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Abdelkader NN, Awaisu A, Elewa H, El Hajj MS. Prescribing patterns of antihypertensive medications: A systematic review of literature between 2010 and 2020. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100315. [PMID: 37635839 PMCID: PMC10448163 DOI: 10.1016/j.rcsop.2023.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
Background Hypertension has affected over 1.13 billion people worldwide in 2015 and it's one of the most preventable risk-factors for morbidity and mortality. Antihypertensives significantly reduce cardiovascular risks. Several studies on antihypertensives' prescribing patterns were conducted worldwide, and guidelines were developed on hypertension management. However, no systematic reviews were conducted globally to synthesize the evidence from these studies. This review aims to evaluate antihypertensives' prescription patterns, and adherence to international guidelines for hypertension management worldwide. Methods Full-text antihypertensives' prescribing patterns evaluation studies were included. Reviews, commentaries, guidelines, and editorials were excluded. Various databases were searched including PubMed, Embase, and others. Studies were limited to English only and to articles published from (01/01/2010) to (20/03/2020). Crowe Critical Appraisal Tool (CCAT) was used for quality assessment. Results The most commonly prescribed antihypertensives as monotherapy in adult patients with no comorbidities were ACEIs/ARBs (Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers), followed by CCBs (Calcium channel blockers), and BBs (Beta Blockers). Most commonly prescribed dual combinations were thiazide diuretics+ACEIs/ARBs, BBs + CCBs and CCBs+ACEIs/ARBs. Among diabetic patients, the most common agents were ACEIs/ARBs. Among patients with heart diseases, CCBs were prescribed frequently. While patients with kidney diseases, CCBs and ARBs were most prescribed. Of the 40 studies included in the review, only four studies directly assessed the prescribing patterns of antihypertensives in adherence to clinical practice guidelines. And only two studies confirmed adherence to guidelines. Furthermore, the quality of the majority of studies was moderate (50%), while 25% of articles were reported as either high or low quality. Conclusion This review revealed that there are areas for improvement for prescribing practices of antihypertensives in concordance with the latest evidence and with clinical practice guidelines.
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Affiliation(s)
- Nada Nabil Abdelkader
- College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Ahmed Awaisu
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Hazem Elewa
- College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Maguy Saffouh El Hajj
- College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
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Ernst ME, Fravel MA. Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide. Am J Hypertens 2022; 35:573-586. [PMID: 35404993 DOI: 10.1093/ajh/hpac048] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/27/2023] Open
Abstract
The term thiazide is universally understood to refer to diuretics that exert their principal action in the distal tubule. The thiazide class is heterogenous and can be further subdivided into compounds containing the benzothiadiazine ring structure-the thiazide-type (e.g., hydrochlorothiazide)-and those lacking the benzothiadiazine ring-the thiazide-like (e.g., chlorthalidone and indapamide) drugs. Thiazide-like agents are longer acting and constitute the diuretics used in most of the cardiovascular outcome trials that established benefits of treatment with diuretics, but pragmatic aspects, such as lack of availability in convenient formulations, limit their use. Regardless of class heterogeneity, thiazides have retained importance in the management of hypertension for over 60 years. They are reliably effective as monotherapy in a majority of hypertensive patients, and augment the efficacy of other classes of antihypertensives when used in combination. Importantly, a thiazide-based treatment regimen lowers cardiovascular events, and their sturdy effect reinforces their place among the recommended first-line agents to treat hypertension in major domestic and international hypertension guidelines. There are few head-to-head comparisons within the class, but potential differences have been explored indirectly as well as in non-blood pressure mechanisms and potential pleiotropic properties. Until proven otherwise, the importance of these differences remains speculative, and clinicians should assume that cardiovascular events will be lowered similarly across agents when equivalent blood pressure reduction occurs. Thiazides remain underutilized, with only about one-third of hypertensive patients receiving them. For many patients, however, a thiazide is an indispensable component of their regimen to achieve adequate blood pressure control.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA.,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
