Choice Of Antihypertensive Treatment Research Articles

Abstract 16795: Blood Pressure Lowering Therapeutical Strategies Have Different Impact on Brain Functional Connectivity

Hypertension is a major risk factor for cognitive impairment and dementia. Using functional MRI, researchers have been able to study the brain’s functional connectivity in hypertensive patients. This has revealed that even before showing signs of vascular dementia, hypertensive patients have altered brain connections compared to normotensive patients. Our aim is now to characterize whether different classes of antihypertensive drugs, which vary in their mechanism of action and ability to cross the blood-brain barrier, have different effects on the brain’s functional organization. In this study, 42 hypertensive patients with controlled blood pressure underwent resting-state functional MRI. The data was analyzed using CONN to build functional connectivity network matrices and analyze the amplitude of spontaneous brain activity fluctuations (fALFF). These results were then evaluated using general linear models to identify connections that were modulated by specific classes of antihypertensive drugs. We applied regression models taking into account age, sex, BMI, alcohol, smoke and BP levels as covariates. Our results show that treatment with diuretics was associated with a large connectivity network among several brain networks (A). Treatment with ACE inhibitors (B), ARBs (C), and beta-blockers (D) was also associated with significant modulation of specific connections (all highlighted connections p<0.05, statistics in figure). Overall, diuretics had the greatest impact on brain function, possibly due to their effect on blood volume and cerebral circulation, with the effect further confirmed by fALFF analyses, showing a widespread reduction of the BOLD-signal intensity of spontaneous cerebral activity (all highlighted clusters p<0.05, statistics in figure E). These findings may help inform the choice of antihypertensive treatment for individual patients, taking into account the potential cognitive and functional impact of different drugs.

Prevalence and correlates of frailty in older hypertensive outpatients according to different tools: the HYPER-FRAIL pilot study.

To date, few studies have investigated frailty in hypertensive individuals. This study aimed at identifying the prevalence of frailty in a sample of hypertensive older outpatients using six different identification tools. Clinical correlates of frailty and agreement between different frailty definitions were also investigated. The HYPER-FRAIL pilot study recruited hypertensive patients aged at least 75 years from two geriatric outpatient clinics of Careggi Hospital, Florence, Italy. Four frailty scales [Fried Frailty Phenotype, Frailty Index, Clinical Frailty Scale (CFS), Frailty Postal Score] and two physical performance tests [Short Physical Performance Battery (SPPB) and usual gait speed] were applied. The Cohen's kappa coefficient was calculated to assess agreement between measures. Multiple logistic regression was used to identify clinical features independently associated with frailty. Among 121 participants (mean age 81, 60% women), frailty prevalence varied between 33 and 50% according to the tool used. Moderate agreement was observed between Fried Frailty Phenotype, Frailty Index and SPPB, and between Frailty Index and CFS. Agreement was minimal or weak between the remaining measures (K < 0.60). Use of walking aids and depressive symptoms were independently associated with frailty, regardless of the definition used. Frailty correlates also included dementia, disability and comorbidity burden, but not office and 24-h blood pressure values. Frailty is highly prevalent among older hypertensive outpatients, but agreement between different frailty tools was moderate-to-weak. Longitudinal studies are needed to assess the prognostic role of different frailty tools and their clinical utility in the choice of antihypertensive treatment.

Management of Hypertension in Patients with Diabetes: A Comprehensive Review of the Perceptions and Practices of Health Care Providers in India.

This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31-50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin-angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.

