Antihypertensive Patients Research Articles

Comparison of Blood Pressure in Hypertensive Patients with Monotherapy and Combination Antihypertensive Therapy

Background: Hypertension is a cardiovascular risk factor that is closely related to the patient's systolic and diastolic blood pressure profile. Objective: This study aims to determine the comparison of systolic and diastolic blood pressure profiles using antihypertensives in patients with cardiovascular risk factors. Method: Conducted in the period August-December 2021 on 83 patients who met the inclusion criteria, namely outpatients diagnosed with hypertension with cardiovascular risk factors, adult patients over 18 years of age, a medical record sheet, and a written prescription in full. Data analysis used the Kruskal Wallis test. Results: Shows a p value of 0.02 < 0.05 that there is a difference in systolic and diastolic blood pressure when using antihypertensive monotherapy or combination. The use of antihypertensive monotherapy is able to achieve the target of reducing systolic and diastolic blood pressure, namely amlodipine by -42.4mmHg/-11.7mmHg. Meanwhile, the combination antihypertensive that provides maximum results is a combination of 2 drugs, namely Candesartan + Hydrochlorthiazide which produces a reduction of -42.64 mmHg/-16.09 mmHg; a combination of 3 drugs: Amlodipine + Candesartan + Hydrochlorthiazide resulted in a reduction of -49 mmHg/-19.1 mmHg. Conclusion: There are differences in the profile of reducing systolic and diastolic blood pressure when using monotherapy and combination antihypertensives. The choice of monotherapy and combination can provide benefits in reducing blood pressure, tolerability and the level of compliance with the drugs consumed. Rational dose selection and drug selection in hypertensive patients is an important part in achieving successful therapy and preventing drug related problems, so pharmacists need to always monitoring blood pressure profiles as a form of monitoring the effectiveness of existing antihypertensive drugs consumed by patients.

TCT-726 Efficacy of Renal Denervation and Antihypertensives in Patients With Resistant Hypertension: A Systematic Review and Network Meta Analysis

TCT-726 Efficacy of Renal Denervation and Antihypertensives in Patients With Resistant Hypertension: A Systematic Review and Network Meta Analysis

Safety and cardiovascular effectiveness of olmesartan in combination therapy for advanced hypertension: an electronic health record-based cohort study.

Compared with placebo, olmesartan has been linked to numerical imbalances in cardiovascular mortality. There is a paucity of contemporary real-world evidence on this agent for different study populations. This study investigated the clinical outcomes of olmesartan and other antihypertensives in patients with advanced hypertension. This multicenter retrospective study used data from the Korea University Medical Center database, built from electronic health records. Patients prescribed at least two antihypertensive medications as a combined therapy were followed-up for 3 years. The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), stroke, and hospitalization for heart failure. Adjusted outcomes were compared using propensity score (PS) matching. Among 24 806 patients, 4050 (16.3%) were olmesartan users between January 2017 and December 2018. The average patient age was 64 years, 45% were women, and 41% had diabetes. Olmesartan users were younger and less likely to have diabetes mellitus or chronic kidney disease. In PS-matched cohort, the 3-year cumulative incidences of the primary outcome were similar between the two groups (P = 0.91). The cumulative incidence of MI at 3 years was 1.4% in olmesartan users (4.8 per 1000 person-years) and 1.5% in active comparators (5.2 per 1000 person-years; P = 0.74). Olmesartan also showed similar safety profiles, including acute kidney injury and newly started dialysis. In real-world practice, olmesartan use in combination therapy resulted in similar cardiovascular outcomes when compared with those of active comparators, and our findings did not show any conclusive evidence that olmesartan is harmful in patients with hypertension.

