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Qin W, Xu L. Pathways linking relative deprivation to blood pressure control: the mediating role of depression and medication adherence among Chinese middle-aged and older hypertensive patients. BMC Geriatr 2023; 23:57. [PMID: 36721087 PMCID: PMC9890848 DOI: 10.1186/s12877-023-03769-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies have demonstrated that individuals of low socioeconomic status have higher blood pressure. Yet, whether socioeconomic inequality would influence blood pressure control and the underlying mechanisms associated with socioeconomic inequality in blood pressure control are unknown. Central to socioeconomic inequality is relative deprivation. We aim to examine the association between relative deprivation and blood pressure control and to investigate the pathways of the association among middle-aged and older adults with hypertension. METHODS Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. This study included 2382 eligible respondents aged 45 years and older with a diagnosis of hypertension. Our primary outcome was dichotomous blood pressure control. Relative deprivation was calculated with the Deaton Index. Depressive symptoms and medication adherence were considered as mediators. Multivariable binary logistic regression models were used to estimate the effect of relative deprivation on blood pressure control. The "KHB-method" was used to perform mediation analysis. RESULTS Among 2382 middle-aged and older adults with hypertension, the mean age was 64.9 years (SD 9.1), with 61.3% females. The overall proportion of participants with uncontrolled blood pressure was 65.1%. Increased relative deprivation was likely to have higher odds of uncontrolled blood pressure (OR: 2.35, 95%CI: 1.78-7.14). Furthermore, depressive symptoms and medication adherence partially mediated the overall association between relative deprivation and blood pressure control, with depressive symptoms and medication adherence explaining 5.91% and 37.76%, respectively, of the total effect of relative deprivation on blood pressure control. CONCLUSIONS Individual relative deprivation could threaten blood pressure control among middle-aged and older hypertension patients through the mechanisms of depression and medication adherence. Hence, improving blood pressure control may require more than just health management and education but fundamental reform of the income distribution and social security system to narrow the income gap, reducing relative economic deprivation. Additionally, interventions tailoring psychological services and medication adherence could be designed to reduce the harmful effect of relative deprivation on blood pressure control among disadvantaged individuals.
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Affiliation(s)
- Wenzhe Qin
- grid.27255.370000 0004 1761 1174Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University), Jinan, 250012 China
| | - Lingzhong Xu
- grid.27255.370000 0004 1761 1174Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University), Jinan, 250012 China
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Myrtle improves renovascular hypertension-induced oxidative damage in heart, kidney, and aortic tissue. Biologia (Bratisl) 2022. [DOI: 10.1007/s11756-022-01039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Cardiovascular disease (CVD), which seriously threatens human health, can be prevented by blood pressure (BP) measurement. However, convenient and accurate BP measurement is a vital problem. Although the easily-collected pulse wave (PW)-based methods make it possible to monitor BP at all times and places, the current methods still require professional knowledge to process the medical data. In this paper, we combine the advantages of Convolutional Neural Networks (CNN) and Long Short-Term Memory (LSTM) networks, to propose a CNN-LSTM BP prediction method based on PW data. In detailed, CNN first extract features from PW data, and then the features are input into LSTM for further training. The numerical results based on real-life data sets show that the proposed method can achieve high predicted accuracy of BP while saving training time. As a result, CNN-LSTM can achieve convenient BP monitoring in daily health.
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Grassi G, Quarti-Trevano F, Dell'oro R, Cuspidi C, Mancia G. The pressioni arteriose monitorate e loro associazioni (PAMELA) research project: a 25-year long journey. Panminerva Med 2021; 63:430-435. [PMID: 33878850 DOI: 10.23736/s0031-0808.21.04396-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Among the observational studies performed in the area of blood pressure measurements in the population the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) investigation represents an unique research for a number of reasons. EVIDENCE ACQUISITION AND SYNTHESIS The PAMELA study combines clinic, home and 24-hour blood pressure measurements in all partiicipants, which were representative of the general population. Examination included metabolic variables, allowing us to determine the interrelationships between bood pressure and metabolic profile. The protocol also included evaluation of organ damage, such as left ventricular hypertrophy, left ventricular diastolic dysfunction, left atrial dimensions and aortic root diameters. Finally, PAMELA represents one of the few studies with a prolonged follow-up, the last survey being completed three years ago and data collected are actually under analysis. This will allow to update the information related to cardiovascular morbidity and mortality in the study cohort. CONCLUSIONS The present paper will provide an overview of the various scientific contributions of the PAMELA study to the epidemiology, pathophysiology and clinical aspects of hypertension and hypertension related cardiovascular risk.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy -
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Dell'oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Mancia
- Policlinico di Monza, Monza, Italy.,University Milano-Bicocca, Milan, Italy
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Bu F, Steptoe A, Fancourt D. Relationship between loneliness, social isolation and modifiable risk factors for cardiovascular disease: a latent class analysis. J Epidemiol Community Health 2021; 75:749-754. [PMID: 33408162 PMCID: PMC8292586 DOI: 10.1136/jech-2020-215539] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/13/2020] [Accepted: 12/16/2020] [Indexed: 01/15/2023]
Abstract
Background There is growing research into the effects of psychological and social factors such as loneliness and isolation on cardiovascular disease (CVD). However, it is unclear whether individuals with particular clusters of CVD risk factors are more strongly affected by loneliness and isolation. This study aimed to identify latent clustering of modifiable risk factors among adults aged 50+ and explore the relationship between loneliness, social isolation and risk factor patterns. Methods Data from 8218 adults of English Longitudinal Study of Ageing were used in latent class analyses to identify latent classes of cardiovascular risk factors and predictors of class membership. Results There were four latent classes: low-risk (30.2%), high-risk (15.0%), clinical-risk (42.6%) and lifestyle-risk (12.2%) classes. Loneliness was associated with a greater risk of being in the high-risk class (relative risk ratio (RRR) 2.40, 95% CI 2.40 to 1.96) and lifestyle-risk class (RRR 1.36, 95% CI 1.10 to 1.67) and a lower risk of being in the clinical-risk class (RRR 0.84, 95% CI 0.72 to 0.98) relative to the low-risk class. Social disengagement, living alone and low social contact were also differentially associated with latent class memberships. Conclusion These findings supplement our existing knowledge of modifiable risk factors for CVD by showing how risk factors cluster together and how the risk patterns are related to social factors, offering important implications for clinical practice and preventive interventions.
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Affiliation(s)
- Feifei Bu
- Department of Behavioural Science and Health, University College London, London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
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Mulugeta H, Yehuala A, Haile D, Mekonnen N, Dessie G, Kassa GM, Kassa ZS, Habtewold TD. Magnitude, risk factors and outcomes of stroke at Debre Markos Referral Hospital, Northwest Ethiopia: a retrospective observational study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00173-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Stroke is one of the leading causes of death and disability in developing countries. The burden of stroke has varied widely in different areas, and there is a paucity of information about stroke in the selected study area.
Objectives
To assess the burden, risk factors, and outcomes of stroke at Debre Markos Referral Hospital, Northwest Ethiopia
Patients and methods
A hospital-based retrospective observational study was conducted in the medical ward of Debre Markos Referral Hospital from March 2017 to April 2019. A pretested checklist was used to extract relevant data from the chart of stroke patients. All statistical analyses were performed in the SPSS version 20 software.
Results
From a total of 2100 admissions in the medical ward, 162 of them were stroke patients, giving the in-hospital magnitude of 7.7%. The in-hospital case fatality rate was 8.6%. Additionally, 27.2% of patients were improved and 39.5% of them were referred. There was a significant association between types of stroke and risk factors such as sex, comorbid hypertension, hyperlipidemia, and atrial fibrillation (P ≤ 0.05).
Conclusion
The in-hospital period prevalence of stroke was 7.7%. Ischemic stroke was the most common type of stroke. Hypertension and hyperlipidemia were the leading identified risk factors for stroke. The overall in-hospital mortality was lower than previous studies in sub-Saharan African countries. Therefore, effective strategies and guidelines for the prevention and control of stroke and its risk factors are needed.
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Clemmer JS, Pruett WA, Lirette ST. Racial and Sex Differences in the Response to First-Line Antihypertensive Therapy. Front Cardiovasc Med 2020; 7:608037. [PMID: 33392272 PMCID: PMC7773696 DOI: 10.3389/fcvm.2020.608037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: As compared to whites, the black population develops hypertension (HTN) at an earlier age, has a greater frequency and severity of HTN, and has poorer control of blood pressure (BP). Traditional practices and treatment efforts have had minor impact on these disparities, with over a 2-fold higher death rate currently for blacks as compared to whites. The University of Mississippi Medical Center (UMC) is located in the southeastern US and the Stroke Belt, which has higher rates of HTN and related diseases as compared to the rest of the country. Methods: We retrospectively analyzed the UMC's Research Data Warehouse, containing >30 million electronic health records from >900,000 patients to determine the initial BP response following the first prescribed antihypertensive drug. Results: There were 5,973 white (45% overall HTN prevalence) and 10,731 black (57% overall HTN prevalence) patients who met criteria for the study. After controlling for age, BMI, and drug dosage, black males were overall less likely to have controlled BP (defined as < 140/90 mmHg) and were associated with smaller falls in BP as compared to whites and black females. Blockers of the renin-angiotensin system (RAS) failed to significantly improve odds of HTN control vs. the untreated group in black patients. However, our data suggests that these drugs do provide significant benefit in blacks when combined with THZ, as compared to untreated and as compared to THZ alone. Conclusion: These data support the use of a single-pill formulation with ARB or ACE inhibitor with a thiazide in blacks for initial first-line HTN therapy and suggests that HTN treatment strategies should consider both race and gender. Our study gives a unique insight into initial antihypertensive responses in actual clinical practice and could have an impact in BP control efficiency in a state with prevalent socioeconomic and racial disparities.
