Control Of Blood Pressure Levels Research Articles

Development of Diabetes With Thiazide Diuretics: The Potassium Issue

Development of Diabetes With Thiazide Diuretics: The Potassium Issue

Blood pressure control in an African American sample with diabetes mellitus in an urban eye clinic

The adequate control of blood pressure in patients with diabetes mellitus (DM) is important to limit the ocular and systemic complications of the disease. Hypertension in African Americans is among the highest in the world. This cross-sectional study reports the level of blood pressure control in a small sample of African American patients with DM at an urban eye care facility using the criteria defined by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII). Five attending faculty members of the Illinois College of Optometry identified 234 African American patients with a diagnosis of DM over a period of 16 months. Blood pressure readings were recorded once at the time of their visit and were classified as controlled or uncontrolled based on the JNC VII cutoff of blood pressure less than 130/80 mmHg. Among the 234 African American patients in this study, 174 (74.4%) reported having DM and hypertension, and 60 (25.6%) reported having DM without hypertension. Of the patients with DM and a self-reported diagnosis of hypertension, 13.2% were controlled. Of the patients with diabetes without a self-reported diagnosis of hypertension, 26.7% were found to be adequately controlled. For the pooled data of 234 patients with diabetes, 16.7% met the JNC VII guidelines. The inadequate control of blood pressure in the African American population with DM is associated with increased disability and death from cardiovascular and renal disease. The results of this small cross-sectional study are consistent with those of other studies that show poor control of blood pressure in African American patients who have DM. Preventable blindness secondary to accelerated diabetic retinopathy from uncontrolled hypertension is a concern to all eye care practitioners.

Characteristics and control of severe hypertension in a specialist, private practice in Jamaica

To determine the characteristics of patients with severe uncontrolled hypertension, in a Jamaican specialist practice; the level of blood pressure control achieved in routine clinical practice, and the number/type of antihypertensive medications required for blood pressure control. This was a retrospective analysis of the medical records of 500 consecutive patients presenting to a consultant physician private group-practice between January and December 2000. Data were extracted from the records of the 48 patients with severe (Grade III) hypertension (WHO/ISH). Fifty per cent (252) werefound to be hypertensive, 19% (48) had Grade III hypertension. The patients with severe uncontrolled hypertension were of mixed ethnicity, predominantly African. Most were less than 65 years old, never smoked cigarettes and were overweight/obese. Nearly one-half had LDL cholesterol >3.4 mg/dL. Diabetes (31%) and congestive heart failure (21%) were the most common comorbid conditions. Fifteen per cent had no illnesses other than severe hypertension. Cardiovascular symptoms were predominant, followed by dizziness. Only 19% of patients were asymptomatic. More than half of the patients achieved blood pressure > 140/90 mm Hg during the study period. Most patients received four drugs and the number of drugs prescribed increased with duration of follow-up. The antihypertensive medications most prescribed at one year were--angiotensin converting enzyme inhibitors (87%), diuretics (78%), calcium channel blockers (63%) and beta-blockers (69%). Severe hypertension was a common problem in the specialist private practice in Jamaica. Most patients had cardiovascular symptoms, were dyslipidaemic and required four or more antihypertensive drugs for adequate long-term control.

An Editorial Update: What Level of Blood Pressure Control in Chronic Kidney Disease?

Editorials5 July 2005An Editorial Update: What Level of Blood Pressure Control in Chronic Kidney Disease?Andrew S. Levey, MD and Cynthia D. Mulrow, MD, MSc, Deputy EditorAndrew S. Levey, MDFrom Tufts-New England Medical Center, Boston, MA 02111, and the American College of Physicians, Philadelphia, PA 19106.Search for more papers by this author and Cynthia D. Mulrow, MD, MSc, Deputy EditorFrom Tufts-New England Medical Center, Boston, MA 02111, and the American College of Physicians, Philadelphia, PA 19106.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-143-1-200507050-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Chronic kidney disease affects about 11% of adults in the United States (1). Hypertension causes about 20% of new cases of kidney failure and complicates 60% to 80% of cases of chronic kidney disease caused by other disorders (2). Irrespective of the cause of chronic kidney disease, hypertension increases the risk for important adverse outcomes, such as progressive loss of kidney function and kidney failure, early development and accelerated progression of cardiovascular disease, and premature death. Angiotensin-converting enzyme (ACE) inhibitors are recommended in chronic kidney disease because in addition to lowering blood pressure, they reduce proteinuria, slow the decline of ...

