Improving quality of life in hypertension management using a fixed-dose combination of olmesartan and amlodipine in primary care

24-Hour Blood Pressure Control with Amlodipine: A Review of the Current Scenario

Introduction Hypertension is the leading cause of cardiovascular diseases and premature death worldwide. Antihypertensive therapy using calcium channel blockers (CCBs) is one of the preferred choices to treat blood pressure (BP) and control blood pressure variability (BPV). In contrast to clinic BP, 24-hour ambulatory BP monitoring (ABPM) has evolved into an accurate and reproducible tool for the assessment and management of hypertension. Amlodipine, a longer acting dihydropyridine CCB is effective for 24 hours BP control and also minimizing BPV. The present article is the comprehensive review highlighting the efficacy of amlodipine in controlling 24-hour BP and minimizing BPV from the review of recent studies.

Materials and Methods The literature search was done using PubMed, Google Scholar, and MEDLINE databases. The studies to be included for review, were identified through the keywords: “amlodipine,” “ambulatory BP monitoring (ABPM),”“blood pressure variability (BPV),” “CCBs,” and filtering articles published in English language only.

Results Pharmacological evidence suggests that amlodipine has the ability to block all the subtypes of CCBs such as L-, N-, P-, Q-, R-, and T-type. Various clinical studies reported that amlodipine is a powerful, well-tolerated, and safe antihypertensive agent which is widely used either alone or as a key component of combination therapy for control of 24 hours BP.

Conclusion Overall, amlodipine is a proven and effective antihypertensive drug and helpful in controlling 24-hour BP, minimizing BP variability and hence reducing the risk of cardiovascular complications.

Quality of life and treatment adherence in hypertensive patients: systematic review with meta-analysis

OBJECTIVE

To verify the effects of antihypertensive treatment (pharmacological and non-pharmacological) on the health-related quality of life of individuals with hypertension.

METHODS

We conducted a systematic review with meta-analysis using the following databases: IBECS, LILACS, SciELO, Medline, Cochrane, Science Direct, Scopus and the Brazilian Capes Theses and Dissertations Database. The statistical analysis was performed using Review Manager, version 5.2. The average difference was used for the summarization of meta-analytic effect by the fixed-effect model. Twenty studies were included.

RESULTS

The summarization of the effect showed an average increase of 2.45 points (95%CI 1.02-3.87; p < 0.0008) in the quality of life of individuals adhering to non-pharmacological treatment for arterial hypertension. Adherence to pharmacological treatment indicated an average increase of 9.24 points (95%CI 8.16-10.33; p < 0.00001) in the quality of life of individuals with arterial hypertension.

CONCLUSIONS

Non-pharmacological treatment improves the overall quality of life and physical domain of people with arterial hypertension. Adherence to pharmacological treatment has a positive impact on the mental and physical domains of patients, as it did on the overall quality of life score.

OBJETIVO

Verificar os efeitos do tratamento anti-hipertensivo (farmacológico e não-farmacológico) na qualidade de vida relacionada à saúde de pessoas com hipertensão arterial.

MÉTODOS

Foi conduzida revisão sistemática com metanálise utilizando as bases de dados IBECS, Lilacs, SciELO, Medline, Cochrane, Science Direct, Scopus e o banco de teses da Capes. A análise estatística foi realizada pelo Review Manager versão 5.2. Foi utilizada a diferença da média na sumarização do efeito metanalítico pelo modelo de efeito fixo. Vinte estudos foram incluídos.

RESULTADOS

A sumarização do efeito mostrou incremento de 2,45 pontos na média (IC95% 1,02-3,87; p < 0,0008) da qualidade de vida em pessoas com adesão ao tratamento não farmacológico para hipertensão arterial. A adesão ao tratamento farmacológico indicou aumento de 9,24 pontos na média (IC95% 8,16-10,33; p < 0,00001) da qualidade de vida em pessoas com hipertensão arterial.

CONCLUSÕES

O tratamento não-farmacológico melhora a qualidade de vida global e o domínio físico de pessoas com hipertensão arterial. A adesão ao tratamento farmacológico impacta positivamente nos domínios mental, físico e escore total da qualidade de vida.

