The uses and expenses of antihypertensive medications among hypertensive adults

Hemp seed protein and its hydrolysate compared with casein protein consumption in adults with hypertension: a double-blind crossover study

BACKGROUND

The effects of consuming hemp seed protein (HSP) as well as its hydrolysate-derived bioactive peptide (HSP+) on blood pressure (BP) has not, to our knowledge, been investigated in humans.

OBJECTIVES

We aimed to investigate how consumption of HSP and its hydrolysate modulates 24-h systolic (SBP) and diastolic BP (DBP) and plasma biomarkers of BP compared with casein.

METHODS

In a double-blind, randomized, crossover design trial, 35 adults who had mild hypertension with SBP between 130 and 160 mmHg and DBP ≤110 mmHg were recruited. Participants were randomly assigned to varying sequences of 3 6-wk treatments, 50 g casein/d, 50 g HSP/d, or 45 g HSP plus 5 g HSP-derived bioactive peptides/d (HSP+), separated by a 2-wk washout period. Treatment effects were assessed with a linear mixed model with repeated measures.

RESULTS

Compared with casein, after HSP+ consumption, 24-h SBP and 24-h DBP decreased from 135.1 and 80.0 mmHg to 128.1 ± 1.6 (P < 0.0001) and 76.0 ± 1.4 mmHg (P < 0.0001), respectively, whereas these values were 133.5 ± 1.6 and 78.9 ± 1.4 mmHg after HSP consumption (P < 0.0001). There were no differences between the HSP and HSP+ consumption in plasma angiotensin-converting enzyme (ACE) activity, renin, or nitric oxide (NO) concentrations. However, these 2 treatments were able to lower both ACE and renin activities and raise NO concentration in plasma compared with casein.

CONCLUSIONS

These results suggest that hemp protein consumption, as well as in combination with bioactive peptides, may have a role in the dietary management of hypertension. This trial was registered at clinicaltrials.gov as NCT03508895.

Impact of blood pressure and antihypertensive drug classes on intracranial aneurysm: a Mendelian randomization study

BACKGROUND

Blood pressure is a risk factor for intracranial aneurysms (IA). Nevertheless, whether various antihypertensive drug classes discriminate in reducing IA risk is unclear.

METHODS

Genome-wide association study summary statistics for systolic blood pressure (SBP), diastolic blood pressure (DBP), IA (non-ruptured), and IA [subarachnoid hemorrhage (SAH)] were downloaded. To proxy the effects of antihypertensive drugs, genetic variants associated with SBP adjacent to the coding regions of different antihypertensive drugs were selected. The inverse-variance-weighted (IVW) method was employed as the primary method for causal estimation. In addition, three additional MR methods and sensitivity tests were utilized to assess the reliability.

RESULTS

Elevated blood pressure significantly increases the risk of IA: (i) SBP-IA (non-ruptured): odds ratio (OR) = 1.046, 95 % confidence interval (CI): 1.032-1.061, P = 1.05E-10; (ii) SBP-IA (SAH): OR = 1.040, 95 % CI: 1.030-1.050, P = 2.56E-15; (iii) DBP-IA (non-ruptured): OR = 1.082, 95 % CI: 1.056-1.110, P = 3.15E-10; (iv) DBP-IA (SAH): OR = 1.066, 95 % CI: 1.047-1.085, P = 1.25E-12. In addition, among calcium channel blockers (CCBs), beta-blockers (BBs), and thiazide diuretics (TDs), only SBP mediated by TDs target genes significantly increased the risk of IA (non-rupture) (OR = 1.164, 95 % CI: 1.060-1.279, P = 0.001) and IA (SAH) (OR = 1.136, 95 % CI: 1.063-1.214, P = 1.58E-04), while SBP mediated by target genes of BBs or CCBs did not causally associate with IA.

CONCLUSION

Elevated blood pressure significantly increases IA risk, while TDs may be a promising antihypertensive medication for reducing IA risk. Further research with larger cohorts is essential for validation.

Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States

Importance

Pharmacist-led interventions can significantly improve blood pressure (BP) control. The long-term cost-effectiveness of pharmacist-prescribing interventions implemented on a large scale in the US remains unclear.

Objective

To estimate the cost-effectiveness of implementing a pharmacist-prescribing intervention to improve BP control in the US.

Design, Setting, and Participants

This economic evaluation included a 5-state Markov model based on the pharmacist-prescribing intervention used in The Alberta Clinical Trial in Optimizing Hypertension (or RxACTION) (2009 to 2013). In the trial, control group patients received an active intervention, including a BP wallet card, education, and usual care. Data were analyzed from January to June 2023.

