Antihypertensive Medication In Patients Research Articles

Drug adherence and psychosocial characteristics of patients presenting with hypertensive urgency at the emergency department.

To identify potentially targetable psychosocial factors associated with nonadherence to prescribed antihypertensive medications in patients presenting with hypertensive urgencies at an emergency department. This prospective study included patients treated with antihypertensive drugs who presented with hypertensive urgencies (SBP ≥180 mmHg and/or DBP ≥110 mmHg) at the emergency department of a tertiary referral clinic between April 2018 and April 2019. Health literacy was assessed using the Newest Vital Sign test. The Hospital Anxiety and Depression Scale (HADS) was used to quantify symptoms of anxiety and depression. Patients were classified nonadherent if less than 80% of the prescribed antihypertensive drugs were detectable in urine or plasma using liquid chromatography-high-resolution mass spectrometry. A total of 104 patients (62% women) presenting with hypertensive urgencies with a median SBP of 200 mmHg (IQR 190-212) and DBP of 97.5 mmHg (IQR 87-104) were included. Twenty-five patients (24%) were nonadherent to their antihypertensive medication. Nonadherent patients were more often men (66 versus 23%, P = 0.039), prescribed higher numbers of antihypertensive drugs (median 3, IQR 3-4 versus 2, IQR 1-3; P < 0.001), and more often treated with calcium channel blockers (76 versus 25%; P < 0.001) and/or diuretics (64 versus 40%; P = 0.030). There was no difference in health literacy (P = 0.904) or the scores on the HADS subscales for depression (P = 0.319) and anxiety (P = 0.529) between adherent and nonadherent patients. Male sex, higher numbers of antihypertensive drugs, and treatment with diuretics and/or calcium channel blockers were associated with nonadherence. We did not identify a specific psychosocial characteristic associated with nonadherence.

Plasma Trough Concentrations of Antihypertensive Drugs for the Assessment of Treatment Adherence: A Meta-Analysis.

Biochemical drug screening by liquid chromatography-tandem mass spectrometry in plasma is an accurate method for the quantification of plasma concentrations of antihypertensive medications in patients with hypertension. Trough concentrations could possibly be used as drug-specific cutoff values in the biochemical assessment of (non-)adherence. We performed a literature review and meta-analysis of pharmacokinetic studies to determine plasma trough concentrations of amlodipine, hydrochlorothiazide, and valsartan. PubMed was searched for pharmacokinetic studies up to September 2020. Eligible studies reported steady-state mean trough concentration and their variance. Pooled trough concentrations were estimated using a three-level random effects meta-analytic model. Moderator analyses were performed to explore sources of heterogeneity. One thousand three hundred eighteen potentially relevant articles were identified of which 45 were eligible for inclusion. The pooled mean trough concentration was 9.2 ng/mL (95% CI, 7.5-10.8) for amlodipine, 41.0 ng/mL (95% CI, 17.4-64.7) for hydrochlorothiazide, and 352.9 ng/mL (95% CI, 243.5-462.3) for valsartan. Substantial heterogeneity was present for all 3 pooled estimates. Moderator analyses identified dosage as a significant moderator for the pooled trough concentration of amlodipine (β1=0.9; P<0.05), mean age, and mean body weight for the mean trough concentration of hydrochlorothiazide (β1=2.2, P<0.05, respectively, β1=-4.0, P<0.05) and no significant moderators for valsartan. Plasma trough concentrations of amlodipine, hydrochlorothiazide, and valsartan, measured with liquid chromatography-tandem mass spectrometry, are highly heterogeneous over the different studies. Use of the pooled trough concentration as a cutoff in the biochemical assessment of adherence can result in inaccurate diagnosis of (non-)adherence, which may seriously harm the patient-physician relationship, and is therefore not recommended.

Changes in blood pressure thresholds for initiating antihypertensive medication in patients with diabetes: a repeated cross-sectional study focusing on the impact of age and frailty

ObjectiveTo assess trends in systolic blood pressure (SBP) thresholds at initiation of antihypertensive treatment in patients with type 2 diabetes and the impact of age and frailty on these trends.Study...

