Blood Pressure Achievement Rate Research Articles

Pretreatment body mass index affects achievement of target blood pressure with sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus and chronic kidney disease.

Sodium-glucose cotransporter 2 inhibitor (SGLT2-I) shows excellent antihypertensive effects in addition to its hypoglycemic effects. However, whether body mass index (BMI) affects the antihypertensive effect of SGLT2-I remains unknown. We investigated the impact of baseline BMI on the achievement of target blood pressure (BP) with SGLT2-I treatment in Japanese patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). We retrospectively evaluated 447 Japanese patients with T2DM and CKD treated with SGLT2-I for at least 1 year. The primary outcome was achieving the target BP (<130/80 mmHg) after SGLT2-I treatment. Patients were divided into two groups according to a baseline BMI of 29.1 determined by receiver operating characteristic analysis and analyzed in a cohort model with propensity score matching. In each group, 130 patients were compared by propensity score matching. The target BP achievement rate was significantly higher in the BMI < 29.1 group than in the BMI ≥ 29.1 group (34% and 21%, respectively, p = 0.03). The odds ratio for achieving the target BP in the BMI ≥ 29.1 group was 0.50 (95% confidence interval, 0.28-0.90, p = 0.02). The BMI < 29.1 group had significantly lower systolic and diastolic BPs after SGLT2-I treatment than the BMI ≥ 29.1 group. Only the BMI < 29.1 group was showed a significant decrease in the logarithmic albumin-to-creatinine ratio from baseline after SGLT2-I treatment. In patients with T2DM and CKD, baseline BMI was associated with the antihypertensive effects of SGLT2-I. Patients in the lower baseline BMI group were more likely to achieve the target BP after SGLT2-I treatment. Pretreatment BMI affects the antihypertensice effect of SGLT2 inhibirors in patients with T2DM and CKD.

Cross-sectional survey of hypertension management in clinical practice in Japan: the Kanagawa Hypertension Study 2021 conducted in collaboration with Japan Medical Association Database of Clinical Medicine.

We aim to assess the data of patients with hypertension in Kanagawa Prefecture, Japan, collected in 2021 that were provided by the Japan Medical Association Database of Clinical Medicine. Data collected in 2011 and 2014 by the Kanagawa Physicians Association were used for comparative analysis. The target blood pressure (BP) achievement rates for patients whose target office and home BP were <140/90 mmHg and <135/85 mmHg, respectively, were 72.5% and 75.8% in 2011, 66.0% and 68.5% in 2014, and 46.7% and 83.3% in 2021, respectively. The target office BP achievement rate in 2021 was significantly lower than those in 2011 and 2014 (p ≤ 0.009). In contrast, there was no significant difference and improvement of the achievement rates for patients whose target office and home BP were <130/80 mmHg and <125/75 mmHg, respectively, among the three surveys. After the Japanese Society of Hypertension 2019 Guidelines were released, the achievement rates for patients whose target BP was tightened were significantly lower than those for patients with unchanged target BP (office/home, p < 0.001/0.04). The proportion of the patients who achieved their office and home target BP using more than three drugs was 38.5% and 20.0%, respectively. In the present analysis, we unveiled the current problems encountered in the clinical management of hypertension in Japan. In particular, efforts should be focused on the management of patients that require strict BP control.

The Efficacy of Single-pill Combination of Olmesartan Medoxomil and Amlodipine Besylate on Office Blood Pressure in Hypertensive Patients who did not Respond to Amlodipine Besylate Monotherapy.

As combination therapy, switching to single-pill combination (SPC) medication after a short period of monotherapy is helpful because reducing pill numbers can improve patients' adherence to medications. This study was aimed to assess the effect of the single-pill combination (SPC) of olmesartan medoxomil 20 mg and amlodipine besylate 5mg (OLM 20 mg/AML 5 mg) on blood pressure (BP) reduction in hypertensive patients who did not respond to amlodipine besylate 5 mg (AML 5 mg) monotherapy for 4 weeks. This study was a prospective, open-label, multi-center, non-comparative study. Patients whose BP was not got the target BP (≥140 mmHg and if diabetic patients ≥130 mmHg) after 4 weeks treatment with AML 5 mg, were enrolled. AML 5 mg was switched to the SPC (OLM 20 mg/AML 5 mg) treatment for 8 weeks. The primary effectiveness endpoint was the reduction of seated systolic blood pressure (SeSBP) after SPC (OLM 20 mg/AML 5 mg) treatment for 8 weeks. The changes of brachial-ankle pulse wave velocity (baPWV), central BP (CBP), and augmentation index (AIx@75) were evaluated also. Forty-seven patients were enrolled (mean age = 52±9 years, 36 men). After the SPC treatment for 8 weeks, SeSBP was reduced from 153±9 mmHg to 131±18 mmHg and seated diastolic BP (SeDBP) from 95±8 mmHg to 81±11 mmHg (p<0.001 and p<0.001, respectively). The reduction of SeSBP/SeDBP were 22 mmHg and 14 mmHg, respectively. The target goal BP achievement rate was 74.5%, and baPWV, CBP, and AIx@75 were improved. SPC (OLM 20 mg/AML 5 mg) treatment for 8 weeks was effective in reducing BP, achieving target BP goal, and also improving arterial stiffness in uncontrolled hypertensive patients with AML 5 mg monotherapy.

