Attitudes and preferences for the clinical management of patients with hypertension and hypertension with chronic obstructive pulmonary disease in Italy: main results of a survey questionnaire

Hypertension treatment and control represent a clinical challenge, particularly in case of concomitant risk factors and comorbidities, including chronic obstructive pulmonary disease (COPD). To evaluate attitudes and preferences for the clinical management of hypertension and hypertension associated with COPD by a large community sample of physicians in Italy. A predefined 18-item survey questionnaire was anonymously administered to both specialised physicians (SPs) and general practitioners (GPs), who have been included in an educational programme, performed between January and June 2014. A total of 1181 physicians (767 males, mean age 55.8 ± 7.3 years, average age of medical activity 27.6 ± 8.3 years), among whom 64 (5.4 %) SPs and 1117 (94.6 %) GPs, provided 21,809 valid answers to the survey questionnaire. Concomitant presence of hypertension and COPD was frequently associated (21-40 %) with hypertension-related organ damage and comorbidities. Concomitant presence of hypertension and COPD was able to affect physicians' ability to achieve the recommended therapeutic targets. To achieve the recommended BP goals, ACE inhibitors or ARBs were considered the most effective antihypertensive strategies, both in monotherapies and in combination therapies with either diuretics or calcium-channel blockers. This observational, cross-sectional survey provides useful information on physicians' attitudes and preferences for the clinical management of patients with hypertension and hypertension associated with COPD.

Impact of hypertension on global cardiovascular risk stratification: analysis of a large cohort of outpatient population in Italy

BACKGROUND

Control of hypertension remains a major unmet need, worldwide.

HYPOTHESIS

To test whether the presence of hypertension may improve global cardiovascular (CV) risk stratification and achievement of therapeutic targets for CV risk factors in adult outpatients in Italy.

METHODS

Physicians were asked to submit data covering the first 10 consecutive adult outpatients. All data were centrally analyzed for global CV risk assessment and rates of control of major CV risk factors, mostly blood pressure (BP) levels, in different high-risk subgroups of hypertensive patients.

RESULTS

Overall, 1078 physicians collected data of 9864 outpatients (46.7% females, age 66.1 ± 10.3 years) with valuable data on BP levels, among which 7147 (72.5%) had a diagnosis of hypertension and 2717 (27.5%) were normotensive subjects. Hypertensive patients were older and had a higher prevalence of major risk factors, including smoking, obesity, dyslipidemia, and family history of cardiovascular disease, as well as comorbidities, than did normotensive subjects (P < 0.001 for all comparisons). Despite worse control of BP (66.9% vs 36.2%, P < 0.001), high-density lipoprotein cholesterol (40.5% vs 37.4%, P < 0.005), triglycerides (72.1% vs 67.8%, P < 0.001), and fasting plasma glucose (71.2% vs 67.0%, P < 0.005), hypertension was associated with larger availability and frequency of diagnostic examinations and greater use of antihypertensive, glucose-lowering, and lipid-lowering drugs, as well as antiplatelet agents, compared with normotension (P < 0.001).

CONCLUSIONS

Presence of hypertension significantly improved clinical data collection and CV risk stratification. Such an approach, however, was not paralleled by better control of major CV risk factors.

Calcium channel blockers and hypertension

Effective treatment of high blood pressure (BP) represents a key strategy for reducing the burden of hypertension-related cardiovascular and renal diseases. In spite of these well-established concepts, hypertension remains poorly controlled worldwide. In order to improve BP control in patients with hypertension, several interventions have been proposed, among which (1) preferred use of more effective, sustained, and well-tolerated antihypertensive drug aimed to ensure adherence to prescribed medications and (2) extensive use of rational, integrated, and synergistic combination therapies, even as first-line strategy, aimed to achieve the recommended BP targets. Within the possible antihypertensive drug classes currently available for the clinical management of hypertension, both in monotherapy and in combination therapy, drugs inhibiting the renin-angiotensin system and calcium channel blockers (CCBs) have demonstrated to be effective and safe in lowering BP levels and achieving the recommended BP targets with a good tolerability profile. In particular, CCBs have been one of the most widely used classes of antihypertensive agents in the last 20 years, based on their effectiveness in reducing BP levels, good tolerability, and abundant evidence on reducing cardiovascular and renal consequences of hypertension. This article provides an updated overview of the evidence supporting the use of CCBs-based antihypertensive regimen, both in monotherapy and in combination therapies with different classes of antihypertensive drugs.

