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Yoon GE, Jung JK, Lee YH, Jang BC, In Kim J. Histone deacetylase inhibitor CG200745 ameliorates high-fat diet-induced hypertension via inhibition of angiotensin II production. Naunyn Schmiedebergs Arch Pharmacol 2019; 393:491-500. [PMID: 31655853 PMCID: PMC7280340 DOI: 10.1007/s00210-019-01749-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022]
Abstract
Obesity is growing rapidly worldwide due to consumption of westernized diet and lack of exercise. Obesity is one of the major risk factors of hypertension. The novel histone deacetylase (HDAC) inhibitor CG200745 was originally developed to treat various cancers. Previous studies showed that CG200745 attenuated hypertension through inhibition of cardiac hypertrophy and fibrosis in deoxycorticosterone acetate-induced hypertensive rat. The purpose of this study is to investigate the role and underlying mechanism of CG200745 in high-fat diet (HFD)-induced hypertension. Nine-week old C57BL/6 mice were fed a normal diet (ND) or HFD for 17 weeks. Each group of mice was treated with vehicle or CG200745 by intraperitoneal injection for 9 days. HFD group showed higher body weight, blood pressure (BP), HDAC activities, angiotensinogen and renin expressions in kidney, angiotensin-converting enzyme (ACE) expression in the lung, serum angiotensin II (Ang II) concentration, and myosin light chain20 (MLC20) phosphorylation in mesenteric artery compared with ND group. CG200745 lowered BP, HDAC activity, renin and angiotensinogen in the kidney, ACE in the lung, serum Ang II level, and phosphorylation of MLC20 in HFD group. In conclusion, CG200745 ameliorated HFD-induced hypertension through inhibition of HDAC/Ang II/vascular contraction axis. Our results offer CG200745 as a novel therapeutic option for HFD-induced hypertension.
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Affiliation(s)
- Ga-Eun Yoon
- Department of Molecular Medicine and Medical Research Center, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| | - Jin Ki Jung
- Department of Molecular Medicine and Medical Research Center, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| | - Yun-Han Lee
- Department of Molecular Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byeong-Churl Jang
- Department of Molecular Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jee In Kim
- Department of Molecular Medicine and Medical Research Center, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
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2
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Mann SJ. Neurogenic hypertension: pathophysiology, diagnosis and management. Clin Auton Res 2018; 28:363-374. [DOI: 10.1007/s10286-018-0541-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
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Keohane DM, Dennehy T, Keohane KP, Shanahan E. Reducing inappropriate non-steroidal anti-inflammatory prescription in primary care patients with chronic kidney disease. Int J Health Care Qual Assur 2017; 30:638-644. [PMID: 28809591 DOI: 10.1108/ijhcqa-09-2016-0145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to reduce inappropriate non-steroidal anti-inflammatory prescribing in primary care patients with chronic kidney disease (CKD). Once diagnosed, CKD management involves delaying progression to end stage renal failure and preventing complications. It is well established that non-steroidal anti-inflammatories have a negative effect on kidney function and consequently, all nephrology consensus groups suggest avoiding this drug class in CKD. Design/methodology/approach The sampling criteria included all practice patients with a known CKD risk factor. This group was refined to include those with an estimated glomerular filtration rate (eGFR)<60 ml/min per 1.73m2 (stage 3 CKD or greater). Phase one analysed how many prescriptions had occurred in this group over the preceding three months. The intervention involved creating an automated alert on at risk patient records if non-steroidal anti-inflammatories were prescribed and discussing the rationale with practice staff. The re-audit phase occurred three months' post intervention. Findings The study revealed 728/7,500 (9.7 per cent) patients at risk from CKD and 158 (2.1 per cent) who were subsequently found to have an eGFR<60 ml/min, indicating=stage 3 CKD. In phase one, 10.2 per cent of at risk patients had received a non-steroidal anti-inflammatory prescription in the preceding three months. Additionally, 6.2 per cent had received non-steroidal anti-inflammatories on repeat prescription. Phase two post intervention revealed a significant 75 per cent reduction in the total non-steroidal anti-inflammatories prescribed and a 90 per cent reduction in repeat non-steroidal anti-inflammatory prescriptions in those with CKD. Originality/value The study significantly reduced non-steroidal anti-inflammatory prescription in those with CKD in primary care settings. It also created a CKD register within the practice and an enduring medication alert system for individuals that risk nephrotoxic non-steroidal anti-inflammatory prescription. It established a safe, reliable and efficient process for reducing morbidity and mortality, improving quality of life and limiting the CKD associated health burden.
