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*For reference only for medical professionals to help break the problem of stroke combined with hypertension treatment, ARNI brings a new 24-hour stable blood pressure reduction program
.
In our country, stroke is the leading cause of death and disability among residents
.
In the great plan of Healthy China, stroke has become a prominent "blocker", and high blood pressure is one of its important risk factors
.
In order to effectively prevent and control high-risk factors of stroke, reduce morbidity, standard and timely treatment of stroke, and reduce the occurrence of disability, in June this year, ten ministries and commissions jointly issued a comprehensive plan for strengthening stroke prevention and treatment and reducing millions of new disability projects
.
And the new antihypertensive drug Angiotensin Receptor Enkephalinase Inhibitor (ARNI)-Sacubitril and Valsartan was approved for hypertension indications on June 1 this year, not only for stroke patients with hypertension The new choice has also helped to a certain extent the advancement of China's "Millions of Disability Reduction Project"
.
At the 7th "Nova China Quanxin E-generation Summit Forum", we invited Professor Song Haiqing from Xuanwu Hospital of Capital Medical University and Professor Xiao Bo from Xiangya Hospital of Central South University to talk with us about how ARNI can help patients with stroke and hypertension.
What are the benefits! The current situation of stroke hypertension management is not optimistic, and 24-hour blood pressure reduction is even more critical! Professor Song Haiqing analyzed that 84% of stroke patients currently have hypertension, but the rate of achieving blood pressure control is only 21%
.
Increasing the awareness and compliance rate of hypertension is one of the core measures in the "Millions of Disability Reduction Project"
.
The approval of ARNI hypertension indications this year undoubtedly helped advance the "Millions of Disability Reduction Project"
.
Figure 1: Professor Song Haiqing and Professor Xiao Bo also pointed out that paying attention to blood pressure is an important part of preventing stroke recurrence.
Stroke is a downstream disease.
If the patient's blood pressure is not effectively managed, it may cause more serious recurrence
.
A Chinese adult study [1] analyzed the relationship between baseline blood pressure and vascular disease and found that every 10 mmHg increase in systolic blood pressure (SBP) increased the risk of ischemic stroke by 30%
.
Figure 2: Professor Xiao Bo's management of stroke patients with hypertension.
Both professors said that 24-hour instability of blood pressure and increased nighttime blood pressure will lead to a high incidence of stroke, so the management of stroke patients with hypertension cannot Only focus on lowering blood pressure, but also focus on 24-hour blood pressure and night blood pressure
.
A cohort study of 1178 elderly patients from multiple countries showed [2] that 24-hour ambulatory blood pressure, 24-hour pulse pressure and night systolic blood pressure can independently predict all-cause mortality and cardiovascular mortality, respectively
.
Nocturnal blood pressure increase was significantly correlated with cumulative mortality (P=0.
006)
.
Figure 3: 24-hour blood pressure can predict all-cause mortality and cardiovascular mortality.
The IDACO study [3] proved that a 20mmHg increase in blood pressure at night increases the risk of stroke by 36%
.
In addition, poor night-time blood pressure control can also lead to "morning peak phenomenon", which further increases the risk of stroke.
For every 10mmHg increase in blood pressure in the morning, the risk of stroke increases by about 44% [4]
.
Figure 4: The relationship between morning peak blood pressure and stroke So in the face of the dilemma of stroke hypertension management, how does ARNI achieve a steady reduction of 24-hour blood pressure and a strong reduction of night blood pressure? ARNI has new ways to lower blood pressure.
The unique mechanism shows that the traditional five major types of antihypertensive drugs are all anti-hypertensive systems.
ARNI makes full use of the new target for lowering blood pressure, the natriuretic peptide system, which has been neglected in the past.
Unique dual-channel multi-target action mechanism, which can simultaneously act on the renin-angiotensin-aldosterone system (RAAS) and natriuretic peptide system, inhibiting the boosting mechanism while enhancing the lowering mechanism
.
Figure 5: ARNI’s unique antihypertensive mechanism was found in a study of 118 hypertensive patients [5].
In hypertensive patients, compared with the blood pressure level of a single consultation, atrial natriuretic peptide (ANP) and The level of brain natriuretic peptide (BNP) is more closely related to the 24-hour blood pressure level (P<0.
001), so natriuretic peptide is an endogenous hormone that truly reflects the 24-hour blood pressure change
.
Sacubitril and valsartan can prolong the physiological activity of endogenous linatide and exert a hypotensive effect
.
Figure 6: ANP and BNP levels are closely related to 24-hour blood pressure levels.
Based on the mechanism of ARNI, Professor Song Haiqing pointed out that ARNI was approved for hypertension indications in June this year.
Neurologists are very pleased.
ARNI focuses on enhancing the natriuretic peptide system.
