Antihypertensive Drugs In Patients Research Articles

Prescripción de antihipertensivos en personas con diabetes tipo 2 en Andalucía y recomendaciones SEH-LELHA 2022: evaluación del coste y uso

ObjectiveThis study aims to analyze the prescription of antihypertensive drugs in patients with type 2 diabetes (T2D) in Andalusia, comparing it with the SEH-LELHA 2022 guidelines, and to assess the direct cost of these treatments. Materials and methodsA multicentric, cross-sectional, and descriptive study was conducted with 385 T2D patients. Participants were randomly selected from the patient lists of 120 primary care physicians from Andalusia. Inclusion criteria included a diagnosis of T2D and complete clinical records for the year 2022. Demographic data and drug prescription information were collected, with the average cost per patient being calculated. ResultsThe mean age of the subjects was 70.72 years, with 53.51% being male. A total of 70.9% of the patients were taking antihypertensive drugs, the most common being ACE inhibitors/ARBs (70.9%), diuretics (70.1%), beta-blockers (40.0%), and calcium channel blockers (20.0%). Each patient took an average of 2.46±1.06 antihypertendsive, and fixed association of 2 or more antihypertensive drugs were used by 40.9% of the studied patients. The annual cost per patient was 141.45€/year. ConclusionsThe study reveals strong adherence to the SEH-LELHA 2022 guidelines among physicians in Andalusia regarding the of antihypertensives for T2D patients, with a significant preference for Renin-Angiotensin System blockers, diuretics, and beta-blockers. However, a notable deviation in prescription practices was observed with the frequent choice of doxazosin over spironolactone, despite the latter being the recommended option for resistant hypertension. Although the overall expenditure on antihypertensives is moderate, their cost-effectiveness is enhanced by the efficacy of these treatments in preventing cardiovascular complications.

CHEMICAL ADHERENCE IN RESISTANT HYPERTENSION: PILOT STUDY IN AN ESH EXCELLENCE CENTER

Objective: Arterial hypertension (HTN) is responsible for the largest proportion of preventable mortality in the world. The primary cause of resistant hypertension (rHTN) is poor medication adherence. Blood or urine drug assays enable us to assess chemical adherence more accurately than self-reported questionnaires. We assayed anti-hypertensive drugs in patients with rHTN at our Center of Excellence in Hypertension, in collaboration with the Pharmacology and Toxicology Laboratory. Design and method: Patients with rHTN (office SBP/DBP >140/90 mmHg or out of office daytime >135/85 mmHg despite being prescribed 3 drugs at optimal dosage, including a diuretic, a renin angiotensin system inhibitor (RASI) and a calcium channel blocker (CCB), were informed of the study and agreed to have blood drugs concentrations measured. We describe the results for chemical adherence in the first 54 patients included between January 1, 2021 and September 1, 2023 in our center. Results: Of the 54 patients included, 38 (70%) were men, with a mean age of 65 +/- 11 years. The mean number of antihypertensive treatments prescribed was 5 +/- 1 (min 3, max 8). The proportions of treatments were RASI 87%, CCB (mainly dihydropyridines) 81%, diuretics 81%, beta-blockers 76%, alpha-blockers 57%, mineralocorticoid receptor antagonists (MRA) 37%, and central antihypertensives 26%. The best compliance was observed with alpha-blockers 81%, followed by CCB 50%, RASI 45%, diuretics 37% and beta-blockers 34%. The least compliant were central antihypertensives 0% and MRA 5%. All prescribed drugs were completely absent in the blood in 26% of patients, and 63% of patients had incomplete adherence (1 or more but not all drugs present in the blood), of whom 1/3 were non-compliant to 3 or more medications. Only for 9% of patients chemical adherence was excellent. Conclusions: Chemical adherence when measured at clinical visit was poor in this cohort of patients followed in a center of excellence. Limitations of this study are lack of follow-up for the same patient to assess variation in adherence over time, and small sample size. These results suggest the need to develop therapeutic education to improve patient involvement in the management of HTN and compliance.

