P-225: Effective blood-pressure control with valsartan/HCTZ combination therapy in patients with moderate to severe systolic hypertension: The valor trial

Increasing evidence shows that combination therapy with at least two antihypertensive agents is needed to achieve appropriate blood-pressure (BP) control in a large part of the hypertensive population. One of the most appealing combinations is that of adding a diuretic to an angiotensin-receptor blocker (ARB). We studied the effects on sitting systolic BP of the combinations valsartan (V; an ARB) 160 mg + HCTZ 12.5 mg and V160 mg + HCTZ 25 mg od, compared with monotherapy V160 mg od. Treatment-naive and previously treated patients (N=767) with moderate to severe systolic hypertension (SBP ≥160 mm Hg and ≤200 mmHg) and with or without co-morbidities, were randomised (after a 2-week washout if previously treated and a 2 week placebo run-in period) to either V80 od (monotherapy group) or V160 od (combination groups) for 4 weeks, with force-tration to V160 mg, V160/HCTZ 12.5 od or V160/HCTZ 25 od for an additional 4 weeks. Endpoints were change in SBP between V160 and V160/HCTZ 25 and between V160/HCTZ 12.5 and V160; changes in DBP between groups, response rates and tolerability. As shown in the Table, all treatments were highly effective and there were additional SBP and DBP reductions in the combination groups. Responder rates were above 50% in all groups and reached 75% in the V160/HCTZ 25 group. Rates of adverse events did not differ significantly between monotherapy and combination therapies. Table 1 V160 V160/HCTZ12.5 V160/HCTZ25 N 261 254 252 Male/female 130/131 141/113 140/112 Mean age 60.4 (10.6) 60.8 (11.5) 60.7 (11.6) Baseline mean SBP/DBP 167.9 (8.0)/93.2 (8.9) 167.4 (8.3)/93.4 (9.6) 167.2 (7.9)/93.7 (8.8) Mean change SBP/DBP −20.7 (15.7)/−6.6 (8.9) −27.9 (13.8) *−10.2 (7.7)* −28.3 (13.1) *−10.1 (7.8)* Response rate¥ 56.9% 74.4% * 75% * Any AE (monotherapy phase/combination phase) 37.3%/27.5% 32.1%/28.6% 32.8%/34.0% Values in brackets are ± SD. *P < 0.05 vs V160; ¥SBP < 140 or decrease in SBP ≥20 mmHg and/or DBP<90 mmHg. V160 mg od is safe and effective in patients with moderate to severe systolic hypertension. Adding HCTZ 12.5 or 25 mg provides significant additional reductions in systolic and diastolic BP and increases responder rates compared with V160 mg monotherapy, with maintained excellent tolerabilit

P-181: Fixed-dose valsartan + hydrochlorothiazide combination therapy compared with amlodipine monotherapy in hypertensive patients with additional cardiovascular risk factors: The vast study

Objectives: To determine whether the combination of valsartan 160 mg and hydrochlorothiazide (HCTZ) 25 mg once-daily (od) is more effective than amlodipine 10 mg od in reducing systolic blood pressure (BP) in patients suffering from moderate hypertension combined with at least one other cardiovascular risk factor or concomitant condition. Further, to study the effects of treatment on vascular markers. Methods: A multicenter, randomized, double-blind, active-controlled, three-arm study over 24 weeks. After a two-week single-blind placebo run-in period, 1088 stage-II hypertensive patients with additional risk factors were randomized to three groups, two receiving valsartan 160 mg od and one group receiving amlodipine 5 mg od. At Week 4, HCTZ 12.5 mg and 25 mg respectively, were added to the valsartan groups and the amlodipine dose was force-titrated to 10 mg od. Patients were followed-up for a total of 24 weeks. Results: The combination of valsartan 160 mg+HCTZ 25 mg reduced systolic BP significantly (p<0.05) more than amlodipine monotherapy (least-squares mean changes from baseline 29.7±0.7 mmHg and 27.6± 0.7 mmHg, respectively). For diastolic BP the values were 11.1±0.4 mmHg and 10.8±0.4 mmHg, respectively (differences not significant). Levels of IL-6, t-PA antigen and hs-CRP were reduced with both combination therapies at week 12 (figure). Significantly more patients discontinued because of adverse events in the amlodipine group (18.2%) than in the combination-therapy groups (4.2% and 3.5%) over the 6 months treatment period. Conclusions: Valsartan 160 mg+HCTZ 25 mg is an effective and well-tolerated therapy in this patient population with possible beneficial effects on vascular marker

