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Dorobantu M, Cojocaru C, Stanciulescu L, Pop C, Bala C, Benedek T, Parepa I, Lighezan D, Darabont R, Darabantiu D, Mitu F, Gheorghita V, Scafa-Udriste A, Gheorghe-Fronea OF. Ups and downs of conducting a national representative survey on hypertension during pandemic time: main results of SEPHAR IV. J Hypertens 2023; 41:1271-1280. [PMID: 37195226 DOI: 10.1097/hjh.0000000000003461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES This national representative survey sought to assess hypertension's prevalence, awareness, treatment and control in Romania. METHODS A representative sample (by age, sex and residence) of 1477 Romanian adults (51.19 ± 16.61 years, range 18-80 years, 59.9% women) was multimodally evaluated during two study visits. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg or previously diagnosed hypertension, regardless of BP. Awareness was defined by knowledge of previous hypertension diagnosis or of current use of antihypertensive treatment. Treatment was defined by antihypertensive medication taken at least 2 weeks prior to enrolment. Control was defined as SBP less than 140 mmHg and DBP less than 90 mmHg at both visits in treated hypertensive patients. RESULTS Hypertension prevalence was 46% ( n = 680) consisting of 81.02% ( n = 551) known hypertensive patients and 18.98% ( n = 129) newly diagnosed hypertensive patients. Awareness, treatment and control of hypertension were: 81% ( n = 551), 83.8% ( n = 462) and 39.2% ( n = 181). CONCLUSION Despite numerous pandemic-related obstacles in conducting a national survey, SEPHAR IV updates hypertension epidemiological data of a high-cardiovascular-risk Eastern-European population. This study confirms previous predictions of hypertension prevalence, treatment and control, which remain unfavourable because of unsatisfactory control of promoting factors.
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Affiliation(s)
- Maria Dorobantu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy
- Romanian Academy
| | - Cosmin Cojocaru
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy
- Cardiology Department, Clinical Emergency Hospital, Bucharest
| | | | - Calin Pop
- Emergency Clinical County Hospital of Baia Mare, Baia Mare
| | - Cornelia Bala
- Faculty of Medicine, "Iuliu Hateganu" University of Medicine and Pharmacy, Cluj-Napoca
| | - Theodora Benedek
- Cardiology Department, County Clinical Emergency Hospital, Targu Mures
| | - Irinel Parepa
- Cardiology Department, "Ovidius" University Constanta, Constanta
| | - Daniel Lighezan
- Faculty of Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara
| | - Roxana Darabont
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy
- Cardiology Department, University Emergency Hospital Bucharest, Bucharest
| | | | - Florin Mitu
- Cardiology Department, Clinical Rehabilitation Hospital, Iaşi
| | - Valeriu Gheorghita
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy
- Central Military Emergency University Hospital Dr Carol Davila, Bucharest, Romania
| | - Alexandru Scafa-Udriste
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy
- Cardiology Department, Clinical Emergency Hospital, Bucharest
| | - Oana-Florentina Gheorghe-Fronea
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy
- Cardiology Department, Clinical Emergency Hospital, Bucharest
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Knowledge, perception and practice of Québec nurses for ambulatory and clinic blood pressure measurement methods: are we there yet? J Hypertens 2021; 39:2455-2462. [PMID: 34326278 DOI: 10.1097/hjh.0000000000002949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines regarding blood pressure measurement (BPM) methods, namely home (HBPM), ambulatory (ABPM), office (OBPM) and automated (AOBP) are published by Hypertension Canada and rely on accurate measurement technique. Nurses commonly perform BPM but their knowledge, perception and practice considering all methods is understudied. This study is the first to establish the picture of Québec nurses working in primary care settings concerning the four BPM methods. METHODS All nurses licensed to practice in primary care in Québec were targeted in our survey. Data were collected using a validated and pretested investigator-initiated questionnaire in English and French. A personalized e-mail invitation, and two reminders, including a link to a secured platform was sent in December 2019. A certificate of ethics was issued by UQTR. RESULTS A total of 453 nurses participated in the study. Median age was 40 ± 11 years, and 92% were women. The overall score on BPM methods knowledge was slightly below 50% (46% ± 23). The perception was mostly positive, with an overall score above 50% (73% ± 8). In practice, HBPM was recommended by 47% of nurses, and ABPM by 18%. Although AOBP is the preferred method in Canada, only 25% of the nurses use it, including the 57% that use an oscillometric device and 11% that use manual auscultation. CONCLUSION Nurses working in primary care play a central role in BPM. Our results highlight that overall knowledge and practice are suboptimal. Resources should, therefore, be allocated to ensure that initial training and continuing education are addressed.
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Chow CK, Atkins ER, Billot L, Chalmers J, Hillis GS, Hay P, Neal B, Nelson M, Patel A, Reid CM, Schlaich M, Usherwood T, Webster R, Rodgers A. Ultra-low-dose quadruple combination blood pressure-lowering therapy in patients with hypertension: The QUARTET randomized controlled trial protocol. Am Heart J 2021; 231:56-67. [PMID: 33017580 PMCID: PMC7531985 DOI: 10.1016/j.ahj.2020.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/27/2020] [Indexed: 10/25/2022]
Abstract
High blood pressure is the leading cause of preventable morbidity and mortality globally. Many patients remain on single-drug treatment with poor control, although guidelines recognize that most require combination therapy for blood pressure control. Our hypothesis is that a single-pill combination of 4 blood pressure-lowering agents each at a quarter dose may provide a simple, safe, and effective blood pressure-lowering solution which may also improve long-term adherence. The Quadruple UltrA-low-dose tReaTment for hypErTension (QUARTET) double-blind, active-controlled, randomized clinical trial will examine whether ultra-low-dose quadruple combination therapy is more effective than guideline-recommended standard care in lowering blood pressure. QUARTET will enroll 650 participants with high blood pressure either on no treatment or on monotherapy. Participants will be randomized 1:1 and allocated to intervention therapy of a single pill (quadpill) containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg or to control therapy of a single identical-appearing pill containing irbesartan 150 mg. In both arms, step-up therapy of open-label amlodipine 5 mg will be provided if blood pressure is >140/90 at 6 weeks. The primary outcome is the difference between groups in the change from baseline in mean unattended automated office systolic blood pressure at 12-week follow-up. The primary outcome and some secondary outcomes will be assessed at 12 weeks; there is an optional 12-month extension phase to assess longer-term efficacy and tolerability. Our secondary aims are to assess if this approach is safe, has fewer adverse effects, and has better tolerability compared to standard care control. QUARTET will therefore provide evidence for the effectiveness and safety of a new paradigm in the management of high blood pressure.