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Yang R, Tang J, Zhuo Y, Kuang M, Liu H. Current prescription status of antihypertensive drugs in Chinese patients with hypertension: analysis by type of comorbidities. Clin Exp Hypertens 2022; 44:240-248. [PMID: 34974781 DOI: 10.1080/10641963.2021.2022688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In 2020, the National Center for Cardiovascular Diseases with National Committee on Hypertension Management in Primary Health Care in China issued revised national clinical practice guidelines on the management of hypertension in primary health care based on the 2018 Chinese guidelines for the management of hypertension. To evaluate adherence to the guidelines, this retrospective study assessed the real-world status of antihypertensive drug prescribing for Chinese patients with hypertension, classified by comorbidity: coronary heart disease, diabetes mellitus, heart failure, stroke, and renal disease. About 1088212 hypertensive patients who received their first prescription for antihypertensive therapy between January 2021 to June 2021, were obtained from a database of Hangzhou Kang Sheng Health Consulting CO., Ltd. Calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) were the most common drugs prescribed for each comorbidity subgroup. Whereas diabetes mellitus or renal disease is a compelling indication for use of renin-angiotensin system inhibitors, CCBs were often administered in these subgroups. The treatment pattern for patients with coronary heart disease was closely similar to that for the overall patient population. Beta-blockers (BBs) were prescribed more frequently for patients with heart failure than for those with other comorbidities. Although antihypertensive drug prescription varied by comorbidity, pharmacological decisions were largely made under Chinese recommendations while physicians could select antihypertensive drugs based on the patients' comorbidities. However, educational initiatives are still necessary to inspire clinicians to better familiarize themselves with the guidelines and manage hypertension comorbid diseases.
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Affiliation(s)
- Renren Yang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
| | - Jia Tang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
| | - Yunping Zhuo
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
| | - Ming Kuang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
| | - Hongying Liu
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
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Marshall C, Adams AS, Ma L, Altschuler A, Lin MW, Thompson NA, Young JD. Clinical Decision Support to Address Racial Disparities in Hypertension Control in an Integrated Delivery System: Evaluation of a Natural Experiment. Perm J 2021; 26:11-20. [PMID: 35609161 PMCID: PMC9126555 DOI: 10.7812/tpp/21.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Effective, equity-promoting interventions implemented by health care systems are needed to address health care disparities and population-level health disparities. We evaluated the impact of a clinical decision support tool to improve evidence-based thiazide diuretic prescribing among Black patients to address racial disparities in hypertension control. METHODS We employed an interrupted time series design and qualitative interviews to evaluate the implementation of the tool. Our primary outcome measure was the monthly rate of thiazide use among eligible patients before and after implementation of the tool (January 2013-December 2016). We modeled month-to-month changes in thiazide use for Black and White patients, overall, and by sex and medical center racial composition. We conducted key informant interviews to identify modifiable facilitators and barriers to implementation of the tool across medical centers. RESULTS Of the 318,720 patients, 15.5% were Black. We observed no change in thiazide use or blood pressure control following the implementation of the tool in either racial subgroup. There was a slight but statistically significant reduction (2.32 percentage points, p < 0.01) in thiazide use among Black patients following the removal the tool that was not observed among White patients. Factors affecting the tool's implementation included physician and pharmacist resistance to thiazide use and a lack of ongoing promotion of the tool. DISCUSSION The clinical decision support tool was insufficient to change prescribing practices and improve blood pressure control among Black patients. CONCLUSIONS Future interventions should consider physician attitudes about thiazide prescribing and the importance of multilevel approaches to address hypertension disparities.