Antihypertensive efficacy and safety of azilsartan medoxomil in patients with diabetes mellitus in real clinical practice. According to the CONSTANT study

Background. Obesity and associated diseases are the most common comorbidities in patients with arterial hypertension (AH). The combination of AH and type 2 diabetes mellitus (DM2) significantly exacerbates the cardiovascular risk in this patients. BP control is one of the key components of the multivariate approach to reducing the risk of DM 2 complications. The use of drugs with pronounced antihypertensive properties and at the same time the ability to improve metabolic parameters should be a priority in this category of patients. Assessing the efficacy and safety of azilsartan medoxomil, the last molecule from the ARB class in patients with AH and DM 2 is an urgent task.Purpose. Evaluation of antihypertensive efficacy and safety of azilsartan medoxomil in patients with AH and DM 2 and overweight or obesity.Materials and methods. 235 overweight or obese patients with AH and DM2 enrolled in the international multicenter observational non-interventional prospective study CONSTANT with azilsartan medoxomil according to the approved label. The observation period is 6 months.Results. The dynamics of SBP by visit 4 (6 months) was 29,7±14,5 mmHg, DBP - 13,36±10,9 mmHg (r≤0,001). Overall, the group achieved BP targets in 211 (89.41%) DM patients enrolled in the study. Response to therapy (reduction in SBP by at least 20 mmHg, DBP of 10 mm Hg) was obtained in 177 (75.0%) patients. Glycated hemoglobin (p<0.001) and fasting glucose (p<0.001) significantly decreased in patients with AH and DM. A decrease in total cholesterol, triglycerides, and LDL was observed, including in DM patients not taking statins (p<0.001). Overall, a decrease in waist circumference was observed across the group (p<0.005).Conclusion. Azilsartan medoxomil in real clinical practice proved to be a highly effective antihypertensive drug in patients with AH and DM. The ability of the drug, including in combination with other drugs, to improve the metabolic profile, reduce the volume of adipose tissue makes it a priority drug of choice in patients with AH, obesity and type 2 DM.

Correlation of Knowledge and Family Support with Treatment Compliance of Tuberculosis Sufferers

Introduction: The Hypertension is a cardiovascular disease characterized by increased blood pressure. Pharmacological and non-pharmacological therapies are one of the factors that can control hypertension. Pharmacological therapy involves the use of drugs which is the basis of a person's compliance with treatment. Adherence in taking medication also has factors that can influence such as knowledge, family support, access to health services. Knowing the relationship between knowledge and family support with adherence to taking anti-hypertensive drugs in hypertensive patients at the Matraman District Health Center. Methods: This study is a quantitative study with an analytical descriptive design and uses a cross-sectional approach. The population in this study were all patients aged 40-73 years who sought treatment at the PTM Poly of the Matraman District Health Center. The sample taken was 96 respondents using purposive sampling technique. Data collection using a questionnaire and then analyzed using the Chi square test. Results: The results of research conducted on 96 respondents obtained on the characteristics of respondents most of the respondents were 52-73 years old, female gender, and secondary education level. The results of the chi square test showed that there was a relationship between knowledge and adherence to taking anti-hypertensive drugs (p-value 0.03) and family support with adherence to taking anti-hypertensive drugs (p-value 0.01). Conclusions: The There is a significant relationship between knowledge and family support with adherence to taking anti-hypertensive drugs in patients with hypertension at the Matraman District Health Center.

Prescription pattern and effectiveness of antihypertensive drugs in patients with aortic dissection who underwent surgery.

Background: Surgical patients with aortic dissection often require multiple antihypertensive drugs to control blood pressure. However, the prescription pattern and effectiveness of antihypertensive drugs for these patients are unclear. We aimed to investigate the prescription pattern and effectiveness of different classes of antihypertensive drugs in surgical patients with aortic dissection. Methods: Newly diagnosed aortic dissection patients who underwent surgery, aged >20years, from 1 January 2012 to 31 December 2017 were identified. Patients with missing data, in-hospital mortality, aortic aneurysms, or congenital connective tissue disorders, such as Marfan syndrome, were excluded. Prescription patterns of antihypertensive drugs were identified from medical records of outpatient visits within 90days after discharge. Antihypertensive drugs were classified into four classes: 1) β-blockers, 2) calcium channel blockers (CCBs), 3) renin-angiotensin system, and 4) other antihypertensive drugs. Patients were classified according to the number of classes of antihypertensive drugs as follows: 1) class 0, no exposure to antihypertensive drugs; 2) class 1, antihypertensive drugs of the same class; 3) class 2, antihypertensive drugs of two classes; 4) class 3, antihypertensive drugs of three classes; or 5) class 4, antihypertensive drugs of four classes. The primary composite outcomes included rehospitalization associated with aortic dissection, death due to aortic dissection, and all-cause mortality. Results: Most patients were prescribed two (28.87%) or three classes (28.01%) of antihypertensive drugs. In class 1, β-blockers were most commonly used (8.79%), followed by CCBs (5.95%). In class 2, β-blockers+CCB (10.66%) and CCB+RAS (5.18%) were the most common drug combinations. In class 3, β-blockers + CCB+RAS (14.84%) was the most prescribed combination. Class 0 had a significantly higher hazard of the composite outcome (HR, 2.1; CI, 1.46-3.02; p < 0.001) and all-cause mortality (HR, 2.34; CI, 1.56-3.51; p < 0.001) than class 1. There were no significant differences in hazards for rehospitalization associated with aortic dissection among classes. Conclusion: Among operated patients with type A aortic dissection, no specific type of antihypertensive drug was associated with a better outcome, whereas among those with type B aortic dissection, the use of β-blockers and CCBs was related to a significantly lower risk of the composite outcome.