Adherence to antihypertensive medications in patients attending public hospitals in Kano State, Nigeria

Hypertension is a chronic medical condition characterized by an elevated arterial blood pressure with increasing prevalence in developing countries including Nigeria. One of the integral elements in management of hypertension is adherence to medication and life-style modification. This study aimed to assess adherence level for anti-hypertensive medications among adult hypertensive patients attending public hospitals in Kano State, Nigeria. The study was a cross sectional prospective survey involving 600 patients from six public healthcare facilities selected by multistage sampling technique. Adherence status was assessed using Morisky medication adherence scale. Sociodemographic data and other factors that may influence adherence to hypertension medications were evaluated. Out of the 598 patients that participated in the study, only 178 (29.8%) have their BP controlled based on JNC8. Three hundred and thirty two (55.5%) out of 598 patients have good adherence, while 266 (45.5%) have poor adherence. Of the 178 patients who had good BP control, 120 (67.5%) have good adherence while 58 (32.5%) have poor adherence. BP control was significantly higher in those that adhered to antihypertensive medication compared with non-adhering patients (χ2 = 14.526; df = 1; p-value = &lt; 0.001). Additionally, Chi-square test showed significant association between number of antihypertensives and blood pressure control. (χ2=37.556, df=3, p&lt;0.001). The study established that 55.5% of the respondents have good adherence to their antihypertensive medication while 29.8% had their BP controlled. Adherence and number of antihypertensive medication a patient is taking were found to have significant relationship with BP control.&#x0D; Keywords: Medication, adherence, hypertension, antihypertensive

Hemodynamic Impact of Cardiovascular Antihypertensive Medications in Patients With Sepsis-Related Acute Circulatory Failure.

Impact of prior cardiovascular antihypertensive medication during the initial phase of septic shock in terms of catecholamine requirements and mortality has been poorly investigated and remains unclear. To investigate the association between chronic prescription of cardiovascular antihypertensive medication prior to intensive care unit (ICU) admission, catecholamine requirement, and mortality in patients with septic shock. We included all consecutive patients diagnosed with septic shock within the first 24 h of ICU admission, defined as a microbiologically proven or clinically suspected infection, associated with acute circulatory failure requiring vasopressors despite adequate fluid filling. Prior cardiovascular antihypertensive medication was defined as the chronic use of betablockers (BB), calcium channel blockers (CCB), angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blockers (ARB). ICU mortality was investigated using multivariate competitive risk analysis. Among 735 patients admitted for septic shock between 2008 and 2016, 46.9% received prior cardiovascular antihypertensive medication. Prior cardiovascular antihypertensive therapy was not associated with increased norepinephrine requirements during the first 24 h (median = 0.28 μg/kg/min in patients previously treated vs. 0.26 μg/kg/min). Prior cardiovascular antihypertensive medication was not associated with a higher risk of ICU mortality after adjustment (cause-specific hazard = 1.28, 95% confidence interval [0.98-1.66], P = 0.06). Subgroups analyses for BB, CCB, and ACEi/ARB using propensity score analyses retrieved similar results. In patients admitted with septic shock, prior cardiovascular antihypertensive medication seems to have limited impact on initial hemodynamic failure and catecholamine requirement.

Adherence to Antihypertensive Medication in Patients with Hypertension in Indonesia

Objective: Adherence to medication is crucial for hypertension patients in order to control and prevent complications. This study aimed to describe the adherence to antihypertensive drugs among patients with hypertension in Bandung District, West Java, Indonesia. Methods: This was a cross-sectional observational study on patients with hypertension in the work area of Cileunyi Public Health Center (PHC), Bandung District, West Java, Indonesia. The inclusion criteria used were patients with hypertension who were prescribed an antihypertensive drug by a physician, above 18 years old, and had been using an antihypertensive medication for at least two months before the study. Data were obtained through interviews during the month of July to August 2018 using a modified MMAS-8 questionnaire of the Morisky Medication Adherence Scale (MMAS-8), which includes Likert-type scale questions. Data collected were then analyzed using the Rasch Model, and the mean logit person was used as a cut off between adherence and non-adherence categories. Results: A total of 75 patients with hypertension were recruited. The prevalence of adherence to medication was 59%. Most patients who adhered to the medication were &gt; 55 years old (31%), female (59%), had been diagnosed with hypertension for &lt; 5 years (31%), and received support from family/social environment (40%). Conclusion: Many factors support the adherence to antihypertensive medication, including age, gender, time of hypertension diagnosis, and support from family or social environment. The adherence to antihypertensive medication among patients with hypertension visited Cileunyi Primary Health Care, Bandung District, West Java, Indonesia is good.

