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5. Hypertensie

Author

Deinum, J., Elte, J.W.F., editor, Overbosch, D., editor, Gans, R.O.B., editor, and Aken, M.O., editor

Published
2015
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8. The effects of induced blood pressure increase and decrease on cerebral small vessels: The Hyperintense study

Author

Janssen, E., Telgte, A. ter, Verburgt, E., Jong, J.J.A. de, Marques, J.P., Kessels, R.P.C., Backes, W.H., Maas, M.C., Meijer, F.J.A., Deinum, J., Riksen, N.P., Tuladhar, A.M., and Leeuw, H.F. de

Subjects
Neuro- en revalidatiepsychologie, Physiology, Neuropsychology and rehabilitation psychology, Internal Medicine, Cardiology and Cardiovascular Medicine, 320 000 MR Structural Quantitative Imaging
Abstract

Item does not contain fulltext 2 p.

Published
2023

10. The position of renal denervation in treatment of hypertension: an expert consensus statement

Author

Zeijen, V. J. M., primary, Kroon, A. A., additional, van den Born, B. H., additional, Blankestijn, P. J., additional, Meijvis, S. C. A., additional, Nap, A., additional, Lipsic, E., additional, Elvan, A., additional, Versmissen, J., additional, van Geuns, R. J., additional, Voskuil, M., additional, Tonino, P. A. L., additional, Spiering, W., additional, Deinum, J., additional, and Daemen, J., additional

Published
2022
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11. Volumetric evaluation of CT images of adrenal glands in primary aldosteronism

Author

Velema, M.S., Canu, L., Dekkers, T., Hermus, A.R.M.M., Timmers, H.J.L.M., Schultze Kool, L.J., Groenewoud, H., Sweep, F.C.G.J., Wilt, G.J. van der, Langenhuijsen, J.F., Lenders, J.W.M., Jacobs, C., Deinum, J., Public and occupational health, Vascular Medicine, ACS - Atherosclerosis & ischemic syndromes, APH - Personalized Medicine, APH - Global Health, and ACS - Heart failure & arrhythmias

Subjects
Prognostic factor, Adrenal gland neoplasms, Endocrinology, Diabetes and Metabolism, Concordance, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Adrenal Gland Neoplasm, Stress-related disorders Donders Center for Medical Neuroscience [Radboudumc 13], X-ray computed, 030209 endocrinology & metabolism, Normal values, CT-scanning, Unilateral disease, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Primary aldosteronism, Diagnosis, Hyperaldosteronism, medicine, In patient, Tomography, business.industry, Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16], medicine.disease, Women's cancers Radboud Institute for Health Sciences [Radboudumc 17], Urological cancers Radboud Institute for Health Sciences [Radboudumc 15], 030220 oncology & carcinogenesis, Nuclear medicine, business, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Abstract

Contains fulltext : 244324.pdf (Publisher’s version ) (Open Access) OBJECTIVES: To investigate whether adrenal volumetry provides better agreement with adrenal vein sampling (AVS) than conventional CT for subtyping PA. Furthermore, we evaluated whether the size of this contralateral adrenal was a prognostic factor for clinical outcome after unilateral adrenalectomy. METHODS: We retrospectively analyzed volumes of both adrenal glands of the 180 CT-scans (88/180 with unilateral and 92/180 with bilateral disease) of the patients with PA included in the SPARTACUS trial of which 85 also had undergone an AVS. In addition, we examined CT-scans of 20 healthy individuals to compare adrenal volumes with published normal values. RESULTS: Adrenal volume was higher for the left than the right adrenal (mean and SD: 6.49 ± 2.77 ml versus 5.25 ± 1.87 ml for the right adrenal; p

Published
2021

12. Stepwise Treatment of Uncontrolled Hypertension (Stepwise-HTN): Study Design of a Cluster Randomised Controlled Trial in Primary Care

