Choice Of Antihypertensive Drugs Research Articles

Antihypertensive utilization patterns among pregnant persons with pre-existing hypertension in the US: A population-based study.

Hypertension among persons with childbearing potential is on the rise. Maintaining proper blood pressure during pregnancy is vital to prevent maternal and neonatal complications. Yet, limited evidence on the risk-benefit of various antihypertensives presents challenges for informed decision-making during this critical period. This study aimed to examine the utilization patterns of different classes of antihypertensives among persons with pre-existing hypertension before, during, and after pregnancy. We used MarketScan® Commercial Database 2011-2020 to analyze antihypertensive utilization among pregnant persons aged 12 to 55 identified via a validated algorithm. Pre-existing hypertension was defined as ≥1 inpatient or ≥2 outpatient encounters for hypertension within the 180 days preceding the LMP. Antihypertensive utilization was described during target periods: 0-3 months (0-3M) before pregnancy, 1st/2nd/3rd trimester (T1/2/3), 0-3M, and 4-6M after pregnancy. We identified 1,950,292 pregnancies, of which 20,576 (12,978 live and 7,598 non-live) had pre-existing hypertension. Both groups had similar antihypertensive use (80.1% and 81.0%, respectively) during the 6 months before pregnancy (baseline). For live-birth pregnancies, 13.9% of baseline users discontinued treatment during pregnancy, while 28.9% of non-users initiated antihypertensives during pregnancy, and 17.2% started postpartum. Before pregnancy, the predominant antihypertensives included thiazide diuretics (21.9%), combined α- and β-blockers (18.4%), and dihydropyridines (16.2%). During pregnancy, thiazide diuretics, cardioselective β-blockers, and ACE inhibitors declined (T3: 3.0%, 4.2%, and 0.8%). Dihydropyridine use was steady during pregnancy, but preference shifted from amlodipine to nifedipine in T3 (2.2.% vs.10.8%). Central α2-agonists increased during pregnancy (up to 15.2% in T3) compared to both pre- (9.8%) and post-pregnancy (5.7%). ARBs mirrored ACE inhibitors, with less than 1% utilization in later trimesters. Combination agents dropped from 10.8% pre-pregnancy to 0.8% in T3, then rebounded to 7.3% post-pregnancy. Research is warranted to evaluate the choice of antihypertensives and optimal timing to switch to safer alternatives, considering maternal and fetal outcomes.

Improving cardiovascular control in a hypertensive population in primary care. Results from a staff training intervention

Objective A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model. Design and setting Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention. Intervention Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols. Patients Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively. Main outcome measures Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on −0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured. Results In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%–61% (control 50%–52%), non-significant. However, the percentage of patients with LDL-C < 3.0 mmol/L increased from 34%–40% (control 36%–36%), p = .043, and digit preference decreased, 39%−27% (control 41%−35%), p = 0.000. The number of antihypertensive drugs was constant, 1.63 − 1.64 (control 1.62 − 1.62), non-significant, but drug choice changed in line with recommendations. Conclusion Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment.

Hypertension in frail older adults: current perspectives.

Hypertension is one of the most common chronic diseases in older people, and the prevalence is on the rise as the global population ages. Hypertension is closely associated with many adverse health outcomes, including cardiovascular disease, chronic kidney disease and mortality, which poses a substantial threat to global public health. Reasonable blood pressure (BP) management is very important for reducing the occurrence of adverse events. Frailty is an age-related geriatric syndrome, characterized by decreased physiological reserves of multiple organs and systems and increased sensitivity to stressors, which increases the risk of falls, hospitalization, fractures, and mortality in older people. With the aging of the global population and the important impact of frailty on clinical practice, frailty has attracted increasing attention in recent years. In older people, frailty and hypertension often coexist. Frailty has a negative impact on BP management and the prognosis of older hypertensive patients, while hypertension may increase the risk of frailty in older people. However, the causal relationship between frailty and hypertension remains unclear, and there is a paucity of research regarding the efficacious management of hypertension in frail elderly patients. The management of hypertension in frail elderly patients still faces significant challenges. The benefits of treatment, the optimal BP target, and the choice of antihypertensive drugs for older hypertensive patients with frailty remain subjects of ongoing debate. This review provides a brief overview of hypertension in frail older adults, especially for the management of BP in this population, which may help in offering valuable ideas for future research in this field.

