Attain Target Blood Pressure Research Articles

Evaluation of treatment effectiveness and 10-year cardiovascular disease risk level in hypertensive outpatients

Hypertension represents a substantial risk factor for the development of cardiovascular disease (CVD), stroke, and chronic kidney disease. CVD stands as the primary cause of global mortality. This study employed a prospective cross-sectional design spanning 4 weeks. Data were collected using a pro forma designed to capture patients’ sociodemographic and clinical information. Prescribers’ adherence to anti-hypertensive prescription guidelines, as per the JNC8 guideline, and patients’ attainment of target blood pressure (BP) goals were assessed. Framingham 10-year CVD risk score estimation was employed to estimate patients’ 10-year CVD risk levels. Among the patients, 51 (59.3%) had anti-hypertensive prescriptions that adhered to the JNC8 guidelines. However, a majority, 54 (62.8%), failed to achieve their JNC8 target BP goals, and 44 (51.2%) exhibited intermediate 10-year CVD risk levels. Furthermore, 71 (98.6%) of the patients did not receive the recommended statin and/or aspirin therapy, despite its necessity. An association was found between patients’ achievement of JNC8 target BP goals and their 10-year CVD risk levels. The majority of patients received anti-hypertensive prescriptions that aligned with JNC8 guidelines. Nonetheless, most of them did not attain their JNC8 target BP goals and exhibited intermediate to high 10-year CVD risk levels.

Assessing adherence to hypertension medications and its impact on blood pressure control: A community-based observational study

Background: Hypertension is a prevalent cardiovascular condition requiring effective medication management for blood pressure control. Aims and Objectives: The aim is to explore the relationship between adherence to hypertension medications and its impact on blood pressure control among a diverse population. Materials and Methods: A participant cohort of 500 adults, with a mean age of 56 years, was examined for their adherence to hypertension medications and blood pressure control outcomes. Adherence was assessed through self-report questionnaires and pill count analysis, while blood pressure control was defined as systolic blood pressure below 140 mmHg and diastolic blood pressurebelow 90 mmHg. The statistical analysis included logistic regression with adjustments for potential confounding variables. Results: The participant cohort displayed a balanced gender distribution and predominantly managed hypertension through multi-drug regimens. Around 65% reported high medication adherence, confirmed by pill count analysis. Notably, 55% achieved the defined blood pressure control target, indicating effective management. A robust association was observed between high adherence and improved blood pressure control (adjusted odds ratio=1.65, 95% confidence interval: 1.28–2.12, P<0.001). Participants with high adherence were 1.65 times more likely to attain target blood pressure control than those with lower adherence, with a high level of statistical significance. Conclusions: This study highlights the crucial link between medication adherence and blood pressure control in hypertensive individuals. High adherence increases the likelihood of optimal blood pressurecontrol, underscoring patient commitment. Tailored interventions and support mechanisms are essential for enhancing adherence and improving hypertension management outcomes.

PARACETAMOL AND BLOOD PRESSURE CONTROL IN 45211 PATIENTS TREATED FOR HYPERTENSION: A CROSS-SECTIONAL STUDY FROM THE SWEDISH PRIMARY CARE CARDIOVASCULAR DATABASE