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Affiliation(s)
- John S Clemmer
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - W Andrew Pruett
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Seth T Lirette
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
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Taddei S. ACE-inhibitor/calcium antagonist combination: is this the first-choice therapy in arterial hypertension? Minerva Med 2020; 110:546-554. [DOI: 10.23736/s0026-4806.19.06282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Degli Esposti L, Perrone V, Veronesi C, Gambera M, Nati G, Perone F, Tagliabue PF, Buda S, Borghi C. Modifications in drug adherence after switch to fixed-dose combination of perindopril/amlodipine in clinical practice. Results of a large-scale Italian experience. The amlodipine-perindopril in real settings (AMPERES) study. Curr Med Res Opin 2018; 34:1571-1577. [PMID: 29376432 DOI: 10.1080/03007995.2018.1433648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the changes in adherence to treatment, in patients who switched from perindopril and/or amlodipine as a monotherapy (single-pill therapy, SPT) or two-pill combinations to fixed-dose combination (FDC) therapy. METHODS A large retrospective cohort study, in three Italian Local Health Units, was performed. All adult subjects who received at least one prescription of anti-hypertensive drugs between January 1, 2010 and December 31, 2014 were selected. The date of the first anti-hypertensive prescription was defined as the index-date (ID). For each patient, we evaluated the anti-hypertensive therapy and the adherence to treatment during the two 12-month periods preceding and following the ID. Changes in the level of adherence have been compared in patients who switched to the FDC of perindopril/amlodipine after the ID, as well as in patients who did not. RESULTS A total of 24,020 subjects were initially included in the study. Subjects treated with the free dose combination switched more frequently to FDC of perindopril/amlodipine than subjects treated with SPT (p < .001). Adherence to treatment was found to be higher in the 3,597 subjects who switched to the perindopril/amlodipine FDC therapy, than in the 20,423 subjects who did not. A significant decrease in the number of concomitant anti-hypertensive drugs has been observed in patients treated with the same FDC. CONCLUSIONS The results show that perindopril/amlodipine FDC increases the rate of stay-on-therapy and reduces the number of concomitant anti-hypertensive drugs in subjects previously treated with the same drugs as a two-pill combination or as SPT.
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Affiliation(s)
- Luca Degli Esposti
- a Clicon S.r.l. Health Economics and Outcomes Research , Ravenna , Italy
| | - Valentina Perrone
- a Clicon S.r.l. Health Economics and Outcomes Research , Ravenna , Italy
| | - Chiara Veronesi
- a Clicon S.r.l. Health Economics and Outcomes Research , Ravenna , Italy
| | - Marco Gambera
- b Local Pharmaceutical Service , Bergamo Local Health Authority , Bergamo , Italy
| | - Giulio Nati
- c Italian Society of General Practice , Italy
| | | | - Paola Fausta Tagliabue
- e General Practitioner of Agenzia di Tutela e Salute della provincia di Bergamo , Bergamo , Italy
| | - Stefano Buda
- a Clicon S.r.l. Health Economics and Outcomes Research , Ravenna , Italy
| | - Claudio Borghi
- f Department of Medical and Surgical Sciences , University of Bologna , Bologna , Italy
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Big Data and Blood Pressure Control: Insights from the PAMELA and BP-CARE Study Cohorts. Curr Hypertens Rep 2018; 20:82. [DOI: 10.1007/s11906-018-0885-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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11
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Difficult-to-control hypertension: identification of clinical predictors and use of ICT-based integrated care to facilitate blood pressure control. J Hum Hypertens 2018; 32:467-476. [PMID: 29713051 PMCID: PMC6057905 DOI: 10.1038/s41371-018-0063-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 11/09/2022]
Abstract
Difficult-to-control (DTC) hypertension represents a burden in real life that can be partially solved through identification of the characteristics of clinical patterns and tailoring antihypertensive strategies, including ICT-enabled integrated care (ICT-IC). In the quest for clinical predictors of DTC hypertension, we screened 482 hypertensive patients who were consecutively referred to the departmental hypertension clinic. Following a data quality check, patients were divided into controlled (C, 49.37%) and uncontrolled (UC, 50.63%) groups based on their systolic blood pressure (BP) at follow-up. We then performed statistical analysis on the demographic, clinical, laboratory, and ultrasound data and observed that older age, female sex, higher BP levels, and a family history of hypertension were predictors of DTC hypertension. We then developed a pilot service of ICT-IC, including weekly home visits by nurses and patient education on self-monitoring of BP, heart rate, body weight, and oxygen saturation using 3G-connected devices. Self-monitored data were transmitted to the hospital servers on the electronic chart of the patient for remote assessment by the hospital hypertension specialists. A total of 20 UC patients (M/F = 10/10; age: 72.04 ± 2.17 years) were enrolled to verify the efficacy of BP control without changes in medical treatment. After 1 month of the ICT-IC program, BP was reduced both at the office assessment (systolic BP (SBP): 162.40 ± 2.23 mm Hg, beginning of the program vs. 138.20 ± 4.26 mm Hg at 1 month, p < 0.01) and at home (SBP: 149.83 ± 3.44, beginning of the program vs. 134.16 ± 1.67 mm Hg at 1 month, p < 0.01). We concluded that DTC hypertension can be predicted based on the clinical characteristics at the first visit. For these patients, ICT-IC is a feasible therapeutic strategy to achieve BP control.
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Damian DJ, McNamee R, Carr M. Changes in selected metabolic parameters in patients over 65 receiving hydrochlorothiazide plus amiloride, atenolol or placebo in the MRC elderly trial. BMC Cardiovasc Disord 2016; 16:188. [PMID: 27716064 PMCID: PMC5050956 DOI: 10.1186/s12872-016-0368-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/28/2016] [Indexed: 11/25/2022] Open
Abstract
Background Treatment of hypertension reduces incidence of stroke, myocardial infarction and heart failure perhaps partly by controlling different metabolic parameters. There is limited information regarding the changes in potassium, sodium, weight, cholesterol and glucose levels in patients using anti-hypertensives. This study aimed to determine changes in potassium, sodium, glucose, cholesterol, weight, urea and urate levels in patients using anti-hypertensives. Furthermore, to describe these changes and differences between the atenolol, hydrochlorothiazide plus amiloride and placebo arms of the Medical Research Council (MRC) elderly randomised controlled trial. Methods Patients were randomly allocated to one of the three treatment arms. Measurements were taken at baseline, end of year one and end of year two in 4396 subjects. Linear Mixed Models (LMM) were used to determine the longitudinal profiles of sodium, potassium, weight, cholesterol, glucose, urea and urate. Estimates of changes within groups and difference between groups were obtained. Results Patients randomised to receive hydrochlorothiazide + amiloride experienced a significantly greater mean reduction in potassium, sodium and weight compared to placebo at end of year one - mean differences in change −0.18 mmol/L, (95 % CI: −0.21, −0.15); −1.45 mmol/L, (95 % CI: −1.62, −1.29) and −0.46 kgs (95 % CI: −0.73, −0.20) respectively, and greater increases in cholesterol, urea and urate - mean differences in change 0.16 mmol/L, (95 % CI: 0.10,0.22); 0.77 mmol/L, (95 % CI: 0.68, 0.87) and 53.10 μmol/L, (95 % CI: 49.35, 56.85) respectively. Changes were in the same direction but smaller in the atenololarm except for potassium and weight (increases). No group differences in glucose were found. Conclusion Results were in line with expectation except for lack of change in glucose in the hydrochlorothiazide + amiloride arms. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0368-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Damian J Damian
- Community Health Department, Kilimanjaro Christian Medical Centre, P. O. Box 3010, Moshi, Tanzania. .,Biostatistics, Institute for Population Health, University of Manchester, Manchester, UK.
| | - Roseanne McNamee
- Biostatistics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Matthew Carr
- Biostatistics, Institute for Population Health, University of Manchester, Manchester, UK
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Brown MJ. Review: Implications from hypertension outcome trials for the management of patients with hypertension and diabetes. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514030030040201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The UKPDS highlighted the importance of blood pressure control in patients with type 2 diabetes. In this review I draw on data from the INSIGHT and other recent outcome trials in hypertension which provide clear evidence that it is the achievement of good control of blood pressure, irrespective of the initial choice of drug, that is the major determinant of outcome. The INSIGHT trial provides hard evidence of how resistant to treatment patients with diabetes really are. In this review I offer a theoretical and practical solution in the form of a stepwise algorithm using multiple therapies.
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Affiliation(s)
- Morris J Brown
- Clinical Pharmacology Unit, Level 6, ACCI, Box 110, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK,
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Li J, Peplinski SJ, Nia SM, Farajidavar A. An interoperable pillbox system for smart medication adherence. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:1386-9. [PMID: 25570226 DOI: 10.1109/embc.2014.6943858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We have designed and fabricated an interoperable system for medication adherence. The system is composed of a pillbox that wirelessly communicates with a computer application and a custom-made wristband. The system receives the information of taking specific medication from the user or caregiver, reminds the user to take the medication, monitors the user's hand gesture during the medication intake and monitors the compartments of the pillbox for refilling purpose. The performance of the developed system was examined in various bench-top scenarios. The system has the potential to improve the existing systems by reminding the user to take the medication through the wristband, automatically collecting user's hand gestures during the medication intake, and providing detailed information about the exisexistencetence of medication in the compartments of the pillbox.