Differences in Antihypertensive Medication Prescription Profiles Between 2009 and 2021: A Retrospective Cohort Study of CARTaGENE.

Although blood pressure (BP) control is critical to prevent cardiovascular diseases, hypertension control rates in Canada are in decline. To assess this issue, we sought to evaluate the differences in antihypertensive medication prescription profiles in the province of Quebec between 2009 and 2021. This is a retrospective cohort study. We used data from the CARTaGENE population-based cohort linked to administrative health databases. Participants with any drug claim in the 6 months prior to the end of follow-up were included. Guideline-recommended antihypertensive drug prescription profiles were assessed at the time of enrollment (2009-2010) and end of follow-up (March 2021). Prescriptions practices from the 2 time periods were compared using Pearson's chi-square tests. A sensitivity analysis was performed by excluding participants in which antihypertensive drugs may not have been prescribed solely to treat hypertension (presence of atrial fibrillation/flutter, ischemic heart disease, heart failure, chronic kidney disease, or migraines documented prior to or during follow-up). Of 8447 participants included in the study, 31.4% and 51.3% filled prescriptions for antihypertensive drugs at the beginning and end of follow-up. In both study periods, guideline-recommended monotherapy was applied in most participants with hypertension (77.9% vs 79.5%, P = .3), whereas optimal 2 and 3-drug combinations were used less frequently (62.0% vs 61.4%, P = .77, 51.9% vs 46.7%, P = .066, respectively). Only the use of long-acting thiazide-like diuretics (9.5% vs 27.7%, P < .001) and spironolactone as a fourth-line agent (8.3% vs 15.9%, P = .054) increased with time but nonetheless remained infrequent. Results were similar in the sensitivity analysis. Specific indication of the prescribed antihypertensive medications and follow-up BP data was not available. Application of hypertension guidelines for the choice of antihypertensive drugs remains suboptimal, highlighting the need for education initiatives. This may be an important step to raise BP control rates in Canada.

1118 Postpartum Antihypertensive Choice and Readmission Outcomes

1118 Postpartum Antihypertensive Choice and Readmission Outcomes

Effective therapy of hypertension from the standpoint of patient-centered medicine

The article presents current data on the choice of antihypertensives from the standpoint of patient-centered medicine. The advantages of combined initial therapy includes high medical adherence, achievement of target blood pressure, and organ protection. Data on the effectiveness of a fixed-dose combination of an angiotensin-converting enzyme inhibitor and a thiazide-like diuretic, in particular, the most commonly used angiotensin-converting enzyme inhibitor lisinopril and long-acting indapamide, are presented. This combination is not only highly effective, but also metabolically neutral, which allows it to be used in patients with obesity, diabetes, and liver diseases. Data are presented on the new favorable effects of lisinopril and indapamide, in particular, on the effect of indapamide on the intestinal microbiota. The potential advantages of this combination as an initial therapy for hypertension in Russian patients are described.

АНАЛИЗ ПРОГНОСТИЧЕСКИХ ПАРАМЕТРОВ, ДЕТЕРМИНИРУЮЩИХ РИСКИ РАЗВИТИЯ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ ДЛЯ ПОВЫШЕНИЯ ПРИВЕРЖЕННОСТИ ПАЦИЕНТОВ К ЛЕЧЕНИЮ

To improve the quality of drug care for patients with arterial hypertension, using a sociological survey, we determined prognostic parameters that determine the risks of developing the disease, which included: hereditary burden, duration of the disease, blood pressure indicators, the presence of concomitant diseases, the frequency of blood pressure measurement, lifestyle, adherence to treatment, quality of life indicators, assessment of the significance of factors in the choice of antihypertensive drugs. The results of the analysis of patient survey data showed that most patients do not underestimate the significance of these parameters, do not have enough knowledge necessary for effective treatment. As an organizational and functional form of improving the professional interaction of medical and pharmaceutical specialists in order to meet the information needs and improve the quality of life of patients, the creation of a medical and pharmaceutical school was recommended. The main purpose of the functioning of the Medical and Pharmaceutical School is to increase the educational level of patients.