Objective: Paracetamol (acetaminophen) is widely recommended for analgetic and antipyretic indications due to its perceived high safety. However, studies have shown contradicting results regarding the effect of paracetamol on blood pressure (BP). We aimed to study how regular paracetamol use could affect BP control in patients on antihypertensive mediation. Design and method: Data for 42 511 patients attending primary care and a documented diagnosis of hypertension before 2007 (to rule out new onset of hypertension) and with 1 or more BP measurements recorded 2007–2008 were collected from the Swedish primary care cardiovascular database (SPCCD). There were 8 367 paracetamol users, defined as 1 or more dispensed prescriptions 6 months prior to the last BP recorded, and 34 144 non-users of paracetamol. Target BP was set to <140/90 mm Hg. Dose-response relationships were examined by the number of defined daily doses (DDD) dispensed. Multivariate linear regression analyses accounted for potential confounders. Results: Paracetamol users were older, had higher creatinine levels, more often diabetes, cardiovascular diseases and musculoskeletal diseases, and lower educational level than non-users (all P < 0.001), but attained target systolic and diastolic BP to similar degrees (58 and 93% vs 58 and 92%, respectively). There were no relations between number of DDD and systolic and diastolic BP in paracetamol users, also when DDD deciles were evaluated to account for the low proportion of patients with high DDD dispensed (all R2 <0.001). Sensitivity analyses including dispensed prescriptions of paracetamol 3 months before and 6 months after the first BP measurement provided similar results. Paracetamol had no impact on attaining target BP in subgroup analyses on patients with diabetes, musculoskeletal diseases, with concomitant use of NSAID, or in relation to number of antihypertensive medications (suggesting severity of hypertensive disease). Conclusions: Concomitant use of paracetamol does not impair the ability to reach target BP in hypertensive patients. No dose-response relationship was observed between dispensed prescriptions of paracetamol and BP.

Attainment of NICE blood pressure targets among older people with newly diagnosed hypertension: nationwide linked electronic health records cohort study.

it is not known if clinical practice reflects guideline recommendations for the management of hypertension in older people and whether guideline adherence varies according to overall health status. to describe the proportion of older people attaining National Institute for Health and Care Excellence (NICE) guideline blood pressure targets within 1 year of hypertension diagnosis and determine predictors of target attainment. a nationwide cohort study of Welsh primary care data from the Secure Anonymised Information Linkage databank including patients aged ≥65years newly diagnosed with hypertension between 1st June 2011 and 1st June 2016. The primary outcome was attainment of NICE guideline blood pressure targets as measured by the latest blood pressure recording up to 1year after diagnosis. Predictors of target attainment were investigated using logistic regression. there were 26,392 patients (55% women, median age 71 [IQR 68-77] years) included, of which 13,939 (52.8%) attained a target blood pressure within a median follow-up of 9 months. Success in attaining target blood pressure was associated with a history of atrial fibrillation (OR 1.26, 95% CI 1.11, 1.43), heart failure (OR 1.25, 95% CI 1.06, 1.49) and myocardial infarction (OR 1.20, 95% CI 1.10, 1.32), all compared to no history of each, respectively. Care home residence, the severity of frailty, and increasing co-morbidity were not associated with target attainment following adjustment for confounder variables. blood pressure remains insufficiently controlled 1 year after diagnosis in nearly half of older people with newly diagnosed hypertension, but target attainment appears unrelated to baseline frailty, multi-morbidity or care home residence.

A Study on Attainment of Target Blood Pressure in Hypertensives in a Teaching Hospital

A Study on Attainment of Target Blood Pressure in Hypertensives in a Teaching Hospital

Prescribing patterns and pharmacoeconomic analysis of antihypertensive drugs in South Indian population: A cross-sectional study.

Global evidence-based recommendations for hypertension management are periodically updated, and ensuring adherence to the guidelines is imperative. Furthermore, the current high prevalence of hypertension effectuates a high health-care cost. To evaluate the prescribing patterns of antihypertensive drugs and other factors affecting blood pressure (BP) with the objective of assessing the proportion of patients achieving the target BP and to perform a pharmacoeconomic analysis in a South Indian population. In a cross-sectional study, 650 patients previously diagnosed with hypertension and already on treatment with one or more drugs were included. A prospective interview of patients was done using a prevalidated questionnaire on various factors in BP control. Prescribing patterns and pharmacoeconomic analyses, namely, cost acquisition, cost of illness, and cost-effectiveness analyses were carried out. Of 650 subjects, 257 (39.54%) achieved the target BP, while 393 (60.46%) did not. A significant association of age, occupational status, monthly family income, and area of residence in addition to physical activity and diet scores, with achieving target BP was noted. A significantly higher cost of anti-hypertensive drug treatment in achieving target BP (P = 0.02) was observed. Among patients who achieved target BP, 37.35% were on monotherapy and 48.25% on multiple drug therapy compared to 46.31% and 35.62%, respectively, in patients who did not. Average cost-effectiveness ratio were found to be Rs. 20.45 and Rs. 57.27, respectively, for single and multiple drug therapies, with incremental cost-effectiveness of Rs. 194.14 per additional patient treated with multiple free drug combinations. This study identified the anti-hypertensive prescribing pattern and provided insight into the various pharmacoeconomic factors that play a significant role in attaining target BP in the treated population.

