1
|
Guo L, Du X, Wu H, Xia S, Du J, Kong X, Yang X, Wang C, Dong J, Ma C, Engineer L. Factors associated with patients' healthcare-seeking behavior and related clinical outcomes under China's hierarchical healthcare delivery system. Front Public Health 2024; 12:1326272. [PMID: 38680927 PMCID: PMC11047042 DOI: 10.3389/fpubh.2024.1326272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/07/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction The hierarchical healthcare delivery system is an important measure to improve the allocation of medical resources and promote equitable distribution of basic medical and health services. It is one of the key factors in the success or failure of China's medical reform. This study aims to analyze the factors influencing patients' healthcare-seeking behaviors, including socioeconomic and clinical outcomes, under China's hierarchical healthcare delivery system, and to provide potential solutions. Methods Patients receiving outpatient treatment in the past 14 days and inpatient care in the past 1 year were investigated. The multivariate logistic regression was used to analyze the influencing factors of patient's medical treatment behavior selection, and to compare whether the clinical outcomes of primary medical institutions and grade A hospitals are the same. Results Nine thousand and ninety-eight person-times were included in the study. Of these, 4,538 patients were outpatients, 68.27% of patients were treated in primary medical institutions; 4,560 patients were hospitalized, 58.53% chose to be hospitalized in grade A hospitals. Provinces and cities, urban and rural areas, occupation, education level, medical insurance type, income, whether there are comorbid diseases, and doctors' medical behavior are the factors affecting the choice of medical treatment behavior. Patients who choose primary medical institutions and grade A hospitals have different control levels and control rate for the blood pressure, blood lipids, blood glucose. Conclusion Under the hierarchical diagnosis and treatment system, the patients' choice of hospital is mainly affected by their level of education, medical insurance types, and the inpatients are also affected by whether there are comorbid conditions. Clinical outcomes of choosing different levels of hospitals were different.
Collapse
Affiliation(s)
- Lizhu Guo
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Xin Du
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huanqi Wu
- Data Science Academy, Capital University of Economics and Business, Beijing, China
| | - Shijun Xia
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Du
- Beijing Centre for Disease Prevention and Control, Beijing, China
| | - Xiangrong Kong
- Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Xiaohui Yang
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chi Wang
- Heart Health Research Centre, Beijing, China
| | - Jianzeng Dong
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lilly Engineer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
2
|
Tahkola A, Korhonen P, Kautiainen H, Niiranen T, Mäntyselkä P. The impact of antihypertensive treatment initiation on health-related quality of life and cardiovascular risk factor levels: a prospective, interventional study. BMC Cardiovasc Disord 2021; 21:444. [PMID: 34530733 PMCID: PMC8447729 DOI: 10.1186/s12872-021-02252-7] [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: 02/20/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Effective prevention and treatment of hypertension is one of the most potential interventions in terms of preventing cardiovascular deaths and disabilities. However, the treatment control is often poor. This may be partly explained by the impact of hypertension diagnoses and treatment on health-related quality of life. Quality of life is also an important outcome for a hypertensive patient. Most of the previous studies on health-related quality of life in hypertension have concentrated on patients with treated hypertension and less is known about the initiation of medication and the first treatment year. Methods In this interventional study, we followed 111 primary care patients with newly diagnosed hypertension in real world primary care setting in Finland for 12 months. Results We found significant decrease in both systolic and diastolic blood pressure levels, as well as modest decrease in cholesterol levels and alcohol consumption. However, the health-related quality of life also slightly deteriorated during the first treatment year. Conclusions Our study shows that the initiation of hypertension treatment results in cardiovascular risk decrease among newly diagnosed Finnish hypertensive patients, but it is accompanied by small negative impact on health-related quality of life. However, the deterioration in health-related quality of life is of small magnitude and earlier research demonstrates several measures to enhance treatment and avoid impairment in health-related quality of life. Trial registration ClinicalTrials NCT02377960 (Date of registration: 04/03/2015).
Collapse
Affiliation(s)
| | | | | | | | - Pekka Mäntyselkä
- Primary Health Care Unit, Kuopio University Hospital and University of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
3
|
Referrals to, and characteristics of patients attending a specialist hypertension clinic. J Hum Hypertens 2021; 36:315-324. [PMID: 33686210 DOI: 10.1038/s41371-021-00514-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/08/2022]
Abstract
The management of hypertension is suboptimal in Ireland and internationally. The role of a specialist hypertension clinic is not always defined but an analysis of the reasons for referral are likely informative. Also, a description of the clinical characteristics of patients with hypertension will inform requirements for comprehensive hypertension management in the community and secondary care. Patients were recruited at consecutive hypertension clinics at St James Hospital, Dublin from July to September 2019. Reasons for referral, clinical characteristics of patients, their investigations and treatment were analyzed. 236 patients were included in the study. The majority of patients, 83%, were obese or overweight. A family history of hypertension was a frequent finding with 70.8% of patients reporting same. 26.7% of patients were under the age of 40. 78% of referrals were from primary care and the most referrals were to investigate secondary causes of hypertension or because the patient was ≤40 years of age. Calcium channel blockers were the treatment most frequently prescribed (51.7%). Clinic blood pressure for the cohort was 137/81 mmHg and this was replicated by their ambulatory BP. This insight into the contemporary management of hypertension highlights the frequency of obesity and a positive family history in those with hypertension. Most referrals were consistent with international guidance though deviations were evident. Findings suggest a national program for hypertension with greater focus on public health interventions and better resourcing of primary care is required.
Collapse
|
4
|
Bord S, Zelber‐Sagi S, O'Brien Cherry C, Yeshua H, Matalon A, Schuster RJ. A Model of Chronic Disease Management: Israeli Physicians' Approach to Cardiovascular Risk Factor Management. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
5
|
Feasibility of a checklist in treating hypertension in primary care - base line results from a cluster-randomised controlled trial (check and support). BMC Cardiovasc Disord 2018; 18:240. [PMID: 30567497 PMCID: PMC6299921 DOI: 10.1186/s12872-018-0963-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/21/2018] [Indexed: 12/11/2022] Open
Abstract
Background Most patients with antihypertensive medication do not achieve their blood pressure (BP) target. The most important factor behind this failure is poor medication adherence. However, non-adherence to therapy does not concern only patients. Clinicians also tend to lack adherence to hypertension guidelines, overestimate BP control and be satisfied with inadequate BP control. The aim of this non-blinded, cluster-randomised, controlled study was to investigate if using a checklist would improve the quality of care in the initiation of new antihypertensive medication and help reduce non-adherence. Methods The study was conducted in eight primary care study centres in Central Finland, randomised to function as either intervention (n = 4) or control sites (n = 4). We included patients aged 30–75 years who were prescribed antihypertensive medication for the first time. Initiation of medication in the intervention group was carried out with a 9-item checklist, filled in together by the treating physician and the patient. Hypertension treatment in the control group was managed by the treating physician without a study-specific protocol. Results In total, 119 patients were included in the study, of which 118 were included in the analysis (n = 59 in the control group, n = 59 in the intervention group). When initiating antihypertensive medication, an adequate BP target was set for 19% of the patients in the control group and for 68% in the intervention group. Shortly after the appointment, only 14% of the patients in the control group were able to remember the adequate BP target, compared with 32% in the intervention group. The use of the checklist was also related to more regular agreement on the next follow-up appointment (64% in the control group versus 95% in the intervention group). No adverse events or side effects were related to the intervention. Conclusions Even highly motivated new hypertensive patients in Finnish primary care have significant gaps in their informational and behavioural skills. The use of a checklist for initiation of antihypertensive medication was related to significant improvement in these skills. Based on our findings, the use of a checklist might be a practical tool for addressing this problem. Trial registration NCT02377960. Date of registration: February 26th, 2015.
Collapse
|
6
|
Zechmann S, Senn O, Valeri F, Neuner-Jehle S, Rosemann T, Djalali S. The impact of an individualized risk-adjusted approach on hypertension treatment in primary care. J Clin Hypertens (Greenwich) 2017; 19:510-518. [PMID: 28058765 DOI: 10.1111/jch.12958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 01/13/2023]
Abstract
Previous studies suggest that up to 60% of all patients with hypertension receive inappropriate treatment. Current 2013 European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines recommend taking cardiovascular risk factors into account when assessing treatment for patients with hypertension. The authors hypothesize that this approach will reduce the proportion of patients receiving inappropriate treatment. In this cross-sectional study using electronic medical records of Swiss primary care patients, the authors estimate the proportion of patients receiving inappropriate treatment using two approaches: (1) based on a blood pressure threshold of 140/90 mm Hg; and (2) based on cardiovascular risk factors. A total of 22 434 patients with hypertension were identified. Based on these approaches, 72.7% and 44.6% of patients, respectively, qualified for drug treatment. In addition, 23.0% and 10.8% of patients, respectively, received inappropriate treatment. Application of the 2013 ESH/ESC guidelines reduced the proportion of patients receiving inappropriate treatment by 50%. This shows the major impact of risk adjustment and highlights the need for a patient-centered approach in hypertension treatment.
