Combined Antihypertensive Treatment Research Articles

Correction particularities of left ventrical diastolic dysfunction in patients with essential arterial hypertension with hyperuricemia

The effect of the combined antihypertensive treatment with lisinopril or valsartan on the left ventricle diastolic dysfunction (LVDD) was compared in hypertensive patients depending on the uric acid level. 118 patients with the second stage and 2 and 3 degrees of arterial hypertension (AH) were observed, 69 patients among them had concomitant symptom-free hyperuricemia (basic group) and 49 had normal uric acid (UA) blood level (comparing group). The direct correlation between the LVDD index E/E’ and UA level was determined, which proves the more often association of hyperuricemia and left ventricle diastolic function disturbances in hypertensive patients. In the same time, the UA level in patients with pseudonormal type of LVDD was higher than in patients with relaxation type. In valsartan group after the 6 months treatment the more significant improvement of the LVDD was determined in both normo- and hyperuricemia patients. The effect of valsartan on the decreasing of hyperuricemia level was found to be more marked than that of lisinopril.

CONCOMITANT CARDIOVASCULAR DISEASES AND ANTIHYPERTENSIVE TREATMENT IN OUTPATIENT PRACTICE (BY THE RECVASA REGISTRY DATA)

Aim. To study a pattern of concomitant cardiovascular diseases (CVDs) and to estimate particularities and quality of medical antihypertensive therapy in hypertensive patients in real outpatient practice with a help of the Registry in Ryazan region. Material and methods. A total of 3690 patients with hypertension, ischemic heart disease, chronic heart failure and atrial fibrillation, who had attended general practitioners and cardiologists of 3 outpatient clinics in Ryazan city, were enrolled in the outpatient Registry of cardiovascular diseases (RECVASA). The diagnosis of hypertension was recorded in 3648 of 3690 (98.9%) outpatient charts, 28.1% of the subjects were men and 71.9% - women. Results. A total of 2907 (79.7%) of 3648 patients had combination of hypertension with other CVDs. Combination of 3-4 cardiovascular diagnoses was registered in 63.8% of the cases. 11.5% and 9.5% of the patients had a history of myocardial infarction and cerebral stroke, respectively. Diagnosis of hypertension was verified in 448 of 450 randomized hypertensive patients (99.6%). The incidence of prescription of one and two antihypertensive drugs (AHDs) was 25% and 39%, respectively, of 3 AHDs – 21%, 4 and more – 2%. AHDs were not prescribed in 13% of hypertensive patients. The mean number of prescribed AHDs was 1.73. The mean incidence rate of target blood pressure achievement was 26.1%. We have noted insufficient ACE inhibitors/angiotensin receptor blockers (ARB) and beta-blockers prescription in different concomitant CVDs. Patients with 3-4 cardiovascular diagnoses were more often prescribed combined antihypertensive treatment. Prescription of ACE inhibitors/ARB, beta-blockers and thiazide diuretics combination was preferable in 74.1% of the cases, when taking into account absolute and relative contraindications for betablockers use – in 64.0%. 15.2% of the hypertensive patients used reimbursed drugs for CVDs at the moment of the Registry enrollment as compared with 39.2% in previous years (p<0.05). Conclusion. The RECVASA study data allowed revealing high incidence of concomitant CVDs in hypertensive patients, insufficient use of combined antihypertensive treatment, including AHDs with proved favorable influence on prognosis. Achievement of concordance of medical treatment to national and international guidelines, taking into account concomitant CVDs, and optimization of patients’ coverage with reimbursed drugs are the main reserves for antihypertensive treatment quality improvement.