Postpartum Titration of Antihypertensives in Patients With Hypertensive Disorders of Pregnancy [ID: 1380430

INTRODUCTION: Postpartum hypertension is observed in up to 20% of patients within 6 weeks of delivery. While blood pressure evaluation is an integral component of prenatal care, effective blood pressure follow-up postpartum is uncertain. The objective of this study was to evaluate the use of antihypertensive medications and subsequent dosage adjustments in the postpartum period. METHODS: This was a retrospective qualitative observational study of patients with hypertensive disorders of pregnancy who delivered at a single quaternary care safety net hospital from July to December 2021. Patients with at least one of the following diagnoses: chronic hypertension (cHTN), gestational hypertension (gHTN), and/or severe preeclampsia (SPE), were included. Data collected included initiation and/or titration of antihypertensives during delivery admission, postpartum visit attendance, outpatient antihypertensive dose adjustments, and emergency department visits. RESULTS: From July to December 2021, 1,232 pregnancies were complicated by hypertensive disorders: gHTN only, 577 (46.8%); both gHTN and cHTN, 34 (2.8%); both gHTN and SPE, 499 (40.5%); and all three, 122 (9.9%). Of these, 256 (20.8%) required initiation and/or titration of antihypertensives during delivery admission with over 90% of these complicated by SPE. Of the 197 (77.0%) attending at least one follow-up, medication was stopped in 26 (13%), increased in 9 (5%), decreased in 22 (11%), and continued unchanged in 140 (71%). The majority of medication adjustment occurred in the first 2 weeks postpartum. CONCLUSION: Postpartum hypertensive therapy management occurs predominantly within 2 weeks postpartum, with nearly one-fourth decreasing and only 5% requiring increased medication.

The Analysis between the Diagnose of Preeclampsia and Eclampsia to Treatment at Dr. H. Jusuf SK Hospital Indonesia

Preeclampsia and eclampsia are types of gestational hypertension that are considered causes of maternal and perinatal death. Preeclampsia in severe conditions will result in eclampsia accompanied by symptoms of seizures or decreased consciousness. In the condition of preeclampsia, antihypertensive therapy is needed. The use of antihypertensives in patients with Preeclampsia and Eclampsia, namely methyldopa and labetalol, is the first line, and hydralazine, nifedipine, prazosin, and clonidine are the second line. The design of this study is a descriptive cross-sectional study to see the relationship between diagnoses and types of treatment. This research was conducted at Dr.H.Jusuf SK Hospital, Tarakan City, North Kalimantan Province, with secondary data from medical records as research data. The research subjects were pregnant women diagnosed with preeclampsia and eclampsia without accompanying comorbid diseases, with a sample of 49 respondents using a total sampling system. The results of this study found that one patient was diagnosed with Mild Preeclampsia with a single therapy, 45 patients were diagnosed with Severe Preeclampsia with a single therapy, a combination of 2 drugs and a combination of 3 drugs, and three patients were diagnosed with eclampsia with single therapy and a combination of 4 drugs. The data from this study showed a relationship between diagnosis and the type of treatment therapy with a significant value of 0.004 (p<0.05). The findings of this study can be used as a guide for medical therapy by healthcare professionals.

EVALUASI PENGGUNAAN OBAT ANTIHIPERTENSI PADA PASIEN GAGAL GINJAL KRONIK (GGK) DI UNIT HEMODIALISA RSU IMELDA PEKERJA INDONESIA MEDAN

Chronic kidney failure (CKD) is a clinical symptom caused by chronic, progressive, and irreversible kidney function disorders. The World Health Organization (2017) reports that globally, CKD occurs in more than 500 million people. According to Riskesdas (2018) the prevalence of CKD based on a doctor's diagnosis in the population aged 15 years in Indonesia is 0.38% while in North Sumatra it is 0.33%. This method replaces the work normally carried out by the kidneys, namely cleansing the blood of metabolic wastes, toxic substances, and removing accumulated water in the body. This study aims to see the pattern of use of antihypertensives in patients with chronic kidney failure in hemodialysis Imelda Indonesian Workers General Hospital Medan period 2020. This study is a descriptive observation study in which data were taken retrospectively and analyzed by descriptive statistical methods. The pattern of use of antihypertensives in CKD patients in the hemodialysis unit of Imelda RSU Indonesian Workers is mostly amlodipine 13.0%, and the most widely used combination therapy is amlodipine with valsartan 14.4%.

