e36 Journal of Hypertension Vol 35, e-Supplement 2, September 2017
Conclusions: This three dimensional meta-analysis may be useful in guiding cli-
nicians in choosing the appropriate antihypertensive medication class in clinical
care. Odds ratios may be used to summarize clinical trials, while absolute risk
reduction and drop out rate are more appropriate in answering specific clinical
questions.
OP.4A.08 A RANDOMIZED DOUBLE-BLIND PLACEBO
CONTROLLED CROSSOVER STUDY TO COMPARE
QGC001, A BRAIN AMINOPEPTIDASE A INHIBITOR,
WITH PLACEBO IN PATIENTS WITH GRADE I/II
ESSENTIAL HYPERTENSION
M. Azizi1, P. Courand2, T. Denolle3, V. Zhygalina1, P. Delsart4, L. Amar1,
P. Lantelme2, D. Deplanque4, C. Mounier-Vehier4, F. Balavoine5, O. Madonna5,
C. Llorens-Cortes6. 1Hopital Europeen Georges Pompidou - CIC/Vascular
Medicine and Hypertension Department, Paris, France, 2Hôpital de la Croix-
Rousse - Cardiology Department, Lyon, France, 3Hôpital Arthur Gardiner -
Cardiology Department, Dinard, France, 4CHRU Lille - Vascular Medicine and
Hypertension Department, Lille, France, 5Quantum Genomics, Paris, France,
6Collège de France - CIRB - INSERM U1050/CNRS UMR 7241, Paris, France
Objective: To assess the hemodynamic and hormonal effects, the safety and tol-
erability of QGC001, a brain aminopeptidase A inhibitor, in hypertensive patients
compared to placebo.
Design and method: After 2-week period of discontinuation of current anti-
hypertensive therapy and a 2-week placebo run-in period, patients with grade I
to II hypertension confirmed by daytime ABPM (above or equal to 135 or 85
mmHg) were randomly assigned to two-periods of 4-week oral QGC001 (250 mg
b.i.d. for 1 week uptitrated to 500 mg b.i.d. for 3 weeks) or placebo in crossover
study. Safety biochemical parameters and plasma hormone concentrations (active
renin, aldosterone, cortisol, copeptin and apelin) were measured at 09:00 (trough)
before and after 4-week of QGC001 or placebo administration. The primary end-
point was the difference in the change from baseline in daytime ambulatory SBP
(dASBP) after 4-week of QGC001 or placebo.
Results: 50 patients were screened, 40 entered the run-in period, 34 were ran-
domized (intention-to-treat population) and 30 completed the study (56.6 ± 9.1
years; 73.5% men; 88.2% white). dASBP, nighttime ambulatory SBP (nASBP),
and office SBP (OSBP) results (mmHg) are shown in table 1. There was no
significant effect of QGC001 on any of the hormonal parameters. 14 patients
(42.4%) had a total of 16 reversible adverse events (AE) of mild intensity dur-
ing the study. A single episode of reversible macular rash with facial oedema
occurred during the QGC001 period. There was no change in safety biochemical
parameters.
Conclusions: Four-week administration of 1000 mg/d QGC001 decreased
dASBP by 2.7 mmHg and OSBP by 4.7 mmHg compared to placebo. QGC001
administration was safe, with the exception of occurrence of one episode of
macular rash.
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
OP.4A.09 THE RELATIONSHIP OF ALL-CAUSE MORTALITY
TO AVERAGE ON-TREATMENT SYSTOLIC
BP IS RELATED TO BASELINE SYSTOLIC BP:
IMPLICATIONS FOR INTERPRETATION OF THE
SPRINT STUDY
S. Kjeldsen1, K. Wachtell2, R. Devereux3, P. Okin3. 1Department of Cardiology,
University of Oslo, Ullevaal Hospital, Oslo, Norway, 2Department of Cardiology,
University of Oslo Hospital, Rikshospitalet, Oslo, Norway, 3Department of Cardi-
ology, Weill Cornell Medical College, New York, NY, USA