Возможности регистра в оценке лечения больных артериальной гипертензией в первичном звене (на примере поликлиники Саратовской области)

Aim ― to evaluate the quality of treatment among hypertensive patients in workers settlement of Saratovskaya oblast using an research and information system of a registry. Material and Methods ― Ambulatory cards of 88 patients with essential hypertension (aged 64.6±11.3 years, males – 40.5%) who visited therapist, general practitioner or cardiologist during one randomly selected day were analyzed retrospectively. To assess the treatment quality we used computer research and informal system of hypertension (Htn), coronary artery disease (CAD) and chronic heart failure (CHF) registry. The registry controls a performance of hypertension guidelines in Htn patients. Results ― Patients in the studied group were followed-up according to the guidelines. All patients visited polyclinic no less then four times during the previous year. 42% of patients were administered two or more antihypertensive drugs. However, about one third of hypertensives with uncontrolled blood pressure continued monotherapy. Patients in whom Htn was associated with CAD were prescribed with antiplatelets in 82% of cases, with statins – in 60% of cases and with beta-blockers – in 80% of cases. When Htn were associated with CHF, angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin II receptor blockers (ARBs) were prescribed in 87% of cases. When patients suffered from Htn and atrial fibrillation oral anticoagulants were administered in 62% of cases. Conclusion ― Using the Htn, CAD and CHF Registry in primary care unit allows objective evaluation of clinical guidelines performance among Htn patients. It was revealed that combined antihypertensive treatment and separated recommended drugs in case of associated clinical conditions (statins in CAD, anticoagulants in atrial fibrillation) was administered sub optimally. Only half of patients with essential hypertension had their blood pressure controlled.

Effectiveness of combined antihypertensive treatment depending on the phenomenon of salt sensitivity in patients with refractory arterial hypertension

Purpose of study - evaluate the effectiveness of combined antihypertensive treatmentthat includes direct renin inhibitor in salt-sensitive and salt-resistant patients with refractory hypertension (RHT).Methods and materials. The study included 192 patients with RHT. Based on the results of the V.I.Kharchenko test and a variation of combined antihypertensive therapy, all patients were randomized into groups: group 1 - salt-sensitive patients treated with an ACE inhibitor (ACEI), dihydropyridine calcium antagonist (CA), thiazide diuretic (TD) and direct renin inhibitor aliskiren (subgroup 1A) or b-blocker - BB (subgroup 1B); group 2 - salt-resistant patients treated with ACE inhibitors, dihydropyridine CA, TD and aliskiren (subgroup 2A) or BB (subgroup 2B). In the absence of achieving target BP after 6 weeks from the start of observation, patients started receiving five-component treatment: ACE inhibitor, CA, TD, BB and aliskiren. Initially and after 48 weeks of observation, all patients underwent ambulatory blood pressure monitoring (ABPM).Results. In the group of salt-sensitive patients treatment including aliskiren contributed to achievement of target values of BP in 43.3%, and with pre- scription of BB - in 54.3% of patients. In both groups there was a significant improvement in most of the parameters of ABPM, more pronounced when using BB. Normalization of circadian BP profile was registered significantly more often ( p

Improved but still poor status of hypertension control in China: a cross-sectional analysis of screening data from 183 478 patients in tertiary hospitals

BackgroundThe population with hypertension is large in China, but the control rate is poor, even for those treated in tertiary hospitals. iSTATUS is an ongoing blood pressure screening project aiming to improve hypertension control. This study reports the status from patients' first visit. MethodsIn 2014, iSTATUS recruited 614 physicians from 266 tertiary hospitals in 56 cities. Patients invited had previously diagnosed hypertension and had visited the physicians in outpatient clinics, mostly (73%) cardiology clinics. Blood pressure was measured onsite using automatic devices and transferred directly to the data management system. An online questionnaire was used to record patients' ongoing blood pressure control information. The screening project was approved by the ethics committee of the First Affiliate Hospital of Peking University, Beijing, China. Verbal informed consent was obtained from the participants or their guardians. As no paper forms were used, all data, including consent, were collected and recorded electronically. FindingsAmong 183 478 patients with hypertension at their first visit (88 069 [48%] men, 95 409 [52%] women; mean age 59·3 years [SD 12·1]), 74 125 (40·4%) reached the general blood pressure control goal (<140/90 mmHg), 62 016 (33·8%) had 140–159/90–99 mmHg, and 47 337 (25·8%) had ≥160/100 mmHg. Only 2936 (1·6%) patients had resistant hypertension (those who took three or more antihypertensive drugs, including a diuretic, and had ≥140/90 mmHg). Regarding use of antihypertensive drugs, 18 531 (10·1%) patients did not take their drugs, 108 252 (59·0%) were on single-drug therapy, 46 970 (25·6%) took two drugs, and 9724 (5·3%) took three or more drugs. The control rate was higher for combined antihypertensive treatment (45·1%) than for monotherapy (39·7%). The preferred drugs were calcium-channel blockers (35·3%), angiotensin II receptor blockers (31·2%), angiotensin-converting enzyme inhibitors (15·8%), β blockers (5·1%), and diuretics (2·6%), as monotherapy or in combination with other antihypertensive drugs. InterpretationAlthough the control rate (40·4%) improved for treated hypertension compared with that (31·6%) in 2010, most patients did not reach their blood pressure goal. Increasing the treatment rate and combination therapy could substantially improve blood pressure control in China. FundingBeijing Lisheng Cardiovascular Health Foundation and Beijing Novartis Pharma.

Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents: The PARTAGE Study.

Clinical evidence supports the beneficial effects of lowering blood pressure (BP) levels in community-living, robust, hypertensive individuals older than 80 years. However, observational studies in frail elderly patients have shown no or even an inverse relationship between BP and morbidity and mortality. To assess all-cause mortality in institutionalized individuals older than 80 years according to systolic BP (SBP) levels and number of antihypertensive drugs. This longitudinal study included elderly residents of nursing homes. The interaction between low (<130 mm Hg) SBP and the presence of combination antihypertensive treatment on 2-year all-cause mortality was analyzed. A total of 1127 women and men older than 80 years (mean, 87.6 years; 78.1% women) living in nursing homes in France and Italy were recruited, examined, and monitored for 2 years. Blood pressure was measured with assisted self-measurements in the nursing home during 3 consecutive days (mean, 18 measurements). Patients with an SBP less than 130 mm Hg who were receiving combination antihypertensive treatment were compared with all other participants. All-cause mortality over a 2-year follow-up period. A significant interaction was found between low SBP and treatment with 2 or more BP-lowering agents, resulting in a higher risk of mortality (unadjusted hazard ratio [HR], 1.81; 95% CI, 1.36-2.41); adjusted HR, 1.78; 95% CI, 1.34-2.37; both P < .001) in patients with low SBP who were receiving multiple BP medicines compared with the other participants. Three sensitivity analyses confirmed the significant excess of risk: propensity score-matched subsets (unadjusted HR, 1.97; 95% CI, 1.32-2.93; P < .001; adjusted HR, 2.05; 95% CI, 1.37-3.06; P < .001), adjustment for cardiovascular comorbidities (HR, 1.73; 95% CI, 1.29-2.32; P < .001), and exclusion of patients without a history of hypertension who were receiving BP-lowering agents (unadjusted HR, 1.82; 95% CI, 1.33-2.48; P < .001; adjusted HR, 1.76; 95% CI, 1.28-2.41; P < .001). The findings of this study raise a cautionary note regarding the safety of using combination antihypertensive therapy in frail elderly patients with low SBP (<130 mm Hg). Dedicated, controlled interventional studies are warranted to assess the corresponding benefit to risk ratio in this growing population.

Эффективность комбинированной антигипертензивной терапии в зависимости от феномена солечувствительности у пациентов с рефрактерной артериальной гипертонией

Эффективность комбинированной антигипертензивной терапии в зависимости от феномена солечувствительности у пациентов с рефрактерной артериальной гипертонией

Blood pressure control and acceptability of Perindopril and its fixed dose combinations with Amlodipine or Indapamide, in younger patients with hypertension

ObjectiveRecent hypertension guidelines recommend initiation of treatment with a fixed dose combination of two drugs for more effective and quicker blood pressure control. Few of these have been assessed for efficacy and acceptability. This study examines the short term blood pressure control and acceptability of perindopril, with or without its fixed dose combinations (FDC) with amlodipine and Indapamide in younger patients. MethodsIn a multicentre prospective observational study, patients with stage 1 hypertension were prescribed perindopril 4 mg per day. Those with stage 2 or 3 hypertension were prescribed a single tablet per day of 4 mg perindopril and 5 mg amlodipine (COVERSYL AM), or 4 mg perindopril and 1.25 mg indapamide (COVERSYL PLUS)for 45 days. The primary outcomes were the frequency of patients achieving blood pressure control and the adverse effect of pedal edema. ResultsOf 426 patients, with a mean age of 45 years, distributed throughout India, and an average (SD) baseline systolic/diastolic blood pressure of 157.2 (13.5)/98.6 (7.4), 303 (71.1%) achieved blood pressure control. Mean (SD) SBP/DBP decreased from baseline by 26.9 (12.6), and DBP by 15.4 (7.2) mm Hg. Few patients discontinued treatment, and the frequency of cough that interfered with sleep and ankle edema was low. ConclusionIn patients requiring combination antihypertensive treatment, the regimen of perindopril alone or its FDC with Indapamide or amlodipine reduces blood pressure effectively, resulting in high rates of blood pressure control over the short term, with a low frequency of side effects including cough and pedal edema.

