Achieve Blood Pressure Goals Research Articles

PP.26.07] IMPACT OF VALSARTAN AND COMBINATION OF VALSARTAN AND HYDROCHLOROTHIAZIDE ON ERECTILE DYSFUNCTION IN PATIENTS WITH MILD TO MODERATE HYPERTENSION

Objective: Erectile dysfunction is recognised quality of life disorder frequently occurring in hypertensive patients. It can be caused by high blood pressure per se or due to antihypertensive treatment. Diuretics and -blockers (except nebivolol) are the drugs most commonly linked to erectile dysfunction. ACE inhibitors and calcium antagonists seem to exert neutral effects, while ARBs seem to be associated with beneficial effects on erectile function. The aim of our study was to assess the effect of treatment with valsartan and valsartan-HCTZ on erectile function. Design and method: We assessed erectile dysfunction in 98 patients, aged 40 – 79 years, with mild to moderate hypertension, participating in international, multicentre, open labelled trial – VICTORY (sponsored by KRKA, d.d.) using the questionnaire IIEF-5, before and after 16 week of treatment with valsartan or valsartan-HCTZ. The treatment was initiated with 80 mg of valsartan daily. After four weeks of treatment the dose was increased to 160 mg valsartan daily in patients who did not achieve goal blood pressure. If target blood pressure was not achieved after consequent 4 weeks the dose of valsartan was further increased to 320 mg daily or fixed combination of valsartan-HCTZ 160/12.5 mg daily was implemented. At next visit, after additional 4 weeks, in patients who did not achieve goal blood pressure, the dose of fixed combination was increased to 320/12.5 mg of valsartan-HCTZ daily. Results: At the end of the trial, in 90.6% of patients, the goal blood pressure, according to 2013 ESH/ESC Guidelines for the management of arterial hypertension, was achieved. The slight statistically significant increase in mean IIEF-5 score after 16 weeks of treatment was observed in patients on monotherapy with valsartan and in patients on combination therapy with valsartan-HCTZ which was introduced on visit 3 or visit 4 (from 23.5 7.7 to 24.1 8.1, and from 23.8 5.0 to 24.2 6.7, respectively). Conclusions: Goal blood pressure was achieved in 90.6% of patients. Treatment with valsartan as well as adding low dose of HCTZ to valsartan did not lead to deterioration of erectile function in patients with mild to moderate hypertension.

PP.28.09] VISIT-TO-VISIT VARIABILITY OF BLOOD PRESSURE AND END-STAGE RENAL DISEASE, LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: Visit-to-visit long term variability of blood pressure (BP) is an important independent risk factor for premature death and cardiovascular events, but relatively little is known about this parameter in patients with chronic kidney disease (CKD). The aim of the study was to clarify the influence of BP long-term variability on the progression of CKD in hypertensive patients. Design and method: 34 patients (16 men and 18 woman) with essential hypertension and CKD included in the study. Mean age was 68,8 ± 13,6 years. 7 pts had impaired glucose tolerance and 9 diabetes mellitus 64% of patients had left ventricular hypertrophy (LVH) by Echocardiography. 34% of patients had carotid atherosclerosis. 10 pts had 2 st of CKD at the beginning of the study, 24 – 3 st CKD. All patients receive antihypertensive treatment: 56% ACE inhibitors, 30% – ARB, 43% - calcium antagonists, 61% - beta-blocker and 30% - diuretics. 86% of patients achieved BP goal. The participants had their office BP measured during the 12-month follow-up We defined systolic and diastolic visit-to-visit variability of BP using three metrics: coefficient of variation, standard deviation of the mean SBP, and average real variability. Results: Glomerular filtration rate correlate significantly with systolic BP variability, but not with BP level. After the 1 year of follow up 6 patients had end-stage renal disease End-stage renal disease in multiple regression analysis was independently associated with systolic BP variability (OR 1,84 CI 95%[1,22–2,46], p = 0,031) and patients age (OR 2,89CI 95%[1,47–10,71], p = 0,034). Left ventricular mass index also significantly correlate with systolic BP variability (r = 0,456; p = 0,050) The correlation was more significant in patients with diabetes mellitus (r = 0,635; p = 0,036). Multiple regression analysis indicated that only mean visit-to-visit systolic BP remained independently associated with LVH after adjustment for age, sex, hypertension, diabetes mellitus, and glomerular filtration rate (p = 0.047). In patients with carotid atherosclerosis diastolic BP variability was higher, then in patients without it (p = 0,05). Conclusions: Thus, the variability of blood pressure may be more significant determinant of CKD progression and development of LVH in patients with hypertension than the achieved BP level.

