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 .
Effects of Ramipril and Vitamin E on Atherosclerosis: The Study to Evaluate Carotid Ultrasound Changes in Patients Treated With Ramipril and Vitamin E (SECURE)
Background —Activation of the renin-angiotensin-aldosterone system and oxidative modification of LDL cholesterol play important roles in atherosclerosis . The Study to Evaluate Carotid Ultrasound changes in patients treated with Ramipril and vitamin E ( SECURE ) , a sub study of the Heart Outcomes Prevention Evaluation ( HOPE ) trial , was a prospect i ve , double-blind , 3 × 2 factorial design trial that evaluated the effects of long-term treatment with the angiotensin-converting enzyme inhibitor ramipril and vitamin E on atherosclerosis progression in high-risk patients . Methods and Results —A total of 732 patients ≥55 years of age who had vascular disease or diabetes and at least one other risk factor and who did not have heart failure or a low left ventricular ejection fraction were r and omly assigned to receive ramipril 2.5 mg/d or 10 mg/d and vitamin E ( RRR-&agr;-tocopheryl acetate ) 400 IU/d or their matching placebos . Average follow-up was 4.5 years . Atherosclerosis progression was evaluated by B-mode carotid ultrasound . The progression slope of the mean maximum carotid intimal medial thickness was 0.0217 mm/year in the placebo group , 0.0180 mm/year in the ramipril 2.5 mg/d group , and 0.0137 mm/year in the ramipril 10 mg/d group ( P = 0.033 ) . There were no differences in atherosclerosis progression rates between patients on vitamin E and those on placebo . Conclusions —Long-term treatment with ramipril had a beneficial effect on atherosclerosis progression  . Vitamin E had a neutral effect on atherosclerosis progression
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 .