Blood Pressure Control In Patients Research Articles

Optimal blood-pressure control in patients with hypertension.

'Optimal blood-pressure control in patients with hypertension is vital to reduce risk of complications, and medication adherence is an important yet oft en ignored factor influencing blood-pressure control. This article in Primary Health Care explores influencing factors and successful interventions that improve adherence'.

Does Garlic Supplementation Control Blood Pressure in Patients with Severe Coronary Artery Disease? A Clinical Trial Study

BackgroundHypertension is one of the major risk factors for cardiovascular morbidities, including coronary artery disease (CAD).ObjectivesWith interest on the important role of hypertension in the progression of CAD, this study was designed to estimate the effect of garlic powder tablets on the blood pressure (BP) in patients with severe CAD.MethodsA randomized, placebo-controlled, clinical trial was conducted on 56 CAD patients, aged 25 - 75 years old. The patients were randomly divided into two groups: Galois groups (n = 27), receiving garlic powder tablet (400 mg garlic) twice daily and the placebo groups (n = 29), receiving placebo for 3 months. The BP was assessed at baseline and at the end of the study.ResultsDuring the 3 months study, in the placebo group, systolic BP (SBP) increased with 6.3 mmHg and diastolic BP (DBP) increased with 4.6 mmHg, changes which were significant. After the 3 months, the effect of garlic on SBP, after adjusting for baseline value, was significant, and this effect was more significant in hypertensive patients. Plasma lipids and lipoproteins did not change significantly in either the garlic or placebo groups, during the study. Tolerability, compliance and acceptability were high in all patients.ConclusionsThese results demonstrate that treatment with garlic-based drugs can be an effective treatment for controlling BP in CAD patients and has no interaction with other drugs that CAD patients take. Therefore, it may be considered as a safe adjunct treatment for this group of patients.

Comparative Effectiveness of Management Strategies for Renal Artery Stenosis

Atherosclerotic renal artery stenosis (ARAS) is associated with high blood pressure (BP), decreased kidney function, renal replacement therapy (RRT), and death. To compare benefits and harms of percutaneous transluminal renal angioplasty with stent placement (PTRAS) versus medical therapy alone in adults with ARAS. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1993 to 16 March 2016; gray literature; and prior systematic reviews. Randomized, controlled trials (RCTs); nonrandomized, comparative studies (NRCSs); single-group studies; and selected case reports that reported all-cause and cardiovascular mortality, RRT, kidney function, BP, and adverse events. Six researchers extracted data on design, interventions, outcomes, and study quality into a Web-based database. Eighty-three studies met eligibility criteria. In 5 of 7 RCTs, PTRAS and medical therapy led to similar BP control in patients with ARAS, and no RCTs showed statistically significant differences in kidney function, mortality, RRT, cardiovascular events, or pulmonary edema. Eight NRCSs had more variable results, finding mostly no significant differences in mortality, RRT, or cardiovascular events but heterogeneous effects on kidney function and BP. Procedure-related adverse events were rare, and medication-related adverse events were not reported. Two RCTs found no patient characteristics that were associated with outcomes with either PTRAS or medical therapy. Single-group studies found various but inconsistent factors that predict outcomes. Case reports provided examples of clinical improvement after PTRAS in patients with acute decompensation. Limited clinical applicability and power in RCTs, and possible publication bias and lack of adjusted analyses in NRCSs. The strength of evidence regarding the relative benefits and harms of PTRAS versus medical therapy alone for patients with ARAS is low. Studies have generally focused on patients with less severe ARAS. Agency for Healthcare Research and Quality.

Blood Pressure Control in Hypertensive Patients in Federally Qualified Health Centers: Impact of Shared Decision Making in the Office-GAP Program.

Background: Hypertension (HTN) in people with diabetes doubles the risk of cardiovascular disease. Prior patient activation studies largely show improved communication but little impact on behavior or health outcomes. We sought to 1) assess the impact of Office-Based Guidelines Applied to Practice (Office-GAP) Program on blood pressure (BP) control; 2) determine the rate and predictors of BP control in patients with HTN and/or diabetes mellitus (DM) in federally qualified health centers. Methods: Sample: Patients with coronary heart disease (CHD) and/or DM with history of HTN; analyzed patients with DM and HTN compared to HTN without DM. Intervention: Office-GAP included physician training, patient activation, and an Office-GAP decision checklist. Two-site intervention/control design; data collection at baseline and after 3, 6, and 12 months. Logistic regression with propensity scoring assessed impact on BP control over time. Results: Of 243 patients, HTN was present in 75% at baseline; 32% had BP controlled. Consistent trend showed Office-GAP slightly improved the rate of BP control across time, while the control arm showed a nonsignificant decrease in the rate of BP control across time, compared to baseline. BP improved at 6 months at the intervention site compared to control site (odds ratio = 2.92; 95% confidence interval = 1.11–7.69). Conclusion: BP control was better at the intervention site compared to the control site at 6 months. Office-GAP shows promise to implement guidelines-based patient-centered care that improves BP.