Reaching Urban Poor Hypertensive Patients: A Novel Model of Chronic Disease Care Versus a Traditional Fee-for-Service Approach.

There is a significant disparity in hypertensive treatment rates between those with and without health insurance. If left untreated, hypertension leads to significant morbidity and mortality. The uninsured face numerous barriers to access chronic disease care. We developed the Community-based Chronic Disease Management (CCDM) clinics specifically for the uninsured with hypertension utilizing nurse-led teams, community-based locations, and evidence-based clinical protocols. All services, including laboratory and medications, are provided on-site and free of charge. In order to ascertain if the CCDM model of care was as effective as traditional models of care in achieving blood pressure goals, we compared CCDM clinics' hypertensive care outcomes with 2 traditional fee-for-service physician-led clinics. All the clinics are located near one another in poor urban neighborhoods of Milwaukee, Wisconsin. Patients seen at the CCDM clinics and at 1 of the 2 traditional clinics showed a statistically significant improvement in reaching blood pressure goal at 6 months ( P < .001 and P < .05, respectively). Logistic regression analysis found no difference in attaining blood pressure goal at 6 months for either of the 2 fee-for-service clinics when compared with the CCDM clinics. The CCDM model of care is at least as effective in controlling hypertension as more traditional fee-for-service models caring for the same population. The CCDM model of care to treat hypertension may offer another approach for engaging the urban poor in chronic disease care.

Olmesartan medoxomil: a guide to its use as monotherapy or in fixed-dose combinations with amlodipine and/or hydrochlorothiazide

Olmesartan medoxomil (OLM)-based antihypertensive treatment is a valuable option in the treatment of patients with mild to severe hypertension, including those with difficult-to-treat disease. Once-daily OLM, as monotherapy or in combination with hydrochlorothiazide (HCT) and/or amlopidine (AML), provides blood pressure (BP) control over the entire 24-h dosing interval, reduces systolic and diastolic BP, enables patients to achieve BP goals and is generally well tolerated. In patients who require treatment with two or more antihypertensives, treatment with fixed-dose combinations (FDC) of OLM (an angiotensin II receptor blocker) + AML (a calcium channel blocker) and/or HCT (a diuretic) is a rational choice, as the drugs have complementary mechanisms of action, and the use of FDCs reduces pill burden, which may improve patient adherence and persistence to treatment, and clinical outcomes.

ASSESSING THE OUTCOMES OF TREATMENT AND MANAGEMENT, 400 HYPERTENSIVE PATIENTS IN BONG SON GENERAL HOSPITAL, BINH DINH PROVINCE

