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Wilkinson MJ, Bajaj A, Brousseau ME, Taub PR. Harnessing RNA Interference for Cholesterol Lowering: The Bench-to-Bedside Story of Inclisiran. J Am Heart Assoc 2024; 13:e032031. [PMID: 38456415 PMCID: PMC11010004 DOI: 10.1161/jaha.123.032031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/06/2023] [Indexed: 03/09/2024]
Abstract
Lowering low-density lipoprotein cholesterol (LDL-C) is a cornerstone of reducing risk for atherosclerotic cardiovascular disease. Despite the approval of nonstatin therapies for LDL-C lowering over the past 2 decades, these medications are underused, and most patients are still not at guideline-recommended LDL-C goals. Barriers include poor adherence, clinical inertia, concern for side effects, cost, and complex prior authorization processes. With atherosclerotic cardiovascular disease-related mortality increasing globally, there remains a need for additional therapeutic options for lowering LDL-C as part of an atherosclerotic cardiovascular disease prevention strategy. Following the identification of PCSK9 (proprotein convertase subtilisin/kexin type 9) as a promising therapeutic target, inclisiran was developed using the natural process of RNA interference for robust, sustained prevention of hepatic PCSK9 synthesis. Twice-yearly maintenance subcutaneous inclisiran (following initial loading doses at Day 1 and Day 90) reduces circulating LDL-C levels by ≈50% versus placebo when added to maximally tolerated statins. Long-term safety and tolerability of inclisiran have been assessed, with studies underway to evaluate the effects of inclisiran on cardiovascular outcomes and to provide additional safety and effectiveness data. In 2021, <20 years after the discovery of PCSK9, inclisiran became the first RNA interference therapeutic approved in the United States for LDL-C lowering in patients with established atherosclerotic cardiovascular disease or familial hypercholesterolemia and has since been approved for use in patients with primary hyperlipidemia. This article reviews the journey of inclisiran from bench to bedside, including early development, the clinical trial program, key characteristics of inclisiran, and practical points for its use in the clinic.
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Affiliation(s)
- Michael J. Wilkinson
- Division of Cardiovascular Medicine, Department of MedicineCardiovascular Institute, University of California San DiegoSan DiegoCAUSA
| | - Archna Bajaj
- Department of MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Margaret E. Brousseau
- Cardiovascular and Metabolism Disease Area, Novartis Institutes for BioMedical ResearchCambridgeMAUSA
| | - Pam R. Taub
- Division of Cardiovascular Medicine, Department of MedicineCardiovascular Institute, University of California San DiegoSan DiegoCAUSA
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Tan JW, Bhalla V. RNA Interference as a Therapeutic Approach for Managing Hypertension. Clin J Am Soc Nephrol 2024; 19:01277230-990000000-00356. [PMID: 38349665 PMCID: PMC11168811 DOI: 10.2215/cjn.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
- Jia Wei Tan
- Division of Nephrology, Stanford University School of Medicine, Stanford, California and Department of Medicine, Stanford Hypertension Center, Stanford University School of Medicine, Stanford, California
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Funes Hernandez M, Babakhanian M, Chen TP, Sarraju A, Seninger C, Ravi V, Azizi Z, Tooley J, Chang TI, Lu Y, Downing NL, Rodriguez F, Li RC, Sandhu AT, Turakhia M, Bhalla V, Wang PJ. Design and Implementation of an Electronic Health Record-Integrated Hypertension Management Application. J Am Heart Assoc 2024; 13:e030884. [PMID: 38226516 PMCID: PMC10926825 DOI: 10.1161/jaha.123.030884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND High blood pressure affects approximately 116 million adults in the United States. It is the leading risk factor for death and disability across the world. Unfortunately, over the past decade, hypertension control rates have decreased across the United States. Prediction models and clinical studies have shown that reducing clinician inertia alone is sufficient to reach the target of ≥80% blood pressure control. Digital health tools containing evidence-based algorithms that are able to reduce clinician inertia are a good fit for turning the tide in blood pressure control, but careful consideration should be taken in the design process to integrate digital health interventions into the clinical workflow. METHODS We describe the development of a provider-facing hypertension management platform. We enumerate key steps of the development process, including needs finding, clinical workflow analysis, treatment algorithm creation, platform design and electronic health record integration. We interviewed and surveyed 5 Stanford clinicians from primary care, cardiology, and their clinical care team members (including nurses, advanced practice providers, medical assistants) to identify needs and break down the steps of clinician workflow analysis. The application design and development stage were aided by a team of approximately 15 specialists in the fields of primary care, hypertension, bioinformatics, and software development. CONCLUSIONS Digital monitoring holds immense potential for revolutionizing chronic disease management. Our team developed a hypertension management platform at an academic medical center to address some of the top barriers to adoption and achieving clinical outcomes. The frameworks and processes described in this article may be used for the development of a diverse range of digital health tools in the cardiovascular space.