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Affiliation(s)
- Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Alyce S Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lin Ma
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Mark W Lin
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
| | - Nailah A Thompson
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
| | - Joseph D Young
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
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Haley W, Shawl F, Charles Sternbergh W, Turan TN, Barrett K, Voeks J, Brott T, Meschia JF. Non-Adherence to Antihypertensive Guidelines in Patients with Asymptomatic Carotid Stenosis. J Stroke Cerebrovasc Dis 2021; 30:105918. [PMID: 34148021 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE Hypertension and carotid stenosis are both risk factors for stroke, but the presence of carotid stenosis might dampen enthusiasm for tight control of hypertension because of concerns for hypoperfusion. OBJECTIVE To determine the extent to which there are opportunities to potentially improve pharmacotherapy for hypertension in patients known to have asymptomatic high-grade carotid stenosis. DESIGN We examined anti-hypertensive medication prescription and adherence to evidence-based hypertension treatment guidelines in a cross-sectional analysis of baseline data of patients enrolled in a clinical trial. SETTING The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) is a multicenter prospective randomized open blinded end-point clinical trial of intensive medical management with or without revascularization by endarterectomy or stenting for asymptomatic high-grade carotid stenosis. PARTICIPANTS 1479 participants (38.6% female; mean age 69.8 years) from 132 clinical centers enrolled in the CREST-2 trial as of April 6, 2020 who were taking ≥1 antihypertensive drug at baseline. EXPOSURES Pharmacotherapy for hypertension. MAIN OUTCOME Adherence to evidence-based guidelines for treating hypertension. RESULTS Of 1458 participants with complete data, 26% were on one, 31% on 2, and 43% on ≥3 antihypertensive medications at trial entry. Thirty-two percent of participants were prescribed thiazide; 74%, angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB); 38%, calcium channel blocker (CCB); 56%, a beta blocker; 11%, loop diuretic; and 27%, other. Of those prescribed a single antihypertensive medication, the proportion prescribed thiazide was 5%; ACEI or ARB, 55%, and CCB, 11%. The prevalence of guideline-adherent regimens was 34% (95% CI, 31-36%). CONCLUSIONS AND RELEVANCE In a diverse cohort with severe carotid disease and hypertension, non-adherence to hypertension guidelines was common. All preferred classes of antihypertensive drug were under-prescribed. Using staged iterative guideline-based care for hypertension, CREST-2 will characterize drug tolerance and stroke rates under these conditions. TRIAL REGISTRATION ClinicalTrials.gov Number NCT02089217.
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Affiliation(s)
- William Haley
- Department of Hypertension and Nephrology (retired), Mayo Clinic, Jacksonville, FL, United States
| | - Fayaz Shawl
- Department of Interventional Cardiology, White Oak Medical Center, Silver Springs, MD, United States
| | - W Charles Sternbergh
- Department of Vascular Surgery, Ochsner Health System, New Orleans, LA, United States
| | - Tanya N Turan
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Kevin Barrett
- Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States
| | - Jenifer Voeks
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Thomas Brott
- Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States
| | - James F Meschia
- Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States.
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Faulkner JL, Lluch E, Kennard S, Antonova G, Jaffe IZ, Belin de Chantemèle EJ. Selective deletion of endothelial mineralocorticoid receptor protects from vascular dysfunction in sodium-restricted female mice. Biol Sex Differ 2020; 11:64. [PMID: 33228767 PMCID: PMC7685592 DOI: 10.1186/s13293-020-00340-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background Recent evidence by our laboratory demonstrates that women and female mice endogenously express higher endothelial mineralocorticoid receptor (ECMR) than males. Mounting clinical evidence also indicates that aldosterone production is higher in pathological conditions in females compared to males. However, the role for increased activation of ECMR by aldosterone in the absence of a comorbid condition is yet to be explored. The current study hypothesized that increased ECMR activation induced by elevated aldosterone production predisposes healthy female mice to endothelial dysfunction. Method Vascular reactivity was assessed in aortic rings from wild-type (WT) and ECMR KO (KO) mice fed either a normal salt (NSD, 0.4% NaCl) or sodium-restricted diet (SRD, 0.05% NaCl) for 28 days. Results SRD elevated plasma aldosterone levels as well as adrenal CYP11B2 and angiotensin II type 1 receptor (AT1R) expressions in female, but not male, WT mice. In baseline conditions (NSD), endothelial function, assessed by vascular relaxation to acetylcholine, was higher while vascular contractility to phenylephrine, serotonin, and KCl lower in female than male WT mice. SRD impaired endothelial function and increased vascular contractility in female, but not male, WT mice effectively ablating the baseline sex differences. NOS inhibition with LNAME ablated endothelial relaxation to a higher extent in male than female mice on NSD and ablated differences in acetylcholine relaxation responses between NSD- and SRD-fed females, indicating a role for NO in SRD-mediated endothelial function. In association, SRD significantly reduced vascular NOX4 expression in female, but not male, mice. Lastly, selective deletion of ECMR protected female mice from SRD-mediated endothelial dysfunction and increased vascular contractility. Conclusion Collectively, these data indicate that female mice develop aldosterone-induced endothelial dysfunction via endothelial MR-mediated reductions in NO bioavailability. In addition, these data support a role for ECMR to promote vascular contractility in female mice in response to sodium restriction.