Antihypertensive Drug Usage and Target Blood Pressure Attainment in Postrenal Transplant: A Prospective Study in Indian Population

Introduction: The etiology of hypertension in post renal transplant patients is multifold and effective control of blood pressure (BP) contributes towards proper graft functioning and reduces risk of cardiovascular diseases. This prospective observational study was undertaken to evaluate the prevalence of antihypertensive drug use, the prescribing pattern and trends of blood pressure control in a cohort of post renal transplant patients from eastern India. Materials and Methods: Patients who had undergone renal transplant in this public hospital were enrolled as per eligibility criteria. All enrolled patients were on antihypertensive from at least 3months prior to transplant and were followed upto one year post-transplant. Antihypertensive drug (AHD) and immunosuppressant intake, BP recordings and occurrence of major adverse cardiac events (MACE), if any were noted at each visit. Results: 56 patients were enrolled with a mean age of 33.04 ± 9.96 years, 87.5% were male. 75% were hypertensive at discharge (2-3 weeks post-transplant). Percentage of patients on AHD at 3, 6, 9 and 12 months post-transplant were 83.9%, 82.1%, 75% and 71.4% respectively. Amlodipine was the most common prescribed AHD. Target BP control (≤130/80 mm of Hg) was achieved in 62.5% patients at 1year post-transplant. There were no major adverse cardiac events (MACE) during the study period. Conclusion: In our study comprising of a relatively young cohort of transplant patients from India, hypertension control was well achieved in majority of the subjects and no MACE were noted. Amlodipine was the most commonly used AHD either as monotherapy or in combination with beta-blocker. Long term follow up of this cohort shall provide further insights into the trends of such control.

Left Ventricular Hypertrophy in Diabetic Cardiomyopathy: A Target for Intervention.

Heart failure is an important manifestation of diabetic heart disease. Before the development of symptomatic heart failure, as much as 50% of patients with type 2 diabetes mellitus (T2DM) develop asymptomatic left ventricular dysfunction including left ventricular hypertrophy (LVH). Left ventricular hypertrophy (LVH) is highly prevalent in patients with T2DM and is a strong predictor of adverse cardiovascular outcomes including heart failure. Importantly regression of LVH with antihypertensive treatment especially renin angiotensin system blockers reduces cardiovascular morbidity and mortality. However, this approach is only partially effective since LVH persists in 20% of patients with hypertension who attain target blood pressure, implicating the role of other potential mechanisms in the development of LVH. Moreover, the pathophysiology of LVH in T2DM remains unclear and is not fully explained by the hyperglycemia-associated cellular alterations. There is a growing body of evidence that supports the role of inflammation, oxidative stress, AMP-activated kinase (AMPK) and insulin resistance in mediating the development of LVH. The recognition of asymptomatic LVH may offer an opportune target for intervention with cardio-protective therapy in these at-risk patients. In this article, we provide a review of some of the key clinical studies that evaluated the effects of allopurinol, SGLT2 inhibitor and metformin in regressing LVH in patients with and without T2DM.

Comparison of Efficacies of Commonly Used Hypertension Treatment Modalities: A Retrospective Study of 1900 Participants in a Hypertension Clinic.