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Affiliation(s)
- Clara K Chow
- The Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia.
| | - Emily R Atkins
- The Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - John Chalmers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital and University of Western Australia, Perth, Western Australia, Australia
| | - Peter Hay
- Castle Hill Medical Centre, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Anushka Patel
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, School of Medicine, University of Western Australia and Royal Perth Hospital, Perth, Western Australia
| | - Tim Usherwood
- The Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ruth Webster
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia; Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Anthony Rodgers
- The Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
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Knowledge, perception and practice of health professionals regarding blood pressure measurement methods: a scoping review. J Hypertens 2020; 39:391-399. [PMID: 33031184 DOI: 10.1097/hjh.0000000000002663] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Guideline-concordant performance of accurate blood pressure measurement (BPM), whether the modality is home (HBPM), ambulatory (ABPM), automated (AOBP) or office (OBPM), is dependent on proper technique. Knowledge, perception and practice of health professionals for BPM is crucial and has been partly studied, but a thorough review has never been reported. A scoping review of global studies was conducted to synthesize published data on this topic. METHODS An Arksey and O'Malley methodological framework was used. Keywords were identified and extraction was completed to April 2019 using CINAHL and MEDLINE. Studies were classified as positive for knowledge, perception and practice if the majority (>50%) of reported responses were favourable, and negative otherwise. If specific results were not reported, the author's conclusions were used to classified. RESULTS Seventy-two studies were identified: 25 HBPM, 14 ABPM, two AOBP, 40 OBPM. For knowledge, the percentage of negative studies were higher for HBPM (40%) and OBPM (68%) and lower for ABPM (14%) regarding BPM techniques. For perception, the number of negative studies were lower for HBPM (20%) and ABPM (7%) regarding usefulness of BPM methods in hypertension management. For practice, the number of negative studies were higher for HBPM (48%), ABPM (71%), OBPM (73%) and AOBP (50%) regarding implementation of hypertension guidelines. CONCLUSION The results of this scoping review demonstrate adequate perception of BPM but suboptimal knowledge and practice. Education is still needed to improve knowledge and practice. Future efforts should focus on improving what we know and what we do when measuring BP.
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Wang J, Jiang W, Sharma M, Wu Y, Li J, You N, Ding Z, Zhao X, Chen H, Tang H, Zhou X, Li X. Sex differences in antihypertensive drug use and blood pressure control. Postgrad Med J 2019; 95:295-299. [PMID: 31171709 DOI: 10.1136/postgradmedj-2019-136513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/26/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hypertension is the most important modifiable cardiovascular risk factor. Epidemiological studies have shown the benefits of lowering blood pressure (BP), but BP control is a major challenge. Furthermore, there are significant sex differences in antihypertensive drug use and BP control. This study examined sex differences in antihypertensive drug use and BP control, with the aim of reducing the complications of hypertension and improving quality of life. METHODS The study was performed in our outpatient hypertension clinic, and included 1529 patients without secondary hypertension or comorbidities. The study, investigated BP control rates and patterns of antihypertensive drug use in male and female. All data were collected using structured questionnaires and patient measurements. RESULTS The study included 713 males and 816 females in this study. Fewer females had hypertension in the younger age group (16.2% vs 11.6%; p>0.05), but this difference disappeared in middle-aged (47.8% vs 49.9 %; p<0.05) and elderly age groups (36.0% vs 38.5%; p<0.05). BP control rates differed between males and females (35.6% in male, 31.9% in female, p<0.01). There was an overall difference in BP control rates between males and females (35.6% in males, 31.9% in females, p<0.01). In this aged 18-44 years, angiotensin converting enzyme inhibitors (ACEIs) showed the best control rate in males, while calcium channel blockers (CCBs) were least effective (61.5% with ACEIs, 28.6% with CCBs; p<0.05). In this aged 45-64 years, diuretics (DUs) showed the best control rate in females, while CCBs were least effective (47.5% with DUs, 28.3% with CCBs; p<0.05). CONCLUSIONS Sex plays an important role in BP control. In those aged 18-44 years, males using ACEIs showed best control rates. In those aged 45-64 years, females using DUs showed best control rates. Our study provides a basis with the selection of antihypertensive drugs according to sex and age.
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Affiliation(s)
- Junwen Wang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Weihong Jiang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Manju Sharma
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yuyan Wu
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jiayin Li
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Nana You
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zewen Ding
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiexiong Zhao
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Huilin Chen
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Huiting Tang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoyu Zhou
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaogang Li
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
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Abstract
PURPOSE OF REVIEW To review data supporting the use of home blood pressure monitoring (HBPM) and provide practical guidance to clinicians wishing to incorporate HBPM into their practice. RECENT FINDINGS HBPM more accurately reflects the risk of cardiovascular events than office blood pressure measurement. In addition, there is high-quality evidence that HBPM combined with clinical support improves blood pressure control. Therefore, HBPM is increasingly recommended by guidelines to confirm the diagnosis of hypertension and evaluate the efficacy of blood pressure-lowering medications. Nevertheless, HBPM use remains low due to barriers from the patient, clinician, and healthcare system level. Understanding these barriers is crucial for developing strategies to effectively implement HBPM into routine clinical practice. HBPM is a valuable adjunct to office blood pressure measurement for diagnosing hypertension and guiding antihypertensive therapy. Following recommended best practices can facilitate the successful implementation of HBPM and impact how hypertension is managed in the primary care setting.
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Xuan Y, Wang W, Zhang H, Tan I, Butlin M, Avolio A, Zuo J. Osteoporosis is inversely associated with arterial stiffness in the elderly: An investigation using the Osteoporosis Self-assessment Tool for Asians index in an elderly Chinese cohort. J Clin Hypertens (Greenwich) 2019; 21:405-411. [PMID: 30734463 DOI: 10.1111/jch.13493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 12/21/2022]
Abstract
Although the association of arterial stiffness and osteoporosis has been reported, the relation of arterial stiffness with risk of osteoporosis and bone fracture is not established. The authors investigated the correlation between arterial stiffness (brachial-ankle pulse wave velocity [baPWV]), including a cutoff value, and risk of osteoporosis as assessed by the Osteoporosis Self-assessment Tool for Asia (OSTA) index in 129 elderly Chinese community-dwelling individuals (age 83.2 ± 12.8 years, 63 females). OSTA was negatively correlated with baPWV (r = -0.326, P = 0.023) after adjusting for confounding factors such as gender, body mass index, low-density lipoprotein, triglycerides, estimated glomerular filtration rate, absence or presence of diabetes, absence or presence of hypertension, and uric acid. baPWV was an independent factor for changes in OSTA (β = -0.001, P = 0.002). ROC curve analysis confirmed association between baPWV and OSTA index (AUC = 0.742 [CI: 0.660, 0.824]; P < 0.001) with a baPWV cutoff value of 1676 cm/s (sensitivity, 80.7%; specificity, 60%) for prediction of high OSTA index. The study showed a significant correlation between OSTA index and baPWV, suggesting a potential predictive value of baPWV in elderly patient at high risk of osteoporosis.
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Affiliation(s)
- Yan Xuan
- Department of Geriatric Medicine, Shanghai Jiatong School of Medicine, Ruijin Hospital North, Shanghai, China
| | - Weiliang Wang
- Department of Neurology Medicine, Xuhui District Central Hospital, Shanghai, China
| | - Hong Zhang
- Department of Geriatric Medicine, Shanghai Jiatong School of Medicine, Ruijin Hospital North, Shanghai, China
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Junli Zuo
- Department of Geriatric Medicine, Shanghai Jiatong School of Medicine, Ruijin Hospital North, Shanghai, China
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Naydenov Naydenov S, Margaritov Runev N, Ivanov Manov E, Georgieva Torbova-Gigova S. EFFICACY AND SAFETY OF A SINGLE-PILL COMBINATION OF ATORVASTATIN/AMLODIPINE IN PATIENTS WITH ARTERIAL HYPERTENSION AND DYSLIPIDEMIA. Acta Clin Croat 2018; 57:464-472. [PMID: 31168179 PMCID: PMC6536285 DOI: 10.20471/acc.2018.57.03.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
- The aim was to evaluate the efficacy of a single-pill combination of atorvastatin/amlodipine in patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk. This prospective study included 243 patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk, mean age 63.3±9.8 years. All patients were prescribed a treatment with one of the following doses of a single-pill combination of atorvastatin/amlodipine: 10/5, 10/10, 20/5 or 20/10 mg daily. The follow-up period was 3 months. The mean baseline values of the systolic and diastolic blood pressure were 155.7±16.2 and 92.0±9.2 mm Hg, respectively. At month 3, the respective mean systolic and diastolic blood pressure values were 136.9±26.9 and 80.6±5.1 mm Hg. The mean baseline values of total cholesterol and low-density lipoprotein cholesterol were 6.6±1.2 and 4.4±1.1 mmol/L, respectively. At month 3, the respective mean values of total cholesterol and low-density lipoprotein cholesterol were 5.1±0.9 and 2.9±1.0 mmol/L. Treatment was discontinued in 9 (3.7%) patients due to adverse events. In conclusion, treatment with the single-pill combination of atorvastatin/amlodipine was effective and well tolerated by the patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk.