Renin-Angiotensin-Aldosterone System Modulates Blood Pressure Response During Vascular Endothelial Growth Factor Receptor Inhibition

ObjectivesThis study postulated that antihypertensive therapy with renin-angiotensin-aldosterone system (RAAS) inhibition may mitigate vascular endothelial growth factor inhibitor (VEGFi)–mediated increases in blood pressure more effectively than other antihypertensive medications in patients receiving VEGFi therapy. BackgroundVEGFi therapy is commonly used in the treatment of cancer. One common side effect of VEGFi therapy is elevated blood pressure. Evidence suggests that the RAAS may be involved in VEGFi-mediated increases in blood pressure. MethodsThis retrospective cohort analysis was performed using a de-identified version of the electronic health record at Vanderbilt University Medical Center in Nashville, Tennessee. Subjects with cancer who were exposed to VEGFi therapy were identified, and blood pressure and medication data were extracted. Changes in mean systolic and diastolic blood pressure in response to VEGFi therapy in patients receiving RAAS inhibitor (RAASi) therapy before VEGFi initiation were compared with changes in mean systolic and diastolic blood pressure in patients not receiving RAASi therapy before VEGFi initiation. ResultsMean systolic and diastolic blood pressure rose in both groups after VEGFi use; however, patients who had RAASi therapy before VEGFi initiation had a significantly lower increase in systolic blood pressure as compared with patients with no RAASi therapy (2.46 mm Hg [95% confidence interval: 0.7 to 4.2] compared with 4.56 mm Hg [95% confidence interval: 3.5 to 5.6], respectively; p = 0.034). ConclusionsIn a real-world clinical population, RAASi therapy before VEGFi initiation may ameliorate VEGFi-mediated increases in blood pressure. Randomized clinical trials are needed to further our understanding of the role of RAASi therapy in VEGFi-mediated increases in blood pressure.

Connected Health in Hypertension Management.

e-health is defined as the use of communication and information technologies (ICT) to manage patients and their health in a more efficient way, with the aim of improving the overall quality of care. Healthcare services relying on telehealth (or telemedicine) and mobile health (m-health) are the most popular e-health tools used by healthcare professionals and consumers. These applications allow the exchange of medical data between patients and their doctors or among healthcare professionals, mainly through the Internet, and are used to provide healthcare services remotely (so-called “connected health”). The most popular telemedicine application in the field of hypertension is blood pressure telemonitoring (BPT), which enables transmission of BP and various clinical information from patients' homes or from the community to the doctor's surgery or the hospital. Numerous randomized controlled trials have documented a significant BP reduction combined with an intensification and optimization of the use of antihypertensive medications in patients making use of BPT plus remote counseling by a case manager, with the supervision of a doctor or a community pharmacist (telepharmacy). The major benefits of BPT are usually observed in high-risk patients. BPT can also be based on m-health wireless solutions, provided with educational support, medication trackers and reminders, and teleconsultation. In this context, BPT may favor patient's self-management, as an adjunct to the doctor's intervention, and foster patient's participation in medical decision making, with consequent improvement in BP control and increase in medication adherence. In conclusion, e-health solutions, and in particular telemedicine, are increasingly attaining a key position in the management of the hypertensive patient, with an enormous potential in terms of improvement of the quality of the delivered care, increase in the chance of a successful BP control and effective prevention of cardiovascular diseases.