Antihypertensive Choices during Pregnancy in Limited Setting

Antihypertensive Choices during Pregnancy in Limited Setting

MP75-14 ANTIHYPERTENSIVE CHOICES IN BLACK MEN CONTRIBUTE TO WORSENED RATES OF ED AND POOR HYPERTENSION CONTROL

You have accessJournal of UrologyCME1 Apr 2023MP75-14 ANTIHYPERTENSIVE CHOICES IN BLACK MEN CONTRIBUTE TO WORSENED RATES OF ED AND POOR HYPERTENSION CONTROL Denise Asafu-Adjei, Olivia Copelan, Cara Joyce, and Milan Patel Denise Asafu-AdjeiDenise Asafu-Adjei More articles by this author , Olivia CopelanOlivia Copelan More articles by this author , Cara JoyceCara Joyce More articles by this author , and Milan PatelMilan Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of death in Black men in the U.S. Erectile dysfunction (ED) serves as an indicator of CVD. CVD disproportionately affects Black men, with hypertension being the leading contributor. Several studies have cited ED side effects as a major factor in antihypertensive noncompliance in Black men, further exacerbating hypertension and ED. For decades, guidelines have recommended thiazides and calcium channel blockers as first line therapies for hypertension in Blacks, despite these options being associated with increased rates of ED. A 2022 retrospective study by Holt et al showed that race-based hypertension guidelines yielded no clear benefits in patient outcomes. We aimed to assess the clinical characteristics and treatment patterns of hypertensive men with ED at an academic medical center. METHODS: All men presenting for an initial visit for ED (primary ICD-10 code N52.9) between October 2015-July 2022 were included for analysis. The electronic health record was queried for patient demographics, provider type, comorbidities, and major drug classes of antihypertensives. Adjusted odds ratios were estimated from multivariable logistic regression (any CVD and any medications) and ordinal logistic regression (number of CVD comorbidities) analyses. RESULTS: Of 2020 men who presented for ED, the mean age was 55±14, 49.7% were White (n=987, 49.7%), 24.8% Black (n=493), and 18.9% Hispanic (n=375). The most common cardiovascular comorbidity was hypertension (n=960, 47.5%). Underlying cardiovascular disease burden was generally higher among Black men. Black men had higher odds of being prescribed an antihypertensive (aOR vs White: 1.50, 95% CI: 1.16-1.93; aOR vs Hispanic: 1.96, 95% CI: 1.45-2.67). However, Black men were prescribed beta blockers and thiazides significantly more than White and Hispanic men. White men were prescribed angiotensin receptor blockers (ARBs) significantly more than Black and Hispanic men. CONCLUSIONS: This study mirrors the effects of race-based hypertension guidelines. ARBs have typically been more favorable antihypertensives when considering sexual function. In this study, we showed that Black men were prescribed ARBs at significantly lower rates compared to White and Hispanic men. Given the significant ED side effects has on hypertension compliance, shifting traditional treatment regimens could lead to improved rates of hypertension control and erectile function. ED sits in a unique position to impact how we solve the CVD crisis. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1085 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Denise Asafu-Adjei More articles by this author Olivia Copelan More articles by this author Cara Joyce More articles by this author Milan Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