Objective: The SPRINT study demonstrated that targeting systolic blood pres-
sure (SBP) < 120 mm Hg was associated with lower cardiovascular event and
mortality rates. However, in the LIFE study, a lower achieved SBP (<130 mm
Hg) was associated with increased mortality. Mean baseline SBP in SPRINT was
140 and a third of the population had a baseline SBP <= 132, raising the question
of whether the lower baseline SBP in SPRINT could in part account for these
differences.
Design and method: All-cause mortality in relation to tertiles of on-treatment
average SBP achieved was examined in patients with baseline SBP < = or >25th
percentile value of 164 mm Hg during 4.8 ± 0.9 years follow-up in 7998 non-
diabetic hypertensive patients with ECG left ventricular hypertrophy assigned to
losartan- or atenolol-based treatment. Average on-treatment SBP < 142 (lowest
tertile) and average SBP 142 to < 152 (middle tertile) were compared with aver-
age SBP >= 152 (highest tertile and reference group).
Results: In the overall population, there was a highly significant interaction be-
tween baseline SBP <= 164 and average on-treatment SBP < 142 in Cox analysis
(X2 = 15.48, p < 0.001). Among patients with baseline SBP > 164, in multivariate
Cox analyses adjusting for other potential predictors of mortality and a propen-
sity score for having baseline SBP <= 164, compared with average on-treatment
SBP >= 152 an average on-treatment SBP < 142 was associated with 32% in-
creased risk of mortality (HR 1.32, 95% CI 1.01–1.65), whereas average SBP
of 142 to < 152 was associated with 24% lower mortality risk (HR 0.76, 95%
CI 0.59–0.98). In contrast, in parallel Cox analyses among patients with base-
line SBP <= 164, both an average on-treatment SBP < 142 (HR 0.60, 95% CI
0.36–0.99) and average SBP of 142 to < 152 (HR 0.51, 95% CI 0.30–0.89) were
associated with statistically significant lower risks of mortality compared with
average SBP >= 152.
Conclusions: All-cause mortality risk associated with achievement of an aver-
age SBP < 142 is strongly related to baseline SBP level in LIFE. These findings
suggest that the lower mortality associated with a lower targeted SBP in SPRINT
may not be applicable to patients with considerably higher baseline SBP than
SPRINT patients.
OP.4A.10 MODERATION OF ALCOHOL INTAKE AS A
RECOMMENDED LIFESTYLE CHANGE IN
HYPERTENSION: AWARENESS AND USE IN
CLINICAL PRACTICE AMONG EUROPEAN
PHYSICIANS
R. Kreutz1, L. Zaidi Touis1, J. Bolbrinker1, H. Gohlke2, B. Weisser3. 1Institut für
Klinische Pharmakologie und Toxikologie, Charité, Universitätsmedizin Ber-
lin, Berlin, Germany, 2Ballrechten-Dottingen, Dottinger, Germany, 3Institut für
Sportwissenschaften, Sportmedizin, Christian, Albrechts-Universität zu Kiel,
Kiel, Germany
Objective: Moderation of alcohol consumption is one of the six lifestyle changes
recommended in the 2013 ESH/ESC hypertension guidelines for the treatment of
hypertensive patientswith class I evidence level A. Thus, the guidelines recom-
mend a maximum alcohol consumption of 20–30 g/day in hypertensive men and
10–20 g/day in hypertensive women. Within a survey assessing the level of aware-
ness and implementation of the 2013 ESH/ESC guideline recommendations on
lifestyle changes we specifically investigated the role of alcohol consumption in
the management of hypertensive patients among European physicians.
Design and method: The complete survey included a total of 16 questions cov-
ering demographic data and questions that aimed to assess the level of aware-
 Abstracts e37