Collapse
Affiliation(s)
- Stefan Zechmann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Sima Djalali
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
7
|
|
8
|
Schmieder RE, Jumar A, Fronk EM, Alexandre AF, Bramlage P. Quality of life and emotional impact of a fixed-dose combination of antihypertensive drugs in patients with uncontrolled hypertension. J Clin Hypertens (Greenwich) 2016; 19:126-134. [DOI: 10.1111/jch.12936] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Roland E. Schmieder
- Department for Nephrology and Hypertension; University Hospital Erlangen; Erlangen Germany
| | - Agnes Jumar
- Department for Nephrology and Hypertension; University Hospital Erlangen; Erlangen Germany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine; Mahlow Germany
| |
Collapse
|
9
|
Lavoie KL, Rash JA, Campbell TS. Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia. Annu Rev Pharmacol Toxicol 2016; 57:263-283. [PMID: 27618738 DOI: 10.1146/annurev-pharmtox-010716-104952] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Limitations are highlighted in the emerging literature examining interventions to reduce clinical inertia. An evidence-based framework to address these limitations is proposed that uses behavior change theory and advocates for shared decision making and enhanced guideline development and dissemination.
Collapse
Affiliation(s)
- Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal (UQAM), Montreal, Quebec H3C 3P8, Canada.,Montreal Behavioural Medicine Centre (MBMC), Research Centre, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec H2J 1C5, Canada
| | - Joshua A Rash
- Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada;
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada;
| |
Collapse
|
10
|
Evolution of therapy inertia in primary care setting in Spain during 2002–2010. J Hypertens 2014; 32:1138-45; discussion 1145. [DOI: 10.1097/hjh.0000000000000118] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
11
|
Distinctive unhealthy eating pattern in free-living middle-aged hypertensives when compared with dyslipidemic or overweight patients. J Hypertens 2014; 31:1554-63. [PMID: 23591702 DOI: 10.1097/hjh.0b013e32836130f8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate habitual dietary intakes in patients with established hypertension, dyslipidemia and/or overweight. METHODS A national sample of 6167 French free-living patients, aged 45-65 years, in whom daily food and nutrient intakes (24-h records) and clinical status were regularly monitored between 1994 and 2002. RESULTS For each disorder, affected patients have reduced fat and energy intakes compared with nonaffected participants after adjustment for confounding factors. In addition, after further adjustment for energy intake, dyslipidemic patients eat less cheeses, sweets, eggs and appetizers, whereas overweight patients eat less bread and sweets, more yoghurts, vegetables, meats and poultries in comparison to their nonaffected counterparts. By contrast, hypertensive patients drink more wines and less milk, eat less yoghurts, fruits and vegetables, more processed meats than participants without hypertension. Nutrient intakes also reflect these distinctive eating patterns as shown by reduced carbohydrate intake and increased protein and mineral intakes in overweight patients and increased alcohol intake and decreased mineral intakes in hypertensives when compared with nonaffected participants. Among affected patients, antihypertensive and hypolipidemic drug treatments are not associated with additional differences in daily food and nutrient intakes except eggs that are consumed in smaller amounts by treated dyslipidemic patients. CONCLUSION Hypertensive patients maintain an unhealthy eating pattern that tends to perpetuate their disorder in contrast to dyslipidemic or overweight patients who adopt more protective diets. The origin of this behavioural difference and poor adherence to practice guidelines between hypertensives and other cardiovascular risk patients needs to be investigated.
Collapse
|
12
|
Ott C, Schneider MP, Raff U, Ritt M, Striepe K, Alberici M, Schmieder RE. Effects of manidipine vs. amlodipine on intrarenal haemodynamics in patients with arterial hypertension. Br J Clin Pharmacol 2013; 75:129-35. [PMID: 23240643 DOI: 10.1111/j.1365-2125.2012.04336.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Intraglomerular pressure is one of the main drivers of progression of renal failure. Experimental data suggest that there are important differences between calcium channel blockers (CCBs) in their renal haemodynamic effects: manidipine reduces, whereas amlodipine increases intraglomerular pressure. The aim of this study was to investigate the effects of manidipine and amlodipine treatment on intragomerular pressure (P(glom)) in patients with mild to moderate essential hypertension. METHODS In this randomized, double-blind, parallel group study, hypertensive patients were randomly assigned to receive manidipine 20 mg (n = 54) or amlodipine 10 mg (n = 50) for 4 weeks. Renal plasma flow (RPF) and glomerular filtration rate (GFR) were determined by constant-infusion input-clearance technique with p-aminohippurate (PAH) and inulin. P(glom) and resistances of the afferent (R(A)) and efferent (R(E)) arterioles were calculated according to the model established by Gomez. RESULTS P(glom) did not change in the manidipine group (P = 0.951), whereas a significant increase occurred in the amlodipine group (P = 0.009). There was a significant difference in the change of P(glom) by 1.2 mmHg between the manidipine and amlodipine group (P = 0.042). In both treatment arms, R(A) was reduced (manidipine P = 0.018; amlodipine P < 0.001). The reduction of R(A) was significantly more pronounced with amlodipine compared with manidipine treatment (P < 0.001). R(E) increased in both treatment arms (manidipine P = 0.012; amlodipine P = 0.002), with no difference between the treatment arms. Both CCBs significantly reduced systolic and diastolic blood pressure (BP) (both P < 0.001). However, amlodipine treatment resulted in a significantly greater decrease of BP compared with manidipine (P < 0.001). CONCLUSIONS In accordance with experimental data after antihypertensive treatment of 4 weeks, intraglomerular pressure was significantly lower with the CCB manidipine than with amlodipine, resulting and explaining their disparate effects on albuminuria.
Collapse
Affiliation(s)
- Christian Ott
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Germany
| | | | | | | | | | | | | |
Collapse
|
13
|
Patients with treatment-resistant hypertension report increased stress and anxiety. J Hypertens 2013; 31:610-5; discussion 615. [PMID: 23303395 DOI: 10.1097/hjh.0b013e32835d6e53] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Paulsen MS, Andersen M, Thomsen JL, Schroll H, Larsen PV, Lykkegaard J, Jacobsen IA, Larsen ML, Christensen B, Sondergaard J. Multimorbidity and blood pressure control in 37 651 hypertensive patients from Danish general practice. J Am Heart Assoc 2012; 2:e004531. [PMID: 23525411 PMCID: PMC3603256 DOI: 10.1161/jaha.112.004531] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Patients with hypertension are primarily treated in general practice. However, major studies of patients with hypertension are rarely based on populations from primary care. Knowledge of blood pressure (BP) control rates in patients with diabetes and/or cardiovascular diseases (CVDs), who have additional comorbidities, is lacking. We aimed to investigate the association of comorbidities with BP control using a large cohort of hypertensive patients from primary care practices. Methods and Results Using the Danish General Practice Database, we included 37 651 patients with hypertension from 231 general practices in Denmark. Recommended BP control was defined as BP <140/90 mm Hg in general and <130/80 mm Hg in patients with diabetes. The overall control rate was 33.2% (95% CI: 32.7 to 33.7). Only 16.5% (95% CI: 15.8 to 17.3) of patients with diabetes achieved BP control, whereas control rates ranged from 42.9% to 51.4% for patients with ischemic heart diseases or cerebrovascular or peripheral vascular diseases. A diagnosis of cardiac heart failure in addition to diabetes and/or CVD was associated with higher BP control rates, compared with men and women having only diabetes and/or CVD. A diagnosis of asthma in addition to diabetes and CVD was associated with higher BP control rates in men. Conclusion In Danish general practice, only 1 of 3 patients diagnosed with hypertension had a BP below target. BP control rates differ substantially within comorbidities. Other serious comorbidities in addition to diabetes and/or CVD were not associated with lower BP control rates; on the contrary, in some cases the BP control rates were higher when the patient was diagnosed with other serious comorbidities in addition to diabetes and/or CVD.