Antihypertensive efficacy and safety of azilsartan medoxomil in patients with CАD, obesity and metabolic disorders. According to the CONSTANT study

Background: epidemiological studies show that the most common arterial hypertension (AH) is complicated by coronary artery disease (CAD), such patients are classified as very high risk. Effective BP control in this category of patients is critical. Therefore, assessing the efficacy and safety of current antihypertensive drugs in patients with AH and CAD against obesity or overweight is an important task.Purpose. Evaluation of antihypertensive efficacy and safety of azilsartan medoxomil in patients with overweight or obesity and stable CAD.Materials and methods. 335 patients with stable CAD and overweight or obese enrolled in the international multicenter observational non-interventional prospective study CONSTANT with azilsartan medoxomil according to the approved label. The observation period is 6 months.Results. The dynamics of SBP by visit 4 (6 months) was 30,1±15,3 mmHg, DBP – 12,5±10,4 mmHg (r≤0,001). Overall, 84,5% of patients enrolled in the study achieved BP targets across the group. Response to therapy (reduction in SBP by at least 20 mm Hg, DBP of 10 mm Hg) was obtained in 75,2% of patients. In patients who did not take statins, the level of cholesterol, triglycerides and LDL decreased significantly (p&lt;0,001), the HDL did not change significantly. In patients with diabetes mellitus, a decrease in glycated hemoglobin was recorded (p&lt;0,001). Overall, a decrease in waist circumference was observed across the group (p&lt;0,005).Conclusion. Azilsartan medoxomil has high antihypertensive properties, the ability to influence the metabolic profile and volume of adipose tissue, as well as tolerability comparable to placebo, which makes it the drug of choice in patients with AH with CAD and obesity or overweight in real clinical practice.

Efficacy of single-pill combination in uncontrolled essential hypertension: A systematic review and network meta-analysis.

This study aimed to evaluate the efficacy of single-pill combination (SPC) antihypertensive drugs in patients with uncontrolled essential hypertension. Through Searching Pubmed, EMBASE, the Cochrane Library, and Web of Science collected only randomized controlled trials on the efficacy of single-pill combination antihypertensive drugs in people with uncontrolled essential hypertension. The search period is from the establishment of the database to July 2022. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Assessment, and statistical analyses were performed using Review Manage 5.3 and Stata 15.1 software. This review ultimately included 32 references involving 16 273 patients with uncontrolled essential hypertension. The results of the network meta-analysis showed that a total of 11 single-pill combination antihypertensive drugs were included, namely: Amlodipine/valsartan, Telmisartan/amlodipine, Losartan/HCTZ, Candesartan/HCTZ, Amlodipine/benazepril, Telmisartan/HCTZ, Valsartan/HCTZ, Irbesartan/amlodipine, Amlodipine/losartan, Irbesartan/HCTZ, and Perindopril/amlodipine. According to SUCRA, Irbesartan/amlodipine may rank first in reducing systolic blood pressure (SUCRA: 92.2%); Amlodipine/losartan may rank first in reducing diastolic blood pressure (SUCRA: 95.1%); Telmisartan/amlodipine may rank first in blood pressure control rates (SUCRA: 83.5%); Amlodipine/losartan probably ranks first in diastolic response rate (SUCRA: 84.5%). Based on Ranking Plot of the Network, we can conclude that single-pill combination antihypertensive drugs are superior to monotherapy, and ARB/CCB combination has better advantages than other SPC in terms of systolic blood pressure, diastolic blood pressure, blood pressure control rate, and diastolic response rate. However, due to the small number of some drug studies, the lack of relevant studies has led to not being included in this study, which may impact the results, and readers should interpret the results with caution.