PS-C33-7: TRUE RESISTANT HYPERTENSION IN A TERTIARY HYPERTENSION CLINIC IN SAUDI ARABIA

Objective: Resistant hypertension(RH), defined as office blood pressure (BP) above goal despite the use of more than three anti-hypertensives (one ideally being a diuretic) or BP that requires more than four agents to achieve control, has received more attention with increased efforts to improve BP control rates and the emergence of device-based therapies. Based on this definition of RH, the prevalence rates vary around 15–30% worldwide. However, there is paucity of data on RH, particularly true RH in the Middle-East. The aim of this study was to explore the prevalence, clinical characteristics and choice of anti-hypertensives in a Saudi RH population. Design &amp; Methods: We analysed retrospectively clinic and ambulatory BP monitory (ABPM) data in Saudi patients between January 2016 to June 2018. Office HTN was defined as greater than 140 systolic or greater than 90 diastolic, mm Hg. HTN was confirmed using one of the following ABPM cut-offs; 24-hr greater than 130/80 or daytime greater than 135/85, mm Hg. Results were analysed using JMP version 13, p less than 0.05 considered significant. Results: The mean age of the population(n = 540) was 54 ± 15 years, 40% female. The overall prevalence of RH was 47% in our cohort, of which 35% was true RH. The patients with RH were older; 62 ± 13 vs. 50.5 ± 14 years with no significant gender difference. RH was associated with diabetes (OR = 6.2, CI%, 3–12); CAD(OR = 3.3, CI%, 2–5); history of coronary revascularization(CABG/PCI) (OR = 3, CI%, 2–5); CKD(OR = 5.7, CI%, 3–12) and heart failure(OR = 1.9, CI%, 1–3). The average number of anti-hypertensives was 4.2 ± 1 in RH compared with 1.1 ± 1 in control group. Only a third of the patients were prescribed spironolactone in the RH group with some 10% on an alpha blocker. Conclusions: To the best of our knowledge, this is the first study in the Middle-East to establish the prevalence of true RH using ABPM. With a high prevalence rate, our cohort of RH is complex with high number of co-morbidities, sub optimal prescription rates of spironolactone or alpha-blockers, representing a therapeutic challenge.

A Prospective Study on Hypertension-Revealing it to be a key factor for various Medical Complications, their Management and Prevalence in a Secondary Care Hospital

Background: High blood pressure or HTN is a heterogeneous group of disorder characterized by a persistent increase in blood pressure due to the force of blood pushing against the blood vessel walls, which develops over time due to unhealthy lifestyle choices, lack of awareness accompanied by low levels of treatment and uncontrolled rates lead to mortality. Globally Hypertension (HTN) affects two-third of the population resulting in 10.4 million deaths annually. Despite several initiatives, the prevalence of HTN and its adverse impact on cardiovascular, renal, and cerebrovascular morbidity and mortality are globally increasing.&#x0D; Objectives: The objective of the study is to detect the adverse outcomes of uncontrolled hypertension and review the treatment patterns in the management of hypertension to reduce its further complications. To assess whether the higher prevalence of undiagnosed hypertension or poor adherence to antihypertensive therapy or both may explain the higher prevalence of hypertensive complications.&#x0D; Results: In the study, the prevalence of hypertension was found to be 46% among the patient population with males (52.5%) being more prevalent than females (47.5%). Among all age groups, individuals aged 50-69 years were highly affected. From the study, it was found that a greater number of patients fall in the category of stage-2 hypertension (38.75%) followed by hypertension crisis (28.75%), stage-1 hypertension (25%), and normal (7.5%). More patients with uncontrolled hypertension experienced cardiovascular complications (55%) when compared to cerebrovascular (27.5%) and renal (17.5%) complications. The choice of antihypertensive drugs used in the management were diuretics (43.75%), CCB (41.25%), ARB (37.5%), BB (32.5%), B+A (11.25%), ACEI (6.25%), CS (3.75%), and AAB (2.5%). The most commonly prescribed drugs in the study were Furosemide (11.25%), Telmisartan (11.25%), Amlodipine (7.5%), and Metoprolol (6.25%).&#x0D; Conclusion: The study concludes that most of the patients with uncontrolled hypertension were suffering from cardiovascular complications with least being affected by renal and cerebrovascular complications. A regular and moderate degree of physical activity in combination with good lifestyle choices may have a good impact on hypertension control thus preventing further complications. However, blood pressure control is obtained in some individuals, while in some blood pressure was still elevated after the drug management due to the presence of co-morbid conditions and poor lifestyle modifications.&#x0D;

