Sex differences in the pharmacological treatment of hypertension in primary care

Recommended treatment protocols to improve management of hypertension globally: A statement by Resolve to Save Lives and the World Hypertension League (WHL).

Getting to Goal Blood Pressure: Why Reserpine Deserves a Second Look

Analysis of Recent Papers in Hypertension

How well do we care for patients with hypertension?

The prescribing pattern of drugs used for treating hypertension changes over time in response to changes in recommended guidelines and innovations in drug formulations, among others. In addition, the classes of antihypertensive drugs used vary among the countries. The aim of this study was to investigate the practice of antihypertensive medications in primary care units in Turkey. TURKSAHA is a cross-sectional screening study conducted in 1000 primary care units considered to be representative of primary care in Turkey, with the purpose of defining the demographic characteristics, clinical features, rate of blood pressure control achieved and the antihypertensive drugs prescribed for the hypertensive patients treated in these centers. In this analysis, we investigated the agents used in the treatment regimen. Of the 16,270 patients considered to be eligible for inclusion in the study, 15,187 (93.3%) were on an antihypertensive treatment, and 1083 (6.7%) were receiving no treatment. Patients who received treatment but whose antihypertensive medication was not specified (2290 patients) were subsequently excluded, and the trial was carried out with the remaining 12,897 patients. The mean age of the patients was 60 +/- 11 years (60.2% female). Of the 12,897 patients, 75.7% were receiving monotherapy, 19.7% two drugs, 4.1% three drugs and 0.5% four or more drugs. The rate of successful blood pressure control (<140/90 mmHg; for diabetics <130/80 mm Hg) in relation to the number of drugs received was 26.3, 25.9, 24.5 and 26.2%, respectively. Among the patients receiving monotherapy, the most frequently used antihypertensive drug class was angiotensin-converting enzyme inhibitors (30.1%), followed by beta-blockers (20.6%), calcium-channel blockers (17.9%), diuretics (15.4%) and angiotensin-receptor blockers (14%). As in other European countries, the rate of successful blood pressure control was low among hypertensive patients receiving treatment, and despite the inadequacy of monotherapy to control blood pressure, many of the patients continued this treatment regimen. Consistent with the global trend, the most frequently prescribed anti-hypertensives were angiotensin blockers.

The importance of tight blood pressure (BP) control has been established. We performed cross-sectional studies on the current status of BP control and the prescription and efficacy of antihypertensive drugs in hypertensive patients in Japan. The data were also evaluated in subgroups with or without diabetes mellitus (DM) and in winter and summer. Analyses were performed on the collected data of 12,437 treated hypertensive patients in winter and 5,972 in summer 2002. In winter, 50.3% of patients received calcium channel blockers (CCBs), 15.3% received angiotensin converting enzyme inhibitors (ACEIs) and 11.0% received angiotensin receptor blockers (ARBs). In the patients receiving monotherapy, 69% of patients received a CCB, 13% an ACEI and 11.0% an ARB. A total of 2,918 patients received combination therapy, and CCBs were the most frequently (89.6%) prescribed component of such therapy. Prescriptions of beta-blockers (BBs) decreased and those of CCBs and diuretics (D) increased with age (p<0.001). The rate of patients with adequately controlled BP less than 140/90 mmHg was 40.3% in the CCB group, 37.6% in the D group, and 36.9% in the BB group (p<0.001). In patients receiving combination therapy, those with CCB+D had the best rate of BP control (40.7%). The rate of patients with adequately controlled BP was lower in winter than in summer at both a target BP of 140/90 mmHg (36.2% vs. 43.8%, p<0.001) and a target BP of 130/85 mmHg in patients younger than 60 years old (15.5% vs. 18.6%, p<0.02). In diabetic patients, the target BP (130/80 mmHg) was achieved in only 11.3%, which was lower (p<0.05) than the rate in non-diabetic patients (13.1%). In conclusion, the present cross-sectional study showed that CCBs were the most frequently prescribed agent for the treatment of hypertension in Japan. The rate of adequate BP control was less than 50% and was even worse in patients with DM and in winter. Our results indicate that physicians should treat hypertension more intensively to achieve the target BP.

Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.

The Clock Is Ticking: The Case for Achieving More Rapid Control of Hypertension

In Germany, an estimated 20-25 million patients suffer from hypertension. Blood pressure control rates are, however, lower than in many other European countries and the USA. The present analysis reports blood pressure treatment and control rates in Germany in patients with hypertension treated by cardiologists. The present analysis reports data from a German subgroup analysis of a large, multinational, observational survey i-SEARCH that recruited patients in 2005/2006. It reports blood pressure readings, drug utilization and control rates in cardiology practice. A total of 4,982 patients were documented at 417 sites. Mean systolic/diastolic blood pressure (SBP/DBP) was 152 ± 19.5/88.4 ± 11.5 mmHg. SBP was 1.3 mmHg higher in men than in women (p = 0.021). The majority of patients had an SBP between 141 and 160 mmHg and 31.4% of patients had normal SBP. Overall blood pressure control rate was only 11.6% [95% CI 10.7-12.6] in treated patients. It was different in men [10.2%; 95% CI 9.0-11.6] than in women [8.1%; 95% CI 7.1-9.4; p = 0.008] and higher in patients without diabetes [12.7%; 95% CI 11.6-14.0] than in those with diabetes [4.3%; 95% CI 3.4-5.4; p < 0.0001]. One-third of patients received either monotherapy or dual therapy, or three and more drugs, respectively; 42.2% of patients received guideline-recommended dual combination therapy. A combination of beta-blockers + ACE inhibitors was most frequently prescribed (30.8%). Our data indicate a low level of blood pressure control, especially in patients at an increased risk for cardiovascular events, such as those with diabetes or cardiovascular comorbidities. Major efforts are required to improve hypertension management as recommend by current treatment guidelines.