The unique mechanism, its smooth lowering of blood pressure, effective control of night blood pressure, and protection of multiple target organs are all very exciting
.
Professor Song Haiqing further pointed out that stable pressure control can prevent cerebral blood flow hypoperfusion in patients with stroke and hypertension
.
In the "Guiding Standards for Blood Pressure Management of Stroke Prevention and Treatment in China", it is mentioned that both SBP levels are too low (<120mmHg) and too high (>140mmHg) are significantly related to the increased risk of stroke recurrence [6]
.
(Interview with Professor Song Haiqing) And the current evidence-based evidence also proves that ARNI can steadily lower blood pressure for 24 hours
.
A Meta-analysis of a total of 6064 hypertensive patients included in 12 studies [7] showed that compared with angiotensin II receptor blocker (ARB), sacubitril and valsartan 200 mg Qd significantly reduced patients 24 Hour ambulatory blood pressure
.
Figure 7: ARNI can improve blood pressure in 24 hours.
The PARAMETER study [8] included 454 hypertensive patients who were randomly given ARNI 200mg Qd or Olmesartan 20mg Qd.
The results showed that after 12 weeks of treatment, ARNI can be significantly compared with Olmesartan.
Reduce the 24-hour average brachial artery and aortic SBP, control the SBP steadily between 120-140mmHg, and reduce the blood pressure at night more significantly
.
Figure 8: ARNI is more effective than Olmesartan in lowering 24-hour blood pressure and night blood pressure.
Based on the above evidence-based evidence, ARNI is mentioned in the Asian Ambulatory Blood Pressure Monitoring Expert Consensus in 2019 as having excellent cardiovascular protection, regardless of the Western population In Asian populations, it has been proven to lower blood pressure for 24 hours and night blood pressure
.
In the 2020 "Guidelines for Ambulatory Blood Pressure Monitoring in China", it is recommended that nocturnal hypertension be treated with new antihypertensive drugs that can effectively lower night blood pressure, such as ARNI
.
In addition to smoothly controlling 24-hour blood pressure and effectively reducing night blood pressure, what benefits can ARNI bring to stroke patients with hypertension? ARNI strengthens the protection of target organs and realizes the full benefit of the cardiovascular and cerebrovascular event chain.
Professor Xiao Bo said that in addition to stabilizing blood pressure for 24 hours and effectively reducing night blood pressure in stroke patients with hypertension, they must also pay attention to the protection of target organs in order to achieve the heart and brain The full benefit of the vascular event chain
.
In addition to being proven to have cardioprotective and renal protective effects, ARNI can also bring vascular protection to patients, and it is a drug with a truly multi-target organ protective effect
.
(Interview with Professor Xiao Bo) In a study on the treatment of mice lacking apolipoprotein E [9], it was found that after 12 weeks of treatment, compared with valsartan, sacubitril and valsartan can significantly Reduce carotid plaque lipids, increase the thickness of the fiber cap, stabilize the plaque, and inhibit the process of arteriosclerosis
.
Figure 9: ARNI can effectively improve carotid artery plaque Another study [10] proved that compared with valsartan, ARNI can significantly reduce the cerebral infarction area of middle cerebral artery occlusion model mice and reduce cerebral edema
.
Figure 10: ARNI can reduce the area of cerebral infarction and reduce cerebral edema.
Summary ARNI's unique mechanism can not only effectively stabilize 24-hour ambulatory blood pressure and powerfully reduce night blood pressure, but also play a multi-target organ protection effect, truly achieving brain-heart- Treating the kidneys at the same time, realizing the full benefit of the entire event chain, is a new choice for stroke patients with hypertension
.
References: [1] Lacey B, et al.
Lancet Glob Health.
2018 Jun; 6 (6): e641-e649.
[2] Walter Palmas, et al.
Hypertension.
2009 February; 53 (2): 120–127 .
[3]JAMA 2019;322(5):409-420[4]KARIO K, et al.
Hypertens Res, 2006,29(8):581-587.
[5]J Hypertens.
1998 Sep;16(9 ): 1253-9.
[6] "Guiding Standards for Blood Pressure Management of Stroke Prevention and Treatment in China".
Stroke Prevention and Treatment Engineering Committee of the National Health and Family Planning Commission [7] Cardiology.
2020; 145 (9): 589-598.
[8]Williams B , Et al.
Hypertension.
2017 Mar; 69(3): 411-420.
[9]Neprilysin Inhibitor–Angiotensin II Receptor Blocker Combination therapy (Sacubitril/valsartan) Supp resses AtheroscleroticPlaque Formation and Inhibits Inflammation in Apolipoprotein E- Deficient Mice, ( 2019) 9: 6509[10] Eur J Pharmacol.