The choice of antihypertensive drugs in the treatment of arterial hypertension in children and adolescents: retrospective study

Aim. To conduct a study of prescribed antihypertensive therapy in order to determine the criteria for choosing antihypertensive drugs and assess their effectiveness in children with arterial hypertension (AH).&#x0D; Materials and methods. A retrospective study was carried out. We have analyzed medical records of 102 children with AH aged 6 to 17 years, who were examined and treated at the Smolensk Regional Children's Clinical Hospital in the period from 01.01.2019 to 31.12.2019.&#x0D; Results. Based on the inclusion criteria, 102 children were selected for the retrospective study, of which 74 (72.6%) were boys and 28 (27.4%) girls. In 56 (54.9%) patients heredity was burdened by cardiovascular diseases in the line of parents and grandparents, in 46 (45.1%) patients heredity was not burdened. The most frequent complaints registered in the case histories of patients were: 89 (87.3%) headache, mainly in the occipital region; 18 (17.7%) dizziness; 16 (15.7%) stabbing pain in heart; 10 (9.8%) increased heart rate. In 31 (28.4%) of the examined children, grade I AH was detected; in 56 (54.9%) grade II AH; 6 (5.9%) autonomic dysfunction syndrome; 9 (8.8%) had labile AH. As a drug antihypertensive monotherapy for the treatment of hypertension in children and adolescents in the Russian Federation, five main pharmacological groups are recommended: angiotensin-converting enzyme inhibitors (ACE inhibitors); angiotensin receptor blockers; -blockers; calcium channel blockers (dihydropyridine); thiazide diuretics, which was confirmed by a retrospective analysis. Drug therapy for AH was prescribed to children after 612 months of ineffectiveness of non-drug therapy. Of the ACE inhibitors group, 46 (45.1%) patients were prescribed a drug enalapril, 5 (4.9%) fosinopril, 2 (2%) captopril. -blockers 11 (10.7%) patients were prescribed bisoprolol, 1 (1%) patient atenolol. From the group of angiotensin receptor blockers, 1 (1%) child was prescribed losartan, 1 (1%) irbesartan. Calcium channel blockers were recommended for 1 (1%) patient as amlodipine. Diuretics were prescribed to 1 (1%) child with the drug indapamide.&#x0D; Conclusion. Based on our study, it was found that angiotensin-converting enzyme inhibitors are the priority pharmacological group in the treatment of hypertension in children and adolescents.

Novi pristup sagledavanju hipertenzije u hroničnoj bubrežnoj bolesti kroz prizmu poslednjeg KDIGO vodiča 2021

Hypertension associated with chronic kidney disease (CKD) is related with a high risk of cardiovascular disease (CVD), which is the most common cause of morbidity and mortality in patients with CKD. Control of hypertension is important primarily because it reduces the risk of CVD and all-cause mortality in patients with CKD. The new KDIGO (Kidney Disease: Improving Global Outcomes) guideline for the management of blood pressure in CKD were published in 2021 and represented an updated version of the original guideline from 2012. This guideline covers all topics contained in the original instructions, such as optimal blood pressure targets, lifestyle interventions, choice of antihypertensive drugs, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid control and smoking, are excluded. In addition, this guideline introduces a chapter dedicated to proper blood pressure measurement as all large randomized trials from which the evidence and recommendations of this guide emerged used standardized preparation and measurement protocols adhered to by patients and clinicians. The key recommendation of the KDIGO guideline refers to target systolic blood pressure under120 mmHg in most adults with CKD, provided that the standardized office blood pressure measurement is used. Despite recommendations for lowering target blood pressure, general lack of evidence, especially in patients with diabetes and advanced CKD, still suggests the need to individualize targets according to the characteristics, tolerances, and preferences of each patient. Larger randomized controlled trials are needed to examine the effects of blood pressure targets on major adverse events and mortality in patients with CKD, especially in subpopulations that were not adequately represented in previous studies.