P-182: 24-hour ambulatory blood-pressure effects of valsartan + hydrochlorothiazide combinations compared with amlodipine in hypertensive patients at increased cardiovascular risk

In a randomised, double-blind trial, the effects on 24-hr ABP of the combination valsartan 160 mg od and hydrochlorothiazide (HCTZ) 25 or 12.5 mg during 24 weeks of therapy were compared with the effects of amlodipine 10 mg monotherapy (group A10) in 474 stage-II hypertensive patients with additional cardiovascular risk factors. After a two-week single-blind placebo run-in period, patients were randomised to receive valsartan 160 mg od or amlodipine 5 mg od. At Week 4, HCTZ 12.5 mg (group V160/HCTZ12.5) and 25 mg (group V160/HCTZ25) were added to the valsartan groups and in the A10 patients the amlodipine dose was force-titrated to 10 mg od. All treatments reduced BP as well as night-time and daytime BP levels from baseline. 24-hr SBP was reduced by 15.9 ±1.0 mmHg (least-squares mean change ±SE), 19.3 ±1.0 mmHg and 16.1 ±1.1 mmHg in the V160/HCTZ12.5, V160/HCTZ25 and A10 groups, respectively and 24-hr DBP was reduced by 9.3 ±0.6 mmHg, 11.4 ±0.6 mmHg and 9.6 ±0.7 mmHg in the three groups. The differences between the V160/HCTZ25 group and the A10 group were significant (p<0.05) for the changes in 24-hr systolic BP as well as for changes in daytime systolic BP and night-time diastolic BP. Control rates defined as ABPM ≤130/80 mmHg were: 48.4%, 60.8% and 50.9% in the V160/HCTZ12.5, V160/25 and A10 groups, respectively; the differences between the V160/HCTZ25 group and the other two treatment groups were significant at p<0.05. (See Figure) In conclusion, the fixed-dose combination of valsartan 160 mg + HCTZ 25 mg od is an attractive therapeutic option measured on the effects on 24-hr ABPM, night-time and daytime BP reduction and control rates in hypertensive patients at additional cardiovascular ris

The effect of sacubitril/valsartan compared to olmesartan on cardiovascular remodelling in subjects with essential hypertension: the results of a randomized, double-blind, active-controlled study

Aims: Progressive aortic stiffening eventually leads to left ventricular (LV) hypertrophy and heart failure if left untreated. Anti-hypertensive agents have been shown to reverse this to some extent. The effects of sacubitril/valsartan (LCZ696), a dual-action angiotensin receptor blocker (ARB), and neprilysin inhibitor, on arterial stiffness and LV remodelling have not been investigated. Methods and results: This was a randomized, multi-centre, double-blind, double-dummy, active-controlled, parallel group, study to compare the effects on cardiovascular remodelling of sacubitril/valsartan with those of olmesartan in patients with hypertension and elevated pulse pressure. Magnetic resonance imaging scans were used to assess LV mass and local aortic distensibility, at baseline and at 12 and 52 weeks after initiation of treatment. Central pulse and systolic pressure were determined using a SphymoCor® XCEL device at each time point. A total of 114 patients were included, with 57 in each treatment group. The mean age was 59.8 years, and 67.5% were male. Demographic characteristics did not vary between the two sets of patients. Left ventricular mass index decreased to a greater extent in the sacubitril/valsartan group compared to the olmesartan group from baseline to 12 weeks (−6.36 vs. −2.32 g/m2; P = 0.039) and from baseline to 52 weeks (−6.83 vs. −3.55 g/m2; P = 0.029). These differences remained significant after adjustment for systolic blood pressure (SBP) at follow-up (P = 0.036 and 0.019 at 12 and 52 weeks, respectively) and similar signals (though formally non-significant) were observed after adjusting for changes in SBP (P = 0.0612 and P = 0.0529, respectively). There were no significant differences in local distensibility changes from baseline to 12 or 52 weeks between the two groups; however, there was a larger reduction in central pulse pressure for the sacubitril/valsartan group compared to the olmesartan group (P = 0.010). Conclusion: Since LV mass change correlates with cardiovascular prognosis, the greater reductions in LV mass indicate valuable advantages of sacubitril/valsartan compared to olmesartan. The finding that LV mass index decrease might be to some extent independent of SBP suggests that the effect of the dual-acting agent may go beyond those due to its BP-lowering ability