Epidemiological Observational Study on the Assessment of the Comorbidity and the Efficacy of the Treatment of Hypertensive Patients with Single Pill Combination of Lysinopril, Amlodipine and Rosuvastatin "PHENOTYPE-AG"

Aim. To study the prevalence of comorbidity affecting the choice of antihypertensive treatment, as well as the efficacy and safety of the application of a single pill combination of lysinopril, amlodipine and rosuvastatin (SPC LAR) in hypertensive patients.Material and methods. Observational epidemiological study with the participation of 626 doctors and 13037 hypertensive patients with high cardiovascular risk and dyslipidemia treated with SPC LAR were held in 24 cities of Russia from November 2020 to March 2021. Prevalence and types of comorbidity, changes of blood pressure (BP), of total cholesterol (TC) and blood glucose levels and adverse events were studied during observation. Patients had 3 visits – initially, after 4 and 12 weeks. The obtained data was recorded by doctors through a web portal.Results. Concominant cardiovascular diseases found in all patients (in 38.7% of cases – from 2 to 5 diseases). The most commonly diseases were coronary artery disease (43.1%), metabolic syndrome (36.6%), diabetes (25.2%), chronic heart failure (24.9%), cerebrovascular diseases (12.3%) and chronic obstructive pulmonary disease (0.5%). SPC LAR with minimal doses of components (in 41.1% of patients) or with reinforced antihypertensive or hypocholesterolemic effects, based on the experience of treatment, the patient was prescribed as starting treatment with doctors. Reducing the level of systolic and diastolic BP, as well as the level Tc, respectively, by 20.9%, 16.9% and 29.7% found during the study. Target levels of systolic BP were achieved in 97.6% of patients, diastolic BP – in 99.6%, and target levels TC ≤5 mmol/l, ≤4 mmol/l and ≤3 mmol/l were achieved, respectively, in 94.5%, 68.6% and 23.5% patients. No significant dynamics of the level of glycemia were not found. The treatment was well tolerated by patients. Side effects found in 0.53% of patients (more often there was a dry cough, feet edema and headache). Commitment to treatment was 92.7%.Conclusion. The modern hypertension phenotype has cardiovascular atherosclerosis-associated diseases, which justifies the need to combine antihypertensive and hypolipidemic therapy. Triple SPC LAR, which effectively controlled the blood pressure and improved the violation of lipid metabolism was prescribed to patients in this observational study. The low frequency of side effects and good tolerance of treatment was accompanied by a high adherence of patients to treatment.

Clinical outcomes between calcium channel blockers and angiotensin receptor blockers in hypertensive patients without established cardiovascular diseases during a 3-year follow-up

Although both angiotensin receptor blockers (ARBs) and dihydropyridine calcium channel blockers (CCBs) are all suitable for the initiation of antihypertensive treatment, studies investigating efficacy and safety between ARBs and CCBs are limited, and there is no previous study comparing their clinical outcomes during long-term follow-up periods in real world setting. We compared cardiovascular (CV) events between ARBs and CCBs in 464,948 hypertensive adults using the Korean National Health Insurance Service database during a 3-year follow-up. The patients with hypertension without heart failure, ischemic heart disease, cerebrovascular disease, or peripheral artery disease were enrolled. The CV events between only single prescription of CCBs and ARBs were finally compared. The primary endpoint for this study was the first occurrence of a major adverse CV events, defined as the composite of all-cause death, cardiac death, nonfatal myocardial infarction, or nonfatal stroke. ARB was significantly more administered in male and patients with higher income, diabetes mellitus, chronic kidney diseases, and higher Charlson comorbidity index. The primary endpoints occurred in 10,526 patients (5.2%) in the ARB group and in 19,363 patients (7.3%) in the CCB group (p < 0.001) during a 3-year follow-up (HR 0.96, 95% CI 0.93–0.98). All the components of CV events including all-cause death, cardiac death, nonfatal myocardial infarction, and nonfatal stroke occurred more frequently in the CCB group. With multivariable models adjusting age, sex, income, diabetes, chronic kidney disease, and Charlson comorbidity index, the primary endpoints less frequently developed in the ARB group than in the CCB group (HR 0.957, 95% CI 0.933–0.983, p < 0.001). After the propensity-score matching, baseline characteristics were similar and still showed significantly better primary endpoints in ARB group than CCB group (5.3% vs. 5.8%, p < 0.001). In this nationwide population-based simple hypertension study, administration of ARBs showed superior protection against CV events than CCBs during a 3-year follow-up. Our results suggest that ARBs could be preferred over CCBs as the initial choice of antihypertensive treatment regardless of age in real-world practice.