Objective: To evaluate the results of treatment achieved blood pressure goal (BP goal) and results of hypertensive patient management. Subjects and methods: A study of 400 hypertensive patient intervention, treatment and management after 2 year. To assess the results of BP target, monitor the use of medicines, the situation of hospitalization and complications of stroke. Results: Treatment: -100% of patients using diuretics and angiotensin-converting enzyme inhibitors (ACEIs), 33% of patients using angiotensin receptor blockers (ARBs), 46.25% of patients using calcium channel blockers (CCBs) and 19.5% of patients using beta-blocker. After 24 months of treatment: 50.5% of patients using 1 antihypertensive drug, 22% of patients using 2 drugs, 20.5% of patients using 3 drugs and 7% of patients taking more than 3 drugs. After 24 months of treatment: 91.75% achieved BP target and 8.25% fail. -Average risk stratification: 97.32% achieved BP target, hight risk stratification: 95.91% and very hight risk stratification: 73.03%. After 24 months of treatment. -Stage 1: 88.48% achieved BP target, stage 2: 92.85% achieved BP target and stage 3: 71.08% achieved BP target. After 24 months of treatment. -Hypertesive results before treatment were: 159.80 ± 20,22mmHg average systolic blood pressure and 82.97 ± 5,82mmHg average diastolic blood pressure. After treatment: average systolic blood pressure 125.38 ± 6,88mmHg and average diastolic blood pressure 79.83 ± 1,79mmHg. No adverse change in the index of tests about lipidemia, liver, kidney, glucomia and no recorded cases of drug side effects. Management of patients: -There were 89% non-medical examinational patients 1 month, 5.25% non-medical examinational patients 2 months, 4.25% non-medical examinational patients 3 months and 1.5% non-medical examinational patients 4 months. There were 93.5% drop pill 1 month, 3.25% drop pill 2 months, 4.25% drop pill 3 months and no patient drop pill over 3 months. In 24 months follow-up, 47% hospitalized inpatients &lt;5 times, 44.5% hospitalized inpatients 5-10 times, 3% hospitalized inpatients 11-15 times, 4.75% hospitalized inpatients from 16-20 times and 0.75% hospitalized inpatients &gt; 20 times. -There were 32.75% hospitalized inpatients for reasons of hypertension and 63.75% hospitalized inpatients for other common diseases. -There were a total of 11592 contacts directly by phone for medical advice, medical reminders and examinational reminders during 24 months of management. -There were 0.5% of patients stroked during 24 months of treatment and management. Conclusion: Treatment by protocol and management by phone directly for medical taking and re-examinational reminders is the best resulted method of achieving blood pressure target and reducing complications of stroke for hypertensive patients. Key word: : blood pressure target; risk stratification; treatment; management; stage; phone.

Abstract WP402: Performance Measurement of Blood Pressure Management in the Acute Phase of Intracerebral Hemorrhage

Background: Patients with intracerebral hemorrhage (ICH) frequently present with elevated blood pressure (BP) requiring treatment. We conducted an exploratory analysis to examine BP management during the acute phase of ICH. We hypothesized that BP management and time to achieve goal BP would be variable. Our aim was to identify areas for improvement in BP management. Methods: We performed a retrospective chart review on consecutive patients with spontaneous ICH admitted to our neurosurgical intensive care unit (NSICU) from February-March 2015. Exclusions included secondary causes of ICH or comfort care orders placed within 72 hours of arrival. Demographic and clinical characteristics were collected as well as times for BP treatment order placement, IV treatment initiation and discontinuation. We recorded hourly BPs for the first 72 hours of hospitalization. Primary outcome measure was the time to achieve institutional guideline recommended BP control defined as SBP &lt;150 mmHg, maintained for &gt;6 hours. Secondary outcome included the proportion of patients who achieved SBP target &gt;85% of the time. Results: We screened 37 patients and 29 met criteria. Baseline information is summarized in Table 1. Documented BP goals for 25 of 29 patients targeted a SBP goal &lt;150 mmHg. Documentation of BP goals, orders for treatment and initiation of IV medication for BP treatment all happened concurrently about 1 hour after admission (Figure 1). SBP control was achieved at a median of 9.3 hours after admission. Only 46.4% of patients achieved target SBP &gt;85% of the time. Conclusions: In our population, there is variability in the time it takes to achieve and maintain goal SBP with less than half of patients maintaining BP control. We identified targeted areas for improvement. Our data is limited by its retrospective nature and small size. Since aggressive BP management limits hematoma growth and may improve outcomes, we propose development of benchmarks to guide BP management in ICH patients.

