Antihypertensive Drugs In Hypertensive Patients Research Articles

Single nucleotide polymorphism (SNP) rs4291 of the angiotensin-converting enzyme (ACE) gene is associated with the response to losartan treatment in hypertensive patients.

Arterial hypertension is characterized by systolic pressure ≥ 140 mmHg and/or diastolic pressure ≥ 90 mmHg and its treatment consists of the use of antihypertensive drugs, as losartan and hydrochlorothiazide. Blood pressure is regulated by angiotensin-converting enzyme (ACE) and polymorphisms in the ACE gene are associated to a greater predisposition to hypertension and response to treatment. The aim of this study was to evaluate the association of genetic polymorphisms of ACE rs4363, rs4291 and rs4335 and the response to antihypertensive drugs in hypertensive patients from Ouro Preto/MG, Brazil. A case-control study was carried out with 87 hypertensive patients being treated with losartan and 75 with hydrochlorothiazide, who answered a questionnaire and had blood samples collected. Biochemical analyzes were performed on serum using UV/Vis spectrophotometry and identification of ACE variants rs4363, rs4291 and rs4335 was performed by real-time PCR using the TaqMan® system. Univariate logistic regression test was performed to compare categorical data in STATA 13.0 software. The results showed that there was an influence of ACE polymorphisms on the response to losartan, demonstrating that AT or TT genotypes of rs4291 were more frequent in the group of controlled AH (54.9%), indicating that these individuals are 2.8 times more likely to of being controlled AH (95% CI 1.12-6.80, p. =0.026) compared to those with AA genotype. In contrast, no influence of ACE polymorphisms on the response to hydrochlorothiazide was observed. In conclusion, the presence of the T allele of the rs4291 variant was associated to controled blood pressure when losartan was used as an antihypertensive agent. These results show the importance of pharmacogenetic studies to detect genetic characteristics, enabling therapeutic individuality and reducing costs for the healthcare system.

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.

Profile of Antihypertensive Drugs in Hypertensive Patients with Chronic Kidney Disease

Profile of Antihypertensive Drugs in Hypertensive Patients with Chronic Kidney Disease

Study of the Cost Effectiveness of Therapy in Hypertention Patients in Hospital

Hypertension is where the blood pressure is > 140 mmHg and > 90 mmHg. Combination therapy is needed if a single antihypertensive has not been able to control the desired blood pressure target while the cost of treatment is increasing from time to time. The purpose of this study was to determine the cost-effective combination therapy for antihypertensive drugs in hypertensive patients in an inpatient setting. This study is a descriptive study with a pharmacoeconomic analysis approach using the Cost Effectiveness Analysis (CEA) method which was carried out retrospectively. Data were collected using the Total Sampling technique with 93 patients which were then analyzed to determine the cost-effective therapy based on ACER and ICER. The results showed that hypertension was mostly experienced by patients aged 50-60 years, male sex was more than female. HT stage 2 is often experienced by patients. Type II DM is the most common comorbidity. The lowest ACER value is Rp. 65.195.77. The lowest ICER value is Rp. 7.047.2551 when compared with standard therapy, namely CCB + ACEI. The combinations used in the inpatient unit include two combinations of 42 patients (45.16%) three combinations of 37 patients (39.78%), four combinations 6 (6.45%) five combinations of 8 patients (8.6%). The lowest average direct medical cost is the combination of ACEI antihypertensive + Diuretic + -Blocker Rp. 2.765.262. The cost effective therapy based on ACER and ICER values is a combination of Diuretics + CCB + ACEI + Blockers with an ACER value of Rp. 65,195.77 and also dominant.            Â