Diagnosis of hypertension and high blood pressure levels negatively affect cognitive function in older adults

Hypertension is associated with diminished performance on tests of cognitive function. The degree to which those diagnosed with hypertension have controlled blood pressure (BP) levels may be a critical determinant of cognitive outcomes. Persons with hypertension and poorly controlled BP are likely to display the worst performance on cognitive tests. The purpose is to examine potential interactive relations of hypertension diagnostic status and current BP levels to cognitive function. Participants were 101 healthy older adults (ages 53-84, 62% male, 90% White, 29% diagnosed with hypertension) who engaged in biomedical and neuropsychological assessment. After statistical adjustment for age and education, persons with high BP performed more poorly than those with normal BP on the Visual Reproductions-Immediate and Delayed Recall and the Grooved Pegboard tests. Diagnosed hypertension was related to poorer performance on the Grooved Pegboard tests. An interaction of diagnosed hypertension and BP level revealed that those diagnosed with hypertension and also having poorly controlled BP levels performed least well on the Grooved Pegboard tests and the Trail Making Test-Part A. Irrespective of prior diagnostic status, individuals with high BP displayed compromised performance on tests of nonverbal memory, motor speed, and manual dexterity. However, as compared to the other groups, those diagnosed with hypertension and also having poorly controlled BP elevation were most vulnerable to difficulties on tests of perceptuo-motor speed, motor speed, and manual dexterity. These findings suggest the need for increased attention to preventative efforts with respect to BP assessment and control in older adults to help preserve cognitive function.

Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention

In hypertensive stroke patients, for the same level of blood pressure control, eprosartan will be more effective than nitrendipine in reducing cerebrovascular and cardiovascular morbidity and mortality. A total of 1405 well-defined, high-risk hypertensives with cerebral event during the last 24 months (proven by cerebral computed tomography scan or nuclear magnetic resonance) were randomized to eprosartan or nitrendipine (mean follow-up 2.5 years). Primary end point was the composite of total mortality and all cardiovascular and cerebrovascular events, including all recurrent events. Randomization was successful without significant differences in the baseline characteristics. Blood pressure was reduced to a comparable extent without any significant differences between the 2 groups during the whole study period (150.7/84 mm Hg and 152.0/87.2 mm Hg with eprosartan and nitrendipine therapy to 137.5/80.8 mm Hg and 136.0/80.2 mm Hg, respectively, confirmed by ambulatory blood pressure monitoring). Moreover, already after 3 months, normotensive mean values were achieved, and 75.5% reached values <140/90 mm Hg with the eprosartan regimen and 77.7% with the nitrendipine regimen. During follow-up, in total, 461 primary events occurred: 206 eprosartan and 255 nitrendipine (incidence density ratio [IDR], 0.79; 95% CI, 0.66 to 0.96; P=0.014). Cardiovascular events were: 77 eprosartan and 101 nitrendipine (IDR, 0.75; 95% CI, 0.55 to 1.02; P=0.06); cerebrovascular events: 102 eprosartan and134 nitrendipine (IDR, 0.75; 95% CI, 0.58 to 0.97; P=0.03). The Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention (MOSES) study was the first to compare an angiotensin II type 1 receptor antagonist with a calcium antagonist in secondary stroke prevention. In these high-risk hypertensive stroke patients, an early normotensive and comparable blood pressure was achieved. The combined primary end point was significantly lower in the eprosartan group.