Review of the Systolic Blood Pressure Intervention Trial for Hypertension Management: How Low to Go for Patients With Stroke?

One of the great successes of modern medicine is the development of effective pharmacological treatments to lower blood pressure (BP). Of the modifiable risk factors for cardiovascular disease, elevated BP or hypertension has the highest population attributable risk,1 and a near continuous relationship with rates of stroke and coronary heart disease from levels of 115 mm Hg systolic and 75 mm Hg diastolic BP.2 Overviews of randomized trials are consistent in showing that lowering systolic BP by 5 to 10 mm Hg reduces the risk of stroke by one third, irrespective of disease history, initial BP level, or type of agent used.3–5 Moreover, more intensive long-term BP lowering can result in additional benefits proportional to the size of fall in BP.4–6 Despite this body of evidence, there has been longstanding controversy (and consternation) over the levels to which BP should be brought down by treatment for the prevention of cardiovascular disease. Because there has been limited randomized evidence, guideline committees have been challenged in defining BP targets below 130 to 140 mm Hg to manage individual patients.7 Concerns over diminishing net benefit being overtaking by excessive harm with increasing reductions in BP is supported by a physiological argument over critical thresholds for organ perfusion and secondary analysis of randomized trials suggesting a J-shaped relationship with cardiovascular events.8 Moreover, recent trials of more intensive BP lowering, including the Action to Control Cardiovascular Risk on Type 2 Diabetes (ACCORD)9 and Secondary Prevention of Small Subcortical Strokes (SPS3),10 failed to show significant reductions in rates of ischemic stroke with systolic BP reductions below 120 and 130 mm Hg, respectively. The main result of the Systolic …

Blood Pressure Control in Hypertensive Patients, Cardiovascular Risk Profile and the Prevalence of Masked Uncontrolled Hypertension (MUCH).

Introduction:The term masked hypertension (MH) should be used for untreated individuals who have normal office blood pressure but elevated ambulatory blood pressure. For treated patients, this condition should be termed masked uncontrolled hypertension (MUCH).Research Objectives:Masked uncontrolled hypertension (MUCH) has gone unrecognized because few studies have used 24-h ABPM to determine the prevalence of suboptimal BP control in seemingly well-treated patients, and there are few such studies in large cohorts of treated patients attending usual clinical practice. This is important because masked hypertension is associated with a high risk of cardiovascular events. This study was conducted to obtain more information about the association between hypertension and other CV risk factors, about office and ambulatory blood pressure (BP) control as well as on cardiovascular (CV) risk profile in treated hypertensive patients, also to define the prevalence and characteristics of masked uncontrolled hypertension (MUCH) among treated hypertensive patients in routine clinical practice.Patients and methods:In this study 2514 male and female patients were included during a period of 5 years follow up. All patients have ambulatory blood pressure monitoring (ABPM) for at least 24h. We identified patients with treated and controlled BP according to current international guidelines (clinic BP, 140/90mmHg). Cardiovascular risk assessment was based on personal history, clinic BP values, as well as target organ damage evaluation. Masked uncontrolled hypertension (MUCH) was diagnosed in these patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP ≥130mmHg and/or 24-h diastolic BP ≥80mmHg).Results:Patients had a mean age of 60.2+10 years, and the majority of them (94.6%) were followed by specialist physicians. Average clinic BP was 150.4+16/89.9+12 mmHg. About 70% of patients displayed a very high-risk profile. Ambulatory blood pressure monitoring (ABPM) was performed in all recruited patients for at least 24h. Despite the combined medical treatment (78% of the patients), clinic control (<140/90 mmHg) was achieved in only 26.2% of patients, the corresponding control rate for ambulatory BP (<130/80 mmHg) being 32.7%. From 2514 patients with treated BP, we identified 803 with treated and controlled office BP control (<140/90 mmHg), of whom 258 patients (32.1%) had MUCH according to 24-h ABPM criteria (mean age 57.2 years, 54.7% men). The prevalence of MUCH was slightly higher in males, patients with borderline clinic and office BP (130–139/80–89 mmHg), and patients at high cardiovascular risk (smokers, diabetes, obesity). Masked uncontrolled hypertension (MUCH) was most often due to poor control of nocturnal BP, with the proportion of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that solely attributable to daytime BP elevation (22.3 vs. 10.1%, P 0.001).Conclusion:The prevalence of masked suboptimal BP control in patients with treated and well-controlled clinic BP is high. The characteristics of patients with MUCH (male, longer duration of hypertension, obesity, smoking history, and diabetes) indicate that this is a higher-risk group with most to gain from improved BP.