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Cournot M, Lenclume V, Le Moullec N, Debussche X, Doussiet E, Fagot-Campagna A, Favier F. Prevalence, treatment and control of hypertension in La Réunion: the RÉDIA population-based cohort study. Blood Press 2016; 26:39-47. [PMID: 27195533 DOI: 10.1080/08037051.2016.1182854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A better knowledge of prevalence, management and determinants of hypertension is needed in regions in epidemiological transition to adapt the strategies of public health screening and prevention, and to reduce the burden of cardiovascular diseases. We conducted a prospective cohort study including 4610 participants aged between 18 and 69 years and representative of the general population of La Réunion, a French overseas island located in the western Indian Ocean. The median time between inclusion and follow-up was 7.4 years. Blood pressure data at baseline and follow-up of 3087 participants were analyzed. We found a high prevalence of hypertension, especially in women (36.7% [34.5-39.0]) and in men (40.3% [37.6-43.0]) and in the under 30s (17.1% [14.0-20.5]), with an increase of 10% at follow-up. Treatment rates were very low in men (19.5% versus 39.1% in women) as was awareness of their condition (25.7% versus 44.6%). Blood pressure control rates were similar (18% at baseline and 34% at follow-up for both sexes). Diagnosis of hypertension at follow-up among subjects normotensive at baseline was independently associated with obesity at baseline (relative risk (RR) = 1.40 [1.12-1.75] for BMI between 27 and 30 kg/m2 and 1.72 [1.33-2.25] for BMI ≥30 kg/m2 as compared with BMI <27 kg/m2) and HbA1C (RR =1.12 [1.05-1.19] per %), suggesting a prominent role of insulin resistance in our population. Our study provides original data that cannot be assimilated to any existing model and should guide the implementation of original community-based programs in such countries.
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Affiliation(s)
- Maxime Cournot
- a CHU de La Réunion, Centre d'Investigations Cliniques , Saint Denis , France.,b INSERM, CIC 1410 , Saint Pierre , France.,c INSERM, UMR 1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI) , Sainte-Clotilde , France.,d Centre Hospitalier Gabriel Martin, Service de cardiologie , Saint-Paul , France
| | | | - Nathalie Le Moullec
- e CHU de La Réunion, Service d'endocrinologie, diabétologie et nutrition , Saint-Pierre , France
| | - Xavier Debussche
- f CHU de La Réunion, Service d'endocrinologie et diabétologie , Saint-Denis , France
| | | | - Anne Fagot-Campagna
- g Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés , Paris , France
| | - François Favier
- b INSERM, CIC 1410 , Saint Pierre , France.,e CHU de La Réunion, Service d'endocrinologie, diabétologie et nutrition , Saint-Pierre , France
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Pre-awakening diastolic hypotension in treated hypertensive patients: prevalence and predictors. J Hum Hypertens 2015. [DOI: 10.1038/jhh.2015.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Robinson H, MacDonald B, Broadbent E. The Role of Healthcare Robots for Older People at Home: A Review. Int J Soc Robot 2014. [DOI: 10.1007/s12369-014-0242-2] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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De Socio GV, Ricci E, Maggi P, Parruti G, Pucci G, Di Biagio A, Calza L, Orofino G, Carenzi L, Cecchini E, Madeddu G, Quirino T, Schillaci G. Prevalence, awareness, treatment, and control rate of hypertension in HIV-infected patients: the HIV-HY study. Am J Hypertens 2014; 27:222-8. [PMID: 24077828 DOI: 10.1093/ajh/hpt182] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We aimed to assess the prevalence of hypertension in an unselected human immunodeficiency virus (HIV)-infected population and to identify factors associated with hypertension prevalence, treatment, and control. METHODS We used a multicenter, cross-sectional, nationwide study that sampled 1,182 unselected, consecutive, HIV-infected patients. Office blood pressure was accurately measured with standard procedures. RESULTS Patients were 71% men and 92% white, with a median age of 47 years (range = 18-78); 6% were antiretroviral treatment naive. The overall prevalence of hypertension was 29.3%; high-normal pressure accounted for an additional 12.3%. Among hypertensive subjects, 64.9% were aware of their hypertensive condition, 52.9% were treated, and 33.0% were controlled (blood pressure < 140/90 mm Hg). Blood pressure-lowering medications were used in monotherapy in 54.3% of the subjects. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were the most frequently used drugs (76.1%: monotherapy = 39.1%, combination treatment = 37.0%). In multivariable regression models, hypertension was independently predicted by traditional risk factors, including age ≥50 years, male sex, family history of cardiovascular disease, body mass index ≥25 kg/m2, previous cardiovascular events, diabetes, central obesity, and metabolic syndrome, as well as by duration of HIV infection, duration of antiretroviral therapy, and nadir CD4+ T-cell count <200/μl. The choice of protease inhibitors vs. nonnucleoside reverse transcriptase inhibitors as a third antiretroviral drug was irrelevant. CONCLUSIONS Hypertension affects nearly 30% of HIV adult outpatients in Italy. More than one-third of the hypertensive subjects are unaware of their condition, and more than two-thirds are uncontrolled. A higher level of attention to the diagnosis and treatment of hypertension is mandatory in this setting.
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Jana U, Mohanty AK, Manna PK, Mohanta GP. Preparation and characterization of nebivolol nanoparticles using Eudragit® RS100. Colloids Surf B Biointerfaces 2014; 113:269-75. [DOI: 10.1016/j.colsurfb.2013.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/17/2013] [Accepted: 09/02/2013] [Indexed: 11/25/2022]
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Kwon HM, Shin JW, Lim JS, Hong YH, Lee YS, Nam H. Comparison of the effects of amlodipine and losartan on blood pressure and diurnal variation in hypertensive stroke patients: a prospective, randomized, double-blind, comparative parallel study. Clin Ther 2013; 35:1975-82. [PMID: 24296324 DOI: 10.1016/j.clinthera.2013.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/20/2013] [Accepted: 10/28/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Lowering blood pressure (BP) and reducing diurnal variation are important for the prevention of stroke in patients with hypertension. OBJECTIVE This study was conducted to compare the BP-lowering and diurnal BP variation effects of amlodipine and losartan on acute stroke patients. METHODS Seventy-seven hypertensive patients with acute stroke were enrolled in this randomized, double-blind, single-center clinical trial. They were randomly assigned to receive either amlodipine or losartan daily. To evaluate whether amlodipine was noninferior to losartan, ambulatory BP monitoring was performed before the drugs were first administered and at the end of week 8. BP variables analyzed included the mean awake, sleep, morning, evening, and prewake BP values; the nocturnal dipping status; and the morning surge. RESULTS Thirty-nine patients in the amlodipine group and 38 patients in the losartan group completed the follow-up. In the baseline characteristics, mean age was 63.6 years, and 68.8% were male. In the intention-to-treat analysis, the mean (SD) systolic BP decreased 14.82 (11.71) mm Hg in the amlodipine group and 13.11 (12.69) mm Hg in the losartan group, and amlodipine proved noninferior to losartan (mean difference, 1.71 mm Hg [95% CI, -3.83 to 7.26]). However, in the per-protocol analysis, noninferiority was not proven (BP reduction, 16.06 [11.33] vs 17.17 [11.85] mm Hg; mean difference, -1.11 mm Hg [95% CI, -6.88 to 4.65]). Amlodipine had a greater tendency than losartan to produce a blunt morning surge. CONCLUSIONS The noninferiority of amlodipine was not confirmed by the per-protocol analysis. However, amlodipine showed a favorable effect on the morning surge. ClinicalTrials.gov identifier: NCT01830517.
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Affiliation(s)
- Hyung-Min Kwon
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Won Shin
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Sung Lim
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon-Ho Hong
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Seok Lee
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunwoo Nam
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
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Yi-Bing W, De-Gui K, Long-Le M, Le-Xin W. Patient related factors for optimal blood pressure control in patients with hypertension. Afr Health Sci 2013; 13:579-83. [PMID: 24250292 DOI: 10.4314/ahs.v13i3.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patient related factors hindering optimal blood pressure (BP) control in patients with hypertension are unclear. OBJECTIVES To investigate the barriers to optimal hypertension management. METHODS A survey on the awareness and management of hypertension was conducted in 556 patients (365 males, mean age 60.9 ± 10.1) from a rural community. RESULTS Of the 556 patients who had a clinical diagnosis of hypertension, 127 (22.8%) were unaware the existence of the condition and received no therapy. In the 429 patients who were aware the presence of hypertension, 206 (48.0%) did not receive any antihypertensive medication at the time of this study. Fifty-four (12.5%) had a BP of less than 140/90 mm Hg. Only 21 (4.9%) received formal counselling or education from health professionals and 74 (17.2%) were aware of the optimal level of BP. Difficulty in accessing a specialist doctor was reported by 126 (29.4%). In 279 (65.0%), missing regular antihypertensive medications was reported in the 4-week period prior to this study. Omitting prescribed antihypertensive drugs due to the costs was reported by 169 (39.4%). CONCLUSION Inadequate counselling, lack of understanding on the disease, difficulties in accessing specialist care and poor medication adherence are the barriers to optimal BP control.
