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Muambo KE, Kim MG, Kim DH, Park S, Oh JE. Pharmaceuticals in raw and treated water from drinking water treatment plants nationwide: Insights into their sources and exposure risk assessment. WATER RESEARCH X 2024; 24:100256. [PMID: 39291270 PMCID: PMC11406100 DOI: 10.1016/j.wroa.2024.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 08/06/2024] [Accepted: 09/02/2024] [Indexed: 09/19/2024]
Abstract
Due to the large amounts of pharmaceuticals and personal care products (PPCPs) currently being consumed and released into the environment, this study provides a comprehensive analysis of pharmaceutical pollution in both raw and treated water from full-scale drinking water treatment plants nationwide. Our investigation revealed that 30 out of 37 PPCPs were present in raw water with mean concentrations ranging from 0.01-131 ng/L. The raw water sources, surface water (ND - 147 ng/L), subsurface water (ND - 123 ng/L) and reservoir sources (ND - 135 ng/L) exhibited higher mean concentration levels of pharmaceutical residues compared to groundwater sources (ND - 1.89 ng/L). Meanwhile, in treated water, 17 of the 37 analyzed PPCPs were present with carbamazepine, clarithromycin, fluconazole, telmisartan, valsartan, and cotinine being the most common (detection frequency > 40 %), and having mean concentrations of 1.22, 0.12, 3.48, 40.1, 6.36, and 3.73 ng/L, respectively. These findings highlight that, while water treatment processes are effective, there are some persistent compounds that prove challenging to fully eliminate. Using Monte Carlo simulations, risk assessment indicated that most of these compounds are likely to have negligible impact on human health, except for the antihypertensives. Telmisartan was identified as posing the highest ecological risk (RQ > 1), warranting further investigation, and monitoring. The study concludes by prioritizing specific 14 pharmaceuticals, including telmisartan, clarithromycin, lamotrigine, cotinine, lidocaine, tramadol, and others, for future monitoring to safeguard both ecological and human health.
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Affiliation(s)
- Kimberly Etombi Muambo
- Department of Civil and Environmental Engineering, Pusan National University, Busan 46241, Republic of Korea
| | - Min-Gyeong Kim
- Department of Civil and Environmental Engineering, Pusan National University, Busan 46241, Republic of Korea
| | - Da-Hye Kim
- Institute for Environment and Energy, Pusan National University Busan 46241, Republic of Korea
| | - Sangmin Park
- Department of Environmental Infrastructure Research, National Institute of Environmental Research, Ministry of Environment, Incheon 22689, South Korea
| | - Jeong-Eun Oh
- Department of Civil and Environmental Engineering, Pusan National University, Busan 46241, Republic of Korea
- Institute for Environment and Energy, Pusan National University Busan 46241, Republic of Korea
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Mishra SK, Sonnahalli NK, Chowdhary R. Do antihypertensive medications have an effect on dental implants? A systematic review. Oral Maxillofac Surg 2024; 28:459-468. [PMID: 37330427 DOI: 10.1007/s10006-023-01167-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE The purpose of this systematic review was to compare the clinical outcomes of dental implants in users of antihypertensive medication with those of nonusers. METHODS This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was registered in the International Prospective Register of Systematic Reviews under the number CRD42022319336. The electronic databases Medline (PubMed) and Central Cochrane were searched for relevant scientific literature published in English through May 2022. The focused question was, "Do patients taking antihypertensive medications have a similar impact on the clinical outcome and survival of dental implants compared with nonusers?". RESULTS A total of 49 articles were found, of which 3 articles were finally selected for a qualitative synthesis. The three studies included 959 patients. In all three studies, the commonly used medication was renin-angiotensin system (RAS) inhibitors. Two studies mentioned implant survival rate, which was 99.4% in antihypertensive medication users and 96.1% in the nonusers. One study found a higher implant stability quotient (ISQ) in patients taking antihypertensive medication (75.7 ± 5.9) compared with patients not taking antihypertensive medication (73.7 ± 8.1). CONCLUSIONS The limited available evidence showed that patient taking antihypertensive medications had comparable success rate and implant stability to patients not taking medications. The studies included patients taking different antihypertensive medications, so a drug-specific conclusion regarding the clinical outcome of dental implants is not possible. Further studies are needed, including patients taking certain antihypertensive medications, to determine their effects on dental implants.
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Affiliation(s)
- Sunil Kumar Mishra
- Department of Prosthodontics, Rama Dental College Hospital and Research Centre, Kanpur, Uttar Pradesh, 208024, India.
| | - Nithin Kumar Sonnahalli
- Department of Prosthodontics, Sri Siddhartha Dental College and Hospital, Tumkur, Karnataka, India
| | - Ramesh Chowdhary
- Department of Prosthodontics, Sri Siddhartha Dental College and Hospital, Tumkur, Karnataka, India
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Shahi A, Harrer SL, Shilling JW, Brown ML, Martino N, McFadden C. Acute Kidney Injury After Total Hip and Knee Arthroplasty. What Is the Culprit? Arthroplast Today 2024; 27:101362. [PMID: 38680845 PMCID: PMC11047205 DOI: 10.1016/j.artd.2024.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/31/2024] [Accepted: 02/27/2024] [Indexed: 05/01/2024] Open
Abstract
Background Acute kidney injury (AKI) is associated with increased complications after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to determine the risk factors for AKI after THA and TKA and evaluate if preoperative use of antihypertensive drugs is a risk factor for AKI. Methods A retrospective review of 7406 primary TKAs and THAs (4532 hips and 2874 knees) from 2013 to 2019 was performed. The following preoperative variables were obtained from medical records: medications, chemistry 7 panel, Elixhauser comorbidities, and demographic factors. AKI was defined as an increase in serum creatinine by 26.4 μmol·L-1. Multivariate analysis was performed to identify the risk factors. Results The overall incidence of postoperative AKI was 6.2% (n = 459). Risk factors for postoperative AKI were found to be: chronic kidney disease (odds ratio [OR] = 7.09; 95% confidence interval [CI]: 4.8-9.4), diabetes (OR: 5.03; 95% CI: 2.8-6.06), ≥3 antihypertensive drugs (OR: 4.2; 95% CI: 2.1-6.2), preoperative use of an angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (OR: 3.8; 95% CI: 2.2-5.9), perioperative vancomycin (OR: 2.7; 95% CI: 1.8-4.6), and body mass index >40 kg/m2 (OR: 1.9; 95% CI: 1.3-3.06). Conclusions We have identified several modifiable risk factors for AKI that can be optimized prior to an elective THA or TKA. The use of certain antihypertensive agents namely angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and multidrug antihypertensive regimens were found to significantly increase the risk of AKI. Therefore, perioperative management of patients undergoing joint replacement should include medical comanagement with a focus on careful management of antihypertensives.
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Affiliation(s)
- Alisina Shahi
- Cooper Bone and Joint Institute, Department of Orthopaedics, Cooper University Hospital, Camden, NJ, USA
| | - Samantha L. Harrer
- Cooper Bone and Joint Institute, Department of Orthopaedics, Cooper University Hospital, Camden, NJ, USA
| | - Jack W. Shilling
- Cooper Bone and Joint Institute, Department of Orthopaedics, Cooper University Hospital, Camden, NJ, USA
| | - Matthew L. Brown
- Cooper Bone and Joint Institute, Department of Orthopaedics, Cooper University Hospital, Camden, NJ, USA
| | - Nicole Martino
- Cooper Bone and Joint Institute, Department of Orthopaedics, Cooper University Hospital, Camden, NJ, USA
| | - Christopher McFadden
- Cooper Bone and Joint Institute, Department of Orthopaedics, Cooper University Hospital, Camden, NJ, USA
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Lin PD, Rifas‐Shiman S, Merriman J, Petimar J, Yu H, Daley MF, Janicke DM, Heerman WJ, Bailey LC, Maeztu C, Young J, Block JP. Trends of Antihypertensive Prescription Among US Adults From 2010 to 2019 and Changes Following Treatment Guidelines: Analysis of Multicenter Electronic Health Records. J Am Heart Assoc 2024; 13:e032197. [PMID: 38639340 PMCID: PMC11179868 DOI: 10.1161/jaha.123.032197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Guidelines for the use of antihypertensives changed in 2014 and 2017. To understand the effect of these guidelines, we examined trends in antihypertensive prescriptions in the United States from 2010 to 2019 using a repeated cross-sectional design. METHODS AND RESULTS Using electronic health records from 15 health care institutions for adults (20-85 years old) who had ≥1 antihypertensive prescription, we assessed whether (1) prescriptions of beta blockers decreased after the 2014 Eighth Joint National Committee (JNC 8) report discouraged use for first-line treatment, (2) prescriptions for calcium channel blockers and thiazide diuretics increased among Black patients after the JNC 8 report encouraged use as first-line therapy, and (3) prescriptions for dual therapy and fixed-dose combination among patients with blood pressure ≥140/90 mm Hg increased after recommendations in the 2017 Hypertension Clinical Practice Guidelines. The study included 1 074 314 patients with 2 133 158 prescription episodes. After publication of the JNC 8 report, prescriptions for beta blockers decreased (3% lower in 2018-2019 compared to 2010-2014), and calcium channel blockers increased among Black patients (20% higher in 2015-2017 and 41% higher in 2018-2019, compared to 2010-2014), in accordance with guideline recommendations. However, contrary to guidelines, dual therapy and fixed-dose combination decreased after publication of the 2017 Hypertension Clinical Practice Guidelines (9% and 11% decrease in 2018-2019 for dual therapy and fixed-dose combination, respectively, compared to 2015-2017), and thiazide diuretics decreased among Black patients after the JNC 8 report (6% lower in 2018-2019 compared to 2010-2014). CONCLUSIONS Adherence to guidelines on prescribing antihypertensive medication was inconsistent, presenting an opportunity for interventions to achieve better blood pressure control in the US population.
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Affiliation(s)
- Pi‐I Debby Lin
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Sheryl Rifas‐Shiman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - John Merriman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Joshua Petimar
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Han Yu
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente ColoradoAuroraCOUSA
| | - David M. Janicke
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFLUSA
| | - William J. Heerman
- Department of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
| | - L. Charles Bailey
- Applied Clinical Research Center, Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Carlos Maeztu
- Department of Health Outcomes and Biomedical InformaticsUniversity of FloridaGainesvilleFLUSA
| | - Jessica Young
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Jason P. Block
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
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Shimizu S. Insights into the associative role of hypertension and angiotensin II receptor in lower urinary tract dysfunction. Hypertens Res 2024; 47:987-997. [PMID: 38351189 DOI: 10.1038/s41440-024-01597-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
In men, the lower urinary tract comprises the urinary bladder, urethra, and prostate, and its primary functions include urine storage and voiding. Hypertension is a condition that causes multi-organ damage and an age-dependent condition. Hypertension and the renin-angiotensin system activation are associated with the development of lower urinary tract dysfunction. Hypertensive animal models show bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. In the renin-angiotensin system, angiotensin II and the angiotensin II type 1 receptor, which are expressed in the lower urinary tract, have been implicated in the pathogenesis of lower urinary tract dysfunction. Moreover, among the several antihypertensives, renin-angiotensin system inhibitors have proven effective in human and animal models of lower urinary tract dysfunction. This review aimed to elucidate the hitherto known mechanisms underlying the development of lower urinary tract dysfunction in relation to hypertension and the angiotensin II/angiotensin II type 1 receptor axis and the effect of renin-angiotensin system inhibitors on lower urinary tract dysfunction. Possible mechanisms through which hypertension or activation of Ang II/AT1 receptor axis causes LUTD such as bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. LUT: lower urinary tract, LUTD: lower urinary tract dysfunction, AT1: angiotensin II type 1, ACE: angiotensin-converting enzyme.
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Affiliation(s)
- Shogo Shimizu
- Department of Pharmacology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, 783-8505, Japan.
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Ram CVS, Muruganathan A, S M, Kumar M K. Indian Clinician's Perspective on the Approach to the Management of Hypertension: A Cross-Sectional Study. Cureus 2024; 16:e57435. [PMID: 38699103 PMCID: PMC11063652 DOI: 10.7759/cureus.57435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Hypertension (HTN) is considered one of the most frequent life-threatening noncommunicable illnesses. Because HTN has a significant public health impact on cardiovascular health status and healthcare systems in India, it is critical to study Indian clinicians' approaches to HTN management. Methodology This was a cross-sectional, multicentric, non-interventional, and single-visit study that aimed to gather data from across India and examine sociodemographic characteristics and clinician treatment choices in the management of HTN in Indian individuals. As a result, building an information platform about HTN is critical to preventing and controlling this growing burden. Results A total of 5298 patients were recruited in the study from 1061 study centers across India. Among the study patients, 66.67% were females with a mean age of 53.95 ± 14.4, and 66.28% of hypertensive patients presented comorbidities. Among the known risk factors for HTN, 2227 (44.5%) were smokers, while 2587 (51.7%) had sedentary lifestyles. A family history of HTN in either one or both parents was seen in 1076 (21.50%) patients. In management, 40.40% of patients were on anti-hypertensive monotherapy. Amlodipine (41.8%) in monotherapy and amlodipine + metoprolol (32.34%) in combination therapy were the most commonly prescribed antihypertensive. Conclusion Management of HTN can be improved by imparting patient education and awareness about the need for medication compliance, lifestyle modifications, and regular follow-up clinic visits.