EVALUASI RASIONALITAS PENGGUNAAN OBAT ANTIHIPERTENSI TERHADAP PASIEN HIPERTENSI DI RSUD KARAWANG

Hypertension is a disease characterized by an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg on two measurements, with an interval of five minutes in a state of sufficient rest/calm. This study aims to determine the relationship between hypertension and the patient's gender and age on the incidence of hypertension and the rationality of using antihypertensive drugs in hypertensive patients at the Karawang Hospital Outpatient Installation in 2019. This research is an observational study with a cross-sectional descriptive analysis design. Data collection was carried out retrospectively using secondary data from medical records taken from Karawang Hospital in 2019 at Karawang Hospital. Next, calculate the use of antihypertensive drugs and evaluate the rationale for using antihypertensive drugs in hypertensive patients based on the right patient, right indication, right drug, and the right dose. Data were obtained for 60 patients compared to Dipiro and JNC VIII guidelines. The results showed that the most widely used antihypertensive drugs were amlodipine 15% and a combination of 2 drugs (amlodipine and candesartan) 85%. Evaluation of the rationality of using hypertension drugs in hypertensive patients as follows: right drug 91.7%, right indication 100%, right patient 100%, right dose 91.7% and there is no relationship between gender and age of the patient to the incidence of hypertension in Karawang Hospital.

Patterns of Use of Antihypertensive Drugs in Hypertensive Patients in the Outpatient Unit of the Kowel Health Center, Pamekasan Regency

Penggunaan obat yang tidak tepat akan memberikan dampak negatif yang besar dan merugikan bagi unit atau instansi pelayanan kesehatan pasien maupun masyarakat. Oleh karena itu diperlukan pemilihan dan penggunaan obat secara tepat, sehingga intervensi obat dapat mencapai sasarannya (penyembuhan penderita) dengan efek samping obat seminimal mungkin. Penelitian Ini bertujuan Untuk mengetahui pola penggunaan obat anti hipertensi pada pasien dengan hipertensi di unit rawat jalan Puskesmas Kowel Kabupaten Pamekasan. Sampel diambil dari data rekam medik pasien hipertensi dari periode Januari-Mei 2022 dengan total sampel 75 pasien. Variabel penelitian antara lain, jenis obat, dosis, frekuensi, lama pemakaian,efek samping, interaksi obat, dan rutinitas kontrol pasien. Obat dosis tunggal paling banyak digunakan adalah golongan antagonis kalsium yaitu amlodipin sebanyak 46 pasien (61,33%). Dan Dosis kombinasi paling banyak terdapat pada Antagonis kalsium + Ace Inhibitor yaitu amlodipin dan captopril sebanyak 3 pasien (4%).
 

Prescribing Pattern of Antihypertensive Drugs in Hypertensive Patients with Non-Insulin Dependent Diabetes Mellitus at Tertiary Care Hospitals in Karachi Pakistan

Introduction: Hypertension (HTN) is one of the most serious public health issues in the world, affecting around 1.4 billion people worldwide. HTN is becoming highly prevalent in Pakistan, about more than 33% of people over the age of 40 years suffering from the HTN. The illness burden is continuously growing due to the incorrect medicine prescriptions, a lack of education, and a lack of patient compliance. The existence of comorbidities such as Diabetes Mellitus (DM) should be properly considered while choosing an Antihypertensive medication. Similarly, the prescriptions of Oral Hypoglycemic agent’s appropriate consideration are essential. Oral hypoglycemic medications are divided into several categories. Physicians face a challenge in rationally selecting a regimen from a variety of classes, and the situation becomes more complicated when the patients have additional non-communicable illnesses, such as HTN. The combination therapy of ailments not only effects the patient`s economic status but also effects the quality of life.
 Objective: To study the prescribing pattern of Antihypertensive drugs in Hypertensive patients with Type 2 Diabetes Mellitus at Tertiary care hospitals in Karachi, Pakistan.
 Methods: A cross sectional study was undertaken for six months in medicine outpatient department at tertiary care hospitals of Karachi. The study population was observed for the prescribed pattern of Antihypertensive medicines by assessing the 300 prescriptions of Hypertensive patients with Type 2 Diabetes Mellitus. Statistical analysis was performed using SPSS version 20. Data was presented as frequencies and percentages.
 Results: The result revealed that the most commonly prescribed single antihypertensive drug was Enalapril 66 (22%) followed by Amlodipine 63(21%), Ramipril 57(19%), Diltiazem 33(11%), Lisinopril 21(7%) losartan k 6(2%), Nebivolol 6(2%), Bisoprolol 3(1%). Dual therapy included Ramipril and Nebivolol 1(0.33%) and Amlodipine+Valsartan 35 (11.67%), Amlodipine+Valsartan+HCTZ 9 (3%) were the antihypertensive drugs prescribed as fixed dose combinations.
 Conclusion: The present study shows Enalapril belonging to Angiotensin Converting Enzyme Inhibitor (ACEI) class was frequently used as single Antihypertensive agent and Amlodipine+Valsartan belonging Calcium Channel Blockers (CCBs) and Angiotensin Receptor Blockers (ARBs) was the most frequently prescribed fixed dose combination while managing Hypertension of Hypertensive patients with Type 2 Diabetes Mellitus.