Collapse
Affiliation(s)
- Maja S Paulsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Suzuki H, Shimada Y, Fujiwara K. Combination therapy with losartan/hydrochlorothiazide for blood pressure reduction and goal attainment in a real-world clinical setting in Japan. Ther Adv Cardiovasc Dis 2012; 6:237-244. [DOI: 10.1177/1753944712464285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Objective: When physicians prescribe a new antihypertensive drug, they do not know the extent of the drug’s effect on lowering blood pressure. To resolve this dilemma, a Web-based program was constructed for real-time entry and analysis of treatment. This observational study evaluated the efficacy of losartan/hydrochlorothiazide (Lo/HCTZ) in lowering blood pressure (BP) and achieving BP target values. Methods: Physicians prescribed Lo/HCTZ for patients with hypertension who failed to achieve target BP values of < 140/90 mmHg and < 130/80 mmHg in patients with diabetes or chronic kidney disease, respectively, with antihypertensive drugs including an angiotensin receptor blocker. Results: From December 2006 to December 2009, the data of 88,254 patients were entered into this database, and the data of 24,825 subjects were analyzed. At the first visit, a total of 88,254 patients received a first prescription of Lo/HCTZ daily. Among these, at the end of the present analysis, 24,825 (28%) outpatients had a follow-up visit at 1 month and 20,726 (23%) outpatients had a follow-up visit at 6 months. The prevalence of hypertensive patients achieving systolic blood pressure (SBP) control (< 140 mmHg) increased over time from 6.9% to 54.3% in females and 6.1% to 52.3% in males ( p < 0.05). At the start of the study, the levels of SBP were significantly highest in the eldest patients (≥ 75 years) followed by the group of 65–75 years and lowest in the youngest patients (≤ 64 years). However, at the end of the study, there were no differences in levels of SBP among the three groups. Conclusions: This Web-based system may provide useful information when a new drug is first released into the market. Treatment with Lo/HCTZ enabled a substantial proportion of hypertensive patients to achieve the recommended goal of < 140/90 mmHg.
Collapse
Affiliation(s)
- Hiromichi Suzuki
- Department of Nephrology, Saitama Medical University, 38 Morohonngo, Moroyama machi, Iruma gun, Saitama, 350-0495, Japan
| | - Yukio Shimada
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | | |
Collapse
|
16
|
Almas A, Godil SS, Lalani S, Samani ZA, Khan AH. Good knowledge about hypertension is linked to better control of hypertension; a multicentre cross sectional study in Karachi, Pakistan. BMC Res Notes 2012; 5:579. [PMID: 23095492 PMCID: PMC3534478 DOI: 10.1186/1756-0500-5-579] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/16/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND According to the National Health survey only 3% of the population has controlled hypertension. This study was designed to elucidate the knowledge about hypertension in hypertensive patients at three tertiary care centers in Karachi. Secondly we sought to compare the knowledge of those with uncontrolled hypertension and controlled hypertension. METHODS It was a cross-sectional study conducted at The Aga Khan University hospital (AKUH), Ziauddin Hospital (ZH) and Civil hospital, Karachi (CHK. All diagnosed Hypertensive patients (both inpatients and outpatients) coming to a tertiary care hospital in Pakistan aged > 18 years were included. Patients were categorized into 2 groups: controlled and uncontrolled hypertension based on their initial BP readings on presentation Uncontrolled Hypertension was defined as average BP ≥ 140/90 mm Hg in patients on treatment. Controlled Hypertension (HTN) was defined as average BP <140/90 mm Hg in patients on treatment. Standardized methods were used to record BP in the sitting position. Knowledge was recorded as a15 item question. Primary outcome was knowledge about hypertension. RESULTS A total of 650 participants were approached and consented 447 were found eligible. 284(63.5%) were from Aga Khan University, 101(22.6) from Dow University of health sciences and 62(13.9) were from Ziauddin University. Mean (SD) age of participants was 57.7(12) years, 50.1(224) were men. Controlled hypertension was present in 323(72.3) and uncontrolled hypertension was present in 124(27.4). The total mean (SD) Knowledge score was 20.97(4.93) out of a maximum score of 38. On comparison of questions related to knowledge between uncontrolled and controlled hypertension, there was statistically significant different in; meaning of hypertension (p <0.001), target SBP(p0.001), target DBP(p 0.001), importance of SBP versus DBP, improvement of health with lowering of blood pressure (p 0.002), high blood pressure being asymptomatic (p <0.001), changing lifestyle improves blood pressure(p 0.003),hypertension being a lifelong disease (<0.001), lifelong treatment with antihypertensives(<0.001) and high blood pressure being part of aging(<0.001). On comparison of knowledge as a composite score between uncontrolled and controlled hypertensive; Mean (SD) score was 21.85(4.74) v18.67 (4.70) (p value: < 0.001). On multivariate analysis; gender β (95% CI) 1.67(0.75, 2.59) p <0.001, uncontrolled blood pressure; -2.70(-3.76,-1.67) p <0.001, Sindhi ethnicity; -1.79(-3.25,-3.27) p 0.01 and pukhtoon ethnicity; -2.72(-4.13,-1.32) p <0.001 were significantly associated with knowledge score. CONCLUSION Knowledge about hypertension in hypertensive patients is not adequate and is alarmingly poor in patients with uncontrolled hypertension. More emphasis needs to be made on target blood pressure and need for taking antihypertensives for life to patients by physicians.
Collapse
Affiliation(s)
- Aysha Almas
- Department of Medicine, Aga Khan University, Stadium road, Karachi, Pakistan.
| | | | | | | | | |
Collapse
|
17
|
[Medical conduct in primary care as regards blood pressure control. PRESCAP 2010 study]. Semergen 2012; 39:3-11. [PMID: 23517891 DOI: 10.1016/j.semerg.2012.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 05/15/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. PATIENTS AND METHODS Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where ≥140/90mmHg. RESULTS A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. CONCLUSIONS The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia.
Collapse
|
18
|
Williamson M, Cardona-Morrell M, Elliott JD, Reeve JF, Stocks NP, Emery J, Mackson JM, Gunn JM. Prescribing Data in General Practice Demonstration (PDGPD) project--a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension. BMC Health Serv Res 2012; 12:273. [PMID: 22913571 PMCID: PMC3515472 DOI: 10.1186/1472-6963-12-273] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 07/30/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1) hypertension (HT) and 2) chronic heart failure (CHF). The objectives of this study were to improve general practitioner's drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. METHODS A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI) intervention on prescribing practice among Australian general practitioners (GP) in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion) with each group undertaking the clinical topics (CHF and HT) in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a "control" for the other two groups.De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. DISCUSSION This paper describes the study protocol for a project that will contribute to the development of acceptable and sustainable methods to promote QI activities within routine general practice, enhance prescribing practices and improve patient outcomes in the context of CHF and HT. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), Trial # 320870.
Collapse
Affiliation(s)
- Margaret Williamson
- Research & Development Team, National Prescribing Service, Level 7, 418a Elizabeth St, Surry Hills, NSW 2012, Australia
| | - Magnolia Cardona-Morrell
- Research & Development Team, National Prescribing Service, Level 7, 418a Elizabeth St, Surry Hills, NSW 2012, Australia
| | - Jeffrey D Elliott
- Program Implementation Team, National Prescribing Service, Level 7, 418a Elizabeth St, Surry Hills, NSW 2012, Australia
| | - James F Reeve
- e-Health and Decision Support Team, National Prescribing Service, Level 6, 176 Wellington Parade, East Melbourne, VIC, 3002, Australia
| | - Nigel P Stocks
- Discipline of General Practice, The University of Adelaide, 178 North Terrace, Adelaide, SA, 5005, Australia
| | - Jon Emery
- Department of General Practice, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Judith M Mackson
- Program Implementation Team, National Prescribing Service, Level 7, 418a Elizabeth St, Surry Hills, NSW 2012, Australia
| | - Jane M Gunn
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, VIC, 3053, Australia
| |
Collapse
|
19
|
Use of aliskiren in a 'real-life' model of hypertension management: analysis of national Web-based drug-monitoring system in Italy. J Hypertens 2012; 30:194-203. [PMID: 22157325 DOI: 10.1097/hjh.0b013e32834e1c66] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In Italy, prescriptions of the direct renin inhibitor aliskiren (aliskiren) to high-risk hypertensive patients must be electronically filled by specialized physicians only when at least two antihypertensive drug classes (independently of the dosages), fails to normalize blood pressure (BP) levels. AIM To analyze the effects of the addition of aliskiren 150-300 mg daily to antihypertensive therapy in a population of high cardiovascular risk hypertensive patients with uncontrolled BP levels. METHODS Clinical data were derived from patients included in the national Web-based drug-monitoring system. Follow-up visits were required for measuring BP levels, and collecting data on drug safety and tolerability. RESULTS Between March 2009 and February 2010, aliskiren was prescribed by 6464 specialized physicians to 11 511 treated, uncontrolled hypertensive patients (47.6% women, aged 68.0 ± 11.1 years, BMI 28.4 ± 4.9 kg/m) with organ damage or comorbidities. During 6-month observation, only a few drug-related side-effects were reported (n = 33). At the entry and 1-month follow-up visits (n = 8197; 70.6%), BP levels were 158.9 ± 16.8 and 142.1 ± 15.2 mmHg for SBP and 90.8 ± 9.6 and 83.1 ± 8.5 mmHg for DBP, respectively. At 6-month (n = 4907; 42.3%), SBP and DBP levels were 137.9 ± 13.9 and 81.3 ± 8.0 mmHg, respectively. A consistent reduction in the use of all classes of concomitant antihypertensive drugs was recorded. CONCLUSION Although data derived from national registries need to be interpreted with caution, the Italian Web-based drug-monitoring system provided information on 'real-life' use of aliskiren in hypertension. In this uncontrolled, high-risk treated hypertensive population, SBP and DBP levels recorded during treatment with aliskiren were consistently lower than those recorded at entry visits in a context of a very low rate of reported side-effects.