Angiotensin-II stimulating vs. inhibiting antihypertensive drugs and the risk of Alzheimer's disease or related dementia in a large cohort of older patients with colorectal cancer.

Several previous studies showed that patients who received angiotensin II-stimulating antihypertensive medications had a lower incident dementia rate than those angiotensin II-inhibiting antihypertensive users, but no study has been conducted in long-term cancer survivors. To determine the risk of Alzheimer's disease (AD) and related dementia (ADRD) associated with the types of antihypertensive medications in a large cohort of survivors with colorectal cancer in 2007-2015 with follow-up from 2007 to 2016. We identified 58,699 men and women with colorectal cancer aged 65 or older from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 17 SEER areas in 2007-2015 with follow-up to 2016, who were free of any diagnosed ADRD at the baseline (within 12 months prior to and 12 months after the date of diagnosis for colorectal cancer). All patients who were defined as having hypertension by ICD diagnosis code or received antihypertensive drugs during this baseline 2-year period were classified into 6 groups based on whether they received angiotensin-II stimulating or inhibiting antihypertensive drugs. Crude cumulative incidence rates of AD and ADRD were similar between those who received angiotensin II-stimulating antihypertensive medications (4.3% and 21.7%) and those receiving angiotensin II-inhibiting antihypertensive medications (4.2% and 23.5%). As compared to patients who received angiotensin II-stimulating antihypertensive drugs, those who received angiotensin II-inhibiting antihypertensives were significantly more likely to develop AD (adjusted hazard ratio: 1.15, 95% CI: 1.01-1.32), vascular dementias (1.27, 1.06-1.53), and total ADRD (1.21, 1.14-1.28) after adjusting for potential confounders. These results remained similar after adjusting for medication adherence and considering death as a competing risk. The risk of AD and ADRD in patients with hypertension who received angiotensin II-inhibiting antihypertensive medications was higher than in those receiving angiotensin II-stimulating antihypertensive drugs in patients with colorectal cancer.

An Overview of the Use of Antihypertensive Drugs at the Outpatient Pharmacy of Tarakan "X" Hospital in 2022

Hypertension is a global health problem often encountered, and the appropriate use of antihypertensive drugs is very important for optimal blood pressure control. Therefore, it is necessary to research the description of the use of antihypertensive drugs in various health facilities. The purpose of this study was to describe the prescription of antihypertensive drugs in patients at "X" hospital in the outpatient department. The research data obtained were digital data from prescription services from January-December 2022. This study used retrospective data by accessing computer service data at the "X" hospital outpatient pharmacy to track the history of past hypertensive patients’ treatment. The sampling technique used is total sampling. The results showed that the most prescribed antihypertensive drugs were amlodipine, with 13,203 prescription items. Bisoprolol with 10,704 prescription items, and candesartan with 9,885 prescription items. The frequency of prescribing the antihypertensive drug class the most was calcium channel blockers, as much as 13,784 (23.41%), while for the drug class which was the least prescribed, namely alpha-2 agonists, there were 68 drugs (0.12%). Based on the study results, it can be concluded that the most widely prescribed antihypertensive drugs at the outpatient pharmacy at "X" hospital are amlodipine, bisoprolol, and candesartan.

Pharmacoepidemiological analysis of antihypertensive therapy in older age groups with senile asthenia syndrome