Prevalence and Management of Hypertension along with its Complications - A Prospective Study

Aim: The main aim of the study was to estimate the prevalence of hypertension and correlate hypertension with the occurrence of its complications.&#x0D; Study Design: The study was designed to detect the adverse outcomes of uncontrolled hypertension and review the treatment patterns in the management of hypertension along with the complications.&#x0D; Place and Duration of the Study: This study was an observational study conducted for a period of six months from January to June 2020, at THUMBAY HOSPITAL NEW LIFE, in an inpatient department.&#x0D; Methodology: Using a suitable designed data form, details of the patient were collected from patient demographics, prescription charts, laboratory data, medical records, doctor's and nursing notes.&#x0D; Results: In this study, the prevalence of hypertension was found to be more in males (52.5%) than in females (47.5%). Among all age groups, individuals aged 50-59 yrs were highly affected. From the study, it was found that a greater number of patients fall in the category of stage-2 hypertension (38.75%) followed by hypertension crisis (28.75%), stage-1 hypertension (25%), and normal (7.5%). More patients with uncontrolled hypertension experienced cardiovascular complications (55%) when compared to cerebrovascular (27.5%) and renal (17.5%) complications. Chi Squared Test was used to analyse the significance of the study. P values &lt; 0.0001 was considered as statistically significant.&#x0D; Conclusion: It was concluded that the choice of antihypertensive drugs used in the management of hypertension were diuretics followed by Angiotensin receptor blockers (ARBs) and Calcium Channel blockers. The most commonly prescribed drugs in the study were Furosemide, Telmisartan, Amlodipine, Metoprolol, followed by clinidipine, carvedilol, metolazone, perindopril, cardiopril, and torsemide.

AMBULATORY BLOOD PRESSURE MONITORING INDICATORS IN MIDDLE-AGED AND ELDERLY HYPERTENSIVE PATIENTS UNDER COMBINED ANTIHYPERTENSIVE THERAPY

It is known that arterial hypertension affects 30-35% of adult population of industrialized countries, and its prevalence reaches 40-50% among the elderly. In recent years, the issue of optimizing of treatment of hypertension in elderly people has been discussed such as choice of effective antihypertensive drugs with the least number of side effects, prevention of complications, reduced mortality, improvement of quality of life.&#x0D; The aim of the study was to substantiate the antihypertensive efficacy of the combination of enalapril and amlodipine in middle-aged and elderly hypertensive patients.&#x0D; Material and methods. Indices of ambulatory blood pressure monitoring were identified in 57 middle-aged patients (45-59 years) (group I) and 43 elderly patients (60-74 years) (group II), who underwent two-week in-patient treatment. All patients received the combined antihypertensive therapy (enalapril 10 mg twice daily and amlodipine 5 mg daily) for 2 weeks. And they were divided into 2 groups of 24 hours day's profile of blood pressure: dippers and non-dippers.&#x0D; Results. The combination of enalapril and amlodipine in elderly patients reduced the average daily diastolic blood pressure by 20,3% (p&lt;0,05). Instead, in middle-aged patients there was the decrease in the average daily and the maximal daily systolic blood pressure by 17,3% (p&lt;0,001) and 7,8% (p&lt;0,05) and diastolic blood pressure respectively − by 23,2% (p&lt;0,001) and 11,8% (p&lt;0,05).&#x0D; Conclusions. Therefore, combined antihypertensive therapy in the elderly for 14 days was insufficient to improve significantly ambulatory blood pressure monitoring indicators. Obviously, positive changes require longer treatment.