Incidence, aetiology and mortality secondary to hypertensive emergencies in a large-scale referral centre in Israel (1991-2010).

Hypertensive emergency (HE) is a life-threatening condition that requires immediate blood pressure (BP) reduction. Although it has been on the decline, the incidence of HE has recently increased in a few countries. The aim of the present retrospective study was to evaluate the incidence, aetiology and 1-year mortality of HE in a large medical centre over a 20-year period (1991-2010). The electronic medical records of all patient files who were hospitalized in the Chaim Sheba Medical Center in Israel from 1991 to 2010 with a primary diagnosis (at admission or discharge) of Malignant Hypertension, Hypertensive Emergency or Accelerated Hypertension were retrieved and analysed. The study interval was divided into four periods of 5 years each. Among 306 files reviewed, only 142 patients had a true HE. Average age at presentation was 63.3±16.5 years. Men were younger than women (59±16 vs 68±16 years; P<0.001). At presentation, most patients (80.3%) had been diagnosed with essential hypertension previously and were undertreated. Average maximum mean arterial pressure (MAP) was higher in men (169±22 mm Hg) than in women (161±17 mm Hg; P=0.026). The rate of HE decreased over the course of the study, from 12.7/100 000 admissions during 1991-1995 to 6.2/100 000 admissions (2006-2010). Similarly, 1-year mortality decreased from 16.7 to 3.6%. The rate of HE has decreased and the prognosis has improved over the last two decades. Appropriate BP control of patients with essential hypertension may further decrease the risk of HE.

Hypertension in 2015: Resistant hypertension: impact and evolving treatment options.

Combination therapy with optimal doses of multiple antihypertensive drugs fails to achieve blood pressure (BP) control in up to 15% of hypertensive patients. Key studies in 2015 highlighted the risks of uncontrolled hypertension and evaluated new therapeutic modalities designed to achieve satisfactory BP control in patients with treatment-resistant hypertension.

Blood Pressure Management After Intracerebral Hemorrhage.

Elevated blood pressure (BP), which presents in approximately 80% of patients with acute intracerebral hemorrhage (ICH), is associated with increased risk of poor outcome. The Second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2) study, a multinational, multicenter, randomized controlled trial published in 2013, demonstrated better functional outcomes with no harm for patients with acute spontaneous ICH within 6h of onset who received target-driven, early intensive BP lowering (systolic BP target <140mmHg within 1h, continued for 7days) and suggested that greater and faster reduction in BP might enhance the treatment effect by limiting hematoma growth. The trial resulted in revisions of guidelines for acute management of ICH, in which intensive BP lowering in patients with acute ICH is recommended as safe and effective treatment for improving functional outcome. BP lowering is also the only intervention that is proven to reduce the risk of recurrent ICH. Current evidences from several randomized trials, including PROGRESS and SPS3, indicate that long-term strict BP control in patients with ICH is safe and could offer additional benefits in major reduction in risk of recurrent ICH. The latest American Heart Association/American Stroke Association (AHA/ASA) guidelines recommended a target BP of <130/80mmHg after ICH, but supporting evidence is limited. Randomized controlled trials are needed that focus on strict BP control, initiated early after onset of the disease and continued long-term, to demonstrate effective prevention of recurrent stroke and other major vascular events without additional harms in the ICH population.

Effect of Intensive Blood Pressure Lowering on Incident Atrial Fibrillation and P-Wave Indices in the ACCORD Blood Pressure Trial.