Lowering blood pressure for cardiovascular risk reduction

The association between blood pressure and cardiovascular risk is continuous, with no known lower threshold; epidemiologically, the lower the blood pressure, the better. In reality, the relationship must be J- or U-shaped, as a blood pressure of zero is associated with 100% mortality. However, the level of blood pressure control below which risk increases is well below that achieved in clinical practice, and reducing blood pressure is a cornerstone of strategies to reduce cardiovascular risk. Even relatively small reductions in blood pressure (systolic blood pressure 10-12 mmHg, diastolic blood pressure 5-6 mmHg) substantially reduce cardiovascular risk. Optimal cardiovascular protection is achievable through early and aggressive blood pressure control, but precisely which agents confer the greatest benefits for cardiovascular protection remains widely debated. Angiotensin II receptor blockers (ARBs) appear to be unique in providing additional protection beyond blood pressure control, whereas similar claims for other agents do not withstand close scrutiny. Nearly all patients with hypertension require several antihypertensive treatments to reach their target blood pressure, and it is important to choose treatments that are well tolerated and have complementary modes of action. For this reason, ARBs such as telmisartan emerge as logical choices for combination therapy, particularly when combined with a diuretic, as they fulfil all the essential requirements for combination therapy and are effective in a wide range of different types of patient. Regrettably, a rigorous approach to blood pressure control using multiple agents is still rare in general practice, partly because of a lack of understanding and partly because of 'professional non-compliance'. Prescribing habits must change, and soon, if we are to avoid an upsurge in cardiovascular complications.

Isolated Home Hypertension in the Morning is Associated with Target Organ Damage in Patients with Type 2 Diabetes

To investigate the relationship between the blood pressure control level and cardiovascular risk in type 2 diabetic patients, we evaluated home blood pressure, office blood pressure, biochemical data, and carotid echographic and echocardiographic findings in 148 patients with type 2 diabetes. According to the criteria for hypertension in the guidelines of the Japanese Society of Hypertension, we classified patients into a normotensive group with home systolic blood pressure in the morning (morning HSBP)<135 mmHg and office systolic blood pressure (OSBP)<140 mmHg, an office hypertension group with a morning HSBP<135 mmHg and OSBP>or=140 mmHg, an isolated home hypertension in the morning group with morning HSBP>or=135 mmHg and OSBP<140 mmHg, and a sustained hypertension group with morning HSBP>or=135 mmHg and OSBP>or=140 mmHg. In the isolated home hypertension in the morning group, the fasting insulin level, urinary albumin excretion, maximum carotid artery intima-media complex thickness, and left ventricular posterior wall thickness were significantly higher and the coefficient of variation for RR intervals was significantly lower than in the normotensive group. These results suggest that isolated home hypertension in the morning is a risk factor for target organ damage in type 2 diabetic patients.

Statin Therapy Helps to Control Blood Pressure Levels in Hypertensive Dyslipidemic Patients

Aim. Aside from lowering lipid levels; statins improve endothelial function, decrease platelet aggregation, reduce procoagulant blood factors, and decrease vascular tone. This study was conducted to investigate the possible effect of atorvastatin on blood pressure (BP) in a group of hypertensive and dyslipidemic patients. Methods. Thirty-six hypertensive and dyslipidemic patients with inadequately controlled lipid levels by diet were treated with atorvastatin 20 mg/day for 8 weeks and compared with 24 patient matched controls treated with diet alone. The type and dosage of antihypertensive medications were not altered during statin therapy. Blood lipid profile including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride (TG) levels were noted at inclusion and after 8 weeks. Ambulatory BP monitoring (ABPM) was carried out at study entry and at the end of week eight. Results. A total of 49 patients (32 patients in the atorvastatin group and 17 patients in the control group) completed the 3-month follow-up period of observation. The ABPM studies indicated significant reductions in total average systolic BP, total average diastolic BP, total average mean BP, day average systolic BP, day average diastolic BP, night average systolic BP, night average diastolic BP, and night average mean BP levels in the atorvastatin group, whereas these reductions were not observed in the control group. Conclusion. Our results indicate that atorvastatin therapy significantly improves BP control in hyperlipidemic hypertensive patients. However, the effects of other statins on BP, as well as, the different dosages need to be further investigated.