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Affiliation(s)
- Mario Funes Hernandez
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
- Division of Nephrology, Department of MedicineStanford University School of MedicineStanfordCAUSA
- Stanford Hypertension CenterStanford University School of MedicineStanfordCAUSA
| | - Meghedi Babakhanian
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCAUSA
| | - Tania P. Chen
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCAUSA
| | - Ashish Sarraju
- Stanford Hypertension CenterStanford University School of MedicineStanfordCAUSA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCAUSA
| | - Clark Seninger
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
| | - Vishnu Ravi
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
| | - Zahra Azizi
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
| | - James Tooley
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCAUSA
| | - Tara I. Chang
- Division of Nephrology, Department of MedicineStanford University School of MedicineStanfordCAUSA
- Stanford Hypertension CenterStanford University School of MedicineStanfordCAUSA
| | - Ying Lu
- Department of Biomedical Data SciencesStanford University School of MedicineStanfordCAUSA
| | - N. Lance Downing
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
- Biomedical Informatics Research, Department of MedicineStanford University School of MedicineStanfordCAUSA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCAUSA
| | - Ron C. Li
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
- Biomedical Informatics Research, Department of MedicineStanford University School of MedicineStanfordCAUSA
| | - Alexander T. Sandhu
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCAUSA
- Veterans Affairs Palo Alto Health Care SystemPalo AltoCAUSA
| | - Mintu Turakhia
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCAUSA
| | - Vivek Bhalla
- Division of Nephrology, Department of MedicineStanford University School of MedicineStanfordCAUSA
- Stanford Hypertension CenterStanford University School of MedicineStanfordCAUSA
| | - Paul J. Wang
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCAUSA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCAUSA
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Chan RJ, Helmeczi W, Hiremath SS. Revisiting resistant hypertension: a comprehensive review. Intern Med J 2023; 53:1739-1751. [PMID: 37493367 DOI: 10.1111/imj.16189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
Resistant hypertension (RHT) is typically defined as blood pressure that remains above guideline-directed targets despite the use of three anti-hypertensives, usually including a diuretic, at optimal or maximally tolerated doses. It is generally estimated to affect 10-30% of those diagnosed with hypertension, though the true incidence might be lower after one factor in the prevalence of non-adherence. Risk factors for its development include diabetes, obesity and other adverse lifestyle factors, and a diagnosis of RHT confers a greater risk of adverse cardiovascular outcomes, such as stroke, heart failure and mortality. It is essential to exclude pseudoresistance and secondary hypertension and to ensure non-pharmacologic management is optimised prior to consideration of fourth-line anti-hypertensive agents or advanced interventions, such as device therapies. In this review, we will cover the different definitions of RHT, along with the importance of careful diagnosis and management strategies, and discuss newer agents and research needs.
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Affiliation(s)
- Ryan J Chan
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Wryan Helmeczi
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Swapnil S Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Sharma JR, Dludla PV, Dwivedi G, Johnson R. Measurement Tools and Utility of Hair Analysis for Screening Adherence to Antihypertensive Medication. Glob Heart 2023; 18:17. [PMID: 36968302 PMCID: PMC10038111 DOI: 10.5334/gh.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Poor adherence to the prescribed antihypertensive therapy is an understated public health problem and is one of the main causes of the high prevalence of uncontrolled hypertension in sub-Saharan Africa. Medication adherence is vital for the effectiveness of antihypertensive treatment and is key to ameliorating the clinical outcomes in hypertensive patients. However, it has often been ignored because the current methods used to assess medication adherence are not reliable, limiting their utilization in clinical practice. Therefore, the identification of the most accurate and clinically feasible method for measuring medication adherence is critical for tailoring effective strategies to improve medication adherence and consequently achieve blood pressure goals. This review not only explores various available methods for estimating medication adherence but also proposes therapeutic drug monitoring in hair for the measurement of medication adherence to the antihypertensive medication period.