Hypertension treatment features in perimenopausal women

Major causes of disability among women are chronic heart failure, developed on arterial hypertension (AH) and cerebral stroke. However, the prevalence of AH among postmenopausal women is significantly higher than for men. Women are more likely to develop AH with metabolic disorders, including metabolic syndrome. Therefore, the drugs of choice to treat AH in women in perimenopauseare ACE inhibitors and Angiotensin II Receptor Blocker. If necessary, combination antihypertensive treatment drugs of choice are agonistsimidazoline receptors, such as moxonidine. The use of this category of patients havemoxonidine action justified by the features of the pharmacological action of this drug (decrease in sympathetic hyperactivity), high efficiency, antihypertensive as well as additional positive effects on body weight and metabolic parameters.

Особенности лечения артериальной гипертонии у женщин в перименопаузе

Major causes of disability among women are chronic heart failure, developed on arterial hypertension (AH) and cerebral stroke. However, the prevalence of AH among postmenopausal women is significantly higher than for men. Women are more likely to develop AH with metabolic disorders, including metabolic syndrome. Therefore, the drugs of choice to treat AH in women in perimenopauseare ACE inhibitors and Angiotensin II Receptor Blocker. If necessary, combination antihypertensive treatment drugs of choice are agonistsimidazoline receptors, such as moxonidine. The use of this category of patients havemoxonidine action justified by the features of the pharmacological action of this drug (decrease in sympathetic hyperactivity), high efficiency, antihypertensive as well as additional positive effects on body weight and metabolic parameters.

Test characteristics of the aldosterone-to-renin ratio as a screening test for primary aldosteronism

The aldosterone-to-renin ratio (ARR) is a widely used screening test for primary aldosteronism. Current guidelines recommend a cut-off value of 91 pmol/mU. Studies on its sensitivity, specificity, reproducibility and the role of medication have been conflicting. We prospectively assessed the test characteristics of the ARR and the effect of combination antihypertensive treatment. In 178 patients with persistent hypertension despite the use of at least two antihypertensives, plasma renin and aldosterone were assessed twice within an interval of 4 weeks. All patients underwent an intravenous salt loading test. A posttest plasma aldosterone exceeding 235 pmol/l was considered diagnostic for primary aldosteronism. ARR was repeated after 4 weeks of standardized treatment with a calcium channel blocker and/or α-adrenergic-receptor blocker. The prevalence of primary aldosteronism was 15.2%. The median ARR was 35.0 (interquartile range 16.2-82.0) in primary aldosteronism versus 7.1 (2.2-17.5) pmol/mU in essential hypertensive patients (P < 0.001). Under random medication, the ARR had 22.2% sensitivity and 98.7% specificity. On standardized treatment, the ARR rose from 9.6 (2.5-24.8) to 21.4 (10.8-52.1) (P < 0.001). Multivariate regression showed that angiotensin-converting enzyme (ACE)-inhibitors and angiotensin II-receptor blockers were responsible for the lower ARR during random treatment. The area under the receiver operating characteristic curve was, however, similar under random and standardized treatment (84 vs. 86%, respectively, P = 0.314). Bland-Altman plots showed an almost five-fold difference in ARR values taken under the same conditions. ARR sensitivity for primary aldosteronism is low when the recommended cut-off is used. Reproducibility is also poor, stressing the need for alternative screening tests.