Prevalência, reconhecimento e controle da hipertensão arterial sistêmica no estado do Rio Grande do Sul

To report the prevalence of cardiovascular risk factors, particularly of systemic arterial hypertension, in the adult population of the Brazilian state of Rio Grande do Sul, in addition to the public's level of awareness, hypertensive control, and associated factors. A cross-sectional, population-based study with random sampling from a population pool was carried out with 918 patients older than 20 years from 1999 to 2000. Systemic arterial hypertension was defined as blood pressure > or = 140/90 or current use of antihypertensive drugs. The prevalence of systemic arterial hypertension was 33.7% (n = 309), and 49.2% of the individuals were unaware of their hypertensive condition; 10.4% knew they were hypertensive, but did not undergo treatment; 30.1% underwent antihypertensive treatment, but did not have adequate control; and 10.4% underwent antihypertensive treatment with adequate control. Based on multivariate analysis, the following variables were found to be significantly associated with the presence of systemic arterial hypertension: age (OR = 1.06), obesity (OR = 3.03), and low educational level (OR = 1.82). These same variables were associated with unawareness of the hypertensive condition: age (OR = 1.05), obesity (OR = 2.46), and low educational level (OR = 2.17). Prevalence of systemic arterial hypertension in the state of Rio Grande do Sul has been remained at constant levels for the past decades, and the population's level of awareness of it has improved slightly. However, the control level of systemic arterial hypertension has not increased. This study allowed the definition of a target group -- elderly, obese individuals with low educational level -- for both diagnostic campaigns and better control of blood pressure levels.

Hypertension and dementia: does blood pressure control favorably affect cognition?

Dementia and aging are not synonymous. Dementia is a progressive deterioration in cognitive and social and/or occupational functions that can eventually impair a patient's ability to live independently. Alzheimer's disease is the most common form of dementia. It accounts for 50% to 70% of all patients with dementia. Vascular dementia, responsible for up to 15% of all diagnosed cases, is the second most common form of dementia. Hypertension remains a significant risk factor for vascular dementia. The optimal level of blood pressure control for the prevention of dementia and whether one particular class of antihypertensive drug is more beneficial than another remains uncertain.

Blood pressure control in kidney transplantation: therapeutic implications.

Post-transplant hypertension remains a significant risk factor for graft loss, but whether or not specific blood pressure (BP) medications affect graft outcome is still unknown. We assessed the interaction between BP control and antihypertensive drugs on graft outcome. We retrospectively examined clinic BP data for 1662 renal transplant (RTx) patients, transplanted between 1994 and 2000 at our centre. The analysis examined all patients who received central alpha-agonists and peripheral alpha-antagonists, beta-blockers, calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibition (ACEI), angiotensin receptor blockers (ARBs). BP recordings during treatment were categorized for each agent. Thus, a particular BP could be categorized for multiple medications. A total of 1462 patients (pts) (88%) were Caucasian and 800 pts (46%) received cadaveric RTx. There were 10.6+/-6.8 BP measurements for each patient post-RTx. CCBs, alone among the classes of antihypertensive drugs evaluated, reduced the risk for graft loss (RR: 0.736; P=0.035) in the overall analysis. Interestingly, stratifying levels of BP control unmasked a beneficial effect on graft survival of ACEI/ARB therapy in individuals with higher levels of systolic (>152 mmHg) and diastolic blood pressure (>98 mmHg) treated with ACEI/ARBs compared to individuals treated with CCBs (P<0.01 for each). Thus, stabilizing BP is important post-RTx. CCBs are associated with improved rates of graft survival. Their role in a compromised RTx, however, deserves further study. ACEI/ARBs have clear benefits, improving graft survival in individuals with elevated systolic blood pressure and proteinuria. CCBs are not as efficacious in this setting.

