Choice Of Antihypertensive Drugs Research Articles

Antihypertensive agents in systemic hypertension associated with Type 2 diabetes in a tertiary care hospital

Background: Hypertension and diabetes mellitus are both chronic disorders and when they occur as co-morbidities create havoc by presenting with a plethora of morbidity and mortality. Both require drug treatment over a long period of time, which calls for stringent analysis of prescribing trends of the same. Objectives: The present study was intended to analyze prescribing pattern and establish prescribing trends of anti-hypertensive drugs (AHD) in hypertensive diabetic patients. Methods: The present study was a record based, randomized, non-interventional study of 2 years duration conducted at a tertiary care hospital of central India. Prescriptions from 400 case records of hypertensive diabetics were obtained from the medical record section. Demographic details, blood pressure, and AHDs prescribed were systematically entered in pre-validated case record form. All data were thoroughly analyzed for fallacies and appropriateness. Results: Among 400 patients, 221 were males, and 179 were females. Monotherapy was used in 366 (91.5%) patients while combination therapy was used in 34 (8.5%) patients. Most commonly used combination was angiotensin converting enzyme inhibitor (ACEI)+calcium channel blocker (CCB), while in monotherapy CCB≥ACEI>beta blocker>diuretic>angiotensin II receptor blocker were most commonly prescribed. Conclusion: The present study represents trend and attitude of physicians in prescribing AHDs. On comparing with Joint National Committee 7 guidelines, the majority of the cases deviated from the guidelines, mostly in a choice of AHDs and Fixed dose combination.

NEW ASPECTS IN THE TREATMENT OF HYPERTENSION

Hypertension is currently the leading cause of cardiovascular complications (heart attack, stroke) and the resulting deaths of patients. Reduced morbidity and mortality from cardiovascular complications is the main goal of treating patients suffering from high blood pressure (BP). To achieve target BP levels in the arsenal of physicians are five major classes of antihypertensive drugs: angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, β-blockers, diuretics. The choice of antihypertensive drug in concrete clinical situation often complicated and determined by complex factors. Among these presence of risk factors; target organ damage; associated clinical conditions, metabolic syndrome, diabetes, comorbidities; possible individual patient response to antihypertensive drugs of different classes in history; the likelihood of drug interactions; socio-economic factors, including the cost of treatment of hypertension. Promising is the use of angiotensin II receptor blockers ‑ drugs with pleiotropic pharmacological properties that have a multicomponent antihypertensive efficacy, good tolerability, diverse organoprotection that are safe, able to enhance remote prognosis for patients with hypertension. Azilsartan medoxomil is a competitive reversible angiotensin II type 1 receptor antagonist. Azilsartan developing hypotensive effect faster, prolonged and pronounced compared to other sartans (valsartan, candesartan and olmesartan). In addition to antihypertensive action azilsartan medoxomil shows a number of additional pleiotropic effects. These include antithrombotic, antiproliferative and antyfibrotic action. It demonstrates the improvement in glucose tolerance and tissue insulin sensitivity, improves endothelial function, reduces the progression of albuminuria, proteinuria.

«Новые» молекулы в составе рациональных комбинаций антигипертензивных препаратов: вопросы выбора

The article discusses the factors that determine the choice of antihypertensive drugs, especially blockers of receptors of angiotensin and thiazide diuretics. The data about the peculiarities of azilsartan medoxomil, it differs from other sartans. Among the main properties of azilsartan medoxomil, which may determine his choice for the treatment of patients with arterial hypertension, is called the significant strength of the binding of blockers of receptors of angiotensin to AT1 receptor and its duration of action, as well as special properties that improve tissue sensitivity to insulin. Discussed the feasibility of establishing fixed combinations azilsartan medoxomil with thiazide diuretics chlorthalidone.

Peculiarity of medical management of patients with arterial hypertension after liver transplantation

The article analyzes information of the prevalence, causes and mechanisms of development of hypertension in patients after liver transplantation. The authors integrate data from domestic and foreign literature about priorities of choice of antihypertensive drugs and possible changes in patterns of immunosuppressive drug therapy to reduce the risk of onset and progression of cardiovascular disease in patients who were underwent orthotopic liver transplantation.

Optimum antihypertensive therapy: does adiposity matter?