Novel Pathophysiological Mechanisms in Hypertension.

Hypertension is the most common disease affecting humans and imparts a significant cardiovascular and renal risk to patients. Extensive research over the past few decades has enhanced our understanding of the underlying mechanisms in hypertension. However, in most instances, the cause of hypertension in a given patient continues to remain elusive. Nevertheless, achieving aggressive blood pressure goals significantly reduces cardiovascular morbidity and mortality, as demonstrated in the recently concluded SPRINT trial. Since a large proportion of patients still fail to achieve blood pressure goals, knowledge of novel pathophysiologic mechanisms and mechanism based treatment strategies is crucial. The following chapter will review the novel pathophysiological mechanisms in hypertension, with a focus on role of immunity, inflammation and vascular endothelial homeostasis. The therapeutic implications of these mechanisms will be discussed where applicable.

Effective antihypertensive strategies for high-risk patients with diabetic nephropathy.

Clinical guidelines recommend blood pressure (BP) lowering and renin-angiotensin-aldosterone system inhibition to slow kidney disease progression in patients with diabetic nephropathy. This study's purpose was to determine whether an antihypertensive regimen including a maximally dosed angiotensin-converting enzyme inhibitor could safely achieve target BP in indigent, predominantly minority patients with this disease. We studied 81 hypertensive adults (52% Hispanic and 31% African American) with nephropathy attributed to type 1 or 2 diabetes during the run-in period of a randomized controlled trial. The subjects received lisinopril titrated to 80 mg daily and additional antihypertensives to target a systolic BP (SBP) lower than 130 mm Hg. Blood pressure and serum potassium level were measured weekly, and a 4-gram sodium diet was prescribed. The primary outcome variable was SBP change from screening to randomization. Success in achieving SBP goal, change in urine albumin-creatinine ratio, hyperkalemia (serum potassium ≥5.5 mmol/L) and hypotension (SBP < 100 mm Hg) were also analyzed. The median SBP decreased from 144 to 133 mm Hg (median change, -9.6%.) Fifty-eight (71%) achieved goal SBP during run-in. The median UACR decreased from 206.8 to 112.7 mg/mmol (median change, -42.7%). The UACR reduction correlated with SBP reduction. Seventeen subjects experienced hyperkalemia responsive to dietary/medical management. Two subjects experienced hypotension responsive to medication adjustments. A regimen using a maximally dosed angiotensin-converting enzyme inhibitor is safe and effective for achieving BP goal in high-risk, predominantly minority patients with diabetic nephropathy. Implementing this regimen necessitates close monitoring of serum potassium level.

Management of Blood Pressure Control: At the Cutting Edge

Prof Williams opened the symposium by discussing the current state of blood pressure (BP) control in Europe and the key barriers to improving BP control rates. Prof Weiss presented the ‘Low BP in Vienna’ initiative that has been initiated in Austria in order to improve BP control. Prof Mourad discussed the ongoing campaign to improve BP control rates in France, and Prof Volpe presented a case study of an elderly patient with hypertension and chronic kidney disease (CKD). Prof Parati concluded the symposium by commenting on the improvements in technology with respect to BP control. The meeting objectives were to review the current achievement of BP goals in Europe since 2008; to evaluate the 70% BP goal initiatives in France and Italy; to use practical examples to assess the use of single-pill fixed-dose combinations (FDCs); and to assess the impact of technological advances on BP control.