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Affiliation(s)
- Wang Yi-Bing
- Department of Public Policy and Management, International Business College, Qingdao University, Qingdao, Shandong Province, PR China
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de Simone G, Izzo R, Verdecchia P. Are Observational Studies More Informative Than Randomized Controlled Trials in Hypertension? Hypertension 2013; 62:463-9. [DOI: 10.1161/hypertensionaha.113.00727] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Giovanni de Simone
- From the Department of Translational Medical Sciences, Hypertension Center, Federico II University Hospital, Naples, Italy (G.d.S., R.I.); and Division of Medicine, Assisi Hospital, Assisi, Italy (P.V.)
| | - Raffaele Izzo
- From the Department of Translational Medical Sciences, Hypertension Center, Federico II University Hospital, Naples, Italy (G.d.S., R.I.); and Division of Medicine, Assisi Hospital, Assisi, Italy (P.V.)
| | - Paolo Verdecchia
- From the Department of Translational Medical Sciences, Hypertension Center, Federico II University Hospital, Naples, Italy (G.d.S., R.I.); and Division of Medicine, Assisi Hospital, Assisi, Italy (P.V.)
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Blood pressure control among stroke patients in Thailand--the i-STROKE study. J Stroke Cerebrovasc Dis 2013; 23:476-83. [PMID: 23800493 DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/28/2013] [Accepted: 04/06/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Direct correlation between stroke mortality and hypertension calls for a tight blood pressure (BP) control. Our study determined the prevalence of the BP control and evaluated current clinical practices on hypertension management in stroke patients in Thailand. METHODS This multicenter, cross-sectional, retrospective, observational study was carried out between February 2010 and January 2011 and enrolled stroke patients aged 45 years or older with ictus incidence 12,030 days before the enrollment. The events were confirmed by either computerized tomography scan or magnetic resonance imaging. Patient data including demographics, medical, and clinical history were collected. RESULTS At enrollment, 274 of 558 (49.1%) patients had controlled arterial BP with an average pressure of 134.220.4/78.812.8 mm Hg; 412 (73.8%) patients received antihypertensive medications and the most common use was angiotensin-converting enzyme inhibitors (ACEIs), reported in 200 (35.8%) patients. With questionnaire, insufficient antihypertensive use and lack of patients' awareness were the 2 most common reasons given by physicians for the patients' uncontrolled BP. Factors identified to have adverse association with the controlled BP at enrollment were diabetes at baseline, stage II hypertension, stage I hypertension, and the use of ACEIs at discharge (odds ratio of .18, .24, .30 [P < .001], and .53 [P = .009], respectively). CONCLUSIONS Despite clinical evidence of the benefits of the BP control in reduction of secondary stroke events, a substantial number of stroke patients in Thailand do not achieve their BP targets, and this could possibly be a result of inadequate use of antihypertensive therapies and lack of compliance to BP management guidelines.
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de Simone G, Devereux RB, Izzo R, Girfoglio D, Lee ET, Howard BV, Roman MJ. Lack of reduction of left ventricular mass in treated hypertension: the strong heart study. J Am Heart Assoc 2013; 2:e000144. [PMID: 23744404 PMCID: PMC3698775 DOI: 10.1161/jaha.113.000144] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Hypertensive left ventricular mass (LVM) is expected to decrease during antihypertensive therapy, based on results of clinical trials. Methods and Results We assessed 4‐year change of echocardiographic LVM in 851 hypertensive free‐living participants of the Strong Heart Study (57% women, 81% treated). Variations of 5% or more of the initial systolic blood pressure (SBP) and LVM were categorized for analysis. At baseline, 23% of men and 36% of women exhibited LV hypertrophy (LVH, P<0.0001). At the follow‐up, 3% of men and 10% of women had regression of LVH (P<0.0001 between genders); 14% of men and 15% of women, free of baseline LVH, developed LVH. There was an increase in LVM over time, more in men than in women (P<0.001). Participants whose LVM did not decrease had similar baseline SBP and diastolic BP, but higher body mass index (BMI), waist/hip ratio, heart rate (all P<0.008), and urinary albumin/creatinine excretion (P<0.001) than those whose LVM decreased. After adjusting for field center, initial LVM index, target BP, and kinship degree, lack of decrease in LVM was predicted by higher baseline BMI and urinary albumin/creatinine excretion, independently of classes of antihypertensive medications, and significant effects of older age, male gender, and percentage increase in BP over time. Similar findings were obtained in the subpopulation (n=526) with normal BP at follow‐up. Conclusions In a free‐living population, higher BMI is associated with less reduction of hypertensive LVH; lack of reduction of LVM is independent of BP control and of types of antihypertensive treatment, but is associated with renal damage.
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Affiliation(s)
- Giovanni de Simone
- Department of Translational Medical Sciences, Federico II University, Napoli, Italy.
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Abstract
BACKGROUND This review is an update of the Cochrane Review published in 2007, which assessed the role of beta-blockade as first-line therapy for hypertension. OBJECTIVES To quantify the effectiveness and safety of beta-blockers on morbidity and mortality endpoints in adults with hypertension. SEARCH METHODS In December 2011 we searched the Cochrane Central Register of Controlled Trials, Medline, Embase, and reference lists of previous reviews; for eligible studies published since the previous search we conducted in May 2006. SELECTION CRITERIA Randomised controlled trials (RCTs) of at least one year duration, which assessed the effects of beta-blockers compared to placebo or other drugs, as first-line therapy for hypertension, on mortality and morbidity in adults. DATA COLLECTION AND ANALYSIS We selected studies and extracted data in duplicate. We expressed study results as risk ratios (RR) with 95% confidence intervals (CI) and combined them using the fixed-effects or random-effects method, as appropriate. MAIN RESULTS We included 13 RCTs which compared beta-blockers to placebo (4 trials, N=23,613), diuretics (5 trials, N=18,241), calcium-channel blockers (CCBs: 4 trials, N=44,825), and renin-angiotensin system (RAS) inhibitors (3 trials, N=10,828). Three-quarters of the 40,245 participants on beta-blockers used atenolol. Most studies had a high risk of bias; resulting from various limitations in study design, conduct, and data analysis.Total mortality was not significantly different between beta-blockers and placebo (RR 0.99, 95%CI 0.88 to 1.11; I(2)=0%), diuretics or RAS inhibitors, but was higher for beta-blockers compared to CCBs (RR 1.07, 95%CI 1.00 to 1.14; I(2)=2%). Total cardiovascular disease (CVD) was lower for beta-blockers compared to placebo (RR 0.88, 95%CI 0.79 to 0.97; I(2)=21%). This is primarily a reflection of the significant decrease in stroke (RR 0.80, 95%CI 0.66 to 0.96; I(2)=0%), since there was no significant difference in coronary heart disease (CHD) between beta-blockers and placebo. There was no significant difference in withdrawals from assigned treatment due to adverse events between beta-blockers and placebo (RR 1.12, 95%CI 0.82 to 1.54; I(2)=66%).The effect of beta-blockers on CVD was significantly worse than that of CCBs (RR 1.18, 95%CI 1.08-1.29; I(2)=0%), but was not different from that of diuretics or RAS inhibitors. In addition, there was an increase in stroke in beta-blockers compared to CCBs (RR 1.24, 95%CI 1.11-1.40; I(2)=0%) and RAS inhibitors (RR 1.30, 95%CI 1.11 to 1.53; I(2)=29%). However, CHD was not significantly different between beta-blockers and diuretics, CCBs or RAS inhibitors. Participants on beta-blockers were more likely to discontinue treatment due to adverse events than those on RAS inhibitors (RR 1.41, 95% CI 1.29 to 1.54; I(2)=12%), but there was no significant difference with diuretics or CCBs. AUTHORS' CONCLUSIONS Initiating treatment of hypertension with beta-blockers leads to modest reductions in cardiovascular disease and no significant effects on mortality. These effects of beta-blockers are inferior to those of other antihypertensive drugs. The GRADE quality of this evidence is low, implying that the true effect of beta-blockers may be substantially different from the estimate of effects found in this review. Further research should be of high quality and should explore whether there are differences between different sub-types of beta-blockers or whether beta-blockers have differential effects on younger and elderly patients.
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Affiliation(s)
- Charles Shey Wiysonge
- Division of Medical Microbiology & Institute of Infectious Disease andMolecular Medicine, University of Cape Town, Observatory,South Africa.
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Blood pressure and global risk assessment in a Swedish population. Int J Hypertens 2012; 2012:835812. [PMID: 22991653 PMCID: PMC3443609 DOI: 10.1155/2012/835812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 11/18/2022] Open
Abstract
This study investigated the association between SCORE and the 2007 ESH-ESC blood pressure categories and explored achievements of blood pressure goals considering global risk. In 2001–2005, a random sample of inhabitants aged 30–74 years in southwestern Sweden was invited to a survey of cardiovascular risk factors. The study enrolled 2816 participants (participation rate 76%). Blood pressure was categorized according to the 2007 ESH-ESC guidelines. Global risk of 10-year CVD death was estimated using the Swedish SCORE chart also accounting for additional risk from diabetes (SCORE-DM). SCORE-DM increased in both sexes from optimal blood pressure to manifest hypertension but did not differ between the normal blood pressure categories. However, SCORE-DM became significantly higher among those with temporarily high blood pressure (men 3.3 SD (1.7), women 1.1 (1.8)) and hypertension (3.6 (2.0), 2.0 (2.0)), compared to optimal blood pressure (1.6 (2.9), 0.6 (1.9)). In the presence of both hypertension and diabetes, high-risk subjects dominated (men 76%, women 61%), and correspondingly a major proportion of patients with known hypertension were at high risk at a blood pressure ≥160/100 mm Hg. These findings have strong implications on blood pressure evaluation in clinical practice and support the use of SCORE to evaluate global risk.