BackgroundAlthough various antihypertensive medications are available, some hypertensive patients have uncontrolled blood pressures, especially in the clinic. The aim of the present study was to compare the efficacies of various antihypertensive therapies in our hypertension (HTN) clinic (monotherapy vs. combination therapy, fixed-dose combination (FDC) versus free equivalent combination (FEC), and diuretics versus non-diuretics.Material/MethodsIn this retrospective study, patients at the HTN clinic of the Third Xiangya Hospital with primary hypertension were enrolled from June 2016 to February 2017. Data on participants’ basic characteristics, blood pressure data, and treatment modalities were collected. The proportions of participants attaining target blood pressure after treatment with antihypertensive modalities were calculated and compared.ResultsAmong 1900 participants, combination therapy had a better control efficacy than monotherapy (P<0.0005). When HTN was treated by 2 kinds of drugs, FEC was used much more frequently than FDC (P<0.0005). In grade 3 HTN, FDC had a higher control rate (P=0.002). If more than 2 kinds of drugs were used, FDC+OTHER had a slightly higher control rate in grade 2 and 3 (42.1% vs. 38.5%, P=0.724; 36.2% vs. 31.0%, P=0.526, respectively). Therapies with diuretics had better control rates than those without diuretics (43.1% vs. 36.9%, P=0.025).ConclusionsIn our clinic, FEC was prescribed more often than FDC. When blood pressure is significantly elevated, especially at levels 2 or 3, FDC seems to have a better control rate than FEC. Therapies with diuretics controlled HTN more efficiently.

SUN-174 EFFICACY AND SAFETY OF INTRAVENOUS LABETALOL FOR HYPERTENSIVE CRISIS IN CHILDREN

Hypertensive crisis is uncommon in children. American Association of Pediatrics acknowledges the lack of robust evidence-based management guidelines for the same. Most data on the choice of drugs is extrapolated from adults and small case series in children. The objectives of this study were to determine the efficacy and safety of IV labetalol as a first-line agent or an add on drug compared to IV nitroprusside/nitroglycerine in the management of hypertensive crisis in children. A retrospective chart review of 56 consecutive children (age 1 month to ≤ 12 years) with hypertensive crisis admitted to pediatric intensive care unit (PICU) during a 10-year period (July 2009- 2019) was done. Data with respect to baseline demographics, clinical presentation, etiological workup, treatment details, and blood pressure (BP) trends were recorded. The choice of antihypertensive agents was left to the clinician's discretion. The proportion of patients, attaining target BP (95th percentile) in >12 to ≤ 48 hours after admission was taken as primary endpoint. The secondary endpoints were PICU needs, morbidity, and mortality. The median age of the children was 7 years (range 1-12). Hypertensive crisis comprised < 1 % of PICU admissions. Most crisis presented as hypertensive emergency (89%) and had renal etiology as the leading cause (61%). The proportion of children attaining the primary endpoint was significantly more in the group receiving labetalol (n=23) as compared to those not receiving labetalol (n=33) (62% vs. 29%, p < 0.0001). The proportion of children having precipitous fall in BP before 12 hours, leading to hypotension was similar in both treatment groups (13% vs 15%). The PICU needs for ventilation (0% vs 27%, p < 0.0001), renal replacement therapy (0% vs 9%, p = 0.003) and raised intracranial pressure (ICP) (0% vs 9%, p = 0.003) were significantly less in the labetalol group. The central nervous system (CNS) morbidity was also significantly reduced in the labetalol group (41% vs. 9%, p < 0.0001). One child compared to three died in the labetalol and non-labetalol group respectively (4.3% vs. 9%, p = 0.2). The data were also analyzed for practice variations between two periods of five years each (2009-2013 and 2014-2019). There latter cohort showed significantly more use of labetalol (74% for 2014-2019 vs. 26% for 2009-2013, p < 0.0001). Labetalol, when used alone or as an add on drug was more efficacious than IV nitroprusside/nitroglycerine in attaining the primary endpoint. There was a lesser need for ventilation and renal replacement therapy with labetalol. The CNS morbidity at discharge was also lesser. The propensity to hypotension was however similar in both groups. There is only one study looking at the safety and efficacy of labetalol in children with hypertensive crisis up to ≤ 24 months of age. Ours is the only study to the best of our knowledge in children up to 12 years of age. However, our study suffers from the inherent problems of a retrospective analysis. In conclusion, our study shows that labetalol is safe and efficacious in hypertensive crisis in children up to ≤ 12 years of age.