Collapse
|
20
|
Schmieder RE, Goebel M, Bramlage P. Barriers to cardiovascular risk prevention and management in Germany--an analysis of the EURIKA study. Vasc Health Risk Manag 2012; 8:177-86. [PMID: 22536072 PMCID: PMC3333468 DOI: 10.2147/vhrm.s29915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background and purpose Despite the availability of risk engines to determine cardiovascular risk, risk factor control is suboptimal. Using EURIKA data we compared risk factor control in Germany with that of 11 other European countries (rest of Europe [ROE]) to identify differences and opportunities for improvement. Methods EURIKA was a multinational, cross-sectional study in 12 European countries including Germany from May 2009 to January 2010. Physicians’ attitudes to risk factor control based on the 2007 European guidelines on cardiovascular disease (CVD) prevention in a representative cohort of 7641 primary care outpatients aged ≥50 years with no CV disease and at least one major CV risk factor were determined. Results Compared to the ROE, German physicians were more frequently male (72.7% vs 62.6%), had a higher mean age (51.7 ± 8.4 vs 47.0 ± 9.7 years), faced higher patient loads (37.9% vs 16.5% had >199 patients/week), and involved other health sector professionals (dieticians, psychologists) less (31.8% vs 41.0% in the ROE). The European Society of Cardiology (ESC) guidelines on CVD prevention were more important for German physicians (60.6% vs 55.9%), while those who didn’t use them gave reasons for nonuse as too many (62.5% vs 46.2%), too confusing, unrealistic, or not applicable to their patients. Risk engines were used less (54.5% vs 70.7%), with perceived lack of time (65.5% vs 60.2%) a frequent reason for nonuse. Risk factor control in German patients was inadequate (control rates: hypertension 36.3%, dyslipidemia 30.4%, type 2 diabetes 40.6%, obesity 28.8%) but largely comparable to other ROE countries; however, physicians tended to overestimate control rates. Conclusion EURIKA provides comprehensive data on the status of primary prevention of CVD in clinical practice in Germany and reveals considerable potential for improving the primary prevention of CVD.
Collapse
|
21
|
Gil-Guillén V, Orozco-Beltrán D, Márquez-Contreras E, Durazo-Arvizu R, Cooper R, Pita-Fernández S, González-Segura D, Carratalá-Munuera C, Martín de Pablo JL, Pallarés V, Pertusa-Martínez S, Fernández A, Redón J. Is There a Predictive Profile for Clinical Inertia in Hypertensive Patients? Drugs Aging 2011; 28:981-92. [PMID: 22117096 DOI: 10.2165/11596640-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
22
|
Banegas JR, Lundelin K, de la Figuera M, de la Cruz JJ, Graciani A, Rodríguez-Artalejo F, Puig JG. Physician perception of blood pressure control and treatment behavior in high-risk hypertensive patients: a cross-sectional study. PLoS One 2011; 6:e24569. [PMID: 21935425 PMCID: PMC3173407 DOI: 10.1371/journal.pone.0024569] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 08/11/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We examined physician perception of blood pressure control and treatment behavior in patients with previous cardiovascular disease and uncontrolled hypertension as defined by European Guidelines. METHODS A cross-sectional study was conducted in which 321 primary care physicians throughout Spain consecutively studied 1,614 patients aged ≥18 years who had been diagnosed and treated for hypertension (blood pressure ≥140/90 mmHg), and had suffered a documented cardiovascular event. The mean value of three blood pressure measurements taken using standardized procedures was used for statistical analysis. RESULTS Mean blood pressure was 143.4/84.9 mmHg, and only 11.6% of these cardiovascular patients were controlled according to 2007 European Guidelines for Hypertension Management target of <130/80 mmHg. In 702 (49.2%) of the 1426 uncontrolled patients, antihypertensive medication was not changed, and in 480 (68.4%) of these cases this was due to the physicians judgment that blood pressure was adequately controlled. In 320 (66.7%) of the latter patients, blood pressure was 130-139/80-89 mmHg. Blood pressure level was the main factor associated (inversely) with no change in treatment due to physician perception of adequate control, irrespective of sociodemographic and clinical factors. CONCLUSIONS Physicians do not change antihypertensive treatment in many uncontrolled cardiovascular patients because they considered it unnecessary, especially when the BP values are only slightly above the guideline target. It is possible that the guidelines may be correct, but there is also the possibility that the care by the physicians is appropriate since BP <130/80 mmHg is hard to achieve, and recent reviews suggest there is insufficient evidence to support such a low BP target.
Collapse
Affiliation(s)
- José R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
23
|
Petrella R, Michailidis P. Retrospective analysis of real-world efficacy of angiotensin receptor blockers versus other classes of antihypertensive agents in blood pressure management. Clin Ther 2011; 33:1190-203. [PMID: 21885126 DOI: 10.1016/j.clinthera.2011.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Efficacy of blood pressure (BP) lowering may differ between clinical trials and what is observed in clinical practice. These differences may contribute to poor BP control rates among those at risk. OBJECTIVE We conducted an observational study to determine the BP-lowering efficacy of angiotensin receptor blocker (ARB) versus non-ARB-based antihypertensive treatments in a large Canadian primary care database. METHODS We analyzed the South Western Ontario database of 170,000 adults (aged >18 years) with hypertension persisting with antihypertensive medication for ≥9 months. Routine standard of care office BP was measured using approved manual aneroid or automated devices. BP <140 mm Hg and/or <90 mm Hg ≤9 months after treatment initiation, persistence (presence of initial antihypertensive prescription at the first, second, third, and fourth year anniversary) with antihypertensive therapy, and the presence of a cardiovascular (CV) event (ie, myocardial infarction) were studied. RESULTS After 9 months of monotherapy, 28% (978 of 3490) of patients on ARBs achieved target BP versus 27% (839 of 3110) on angiotensin-converting enzyme inhibitors (ACEIs) (P > 0.05), 26% (265 of 1020) on calcium channel blockers (CCBs) (P > 0.05), 21% (221 of 1050) on β-blockers (P = 0.002), and 19% (276 of 1450) on diuretics (P = 0.001). Attainment rates were significantly higher with irbesartan (38%; 332 of 873) versus losartan (32%; 335 of 1047; P = 0.01), valsartan (19%; 186 of 977; P = 0.001), and candesartan (25%; 148 of 593; P = 0.001). BP goal attainment rates were significantly higher when ARB was compared with non-ARB-based dual therapy (39%; 1007 of 2584 vs 31%; 1109 of 3576; P = 0.004); irbesartan + hydrochlorothiazide (HCTZ) was significantly higher than losartan + HCTZ (36%; 500 of 1390 vs 20%; 252 of 1261; P = 0.001). For patients receiving dual or tri-therapy, 48% (667 of 1390) of patients receiving irbesartan reached target BP versus 41% to 42% for losartan (517 of 1261), valsartan (194 of 462), and candesartan (168 of 401) (P = 0.001 for each). After 4 years, persistence rates were not statistically different among ARB, CCB, and diuretic monotherapies, but appeared somewhat higher with ACEIs and β-blockers (78%, 78%, 79%, 91%, and 84%, respectively). Persistence was not significantly different between irbesartan and losartan monotherapy (76% for both; P > 0.05), but was significantly higher with irbesartan + HCTZ versus losartan + HCTZ (96% vs 73%, respectively; P = 0.001). Patients treated with ARBs reported fewer CV events than those receiving ACEIs or CCBs (4.3% vs 7.0% and 11.0%, respectively; P < 0.001). Within the ARB class, the lowest rate was with irbesartan (3.0% vs 4.6%-5.0% for other ARBs; P < 0.02). CONCLUSIONS In this real-world setting, hypertensive adults treated with ARBs versus β-blockers or diuretics were more likely to have evidence-based target BP recorded. In addition, patients using ARBs versus ACEIs or CCBs had fewer reports of CV events.