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Abstract
BACKGROUND This review is an update of the Cochrane Review published in 2007, which assessed the role of beta-blockade as first-line therapy for hypertension. OBJECTIVES To quantify the effectiveness and safety of beta-blockers on morbidity and mortality endpoints in adults with hypertension. SEARCH METHODS In December 2011 we searched the Cochrane Central Register of Controlled Trials, Medline, Embase, and reference lists of previous reviews; for eligible studies published since the previous search we conducted in May 2006. SELECTION CRITERIA Randomised controlled trials (RCTs) of at least one year duration, which assessed the effects of beta-blockers compared to placebo or other drugs, as first-line therapy for hypertension, on mortality and morbidity in adults. DATA COLLECTION AND ANALYSIS We selected studies and extracted data in duplicate. We expressed study results as risk ratios (RR) with 95% confidence intervals (CI) and combined them using the fixed-effects or random-effects method, as appropriate. MAIN RESULTS We included 13 RCTs which compared beta-blockers to placebo (4 trials, N=23,613), diuretics (5 trials, N=18,241), calcium-channel blockers (CCBs: 4 trials, N=44,825), and renin-angiotensin system (RAS) inhibitors (3 trials, N=10,828). Three-quarters of the 40,245 participants on beta-blockers used atenolol. Most studies had a high risk of bias; resulting from various limitations in study design, conduct, and data analysis.Total mortality was not significantly different between beta-blockers and placebo (RR 0.99, 95%CI 0.88 to 1.11; I(2)=0%), diuretics or RAS inhibitors, but was higher for beta-blockers compared to CCBs (RR 1.07, 95%CI 1.00 to 1.14; I(2)=2%). Total cardiovascular disease (CVD) was lower for beta-blockers compared to placebo (RR 0.88, 95%CI 0.79 to 0.97; I(2)=21%). This is primarily a reflection of the significant decrease in stroke (RR 0.80, 95%CI 0.66 to 0.96; I(2)=0%), since there was no significant difference in coronary heart disease (CHD) between beta-blockers and placebo. There was no significant difference in withdrawals from assigned treatment due to adverse events between beta-blockers and placebo (RR 1.12, 95%CI 0.82 to 1.54; I(2)=66%).The effect of beta-blockers on CVD was significantly worse than that of CCBs (RR 1.18, 95%CI 1.08-1.29; I(2)=0%), but was not different from that of diuretics or RAS inhibitors. In addition, there was an increase in stroke in beta-blockers compared to CCBs (RR 1.24, 95%CI 1.11-1.40; I(2)=0%) and RAS inhibitors (RR 1.30, 95%CI 1.11 to 1.53; I(2)=29%). However, CHD was not significantly different between beta-blockers and diuretics, CCBs or RAS inhibitors. Participants on beta-blockers were more likely to discontinue treatment due to adverse events than those on RAS inhibitors (RR 1.41, 95% CI 1.29 to 1.54; I(2)=12%), but there was no significant difference with diuretics or CCBs. AUTHORS' CONCLUSIONS Initiating treatment of hypertension with beta-blockers leads to modest reductions in cardiovascular disease and no significant effects on mortality. These effects of beta-blockers are inferior to those of other antihypertensive drugs. The GRADE quality of this evidence is low, implying that the true effect of beta-blockers may be substantially different from the estimate of effects found in this review. Further research should be of high quality and should explore whether there are differences between different sub-types of beta-blockers or whether beta-blockers have differential effects on younger and elderly patients.
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Affiliation(s)
- Charles Shey Wiysonge
- Institute of Infectious Disease and Molecular Medicine & Division of Medical Microbiology, University of Cape Town, Anzio Road, Observatory, South Africa, 7925
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Guessous I, Bochud M, Theler JM, Gaspoz JM, Pechère-Bertschi A. 1999-2009 Trends in prevalence, unawareness, treatment and control of hypertension in Geneva, Switzerland. PLoS One 2012; 7:e39877. [PMID: 22761919 PMCID: PMC3384604 DOI: 10.1371/journal.pone.0039877] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/28/2012] [Indexed: 01/13/2023] Open
Abstract
Background There are no time trends in prevalence, unawareness, treatment, and control of hypertension in Switzerland. The objective of this study was to analyze these trends and to determine the associated factors. Methods/Findings Population-based study conducted in the Canton of Geneva, Switzerland, between 1999 and 2009. Blood pressure was measured thrice using a standard protocol. Hypertension was defined as mean systolic or diastolic blood pressure ≥140/90 mmHg or self-reported hypertension or anti-hypertensive medication. Unawareness, untreated and uncontrolled hypertension was determined by questionnaires/blood pressure measurements. Yearly age-standardized prevalences and adjusted associations for the 1999–2003 and 2004–2009 survey periods were reported. The 10-year survey included 9,215 participants aged 35 to 74 years. Hypertension remained stable (34.4%). Hypertension unawareness decreased from 35.9% to 17.7% (P<0.001). The decrease in hypertension unawareness was not paralleled by a concomitant absolute increase in hypertension treatment, which remained low (38.2%). A larger proportion of all hypertensive participants were aware but not treated in 2004–2009 (43.7%) compared to 1999–2003 (33.1%). Uncontrolled hypertension improved from 62.2% to 40.6% between 1999 and 2009 (P = 0.02). In 1999–2003 period, factors associated with hypertension unawareness were current smoking (OR = 1.27, 95%CI, 1.02–1.59), male gender (OR = 1.56, 1.27–1.92), hypercholesterolemia (OR = 1.31, 1.20–1.44), and older age (OR 65–74yrs vs 35–49yrs = 1.56, 1.21–2.02). In 1999–2003 and 2004–2009, obesity and diabetes were negatively associated with hypertension unawareness, high education was associated with untreated hypertension (OR = 1.45, 1.12–1.88 and 1.42, 1.02–1.99, respectively), and male gender with uncontrolled hypertension (OR = 1.49, 1.03–2.17 and 1.65, 1.08–2.50, respectively). Sedentarity was associated with higher risk of hypertension and uncontrolled hypertension in 1999–2003. Conclusions Hypertension prevalence remained stable since 1999 in the canton of Geneva. Although hypertension unawareness substantially decreased, more than half of hypertensive subjects still remained untreated or uncontrolled in 2004–2009. This study identified determinants that should guide interventions aimed at improving hypertension treatment and control.
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Affiliation(s)
- Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Lindblad U, Ek J, Eckner J, Larsson CA, Shan G, Råstam L. Prevalence, awareness, treatment, and control of hypertension: rule of thirds in the Skaraborg project. Scand J Prim Health Care 2012; 30:88-94. [PMID: 22643153 PMCID: PMC3378010 DOI: 10.3109/02813432.2012.684207] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the prevalence, awareness, and control of hypertension in a Swedish population during the early 2000s to address implications for care and prevention. DESIGN A cross-sectional population survey. SETTING Primary health care in Skaraborg, a rural part of western Sweden. SUBJECTS Participants (n =2816) in a population survey of a random sample of men and women between 30 and 75 years of age in the municipalities of Vara (81% participation rate) and Skövde (70%), in western Sweden during 2001-2005. MAIN OUTCOME MEASURES Anthropometric measures, blood pressure, leisure-time physical activity, current smoking, fasting glucose, and cholesterol. Hypertension was defined as ongoing treatment for hypertension, or three consecutive blood pressure readings ≥140 systolic and/or ≥90 mmHg diastolic. Hypertension was considered controlled when the blood pressure was <140/90 mm Hg (both). RESULTS The prevalence of hypertension was 20% in both men and women with a steep increase by age. Among hypertensive subjects, 33% were unaware, 36% aware but uncontrolled, and 31% aware and controlled, with no statistically significant differences between men and women. Patients with diabetes had a higher awareness (87% vs. 64%, p <0.001), but the same control rate (56% vs. 44%, p =0.133), when compared with those without diabetes. CONCLUSION A large proportion of subjects with hypertension are still unaware of their condition, or aware but not controlled. It is important to emphasize population-based prevention to reduce the prevalence of hypertension, to perform screening to increase awareness, and to improve implementation of expert guidelines in clinical practice to improve control.
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Affiliation(s)
- Ulf Lindblad
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Vera G, Nataša D, Svetlana K, Sonja S, Jasmina G, Sonja T. Epidemiology of hypertension in Serbia: results of a National Survey. J Epidemiol 2012; 22:261-6. [PMID: 22374365 PMCID: PMC3798628 DOI: 10.2188/jea.je20110077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 12/12/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We evaluated the prevalence of high blood pressure and the level of awareness, treatment, and control of hypertension in a Serbian population. METHODS A cross-sectional study of an adult population was carried out across Serbia in 2006. The study involved 14 204 adults aged 20 years or older. Interviews and measurements of blood pressure were performed at participants' homes. RESULTS Overall, 47% of the Serbian adult population had hypertension: 25.3% had stage 1 hypertension and 18.1% had stage 2 hypertension. Only 58.0% of the hypertensive population were aware that they had the disease, and 60.4% were receiving medical treatment. Among those receiving medical treatment, only 20.9% had a blood pressure within the normal range. One in 10 participants with hypertension were not treated because, among other reasons, they thought treatment was unnecessary (55.3%) or they lacked money for medication (19.3%). CONCLUSIONS The prevalence of undiagnosed and untreated hypertension is high in the adult population of Serbia. Further action is required to hasten detection and treatment of high blood pressure. Attention should be directed toward educational programs that improve knowledge, attitudes, and awareness of hypertension among adults.