Author

Kilic, Birsen, Biermans, M.C.J., Rutten, Frans H., Deinum, J., Spiering, W., Wel, M.C. van der, Grauw, W.J.C. de, Bots, M.L., and Hollander, Monika

Subjects
History, All institutes and research themes of the Radboud University Medical Center, Polymers and Plastics, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Pharmacology (medical), General Medicine, Business and International Management, Industrial and Manufacturing Engineering
Abstract

Contains fulltext : 290550.pdf (Publisher’s version ) (Open Access)

Published
2022

13. [Dizziness upon standing: consider autonomic dysfunction]

Author

Riksen, N.P., Rutten, J.H.W., Bloem, B.R., and Deinum, J.

Subjects
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16], Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3]
Abstract

Contains fulltext : 251929.pdf (Publisher’s version ) (Open Access) Many people, particularly elderly, experience dizziness upon standing. It is important to always measure the blood pressure and heart rate in the supine and standing position in these patients. In case of orthostatic hypotension with an insufficient increase in heart rate, one has to consider autonomic dysfunction. Alpha-synucleopathies are frequent causes of autonomic dysfunction, including Parkinson's disease, Pure Autonomic Failure and Multiple System Atrophy. The quality of life can significantly be improved in patients with autonomic dysfunction due to life-style measures (increased salt and water intake, compressive stockings, head-up sleeping) and medication to increase blood pressure (fludrocortisone, midodrine). There is often a considerable delay in the diagnosis of autonomic dysfunction, which prevents adequate treatment. The main message of this paper is that we should all search for orthostatic hypotension in patients with dizziness and, in case of insufficient heart rate increase, refer these patients for autonomic function testing.

Published
2022

14. Higher SBP in female patients with mitochondrial disease

Author

Viering, D.H.H.M., Borselen, M.D. van, Deinum, J., Bindels, R.J.M., Baaij, J.H.F. de, and Janssen, M.C.H.

Subjects
All institutes and research themes of the Radboud University Medical Center, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Physiology, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Internal Medicine, Metabolic Disorders Radboud Institute for Molecular Life Sciences [Radboudumc 6], Cardiology and Cardiovascular Medicine, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract

Contains fulltext : 250176.pdf (Publisher’s version ) (Open Access)

Published
2022

18. Hoge bloeddruk in het ziekenhuis: Medicatie intensiveren of vooral negeren?

Author

van den Born, Bert-Jan, Versmissen, Jorie, Deinum, J (Jacob), Internal Medicine, and Pharmacy

Abstract

Regelmatig worden bij patiënten die in het ziekenhuis zijn opgenomen te hoge bloeddrukwaarden gemeten. Moeten we tijdens opname met een bloeddrukverlagende behandeling beginnen of die intensiveren? Of kunnen we de bloeddrukwaarden beter negeren?

Published
2021

22. [High blood pressure in the hospital: intensify medication or ignore?]

Author

Born, B.J. van den, Versmissen, J., and Deinum, J.

Subjects
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Abstract

Item does not contain fulltext High blood pressure is a common finding in hospitalized patients. Anxiety, pain and fever can all increase blood pressure to various degrees. The question is whether this adaptive response is harmful and should lead to initiation or intensification of treatment or can be ignored. A recent retrospective study has shown that intensification of blood pressure lowering medication in patients who are hospitalized with non-cardiac conditions is associated with a higher incidence of in-hospital complications, in particular myocardial infarction and renal insufficiency, while another study demonstrated that patients who are discharged from hospital with intensified antihypertensive treatment have an increased risk of readmission without a reduction in cardiac events after one year. Although retrospective in nature, these data show that we should be careful with anti-hypertensive medication in patients hospitalized for non-cardiac conditions and that blood pressure monitoring should be focused on the identification of low rather than high blood pressure values.

Published
2021

29. Steroid metabolome analysis reveals prevalent glucocorticoid excess in primary aldosteronism

Author

Arlt, Wiebke, Lang, Katharina, Sitch, Alice J., Dietz, A.S., Rhayem, Y., Bancos, Irina, Dekkers, T., Deinum, J., Beuschlein, F., and Reincke, M.