Collapse
Affiliation(s)
- Robert Petrella
- Faculty of Medicine, Dentistry University of Western Ontario, London, Canada.
| | | |
Collapse
|
24
|
Doménech CS, Caro JLL, Sanz VP, Moreno FJA, Rodríguez IL, Loro AN, Zamorano MÁ, García NG, Conesa MDA, Lázaro Y de Mercado P. [Objective KONTROL study: therapeutic inertia in hypertensive patients attended in primary care of Spain]. Aten Primaria 2011; 43:638-47. [PMID: 21414690 DOI: 10.1016/j.aprim.2010.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/20/2010] [Accepted: 09/09/2010] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVES To determine the level of therapeutic inertia (TI), and the factors associated to the patient, doctor and the health organisation, in hypertensive patients treated in Primary Care (PC). DESIGN Cross-sectional, multicentre study. SETTING A sample of PC Teams from all over Spain. PARTICIPANTS The study was conducted among PC doctors using a questionnaire and clinical records of 4 patients. MAIN MEASUREMENTS The TI was calculated for each patient (TIp) as the proportion of visits in which there was no change in medication when this was indicated. RESULTS A total of 543 PC doctors provided data on 2,032 patients, who fulfilled the indication of a change in requirement. There was TI In 77.8% of cases. The TIp observed was non-existent or low for 17.1% of the patients, intermediate for 42% and high for 40.8%. For the patients, the factors most associated with TIp were, age (P<.001), diabetes (P<.001), stroke (P<.01), obesity (P<.01) and a low education level (P<.001). To be female, be less than 40 years or more than 55 years, to be a family doctor with a training program other than MIR and to work in the public sector increased the probability of TIp (P<.001 for all the assumptions). CONCLUSIONS The results of the study indicate that there is TI in 7 out every 10 visits made by hypertensive patients in Primary care. There are significant differences as regards the clinical characteristics of the patients and of the doctors.
Collapse
|
25
|
Abellán Alemán J, Ruilope Urioste LM, Leal Hernández M, Armario García P, Tiberio López G, Martell Claros N. [Control of cardiovascular risk factors in patients with stroke attended in primary care in Spain. ICTUSCARE study]. Med Clin (Barc) 2011; 136:329-35. [PMID: 21334698 DOI: 10.1016/j.medcli.2010.04.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 04/08/2010] [Accepted: 04/13/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this cross-sectional, multicenter survey was: 1) To investigate the level of control of cardiovascuar risk factors in patients with a previous stroke. 2) To know the pharmacological therapy used to attain the control. PATIENTS AND METHODS Data obtained from a total of 955 patients were included in the analysis.. There were evaluated cardiovascular risk factors, parameters related to the degree of control, analytical parameters, antropometric and pharmacological indicated treatment. RESULTS The majority (61%) had suffered an ischemic stroke and 97.7% presented at least one associated cardiovascular risk factor, being hypertension (84.8%) and dyslipidemia (61.8%) the most frequent. Other factors were abdominal obesity (42.9%), diabetes mellitus (35.6%) and smoking (25.1%). Only 1.2% of the patients presented an adequate control of all cardiovascular risk factors. Only 17.6% had a well controlled blood pressure and in 29.8% LDL-cholesterol was well controlled. In 50.2% of diabetic patients HbA1c was well controlled. Angiotensin receptor blockers were the most widely used antihypertensive drugs (57.6%) while thiazide diuretics were prescribed in 33.4%. Statins were prescribed in 72.8% of patients and metformin, aspirin and acenocumarol in 30.2%, 57.3%, and 15.0% respectively. CONCLUSIONS In conclusion, in patients with a past history of stroke arterial hypertension is the most common cardiovascular risk factor and the control of these factors requires an improvement.
Collapse
Affiliation(s)
- José Abellán Alemán
- Universidad Católica de Murcia, Cátedra de Riesgo cardiovascular, Murcia, España.
| | | | | | | | | | | |
Collapse
|
26
|
Weir MR, Hsueh WA, Nesbitt SD, Littlejohn TJ, Graff A, Shojaee A, Waverczak WF, Qian C, Jones CJ, Neutel JM. A Titrate-to-Goal Study of Switching Patients Uncontrolled on Antihypertensive Monotherapy to Fixed-Dose Combinations of Amlodipine and Olmesartan Medoxomil ± Hydrochlorothiazide. J Clin Hypertens (Greenwich) 2011; 13:404-12. [DOI: 10.1111/j.1751-7176.2011.00437.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
27
|
Richy FF, Laurent S. Efficacy and safety profiles of manidipine compared with amlodipine: a meta-analysis of head-to-head trials. Blood Press 2011; 20:54-9. [PMID: 20945994 PMCID: PMC3026391 DOI: 10.3109/08037051.2010.518670] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 08/09/2010] [Indexed: 01/05/2023]
Abstract
Abstract The aim of this meta-analysis was to compare the efficacy and safety profile of manidipine 20 mg with that of amlodipine 10 mg. A systematic research of quantitative data produced or published between 1995 and 2009 was performed. Head-to-head randomized controlled trials (RCTs) of 12 months minimum duration reporting comparative efficacy (changes in systolic and diastolic blood pressure) and safety (total adverse events and ankle oedema), were included. Four high-quality RCTs, accounting for 838 patients (436 received manidipine and 402 received amlodipine) were included. The efficacy of manidipine and amlodipine was statistically equivalent: effect size for DBP = -0.08 (p = 0.22) and SBP = -0.01 (p = 0.83). The global safety of manidipine was significantly better than amlodipine: the relative risk (RR) for adverse event was 0.69 (0.56-0.85), and particularly for ankle oedema RR was 0.35 (0.22-0.54). Publication bias was not significant and the robustness of the analyses was good. These data suggest a better efficacy/safety ratio of manidipine over amlodipine.
Collapse
Affiliation(s)
- Florent F Richy
- Department of Public Health, Epidemiology and Health Economics, University of Liege Faculty of Medicine, Belgium.
| | | |
Collapse
|
28
|
Schuster RJ, Steichen O, Ogunmoroti O, Ellison S, Terwoord N, Duhot D, Beaufils M. Physician cardiovascular disease risk factor management: practices in France vs the United States. J Clin Hypertens (Greenwich) 2011; 13:10-8. [PMID: 21214716 PMCID: PMC8673332 DOI: 10.1111/j.1751-7176.2010.00370.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 07/07/2010] [Accepted: 07/12/2010] [Indexed: 11/30/2022]
Abstract
Cardiovascular risk factor management by French vs US primary care physicians was studied. A survey was conducted that found that French physicians spend >20 minutes while US physicians spend five to 10 minutes (P<.001) addressing cardiovascular risk with patients. Fifty-three percent of French (vs 33% of US) physicians focus more on lifestyle modification and less on medication management (P<.0001). Sixty-nine percent of French physicians spend 0% to 20% of their time on administration while 65% of US physicians spend 10% to 30% (P=.0028). Fifty-one percent of French physicians see patients in one to three months for follow-up, while 51% of US physicians see patients in three to six months (P<.0001). Eighty-seven percent of French (vs 39% of US) physicians have guidelines available in the examination room either frequently or very frequently. US physicians report disparities in care more frequently than do French physicians (P<.0001). Forty-nine percent of French (vs 10% of US) physicians believe that they have relative freedom to practice medicine (P<.001). US physicians report greater administrative efforts, frustration, and disparities in their practice. French physicians focus more of their efforts on lifestyle management and see their patients more frequently and for a longer visit time.