To conduct a pharmacoepidemiological study to determine the characteristics of antihypertensive therapy in older patients with senile asthenia syndrome (SSA) and compliance of this therapy with modern clinical recommendations. The study included 146 patients diagnosed with stage I-III hypertension who underwent inpatient treatment in the therapeutic department of the Krasnoyarsk Regional Hospital for War Veterans, the subjects were divided into two groups. The first group included 55 elderly patients (WHO, 2012) with hypertension and SSA. The second group included 35 elderly patients (WHO, 2012) with hypertension and SSA. The comparison group consisted of 56 patients aged 60 to 84 years with hypertension without SSA. Evaluation of the pharmacotherapy was carried out based on extracts from the medical histories of inpatient patients. The most commonly taken groups of antihypertensive drugs in patients of older age groups with hypertension and SSA according to the study are diuretics and β-blockers. Diuretics were taken by 88.6% of elderly patients and 83.6% of senile patients. The main combinations of antihypertensive drugs in patients with hypertension and SSA were: a two-component scheme of combination of an ACE inhibitor and a diuretic, a three-component scheme of combination of an ACE inhibitor, a β-blocker and a diuretic, four-component schemes of combination of an ACE inhibitor, a β-blocker, a calcium channel blocker and a diuretic, as well as a combination of an angiotensin II receptor blocker, a β-blocker, calcium channel blocker and diuretic with combined medications. The prescribed antihypertensive therapy in patients of older age groups with hypertension and SSA in most cases is represented by a combination of several drugs. Many patients take three-component antihypertensive therapy regimens. There were no statistically significant differences between patients of older age groups with hypertension and SSA, as well as patients of older age groups with hypertension without SSA. Therefore, it can be concluded that the presence of senile asthenia syndrome does not affect the tactics of treatment of hypertension and regardless of the presence or presence of SSA, patients receive the same hypotensive therapy, which contradicts existing clinical guidelines.

Effectiveness of antihypertensive agents in stage I/II hypertensive patients with ace (I/D) gene polymorphism

Background: Angiotensin converting enzyme (ACE) is the key enzyme, regulates the blood pressure which is encoded by 21kb gene that consists of 26 exons and is located on chromosome 17, contains a polymorphism in the form of either Insertion (I) or Deletion (D). The aim was to study the effect of antihypertensive drugs in patients of essential hypertension associated with ACE gene polymorphism. Methods: Hypertensive patients were recruited followed by genetic test was done for detecting ACE gene polymorphism, then patients were divided as Group-A &amp; B. Group –A and B patients were treated with atenolol (25mg) and azilsartan (40 mg) for three months respectively. Results: Systolic and diastolic blood pressure was recorded in both the groups before and after commencement of treatment. Among 88 patients of newly diagnosed hypertension, majority of study population belongs to genotype D/D (38.63%) followed by I/D (31.81%) and II (29.54%) genotype. Significant difference was found in systolic blood pressure (p&lt;0.05) of both groups but not diastolic blood pressure (p&gt;0.05). Conclusion: The rate of control of blood pressure was high in I/I genotype followed by D/D genotype irrespective of treatment group. Overall better prognosis was observed with azilsartan 40mg compared to atenolol 25mg treatment in patients with ACE gene polymorphisms.

PS-C27-3: MEASURING ANTIHYPERTENSIVE DRUG CONCENTRATIONS TO DETERMINE NON-ADHERENCE IN HYPERTENSIVE PATIENTS WITH AND WITHOUT KIDNEY TRANSPLANTATION

Introduction: Non-adherence to antihypertensive drugs (AHDs) is one of the main causes of resistant hypertension which is defined as uncontrolled blood pressure despite the prescription of at least 3 AHDs. Objectives: Our primary objective was to determine the prevalence of non-adherence to AHDs in patients visiting the nephrology and vascular outpatient clinics. Inclusion rates at both departments allowed comparison between non-adherence of kidney transplantation (KT) patients with patients without KT as secondary objective. Design and method: This was a prospective observational study called RHYME-AD (Resistant Hypertension: MEasure Antihypertensive Drugs, MEC-2020–0096). Patients were eligible if they used at least 2 AHDs that could be measured with a validated UPLC-MS/MS method and had an office blood pressure &gt; 140 and/or 90 mmHg. After informed consent was signed, rest material was collected from a regular venipuncture measurement. The total absence of drug in blood (&lt;lower limit of detection) was defined as non-adherent. We made comparisons between patients with and without KT and with and without resistant hypertension, defined as an office blood pressure &gt; 140 and/or 90 mmHg despite the use of 3 or more AHDs. Results: Material was available from 143 patients of which 93 had a KT and 66 patients fulfilled the definition of resistant hypertension. The overall adherence rate was 78.3%. From the non-adherent patients 87.8% was partially non-adherent and 12.2% non-adherent for all prescribed AHDs. When looking at the two separate groups, with and without KT, more patients in the non-KT cohort fulfilled the definition of resistant hypertension as compared to the KT-cohort (62.0% vs 37.6%, p = 0.005). There was a significant difference between having resistant hypertension and being non-adherent (non-adherence RH vs non-RH, 31.8% vs 13.0%, p = 0.023) and having KT and being non-adherent (non-adherence KT vs non-KT, 14.0% vs 36.0%, p = 0.005). In addition, patients with KT and no resistant hypertension were the most adherent to AHDs (91.2%). Conclusions: Hypertensive patients with a KT are less likely to be non-adherent to their AHDs as compared to hypertensive patients without a KT. However, patients fulfilling the definition of having resistant have a higher risk of being non-adherent to AHDs.