Frailty and hypertension in older adults: current understanding and future perspectives.

Hypertension is an important factor affecting the health of older adults. Antihypertensives can reduce stroke, cardiovascular events, and mortality in older hypertensive patients. Blood pressure management is difficult in older adults since geriatric syndromes such as frailty and comorbidities often coexist with hypertension. Recent guidelines propose taking functional status into account when targeting blood pressure in older people. Therefore, a better understanding and control of frailty risk factors could improve the prognosis of older adults with hypertension. However, there are relatively few studies on hypertension and frailty in older adults, especially studies focused on antihypertensive treatment. The goals, target values, and choice of antihypertensive treatment for frail older adults are still disputed. We reviewed the recent literature focusing on frailty and hypertension in older adults and propose a management process for screening and assessing frailty and hypertension before the use of antihypertensives. The process can support older adults with lifestyle interventions and frailty management and help them begin taking a single antihypertensive medication.

Choice of anti-hypertensive treatment in HELLP syndrome at ehu Oran

In Africa and Asia, nearly 10% of maternal deaths are associated with hypertensive disorders during pregnancy. Among the hypertensive disorders, HELLP syndrome (Hemolysis Elevated Liver Enzymes, Low Platelets: HS) represents a significant cause of severe morbidity and long-term disability. Our goal was to evaluate the management of antihypertensive treatment in HS syndrome. Our prospective, monocentric study included patient with a HS between January 2013 and December 2016. Our protocol was based on the antihypertensive molecules available in our institution administered orally: alfa methyl-dopa, nicardipine and acebutolol and intravenously: most often nicardipine and magnesium sulfate when pre-eclampsia was diagnosed. One hundred and sixty-five patients with HS were admitted; mean age: 32 ± 6.33 years old, the average parity was 2 ± 1, the average term for onset of pre-partum HS was 32 weeks of amenorrhea. At admission, 112 patients (68%) had epigastric pain in the upper right thoracic quadrant; severe hypertension with arterial pressure values > 160/110 mmHg was found in 116 patients (70.3%), headache in 83 patients (50%), visual disturbances in 27 (16.4%), confusion and hyper-reflexivity in 43 patients (26.1%). Magnesium sulfate was used in 68 patients. 96 patients received nicardipine alone intravenously. The combination of magnesium sulfate and nicardipine was performed in 27 patients, without significant deleterious hemodynamic or respiratory side effects. The management of hypertension was done according to a codified protocol with molecules available in each Maghreb establishment; it requires deep involvement of the paramedical staff.

Hypertension et grossesse. Le post-partum

Post-partum period is associated with specific characteristics in women with gestational disorders or preeclampsia. For breastfeeding women, the choice of antihypertensive treatment should take into account the impact on child health. The impact of breastfeeding on health mother must be also discussed. Moreover, for lactation inhibition, bromocriptine should not be used, especially in the context of gestational disorders. In post-partum period, the best contraceptive strategy is only-progestin contraception or non-hormonal contraceptives use. However, this choice will depend on the stabilization or normalization of blood pressure in early post-partum period. Finally, several consultations should be suggested: an information and announcement to explain the consequences of these gestational disorders and organize their multidisciplinary management and follow-up. A preconceptional consultation takes its place to anticipate potential recurrent preeclampsia or gestational hypertension and to schedule a future pregnancy in optimal conditions.

Individualization of antihypertensive drug treatment.