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Affiliation(s)
| | - Nikolay Margaritov Runev
- 1Prof. St. Kirkovich Department of Internal Diseases, Medical University of Sofia, Sofia, Bulgaria; 2Tokuda Hospital, Sofia, Bulgaria
| | - Emil Ivanov Manov
- 1Prof. St. Kirkovich Department of Internal Diseases, Medical University of Sofia, Sofia, Bulgaria; 2Tokuda Hospital, Sofia, Bulgaria
| | - Svetla Georgieva Torbova-Gigova
- 1Prof. St. Kirkovich Department of Internal Diseases, Medical University of Sofia, Sofia, Bulgaria; 2Tokuda Hospital, Sofia, Bulgaria
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Ramirez-Jimenez M, Morales-Palomo F, Ortega JF, Mora-Rodriguez R. Effects of intense aerobic exercise and/or antihypertensive medication in individuals with metabolic syndrome. Scand J Med Sci Sports 2018; 28:2042-2051. [PMID: 29771450 DOI: 10.1111/sms.13218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
We studied the blood pressure lowering effects of a bout of exercise and/or antihypertensive medicine with the goal of studying if exercise could substitute or enhance pharmacologic hypertension treatment. Twenty-three hypertensive metabolic syndrome patients chronically medicated with angiotensin II receptor 1 blockade antihypertensive medicine underwent 24-hr monitoring in four separated days in a randomized order; (a) after taking their habitual dose of antihypertensive medicine (AHM trial), (b) substituting their medicine by placebo medicine (PLAC trial), (c) placebo medicine with a morning bout of intense aerobic exercise (PLAC+EXER trial) and (d) combining the exercise and antihypertensive medicine (AHM+EXER trial). We found that in trials with AHM subjects had lower plasma aldosterone/renin activity ratio evidencing treatment compliance. Before exercise, the trials with AHM displayed lower systolic (130 ± 16 vs 133 ± 15 mm Hg; P = .018) and mean blood pressures (94 ± 11 vs 96 ± 10 mm Hg; P = .036) than trials with placebo medication. Acutely (ie, 30 min after treatments) combining AHM+EXER lowered systolic blood pressure (SBP) below the effects of PLAC+EXER (-8.1 ± 1.6 vs -4.9 ± 1.5 mm Hg; P = .015). Twenty-four hour monitoring revealed no differences among trials in body motion. However, PLAC+EXER and AHM lowered SBP below PLAC during the first 10 hours, time at which PLAC+EXER effects faded out (ie, at 19 PM). Adding exercise to medication (ie, AHM+EXER) resulted in longer reductions in SBP than with exercise alone (PLAC+EXER). In summary, one bout of intense aerobic exercise in the morning cannot substitute the long-lasting effects of antihypertensive medicine in lowering blood pressure, but their combination is superior to exercise alone.
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Affiliation(s)
- M Ramirez-Jimenez
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - F Morales-Palomo
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - J F Ortega
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - R Mora-Rodriguez
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
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Verma AA, Khuu W, Tadrous M, Gomes T, Mamdani MM. Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study. PLoS Med 2018; 15:e1002584. [PMID: 29889841 PMCID: PMC5995349 DOI: 10.1371/journal.pmed.1002584] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/11/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The majority of people with hypertension require more than one medication to achieve blood pressure control. Many patients are prescribed multipill antihypertensive regimens rather than single-pill fixed-dose combination (FDC) treatment. Although FDC use may improve medication adherence, the impact on patient outcomes is unclear. We compared clinical outcomes and medication adherence with FDC therapy versus multipill combination therapy in a real-world setting using linked clinical and administrative databases. METHODS AND FINDINGS We conducted a population-based retrospective cohort study of 13,350 individuals 66 years and older in Ontario, Canada with up to 5 years of follow-up. We included individuals who were newly initiated on one angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II-receptor blocker (ARB) plus one thiazide diuretic. High-dimensional propensity score matching was used to compare individuals receiving FDC versus multipill therapy. The primary outcome was a composite of death or hospitalization for acute myocardial infarction (AMI), heart failure, or stroke. We conducted 2 analyses to examine the association between adherence and patient outcomes. First, we performed an on-treatment analysis to determine whether outcomes differed between groups while patients were on treatment, censoring patients when they first discontinued treatment, defined as not receiving medications within 150% of the previous days' supply. Second, we conducted an intention-to-treat analysis that followed individuals allowing for breaks in treatment to quantify the difference in drug adherence between groups and assess its impact on clinical outcomes. As expected, there was no significant difference in the primary outcome between groups in the on-treatment analysis (HR 1.06, 95% CI 0.86-1.31, P = 0.60). In the intention-to-treat analysis, the proportion of total follow-up days covered with medications was significantly greater in the FDC group (70%; IQR 19-98) than in the multipill group (42%, IQR 11-91, P < 0.01), and the primary outcome was less frequent in FDC recipients (3.4 versus 3.9 events per 100 person-years; HR 0.89, 95% CI 0.81-0.97, P < 0.01). The main limitations of this study were the lack of data regarding cause of death and blood pressure measurements and the possibility of residual confounding. CONCLUSIONS Among older adults initiating combination antihypertensive treatment, FDC therapy was associated with a significantly lower risk of composite clinical outcomes, which may be related to better medication adherence.
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Affiliation(s)
- Amol A. Verma
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael’s Hospital, Toronto, Ontario, Canada
- Eliot Phillipson Clinician-Scientist Training Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wayne Khuu
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Mina Tadrous
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad M. Mamdani
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Intense aerobic exercise lowers blood pressure in individuals with metabolic syndrome taking antihypertensive medicine. Blood Press Monit 2018; 23:230-236. [PMID: 29768290 DOI: 10.1097/mbp.0000000000000328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is a growing tendency for physicians to prescribe exercise in accordance with the 'exercise is medicine' global health initiative. However, the exercise-pharmacologic interactions for controlling blood pressure are not well described. Our purpose was to study whether angiotensin II receptor type 1 blocker (ARB) antihypertensive medicine enhances the blood pressure-lowering effects of intense exercise. PARTICIPANTS AND METHODS Fifteen hypertensive individuals with metabolic syndrome chronically medicated with ARB underwent two exercise trials in a blind randomized order. One trial was conducted after taking their habitual dose of ARB (ARB MED trial) and another after 48 h of placebo medicine (i.e. dextrose; PLAC trial). RESULTS After placebo medication, brachial systolic blood pressure increased by 5.5 mmHg [P=0.009; effect size (ES)=0.476] and diastolic by 2.5 mmHg (P=0.030; ES=0.373). Exercise reduced systolic and diastolic blood pressures to the same extent in ARB MED and PLAC trials (7 and 8 mmHg, respectively, for systolic and 5 and 4 mmHg, respectively, for diastolic, all P<0.05). Pulsatile measures of arterial stiffness did not reveal an interaction effect between exercise and medication. However, postocclusion reactive hyperemia increased after exercise only in the ARB MED trial (361±169 to 449±240% from baseline; P=0.033; ES=0.429). CONCLUSION ARBs and a bout of intense exercise each have an independent effect on lowering blood pressure in hypertensive individuals, and these effects are additive.