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Affiliation(s)
- David M Keohane
- The South West Specialist Training Programme in General Practice, Tralee, Ireland
| | - Thomas Dennehy
- The South West Specialist Training Programme in General Practice, Tralee, Ireland
| | - Kenneth P Keohane
- The South West Specialist Training Programme in General Practice, Tralee, Ireland
| | - Eamonn Shanahan
- The South West Specialist Training Programme in General Practice, Tralee, Ireland
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4
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Constantine GR, Ranasinghe P, Weeratunga P, Weeraratne C, Galappatthy P, Rajapakse S, Senarath U, Katulanda P. Addition of Propranolol in Resistant Arterial hypertension Treatment (APROPRIATE study): study protocol for a randomized double-blind placebo-controlled trial. Trials 2017; 18:124. [PMID: 28292320 PMCID: PMC5351190 DOI: 10.1186/s13063-017-1863-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 02/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Resistant hypertension is defined as an uncontrolled blood pressure despite treatment at best-tolerated doses with at least three antihypertensive agents including a diuretic. It is an emerging public health problem. At present clinical trial data on management of resistant hypertension is limited. Management is largely based on observational studies and expert opinions. Propranolol is a nonselective beta blocker. Several studies have confirmed that propranolol has a significant hypotensive action, both when used alone and as an adjuvant therapy. At present there are no prospective, randomized, clinical studies evaluating the effectiveness of propranolol in patients with resistant hypertension. Therefore, we have designed a prospective randomized trial to evaluate the safety and efficacy of propranolol in patients with resistant hypertension. Methods/design The study will be conducted as a randomized, double-blind, placebo-controlled clinical trial for a period of 3 months. The study has been approved by the Ethics Review Committee of the Faculty of Medicine, University of Colombo. A total of 200 adults with resistant hypertension will be recruited for the study. They will be randomly assigned to the test and placebo groups on a 1:1 ratio. The test group will receive propranolol 40 mg three times a day and the control group will receive an identical placebo capsule. The study drugs will be double blinded to both investigators and subjects. The visits and the evaluations will be done as follows: screening (visit 0), 1 month (visit 1), 2 months (visit 2) and 3 months (visit 3). The primary outcomes of the study is to find a statistically significant difference between the fall in mean systolic and mean diastolic blood pressure measured by ABPM (ambulatory blood pressure monitoring) from baseline between the two groups. Data will be analyzed using SPSS v16. Discussion To our knowledge this is one of the first randomized controlled trials evaluating the effects of propranolol in resistant hypertension. This study will provide the necessary groundwork for future large-scale, multicentered clinical trials. The result, positive or negative, should provide a step change in the evidence guiding current and future policies regarding treatment of resistant hypertension. Trial registration Sri Lanka Clinical Trials Registry, identifier: SLCTR/2016/002. Registered on 27 January 2016; Study protocol version 2.1. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1863-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G R Constantine
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - P Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - P Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - C Weeraratne
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - P Galappatthy
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - S Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - U Senarath
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - P Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Martell-Claros N, Abad-Cardiel M. ¿Qué posibilidades farmacológicas existen para tratar la hipertensión arterial resistente? HIPERTENSION Y RIESGO VASCULAR 2017; 34 Suppl 1:25-28. [DOI: 10.1016/s1889-1837(18)30060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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6
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Reversible acute renal failure in a patient with acquired aortic coarctation. Int J Cardiol 2016; 222:683-685. [DOI: 10.1016/j.ijcard.2016.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
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Abstract
Loop diuretics are not recommended in current hypertension guidelines largely due to the lack of outcome data. Nevertheless, they have been shown to lower blood pressure and to offer potential advantages over thiazide-type diuretics. Torsemide offers advantages of longer duration of action and once daily dosing (vs. furosemide and bumetanide) and more reliable bioavailability (vs. furosemide). Studies show that the previously employed high doses of thiazide-type diuretics lower BP more than furosemide. Loop diuretics appear to have a preferable side effect profile (less hyponatremia, hypokalemia, and possibly less glucose intolerance). Studies comparing efficacy and side effect profiles of loop diuretics with the lower, currently widely prescribed, thiazide doses are needed. Research is needed to fill gaps in knowledge and common misconceptions about loop diuretic use in hypertension and to determine their rightful place in the antihypertensive arsenal.
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Affiliation(s)
- Line Malha
- Department of Nephrology and Hypertension, Hypertension Center, NY Presbyterian Hospital-Weill Cornell Medicine, 424 E. 70th Street, New York, NY, 10021, USA
| | - Samuel J Mann
- Department of Nephrology and Hypertension, Hypertension Center, NY Presbyterian Hospital-Weill Cornell Medicine, 424 E. 70th Street, New York, NY, 10021, USA.
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Jujo K, Saito K, Ishida I, Furuki Y, Ouchi T, Kim A, Suzuki Y, Sekiguchi H, Yamaguchi J, Ogawa H, Hagiwara N. Efficacy of 24-Hour Blood Pressure Monitoring in Evaluating Response to Percutaneous Transluminal Renal Angioplasty. Circ J 2016; 80:1922-30. [PMID: 27439675 DOI: 10.1253/circj.cj-16-0347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Percutaneous transluminal renal angioplasty (PTRA) improves patency in atherosclerotic renal artery stenosis (ARAS), but improvement in clinic blood pressure (BP) is seen in only 20-40% of patients who undergo PTRA. This study investigated the effects of PTRA on BP lowering, assessed on 24-h ambulatory BP monitoring (ABPM), and identified preoperative features predictive of satisfactory BP improvement after PTRA. METHODS AND RESULTS Of 1,753 consecutive patients undergoing coronary angiography, 31 patients with angiographically significant ARAS and translesional pressure gradient (TLPG) >20 mmHg underwent PTRA. ABPM was performed before, at 1 month and at 1 year after PTRA; patients with average systolic ABPM-BP decrease >10 mmHg at 1 month from baseline were categorized as responders. There was no obvious relationship between clinic BP and ABPM-BP at baseline. ABPM-BP was significantly higher in responders at baseline (SBP: 148 vs. 126 mmHg, P<0.01) and was improved 1 month after PTRA. This difference persisted until 1 year after PTRA. Night-time BP improved more than daytime BP in responders. Patients with higher baseline ABPM-BP achieved a larger decrease in ABPM-BP, but the severity of stenosis reflected by TLPG; renal duplex findings; and neurohumoral parameters other than baseline renal function, did not differ between the groups. CONCLUSIONS Clinic BP does not represent daily hemodynamic status, whereas high ABPM-BP is a potent predictor of satisfactory BP response to PTRA. (Circ J 2016; 80: 1922-1930).
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Affiliation(s)
- Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University
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Olson SW, Yoon S, Baker T, Prince LK, Oliver D, Abbott KC. Longitudinal plasma metanephrines preceding pheochromocytoma diagnosis: a retrospective case-control serum repository study. Eur J Endocrinol 2016; 174:289-95. [PMID: 26671972 DOI: 10.1530/eje-15-0651] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/15/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Plasma metanephrines (PMN) are highly sensitive for diagnosis of pheochromocytoma, but the natural history of PMN before pheochromocytoma diagnosis has not been previously described. The aim of the study was to compare the progression of PMN before pheochromocytoma diagnosis to matched healthy and essential hypertension disease controls. DESIGN A retrospective case-control Department of Defense Serum Repository (DoDSR) study. METHODS We performed a DoDSR study that compared three longitudinal pre-diagnostic PMN for 30 biopsy-proven pheochromocytoma cases to three longitudinal PMN for age, sex, race, and age of serum sample matched healthy and essential hypertension disease controls. Predominant metanephrine (MN) or normetanephrine (NMN) production was identified for each case and converted to a percentage of the upper limit of normal to allow analysis of all cases together. PMN were measured by Quest Diagnostics. RESULTS The predominant plasma metanephrine (PPM) was >100 and 300% of the upper limit of normal a median of 6.6 and 4.1 years before diagnosis respectively. A greater percentage of pheochromocytoma patients had a PPM >100 and >300% of the upper limit of normal compared with combined healthy and essential hypertension disease controls <2, 2-8, and >8 years prior to diagnosis. For patients with a baseline PPM 90-300% of the upper limit of normal, a 25% rate of rise per year was 100% specific for pheochromocytoma. CONCLUSIONS PPMs elevate years before diagnosis which suggests that delayed diagnoses are common. For mild PMN elevations, follow-up longitudinal PMN trends may provide a highly specific and economical diagnostic tool.