7 IMPACT OF DAY-TO-DAY BLOOD PRESSURE VARIABILITY TO IN-HOSPITAL MORTALITY IN PATIENTS WITH COVID-19 AND EFFICACY OF ANTIHYPERTENSIVE AGENTS

Background: Blood pressure variability (BPV) plays an important role in hypertensive patients, and frequently associated with organ damage, but the impact of BPV to outcome in COVID-19 patients remain unclear. Objectives: To investigate the relationship between BPV and in-hospital mortality, hypertensive status, severity of COVID-19, and antihypertensives in patients with COVID-19. Methods: This was a cohort prospective study that enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the presence of hypertension, the severity of COVID-19, and BPV status. Mean Arterial Pressure (MAP) was measured at 6 a.m. and 6 p.m. during hospitalization, and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. We compared the hypertensive status, COVID-19 severity, in-hospital mortality and antihypertensive agents between the BPV groups. Results: The mean age was 53.85±18.84 years-old. Subjects with high BPV were significantly associated with hypertension status (PR=1.38; 95%CI=1.13-1.70; p=0.003) or severe COVID-19 (PR=1.39; 95%CI=1.09-1.76; p=0.005). High BPV also significantly increased risk of mortality (HR=2.30; 95%CI=1.73-3,86; p=<0.001). Patients with severe COVID-19, hypertension, and high BPV had the highest risk of in-hospital mortality (HR=3.51; 95%CI=2.32-4,97; p<0.001) compared to other groups. In COVID-19 patients with hypertension, CCB had significantly decreased BPV (PR=0.50; 95%CI=0.27-0.93; p=0.004) and mortality (HR=0.17; 95%CI=0.05-0.56; p=0.004). Conclusions: High BPV was associated with hypertensive status and severe COVID-19, and these factors together increased in-hospital mortality. CCB are antihypertensive agents that were potentially effective in suppressing BPV and mortality in COVID-19 patients.

GPs' mindlines on deprescribing antihypertensives in older patients with multimorbidity: a qualitative study in English general practice.

BackgroundOptimal management of hypertension in older patients with multimorbidity is a cornerstone of primary care practice. Despite emphasis on personalised approaches to treatment in older patients, there is little guidance on how to achieve medication reduction when GPs are concerned that possible risks outweigh potential benefits of treatment. Mindlines — tacit, internalised guidelines developed over time from multiple sources — may be of particular importance in such situations.AimTo explore GPs’ decision-making on deprescribing antihypertensives in patients with multimorbidity aged ≥80 years, drawing on the concept of mindlines.Design and settingQualitative interview study set in English general practice.MethodThematic analysis of face-to-face interviews with a sample of 15 GPs from seven practices in the East of England, using a chart-stimulated recall approach to explore approaches to treatment for older patients with multimorbidity with hypertension.ResultsGPs are typically confident making decisions to deprescribe antihypertensive medication in older patients with multimorbidity when prompted by a trigger, such as a fall or adverse drug event. GPs are less confident to attempt deprescribing in response to generalised concerns about polypharmacy, and work hard to make sense of multiple sources (including available evidence, shared experiential knowledge, and non-clinical factors) to guide decision-making.ConclusionIn the absence of a clear evidence base on when and how to attempt medication reduction in response to concerns about polypharmacy, GPs develop ‘mindlines’ over time through practicebased experience. These tacit approaches to making complex decisions are critical to developing confidence to attempt deprescribing and may be strengthened through reflective practice.

Deprescribing antihypertensives in patients with multimorbidity

Deprescribing preventative medications such as antihypertensives may reduce adverse events in some older adults, leading to improved quality of life. The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE) trial examined the safety and efficacy of antihypertensive deprescribing in older patients taking more than one treatment for hypertension. This article discusses the findings of the study and their implications for clinical practice.

A3083 Factors affecting poor compliance on antihypertensives in patients with hypertension

A3083 Factors affecting poor compliance on antihypertensives in patients with hypertension

Identifying treatment response to antihypertensives in patients with obesity-related hypertension

BackgroundIn patients with obesity-related hypertension (ORH), reaction to antihypertensive medication is likely influenced by patientcharacteristics.MethodsEffects of aliskiren, moxonidine and hydrochlorothiazide on 24-h blood pressure (BP) were compared to placebo. Linear mixed effect models were used to analyze the effect of patient characteristics on BP levels and treatment response.ResultsSystolic BP response to aliskiren was higher in patients with a BMI > 30.7 kg/m2 compared to patients with a BMI ≤ 30.7 kg/m2 (−21 mmHg versus -4 mmHg). In patients with a hsCRP > 1.8 mg/L the systolic BP response to aliskiren was higher than in patients with a low hsCRP (−15 mmHg versus −7 mmHg). Hydrochlorothiazide (HCTZ) treatment effect on systolic BP was −13 mmHg when heart rate > 71 beats/min compared to -3 mmHg when heart rate was ≤ 71 beats/min.ConclusionIn patients with ORH, BP response to aliskiren is positively related to BMI and hsCRP. Systolic BP response to HCTZ is positively related to heart rate and negatively to renin levels.Trial registrationNCT01138423. Registered June 4th, 2010.