Main Outcomes and Measures

Cardiovascular (CV) events, end-stage kidney disease events, life years, quality-adjusted life years (QALYs), lifetime costs, and lifetime incremental cost-effectiveness ratio (ICER). CV risk was calculated using Framingham risk equations. Costs were based on the reimbursement rate for level 1 encounters, medication costs from published literature, and event costs from national surveys and pricing data sets. Quality of life was determined using a published catalog of EQ-5D utility values. One-way sensitivity analyses were used to assess alternative reimbursement values, a reduced time horizon of 5 years, alternative assumptions for BP reduction, and the assumption of no benefit to the intervention after 10 years. The model was expanded to the US population to estimate population-level cost and health impacts.

Results

Assumed demographics were mean (SD) age, 64 (12.5) years, 121 (49%) male, and a mean (SD) baseline BP of 150/84 (13.9/11.5) mm Hg. Over a 30-year time horizon, the pharmacist-prescribing intervention yielded 2100 fewer cases of CV disease and 8 fewer cases of kidney disease per 10 000 patients. The intervention was also associated with 0.34 (2.5th-97.5th percentiles, 0.23-0.45) additional life years and 0.62 (2.5th-97.5th percentiles, 0.53-0.73) additional QALYs. The cost savings were $10 162 (2.5th-97.5th percentiles, $6636-$13 581) per person due to fewer CV events with the pharmacist-prescribing intervention, even after the cost of the visits and medication adjustments. The intervention continued to produce benefits in more conservative analyses despite increased costs as the ICER ranged from $2093 to $24 076. At the population level, a 50% intervention uptake was associated with a $1.137 trillion in cost savings and would save an estimated 30.2 million life years over 30 years.

Conclusion and Relevance

These findings suggest that a pharmacist-prescribing intervention to improve BP control may provide high economic value. The necessary tools and resources are readily available to implement pharmacist-prescribing interventions across the US; however, reimbursement limitations remain a barrier.

Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems

Poor medication adherence is a pervasive issue with considerable health and socioeconomic consequences. Although the underlying reasons are generally understood, traditional intervention strategies rooted in patient-centric education and empowerment have proved to be prohibitively complex and/or ineffective. Formulating a pharmaceutical in a drug delivery system (DDS) is a promising alternative that can directly mitigate many common impediments to adherence, including frequent dosing, adverse effects and a delayed onset of action. Existing DDSs have already positively influenced patient acceptability and improved rates of adherence across various disease and intervention types. The next generation of systems have the potential to instate an even more radical paradigm shift by, for example, permitting oral delivery of biomacromolecules, allowing for autonomous dose regulation and enabling several doses to be mimicked with a single administration. Their success, however, is contingent on their ability to address the problems that have made DDSs unsuccessful in the past.

Antihypertensive Use and the Risk of Alzheimer's Disease and Related Dementias among Older Adults in the USA

BACKGROUND

Epidemiological evidence on different classes of antihypertensives and risks of Alzheimer's disease and related dementias (ADRD) is inconclusive and limited. This study examined the association between antihypertensive use (including therapy type and antihypertensive class) and ADRD diagnoses among older adults with hypertension.

METHODS

A retrospective, cross-sectional study was conducted, involving 539 individuals aged ≥ 65 years who used antihypertensives and had ADRD diagnosis selected from 2013 to 2018 Medical Expenditure Panel Survey (MEPS) data. The predictors were therapy type (monotherapy or polytherapy) and class of antihypertensives defined using Multum Lexicon therapeutic classification (with calcium channel blockers [CCBs] as the reference group). Weighted logistic regression was used to assess the relationships of therapy type and class of antihypertensives use with ADRD diagnosis, adjusting for sociodemographic characteristics and health status.

RESULTS

We found no significant difference between monotherapy and polytherapy on the odds of ADRD diagnosis. As to monotherapy, those who used angiotensin-converting enzyme inhibitors (ACEIs) had significantly lower odds of developing AD compared to those who used CCBs (OR 0.36, 95 % CI 0.13-0.99).

CONCLUSIONS

Findings of the study suggest the need for evidence-based drug therapy to manage hypertension in later adulthood and warrant further investigation into the mechanism underlying the protective effect of antihypertensives, particularly ACEIs, against the development of AD among older adults with hypertension.