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Knowledge, availability, and use of ambulatory and home blood pressure monitoring in primary care in Spain. J Hypertens 2018; 36:1051-1058. [DOI: 10.1097/hjh.0000000000001673] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Campbell NR. Dissidents and dietary sodium: concerns about the commentary by O'Donnell et al. Int J Epidemiol 2018; 46:362-366. [PMID: 28039383 DOI: 10.1093/ije/dyw292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Norm Rc Campbell
- Departments of Medicine, Community Health Sciences, and Physiology and Pharmacology, O'Brien Institute of Public Health and Libin Cardiovascular Institute of Alberta at the University of Calgary, Calgary, AB, Canada
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Quinn AK, Ae-Ngibise KA, Kinney PL, Kaali S, Wylie BJ, Boamah E, Shimbo D, Agyei O, Chillrud SN, Mujtaba M, Schwartz JE, Abdalla M, Owusu-Agyei S, Jack DW, Asante KP. Ambulatory monitoring demonstrates an acute association between cookstove-related carbon monoxide and blood pressure in a Ghanaian cohort. Environ Health 2017; 16:76. [PMID: 28732501 PMCID: PMC5521137 DOI: 10.1186/s12940-017-0282-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/26/2017] [Indexed: 05/05/2023]
Abstract
BACKGROUND Repeated exposure to household air pollution may intermittently raise blood pressure (BP) and affect cardiovascular outcomes. We investigated whether hourly carbon monoxide (CO) exposures were associated with acute increases in ambulatory blood pressure (ABP); and secondarily, if switching to an improved cookstove was associated with BP changes. We also evaluated the feasibility of using 24-h ambulatory blood pressure monitoring (ABPM) in a cohort of pregnant women in Ghana. METHODS Participants were 44 women enrolled in the Ghana Randomized Air Pollution and Health Study (GRAPHS). For 27 of the women, BP was measured using 24-h ABPM; home blood pressure monitoring (HBPM) was used to measure BP in the remaining 17 women. Personal CO exposure monitoring was conducted alongside the BP monitoring. RESULTS ABPM revealed that peak CO exposure (defined as ≥4.1 ppm) in the 2 hours prior to BP measurement was associated with elevations in hourly systolic BP (4.3 mmHg [95% CI: 1.1, 7.4]) and diastolic BP (4.5 mmHg [95% CI: 1.9, 7.2]), as compared to BP following lower CO exposures. Women receiving improved cookstoves had lower post-intervention SBP (within-subject change in SBP of -2.1 mmHg [95% CI: -6.6, 2.4] as compared to control), though this result did not reach statistical significance. 98.1% of expected 24-h ABPM sessions were successfully completed, with 92.5% of them valid according to internationally defined criteria. CONCLUSIONS We demonstrate an association between acute exposure to carbon monoxide and transient increases in BP in a West African setting. ABPM shows promise as an outcome measure for assessing cardiovascular health benefits of cookstove interventions. TRIAL REGISTRATION The GRAPHS trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490 .
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Affiliation(s)
- Ashlinn K. Quinn
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th St, 11th floor, New York, 10032 NY USA
| | | | - Patrick L. Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Blair J. Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Ellen Boamah
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY USA
| | - Oscar Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Steven N. Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY USA
| | - Mohammed Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Joseph E. Schwartz
- Institute for Applied Behavioral Medicine Research, Stony Brook University, Stony Brook, NY USA
- Center for Behavioral Cardiovascular Health, Columbia University, New York, NY USA
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Columbia University, New York, NY USA
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Darby W. Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th St, 11th floor, New York, 10032 NY USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
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Abdalla M. Ambulatory Blood Pressure Monitoring: A Complementary Strategy for Hypertension Diagnosis and Management in Low-Income and Middle-Income Countries. Cardiol Clin 2017; 35:117-124. [PMID: 27886781 DOI: 10.1016/j.ccl.2016.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) can assess out-of-clinic blood pressure. ABPM is an underutilized resource in low-income and middle-income countries but should be considered a complementary strategy to clinic blood pressure measurement for the diagnosis and management of hypertension. Potential uses for ABPM in low-income and middle-income countries include screening of high-risk individuals who have concurrent communicable diseases, such as HIV, and in task-shifting health care strategies.
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Affiliation(s)
- Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, PH 9-321, New York, NY 10032, USA.
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16
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Rehan HS, Grover A, Hungin APS. Ambiguities in the Guidelines for the Management of Arterial Hypertension: Indian Perspective with a Call for Global Harmonization. Curr Hypertens Rep 2017; 19:17. [PMID: 28233242 DOI: 10.1007/s11906-017-0715-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Many medical professional societies have formulated guidelines to treat hypertension, but there existed differences with respect to diagnosis, blood pressure (BP) targets, pharmacotherapy of hypertension, and grades of evidence. A MEDLINE search for hypertension guidelines was performed to compare Indian guidelines for hypertension (IGH) with these guidelines. A majority of the guidelines had consensus on the cutoff value (140/90 mmHg, recorded twice) to diagnose hypertension. The Joint National Committee 8 (JNC 8), IGH, Japanese Society of hypertension (JSH), Canadian Hypertension Education Program (CHEP), and American Society of Hypertension/International Society of Hypertension (ASH/ISH) guidelines provide a higher BP target for the elderly hypertensive populations, while the National Institute for Health and Care Excellence (NICE) and European Society of Hypertension (ESH) guidelines provided a lower BP target for the elderly patients. However, a meta-analysis showed benefits of having a systolic BP target of <130 mmHg for all patients. Treatment of hypertension according to JNC 8, NICE, and ASH/ISH guidelines varies among the black and the non-black population which recommended thiazide or calcium channel blockers for the black population. There is no special mention of pharmacotherapy or BP targets for the South Asian population in various guidelines including IGH despite evidence of higher risk of hypertension-associated complications in this population. It is suggested that all the available guidelines should be harmonized with highest level of evidence available to minimize ambiguities associated with management of hypertension.
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Affiliation(s)
- Harmeet Singh Rehan
- Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, 110001, India.
| | - Abhinav Grover
- Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - A P S Hungin
- Centre for Integrated Health Care Research, School of Medicine, Pharmacy and Health, Wolfson Building, Queen's Campus, Stockton (Durham University), Stockton, UK
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17
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Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health 2017; 2:e108-e120. [PMID: 29253389 PMCID: PMC6118407 DOI: 10.1016/s2468-2667(17)30003-8] [Citation(s) in RCA: 279] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although it is well established that heavy alcohol consumption increases the risk of hypertension, little is known about the effect of a reduction of alcohol intake on blood pressure. We aimed to assess the effect of a reduction in alcohol consumption on change in blood pressure stratified by initial amount of alcohol consumption and sex in adults. METHODS In this systematic review and meta-analysis, we searched MedLine, Embase, CENTRAL, and ClinicalTrials.gov from database inception up to July 13, 2016, for trials investigating the effect of a change of alcohol consumption on blood pressure in adults using keywords and MeSH terms related to alcohol consumption, blood pressure, and clinical trials, with no language restrictions. We also searched reference lists of identified articles and published meta-analyses and reviews. We included full-text articles with original human trial data for the effect of a change of alcohol consumption on blood pressure in adults, which reported a quantifiable change in average alcohol consumption that lasted at least 7 days and a corresponding change in blood pressure. We extracted data from published reports. We did random-effects meta-analyses stratified by amount of alcohol intake at baseline. All meta-analyses were done with Stata (version 14.1). For the UK, we modelled the effect of a reduction of alcohol consumption for 50% of the population drinking more than two standard drinks per day (ie, 12 g pure alcohol per drink). FINDINGS 36 trials with 2865 participants (2464 men and 401 women) were included. In people who drank two or fewer drinks per day, a reduction in alcohol was not associated with a significant reduction in blood pressure; however, in people who drank more than two drinks per day, a reduction in alcohol intake was associated with increased blood pressure reduction. Reduction in systolic blood pressure (mean difference -5·50 mm Hg, 95% CI -6·70 to -4·30) and diastolic blood pressure (-3·97, -4·70 to -3·25) was strongest in participants who drank six or more drinks per day if they reduced their intake by about 50%. For the UK, the results would translate into more than 7000 inpatient hospitalisations and 678 cardiovascular deaths prevented every year. INTERPRETATION Reducing alcohol intake lowers blood pressure in a dose-dependent manner with an apparent threshold effect. Implementation of effective alcohol interventions in people who drink more than two drinks per day would reduce the disease burden from both alcohol consumption and hypertension, and should be prioritised in countries with substantial alcohol-attributable risk. FUNDING National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH).