There are no proven strategies to prevent atrial fibrillation (AF) in patients with type 2 diabetes (T2DM). We compared standard blood pressure (BP) lowering vs. intensive BP lowering in reducing incidence of AF or P-wave indices (PWI-ECG markers of left atrial abnormality that are considered intermediate phenotypes of AF) in patients with T2DM. We analyzed data from the ACCORD BP trial-a randomized controlled nonblinded trial (2001-2009) which randomized patients with T2DM and systolic BP (SBP) 130-180mm Hg on ≤3 antihypertensive medications aged 40-79 years with cardiovascular disease (CVD) or aged 55-79 years with subclinical CVD or ≥2 CVD risk factors to standard BP lowering (SBP <140mm Hg) vs. intensive BP lowering (SBP <120mm Hg). The primary outcome was a composite of incident AF and PWI. Data from 3,087 participants (mean age, 62.2 years; women, 48.2%; non-White, 39.2%) were analyzed. During a mean follow-up of 4.4 years, the primary outcome occurred in 1,063 participants (incidence rate, 84.5 per 1,000 person-years in the standard-therapy group vs. 73.9 per 1,000 person-years in the intensive-therapy group). The adjusted hazard ratios (95% confidence intervals) of intensive-therapy group for the primary outcome and for incident PWI alone were 0.87 (0.77-0.98), P = 0.02 and 0.87 (0.76-0.98), P = 0.02, respectively. The effect of intensive therapy on the incidence of AF alone did not reach statistical significance. In patients with T2DM, intensive BP lowering reduces the incidence of the composite outcome of AF and PWI, suggesting a potential benefit from stringent BP control in patients with T2DM. clinical trials registration Trial Number NCT00000620.

Blood pressure and prognosis in patients with incident heart failure: the Diet, Cancer and Health (DCH) cohort study.

Our objective was to test the hypothesis that elevated blood pressure (BP) is associated with increased risk of stroke, bleeding and death in patients with incident heart failure (HF). We conducted a prospective cohort study among subjects who were participants in the Diet, Cancer and Health study, born in Denmark, aged 50-64years at recruitment. We assessed stroke (ischemic stroke or systemic embolic events), major bleeding, death and the composite endpoint according to degree of BP control in patients with incident HF. BP was assessed prior to HF at cohort entry. Of the whole cohort of 55,748 subjects, n=2159 (35% female) had incident HF, of which 12% had treatment for hypertension. Median follow-up after incident HF was 3.5years. High systolic (SBP), diastolic (DBP) and pulse (PP) pressures were associated with an increased risk of stroke, major bleeding and the composite endpoint. For death and stroke/death, the relation appeared U-shaped for SBP and DBP. When comparing the highest quartile group (Q4) to first quartile group (Q1), SBP (Q4: SBP>163mmHg) was associated with significantly higher adjusted hazard rate ratio (HR) for stroke (HR 1.46, 95% CI 1.00-2.14) and major bleeding (HR 1.68, 95% CI 1.12-2.53). For DBP (Q4: DBP>94mmHg), adjusted HR was significantly higher for major bleeding (HR 1.63, 95% CI 1.13-2.38). The highest quartile of pulse pressure (Q4: PP>74mmHg) was associated with non-significantly higher risk of stroke (HR 1.40, 95% CI 0.94-2.06). We have shown for the first time that amongst a population with incident HF, higher baseline systolic, diastolic and pulse pressure levels were associated with a higher rate of adverse events. Our data support the importance for optimised BP control, as part of the holistic management of HF patients.

Antyhypertensive drugs and Blood pressure control in patients with obstructive sleep apnea: a prospective observational study