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Affiliation(s)
- C Venkat S Ram
- Hypertension and Blood-Pressure Management Clinic, Apollo Hospitals, Hyderabad, IND
| | - A Muruganathan
- Department of Public Health, Shristy AG Hospital, Tirupur, IND
| | - Manjula S
- Department of Medical Services, Micro Labs Ltd, Bengaluru, IND
| | - Krishna Kumar M
- Department of Medical Services, Micro Labs Ltd, Bengaluru, IND
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Ahuja N, Bhardwaj P, Pathania M, Sethi D, Kumar A, Parchani A, Chandel A, Phadke A. Yoga Nidra for hypertension: A systematic review and meta-analysis. J Ayurveda Integr Med 2024; 15:100882. [PMID: 38484438 PMCID: PMC10950755 DOI: 10.1016/j.jaim.2023.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/05/2023] [Accepted: 12/15/2023] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Hypertension is a prevalent chronic condition that affects a substantial proportion of the world's population. Medications are commonly prescribed for hypertension management, but non-pharmacological interventions like yoga are gaining popularity. OBJECTIVE The purpose of this systematic review and meta-analysis is to assess the efficacy of Yoga Nidra (YN) for the management of hypertension. METHODS A systematic review and meta-analysis of clinical trials, i.e., non-randomized and randomized controlled trials (RCTs) was conducted to investigate the effects of YN on hypertension. PubMed, the Cochrane Library, SCOPUS, and EBSCO were searched for relevant studies published up to September 2022. The quality of the included studies was assessed using the Cochrane risk of bias tool. The primary outcome measure was the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after YN intervention, analyzed as weighted mean difference (WMD), in comparison to control groups. The random-effects model was used for the meta-analysis. Risk of bias was assessed for RCTs and non-RCTs using Cochrane's RoB-2 and ROBINS-I tools, respectively. RESULTS Five RCTs and three Non-RCTs involving a total of 482 participants (239 for YN vs 243 for controls) were included in this review. The meta-analysis indicated that YN significantly reduced SBP (WMD = 12.03 mm Hg, 95% CI [7.12, 16.93], Z = 4.80, p < 0.00001) and DBP (WMD = 6.32 mm Hg, 95% CI [3.53, 9.12], Z = 4.43, p < 0.00001) compared to control groups. The overall risk of bias for the three RCTs was high, whereas for the five non-RCTs, one had an overall moderate risk while the other four had an overall serious risk of bias. DISCUSSION This systematic review and meta-analysis provides evidence supporting the efficacy of YN as a complementary therapy for hypertension management. YN is a safe, cost-effective, and easily accessible intervention that primarily relies on interoception and induces a deep relaxation response in practitioners, aiding them in coping with various components of high blood pressure, such as stress, vascular inflammation, peripheral vascular resistance, etc. Our understanding of the mechanisms of YN is constantly evolving, and there is a need for further research to fully explore and appreciate the significance of this ancient science and its potential efficacy on BP. Considering the results and the multifactorial role of YN, it can act as a safe and reliable adjuvant therapy to complement the pharmacological treatment of hypertension. However, further studies with larger sample sizes, longer follow-up periods, and homogenous populations are warranted. CONCLUSION This meta-analysis suggests that YN is effective in reducing SBP and DBP, particularly in individuals with hypertension. The results highlight the potential of YN as a complementary therapy for hypertension management. Healthcare providers may consider recommending YN to patients with hypertension as an adjuvant therapy to medication. Further studies are required to identify standardized optimal forms and durations of YN best suited for hypertension management.
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Affiliation(s)
- Navdeep Ahuja
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Praag Bhardwaj
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Monika Pathania
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
| | - Dilasha Sethi
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana - SVYASA, Bangaluru, Karnataka, India
| | - Arjun Kumar
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashwin Parchani
- Dept. of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akshita Chandel
- Dept. of General Medicine, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Aashish Phadke
- Division of Endocrine and Metabolic Disorders - Lifestyle Modulations and Yoga Modules, Kasturba Health Society - Medical Research Centre, Mumbai, Maharashtra, India
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Ayebeng C, Okyere J, Salu S, Dickson KS. Examining the influence of wealth status on prehypertension risk in women aged 30-49: evidence from the 2018 Benin demographic and health survey. BMC Res Notes 2024; 17:10. [PMID: 38169420 PMCID: PMC10763151 DOI: 10.1186/s13104-023-06676-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There is an interest in the extent to which the wealth status of women predicts their risk of being pre-hypertensive. This understanding is lacking in the current body of empirical literature, particularly within the context of Benin. Thus, indicating a knowledge gap that must be filled. To this end, the present study aimed to assess the association between wealth status and the risk of prehypertension among women aged 30-49 years in Benin. METHODS This study used a secondary data from the recent (2018) Demographic and Health Survey of Benin. Bivariate and multivariate logistic regression models were computed to examine the association between wealth index and the risks of prehypertension using Stata version 14. Findings were presented in adjusted odds ratio at 95% confidence level. RESULTS Women in the richest wealth index were significantly more likely to have prehypertension than those in the poorest wealth index [AOR = 1.4; 95%CI: 1.26-2.26]. Women aged 45-49 years were more likely to have prehypertension [AOR = 1.5; 95%CI: 1.15-1.98] compared to younger women. Women who used unclean cooking fuel were less likely to have prehypertension compared to those using clean cooking fuel [AOR = 0.6; 95%CI: 0.37,0.87]. CONCLUSION The study concludes that wealth status is a significant predictor of prehypertension among women in Benin. Therefore, the Ministry of Health in Benin should prioritize health education and prehypertension awareness campaigns specifically targeting women in affluent communities and households. These campaigns should focus on promoting healthy dietary choices and encouraging physical activity to mitigate the elevated risk associated with wealth status. Recognizing the influence of age on prehypertension risk, it is imperative for older-middle aged women to be targeted as primary beneficiaries of health education programs and prehypertension screening programs.
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Affiliation(s)
- Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- School of Nursing & Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Samuel Salu
- Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana
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Yang R, Tang J, Kuang M, Liu H. Analysis of prescription status of antihypertensive drugs in Chinese patients with hypertension based on real-world study. Ann Med 2023; 55:276-284. [PMID: 36594446 PMCID: PMC9815216 DOI: 10.1080/07853890.2022.2162113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Globally, the prevalence of hypertension and the accompanying burden of cardiovascular disease are increasing. Through drug utilization research, we can understand the prescription status of hypertension patients and promote rational drug use. The purpose of this retrospective study was to describe the current prescription pattern of antihypertensive drugs in Chinese patients and determine the compliance level of treatment guidelines. MATERIALS AND METHODS Around 11.1 million patients who received a prescription for antihypertensive therapy between January 2021 to December 2021 were obtained from a database of Hangzhou Kang Sheng Health Consulting CO., Ltd. RESULTS The mean age of hypertensive patients was 54.75 ± 12.98 years. About 6.7 million (60.30%) were males. About 46.07% of patients had comorbidities. The most common classes of antihypertensive medications used were calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs). Around 78.33% of participants were on monotherapy. Diuretics + ARBs and Diuretics + CCBs + ARBs were the most commonly prescribed pattern in two-drug combination therapy and three-drug combination therapy, respectively. CONCLUSIONS CCBs and ARBs were the two most frequently prescribed for patients with hypertension. The prescription pattern of antihypertensive medications in the study largely complied with recommended Chinese hypertension guidelines.Key messagesCardiovascular disease is the most common complication of hypertension.Calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) are the two most commonly used drugs for hypertension patients in China.The proportion of combination prescription pattern in Chinese hypertensive patients is low.
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Affiliation(s)
- Renren Yang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Hangzhou, China
| | - Jia Tang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Hangzhou, China
| | - Ming Kuang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Hangzhou, China
| | - Hongying Liu
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Hangzhou, China
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Chen CW, Chang CW, Lin YC, Chen WT, Chien LN, Huang CY. Comparison of clinical outcomes of angiotensin receptor blockers with angiotensin-converting enzyme inhibitors in patients with acute myocardial infarction. PLoS One 2023; 18:e0290251. [PMID: 37708158 PMCID: PMC10501560 DOI: 10.1371/journal.pone.0290251] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Angiotensin receptor blockers (ARBs) are considered an alternative to angiotensin-converting enzyme inhibitors (ACEIs) in patients with acute myocardial infarction (AMI), but in the era of extensive use of preventive therapies and percutaneous coronary intervention, this has not been adequately evaluated in Asians. METHODS This retrospective cohort study used data from the Taiwan National Health Insurance Research Database. In total, 52,620 patients initially hospitalized due to AMI between 2002 and 2015 were assessed. RESULTS After propensity score matching, 14,993 patients each were assigned to ACEI and ARB groups. Patients who received ARBs had significantly lower all-cause mortality (adjusted hazard ratio [aHR]: 0.82; 95% confidence interval [CI]: 0.75-0.90) and hospitalization for heart failure (aHR: 0.92; 95% CI: 0.85-0.99) compared with those who received ACEIs at 18 month follow-up. No significant difference was observed between the two groups in terms of major adverse cardiovascular events (aHR: 098; 95% CI: 0.90-1.07), cardiovascular death (aHR: 0.82; 95% CI: 0.68-1.00), ischemia stroke (aHR: 0.93; 95% CI: 0.77-1.11), and nonfatal myocardial infarction (aHR: 1.04; 95% CI: 0.93-1.17). ARBs showed benefits in many subgroups in terms of all-cause mortality and cardiovascular death. CONCLUSIONS Real-world data demonstrate that ARBs might be associated with lower all-cause mortality and hospitalization for heart failure compared with ACEIs among patients with AMI.
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Affiliation(s)
- Chih-Wei Chen
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Heart institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Wei Chang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Heart institute, Taipei Medical University, Taipei, Taiwan
| | - Yi-Cheng Lin
- Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Wan-Ting Chen
- Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Nien Chien
- Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Heart institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Shahbazi F, Najafi F, Shojaei L, Farzaei MH, Shokoohinia Y, Pasdar Y, Hamzeh B, Tahvilian R, Rahimi W, Shakiba E, Karim H, Dobson A, Bhatt N, Moradinazar M. Hypertension medication from guidelines to practice: A cohort study in western Iran. Pharmacoepidemiol Drug Saf 2023; 32:951-960. [PMID: 36974582 DOI: 10.1002/pds.5626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Hypertension (HTN) is one of the most common risk factors for non-communicable chronic diseases. The aim of the current study is to evaluate the prescribing patterns of antihypertensive medications in Kermanshah Province, west of Iran. METHODS The Ravansar Non-Communicable Diseases (RaNCD) cohort study is the first Kurdish community-based study; subjects' age ranged from 35 to 65 years. In order to examine the use of medications to control blood pressure, participants were asked to bring all prescribed medications to the study center. Treatments were compared with 2013 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guidelines for the management of arterial HTN. RESULTS From a total of 10 040 participants in RaNCD cohort, 1575 (15.7%) individuals were hypertensive, of whom, 1271 (80.7%) people were aware of their condition. From 1153 (73.20%) people under treatment, 840 (72.8%) had their HTN properly controlled. The most common medications used to treat HTN were losartan (27.5%), metoprolol (14.3%), and captopril (11.9%). Regardless of type of treatment, 49.3% of all patients have received the medication for l 6 ≥ years. The most commonly used drugs were β-blockers and angiotension receptor blockers as 620 (31.0%) and 612 (30.6%), respectively. Multivariable analysis showed that female gender, those receive ≥3 antihypertensive agents, and using preferred combinations were associated with a better blood pressure control. In addition, the probability of hypertension control was less likely with increasing duration of treatment (i.e >6 years) and in obese patients with ≥35 kg/m2 . CONCLUSIONS Even though adherence to the international guidelines was acceptable, improvements can be made for better control of HTN. Therefore, it is imperative to educate healthcare professionals on improving their selection of antihypertensive medications and combination therapy for hypertensive patients.