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Affiliation(s)
- Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada; PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Canada.
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Sheldon W Tobe
- Department of Medicine, University of Toronto, Toronto, Canada; Northern Ontario School of Medicine, Ontario, Canada
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; School of Electrical Engineering and Telecommunication, The University of New South Wales, New South Wales, Sydney, Australia
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Canada; Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada
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18
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El Mawardy R, Okba A. Antihypertensive treatment and blood pressure control in patients with hypertension in daily clinical practice: a cross-sectional, multicenter, observational study in Egypt. Curr Med Res Opin 2017; 33:39-45. [PMID: 27676649 DOI: 10.1080/03007995.2016.1232706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Management of hypertension in Egypt is difficult because of various reasons. This real-life study was conducted to determine BP control rate, treatment modalities, factors influencing the choice of antihypertensive drugs, physicians' satisfaction with the treatment, and demographics of patients with uncontrolled BP who were treated for hypertension in daily clinical practice in Egypt. METHODS This was a cross-sectional, multicenter, observational study conducted in patients treated for hypertension in out-patient private clinics in Egypt, during October 2011 to June 2012. RESULTS Of 4139 patients with hypertension, 1509 (36.5%) had controlled BP and 2630 (63.5%) had uncontrolled BP. In BP controlled vs. uncontrolled groups, respectively, beta-blockers (41.7% vs. 41.0%) were the most frequently used antihypertensive agents, followed by diuretics (40% vs. 37.8%), angiotensin-converting enzyme inhibitors (35.3% vs. 34.9%), angiotensin receptor blockers (31.1% vs.19.4%), and calcium channel blockers (21.3% vs. 19.4%); the factors influencing the choice of antihypertensive therapy were "add-on therapy" (1.5% vs. 32.4%) and "change the current medication" (9.3% vs. 50.8%); physicians' satisfaction with treatment was rated as "excellent" (31.6% vs. 3.2%) and "poor" (1.6% vs. 58%). CONCLUSION The majority of patients from Egypt had uncontrolled hypertension even after receiving treatment. This might increase awareness among physicians and enable them to prescribe appropriate treatment to patients with uncontrolled BP. Key limitations: The questionnaire used in the study for the evaluation of patient/physician satisfaction level was not standardized and was based on the choice and practice of the physicians.
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19
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Campbell NRC, Lackland DT, Niebylski ML, Orias M, Redburn KA, Nilsson PM, Zhang XH, Burrell L, Horiuchi M, Poulter NR, Prabhakaran D, Ramirez AJ, Schiffrin EL, Schutte AE, Touyz RM, Wang JG, Weber MA. 2016 Dietary Salt Fact Sheet and Call to Action: The World Hypertension League, International Society of Hypertension, and the International Council of Cardiovascular Prevention and Rehabilitation. J Clin Hypertens (Greenwich) 2016; 18:1082-1085. [PMID: 27515460 DOI: 10.1111/jch.12894] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Norm R C Campbell
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | | | | | | | | | | | | | - Louise Burrell
- ISH Secretariat, c/o The Conference Collective Ltd., Teddington, Middlesex, UK
| | - Masatsugu Horiuchi
- ISH Secretariat, c/o The Conference Collective Ltd., Teddington, Middlesex, UK
| | - Neil R Poulter
- ISH Secretariat, c/o The Conference Collective Ltd., Teddington, Middlesex, UK
| | | | - Agustin J Ramirez
- ISH Secretariat, c/o The Conference Collective Ltd., Teddington, Middlesex, UK
| | - Ernesto L Schiffrin
- ISH Secretariat, c/o The Conference Collective Ltd., Teddington, Middlesex, UK
| | - Alta E Schutte
- ISH Secretariat, c/o The Conference Collective Ltd., Teddington, Middlesex, UK
| | - Rhian M Touyz
- ISH Secretariat, c/o The Conference Collective Ltd., Teddington, Middlesex, UK
| | - Ji-Guang Wang
- ISH Secretariat, c/o The Conference Collective Ltd., Teddington, Middlesex, UK
| | - Michael A Weber
- ISH Secretariat, c/o The Conference Collective Ltd., Teddington, Middlesex, UK
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- International Council of Cardiovascular Prevention and Rehabilitation, York University, Toronto, ON, Canada
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20
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Arcand J, Webster J, Johnson C, Raj TS, Neal B, McLean R, Trieu K, Wong MMY, Leung AA, Campbell NRC. Announcing “Up to Date in the Science of Sodium”. J Clin Hypertens (Greenwich) 2015; 18:85-8. [DOI: 10.1111/jch.12732] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- JoAnne Arcand
- Faculty of Health Sciences; University of Ontario Institute of Technology; Oshawa ON Canada
| | - Jacqui Webster
- George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | - Claire Johnson
- George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | - Thout S. Raj
- George Institute for Global Health India; Hyderabad India
| | - Bruce Neal
- The George Institute for Global Health; University of Sydney and the Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Rachael McLean
- Departments of Preventive & Social Medicine/Human Nutrition; University of Otago; Dunedin New Zealand
| | - Kathy Trieu
- George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | | | | | - Norm R. C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences; O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary AB Canada
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21
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Sundström J, Arima H, Jackson R, Turnbull F, Rahimi K, Chalmers J, Woodward M, Neal B. Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Ann Intern Med 2015; 162:184-91. [PMID: 25531552 DOI: 10.7326/m14-0773] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Effects of blood pressure reduction in persons with grade 1 hypertension are unclear. PURPOSE To investigate whether pharmacologic blood pressure reduction prevents cardiovascular events and deaths in persons with grade 1 hypertension. DATA SOURCES Trials included in the BPLTTC (Blood Pressure Lowering Treatment Trialists' Collaboration) and trials identified from a previous review and electronic database searches. STUDY SELECTION Patients without cardiovascular disease with blood pressures in the grade 1 hypertension range (140 to 159/90 to 99 mm Hg) who were randomly assigned to an active (antihypertensive drug or more intensive regimen) or control (placebo or less intensive regimen) blood pressure-lowering regimen. DATA EXTRACTION Individual-patient data from BPLTTC trials and aggregate data from other trials were extracted. Risk of bias was assessed for all trials. DATA SYNTHESIS Individual-patient data involved 10 comparisons from trials where most patients had diabetes, and aggregate data involved 3 comparisons from trials of patients without diabetes. The average blood pressure reduction was about 3.6/2.4 mm Hg. Over 5 years, odds ratios were 0.86 (95% CI, 0.74 to 1.01) for total cardiovascular events, 0.72 (CI, 0.55 to 0.94) for strokes, 0.91 (CI, 0.74 to 1.12) for coronary events, 0.80 (CI, 0.57 to 1.12) for heart failure, 0.75 (CI, 0.57 to 0.98) for cardiovascular deaths, and 0.78 (CI, 0.67 to 0.92) for total deaths. Results were similar in secondary analyses. Withdrawal from treatment due to adverse effects was more common in the active groups. LIMITATION Blood pressure reductions and numbers of events were small. CONCLUSION Blood pressure-lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension. PRIMARY FUNDING SOURCE Swedish Heart-Lung Foundation, Swedish Research Council, Australian Research Council, and National Health and Medical Research Council of Australia.