Prevalence of resistant hypertension and associated factors in Japanese subjects with type 2 diabetes

ObjectiveThe prevalence of treatment resistant hypertension (RH) depends on methods used for blood pressure (BP) measurements, goals of BP, and therapeutic efforts in terms of medication and adherence. We focused on diabetic subjects and explored the prevalence of RH in primary care practice. MethodsIn 1737 subjects with type 2 diabetes who continued regular visits, office BP was evaluated by multiple measurements over one year. RH was defined as using more than four antihypertensive drugs or failure to achieve the goal with three antihypertensive drugs from different classes. The RH prevalence was investigated with BP goals <130/80 and 140/90mmHg. ResultsThe percentage of subjects who achieved BP goals <130/80 and 140/90 were 70.5% and 93.8% with adherence to medication ≥95%, and the corresponding prevalence rates of RH in treated subjects were 28.4% and 21.8%, respectively. Factors independently associated with RH were age (odds ratio 1.02 [95% CI 1.01–1.04]), body mass index (1.10 [1.06–1.13]), variability in systolic BP (1.06 [1.02–1.09]), triglycerides (2.86 [1.34–6.11]), macroalbuminuria (3.33 [2.03–5.48]), estimated glomerular filtration rate (0.98 [0.97–0.99]), retinopathy (1.91 [1.39–2.61]), and family history of hypertension (1.85 [1.23–2.21]). Worsening albuminuria and glomerular filtration rate enhanced the prevalence of RH in a graded manner. ConclusionCareful estimation of office BP values over one year with a high achievement of BP goals and adequate adherence revealed that the prevalence of RH in type 2 diabetes is high. RH was characterized by accumulation of cardiovascular genetic and environmental risks.

Ambulatory Blood Pressure Monitoring in the Diagnosis, Prognosis, and Management of Resistant Hypertension: Still a Matter of our Resistance?

Resistant hypertension, commonly described as the failure to achieve goal blood pressure (BP) despite an appropriate regimen of three antihypertensive drugs at the maximal tolerated doses, one of which is diuretic, is increasingly recognized as an important problem of public health. Large population studies with office measurements suggest that the prevalence of resistance hypertension is approximately at 6-12 % of the general hypertensive population and 8-28 % of treated hypertensives. However, these estimations do not take into account factors of pseudo-resistance, most importantly, the white-coat effect that can be effectively ruled out with ambulatory blood pressure monitoring (ABPM). Recent studies have clearly shown that when ABPM is used, at least 30-35 % of patients labeled as "resistant hypertensives" turn out to have well-controlled BP on ambulatory basis, a finding changing entirely the estimates of prevalence of resistance hypertension and actual patient handling. Furthermore, current evidence suggests that ABPM is a much more accurate predictor of cardiovascular events in resistant hypertension compared to office BP and thus can offer a better risk stratification for these high-risk individuals. Finally, ABPM offers the potential of a better evaluation of the effect of pharmacologic and non-pharmacologic therapeutic interventions. This review attempts to summarize recent evidence on the advantages of ABPM in the diagnosis, prognosis, and management of resistant hypertension.

Management of hypertension in chronic kidney disease.

Hypertension is a common comorbidity in patients with impaired kidney function. The kidney exerts a marked degree of control over blood pressure through various mechanisms, such as by regulating sodium balance and hormone secretion through the activity of the renin-angiotensin system. The kidney is susceptible to injury, and if already damaged can be at risk of further loss of function as a consequence of elevated blood pressure. Once elevated blood pressure is identified, a combination of sensible lifestyle measures, such as sodium restriction and weight loss, with pharmacological intervention to reduce blood pressure will usually achieve blood pressure goals. In this Review, we outline the importance of blood pressure control for patients with chronic kidney disease (CKD), the mechanisms that affect blood pressure control, and the basis for non-drug and drug therapies. We further discuss the rationale for <140 mmHg systolic and <90 mmHg diastolic targets for blood pressure in patients with CKD, with consideration for tighter targets in the setting of proteinuria.

Different strategies from monotherapies to dual or triple fixed dose combination therapies to achieve blood pressure goals: a summary of a satellite symposium from the European Society of Hypertension.