Effect of Home Based Yoga on Blood Pressure and Quality of Life in Patients with Hypertension

Background and Aim: Hypertension is one of the major growing global problems. Management of hypertension by medicine, diet and exercise is not enough and alternative therapy is need of time. Yoga is one such substitute healthcare practice assumed to improve blood pressure control and quality of life in hypertensive. A prospective intervention was designed to check the effect of home based yoga exercise on blood pressure and quality of life in hypertensives. Methods: A total 74 hypertensive participants were recruited for the present study after following inclusion and exclusion criteria. Participants were divided into two groups, study group (n=39) who have done home based yoga and control group (n=35) who have not done home based yoga. Detailed methodology of home based yoga; their advantage and disadvantage were explained to the study group very well. Study group have done their home based yoga for three months and control group did not have done the home based yoga. Cardiovascular parameters like systolic blood pressure, diastolic blood pressure and pulse rate were recorded after following all standard precautions at the time of initiation of study and at end of every month till completion of study. Participants were also assessed for their quality of life, health and other areas of life by World Health Organization Quality of Life questionnaire at the time of beginning of the study and at every month till completion of study. Results: Significant decrease in systolic blood pressure from 130.60 ± 4.06 to 124.20 ± 0.60 mm of Hg and diastolic blood pressure from 85.62 ± 5.55 to 79.21 ± 0.73 mm of Hg were seen in study group. In control group, blood pressure reduction was not seen. Self rated score of quality of life was improved in study group as compared to control group. Conclusion: A short term home-based yoga program in hypertensive patients have shown to reduce blood pressure as well as positive effect on self-rated quality of life compared to controls. A simple 12-weeks duration home based yoga exercise program may be useful as supplementary therapy in addition to antihypertensive drugs in hypertensive patients.

O papel dos inibidores da enzima conversora de angiotensina e dos antagonistas dos receptores de angiotensina em pacientes com Covid-19: uma revisão narrativa

O objetivo deste trabalho é reunir e discutir os principais achados científicos, opiniões de especialistas e considerações de comunidades médicas a respeito da continuação do tratamento de pacientes hipertensos diagnosticados com Covid-19 em uso de anti-hipertensivos. Trata-se de uma revisão narrativa de literatura, restringida a publicações até abril de 2020, utilizando as bases de dados Medline e Embase e consulta a quatro sociedades científicas de Cardiologia. Um total de 93 publicações foram encontradas nas bases de dados consultadas, e, destas, nove publicações foram elegíveis para análise, sendo que seis publicações se mostraram favoráveis à continuação do tratamento com inibidores da enzima conversora de angiotensina e antagonistas dos receptores de angiotensina, o que foi ao encontro das recomendações das sociedades de Cardiologia; outras três publicações sugeriram que essas classes de anti-hipertensivos podem aumentar a gravidade da infecção. A continuação do tratamento com anti-hipertensivos durante a pandemia de coronavírus ou após o diagnóstico da infecção apresenta um paradoxo entre o potencial aumento da patogenicidade viral e a proteção pulmonar conferida pelo equilíbrio do sistema renina-angiotensina.