Treatment of Hypertension in People With Dementia: A Multicenter Prospective Observational Cohort Study

ObjectivesTo describe the treatment of hypertension in people with dementia and collate evidence on adverse health events whilst on treatment. DesignA multicenter prospective observational cohort study. Setting and participantsPeople with documented diagnoses of hypertension and dementia were recruited through memory clinics and general practice from 8 sites in the United Kingdom. MethodsThe cohort was recruited between July 2013 and October 2014. Participants underwent face-to-face, standardized assessment of blood pressure (BP), activities of daily living, cognitive function, and medication use. Follow-up was by monthly telephone interview for 6 months to collate data on adverse health events. Results181 participants were recruited and 177 followed up; 126 (70%) were female, mean age was 82 [standard deviation (SD) 6.3] years, median Mini-Mental State Examination score was 23 [interquartile range (IQR) 18-26] and mean BP was 141/78 (SD 22/12) mmHg. Antihypertensive drugs were prescribed in 157 (87%). Participants were prescribed a median of 1 (IQR 1-2) antihypertensive medication. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers were the most frequently prescribed antihypertensives in 63% of participants. Target BP was achieved in 58% (95% confidence interval 49%-64%). Increasing number of antihypertensives was not associated with lower systolic or diastolic BP, or with a higher proportion of patients attaining target BP. Participants had 214 falls, 3 had a fracture, 3 developed symptomatic heart failure, 4 had cerebrovascular events, and 8 died. Conclusions/ImplicationsIn this population of people with mild dementia, participants were treated with standard antihypertensive medications in a similar proportion to the general population, with a similar proportion achieving target BP. The rate of adverse health events was higher than in randomized controlled trials of antihypertensives and raises reservations about the assumptions underpinning antihypertensive treatment in people with dementia. These findings may help inform clinical decision making.

Blood pressure control in treated hypertensive Middle Eastern patients: a post hoc analysis based on JNC8 definitions.

BackgroundLong-term blood pressure (BP) control is challenging due to the asymptomatic nature of hypertension and poor treatment adherence among patients. We conducted a post hoc analysis to assess “target BP” attainment and maintenance and to identify their associated factors in a sample of hypertensive Middle Eastern patients.MethodsWe previously conducted an observational study between May 2011 and September 2012 to assess antihypertensive treatment adherence and its determinants in a sample of 1,470 hypertensive patients in Lebanon and Jordan. The study consisted of 3 visits: at baseline, 3 months, and 6 months, where BP control, health-related quality of life, and treatment adherence were assessed. This post hoc analysis of data from the ADHERENCE study examined BP control in terms of target attainment at 3 months and 6 months, and target maintenance at 6 months in treatment-eligible patients as well as the determinants of BP control including the impact of the new JNC8 (Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) guideline on treatment eligibility and target BP attainment in these patients.ResultsBased on JNC8 definitions, our results revealed that 81.2% of patients achieved BP control at 6 months. At 3 months, 62.2% achieved BP control; of those, only 57.5% maintained BP control till 6 months. Factors associated with higher BP target attainment at 3 months were higher educational level, new hypertension diagnosis, older age, and lower waist circumference, systolic BP, and diastolic BP at baseline. Factors associated with higher BP target attainment at 6 months were Lebanese nationality, new hypertension diagnosis, absence of chronic kidney disease, lower systolic BP at baseline, reaching BP target at 3 months, and having a BP target of <150/90 mmHg.ConclusionOlder age, higher education levels, recent hypertension diagnosis, early achievement of target BP, and having milder disease at baseline were associated with better BP control. Moreover, JNC8 guideline reduced the number of treatment-eligible patients and increased BP target attainment.