Раціональна антигіпертензивна терапія пацієнтів старших вікових груп

Стаття присвячена питанню ведення осіб старших вікових груп з артеріальною гіпертензією з наголосом на фармакологічне лікування. Для обґрунтування вибору антигіпертензивного препарату на підставі принципів доказової медицини наведено результати рандомізованих контрольованих клінічних досліджень із залученням хворих похилого і старечого віку з артеріальною гіпертензією. Згідно з проведеними систематичними оглядами та метааналізами в порівняльному аспекті представлено ефекти різних класів антигіпертензивних препаратів щодо впливу на серцево-судинні події при лікуванні цієї категорії пацієнтів. Рекомендації стосовно раціональної фармакотерапії артеріальної гіпертензії з урахуванням вікових особливостей хворих надано з варіантних позицій відповідно до настанов провідних експертів та міжнародних організацій – Європейського товариства кардіологів, Європейського товариства фахівців з гіпертензії, Американського товариства фахівців з гіпертензії, робочої групи Європейського товариства фахівців з гіпертензії та Товариства геріатричної медицини Європейського Союзу з ведення артеріальної гіпертензії в пацієнтів старечого віку, Канадського освітнього проєкту з гіпертензії, Американської колегії терапевтів і Академії сімейних лікарів, Національного інституту охорони здоров’я та вдосконалення медичної допомоги Великої Британії. Узагальнено тактику лікування пацієнтів похилого і старечого віку з артеріальною гіпертензією.

Dynamics of blood pressure indicators in patients with diabetes mellitus after planned percutaneous coronary intervention

Arterial hypertension (AH) is a common modifiable cardiovascular risk factor. Despite the wide choice of antihypertensive drugs, according to epidemiological studies, just over 20% of patients demonstrate effective control of hypertension. Failure to achieve the target values of blood pressure (BP) determines a high probability of developing cardiovascular events, which is also true for patients undergoing percutaneous coronary interventions (PCI). However, there is evidence that individuals who have undergone PCI show a higher percentage of achieving the target blood pressure levels. Aim of the study was to evaluate the dynamics of blood pressure indicators in patients with stable coronary artery disease (CAD) and diabetes mellitus, depending on the fact of performing PCI.Material and methods. The study was conducted at federal state budgetary scientific institution research institute of complex issues of cardiovascular diseases as a prospective, open, not comparative. The study included 75 patients with stable CAD and type 2 diabetes who regularly received therapy for at least 1 month prior to the start of participation in this study. The majority of patients 45 (60%) are represented by males. The median age was 52.64±6.96 years. 44 patients (58.81%) had a history of myocardial infarction, and 46 patients (61.33%) had previously undergone myocardial revascularization, history of stroke had 5 patients (6.66%). All patients according to the daily blood pressure monitoring at the 1st visit had average daily blood pressure values above 130/80 mmHg. Participants were divided into 2 groups: 43 patients had indications for routine PCI at the time of inclusion in the study, 32 patients had no indications for revascularization. The groups did not have significant differences in clinical and anamnestic characteristics, and regular significant differences were noted in relation to previously undergone revascularization (46.51 and 81.25%, respectively, p=0.0022) and the SYNTAX Score (14.39±9.20 and 6.13±8.28, respectively, p=0.0001). During 4 visits (1 visit, 1 month, 3 months, 6 months), ambulatory blood pressure monitoring (ABPM) was performed using the BiPiLAB system.Results. Initially according ABPM parameters group without the alleged PCI had greater variability in systolic blood pressure (SBP) in the daytime, higher values of mean diastolic blood pressure (DBP) at night, more time index of hypertension DBP at night. After 1 month of follow — up (for the group with PCI 1 month after the procedure), there were significant differences in the average daily SBP and DBP, the index of the time of hypertension DBP in the daytime, and the average daily SBP. Patients who underwent revascularization had lower ABPM values. The previously described differences in the night time DBP and the index of hypertension time at night were preserved. After 3 months of follow-up, significant differences were observed only in the indicators of night time SAD and DBP. At the end of the study (6 months of follow-up), the groups had differences only in the indicators of mean diastolic pressure at night.Conclusion. Patients who underwent PCI for 1 month after the procedure have a significant tendency to normalize (compared to the group without revascularization) blood pressure indicators. However, over time, the effect «escapes». Most likely, the short-term improvement in blood pressure is due to a temporary improvement in treatment adherence after an invasive procedure.