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Affiliation(s)
- Grujić Vera
- Institute of Public Health of Vojvodina, Novi Sad, Serbia.
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Classes of antihypertensive medications and blood pressure control in relation to metabolic risk factors. J Hypertens 2012; 30:188-93. [DOI: 10.1097/hjh.0b013e32834e1eda] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Atallah A, Papouin G, Mimran C, Braunstein C, Ganty J, Larifla L, Djaballah K, Inamo J. [Knowledge of hypertension among hypertensive patients in general practice, and its relation to achieving therapeutic goals: The Co-HACT study, French West Indies]. Ann Cardiol Angeiol (Paris) 2011; 60:21-26. [PMID: 20800218 DOI: 10.1016/j.ancard.2010.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 06/18/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Appraisal of the agreement between patients' reports and general practitionners' declaration in a French Caribbean population and relationship with blood pressure normalization. METHODS One hundred French Caribbean practitioners participated in this observational survey: each of them included five essential hypertensives treated for more than three months. BP was considered to be normalized if inferior to 140/90 mmHg. We considered that there is a total agreement between patient and GP declaration when SBP and DBP did not differ by more than 5 mmHg and when the eight risk factors or co-morbidity were identical. Identification of independent factors of BP normalization and awareness was performed using logistic regression. RESULTS Five hundred and nine hypertensives (57% women) were recruited. Sixty-nine percent (n = 328) were less than 65 years, 75% (n = 341) had an educational level less than high school. The normalisation rate was 39% (n = 185) within the whole population. 63.4% had a high cardiovascular risk. BP normalization appeared to be closely associated to BP awareness. CONCLUSIONS In this observational survey, in a French Caribbean hypertensive population, two third had a high cardiovascular risk. The normalization rate was 39%. This BP normalization appeared to be closely associated to BP awareness.
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Affiliation(s)
- A Atallah
- Service de cardiologie, centre hospitalier de la Basse-Terre, Guadeloupe.
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Bielecka-Dabrowa A, Aronow WS, Rysz J, Banach M. The Rise and Fall of Hypertension: Lessons Learned from Eastern Europe. CURRENT CARDIOVASCULAR RISK REPORTS 2011; 5:174-179. [PMID: 21475621 PMCID: PMC3068519 DOI: 10.1007/s12170-010-0152-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypertension is a progressive cardiovascular syndrome that arises from many differing, but interrelated, etiologies. Hypertension is the most prevalent cardiovascular disorder, affecting 20% to 50% of the adult population in developed countries. Arterial hypertension is a major risk factor for cardiovascular diseases and death. Epidemiologic data have shown that control of hypertension is achieved in only a small percentage of hypertensive patients. Findings from the World Health Organization project Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) showed a remarkably high prevalence (about 65%) of hypertension in Eastern Europeans. There is virtually no difference however, between the success rate in controlling hypertension when comparing Eastern and Western European populations. Diagnosing hypertension depends on both population awareness of the dangers of hypertension and medical interventions aimed at the detecting elevated blood pressure, even in asymptomatic patients. Medical compliance with guidelines for the treatment of hypertension is variable throughout Eastern Europe. Prevalence of hypertension increases with age, and the management of hypertension in elderly is a significant problem. The treatment of hypertension demands a comprehensive approach to the patient with regard to cardiovascular risk and individualization of hypertensive therapy.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | | | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
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Nilsson M, Rasmark U, Nordgren H, Hallberg P, Skönevik J, Westman G, Rolandsson O. The physician at a distance: the use of videoconferencing in the treatment of patients with hypertension. J Telemed Telecare 2010; 15:397-403. [PMID: 19948706 DOI: 10.1258/jtt.2009.090509] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated the feasibility and quality of uncomplicated hypertension care based on telemedicine in a rural area of northern Sweden. The intervention subjects were 91 consecutive patients with primary hypertension. For comparison, 182 age- and sex-matched patients with hypertension were randomly selected from a similar health centre. The telemedicine equipment consisted of a video link between the physician and the patients, supported by a system for accessing medical data via the Internet. During a 21-month study period, telemedicine was used in 270 (91%) of the 297 consultations in the intervention group. All health personnel involved in the telemedicine treatment rated the method as feasible. Both systolic and diastolic blood pressure improved in the two groups during the study period. In the intervention group, a higher proportion had their blood pressure within treatment goals (systolic blood pressure <140 mmHg, diastolic blood pressure <90 mmHg) both at baseline and at follow-up than in the comparison group. An adjusted multivariate model (adjustment for sex, age, time between visits, change in number of drugs between first and last visit, blood pressure at first visit) showed that the intervention group had a higher probability (OR 2.7, 95% CI 1.4-5.2) of reaching the target blood pressure levels than the reference group. Treatment of hypertension by means of telemedicine was quite feasible and at least as effective as face-to-face consultations with a physician.
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Affiliation(s)
- Mats Nilsson
- *Futurum - the Academy of Healthcare, Jönköping County Council, Jönköping, Sweden
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Paschos GK, Baggs JE, Hogenesch JB, FitzGerald GA. The role of clock genes in pharmacology. Annu Rev Pharmacol Toxicol 2010; 50:187-214. [PMID: 20055702 DOI: 10.1146/annurev.pharmtox.010909.105621] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The physiology of a wide variety of organisms is organized according to periodic environmental changes imposed by the earth's rotation. This way, a large number of physiological processes present diurnal rhythms regulated by an internal timing system called the circadian clock. As part of the rhythmicity in physiology, drug efficacy and toxicity can vary with time. Studies over the past four decades present diurnal oscillations in drug absorption, distribution, metabolism, and excretion. On the other hand, diurnal variations in the availability and sensitivity of drug targets have been correlated with time-dependent changes in drug effectiveness. In this review, we provide evidence supporting the regulation of drug kinetics and dynamics by the circadian clock. We also use the examples of hypertension and cancer to show current achievements and challenges in chronopharmacology.
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Affiliation(s)
- Georgios K Paschos
- Department of Pharmacology, Institute for Translational Medicine and Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, 19104, USA.
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da Costa FA, Guerreiro JP, de Melo MN, Miranda ADC, Martins AP, Garçāo J, Madureira B. Effect of reminder cards on compliance with antihypertensive medication. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.13.3.0006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
Poor compliance to antihypertensive medications has been identified as a primary cause of uncontrolled blood pressure (BP), with consequent increases in hypertension-related morbidity and mortality. Therefore, any measure known to improve compliance should be encouraged. This study assessed the impact of reminder cards on compliance to antihypertensive therapy.
Method
A field trial was undertaken in pharmacies located in the districts of Lisbon and Porto. Eligible participants comprised those aged 30–74 years, prescribed an angiotensin-converting enzyme inhibitor (ACEI) in monotherapy, and taken on a once-daily regimen. Patients were allocated to control group (CG) or intervention group (IG), the latter being provided with a reminder card, an alarm-type device due to remind the patient of the time to take his medication. Patients were monitored monthly during 3 months for compliance and blood pressure control.
Key findings
Seventy-one patients participated in the study (intervention: 35; control group: 36). Compliance was similar between the groups in the first 2 months of follow-up (97.1% IG vs 94.9% CG at first follow-up and 97.5% IG vs 94.2% CG at second follow-up) and higher in the intervention group at the end of the study (97.3% IG vs 87.3% CG; P = 0.011). There were no mean blood pressure differences between compliant and non-compliant subjects at the end of the study (P value for differences in systolic BP (Psyst) = 0.580; and P value for differences in diastolic BP (Pdlast) = 0.175).
Conclusion
This small-scale study indicates a possible positive impact on patients' compliance resulting from the use of reminder cards. However, this needs confirming in larger scale studies with longer monitoring periods.
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Affiliation(s)
- Filipa Alves da Costa
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - José Pedro Guerreiro
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - Magda Nunes de Melo
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - Ana da Costa Miranda
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - Ana Paula Martins
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - José Garçāo
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
| | - Brenda Madureira
- Centro de Estudos de Farmacoepidemiologia, Associaçāo Nacional das Farmácias, Lisbon, Portugal
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Yusuff KB, Alabi A. Assessing patient adherence to anti-hypertensive drug therapy: can a structured pharmacist-conducted interview separate the wheat from the chaff? INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.15.4.0007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To identify determinants of adherence and assess the impact of structured pharmacist-conducted interviews in determining patients' adherence to prescribed anti-hypertensive medications in a secondary care setting in Nigeria.
Method
The study was conducted in a secondary care facility located in Ibadan, Southwestern Nigeria. Two methodological approaches were employed. The first phase was pharmacist-conducted, pre-physician consultation, cross-sectional interviews of 400 hypertensive patients who presented at the study site within the 2-month study period. The second phase was a follow-up review of case notes of these patients after they had left the physician's office.