ness and implementation of the 2013 guideline recommendations. It included six
questions explicitly related to medical history of alcohol consumption, advice on
alcohol intake and/ or management of hypertensive patients with alcohol con-
sumption. The survey was conducted at two national meetings in Germany (2015
annual meetings of the German Society of Cardiology and the German Society of
Internal Medicine) and at two European meetings (ESH meeting in Milan 2015
and ESC meeting in London 2015).
Results: Overall, 1064 participated. Overall, 81.9% of participating physicians
reported to quantify alcohol consumption in their hypertensive patients. The
medical history of alcohol consumption was taken mostly in the context of newly
detected hypertension (28.6%), rather than in patients with hypertension and very
high blood pressure (BP) (17.5%) or in patients with treatment resistant hyperten-
sion (14.5%). Physicians recommend a mean maximum amount of alcohol intake
of 13.1 ± 11.7 g/day for women (range: 0–150) and 19.7 ± 14.9 g/day for men
(range: 0–125).
Conclusions: Although more than 80% of participating physicians reported to
quantify alcohol consumption in their hypertensive patients, less than a third of
physicians acknowledged to determine a history on alcohol intake in case of new-
ly detected hypertension, very high BP or treatment resistant BP. The mean maxi-
mum amount of alcohol per day recommended did not exceed the recommended
guidelines threshold. Awareness campaigns emphasizing the relationship between
alcohol consumption and high BP, e.g. in patients with resistant hypertension,
might improve currently unsatisfactory BP control rates.
considered patients defined as hypertensive in the original studies (>160/95
mmHg or use of antihypertensives). We studied the effect of beta-blocker and
perindopril therapy on cardiovascular outcomes and mortality with a multivariate
Cox regression analysis versus beta-blocker and placebo.
Results: At baseline, 39% of patients in the three studies received a beta-blocker
(n = 11418 out of 29 463 patients) and of these 51% were hypertensive (n = 5838).
In the population receiving beta-blocker and perindopril, the composite end point
of cardiovascular mortality, nonfatal myocardial infarction, and stroke was sig-
nificantly reduced by 20% (HR 0.80, 95% CI: 0.71–0.90) compared with those
receiving beta-blocker and placebo. The cardioprotective benefits seemed to be
independent of the blood pressure effect. The reduction in risk of the composite
endpoint by treating patients with beta-blocker/perindopril was 23% in patients
with hypertension (HR 0.77, 95% CI: 0.66–0.89), and in non-hypertensive pa-
tients 16% (HR 0.84, 95% CI: 0.71–1.00), both significant without interaction.
Within the hypertensive population, this significant benefit in the beta-blocker/
perindopril group vs the beta-blocker placebo group was also observed for myo-
cardial infarction (HR 0.74, 95% CI 0.58–0.94) and strong effect on all-cause
mortality (HR, 0.68, 95% CI 0.57–0.82) (figure 1).
Conclusions: The addition of perindopril to beta-blockers in hypertensive pa-
tients with vascular disease significantly improves survival and lowers the risk of
myocardial infarction.

OP.4A.11 THE TREATMENT BENEFIT OF THE ACE-INHIBITOR

PERINDOPRIL ON TOP OF BETA-BLOCKER
THERAPY IN PATIENTS WITH VASCULAR DISEASE
AND HYPERTENSION

J. Brugts1, M. Bertrand2, W. Remme3, R. Ferrari4, K. Fox5, S. Macmahon6,

J. Chalmers6, M. Simoons1, E. Boersma1. 1Erasmus MC Thoraxcentre, Rotterdam,
The Netherlands, 2Lille Heart Institute, Lille, France, 3Sticares Research, Rhoon,
The Netherlands, 4Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy,
5Royal Brompton Hospital, London, United Kingdom, 6 The George Institute for

Global Health, Sydney, Australia

Objective: We aimed to determine the potential synergistic effect the combina-
tion of beta-blockers with perindopril in a hypertensive population with cardiovas-
cular disease or at high a risk for cardiovascular disease.
Design and method: In patients participating in the ADVANCE, EUROPA, and
PROGRESS trials who were randomized to an ACE inhibitor based regimen or
placebo, we identified all patients who received a beta-blocker at baseline. We

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