Anemia and the use of antihypertensive medications in hemodialysis patients: multicenter retrospective observational study

Abstract. We hypothesized that the use of antihypertensive medications in patients treated by hemodialysis (HD) may interfere with the activity of erythropoietin and leads to an increase in the dose of erythropoiesis stimulating agents (ESAs). The aim of our study was to analyze the impact of antihypertensive medications on the effectiveness of anemia treatment. Methods. We conducted a multicenter retrospective observational study. The archival medical data from 379 patients treated by HD or hemodiafiltration (HDF) were used. The medical records of 142 patients were excluded from the study. The study group consisted of 237 patients: 108 (45.6%) women and 129 (54.4%) men, with an average age of 54 [41-62.5] years. Results. The analysis of the mean hemoglobin (Hb) stratified by the administration of antihypertensive medications in the dynamics of dialysis treatment demonstrated a significant impact of angiotensin-converting enzyme (ACE) inhibitors (F = 3.97; p = 0.048) and amlodipine (F = 6.9; p = 0.01) on the effectiveness of anemia correction. The significant effect of amlodipine on the need to increase the dosage of iron-containing medications (OR = 3.9; 95% CI (1.27-12.06), p = 0.002; RR = 1.9 95% CI (1.27-2.9) and continuous erythropoietin receptor activator (CERA) (OR = 5.2, 95% CI (1.2-24.4), p = 0.03; RR = 1.3 95% CI (1, 08-1.6), p = 0.006) weas showed by logistic regression analysis. The increased risk of failure to achieve of the target Hb level in HD patients received amlodipine was confirmed by Cox regression model (HR = 2.7 (95% CI 1.5-4.7)). Conclusions: The results of our study demonstrated a significant increase in the frequency of appointment and amount of anti-anemia therapy in HD patients when amlodipine is co-administered. Follow-up studies to determine the effect of amlodipine mechanism for anemia will avoid unreasonable prescriptions for the treatment of НD patients. Conflict of interest statement: the authors declared no competing interests.

Creatinine Rise During Blood Pressure Therapy and the Risk of Adverse Clinical Outcomes in Patients With Type 2 Diabetes Mellitus.

Lowering blood pressure may affect renal function. Current guidelines state that reducing antihypertensive therapy should be considered in patients with a >30% serum creatinine increase after initiation of antihypertensive therapy. We examined the association between a serum creatinine increase and adverse clinical outcomes in the ACCORD-BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure), were patients with type 2 diabetes mellitus were randomized to intensive (target systolic blood pressure <120 mm Hg) and standard antihypertensive (<140 mm Hg) treatment. The primary outcome was a combined end point consisting of all-cause mortality, major cardiovascular events, and renal failure. Patients were stratified into 3 groups according to serum creatinine increase between baseline and 4 months (<10%, 10%-30%, >30%). A total of 4733 patients, aged 62.2 years, 52% men with a mean estimated glomerular filtration rate 81.5 mL/min per 1.73 m2 were included. Follow-up was available for 4446 patients, 2231 were randomized to intensive and 2215 to standard therapy. Kaplan-Meier analysis showed no association between a serum creatinine increase and the composite end point in the intensive ( P=0.20) and the standard treatment group ( P=0.17). After adjusting for possible confounders, a >30% serum creatinine increase was associated with a higher risk of clinical adverse outcomes in both treatment groups, but to a similar extent. These data suggest that a >30% serum creatinine increase that coincides with lower blood pressure values should not directly lead to a reduction in antihypertensive medication in patients with type 2 diabetes mellitus. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00000620.

Association between follow-up in health services and antihypertensive medication adherence.

To analyze the association between the characteristics of follow-up in health services and adherence to antihypertensive medication in patients with cardiovascular disease. Analytical study carried out with 270 patients suffering from hypertension and hospitalized due to cardiovascular complications. Data collection occurred between November 2015 and April 2016, involving sociodemographic variables, presence of self-reported diabetes, accessibility and use of health services, blood pressure levels and medication adherence (analyzed through the Morisky-Green Test). The rate of adherence to antihypertensive therapy was 63.0%. Enrollment in the Hiperdia program had no statistical significance to medication adherence. People who attended at least between 4 and 6 nursing consultations throughout the data collection period (p = 0.02) had better adherence. The study's findings provide support for the reorientation of health services and their public policies towards improving adherence to antihypertensive therapeutics.