Efficacy and Safety of Esaxerenone in Hypertensive Patients with Diabetic Kidney Disease: A Multicenter, Open-Label, Prospective Study.

IntroductionClinical data of esaxerenone in hypertensive patients with diabetic kidney disease (DKD) are lacking. We evaluated the efficacy and safety of esaxerenone in patients with DKD and an inadequate response to blood pressure (BP)-lowering treatment.MethodsIn this multicenter, open-label, prospective study, patients were divided into urinary albumin-to-creatinine ratio subcohorts (UACR < 30, 30 to < 300, and 300 to < 1000 mg/gCr). Esaxerenone was initiated at 1.25 mg/day and followed by incremental dose escalation based on BP and serum potassium level monitoring. The treatment period was 12 weeks. The primary endpoint was change in morning home systolic BP/diastolic BP (SBP/DBP) from baseline to end of treatment (EOT). Secondary endpoints included achievement rate of target BP, change in UACR from baseline, and safety.ResultsIn total, 113 patients were enrolled. Morning home SBP/DBP significantly decreased from baseline to EOT in the total population (− 11.6/− 5.2 mmHg, both p < 0.001) and in all UACR subcohorts (all p < 0.001). The target BP achievement rate was 38.5%. Significant reductions in bedtime home and office BPs were also shown in the total population and all UACR subcohorts. UACR significantly improved from baseline to EOT in the total (− 50.9%, p < 0.001) and all UACR subcohorts (all p < 0.001). Incidence of serum potassium elevation as drug-related treatment emergent adverse events was 2.7%. The change from baseline in estimated glomerular filtration rate (eGFR) was − 4.8 mL/min/1.73 m2.ConclusionEsaxerenone demonstrated a BP-lowering effect and improved albuminuria. The effects were consistent regardless of the severity of albuminuria without clinically relevant serum potassium elevation and eGFR reduction.Clinical Trial RegistrationjRCTs06119002.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02294-z.

Achievement rate of blood pressure

ABSTRACT 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.

Current status of treatment of type 2 diabetes mellitus in Ningbo, China

The treatment status of type 2 diabetes mellitus (T2DM) in Ningbo has not been reported in the past. To evaluate the current status of T2DM in Ningbo and provide evidence to formulate more policies, a multicenter investigation was needed. The Ningbo Clinical Research Group of Diabetes constituted nine hospitals. Participants included 3015 patients who visited the nine hospitals from June to December 2016. General characteristics, the medication situation, the laboratory indexes in nearly 3months consisting of glycosylated hemoglobin level (HbA1c), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose (FBG), and the results of ophthalmologic examination were investigated. The evaluation criteria were defined based on 2013 China guideline for T2DM. The 3015 subjects included 1685 men and 1330 women. The average age was 63.3±13.0years. The prevalence of hypertension and dyslipidemia was 58.7% and 56.7%, respectively. In the examinees, nephropathy appeared in 11.6% and retinopathy in 14.5%. More than half (50.9%) of the subjects were overweight. The achievement rate of blood pressure (BP) was 39.6% (<140/80mmHg), FBG was 46.0% (4.4-7.0mmol/L), HbA1c was 41.7% (<7.0%), and LDL-C was 51.7% (<1.8mmol/L; and if accompanied by CHD, <2.6). Ningbo City T2DM status is not optimistic, and there is a big gap with the indicators.

Physician perceptions of blood pressure control in patients with chronic kidney disease and target blood pressure achievement rate.