Strategic implications of changing rule of halves in hypertension: A cross-sectional observational study.

Context:The burden of non-communicable diseases will sooner overwhelm the health system of the country and could curtail future economic development. Hypertension causes highest cardiovascular morbidities. To attain target Blood Pressure (BP), different strategies are required, which are area specific. The validity of rule of halves of hypertension in various settings needs to be studied for developing strategies for that particular geographical area. To utilize the resources in more efficient way, strategies need to differ in rural-urban and underserved- well-served areas.Aims:The present study aims at exploring whether the rule of halves holds good in the city of Mumbai as the findings of such research may have implications on strategies to control hypertension in communities. Hence, the objectives of this study are to ascertain the proportion of persons with hypertension with respect to the status of diagnosis, treatment, adequate treatment, and validate it with existing rule of halves.Setting and Design:Study was conducted in the urban field practice area of a teaching hospital and medical college of Mumbai that comprises 42 chawl (housing structures); study design- cross-sectional observational study.Materials and Methods:This observational cross-sectional study was conducted over a period of 18 months in the field practice area of a teaching hospital and medical college of Mumbai with a total population of 43,069. Sample size was 667. After ethical clearance, participants were interviewed using pretested semi-structured interview schedule that included socio-demographic factors, risk factor evaluation, clinical examination, and anthropometry. Subjects with diagnosed hypertension were questioned thoroughly about hypertension adherence.Statistical Analysis:Descriptive statistics was applied on quantitative data.Results:A total of 667 people from five chawls of age more than 35 years were included into the study. The mean age of study subjects was 50.84 ± 11.47 years. Out of total 667 respondents, 20.3% respondents were normotensive, 50.3% respondents were pre-hypertensive, 25.3% respondents were in stage 1 hypertension, and 4% respondents were in stage 2 hypertension. In contrary to the classical rule of halves, the present study shows only 31% of the diagnosed hypertensives are adequately treated.Conclusions:The strategies in the national programs are from the traditional understanding of rule of halves and emphasize increasing awareness and treatment. Family physician should actively involve in regular screening, treatment, and adherence of hypertension treatment. As a part of primary care, community participation is required for effectively achieving the target BP goal of the population.

Improved treatment and control of hypertension in Swedish primary care: results from the Swedish primary care cardiovascular database.

To study temporal trends in hypertension treatment and control in Swedish primary care, in relation to clinical characteristics, comorbidity, and drug treatment. Repeated cross-sectional analysis of 43 239 hypertensive patients attending primary care in 2001-2002 and of 62 407 patients in 2007-2008. Mean blood pressure (BP) 2007-2008 was 143/79 mmHg in women and 142/81 mmHg in men. Cardiovascular comorbidity and diabetes were present in 13 and 15% of women, and in 18 and 20% of men. Overall BP reductions from 2001-2002 to 2007-2008 were 9.0/3.1 mmHg; greater in women than men, with advancing age, and in patients with comorbidity (all P < 0.001). Attainment of target BP (<140/90 mmHg) increased from 24 and 26% in women and men (2001-2002) to 37 and 37% (2007-2008; all P < 0.001). Most common drug classes in 2001-2002 were, in descending frequency, β blockers, diuretics, and calcium channel blockers (both sexes), and in 2007-2008 β blockers, diuretics, and angiotensin-converting enzyme inhibitors in women, and β blockers, angiotensin-converting enzyme inhibitors, and diuretics in men. The number of drug classes/patient increased from 1.5 (2001-2002) to 1.8 (2007-2008; P < 0.001) but remained low (1.7) in those above target BP. BP control in hypertensive patients attending Swedish primary care has improved over 5-7 years, and more so in high-risk groups. There is, however, room for improvement. In uncontrolled hypertension the combination of several drug classes remain low.