e10 Volume 37 Number 8S ANTyhyperTeNSiVe drugS ANd Blood preSSure CoNTrol iN pATieNTS wiTh oBSTruCTiVe Sleep ApNeA: A proSpeCTiVe oBSerVATioNAl STudy LN. Diogo; P. Pinto; C. Barbara; A.L. Papoila; and E.C. Monteiro CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal; Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal; and CEAUL, Lisbon, Portugal Background: Obstructive sleep apnea (OSA) is an independent risk factor for hypertension. Continuous positive airway pressure (CPAP) is considered the gold standard treatment for symptomatic OSA patients, but its effectiveness on blood pressure (BP) control is modest and concomitant antihypertensive therapy is still required. The best antihypertensive regimen for BP control in these patients remains unknown. The present work aimed to contribute to the identification of the most effective antihypertensive regimen prescribed in current treatment practice, investigating a hypothetical association between ongoing antihypertensive medication and BP control rates in patients with OSA. Methods: We conducted a prospective observational study (ClinicalTrials.gov: NCT01803815) in a cohort of 205 patients with OSA and hypertension who underwent a sleep study and 24-hour ambulatory blood pressure monitoring (ABPM). Ongoing antihypertensive medication profile was recorded. Logistic regression models were used to investigate the association between antihypertensive regimen and BP control before (n = 205) and, when applicable, after CPAP adaptation (n = 90). Results: According to current guidelines and antihypertensive medication and/or 24-hour ABPM, 63.9% (205/321) of the patients were diagnosed with OSA and hypertension. One hundred fifty-five (155/205) were under antihypertensive medication, and 31 different antihypertensive regimens were found. However, the antihypertensive regimens and the number of antihypertensive drugs were not associated with BP control (P = 0.847; P = 0.991). After CPAP adaptation, a decrease in median nighttime systolic and diastolic BP was observed (P = 0.001; P = 0.006). Nevertheless, the lack of association between antihypertensive regimens and the number of antihypertensive drugs and BP control remained (P = 0.864; P = 0.800). Conclusions: This study shows, for the first time, that BP control is independent of both antihypertensive regimen and the number of antihypertensive drugs and suggests that none of the currently available antihypertensive drugs seem to be effective for the control of BP in patients with OSA. Support: CEDOC/FCT (SFRH/BD/48335/2008 and PTDC/SAUTOX/112264/2009).

General Practitioners' vitamin K antagonist monitoring is associated with better blood pressure control in patients with hypertension--a cross-sectional database study.

BackgroundPatients requiring anticoagulation suffer from comorbidities such as hypertension. On the occasion of INR monitoring, general practitioners (GPs) have the opportunity to control for blood pressure (BP). We aimed to evaluate the impact of Vitamin-K Antagonist (VKA) monitoring by GPs on BP control in patients with hypertension.MethodsWe cross-sectionally analyzed the database of the Swiss Family Medicine ICPC Research using Electronic Medical Records (FIRE) of 60 general practices in a primary care setting in Switzerland. This database includes 113,335 patients who visited their GP between 2009 and 2013. We identified patients with hypertension based on antihypertensive medication prescribed for ≥6 months. We compared patients with VKA for ≥3 months and patients without such treatment regarding BP control. We adjusted for age, sex, observation period, number of consultations and comorbidity.ResultsWe identified 4,412 patients with hypertension and blood pressure recordings in the FIRE database. Among these, 569 (12.9 %) were on Phenprocoumon (VKA) and 3,843 (87.1 %) had no anticoagulation. Mean systolic and diastolic BP was significantly lower in the VKA group (130.6 ± 14.9 vs 139.8 ± 15.8 and 76.6 ± 7.9 vs 81.3 ± 9.3 mm Hg) (p < 0.001 for both). The difference remained after adjusting for possible confounders. Systolic and diastolic BP were significantly lower in the VKA group, reaching a mean difference of −8.4 mm Hg (95 % CI −9.8 to −7.0 mm Hg) and −1.5 mm Hg (95 % CI −2.3 to −0.7 mm Hg), respectively (p < 0.001 for both).ConclusionsIn a large sample of hypertensive patients in Switzerland, VKA treatment was independently associated with better systolic and diastolic BP control. The observed effect could be due to better compliance with antihypertensive medication in patients treated with VKA. Therefore, we conclude to be aware of this possible benefit especially in patients with lower expected compliance and with multimorbidity.

Efficacy and safety of intravenous nimodipine administration for treatment of hypertension in&amp;nbsp;patients with intracerebral hemorrhage

BackgroundNicardipine (NC) is the most commonly used antihypertensive drug in neurological patients with hypertension. Although nimodipine (NM) is widely used to treat cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage, trials exploring its antihypertensive effect after intravenous administration in subjects with intracerebral hemorrhage (ICH) are scarce.MethodsA retrospective study was carried out to compare the safety and efficacy of NC and NM administered intravenously in patients with ICH. Therapeutic responses were assessed by achievement of goal blood pressure (BP); use of additional medications for BP control; proportion of time spent within goal; variability in BP; time to goal BP; number of dose adjustments; variability in ICH volume, Glasgow Coma Scale score, and intracranial pressure; and drug-related complications.ResultsA total of 87 patients were eligible for analysis (n=46 [NC]; n=41 [NM]), and baseline characteristics between groups were similar. Both agents were effective in achieving goal BP during infusion, with 93.5% and 87.8% patients in the NC and NM groups achieving goal, respectively. Fewer additional medications were needed to control BP in the NC group. BP variability was similar and no differences were observed in the mean time to goal BP and mean numbers of dose adjustments between both groups. Interestingly, intracranial pressure declined (P=0.048) during NC administration but increased (P=0.066) after NM treatment. Finally, the incidences of hematoma expansion, neurological deterioration, and adverse drug events were similar in both groups.ConclusionNM is effective and safe for BP control in patients with ICH.