Hypertension in pregnancy: the most recent findings in pathophysiology, diagnosis and therapy

Hypertension in pregnancy is a major cause of maternal, fetal and neonatal morbidity and mortality, both in developing and developed countries. That is because it is the most common pathological condition during pregnancy and its development is associated with high risk of severe complications: mother could be affected by placental abruption, cerebrovascular events, organ dysfunction and could develop disseminated intravascular coagulation, instead the foetus could be affected by intrauterine growth retardation, premature birth and intrauterine death. Aware that preeclampsia still remains an enigma for different aspects, this review aims to provide a comprehensive update of all the current literature regarding this disease. In particular, the main purpose of this review is to emphasize the most recent findings about the pathophysiology, diagnosis and submit a revision of the most recent guidelines in relation to drug therapy, with particular attention to the evaluation of risks and benefits associated with the use of various classes of the currently available drugs.

Triple combination therapy to improve blood pressure control: experience with olmesartan-amlodipine-hydrochlorothiazide therapy

INTRODUCTION

Effective treatment of hypertension is a key strategy for preventing and reducing the burden of hypertension-related cardiovascular diseases. In spite of these well-established concepts, hypertension remains poorly controlled, worldwide. Among the different pharmacological strategies required to improve blood pressure (BP) control, a more extensive use of combination therapy is progressively emerging as a cornerstone of a more effective treatment of hypertension. Among different drug combinations currently available for the clinical management of hypertension, those based on the association of drugs inhibiting the renin-angiotensin system, thiazide diuretics and calcium channel blockers have demonstrated to be very effective in lowering both systolic and diastolic, clinic and 24-h ambulatory BP levels with a good tolerability and safety profile.

AREAS COVERED

In the present manuscript the authors provide an overview of the evidence supporting the use of triple combination therapy with different classes of antihypertensive drugs, with a particular focus on those based on olmesartan medoxomil, a thiazide diuretic (hydrochlorothiazide) and a calcium channel blocker (amlodipine besylate).

EXPERT OPINION

Available data indicate that triple combination therapy based on olmesartan provides effective and sustained clinical and 24-h BP control in a high proportion of individuals among a broad range of hypertensive patients.

Prevalence of 'borderline' values of cardiovascular risk factors in the clinical practice of general medicine in Italy: results of the BORDERLINE study

INTRODUCTION

The prevalence of patients with 'borderline' levels of cardiovascular risk factors has been rarely investigated, being often reported in studies evaluating abnormal values of these parameters. The BORDERLINE study represents a pilot experience to primarily identify the prevalence of 'high-normal' conditions, such as pre-hypertension, lipid and glucose levels in the upper range of normality in the setting of general practice in Italy.

AIM

The aim of this study was to evaluate the prevalence of patients with 'borderline' values of cardiovascular risk factors in Italy.

METHODS

Involved physicians were asked to evaluate the first 20 outpatients, consecutively seen in June 2009. Data were collected in a study-designed case-report form, in which physicians identified thresholds rather than reported absolute values of several clinical parameters. High-normal values were defined as follows: blood pressure (BP) 130-140/85-90 mmHg; total cholesterol 180-200 mg/dL; low-density lipoprotein cholesterol (LDL-C) 130-150 mg/dL; high-density lipoprotein cholesterol (HDL-C) 30-40 mg/dL in males and 40-50 mg/dL in females; triglycerides 130-150 mg/dL and fasting glucose 100-110 mg/dL.

RESULTS

Fifty-three Italian physicians provided valuable clinical data on 826 individual outpatients, among which 692 (83.7%, 377 women, mean age 60.9 ± 13.2 years, body mass index 26.6 ± 5.0 kg/m2) were included in the present analysis. Prevalence of borderline values of systolic BP and total cholesterol levels were at least comparable with those in the normal limits of the corresponding parameters, whereas prevalence of borderline diastolic BP, LDL-C, HDL-C, triglycerides and fasting glucose levels was significantly lower than that of normal values, but higher than that of abnormal values of the corresponding parameters.

CONCLUSIONS

Using this sample of healthy subjects in the setting of general practice in Italy, our results demonstrated a relatively high prevalence of borderline values of cardiovascular risk factors, which was at least comparable with that of normal, but significantly higher than that of abnormal thresholds. These preliminary findings may prompt more extensive investigations in the area of 'borderline' cardiovascular risk. This information may, in fact, potentially enable the design of more effective prevention strategies in the future to limit the burden of cardiovascular disease in the general population in Italy. Received for publication 4 March 2011; accepted for publication 20 April 2011.