Relationship between 25(OH) vitamin D and the number of antihypertensive drugs in hypertensive patients in the area of Blida (Algeria)

The purpose of the study was to evaluate the relationship between 25(OH) vitamin D and the number of antihypertensive drugs (AHTs) used in hypertensive patients. A total of 1145 patients were enrolled in the study between January 2017 and June 2018 in specialized consultation at the department of internal medicine at the Blida university hospital (65.8% female, 34.2% male, age: 52 ± 13 years old). The initial serum 25 (OH) vitamin D level was determined by the enzyme immunoassay for all patients. Antihypertensive therapy was supplemented with 200000 IU/month cholecalciferol for all the patients. A follow-up visit was performed 12 months later. In total, 22.4% of patients received 1 antihypertensive drug, 47.7% of patients 2 drugs, 19.7% of patients 3 drugs, 8.8% of patients 4 drugs, and 1.4% were treated with 5 antihypertensive drugs. The mean number of antihypertensive drugs was 2.5. Glomerular filtration measured by CKD-EPI was 49.3 ± 7.2 ml/min. The mean level of baseline plasma vitamin D was 10.6 ± 5.4 ng/ml. One year later, the mean plasma level of vitamin D increased to 28.3 ± 10.8. Sixty seven percent of the patients were still under vitamin D supplementation at follow-up whereas 32.8% had stopped the treatment. In the former, plasma vitamin D increased to 29.0 ng/ml versus 15.3 ng/ml in the latter group. There was a significant relationship between the 25(OH) vitamin D plasma level and blood pressure ( P = 0.05) and the number of antihypertensive drugs used ( P = 0.013). The difference between those patients who kept the treatment and those who stopped was highly significant ( P < 0.05). The action of diuretics on BP is more synergistic in combination with vitamin D (95.5% vs. 76.4% without vitamin D), followed respectively by calcium channel blockers (67.8% vs. 57.4%), beta-blockers (66.2% vs. 46.5%), converting enzyme inhibitors (50.3% vs. 34.4%) and finally angiotensin II receptor blockers (45.1% vs. 36.2%). The number of antihypertensive drugs have a less significant effect on PA in compared to groups with vitamin D ( P < 0.001). Supplementation with vitamin D improved the control of BP in our studied population. It seems desirable to encourage the prescription of a dual therapy containing a diuretic in hypertensive patients with supplementation in vitamin D. Further studies are necessary to better explore the plasma level of vitamin D and the efficiency of different classes of antihypertensive treatment.

A Prospective Study of Prescription Patterns of Antihypertensive Drugs in Hypertensive Patients at a Tertiary Care Hospital

A Prospective Study of Prescription Patterns of Antihypertensive Drugs in Hypertensive Patients at a Tertiary Care Hospital

Analysis of antihypertensive treatment using real-world Japanese data\u2014the retrospective study of antihypertensives for lowering blood pressure (REAL) study

Hypertension requires strict treatment because it causes diseases that can lead to death. Although various classes of antihypertensive drugs are available, the actual status of antihypertensive drug selection and the transition in prescription patterns over time have not been fully examined. Therefore, we conducted a claims-based study using two claims databases (2008–16) to determine this status in Japan. We examined the prescription rate for each class of antihypertensive drugs in hypertensive patients and compared the patients’ ages and the sizes of the medical institutions treating these patients. Among the 1 560 865 and 302 433 hypertensive patients in each database, calcium channel blockers (CCBs) (>60%) and angiotensin II receptor blockers (ARBs) (>55%) were the most frequently prescribed classes. The prescription rate of CCBs increased and ARBs decreased with the patients’ ages. Although the Japanese guidelines for management of hypertension in 2014 changed the recommendation and indicated that β-blockers should not be used as first-line drugs, their prescription status did not change during this study period up to 2016. Use of CCBs and ARBs as first-line drugs differed by the types of patient comorbidities. Although ARBs or angiotensin-converting enzyme inhibitors were recommended for patients with some comorbidities, CCBs were used relatively frequently. In conclusion, the patients’ ages and comorbidities and the sizes of the medical institutions affect the selection of antihypertensive drugs. Selection and use of drugs may not always follow the guidelines.

