Trends in blood pressure control and medication use during 20 years in a hypertension clinic in Japan

Calcium channel blockers, angiotensin II receptor antagonists and alpha-blockers accentuate blood pressure reducing caused by dental local anesthesia

OBJECTIVE

The primary aim of this study was to investigate the effect associated with patients' factor such as systemic disease on the blood pressure of patients in dental procedure. The secondary aim of this study was to investigate the effect associated with systemic disease and antihypertensive on the blood pressure changes with local anesthesia.

METHODS

The blood pressure was measured before and after local anesthesia injection for dental treatment. The effect associated with patients' factor such as systemic disease on the blood pressure and the effect on blood pressure changes of the type of antihypertensive drugs and the systemic disease were analyzed using a multivariate analysis of variance test.

RESULTS

We analyzed 1306 patients scheduled for the dental procedure. Age and some systemic diseases such as hypertension and angina pectoris affected blood pressure before local anesthesia. On the other hand, age and systemic diseases did not affect blood pressure changes. And, some antihypertensive affected systolic blood pressure changes.

CONCLUSIONS

The blood pressure change with local anesthesia was not associated with systemic diseases and age but was associated with antihypertensive agents. In particular, calcium channel blockers, angiotensin II receptor antagonists and alpha-blockers accentuate blood pressure reducing caused by local anesthesia.

CLINICAL RELEVANCE

The blood pressure change with local anesthesia was associated with antihypertensive agents. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (number UMIN000030695).

Achievement rate of blood pressure <140/90 mmHg and <130/80 mmHg in subjects with hypertension; findings from a Japanese health checkup in 2017

Blood pressure (BP) control status was investigated using data of a health checkup held in a Japanese city. In fiscal year 2017, 54,287 persons (age, 40-74 years; males, 49%) underwent the checkup; 28,167 examinees had a systolic BP ≥140 mmHg, a diastolic BP ≥90 mmHg, or took antihypertensive agents. Of these subjects, 20,153 subjects took antihypertensive agents. A BP <140/90 was achieved in 66.6% (13,426) of the treated subjects; however, a BP <130/80 was achieved only in 30.7% (6,188). In conclusion, in 2017, although a relatively large proportion of treated subjects achieved a BP <140/90 mmHg with antihypertensive agents, only approximately half of these subjects reached a BP <130/80 mmHg, which is the latest treatment target for persons aged 75 years or less according to the Japanese hypertension guidelines 2019.

Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

BACKGROUND

Angiotensin-converting enzyme inhibitors (ACEIs) are the first choice for the treatment of acute myocardial infarction (AMI), and angiotensin receptor blockers (ARBs) should be considered in patients intolerant to ACEIs. Although previous studies support the use of ARBs as an alternative to ACEIs, these studies showed inconsistent results. The objective of this study was to demonstrate the clinical impact of ARBs as an alternative to ACEIs in patients with AMI undergoing percutaneous coronary intervention (PCI).

METHODS

The CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI (COREA-AMI) registry enrolled all consecutive patients with AMI undergoing PCI. The primary endpoint was the composite of cardiovascular death, myocardial infarction, stroke, or hospitalization due to heart failure.

RESULTS

Of the 3,328 eligible patients, ARBs replaced ACEIs in 816 patients, while 824 patients continued to use ACEIs and 826 patients continued to use ARBs. The remaining 862 patients did not receive ACEIs/ARBs. After the adjustment with inverse probability weighting, the primary endpoints in the first groups were similar (7.5% vs. 8.0%, hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.75-1.05; P = 0.164). Composite events were less frequent in the ACEI to ARB group than no ACEI/ARB group (7.5% vs. 11.8%, HR, 0.76; 95% CI, 0.64-0.90; P = 0.002).

CONCLUSION

The alternative use of ARBs following initial treatment with ACEIs demonstrates comparable clinical outcomes to those with continued use of ACEIs and is associated with an improved rate of composite events compared to no ACEI/ARB use in patients with AMI undergoing PCI.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02385682.

Sex differences in antihypertensive drug use and blood pressure control

BACKGROUND

Hypertension is the most important modifiable cardiovascular risk factor. Epidemiological studies have shown the benefits of lowering blood pressure (BP), but BP control is a major challenge. Furthermore, there are significant sex differences in antihypertensive drug use and BP control. This study examined sex differences in antihypertensive drug use and BP control, with the aim of reducing the complications of hypertension and improving quality of life.

METHODS

The study was performed in our outpatient hypertension clinic, and included 1529 patients without secondary hypertension or comorbidities. The study, investigated BP control rates and patterns of antihypertensive drug use in male and female. All data were collected using structured questionnaires and patient measurements.