2015 Sep 5; 762: 293-8.
*This article is only used to provide scientific information to medical and health professionals, and does not represent platform views
.
In our country, stroke is the leading cause of death and disability among residents
.
In the great plan of Healthy China, stroke has become a prominent "blocker", and high blood pressure is one of its important risk factors
.
In order to effectively prevent and control high-risk factors of stroke, reduce morbidity, standard and timely treatment of stroke, and reduce the occurrence of disability, in June this year, ten ministries and commissions jointly issued a comprehensive plan for strengthening stroke prevention and treatment and reducing millions of new disability projects
.
And the new antihypertensive drug Angiotensin Receptor Enkephalinase Inhibitor (ARNI)-Sacubitril and Valsartan was approved for hypertension indications on June 1 this year, not only for stroke patients with hypertension The new choice has also helped to a certain extent the advancement of China's "Millions of Disability Reduction Project"
.
At the 7th "Nova China Quanxin E-generation Summit Forum", we invited Professor Song Haiqing from Xuanwu Hospital of Capital Medical University and Professor Xiao Bo from Xiangya Hospital of Central South University to talk with us about how ARNI can help patients with stroke and hypertension.
What are the benefits! The current situation of stroke hypertension management is not optimistic, and 24-hour blood pressure reduction is even more critical! Professor Song Haiqing analyzed that 84% of stroke patients currently have hypertension, but the rate of achieving blood pressure control is only 21%
.
Increasing the awareness and compliance rate of hypertension is one of the core measures in the "Millions of Disability Reduction Project"
.
The approval of ARNI hypertension indications this year undoubtedly helped advance the "Millions of Disability Reduction Project"
.
Figure 1: Professor Song Haiqing and Professor Xiao Bo also pointed out that paying attention to blood pressure is an important part of preventing stroke recurrence.
Stroke is a downstream disease.
If the patient's blood pressure is not effectively managed, it may cause more serious recurrence
.
A Chinese adult study [1] analyzed the relationship between baseline blood pressure and vascular disease and found that every 10 mmHg increase in systolic blood pressure (SBP) increased the risk of ischemic stroke by 30%
.
Figure 2: Professor Xiao Bo's management of stroke patients with hypertension.
Both professors said that 24-hour instability of blood pressure and increased nighttime blood pressure will lead to a high incidence of stroke, so the management of stroke patients with hypertension cannot Only focus on lowering blood pressure, but also focus on 24-hour blood pressure and night blood pressure
.
A cohort study of 1178 elderly patients from multiple countries showed [2] that 24-hour ambulatory blood pressure, 24-hour pulse pressure and night systolic blood pressure can independently predict all-cause mortality and cardiovascular mortality, respectively
.
Nocturnal blood pressure increase was significantly correlated with cumulative mortality (P=0.
006)
.
Figure 3: 24-hour blood pressure can predict all-cause mortality and cardiovascular mortality.
The IDACO study [3] proved that a 20mmHg increase in blood pressure at night increases the risk of stroke by 36%
.
In addition, poor night-time blood pressure control can also lead to "morning peak phenomenon", which further increases the risk of stroke.
For every 10mmHg increase in blood pressure in the morning, the risk of stroke increases by about 44% [4]
.
Figure 4: The relationship between morning peak blood pressure and stroke So in the face of the dilemma of stroke hypertension management, how does ARNI achieve a steady reduction of 24-hour blood pressure and a strong reduction of night blood pressure? ARNI has new ways to lower blood pressure.
The unique mechanism shows that the traditional five major types of antihypertensive drugs are all anti-hypertensive systems.
ARNI makes full use of the new target for lowering blood pressure, the natriuretic peptide system, which has been neglected in the past.
Unique dual-channel multi-target action mechanism, which can simultaneously act on the renin-angiotensin-aldosterone system (RAAS) and natriuretic peptide system, inhibiting the boosting mechanism while enhancing the lowering mechanism
.
Figure 5: ARNI’s unique antihypertensive mechanism was found in a study of 118 hypertensive patients [5].
In hypertensive patients, compared with the blood pressure level of a single consultation, atrial natriuretic peptide (ANP) and The level of brain natriuretic peptide (BNP) is more closely related to the 24-hour blood pressure level (P<0.
001), so natriuretic peptide is an endogenous hormone that truly reflects the 24-hour blood pressure change
.
Sacubitril and valsartan can prolong the physiological activity of endogenous linatide and exert a hypotensive effect
.
Figure 6: ANP and BNP levels are closely related to 24-hour blood pressure levels.
Based on the mechanism of ARNI, Professor Song Haiqing pointed out that ARNI was approved for hypertension indications in June this year.
Neurologists are very pleased.
ARNI focuses on enhancing the natriuretic peptide system.
The unique mechanism, its smooth lowering of blood pressure, effective control of night blood pressure, and protection of multiple target organs are all very exciting
.
