Effects of antihypertensive drugs on SBP variability are dose-dependent and persist when used in combinations .
Use of a high dose of a calcium channel blocker alone or in combination with other agents is therefore likely to be particularly effective in prevention of stroke
BACKGROUND AND PURPOSE Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke , is reduced by calcium channel blockers and diuretics , and increased by β-blockers .
However , it is unknown whether these effects are dose-dependent and persist in combination with other drugs .
Supramaximal dose of candesartan in proteinuric renal disease.
High levels of proteinuria predict renal deterioration , suggesting that interventions to reduce proteinuria may postpone the development of severe renal impairment . This multicenter Canadian trial evaluated whether supramaximal dosages of c and esartan would reduce proteinuria to a greater extent than the maximum approved antihypertensive dosage . The authors r and omly assigned 269 patients who had persistent proteinuria ( > or = 1 g/d ) despite 7 wk of treatment with the highest approved dosage of c and esartan ( 16 mg/d ) to 16 , 64 , or 128 mg/d c and esartan for 30 wk . The median serum creatinine level was 130.0 micromol/L ( 1.47 mg/dl ) , and the median urinary protein excretion was 2.66 g/d ; most ( 53.9 % ) patients had diabetic nephropathy . The mean difference of the percentage change in proteinuria for patients receiving 128 mg/d c and esartan compared with those receiving 16 mg/d c and esartan was -33.05 % ( 95 % confidence interval -45.70 to -17.44 ; P < 0.0001 ) . Reductions in BP were not different across the three treatment groups . Elevated serum potassium levels ( K+ > 5.5 mEq/L ) led to the early withdrawal of 11 patients , but there were no dosage-related increases in adverse events . In conclusion , proteinuria that persists despite treatment with the maximum recommended dosage of c and esartan can be reduced by increasing the dosage of c and esartan further , but serum potassium levels should be monitored during treatment
Effects of antihypertensive drugs on SBP variability are dose-dependent and persist when used in combinations .
Use of a high dose of a calcium channel blocker alone or in combination with other agents is therefore likely to be particularly effective in prevention of stroke
BACKGROUND AND PURPOSE Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke , is reduced by calcium channel blockers and diuretics , and increased by β-blockers .
However , it is unknown whether these effects are dose-dependent and persist in combination with other drugs .