Subjects
All institutes and research themes of the Radboud University Medical Center, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Abstract

Contains fulltext : 189965.pdf (Publisher’s version ) (Open Access)

Published
2017

35. Adrenal vein sampling vs. CT scan to determine treatment in primary aldosteronism: An outcome-based randomised diagnostic trial

Author

Dekkers, T., primary, Prejbisz, A., additional, Schultze Kool, L.J., additional, Groenewoud, J.M.M., additional, Velema, M., additional, Spiering, W., additional, Kołodziejczyk-Kruk, S., additional, Arntz, M., additional, Kądziela, J., additional, Langenhuijsen, J.F., additional, Kerstens, M.N., additional, Van Den Meiracker, A.H., additional, Van Den Born, B.J., additional, Sweep, F.C.G.J., additional, Hermus, A.R.M.M., additional, Januszewicz, A., additional, Lighthart-Naber, A.F., additional, Makai, P., additional, Van Der Wilt, G.-J., additional, Lenders, J.W.M., additional, and Deinum, J., additional

Published
2017
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38. [Primary aldosteronism: new insights into familial forms]

Author

Meiracker, A.H. van den, Linde, A.A. van der, Claahsen-van der Grinten, H.L., Danser, A.H., and Deinum, J.

Subjects
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16]
Abstract

Item does not contain fulltext - Primary aldosteronism (PA) is characterized by autonomic aldosterone production, usually leading to severe hypertension and hypokalaemia. - PA is a heterogeneous condition caused by sporadic adrenal adenoma, bilateral adrenal hyperplasia or rare familial forms.- Familial aldosteronism type 1 is caused by a hybrid gene that codes for an ACTH-sensitive form of aldosterone synthase.- Familial aldosteronism type 3 was recently recognized as a new form of PA caused by mutation in KCNJ5. The clinical manifestations vary from life-threatening PA and pronounced adrenal hyperplasia to milder forms.- In addition to germline mutations in KCNJ5, somatic KCNJ5 mutations are present in about 40% of aldosterone-producing adrenal adenomas. Mutations in three other genes are also regularly observed.- All these mutations cause increased aldosterone synthase activity, eventually leading to PA.- In patients under 20 with PA, familial forms must be excluded before proceeding to adrenalectomy.

Published
2015

42. PP.32.13

Author

Kolodziejczyk-Kruk, S., primary, Kadziela, J., additional, Michalowska, I., additional, Prejbisz, A., additional, Pregowska-Chwala, B., additional, Makowiecka-Ciesla, M., additional, Janaszek-Sitkowska, H., additional, Toutounchi, S., additional, Skorski, M., additional, Bednarczuk, T., additional, Ambroziak, U., additional, Janas, J., additional, Koperski, L., additional, Maroszek, P., additional, Roslon, M., additional, Reincke, M., additional, Lenders, J., additional, Deinum, J., additional, Witkowski, A., additional, and Januszewicz, A., additional

Published
2015
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44. 317 - Adrenal vein sampling vs. CT scan to determine treatment in primary aldosteronism: An outcome-based randomised diagnostic trial

Author

Dekkers, T., Prejbisz, A., Schultze Kool, L.J., Groenewoud, J.M.M., Velema, M., Spiering, W., Kołodziejczyk-Kruk, S., Arntz, M., Kądziela, J., Langenhuijsen, J.F., Kerstens, M.N., Van Den Meiracker, A.H., Van Den Born, B.J., Sweep, F.C.G.J., Hermus, A.R.M.M., Januszewicz, A., Lighthart-Naber, A.F., Makai, P., Van Der Wilt, G.-J., Lenders, J.W.M., and Deinum, J.

Published
2017
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45. Evaluating the learning curve for retroperitoneoscopic adrenalectomy in a high-volume center for laparoscopic adrenal surgery.