BackgroundBlood pressure (BP) control is the most-established method for the prevention of chronic kidney disease (CKD) progression. However, the ideal BP target for CKD patients is still under debate.MethodsWe performed a survey of regular registered members of the Korean Society of Nephrology to determine physician perceptions of BP control in patients with CKD. In addition, we evaluated the target BP achievement rate using data from the APrODiTe-2 study.ResultsTwo-thirds of physicians considered the target BP for CKD to be < 130/85 mmHg. The systolic BP (SBP) thresholds for diabetic CKD, proteinuria ≥ 300 mg/day, 30 ≤ glomerular filtration rate (GFR) < 60 mL/min/1.73 m2, age < 60 years, and the presence of atherosclerotic (ASO) complications were significantly lower than the SBP thresholds of the opposite parameters. The three major hurdles to controlling BP were non-compliance with lifestyle modification and medications, and self-report of well-controlled home BP. Most physicians prescribed home and ambulatory BP monitoring to less than 50% of their patients. The target BP achievement rates using the SBP thresholds in this survey were as follows: non-diabetic (69.3%); diabetic (29.5%); proteinuria < 300 mg/day (72.3%); proteinuria > 300 mg/day (33.7%); GFR ≥ 60 (76.4%); GFR < 30 (47.8%); no evidence of ASO (67.8%); and the presence of ASO (42.9%).ConclusionThe target BP was lower in patients with higher cerebro-cardiovascular risks. These patient groups also showed lower target BP achievement rates. We also found a relatively lower application and clinical reflection rate of home or ambulatory BP monitoring.

Antihypertensive Efficacy of the Direct Renin Inhibitor Aliskiren as Add-on Therapy in Patients with Poorly Controlled Hypertension.

A direct renin inhibitor, aliskiren, has a longer stable antihypertensive effect compared with other renin-angiotensin-aldosterone system (RAAS) inhibitors. This study was a 6-month, single-center, open trial conducted between December 2010 and November 2011 to assess the antihypertensive effect of adding aliskiren (300 mg) to the treatment of essential hypertension patients whose target blood pressure (BP) had not been achieved and to assess whether it was possible to reduce the amount of antihypertensive drugs used. The results showed an overall improvement in the target BP achievement rate of 60% for clinic BP and 52% for home BP measurements (75 cases total). The mean number of drugs before treatment with aliskiren was 3.28±1.52, whereas at the end of the six months the mean number of drugs prescribed other than aliskiren was 2.85±1.72 (p<0.0001). Moreover, no worsening of the renal function was observed in patients with diabetes or chronic kidney disease (CKD) who were being treated with other RAAS inhibitors in combination to aliskiren. These results showed that when aliskiren was added to the treatment of poorly controlled hypertension, the BP achievement rate increased, and it was possible to reduce the amount of antihypertensive drugs used in combination with aliskiren. Moreover, as a result of careful monitoring of the renal function or decreasing the amounts of drugs used in combination, no worsening of the renal function was observed even in the cases complicated by diabetes or CKD being treated with other RAAS inhibitors.

Losartan/hydrochlorothiazide combination vs. high-dose losartan in patients with morning hypertension—a prospective, randomized, open-labeled, parallel-group, multicenter trial

The treatment of morning hypertension has not been established. We compared the efficacy and safety of a losartan/hydrochlorothiazide (HCTZ) combination and high-dose losartan in patients with morning hypertension. A prospective, randomized, open-labeled, parallel-group, multicenter trial enrolled 216 treated outpatients with morning hypertension evaluated by home blood pressure (BP) self-measurement. Patients were randomly assigned to receive a combination therapy of 50 mg losartan and 12.5 mg HCTZ (n=109) or a high-dose therapy with 100 mg losartan (n=107), each of which were administered once every morning. Primary efficacy end points were morning systolic BP (SBP) level and target BP achievement rate after 3 months of treatment. At baseline, BP levels were similar between the two therapy groups. Morning SBP was reduced from 150.3±10.1 to 131.5±11.5 mm Hg by combination therapy (P<0.001) and from 151.0±9.3 to 142.5±13.6 mm Hg by high-dose therapy (P<0.001). The morning SBP reduction was greater in the combination therapy group than in the high-dose therapy group (P<0.001). Combination therapy decreased evening SBP from 141.6±13.3 to 125.3±13.1 mm Hg (P<0.001), and high-dose therapy decreased evening SBP from 138.9±9.9 to 131.4±13.2 mm Hg (P<0.01). Although both therapies improved target BP achievement rates in the morning and evening (P<0.001 for both), combination therapy increased the achievement rates more than high-dose therapy (P<0.001 and P<0.05, respectively). In clinic measurements, combination therapy was superior to high-dose therapy in reducing SBP and improving the achievement rate (P<0.001 and P<0.01, respectively). Combination therapy decreased urine albumin excretion (P<0.05) whereas high-dose therapy reduced serum uric acid. Both therapies indicated strong adherence and few adverse effects (P<0.001). In conclusion, losartan/HCTZ combination therapy was more effective for controlling morning hypertension and reducing urine albumin than high-dose losartan.