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Affiliation(s)
| | | | - T Baker
- Department of NephrologyWalter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, Maryland 20889, USADepartment Chief, Joint Pathology Center606 Stephen Sitter Avenue, Silver Spring, Maryland 20910, USAThe National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Bethesda, Maryland 20892, USA
| | | | | | - K C Abbott
- Department of NephrologyWalter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, Maryland 20889, USADepartment Chief, Joint Pathology Center606 Stephen Sitter Avenue, Silver Spring, Maryland 20910, USAThe National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Bethesda, Maryland 20892, USA
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Siddiqui M, Dudenbostel T, Calhoun DA. Resistant and Refractory Hypertension: Antihypertensive Treatment Resistance vs Treatment Failure. Can J Cardiol 2015; 32:603-6. [PMID: 26514749 DOI: 10.1016/j.cjca.2015.06.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 11/15/2022] Open
Abstract
Resistant or difficult to treat hypertension is defined as high blood pressure that remains uncontrolled with 3 or more different antihypertensive medications, including a diuretic. Recent definitions also include controlled blood pressure with use of 4 or more medications as also being resistant to treatment. Recently, refractory hypertension, an extreme phenotype of antihypertensive treatment failure has been defined as hypertension uncontrolled with use of 5 or more antihypertensive agents, including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist. Patients with resistant vs refractory hypertension share similar characteristics and comorbidities, including obesity, African American race, female sex, diabetes, coronary heart disease, chronic kidney disease, and obstructive sleep apnea. Patients with refractory vs resistant hypertension tend to be younger and are more likely to have been diagnosed with congestive heart failure. Refractory hypertension might also differ from resistant hypertension in terms of underlying cause. Preliminary evidence suggests that refractory hypertension is more likely to be neurogenic in etiology (ie, heightened sympathetic tone), vs a volume-dependent hypertension that is more characteristic of resistant hypertension in general.
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Affiliation(s)
- Mohammed Siddiqui
- Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tanja Dudenbostel
- Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David A Calhoun
- Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Abstract
Hypertension is widely encountered in family medicine. Despite its prevalence, many patients have uncontrolled or difficult-to-control blood pressure. Resistant hypertension is defined as hypertension that is poorly responsive to treatment and requires the use of multiple medications to achieve acceptable blood pressure ranges. It may be a consequence of secondary hypertension or have no identifiable cause. Resistant hypertension is important to recognise because it places patients at risk of end-organ damage. Primary care physicians should be aware of the therapeutic approach for hypertension when traditional therapy fails. This article aims to familiarise readers with the evaluation and management of resistant hypertension by outlining the most recent evidence-based treatment options.
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Affiliation(s)
- Julian P Yaxley
- Department of Medicine, Redcliffe Hospital, Queensland, Australia
| | - Sam V Thambar
- Department of Medicine, Gold Coast University Hospital, Queensland, Australia
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12
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Mann SJ, Ernst ME. Personalizing the diuretic treatment of hypertension: the need for more clinical and research attention. Curr Hypertens Rep 2015; 17:542. [PMID: 25794956 DOI: 10.1007/s11906-015-0542-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Neither randomized controlled trials nor efforts to identify genetic markers have been helpful with regard to the goal of individualizing diuretic therapy in the treatment of hypertension, a goal that receives little clinical or research attention. This review will examine, and bring attention to, the considerable yet overlooked information relevant to individualizing diuretic therapy. It will bring attention to clinical, biochemical, and pharmacological clues that can be helpful in identifying who is likely to respond to a diuretic, who needs a stronger diuretic regimen, which diuretic to prescribe, and how to minimize adverse effects. New directions for clinical research aimed at individualizing use in hypertension will be explored. Research and clinical attention to the goal of individualizing diuretic treatment in hypertension need to be renewed, to help us achieve greater hypertension control with fewer adverse effects and lower costs.
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Affiliation(s)
- Samuel J Mann
- Division of Nephrology and Hypertension, NY Presbyterian Hospital-Weill Cornell Medical College, 424 East 70th St, New York, NY, 10021, USA,
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13
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Black HR. Treatment: special conditions: resistant hypertension. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2015; 9:71-75. [PMID: 25641108 DOI: 10.1016/j.jash.2014.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Burnier M, Wuerzner G. Ambulatory Blood Pressure and Adherence Monitoring: Diagnosing Pseudoresistant Hypertension. Semin Nephrol 2014; 34:498-505. [DOI: 10.1016/j.semnephrol.2014.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Leon K, El hadidy A, Tawfik M, Gamal A, Zidan A. Observational study on patients’ compliance with Irbesartan in essential hypertension “I Comply”. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2012.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Lackland DT. How will the growing threat of resistant hypertension impact the future treatment of high blood pressure? Expert Rev Cardiovasc Ther 2013; 11:1541-6. [DOI: 10.1586/14779072.2013.851002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schroeder C, Heusser K, Brinkmann J, Menne J, Oswald H, Haller H, Jordan J, Tank J, Luft FC. Truly Refractory Hypertension. Hypertension 2013; 62:231-5. [DOI: 10.1161/hypertensionaha.113.01240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Christoph Schroeder
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Karsten Heusser
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Julia Brinkmann
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Jan Menne
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Hanno Oswald
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Hermann Haller
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Jens Jordan
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Jens Tank
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Friedrich C. Luft
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
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18
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Wong MC, Liu KQ, Wang HH, Lee CL, Kwan MW, Lee KW, Cheung Y, Lee GK, Morisky DE, Griffiths SM. Effectiveness of a Pharmacist-Led Drug Counseling on Enhancing Antihypertensive Adherence and Blood Pressure Control: A Randomized Controlled Trial. J Clin Pharmacol 2013; 53:753-61. [DOI: 10.1002/jcph.101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 04/16/2013] [Indexed: 01/13/2023]
Affiliation(s)