Echocardiographic changes and treatment goal rates after a 6-month combined treatment with amlodipine and losartan: a validation study in Andean countries (METAL study)

The extent to which treatment with amlodipine/losartan may help patients and their doctors from Andean countries to reach their treatment goals remains unknown. We conducted a quasi-experimental, validation study in which patients with primary, uncomplicated hypertension received open-label, fixed combination therapy with amlodipine/losartan 5/50 mg or 5/100 mg according to their baseline blood pressure (BP). The primary outcome was echocardiographic reduction of left ventricular mass (LMV) after 6 months of treatment. Secondary outcomes were changes in BP, uricemia and albuminuria from baseline. We defined patients with adequately controlled hypertension as those with decreases in at least three out of these four variables. From 109 eligible patients with hypertension, 99 started the protocol (70 under the low-dose combination). Echocardiography indices had mutual correlation and contributed independently to the primary outcome (Cronbach's α index = 0.66). Intention-to-treat analysis showed that 60 patients [60.6%, 95% confidence interval (CI) 50.3-70.3] had reduced LVM. Echocardiographic changes were not associated with dose levels. Favorable changes in BP, uricemia and microabuminuria were seen in 77, 64 and 76 patients respectively. After 6 months there were 64 (95% CI 54-74%) patients with adequately controlled hypertension. Every two of three patients of this sample of Andean countries reached adequate control after 6 months of combined antihypertensive treatment with amlodipine/losartan.

Effect of combined antihypertensive and cholesterol lowering treatment on the arterial elasticity in middle-old-aged hypertension patients

Objective: To explore the prehospital first-aid mode of acute cardiovascular events, management and patient prognosis. Methods: 378 patients with acute cardiovascular diseases were continuously registered at the emergency department. The patients were divided into two groups according to the different ways of prehospital care, one group included 194 patients who received first-aid care after calling ‘120’, another was a self-aid group consisting of 184 patients whom were taken to hospital by their relatives. The proportion of subjects had higher than high school education level and better knowledge for cardiovascular disease in first-aid group was higher than self-aid group (51.3 vs 28.6%, 81.0 vs 58.7%, both Pb0.05). Firstaid group received a variety of prehospital treatment, but self-aid group not. At hospital two groups were treated according to our standard procedure, then registered, and a questionnaire was taken. All patients were followed up at the end of first and third months. Results: The major cardiovascular events was myocardial infarction (58.8%) among 378 patients, there were statistically significant differences between twogroups in self-aid response time, first disposal time and prehospital rescuing time, respectively [(31.5±5.4) min vs (87.6±8.5) min, (46.1±6.9) min vs (153.9±13.4) min, (61.5±80) min vs (1539±13.4) min, all Pb0.01], but no difference in-hospital rescuing time [(29.5±5.1)min vs (32.7±4.6)min, PN0.05]. Mortality rate was lower in first-aid group than self-aid group at the end of first and thirdmonths (2.6 vs 7.6%, 4.6 vs 9.2%, both Pb0.05). Conclusion:A perfect prehospital emergency management and process can significantly reduce initial disposal time and out-hospital rescuing time of cardiovascular events, and improved the prognosis. The educational level and health knowledge of patients and their families are related to the treatment mode.

The decrease of complication rate in hypertensives: Benefits of combined antihypertensive treatment by Perindopril and Amlodipine (adapted from the materials from the Annual Scientific Meeting of the European Society of Hypertension [ESH], 2011)

The decrease of complication rate in hypertensives: Benefits of combined antihypertensive treatment by Perindopril and Amlodipine (adapted from the materials from the Annual Scientific Meeting of the European Society of Hypertension [ESH], 2011)

Antihypertensive treatment using an angiotensin receptor blocker and a thiazide diuretic improves patients’ quality of life: The Saga Challenge Antihypertensive Study (S-CATS)

