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Yatabe MS, Yatabe J, Asayama K, Staessen JA, Mujaj B, Thijs L, Ito K, Sonoo T, Morimoto S, Ichihara A. The rationale and design of reduction of uncontrolled hypertension by Remote Monitoring and Telemedicine (REMOTE) study. Blood Press 2017; 27:99-105. [PMID: 29172715 DOI: 10.1080/08037051.2017.1406306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Although self-measurement of home blood pressure (HBP) is common in Japan and HBP telemonitoring via the Internet is possible, whether telemonitoring improves HBP control better than conventional practice remains unclear. Furthermore, hypertension care with online communication using telemonitored HBP is feasible, whereas the efficacy and safety of such telemedicine have not been established. We aim to compare traditional care, care with office visits using HBP telemonitoring, and antihypertensive telemedicine based on HBP telemonitoring. METHODS AND DESIGN In total, 444 patients with uncontrolled hypertension will be recruited and randomly assigned to three groups: (1) control: usual care with office visits and HBP self-report, (2) telemonitoring: weekly assessment of transmitted HBP by physicians and treatment adjustment upon office visits, or (3) telemedicine: online communication instead of office visits to adjust medication using telemonitored HBP. Primary outcome is the time to control of HBP, and secondary outcomes include achieved HBP levels, adherence, treatment intensity, adverse events, patient satisfaction and cost-effectiveness. DISCUSSION Hypertension care with telemonitoring and telemedicine are expected to require shorter time to achieve HBP control compared to usual care. Combining HBP telemonitoring with telemedicine may lower the hurdles for starting and persisting to hypertension treatment and eventually reduce cardiovascular events.
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Affiliation(s)
- Midori Sasaki Yatabe
- a Department of Medicine II, Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan
| | - Junichi Yatabe
- a Department of Medicine II, Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan.,b Tohoku Institute for Management of Blood Pressure , Sendai , Japan
| | - Kei Asayama
- b Tohoku Institute for Management of Blood Pressure , Sendai , Japan.,c Department of Hygiene and Public Health , Teikyo University School of Medicine , Tokyo , Japan
| | - Jan A Staessen
- d KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre , Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven , Leuven , Belgium
| | - Blerim Mujaj
- d KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre , Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven , Leuven , Belgium
| | - Lutgarde Thijs
- d KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre , Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven , Leuven , Belgium
| | - Kyotaro Ito
- e Division of Medical Research , PORT incorporation , Tokyo , Japan
| | - Tomohiro Sonoo
- e Division of Medical Research , PORT incorporation , Tokyo , Japan
| | - Satoshi Morimoto
- a Department of Medicine II, Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan
| | - Atsuhiro Ichihara
- a Department of Medicine II, Endocrinology and Hypertension , Tokyo Women's Medical University , Tokyo , Japan
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Sun N, Feng Y, Gao P, Chen X, Qi L, Zhang S, Dong Y, Yang X, Li X, Chen Y, Liu L. Efficacy and tolerability of once-daily 160 mg valsartan in Chinese patients with mild to moderate hypertension. Exp Ther Med 2017; 13:1109-1116. [PMID: 28450950 DOI: 10.3892/etm.2017.4051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/25/2016] [Indexed: 02/05/2023] Open
Abstract
The present multicentre, prospective, open-label, single treatment arm study (Val-Perfect) examined the efficacy and tolerability of once-daily valsartan monotherapy (80 mg for two weeks, followed by 160 mg for eight weeks) in 195 Chinese patients with mild to moderate hypertension, using office, home, and ambulatory blood pressure (BP) monitoring. Significant mean reductions (P<0.0001) were observed in office BP from baseline to week 10, with mean sitting systolic BP (MSSBP) and mean sitting diastolic BP (MSDBP) values of 15.6±12.3 and 11.1±8.6 mmHg, respectively. The office BP control rate at week 10 was 56.9% (target MSSBP/MSDBP <130/80 mmHg for patients with type 2 diabetes or chronic kidney disease, <140/90 mmHg for others). Valsartan treatment significantly reduced mean 24-h SBP/DBP (-6.1/-4.4 mmHg; both P<0.0001) and mean home-monitored SBP/DBP (-13.3/-9.1 mmHg; both P<0.0001) at week 10. The incidence of adverse events (AEs) leading to discontinuation (1.5%) or drug-related AEs (3.1%) was low, with no instances of mortality or drug-related serious AEs. These results indicate that 160 mg valsartan is safe and effective at lowering BP in Chinese patients with mild to moderate hypertension. The significant reductions in office-based and out-of-office BP measures support the clinical relevance of moderate-dose valsartan monotherapy for effective 24-h BP control.