Antihypertensive drug classes are usually classified as 1st, 2nd, 3rd, and 4th or 5th choice to help physicians select the drug most suitable for treatment initiation among the very many classes available to lower blood pressure (BP) in patients with a BP elevation. However, this approach was appropriate decades ago when several drugs had inconveniences that made their use in monotherapy inadvisable. An example was the then widely used vasodilator hydralazine whose sodium-retaining and tachycardic effects made its administration recommendable only with a diuretic or a β-blocker, with, thus, a classification as a 2nd- or 3rd-choice drug (1). This is no longer the case because several current antihypertensive drug classes are characterized by a similar BP-lowering effect (2), a good tolerability profile (2), and evidence of cardiovascular protection in prospective randomized trials (3,4). As recently argued in a document of the European Society of Hypertension (5), this implies that rather than classifying drugs as 1st, 2nd, 3rd, and further choice, it might be more appropriate to help physicians select the drug (or drug combination) that might be preferred for treatment initiation in a given patient or a given clinical condition. This article will discuss the factors that may help physicians move toward this more individualized treatment approach. ### Demographic factors Evidence is available that antihypertensive treatment is protective in either hypertensive males or hypertensive females and that for a similar decrease in BP the reduction of cardiovascular risk is proportionally similar in both sexes (6). Thus, sex does not represent a factor to consider in the choice of antihypertensive treatment except for the need to avoid blockers of the renin-angiotensin system (ACE inhibitors, angiotensin receptor antagonists, and renin inhibitors) in pregnant women because of the suspicion, from animal studies, of teratogenic effects (7). Although the British guidelines have long maintained …

P 7: Does choice of antidiabetic and/or antihypertensive treatment influence progression of nephropathy in hypertensive type 2 diabetic patients?

It is well known that coexistence of arterial hypertension and type 2 diabetes significantly multiply cardio-renal risks. But the question remains – is it enough to strictly control blood glucose and blood pressure no matter how? Is the choice of treatment also important? So, the aim of this study was to assess the influence of the choice of antidiabetic and/or antihypertensive treatment on the rate of nephropathy progression in hypertensive type 2 diabetic patients, during long-term follow-up period. The study included 126 (62 female/64male) hypertensive type 2 diabetic patients (mean age: 50.45+5.61 years; duration of diabetes: 10.03+4.91 years and duration of hypertension: 11.32+5.38 years). Patients were assigned to antidiabetic and antihypertensive treatment aiming to attain pre-defined level of glycaemic (HbA1c < 7%) and blood pressure control (<130/85 mmHg). Nephropathy progression parameters, average annual increment of microalbuminuria (Δ UAE) and deterioration of glomerular filtration rate (Δ GFR), were prospectively followed-up for a mean period of 6.28 (0.88) years. Statistical analysis was performed using the STATISTICA 4.5 program (StatSoft, Tulsa, OK, USA). The significance of differences was evaluated using the Kruskal-Wallis test. A value of p<0.05 was accepted as statistically significant. A total of 62 (49.2%) patients achieved good glycaemic control while tight blood pressure control was achieved and maintained in 76 (60.3%) patients. Choice of antidiabetic treatment did not significantly influence the quality of glycaemic control (P=0.4233), while choice of antihypertensive drugs significantly influenced the quality of achieved blood pressure control (P=0.0357), speaking in favor of ACEI. Choice of antidiabetic treatment did not significantly influence the rate of microalbuminuria progression as well as the rate of deterioration of glomerular filtration both in patients with good (P=0.641 and P=0.837, respectively) and those with poor glycaemic control (P=0.305 and P=0.256, respectively). However, choice of antihypertensive treatment significantly influenced the rate of microalbuminuria progression (P=0.011) as well as the rate of deterioration of glomerular filtration (P=0.0013), but only in those with tight blood pressure control. Independently from the quality of achieved glycaemic control, choice of the antidiabetic treatment did not significantly influence the rate of nephropathy progression in hypertensive type 2 diabetic patients. However, choice of antihypertensive treatment significantly influenced the rate of progression of microalbuminuria and the rate of deterioration of glomerular filtration but only in those patients in whom good control of blood pressure was achieved.