Management of Hypertension in Pregnancy

Abstract Hypertension in pregnancy is currently defined as a systolic blood pressure (BP) of 140 mmHg or more, or a diastolic BP of 90 mmHg or more. This level of BP warrants antihypertensive therapy. Treating to a target BP of 135/85 mmHg halves the risk of severe hypertension that is itself associated with adverse maternal and perinatal outcomes, similar in magnitude to preeclampsia. While based on the results of the Control of Hypertension in Pregnancy Study (CHIPS) trial, this finding is consistent with all antihypertensive trials to date. Also, in the CHIPS trial, “tight” BP control also halved the risk of progression to thrombocytopenia and elevated liver enzymes for the mother, without adverse effects for the fetus or newborn. This was true regardless of the gestational age at which BP control was instituted. While methyldopa, labetalol, and nifedipine are the most commonly-recommended oral antihypertensives, it is not clear that one antihypertensive agent has advantages over the others for treatment of non-severe hypertension in pregnancy. No antihypertensives, including renin-angiotensin-aldosterone system (RAAS) inhibitors, have been shown to be teratogenic, although there may be an increase in malformations associated with the underlying condition of chronic hypertension. Atenolol and RAAS inhibitors should not be used once pregnancy is diagnosed, based on fetotoxicity. At present, BP treatment targets used in clinic are the same as those used at home as the differences are quite variable among hypertensive women. For treatment of acute severe hypertension, the most commonly-recommended antihypertensives are oral nifedipine, IV labetalol, and IV hydralazine, although oral agents have also been shown to be effective in the majority of women; while concerns raised about IV hydralazine-induced maternal hypotension and its consequences have not been confirmed, this medication may be an inferior antihypertensive to oral nifedipine. While treatment recommendations are based on evidence, women should be engaged in decision-making, as their values may alter target BP and antihypertensive choice. Future work will clarify the optimal target BP based on home BP measurements; whether BP targets should be lowered further if the definition of hypertension is based on a lower BP; which, if any, antihypertensive medication for non-severe hypertension is better with regards to maternal and perinatal outcomes; and whether factors beyond BP level (such as variability, race, and other physiological variables) should inform antihypertensive therapy in pregnancy.

Clinical and Pharmacological Approaches to the Prescription of Centrally Acting Antihypertensive Drugs for Uncontrolled Arterial Hypertension

Episodes of rapid increase in blood pressure due to uncontrolled arterial hypertension, previously known as a hypertensive urgency, is common clinical condition which many of practicing physicians are encountered daily. As a rule, these conditions are not life-threatening, however they could lead to target-organs damage if not promptly relieved. Therefore, clear evidence-based recommendations of optimal antihypertensive drug administration in these situations would provide more safe and effective therapy. Despite that, definite expert consensus regarding optimal choice of antihypertensive drugs to manage these patients have not been reached so far. The aim of the current review was to assess the results obtained from clinical trials regarding the safety and efficacy of moxonidine for urgent hypertensive therapy in patients with uncontrolled arterial hypertension admitted to emergency healthcare units as well as in those at the prehospital stage. Performed literature-based analysis revealed enough evidences proving that moxonidine can be administered in a single dose of 0.4 mg as a drug of choice in situations where prompt and stable hypotensive effect is desired. Results of comparative studies designed to closely match real clinical settings indicate that more adequate and sustainable therapeutic effect is achieved after moxonidine administration in comparison to other frequently used antihypertensive drugs.

Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study

ObjectiveTo evaluate the implementation of National Institute for Health and Care Excellence antenatal hypertension guidelines, to identify strategies to reduce incidences of severe hypertension and associated maternal and perinatal morbidity...