In this special issue of High Blood Pressure and Cardiovascular Prevention we report the proceedings of a satellite symposium at the European Society of Hypertension (ESH) held in Athens, Greece in June 2014. The symposium, entitled ‘‘Effective fixed solutions: one, two, three... goal!’’, addressed a major issue in the contemporary management of hypertension, that is, how to overcome the poor control of hypertension in patients and, more in general, in the population. Professor Josep Redon from Spain provides the introductory remarks in this special issue that outline the current topics in the field of hypertension while another key opinion leader, Professor George Bakris, from Chicago in the United States, provides summary statements about where the field of hypertension is heading. The two keynote papers within this special issue reflect on current clinical data and identify potential areas for improvement for managing BP control in patients with hypertension. The topic on how to achieve BP goal in hypertension by Professor Stephane Laurent from France, is a competent and updated review on the role of combination therapy in the guidelines and in recent studies, and proposes an approach of ‘‘personalized’’ hypertension therapy platform which has also been recently proposed by a panel of international experts. The second paper by Professor Roland Schmieder from Germany focuses on the issue of treatment-resistant hypertension and is a practical, synthetic approach to this topic of growing interest for the medical community. The diagnosis of true resistant hypertension represents an excellent exercise to put in practice clinical guidelines and good clinical practice in the diagnostic process. Finally, two clinical cases entitled ‘‘A patient with apparent compliance’’ and ‘‘A patient with apparent resistant hypertension’’ by Dr. Sarafidis and Dr. Aguiar, respectively, provide practical insights for the readers of this journal who are interested in these subject matters. Single-pill combination therapy based on one, two or three drugs represent a truly new strategy to fight the unmet needs in the control of hypertension, and the title of this symposium, while proposing this new therapeutic solution with a metaphoric soccer representation, reflects the current challenges and the proposed solutions. As the Editor of the Journal, I am honoured and proud to host the presentations of these scientific leaders in the field of hypertension. Massimo Volpe, M.D, FESC, FAHA

The lower the achieved blood pressure goal the better.

Hypertension is the eminent risk factor for renal and cardiovascular disease (CVD). Its management is a topic of public health priority. As either too high or too low blood pressure (BP) levels can have detrimental effects on health, optimal targets for BP continue to be controversial. The current manuscript will review relevant data published over the last year that add to this topic of controversy. Recent studies confirm increased CVD-related risk with increasing SBP levels more than 140 mmHg among patients with hypertension and CVD as well as those over the age of 60 years. A SBP target less than 140 mmHg conveyed lessened risk of CVD-related events. There is some evidence suggesting that the ideal BP target lies between 120 and 140 mmHg. Recent data support a target SBP of less than 140 mmHg among patients with hypertension or CVD, and achievement of this target might benefit those older than 60 years of age as well. Treating to SBPs below 120 mmHg may not result in further benefit. Data from randomized controlled trials specifically addressing the question whether lower BPs are associated with better outcomes are needed to further define ideal BP-target goals.

PP.21.16

Objective: Most patients require 2 or more antihypertensive agents to achieve blood pressure (BP) goal. Single pill combinations of olmesartan medoxomil (OM) with amlodipine (AML), azelnidipine (AZE) or hydrochlorothiazide (HCTZ) improved BP lowering and goal achievement in individual clinical trials. This meta-analysis evaluated OM monotherapy vs OM-single pill combinations on reducing BP and achieving BP goal. Design and method: A meta-analysis of 8 studies (between 2000 and 2008) from a clinical trials database was conducted. Studies had 1 or more dual therapy arms (OM/AML, OM/AZE or OM/HCTZ) and 1 or more OM monotherapy arms. Endpoints were mean change from baseline (BL; first treatment day) in seated cuff blood pressure (SeBP) at 12 weeks, and percent achieving BP < 140/90 mmHg or systolic BP (SBP) goal < 140 mmHg by end of study (EOS). Statistical analysis (2-way ANCOVA, study and treatment as factors, BL SBP as covariate) on absolute change on mean SBP from BL to EOS (last observation carried forward; LOCF) are presented. Results: Demographics and mean baseline BP for OM mono (N = 1955) vs single pill combinations (N = 4004) were similar (Table). Dual therapy resulted in a greater BP reduction vs monotherapy at EOS (treatment difference: -7/-4 mmHg; LOCF; Table) and enabled more patients to achieve BP goal < 140/90 mmHg or SBP goal < 140 mmHg. Forest Plot analysis of absolute change on SBP from BL showed a treatment difference of 5.74 mmHg (95%CI:4.68,6.79) favoring OM dual therapy (Figure). Conclusions: OM-single pill combinations result in clinically relevant greater BP reductions and goal achievement vs OM monotherapy in hypertensive patients.