A cross-sectional study on the treatment goals of blood pressure, serum lipids and blood glucose in elderly patients with coronary heart disease

To investigate the current status of treatment goals for blood pressure, serum lipids and blood glucose in the elderly patients (> 65 years old) with coronary heart disease (CHD) in China and to identify their associated factors. In this cross-sectional survey, the CHD subjects aged > 65 years old were recruited from 66 hospitals in Beijing, Shanghai, Tianjin, Guangdong, Zhejiang and Xinjiang from June 2006 to January 2007. A total of 2420 participants, including 1441 males and 979 females. Their mean age was (73 ± 6) years. The targeted blood pressure was systolic blood pressure < 130 mm Hg (1 mm Hg = 0.133 kPa) and diastolic blood pressure < 80 mm Hg. And the success rate was 24.8% (559/2420). The blood pressure achievement rate among the females was 21.8% (213/979). And it was lower than 26.8%(386/1441) among the males (P < 0.01). The serum lipids goal of achievement was LDL-C (low density lipoprotein-cholesterol) < 2.6 mmol/L for the high-risk patients and LDL-C < 2.07 mmol/L especially for the super-high-risk patients. The success rate for achieving the target LDL-C level was 36.5%(884 cases). The LDL-C achievement rate among the females was 28.7% (281 cases). And it was obviously lower than 41.8%(603 cases) among the males (P < 0.01). The success rate for achieving the target LDL-C level increased with aging (P < 0.05). The blood glucose goal of achievement was FPG (fasting plasma glucose) > 4.4 mmol/L and FPG < 6.1 mmol/L. The success rate for achieving the target blood glucose level was 61.0% (1476/2420). Binary logistic regression analysis indicated that the independent risk factors of achieving the blood pressure target for the elderly CHD patients were female, history of hypertension, diuretics and nifedipine. The odds ratio (OR) of these risk factors were 1.245 [95% confidence interval (CI): 1.016 - 1.527], 2.889 (95%CI: 2.319 - 3.599), 0.689 (95%CI: 0.538 - 0.883), 0.405 (95%CI: 0.170 - 0.964) respectively. The independent risk factors of achieving the serum lipids target for the elderly CHD patients were female, the duration of hypertension of 10 - 20 years, the duration of hypertension of 20 - 30 years, diabetic history or dyslipidemia and therapeutic lifestyle change (TLC). The OR of these risk factors were 1.750 (95%CI: 1.252 - 2.445), 3.988 (95%CI: 1.951 - 8.152), 2.158 (95%CI: 1.075 - 4.333), 3.026 (95%CI: 1.986 - 4.610), 2.166 (95%CI: 1.549 - 3.030) and 0.493 (95%CI: 0.302 - 0.805) respectively. The independent risk factors of achieving the blood glucose target for the elderly CHD patients were diabetic history, TLC, diuretics, calcium channel blocker (CCB) and hypoglycemic drugs. The OR of these risk factors were 3.191 (95%CI: 2.259 - 4.507), 0.690 (95%CI: 0.528 - 0.902), 1.507 (95%CI: 1.150 - 1.975), 0.718 (95%CI: 0.579 - 0.890) and 0.477 (95%CI: 0.235 - 0.969) respectively. In the present survey, the achievement rates of blood pressure, serum lipids and blood glucose are low in the elderly CHD patients, especially in females. There has been a huge gap between the treatment guidelines and clinical practices in China. We should carry out different strategies according to different conditions to enhance the health and life quality for the elderly CHD patients.

Effect of Antihypertensive Treatment on Cardiovascular Events in Elderly Hypertensive Patients: Japan's Benidipine Research on Anti-Hypertensive Effects in the Elderly (J-BRAVE)