A4979 Analysis of antihypertensive medication in patients with hypertension complicating diabetes during hospitalization

Objectives: To investigate the utilization of anti-hypertensive drugs in the hypertension complicating type 2 diabetes mellius (T2DM) for clinical reference of rational drug use. Methods: The Antihypertensive drugs in discharge order of 772 patients with hypertension complicating T2DM who admitted in our internal medicine-cardiovascular department during September 2015 to September 2016 were retrospectively analyzed. Taking DUI as the analysis index, we analyzed the medicine kinds, dosage, DDD, DDDs and combined medication of antihypertensive drugs. Results: The most Antihypertensive agents with DUI < 1. CCB, ARB and Beta adrenoreceptor blocker dominated the first 3 places in terms of DDDs respectively. In 772 patients with hypertension complicating T2DM, the single drug use in the antihypertensive scheme accounted for 26%, two-drug combined use accounted for 39%, three-drug combined use for 24%, four-drug combined use for 9%, and five-drug combined use for 2%. The frequency of angiotensin II receptor antagonist (ARB) + calcium channel blocker (CCB) is the highest in the combination drug therapy. Conclusion: The use of antihypertensive drugs in patients with hypertension complicating T2DM is essentially reasonable and which is in line with the Chinese guidelines for the management of hypertension in our hospital.

The Rates of Overtreatment and Deintensification of Antidiabetic and Antihypertensive Medications in Patients with Diabetes Mellitus

Background: Targeting better HbA1c and blood pressure (BP) goals may endanger older adults with type 2 diabetes mellitus (T2DM) for a number of risks. Overtreatment of T2DM and hypertension (HTN) is a trending issue but awareness and attitudes of physicians need to be explored. Objective: To assess the rates and predictors of overtreatment and undertreatment of glycemia and blood pressure in older adults with T2DM. Treatment deintensification or intensification by the physicians were also investigated. Method: Data from older adults (≥65 years) enrolled in a large nationwide T2DM survey in 2017 across Turkey were analyzed. Overtreatment was defined as HbA1c &amp;lt;6.5% plus use of ≥2 oral hypoglycemics or insulin, and systolic BP &amp;lt;120 mmHg or diastolic BP &amp;lt;65 mmHg plus use of ≥2 drugs). Undertreatment was defined as HbA1c &amp;gt;9% at all, and SBP &amp;gt;140 mmHg or DBP &amp;gt;90 mmHg plus use of &amp;lt;3 drugs. Deintensification or intensification rates were calculated according to treatment modification by the physicians. Results: A total of 1276 patients were included. The overtreatment rates for glycemia and BP were 9.8% and 5.9%, whereas undertreatment rates were 14.2% and 17.7%, respectively. In the adjusted model, use of oral hypoglycemics only (OR:3.1, 95% CI:1.9-5.3) and follow-up at a private clinic (OR:2.2, 95% CI:1.2-3.9) were the predictors of glycemia overtreatment. Presence of microvascular complications (OR:2.0, 95% CI:1.1-3.5) was the only predictor of BP overtreatment. The deintensification and intensification rates for glycemia were 25% and 75.7% respectively, and for the BP 10.9% and 9.0% respectively. Conclusion: The overtreatment rates of diabetes and BP in Turkish older adults with T2DM were consistent with the previous studies, while the undertreatment rates were much higher. Doctors seem to feel more comfortable to intensify glycemic management and largely ignore BP control. The results warrant enforced measures to improve care of older adults with T2DM. Disclosure A. Sonmez: None. I. Tasci: None. I. Demirci: None. C. Haymana: None. C. Barcin: None. H. Aydin: None. S. Cetinkalp: None. F. Yener Ozturk: None. K. Gul: None. T. Sabuncu: None. I. Satman: None. F. Bayram: None.

Effect of Adherence to Antihypertensive Medication on the Long-Term Outcome After Hemorrhagic Stroke in Korea.