The role of antihypertensive drugs in patients with preeclampsia and how to prevent it

HIGHLIGHTS 1. Preeclampsia, or hypertension in pregnancy, remains a serious problem that has negative short and long-term consequences for the mother and the baby.2. The use of antihypertensive medications has its own precautions as it they may harm the fetus.3. Prophylactic measures with minimal or moderate impact may be beneficial for mothers with hypertension in pregnancy. ABSTRACT Treatment of hypertension in pregnancy, such as preeclampsia (PE), is still a difficult issue with negative short and long-term consequences for both the mother and the baby. Screening for preeclampsia at 11-13 weeks' gestation using a combination of maternal demographic characteristics and medical history with biomarker measurements can identify approximately 75% of women who develop premature preeclampsia with delivery at 37 weeks gestation and 90% of those with early preeclampsia. Preeclampsia has a 10% positive screen rate at 32 weeks. Another important worry on the use of antihypertensive medications during pregnancy is the potential harm to the fetus. Methyldopa, hydralazine, labetalol, and nifedipine are some common antihypertensive medications. Aspirin use is frequently related to a decrease in the prevention of early preeclampsia, but it must be accompanied by medication adherence. Aspirin can be coupled with heparin. Recent investigations on the use of furosemide and nifedipine in preeclampsia have also revealed a new combination.

DRUG USAGE PATTERN OF ANTIHYPERTENSIVES IN DIABETIC PATIENTS – A CROSS-SECTIONAL OPD-BASED STUDY IN A TERTIARY CARE SET-UP

Objective: The objective of this study was to observe the pattern of utilization of different groups of antihypertensive drugs in patients with diabetes in a tertiary care hospital and correlate the data obtained from the study. Methods: It was an institution-based cross-sectional study; the present study was carried out at M.G.M. Medical College and L.S.K. Hospital in Kishanganj, Bihar, in the Department of Pharmacology. This study included 520 diabetes mellitus patients with hypertensive disorders who presented to the Department of Medicine at M.G.M. Medical College and L.S.K. Hospital, Kishanganj, during the study period (June 2021–May 2022). Results: When we appeared at the prescribing patterns of antidiabetic drugs, we found that metformin was the most common (80%), followed by sulfonylureas (65%), DDP4 inhibitors (56.7%), and alpha-glucosidase inhibitors (5%). An evaluation of the pattern of hypertensive drugs prescribed to study subjects revealed that monotherapy was the preferred option (77.1%) over combination therapy (22.9%). Telmisartan (32.4%) is the most common drug used in monotherapy among the study subjects included in the present study, followed by Amlodipine (27.4%) and Metoprolol (14.5%), Bisoprolol (14.5%), and Clinidipine (11.2%), respectively. Conclusion: The evaluation of all medications prescribed was reasonable and in compliance with JNC-8 treatment guidelines. Further, research is needed to qualify the rationale for drug choice based on demographics, economic status, comorbidities, and complications to provide additional insight into antihypertensive drug prescribing patterns in people with diabetes so the results can be translated for broader and more real benefits can become a medical community.