Author

Uitert, A., D'ancona, F., Deinum, J., Timmers, H., Langenhuijsen, J., van Uitert, A, d'Ancona, F C H, Timmers, H J L M, and Langenhuijsen, J F

Subjects
LAPAROSCOPIC surgery, ADRENALECTOMY, ADRENAL tumors, BENIGN tumors, ADRENAL surgery, TUMOR treatment, RETROPERITONEUM, ADRENAL diseases, CLINICAL competence, CLINICAL trials, COMPARATIVE studies, LENGTH of stay in hospitals, HOSPITALS, LAPAROSCOPY, LEARNING, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, RESEARCH, EVALUATION research, TREATMENT effectiveness, PSYCHOLOGY, SURGERY
Abstract

Background: Laparoscopic adrenalectomy is an effective method for benign adrenal tumor removal. In the literature, both lateral transperitoneal (TLA) and posterior retroperitoneoscopic (RPA) approaches are described. Since 2007, the number of patients increased significantly in our center. Therefore, RPA was introduced in 2011 because of its potential advantages in operating and recovery times. The learning curve of RPA is now evaluated.Methods: All data of patients undergoing laparoscopic adrenalectomy from 2007 until 2014 were prospectively collected. Patients were eligible for RPA with a tumor <7 cm, with BMI < 35 kg/m2, and with low suspicion of malignancy. The learning curve of RPA was measured by operating time. Furthermore, blood loss, preoperative complications and hospital stay were analyzed. Descriptive statistics were performed using SPSS 20.0.Results: In the study period, 290 patients underwent surgery, of whom 113 underwent RPA. After starting with RPA, operating times decreased significantly (median 100 min in the first 20 patients to 60 min after 40 patients, p < 0.05). There was a significant difference in operating times (median 108 vs. 62 min, p < 0.05) and hospital stay (median 4 vs. 3 days, p < 0.05) in unilateral surgery in favor of RPA, compared to TLA. Also in bilateral surgery, operating times were significantly shorter (median 236 vs. 117 min, p < 0.05). In both groups, few major complications occurred.Conclusion: After the introduction of RPA, a short learning curve was seen for a single surgeon with extensive experience in laparoscopic adrenal surgery. Compared to TLA, RPA has significant advantages in operating times and hospital stay. Therefore, RPA may be the preferred approach for patients with BMI < 35 kg/m2 and small benign adrenal tumors (<7 cm). [ABSTRACT FROM AUTHOR]

Published
2017
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49. Untargeted Plasma Metabolomics of Endocrine Hypertension

Author

Bliziotis, N.G.B., Wevers, R.A., Timmers, H.J.L.M., Kluijtmans, L.A.J., Deinum, J., and Radboud University Nijmegen

Subjects
Radboud Institute for Molecular Life Sciences, Disorders of movement [Radboudumc 3]
Abstract

Contains fulltext : 286400.pdf (Publisher’s version ) (Open Access) Radboud University, 23 januari 2023 Promotores : Wevers, R.A., Timmers, H.J.L.M. Co-promotores : Kluijtmans, L.A.J., Deinum, J. v, 182 p.

Published
2023

50. Dual endothelin antagonist aprocitentan for resistant hypertension (PRECISION): a multicentre, blinded, randomised, parallel-group, phase 3 trial