- Martin C.S. Wong
- School of Public Health and Primary Care, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong SAR; China
| | - Kirin Q.L. Liu
- School of Public Health and Primary Care, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong SAR; China
| | - Harry H.X. Wang
- School of Public Health and Primary Care, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong SAR; China
| | - Catherine L.S. Lee
- School of Public Health and Primary Care, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong SAR; China
| | - Mandy W.M. Kwan
- School of Public Health and Primary Care, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong SAR; China
| | - Ken W.S. Lee
- The Society of Hospital Pharmacists of Hong Kong; Hong Kong SAR; China
| | | | - Gabrielle K.Y. Lee
- School of Public Health and Primary Care, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong SAR; China
| | - Donald E. Morisky
- Department of Community Health Sciences; UCLA Fielding School of Public Health; Los Angeles; California
| | - Sian M. Griffiths
- School of Public Health and Primary Care, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong SAR; China
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Risk of Cardiovascular Events and Blood Pressure Control in Hypertensive HIV-Infected Patients. J Acquir Immune Defic Syndr 2013; 62:396-404. [DOI: 10.1097/qai.0b013e3182847cd0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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20
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Gerber LM, Mann SJ, McDonald MV, Chiu YL, Sridharan S, Feldman PH. Diuretic use in black patients with uncontrolled hypertension. Am J Hypertens 2013; 26:174-9. [PMID: 23382401 PMCID: PMC3626036 DOI: 10.1093/ajh/hps029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 07/16/2012] [Accepted: 07/20/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Highly publicized recommendations favor the use of diuretics as a first-line or add-on agent in the management of hypertension, particularly among black patients and patients with resistant hypertension. Failure to follow such guidelines might contribute to high rates of uncontrolled hypertension. This study assessed diuretic prescribing patterns in a sample of black patients with uncontrolled hypertension who were identified from a population of home care recipients. METHODS The study was conducted in an urban home health organization. Participants were black, aged 21 to 80 years, and had a diagnosis of hypertension. Participants with uncontrolled hypertension were identified, and in-home interviewers collected information on prescribed antihypertensive medications. RESULTS Of 658 participants, 5.5% were not prescribed any antihypertensives, and only 46% were prescribed a diuretic. Participants who were not taking a diuretic were taking fewer antihypertensive medications (1.7 vs. 2.9; P < 0.0001), had a higher mean diastolic blood pressure (89.2 vs. 85.5; P = 0.0005), and were more likely to have a systolic blood pressure ≥160mm Hg (57.6% vs. 49.0%; P = 0.04). The adjusted mean systolic and diastolic blood pressures were 5 and 4mm Hg lower, respectively, in patients who were taking a diuretic. CONCLUSIONS In this sample of black patients with uncontrolled hypertension, despite wide publicizing of the recommendations for use of diuretics, a majority are still not receiving a diuretic. This important issue merits continued attention.
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Affiliation(s)
- Linda M Gerber
- Department of Public Health, Weill Cornell Medical College, New York, NY, USA.
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21
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Mann SJ, Parikh NS. A Simplified Mechanistic Algorithm for Treating Resistant Hypertension: Efficacy in a Retrospective Study. J Clin Hypertens (Greenwich) 2012; 14:191-7. [DOI: 10.1111/j.1751-7176.2012.00605.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Chrysant SG. Single-pill triple-combination therapy: an alternative to multiple-drug treatment of hypertension. Postgrad Med 2012; 123:21-31. [PMID: 22104451 DOI: 10.3810/pgm.2011.11.2492] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension (HTN) affects an estimated 76.4 million US adults. Despite improvements in blood pressure (BP) control rates and the availability of effective antihypertensive agents, only 50% of these individuals achieve BP control. It is now recognized that many patients will require ≥ 2 antihypertensive agents to achieve BP control. Both the current US and reappraisal of the 2007 European guidelines include dual-combination regimens among recommended treatments for initial HTN therapy. For patients requiring 3 drugs, the combination of agents with complementary mechanisms of action (ie, renin-angiotensin-aldosterone system blocker, calcium channel blocker, and diuretic) has been recognized as rational and effective. Three single-pill triple-drug combinations have recently been approved for use in HTN in the United States: valsartan (VAL)/amlodipine (AML)/hydrochlorothiazide (HCTZ); olmesartan medoxomil (OM)/AML/HCTZ; and aliskiren (ALI)/VAL/HCTZ. Triple-combination regimens have resulted in a greater proportion of patients achieving BP control compared with dual-combination regimens, with significantly lower BP levels documented after only 2 weeks at maximum doses. Single-pill combinations offer convenience to address barriers to BP control such as poor adherence to therapy and therapeutic inertia. Additional benefits of combining antihypertensive agents from different classes include improved efficacy, safety, and reduction of cardiovascular risk. In patients with essential HTN for whom dual therapy is inadequate, single-pill triple-drug therapy can offer a simplified and effective treatment strategy.
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Affiliation(s)
- Steven G Chrysant
- Oklahoma Cardiovascular and Hypertension Center, Oklahoma City, OK 73132, USA.
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Plantinga L, Grubbs V, Sarkar U, Hsu CY, Hedgeman E, Robinson B, Saran R, Geiss L, Burrows NR, Eberhardt M, Powe N. Nonsteroidal anti-inflammatory drug use among persons with chronic kidney disease in the United States. Ann Fam Med 2011; 9:423-30. [PMID: 21911761 PMCID: PMC3185478 DOI: 10.1370/afm.1302] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Because avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States. METHODS A total of 12,065 adult (aged 20 years or older) participants in the cross-sectional National Health and Nutrition Examination Survey (1999-2004) responded to a questionnaire regarding their use of over-the-counter and prescription NSAIDs. NSAIDs (excluding aspirin and acetaminophen) were defined by self-report. CKD was categorized as no CKD, mild CKD (stages 1 and 2; urinary albumin-creatinine ratio of ≥ 30 mg/g) and moderate to severe CKD (stages 3 and 4; estimated glomerular filtration rate of 15-59 mL/min/1.73 m(2)). Adjusted prevalence was calculated using multivariable logistic regression with appropriate population-based weighting. RESULTS Current use (nearly every day for 30 days or longer) of any NSAID was reported by 2.5%, 2.5%, and 5.0% of the US population with no, mild, and moderate to severe CKD, respectively; nearly all of the NSAIDs used were available over-the-counter. Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use: (3.8% vs 3.9%, aware vs unaware; P=.979). CONCLUSIONS Physicians and other health care clinicians should be aware of use of NSAIDs among those with CKD in the United States and evaluate NSAID use in their CKD patients.
