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A considerable number of patients with type 1 diabetes have two or more additional cardiovascular disease risk factors (6).
To comply with the current recommendations, the patients targeted for treatment were those with an essential hypertension not controlled by a previous monotherapy associated with one or more additional cardiovascular risk factors.
For example, to be included in the ATHENA trial patients were required to be over 75-years old or over 70-years old with one or more additional cardiovascular risk factor.
The ATHENA trial population comprised patients with paroxysmal or persistent AF/AFL who were aged either ≥75 years (with or without cardiovascular risk factors) or <75 years with one or more additional cardiovascular risk factors.
The present pharmacological trial demonstrated that the combinations of zofenopril and HCTZ and that of irbesartan and HCTZ both provide similarly effective, prolonged and well-tolerated control of BP in hypertensive patients not controlled by previous monotherapy and with one or more additional cardiovascular risk factors.
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Therefore, the patients probably sought medical advice more often during the following year, so additional cardiovascular diseases perhaps present at the initial assessment but undetected by regular screening tests might have been diagnosed.
However, testing for albuminuria in subjects with additional cardiovascular risk factors is warranted, as a more aggressive treatment can be defended in subjects with additional risk factors in presence of albuminuria compared to those with risk factors but without albuminuria.
We defined a patient with an additional cardiovascular comorbidity as one who had one or more of the following diseases: diabetes mellitus, coronary heart disease, stroke, atrial fibrillation, renal failure and heart failure.
However, patients with AF tend to be elderly and have cardiovascular comorbidities that may require treatment with one or more additional medications.
The onset of symptoms is age related and additional cardiovascular events are expected to be observed in the PREVEND cohort as more time passes.
It will determine whether therapeutic strategies targeting normoglycemia, normotension, and/or a normal lipid profile can reduce the rate of cardiovascular events more than standard therapeutic approaches in individuals with type 2 diabetes and either previous cardiovascular events or additional cardiovascular risk factors.
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