Collapse
Affiliation(s)
- Richard J Schuster
- University of Georgia, Center for Global Health, College of Public Health, Athens, GA 30602-7394, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Minasian LM, Carpenter WR, Weiner BJ, Anderson DE, McCaskill-Stevens W, Nelson S, Whitman C, Kelaghan J, O'Mara AM, Kaluzny AD. Translating research into evidence-based practice: the National Cancer Institute Community Clinical Oncology Program. Cancer 2010; 116:4440-9. [PMID: 20572032 PMCID: PMC2945622 DOI: 10.1002/cncr.25248] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The recent rapid acceleration of basic science is reshaping both our clinical research system and our healthcare delivery system. The pace and growing volume of medical discoveries are yielding exciting new opportunities, yet we continue to face old challenges to maintain research progress and effectively translate research into practice. The National Institutes of Health and individual government programs increasingly are emphasizing research agendas that involve evidence development, comparative-effectiveness research among heterogeneous populations, translational research, and accelerating the translation of research into evidence-based practice as well as building successful research networks to support these efforts. For more than 25 years, the National Cancer Institute Community Clinical Oncology Program has successfully extended research into the community and facilitated the translation of research into evidence-based practice. By describing its keys to success, this article provides practical guidance to cancer-focused, provider-based research networks as well as those in other disciplines.
Collapse
Affiliation(s)
- Lori M. Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - William R. Carpenter
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, NC, USA
- UNC-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- North Carolina Comprehensive Cancer Program, Raleigh, NC, USA
| | - Bryan J. Weiner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, NC, USA
- UNC-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | | | - Cynthia Whitman
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Joseph Kelaghan
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Ann M. O'Mara
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Arnold D. Kaluzny
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, NC, USA
| |
Collapse
|
31
|
Aliot E, Breithardt G, Brugada J, Camm J, Lip GYH, Vardas PE, Wagner M. An international survey of physician and patient understanding, perception, and attitudes to atrial fibrillation and its contribution to cardiovascular disease morbidity and mortality. Europace 2010; 12:626-33. [PMID: 20421224 PMCID: PMC2859877 DOI: 10.1093/europace/euq109] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aims Atrial fibrillation (AF) is not always perceived as a serious health threat, but is the most common sustained arrhythmia, with a major impact on morbidity, mortality, and patient quality of life (QoL). A survey was undertaken to examine the level of understanding, perception, and attitudes of the cardiovascular risks associated with AF. Methods and results The AF AWARE group (an international coalition of organizations with an interest in AF) conducted an international quantitative survey in 11 countries in 2009, to investigate patients' (n = 825) and cardiologists' (n = 810) perceptions of AF, preferences for communicating information on AF and burden of AF. Both patients and physicians considered AF life-threatening (55 and 43%, respectively). Physicians were more concerned about the risk of stroke and hospitalizations than patients, whereas patients were most concerned about death risk. One in four patients felt unable to explain AF and >33% were worried or fearful about their disease. Many physicians (51%) wanted more patient information with >60% viewing available information as poor/difficult to find. Hospital specialists and GPs were identified as key information sources for patients. Most patients (83%) reported symptoms, yet 75% claimed to be satisfied with AF therapies. Atrial fibrillation patients, often with associated diseases, made an average of nine visits per year to their doctors, who consider AF difficult and time consuming to manage. Patients and physicians rated the QoL impact of AF as moderate to high. Conclusions A comprehensive international patient and professional information and support programme on AF is needed to improve management and consequently health outcomes.
Collapse
Affiliation(s)
- Etienne Aliot
- Brabois Hospital, University Hospital of Nancy, Nancy, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Bramlage P, Böhm M, Volpe M, Khan BV, Paar WD, Tebbe U, Thoenes M. A global perspective on blood pressure treatment and control in a referred cohort of hypertensive patients. J Clin Hypertens (Greenwich) 2010; 12:666-77. [PMID: 20883226 PMCID: PMC8673112 DOI: 10.1111/j.1751-7176.2010.00322.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 03/04/2010] [Accepted: 03/21/2010] [Indexed: 11/30/2022]
Abstract
Hypertensive patients with cardiovascular (CV) comorbidities are at increased risk, and cardiologists' care should put particular emphasis on controlling blood pressure. Data on blood pressure treatment and control and drug utilization on a global scale, however, are scarce. Aiming to resolve this lack of information, the authors analyzed the data of International Survey Evaluating Microalbuminuria Routinely by Cardiologists in Patients With Hypertension (i-SEARCH) to gain further insights into national and regional blood pressure control and antihypertensive pharmacotherapy prescribed in cardiology practice. A total of 22,282 patients with hypertension from 26 countries were enrolled in 2005/2006. A total of 18,652 patients were treated (mean age, 63.0±11.4 years; 52.2% male; mean body mass index, 28.9 kg/m2). Mean systolic blood pressure was 148.2±19.8 mm Hg and diastolic blood pressure was 86.7±11.6 mm Hg. Blood pressure was controlled in 8.3% of diabetic and 25.3% of nondiabetic patients (21.2% overall), with particularly good control rates in North and Latin America (28.0% and 30.6%, respectively). A total of 31.2% of patients were treated with 1, 39.7% with 2, and 29.1% with ≥3 drugs. β-blockers were being used most frequently (47.9%), in both monotherapy and combination therapy despite low numbers of patients with respective compelling indications for their use. The present data illustrate the potential for an improvement of blood pressure treatment and control in daily cardiology practice.
Collapse
Affiliation(s)
- Peter Bramlage
- Institute for Cardiovascular Pharmacology and Epidemiology, Mahlow, Germany.
| | | | | | | | | | | | | |
Collapse
|
33
|
Conducta del médico ante el mal control de la hipertensión arterial. Aportaciones de los estudios PRESCAP 2002 y PRESCAP 2006 al conocimiento de la inercia terapéutica en España. Semergen 2010. [DOI: 10.1016/j.semerg.2010.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
34
|
Windak A, Gryglewska B, Tomasik T, Narkiewicz K, Yaphe J, Grodzicki T. Competence of Polish primary-care doctors in the pharmacological treatment of hypertension. J Eval Clin Pract 2010; 16:25-30. [PMID: 20367812 DOI: 10.1111/j.1365-2753.2008.01107.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Compliance with treatment guidelines for hypertension is variable. This study assessed the competence of Polish general practitioners in compliance with hypertension treatment guidelines, and doctor and patient characteristics associated with compliance. METHODS The study was conducted on a random sample of Polish primary-care doctors working in clinics contracted by the national health insurance funds. Doctors completed a questionnaire consisting of eight case vignettes describing patients with elevated blood pressure. The cases differed on three variables relating to the level of blood pressure, the presence or absence of diabetes mellitus, and the presence or absence of other risk factors. Doctors were asked to give their treatment decision for each case. Demographic data and details of the doctor's practice were also collected. Treatment decisions were tabulated, and associations between doctor and patient characteristics and treatments were assessed. RESULTS One hundred twenty-five doctors (65% response rate) completed the questionnaire. Compliance with treatment guidelines was judged to be 51%. Poor compliance with guidelines was noted for patients with diabetes mellitus. The level of blood pressure was the strongest predictor of drug treatment. Angiotensin-converting enzyme inhibitors were the most frequently prescribed medications. Appropriate decisions were associated with practice in large cities. CONCLUSIONS Compliance with hypertension treatment guidelines was judged to be poor in this study of a sample of Polish primary-care doctors using case vignettes to test competence. Additional emphasis on hypertension guidelines in training doctors is needed, especially for diabetic patients and for doctors outside urban centres.
Collapse
Affiliation(s)
- Adam Windak
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland.
| | | | | | | | | | | |
Collapse
|
35
|
Mabotuwana T, Warren J. An ontology-based approach to enhance querying capabilities of general practice medicine for better management of hypertension. Artif Intell Med 2009; 47:87-103. [PMID: 19709865 DOI: 10.1016/j.artmed.2009.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 03/24/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
|
36
|
Thoenes M, Neuberger HR, Volpe M, Khan BV, Kirch W, Böhm M. Antihypertensive drug therapy and blood pressure control in men and women: an international perspective. J Hum Hypertens 2009; 24:336-44. [PMID: 19798089 DOI: 10.1038/jhh.2009.76] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular death represents the single largest cause of mortality in women with 70% of deaths attributable to modifiable risk factors, such as hypertension. This analysis aims at evaluating, whether there are gender disparities in antihypertensive drug usage and blood pressure (BP) control. We included 18 017 patients with arterial hypertension from the International Survey Evaluating Microalbuminuria Routinely by Cardiologists in patients with Hypertension (I-SEARCH). The study was conducted between September 2005 and March 2006 in 26 countries, and data on patient demographics, cardiovascular disease and risk factors, BP, and cardiovascular drug treatment were collected. Mean systolic blood pressure (SBP) was 2.1 mm Hg higher in women (150.6+/-0.35 mm Hg, n=8357/18 017) than in men (148.5+/-0.35 mm Hg; P<0.0001, n=9526/18 017), whereas no difference in diastolic BP was seen (88.2+/-0.20 vs 88+/-0.20 mm Hg; P=0.198). Gender differences in SBP were more pronounced in diabetic as compared with non-diabetic patients (3.5 vs 1.7 mm Hg, n=4272 vs n=13 611; P<0.0001) and became evident at an age 55 years old. Overall BP-control rate was 33.6% in men and 30.6% in women (P<0.0001) and was lower in diabetic as compared with non-diabetic patients. In all, 30% of patients used one, 40% used two and 30% used > or = 3 drugs without gender differences. Response rates to different drug regimens appeared to be similar. However, women received more frequently thiazides and beta-blockers, and less frequently ACE-inhibitors as monotherapy. Major efforts are required to improve BP-management, especially in women.