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Affiliation(s)
- Ningling Sun
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Yingqing Feng
- Department of Cardiology, Guangdong General Hospital, Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510080, P.R. China
| | - Pingjin Gao
- Department of Hypertension, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Litong Qi
- Department of Cardiology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Beijing 100730, P.R. China
| | - Yugang Dong
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Xinchun Yang
- Department of Cardiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yundai Chen
- Department of Cardiology, Academy of Military Medical Sciences, Beijing 100850, P.R. China
| | - Lingli Liu
- Medical Affairs, Novartis Pharmaceuticals, Beijing 100004, P.R. China
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Zhu D, Bays H, Gao P, Mattheus M, Voelker B, Ruilope LM. Efficacy and tolerability of a single-pill combination of telmisartan 80 mg and hydrochlorothiazide 25 mg according to age, gender, race, hypertension severity, and previous antihypertensive use: planned analyses of a randomized trial. Integr Blood Press Control 2013; 6:1-14. [PMID: 23637556 PMCID: PMC3636767 DOI: 10.2147/ibpc.s33104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of this work was to describe the efficacy and safety of a telmisartan 80 mg + hydrochlorothiazide 25 mg (T80/H25) single-pill combination therapy in patients with moderate-severe hypertension (mean seated trough cuff systolic blood pressure [BP] ≥ 160 mmHg and diastolic BP ≥ 100 mmHg) in specific patient subpopulations. METHODS This was a planned analysis of a double-blind, multicenter, parallel-group trial that demonstrated the superiority of a single-pill combination of T80/H25 versus T80 monotherapy in terms of systolic BP change from baseline to week 7. Subpopulations included older (aged ≥ 65 years) versus younger, gender, race, hypertension severity, and prior antihypertensive therapy. Endpoints were change from baseline in mean seated trough cuff systolic and diastolic BP, proportion of patients achieving their BP goal (systolic/diastolic BP < 140/90 mmHg), and proportion of patients attaining systolic BP reductions of >30 mmHg and >40 mmHg. RESULTS Across all subgroups, the T80/H25 single-pill combination provided consistently greater systolic and diastolic BP reductions than T80 and more patients had systolic BP reductions of >30 mmHg. In the T80 and T80/H25 groups, BP control was achieved in 34.1% and 48.8% of men, 35.5% and 62.7% of women, 34.5% and 56.6% of Asians, 22.6% and 38.6% of blacks, 36.7% and 57.8% of whites, 36.9% and 57.5% of patients < 65 years, 29.3% and 49.3% ≥65 years, 44.2% and 66.2% of those with grade 2 hypertension, 20.4% and 39.4% of those with grade 3 hypertension, 38.9% and 53.2% of previously untreated patients, 38.1% and 62.5% of patients previously treated with one antihypertensive, and 29.7% and 48.9% of patients previously treated with two or more antihypertensive agents respectively. Treatment was generally well tolerated across the patient subgroups. CONCLUSION The T80/H25 single-pill combination provides consistent BP reductions and higher goal attainment rates versus T80 across a range of hypertensive patient subgroups, which are likely to have a positive impact on patients' cardiovascular risk.
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Affiliation(s)
- Dingliang Zhu
- Shanghai Ruijin Hospital, Shanghai, People's Republic of China
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Hong SH, Wang J, Tak S. A patient-centric goal in time to blood pressure control from drug therapy initiation. Clin Transl Sci 2013; 6:7-12. [PMID: 23399083 DOI: 10.1111/cts.12021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A time frame in which newly diagnosed hypertensive patients attain blood pressure (BP) goal would guide patients through uncertainty associated with initiating drug therapy for hypertension control. This study estimates time to BP goal resulting from drug therapy initiation among real-world hypertensive patients and identifies factors associated with variations in time to BP goal. The study uses a historical cohort design. Hypertensive patients who had initiated antihypertensive drug therapy between July 1, 2002, and December 31, 2003, were followed up to 12 months until the end of 2004. Electronic medical records from a medical group were linked with pharmacy claims, as well as with medical claims. Survival analyses were used to compare lengths of time needed to reach BP goals. A total of 223 patients from a real world practice setting had initiated antihypertensive drug therapy. The patients took 3.25 months (95% CI: 2.49-4.82) to reach BP goal. The patient-centric time to BP goal was 7.1 weeks longer than those reported in controlled experimental settings. This finding highlights the gap between results of controlled clinical trials and their application to clinical practice, and informs healthcare practitioners of the importance of setting a patient-centric goal in pharmacological treatment of hypertension.
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Affiliation(s)
- Song Hee Hong
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN, USA.
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Bains J, Smith WB. Valsartan plus hydrochlorothiazide: a review of its use since its introduction. Expert Opin Pharmacother 2011; 12:1975-84. [DOI: 10.1517/14656566.2011.587124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Joshi SJ, Karbhari PA, Bhoir SI, Bindu K, Das C. RP-HPLC method for simultaneous estimation of bisoprolol fumarate and hydrochlorothiazide in tablet formulation. J Pharm Biomed Anal 2010; 52:362-71. [DOI: 10.1016/j.jpba.2009.10.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 10/21/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
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Lacourcière Y, Poirier L, Samuel R. Valsartan plus hydrochlorothiazide for first-line therapy in hypertension. Expert Rev Cardiovasc Ther 2009; 7:1491-501. [PMID: 19954310 DOI: 10.1586/erc.09.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Goal blood pressure levels are only being achieved in approximately a third of hypertensive patients, which suggests that there is a need for new and/or improved approaches to the treatment of hypertension. The majority of patients with hypertension require combination therapy to control their blood pressure. The use of a combination of drugs with complementary mechanisms of action may provide greater efficacy and tolerability compared with monotherapy, and may allow more rapid achievement of target blood pressure. Moreover, the use of single-pill combinations has the potential to increase adherence and persistence, and reduce costs. The single-pill combination of valsartan plus hydrochlorothiazide was recently approved by the US FDA for first-line use in hypertensive patients who are likely to need multiple drugs to achieve their blood pressure goals. The focus of this article is on those randomized, double-blind trials in which this combination was administered as first-line therapy in patients with essential hypertension.
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Affiliation(s)
- Yves Lacourcière
- Hypertension Research Unit, Centre Hospitalier de l'Université Laval, Quebec, QC, G1V 4G2, Canada.
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