The achievement rate of blood pressure (BP) target and the relationship between on-treatment BP and development of cardiovascular events (i.e., stroke, myocardial infarction, and heart failure) were investigated in a total of 8,897 patients in the Japan's Benidipine Research on Antihypertensive Effects in the Elderly (J-BRAVE) study, a prospective, 3-year observational study of a calcium channel blocker-based treatment in hypertensive patients aged ≥65 years as a post-marketing surveillance. Blood pressure decreased significantly from 164.8 ± 14.1/88.2 ± 10.3 mmHg to 137.0 ± 13.5/75.6 ± 9.5 mmHg and the percentage of patients who achieved BP <140/90 mmHg was 57.2% after 3 years. The incidence of cardiovascular events was 7.54/1,000 patient-years. Subgroups of patients stratified by on-treatment systolic blood pressure (SBP) were analyzed. Baseline BP, body mass index (BMI), the dose of benidipine, the mean number of anti-hypertensive drugs, and the incidence of cardiovascular events were higher in patients with on-treatment SBP ≥160 mmHg than in those with an SBP of <130 mmHg. In patients aged 65 to 74 years (n = 5,092) and patients aged ≥75 years (n = 3,805), the percentages of patients who achieved the BP target of <140/90 mmHg were 57.5% and 56.6% after 3 years, respectively, and the incidence of cardiovascular events was higher in patients with on-treatment SBP ≥160 mmHg in both age subgroups. The results of the J-BRAVE study show that on-treatment SBP ≥160 mmHg is associated with a higher incidence of cardiovascular events in elderly hypertensive patients.

Effects of Intensive Blood Pressure Control in the Management of Patients With Type 2 Diabetes Mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

To appreciate the importance of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial,1 one needs to remember that the systolic blood pressure (BP) target currently recommended by major guidelines for diabetic patients, that is, 130 mm Hg, except in the Appropriate Blood Pressure Control in Diabetes Study (ABCD) normotensive trial,7 which consisted of only a few hundred patients and had changes in creatinine clearance as the primary end point. Thus, ACCORD represents the only large-scale randomized trial that provides information on what happens to the cardiovascular risk of diabetic patients when SBP is reduced to 130 mm Hg as a result of randomization to the usual (rather than the tight) BP control treatment strategy. Thus, the message from ACCORD to guidelines and clinical practice is that in diabetic patients it is not necessary to adopt …

Long-Term Compliance of Salt Restriction and Blood Pressure Control Status in Hypertensive Outpatients

The purpose of the present study was to investigate the long-term compliance with salt restriction and blood pressure (BP) control status in Japanese hypertensive outpatients. Subjects included 103 patients, 59 women and 44 men, mean age 67 ± 9 years, who underwent successful 24-h home urine collection more than 10 times over an interval of 5 years. Urinary salt, potassium, and creatinine were measured. During the follow-up period (average 8.6 years), participants underwent urine collection 11.4 times in average. Urinary salt excretion at the last visit was significantly lower than that of the first visit (8.2 ± 3.1 vs. 9.6 ± 3.7 g/day; p < 0.01). The achievement of urinary salt excretion <6 g/day increased from 18.5% at the first visit to 26.2% at the last visit. Similarly, BP at the last visit was significantly lower than that of the first visit (130 ± 14/69 ± 11 vs. 145 ± 17/86 ± 12 mmHg; p < 0.01). The achievement rate of BP <140/90 mmHg and <130/85 mmHg also increased significantly during this period (39.2% to 70.8% and 13.7% to 39.6%, respectively, p < 0.01). Results suggest that urinary salt excretion decreased by repeated measurements using 24-h home urine collection. Lifestyle modification including weight loss as well as the intensive antihypertensive treatment contributed to the improved BP control during this period.

Controlled Release Nifedipine and Valsartan Combination Therapy in Patients with Essential Hypertension: The Adalat CR and Valsartan Cost-Effectiveness Combination (ADVANCE-Combi) Study

This study was designed to compare the clinical efficacy of two calcium channel blocker-based combination therapies with an angiotensin receptor blocker in Japanese patients with essential hypertension. A 16-week, double-blind, parallel-arm, randomized clinical trial was performed to compare the efficacy and safety of the combination therapy of controlled release nifedipine (nifedipine CR) plus valsartan vs. that of amlodipine plus valsartan. The primary endpoint was the target blood pressure achievement rate. Eligible patients were randomly allocated to nifedipine CR-based or amlodipine-based treatment groups. Patients were examined every 4 weeks to determine whether the blood pressure had reached the target level. When the target level was not achieved, the drug regimen was changed; when the target blood pressure was achieved, the same study medication was continued. A total of 505 patients were enrolled in the study (nifedipine CR group: 245 cases; amlodipine group: 260 cases). After 16 weeks of treatment, blood pressure was significantly reduced in both groups, but to a larger extent in the nifedipine CR group than in the amlodipine group (p < 0.01). The target blood pressure achievement rate was also significantly higher in the nifedipine CR group (p < 0.001). There was no significant difference in the incidence of drug-related adverse events between the groups. These results indicate that the nifedipine CR-based combination therapy was superior to the amlodipine-based therapy for decreasing blood pressure and achieving the target blood pressure in patients with essential hypertension.