Key findings
The outcome of the pharmacist-conducted pre-physician consultation interview shows that financial difficulty was the most frequently identified factor responsible for patients' non-adherence to anti-hypertensive drug therapy (64%). A drug holiday, varying from 5–14 days per month, was the coping strategy adopted by patients to circumvent this difficulty. Only 48% (192) of patients were aware of the negative consequences of non-adherence with anti-hypertensive drug therapy, and of these, 75% were adherent. The level of awareness was significantly higher in adherent patients (P < 0.001). Sixty-seven per cent (268) of patients use a daily medication reminder (DMR) to assist them in taking their anti-hypertensive drugs, and of these 65.7% were adherent. The use of DMRs was significantly higher among adherent patients (P < 0.01). A meal time was the most frequently used DMR (88%). Forty-one per cent (164) of patients had additional measurement of their blood pressure at pharmacies (65.9%) and neighbourhood private hospital (34.1%), and of these 75.6% were judged to be adherent with their prescribed drug therapy. Additional measurement of blood pressure was significantly higher in adherent patients (P < 0.001). Fifty-one per cent of the cohort were judged by pharmacists as non-adherent during pre-consultation interviews (phase 1), while physicians judged 25% of the same cohort as non-adherent during consultation (phase 2). The structured pharmacist-conducted pre-physician consultation interviews were significantly better at identifying patients who were non-adherent with prescribed anti-hypertensive drugs (P < 0.01).
Conclusion
A brief structured pharmacist-conducted interview can be a valuable tool in assessing and/or identifying determinants of adherence with anti-hypertensive drug therapy.
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Affiliation(s)
- Kazeem B Yusuff
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan. Nigeria
| | - Abdrahman Alabi
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan. Nigeria
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Ionescu DD. Antihypertensive efficacy of perindopril 5-10 mg/day in primary health care: an open-label, prospective, observational study. Clin Drug Investig 2010; 29:767-76. [PMID: 19888783 DOI: 10.2165/11319700-000000000-00000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVES Optimal control of hypertension reduces the risk of long-term cardiovascular complications, and current guidelines recommend blood pressure (BP) targets of <140/90 mmHg for patients. Despite this, the BP of many patients with hypertension in primary health care remains poorly controlled. The ACE inhibitor perindopril has proven BP-lowering efficacy as well as protective effects against cardiovascular events among patients with additional cardiovascular risk factors. The PREFER study assessed the antihypertensive efficacy and safety of perindopril 5-10 mg/day among hypertensive patients who were unresponsive to treatment with other ACE-inhibitor-based regimens. METHODS The PREFER study was an open-label, prospective, observational study conducted in primary health-care centres throughout Romania. Patients selected for the study (n = 824; mean + or - SD age 60.3 + or - 9.8 years) had uncontrolled hypertension (i.e. seated BP > or =140/90 mmHg, or > or = 130/80 mmHg in patients with diabetes mellitus or at high cardiovascular risk) despite receiving ACE inhibitors either alone or in free combination with other antihypertensive classes. At study entry, current ACE inhibitor treatment was replaced by perindopril 5 mg/day. Patients were followed up monthly for 3 months and the dosage of perindopril could be increased to 10 mg/day in cases of failure to achieve BP control. No other change in antihypertensive therapy was permitted. RESULTS Replacing the previous ACE inhibitor with perindopril 5-10 mg/day resulted in decreases of 26.2 mmHg (from 162.6 + or - 15.6 to 136.4 + or - 14.6 mmHg [p < 0.001]) in systolic BP and of 12.6 mmHg (from 96.9 + or - 17.2 to 84.3 + or - 12.8 mmHg [p < 0.001]) in diastolic BP. Mean pulse pressure (PP) was reduced by 13.6 mmHg (from 65.7 to 52.1 mmHg) with greater decreases seen in patients aged >70 years or with isolated systolic hypertension. BP control was achieved in 48.1% of the previously uncontrolled population. Antihypertensive efficacy was observed across patient subgroups regardless of the severity of hypertension at baseline and number of cardiovascular risk factors. Patient compliance with treatment was high throughout the study. CONCLUSIONS Perindopril 5-10 mg/day lowers BP and PP and improves BP control among hypertensive patients who were previously unresponsive to other ACE inhibitor-based regimens.
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Affiliation(s)
- Dan-Dominic Ionescu
- University of Medicine and Pharmacy of Craiova, Craiova Cardiology Centre, Craiova, Romania
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Wong MC, Jiang JY, Griffiths SM. Short-term adherence to β-blocker therapy among ethnic Chinese patients with hypertension: A cohort study. Clin Ther 2009; 31:2170-7; discussion 2150-1. [DOI: 10.1016/j.clinthera.2009.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2009] [Indexed: 11/28/2022]
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Roux O, Chapellier M, Czernichow S, Nisse-Durgeat S, Safar ME, Blacher J. Determinants of hypertension control in a large French population of treated hypertensive subjects. Blood Press 2009; 15:6-13. [PMID: 16492610 DOI: 10.1080/08037050500450114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Only a minority of all hypertensives is well controlled in the population. In order to assess the proportion of well controlled hypertensives and the factors associated with hypertension control in France, we designed an observational cross-sectional epidemiological study in a population of 4702 treated adult hypertensives selected by general practitioners: EPISTRAT. This hypertensive treated population presented the following characteristics (mean+/-standard deviation): age: 60+/-12 years; blood pressure: 151+/-16/87+/-10 mmHg; men: 58%; body mass index: 27+/-5 kg/m2; diabetes mellitus: 12%; subjects in secondary cardiovascular prevention: 14%. Half of the patients presented two or more CV risk factors in addition to hypertension. Forty-eight per cent of the subjects were treated with antihypertensive monotherapy, 31% with bitherapy and 21% with more than two drugs. Patients with controlled hypertension (<140/90 mmHg) represented "only" 18% of the population. Multivariate analysis showed that male gender and advanced age were the two main variables independently associated with poor blood pressure control. Finally, the majority of patients experienced at least one antihypertensive treatment modification, mainly for insufficient therapeutic effect. In conclusion, this study has shown poor blood pressure control in a primary care-recruited population, especially in males and in the elderly.
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Affiliation(s)
- Olivier Roux
- Centre de Diagnostic, Hôpital Hôtel-Dieu, AP-HP, Université Paris 5, Paris, France
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Tocci G, Giovannelli F, Sciarretta S, Ferrucci A, Zito GB, Volpe M. Management of hypertension and stroke prevention: results of the Italian cardiologist survey. Int J Clin Pract 2009; 63:207-16. [PMID: 19196359 DOI: 10.1111/j.1742-1241.2008.01926.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To provide an overview of current habits, priorities, perceptions and knowledge of cardiologists with regard to hypertension and stroke prevention in outpatient practice. METHODS A sample of 203 cardiologists operating in outpatient clinics and randomly selected amongst members of the largest Italian Outpatient Cardiologist Association were interviewed by e-mail, in April-May 2007. RESULTS The interviewed cardiologists reported that hypertensive outpatients represent a large percentage of their practice population, in which the clinical priority was blood pressure (BP) reduction. Stroke was identified as the most important event to prevent and it was also perceived as the most preventable hypertension-related cardiovascular event. A remarkably high rate of achieved BP control was reported, to a degree that it is inconsistent with current epidemiological reports and with the relatively low percentage use of combination therapies declared by cardiologists. Additional risk factors, organ damage, diabetes mellitus and atrial fibrillation were consistently reported in hypertensive patients. Among antihypertensive drug classes, a preference for angiotensin-converting enzyme inhibitors has been expressed by the majority of physicians; this choice was generally justified by evidence derived from international trials or by the antihypertensive efficacy of this drug class. CONCLUSIONS The results confirm the presence of weaknesses in the current services for patients with hypertension, even when being managed by cardiologists. Discrepancies between perceptions and reality, or clinical practice and guideline recommendations are also highlighted. An analysis of these aspects may help to identify current areas of potential improvement for stroke prevention in the clinical management of hypertension in cardiology practice.
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Affiliation(s)
- G Tocci
- Cardiology, II Faculty of Medicine, University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
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Older people and adherence with medication: a review of the literature. Int J Nurs Stud 2009; 45:1550-61. [PMID: 18395727 DOI: 10.1016/j.ijnurstu.2008.02.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/11/2008] [Accepted: 02/20/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Older people represent a sizeable population of the UK. Many older people receive drug treatment for long-term conditions. Adherence with medication is therefore an important clinical, financial and resource intensive concern. OBJECTIVES This review aimed to examine patient's beliefs, perceptions and views in relation to adherence with medication. DESIGN A comprehensive search of the literature was undertaken using numerous approaches. The search of revealed 30 research papers. FINDINGS Articles were initially evaluated using Critical Appraisal Skills Programme principles to identify those relevant to the review. Relevant studies were then subjected to a narrative analysis to assist the development of relevant themes. Four themes were identified; experience of adherence; perceptions and attitudes to medication adherence and non-adherence; patients acceptance of their illness and impact on medication taking behaviour and shared decision making. CONCLUSIONS The findings of this review imply that there is a need for more emphasis on shared decision making between the older patient and the prescriber. Using this approach, adherence with medication may improve. There is also a need to develop a standardized measure of medication adherence.