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Affiliation(s)
- Foroud Shahbazi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Lida Shojaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yalda Shokoohinia
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Pharmacognosy & Biotechnology, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Nutritional Sciences Department School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Hamzeh
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Tahvilian
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Werya Rahimi
- Research Center of Oils and fats, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebrahim Shakiba
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Karim
- Kermanshah Cardiovascular Research Center, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Annette Dobson
- Centre for Longitudinal and Life Course Research (CLLR), School of Population Health, University of Queensland, Queensland, Australia
| | - Neha Bhatt
- Ric Scalzo Institute for Botanical Sciences, Sonoran University of Health Sciences, Tempe, Arizona, USA
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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A confirmed COVID-19 in a patient with newly diagnosed hypertension and preexisting type 2 diabetes mellitus: a case report. Ann Med Surg (Lond) 2023; 85:431-434. [PMID: 36923768 PMCID: PMC10010790 DOI: 10.1097/ms9.0000000000000151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/22/2022] [Indexed: 03/18/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) aggravates preexisting diabetes mellitus and contributes to newly discovered hypertension by increasing blood pressure by inhibiting the activity of angiotensin-converting enzyme 2 in the rennin-angiotensin system. Diabetes patients may be more vulnerable to COVID-19 due to chronic comorbidities such as obesity and cardiovascular disease such as hypertension. Case presentation On 23 March 2022, a retired black African woman in her 60s was taken into the emergency room with the chief complaints of frequent midnight urine, hazy vision, headache, fever, and tingling in her hands and feet. A throat swab PCR test that revealed positive results after 28 h was used to confirm COVID-19. Her electrocardiogram showed sinus tachycardia with a heart rate of 105 beats per minute. Fluid resuscitation (0.9% normal saline) of 1000 ml and drip insulin administration commenced as soon as she was brought to an ICU. Clinical discussion In this case report, the patient had been previously diagnosed with type 2 diabetes mellitus. COVID-19 affects the beta cells, forcing them to release insulin and increasing insulin insufficiency, which leads to her blood glucose raising. Type 2 diabetes mellitus is therefore the most frequent comorbidity of COVID-19 in this case report. Conclusion Poor blood glucose management in the case of COVID-19 may increase the pathogen's susceptibility, the likelihood that patients will be admitted to the hospital, and the likelihood that mortality will be enhanced.
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Yaqub M, Ngoc NM, Park S, Lee W. Predictive modeling of pharmaceutical product removal by a managed aquifer recharge system: Comparison and optimization of models using ensemble learners. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2022; 324:116345. [PMID: 36191499 DOI: 10.1016/j.jenvman.2022.116345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Pharmaceutical products (PPs) are emerging water pollutants with adverse environmental and health-related impacts, owing to their toxic, persistent, and undetectable microscopic nature. Globally, increasing scientific knowledge and advanced technologies have allowed researchers to study PP-associated problems and their removal for water reuse. Experimental modeling methods require laborious, lengthy, expensive, and environmentally hazardous lab-work to optimize the process. On the other hand, predictive machine learning (ML) models can trace the complex input-output relationship of a process using available datasets. In this study, ensemble ML techniques, including decision tree (DT), random forest (RF), and Xtreme gradient boost (XGB), were used to explore PP (diclofenac, iopromide, propranolol, and trimethoprim) removal by a managed aquifer recharge (MAR) system. The model input parameters included characteristics of reclaimed water and soil used in the columns, pH, dissolved organic carbon, operating time, nitrogen dioxide, sulfate, nitrate, electrical conductivity, manganese, and iron. The selected PP removal was the model output. Datasets were collected through a one-year experimental study of continuous MAR system operation to predict the removal of PPs. DT, RF, and XGB models were then developed for one of the selected compounds and tested for the others to check the reliability of the ML model results. The developed models were assessed using statistical performance matrices. The experimental results showed >80% removal of propranolol and trimethoprim; however, removal of diclofenac and iopromide was only ≈50% by the MAR system. The proposed DT and RF models presented higher coefficients of determination (R2 ≥ 0.92) for diclofenac, propranolol, and trimethoprim than for iopromide (R2 ≤ 0.63). In contrast, the XGB model showed better results for diclofenac, iopromide, propranolol, and trimethoprim, with R2 values of 0.92, 0.72, 0.96, and 0.97, respectively. Therefore, XGB could be the best predictive model to provide insight into the adaptation of ML models to predict PP removal by the MAR system, thereby minimizing experimental work.
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Affiliation(s)
- Muhammad Yaqub
- Department of Environmental Engineering, Kumoh National Institute of Technology, 1 Yangho-dong, Gumi, Gyeongbuk, 730-701, Republic of Korea.
| | - Nguyen Mai Ngoc
- Department of Environmental Engineering, Kumoh National Institute of Technology, 1 Yangho-dong, Gumi, Gyeongbuk, 730-701, Republic of Korea.
| | - Soohyung Park
- Department of Environmental Engineering, Kumoh National Institute of Technology, 1 Yangho-dong, Gumi, Gyeongbuk, 730-701, Republic of Korea.
| | - Wontae Lee
- Department of Environmental Engineering, Kumoh National Institute of Technology, 1 Yangho-dong, Gumi, Gyeongbuk, 730-701, Republic of Korea.
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Atjo NM, Soraya GV, Natzir R, Kasyim H, Rasyid H, Chana G, Erlichster M, Skafidas E, Hardjo M. Point-of-Care Saliva Osmolarity Testing for the Screening of Hydration in Older Adults With Hypertension. J Am Med Dir Assoc 2022; 23:1984.e9-1984.e14. [PMID: 36174654 DOI: 10.1016/j.jamda.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 08/14/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Older adults have an elevated risk of dehydration, a state with proven detrimental cognitive and physical effects. Furthermore, the use of diuretics by hypertensive patients further compounds this risk. This prospective study investigated the diagnostic accuracy of point-of-care (POC) salivary osmolarity (SOSM) measurement for the detection of dehydration in hypertensive adults with and without diuretic pharmacotherapy. DESIGN Prospective diagnostic accuracy study. SETTING Home visits to patients recruited from 4 community health centers in West Sulawesi, Indonesia. PARTICIPANTS A total of 148 hypertensive older adults (57 men, 91 women). The mean ages of male and female patients were 69.4 ± 11.4 and 68.1 ± 7.8 years, respectively. METHODS Hypertensive adults were divided into 2 groups based on the presence of diuretics in their pharmacotherapeutic regimen. First-morning mid-stream urine samples were used to perform urine specific gravity (USG) testing. Same-day SOSM measurements were obtained using a POC saliva testing system. RESULTS Both USG (P = .0002) and SOSM (P < .0001) were significantly elevated in hypertensive patients with diuretic pharmacotherapy. At a USG threshold of ≥1.030, 86% of diuretic users were classified as dehydrated compared with 55% of non-using participants. A strong correlation was observed between USG and SOSM measurements (r = 0.78, P < .0001). Using a USG threshold of ≥1.030 as a hydration classifier, an SOSM threshold of ≥93 mOsm had a sensitivity of 78.6% and a specificity of 91.1% for detecting dehydration. CONCLUSIONS AND IMPLICATIONS Hypertensive patients on diuretics have significantly higher first-morning USG and SOSM values, indicating a higher likelihood of dehydration relative to those on other classes of antihypertensive medication. POC SOSM assessment correlates strongly with first-morning USG assessment, and represents a rapid and noninvasive alternative to urinary hydration assessment that may be applicable for routine use in populations with elevated risk of dehydration.
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Affiliation(s)
- Neng Mira Atjo
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Nursing, Faculty of Health Sciences, University of West Sulawesi, Majene, Indonesia
| | - Gita Vita Soraya
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Rosdiana Natzir
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Hasyim Kasyim
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Haerani Rasyid
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Department of Clinical Nutrition, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Gursharan Chana
- MX3 Diagnostics Inc., VIC, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, VIC, Australia
| | | | - Efstratios Skafidas
- MX3 Diagnostics Inc., VIC, Australia; Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, VIC, Australia
| | - Marhaen Hardjo
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia
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Sen R, Sengupta D, Mukherjee A. Mechanical dependency of the SARS-CoV-2 virus and the renin-angiotensin-aldosterone (RAAS) axis: a possible new threat. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:62235-62247. [PMID: 34859345 PMCID: PMC8638800 DOI: 10.1007/s11356-021-16356-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/01/2021] [Indexed: 04/12/2023]
Abstract
Pathogens in our environment can act as agents capable of inflicting severe human diseases. Among them, the SARS-CoV-2 virus has recently plagued the globe and paralyzed the functioning of ordinary human life. The virus enters the cell through the angiotensin-converting enzyme-2 (ACE-2) receptor, an integral part of the renin-angiotensin system (RAAS). Reports on hypertension and its relation to the modulation of the RAAS are generating interest in the scientific community. This short review focuses on the SARS-CoV-2 infection's direct and indirect effects on our body through modulation of the RAAS axis. A patient having severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, which causes COVID-19 relates to hypertension as a pre-existing disease or develops it in a post-COVID scenario. Several studies on how SARS-CoV-2 modulates the RAAS axis indicate that it alters our body's physiological balance. This review seeks to establish a hypothesis on the mechanical dependency of SARS-CoV-2 and RAAS modulation in the human body. This study intends to impart ideas on drug development and designing by targeting the modulation of the RAAS axis to inactivate the pathogenicity of the SARS-CoV-2 virus. A systematic hypothesis can severely attenuate the pathogenicity of the dreadful viruses of the future.
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Affiliation(s)
- Rohit Sen
- Department of Zoology, Charuchandra College, University of Calcutta, 22, Lake Road, Kolkata, 700029 India
| | | | - Avinaba Mukherjee
- Department of Zoology, Charuchandra College, University of Calcutta, 22, Lake Road, Kolkata, 700029 India
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16
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Sorato MM, Davari M, Kebriaeezadeh A, Sarrafzadegan N, Shibru T. Antihypertensive prescribing pattern, prescriber adherence to ISH 2020 guidelines, and implication of outpatient drug price on blood pressure control at selected hospitals in Southern Ethiopia. Eur J Clin Pharmacol 2022; 78:1487-1502. [PMID: 35708747 DOI: 10.1007/s00228-022-03352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the impact of drug prescribing pattern, outpatient drug price of medicines, and level of adherence to evidence-based international guidelines on blood pressure (BP) control at selected hospitals in Southern Ethiopia. METHODS Hospital-based cross-sectional study was conducted. The data entry and analysis were done by using SPSS version 21.0. RESULTS A mean age of participants was 55.87 ± 11.02 years. The rate of BP control was 17.5% based on International Society of Hypertension (ISH) guidelines 2020. In about two-thirds of patients, 270 (66.5%) were taking combination therapy. Mean annual cost of drugs for hypertension was 11.39 ± 3.98 US dollar (USD). Treatment was affordable for only 91 (22.4%) of patients. There was considerable variation on prescriber's adherence to evidence-based guidelines. Body mass index (BMI) of 18-24.9 kg/m2, adjusted odds ratio (AOR) = 3.63 (95% confidence interval (C.I), 1.169-11.251, p = 0.026), physically activity, AOR = 12.69 (95% C.I, 1.424-113.17, p = 0.023), presence of no comorbidity, AOR = 12.82 (95% C.I, 4.128-39.816, p = 0.000), and taking affordable antihypertensive regimen, AOR = 3.493 (95% C.I, 1.4242-9.826, p = 0.018), were positively associated BP control. CONCLUSION The level of BP control, affordability of drugs for the management of hypertension and related comorbidities, and the prescriber's adherence to evidence-based guidelines were inadequate. Therefore, addressing factors associated with good BP control including affordability and clinician adherence to evidence-based guidelines by responsible stakeholders could improve BP control and reduce associated complications.
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Affiliation(s)
- Mende Mensa Sorato
- Tehran University of Medical Sciences, Tehran, Iran. .,College of Medicine and Health Sciences, Department of Pharmacy, Arba Minch University, Arba Minch, Ethiopia.
| | - Majid Davari
- Faculty of Pharmacy, Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Faculty of Pharmacy, Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, WHO Collaborating Center in EMR, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tamiru Shibru
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Blood Pressure and Blood Glucose Control and Associated Factors Among Adults with Hypertension at Three Public Hospitals in Southern Ethiopia. High Blood Press Cardiovasc Prev 2022; 29:287-304. [PMID: 35403966 DOI: 10.1007/s40292-022-00516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION There is inadequate information on blood pressure (BP) and FBG (Blood pressure and Fasting blood glucose) control among adult hypertensive patients in Southern Ethiopia. AIM To determine the level and factors associated with poor BP and FBG control among adult hypertensive patients on regular follow-up at three public hospitals RESULTS: We included 406 adult hypertensives with mean age of 55.87 ± 11.03 years. Mean systolic BP was 134.46 ± 13.44 mmHg; and mean diastolic BP was 82.10 ± 9.44 mmHg. More than eight out of 205 (86.2%) of patients did not achieve BP and FBG target level. Having body mass index 18-24.9 kg/m2, Adjusted odds ratio (AOR) = 0.317 (95% C.I. for AOR, 0.135-0.740, p = 0.008); having no comorbidity, AOR = 0.425 (95% C.I. for AOR, 0.232-0.779, p = 0.006); physically activity, AOR = 0.303 (95% C.I., 0.110-0.829, p = 0.020); having low perceived health risk, AOR = 0.095 (95% C.I., 0.014-0.632, p = 0.015); taking monotherapy, AOR = 3.34 (95% C.I. for AOR, 1.121-10.524, p = 0.033); and history of hospitalization, AOR = 7.048 (95% C.I. for AOR, 2.486-19.954, p = 0.000) were associated with poor BP and FBG control. CONCLUSIONS The level of BP and FBG control was low. Improving screening of hypertensive patients for diabetes; addressing obesity and mental health; strengthening healthy life style interventions and enhancing appropriate dose intensification of prescribed anti-hypertensives by responsible bodies are critical to improve BP and FBG control.