Hypertension is the single most important risk factor for hemorrhagic stroke, a leading cause of mortality and disability worldwide. Adherence to antihypertensive medication is essential to achieving strict blood pressure control, but poor adherence is common in clinical practice. We evaluated adherence to antihypertensive medication in patients with acute hemorrhagic stroke and its effects on long-term outcome. This was a retrospective cohort study based on a nationwide health insurance claims database in South Korea. We included 1872 hypertensive patients who were admitted with acute hemorrhagic stroke during 2002 to 2013 (1354 cases of intracerebral hemorrhage and 518 cases of subarachnoid hemorrhage). Adherence to antihypertensive medication was calculated using the proportion of days covered by any antihypertensive medication throughout the follow-up period (categorized into poor <40%; intermediate 40%-80%; good >80%) and treated as a time-dependent variable. Primary outcome was defined as a composite of recurrent stroke (hemorrhagic or ischemic), myocardial infarction, or all-cause mortality. Time-dependent Cox proportional hazard regression analyses were performed. During the mean follow-up period of 4.45 years, 634 patients had the primary outcome. The proportion of patients with good adherence to antihypertensive medication was 46.8% at 1 year, 43.2% at 3 years, and 41.7% at 5 years of follow-up. Compared with good adherence, the adjusted hazard ratio (95% confidence interval) for the primary outcome was 1.80 (1.49-2.16) for poor adherence and 1.56 (1.27-1.93) for intermediate adherence.

110 Patterns of Baseline Antihypertensive Medications in Patients with Asymptomatic Carotid Stenosis

110 Patterns of Baseline Antihypertensive Medications in Patients with Asymptomatic Carotid Stenosis

Effects of eplerenone on resistance to antihypertensive medication in patients with primary or secondary hyperaldosteronism

Resistant hypertension is an important problem; nearly half of diagnosed hypertensives are not controlled to target blood pressure levels, and approximately 90% of strokes occur among patients with resistant hypertension. Primary aldosteronism accounts for approximately 20% of resistant hypertension, but the role of secondary hyperaldosteronism in resistant hypertension is seldom considered. We assessed the effects of eplerenone in patients with hypertension and either primary or secondary hyperaldosteronism. Patients with a history of resistant hypertension and a supine plasma aldosterone level ≥ 360 pmol/L were randomized to eplerenone versus placebo in a fully blinded study for one year. A medication intensity score was developed to assess the resistance of hypertension to medication (blood pressure × medication intensity). We assessed the effects of eplerenone on blood pressure and on resistance to concomitant medication. Final results were available in 37 patients (19 on eplerenone and 18 on placebo). Resistance to medication, as assessed by the intensity of concomitant medication required to maintain blood pressure control, was markedly reduced by eplerenone: medication intensity scores declined by -0.50 ± 1.04 (SD) on placebo versus -2.11 ± 1.45 with eplerenone (P = 0.0001), the Systolic Resistance Score declined by -80.00 ± 122.93 on placebo versus -334.05 ± 21.73 on eplerenone (P = 0.0001), and the Diastolic Resistance Score increased by 1.28 ± 31.65 on placebo and declined by -40.74 ± 57.08 on eplerenone (P = 0.009). Eplerenone significantly reduced resistance to concomitant antihypertensive medication in both primary and secondary hyperaldosteronism.

Effect of adherence to antihypertensive medication on stroke incidence in patients with hypertension: a population-based retrospective cohort study

ObjectiveHigh blood pressure is a modifiable risk factor for stroke, but non-adherence to antihypertensive medication is a growing concern for healthcare providers in controlling blood pressure. This study aimed to...