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Affiliation(s)
- Jessica L Faulkner
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA.
| | - Emily Lluch
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA
| | - Simone Kennard
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA
| | - Galina Antonova
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, USA
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA.,Department of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Park JH, Dehaini D, Zhou J, Holay M, Fang RH, Zhang L. Biomimetic nanoparticle technology for cardiovascular disease detection and treatment. NANOSCALE HORIZONS 2020; 5:25-42. [PMID: 32133150 PMCID: PMC7055493 DOI: 10.1039/c9nh00291j] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiovascular disease (CVD), which encompasses a number of conditions that can affect the heart and blood vessels, presents a major challenge for modern-day healthcare. Nearly one in three people has some form of CVD, with many suffering from multiple or intertwined conditions that can ultimately lead to traumatic events such as a heart attack or stroke. While the knowledge obtained in the past century regarding the cardiovascular system has paved the way for the development of life-prolonging drugs and treatment modalities, CVD remains one of the leading causes of death in developed countries. More recently, researchers have explored the application of nanotechnology to improve upon current clinical paradigms for the management of CVD. Nanoscale delivery systems have many advantages, including the ability to target diseased sites, improve drug bioavailability, and carry various functional payloads. In this review, we cover the different ways in which nanoparticle technology can be applied towards CVD diagnostics and treatments. The development of novel biomimetic platforms with enhanced functionalities is discussed in detail.
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Affiliation(s)
| | | | - Jiarong Zhou
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Maya Holay
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Ronnie H. Fang
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Liangfang Zhang
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
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Amar J, Angoulvant T, Boivin JM, Amar L, Lantelme P, Blacher J, Plu-Bureau G, Vehier CM. Spécificités du traitement médicamenteux antihypertenseur chez la femme. Presse Med 2019; 48:1261-1264. [PMID: 31735525 DOI: 10.1016/j.lpm.2019.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 11/18/2022] Open
Abstract
The impact of antihypertensive drugs on blood pressure does not differ according to the sex. There are women-specific conditions or medical conditions encountered more frequently among womens that guide the selection of therapy such as a desire to become pregnant, a pregnancy, a polycystic ovarian syndrome, breast cancer, osteoporosis or migraine.
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Affiliation(s)
- Jacques Amar
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France.