Blood pressure and lipid target adherence in Korean patients receiving angiotensin II receptor blockers/statin regimens

Objectives: Hypertension and dyslipidemia are important cardiovascular risk factors. Simultaneously controlling blood pressure (BP) and lipid levels is effective in preventing cardiovascular events and premature death. This study investigated the association between adherence to angiotensin II receptor blocker (ARB)/statin regimens and BP or low density lipoprotein-cholesterol (LDL-C) target attainment in Korean patients with concomitant hypertension and dyslipidemia.Methods: In this retrospective, multicenter study, we collected case report forms (CRFs) of hypertensive patients with concomitant dyslipidemia who were prescribed an ARB/statin regimen between 1 April 2014 and 31 March 2015 from 51 outpatient clinics. A total of 672 and 609 patients were eventually included for statistical analyses of BP and LDL-C, respectively. Adherence was measured by medication possession ratio (MPR) for 6 months following the index date.Results: The overall rates of attaining BP and LDL-C targets were 75.6% and 81.1%, respectively. The mean value of MPR for patients attaining target BP or LDL-C was significantly higher than that for those not attaining target BP or LDL-C. After adjustment for all covariates, increases in the quartiles of MPR were significantly associated with an increased probability of attaining target BP or LDL-C in all models (all p-trend <0.05). Attaining of BP control was significantly higher in quartiles 3 and 4 of MPR (MPR >0.95) than the lowest MPR (quartile 1), whereas attaining LDL-C target was associated with quartile 4 of MPR (MPR >0.97).Conclusion: We identified a strong correlation between medication adherence and BP or LDL-C target achievement in Korean patients with concomitant hypertension and dyslipidemia. The adherence for reaching targets could be different between BP and LDL-C levels.

A randomized comparison between lercanidipine and amlodipine for efficacy and tolerability in patients with essential hypertension

Background: Lercanidipine, a newly added dihydropyridine, was compared with one of its older and time tested congener- amlodipine for their efficacy and tolerability. Methods: This was a prospective, double blind, parallel group study. 100 patients according to inclusion and exclusion criteria were randomised into two groups of 50 each. One group received lercanidipine 10 mg while second group received tablet amlodipine 5 mg at the beginning, both once daily orally for 12 weeks of duration. Follow up was done at 2, 4, 8 and 12 weeks. Systolic and diastolic blood pressure was recorded in sitting position. If the patient did not attain target blood pressure of 140/90 mmHg, dose was titrated at 4, 8 weeks. Tolerability was assessed by questioning about adverse drug reactions at follow up and derangements of routine laboratory parameters at the end. Z test was used for analysis. Results: There was no statistical difference between antihypertensive efficacies of two drugs. Number of patients showing adverse reactions were significantly less in lercanidipine group compared to amlodipine. Though vasodilation related adverse reactions were less lercanidipine group, significant difference was observed only in occurrence of pedal edema. This difference in incidence of edema cannot be related to the extent of reduction in blood pressure. Conclusions: With the comparable antihypertensive efficacy, lercanidipine is associated with considerably lower incidence of vasodilation related side effects than amlodipine, especially pedal edema. This favourable tolerability profile can potentially enhance treatment outcome by promoting better adherence to drug therapy.

32 Reductions in peak blood pressures and variability following central arteriovenous anastomosis in patients with resistant hypertension

Background Elevated blood pressure remains the most common modifiable cardiovascular risk factor. Many patients continue to be exposed to this risk due to the failure to attain target blood pressure levels due to pharmacologic resistance. The creation of a 4 mm central iliac arteriovenous anastomosis, a treatment targeting the mechanical properties of the arterial system has recently been shown to reduce average blood pressure in patients resistant to pharmacotherapy. Objectives We undertook this study to evaluate the impact of central arteriovenous fistula on 24 h peak pressures and blood pressure variability in resistant hypertensive patients. Methods In this open-label, multicentre, prospective, randomised trial, patients with elevated blood pressure despite therapy were randomised to undergo implantation of an AV coupler device along with previous treatment, or to maintain previous treatment alone. All patients underwent ABPM at baseline and at 6 months. Results Data is presented on 75 patients who were randomised to arteriovenous coupler therapy (n = 40) or control (n = 35) groups. Peak systolic pressures during the 24 h period were reduced by 17.4 ± 22.1 mmHg, (p Conclusions In this study we have shown a reduction in blood pressure variability following iliac AV anastomosis creation. The coupling of blood pressure reduction and cushioning of blood pressure peaks and BP variation over the 24-hour period may be of benefit for patients with uncontrolled hypertension.