Effectiveness of Educational Technology in Promoting Quality of Life and Treatment Adherence in Hypertensive People

The objective of this study was to test the effectiveness of an educational intervention with use of educational technology (flipchart) to promote quality of life (QOL) and treatment adherence in people with hypertension. It was an intervention study of before-and-after type conducted with 116 hypertensive people registered in Primary Health Care Units. The educational interventions were conducted using the flipchart educational technology. Quality of life was assessed through the MINICHAL (lowest score = better QOL) and the QATSH (higher score = better adherence) was used to assess the adherence to hypertension treatment. Both were measured before and after applying the intervention. In the analysis, we used the Student's t-test for paired data. The average baseline quality of life was 11.66 ± 7.55, and 7.71 ± 5.72 two months after the intervention, showing a statistically significant reduction (p <0.001) and mean of differences of 3.95. The average baseline adherence to treatment was 98.03 ± 7.08 and 100.71 ± 6.88 two months after the intervention, which is statistically significant (p < 0.001), and mean of differences of 2.68. The conclusion was that the educational intervention using the flipchart improved the total score of quality of life in the scores of physical and mental domains, and increased adherence to hypertension treatment in people with the disease.

Responder and health-related quality of life analyses in men with lower urinary tract symptoms treated with a fixed-dose combination of solifenacin and tamsulosin oral-controlled absorption system: results from the NEPTUNE study

OBJECTIVE

To evaluate the effect of a fixed-dose combination (FDC) of solifenacin and an oral-controlled absorption system (OCAS™) formulation of tamsulosin (TOCAS) on health-related quality of life (HRQoL) in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH).

PATIENTS AND METHODS

Men with moderate-to-severe storage symptoms and voiding symptoms were treated for 12 weeks with a FDC of solifenacin 6 or 9 mg plus TOCAS (0.4 mg), TOCAS monotherapy (0.4 mg) or placebo in a randomised, double-blind study (NEPTUNE). The co-primary endpoints were Total Urgency Frequency Score (TUFS) and total International Prostate Symptom Score (IPSS). HRQoL was assessed by several secondary endpoints: IPSS QoL index, overactive bladder questionnaire (OAB-q), and Patient Global Impression (PGI) scale. The correlation between symptom improvement (TUFS) and HRQoL was assessed by Spearman rank correlation coefficients. Single and double responder analyses, using subjective and objective measures, were also performed.

RESULTS

In the responder analyses, men treated with a FDC of solifenacin 6 mg plus TOCAS consistently had significantly improved outcomes compared with placebo (8/8 responder analyses performed) and TOCAS (6/8 responder analyses performed). There was a significant correlation (P < 0.001) between the reduction in TUFS and the improvement in HRQoL defined by IPSS QoL score, OAB-q symptom bother score, PGI overall bladder symptoms and PGI general health.

CONCLUSIONS

In men with LUTS/BPH who have moderate-to-severe storage symptoms and voiding symptoms, the reduction in symptoms with a once-daily FDC of solifenacin and TOCAS was associated with consistent patient-relevant improvements in HRQoL compared with placebo and TOCAS monotherapy.

Olmesartan/amlodipine: blood pressure lowering and beyond in special populations

Clinical studies and population-based analyses show that in patients with hypertension, the majority cannot control their blood pressure (BP) by treatment with a single antihypertensive agent. Combining agents from different antihypertensive classes with complementary modes of action significantly increases efficacy and is a treatment strategy recommended by European treatment guidelines, particularly in patients at high cardiovascular risk. The combinations of antihypertensive agents recommended by the European guidelines include an angiotensin receptor blocker (ARB) with a calcium channel blocker (CCB). The single-pill combination formulation of the ARB olmesartan medoxomil plus the CCB amlodipine is an effective and well-tolerated treatment that provides greater blood pressure lowering and control than the component monotherapies and favours compliance by not increasing pill burden. Importantly, the efficacy and tolerability of olmesartan plus amlodipine is not affected by age, gender, hypertension severity, diabetes status, race or body mass index. Additional blood pressure lowering effects are observed with stepwise uptitration of olmesartan plus amlodipine with or without hydrochlorothiazide, with more patients achieving blood pressure goals. In addition, olmesartan plus amlodipine has demonstrated effects beyond BP lowering by showing beneficial effects on markers of inflammation, endothelial dysfunction and oxidative stress, as well as metabolic improvements and a reduction in new-onset diabetes incidence in hypertensive patients with metabolic syndrome.