Given that at least 75% of patients with hypertension are obese, it is no coincidence that the continuing obesity epidemic is driving the increasing incidence of hypertension. 1 Landsberg L Aronne LJ Beilin LJ et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment. A position paper of the Obesity Society and the American Society of Hypertension. J Clin Hypertens. 2013; 15: 14-33 Crossref Scopus (266) Google Scholar Physicians have questioned whether the benefits of blood pressure lowering for cardiovascular disease might depend, in part, on choice of antihypertensive drugs (as shown in ACCOMPLISH 2 Jamerson K Weber MA Bakris G et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008; 359: 2417-2428 Crossref PubMed Scopus (1728) Google Scholar ) and that the choice of drugs should vary with the state of adiposity. 3 Weber MA Jamerson K Bakris GL et al. Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trial. Lancet. 2013; 381: 537-545 Summary Full Text Full Text PDF PubMed Scopus (91) Google Scholar Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trialsWe found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean. Full-Text PDF

Community pharmacist surveillance of hypertension in pregnancy: Are we ready for prime time?

Hypertensive disorders of pregnancy (HDP) are associated with serious maternal and perinatal complications. For nonsevere hypertension, there is a lack of consensus regarding treatment during pregnancy and while breastfeeding. Further, there is considerable variability in guidelines for antihypertensive drug choices. As part of a Drug Safety and Effectiveness Network (DSEN)-funded project, we piloted a novel surveillance strategy in which community pharmacists recruited pregnant and breastfeeding women to monitor their blood pressure and medication use and to provide education on HDP. Participating pharmacists were required to complete a certified training program, identify and recruit patients who were pregnant or breastfeeding, obtain informed consent, administer a patient questionnaire and complete an initial case report form for enrolled patients. Study outcomes included the feasibility of community pharmacists to enroll patients and carry out study-related documentation and follow-up. The criteria for success in this pilot study included the ability of pharmacists to recruit 10 participants per pharmacy. 178 community pharmacies across British Columbia agreed to participate in this feasibility study, of which 63 pharmacists completed the study training. Of these, only 21 pharmacists recruited at least 1 patient and 1 pharmacist met the success criteria. Overall, 51 patients were enrolled, 2 withdrew from the study and 7 patients were diagnosed with HDP. Antihypertensive medications used by patients included methyldopa and labetalol. While postmarketing surveillance is an important tool for the assessment of drug safety in the pregnant and breastfeeding patient population, the feasibility of community pharmacists taking on this role was not successfully demonstrated.

Discontinuation of anti-hypertensive drugs increases 11-year cardiovascular mortality risk in community-dwelling elderly (the Bambuí Cohort Study of Ageing).

BackgroundHypertension remains a major public health problem whose management is hampered by poor persistence with pharmacological therapy. The aim of this study was to evaluate the association between discontinuing antihypertensive drugs (AHDs) and the risk of cardiovascular mortality in the elderly.MethodsA population-based prospective cohort study of all of the ≥60-year-old residents in Bambuí city (Brazil) enrolled 1606 subjects (92.2%), of whom 1494 (93.0%) were included in this study. The use of AHDs was ascertained annually in a real-clinical context, and time-varying AHD exposure was categorised as non-use, current use or stopped. The predicted cardiovascular mortality rates were estimated using interval Poisson models for ungrouped person-time data, taking into account current levels of systolic blood pressure (BP).ResultsThe overall adjusted cardiovascular mortality risk ratio of AHD stoppers vs current users was 3.12 (95% CI: 2.35-4.15). There was a significant interaction with BP levels: the association between discontinuing AHDs and the risk of cardiovascular mortality was stronger at higher systolic BP levels. The estimates of the risk of cardiovascular mortality over the follow-up period were similar in AHD users and non-users, for whom AHDs were never prescribed.ConclusionDiscontinuing AHDs increases the risk of cardiovascular mortality in the elderly. Misconceptions about symptoms or drug-related adverse effects could underlie a subject’s decision to discontinue AHDs. Greater attention should be paid to the choice of AHDs and informative action.