Recording a diagnosis of stroke, transient ischaemic attack or myocardial infarction in primary healthcare and the association with dispensation of secondary preventive medication: a registry-based prospective cohort study

ObjectivesThe aim of this study was to explore whether recording in primary care of a previously recorded hospital diagnosis was associated with increased patient utilisation of recommended medications.DesignRegistry-based prospective cohort...

Adherence to Antihypertensives in Patients With Comorbid Condition.

Background:Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications.Objectives:We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen.Patients and Methods:Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews.Results:The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions.Conclusions:With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time.

Temporal trends in vascular risk factors and etiology of urban Polish stroke patients from 1995 to 2013

BackgroundDespite estimates about general trends in stroke epidemiology worldwide, there are only a few reports of detailed longitudinal data and none of them reflects the economic transition that occurred in Central and Eastern Europe over the last two decades. The aim of this study was to investigate long term trends in risk factors and their pre-stroke control as well as acute stroke clinical presentation and etiology in Polish urban setting. MethodsThis is a retrospective registry-based analysis of consecutive acute stroke patients from a highly urbanized area (Warsaw, Poland) admitted to a single stroke center between 1995 and 2013. Patients were divided into four time periods: 1995–1999 (n=529), 2000–2004 (n=1253), 2005–2009 (n=1320) and 2010–2013 (n=871). ResultsDuring the study period 3973 first-ever stroke patients were admitted. The proportion of ischaemic strokes (88.2% to 90.9%) and male patients (45.2% to 46.2%) remained stable throughout the whole study period. Admitted patients became older (72, 73, 74 and 76years, consecutive time periods), were more likely to be diagnosed with hypertension (from 61.1% to 72.8%) and disable (84.3% to 67.4%) prior to stroke. There was an increase in pre-stroke use of antihypertensives in patients with hypertension (from 77.8% to 90.5%), antiplatelets in patients with coronary artery disease (from 33.9% to 56.5%), vitamin K antagonists in patients with atrial fibrillation (from 6.3% to 39.8%) and statins (from 7.6% to 26.3%). There was a decrease in mean stroke severity (9, 11, 8 and 6 points on the National Institutes of Stroke Scale) on admission and the proportion of strokes attributed to small-vessel disease (22.0%, 20.0%, 10.6% and 8.3%). ConclusionsOver the last two decades the profile of urban Polish stroke patients has changed significantly and it can be attributed to marked economic improvement in Poland since 1990s. Increasing age and better management of pre-existing vascular risk factors were accompanied by decreasing stroke severity and lower proportion of strokes attributed to small-vessel disease.

Pattern of antihypertensive drug utilisation among chronic kidney disease patients in a dialysis unit of a tertiary care hospital

Background: India is experiencing a rapid health transition and is projected to become a major reservoir of chronic diseases like diabetes and hypertension and 2540% of these subjects may develop chronic kidney disease (CKD) and end stage renal disease (ESRD)Objectives: To analyse the drug utilisation pattern of antihypertensives in patients with Chronic Kidney Disease.Materials and Methods: A cross sectional study conducted in patients with Chronic Kidney Disease in a tertiary care hospital over a period of 6 months in 2014. The information regarding demographic details and antihypertensive drugs prescribed were collected from the patients case records and the data was compiled and subjected to statistical analysisResults: Total of 95 case records was analyzed. CKD was more common in males, with male to female ratio of 4:1. 49.47% of the patients belonged to the age group of 40 60 years followed by 31 40 years (26.32%). Among the antihypertensives calcium channel blockers, diuretics, centrally acting antihypertensives, ? blockers, ? blockers, vasodilators, ?+? blockers and ACE inhibitors were routinely used.