The aim of the Saga Challenge Antihypertensive Study (S-CATS), a single-arm, prospective and multi-center trial, was to evaluate the effectiveness of combined antihypertensive treatment with losartan and hydrochlorothiazide (HCTZ). Enrolled in the study were a total of 161 patients with hypertension, who in spite of treatment with an angiotensin receptor blocker (ARB) alone or an ARB and calcium channel blocker (CCB), had not been able to reach blood pressure control goals set by the Japanese Society of Hypertension Guidelines (JSH 2004). The ARBs were replaced with a combination pill containing losartan (50 mg) and HCTZ (12.5 mg), and this treatment was continued for 3 months. This change in therapy resulted in significant decreases in systolic (158±14 to 137±15 mm Hg, P<0.001) and diastolic (85±11 to 76±10 mm Hg, P<0.001) blood pressure and heart rate (73±3 to 72±3) during the study. The patients' quality of life (QOL) score, the EuroQol 5 dimensions (EQ-5D) and the visual analog scale (VAS) (n=96; 70.0 (68.8-80.0) to 80.0 (70.0-90.0), P<0.01) all improved significantly. Another QOL score, the hypertension symptom score (HSS), which we originally developed for the S-CATS trial, decreased significantly (n=93; 4.0 (1.0-9.0) to 2.0 (1.0-8.0), P<0.05). The Pittsburgh sleep quality index (PSQI), which is a psychometric assessment of subjective sleep quality, also decreased significantly (n=45; 4.0 (2.0-7.0) to 3.0 (2.0-5.0), P<0.05). There was a significant correlation between a change in HSS (baseline value -3-months value) and a decrease in systolic blood pressure (n=93; R=0.241, P<0.05). These results suggest that an anti-hypertensive treatment combined with an ARB and a thiazide diuretic may improve patients' QOL, including sleep quality.

Enhanced Angiotensin II type 1 receptor expression in leukocytes of patients with chronic kidney disease

Previously, we demonstrated increased Angiotensin II type I receptor expression in leukocytes from patients with untreated, but not in treated, essential hypertension (essential hypertension). We hypothesized that the Angiotensin II AT1 receptor is also increased in leukocytes from patients with chronic kidney disease, however and can still be corrected with combined anti-hypertensive treatment with renin–angiotensin system (RAS) blockers and statins. Blood pressure, cholesterol, renal function oxidative stress parameters, inflammation, and leukocyte Angiotensin II AT1 receptor mRNA expression were measured both on and (6 weeks) off treatment. Data were compared to data of 10 healthy control subjects. Untreated chronic kidney disease patients (n = 20) had higher blood pressure, cholesterol and leukocyte Angiotensin II AT1 receptor mRNA expression, but no different ox-LDL, thiobarbituric acid reactive substances, paraoxonase activity or hs-CRP. OxLDL and Lipoprotein(a) were increased in untreated chronic kidney disease. Angiotensin II AT1 receptor expression inversely correlated with renal function (R 2 = 0.15, P < 0.03) and Lipoprotein(a) but not with the other parameters. Treatment with RAS blockers and statins normalized blood pressure and cholesterol, however it did not correct enhanced leukocyte Angiotensin II AT1 receptor expression. Leukocyte Angiotensin II AT1 receptor expression is inappropriately high in chronic kidney disease, correlates inversely with renal function and does not depend on antihypertensive and lipid-lowering treatment. The uremic environment seems to dominate over previously reported actions of high blood pressure and cholesterol to enhance leukocyte Angiotensin II AT1 receptor expression.

Adding a low-dose antihypertensive regimen would substantially improve the control of hypertension and reduce cardiovascular morbidity among uncomplicated hypertensive patients

To assess the utilization of antihypertensive drugs among uncomplicated hypertensive patients in Finland between 2000 and 2006 and to calculate the achievable reduction in cardiovascular morbidity, with intensified antihypertensive treatment. From the databases of the Social Insurance Institution of Finland, 428,986 treated hypertensives without diabetes or cardiac disease (further named uncomplicated hypertensives) in 2000 and 591,206 in 2006, respectively, were identified. In addition, from the Health 2000 survey representing the whole Finnish adult population, 729 uncomplicated hypertensives were determined to assess their characteristics and control of hypertension. Applying Law's meta-analyses we calculated the reduction of blood pressure (BP) by intensifying the treatment with low-dose antihypertensive regimens for those with a BP ≥140/90 mmHg. The nationwide data suggests a relative overuse of beta-blockers. Combination antihypertensive treatment increased relatively 8%, while at least three drug combinations increased from 19.8% to 21.6% between 2000 and 2006. However, calculated prevalence of controlled BP (<140/90 mmHg) increased only from 30.3% to 33.9%. Addition of one half standard dose or one to two half standard doses for the treatment of the patients with a BP ≥140/90 mmHg would improve the control of hypertension from 33.9% to 47.8% and 67.3%, respectively. The intensified treatment would reduce strokes by 18% and 28%, and ischaemic heart disease events by 13% and 21%, respectively. Underutilization of preferred drugs and poor control of BP continues. Surprisingly small addition of the number of low-dose antihypertensive regimen is needed in order to substantially improve the control of hypertension and to decrease cardiovascular morbidity among uncomplicated hypertensive patients.