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Affiliation(s)
- Jyoti R. Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Phiwayinkosi V. Dludla
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Girish Dwivedi
- Medical School, University of Western Australia, Harry Perkins Institute of Medical Sciences, Fiona Stanley Hospital, Verdun Street, Nedlands WA, 6009, Australia
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
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Pio-Abreu A, Trani-Ferreira F, Silva GV, Bortolotto LA, Drager LF. Directly observed therapy for resistant/refractory hypertension diagnosis and blood pressure control. Heart 2022; 108:1952-1956. [PMID: 35444006 DOI: 10.1136/heartjnl-2022-320802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/04/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To test the impact of directly observed therapy (DOT) at hospital for checking not only adherence/diagnosis in patients with resistant (RHTN) and refractory (RefHTN) hypertension but also blood pressure (BP) control after hospital discharge. METHODS During 2 years, Brazilian patients with clinical suspicion of RHTN/RefHTN after several attempts (≥3) to control BP in the outpatient setting were invited to perform DOT (including low-sodium diet and supervised medications intake) at the hospital. RHTN and RefHTN were categorised using standard definitions. After hospital discharge, we evaluated the BP values and the number of antihypertensive drugs prescribed by physicians who were not involved with the investigation. RESULTS We studied 83 patients clinically suspected for RHTN (31%) and RefHTN (69%) (mean age: 53 years; 76% female; systolic BP 177±28 mm Hg and diastolic BP 106±21 mm Hg; number of antihypertensive drugs: 5.3±1.3). DOT confirmed RHTN in 77%, whereas RefHTN was confirmed in only 32.5%. The number of antihypertensive drugs reduced to 4.5±1.3 and systolic/diastolic BP at hospital discharge reduced to 131±17 mm Hg/80±12 mm Hg. After hospital discharge, systolic BP remained significantly lower than the last outpatient visit prehospital admission (delta changes (95% CI): 1 month: -25.7 (-33.8 to -17.6) mm Hg; 7 months: -27.3 (-35.5 to -19.1) mm Hg) despite fewer number of antihypertensive classes (1 month: -1.01 (-1.36 to -0.67); 7 months: -0.77 (-1.11 to -0.42)). Similar reductions were observed for diastolic BP. CONCLUSIONS DOT at hospital is helpful not only in confirming/excluding RHTN/RefHTN phenotypes, but also in improving BP values and BP control and in reducing the need for antihypertensive drugs after hospital discharge.
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Affiliation(s)
- Andrea Pio-Abreu
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Trani-Ferreira
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Giovanio V Silva
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luciano F Drager
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil .,Unidade de Hipertensão, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Leung AA, Williams JVA, Tran KC, Padwal RS. Epidemiology of Resistant Hypertension in Canada. Can J Cardiol 2022; 38:681-687. [PMID: 35122938 DOI: 10.1016/j.cjca.2022.01.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Resistant hypertension is associated with cardiovascular morbidity and mortality. The objective of this study was to estimate the prevalence of apparent treatment-resistant hypertension in Canadian adults and examine the characteristics of those affected. METHODS A nationally-representative, cross-sectional study was conducted using Canadian Health Measures Survey (2007-2017) data. The frequency of respondents with uncontrolled blood pressure despite 3 or more antihypertensive medications of different drug classes (and at least one agent being a diuretic), or treatment with 4 or more agents, irrespective of blood pressure, was determined. RESULTS A total of 245,700 people were identified to have apparent treatment-resistant hypertension, representing 5.3% (95% confidence intervals [CI], 4.5% to 6.2%) of adults treated for hypertension in Canada. Respondents who had uncontrolled blood pressure with 3 or more antihypertensive drugs were more likely women (55.8% [95% CI, 41.1% to 70.4%]), 70 years of age or older (45.3% [95% CI, 32.8-57.9]), and overweight or obese (84.2% [95% CI, 72.3% to 96.1%]). Respondents with apparent treatment-resistant hypertension also had a high likelihood of chronic kidney disease (36.0% [95% CI, 21.4% to 50.6%]), diabetes (35.2% [95% CI, 21.7% to 48.7%]), dyslipidemia (68.0% [95% CI, 55.2% to 80.8%]), and previous history of heart attack (9.9% [95% CI, 4.8% to 15.1%]) or stroke (7.1% [95% CI, 0 to 14.4%]). CONCLUSIONS Despite being prescribed at least 3 antihypertensive drugs, a considerable proportion of Canadians, especially women, have difficulty achieving blood pressure control, predisposing them to a higher risk of cardiovascular complications and death.