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Touzé E, Coste J, Voicu M, Kansao J, Masmoudi R, Doumenc B, Durieux P, Mas JL. Importance of In-Hospital Initiation of Therapies and Therapeutic Inertia in Secondary Stroke Prevention. Stroke 2008; 39:1834-43. [DOI: 10.1161/strokeaha.107.503094] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emmanuel Touzé
- From the Department of Neurology (E.T., M.V., J.L.M.), Université Paris-Descartes, EA 4055 UMR 894, Centre Hospitalier Sainte-Anne, Paris, France; the Departments of Biostatistics (J.C.) and Emergencies (J.K.), APHP, Hôpital Cochin, Paris, France; Hôpital Européen Georges Pompidou (R.M.), Paris, France; Hôpital Bicêtre (B.D.), Le Kremlin-Bicêtre, Paris, France; and the Department of Public Health (P.D.), APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Joël Coste
- From the Department of Neurology (E.T., M.V., J.L.M.), Université Paris-Descartes, EA 4055 UMR 894, Centre Hospitalier Sainte-Anne, Paris, France; the Departments of Biostatistics (J.C.) and Emergencies (J.K.), APHP, Hôpital Cochin, Paris, France; Hôpital Européen Georges Pompidou (R.M.), Paris, France; Hôpital Bicêtre (B.D.), Le Kremlin-Bicêtre, Paris, France; and the Department of Public Health (P.D.), APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Magdalena Voicu
- From the Department of Neurology (E.T., M.V., J.L.M.), Université Paris-Descartes, EA 4055 UMR 894, Centre Hospitalier Sainte-Anne, Paris, France; the Departments of Biostatistics (J.C.) and Emergencies (J.K.), APHP, Hôpital Cochin, Paris, France; Hôpital Européen Georges Pompidou (R.M.), Paris, France; Hôpital Bicêtre (B.D.), Le Kremlin-Bicêtre, Paris, France; and the Department of Public Health (P.D.), APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Jamal Kansao
- From the Department of Neurology (E.T., M.V., J.L.M.), Université Paris-Descartes, EA 4055 UMR 894, Centre Hospitalier Sainte-Anne, Paris, France; the Departments of Biostatistics (J.C.) and Emergencies (J.K.), APHP, Hôpital Cochin, Paris, France; Hôpital Européen Georges Pompidou (R.M.), Paris, France; Hôpital Bicêtre (B.D.), Le Kremlin-Bicêtre, Paris, France; and the Department of Public Health (P.D.), APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Rafik Masmoudi
- From the Department of Neurology (E.T., M.V., J.L.M.), Université Paris-Descartes, EA 4055 UMR 894, Centre Hospitalier Sainte-Anne, Paris, France; the Departments of Biostatistics (J.C.) and Emergencies (J.K.), APHP, Hôpital Cochin, Paris, France; Hôpital Européen Georges Pompidou (R.M.), Paris, France; Hôpital Bicêtre (B.D.), Le Kremlin-Bicêtre, Paris, France; and the Department of Public Health (P.D.), APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Benoît Doumenc
- From the Department of Neurology (E.T., M.V., J.L.M.), Université Paris-Descartes, EA 4055 UMR 894, Centre Hospitalier Sainte-Anne, Paris, France; the Departments of Biostatistics (J.C.) and Emergencies (J.K.), APHP, Hôpital Cochin, Paris, France; Hôpital Européen Georges Pompidou (R.M.), Paris, France; Hôpital Bicêtre (B.D.), Le Kremlin-Bicêtre, Paris, France; and the Department of Public Health (P.D.), APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Pierre Durieux
- From the Department of Neurology (E.T., M.V., J.L.M.), Université Paris-Descartes, EA 4055 UMR 894, Centre Hospitalier Sainte-Anne, Paris, France; the Departments of Biostatistics (J.C.) and Emergencies (J.K.), APHP, Hôpital Cochin, Paris, France; Hôpital Européen Georges Pompidou (R.M.), Paris, France; Hôpital Bicêtre (B.D.), Le Kremlin-Bicêtre, Paris, France; and the Department of Public Health (P.D.), APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Louis Mas
- From the Department of Neurology (E.T., M.V., J.L.M.), Université Paris-Descartes, EA 4055 UMR 894, Centre Hospitalier Sainte-Anne, Paris, France; the Departments of Biostatistics (J.C.) and Emergencies (J.K.), APHP, Hôpital Cochin, Paris, France; Hôpital Européen Georges Pompidou (R.M.), Paris, France; Hôpital Bicêtre (B.D.), Le Kremlin-Bicêtre, Paris, France; and the Department of Public Health (P.D.), APHP, Hôpital Européen Georges Pompidou, Paris, France
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Guías de práctica clínica sobre prevención de la enfermedad cardiovascular: versión resumida. Rev Esp Cardiol 2008. [DOI: 10.1157/13114961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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ZHU N, BU M, CHEN D, LI T, QIAN J, YU Q, CHEN Q, WAN C, QU H, ZHU M, ZOU X. A Study of the White-Coat Phenomenon in Patients with Primary Hypertension. Hypertens Res 2008; 31:37-41. [DOI: 10.1291/hypres.31.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Randomized study of traditional versus aggressive systolic blood pressure control (Cardio-Sis): rationale, design and characteristics of the study population. J Hum Hypertens 2007; 22:243-51. [PMID: 18046432 DOI: 10.1038/sj.jhh.1002313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Op Reimer WS, Weissberg P, Wood D, Yarnell J, Zamorano JL, Walma E, Fitzgerald T, Cooney MT, Dudina A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Funck-Brentano C, Filippatos G, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Altiner A, Bonora E, Durrington PN, Fagard R, Giampaoli S, Hemingway H, Hakansson J, Kjeldsen SE, Larsen ML, Mancia G, Manolis AJ, Orth-Gomer K, Pedersen T, Rayner M, Ryden L, Sammut M, Schneiderman N, Stalenhoef AF, Tokgözoglu L, Wiklund O, Zampelas A. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). ACTA ACUST UNITED AC 2007; 14 Suppl 2:E1-40. [PMID: 17726406 DOI: 10.1097/01.hjr.0000277984.31558.c4] [Citation(s) in RCA: 259] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Other experts who contributed to parts of the guidelines: Edmond Walma, Schoonhoven (The Netherlands), Tony Fitzgerald, Dublin (Ireland), Marie Therese Cooney, Dublin (Ireland), Alexandra Dudina, Dublin (Ireland) European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG):, Alec Vahanian (Chairperson) (France), John Camm (UK), Raffaele De Caterina (Italy), Veronica Dean (France), Kenneth Dickstein (Norway), Christian Funck-Brentano (France), Gerasimos Filippatos (Greece), Irene Hellemans (The Netherlands), Steen Dalby Kristensen (Denmark), Keith McGregor (France), Udo Sechtem (Germany), Sigmund Silber (Germany), Michal Tendera (Poland), Petr Widimsky (Czech Republic), José Luis Zamorano (Spain) Document reviewers: Irene Hellemans (CPG Review Coordinator) (The Netherlands), Attila Altiner (Germany), Enzo Bonora (Italy), Paul N. Durrington (UK), Robert Fagard (Belgium), Simona Giampaoli(Italy), Harry Hemingway (UK), Jan Hakansson (Sweden), Sverre Erik Kjeldsen (Norway), Mogens Lytken Larsen (Denmark), Giuseppe Mancia (Italy), Athanasios J. Manolis (Greece), Kristina Orth-Gomer (Sweden), Terje Pedersen (Norway), Mike Rayner (UK), Lars Ryden (Sweden), Mario Sammut (Malta), Neil Schneiderman (USA), Anton F. Stalenhoef (The Netherlands), Lale Tokgözoglu (Turkey), Olov Wiklund (Sweden), Antonis Zampelas (Greece)
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Affiliation(s)
- Ian Graham
- Department of Cardiology, The Adelaide and Meath Hospital, Tallaght, Doublin, Ireland.
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Association of suboptimal blood pressure control with body size and metabolic abnormalities. J Hypertens 2007; 25:2296-300. [DOI: 10.1097/hjh.0b013e3282e9a9e4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Neutel JM, Franklin SS, Lapuerta P, Bhaumik A, Ptaszynska A. A comparison of the efficacy and safety of irbesartan/HCTZ combination therapy with irbesartan and HCTZ monotherapy in the treatment of moderate hypertension. J Hum Hypertens 2007; 22:266-74. [PMID: 17928878 DOI: 10.1038/sj.jhh.1002293] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This prospective, double-blind, parallel-group study randomized patients with moderate hypertension (seated systolic blood pressure (SeSBP) 160-179 mm Hg when seated diastolic blood pressure (SeDBP) <110 mm Hg; or SeDBP 100-109 mm Hg when SeSBP <180 mm Hg) 3:1:1 to treatment with irbesartan 300 mg/hydrochlorothiazide (HCTZ) 25 mg combination therapy (n=328), irbesartan 300 mg monotherapy (n=106) or HCTZ monotherapy 25 mg (n=104). Treatment was initiated at half dose, with forced titration to full dose after two weeks followed by ten further weeks' treatment. The primary efficacy variable was the mean reduction in SeSBP from baseline to week 8. Baseline characteristics were similar between groups, with mean baseline blood pressure approximately 162/98 mm Hg; the mean age was 55 years. At week 8 there was a reduction in SeSBP of 27.1 mm Hg with irbesartan/HCTZ, compared with 22.1 mm Hg with irbesartan monotherapy (P=0.0016) and 15.7 mm Hg with HCTZ (P<0.0001). Both the rate of decline and the total degree of decline achieved were greatest with irbesartan/HCTZ and least with HCTZ. A significantly greater percentage of patients reached a treatment goal of SeSBP <140 mm Hg and SeDBP <90 mm Hg by week 8 with irbesartan/HCTZ (53.4%), compared with irbesartan (40.6%; P=0.0254) and HCTZ (20.2%; P<0.0001) alone. Treatment was well tolerated in all three-treatment groups with a slight increase in adverse events in the combination therapy group. In conclusion, irbesartan/HCTZ (300/25 mg) is well tolerated and achieves rapid and sustained reductions in both systolic blood pressure and diastolic blood pressure in patients with moderate hypertension.
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Affiliation(s)
- J M Neutel
- Orange County Research Center, Tustin, CA 92780, USA.
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