Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy

Roland Asmar1, Juan Garcia-Puig2, Philippe Gosse3, Yuri A Karpov4, Peter Wilhem De Leeuw5, Dieter Magometschniggs6, Lajos Matos7, Roland Schmieder81Institut Cardiovasculaire, Paris, France; 2Hospital La Paz, Madrid, Spain; 3Hôpital Saint André, Bordeaux, France; 4Russian Academy of Medical Sciences, Moscow, Russia; 5Academisch Ziekenhuis, Maastricht, the Netherlands; 6Institut für Hypertoniker, Vienna, Austria; 7Hungarian Institut of Cardiology, Budapest, Hungary; 8Medizinische FakultÄt, Erlangen GermanyBackground: Ambulatory blood pressure (BP) is more sensitive than office BP and is highly correlated with the left ventricular mass (LVM) of hypertensive patients with left ventricular hypertrophy (LVH). Methods: In this prospectively designed ancillary study of the PICXEL trial, the effects of first-line combination perindopril/indapamide on ambulatory BP were compared with those of monotherapy with enalapril in 127 patients. Hypertensive patients with LVH received once daily either perindopril 2 mg/indapamide 0.625 mg (n = 65) or enalapril 10 mg (n = 62) for 52 weeks. Dose adjustments were allowed for uncontrolled BP. Twenty-four-hour ambulatory BP and echocardiographic parameters were measured at baseline, week 24, and week 52. Results: At study end, both treatments significantly improved ambulatory BP compared with baseline (p ≤ 0.01). Perindopril/indapamide treatment reduced 24-hour and daytime systolic BP (SBP) and pulse pressure (PP) significantly more than enalapril treatment (p < 0.01). No significant between-group differences were noted for diastolic BP (DBP) or for night-time measurements. Trough/peak ratios were higher with perindopril/indapamide than with enalapril (88.5 vs 65.8 for SBP and 86.7 vs 63.9 for DBP, respectively). The global smoothness index was higher with perindopril/indapamide than with enalapril (6.6 vs 5.2 for SBP and 5.6 vs 4.9 for DBP, respectively). With perindopril/indapamide treatment, LVM index was significantly reduced (−9.1 g/m2 from baseline; p vs baseline <0.001). More patients required dose increases with enalapril (87%) than with perindopril/indapamide (71%). No unusual safety elements were noted.Conclusions: First-line perindopril/indapamide combination decreased ambulatory SBP and PP, and LVM more effectively than enalapril.Keywords: left ventricular hypertrophy, ambulatory blood pressure monitoring, perindopril, indapamide, enalapri

A Systematic Approach For Kinematic Design Of Upper Limb Rehabilitation Exoskeletons

Kinematic structure of an exoskeleton is the most fundamental block of its design and is determinant of many functional capabilities of it. Although numerous upper limb rehabilitation devices have been designed in the recent years, there is not a framework that can systematically guide the kinematic design procedure. Additionally, diversity of currently available devices and the many minute details incorporated to address certain design requirements hinders pinpointing the core kinematics of the available devices to compare them against each other. This makes the review of literature for identifying drawbacks of the state of the art systems a challenging and puzzling task. In fact, lack of a unifying framework makes designing rehabilitation devices an intuitive process and prone to biases from currently available designs. This research work proposes a systematic approach for kinematic design of upper limb rehabilitation exoskeletons based on conceptual design techniques. Having defined a solution neutral problem statement based on the characteristics of an ideal device, the main functionality of the system is divided into smaller functional units via the Functional Decomposition Method. Various directions for concept generation are explored and finally, it has been shown that a vast majority of the current exoskeleton designs fit within the proposed design framework and the defined functionalities

Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: The PICXEL study

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy-0

<p><b>Copyright information:</b></p><p>Taken from "Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy"</p><p></p><p>Vascular Health and Risk Management 2007;3(4):371-380.</p><p>Published online Jan 2007</p><p>PMCID:PMC2291338.</p><p>© 2007 Dove Medical Press Limited. All rights reserved</p

Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy-1

<p><b>Copyright information:</b></p><p>Taken from "Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy"</p><p></p><p>Vascular Health and Risk Management 2007;3(4):371-380.</p><p>Published online Jan 2007</p><p>PMCID:PMC2291338.</p><p>© 2007 Dove Medical Press Limited. All rights reserved</p

Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy-3

<p><b>Copyright information:</b></p><p>Taken from "Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy"</p><p></p><p>Vascular Health and Risk Management 2007;3(4):371-380.</p><p>Published online Jan 2007</p><p>PMCID:PMC2291338.</p><p>© 2007 Dove Medical Press Limited. All rights reserved</p

Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy-4

<p><b>Copyright information:</b></p><p>Taken from "Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy"</p><p></p><p>Vascular Health and Risk Management 2007;3(4):371-380.</p><p>Published online Jan 2007</p><p>PMCID:PMC2291338.</p><p>© 2007 Dove Medical Press Limited. All rights reserved</p

Efficacy of very low dose perindopril 2 mg/indapamide 0.625 mg combination on left ventricular hypertrophy in hypertensive patients: The P.I.C.X.E.L. Study rationale and design

The PICXEL study is designed to evaluate the effects of long-term administration of very low-dose combination perindopril 2 mg/indapamide 0.625 mg (Per/Ind) vs enalapril in reducing left ventricular hypertrophy (LVH) in hypertensive patients. This multicentre, controlled, randomised, double-blind, parallel group study is carried-out to assess the variation of left ventricular mass index (LVMI) after treatment, using a centralised control of M-mode echocardiography determinations, and a dedicated software for semi-automatic measurement. Following a 4-week placebo run-in period, hypertensive outpatients aged ≥18 years, with LVH (LVMI >120 and 100 g/m2 for men and women, respectively), are randomised to receive once daily, over 52 weeks, either Per/Ind or enalapril. According to blood pressure levels, the dose may be adjusted. In addition to clinical examinations, ECG, blood pressure, heart rate and laboratory assessments echocardiographic determinations are performed for selection, at baseline, after 24 weeks and at the end of the study. The main outcome criteria is the change from baseline in LVMI which is considered the primary efficacy criterion; changes in blood pressure and echo-Doppler parameters constitute secondary criteria. Two-sided Student's t-test for independent samples will be used to differentiate the effects of the treatment between groups with α = 5%, and the inter-group difference of LVMI variation will be analysed with a power of 90%. A sample size of 500 patients is required making it necessary to randomise at least 550 patients, based on a 10% proportion of potentially non-assessable patients. The results of this study, obtained after applying strict methodological procedures and requirements, are expected to provide valuable and reliable information on the effects of long-term administration of Per/Ind on LVH, and on its potential superiority over enalapril.SCOPUS: ar.jinfo:eu-repo/semantics/publishe