| | - Theodora Angoulvant
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Jean Marc Boivin
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Laurence Amar
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Pierre Lantelme
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Jacques Blacher
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Geneviève Plu-Bureau
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Claire Mounier Vehier
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
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Coll-de-Tuero G, Comas-Cufí M, Rodríguez-Poncelas A, Barrot-de-la Puente J, Blanch J, Figa-Vaello J, Barceló MA, Saez M. Prognostic Value of the Estimated Glomerular Filtration Rate Decline in Hypertensive Patients Without Chronic Kidney Disease. Am J Hypertens 2019; 32:890-899. [PMID: 30794282 DOI: 10.1093/ajh/hpz029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Our objective of this study was to determine if rate of estimated glomerular filtration rate (eGFR) decline and its intensity was associated with cardiovascular risk and death in patients with hypertension whose baseline eGFR was higher than 60 ml/minute/1.73 m2. METHODS This study comprised 2,516 patients with hypertension who had had at least 2 serum creatinine measurements over a 4-year period. An eGFR reduction of ≥10% per year has been deemed as high eGFR and a reduction in eGFR of less than 10% per year as a low decline. The end points were coronary artery disease, stroke, transitory ischemic accident, peripheral arterial disease, heart failure, atrial fibrillation, and death from any cause. Cox regression analyses adjusted for potentially confounding factors were conducted. RESULTS A total of 2,354 patients with low rate of eGFR decline and 149 with high rate of eGFR decline were analyzed. The adjusted model shows that a -10% rate of eGFR decline per year is associated with a higher risk of the primary end point (HR 1.9; 95% CI 1.1-3.5; P = 0.02) and arteriosclerotic vascular disease (HR 2.2; 95% CI 1.2-4.2; P < 0.001) in all hypertensive groups. The variables associated to high/low rate of eGFR decline in the logistic regression model were serum creatinine (OR 3.35; P < 0.001), gender, women (OR 15.3; P < 0.001), tobacco user (OR 1.9; P < 0.002), and pulse pressure (OR 0.99; P < 0.05). CONCLUSIONS A rate of eGFR decline equal to or higher than -10% per year is a marker of cardiovascular risk for patients with arterial hypertension without chronic kidney disease at baseline. It may be useful to consider intensifying the global risk approach for these patients.
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Affiliation(s)
- Gabriel Coll-de-Tuero
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marc Comas-Cufí
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Antonio Rodríguez-Poncelas
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Joan Barrot-de-la Puente
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Jordi Blanch
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Josep Figa-Vaello
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Maria A Barceló
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - Marc Saez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
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Antihypertensive Treatment Patterns and Blood Pressure Control in Older Adults: Results from the Berlin Aging Study II. Drugs Aging 2019; 35:993-1003. [PMID: 30187292 DOI: 10.1007/s40266-018-0580-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hypertension is highly prevalent in older adults and represents a major public health issue since recognition, awareness, treatment and control are insufficient. Analyses of prescription patterns in conjunction with clinical parameters can provide novel insights into the current practice of hypertension management and help to identify barriers to sufficient hypertension control. METHODS A cross-sectional analysis was conducted. Prevalence of hypertension, patterns of antihypertensive therapy, and determinants of blood pressure (BP) control were examined in the Berlin Aging Study II cohort, including 1654 community-dwelling older adults (60-85 years of age). RESULTS Of the participants, 75.9% had hypertension; 40.6% of these were not prescribed BP medications. Lack of hypertension awareness, younger age, absence of comorbidities, not being on a statin, and not having visited a physician in the past 3 months were associated with lack of treatment. Forty-two percent of treated hypertensive individuals received monotherapy and 58.0% received combination therapy. Renin-angiotensin-aldosterone system (RAAS) inhibitors, and β-blockers were most commonly prescribed, while calcium channel blockers were least prescribed. Only 38.5% of treated hypertensive individuals had their BP controlled to < 140/90 mmHg. Number and choice of BP medications were not predictive of BP control; neither were age, glycated hemoglobin (HbA1c), kidney function, or number of healthcare visits. However, female sex, lower low-density lipoprotein cholesterol (LDL-C) levels and current smoking, amongst others, were positively associated with BP control. There was evidence of significant effect modification by statins in the association of LDL-C and BP. CONCLUSION The majority of older adults do not reach BP goals. Antihypertensive prescription patterns do not conform to current guidelines. Using more BP medications was not associated with higher odds of BP control. Lowering LDL-C might be favorable in terms of BP control.