PRESCRIPTION PATTERN OF ANTI-HYPERTENSIVE DRUGS IN A TERTIARY CARE HOSPITAL IN KERALA AND ADHERENCE TO JNC-8 GUIDELINES

Objective: Hypertension is a leading contributor to the global burden of cardiovascular morbidity and mortality. Worldwide prevalence is continuing to increase. Treatment for hypertension is constantly evolving and many new drugs are added at rapid pace. The objective of this study is to investigate utilization pattern of antihypertensive drugs in hypertensive patients in Azeezia institute of Medical Sciences and Research and to find its adherence to JNC-8 guidelines for management of hypertension. Methods: Descriptive drug utilization study was conducted on 266 hypertensive patients for period of 3 months. Data retrieved from patient's medical record. The study included all hypertensive patients with or without co-morbidities and above 18 yrs who attended out-patient department. Following classes of antihypertensive drugs were analyzed: Angiotensin Converting Enzyme Inhibitors (ACEI), Angiotensin Receptor blockers (ARB), beta blockers, calcium channel blockers, diuretics. ACEI/ARB was mostly prescribed which is in adherence to JNC-8 guidelines which recommends the use of ACEI/ARB as the first choice of drug. Results: Hypertension is more prevalent in males than in females. ACEI/ARB are the most frequently prescribed classes of drugs alone or in combination, supporting the medication adherence to JNC-8 guidelines. Conclusion: The study concludes that the hypertension is more prevalent in males than in females, with its prevalence increasing with age. Peer Review History: Received 27 March 2018; Revised 20 June; Accepted 8 July, Available online 15 July 2018 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6/10 Average Peer review marks at publication stage: 8.5/10 Reviewer(s) detail: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. Heba-Tallah Ahmed Mohamed Moustafa, Heliopolis University Cairo, Egypt, anasweety2003@yahoo.com Similar Articles: CURRENT TREND OF RESISTANT FOR THE COMMONLY PRESCRIBED NEW FLUOROQUINOLONES AMONG HOSPITALISED PATIENTS IN SANA'A, YEMEN

A study of prescribing pattern of antihypertensive drugs in hypertensive patients with co morbid diabetes in a tertiary care teaching hospital

Background: Hypertension and diabetes mellitus are among the commonest non-communicable diseases. Co-existence of hypertension and diabetes increases morbidity and mortality. So co-existence of these diseases requires attention and rational management. Studying current prescribing pattern of drugs provide data for recommendations and decisions regarding rational practice. We undertook this study to study prescribing pattern.Methods: It was cross sectional, observational, descriptive study in outdoor patients suffering from hypertension and type 2 diabetes mellitus for duration of one year. Data of 601 patients were analyzed using descriptive statistics to determine prescribing pattern of drugs.Results: In this study, 71.55% patients were above 50 years age. Female patients were 56.57%. Average duration of hypertension was 4.08 years. Commonly prescribed antihypertensive drug groups were angiotensin converting enzyme (ACE) inhibitors (85.36%) followed by β receptor blockers (33.44%) and calcium channel blockers (29.95%). Enalapril (85.36%) followed by amlodipine (29.95%) and atenolol (21.46%) were commonly prescribed antihypertensive drugs. Single antihypertensive drug was prescribed in 292 (48.59%) prescriptions. The most common monotherapy drug was enalapril (82.19%). Two antihypertensive drugs were prescribed in 231 (38.43%) prescriptions. The most common two drug combination was ACE inhibitors + β receptor blockers (40.69%). Four antihypertensive drugs were prescribed in only 1.50% prescriptions.Conclusions: From this study, the results suggest that the prescribing pattern of antihypertensive drugs reflects recommendations of current guidelines and practices. However, β receptor blockers were prescribed more commonly. There is room for improvement in choice of drugs.

Meta-analysis of the effectiveness of traditional Chinese herbal formula Zhen Wu Decoction for the treatment of hypertension

ObjectivesZhen Wu Decoction (ZWD), a famous classic herbal formula documented in traditional Chinese medicine (TCM), is widely available in China for treating hypertensive patients with kidney yang deficiency and fluid...