Risk of Hypertension and Use of Antihypertensive Drugs in the Physically Active Population under-70 Years Old—Spanish Health Survey

Introduction: Reducing the prevalence of hypertension is a major priority of the World Health Organization (WHO). Its high prevalence and associated risks generate high economic and social costs. Physical activity (PA) is associated with a decrease in hypertension and in the use of antihypertensive drugs. Objective: To explore the association between PA levels (PAL), prevalence of hypertension and the use of antihypertensive drugs in Spanish population. To calculate risks of hypertension and use of antihypertensive in the inactive versus physically active population. Method: This cross-sectional study used data from 17717 individuals, sampled in the 2017 National Health Survey. Interaction by sex, age groups, body mass index (BMI), hypertension prevalence, antihypertensive drugs use and PAL, using a pairwise z-test, and dependence relationships between variables, were studied using a chi square test. Odds ratios of hypertension and antihypertensive drug use were calculated among the inactive and the physically active populations. Results: The findings showed a significant inverse association between prevalence of hypertension, antihypertensive use, and PAL in both sexes and different age and BMI groups, with lower prevalence of hypertension and antihypertensive use when PAL were higher. The risks of hypertension and antihypertensive use seems to be reduced when related to higher PAL compared to inactive people. Conclusions: High PAL is associated with lower prevalence of hypertension and lower antihypertensive use. Thus, being physically active or very active may reduce the risks of suffering from hypertension and the need to use antihypertensives compared to inactive people or walkers.

Starting Antihypertensive Drug Treatment With Combination Therapy: Controversies in Hypertension - Con Side of the Argument

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The current practice of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in diabetic hypertensive and non-hypertensive patients. Is there a room for vitamin D?

OBJECTIVES

To determine the current pattern of using angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in diabetic nephropathy (DN), and assess physician awareness of using vitamin D in the prevention and treatment of DN.

METHODS

A cross-sectional study implementing a validated questionnaire, which was distributed to physicians in the aforementioned specialties in 3 hospitals in Saudi Arabia (Almanee Hospital, King Saud Medical City [KSMC], and Riyadh Care Hospital [RCH]) between April 2019 and November 2019. We used IBM SPSS 26.0 to perform descriptive statistical analyses and comparisons were based on the Chi-square test.

RESULTS

Forty-one physicians (30%) reported the use of combination therapy of ACEi and ARBs. Fifty-six (41%) physicians reported that they never used vitamin D in the treatment of DN, and 48% agreed that vitamin D can benefit patients with DN. 52% of the respondents reported the existence of guidelines. The vast majority (94%) recommended clearer guidelines on monitoring renal function in patients treated with ACEi or ARBs.

CONCLUSION

There is a universal agreement among physicians regarding the use of ACEi and ARBs for the treatment of DN with limited awareness of the bene ts of using vitamin D. Hence, the development of specific guidelines for its use are recommended.

Association Between Cost-Related Medication Nonadherence and Hypertension Management Among US Adults

BACKGROUND

Medication nonadherence is an important element of uncontrolled hypertension. Financial factors frequently contribute to nonadherence. The objective of this study was to examine the association between cost-related medication nonadherence (CRMN) and self-reported antihypertensive medication use and self-reported normal blood pressure among US adults with self-reported hypertension.

METHODS

Participants with self-reported hypertension from the 2017 National Health Interview Survey were included (n = 7,498). CRMN was defined using standard questions. Hypertension management included: (i) self-reported current antihypertensive medication use and (ii) self-reported normal blood pressure within the past 12 months. Adjusted prevalence and prevalence ratios of hypertension management indicators among those with and without CRMN were estimated.

RESULTS

Overall, 10.7% reported CRMN, 83.6% reported current antihypertensive medication use, and 67.4% reported normal blood pressure within past 12 months. Adjusted percentages of current antihypertensive medication use (88.6% vs. 82.9%, P < 0.001) and self-reported normal blood pressure (69.8% vs. 59.5%, P = 0.002) were higher among those without CRMN compared with those with CRMN. Adjusted prevalence ratios showed that, compared with those with CRMN, those without CRMN were more likely to report current antihypertensive medication use (odds ratio = 1.08, 95% confidence interval 1.04-1.12) and self-reported normal blood pressure (1.15 (1.07-1.23)).

CONCLUSIONS

Among US adults with self-reported hypertension, those without CRMN were more likely to report current antihypertensive medication use and normal blood pressure within the past 12 months. Financial barriers to medication adherence persist and impact hypertension management.