Blood pressure control to prevent decline in cognition after stroke.

BackgroundTreatment of hypertension post-stroke preserves cognition through prevention of recurrent stroke, but it is not clear whether it prevents cognitive decline through other mechanisms. We aimed to describe changes in blood pressure from baseline to 1 year post-stroke and to evaluate the association between achieved blood pressure targets and cognitive function, mild cognitive impairment (MCI), and dementia.MethodsWe included patients with first-ever stroke, and defined achieved blood pressure goals as systolic blood pressure (SBP) in the categories ≤125 mmHg, ≤140 mmHg, and ≤160 mmHg, SBP reduction of ≥10 mmHg, and diastolic blood pressure (DBP) reduction of ≥5 mmHg. The main outcome variables were cognitive assessments 1 year post stroke. Secondary outcomes were diagnoses of MCI or dementia.ResultsForty-one of 166 patients (25%) reached SBP ≤125 mmHg after 1 year, 92/166 (55%) reached SBP ≤140 mmHg, and 150/166 (90%) reached SBP ≤160 mmHg. SBP was reduced by ≥10 mmHg in 44/150 (29%) and DBP by ≥5 mmHg in 57/150 (38%). We did not find any statistically significant associations between cognitive test performances and different blood pressure goals (P=0.070–1.0). Nor was there any significant association between achieved goal blood pressure or blood pressure reduction after 1 year and the diagnoses of MCI or dementia (P=0.32–0.56).ConclusionTreatment of hypertension is important for primary and secondary prevention of stroke. Showing a potential beneficial effect of blood pressure control on cognitive function, however, probably needs longer follow-up.

Efficacy and safety of intravenous nimodipine administration for treatment of hypertension in&amp;nbsp;patients with intracerebral hemorrhage

BackgroundNicardipine (NC) is the most commonly used antihypertensive drug in neurological patients with hypertension. Although nimodipine (NM) is widely used to treat cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage, trials exploring its antihypertensive effect after intravenous administration in subjects with intracerebral hemorrhage (ICH) are scarce.MethodsA retrospective study was carried out to compare the safety and efficacy of NC and NM administered intravenously in patients with ICH. Therapeutic responses were assessed by achievement of goal blood pressure (BP); use of additional medications for BP control; proportion of time spent within goal; variability in BP; time to goal BP; number of dose adjustments; variability in ICH volume, Glasgow Coma Scale score, and intracranial pressure; and drug-related complications.ResultsA total of 87 patients were eligible for analysis (n=46 [NC]; n=41 [NM]), and baseline characteristics between groups were similar. Both agents were effective in achieving goal BP during infusion, with 93.5% and 87.8% patients in the NC and NM groups achieving goal, respectively. Fewer additional medications were needed to control BP in the NC group. BP variability was similar and no differences were observed in the mean time to goal BP and mean numbers of dose adjustments between both groups. Interestingly, intracranial pressure declined (P=0.048) during NC administration but increased (P=0.066) after NM treatment. Finally, the incidences of hematoma expansion, neurological deterioration, and adverse drug events were similar in both groups.ConclusionNM is effective and safe for BP control in patients with ICH.