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Affiliation(s)
- Johan Sundström
- From Uppsala University, Uppsala, Sweden; Sydney University, Sydney, Australia; University of Auckland, Auckland, New Zealand; University of Oxford, Oxford, United Kingdom; and Imperial College, London, United Kingdom
| | - Hisatomi Arima
- From Uppsala University, Uppsala, Sweden; Sydney University, Sydney, Australia; University of Auckland, Auckland, New Zealand; University of Oxford, Oxford, United Kingdom; and Imperial College, London, United Kingdom
| | - Rod Jackson
- From Uppsala University, Uppsala, Sweden; Sydney University, Sydney, Australia; University of Auckland, Auckland, New Zealand; University of Oxford, Oxford, United Kingdom; and Imperial College, London, United Kingdom
| | - Fiona Turnbull
- From Uppsala University, Uppsala, Sweden; Sydney University, Sydney, Australia; University of Auckland, Auckland, New Zealand; University of Oxford, Oxford, United Kingdom; and Imperial College, London, United Kingdom
| | - Kazem Rahimi
- From Uppsala University, Uppsala, Sweden; Sydney University, Sydney, Australia; University of Auckland, Auckland, New Zealand; University of Oxford, Oxford, United Kingdom; and Imperial College, London, United Kingdom
| | - John Chalmers
- From Uppsala University, Uppsala, Sweden; Sydney University, Sydney, Australia; University of Auckland, Auckland, New Zealand; University of Oxford, Oxford, United Kingdom; and Imperial College, London, United Kingdom
| | - Mark Woodward
- From Uppsala University, Uppsala, Sweden; Sydney University, Sydney, Australia; University of Auckland, Auckland, New Zealand; University of Oxford, Oxford, United Kingdom; and Imperial College, London, United Kingdom
| | - Bruce Neal
- From Uppsala University, Uppsala, Sweden; Sydney University, Sydney, Australia; University of Auckland, Auckland, New Zealand; University of Oxford, Oxford, United Kingdom; and Imperial College, London, United Kingdom
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Campbell NR, Lackland DT, Niebylski ML. 2014 dietary salt fact sheet of the World Hypertension League, International Society of Hypertension, Pan American Health Organization technical advisory group on cardiovascular disease prevention through dietary salt reduction, the World Health Organization collaborating centre on population salt reduction, and World Action on Salt & Health. J Clin Hypertens (Greenwich) 2015; 17:7-9. [PMID: 25265529 PMCID: PMC8031790 DOI: 10.1111/jch.12402] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Affiliation(s)
- Norm R.C. Campbell
- Departments of Medicine, Community Health Sciences and of Physiology and PharmacologyLibin Cardiovascular InstituteUniversity of CalgaryCalgaryABCanada
| | - Daniel T. Lackland
- Department of NeurosciencesMedical University of South CarolinaCharlestonSC
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Varagic J, Punzi H, Ferrario CM. Clinical utility of fixed-dose combinations in hypertension: evidence for the potential of nebivolol/valsartan. Integr Blood Press Control 2014; 7:61-70. [PMID: 25473311 PMCID: PMC4251532 DOI: 10.2147/ibpc.s50954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Despite significant advances in pharmacologic approaches to treat hypertension during the last decades, hypertension- and hypertension-related organ damage are still a high health and economic burden because a large proportion of patients with hypertension do not achieve optimal blood pressure control. There is now general agreement that combination therapy with two or more antihypertensive drugs is required for targeted blood pressure accomplishment and reduction of global cardiovascular risk. The goals of combination therapies are to reduce long-term cardiovascular events by targeting different mechanism underlying hypertension and target organ disease, to block the counterregulatory pathways activated by monotherapies, to improve tolerability and decrease the adverse effects of up-titrated single agents, and to increase persistence and adherence with antihypertensive therapy. Multiple clinical trials provide evidence that fixed-dose combinations in a single pill offer several advantages when compared with loose-dose combinations. This review discusses the advances in hypertension control and associated cardiovascular disease as they relate to the prospect of combination therapy targeting a third-generation beta (β) 1-adrenergic receptor (nebivolol) and an angiotensin II receptor blocker (valsartan) in fixed-dose single-pill formulations.
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Affiliation(s)
- Jasmina Varagic
- Hypertension and Vascular Research Center, Wake Forest University, Winston-Salem, NC USA ; Division of Surgical Sciences, Wake Forest University, Winston-Salem, NC USA ; Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC USA
| | - Henry Punzi
- Trinity Hypertension and Diagnostic Research Center, Carrollton, TX, USA ; Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carlos M Ferrario
- Division of Surgical Sciences, Wake Forest University, Winston-Salem, NC USA ; Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC USA ; Department of Internal Medicine and Nephrology, Wake Forest University, Winston-Salem, NC, USA
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Campbell NRC, Correa-Rotter R, Cappuccio FP, Webster J, Lackland DT, Neal B, MacGregor GA. Proposed nomenclature for salt intake and for reductions in dietary salt. J Clin Hypertens (Greenwich) 2014; 17:247-51. [PMID: 25413335 DOI: 10.1111/jch.12442] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
There is considerable confusion about what ranges of dietary salt(a) could be considered low, normal, or high and also what ranges of reduction in dietary salt are small or large. The World Hypertension League with other organizations involved in dietary salt reduction have proposed a standardized nomenclature based on normal ancestral levels of salt intake and also on ranges of reduction in salt intake in clinical and population interventions. Low daily salt (sodium) intake where harm due to deficiency would be expected to occur is recommended to remain undefined because of inadequate research but likely <0.25 g (100 mg), normal (physiological) intake <2.5 g (1000 mg), recommended intake <5.0 g (2000 mg), high ≥5.0 g (2000 mg), very high >10 to 15 g (4000-6000 mg), and extremely high >15 g (6000 mg). Reductions in daily salt (sodium) intake are recommended to be called small if <2.5 g (1000 mg), moderate if 2.5 to 5.0 g (1000-2000 mg) and large if >5.0 g (2000 mg). Use of this nomenclature is likely to result in less confusion about salt intake and interventions to reduce dietary sodium.