Business Intelligence and Data Mining: Opportunities and Future

In the business world, endless streams of information “data” are needed in order to properly initiate the process of an effective business by analyzing different needs that the service has in relation to the needs of the end-customer, by anticipating these needs, the aim of any service creation is to meet customer requirements.  In the recent years business intelligence (BI) been an interesting topic in almost every field. Likewise data mining which is a good solution in business intelligence matter, as for discussion, application and business domain. There are various attempts to detect the characteristics of services that are important to the acceptance of the service offered. The quest for attributes that satisfy and excite the consumer is possible through the use of various technological research approaches, but the efforts are enormous. The business is able to collect customer data in a more reliable and simpler way with the use of 'Smart Systems,' which are Information and Communication Technology (ICT) enabled services. The use of data mining and business intelligence to enhance the reversal of consumer needs when designing collection techniques is defined in this paper.  The main purpose of this study is to define the importance of business intelligence with it features, how data mining works and some data mining techniques discussed in brief, in addition to exploring the future and opportunities of Business Intelligence and Data Mining. Keywords: Business Intelligence, Data Mining, Business needs, Data Mining Techniques DOI: 10.7176/EJBM/13-11-01 Publication date:June 30th 202

The role of agricultural employees in the transfer of agricultural techniques to farmers in Salah al-Din

The research aimed to identify the role of agricultural employees in transferring agricultural technologies to farmers in Salah al-Din Governorate, and to find a correlation between the role of agricultural employees in transferring agricultural technologies to farmers and each of the following variables (age, academic achievement, job title). The research included all the agricultural employees in the Directorate of agriculture in Salah al-Din and agricultural people, which numbered (280) agricultural employees, a proportional random sample of (40%) was elected by (100) respondents after excluding (30) of them whose service was less than two years. A special questionnaire was designed for the research that includes two parts: the first part includes the personal and functional characteristics of the respondents, and the the second part includes a number of paragraphs, each of these express the role of agricultural employees in the process of transferring agricultural technologies to farmers and the number of paragraphs was (70) paragraphs. After ensuring the apparent validity of the questionnaire form, the stability factor and validity of the scale, whose value (0.91) was measured by the half-segmentation method, then collected, and after data dump and classifying it, it was processed statistically using the statistical analysis program for the social sciences (SPSS), and using a number of statistical methods. The most important of them are (Pearson and Spearman correlation coefficient, the arithmetic mean, the standard score, and the law of (t) as well as the law of range and length of the category. The results of the research showed that more than (87%) of the respondents fall into the large and medium role categories, so their role is described as large tends to medium. In the process of transferring agricultural technologies to farmers, the results also showed a significant correlation between the role of agricultural employees in transferring agricultural technologies to farmers and each of the variables (age, academic achievement, job title)

Requirements for Using Smartphone Applications in Arab Universities Libraries

The use of information technology and smart devices has become within the reach of every individual and a basic requirement in many life fields such as economics, medicine, sports, education and others. Universities and academic centers are racing to use information technology and applications of smart devices in providing their services to users, including students, academics and visitors, and since libraries are among the most important departments and centers in universities that must undertake this technical progress in information technology and the use of smart devices, The study aimed to reveal the requirements for the providing smart phones services in the libraries of Arab universities from the users and employees viewpoint. To achieve the objectives of the study, the study used the survey tool to collect data from the study population sample where the results collected from 200 Arab universities librarian. The study reached the results that the majority of the respondents answered with strongly agree to the study questions, which are summarized in (the requirements for providing smart phone application services in Arab universities libraries), and the study recommended the need to provide all the requirements for enabling smart phones services in the libraries of Arab universities identified by this study, and achieving benefit from those requirements in the development of university library services through the provision of smart applications, adequate training and financial support for that