KEPATUHAN PENGAMBILAN ULANG OBAT ANTI HIPERTENSI PASIEN HIPERTENSI RUJUK BALIK DI APOTEK APPO FARMA BANJARMASIN

Complications of hypertension in the body's organs cause a high mortality rate. Hypertension requires long-term drug therapy so that patients must adhere to treatment. One type of adherence in the treatment of hypertension is adherence to taking drugs from health care facilities so that patients always have the availability of drugs to drink. The purpose of this study was to examine the adherence to taking antihypertensive drugs in patients with hypertension who were referred back at the Appo Farma Pharmacy Banjarmasin. The study used an observational design. Data collection was carried out retrospectively. Data were collected from patient prescriptions for referrals at the Appo Farma Pharmacy Banjarmasin in the period May-June 2022. A total of 123 samples were used in this study. The sampling method used simple random sampling technique. Data on adherence to drug taking was analyzed using the Medication Possession Ratio (MPR) method. The parameters of the MPR calculation results are divided into compliant categories if 80% and non-compliant if less than 80%. The research data is displayed descriptively. The results showed that the measurement of adherence to repeated drug taking with a period of 3 months and 6 months were both dominated by samples with the category of adherence to taking medication again with a total of 103 samples (83.74%). Based on these data, it can be concluded that the samples of hypertensive patients in this study were not all adherence in taking their antihypertensive drugs.

Hubungan Pengetahuan Terhadap Tingkat Kepatuhan Minum Obat Anti Hipertensi

Hypertension is a condition where an increase in systolic or diastolic blood pressure ≥ 140/90 mmHg. Success of hypertension therapy is influenced by several factors, one of which is compliance with taking hypertension medication. Adherence to take medication is very important to improve the effectiveness of treatment and prevent complications. Poor adherence to drug consumption is the most frequent cause of failure of antihypertensive therapy. Compliance can be used as a parameter of a patient's level of knowledge in carrying out instructions from medical personnel. The purpose of this study was to determine the relationship of knowledge of adherence to taking antihypertensive drugs for patients in the work area of the Lebong District Health Center in 2019. The research method used in this study is analytical research using a cross-sectional design which is a research plan of a study to study the dynamics of the correlation between the independent variable (knowledge) with the effect or dependent variable (the level of compliance taking antihypertensive medication) which is observed or collected data at once at the same time. From this study obtained the Odds Ratio (OR) = 3,781 (95% CI: 1,503-9,513) which means someone with less knowledge has a risk of 1.503 times for not compliant to take anti-hypertensive drugs than someone who has good knowledge. There is a significant relationship between knowledge with the level of adherence to take antihypertensive medication in the working area of the Lebong District Health Center.

THE EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY IN COMORBID PATIENTS

Objective: An analysis of antihypertensive drugs in patients with comorbidities, namely, arterial hypertension (AH), type 2 diabetes mellitus, obesity, indicates that the complex treatment of these patients should include drugs that inhibit excessive activation of the renin-angiotensin-aldosterone system, in particular, angiotensin converting enzyme (ACE) and angiotensin II receptor blocker (ARB II). Numerous scientific data have established that angiotensin II is the main effector mediator of the RAAS, and ACE inhibitors do not fully inhibit the synthesis of angiotensin II. ARB II, their advantages over ACE inhibitors should be emphasized by their ability to reduce the effects of angiotensin II, regardless of the ways of its formation, aim of this study was to compare the results of treatment of patients with comorbidities Design and method: 56 patients of middle age (64.4 ± 1.1) years old, men/women—43%/57% were examined and treated. Arterial hypertension was diagnosed, according to the recommendations of the International Society of Hypertension (ISH), 2020. The type 2 diabetes mellitus, obesity were diagnosed on the basis of clinical, instrumental, biochemical criteria, in accordance with the recommendations of WHO experts, the European Society of Endocrinologists. Results: After treatment for three months, there was a significant decrease in systolic blood pressure (SBP) (by 19.6%), diastolic blood pressure (DBP) (by 15%), and heart rate (HR) (by 9%). From the side of echocardiographic characteristics, the following levels have decreased: EDV—by 25.5%, ESV—by 17.3%, EDD—by 24.0%, ESD—by 12.6%, LVMM—by 8.3%; LVEF has increased by 6% compared with the indicated indicators before treatment. There were no significant differences between such indicators as fasting blood glucose, HbA1c, insulin, TChC, TG, HDL cholesterol, AI; however, a significant decrease was found after treatment in the levels of VLDL cholesterol and BMI. Conclusions: Treatment of arterial hypertension in patients with type 2 diabetes mellitus and obesity with the inclusion of ramipril or telmisartan in the standard therapy had a positive effect on the structural and functional parameters of the left ventricle and ejection fraction. At the same time, the neutral effect of these drugs on carbohydrate metabolism in the examined category of patients has been determined.

Effect of continuing versus stopping pre-stroke antihypertensive agents within 12h on outcome after stroke: A subgroup analysis of the efficacy of nitric oxide in stroke (ENOS) trial.