Pulse Pressure Is Useful for Determining the Choice of Antihypertensive Drugs in Postmenopausal Women

Objective: To assess the efficacy of various classes of antihypertensive drugs in postmenopausal women with hypertension using pulse pressure (PP) as an index. Patients and Methods: Selected women were required to be naturally menopausal for at least 1 year but not more than 5 years past their menstrual period. Exclusion criteria were a history of preeclampsia or eclampsia, a severe illness such as myocardial infarction or stroke within 6 months, the use of estrogens or progestins within 3 months, proteinuric nephropathy, and surgically induced menopause. There were 114 women who participated in this study after having given informed consent. These women were diagnosed as having hypertension based on an office blood pressure >140/90 mm Hg as well as a self-measured blood pressure at home >130/85 mm Hg. If both levels of blood pressure were not fulfilled, the patients were excluded. All antihypertensive medications were withdrawn 6 weeks before the initiation of the study. The patients were randomly assigned in equal numbers to the following groups: (1) combination therapy with losartan (angiotensin receptor blocker) 50 mg daily + trichlormethiazide (diuretic) 2 mg twice a week, and (2) combination therapy with cilnidipine (calcium channel blocker) 5 mg + arotinolol (αβ-blocker) 10 mg daily. Results: The patients were retrospectively divided into three groups according to their PP at the start of the study: Group I (n = 24), >65 mm Hg; Group II (n = 58), 65-45 mm Hg, and Group III (n = 32), <45 mm Hg. In Group I, combination therapy with cilnidipine + arotinolol resulted in a greater reduction in the systolic blood pressure than the combination therapy with losartan + trichlormethiazide (from 169/88 ± 2/5 to 133/73 ± 2/5 mm Hg vs. from 169/88 ± 2/5 to 149/66 ± 2/5 mm Hg, p < 0.05). On the other hand, in Group III, losartan + trichlormethiazide decreased diastolic as well as systolic blood pressures (from 152/106 ± 2/2 to 123/78 ± 1/1 mm Hg vs. from 149/107 ± 2/2 to 129/84 ± 2/1 mm Hg, p < 0.05). In Group II, there were no differences between the two antihypertensive regimens. Laboratory findings were not influenced by any type of treatment. Conclusions: PP measurement before starting medication for hypertension may be useful for determining the choice of antihypertensive drugs.

QUALITY ASSESSMENT OF ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH ARTERIAL HYPERTENSION WITHOUT CONCOMITANT CARDIOVASCULAR DISEASES AS A PART OF OUTPATIENT RECVASA REGISTER

Aim. To assess the quality of arterial hypertension (HT) pharmacotherapy within the outpatient register RECVASA, emphasizing whether the choice of antihypertensive drugs (AHD) is in line with current clinical guidelines. Material and methods. Patients with HT without ischemic heart disease, chronic heart failure and atrial fibrillation (n=741) were selected from all patients (n=3690) included into the register. Among concomitant diseases were revealed the following: bronchial asthma and/or chronic obstructive pulmonary disease (COPD) – in 42 (5.7%) patients; obesity – in 93 patients, impaired glucose tolerance – in 9 patients, and diabetes mellitus – 84 patients. Prescription of AHD, their number and class were recorded at every next visit to doctor. Accuracy of AHD choice, compliance with current clinical guidelines, and other considerations were assessed through the example of beta-blockers (BBs). Results. AHD were prescribed to 641 patients, and in 13.5% of patients did not receive any AHD. 49.7% of patients received ACE inhibitors, 38.5% – diuretics, 32.5% – BBs. BBs were prescribed to the third part of patients with diabetes and obesity. Furthermore a quarter patients with COPD and the third part of patients with bronchial asthma received BBs. BBs in combination with thiazide diuretics were prescribed to 12 (41.4%) patients with diabetes mellitus and to 13 (40.6%) patients with obesity. Conclusion. Doctors do not always make AHD choice according to current clinical guidelines. Compliance of AHD choice with current clinical guidelines should be an element of treatment quality assessment.

Pharmacological management of hypertension in adults: updates from Eighth Joint National Committee

The choice of first-line antihypertensive drug(s) is a matter of intensive research despite the availability of data from large, randomized, and controlled clinical trials. The Eighth Joint National Committee (JNC) guideline on management of high blood pressure (BP) in adults has significant updates over the earlier guidelines.

Особенности ведения пациентов с артериальной гипертензией после трансплантации печени

The article analyzes information of the prevalence, causes and mechanisms of development of hypertension in patients after liver transplantation. The authors integrate data from domestic and foreign literature about priorities of choice of antihypertensive drugs and possible changes in patterns of immunosuppressive drug therapy to reduce the risk of onset and progression of cardiovascular disease in patients who were underwent orthotopic liver transplantation.

