC 7 and demonstrated a 20 % advantage in cardiovascular risk reduction when blood pressure was lowered using the single-pill combination of benazepril-amlodipine compared to benazepril-hydrochlorothiazide (Jamerson et al. 359(23):2417–28 [1]). This new and significant finding provided compelling evidence that the long-standing preference for Diuretics as initial therapy could be refuted, but it may also be relevant to the lower-than-expected reduction in coronary disease related events (compared to stroke) observed for decades prior to the ACCOMPLISH approach to therapy. The JNC 8 panel members recently published their recommendations, and while the group did not recommend benazepril-hydrochlorothiazide over other combinations, they did highlight the findings of ACCOMPLISH, rating the primary ACCOMPLISH paper as “good.” The American Society of Hypertension position paper and the European Hypertension Society guidelines endorse such combinations as a first-line agent for patients with stage 2 hypertension. We review the current position of ACCOMPLISH in the guidelines regarding treatment of stage 2 hypertension.

  • azilsartan medoxomil plus chlorthalidone reduces blood pressure more effectively than olmesartan plus hydrochlorothiazide in stage 2 systolic hypertension
    Hypertension, 2012
    Co-Authors: William C. Cushman, George L Bakris, William B. White, Domenic A Sica, Michael Weber, A V Roberts, Eric E Lloyd, Stuart Kupfer
    Abstract:

    Azilsartan medoxomil, an effective, long-acting angiotensin II receptor blocker, is a new treatment for hypertension that is also being developed in fixed-dose combinations with chlorthalidone, a potent, long-acting Thiazide-Like Diuretic. We compared once-daily fixed-dose combinations of azilsartan medoxomil/chlorthalidone force titrated to a high dose of either 40/25 mg or 80/25 mg with a fixed-dose combination of the angiotensin II receptor blocker olmesartan medoxomil plus the thiazide Diuretic hydrochlorothiazide force titrated to 40/25 mg. The design was a randomized, 3-arm, double-blind, 12-week study of 1071 participants with baseline clinic systolic blood pressure 160 to 190 mm Hg and diastolic blood pressure ≤119 mm Hg. Patients had a mean age of 57 years; 59% were men, 73% were white, and 22% were black. At baseline, mean clinic blood pressure was 165/96 mm Hg and 24-hour mean blood pressure was 150/88 mm Hg. Changes in clinic (primary end point) and ambulatory systolic blood pressures at week 12 were significantly greater in both azilsartan medoxomil/chlorthalidone arms than in the olmesartan/hydrochlorothiazide arm ( P

  • blood pressure lowering efficacy of the fixed dose combination of azilsartan medoxomil and chlorthalidone a factorial study
    Journal of Clinical Hypertension, 2012
    Co-Authors: Domenic A Sica, George L Bakris, William B. White, William C. Cushman, A V Roberts, Michael A Weber, Patrick Huang, Stuart Kupfer
    Abstract:

    This study compared the efficacy and safety of fixed-dose combinations (FDCs) of the angiotensin II receptor blocker azilsartan medoxomil (AZL-M) and the Thiazide-Like Diuretic chlorthalidone (CLD) with the individual monotherapies in a double-blind factorial study. A total of 1714 patients with clinic systolic blood pressure (SBP) 160 mm Hg to 190 mm Hg inclusive were randomized to AZL-M 0 mg, 20 mg, 40 mg, or 80 mg and/or chlorthalidone 0 mg, 12.5 mg, or 25 mg. The primary efficacy end point was change from baseline to 8 weeks in trough (hour 22-24) SBP by ambulatory blood pressure (BP) monitoring (ABPM). Patients' mean age was 57 years; 47% were men and 20% were black. Baseline trough BP was approximately 165/95 mm Hg and 151/91 mm Hg by clinic and ABPM measurements, respectively. For the pooled AZL-M/CLD 40/25-mg and 80/25-mg FDC groups, SBP reduction by ABPM at trough was 28.9 mm Hg and exceeded AZL-M 80 mg and CLD 25 mg monotherapies by 13.8 mm Hg and 13 mm Hg, respectively (P<.001 for both comparisons). Discontinuation rates and elevations in serum creatinine were dose-dependent and occurred more often in the AZL-M/CLD groups. In patients with stage 2 hypertension, treatment with the combination of AZL-M and CLD resulted in substantially greater SBP reduction compared with either agent alone.

Johnmichael Gamble - One of the best experts on this subject based on the ideXlab platform.

  • thiazide Diuretic induced change in fasting plasma glucose a meta analysis of randomized clinical trials
    Journal of General Internal Medicine, 2020
    Co-Authors: Jill Hall, Dean T Eurich, Danielle Nagy, Lisa Tjosvold, Johnmichael Gamble
    Abstract:

    Prior meta-analyses measuring thiazide-induced glycemic change have demonstrated an increased risk of incident diabetes; however, this measure’s definition has changed over time. To determine the magnitude of change in fasting plasma glucose (FPG) for thiazide Diuretics. A research librarian designed and conducted searches in Medline®, EMBASE, and EBM Reviews-Cochrane Central Register of Controlled Trials (inception through July 2018) and International Pharmaceutical Abstracts (inception to December 2014). Randomized, controlled trials comparing a thiazide or Thiazide-Like Diuretic to any comparator reporting FPG were identified. Trials enrolling < 50 participants, those with a follow-up period of < 4 weeks, and conference abstracts were excluded. Independent duplicate screening of citations and full-text articles, data extraction, and assessment of risk of bias was conducted. Ninety-five studies were included (N = 76,608 participants), with thiazides compared with placebo, beta-blockers, calcium channel blockers, renin-angiotensin-aldosterone-system inhibitors, potassium-sparing Diuretic, and others alone or in combination. Thiazide Diuretics marginally increased FPG (weighted mean difference 0.20 mmol/L (95% CI 0.15–0.25); I2 = 84%) (1 mmol/L = 18 mg/dL). Results did not change substantially when considering dose or duration, comparing thiazides with placebo or an active comparator, or using thiazides as monotherapy or combination therapy, even when combined with a potassium-correcting agent. Thiazide Diuretics have a small and clinically unimportant impact on FPG.

  • Thiazide Diuretic–Induced Change in Fasting Plasma Glucose: a Meta-analysis of Randomized Clinical Trials
    Journal of General Internal Medicine, 2020
    Co-Authors: Jill J. Hall, Dean T Eurich, Danielle Nagy, Lisa Tjosvold, Johnmichael Gamble
    Abstract:

    Background Prior meta-analyses measuring thiazide-induced glycemic change have demonstrated an increased risk of incident diabetes; however, this measure’s definition has changed over time. Aim To determine the magnitude of change in fasting plasma glucose (FPG) for thiazide Diuretics. Data Sources A research librarian designed and conducted searches in Medline®, EMBASE, and EBM Reviews-Cochrane Central Register of Controlled Trials (inception through July 2018) and International Pharmaceutical Abstracts (inception to December 2014). Study Selection Randomized, controlled trials comparing a thiazide or Thiazide-Like Diuretic to any comparator reporting FPG were identified. Trials enrolling

Anna F Dominiczak - One of the best experts on this subject based on the ideXlab platform.

Martine De Champvallins - One of the best experts on this subject based on the ideXlab platform.