Choice of Antihypertensive Treatment in Subjects with Pre-Diabetes. Is There a Dream After the Navigator

The majority of individuals with pre-diabetic states eventually appear to develop diabetes mellitus. During the pre-diabetic state, that may last many years, the risk of cardiovascular disease is modestly increased, with impaired glucose tolerance being slightly stronger predictor for future cardiovascular disease than impaired fasting glucose. The role of different antihypertensive drugs in the acceleration or the delay of diabetes onset is controversial. Agents that interrupt the renin-angiotensin system, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers are likely to be beneficial in the prevention of diabetes, while calcium channel blockers are thought to act metabolically neutral. In contrast, diuretics or β-blockers, and especially their combination, are thought to increase the incidence of diabetes. Carvedilol, a non-selective β-blocker with α(1)-blocking properties, and nebivolol, a third-generation highly selective β(1)- blocker with additional endothelial nitric oxide (NO)-mediated vasodilator activity have been shown to have a favorable effect on glucose metabolism compared with others β-blockers. Nevertheless, the key goal still remains to reduce blood pressure, which may require combination of different antihypertensive drug classes. Changes from diuretics and β- blockers to renin-angiotensin system inhibitors certainly have cost implications. However, treatment with angiotensin converting enzyme inhibitors and angiotensin receptor blockers may be cheaper in the long run, due to less risk of new-onset diabetes and other metabolic disturbances. Thus, for patients with pre-diabetes it is wise to choose medications with the least diabetogenic potential and until more data are available, it seems prudent to restrict use of diuretics and classic β- blockers.

2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

For several years the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) decided not to produce their own guidelines on the diagnosis and treatment of hypertension but to endorse the guidelines on hypertension issued by the World Health Organization (WHO) and International Society of Hypertension (ISH)1,2 with some adaptation to reflect the situation in Europe. However, in 2003 the decision was taken to publish ESH/ESC specific guidelines3 based on the fact that, because the WHO/ISH Guidelines address countries widely varying in the extent of their health care and availability of economic resource, they contain diagnostic and therapeutic recommendations that may be not totally appropriate for European countries. In Europe care provisions may often allow a more in-depth diagnostic assessment of cardiovascular risk and organ damage of hypertensive individuals as well as a wider choice of antihypertensive treatment. The 2003 ESH/ESC Guidelines3 were well received by the clinical world and have been the most widely quoted paper in the medical literature in the last two years.4 However, since 2003 considerable additional evidence on important issues related to diagnostic and treatment approaches to hypertension has become available and therefore updating of the previous guidelines has been found advisable. In preparing the new guidelines the Committee established by the ESH and ESC has agreed to adhere to the principles informing the 2003 Guidelines, namely 1) to try to offer the best available and most balanced recommendation to all health care providers involved in the management of hypertension, 2) to address this aim again by an extensive and critical review of the data accompanied by a series of boxes where specific recommendations are given, as well as by a concise set of practice recommendations to be published soon thereafter as already done in 2003; …

The Effect of Antihypertensive Agents on New-Onset Diabetes Mellitus

Recent large hypertension trials have shown great differences in incidence of new-onset diabetes mellitus among patients receiving different antihypertensive drug therapies. The incidence of diabetes is unchanged or increased by the use of thiazide diuretics and beta-adrenoceptor antagonists (beta-blockers) and unchanged or decreased by ACE inhibitors, calcium channel blockers (CCBs), and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers). Recent results from ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) showed superiority of the 'new' combination of CCBs and ACE inhibitors over the 'old' or 'conventional' combination of beta-blockers and diuretics. In this review, the results from some of the large hypertension trials are discussed, and the hypotheses on how different antihypertensive drug regimens can affect glucose homeostasis are considered. The question now is whether the results from these recent trials should affect the choice of antihypertensive treatment, particularly for special groups. However, the key goal is still to reduce BP, and this usually requires combinations of drugs.