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18
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Yang R, Tang J, Zhuo Y, Kuang M, Liu H. Current prescription status of antihypertensive drugs in Chinese patients with hypertension: analysis by type of comorbidities. Clin Exp Hypertens 2022; 44:240-248. [PMID: 34974781 DOI: 10.1080/10641963.2021.2022688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In 2020, the National Center for Cardiovascular Diseases with National Committee on Hypertension Management in Primary Health Care in China issued revised national clinical practice guidelines on the management of hypertension in primary health care based on the 2018 Chinese guidelines for the management of hypertension. To evaluate adherence to the guidelines, this retrospective study assessed the real-world status of antihypertensive drug prescribing for Chinese patients with hypertension, classified by comorbidity: coronary heart disease, diabetes mellitus, heart failure, stroke, and renal disease. About 1088212 hypertensive patients who received their first prescription for antihypertensive therapy between January 2021 to June 2021, were obtained from a database of Hangzhou Kang Sheng Health Consulting CO., Ltd. Calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) were the most common drugs prescribed for each comorbidity subgroup. Whereas diabetes mellitus or renal disease is a compelling indication for use of renin-angiotensin system inhibitors, CCBs were often administered in these subgroups. The treatment pattern for patients with coronary heart disease was closely similar to that for the overall patient population. Beta-blockers (BBs) were prescribed more frequently for patients with heart failure than for those with other comorbidities. Although antihypertensive drug prescription varied by comorbidity, pharmacological decisions were largely made under Chinese recommendations while physicians could select antihypertensive drugs based on the patients' comorbidities. However, educational initiatives are still necessary to inspire clinicians to better familiarize themselves with the guidelines and manage hypertension comorbid diseases.
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Affiliation(s)
- Renren Yang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
| | - Jia Tang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
| | - Yunping Zhuo
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
| | - Ming Kuang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
| | - Hongying Liu
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Gateshead, UK
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Effect of Yoganidra on Blood Pressure, Hs-CRP, and Lipid Profile of Hypertensive Subjects: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2858235. [PMID: 35003295 PMCID: PMC8739171 DOI: 10.1155/2021/2858235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/28/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
Background Yoganidra is a systematic method of promoting a state of complete physical, mental, and emotional relaxation. It is a safe, inexpensive, and very effective method of management of hypertension when used along with standard pharmacological therapy. This study aims to assess the effect of yoganidra on blood pressure (both systolic blood pressure (SBP) and diastolic blood pressure (DBP)), Hs-CRP, and lipid profile of hypertensive subjects at the time of enrollment (subjects that are hypertensive at the time of enrollment). Methods Both treated and untreated subjects (n = 74) with hypertension (blood pressure ≥140/90 mmHg) and age between 35 and 70 years were included in this study after obtaining ICMR-NIN-IEC approval and written informed consent from all subjects. Subjects with critical illness and/or psychological disturbances were excluded from this study. The subjects in the experimental group (n = 31) practiced yoganidra for 45 minutes daily for 12 weeks under strict supervision. There was no intervention in the control group (n = 43). Weekly blood pressure was recorded in the experimental group, whereas it was performed at baseline and at endpoint for control groups. Hs-CRP and lipid profile were estimated at baseline and endpoint for both the groups. Results A significant reduction in mean SBP from 142.9 mm Hg (SD ± 16.46) to 118.68 mm Hg (SD ± 9.21; p value 0.0001) and DBP from 89.84 mm Hg (SD ± 10.42) to 77.03 mm Hg (SD ± 6.47: p value 0.0001) was observed among the experimental group after 12 weeks of yoganidra practice when compared with the control group. A significant reduction in mean Hs-CRP (2.21 ± 1.49 to 1.06 ± 0.82 mg/L, p < 0.001∗∗∗) was observed among the experimental group. There were no significant differences between triglycerides and total cholesterol levels, whereas LDL-C and HDL-C showed a trend of improvement in the experimental group after intervention. Conclusions In this pilot study, we observed a significant reduction in blood pressure and Hs-CRP in the yoganidra group compared with the control group. There were no significant side effects observed in the intervention group during the study period.
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Aljadeeah S, Nagel E, Wirtz VJ. Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis. BMC Health Serv Res 2021; 21:1088. [PMID: 34645430 PMCID: PMC8515648 DOI: 10.1186/s12913-021-07124-6] [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: 07/16/2021] [Accepted: 09/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines. Methods Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate. Results Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government. Conclusions Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07124-6.
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Affiliation(s)
- Saleh Aljadeeah
- University of Bayreuth, Institute of Medical Management and Health Sciences, Prieserstr. 2, 95440, Bayreuth, Germany.
| | - Eckhard Nagel
- University of Bayreuth, Institute of Medical Management and Health Sciences, Prieserstr. 2, 95440, Bayreuth, Germany
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA, 02118, USA
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21
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Shylesh C M S, V S A, S K K, P UD. Renin-angiotensin system modulators in COVID-19 patients with hypertension: friend or foe? Clin Exp Hypertens 2021; 44:1-10. [PMID: 34414841 DOI: 10.1080/10641963.2021.1963070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: ACE2, a component of the non-classic renin-angiotensin system (RAS), acts as a functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) spike protein, which enables the entry of the virus into the host cells. Non-classical ACE2 is one of two types of ACE2 that has a protective effect on vascular and respiratory cells. RAS modulators like angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are among the first-line treatment for hypertensive patients. An upregulation in ACE2 levels with RAS modulators was observed in few preclinical studies, which raised concerns regarding possible increased infectivity among patients treated with RAS modulators.Method: For shortlisting the outcome effects, open-ended, English-restricted databases, published literature, and various clinical studies performed utilizing RAS modulators in COVID 19 patients were considered. Conclusion: Current evidence reveals no increased risk of COVID-19 infection among hypertensive patients on ACEIs/ARBs compared to other antihypertensive medications. Several studies have demonstrated no detrimental effects of RAS modulators on clinical severity, hospital/intensive care unit stay, ventilation and mortality. Hence, we can conclude that neither ARBs nor ACEIs treatment will cause any side effects or undesirable interactions in COVID-19 infected hypertensive patients.
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Affiliation(s)
- Shakhi Shylesh C M
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi, Kerala 682041
| | - Arya V S
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi, Kerala 682041
| | - Kanthlal S K
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi, Kerala 682041
| | - Uma Devi P
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi, Kerala 682041
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Atibila F, Ten Hoor G, Donkoh ET, Kok G. Challenges experienced by patients with hypertension in Ghana: A qualitative inquiry. PLoS One 2021; 16:e0250355. [PMID: 33956798 PMCID: PMC8101754 DOI: 10.1371/journal.pone.0250355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypertension (HPT) is an essential public health problem affecting both lower and middle-income countries disproportionately. Evidence suggests that HPT is the leading risk factor for cardiovascular diseases and chronic kidney disease. Yet, challenges faced by patients with HPT in Ghana are not sufficiently explored. This study, documents the challenges patients with HPT face in Ghana. METHODS We used an explorative descriptive qualitative design. Face-to-face in-depth interviews were conducted with 15 patients with HPT. Interviews were recorded and transcribed verbatim. A thematic content analysis procedure was followed to analyse the data. RESULTS Four main themes emerged from interviews; three of which pertained to dimensions of challenges and a fourth which pertained to coping strategies. These include: [1] impairment in physical activities and mobility constraints [2]. Psychological challenges such as suicidal ideations, sadness, fear, anxiety, and reduced sexual affection [3]. Socio-economic challenges identified include loss of friends and social network, difficulty in job demands, and financial burden, and [4] coping strategies such as health system support, social support, and religiosity were identified. CONCLUSION Patients with HPT experience an array of challenges. We suggest that health care facilities incorporate post HPT diagnosis counseling sessions for HPT patients in the study area. Also, the National Health Insurance Authority (NHIA) should re-examine their scope of services; thus, drugs, laboratory services, and electrocardiogram services to avoid the issue of co-payment. Collaboration between healthcare professionals and family relations of patients with HPT ought to also be strengthened to ensure optimal care.
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Affiliation(s)
- Fidelis Atibila
- Valley View University, Techiman-Bono East Region, Ghana
- Department of Works and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Gill Ten Hoor
- Department of Works and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Emmanuel Timmy Donkoh
- Department of Basic and Applied Biology, University of Energy and Natural Resources, UENR Sunyani, Sunyani, Ghana
| | - Gerjo Kok
- Professor Emeritus of Applied Psychology, Department of Works and Social Psychology Maastricht University, Maastricht, the Netherland
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23
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Wang W, He Q, Zhang H, Zhuang C, Wang Q, Li C, Sun R, Fan X, Yu J. A narrative review on the interaction between genes and the treatment of hypertension and breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:894. [PMID: 34164528 PMCID: PMC8184430 DOI: 10.21037/atm-21-2133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective The aim to discuss the close relationship between the common biological mechanisms of breast cancer and hypertension, inflammation and oxidative stress, breast cancer gene mutations breast cancer susceptibility gene (BRCA), G protein-coupled receptor kinase (GRK4), etc. and breast cancer treatment includes chemotherapy, Endocrine therapy, Targeted therapy and anti-angiogenesis drugs. In anti-angiogenesis drugs focusing on the mechanism of tyrosine kinase inhibitors (TKI) that may activate the rhoa/rock pathway to cause hypertension, as well as the relationship between breast cancer and antihypertensive drugs includes angiotensin-converting enzyme inhibitors (ACEIs), Calcium channel blockers (CCBs) and β-blockers (BBs)will be explored. Background Cardiovascular diseases (CVD) and tumors are the two major types of diseases with the highest mortality rates, while hypertension accounts for the largest proportion of CVDs. A large number of the same or similar risk factors are shared between hypertension and tumors, and they influence each other. Many patients, particularly elderly patients, often present with the coexistence of the two diseases. As medical advances have enabled clinicians to cure tumors, many patients with cancer live longer, leading to a gradual increase in the incidence of CVDs, including hypertension. With the second highest incidence among tumors, breast cancer has gradually attracted widespread attention and has been the topic of numerous studies. Studies have confirmed that CVD is one of the causes of death in elderly patients with breast cancer. Methods Publications from 1985 to 2020 were retrieved from the Web Of Science, Cochrane Library, PubMed, EMBASE and MEDLINE database. We used a mix of MeSH and keywords. Conclusions Hypertension and cancer may share a common mechanism. The screening and risk assessment of breast cancer in patients with hypertension must be strengthened. Breast cancer cardiology is the interdisciplinary study of oncology and cardiology, and in-depth research in this field may result in long-term improvements in the survival and prognosis of patients with both clinical hypertension and breast cancer.
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Affiliation(s)
- Wenjuan Wang
- Department of Hypertension Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Qingjian He
- Department of Breast and Thyroid Surgery, Zhoushan Hospital of Zhejiang Province, Zhoushan, China
| | - Haodong Zhang
- Department of Hypertension Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Chenchen Zhuang
- Department of Hypertension Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Qiongying Wang
- Department of Hypertension Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Caie Li
- Department of Hypertension Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Runmin Sun
- Department of Hypertension Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Xin Fan
- Department of Hypertension Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Jing Yu
- Department of Hypertension Center, Lanzhou University Second Hospital, Lanzhou, China
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Oamen TE, Osemene KP. Drug Utilization Evaluation of Medications Used by Hypertensive Patients in Hospitals in Nigeria. Hosp Top 2021; 100:44-53. [PMID: 33934688 DOI: 10.1080/00185868.2021.1916416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Drug utilization studies in developing countries is evolving. Rising medication cost for hypertensive patients is a major cause of noncompliance to therapy. The study was a cross-sectional drug utilization review involving outpatients in two purposively selected hospitals (secondary and tertiary) in Abeokuta, Southwestern Nigeria. Data and relevant information were obtained from the patients' medical records domiciled in the outpatients' hospital records department. Descriptive and inferential statistics were used at p < 0.05. Total medication cost to patients was USD$48,575; out of which antihypertensive medications accounted for 46% (USD$21,588) in two referral hospitals. Ramipril was the most prescribed in both hospitals. Generic drugs were cheaper than their branded alternatives. Study outcomes are beneficial for managing costs for hypertensive patients.