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Affiliation(s)
- Laura Plantinga
- Department of Medicine, University of California, San Francisco, California, USA.
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Makris A, Seferou M, Papadopoulos DP. Resistant hypertension workup and approach to treatment. Int J Hypertens 2010; 2011:598694. [PMID: 21234416 PMCID: PMC3014709 DOI: 10.4061/2011/598694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/18/2010] [Indexed: 01/13/2023] Open
Abstract
Resistant hypertension is defined as blood pressure above the patient's goal despite the use of 3 or more antihypertensive agents from different classes at optimal doses, one of which should ideally be a diuretic. Evaluation of patients with resistive hypertension should first confirm that they have true resistant hypertension by ruling out or correcting factors associated with pseudoresistance such as white coat hypertension, suboptimal blood pressure measurement technique, poor adherence to prescribed medication, suboptimal dosing of antihypertensive agents or inappropriate combinations, the white coat effect, and clinical inertia. Management includes lifestyle and dietary modification, elimination of medications contributing to resistance, and evaluation of potential secondary causes of hypertension. Pharmacological treatment should be tailored to the patient's profile and focus on the causative pathway of resistance. Patients with uncontrolled hypertension despite receiving an optimal therapy are candidates for newer interventional therapies such as carotid baroreceptor stimulation and renal denervation.
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Affiliation(s)
- Anastasios Makris
- European Excellent Center of Hypertension, Laiko University Hospital, 24 Agiou Ioannou Theologou Street, 155-61 Athens, Greece
| | - Maria Seferou
- European Excellent Center of Hypertension, Laiko University Hospital, 24 Agiou Ioannou Theologou Street, 155-61 Athens, Greece
| | - Dimitris P. Papadopoulos
- European Excellent Center of Hypertension, Laiko University Hospital, 24 Agiou Ioannou Theologou Street, 155-61 Athens, Greece
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Handler J. Resistant hypertension responding to change from furosemide to thiazide: understanding calcium channel blocker-related edema. J Clin Hypertens (Greenwich) 2010; 12:949-52. [PMID: 21122060 DOI: 10.1111/j.1751-7176.2010.00374.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Deoxycorticosterone producing tumor as a cause of resistant hypertension. Case Rep Med 2010; 2010:372719. [PMID: 20671982 PMCID: PMC2909735 DOI: 10.1155/2010/372719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/05/2010] [Accepted: 06/09/2010] [Indexed: 11/17/2022] Open
Abstract
We describe a young woman with longstanding resistant hypertension. Evaluation for renal artery stenosis and primary aldosteronism was unrevealing. In this setting of a suppressed plasma aldosterone concentration (PAC) and a suppressed plasma renin activity (PRA), a differential diagnosis of a deoxycorticosterone (DOC) producing tumor was entertained. Biochemical and imaging studies confirmed this diagnosis. Rare and novel DOC producing tumors are an important cause of resistant hypertension.
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Düsing R. Optimizing blood pressure control through the use of fixed combinations. Vasc Health Risk Manag 2010; 6:321-5. [PMID: 20531950 PMCID: PMC2879293 DOI: 10.2147/vhrm.s9989] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 11/23/2022] Open
Abstract
The majority of hypertensive patients need ≥2 antihypertensive agents to reach goal blood pressure. As an estimate, one-third of unselected hypertensive patients may be successfully treated with monotherapy, one-third may require 2 and the remaining one-third of patients will need ≥3 antihypertensive agents for effective blood pressure control. However, doctors are often hesitant to expand therapy in treated patients whose blood pressure is not lowered to goal (therapeutic inertia). Multiple-drug therapy in the majority of hypertensive patients may also represent one of several factors responsible for the low rates of adherence with chronic antihypertensive treatment. As a consequence, both US and European guidelines recommend single pill combinations to lower the number of pills needed in order to increase medication adherence and, possibly, reduce therapeutic inertia. For 2 drug combinations, the recently revised European (ESC/ESH) guidelines recommend the following options: diuretic plus either calcium channel blocker (CCB) or renin–angiotensin system (RAS) blocker (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker) or CCB plus RAS-blocker. In the absence of substantial evidence, neither JNC-7 (from 2003) nor the European guidelines from 2007 give any meaningful advice on triple combination treatment. It is therefore of interest that the 2009 reappraisal of the European guidelines gives preference to the combination of a RAS blocker and a CCB plus a diuretic. On the background of the substantial number of patients requiring ≥3 drugs for blood pressure control, the recent approval of a single-pill 3-drug combination composed in accordance with the above mentioned ESC/ESH recommendations should be appreciated.
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Affiliation(s)
- Rainer Düsing
- Medizinische Klinik und Poliklinik 1, Bonn, Germany.
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Características clínicas y riesgo vascular en pacientes con hipertensión arterial resistente. HIPERTENSION Y RIESGO VASCULAR 2010. [DOI: 10.1016/j.hipert.2009.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Six-item self-administered questionnaires in the waiting room: an aid to explain uncontrolled hypertension in high-risk patients seen in general practice. ACTA ACUST UNITED AC 2009; 3:221-7. [DOI: 10.1016/j.jash.2008.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 12/12/2008] [Accepted: 12/13/2008] [Indexed: 01/04/2023]
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Al-Mehza AM, Al-Muhailije FA, Khalfan MM, Al-Yahya AA. Drug Compliance Among Hypertensive Patients; an Area Based Study. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2009. [DOI: 10.29333/ejgm/82628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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31
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Masa Jiménez JF, Corral Peñafiel J, García Ledesma E, María Montserrat J. 2006: Año de la Apnea del Sueño. Análisis de las publicaciones en Archivos de Bronconeumología. Arch Bronconeumol 2008. [DOI: 10.1157/13128328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Santschi V, Rodondi N, Bugnon O, Burnier M. Impact of electronic monitoring of drug adherence on blood pressure control in primary care: a cluster 12-month randomised controlled study. Eur J Intern Med 2008; 19:427-34. [PMID: 18848176 DOI: 10.1016/j.ejim.2007.12.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 11/04/2007] [Accepted: 12/18/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Poor long-term adherence is an important cause of uncontrolled hypertension. We examined whether monitoring drug adherence with an electronic system improves long-term blood pressure (BP) control in hypertensive patients followed by general practitioners (GPs). METHODS A pragmatic cluster randomised controlled study was conducted over one year in community pharmacists/GPs' networks randomly assigned either to usual care (UC) where drugs were dispensed as usual, or to intervention (INT) group where drug adherence could be monitored with an electronic system (Medication Event Monitoring System). No therapy change was allowed during the first 2 months in both groups. Thereafter, GPs could modify therapy and use electronic monitors freely in the INT group. The primary outcome was a target office BP<140/90 mmHg. RESULTS Sixty-eight treated uncontrolled hypertensive patients (UC: 34; INT: 34) were enrolled. Over the 12-month period, the likelihood of reaching the target BP was higher in the INT group compared to the UC group (p<0.05). At 4 months, 38% in the INT group reached the target BP vs. 12% in the UC group (p<0.05), and 21% vs. 9% at 12 months (p: ns). Multivariate analyses, taking account of baseline characteristics, therapy modification during follow-up, and clustering effects by network, indicate that being allocated to the INT group was associated with a greater odds of reaching the target BP at 4 months (p<0.01) and at 12 months (p=0.051). CONCLUSION GPs monitoring drug adherence in collaboration with pharmacists achieved a better BP control in hypertensive patients, although the impact of monitoring decreased with time.