Collapse
Affiliation(s)
- M Thoenes
- Medical Faculty Carl Gustav Carus, Institute for Clinical Pharmacology, Technical University Dresden, Dresden, Germany
| | | | | | | | | | | |
Collapse
|
37
|
Germino FW. Efficacy and tolerability of nebivolol monotherapy by baseline systolic blood pressure: A retrospective analysis of pooled data from two multicenter, 12-week, randomized, double-blind, placebo-controlled, parallel-group, dose-ranging studies in patients with mild to moderate essential hypertension. Clin Ther 2009; 31:1946-56. [DOI: 10.1016/j.clinthera.2009.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2009] [Indexed: 10/20/2022]
|
38
|
Lima SML, Portela MC, Koster I, Escosteguy CC, Ferreira VMB, Brito C, Vasconcellos MTLD. Utilização de diretrizes clínicas e resultados na atenção básica à hipertensão arterial. CAD SAUDE PUBLICA 2009; 25:2001-11. [DOI: 10.1590/s0102-311x2009000900014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 05/19/2009] [Indexed: 11/22/2022] Open
Abstract
Este estudo objetivou identificar estratégias facilitadoras da implantação de diretrizes clínicas de hipertensão arterial em uma unidade de atenção básica, focalizando os efeitos do Programa Saúde da Família (PSF) e do Programa Remédio em Casa na adesão dos profissionais e nos resultados assistenciais. Partiu-se de um cadastro com 5.499 pacientes hipertensos, estratificados segundo inscrição no PSF e no Programa Remédio em Casa. O procedimento de seleção aleatória adotado resultou em amostras de 150 prontuários em três estratos e um estrato (sem PSF e sem PRC) com somente 22 prontuários. Estatísticas descritivas e modelos de regressão linear foram obtidos, incorporando-se as informações estruturais do desenho da amostra utilizado (estratos e peso amostrais). A adesão às diretrizes clínicas, segundo registros nos prontuários, foi muito baixa. Esperava-se um efeito positivo das estratégias PSF e Programa Remédio em Casa na adesão às diretrizes clínicas e resultados assistenciais. Observou-se a tendência de um efeito positivo do Programa Remédio em Casa nos resultados assistenciais e um desempenho levemente favorável do PSF na adesão às diretrizes clínicas.
Collapse
|
39
|
Buckley B, Shanahan E, Colwell N, Turgonyi E, Bramlage P, Perry IJ. Blood Pressure Control in Hypertensive Patients in Irish Primary Care Practices. J Clin Hypertens (Greenwich) 2009; 11:432-40. [DOI: 10.1111/j.1751-7176.2009.00151.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
40
|
Fazekas C, Matzer F, Greimel ER, Moser G, Stelzig M, Langewitz W, Loewe B, Pieringer W, Jandl-Jager E. Psychosomatic medicine in primary care: influence of training. Wien Klin Wochenschr 2009; 121:446-53. [PMID: 19657607 DOI: 10.1007/s00508-009-1176-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 04/01/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Christian Fazekas
- Department of Medical Psychology and Psychotherapy, Medical University Graz, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Sanchis Doménech C, Llisterri Caro JL, Palomo Sanz V, Aranda Lara P, Sánchez Zamorano MÁ, Lázaro y de Mercado P. Estudio “Objetivo Kontrol”: inercia terapéutica en hipertensión arterial. Diseño y metodología. HIPERTENSION Y RIESGO VASCULAR 2009. [DOI: 10.1016/s1889-1837(09)71434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
42
|
Bramlage P. Fixed combination of irbesartan and hydrochlorothiazide in the management of hypertension. Vasc Health Risk Manag 2009; 5:213-24. [PMID: 19436667 PMCID: PMC2672456 DOI: 10.2147/vhrm.s3302] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Approximately 25% of the adult population worldwide is hypertensive and thus at risk of cardiovascular morbidity and mortality. Despite the availability of many antihypertensive drugs, at least 50% of patients do not achieve blood pressure (BP) targets and thus remain at increased cardiovascular risk. Fixed-dose (FD) irbesartan/hydrochlorothiazide (HCTZ) is an antihypertensive combination therapy approved for the treatment of patients whose BP is not adequately controlled on monotherapy and for initial treatment of patients likely to need multiple drugs to achieve their BP goal. The efficacy and tolerability of FD irbesartan/HCTZ has been demonstrated in both patient populations in large multicenter studies. In patients failing antihypertensive monotherapy, FD irbesartan/HCTZ (150/12.5 mg) has been shown to be more effective than FD valsartan/HCTZ (80/12.5 mg) and at least comparable to FD losartan/HCTZ (50/12.5 mg). In patients with moderate or severe hypertension receiving FD irbesartan/HCTZ as initial therapy, this combination achieved more rapid BP reductions compared with irbesartan monotherapy and enabled a greater proportion of patients with severe hypertension to achieve their BP target. FD irbesartan/HCTZ is thus a valuable addition to the clinician’s armamentarium for the management of hypertension and should help more patients achieve their BP target.
Collapse
Affiliation(s)
- Peter Bramlage
- Institute for Cardiovascular Pharmacology and Epidemiology, Mahlow, Germany.
| |
Collapse
|
43
|
Bramlage P, Hasford J. Blood pressure reduction, persistence and costs in the evaluation of antihypertensive drug treatment--a review. Cardiovasc Diabetol 2009; 8:18. [PMID: 19327149 PMCID: PMC2669450 DOI: 10.1186/1475-2840-8-18] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 03/27/2009] [Indexed: 12/18/2022] Open
Abstract
Background Blood pressure lowering drugs are usually evaluated in short term trials determining the absolute blood pressure reduction during trough and the duration of the antihypertensive effect after single or multiple dosing. A lack of persistence with treatment has however been shown to be linked to a worse cardiovascular prognosis. This review explores the blood pressure reduction and persistence with treatment of antihypertensive drugs and the cost consequences of poor persistence with pharmaceutical interventions in arterial hypertension. Methods We have searched the literature for data on blood pressure lowering effects of different antihypertensive drug classes and agents, on persistence with treatment, and on related costs. Persistence was measured as patients' medication possession rate. Results are presented in the form of a systematic review. Results Angiotensin II receptor blocker (ARBs) have a competitive blood pressure lowering efficacy compared with ACE-inhibitors (ACEi) and calcium channel blockers (CCBs), beta-blockers (BBs) and diuretics. 8 studies describing the persistence with treatment were identified. Patients were more persistent on ARBs than on ACEi and CCBs, BBs and diuretics. Thus the product of blood pressure lowering and persistence was higher on ARBs than on any other drug class. Although the price per tablet of more recently developed drugs (ACEi, ARBs) is higher than that of older ones (diuretics and BBs), the newer drugs result in a more favourable cost to effect ratio when direct drug costs and indirect costs are also considered. Conclusion To evaluate drugs for the treatment of hypertension several key variables including the blood pressure lowering effect, side effects, compliance/persistence with treatment, as well as drug costs and direct and indirect costs of medical care have to be considered. ARBs, while nominally more expensive when drug costs are considered only, provide substantial cost savings and may prevent cardiovascular morbidity and mortality based on the more complete antihypertensive coverage. This makes ARBs an attractive choice for long term treatment of hypertension.