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Affiliation(s)
- Theophilus Ehidiamen Oamen
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ife, Osun State, Nigeria
| | - Kanayo Patrick Osemene
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ife, Osun State, Nigeria
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25
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Impact of renin-angiotensin system inhibitors and beta-blockers on dental implant stability. Int J Implant Dent 2021; 7:31. [PMID: 33829330 PMCID: PMC8026804 DOI: 10.1186/s40729-021-00309-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Current experimental research suggests antihypertensive medication reduces the failure risk of dental implants due to enhanced bone remodeling. However, evidence from clinical studies evaluating the impact of antihypertensive medication on implant stability is lacking. METHODS We retrospectively analyzed 377 implants in 196 patients (46 implants inserted in antihypertensive drug users (AH) and 331 implants in non-users (NAH)) for implant stability measured by radiofrequency analysis, and we determined the implant stability quotient (ISQ). AH subgroups were stratified by the use of beta-blockers, renin-angiotensin system (RAS) inhibitors, and both of the aforementioned. The impact of antihypertensive medication on ISQ values at implant insertion (primary stability) and implant exposure (secondary stability) was analyzed by a linear regression model with a regression coefficient and its 95% confidence interval (95% CI), adjusted for potential confounders. RESULTS Time between implant insertion and implant exposure was 117.1 ± 56.6 days. ISQ values at insertion were 71.8 ± 8.7 for NAH and 74.1 ± 5.6 for AH, respectively. ISQ at exposure was 73.7 ± 8.1 for NAH and 75.7 ± 5.9 for AH. Regression analysis revealed that none of the AH subgroups were significantly related to ISQ at implant insertion. However, renin-angiotensin system inhibitors (RAS) were significantly associated with higher ISQ values at exposure (reg. coeff. 3.59, 95% CI 0.46-6.71 (p=0.025)). CONCLUSIONS Outcome of the present study indicates enhanced bone remodeling and osseointegration following dental implant insertion in patients taking RAS inhibitors than in non-users. Future randomized prospective studies must confirm these indicative results.
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The Ecology of Antihypertensives in the United States, 1997-2017. J Gen Intern Med 2021; 36:699-704. [PMID: 32968967 PMCID: PMC7947049 DOI: 10.1007/s11606-020-06214-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/03/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Antihypertensives are the most used medication type in the USA, yet there remains uncertainty about the use of different antihypertensives. We sought to characterize use of antihypertensives by and within medication class(es) between 1997 and 2017. PATIENTS AND METHODS A repeated cross-sectional study of 493,596 adult individuals using the 1997-2017 Medical Expenditure Panel Survey (MEPS). The Orange Book was used for adjunctive information. The primary outcome was the estimated use by and within antihypertensive medication class(es). RESULTS The proportion of individuals taking any antihypertensive during a year increased from 1997 to the early 2010s and then remained stable. The proportion of adults using angiotensin II receptor blockers (ARBs) and dihydropyridine calcium channel blockers (CCBs) increased during the study period, while angiotensin-converting enzyme inhibitors (ACE-Is) increased until 2010 after which rates remained stable. Beta-blocker use was similar to that of ACE-Is with an earlier decline starting in 2012. Thiazide diuretic use increased from 1997 to 2007, leveled off until 2014, and declined from 2015 to 2017. Non-dihydropyridine CCB use declined throughout the study. ACE-Is, ARBs, CCBs, thiazide diuretics, and loop diuretics all had one dominant in-class medication. There was a clear increase in the use of losartan within ARBs, lisinopril within ACE-Is, and amlodipine within CCBs following generic conversion. Furosemide and hydrochlorothiazide started with and maintained a dominant position in their classes. Metoprolol use increased throughout the study and became the dominant beta-blocker. CONCLUSIONS Antihypertensive classes appear to have a propensity to equilibrate to an individual medication, despite a lack of outcomes-based research to compare medications within a class.
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27
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Dzudie A, Fomo MF, Teuwafeu DG, Nkoke C, Kenfack A, Bonghaseh DT, Ekaney D, Tantchou A, Tantchou C, Ngoa LSE, Kengne AP, Choukem SP. Prescription of pharmacotherapy and blood pressure control among hypertensive outpatients in two semi-urban hospitals in Cameroon: a cross-sectional study. Pan Afr Med J 2021; 37:122. [PMID: 33425155 PMCID: PMC7755361 DOI: 10.11604/pamj.2020.37.122.21156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/02/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction several international guidelines are available on drug treatment for hypertension, but the control of hypertension remains very poor in sub-Saharan Africa (SSA). We investigated the commonly prescribed antihypertensive drugs and their association with blood pressure (BP) control in adult Cameroonians. Methods we consecutively recruited hypertensive outpatients attending the Buea and Limbe Regional Hospitals (southwest region of Cameroon). Controlled BP was defined as BP < 140/90mmHg in hypertensive patients aged 60 years or younger, diabetics or patients with chronic kidney disease or a BP < 150/90mmHg in non-diabetic hypertensive patients older than 60 years of age (JNC8). Results of the 408 participants included (mean age 61.1 years), 67% were female. The median duration of hypertension was 6 years and the median duration of the current treatment was 22 weeks. Commonly prescribed antihypertensives were calcium channel blockers (CCB, 35.1%), thiazide/thiazide-like diuretics (TD/TLD, 26.1%) and angiotensin-converting enzyme inhibitors (ACEI, 19.5%). The median monthly cost of antihypertensive was 10279.6 CFA (approximately equal to US$ 172). Seventy percent (70%) of participants were receiving at least 2 drugs, with ACEI+TD/TLD, CCB+TD/TLD, and ACEI+CCB+TD/TLD being the most frequent combination. The rate of BP control was 52% overall, and 60% in participants on monotherapy. Conclusion CCBs were the most prescribed single antihypertensive drugs in this setting while ACEI+TD/TLD was the most common combination. About half of patients were at target BP control levels Improving availability and affordability of these medications may improve hypertension management and control.
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Affiliation(s)
- Anastase Dzudie
- Department of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Department of Internal Medicine and Subspecialties, Douala General Hospital, Douala, Cameroon
| | - Messaline Fodom Fomo
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon
| | | | - Clovis Nkoke
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Department of Internal Medicine, Buea Regional Hospital, Buea, Cameroon
| | - Azabji Kenfack
- Department of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Divine Tim Bonghaseh
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon.,Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Domin Ekaney
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Sub-divisional Hospital Batoke, Limbe, Cameroon
| | | | | | - Laurent Serges Etoundi Ngoa
- Department of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Andre Pascal Kengne
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Non-communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Simeon Pierre Choukem
- Department of Internal Medicine and Subspecialties, Douala General Hospital, Douala, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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Ching SM, Mokshashri NR, Kannan MM, Lee KW, Sallahuddin NA, Ng JX, Wong JL, Devaraj NK, Hoo FK, Loo YS, Veettil SK. Effects of qigong on systolic and diastolic blood pressure lowering: a systematic review with meta-analysis and trial sequential analysis. BMC Complement Med Ther 2021; 21:8. [PMID: 33407414 PMCID: PMC7789757 DOI: 10.1186/s12906-020-03172-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/30/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The benefits of qigong for systolic and diastolic blood pressure (BP) reduction have been noted in previously published systematic reviews; however, the data on its effectiveness has been at best scarce. We aimed to update the evidence of qigong on blood pressure reduction after taking into consideration the risks of random error and reliability of data in the cumulative meta-analysis using trial sequential analysis (TSA). METHODS Included trials were assessed using Cochrane risk of bias instrument. We performed meta-analysis with random-effects model and random errors were evaluated with TSA. We performed the search for the eligible randomized controlled trial (RCT) through Medline, Cinahl, Cochrane Central Register of Controlled Trials and also PubMed. RESULTS A total of 370 subjects sourced from seven eligible RCTs were entered into the analysis. The pooled results demonstrated the significant reduction with the use of qigong of the systolic blood pressure [weighted mean difference (WMD), - 10.66 mmHg (95% confidence interval (CI) = - 17.69,-3.62, p < 0.001] and diastolic BP [WMD, - 6.76 mmHg, 95% CI = - 12.22, - 1.30, p < 0.001] as compared to the control group. CONCLUSIONS Significant reductions in BP is seen with the use of qigong as compared with the control group, suggesting that qigong may be used as a complementary therapy in the somewhat complicated management of hypertension.
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Affiliation(s)
- Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Naidu Ragubathi Mokshashri
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Maharajan Mari Kannan
- School of Pharmacy/School of Postgraduate Studies, International Medical University, Kuala Lumpur, 57000 Malaysia
| | - Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, 43000 Kajang, Selangor Malaysia
| | - Nurin Amalina Sallahuddin
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Jun Xun Ng
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Jie Lin Wong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Fan Kee Hoo
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Yee Shen Loo
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, 30 2000 E, Salt Lake City, UT 84112 USA
| | - Sajesh K. Veettil
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, 30 2000 E, Salt Lake City, UT 84112 USA
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Masilela C, Pearce B, Ongole JJ, Adeniyi OV, Benjeddou M. Genomic Association of Single Nucleotide Polymorphisms with Blood Pressure Response to Hydrochlorothiazide among South African Adults with Hypertension. J Pers Med 2020; 10:jpm10040267. [PMID: 33316892 PMCID: PMC7768450 DOI: 10.3390/jpm10040267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
This study described single nucleotide polymorphisms (SNPs) in hydrochlorothiazide-associated genes and further assessed their correlation with blood pressure control among South African adults living with hypertension. A total of 291 participants belonging to the Nguni tribes of South Africa on treatment for hypertension were recruited. Nineteen SNPs in hydrochlorothiazide pharmacogenes were selected and genotyped using MassArray. Uncontrolled hypertension was defined as blood pressure ≥140/90 mmHg. The association between genotypes, alleles and blood pressure response to treatment was determined by conducting multivariate logistic regression model analysis. The majority of the study participants were female (73.19%), Xhosa (54.98%) and had blood pressure ≥140/90 mmHg (68.73%). Seventeen SNPs were observed among the Xhosa tribe, and two (rs2070744 and rs7297610) were detected among Swati and Zulu participants. Furthermore, alleles T of rs2107614 (AOR = 6.69; 95%CI 1.42–31.55; p = 0.016) and C of rs2776546 (AOR = 3.78; 95%CI 1.04–13.74; p = 0.043) were independently associated with uncontrolled hypertension, whilst rs2070744 TC (AOR = 38.76; 95%CI 5.54–270.76; p = 0.00023), CC (AOR = 10.44; 95%CI 2.16–50.29; p = 0.003) and allele T of rs7297610 (AOR = 1.86; 95%CI 1.09–3.14; p = 0.023) were significantly associated with uncontrolled hypertension among Zulu and Swati participants. We confirmed the presence of SNPs associated with hydrochlorothiazide, some of which were significantly associated with uncontrolled hypertension in the study sample. Findings open doors for further studies on personalized therapy for hypertension in the country.
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Affiliation(s)
- Charity Masilela
- Department of Biotechnology, University of the Western Cape, Bellville 7530, South Africa
| | - Brendon Pearce
- Department of Biotechnology, University of the Western Cape, Bellville 7530, South Africa
| | - Joven Jebio Ongole
- Center for Teaching and Learning, Department of Family Medicine, Piet Retief Hospital, Mkhondo 2380, South Africa
| | | | - Mongi Benjeddou
- Department of Biotechnology, University of the Western Cape, Bellville 7530, South Africa
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Derington CG, King JB, Delate T, Botts SR, Kroehl M, Kao DP, Trinkley KE. Twice-daily versus once-daily lisinopril and losartan for hypertension: Real-world effectiveness and safety. PLoS One 2020; 15:e0243371. [PMID: 33270787 PMCID: PMC7714357 DOI: 10.1371/journal.pone.0243371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/19/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Lisinopril and losartan manufacturer labels recommend twice-daily dosing (BID) if once-daily (QDay) is insufficient to lower blood pressure (BP). METHODS AND RESULTS Retrospective cohort study of patients taking QDay lisinopril and losartan who experienced a dose-doubling (index date). A text-processing tool categorized BID and QDay groups at the index date based on administration instructions. We excluded: pregnant/hospice, regimens other than BID/QDay, and without BP measurements -6 months/+12 months of the index date. The most proximal BP measurements -6 months and +2 weeks to 12 months of the index date were used to evaluate BP differences. Propensity scores were generated, and differences in BP and adverse events (angioedema, acute kidney injury, hyperkalemia) between BID/QDay groups were analyzed within dosing cohorts using inverse propensity of treatment-weighted regression models. Of 11,210 and 6,051 patients who met all criteria for lisinopril and losartan, 784 (7.0%) and 453 (7.5%) were taking BID, respectively. BID patients were older and had higher comorbidity and medication burdens. There were no differences in systolic/diastolic BP between BID and QDay, with absolute differences in mean systolic BP ranging from -1.8 to 0.7 mmHg and diastolic BP ranging from -1.1 to 0.1 mmHg (all 95% confidence intervals [CI] cross 0). Lisinopril 10mg BID was associated with an increased odds of angioedema compared to lisinopril 20mg QDay (odds ratio 2.27, 95%CI 1.13-4.58). CONCLUSIONS Adjusted models do not support improved effectiveness or safety of BID lisinopril and losartan.