Prescription Pattern of Anti-Hypertensive Drugs in Adherence to JNC- 7 Guidelines

The main objective of the present study to investigate the utilization pattern of antihypertensive drugs in hypertensive patients and to find out whether the prescription pattern is in adherence with the JNC7 guidelines for the management of hypertension. A prospective study was conducted and drug utilization data were collected from 137 hypertensive patients who were attended as Out Patient Department (OPD) of Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India. The data was retrieved from patient’s medical records as well as from the interview of patients and their legally acceptable representatives. The following classes of antihypertensive drugs were analyzed; Angiotensin Converting Enzyme Inhibitors (ACEI), Angiotensin Receptor Blockers (ARBs), Beta Blockers (BBs), Calcium Channel Blockers (CCBs) and Diuretics. The inclusion criteria for the recruitment of study subjects were the patients suffering from hypertension with or without other co-morbid conditions. The analysis of the prescription frequency, proportion of the different antihypertensive classes of drugs as monotherapy as well as combination therapy was done. The most frequently prescribed classes of antihypertensive medications were Diuretics (mainly thiazides followed by Loop category) followed by CCBs, BBs, ACEIs and ARBs. Antihypertensive drug combination therapy was given to 72.26% of the total population while monotherapy was received by 27.73% of the total hypertensive population, representing more utilization of combination therapy as compared to monotherapy. The prescription pattern of these classes of drugs was found to be considerately in adherence to JNC7 guidelines for the management of hypertension. It was evident from the study that hypertension is more pronounced in males with increasing age as compared to females. The diuretics were the first choice alone or in combination and pattern of prescription was adhered to JNC-7 Guidelines.

Value of haemodynamic profiling to the response of antihypertensive therapy

BackgroundEssential hypertension is characterised by alterations in haemodynamics. Hence haemodynamic profiling could lead to improved blood pressure (BP) control in these patients. We tested if baseline haemodynamic indices predict the BP lowering effects of different classes of antihypertensive drugs in hypertensive patients. MethodsIn this double-blind placebo-controlled crossover study we randomised 53 hypertensive patients to receive doxazosin 4 mg, candesartan 16 mg, bisoprolol 5 mg, isosorbide mononitrate (ISMN) 50 mg, and placebo daily for 6 weeks. Brachial and central BP, augmentation index (AIx), aortic pulse wave velocity (aPWV), stroke volume (SV), cardiac output (CO), peripheral vascular resistance (PVR), and pulse pressure amplification (PPA) were measured at baseline and after each drug. ResultsBaseline AIx and PPA determined BP reduction with antihypertensive therapy, particularly with bisoprolol. In patients with low baseline AIx (1.7–28.9%) and high PPA (1.22–1.87), bisoprolol had a weak antihypertensive effect, while the opposite was observed in patients with high AIx (36.3–48.2%) and low PPA (1.05–1.11). With candesartan, BP reduction was the largest, regardless of baseline AIx or PPA levels. ConclusionsOur study suggests that ARBs reduce BP the most irrespective of the underlying haemodynamic profile. Antihypertensive therapy guided by AIx and PPA may have some merit in the guidance of antihypertensive drug treatment, particularly if beta-blockers are considered for treatment. However, larger studies are needed to confirm these results.Clinical Trials Registry number: EudraCT 2006-006981-40.

Anti hypertensive prescribing patterns and cost analysis for primary hypertension: a retrospective study.