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Kocyigit SE, Soysal P, Ates Bulut E, Dokuzlar O, Isik AT. Thiazide therapy is not related to any changes in cognitive function in older hypertensive patients with or without dementia: a 26-week follow-up study. Psychogeriatrics 2019; 19:16-22. [PMID: 30058745 DOI: 10.1111/psyg.12353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/11/2018] [Accepted: 06/29/2018] [Indexed: 12/14/2022]
Abstract
AIM The study aimed to evaluate the effect of thiazide diuretics, a first-line antihypertensive therapy, on cognitive function in elderly hypertensive patients with or without cognitive impairment. METHODS This retrospective and observational study assessed 286 elderly patients with hypertension. Patients were divided based on thiazide diuretic usage and then into dementia and non-dementia groups. The comprehensive geriatric assessment was performed for all patients. All participants were re-evaluated after a 26-week period. RESULTS In total, 133 patients, including 62 with dementia, took thiazide. There were no significant differences between baseline and follow-up laboratory findings, comprehensive geriatric assessment parameters, including detailed neurocognitive assessment, or electrolytes in the thiazide group, the non-thiazide group, and the dementia group (P > 0.05). CONCLUSION Thiazide therapy does not show any effect on cognitive function in older hypertensive adults regardless of dementia status.
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Affiliation(s)
- Suleyman Emre Kocyigit
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Esra Ates Bulut
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ozge Dokuzlar
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ahmet Turan Isik
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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12
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Ishida T, Oh A, Hiroi S, Shimasaki Y, Tsuchihashi T. Current prescription status of antihypertensive drugs in Japanese patients with hypertension: Analysis by type of comorbidities. Clin Exp Hypertens 2018; 41:203-210. [PMID: 29781721 DOI: 10.1080/10641963.2018.1465074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In 2014, the Japanese Society of Hypertension (JSH) issued revised guidelines for hypertension management. To assess adherence to the guidelines, this retrospective study evaluated the real-world status of antihypertensive drug prescribing for Japanese patients with hypertension, classified by comorbidity: diabetes mellitus, dyslipidemia, gout/hyperuricemia and renal diseases. Data on 59,867 hypertensive patients who received their first prescription for antihypertensive therapy between April 2014 and March 2015, were obtained from a medical insurance claims database for hospitals participating in the Diagnosis Procedure Combination/Per-Diem payment system. The most common drugs prescribed for each comorbidity subgroup were calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs), with prescription rates of around 60-70%. Contrary to JSH recommendations, diuretics and angiotensin-converting enzyme inhibitors were prescribed less often than β-blockers. Whereas diabetes mellitus is a compelling indication for use of renin-angiotensin system inhibitors, CCBs were commonly prescribed in this subgroup. The treatment pattern for patients with comorbid dyslipidemia closely resembled that for the overall patient population. Loop diuretics were prescribed more frequently for patients with renal diseases or gout/hyperuricemia than for those with diabetes mellitus or dyslipidemia. Although antihypertensive drug prescribing varied by comorbidity, JSH 2014 guidelines appeared not to be incorporated adequately into actual clinical practice.