Author

Markus P Schlaich, Marc Bellet, Michael A Weber, Parisa Danaietash, George L Bakris, John M Flack, Roland F Dreier, Mouna Sassi-Sayadi, Lloyd P Haskell, Krzysztof Narkiewicz, Ji-Guang Wang, Christopher Reid, Markus Schlaich, Ivor Katz, Andrew Ajani, Sinjini Biswas, Murray Esler, Grahame Elder, Simon Roger, David Colquhoun, John Mooney, Tine De Backer, Alexandre Persu, Martin Chaumont, Jean-Marie Krzesinski, Thomas Vanassche, Ginette Girard, Lew Pliamm, Ernesto Schiffrin, Fatima Merali, George Dresser, Michel Vallee, Shivinder Jolly, Stephen Chow, Jiguang Wang, Jianjun Mu, Jing Yu, Hong Yuan, Yingqing Feng, Xin Zhang, Jianhong Xie, Ling Lin, Miroslav Soucek, Jiri Widimsky, Renata Cifkova, Jan Vaclavik, Martin Ullrych, Martin Lukac, Ivan Rychlik, Thomas Guldager Lauridsen, Ilkka Kantola, Jyrki Taurio, Olavi Ukkola, Olivier Ormezzano, Philippe Gosse, Michel Azizi, Pierre-Yves Courand, Pascal Delsart, Jean Michel Tartiere, Felix Mahfoud, Roland Schmieder, Johannes Stegbauer, Philipp Lurz, Michael Koziolek, Christian Ott, Nicole Toursarkissian, Konstantinos Tsioufis, Konstantinos Kyfnidis, Athanasios Manolis, Sotirios Patsilinakos, Pantelis Zebekakis, Apostolos Karavidas, Pall Denes, Katalin Bezzegh, Marianna Zsom, Laszlo Kovacs, Yehonatan Sharabi, Mazen Elias, Ivetta Sukholutsky, Chaim Yosefy, Irina Kenis, Shaul Atar, Massimo Volpe, Muiesan Maria Lorenza, Stefano Taddei, Guido Grassi, Franco Veglio, Jung Woo Son, Jang-Young Kim, Joong-Il Park, Chang Hoon Lee, Hae-Young Lee, Rasa Raugaliene, Jolanta Elena Marcinkeviciene, Roma Kavaliauskiene, Jaap Deinum, Abraham Kroon, Bert-Jan van den Born, Andrzej Januszewicz, Andrzej Tykarski, Jolanta Walczewska, Zbigniew Gaciong, Andrzej Wiecek, Marzena Chrostowska, Andrzej Kleinrok, Jan Krekora, Grzegorz Kania, Anna Podrazka-Szczepaniak, Cezary Golawski, Maciej Podziewski, Barbara Kaczmarek, Grzegorz Skoczylas, Andrzej Wilkolaski, Iwona Wozniak, Marzena Janik-Palazzolo, Barbara Rewerska, Aleksandra Konradi, Yuriy Shvarts, Tamara Pecherina, Konstantin Nikolaev, Gapon Liudmila, Olga Orlikova, Viktor Mordovin, Natalia Petrochenkova, Gadel Kamalov, Elena Kosmacheva, Vadim Tyrenko, Vladimir Gorbunov, Andrey Obrezan, Tatiana Supryadkina, Irina Ler, Oleg Kotenko, Anatoly Kuzin, Fernando Martínez García, Josep Redon, Anna Oliveras, Luis Beltran Romero, Valerii Shatylo, Leonid Rudenko, Andriy Bazylevych, Yurii Rudyk, Oleksandr Karpenko, Mykola Stanislavchuk, Vira Tseluyko, Mykola Kushnir, Ervin Asanov, Yuriy Sirenko, Andriy Yagensky, David Collier, Pankaj Gupta, David Webb, Mary MacLeod, James McLay, Aaron Peace, Samir Arora, Patricia Buchanan, Robert Harris, Ronald Degarmo, Mario Guillen, Adam Karns, Joel Neutel, Yogesh Paliwal, Karlton Pettis, Phillip D. Toth, Jeffrey M. Wayne, Michael Bain Butcher, Phillip M. Diller, Suzanne Oparil, David Calhoun, Donald Brautigam, John Flack, Jesse M. Goldman, Arash Rashidi, Nabeel Aslam, William Haley, Nabil Andrawis, Brian Lang, Randy Miller, James Powell, Robert Dewhurst, James Pritchard, Dinesh Khanna, Dennis Tang, Nashwa Gabra, Jean Park, Conigliaro Jones, Cranford Scott, Blanca