Recent insights in the development of organ damage caused by hypertension

Recent recommendations for the management of hypertension have stressed the importance of assessing subclinical target organ damage for the evaluation of cardiovascular risk, the choice of antihypertensive treatment and the follow-up of hypertensive patients. In addition to classic hallmarks of target organ damage (left ventricular hypertrophy, renal dysfunction, microalbuminuria), new concepts emerging from basic research and technical progresses have allowed more accurate and earlier detection of target organ damage affecting the heart (plasma BNP, coronary calcifications), the brain (silent lacunar infarcts, advanced deep white matter lesions, microbleedings) and the vasculature. The latter include markers of diffuse atherosclerosis (carotid intima-media thickness), arterial stiffness (pulse wave velocity, augmentation index) and endothelial dysfunction (increased plasma levels of adhesion molecules). Current studies should help to better define the predictive power of these new phenotypes for the occurrence of overt cardio- and cerebrovascular diseases, their reversibility under antihypertensive treatment and the most adapted therapeutic strategy in at-risk patients. Furthermore, early identification of hypertensive patients more likely to develop target organ damage, will be facilitated by a more global evaluation of cardiovascular risk factors, a better use and wider acceptance of ambulatory BP measurement (including determination of nocturnal dip and blood pressure variability) and, maybe, an increased knowledge of the genetic factors underlying susceptibility to target organ damage. Lastly, randomized studies comparing different classes of antihypertensive drugs should help to test the well-known but frequently challenged concept of additional benefits of some antihypertensive drugs “beyond BP” on prevention and reversal of target organ damage.

Nitric oxide and the regulation of large artery stiffness: from physiology to pharmacology.

The association between arterial stiffening and aging is well described and can be observed in almost all populations worldwide. A number of other cardiovascular risk factors including diabetes and cigarette smoking are also associated with increased large artery stiffness, often referred to as “premature arterial stiffening.” It is now apparent that the aortic pulse wave velocity (PWV), a measure of arterial distensibility, predicts outcome in a variety of different populations, including hypertensives,1 diabetics,2 individuals with end-stage renal disease (ESRD),3 and even in older adults.4 Indeed, in some populations, aortic PWV is a better predictor of future events than peripheral blood pressure.4 Moreover, arterial stiffening may be more than just a marker of cardiovascular risk; stiffening may also play a more direct role in the development of atherosclerotic plaques. Thus, arterial stiffness would appear to be a novel therapeutic target for the prevention of excess cardiovascular morbidity and mortality. To exploit such an exciting prospect fully, it is necessary to understand the factors regulating arterial stiffness. Traditionally, the stiffness of a vessel was viewed as simply a function of the structural elements of the vessel wall and distending (mean arterial) pressure. However, the large arteries also have a generous coat of smooth muscle, which can alter the distribution of stresses between the elastic and collagenous fibers of the vessel wall and thus alter arterial stiffness. Because smooth muscle tone is influenced by a number of circulating and local vasoactive mediators, arterial stiffness may be actively regulated, and indeed modifiable, at least in the short-term. The muscular arteries have a rich sympathetic innervation, and catecholamines are known to alter smooth muscle tone. Moreover, removal of the vascular endothelium in animals alters large artery stiffness,5,6 suggesting that endothelial-derived substances regulate arterial stiffness in vivo. However, the endothelium …

Microalbuminuria

Microalbuminuria

Is it time to measure microalbuminuria in hypertension?

Former guidelines on hypertension never made a commitment to the detection of microalbuminuria for screening or follow-up of hypertensive patients. On the other hand, growing evidence support the contributory role of microalbuminuria in the prediction of absolute cardiovascular risk in hypertension and document the potential relevance of this parameter to the initial choice of antihypertensive treatment. Upcoming new guidelines and diagnostic algorithms in hypertension need to underscore the clinical positioning of microalbuminuria for stratification of risk and follow-up purposes.