The present study was conducted to analyze the current prescription pattern and cost analysis of antihypertensive drugs in hypertensive patients in a tertiary care hospital. A retrospective cross-sectional study was conducted in tertiary care hospital, Bangalore for three months and utilized 300 prescriptions for the analysis. The data analysed from the prescription included patients demographics, stage of hypertension according to JNC VII guidelines, type of drug therapy, class of anti-hypertensive, and cost effectiveness of therapy. Drug acquisition costs was calculated, using the cost of the cheapest available drug and the most commonly prescribed dosage, for each drug on a daily and annual basis. Total annual drug expenditure on buying required doses of all antihypertensive prescribed in the study population for a year was calculated. Monotherapy (48.94%) was leading trends of antihypertensive therapy followed by fixed dose combination (35.04%) and polytherapy (16.01%). The most frequent antihypertensive class to be prescribed were CCBs (38.59%) followed by beta blockers (24.07%). The ranking in terms of cost utilized per year from the highest to the lowest found in this study was: alpha blockers> ACE-inhibitors> ARBs> CCBs> beta blockers > diuretics. The diuretics were most cost-effective (Cost per day: 5.89 ± 2.87; Cost per year: 2129.02 ± 1080.49) in relation to the other antihypertensive prescribed.

Amlodipine Seems To Be Superior to Valsartan in Decreasing Microalbuminuria in Newly Diagnosed Hypertensive Patients: A Novel Effect To Be Explained with Hyperfiltration?

Background: Microalbuminuria (MA) is common in hypertensive population and is a marker for endothelial dysfunction and a predictor of increased cardiovascular risk. A great body of data shows the importance of MA as a strong predictor of renal and cardiovascular disease (CVD) risk in hypertensive population. Aim: In this study, we aimed to compare the anti-albuminuric effects of an angiotensin II receptor antagonist, valsartan, with a calcium channel blocker, amlodipine, in newly diagnosed hypertensive patients. Material and methods: Totally, 20 patients were recruited into the study. Patients were randomized to one of the following intervention protocols: An (a) angiotensin II receptor blocker (valsartan, 80–320 mg/day) or (b) calcium channel blocker (amlodipine, 5–10 mg/day), for 12 weeks immediately after baseline measurements. Ten patients were randomized into valsartan group and 10 patients into the amlodipine group. Twenty-four-hour urinary albumin excretion (UAE) levels of the patient groups were measured before treatment and on the 12th week. Results: Patients of the two groups were matched for age and body mass index. In the amlodipine group, baseline urine microalbumin levels were higher compared to valsartan group, although the difference was not statistically significant (p = 0.082). At the 12th week, there was a significant decrease in urine microalbumin levels in the amlodipine group, but no significant change was observed in the valsartan group. Conclusion: Amlodipine seems to be superior to valsartan in decreasing UAE. To reduce cardiovascular risks, endothelial dysfunction, and microinflammation, these factors are taken into consideration while prescribing antihypertensive drugs in hypertensive patients.

Individual approach to antihypertensive drug choice in hypertensive patients based on individual features of autonomic cardiovascular dysfunction

Objective. Development of differentiated method for selection of antihypertensive drugs in hypertensive patients based on assessment of individual features of autonomic cardiovascular dysfunction evaluated by spectral parameters of heart rate variability (HRV) and synchronization of 0.1 Hz oscillation in heart rate and microcirculation. Design and methods. 105 patients with arterial hypertension stage 1-2 aged 47 ± 8 years were examined. 0.1 Hz oscillations in heart rate and microcirculation were registered during passive tilt test under spontaneous breathing. The signals were recorded before and after three-week treatment by angiotensin-converting enzyme (ACE) inhibitors (fosinopril or enalapril) and β-blockers (atenolol or metoprolol). Phase differences between 0.1 Hz oscillations were used to measure the synchronization index S . Power of low- (LF) and high-frequency (HF) bands of HRV spectrum was also assessed. Results. ACE inhibitors are preferred for treatment of hypertensive patients with initially severe systemic autonomic dysfunction (index S is 250 ms 2 in supine position). β-blockers are recommended for patients with initially severe systemic autonomic dysfunction and dysfunction of autonomic heart regulation (index S 2 in vertical body position). If severe autonomic dysfunction (index S is > 25 % and power of LF band of HRV spectrum is > 250 ms 2 ) is not present the treatment by ACE inhibitors and β-blockers is not recommended. Conclusions. The type of antihypertensive drugs (ACE inhibitors or β-blockers) should be selected based on individual features of autonomic cardiovascular dysfunction. Sensitivity and specificity of this method was 65 and 73 %, respectively.