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Affiliation(s)
- Catherine G. Derington
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Jordan B. King
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, United States of America
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States of America
| | - Thomas Delate
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, United States of America
- Drug Use Management, Kaiser Permanente National Pharmacy, Aurora, CO, United States of America
| | - Sheila R. Botts
- Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO, United States of America
| | - Miranda Kroehl
- Colorado School of Public Health, Aurora, CO, United States of America
| | - David P. Kao
- Cardiac and Vascular Center, University of Colorado Health, Aurora, CO, United States of America
- School of Medicine, University of Colorado, Aurora, CO, United States of America
| | - Katy E. Trinkley
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, United States of America
- School of Medicine, University of Colorado, Aurora, CO, United States of America
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Anyanti J, Akuiyibo S, Idogho O, Amoo B, Aizobu D. Hypertension and Diabetes Management Practices Among Healthcare Workers in Imo and Kaduna States, Nigeria: An Exploratory Study. Risk Manag Healthc Policy 2020; 13:2535-2543. [PMID: 33204194 PMCID: PMC7667702 DOI: 10.2147/rmhp.s271668] [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: 07/20/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Effective management of hypertension and diabetes through accurate diagnosis and treatment can reduce the risk of complications and early deaths. This study was a descriptive cross-sectional study aimed at determining practices regarding hypertension and type 2 diabetes management among healthcare providers in Kaduna and Imo States, Nigeria. Data were collected using a semi-structured interviewer administered questionnaire consisting of questions across four major domains: 1) screening; 2) diagnosis; 3) pharmacological; and 4) non-pharmacological treatment of hypertension and diabetes. RESULTS A total of 77 healthcare providers were interviewed and they included; 20 (26.5%) medical doctors, 25 (32.5%) nurses/midwives, 18 (23.4%) community health extension workers and 3 (3.9%) pharmacists. Almost half (46.8%) of the respondents indicated that they prioritize routine blood pressure (BP) checks among all adult patients while only 30 (39.0%) and 8 (10.4%) correctly identified the diagnostic criteria for hypertension and diabetes, respectively. Calcium chain blockers only were the most prescribed medication for treatment of hypertension across all stages of hypertension while metformin (glucophage) was stated as the preferred medication prescribed for controlling blood glucose levels among the respondents. Only 32.5% of the respondents stated that they have a means in place in their facilities to ensure that hypertension and diabetes patients adhere to follow-on visit recommendations. CONCLUSION A significant knowledge gap was identified in the diagnosis and treatment of hypertension and diabetes among the respondents due to unavailability of properly outlined management guidelines for these conditions for the different cadres of healthcare workers in Nigeria. There is a need for the development and wide distribution of guidelines highlighting cadre-specific roles for healthcare providers in hypertension and diabetes management and standard operating procedures based on such guidelines should be available at various points of care to ensure better treatment outcomes.
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Jung M, Choo E, Lee S. Comprehensive Trends and Patterns of Antihypertensive Prescriptions Using a Nationwide Claims Database in Korea. Clin Epidemiol 2020; 12:963-975. [PMID: 32982461 PMCID: PMC7494009 DOI: 10.2147/clep.s265966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/11/2020] [Indexed: 01/13/2023] Open
Abstract
Purpose The number of people receiving antihypertensive prescriptions in Korea has increased more than threefold from 2002 to 2016. However, previous studies regarding the current use of these medications have been fairly limited. We aimed to examine the current trends and changes in the patterns of antihypertensive prescriptions based on a nationwide claims database. Patients and Methods Patients receiving antihypertensive medications over 30 days, without any limited therapeutic indication, were identified using the Health Insurance Review and Assessment Service (HIRA) database between 2015 and 2017. For each patient, the use of antihypertensive medication was specified as the class of drug used for the longest duration in each year. Results A total of 8,625,821 patients in 2015, 8,997,829 patients in 2016, and 9,357,751 patients in 2017 taking antihypertensives were included in this study. Angiotensin II receptor blockers (ARB) (35.9% in 2015 and 38.9% in 2017) and calcium channel blockers (CCB) (37.1% in 2015 and 35.2% in 2017) for monotherapy, ARB+CCB combinations (49.3% in 2015 and 56.3% in 2017) for dual therapy, and ARB+CCB+diuretics combinations (48.8% in 2015 and 48.9% in 2017) for more than triple therapy were the most frequently prescribed. Subjects aged ≥70 showed the highest prescription rate of antihypertensives compared with those <70; however, a decreasing trend presented from 62.3% in 2015 to 54.2% in 2017. Additionally, in subjects aged >70 years, the rate in women was higher than that in men, but this was reversed in younger patients. While changes arose in the patterns of the use of antihypertensives, these were similar each year. Conclusion The trends and changes in the patterns of the use of antihypertensive medications were affected by age, sex, and type of therapy. Our findings may contribute to a better understanding of the actual status regarding the use of antihypertensive medications in Korea.
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Affiliation(s)
- Minji Jung
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Eunjung Choo
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Sukhyang Lee
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea
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Liao CT, Wu PC, Shih JC, Cheng TJ, Wu WS. Higher hypertension prevalence, lower incidence, and aggressive treatment with decreasing mortality, cardiovascular, and cerebrovascular incidence in Taiwan from 2005 to 2010: A 2 population-based cohorts study. Medicine (Baltimore) 2020; 99:e22437. [PMID: 32991480 PMCID: PMC7523812 DOI: 10.1097/md.0000000000022437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hypertension continues to be an important public health concern because of its associated morbidity, mortality, and economic impact on society. The aims of this study are to compare the secular changes in age-stratified hypertension prevalence, incidence, co-morbidity, and 3 years of cardiovascular outcome in Taiwan in the years 2005 and 2010.We enrolled hypertensive individuals from the datasets of the Longitudinal Health Insurance Database (LHID) in 2005 and 2010 in Taiwan separately. We analyzed the hypertension prevalence, incidence, medication treatment, and associated morbidities. The risks of cardiovascular and cerebrovascular events and all-causes mortalities among the hypertensive individuals were evaluated in 3 years of follow-up.There was an increased prevalence of hypertension but decreased incidence of hypertension in those over 65 from 2005 to 2010. Dyslipidemia was the highest rate of co-morbidity in 2005 and 2010. The most frequent categories of anti-hypertensive agents prescribed was 1 or 2 for both 2005 and 2010. Calcium channel blockers were the most common anti-hypertensive agents prescribed, followed by Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers. After 3 years of follow-up, the risks of coronary artery disease (CAD), cerebrovascular diseases (CVD) as well as death were less in 2010 than in 2005 in Taiwan.Our study showed that hypertension individuals had an increased prevalence, younger age, decreased incidence, increased medication treatment associated with decreased the CAD, CVD, and mortalities in 2010 compared to 2005 in Taiwan.
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Affiliation(s)
- Chia-Te Liao
- Division of Cardiovascular Medicine, Chi-Mei Medical Center
- Department of Public Health of Medicine, College of Medicine, National Cheng Kung University
| | - Pei-Chih Wu
- Department of Green Energy and Environmental Resources
- Department of Occupational Safety and Health, Chang Jung Christian University
| | - Jung-Chang Shih
- Division of Cardiovascular Medicine, Chiali branch of Chi-Mei Hospital
| | - Tain-Junn Cheng
- Departments of Neurology and Occupational Medicine, Chi-Mei Medical Center
| | - Wen-Shiann Wu
- Division of Cardiovascular Medicine, Chi-Mei Medical Center
- Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
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Masilela C, Pearce B, Ongole JJ, Adeniyi OV, Benjeddou M. Cross-sectional study of prevalence and determinants of uncontrolled hypertension among South African adult residents of Mkhondo municipality. BMC Public Health 2020; 20:1069. [PMID: 32631300 PMCID: PMC7339580 DOI: 10.1186/s12889-020-09174-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/28/2020] [Indexed: 01/01/2023] Open
Abstract
Background Achieving the blood pressure treatment target in individuals with hypertension is a serious global health challenge. Furthermore, the actual burden of uncontrolled hypertension is poorly understood, especially in the developing countries. Therefore, this study comprehensively examined the prevalence and factors associated with uncontrolled hypertension in individuals receiving care at the primary healthcare facilities in the rural areas of Mkhondo Municipality in the Mpumalanga Province, South Africa. Methods In this cross-sectional study, 329 individuals attending care for hypertension were recruited from January 2019 to June 2019 at three primary healthcare centres, namely, Piet Retief hospital, Mkhondo town clinic and Thandukukhanya community health centre. Uncontrolled hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg in accordance with the South African Hypertension Society guideline (2014). Multiple logistic regression (Forward LR method) analysis was used to identify the significant determinants of uncontrolled hypertension. Results The majority of the participants were 55 years old and above (69.0%), Zulus (81.2%), non-smokers (84.19%) and had been diagnosed with hypertension for more than a year prior to the study (72.64%). The overall prevalence of uncontrolled hypertension was 56.83% (n = 187) with no significant difference between sexes, 57.38% male versus 56.88% female, respectively. In the multiple logistic regression model analysis after adjusting for confounding variables, obesity (AOR = 2.90; 95% CI 1.66–5.05), physical activity (AOR = 4.79; 95% CI 2.15–10.65) and HDL-C (AOR = 5.66; 95% CI 3.33–9.60) were the significant and independent determinants of uncontrolled hypertension in the cohort. Conclusion The high prevalence of uncontrolled hypertension in the study setting can be largely attributed to obesity, physical activity and dyslipidaemia. Treatment will require the collaborative efforts of individuals, clinicians and health authorities. All these determinants should be addressed decisively so as to achieve the treatment blood pressure targets in the study population.
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Affiliation(s)
- Charity Masilela
- Department of Biotechnology, University of the Western Cape, 7535, Bellville, Cape Town, South Africa.
| | - Brendon Pearce
- Department of Biotechnology, University of the Western Cape, 7535, Bellville, Cape Town, South Africa
| | - Joven Jebio Ongole
- Department of Family Medicine, Center for Teaching and Learning, Piet Retief Hospital, Mkhondo, South Africa
| | | | - Mongi Benjeddou
- Department of Biotechnology, University of the Western Cape, 7535, Bellville, Cape Town, South Africa
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Yamane SS, De Gagne JC, Riggs A, Kimberly GD, Holye M. Assessment of a patient-centered initiative to improve hypertension management for adults with comorbid type 2 diabetes at a free clinic in the rural south. Nurs Forum 2020; 55:348-355. [PMID: 32034778 DOI: 10.1111/nuf.12434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hypertension is the most modifiable risk factor for cardiovascular disease. Low levels of adherence to medication regimens, positive health behaviors, and ideal metric goals are associated with low rates of morbidity and mortality, impaired physical function, and frailty. AIM This quality improvement study sought to assess whether a program of patient and provider education, combined with a decision aid (DA) designed to increase shared decision making, would improve (a) patient knowledge about hypertension management, (b) provider adherence to prescription guidelines for the management of hypertension, (c) medication adherence for the management of hypertension by the patient, and (d) communication between provider and patient. SETTING Free clinic in the United States rural south. PARTICIPANTS Twenty-four patients with comorbid hypertension and type 2 diabetes. METHODS A pretest/posttest design utilizing a provider education, pre-encounter quiz, focused patient education, and DA was used to evaluate the intervention. RESULTS A significant increase in pretest/posttest scores 60% (SD = 29%) to 93% (SD = 15%), P < .001 about hypertension and its management was observed. Adherence to guideline-based medication use increased angiotensin-converting enzyme inhibitors 38% to 64%, angiotensin II receptor blockers 17% to 29%, dihydropyridine calcium channel blockers 29% to 43%, beta-blockers 8% to 25%, statins 65% to 83%, and diuretics 38% to 46%. CONCLUSIONS The intervention was an efficient method to provide patient-centered education that increased patient knowledge about medication and lifestyle management of hypertension.
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Affiliation(s)
- Sandra S Yamane
- Department of Nursing, Catawba College, Salisbury, North Carolina
| | | | - Alysse Riggs
- Davie County Health Department, Mocksville, North Carolina
| | | | - Martha Holye
- Storehouse for Jesus, Mocksville, North Carolina
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Antwi-Amoabeng D, Beutler BD, Moody AE, Kanji Z, Gullapalli N, Rowan CJ. Management of hypertension in COVID-19. World J Cardiol 2020; 12:228-230. [PMID: 32547717 PMCID: PMC7283999 DOI: 10.4330/wjc.v12.i5.228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
The ACE2 receptor plays a central role in severe acute respiratory syndrome coronavirus 2 host cell entry and propagation. It has therefore been postulated that angiotensin converting enzyme inhibitors and angiotensin receptor blockers may upregulate ACE2 expression and thus increase susceptibility to infection. We suggest that alternative anti-hypertensive agents should be preferred among individuals who may be exposed to this increasingly common and potentially lethal virus.