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Affiliation(s)
- Takayuki Ishida
- a Japan Medical Affairs , Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | - Akinori Oh
- a Japan Medical Affairs , Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | - Shinzo Hiroi
- a Japan Medical Affairs , Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | - Yukio Shimasaki
- a Japan Medical Affairs , Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | - Takuya Tsuchihashi
- b Department of Cardiology and Hypertension, Steel Memorial Yawata Hospital , Kitakyushu , Japan
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13
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Del Pinto R, Pietropaoli D, Ferri C. Diastolic blood pressure and risk profile in renal and cardiovascular diseases. Results from the SPRINT trial. ACTA ACUST UNITED AC 2018; 12:513-523.e3. [PMID: 29803637 DOI: 10.1016/j.jash.2018.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/08/2018] [Accepted: 04/19/2018] [Indexed: 01/13/2023]
Abstract
The Systolic Blood Pressure Intervention Trial (SPRINT) trial demonstrated the efficacy and safety of targeting a systolic blood pressure of <120 mmHg compared to <140 mmHg in selected hypertensive patients. Some evidence, however, suggests a J-curve for; diastolic blood pressure (DBP) particularly in subjects with cardiovascular (CV) and chronic kidney disease. We evaluated the risk of events in SPRINT with focus on these subgroups according to DBP. Mean DBP (±standard deviation) throughout follow-up time was calculated for each patient. Patients were then categorized into five groups according to mean DBP (<60 mmHg, 60-69 mmHg, 70-79 mmHg [reference], 80-89 mmHg, ≥90 mmHg); hazard ratio for outcomes was assessed overall and in the predefined subgroups. A higher risk for CV events was observed in the lower DBP range overall (hazard ratio 1.46, confidential interval 95% 1.1-1.95, P < .001), but not in the absence of pre-existing CV or renal disease. Indeed, such risk significantly increased above 80 mmHg in patients with CV disease and below 70 mmHg in those with chronic kidney disease for selected outcomes. DBP<70 mmHg particularly affected renal outcomes irrespective of renal status. Different risk profiles according to DBP appear to be related to specific clinical characteristics in SPRINT. These findings require further testing in dedicated trials with appropriate follow-up.
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Affiliation(s)
- Rita Del Pinto
- Division of Internal Medicine & Nephrology, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
| | - Davide Pietropaoli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, San Salvatore Hospital, Dental Clinic, L'Aquila, Italy
| | - Claudio Ferri
- Division of Internal Medicine & Nephrology, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
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14
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Yan Z, Wang Y, Li S, Wang J, Zhang L, Tan H, Li S, Yang L, Pei H, Zhang L, Wang Y, Duan J, Jiao S, Zhao M, Fu S. Hypertension Control in Adults With CKD in China: Baseline Results From the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). Am J Hypertens 2018; 31:486-494. [PMID: 29304216 DOI: 10.1093/ajh/hpx222] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 01/01/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hypertension contributes to increased morbidity and mortality in the chronic kidney disease (CKD) population. Studies on blood pressure control in CKD patients in China are limited. In this study, we aimed to describe the status of blood pressure control in Chinese CKD patients based on the first national prospective CKD cohort data. METHODS A subgroup of Chinese Cohort Study of Chronic Kidney Disease participants with hypertension at baseline was included in the present study. Uncontrolled blood pressure was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Defined daily doses (DDDs) are used as a standard measurement of drug utilization in this population. Factors associated with uncontrolled blood pressure were analyzed using multivariable logistic regression. RESULTS There were 2,251 hypertensive CKD subjects among 2,873 predialysis CKD participants. The awareness, treatment, and control rates of hypertension were 80.7%, 95.6%, and 57.1%, respectively. Factors independently associated with uncontrolled blood pressure were overweight, obesity, albuminuria, decreased estimated glomerular filtration rate (eGFR), and diabetes. Over 50% of study subjects were prescribed 2 or more antihypertensive medications and only 7% were prescribed diuretics. Uncontrolled hypertensive patients were prescribed less antihypertensive medication than controlled hypertensives (DDD 1.3 [1.0-2.3] vs. 2.0 [1.0-3.1], P < 0.001). CONCLUSIONS Hypertension control was suboptimal among hypertensive CKD patients in China, especially among those overweight or with obesity, albuminuria, lower eGFR, and diabetes. Patients with uncontrolled hypertension should undergo treatment regimen evaluation to select the appropriate dosage and type of antihypertensive medications.