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Affiliation(s)
- Alexander A Leung
- Department of Medicine, University of Calgary, Calgary, AB, Canada;; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada;.
| | - Jeanne V A Williams
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Karen C Tran
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Edwards C, Hundemer GL, Petrcich W, Canney M, Knoll G, Burns K, Bugeja A, Sood MM. Comparison of Clinical Outcomes and Safety Associated With Chlorthalidone vs Hydrochlorothiazide in Older Adults With Varying Levels of Kidney Function. JAMA Netw Open 2021; 4:e2123365. [PMID: 34524440 PMCID: PMC8444030 DOI: 10.1001/jamanetworkopen.2021.23365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Thiazide diuretics are commonly prescribed for the treatment of hypertension, a disease highly prevalent among older individuals and in those with chronic kidney disease. How specific thiazide diuretics compare in regard to safety and clinical outcomes in these populations remains unknown. OBJECTIVE To compare safety and clinical outcomes associated with chlorthalidone or hydrochlorothiazide use among older adults with varying levels of kidney function. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study was conducted in Ontario, Canada, from 2007 to 2015. Participants included adults aged 66 years or older who initiated chlorthalidone or hydrochlorothiazide during this period. Data were analyzed from December 2019 through September 2020. EXPOSURES New chlorthalidone users were matched 1:4 with new hydrochlorothiazide users by a high-dimensional propensity score. Time-to-event models accounting for competing risks examined the associations between chlorthalidone vs hydrochlorothiazide use and the outcomes of interest overall and within estimated glomerular filtration rate (eGFR) categories (≥60, 45-59, and <45 mL/min/1.73 m2). MAIN OUTCOMES AND MEASURES The outcomes of interest were adverse kidney events (ie, eGFR decline ≥30%, dialysis, or kidney transplantation), cardiovascular events (composite of myocardial infarction, coronary revascularization, heart failure, or atrial fibrillation), all-cause mortality, and electrolyte anomalies (ie, sodium or potassium levels outside reference ranges). RESULTS After propensity score matching, the study cohort included 12 722 adults (mean [SD] age, 74 [7] years; 7063 [56%] women; 5659 [44%] men; mean [SD] eGFR, 69 [19] mL/min/1.73 m2), including 2936 who received chlorthalidone and 9786 who received hydrochlorothiazide. Chlorthalidone use was associated with a higher risk of eGFR decline of 30% or greater (hazard ratio [HR], 1.24 [95% CI, 1.13-1.36]) and cardiovascular events (HR, 1.12 [95% CI, 1.04-1.22]) across all eGFR categories compared with hydrochlorothiazide use. Chlorthalidone use was also associated with a higher risk of hypokalemia compared with hydrochlorothiazide use, which was more pronounced among those with higher eGFR (eGFR ≥60 mL/min/1.73 m2: HR, 1.86 [95% CI, 1.67-2.08]; eGFR 45-59 mL/min/1.73 m2: HR, 1.57 [95% CI, 1.25-1.96]; eGFR <45 mL/min/1.73 m2: HR, 1.10 [95% CI, 0.84-1.45]; P for interaction = .001). No significant differences were observed between chlorthalidone and hydrochlorothiazide for dialysis or kidney transplantation (HR, 1.44 [95% CI, 0.88-2.36]), all-cause mortality (HR, 1.10 [95% CI, 0.93-1.29]), hyperkalemia (HR, 1.05 [95% CI, 0.79-1.39]), or hyponatremia (HR, 1.14 [95% CI, CI 0.98-1.32]). CONCLUSIONS AND RELEVANCE This cohort study found that among older adults, chlorthalidone use was associated with a higher risk of eGFR decline, cardiovascular events, and hypokalemia compared with hydrochlorothiazide use. The excess risk of hypokalemia with chlorthalidone was attenuated in participants with reduced kidney function. Placed in context with prior observational studies comparing the safety and clinical outcomes associated with thiazide diuretics, these results suggest that there is no evidence to prefer chlorthalidone over hydrochlorothiazide.