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Affiliation(s)
- Norm R C Campbell
- Departments of Medicine, Community Health Sciences and of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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25
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Khalsa TK, Campbell NR, Lackland DT, Lisheng L, Niebylski ML, Zhang XH. A Needs Assessment of National Hypertension Organizations for Hypertension Prevention and Control Programs. J Clin Hypertens (Greenwich) 2014; 16:848-55. [DOI: 10.1111/jch.12432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tej K. Khalsa
- Department of Medicine; University of Calgary; Calgary AB Canada
| | - Norm R.C. Campbell
- Departments of Medicine, Community Health Sciences and of Physiology and Pharmacology; Libin Cardiovascular Institute; University of Calgary; Calgary AB Canada
| | - Daniel T. Lackland
- Department of Neurosciences; Medical University of South Carolina; Charleston SC
| | - Liu Lisheng
- Beijing Hypertension League Institute; Fu Wai Hospital; Beijing China
| | | | - Xin-Hua Zhang
- Department of Medicine; Beijing Hypertension League Institute; Beijing China
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26
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Campbell NR, Appel LJ, Cappuccio FP, Correa-Rotter R, Hankey GJ, Lackland DT, MacGregor G, Neal B, Niebylski ML, Webster J, Willis KJ, Woodward M. A Call for Quality Research on Salt Intake and Health: From the World Hypertension League and Supporting Organizations. J Clin Hypertens (Greenwich) 2014; 16:469-71. [DOI: 10.1111/jch.12364] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Norm R.C. Campbell
- Departments of Medicine, Community Health Sciences and of Physiology and Pharmacology; Libin Cardiovascular Institute; University of Calgary; Calgary AB Canada
| | - Larry J. Appel
- Welch Center for Prevention, Epidemiology and Clinical Research; Johns Hopkins School of Medicine; Baltimore MD
| | - Francesco P. Cappuccio
- Cardiovascular Medicine & Epidemiology; WHO Collaborating Centre for Nutrition; University of Warwick; Warwick Medical School & University Hospitals Coventry & Warwickshire NHS Trust; Coventry UK
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism; National Medical Science and Nutrition Institute Salvador Zubirán; Mexico City Mexico
| | - Graeme J. Hankey
- Neurology; School of Medicine and Pharmacology; Harry Perkins Institute of Medical Research; The University of Western Australia; Perth WA Australia
| | - Daniel T. Lackland
- Department of Neurosciences; Medical University of South Carolina; Charleston SC
| | - Graham MacGregor
- Cardiovascular Medicine; Wolfson Institute of Preventive Medicine; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Bruce Neal
- Medicine; The George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | | | - Jacqui Webster
- The George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | | | - Mark Woodward
- Epidemiology and Biostatistics; The George Institute for Global Health; University of Sydney; Sydney NSW Australia
- Nuffield Department of Population Health; Department of Epidemiology; University of Oxford; Johns Hopkins University; Baltimore MD
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27
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Chen WR, Liu ZY, Shi Y, Yin DW, Wang H, Sha Y, Chen YD. Vitamin D and nifedipine in the treatment of Chinese patients with grades I-II essential hypertension: a randomized placebo-controlled trial. Atherosclerosis 2014; 235:102-9. [PMID: 24942709 DOI: 10.1016/j.atherosclerosis.2014.04.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/28/2014] [Accepted: 04/07/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Low vitamin D status has been shown to be associated with hypertension. We planned to research the effect of vitamin D and nifedipine in the treatment of patients with essential hypertension. METHODS Patients with grades I-II essential hypertension were enrolled in this single-center, double-blind, placebo-controlled trial in Beijing. All patients received a conventional antihypertensive drug (nifedipine, 30 mg/d). One hundred and twenty-six patients were randomly assigned to receive vitamin D (n=63, 2000 IU/d) or a placebo (n=63) as an add-on to nifedipine, by the method of permutated block randomization. Ambulatory blood pressure monitoring was performed at baseline (month 0), at month 3 and at month 6. RESULTS In vitamin D supplementation group, there was a significant increase in mean 25-hydroxyvitamin D levels from baseline (19.4 ± 11.6 ng/ml) to 6 months (34.1 ± 12.2 ng/ml; p<0.001). At 6 months, the primary end points, a difference in the fall of 24-h mean blood pressure, between the groups was -6.2 mmHg (95% CI -11.2; -1.1) for systolic blood pressure (p<0.001) and -4.2 mmHg (95% CI -8.8; -0.3) for diastolic blood pressure (p<0.001) under intention to treat analysis. In patients with vitamin D <30 ng/ml at baseline (n=113), 24-h mean blood pressure decreased by 7.1/5.7 mmHg (p<0.001). Safety and tolerability were similar among the two groups. CONCLUSIONS Vitamin D supplementation can reduce blood pressure in patients with hypertension, it can be an adjuvant therapy for patients with grades I-II essential hypertension. CLINICAL TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry, it is available in Website: http://www.chictr.org/cn/; REGISTRATION NUMBER ChiCTR-ONC-13003840.
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Affiliation(s)
- Wei Ren Chen
- Department of South-Building Cardiology, PLA General Hospital at Beijing, Beijing 100853, China
| | - Zhi Ying Liu
- Department of South-Building Cardiology, PLA General Hospital at Beijing, Beijing 100853, China
| | - Yang Shi
- Department of South-Building Cardiology, PLA General Hospital at Beijing, Beijing 100853, China.
| | - Da Wei Yin
- Department of South-Building Cardiology, PLA General Hospital at Beijing, Beijing 100853, China
| | - Hao Wang
- Department of South-Building Cardiology, PLA General Hospital at Beijing, Beijing 100853, China
| | - Yuan Sha
- Department of South-Building Cardiology, PLA General Hospital at Beijing, Beijing 100853, China
| | - Yun Dai Chen
- Department of Cardiology, PLA General Hospital at Beijing, Beijing 100853, China
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28
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Abstract
Arterial hypertension is a major health problem, accounting for 12 % of the global death rate. A large proportion of patients treated for high blood pressure do not reach target blood pressure values. The question arises if new antihypertensive drugs could improve present hypertension treatment. Rho-kinases (ROCKs) are ubiquitously expressed serine/threonine kinases and involved in a variety of cell functions. They contribute to the pathogenesis of human and experimental hypertension. Pharmacological ROCK inhibition has been shown to effectively lower blood pressure in patients and experimental animals. Progress has been made towards the understanding on how non-selective ROCK inhibitors lower arterial pressure and efforts are currently undertaken to develop ROCK inhibitors to improve their specificity and isoenzyme selectivity. If introduction of ROCK inhibitors for the treatment of high blood pressure can significantly advance currently available options of antihypertensive pharmacotherapy awaits further experimental and clinical research.
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Affiliation(s)
- Olaf Grisk
- Department of Physiology, University of Greifswald, Greifswalder Str. 11c, 17495, Greifswald, Karlsburg, Germany,
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29
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How far to lower blood pressure in the long term, after a stroke? J Hypertens 2014; 32:746-8. [PMID: 24609214 DOI: 10.1097/hjh.0000000000000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Tomasik T, Windak A, Seifert B, Kersnik J, Jozwiak J. Treatment targets in patients with type 2 diabetes set by primary care physicians from Central and Eastern Europe. Eur J Gen Pract 2014; 20:253-9. [PMID: 24520868 DOI: 10.3109/13814788.2013.877130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary care physicians have an important role in the care of patients with Type 2 diabetes but little is known about this issue in Central and Eastern European countries. OBJECTIVES To investigate the treatment goals of patients with type 2 diabetes mellitus (type 2 DM) set by primary care physicians in Central and Eastern European countries and illustrate inter-country variation. METHODS A cross-sectional survey of primary care physicians randomly chosen in nine countries. A validated questionnaire was used. Physicians reported treatment goals for patients with type 2 DM. RESULTS A total of 44.1% of physicians, reported the acceptance of HbA1c < 6.5% (48 mmol/mol) as a treatment goal, whilst 40% chose lower levels (< 6.1%; 43 mmol/mol). In all countries, 62% of physicians set FPG at a level of < 6.0 mmol/l. Most respondents set low BP levels as a goal of therapy (47% of physicians in all countries: BP < 130/80 mmHg and 48% < 120/80 mmHg). A TC level < 4.5 mmol/l and a LDL-C level < 2.5 mmol/l were reported as the targets for patients with diabetes by 51% and 69% of all respondents, respectively. The overall differences between all the countries were statistically significant (P < 0.01). CONCLUSION For patients with diabetes approximately half of physicians set treatment goals at levels that were recommended within the international guidelines. Most of them set treatment goals for HbA1c and BP at very low levels. Educational efforts to raise awareness about new treatment goals are needed.