Luna, Murtaza Mussaji, Ravi Bhagwat, Michael Bauer, John McGinty, Rajesh Nambiar, Renee Sangrigoli, William Ross Davis, William Eaves, Frank McGrew, Ahmed Awad, Eric Bolster, David Scott, Paramjit Kalirao, Pascal Dabel, Wesley Calhoun, Steven Gouge, Mark Warren, Mary Katherine Lawrence, Aamir Jamal, Mohamed El-Shahawy, Carlos Mercado, Jayant Kumar, Pedro Velasquez-Mieyer, Robert Busch, Todd Lewis, Lisa Rich, Public and occupational health, Vascular Medicine, ACS - Atherosclerosis & ischemic syndromes, APH - Global Health, APH - Personalized Medicine, ACS - Heart failure & arrhythmias, Schlaich, M, Bellet, M, Weber, M, Danaietash, P, Bakris, G, Flack, J, Dreier, R, Sassi-Sayadi, M, Haskell, L, Narkiewicz, K, Wang, J, Reid, C, Katz, I, Ajani, A, Biswas, S, Esler, M, Elder, G, Roger, S, Colquhoun, D, Mooney, J, De Backer, T, Persu, A, Chaumont, M, Krzesinski, J, Vanabsche, T, Girard, G, Pliamm, L, Schiffrin, E, Merali, F, Dresser, G, Vallee, M, Jolly, S, Chow, S, Mu, J, Yu, J, Yuan, H, Feng, Y, Zhang, X, Xie, J, Lin, L, Soucek, M, Widimsky, J, Cifkova, R, Vaclavik, J, Ullrych, M, Lukac, M, Rychlik, I, Guldager Lauridsen, T, Kantola, I, Taurio, J, Ukkola, O, Ormezzano, O, Gosse, P, Azizi, M, Courand, P, Delsart, P, Tartiere, J, Mahfoud, F, Schmieder, R, Stegbauer, J, Lurz, P, Koziolek, M, Ott, C, Toursarkissian, N, Tsioufis, K, Kyfnidis, K, Manolis, A, Patsilinakos, S, Zebekakis, P, Karavidas, A, Denes, P, Bezzegh, K, Zsom, M, Kovacs, L, Sharabi, Y, Elias, M, Sukholutsky, I, Yosefy, C, Kenis, I, Atar, S, Volpe, M, Lorenza, M, Taddei, S, Grassi, G, Veglio, F, Son, J, Kim, J, Park, J, Lee, C, Lee, H, Raugaliene, R, Marcinkeviciene, J, Kavaliauskiene, R, Deinum, J, Kroon, A, van den Born, B, Januszewicz, A, Tykarski, A, Walczewska, J, Gaciong, Z, Wiecek, A, Chrostowska, M, Kleinrok, A, Krekora, J, Kania, G, Podrazka-Szczepaniak, A, Golawski, C, Podziewski, M, Kaczmarek, B, Skoczylas, G, Wilkolaski, A, Wozniak, I, Janik-Palazzolo, M, Rewerska, B, Konradi, A, Shvarts, Y, Pecherina, T, Nikolaev, K, Liudmila, G, Orlikova, O, Mordovin, V, Petrochenkova, N, Kamalov, G, Kosmacheva, E, Tyrenko, V, Gorbunov, V, Obrezan, A, Supryadkina, T, Ler, I, Kotenko, O, Kuzin, A, Martinez, F, Redon, J, Oliveras, A, Beltran Romero, L, Shatylo, V, Rudenko, L, Bazylevych, A, Rudyk, Y, Karpenko, O, Stanislavchuk, M, Tseluyko, V, Kushnir, M, Asanov, E, Sirenko, Y, Yagensky, A, Collier, D, Gupta, P, Webb, D, Macleod, M, Mclay, J, Peace, A, Arora, S, Buchanan, P, Harris, R, Degarmo, R, Guillen, M, Karns, A, Neutel, J, Paliwal, Y, Pettis, K, Toth, P, Wayne, J, Butcher, B, Diller, P, Oparil, S, Calhoun, D, Brautigam, D, Goldman, J, Rashidi, A, Aslam, N, Haley, W, Andrawis, N, Lang, B, Miller, R, Powell, J, Dewhurst, R, Pritchard, J, Khanna, D, Tang, D, Gabra, N, Jones, C, Scott, C, Luna, B, Mussaji, M, Bhagwat, R, Bauer, M, Mcginty, J, Nambiar, R, Sangrigoli, R, Ross Davis, W, Eaves, W, Mcgrew, F, Awad, A, Bolster, E, Scott, D, Kalirao, P, Dabel, P, Calhoun, W, Gouge, S, Warren, M, Lawrence, M, Jamal, A, El-Shahawy, M, Mercado, C, Kumar, J, Velasquez-Mieyer, P, Busch, R, Lewis, T, and Rich, L