Effect of comprehensive intervention residents health literacy in hypertensive patients with diabetes

Objective To investigate the comprehensive intervention residents health literacy with the therapeutic efficacy of hypertensive patients on diabetes, and to provide a reference for the implementation of clinical interventions. Methods 1 684 cases of community residents were selected as the research objects. Lectures on health, one on one counseling, health manuals mode on the implementation of comprehensive intervention residents health literacy. Comparison of the residents after comprehensive interventionChina citizen health literacy questionnairesurvey results,and the awareness rate of diabetes, high blood pressure, diabetes hypertension compared after comprehensive intervention, the awareness rate, treatment rate and control rate of blood pressure,blood glucose were investigated. Results After comprehensive intervention, the basic knowledge and concept healthy residents of the ratio of 81.94%,healthy lifestyle and behavior of the ratio of 82.18%to 81.77%the proportion of health,skills, health literacy was 54.98%,which were significantly higher than those of intervention, the difference(χ2=17.88,90.67,193.72,413.88,all P<0.05);the number of patients of hypertension in 537 cases,the incidence was 31.89%.The prevalence of hypertension in residents after comprehensive intervention,the awareness rate was 64.06%, the standardized treatment rate was 51.02%and the control rate of hypertension was 35.01%,which were significantly higher than those of intervention(χ2=67.93,24.85,30.66,all P<0.05);prevalence of diabetes in 269 cases,the incidence was 15.97%.The prevalence of diabetes in residents after comprehensive intervention,the awareness rate of diabetes was 78.07%,standardized treatment rate was 60.97%,the blood sugar control rate was 37.17%,which were significantly higher than those of intervention(χ2=68.78,6.33,17.48,all P<0.05). Conclusion The comprehensive intervention residents health literacy is the effective measures to improve the residents'health literacy and health literacy, improve help control blood pressure in patients with hypertension and diabetes, glycemic index, which is of positive significance to promoting the control hypertension, diabetes. Key words: Health literacy; Comprehensive intervention; Diabetes; Hypertension

Control of blood pressure in hypertensive patients on combination therapy

Background and aimThe impact of antihypertensive treatment on blood pressure (BP) control is fairly unknown. The aim of the study was to evaluate the degree of BP control and its relationship with treatment-related factors in hypertensive patients treated with two or three agents and attended in referral units. Patients and methodsWe studied 1337 hypertensive subjects (41% women) with a mean age (SD) of 63 (12) years, who were receiving two or three antihypertensive drugs. The degree of BP control was estimated in a single visit by the proportion of patients with BP below 140/90mmHg. ResultsBP was controlled in 767 patients (57%). Lack of BP control was related to older age (12% risk for each 10-year increase) and the presence of microalbuminuria (64% risk increase). In those treated with two agents, BP control was 61%, without differences between those treated with fixed-drug or free combinations. BP control in those treated with three agents was 55%, higher in those receiving three agents in a fixed-drug combination (68%) compared with those on three agents administered separately (52%; p=0.025). Drug classes used in combinations did not influence the degree of BP control. ConclusionsThe degree of BP control in patients treated with two or three agents is 57%. Microalbuminuria is related to a lack of BP control. In those receiving three agents, the use of fixed-drug combinations is associated with better BP control.

Managing hypertension with ambulatory blood pressure monitoring.

There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.

The Association Between Antihypertensive Medication and Blood Pressure Control in Patients with Obstructive Sleep Apnea.