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Affiliation(s)
- Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College , Krakow , Poland
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31
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Huynh K, Bernardo BC, McMullen JR, Ritchie RH. Diabetic cardiomyopathy: mechanisms and new treatment strategies targeting antioxidant signaling pathways. Pharmacol Ther 2014; 142:375-415. [PMID: 24462787 DOI: 10.1016/j.pharmthera.2014.01.003] [Citation(s) in RCA: 404] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/08/2014] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease is the primary cause of morbidity and mortality among the diabetic population. Both experimental and clinical evidence suggest that diabetic subjects are predisposed to a distinct cardiomyopathy, independent of concomitant macro- and microvascular disorders. 'Diabetic cardiomyopathy' is characterized by early impairments in diastolic function, accompanied by the development of cardiomyocyte hypertrophy, myocardial fibrosis and cardiomyocyte apoptosis. The pathophysiology underlying diabetes-induced cardiac damage is complex and multifactorial, with elevated oxidative stress as a key contributor. We now review the current evidence of molecular disturbances present in the diabetic heart, and their role in the development of diabetes-induced impairments in myocardial function and structure. Our focus incorporates both the contribution of increased reactive oxygen species production and reduced antioxidant defenses to diabetic cardiomyopathy, together with modulation of protein signaling pathways and the emerging role of protein O-GlcNAcylation and miRNA dysregulation in the progression of diabetic heart disease. Lastly, we discuss both conventional and novel therapeutic approaches for the treatment of left ventricular dysfunction in diabetic patients, from inhibition of the renin-angiotensin-aldosterone-system, through recent evidence favoring supplementation of endogenous antioxidants for the treatment of diabetic cardiomyopathy. Novel therapeutic strategies, such as gene therapy targeting the phosphoinositide 3-kinase PI3K(p110α) signaling pathway, and miRNA dysregulation, are also reviewed. Targeting redox stress and protective protein signaling pathways may represent a future strategy for combating the ever-increasing incidence of heart failure in the diabetic population.
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Affiliation(s)
- Karina Huynh
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Julie R McMullen
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia; Department of Physiology, Monash University, Clayton, Victoria, Australia.
| | - Rebecca H Ritchie
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia.
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32
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Park JB. Antihypertensive drug therapy: a review based on recent guidelines. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2014. [DOI: 10.5124/jkma.2014.57.12.1034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
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Chalmers J, Arima H, Woodward M, Mancia G, Poulter N, Hirakawa Y, Zoungas S, Patel A, Williams B, Harrap S. Effects of combination of perindopril, indapamide, and calcium channel blockers in patients with type 2 diabetes mellitus: results from the Action In Diabetes and Vascular Disease: Preterax and Diamicron Controlled Evaluation (ADVANCE) trial. Hypertension 2013; 63:259-64. [PMID: 24324048 DOI: 10.1161/hypertensionaha.113.02252] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective of the present analysis was to determine the effects of a fixed combination of perindopril and indapamide in combination with calcium channel blockers (CCBs) in patients with type 2 diabetes mellitus. The Action in Diabetes and Vascular Disease: Preterax and Diamicron Controlled Evaluation (ADVANCE) trial was a factorial randomized controlled trial. A total of 11 140 patients with type 2 diabetes mellitus were randomly assigned to fixed combination of perindopril-indapamide (4/1.25 mg) or placebo. Effects of randomized treatment on mortality and major cardiovascular outcomes were examined in subgroups defined by baseline use of CCBs. Patients on CCB at baseline (n=3427) constituted a higher risk group compared with those not on CCB (n=7713), with more extensive use of antihypertensive and other protective therapies. Active treatment reduced the relative risk of death by 28% (95% confidence interval, 10%-43%) among patients with CCB at baseline compared with 5% (-12% to 20%) among those without CCB (P homogeneity=0.02) and 14% (2%-25%) for the whole population. Similarly, the relative risk reduction for major cardiovascular events was 12% (-8% to 28%) versus 6% (-10% to 19%) for those with and without CCB at baseline although the difference was not statistically significant (P homogeneity=0.38). There was no detectable increase in adverse effects in those receiving CCB. The combination of perindopril and indapamide with CCBs seems to provide further protection against mortality in patients with type 2 diabetes mellitus.
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Affiliation(s)
- John Chalmers
- The George Institute for Global Health, PO Box M201, Camperdown, NSW 2050, Australia.
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Mozheyko M, Eregin S, Vigdorchik A, Tobe S, Campbell N, Riahi F, Hughes D. Changes in hypertension treatment in the yaroslavl region of Russia: improvements observed between 2 cross-sectional surveys. J Clin Hypertens (Greenwich) 2013; 15:918-24. [PMID: 24118731 PMCID: PMC4255293 DOI: 10.1111/jch.12214] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/21/2013] [Accepted: 09/13/2013] [Indexed: 11/29/2022]
Abstract
This prospective before-and-after survey of hypertensive patients visiting government-run outpatient health facilities in the Yaroslavl Region of Russia assessed blood pressure (BP)-related endpoints following initiation of a comprehensive health system improvement program for hypertension. Two cross-sectional surveys, one at baseline and the other approximately 1 year after program initiation, evaluated the primary measure of BP control rate. Secondary measures included mean BP levels and distribution, cardiovascular risk factors, and associated conditions, heart rate levels, and antihypertensive therapy. From the 2011 survey (n=1794) to the 2012 survey (n=2992), BP control rate (<140/90 mm Hg) significantly increased from 16.8% to 23.0%, reflecting a 37% relative improvement (P<.0001). Mean BP level was significantly reduced from 151/90 mm Hg to 147/88 mm Hg (P<.0001). Severe uncontrolled hypertension (systolic BP ≥180 mm Hg) was reduced from 9.7% to 6.4% (P<.0001). Implementing a guidelines-based treatment protocol with medical and patient education programs resulted in physician behavior change and improved patient BP control.
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Affiliation(s)
- Maria Mozheyko
- Department of CardiologyYaroslavl Regional Clinical Hospital of War VeteransYaroslavlRussia
| | - Sergey Eregin
- Cardiology CenterYaroslavl Regional Clinical HospitalYaroslavlRussia
| | | | - Sheldon Tobe
- Sunnybrook Health Sciences CentreTorontoONCanada
| | - Norman Campbell
- Community Health Sciences and Physiology and PharmacologyLibin Cardiovascular Institute of AlbertaABCanada
| | - Farhad Riahi
- Healthcare SystemsNovartis International AGBaselSwitzerland
| | - David Hughes
- Healthcare SystemsNovartis International AGBaselSwitzerland
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35
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Abstract
Despite cardiovascular disease (CVD) being by far the most common cause of death in women worldwide, awareness is low. Myocardial infarction occurs 10 years later in women than in men. Symptoms may be atypical: dyspnea rather than chest pain. Also more women than men have myocardial infarction with normal coronary angiography, probably due to microvascular disease or coronary spasm. The prognosis of non-obstructive disease is now recognized to be the same than for obstructive disease. The conventional risk factors for CVD are the same for both genders but have a different impact for women. One example is psychosocial stress and angina pectoris can more often be induced by mental stress in women than in men. Also there are risk factors specific to women such as a history of pre-eclampsia, gestational hypertension or diabetes and polycystic ovary syndrome (PCOS). Furthermore atrial fibrillation increases the risk of stroke more in women than in men. However, 6 out of 10 deaths from CVD can be prevented by a healthy life style and dealing with preexisting risk factors. Hence it is important that gynecologists who start seeing women at an earlier age than cardiologists should be aware of cardiovascular disease.
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