Hypertension, antihypertensive treatment and stroke prevention

The Translation, Reliability and Validity of the Chinese Version of the Hill-Bone Compliance to High Blood Pressure Therapy Scale in Adults with Hypertension

OBJECTIVE

To assess the reliability and validity of the Chinese version of the Hill-Bone compliance to high blood pressure therapy scale (HBTS) for use in adults with hypertension in China.

METHODS

To develop a Chinese version of the study scale, it was translated into Chinese then back-translated into English. The final version was used in a survey conducted between Jan and June 2019 in a hospital in Xi'an, China. Reliability was assessed by using the Cronbach's alpha as a measure of analyzing the internal consistency. Exploratory factor analysis (EFA) was performed to assess the validity of the Chinese scale.

RESULTS

The EFA revealed a four-component structure representing two of medication taking; appointment keeping and reduced sodium intake. Percentages of explained variance were 37.55%, 52.77%, 65.24% and 73.97%, respectively. All questions have factor loadings >0.4. The Cronbach's alpha score for the entire questionnaire was 0.857.

CONCLUSION

The Chinese Hill-Bone scale (HBTS-C) is a valid and reliable instrument for measuring adherence among Chinese with hypertension. Use of this screening tool for the assessment of adherence to hypertension treatment is recommended.

Post-discharge evaluation of medication adherence and knowledge of hypertension among hypertensive stroke patients in northwestern China

OBJECTIVES

The aims of this study were to assess the knowledge of hypertension (HTN) and investigate risk factors associated with medication adherence among hypertensive stroke patients after discharge in northwestern China.

PATIENTS AND METHODS

A cross-sectional study involving 440 Chinese hypertensive stroke patients was conducted in a tertiary hospital in Xi'an, China. Data were collected by telephone interviews and patients' medical records.

RESULTS

It was found that 35.23% of patients were compliant with their antihypertensive drug treatments, and 42.95%, 52.27% and 4.77% of patients had poor, moderate and adequate knowledge of HTN, respectively. Gender, blood pressure (BP) categories, BP monitoring and HTN knowledge were independently associated with antihypertensive medication adherence.

CONCLUSION

The medication adherence among hypertensive stroke patients in northwestern China was poor. Knowledge of HTN was suboptimal. More attention and effective strategies should be designed to the factors affecting medication adherence. As knowledge positively affects medication adherence, clinical pharmacists should play an important role in patients' medication education.

On target to dual block RAS?

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are thought to possess cardioprotective, cerebroprotective, and nephroprotective properties. Both classes of agents can prevent or reverse endothelial dysfunction and atherosclerosis, thereby potentially reducing the risk of cardiovascular events. Such a reduction has been shown with angiotensin-converting enzyme inhibitors in patients with coronary artery disease, but no such data are scarce with angiotensin receptor blockers (Valsartan in Acute Myocardial Infarction study). Both angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been shown to reduce damage in target organs, such as the heart and kidney, and to decrease cardiovascular mortality and morbidity in patients with congestive heart failure. These drugs (especially angiotensin receptor blockers) may successfully prevent atrial fibrillation and play a protective role in metabolic syndrome. In some clinical settings, combined therapy angiotensin-converting enzyme inhibitors with angiotensin receptor blocker (double blockade of the renin-angiotensin- aldosterone system) may appear the most effective.

[Impact of the presence of cardiovascular disease on blood pressure and lipid control in the hypertense population attended in primary care]

OBJECTIVES

To determine the impact of cardiovascular disease (CVD) (heart failure, ischaemic heart disease, stroke, renal insufficiency, and peripheral arterial disease) on blood pressure (BP) and LDL-cholesterol (LDL-C) control in hypertense patients.

DESIGN

We analysed the subset of patients with CVD from those included in the PRESCOT study (a cross-sectional study of hypertense patients attended in primary care).

SETTING

A total of 2000 primary care physicians participated in the study.

PARTICIPANTS

In an analysis of 12 954 patients (50.1% males; aged 62.1 [10.7]), good BP control was defined as <140/90 mm Hg (<130/80 mm Hg for diabetics) and good LDL-C control, according to the ATP-III stipulations for every risk group.

RESULTS

Overall, 3294 (25.43%) patients had established CVD (mean age, 66.0 [10.2] years; 56.3% males). Of these, 82.2% had dyslipidaemia and 45.6% were diabetics (vs 72.3% and 23.9%, respectively, in non-CVD group; P< .0001). Patients with CVD were treated with more anti-hypertensives (55.7% vs 30.4% were on é2 drugs; P< .001) and more lipid-lowering drugs (67.6% vs 55.4%, P< .001) than patients without CVD. BP was controlled in 25.3% of patients with CVD versus 26.7% (P=.095); and LDL-C in 13.3% versus 40.2% (P< .001). Only 7.0% of patients with CVD were well controlled for both parameters versus 18.7% of those without CVD (P< .001). The main predictive factors of poor BP control were Diabetes (OR, 1.20; 95% CI, 1.10-1.30), sedentary lifestyle (OR, 1.19; 95% CI, 1.11-1.29) and female gender (OR, 1.12; 95% CI, 1.02-1.23), among others; whilst the main factors for poor LDL-C control were a family history of CVD (OR, 1.34; 95% CI, 1.24-1.46), sedentary lifestyle (OR, 1.28; 95% CI, 1.18-1.39), and diabetes (OR, 1.15; 95% CI, 1.06-1.26).

CONCLUSIONS

BP and LDL-C control in the hypertense population with CVD is very poor. In fact, only 7% of these patients have both parameters well controlled.

Targeting angiotensin II type I receptors to reduce the risk of stroke in patients with hypertension

The incidence of stroke is rising among the elderly population. Hypertension is the single most important contributor to stroke, and hypertension treatment and control is the most important intervention to prevent it. Blood pressure reduction by any means will substantially reduce the risk of stroke. However, accumulating evidence indicates that angiotensin receptor blocker-based regimens may provide additional benefits in the prevention of stroke. This effect seems to be particularly prominent in high-risk patients and patients with isolated systolic hypertension. The pathophysiological mechanisms have not been clearly delineated, but favourable remodelling of the left atrium and reduction of the risk of atrial fibrillation has been suggested. In addition, blockade of the central AT1 receptors and stimulation of AT2 receptors and/or preferential reduction of central pressure by angiotensin receptor blockers may account for the beneficial protective effect.