Obstructive sleep apnea and hypertension are closely related diseases. The lowering effect of continuous positive airway pressure (CPAP) on blood pressure (BP) control is modest and concomitant antihypertensive therapy is still required. However, the best antihypertensive regimen for BP control in patients with OSA remains unknown. We aimed to investigate a hypothetical association between ongoing antihypertensive medication and BP control rates in patients with OSA. We conducted a prospective observational study in a cohort of 205 patients with OSA and hypertension who underwent a sleep study and 24-h ambulatory blood pressure monitoring (ABPM). Ongoing antihypertensive medication profile was recorded. Logistic regression models were used to investigate the association between antihypertensive regimen and BP control, before (n = 205) and, when applicable, after CPAP adaptation (n = 90). One hundred and fifty-five patients (155/205) were being treated with 31 different antihypertensive regimens. At baseline, the antihypertensive regimens and the number of antihypertensive drugs were not associated with BP control (p = 0.847; p = 0.991). After CPAP adaptation, a decrease in median night-time systolic and diastolic BP was observed (p = 0.001; p = 0.006). Nevertheless, the lack of association between antihypertensive regimens and the number of antihypertensive drugs and BP control remained (p = 0.864; p = 0.800). Our findings confirm that although CPAP improves nocturnal BP, this improvement is not sufficient to control blood pressure for 24 h. This study shows, for the first time, that in patients with OSA, there is no association between BP control and both the antihypertensive regimen and the number of antihypertensive drugs.

Calcium channel blockers and hypertension.

Effective treatment of high blood pressure (BP) represents a key strategy for reducing the burden of hypertension-related cardiovascular and renal diseases. In spite of these well-established concepts, hypertension remains poorly controlled worldwide. In order to improve BP control in patients with hypertension, several interventions have been proposed, among which (1) preferred use of more effective, sustained, and well-tolerated antihypertensive drug aimed to ensure adherence to prescribed medications and (2) extensive use of rational, integrated, and synergistic combination therapies, even as first-line strategy, aimed to achieve the recommended BP targets. Within the possible antihypertensive drug classes currently available for the clinical management of hypertension, both in monotherapy and in combination therapy, drugs inhibiting the renin-angiotensin system and calcium channel blockers (CCBs) have demonstrated to be effective and safe in lowering BP levels and achieving the recommended BP targets with a good tolerability profile. In particular, CCBs have been one of the most widely used classes of antihypertensive agents in the last 20 years, based on their effectiveness in reducing BP levels, good tolerability, and abundant evidence on reducing cardiovascular and renal consequences of hypertension. This article provides an updated overview of the evidence supporting the use of CCBs-based antihypertensive regimen, both in monotherapy and in combination therapies with different classes of antihypertensive drugs.

Identifying predictors of blood pressure control in the Lebanese population - a national, multicentric survey -- I-PREDICT.

BackgroundBlood Pressure (BP) is not well controlled and factors that predict BP control are not well identified in Lebanon. Improvement of hypertension management requires an understanding of patients’ characteristics and factors associated with uncontrolled BP. This national, multicentric, observational prospective study was designed to determine the predictors of BP control in patients followed up to 6 months.MethodsI-PREDICT study was conducted on 988 patients with newly diagnosed or uncontrolled hypertension. Socio-demographic and clinical characteristics were analyzed. The level of agreement between doctors’ perceptions on BP control status and JNC VII guidelines was analyzed.ResultsThe predictor associated with poor BP control was diabetes (OR = 0.17, CI = 0.10–0.28 at month-1; OR = 0.15, CI = 0.10–0.24 at month-6). The predictors associated with better BP control at month-6 were the early control of BP at month-1 (OR = 10.39, CI = 6.18–17.47) and combination therapy prescribed at baseline and month-1 (OR = 15.14, CI = 1.09–208.46, P = 0.04). In the sub-group of diabetes, the predictors that were associated with better BP control at 6 months were following diet at V1 (OR = 2.27, CI = 1.01 to 5.12) and BP control at V2 (OR = 7.34, CT = 3.83 to 14.07). The predictors that were associated with poor BP control at 6 months were middle economic class (OR = 0.036, CI = 0.16-0.94) and upper economic class (OR = 0.036; CI = 0.13-0.93).The rate of BP control was significantly higher at month 6 versus month 1 (67.52% vs 44.08%, P = 0.001). Additional analysis showed poor agreement between the doctors’ perceptions on BP control status and the guidelines.ConclusionsReaching an early BP control and combination therapy were significant predictors of better BP control, whereas diabetes was a significant predictor of poor BP control. A poor agreement between JNC VII guidelines and clinical practice was observed. I-PREDICT study identified factors that can be targeted for improving BP control.