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Affiliation(s)
- Daniel Antwi-Amoabeng
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
| | - Bryce D Beutler
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
| | - Alastair E Moody
- Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132, United States
| | - Zahara Kanji
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
| | - Nageshwara Gullapalli
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
| | - Christopher J Rowan
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
- Renown Institute for Heart and Vascular Health, Reno, NV 89512, United States
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Zawudie AB, Lemma TD, Daka DW. Cost of Hypertension Illness and Associated Factors Among Patients Attending Hospitals in Southwest Shewa Zone, Oromia Regional State, Ethiopia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:201-211. [PMID: 32308448 PMCID: PMC7154006 DOI: 10.2147/ceor.s241591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/12/2020] [Indexed: 12/03/2022] Open
Abstract
Background Hypertension is a common vascular disease and the main risk factor for cardiovascular diseases. Since the incidence of hypertension is rising in Ethiopia, one may expect that the household’s cost of healthcare services related to the disease will increase in the near future. Yet the cost associated with the disease is not known. We aimed to estimate the total cost of hypertension illness and identify associated factors among patients attending hospitals in Southwest Shewa zone, Oromia regional state, Ethiopia. Patients and Methods An institution-based cross-sectional study design was employed to conduct the study from 13 August to 2 September 2018. All hypertensive patients aged 18 years and older who were on follow-up were eligible for this study. The total cost of hypertension illness was estimated by summing the direct and indirect costs. Bivariate and multivariate linear regression analyses were performed to identify factors associated with hypertension costs of illnesses. Results A total of 349 patients participated in the study. The mean monthly total cost of hypertension illness was US$ 22.3 (95% CI, 21.3–23.3). Direct and indirect costs constitute 51% and 49% of the total cost, respectively. The mean direct cost of hypertension illness per patient per month was US$ 11.39 (95% CI, 10.6–12.1). Out of these, drugs comprised higher cost (31%), followed by food (25%). The mean indirect cost per patient per month was US$ 10.89 (95% CI, 10.4–11.4). In this study, the primary educational status, family size (4–6 and >6), distance from hospital (≥10 km), the presence of a companion and stage of hypertension (stage two) of patients were identified as the predictors of the cost of hypertension illnesses. Conclusion The cost of hypertension illness was very high when compared to the monthly income of households, exposing patients to catastrophic costs. Hence, the government should give due attention to protect patients from catastrophic health expenditures.
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Affiliation(s)
| | - Teferi Daba Lemma
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Dawit Wolde Daka
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
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Derington CG, King JB, Herrick JS, Shimbo D, Kronish IM, Saseen JJ, Muntner P, Moran AE, Bress AP. Trends in Antihypertensive Medication Monotherapy and Combination Use Among US Adults, National Health and Nutrition Examination Survey 2005-2016. Hypertension 2020; 75:973-981. [PMID: 32148129 PMCID: PMC7398637 DOI: 10.1161/hypertensionaha.119.14360] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Blood pressure (BP) control rates among US adults taking antihypertensive medication have not increased over the past decade. Many adults require 2 or more classes of antihypertensive medication to achieve guideline-recommended BP goals, but the proportion of US adults taking antihypertensive medication monotherapy, versus combination therapy, has not been quantified using contemporary data. We analyzed data from 2005 to 2008, 2009 to 2012, and 2013 to 2016 National Health and Nutrition Examination Surveys to determine trends in monotherapy and combinations of antihypertensive medication classes among US adults age ≥20 years with hypertension taking antihypertensive medication (n=7837). The proportion of US adults taking antihypertensive medication with uncontrolled BP (ie, systolic BP ≥140 or diastolic BP ≥90 mm Hg) was 32.3%, 30.2%, and 31.0% in 2005 to 2008, 2009 to 2012, and 2013 to 2016, respectively (Ptrend=0.37). Between 2005 to 2008 and 2013 to 2016, there was no evidence of changes in the proportions of US adults taking antihypertensive monotherapy (39.5%-40.4%, Ptrend=0.67), dual-therapy (37.9%-38.3%, Ptrend=0.75), triple-therapy (17.6%-16.5%, Ptrend=0.36), or quadruple-therapy (4.4%-4.3%, Ptrend=0.93). Between 2005 to 2008 and 2013 to 2016, there was no evidence of changes in the proportions of US adults with uncontrolled BP taking antihypertensive monotherapy (39.3%-40.6%, Ptrend=0.78). A high proportion of US adults with hypertension, including those with uncontrolled BP, are taking one antihypertensive medication class. Increasing the use of dual- and triple-therapy antihypertensive medication regimens may restore the upward trend in BP control rates among US adults.
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Affiliation(s)
- Catherine G Derington
- From the Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO (C.G.D., J.B.K.)
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO (C.G.D., J.J.S.)
| | - Jordan B King
- From the Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO (C.G.D., J.B.K.)
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT (J.B.K., J.S.H., A.P.B.)
| | - Jennifer S Herrick
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT (J.B.K., J.S.H., A.P.B.)
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY (D.S., I.M.K., A.E.M.)
| | - Ian M Kronish
- Department of Medicine, Columbia University Irving Medical Center, New York, NY (D.S., I.M.K., A.E.M.)
| | - Joseph J Saseen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO (C.G.D., J.J.S.)
- Department of Family Medicine, University of Colorado, School of Medicine, Aurora, CO (J.J.S.)
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (P.M.)
| | - Andrew E Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, NY (D.S., I.M.K., A.E.M.)
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT (J.B.K., J.S.H., A.P.B.)
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Magvanjav O, Cooper-Dehoff RM, McDonough CW, Gong Y, Hogan WR, Johnson JA. Combination Antihypertensive Therapy Prescribing and Blood Pressure Control in a Real-World Setting. Am J Hypertens 2020; 33:316-324. [PMID: 31853537 DOI: 10.1093/ajh/hpz196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/14/2019] [Accepted: 12/17/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Specific combinations of two drug classes are recommended in a variety of clinical situations in the management of hypertension. These preferred combinations are based on complimentary blood pressure (BP) lowering mechanisms or benefit for a concomitant disease. METHODS Using electronic health records (EHRs) data from 27,579 ambulatory hypertensive patients, we investigated antihypertensive therapy prescribing patterns and associations of preferred two drug classes with BP control. RESULTS Overall, BP control, defined as BP <140/90 mm Hg, was 65% among treated patients. Preferred dual antihypertensive therapy was prescribed in 55% of patients with uncomplicated hypertension, 49% of patients with diabetes, and 47% of patients with a history of myocardial infarction (MI); these prescribing frequencies of preferred combinations were not explained by worse BP control on those combinations. In fact, we found suggestive evidence of association between prescribing of preferred two drug classes and improved BP control among post-MI (OR: 1.21, 95% CI: 0.99-1.48, P = 0.061) and uncomplicated hypertensive (OR: 1.11, 95% CI: 0.98-1.26, P = 0.089) patients. CONCLUSIONS Prescribing of guideline-recommended antihypertensive drug classes for concomitant diseases is suboptimal and prescribing of preferred/optimized drug class combinations was moderate. We did not find a clear association between the use of optimized drug class combinations and greater BP control. Overall, using EHR data, we identified potential opportunities for re-examining prescribing practices with implications for clinical decision support and healthcare improvement at the community and health system-wide levels.
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Affiliation(s)
- Oyunbileg Magvanjav
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rhonda M Cooper-Dehoff
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Caitrin W McDonough
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study. Support Care Cancer 2020; 28:5315-5321. [PMID: 32124025 DOI: 10.1007/s00520-020-05364-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/17/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Opioid-induced constipation (OIC) is the most common side effect in patient-prescribed opioids for cancer pain treatment. Current guidelines recommend routine prescription of a laxative for preventing OIC in all patients prescribed an opioid unless a contraindication exists. We determined patterns of prescription of laxative agents in patients with lung cancer initiating opioids. METHODS We performed a retrospective cohort study evaluating the prescription of laxatives for OIC to adult patients with incident lung cancer seen in the Veteran's Affairs (VA) system, between January 1, 2003, and December 31, 2016. Exposure to laxative agents was categorized as follows: none, docusate monotherapy, docusate plus another laxative, and other laxatives only. Prevalence of OIC prophylaxis was analyzed using descriptive statistics. Linear regression was performed to identify time trends in the prescription of OIC prophylaxis. RESULTS Overall, 130,990 individuals were included in the analysis. Of these, 87% of patients received inadequate prophylaxis (75% no prophylaxis and 12% docusate alone), while 5% received OIC prophylaxis with the unnecessary addition of docusate to another laxative. Through the study period, laxative prescription significantly decreased, while all other categories of OIC prophylaxis were unchanged. We noted an inverse relationship with OIC prophylaxis and likelihood of a diagnosis of constipation at 3 and 6 months. CONCLUSIONS In this study of veterans with lung cancer, almost 90% received inadequate or inappropriate OIC prophylaxis. Efforts to educate physicians and patients to promote appropriate OIC prophylaxis in combination with systems-level changes are warranted.
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Koraishy FM, Yamout H, Naik AS, Zhang Z, Schnitzler MA, Ouseph R, Lam NN, Dharnidharka VR, Axelrod D, Hess GP, Segev DL, Kasiske BL, Lentine KL. Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation. Clin Transplant 2020; 34:e13803. [DOI: 10.1111/ctr.13803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/16/2019] [Accepted: 01/20/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Farrukh M. Koraishy
- Division of Nephrology Department of Medicine Stony Brook University Stony Brook NY USA
| | - Hala Yamout
- Division of Nephrology Department of Medicine Saint Louis University St. Louis MO USA
| | - Abhijit S. Naik
- Division of Nephrology Department of Medicine University of Michigan Ann Arbor MI USA
| | - Zidong Zhang
- Center for Abdominal Transplantation Saint Louis University School of Medicine St. Louis MO USA
| | - Mark A. Schnitzler
- Center for Abdominal Transplantation Saint Louis University School of Medicine St. Louis MO USA
| | - Rosemary Ouseph
- Center for Abdominal Transplantation Saint Louis University School of Medicine St. Louis MO USA
| | - Ngan N. Lam
- Division of Nephrology Department of Medicine University of Calgary Calgary AB Canada
| | - Vikas R. Dharnidharka
- Division of Nephrology Department of Pediatrics Washington University St. Louis MO USA
| | - David Axelrod
- University of Iowa Transplant Institute University of Iowa School of Medicine Iowa City IA USA
| | | | - Dorry L. Segev
- Center for Transplantation Johns Hopkins School of Medicine Baltimore MD USA
| | - Bertram L. Kasiske
- Department of Medicine Hennepin County Medical Center Minneapolis MN USA
| | - Krista L. Lentine
- Division of Nephrology Department of Medicine Saint Louis University St. Louis MO USA
- Center for Abdominal Transplantation Saint Louis University School of Medicine St. Louis MO USA
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Tata CM, Ndinteh D, Nkeh-Chungag BN, Oyedeji OO, Sewani-Rusike CR. Fractionation and bioassay-guided isolation of antihypertensive components of Senecio serratuloides. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1716447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Charlotte Mungho Tata
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University Mthatha 5117 South Africa
- Department of Chemical Sciences, Faculty of Science, University of Johannesburg Johannesburg South Africa
| | - Derek Ndinteh
- Department of Chemical Sciences, Faculty of Science, University of Johannesburg Johannesburg South Africa
| | | | - Opeopluwa Oyehan Oyedeji
- Department of Chemistry, Faculty of Science and Agriculture, University of Fort Hare PBX1314 Alice Eastern Cape Province 5700 South Africa
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Attimarad M, Venugopala KN, SreeHarsha N, Aldhubiab BE, Nair AB. Validation of rapid RP-HPLC method for concurrent quantification of amlodipine and celecoxib in pure and formulation using an experimental design. Microchem J 2020. [DOI: 10.1016/j.microc.2019.104365] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Risk Scoring Systems to Predict Long-Term Mortality After Carotid Endarterectomy in Asymptomatic Patients: A Systematic Review. Vasc Endovascular Surg 2019; 54:247-253. [DOI: 10.1177/1538574419895378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present review was conducted to describe current published risk scoring systems to predict late mortality after carotid endarterectomy (CEA). The aim of the study is to identify simple, clinical, and reproducible tools to predict life expectancy in patients with asymptomatic carotid artery stenosis candidates to CEA and therefore which patients may benefit from surgery, reaching the goal of life expectancy >3 to 5 years, recommended by guidelines. Advantages, disadvantages, feasibility, simplicity, and reproducibility of each selected score were analyzed. Rigorous statistical analysis and validation of the score are essential components to produce a calibrated and usable score. Future studies should address the impact of using these tools in CEA candidates for asymptomatic disease.
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Siddiqua A, Alshehri A, Alahmari AM, Alshehri RA, Badawy SS. A Study of Prescription Pattern and Compliance of Anti-hypertensives with the Treatment Guidelines in Aseer Region; Saudi Arabia. CURRENT DRUG THERAPY 2019. [PMCID: PMC7040506 DOI: 10.2174/1574885514666190424155014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background A prescription study is an effective method to evaluate irrational prescribing practice. Hypertension is one such major chronic disease. Compliance to guidelines like the JNC-8 (Eighth Joint National Committee) and Saudi Hypertension guidelines is highly recommended to prevent future complications. Objective We conducted this study to assess prescribing pattern and their compliance with the guidelines in the patients. Methods A Retrospective cross-sectional study was carried out for 7 weeks in 2017 in Aseer region, Abha, Saudi Arabia on 122 outpatient prescriptions which were included by Non-probability convenience sampling technique. Data from patients aged above 18 years with any stage of Hypertension with or without Diabetes Mellitus was collected. Results It was found that Angiotensin converting enzyme inhibitors were frequently prescribed as monotherapy in patients with Hypertension with or without Diabetes Mellitus which is in compliance to the guidelines. Beta-blockers were most commonly used in 2 and 3 drug therapy of patients with only Hypertension which was not in accordance with the guidelines. Conclusion By this it could be concluded that the Prescription pattern of Anti-hypertensive in Aseer Region was in compliance with both the guidelines to a partial extent. Though most of the prescriptions were rational, further improvement was required. Studies that focus on demographic data, economic status, associated conditions and complications would give additional insights into prescribing patterns in hypertension.