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Affiliation(s)
- Zhe Yan
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Yu Wang
- Renal Division, Department of Medicine, Peking University First Hospital
| | - Shaomei Li
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital
| | - Huibin Tan
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Sumin Li
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Lin Yang
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Huaying Pei
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Liping Zhang
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Yan Wang
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Jianzhao Duan
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Sumin Jiao
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital
| | - Shuxia Fu
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University
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15
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Shah SJ, Stafford RS. Current Trends of Hypertension Treatment in the United States. Am J Hypertens 2017; 30:1008-1014. [PMID: 28531239 DOI: 10.1093/ajh/hpx085] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/29/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To examine current patterns of hypertension (HTN) treatment in the United States, including blood pressure (BP) control, prevalence of different antihypertensive agents, and variations in treatment associated with patient and physician characteristics. METHODS We used data from the National Disease and Therapeutic Index (NDTI), a nationally representative physician survey produced by QuintilesIMS. We selected patients with a diagnosis of HTN and identified those prescribed antihypertensive therapies. We analyzed the type of antihypertensive agents prescribed. Extent of BP control, and associated patient and physician characteristics. We calculated 95% confidence intervals that accounted for the multistage NDTI sampling design. RESULTS Among those treated for HTN in 2014, BP control varied: systolic BP (SBP) ≥160 (15%) vs. SBP 150-159 (9%) vs. SBP 140-149 (19%) vs. SBP 130-139 (26%) vs. SBP <130 (32%). Of those treated for HTN, 29% used of angiotensin-converting enzyme inhibitors (ACEIs); 24%, thiazide-like diuretics; 22%, angiotensin receptor blockers (ARBs), 21%, calcium-channel blockers (CCBs); and 19% beta-blockers. Newer drugs had very limited uptake; no drugs approved after 2002 were used in more than 5% of patients. Selection of agents varied only modestly by patient and physician characteristics. CONCLUSIONS The treatment of HTN in 2014 predominantly involved older medications in 5 major classes of drugs: ACEIs, thiazide diuretics, ARBs, CCBs, and beta-blockers. Selection of antihypertensive agents showed limited variation by age, gender, race, and insurance type. Although 58% of treated patients had SBP <140, 24% had poorly controlled HTN with SBP ≥150, indicating the need for improved treatment.
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Affiliation(s)
- Shreya J Shah
- Department of Medicine, Stanford University, Palo Alto, California, USA
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16
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Schmittdiel JA, Dlott R, Young JD, Rothmann MB, Dyer W, Adams AS. The Delivery Science Rapid Analysis Program: A Research and Operational Partnership at Kaiser Permanente Northern California. Learn Health Syst 2017; 1. [PMID: 29152588 PMCID: PMC5687292 DOI: 10.1002/lrh2.10035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Health care researchers and delivery system leaders share a common mission to improve health care quality and outcomes. However, differing timelines, incentives, and priorities are often a barrier to research and operational partnerships. In addition, few funding mechanisms exist to generate and solicit analytic questions that are of interest to both research and to operations within health care settings, and provide rapid results that can be used to improve practice and outcomes. Methods The Delivery Science Rapid Analysis Program (RAP) was formed in 2013 within the Kaiser Permanente Northern California Division of Research, sponsored by The Permanente Medical Group. A steering committee consisting of both researchers and clinical leaders solicits and reviews proposals for rapid analytic projects that will use existing data and are feasible within 6 months and with up to $30,000 (approximately 25%–50% full‐time equivalent) of programmer/analyst effort. Review criteria include the importance of the analytic question for both research and operations, and the potential for the project to have a significant impact on care delivery within 12 months of completion. Results The RAP funded 5 research and operational analytic projects between 2013 and 2017. These projects spanned a wide range of clinical areas, including lupus, pediatric obesity, diabetes, e‐cigarette use, and hypertension. The hypertension RAP project, which focused on optimizing thiazide prescribing in Black/African American patients with hypertension, led to new insights that inform an equitable care quality metric designed to reduce blood pressure control disparities throughout the Kaiser Permanente Northern California region. Conclusions Programs that actively encourage research and operational analytic partnerships have significant potential to improve care, enhance research collaborations, and contribute to the building and sustaining of learning health systems.
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Affiliation(s)
- Julie A Schmittdiel
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Rick Dlott
- The Permanente Medical Group, Oakland, California, USA
| | | | | | - Wendy Dyer
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alyce S Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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