The Effects of Calcium Channel Blockers on Cardiovascular Outcomes: a Review of Randomised Controlled Trials

The choice of antihypertensive treatment should be guided by evidence of a reduction in the risk of cardiovascular (CV) events and therefore improved long-term outcome. Using pre-determined criteria, ten randomised, controlled trials that assessed the effects of calcium channel blockers (CCBs) on CV events in patients with hypertension were identified. Six of them enrolled a relatively small number (<1500) of hypertensive patients, whereas four of the studies were much larger (>4500 patients). The smaller studies produced mixed findings, especially those trials where CCBs were compared with diuretics; this may reflect methodological limitations and the impact of random error. The results from the four larger studies produced a consistent message: long-acting CCBs such as nifedipine, administered in a gastro-intestinal-transport-system (GITS) formulation, nitrendipine and diltiazem, reduce CV morbidity and mortality in hypertensive patients. In the one study that specifically enrolled high-risk hypertensive patients, nifedipine GITS was as effective as diuretic therapy in reducing CV events, and in all four larger studies sub-group analyses showed that the benefits of these CCBs extend to hypertensive patients with diabetes. The available evidence supports the use of these long-acting CCBs as a first-line treatment option in hypertensive patients.

PCV35: COMPARABILITY OF PUBLISHED STUDIES ON COST-EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY: DO THE RESULTS HELP THE DECISION-MAKING PROCESS?

OBJECTIVES: Cost-effectiveness studies can provide valuable information for decision-making processes, where limited resources need to be allocated across a variety of different treatments. However, it is argued that the current methods for conducting and reporting cost-effectiveness results for this purpose are sub-optimal. This literature review and analysis compares the most recent hypertension cost-effectiveness studies. The goal is to contribute information so that future cost-effectiveness studies of hypertension treatments will provide more optimal information for clinicians and other decision-makers for the choice of antihypertensive treatment. METHOD: A literature search of several databases for the years 1995–2000 was conducted using the following keywords: hypertension and cost-effectiveness and/or economics. RESULTS: The search resulted in 89 articles, of which only 11% (10 studies) were true pharmacoeconomic studies that contained actual data analysis. Of the 10 studies, the majority reported outcome measures in terms of cost per life year gained, but usually considered more than one outcome measure. Coronary heart diseases and stroke were the most consistent endpoints across the studies but the number and types of endpoints that were included differed significantly among the studies. Only two studies included within-clinical trial treatment effectiveness data, whereas the remaining studies modeled treatment effects from previously published trials. The projected cardiac event rates and life expectancy were most often derived and estimated from the Framingham study. Treatment costs were obtained from several different sources outside clinical trials, and only one study considered costs solely from the trial. CONCLUSION: Despite the increasing emphasis on hypertension as one of the most costly long-term diseases, and the need to reduce costs associated with it, there are relatively few recently published studies on the cost-effectiveness of antihypertensive therapies. Methodologically, these published studies are very different and they do not seem to agree on a common way to provide a cost-effectiveness measure for hypertension treatment, making interpretations and comparability of results across different studies more difficult.

Management of hypertension by general practitioners: an Italian observational study.

Data on patients receiving antihypertensive therapy were collected from 20 general practitioners (GPs) in Campania, Italy, to determine the prescription of different antihypertensive classes and their use with other drugs for concomitant diseases, to investigate the main factors influencing antihypertensive choice, to document treatment outcome, and to assess adverse drug reactions (ADRs). Each GP completed a data card for each consultation that produced an antihypertensive prescription; 1900 cards were collected. The most frequently used antihypertensives were angiotensin-converting enzyme inhibitors (49.6%), calcium antagonists (24.8%), beta blockers (11.7%), angiotensin II-receptor blockers (5.5%), and alpha blockers (0.9%). In 82% of patients, blood pressure was reduced but did not reach normotensive levels. The choice of antihypertensive treatment was influenced by international guidelines (56%), clinical diagnosis (25%), concomitant diseases (8%), cost (4%), compliance (3%), and other factors (5%). ADRs--most often cough (35.7%), edema (22.7%), headache (13.3%), and tachycardia (7.8%)--occurred in 11.8% of patients.