Collapse
Affiliation(s)
- Peter Bramlage
- Institute for Cardiovascular Pharmacology and Epidemiology, Mahlow, Germany.
| | | |
Collapse
|
44
|
Increased prevalence of metabolic syndrome in uncontrolled hypertension across Europe: the Global Cardiometabolic Risk Profile in Patients with hypertension disease survey. J Hypertens 2008; 26:2064-70. [PMID: 18806632 DOI: 10.1097/hjh.0b013e32830c45c3] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Global Cardiometabolic Risk Profile in Patients with hypertension disease survey investigated the cardiometabolic risk profile in adult outpatients with hypertension in Europe according to the control of blood pressure (BP) as defined in the European Society of Hypertension and of the European Society of Cardiology (ESH/ESC) guidelines. METHODS Data on BP control and cardiometabolic risk factors were collected for 3370 patients with hypertension in 12 European countries. Prevalence was analyzed according to BP status and ATP III criteria for metabolic syndrome. RESULTS BP was controlled (BP < 140/90 mmHg for nondiabetic patients; BP < 130/80 mmHg for diabetic patients) in 28.1% of patients. Patients with uncontrolled BP had significantly higher mean weight, BMI, waist circumference, fasting blood glucose, total cholesterol and triglycerides and high-density lipoprotein cholesterol levels were significantly lower (women only) compared with patients with controlled BP (P < 0.05). The prevalence of metabolic syndrome and type 2 diabetes was also significantly higher in patients with uncontrolled BP compared with controlled BP (P < 0.001) (metabolic syndrome: 66.5 versus 35.5%; diabetes 41.1 versus 9.8%, respectively). 95.3% of patients with both metabolic syndrome and type 2 diabetes had uncontrolled BP. In a multivariate analysis, diabetes and metabolic syndrome were found to be associated with a high risk of poor BP control: odds ratio, 2.56 (metabolic syndrome); 5.16 (diabetes). CONCLUSION In this European study, fewer than one third of treated hypertensive patients had controlled BP. Metabolic syndrome and diabetes were important characteristics associated with poor BP control. Thus, more focus is needed on controlling hypertension in people with high cardiometabolic risk and diabetes.
Collapse
|
45
|
Abstract
Cardiologists play a central role in managing hypertensive patients, although recent surveys reveal a marked discrepancy between cardiologists' appreciation of their patients' risk status and the measures taken to reduce that risk. The diagnosis and the management of hypertension, in fact, must be viewed today not in isolation, but as part of a patients' global cardiovascular (CV) risk, resulting from the concomitant presence of a variety of risk factors, organ damage (left ventricular hypertrophy, carotid or peripheral atherosclerosis, microalbuminuria or impaired glomerular filtration rate), and hypertension-related clinical conditions. The choice of timing and the intensity of antihypertensive treatment should be based on blood pressure (BP)-lowering efficacy and the propensity to favourably impact patient's individual absolute CV disease risk profile. As part of this paradigm shift in CV disease prevention strategy, cardiologists can take several key steps to help improve standards of hypertension control: (i) increase the awareness of total risk management; (ii) initiate an integrated management strategy tailored to the individual patient's global CV risk (e.g. hypertension, hypercholesterolaemia, diabetes, age, smoking and gender); (iii) use any elevation in BP as a gateway to begin total risk management and (iv) utilise combination therapies (particularly fixed-dose combinations) to achieve more rapid and persistent BP control and improve patient compliance/persistence with therapy. To help improve standards of hypertension control in the cardiology setting, this review examines the concept of treating hypertension using a global risk assessment approach and proposes effective hypertensive therapy as part of global risk management in patients typically seen in cardiology practice.
Collapse
Affiliation(s)
- M Volpe
- Division of Cardiology, II Faculty of Medicine, University of Rome La Sapienza, Pozzilli, IS, Italy.
| | | |
Collapse
|
46
|
Alonso-Moreno F, Llisterri Caro J, Rodríguez-Roca G, Ferreiro Madueño M, González-Segura Alsina D, Divisón Garrote J, Banegas J, Barrios Alonso V, Lou Arnal S, Sánchez Ruiz T, Santos Rodríguez J, Durá Belinchón R. Conducta del médico de Atención Primaria ante el mal control de los pacientes hipertensos. Estudio PRESCAP 2006. Rev Clin Esp 2008; 208:393-9. [DOI: 10.1157/13126341] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
47
|
Initial combination therapy for rapid and effective control of moderate and severe hypertension. J Hum Hypertens 2008; 23:4-11. [PMID: 18615100 DOI: 10.1038/jhh.2008.72] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Moderate (grade 2) and severe (grade 3) hypertension are important public health problems associated with high cardiovascular risk. Blood pressure (BP) control becomes more difficult to achieve as hypertension progresses. Therefore, early and effective treatment is essential to prevent hypertensive urgencies and emergencies and reduce cardiovascular risk. Currently, less than 50% of patients being treated for moderate or severe hypertension in the United States achieve their BP goal as recommended by treatment guidelines. This review examines the cardiovascular risk and physician inertia associated with moderate and severe hypertension, and concludes that increased use of initial combination therapy can overcome many of the barriers to effective BP control. Furthermore, initial combination therapy with a renin-angiotensin system (RAS) inhibitor and diuretic has the potential to rapidly and effectively reduce BP across a range of baseline BPs, with a comparable adverse event profile to monotherapy.
Collapse
|
48
|
Baguet JP, Legallicier B, Auquier P, Robitail S. Updated meta-analytical approach to the efficacy of antihypertensive drugs in reducing blood pressure. Clin Drug Investig 2008; 27:735-53. [PMID: 17914893 DOI: 10.2165/00044011-200727110-00001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Despite advances in the treatment of hypertension, control rates continue to be suboptimal in both Europe and the US. Strategies that improve hypertension control are therefore urgently needed. This study aimed to assess the relative efficacies of various antihypertensive drugs commonly used in France in reducing systolic and diastolic blood pressure (SBP and DBP) by using a meta-analytical approach. This update of a previously published meta-analytical approach extends the number of drugs evaluated from 13 to 19. METHODS A total of 80 randomised, controlled trials published between 1973 and 2007 involving 10 818 patients were selected for inclusion in the meta-analytical approach. Data were examined for 19 drugs, and 16 drugs were included in the analysis: hydrochlorothiazide, indapamide sustained-release (SR), atenolol, amlodipine, lercanidipine, manidipine, enalapril, ramipril, trandolapril, candesartan cilexetil, irbesartan, losartan, olmesartan medoxomil, telmisartan, valsartan and aliskiren. Weighted average reductions in SBP and DBP over a period of 8-12 weeks were calculated for each drug from information on both the mean and the variability in BP reduction. No trials evaluating furosemide, spironolactone or cicletanine satisfied the inclusion criteria for this analysis. RESULTS The average weighted reductions in SBP over 8-12 weeks were most marked with diuretics, and in particular indapamide SR 1.5 mg/day (mean change from baseline -22.2mm Hg), which reduced SBP to a greater extent than any of the other drugs evaluated (at any dosage considered). Average weighted reductions in DBP were generally similar with all classes of antihypertensives and ranged from -11.4mm Hg with the beta-adrenoceptor blocker atenolol and calcium channel antagonists to -10.3mm Hg with the angiotensin II type 1 receptor antagonists. CONCLUSION This new analysis supports the results of the earlier investigation, in that indapamide SR 1.5 mg/day appeared to be the most effective drug for producing significant reductions in SBP within 8-12 weeks, which is an essential element in optimising cardiovascular prevention among hypertensive patients. The clinical application of these results should take into consideration all the limitations discussed in this analysis.
Collapse
Affiliation(s)
- J P Baguet
- Cardiology and Hypertension Unit, Grenoble University Hospital, Grenoble, France.
| | | | | | | |
Collapse
|
49
|
Abstract
Inadequate control of blood pressure may be attributed to both provider-related and patient-related factors. Health care provider-related factors may include an excessive reliance on monotherapy and reluctance to increase drug doses or add additional antihypertensive agents to the treatment regimen. The primary patient-related factor is nonadherence with the prescribed antihypertensive medication. Although the high cost of therapy is sometimes a reason for poor adherence, drug side effects or dosing considerations may be more important factors. Better adherence with antihypertensive medication is associated with a significantly greater likelihood of achieving blood pressure control and, consequently, with lower costs and reduced utilization of health care resources. Therefore, strategies that improve long-term adherence should be adopted. Single-pill, or fixed-dose, combination therapy is one approach that improves adherence, while also providing the antihypertensive efficacy needed to help patients achieve their blood pressure goals.
Collapse
Affiliation(s)
- William J Elliott
- Department of Preventive Medicine, Rush Medical College of Rush University at Rush University Medical Center, Chicago, IL 60612-3244, USA.
| |
Collapse
|