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Affiliation(s)
- Ayesha Siddiqua
- Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Afaf Alshehri
- Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Amal M. Alahmari
- Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Rawan A. Alshehri
- Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Somayh S. Badawy
- Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
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Venkataraman R, Rashid M, Shashikantha B, Soumya A, Vijayan G, Manuel GG, Islam S. Prescribing pattern of antihypertensive medication and adherence to Joint National Commission-8 guidelines in a rural tertiary care Indian teaching hospital. J Basic Clin Physiol Pharmacol 2019; 31:jbcpp-2019-0133. [PMID: 31503542 DOI: 10.1515/jbcpp-2019-0133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/12/2019] [Indexed: 12/26/2022]
Abstract
Background Antihypertensive medications are one among the most highly used drugs across the globe as well as in India, and their prescribing pattern will be erratic despite the various clinical guidelines. Few studies address the pattern and adherence to the standard treatment guidelines in India. This study aimed to review the prescribing pattern of antihypertensive medications in a rural tertiary care teaching Indian hospital and to investigate the adherence to the Joint National Commission-8 (JNC-8) guidelines on prevention, detection, evaluation, and treatment of hypertension in adults. Methods A prospective observational study was conducted among the participants from four different inpatient wards who are aged >18 years, without gender restriction. The prescription pattern was reviewed and adherence to the JNC-8 guidelines was also assessed. A purposive sampling technique was adopted and descriptive statistics were used in Statistical Package for the Social Sciences v16. Results Of the 101 participants included in the study, 62 (61.39%) were female, 23.76% were aged <30 and >60 years, and the other 52.48% belong to the range of 30-60 years. As per JNC-8 guidelines, 4.95%, 17.82%, 44.55%, and 32.67% of patients were classified as normal, pre-hypertensive, stage I, and stage II, respectively. Most of them (31.68%) were free from comorbidities. The most (23.76%) prescribed drug was calcium channel blocker (CCB), and 15.84% of the patients received combination therapy. Treatment was effective in 70.30% of the patients through analyzing their blood pressure even though the adherence to the JNC-8 guidelines was only in 54.46%. Conclusions Our study revealed that CCB was the most prescribed drug, and in spite of the only 50% adherence rate, treatment was effective in the majority of the population. The treatment outcome can be improved if the adherence rate is increased further.
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Affiliation(s)
- Rajesh Venkataraman
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri Hospital and Research Center, Adichunchanagiri University, Nagamangala, Karnataka 571448, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri Hospital and Research Center, Adichunchanagiri University, BG Nagara,Nagamangala, Karnataka 571448, India, Mobile: +91-9886880633
| | - Bhat Shashikantha
- Department of General Medicine, Adichunchanagiri Institute of Medical Science, Adichunchanagiri Hospital and Research Center, Adichunchanagiri University, BG Nagara,Nagamangala, Karnataka 571448, India
| | - Ayyappankalathil Soumya
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri Hospital and Research Center, Adichunchanagiri University, Nagamangala, Karnataka 571448, India
| | - Greeshma Vijayan
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri Hospital and Research Center, Adichunchanagiri University, Nagamangala, Karnataka 571448, India
| | - Gloriya Grifth Manuel
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri Hospital and Research Center, Adichunchanagiri University, Nagamangala, Karnataka 571448, India
| | - Shahinur Islam
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri Hospital and Research Center, Adichunchanagiri University, Nagamangala, Karnataka 571448, India
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Prescribing Patterns of Antihypertensives for Treatment-Naïve Patients in South Korea: From Korean NHISS Claim Data. Int J Hypertens 2019; 2019:4735876. [PMID: 31534797 PMCID: PMC6732595 DOI: 10.1155/2019/4735876] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/10/2019] [Accepted: 07/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background Several factors influence the choice of antihypertensive drugs. To facilitate the rational use of drugs it is important to assess their prescription patterns over time. This study aims to evaluate doctors' prescribing patterns of antihypertensive drugs for drug-naïve patients in South Korea. Methods The claims data of the Korean National Health Insurance Research Database from 1 January 2011 to 31 December 2015 were analyzed. The data virtually cover the entire South Korean population. Antihypertensive drugs were further subdivided into angiotensin receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEis), calcium channel blockers (CCBs), beta-blockers (BBs), and thiazide diuretics. The prescription pattern of antihypertensive drugs and associated factors were assessed according to the patients' characteristics, including associated comorbidities. Results A total of 2,919,162 subjects had started taking antihypertension medications during the study period. ARB was the most frequently prescribed drug (51.6%) followed by CCB (45.0%), BB (18.5%), diuretics (17.0%), and ACEi (11.7%). Most patients were prescribed with monotherapy (66.7%) rather than combination therapy (33.3%), and CCB was the most frequently prescribed monotherapy drug (25.7%). For combination therapy, ARB + CCB was the most frequently prescribed combination, and the prescription frequency was found to be increasing. In patients prescribed with combination therapy, most had been prescribed single-pill fixed-dose combination. Conclusion We identified the physicians' prescription patterns of antihypertensive drugs for treatment-naïve patients. The findings of this study can lead to a rational, evidence-based, and cost-effective improvement of prescription patterns in newly diagnosed hypertensive patients.
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Singh S, Warren HR, Hiltunen TP, McDonough CW, El Rouby N, Salvi E, Wang Z, Garofalidou T, Fyhrquist F, Kontula KK, Glorioso V, Zaninello R, Glorioso N, Pepine CJ, Munroe PB, Turner ST, Chapman AB, Boerwinkle E, Johnson JA, Gong Y, Cooper-DeHoff RM. Genome-Wide Meta-Analysis of Blood Pressure Response to β 1-Blockers: Results From ICAPS (International Consortium of Antihypertensive Pharmacogenomics Studies). J Am Heart Assoc 2019; 8:e013115. [PMID: 31423876 PMCID: PMC6759913 DOI: 10.1161/jaha.119.013115] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundThere exists a wide interindividual variability in blood pressure (BP) response to β1-blockers. To identify the genetic determinants of this variability, we performed a pharmacogenomic genome-wide meta-analysis of genetic variants influencing β1-blocker BP response.Methods and ResultsGenome-wide association analysis for systolic BP and diastolic BP response to β1-blockers from 5 randomized clinical trials consisting of 1254 patients with hypertension of European ancestry were combined in meta-analysis and single nucleotide polymorphisms (SNPs) with P<10-4 were tested for replication in 2 independent randomized clinical trials of β1-blocker-treated patients of European ancestry (n=1552). Regions harboring the replicated SNPs were validated in a β1-blocker-treated black cohort from 2 randomized clinical trials (n=315). A missense SNP rs28404156 in BST1 was associated with systolic BP response to β1-blockers in the discovery meta-analysis (P=9.33×10-5, β=-3.21 mm Hg) and replicated at Bonferroni significance (P=1.85×10-4, β=-4.86 mm Hg) in the replication meta-analysis with combined meta-analysis approaching genome-wide significance (P=2.18×10-7). This SNP in BST1 is in linkage disequilibrium with several SNPs with putative regulatory functions in nearby genes, including CD38, FBXL5, and FGFBP1, all of which have been implicated in BP regulation. SNPs in this genetic region were also associated with BP response in the black cohort.ConclusionsData from randomized clinical trials of 8 European ancestry and 2 black cohorts support the assumption that BST1 containing locus on chromosome 4 is associated with β1-blocker BP response. Given the previous associations of this region with BP, this is a strong candidate region for future functional studies and potential use in precision medicine approaches for BP management and risk prediction.
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Affiliation(s)
- Sonal Singh
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine University of Florida Gainesville FL
| | - Helen R Warren
- William Harvey Research Institute Barts and The London School of Medicine and Dentistry Queen Mary University of London United Kingdom.,National Institute for Health Research Barts Cardiovascular Biomedical Research Center Queen Mary University of London United Kingdom
| | - Timo P Hiltunen
- Department of Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland.,Research Program for Clinical and Molecular Medicine University of Helsinki Finland
| | - Caitrin W McDonough
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine University of Florida Gainesville FL
| | - Nihal El Rouby
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine University of Florida Gainesville FL
| | - Erika Salvi
- Neuroalgology Unit Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan Italy
| | - Zhiying Wang
- Human Genetics and Institute of Molecular Medicine University of Texas Health Science Center Houston TX
| | - Tatiana Garofalidou
- William Harvey Research Institute Barts and The London School of Medicine and Dentistry Queen Mary University of London United Kingdom
| | - Frej Fyhrquist
- Minerva Foundation Institute for Medical Research Helsinki Finland
| | - Kimmo K Kontula
- Department of Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland.,Research Program for Clinical and Molecular Medicine University of Helsinki Finland
| | | | - Roberta Zaninello
- Hypertension and related diseases Centre Department of Clinical and Experimental Medicine University of Sassari Italy
| | - Nicola Glorioso
- Hypertension and related diseases Centre Department of Clinical and Experimental Medicine University of Sassari Italy
| | - Carl J Pepine
- Division of Cardiovascular Medicine Department of Medicine University of Florida Gainesville FL
| | - Patricia B Munroe
- William Harvey Research Institute Barts and The London School of Medicine and Dentistry Queen Mary University of London United Kingdom.,National Institute for Health Research Barts Cardiovascular Biomedical Research Center Queen Mary University of London United Kingdom
| | - Stephan T Turner
- Division of Nephrology and Hypertension Mayo Clinic Rochester MN
| | | | - Eric Boerwinkle
- Human Genetics and Institute of Molecular Medicine University of Texas Health Science Center Houston TX
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine University of Florida Gainesville FL.,Division of Cardiovascular Medicine Department of Medicine University of Florida Gainesville FL
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine University of Florida Gainesville FL
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine University of Florida Gainesville FL.,Division of Cardiovascular Medicine Department of Medicine University of Florida Gainesville FL
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Bonavia A, Javaherian M, Skojec AJ, Chinchilli VM, Mets B, Karamchandani K. Angiotensin axis blockade, acute kidney injury, and perioperative morbidity in patients undergoing colorectal surgery: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e16872. [PMID: 31415426 PMCID: PMC6831354 DOI: 10.1097/md.0000000000016872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients undergoing surgery and taking angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) are susceptible to complications related to intraoperative hypotension. Perioperative continuation of such medications in patients undergoing colorectal surgery may be associated with more harm than benefit, as these patients are often exposed to other risk factors which may contribute to intraoperative hypotension. Our objectives were to assess the incidence and severity of postinduction hypotension as well as the rates of acute kidney injury (AKI), 30-day all-cause mortality, 30-day readmission, and hospital length of stay in adult patients undergoing colorectal surgery who take ACEi/ARB.We performed a retrospective chart review of patients undergoing colorectal surgery of ≥4 hour duration at a tertiary care academic medical center between January 2011 and November 2016. The preoperative and intraoperative characteristics as well as postoperative outcomes were compared between patients taking ACEi/ARB and patients not taking these medications.Of the 1020 patients meeting inclusion criteria, 174 (17%) were taking either ACEi or ARB before surgery. Patients taking these medications were more likely to receive both postinduction and intraoperative phenylephrine and ephedrine. The incidences of postoperative AKI (P = .35), 30-day all-cause mortality (P = .36), 30-day hospital readmission (P = .45), and hospital length of stay (P = .25), were not significantly different between the 2 groups.Our results support the current recommendation that ACEi/ARB use is probably safe within the colorectal surgery population during the perioperative period. Intraoperative hypotension should be expected and treated with vasopressors.
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Affiliation(s)
- Anthony Bonavia
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Milad Javaherian
- Department of Anesthesiology, Harbor-UCLA Medical Center, Torrance, CA
| | - Alexander J. Skojec
- Department of Anesthesiology, School of Medicine, University of Virginia, Charlottesville, VA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Berend Mets
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Kunal Karamchandani
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
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Modernizing the World Health Organization List of Essential Medicines for Preventing and Controlling Cardiovascular Diseases. J Am Coll Cardiol 2019; 71:564-574. [PMID: 29406862 DOI: 10.1016/j.jacc.2017.11.056] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 11/22/2022]
Abstract
The World Health Organization (WHO) Model List of Essential Medicines (EML) is a key tool for improving global access to medicines for all conditions, including cardiovascular diseases (CVDs). The WHO EML is used by member states to determine their national essential medicine lists and policies and to guide procurement of medicines in the public sector. Here, we describe our efforts to modernize the EML for global CVD prevention and control. We review the recent history of applications to add, delete, and change indications for CVD medicines, with the aim of aligning the list with contemporary clinical practice guidelines. We have identified 4 issues that affect decisions for the EML and may strengthen future applications: 1) cost and cost-effectiveness; 2) presence in clinical practice guidelines; 3) feedback loops; and 4) community engagement. We share our lessons to stimulate others in the global CVD community to embark on similar efforts.
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