Efficacy of irbesartan in arterial hypertension and metabolic syndrome

The paper gives the data of Russian guidelines for the diagnosis and approaches to treating metabolic syndrome. It considers the choice of antihypertensive drugs in the treatment of hypertensive patients with metabolic syndrome. The benefits of angiotensin II receptor blockers are shown. The results of a number of trials evaluating the efficacy and safety of irbesartan used to manage arterial hypertension in metabolic syndrome are analyzed.

The right choice of antihypertensives protects primary human hepatocytes from ethanol- and recombinant human TGF-&amp;beta;1-induced cellular damage

BackgroundPatients with alcoholic liver disease (ALD) often suffer from high blood pressure and rely on antihypertensive treatment. Certain antihypertensives may influence progression of chronic liver disease. Therefore, the aim of this study is to investigate the impact of the commonly used antihypertensives amlodipine, captopril, furosemide, metoprolol, propranolol, and spironolactone on alcohol-induced damage toward human hepatocytes (hHeps).MethodshHeps were isolated by collagenase perfusion. Reactive oxygen species (ROS) were measured by fluorescence-based assays. Cellular damage was determined by lactate-dehydrogenase (LDH)-leakage. Expression analysis was performed by reverse-transcription polymerase chain reaction and Western blot. Transforming growth factor (TGF)-β signaling was investigated by a Smad3/4-responsive luciferase-reporter assay.ResultsEthanol and TGF-β1 rapidly increased ROS in hHeps, causing a release of 40%–60% of total LDH after 72 hours. All antihypertensives dose dependently reduced ethanol-mediated oxidative stress and cellular damage. Similar results were observed for TGF-β1-dependent damage, except for furosemide, which had no effect. As a common mechanism, all antihypertensives increased heme-oxygenase-1 (HO-1) expression, and inhibition of HO-1 activity reversed the protective effect of the drugs. Interestingly, Smad3/4 signaling was reduced by all compounds except furosemide, which even enhanced this profibrotic signaling. This effect was mediated by expressional changes of Smad3 and/or Smad4.ConclusionsOur results suggest that antihypertensives may both positively and negatively influence chronic liver disease progression. Therefore, we propose that in future patients with ALD and high blood pressure, they could benefit from an adjusted antihypertensive therapy with additional antifibrotic effects.

Effect of antihypertensive therapy on hospitalization and mortality among uncomplicated and high risk hypertensive patients

Objective: Evaluate the impact of antihypertensive drugs (AHD) on stroke and acute myocardial infarction (AMI) and death for 3 cohorts of patients: diabetics, high risk, and hypertensive. Methods: This was a retrospective cohort obervational study based on administrative database of 7 Italian Local Health Units. Newly treated patients with AHD were enrolled from 01/01/2004 to 06/30/2007. Drug utilization and incidence of death, stroke and AMI were measured until 12/31/2007. Results: The study enrolled 125,770 patients aged ≥ 18-year-old: 8516 diabetic, 8549 high risk, and 108,705 hypertensive. Diabetic and high risk patients were more frequently male (57.2%, 64.9% VS 46.6%) and older (66.4 ± 11.6, 67.5 ± 13.2 VS 61.6 ± 13.9) than hypertensive patients and were more treated with concomitant therapy. Drugs acting on the renin-angiotensin system were the more fre- quent choice in the three cohorts but with a dif- ferent prevalence (63.9%, 52.9%, 35.9% in dia- betic, hypertensive and high risk patients re- spectively). Adherent patients to AHD > 80% were 44.0% among diabetic patients, 48.4% among high risk, 35.2% among hypertensive. A Cox regression model showed that the risk of the combined outcome was determined by increasing age, male gender, presence of concomitant therapy, low adherence to AHD and first choice of AHD. Conclusions: An integrated analysis of prescription and hospital admission database has the great advantage that it uses routinely available data, it can be done quickly and by few staff, and it is less expensive than planned large scale survey.

SEARCH FOR UNIVERSAL COMBINED ANTIHYPERTENSIVE THERAPY WITHIN LIMITED DATA ON THE COMPARATIVE EFFICACY OF ANTIHYPERTENSIVE AGENTS

Modern approaches to the choice of antihypertensive drugs are considered. Definitions of the universal combined antihypertensive therapy that can be effective in most hypertensive patients, regardless of their individual characteristics are discussed. Results of the most significant clinical trials evaluating the efficacy of combined antihypertensive therapy and the relevant provisions of up-to-date clinical recommendations are given as arguments.