RESULTS

The study included 713 males and 816 females in this study. Fewer females had hypertension in the younger age group (16.2% vs 11.6%; p>0.05), but this difference disappeared in middle-aged (47.8% vs 49.9 %; p<0.05) and elderly age groups (36.0% vs 38.5%; p<0.05). BP control rates differed between males and females (35.6% in male, 31.9% in female, p<0.01). There was an overall difference in BP control rates between males and females (35.6% in males, 31.9% in females, p<0.01). In this aged 18-44 years, angiotensin converting enzyme inhibitors (ACEIs) showed the best control rate in males, while calcium channel blockers (CCBs) were least effective (61.5% with ACEIs, 28.6% with CCBs; p<0.05). In this aged 45-64 years, diuretics (DUs) showed the best control rate in females, while CCBs were least effective (47.5% with DUs, 28.3% with CCBs; p<0.05).

CONCLUSIONS

Sex plays an important role in BP control. In those aged 18-44 years, males using ACEIs showed best control rates. In those aged 45-64 years, females using DUs showed best control rates. Our study provides a basis with the selection of antihypertensive drugs according to sex and age.

Treatment patterns and adherence to antihypertensive combination therapies in Japan using a claims database

Fixed-dose combinations (FDCs) for blood pressure control can simplify prescribing, improve medication adherence, and be cost-effective. In Japan, real-world data about the class effects of antihypertensive drugs on medication adherence are limited. Using the nationwide database of medical health claims from Diagnosis Procedure Combination hospitals, treatment patterns and adherence were analyzed for 47,891 patients prescribed antihypertensive medication between April 2014 and March 2015. Adherence was assessed by the proportion of days covered (expressed as % PDC). Patients were prescribed a mean of 2.0 ± 1.0 antihypertensive drugs and 2.4 ± 1.7 pills for their index prescription. Mean adherence overall was 91.5% PDC and was inversely correlated with the number of antihypertensive drugs or pills prescribed on the index date. Mean % PDC was significantly higher (all P < 0.0001) for CCB + ARB versus ARB + thiazide diuretic combinations and for CCB + ARB + β-blocker versus CCB + ARB + thiazide diuretic combinations. Adherence was significantly higher (P < 0.0001) for FDC (CCB + ARB) versus corresponding single-drug combinations, but not for other comparisons of FDCs versus single-drug combinations. On the other hand, FDCs were not always used effectively; specifically, FDCs were frequently used concomitantly with a single agent(s) from the same drug class(es) as the FDC. From the results of our study, no clear differences were observed in medication adherence according to the presence or absence of FDC formulations, and there were cases in which FDCs were not being utilized effectively to simplify prescribing.

Current prescription status of antihypertensive drugs in Japanese patients with hypertension: Analysis by type of comorbidities

In 2014, the Japanese Society of Hypertension (JSH) issued revised guidelines for hypertension management. To assess adherence to the guidelines, this retrospective study evaluated the real-world status of antihypertensive drug prescribing for Japanese patients with hypertension, classified by comorbidity: diabetes mellitus, dyslipidemia, gout/hyperuricemia and renal diseases. Data on 59,867 hypertensive patients who received their first prescription for antihypertensive therapy between April 2014 and March 2015, were obtained from a medical insurance claims database for hospitals participating in the Diagnosis Procedure Combination/Per-Diem payment system. The most common drugs prescribed for each comorbidity subgroup were calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs), with prescription rates of around 60-70%. Contrary to JSH recommendations, diuretics and angiotensin-converting enzyme inhibitors were prescribed less often than β-blockers. Whereas diabetes mellitus is a compelling indication for use of renin-angiotensin system inhibitors, CCBs were commonly prescribed in this subgroup. The treatment pattern for patients with comorbid dyslipidemia closely resembled that for the overall patient population. Loop diuretics were prescribed more frequently for patients with renal diseases or gout/hyperuricemia than for those with diabetes mellitus or dyslipidemia. Although antihypertensive drug prescribing varied by comorbidity, JSH 2014 guidelines appeared not to be incorporated adequately into actual clinical practice.

Risk Factors Of Heart Disease in Nurses

BACKGROUND

Identifying and correcting the modifiable risk factors reduces the prevalence of coronary artery disorders (CAD). Nurses, with regards to their employment conditions, can be prone to cardiovascular disease (CVD). This study aimed to determine the prevalence of cardiovascular risk factors among nurses.

MATERIALS AND METHODS

In this cross-sectional study, census sampling was conducted among nurses of Jahrom, Iran, in 2014. Data were collected through interviews, blood pressure measurement, anthropometric parameters, and blood sample collection. To analyze the data, descriptive statistical analysis, and comparative (independent t-test) and correlation (Pearson) tests were used; the significance level was considered to be P < 0.05.

RESULTS

In this study, 263 (89.76%) nurses participated, 79.8% of whom were women. The mean age of the participants was 31.04 (6.97). In terms of body mass index, 41.7% was the waist-to-hip ratio, 16.7% was the waist-to-height ratio, and 63.1% were in the range of obesity. In addition, 5.7% had abnormal triglyceride, 4.9% had high cholesterol, and 15.1% had high blood pressure. The mean percentage of the Framingham risk score of the participants was 1.07 (1.84).

CONCLUSIONS

In this study, the total mean percentage of the Framingham risk score of the nurses was 1.07, which showed a low risk of CAD in the study population over the next decade.