Study investigates antihypertensives in patients with diabetes and kidney disease

Study investigates antihypertensives in patients with diabetes and kidney disease

Should More Significance Be Granted to Medication Response to Antihypertensives in Patients With Resistant Hypertension?

In a recent thesis published in the journal, Calhoun et al1 presumed that although resistant hypertension (RH) is relatively common among treated patients with hypertension, true antihypertensive treatment failure is rare. We are grateful to Calhoun et al for their worthy efforts to provide significant information about the prevalence of refractory hypertension. Our next task is to figure out whether true antihypertensive treatment failure is common in treated patients with hypertension. About the article, we have to maintain reservations about the definition of RH. More importantly, the article causes our reflection on medication response evaluation in RH-therapy. In the journal, Calhoun et al defined RH as patients whose blood …

Effectiveness of antihypertensives in patients with diabetes

Effectiveness of antihypertensives in patients with diabetes

Increased pulse pressure linked to dementia

High blood pressure (BP) has been associated with increased risk of dementia. Concerns have been raised about lowering BP too far in the very elderly and thereby increasing risk. There is some evidence to suggest a potential 'J'-shaped relationship between DBP and risk of cognitive impairment. This was investigated using data from the HYpertension in the Very Elderly Trial (HYVET). HYVET was a double-blind, placebo-controlled trial of antihypertensives in patients aged at least 80 years with an untreated SBP of 160-199 mmHg. Active medication was indapamide sustained release 1.5 mg+/- perindopril 2-4 mg to reach goal pressure of less than 150/80 mmHg. Incident dementia was a secondary endpoint and was not significantly different between the two treatment groups. The relationship between pressure and incident dementia was assessed using Cox proportional hazards regression with BP entered as either a discrete (quartile analysis) or continuous predictor variable. Achieved BP was calculated as the mean of all pressures from the 9 month visit onwards. During a mean follow-up of 2.2 years 263 incident cases of dementia were diagnosed. After adjustment for various covariates, baseline DBP was inversely related to incident dementia (P=0.0064). Achieved DBP did not predict later dementia in the placebo group (P=0.43), but showed a U-shaped relationship in the active treatment group (P=0.0195). The relationship between incident dementia and DBP did however not differ significantly between the placebo and active treatment groups (P=0.38). SBP was not associated with incident dementia, at baseline (P=0.62) or during follow-up (placebo group P=0.13, active group P=0.36). Wider achieved pulse pressure (PP) was associated with increased risk of dementia in both treatment groups (placebo P=0.032, active P=0.0046). The same tendency was observed for baseline PP (P=0.095). Wider PP may possibly indicate an increased risk for dementia. Active treatment may act to change the shape of the relationship between DBP and dementia. Future studies need to focus on exploring the ideal goal pressure for this age group.

Overuse of Antihypertensives in Patients with Acute Ischemic Stroke

The Stroke Council of the American Heart Association/American Stroke Association (AHA/ASA) recommends conservative management of hypertension (HTN) during acute ischemic stroke (AIS), although clinicians often manage blood pressure more aggressively. Our hypothesis was that aggressive management of HTN in patients with AIS is associated with hypotensive events and worsened neurologic outcomes. The study was a retrospective, observational cohort of patients who were admitted to the hospital with AIS. Classification of neurologic outcomes was based on nurses' neurologic assessments and were categorized as "worsened," "stayed the same," or "improved." The accuracy of these assessments was verified by review of physician's progress notes. Management of arterial HTN was recorded in all patients. Fifty medical records of patients with AIS who met inclusion criteria were reviewed. While only 22% of patients met the AHA/ASA criteria for hypertension treatment, 98% of the cohort were given antihypertensive therapy. Relative hypotension occurred in 64% of treated patients. Absolute hypotension associated with antihypertensive medications was uncommon but did occur in 2 of 15 patients who experienced neurologic worsening (13%), in 1 of 28 (3%) of patients who stayed the same, and in none of those who improved. Blood pressure was reduced excessively in all 11 of the patients who met AHA/ASA guidelines for treatment. Adherence to AHA/ASA guidelines for HTN management during AIS was poor. Initiation or intensification of antihypertensive drugs was not associated with worsened neurologic outcomes. Furthermore, relative hypotension, absolute hypotension and excessive reductions in blood pressure were not associated with worsened neurologic outcomes.