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Affiliation(s)
- Cedric Edwards
- Ottawa Hospital Research Institute, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Gregory L. Hundemer
- Ottawa Hospital Research Institute, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Mark Canney
- Ottawa Hospital Research Institute, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Greg Knoll
- Ottawa Hospital Research Institute, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Kevin Burns
- Ottawa Hospital Research Institute, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Ann Bugeja
- Ottawa Hospital Research Institute, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Manish M. Sood
- Ottawa Hospital Research Institute, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Canada
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Prescription, over-the-counter (OTC), herbal, and other treatments and preventive uses for COVID-19. ENVIRONMENTAL AND HEALTH MANAGEMENT OF NOVEL CORONAVIRUS DISEASE (COVID-19 ) 2021. [PMCID: PMC8237643 DOI: 10.1016/b978-0-323-85780-2.00001-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The current COVID-19 pandemic has spread rapidly worldwide and has challenged fragile health care systems, vulnerable socioeconomic conditions, and population risk factors, and has led to an overwhelming tendency to misuse prescription drugs and self-medication with prescription drugs, over-the-counter (OTC) drugs, herbals products, and unproven chemicals as a desperate preventive or curative measure for COVID-19. In this chapter, we present the legislative differences between prescription drugs, OTC drugs, and herbals. Various approved and nonapproved prescription and OTC drugs as symptomatic treatment for COVID-19 are listed and evaluated based on their reported efficacy, safety, and toxicological profile. We also present the various herbal products that are currently studied and used as treatment and preventive for COVID-19. The efficacy, toxicology profile, safety, and legal issues of some speculative preventive and treatment options against COVID-19, such as Miracle Mineral Solution (MMS), chlorine dioxide solution (CDS), colloidal silver, and hydrogen peroxide is presented. The chapter also emphasizes the specific strategies that need to be implemented to guide the population in the effective and safe use of prescribed medications, such as the Medication Therapy Management or Pharmaceutical Care process. Finally, this chapter aims to provide a deeper insight into the lack of health literacy in the population and the effect that drug utilization research (DUR) has in the decision making of health authorities and general public. We aim to provide the current information about the various treatment and preventive options used for COVID-19.
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Fay KS, Cohen DL. Resistant Hypertension in People With CKD: A Review. Am J Kidney Dis 2021; 77:110-121. [DOI: 10.1053/j.ajkd.2020.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/17/2020] [Indexed: 01/23/2023]
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Schesing KB, Chia R, Elwood B, Halm EA, Lee SJC, Lodhi H, Wu B, Sharma S, Smith SA, Jarrett RB, Das SR, Vongpatanasin W. Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication adherence in low-income patients with hypertension: a qualitative study. BMJ Open 2020; 10:e039940. [PMID: 33247015 PMCID: PMC7703422 DOI: 10.1136/bmjopen-2020-039940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Previous studies have implicated therapeutic drug monitoring (TDM), by measuring serum or urine drug levels, as a highly reliable technique for detecting medication non-adherence but the attitudes of patients and physicians toward TDM have not been evaluated previously. Accordingly, we solicited input from patients with uncontrolled hypertension and their physicians about their views on TDM. DESIGN Prospective analysis of responses to a set of questions during semistructured interviews. SETTING Outpatient clinics in an integrated health system which provides care for a low-income, uninsured population. PARTICIPANTS Patients with uncontrolled hypertension with either systolic blood pressure of at least 130 mm Hg or diastolic blood pressure of at least 80 mm Hg despite antihypertensive drugs and providers in the general cardiology and internal medicine clinics. PRIMARY AND SECONDARY OUTCOME MEASURES Attitudes towards TDM and the potential impact on physician-patient relationship. RESULTS We interviewed 11 patients and 10 providers and discussed the findings with 13 community advisory panel (CAP) members. Of the patients interviewed, 91% (10 of 11) and all 10 providers thought TDM was a good idea and should be used regularly to better understand the reasons for poorly controlled hypertension. However, 63% (7 of 11) of patients and 20% of providers expressed reservations that TDM could negatively impact the physician-patient relationship. Despite some concerns, the majority of patients, providers and CAP members believed that if test results are communicated without blaming patients, the potential benefits of TDM in identifying suboptimal adherence and eliciting barriers to adherence outweighed the risks. CONCLUSION The idea of TDM is well accepted by patients and their providers. TDM information if delivered in a non-judgmental manner, to encourage an honest conversation between patients and physicians, has the potential to reduce patient-physician communication obstacles and to identify barriers to adherence which, when overcome, can improve health outcomes.