SummaryBackgroundIt is not known whether to continue or temporarily stop existing antihypertensive drugs in patients with acute stroke.MethodsWe performed a prospective subgroup analysis of patients enrolled into the Efficacy of Nitric Oxide in Stroke (ENOS) trial who were randomised to continue vs stop prior antihypertensive therapy within 12 h of stroke onset. The primary outcome was functional outcome, assessed with the modified Rankin Scale at 90 days by observers blinded to treatment assignment, and analysed with ordinal logistic regression.FindingsOf 4011 patients recruited into ENOS from 2001 to 2014, 2097 patients were randomised to continue vs stop prior antihypertensive treatment, and 384 (18.3%, continue 185, stop 199) were enrolled within 12 h of ictus: mean (SD) age 71.8 (11.8) years, female 193 (50.3%), ischaemic stroke 342 (89.1%) and total anterior circulation syndrome 114 (29.7%). As compared with stopping, continuing treatment within 12 h of onset lowered blood pressure by 15.5/9.6 mmHg (p<0.001/<0.001) by 7 days, shifted the modified Rankin Scale to a worse outcome by day 90, adjusted common odds ratio (OR) 1.46 (95% CI 1.01–2.11), and was associated with an increased death rate by day 90 (hazard ratio 2.17, 95% CI 1.24–3.79). Other outcomes (disability - Barthel Index, quality of life - EQ-visual analogue scale, cognition - telephone mini-mental state examination, and mood - Zung depression scale) were also worse with continuing treatment.InterpretationIn this pre-specified subgroup analysis of the large ENOS trial, continuing prior antihypertensive therapy within 12 h of stroke onset in a predominantly ischaemic stroke population was unsafe with worse functional outcome, disability, cognition, mood, quality of life and increased death. Future studies assessing continuing or stopping prior antihypertensives in the context of thrombectomy are awaited.

The benefits of antihypertensive drugs in patients with high blood pressure and glaucoma

Systemic hypertension, atherosclerosis and vasospasm have been recognized as potential factors that are capable of increasing the risk of glaucoma. Several other factors may contribute to the development and progression of the disease, including systemic drugs used to treat other pathologies. Numerous studies have examined the effect of antihypertensive medication on glaucoma, due to their property of modifying vascular events. Effective hypotensive drugs that lower blood pressure reduce the complications of high blood pressure, including changes in intraocular pressure (IOP). It has been shown that the most significant decrease in IOP was registered in patients taking calcium channel blockers, beta-adrenoblockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers and diuretics. The renin-angiotensin system plays a critical role in the pathophysiology of various ocular diseases by causing inflammation, oxidative stress and angiogenesis. All components are currently present in eye structures and play an important role in ocular pathology: diabetic retinopathy, age-related macular degeneration, glaucoma, retinitis pigmentosa. The use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers reduces the formation of aqueous humor, increases uveoscleral flow, reduces intraocular pressure and has a protective effect by reducing the inflammatory process, oxidative stress and angiogenesis.

APPROPRIATE USE OF ORAL ANTIHYPERTENSIVE DRUGS EVALUATION IN NONDIALYSIS CHRONIC KIDNEY DISEASE PATIENT OF PRIVATE HOSPITAL IN EAST BEKASI 2018-2020

Introduction: Chronic Kidney Disease (CKD) is currently one of the most common diseases and being a concern in the world, including in Indonesia. The number of patients with CKD tends to increase year by year. Hypertension is a cause and effect of CKD and contributes to its development. This study aimed to evaluate the appropriateness use of oral antihypertensive drugs in patients with chronic kidney disease of private hospital in East Bekasi for the 2018-2020 period.&#x0D; Method: The method used in this study was observational data taken retrospectively from the medical records of non- dialysis chronic kidney disease patients. The study population were all patients diagnosed with non-dialysis chronic kidney disease at the inpatient installation of private hospital in East Bekasi. The sample was taken by consecutive sampling method where the sample was determined based on the inclusion criteria of 50 patients.&#x0D; Results: Evaluation of drug use in this study included right patient, right indication, right medication and right dose. The following results were obtained: right patient was 100%, right indication was 98%, right medication was 86% and right dose was 94.84%.&#x0D; Conclusion It can be concluded that evaluation of oral antihypertensive drugs usage in patients with chronic kidney disease need to be done so that the contribution of hypertension to CKD development decreases.