Renal denervation superior to drug therapy in hypertension

Despite widespread use of conventional antihypertensive therapy, which effectively reduces blood pressure in most hypertensive patients, a failure to attain target blood pressure levels in about 10% of patients with arterial hypertension suggests a deficit in present strategies, leaving this patient cohort at high risk of cardiovascular and renal disease.1 Although mechanisms underlying the pathogenesis of arterial hypertension are complex and multifactorial, augmented sympathetic activation crucially contributes to hypertension and its adverse effects.

Self blood pressure monitoring improves awareness and attainment of target blood pressure goal: prospective observational study of 7,751 patients

Backgrounds: We investigated self blood pressure monitoring (SBPM) would improve the awareness of importance of blood pressure (BP) control, compliance of antihypertensive medications and the rate of blood pressure control in hypertensive patients. Methods: A total of 7,751patients who visit out-patients clinic of private and university hospitals in Korea were recommended by duty physicians to measure self BP with automatic electronic BP monitors at home. Office BP changes before and after SBPM was compared. Attainment of target BP and compliance of antihypertensive drugs were also compared before and after SBPM. Patients and duty physicians were interviewed on perception of value of SBPM. Results: Mean BP significantly decreased from 142/88mmg to 129/80mmHg (P<0.001) and target BP attainment rate increase from 5% to 15% (P=0.02). Drug compliance measured by no medication day/week increased from 0.86 day to 0.53 day (P=0.013). Only 33% and 57% of patients know the normal BP range and target BP respectively in patients. Awareness of importance of BP control increased from 90% to 98% after SBPM. Ninety two percents of physicians replied SBPM is important, 94% answered SBPM is helpful in controlling BP and 90% recommended their patients to measure SBPM. Conclusions: Self blood pressure monitoring improves BP control rate, drug compliance and knowledge of patients on BP. Most physicians acknowledge the importance and SBPM and recommend it for BP control in Korea.

Pressure points in primary care

Hypertension results in high morbidity and mortality. Its management is predominantly undertaken in the primary care setting. The aim of this study was to assess trends in blood pressure (BP) and hypertensive management in primary care in Australia. A retrospective analysis of patient-based electronic medical records was conducted. Antihypertensive therapy was determined by prescription data. We identified 532 050 patients (55% women, average age 54 ± 18 years) being managed by 733 general practitioners from 286 clinics Australia-wide who had at least one visit with BP recorded between 2005 and 2010. Average BP did not change and men had consistently higher levels than women (132/79 vs. 127/77 mmHg, P < 0.001). At least 25% of all individuals had a visit where elevated BP more than 140/90 mmHg was recorded. Up to 50% of patients on antihypertensive therapy had a BP more than 140/90 mmHg. In any year, the odds of elevated BP more than 140/90 mmHg were three-fold to four-fold higher in treated individuals (yearly range OR 3.0-3.97; 95% CI 2.93-3.83 to 3.08-4.10). Over annual contiguous visits in 51 721 patients with BP more than 140/90 mmHg, BP decreased after two visits and then remained stable (P < 0.001) irrespective of frequency of visits or antihypertensive treatment. Individuals with more frequent visits were more likely to attain target BP less than 140/90 mmHg [OR 1.08 (three visits) to 1.29 (five visits); 95% CI range 1.03-1.38]. In the absence of any significant gains in the community control of hypertension since 2005, a more intensive approach to BP management in primary care is required to ensure more patients achieve BP targets.