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Douma S, Petidis K, Doumas M, Papaefthimiou P, Triantafyllou A, Kartali N, Papadopoulos N, Vogiatzis K, Zamboulis C. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 2008; 371:1921-6. [PMID: 18539224 DOI: 10.1016/s0140-6736(08)60834-x] [Citation(s) in RCA: 361] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Results of several studies published since 1999 suggest that primary hyperaldosteronism (also known as Conn's syndrome) affects more than 10% of people with hypertension; however, such a high prevalence has also been disputed. Experts generally agree that resistant hypertension has the highest prevalence of primary hyperaldosteronism, on the basis of small studies. We aimed to assess the prevalence of primary hyperaldosteronism in a large group of patients with resistant hypertension. METHODS Patients with resistant hypertension (blood pressure >140/90 mm Hg despite a three drug regimen, including a diuretic) who attended our outpatient clinic were assessed for primary hyperaldosteronism. Serum aldosterone and plasma renin activity were determined and their ratio was calculated. Patients with a positive test (ratio >65.16 and aldosterone concentrations >416 pmol/L) underwent salt suppression tests with intravenous saline and fludrocortisone. Diagnosis of primary hyperaldosteronism was further confirmed by the response to treatment with spironolactone. FINDINGS Over 20 years, we studied 1616 patients with resistant hypertension. 338 patients (20.9%) had a ratio of more than 65.16 and aldosterone concentrations of more than 416 pmol/L. On the basis of salt suppression tests, 182 (11.3%) patients had primary hyperaldosteronism, and response to spironolactone treatment further confirmed this diagnosis. Hypokalaemia was seen only in 83 patients with primary hyperaldosteronism (45.6%). INTERPRETATION Although the prevalence of primary hyperaldosteronism in patients with resistant hypertension was high, it was substantially lower than previously reported. On the basis of this finding, we could assume that the prevalence of primary hyperaldosteronism in the general unselected hypertensive population is much lower than currently reported. Thus, the notion of an epidemic of primary hyperaldosteronism is not supported.
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Affiliation(s)
- Stella Douma
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
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Grassi G, Whitworth JA. Resistant hypertension and aldosterone excess: new insights from ambulatory blood pressure monitoring. J Hypertens 2007; 25:2006-7. [PMID: 17885540 DOI: 10.1097/hjh.0b013e3282ef6ce5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Resistant Hypertension. Hypertension 2007. [DOI: 10.1016/b978-1-4160-3053-9.50049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
The incidence of resistant hypertension, the failure to reduce blood pressure below 140/90 mm Hg, despite the use of 3 antihypertensive medications at optimal doses including a diuretic, is estimated to be less than 5% of the hypertensive population. Resistant hypertension increases the risk of stroke, myocardial infarction, congestive heart failure, and renal failure. Evaluation of the patient with resistant hypertension should include 24-hour ambulatory blood pressure monitoring or home measurements and a limited search for secondary causes. Treatment should focus on optimizing the drug regimen in a logical way, based on the patient's comorbidities and tolerability. Long-acting, well-tolerated once-daily medications are preferred, and the regimen should include in sequence a diuretic, beta-blocker, angiotensin-converting enzyme/angiotensin receptor-blocker inhibitors, and a calcium-channel blocker. This article reviews the definitions and causes and provides specific recommendations for the evaluation and management of patients with this life-threatening condition.
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Affiliation(s)
- Dimitris P Papadopoulos
- Hypertension and Cardiovascular Research Clinic, Georgetown University/VAMC 151-E, 50 Irving Street NW, Washington, DC 20422, USA.
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Oikawa T, Obara T, Ohkubo T, Kikuya M, Asayama K, Metoki H, Komai R, Murai K, Hashimoto J, Totsune K, Imai Y. Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study. J Hypertens 2006; 24:1737-43. [PMID: 16915022 DOI: 10.1097/01.hjh.0000242397.53214.27] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To diagnose resistant hypertension using self-measured blood pressure (BP) at home and office BP, and to evaluate the characteristics of resistant hypertensive patients. METHODS The subjects were 528 hypertensive patients taking at least three or more different antihypertensive drugs. Subjects were classified into four groups (controlled hypertension, isolated office resistant hypertension, isolated home resistant hypertension and sustained resistant hypertension) on the basis of the cut-off values of home BP (135/85 mmHg) and office BP (140/90 mmHg). The relationship between each resistant hypertension group and various factors was analysed using univariate and multivariate analyses. RESULTS Of the 528 patients, 17.8% were classified with controlled hypertension, 16.1% with isolated office resistant hypertension, 23.5% with isolated home resistant hypertension and 42.6% with sustained resistant hypertension. The presence of hypercholesterolemia was found to have a significant and independent association with isolated office resistant hypertension. Higher office systolic blood pressure (SBP), a past history of ischaemic heart disease, and a lower prescription rate of potassium-sparing diuretics were found to have a significant and independent association with isolated home resistant hypertension. Patients with sustained resistant hypertension had a significantly lower prescription rate of potassium-sparing diuretics than those with controlled hypertension. CONCLUSIONS The present study demonstrated that resistant hypertension is mediated at least partly by the white-coat effect. Home BP measurements and other relevant factors associated with resistant hypertension, such as relatively higher office SBP, type of drugs prescribed, and cardiovascular complications, should be taken into account for the diagnosis and treatment of resistant hypertension.