Subjects
Endothelin Receptor Antagonists, Treatment Outcome, Double-Blind Method, Hypertension, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Humans, General Medicine, Blood Pressure Monitoring, Ambulatory, resistant hypertension, Dual endothelin antagonist aprocitentan, Antihypertensive Agents
Abstract

Contains fulltext : 286841.pdf (Publisher’s version ) (Closed access) BACKGROUND: Resistant hypertension is associated with increased cardiovascular risk. The endothelin pathway has been implicated in the pathogenesis of hypertension, but it is currently not targeted therapeutically, thereby leaving this relevant pathophysiological pathway unopposed with currently available drugs. The aim of the study was to assess the blood pressure lowering efficacy of the dual endothelin antagonist aprocitentan in patients with resistant hypertension. METHODS: PRECISION was a multicentre, blinded, randomised, parallel-group, phase 3 study, which was done in hospitals or research centres in Europe, North America, Asia, and Australia. Patients were eligible for randomisation if their sitting systolic blood pressure was 140 mm Hg or higher despite taking standardised background therapy consisting of three antihypertensive drugs, including a diuretic. The study consisted of three sequential parts: part 1 was the 4-week double-blind, randomised, and placebo-controlled part, in which patients received aprocitentan 12·5 mg, aprocitentan 25 mg, or placebo in a 1:1:1 ratio; part 2 was a 32-week single (patient)-blind part, in which all patients received aprocitentan 25 mg; and part 3 was a 12-week double-blind, randomised, and placebo-controlled withdrawal part, in which patients were re-randomised to aprocitentan 25 mg or placebo in a 1:1 ratio. The primary and key secondary endpoints were changes in unattended office systolic blood pressure from baseline to week 4 and from withdrawal baseline to week 40, respectively. Secondary endpoints included 24-h ambulatory blood pressure changes. The study is registered on ClinicalTrials.gov, NCT03541174. FINDINGS: The PRECISION study was done from June 18, 2018, to April 25, 2022. 1965 individuals were screened and 730 were randomly assigned. Of these 730 patients, 704 (96%) completed part 1 of the study; of these, 613 (87%) completed part 2 and, of these, 577 (94%) completed part 3 of the study. The least square mean (SE) change in office systolic blood pressure at 4 weeks was -15·3 (SE 0·9) mm Hg for aprocitentan 12·5 mg, -15·2 (0·9) mm Hg for aprocitentan 25 mg, and -11·5 (0·9) mm Hg for placebo, for a difference versus placebo of -3·8 (1·3) mm Hg (97·5% CI -6·8 to -0·8, p=0·0042) and -3·7 (1·3) mm Hg (-6·7 to -0·8; p=0·0046), respectively. The respective difference for 24 h ambulatory systolic blood pressure was -4·2 mm Hg (95% CI -6·2 to -2·1) and -5·9 mm Hg (-7·9 to -3·8). After 4 weeks of withdrawal, office systolic blood pressure significantly increased with placebo versus aprocitentan (5·8 mm Hg, 95% CI 3·7 to 7·9, p

Published
2022

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