Evolution of clinical profile, treatment and blood pressure control in treated hypertensive patients according to the sex from 2002 to 2010 in Spain

To examine the evolution of clinical profile, management of hypertension, and blood pressure (BP) control according to sex in the past decade in Spain. Data were taken from three surveys (PRESión arterial en la población española en los Centros de Atención Primaria studies) aimed to determine BP control rates in treated hypertensive patients, who attended the primary care in Spain during 2002, 2006, and 2010, respectively. Adequate BP control was defined as BP lower than 140/90 mmHg for the general hypertensive population in the three surveys. In patients with diabetes, chronic kidney disease, or cardiovascular disease, BP control was established as lower than 130/85 mmHg in the 2002 survey and lower than 130/80 mmHg in the 2006 and 2010 surveys. A total of 12 754 (57.2% women), 10 520 (53.7% women), and 12 961 (51.7% women) patients were included. The proportion of patients with cardiovascular disease increased from 27.1% in men and 21.9% in women in 2002, to 33.0 and 23.9%, respectively, in 2010 (P < 0.0001 in men and women, respectively). In 2002, 36.3% of men and 35.9% of women achieved BP goals (P = NS); 39.7 and 42.9% in 2006 (P < 0.001); and 44.7 and 47.9% in 2010 (P < 0.0001). The proportion of men on combined therapy increased from 44.2% in 2002 to 63.9% in 2010 (P for trend < 0.0001), and in women it increased from 43.9 and 63.2%, respectively (P for trend <0.0001). Despite the fact that clinical profile of treated hypertensive patients has worsened in the past years in Spain, BP control rates have improved, particularly in women. This improvement was related with a higher use of combined therapy, regardless of sex.

Different strategies from monotherapies to dual or triple fixed dose combination therapies to achieve blood pressure goals: a summary of a satellite symposium from the European Society of Hypertension, June 13-16, 2014 Athens, Greece. Introduction.

Different strategies from monotherapies to dual or triple fixed dose combination therapies to achieve blood pressure goals: a summary of a satellite symposium from the European Society of Hypertension, June 13-16, 2014 Athens, Greece. Introduction.

Abstract W P369: International Variability in Stroke Preventive Care

Introduction: Research protocols for stroke prevention trials commonly specify goals for preventive care. We report variability in goal achievement between 3 countries participating in an on-going stroke secondary prevention trial. Methods: The Insulin Resistance Intervention after Stroke (IRIS) trial is testing pioglitazone, compared with placebo, for prevention of stroke and myocardial infarction among non-diabetic patients with a recent ischemic stroke/TIA. Preventive care is provided by personal physicians, although achievement of prevention goals is monitored and reported to participants and their physicians annually. Goals are from the American Heart Association guidelines: blood pressure (BP) &lt;140/90 mmHg, statin therapy, and anti-platelet or anticoagulation depending on clinical indications. At baseline and year 1, we compared the proportions of participants meeting these goals in the largest enrolling countries: Canada (CA), United Kingdom (UK) and United States (US). Results: Participant characteristics were similar across countries, except the proportions of women and blacks were lower in the UK and CA than the US, and self-reported hypertension was more common in US than CA or UK. At baseline, achievement of BP goal was lower in the UK (53%) compared with the US (66%) and CA (75%) (Chi 2 p&lt;0.0001). Statin therapy was used more commonly in the UK (91%) and CA (88%) compared with the US (80%) (Chi 2 p&lt;0.0001). Differences persisted at year 1. At baseline, use of antithrombotic therapy was high (99%) in all countries. However, at year 1, use fell in US (96%) compared to CA and UK (p=0.02). Conclusions: Secondary preventive care for stroke varied among 3 countries for BP, statin therapy and antithrombotic therapies despite the IRIS protocol specifying uniform goals. These findings may be the result of disagreement among practitioners in the 3 countries for secondary prevention goals, variability in care delivery, or variability in research implementation. Understanding and resolving variability may lead to more efficient research and improved care for patients.