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Affiliation(s)
- Kevin B Schesing
- Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Ricardo Chia
- Hypertension Section, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Bryan Elwood
- General Internal Medicine Division, Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ethan A Halm
- General Internal Medicine Division, Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Hamza Lodhi
- Hypertension Section, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Bryan Wu
- Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Shishir Sharma
- Cardiology Division, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, United States
| | - Scott A Smith
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Robin B Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sandeep R Das
- Cardiology Division, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, United States
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Wanpen Vongpatanasin
- Hypertension Section, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Cardiology Division, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, United States
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Hypertension Canada’s 2020 Evidence Review and Guidelines for the Management of Resistant Hypertension. Can J Cardiol 2020; 36:625-634. [DOI: 10.1016/j.cjca.2020.02.083] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/30/2022] Open
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Chang TI. Is There Any Role for Device Therapies in Resistant Hypertension? Commentary. KIDNEY360 2020; 1:14-15. [PMID: 35378029 PMCID: PMC8808495 DOI: 10.34067/kid.0000682019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Tara I Chang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
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Bourque G, Ilin JV, Ruzicka M, Davis AS, Hiremath S. The Prevalence of Nonadherence in Patients With Resistant Hypertension: A Systematic Review Protocol. Can J Kidney Health Dis 2019; 6:2054358119897196. [PMID: 31903192 PMCID: PMC6931137 DOI: 10.1177/2054358119897196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/03/2019] [Indexed: 01/22/2023] Open
Abstract
Background Resistant hypertension, usually defined as blood pressure remaining above goal despite the concurrent use of 3 or more antihypertensive agents of different classes, is common (about 10% prevalence) and known to be a risk factor for cardiovascular events. These patients also undergo more screening intensity for secondary hypertension. However, not all patients with apparent treatment-resistant hypertension have true resistant hypertension, with some of them being nonadherent to prescribed pharmacotherapy. The prevalence of nonadherence varies from about 5% to 80% in the published literature. However, the relative contributions of intentional and nonintentional nonadherence are not well described. Nonintentional nonadherence refers to occasional forgetfulness and/or carelessness and can sometimes be related to an inability to follow instructions, because of either cognitive or physical limitations. Intentional nonadherence refers to an active process in which a patient may choose to alter the prescribed medication regimen by discontinuing medications, skipping doses, or modifying doses or dosing intervals. Objective Our objective is to establish the overall prevalence of nonadherence in the apparent treatment-resistant hypertension population and evaluate the relative contributions of nonintentional and intentional nonadherence subtypes. Design We will conduct a systematic review and meta-analysis. Setting We will include observational studies and randomized controlled trials where adherence to antihypertensive medications is measured using a test of adherence, either direct or indirect. Patients We will include adult human participants aged 18 years or older with a diagnosis of resistant hypertension. Measurements Data extracted from individual studies will include title, first author, design, country, publication year, funding body, method of assessing adherence to antihypertensive medication, prevalence of medication nonadherence, definition of resistant hypertension, sample size, sex, mean age, and coexistent comorbidities. Methods A librarian will search the databases Medline, EMBASE, Cochrane, CINAHL, and Web of Science for studies meeting criteria for inclusion. Two reviewers will independently screen the titles and abstracts retrieved and assess the methodological quality of eligible full-text articles using the Cochrane Risk of Bias tool for clinical trials and the Newcastle-Ottawa Scale for observational studies. Summary estimates of prevalence will be generated using pooled analysis using the random-effects method. Subgroup analyses, sensitivity analyses, and evaluation of publication bias will also be performed. Results The outcomes of interest are the pooled prevalence of nonadherence to antihypertensive medication in apparent treatment-resistant hypertension and the prevalence of nonadherence based on different methods of assessing nonadherence (indirect vs direct), which will allow us to estimate the relative proportion of unintentional and intentional nonadherence subtypes in the overall phenomenon of medication nonadherence. Limitations Possible limitations of this study include the finding of severe heterogeneity, the limitations of the literature search, publication bias, and the lack of granular data in the published studies for a study-level meta-analysis. Conclusions This systematic review will provide a synthesis of current evidence on the prevalence of medication nonadherence in apparent treatment-resistant hypertension and on the relative contributions of nonintentional and intentional nonadherence subtypes. These findings will provide clinicians with a better understanding of the factors underlying treatment-resistant hypertension and will serve as a strong research base to guide future research on interventions to address medication nonadherence as well as the nonintentional and intentional subtypes. Trial registration This protocol has been registered with PROSPERO. We will add registration details once available.
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