Combination Antihypertensive Treatment: Is Initiation Order Important?

n their recently released report, the Institute ofMedicine (IOM) states that nearly one of everythree adults in the United States has hypertension.In their ‘‘A Population-Based Policy and SystemsChange Approach to Prevent and Control Hyper-tension,’’ the IOM states that one third of heartattacks and almost one half of heart failures inthe United States each year are due to untreatedor poorly treated hypertension. Hypertension isregarded as simple to diagnose and relatively easyto treat, easy to prevent, and inexpensive to man-age; however, it remains the second leading causeof death among Americans. It has been labeledthe ‘‘neglected disease.’’

EFFECTIVENESS OF TREATMENT OF HYPERTENSION AMONG CORONARY PATIENTS IN POLAND: PP.19.232

Background: Control of hypertension (HT) in Polish general population is poor. However, achievement of treatment goal for hypertension is considered as a basis of secondary prevention of coronary heart disease (CAD). Methods: Consecutive patients in age <80 years hospitalized in years 2005–2006 due to acute coronary syndrome, PCI or CABG in Cracow province(1.2 mln. inhabitants) were included. Data for analysis were taken from subsamples examined in Euroaspire III- Poland (2006–2007). During the control visit, 6–18 months after hospitalization, blood pressure (BP) was measured twice and the rate of antihypertensive drugs was assessed. Treatment of HT among patients <65 and > = 65 years of age was compared. Results: There were 640 patients (455 men and 185 women) recruited in the hospital phase. Six - 18 month after hospitalization 513 patients were examined (80.1%). Systolic BP in patients <65 years of age (n = 305) was 133.8 ± 18.7 mmHg and among elderly patients (n = 208) 142.2 ± 21.9 mmHg (p < 0.05). Diastolic BP was found in both groups, respectively 85.5 ± 10.7 mmHg and 83.9 ± 11.6 mmHg (p = NS). Mean number of antihypertensive drugs in younger patients amount to 2.2 0.9, and in elderly patients 2.4 ± 0.9 (p < 0.05) (Table). Treatment target of BP (<140/90 mmHg or <130/80 mmHg in diabetic patients) was achieved in 44.4% younger patients and in 35.7% elderly. Conclusion: Although, combined antihypertensive treatment is commonly used, achievement of BP control is still insufficient, especially among patients with CAD > = 65 years of age.

Physicians’ gender is associated with risk factor control in patients on antihypertensive and lipid lowering treatment

The objective was to study gender differences in cardiovascular risk factors, lipid and blood pressure control in patients on combined lipid-lowering and antihypertensive treatment, in relation to gender of their physician. This was a cross-sectional study of 4319 patients (53% men) on lipid-lowering and antihypertensive treatment from two national surveys. Male physicians included 1643 men and 1311 women, and female physicians 605 men and 648 women. All data were collected consecutively from medical records. Women were older, had a higher systolic blood pressure (SBP), pulse pressure (PP), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), SBP≥140 mmHg, and more often isolated systolic hypertension (ISH) compared with men. Men compared with women had more often diabetes, higher cardiovascular risk (SCORE) and achieved treatment goals more often for blood pressure in non-diabetics and TC in both non-diabetics and diabetics. Both men and women in well controlled and intermediate controlled groups were more often treated by physicians of their own gender. The female diabetes patients treated by female primary healthcare physicians more often achieved treatment goals for blood pressure [SBP/diastolic blood pressure (DBP)<130/80 mmHg]. Female physicians’ male patients with diabetes more often belonged to the well controlled group. Physicians’ gender may influence the control of risk factors for cardiovascular disease in both men and women on combined antihypertensive and lipid-lowering therapy.