Analysis of antihypertensive therapy and its adherence in hypertensive patients with and without concomitant diabetes mellitus

Among patients with hypertension and with a combination of hypertension and diabetes mellitus the majority does not reach target values of arterial pressure levels. There is a number of lacks in ambulatory antihypertensive therapy and adherence to it. The considerable number of patients continues to accept therapy irregularly, the choice of antihypertensive drugs and their combinations is not always adequate, non – medicamentous actions don’t realize by all patients. At the same time the powerful negative contribution is associated with low adherence of patients to spent antihypertensive therapy.

Characteristics of hypertension in Chinese and their relevance for the choice of antihypertensive drugs

According to the 4th National Nutrition and Health Survey in 2002, the prevalence of hypertension in China was 18.8%. Despite that, the treatment rate among hypertensive patients was 82%, the control rate remained low in persons with hypertension (6%), because of the low awareness in general (30%) and the low control rate among treated hypertensive patients (25%). One of the major reasons for the increasing prevalence of hypertension is unbalance of dietary sodium and potassium intakes. In the International Study of Macro/Micro-nutrients and Blood Pressure (INTERMAP), Chinese, compared with American, British, and Japanese populations, had highest dietary sodium intakes and lowest potassium intakes, leading to a two to three times higher sodium/potassium ratio. High dietary sodium intakes may change the circadian rhythm of 24 h blood pressure, which is characterized by a higher night-time blood pressure. Indeed, the prevalence of isolated night-time hypertension, defined as a night-time blood pressure of at least 120 mmHg systolic or 70 mmHg diastolic and a daytime systolic/diastolic blood pressure less than 135/85 mmHg, was higher in Chinese than in Europeans. The complications of hypertension are also different across ethnicities, being mainly stroke instead of myocardial infarction in Chinese. Blood pressure lowering provides more protection against stroke than myocardial infarction, and calcium channel blockers provide more protection against stroke than other classes of antihypertensive drugs. Current Chinese hypertension guidelines recommend calcium channel blockers as the first of the five classes of antihypertensive drugs for stage 1 and low-risk hypertension.

An Additional LDL-Lowering Effect of Amlodipine; Not Only an Antihypertensive?

Hypertension is a modifiable risk factor for cardiovascular diseases and is associated with several metabolic disorders like dyslipidemia. Higher levels of triglyceride and low-density lipoprotein (LDL) are quite strong factors for the development of cardiovascular diseases. In this study, we investigated the effects of valsartan and amlodipine on the lipid profile in patients with newly diagnosed essential hypertension. We observed a beneficial effect of amlodipine on the lipid profile with a significant reduction of LDL compared to valsartan. In the treatment of hypertension, prior knowledge of the plasma cholesterol levels can be important in antihypertensive drug choice.

The Comparative Effects of Valsartan and Amlodipine on Vascular Microinflammation in Newly Diagnosed Hypertensive Patients

Pentraxin 3 (PTX3) is a new candidate immunoinflammatory marker that has been reported to be associated with cardiometabolic risk factors. We aimed to investigate the effects of valsartan and amlodipine on the PTX3 and C-reactive protein (CRP) levels in patients with essential hypertension. Patients with a newly diagnosed essential hypertension were admitted to our internal medicine outpatient clinic. Patients were randomized to one of the following intervention protocols: calcium channel blocker (amlodipine, 5–10 mg/day) as group A (n = 22; mean age ± standard deviation [SD]: 52 ± 11 year) and angiotensine II receptor blocker (valsartan, 80–320 mg/day) as group B (n = 28; mean age ± SD: 50 ± 14 year). Endothelial dysfunction and systemic inflammation were evaluated with PTX3 and CRP. There was a significant decrease in the level of PTX3 after treatment in two groups (P < .05). Although there was a significant decrease in the level of CRP after treatment in amlodipine group, there was no significant decrease in the levels of PTX3 and CRP after treatment in two groups. There were no significant differences in the systolic and diastolic blood pressure reduction between the two treatment groups. In the treatment of hypertension, prior knowledge of the level of plasma PTX3 could be important in antihypertensive drug choice. C-reactive protein and PTX3 are the markers that have role in vascular inflammation and are found associated with the prognosis of cardiovascular outcomes in many trials. In our study, PTX and CRP levels were decreased when compared to baseline levels.

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.