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Affiliation(s)
- Takuya Oikawa
- Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan
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Affiliation(s)
- Marvin Moser
- Section of Cardiovascular Medicine and the Cardiovascular Disease Prevention Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn 06520, USA
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Calvo C, Hermida RC, Ayala DE, López JE, Fernández JR, Mojón A, Covelo M. Efectos de la administración temporalizada de fármacos antihipertensivos en pacientes con hipertensión arterial resistente. Med Clin (Barc) 2006; 126:364-72. [PMID: 16750125 DOI: 10.1157/13086047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with resistant hypertension represent an important clinical problem due to their poor control, high prevalence of target organ damage, and the associated increase in cardiovascular risk. Therapeutic strategies in resistant hypertension currently include a sequential change of drugs or the synergic combination of new drugs. Most patients, however, receive all their drugs in a single morning dose. We have evaluated the impact on the circadian pattern of blood pressure (BP) of modifying the time of treatment without increasing the number of prescribed drugs. PATIENTS AND METHOD We studied 123 patients with resistant hypertension (73 men and 50 women), 59.9 (11.9) years of age, who were receiving 3 antihypertensive drugs in a single morning dose. Patients were randomly assigned to one of two groups according to the modification in their treatment strategy: a) Changing one of the drugs, but keeping all 3 in the morning. b) The same approach but prescribing one of the drugs to be taken at bedtime. Blood pressure was measured at 20-minute intervals from 07:00 to 23:00 hours and at 30-minute intervals at night for 48 consecutive hours at baseline and after 3 months of treatment with the new therapeutic scheme. RESULTS There was a small and non-significant BP reduction when all drugs were still taken on awakening (p > 0.374). On baseline, only 22% of the patients in this group were dippers, and this percentage was further reduced to 15% after 3 months of therapy with all drugs on awakening. The blood pressure reduction was statistically significant (8.6 and 5.9 mmHg for systolic and diastolic blood pressure; p < 0.001) with one drug at bedtime. This effect was markedly larger in the nocturnal mean of blood pressure. Thus, while only 13% of the patients in this group were dippers at baseline, 53% were already dippers after 3 months of therapy. CONCLUSIONS Results from this prospective trial indicate that, in patients with resistant hypertension, time of treatment may be more important for patient control and for the proper modeling of the circadian blood pressure pattern than just changing the drug combination.
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Affiliation(s)
- Carlos Calvo
- Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, La Coruña, Spain
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Martínez-García M, Gómez-Aldaraví R, Gil-Martínez T, Soler-Cataluña J, Bernácer-Alpera B, Román-Sánchez P. Trastornos respiratorios durante el sueño en pacientes con hipertensión arterial de difícil control. Arch Bronconeumol 2006. [DOI: 10.1157/13083275] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Martínez-García MA, Gómez-Aldaraví R, Gil-Martínez T, Soler-Cataluña JJ, Bernácer-Alpera B, Román-Sánchez P. Sleep-Disordered Breathing in Patients With Difficult-to-Control Hypertension. ACTA ACUST UNITED AC 2006; 42:14-20. [PMID: 16426518 DOI: 10.1016/s1579-2129(06)60108-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To analyze the relationship between sleep-disordered breathing and difficult-to-control arterial hyper-tension. PATIENTS AND METHODS Patients were considered to have difficult-to-control hypertension when mean systolic blood pressure was 125 mm Hg or higher and/or mean diastolic blood pressure was more than or equal to 80 mm Hg (as recorded during 2 24-hour ambulatory monitoring studies) despite the use of 3 or more antihypertensive drugs. Respiratory polygraphy using the AutoSet device (ResMed Corp, Sydney, Australia) was then performed to study sleep-disordered breathing in all patients. RESULTS Forty-nine patients with a mean (SD) age of 68.1 (9.1) years, mean systolic and diastolic pressures of 152.5 (13)/89.2 (8.5) mm Hg, and an average of 3.5 prescribed drugs were included in the study. The mean apnea-hypopnea index (AHI) was 26.2 (19.5) and events were predominantly obstructive. Patients with severe sleep apnea-hypopnea syndrome (SAHS) (AHI > or = 30; 40.8%) showed more uncontrolled daytime (P = .017) and nighttime (P = .033) systolic pressure than the rest, as well as higher daytime diastolic pressure (P = .035) and a greater consumption of drugs than those without severe SAHS (AHI < 10; 28.6%) (P = .041). The study population as a whole showed a significant correlation between blood pressure and obesity. There was a significant correlation (adjusted for age and sex) with AHI only in patients with SAHS. AHI was found to be the independent predictor with the greatest effect on blood pressure in these patients. CONCLUSIONS Prevalence of SAHS was very high in patients with difficult-to-control hypertension. In patients with SAHS, AHI was found to be the independent predictor with the greatest affect on arterial blood pressure.
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Affiliation(s)
- M A Martínez-García
- Unidad de Neumología, Hospital General de Requena, Requena, Valencia, Spain.
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Armario García P, Hernández del Rey R. Hipertensión arterial refractaria. HIPERTENSION Y RIESGO VASCULAR 2006. [DOI: 10.1016/s1889-1837(06)71632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The best return visit interval to achieve blood pressure control is currently unknown. This study investigates the relationship between return visit interval and percent change in blood pressure. We reviewed a cohort of hypertensive patient charts from two large, urban family practice offices. Four hundred twenty-nine patients with 7910 intervals showed a mean return visit interval of 79.5 days. Blood pressure control occurred during 34.5% of office visits. Pearson's r correlation coefficients between return visit interval and percent change in systolic and diastolic blood pressure demonstrated a small but statistically significant correlation. Shorter return visit intervals were associated with better percent changes in blood pressure. The return visit interval may be a simple and useful tool to improve management of hypertension.
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Affiliation(s)
- Richard Guthmann
- University of Illinois at Chicago/Illinois Masonic Family Practice Residency, Chicago, IL 60640, USA.