Use of communication tool within electronic medical record to improve primary nonadherence

ObjectivesThe primary objective of this study was to determine if an online reminder decreased the rate of primary nonadherence for antihypertensive medications in patients seen in 2 primary care clinics in Omaha, NE. The secondary objectives were to determine if patients receiving the intervention achieved lower blood pressure values at follow-up visits and to determine if the intervention decreased the number of days between prescribing and prescription pick-up. MethodsA report was generated in an electronic health record to identify patients prescribed a new antihypertensive medication from a physician at one of the primary care clinics. Patients that failed to pick up this new prescription from the pharmacy within 7 days were sent an electronic reminder via an online patient portal. A baseline comparator group was created with the use of retrospective chart reviews for the 6 months before prospective data collection. Primary nonadherence rate and blood pressure values at follow-up visits were compared between the prospective and baseline comparator groups. ResultsThe primary nonadherence rate decreased from 65.5% to 22.2% when comparing the baseline and prospective groups, respectively. The mean days to prescription pick-up decreased from 24.5 to 12.56 in the baseline and prospective groups. The prospective group showed a larger decrease in systolic blood pressure (17.33 mm Hg vs. 0.75 mm Hg) and diastolic blood pressure (6.56 mm Hg vs. 2.25 mm Hg) compared with the baseline group. ConclusionAn online reminder through the electronic medical record appears to improve patient primary nonadherence, number of days between prescribing and prescription pick-up, and blood pressure measurements at follow-up visits. This research shows that an online reminder may be a valuable tool to improve patient primary adherence and health outcomes. Further research is needed with the use of a larger sample population to support any hypotheses about the effectiveness of the intervention.

Safety of Temporary Discontinuation of Antihypertensive Medication in Patients With Difficult-to-Control Hypertension.

Successful control of blood pressure relies on identification of secondary causes and contributing factors of hypertension. As antihypertensive medication can interfere with diagnostic investigations, temporary discontinuation of medication is advised. However, there are concerns about the safety of temporary discontinuation of antihypertensive medication in patients with difficult-to-control hypertension. We assessed the occurrence of adverse cardiovascular and cerebrovascular events potentially attributable to temporary discontinuation of antihypertensive medication between February 2010 and March 2016 (n=604) in our Analysis of Complicated Hypertension screening program. A reference group (n=604) was extracted from the SMART study (Second Manifestations of Arterial Disease) cohort (comprising a similar cohort at our hospital in whom medication was not stopped) and individually matched for blood pressure, age, sex, and history of cardiovascular disease. Discontinuation of medication was well tolerated; 62% reported no complaints, 24% had mild discomfort that could be left untreated, and 14% experienced complaints that required prescription of antihypertensive escape medication. Three major adverse events were observed in the Analysis of Complicated Hypertension group between discontinuation of medication and 30 days after restart of medication (event rate=31.2 events per 1000 patient-year). In the reference cohort, 5 cardiovascular events were observed during a similar follow-up period (event rate=51.2 events per 1000 patient-year). In conclusion, discontinuation of antihypertensive medication for the diagnostic evaluation of hypertension does not increase the acute risk of cardiovascular events when performed in a well-controlled setting in specialized hospitals with appropriate protocols for monitoring safety.

Management of Hypertension in Patients with Chronic Kidney Disease in Asia.

Hypertension is both a cause and consequence of chronic kidney disease (CKD). According to the Chinese national survey in 2007-2010, the prevalence of CKD was much higher in hypertensive patients (18.9%, n=16,691) than in the overall population sample (10.8%, n=47,204). CKD in hypertension confers risks to the kidneys as well as other organs. Probably because of high dietary salt intake, Asian hypertensive patients with CKD show high prevalence of non-dipping and reversed dipping blood pressure pattern, and may have even higher risks of cardiovascular disease. Therefore, out-of-office blood pressure evaluation and comprehensive cardiovascular evaluations are required. Most of current hypertension guidelines recommend intensive antihypertensive treatment in hypertensive patients with CKD. This is probably of particular relevance for cardiovascular prevention in Asia, because stroke, as a major complication of hypertension in Asia, is more closely related to blood pressure than coronary events. Intensive blood pressure control to 130/80 mmHg is often required to prevent CKD progression and cardiovascular complications. The inhibitors of the renin-angiotensin system (RAS) are recommended as the first line antihypertensive medications in patients with a glomerular filtration rate higher than 30 ml/min/1.73 m², which may more efficaciously prevent end-stage renal disease and cardiovascular events. Nonetheless, combination therapy of RAS inhibitors with other classes of antihypertensive drugs, such as calcium-channel blockers, diuretics, etc, is required to control blood pressure to the target.