Professor Song Haiqing further pointed out that stable pressure control can prevent cerebral blood flow hypoperfusion in patients with stroke and hypertension
.
In the "Guiding Standards for Blood Pressure Management of Stroke Prevention and Treatment in China", it is mentioned that both SBP levels are too low (<120mmHg) and too high (>140mmHg) are significantly related to the increased risk of stroke recurrence [6]
.
(Interview with Professor Song Haiqing) And the current evidence-based evidence also proves that ARNI can steadily lower blood pressure for 24 hours
.
A Meta-analysis of a total of 6064 hypertensive patients included in 12 studies [7] showed that compared with angiotensin II receptor blocker (ARB), sacubitril and valsartan 200 mg Qd significantly reduced patients 24 Hour ambulatory blood pressure
.
Figure 7: ARNI can improve blood pressure in 24 hours.
The PARAMETER study [8] included 454 hypertensive patients who were randomly given ARNI 200mg Qd or Olmesartan 20mg Qd.
The results showed that after 12 weeks of treatment, ARNI can be significantly compared with Olmesartan.
Reduce the 24-hour average brachial artery and aortic SBP, control the SBP steadily between 120-140mmHg, and reduce the blood pressure at night more significantly
.
Figure 8: ARNI is more effective than Olmesartan in lowering 24-hour blood pressure and night blood pressure.
Based on the above evidence-based evidence, ARNI is mentioned in the Asian Ambulatory Blood Pressure Monitoring Expert Consensus in 2019 as having excellent cardiovascular protection, regardless of the Western population In Asian populations, it has been proven to lower blood pressure for 24 hours and night blood pressure
.
In the 2020 "Guidelines for Ambulatory Blood Pressure Monitoring in China", it is recommended that nocturnal hypertension be treated with new antihypertensive drugs that can effectively lower night blood pressure, such as ARNI
.
In addition to smoothly controlling 24-hour blood pressure and effectively reducing night blood pressure, what benefits can ARNI bring to stroke patients with hypertension? ARNI strengthens the protection of target organs and realizes the full benefit of the cardiovascular and cerebrovascular event chain.
Professor Xiao Bo said that in addition to stabilizing blood pressure for 24 hours and effectively reducing night blood pressure in stroke patients with hypertension, they must also pay attention to the protection of target organs in order to achieve the heart and brain The full benefit of the vascular event chain
.
In addition to being proven to have cardioprotective and renal protective effects, ARNI can also bring vascular protection to patients, and it is a drug with a truly multi-target organ protective effect
.
(Interview with Professor Xiao Bo) In a study on the treatment of mice lacking apolipoprotein E [9], it was found that after 12 weeks of treatment, compared with valsartan, sacubitril and valsartan can significantly Reduce carotid plaque lipids, increase the thickness of the fiber cap, stabilize the plaque, and inhibit the process of arteriosclerosis
.
Figure 9: ARNI can effectively improve carotid artery plaque Another study [10] proved that compared with valsartan, ARNI can significantly reduce the cerebral infarction area of middle cerebral artery occlusion model mice and reduce cerebral edema
.
Figure 10: ARNI can reduce the area of cerebral infarction and reduce cerebral edema.
Summary ARNI's unique mechanism can not only effectively stabilize 24-hour ambulatory blood pressure and powerfully reduce night blood pressure, but also play a multi-target organ protection effect, truly achieving brain-heart- Treating the kidneys at the same time, realizing the full benefit of the entire event chain, is a new choice for stroke patients with hypertension
.
References: [1] Lacey B, et al.
Lancet Glob Health.
2018 Jun; 6 (6): e641-e649.
[2] Walter Palmas, et al.
Hypertension.
2009 February; 53 (2): 120–127 .
[3]JAMA 2019;322(5):409-420[4]KARIO K, et al.
Hypertens Res, 2006,29(8):581-587.
[5]J Hypertens.
1998 Sep;16(9 ): 1253-9.
[6] "Guiding Standards for Blood Pressure Management of Stroke Prevention and Treatment in China".
Stroke Prevention and Treatment Engineering Committee of the National Health and Family Planning Commission [7] Cardiology.
2020; 145 (9): 589-598.
[8]Williams B , Et al.
Hypertension.
2017 Mar; 69(3): 411-420.
[9]Neprilysin Inhibitor–Angiotensin II Receptor Blocker Combination therapy (Sacubitril/valsartan) Supp resses AtheroscleroticPlaque Formation and Inhibits Inflammation in Apolipoprotein E- Deficient Mice, ( 2019) 9: 6509[10] Eur J Pharmacol.
2015 Sep 5; 762: 293-8.
*This article is only used to provide scientific information to medical and health professionals, and does not represent platform views