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44
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Erhun WO, Agbani EO, Bolaji EE. Positive benefits of a pharmacist-managed hypertension clinic in Nigeria. Public Health 2005; 119:792-8. [PMID: 15990127 DOI: 10.1016/j.puhe.2004.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Revised: 10/12/2004] [Accepted: 11/28/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether the provision of further practice-based support by pharmacists will bring about improved outcomes for blood pressure (BP) control in middle-aged and elderly Nigerian hypertensive patients managed with combination diuretics (amiloride hydrochloride 5 mg+hydrochlorothiazide 50 mg) and/or methyl dopa at the primary care level. DESIGN AND SETTING This was a 1-year prospective, randomized cohort study of the outpatients of a state comprehensive health centre in South-western Nigeria. Free primary health services including free drugs were provided for all patients. PATIENTS AND METHOD The study population comprised 51 Nigerian patients with uncomplicated hypertension aged 45 years or more, with a 0.2-3.0-year history of hypertension, registered at the Comprehensive Health Centre, Ife between October 2002 and March 2003. They were invited into the pharmacist-managed hypertension clinic and followed for the study period. Participating pharmacists counselled for current medication, personalized goals of lifestyle modification stressing weight loss and/or increased activity, increased patient awareness by providing relevant education about hypertension and associated/related diseases, adjusted drug therapy to optimize effectiveness and minimize adverse events, utilized treatment schedules that enhanced patients' adherence to therapy, and monitored treatment outcomes between enrollment and return visits. Patient satisfaction and the number of treatment failures within 6 months post enrollment were compared with retrospective data from our earlier study involving physician-managed patients under a similar setting. RESULTS Uncontrolled BP reduced from 92 to 36.2% by 10.15+/-5.02 days after enrollment. Treatment failures were observed at 5.9% of the total return visits (n=184) within 6 months. CONCLUSION Pharmacist-managed hypertension clinics can improve BP control, reduce treatment failure and increase patient satisfaction.
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Affiliation(s)
- W O Erhun
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria.
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González-Benítez M, Fernández-Sánchez M, Fernández-Parrilla R, Beltrán Robles M, Ramos Guerrero A, Jarast Olivari D, Olmedo Llanes J, Grilo Reina A. Hipertensión arterial refractaria verdadera. Estudio de prevalencia en una consulta hospitalaria. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s0212-8241(05)71562-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aranda JM, Marquez J, Orcasita-Ng JA, Lupu V. Treatment of hypertension in the Hispanic community: cultural case studies. ACTA ACUST UNITED AC 2005; 6:71-5. [PMID: 15707264 DOI: 10.1016/s1098-3597(04)80066-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This patient had good command of English, so most of the interactions and teaching that he participated in was conducted in English. Over time, the patient developed a very good relationship with the doctor's office and relied on that relationship to support making changes that would ensure he was maintaining good health. The involvement of the patient's daughter was absolutely essential, since he had started drinking and neglecting his health following the death of his wife. Involving his daughter in the treatment plan gave him someone else outside of the office on whom he could rely for guidance and support, and so that she, in turn, could oversee his compliance with the plan. Two other issues deserve mention. First, drug-resistant hypertension is defined as BP > 140/90 mm Hg on 3 or more medications. One of the causes of refractory hypertension is inadequate diuresis, often secondary to reduced glomerular filtration. Since this patient appears to have responded to furosemide over a thiazide diuretic, a 24-hour creatinine clearance should be performed. Second, the glycohemoglobin was abnormal at 6.2 corresponding to a mean blood glucose of 120. This is strongly suspicious for metabolic syndrome, and a waistline measurement should be obtained. If this patient is overweight, a 5% weight loss could reduce this patient's chance of developing diabetes by 58%.
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Singh H, Johnson ML. Prescribing patterns of diuretics in multi-drug antihypertensive regimens. J Clin Hypertens (Greenwich) 2005; 7:81-7; quiz 88-9. [PMID: 15722652 PMCID: PMC8109453 DOI: 10.1111/j.1524-6175.2005.03922.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Revised: 12/02/2004] [Accepted: 12/07/2004] [Indexed: 11/28/2022]
Abstract
Recent literature suggests that most hypertensives will require two or more drugs to achieve target blood pressure. Our objective was to estimate the proportion of patients receiving diuretics, including thiazides, for blood pressure control among those receiving two or more drugs. We studied 25,052 hypertensives in a tertiary care Veterans Affairs facility and identified individuals taking any thiazide or loop diuretic among patients receiving two, three, four, or more drugs. Rates of any diuretic use were 50%, 73%, and 89%, and decreased to 39.0%, 59.0%, and 72.5% for thiazide use, respectively. Rates of thiazide use were statistically significantly higher among African Americans compared with the general study population, but did not differ significantly in the elderly. Though overall diuretic use seems to be increasing as compared with previous studies, there is room for improvement in the use of thiazides in multi-drug hypertension regimens.
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Affiliation(s)
- Hardeep Singh
- VA Medical Center (111PC), 2002 Holcombe Boulevard, Houston, TX 77030, USA.
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González-Benítez M, Fernández-Sánchez M, Fernández-Parrilla R, Beltrán Robles M, Ramos Guerrero A, Jarast Olivari D, Olmedo Llanes J, Grilo Reina A. Hipertensión arterial refractaria verdadera. Estudio de prevalencia en una consulta hospitalaria. HIPERTENSION Y RIESGO VASCULAR 2005. [DOI: 10.1016/s1889-1837(05)71849-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Medication Adherence for Antihypertensive Therapy. Hypertension 2005. [DOI: 10.1016/b978-0-7216-0258-5.50131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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50
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Singer GM, Setaro JF. Commentary: The ALLHAT Study: implications for the management of resistant hypertension. J Clin Hypertens (Greenwich) 2005; 7:31-2. [PMID: 15655384 PMCID: PMC8109445 DOI: 10.1111/j.1524-6175.2005.04302.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Gregory M. Singer
- From the Section of Cardiovascular Medicine and the Cardiovascular Disease Prevention Center, Department of Internal Medicine, Yale University of School of Medicine, New Haven, CT
| | - John F. Setaro
- From the Section of Cardiovascular Medicine and the Cardiovascular Disease Prevention Center, Department of Internal Medicine, Yale University of School of Medicine, New Haven, CT
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