<i>Circulation</i> Editors’ Picks

Contemporary Management and Control of Uncomplicated Hypertension in Canada: Insight From the Primary Care Audit of Global Risk Management (PARADIGM) Study

Analysis of Recent Papers in Hypertension. Jan Basile, MD, Section Editor

This clinical advisory statement from the Coordinating Committee of the National High Blood Pressure Education Program is intended to advance and clarify the recommendations of the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI, 1997).1 The advisory addresses several interrelated issues about blood pressure (BP) that affect people approaching the later decades of life. On the basis of the wealth of currently available evidence, the committee now recommends a major paradigm shift in urging that systolic BP become the major criterion for diagnosis, staging, and therapeutic management of hypertension, particularly in middle-aged and older Americans. Several lines of strong evidence support the initiative to emphasize systolic BP. Pathophysiologically, there are strong associations among aging, increased stiffness of large arteries, increased systolic BP, increased pulse pressure, and the prevalence of cardiac and vascular disease. Epidemiologically, isolated systolic hypertension is the most common form of hypertension and is present in approximately two thirds of hypertensive individuals >60 years of age. Diagnostically, classification and staging of hypertension are more precise when systolic rather than diastolic BP is used as the principal criterion. Risk stratification for major complications of hypertension (stroke, myocardial infarction, heart failure, and kidney failure) is actually confounded by the use of diastolic BP; in older people with systolic hypertension, diastolic BP is inversely related to cardiovascular risk. Clinical benefits of treatment of isolated systolic hypertension include reductions in stroke, myocardial infarction, heart failure, kidney failure, and overall cardiovascular disease morbidity and mortality. Currently, only 1 in 4 Americans with hypertension falls below JNC VI–recommended values of 140/90 mm Hg in uncomplicated hypertension or 130/85 mm Hg in individuals with kidney disease or diabetes. Hypertension control rates are poorest in older people, primarily as a result of inadequate …

Aim: To assess blood pressure (BP) control rates according to 2007 and 2009 ESH recommendations in hypertensive patients with diabetes attended in Primary Care setting in Spain. Methods: This was a multicenter and cross sectional study. Patients of both sexes, at least 18-years old and with an established diagnosis of hypertension (at least 3 months under antihypertensive therapy) and diabetes were included in the study. BP goals were defined as <140/90 according to 2009 ESH recommendations and <130/80 mmHg according to 2007 ESH/ESC guidelines. Results: A total of 2,752 patients (67.2 ± 9.8 years; 55.6% women) were included. 64.3% of the patients had dyslipidemia, 61.8% sedentary life style, 46.5% obesity, 41.2% history of cardiovascular disease and 16.0% were smokers. 33.9% were taking only one antihypertensive agent, 43.5% two agents, 17.9% three drugs and 4.7% four or more antihypertensive drugs. The most frequent antihypertensive agents used were ARB (37.6%), ACEi (36.5%), calcium channel blockers (10.0%) and the most common fixed combinations were ARB-diuretic (23.2%) and ACEi-diuretic (12.6%). According to 2009 ESH recommendations, 47.3% (95%CI 45.4–49.2) of patients achieved systolic and diastolic BP goals, 50.2% (95%CI 48.3–52.1) only systolic BP objectives and 79.8% (95%CI 78.3–81.3) only diastolic BP objectives. According to 2007 ESH/ESC guidelines, 15.1% (95%CI 13.8–16.4) of the patients attained systolic and diastolic BP goals, 22.5% (95%CI 20.9–24.1) systolic BP objectives and 38.2% (95%IC 36.4–40.0) diastolic BP objectives. Patients with poorer BP control rates were older and exhibited more obesity and history of cardiovascular disease (p < 0.05 in all cases). Obesity, sedentary life style and not having taken the medication the day of the visit were predictors of lack of BP control (p < 0.01). Conclusions: With regard to BP control rates, there are important differences according 2007 and 2009 ESH recommendations. Only one out of ten patients attained BP goals according to 2007 ESH/ESC guidelines (as well as ADA recommendations). However, when considering 2009 ESH recommendations, this percentage increased to nearly 50%.

To explore the blood pressure (BP) control rate and related factors in different parts of China. This cross-sectional survey was performed between March and May 2011 in 132 tertiary or secondary hospitals from 31 cities across China. Five consecutive hypertensive patients consulted to individual physician in these hospitals were included and a total of 4 110 patients aged ≥ 18 years were included, and 3 682 patients finished the follow-up protocol. All objects underwent questionnaire survey and physical examination. Cities were divided into 3 categories. Among included hypertensive outpatients, the prevalence of coronary heart disease was the highest (37.4%, 1 368/3 662) comorbidity. The most commonly used antihypertensive medication was calcium channel blocker (51.3%, 1 861/3 628). Blood control rate was the highest in city category II(37.0%) and the lowest in city category I (9.1%). Accordingly, body mass index (BMI, (25.7 ± 0.6) kg/m(2)) and waist circumference ( (90.6 ± 3.1 ) cm) were the largest and the prevalence of coronary heart disease (60.8%) and stroke (19.0%) were the highest in hypertensive outpatients from city categoryI. Blood pressure control rate varies among various cities in China. High BMI and co-morbidities of coronary heart disease and stroke are related to poor blood pressure control rate.