Treatment and control of hypertension in the veterans health administration

P-201 Key Words: Antihypertensive Medications, Combination Therapy, Blood Pressure Control

Analysis of Recent Papers in Hypertension

Analysis of Recent Papers in Hypertension

M.546 Atorvastatin therapy helps to control blood pressure levels in hypertensive dyslipidemic patients

M.546 Atorvastatin therapy helps to control blood pressure levels in hypertensive dyslipidemic patients

M.546 Atorvastatin therapy helps to control blood pressure levels in hypertensive dyslipidemic patients

M.546 Atorvastatin therapy helps to control blood pressure levels in hypertensive dyslipidemic patients

Pharmacoeconomic Burden of Undertreating Hypertension

Many studies have shown the importance of antihypertensive drug therapy as a factor in reducing the risk of cardiovascular morbidity and mortality, and in containing the cost of managing hypertension and its complications. Nevertheless, the evidence in clinical practice indicates about half of hypertensive patients do not receive pharmacological treatment and about half of treated patients do not achieve blood pressure level control. Undertreating hypertension is the leading cause of failure in drug therapy effectiveness and cost effectiveness. The pharmacoeconomic burden of undertreating hypertension can be defined as the clinical (number of cardiovascular events) and economic (costs of managing cardiovascular events) consequences that would have been avoided by adequate control of blood pressure levels. In the last few years, the increase in this burden and the restriction of budget constraints has raised the awareness of healthcare providers with regards to the need to achieve better performance and to improve disease management of hypertension. This review aims to present the current situation regarding the pharmacoeconomic burden of undertreating hypertension by identifying the key issues of this medical condition, defining and measuring the extent of undertreatment, defining and measuring costs associated with undertreatment, and discussing some fundamental aspects of disease management for hypertension. The pharmacoeconomic burden of undertreating hypertension appears to be an extremely important phenomenon for which there is currently only very limited adequate research. The present dearth of appropriate data can be largely attributed to the lack of epidemiological studies in clinical practice. Future studies are necessary for a more precise quantification of the therapeutic and economic impact of undertreating arterial hypertension in clinical practice (appropriateness studies) and for more precise selection of antihypertensive drugs on the basis of the different cost-effectiveness profiles detected in 'real world' settings (cost-effectiveness studies).

Cardiovascular Risk Profile in 14???513 Patients with Essential Hypertension Followed by Italian Specialist Physicians

Background: Recent data clearly demonstrated that in Western countries control of blood pressure and modifiable cardiovascular risk factors in the hypertensive population is rather poor and far from being satisfactory. Aim: The Observational Pressure Survey (OPS) was planned to assess control of blood pressure and the major modifiable risk factors within a large Italian hypertensive population, aged ≥60 years, followed by hypertension specialists. Results: Systolic blood pressure was controlled below 140mm Hg in only 30.2% of males and 29.9% of females, while diastolic blood pressure was controlled below 90mm Hg in 63.9% of males and 67.8% of females. According to the most recent classification of the European guidelines on hypertension, only 4.8% of the patients had optimal to normal control, whereas 9.7% had high-normal level of blood pressure, and 70% had grade 1–3 hypertension, despite treatment. Also, the control of cardiovascular modifiable risk factors associated with hypertension appeared rather poor in the study. In particular, total cholesterol levels were found to be <200 mg/dL in approximately 30% of the overall population. Conclusions: The results of the present OPS survey, performed in a hypertensive population routinely followed by specialist physicians, confirm and extend the existing data obtained in other studies, and highlight the need for specific and effective actions directed to modify this negative situation and improve the level of blood pressure control in Italy. Accordingly, this survey suggests that guidelines for treatment of hypertension and cardiovascular risk need to be substantially implemented, not only at the level of general practitioners, but also at the level of specialist physicians.

Acceptance of the 2003 Jean Hamburger Award

Acceptance of the 2003 Jean Hamburger Award

Analysis of Recent Papers in Hypertension

Analysis of Recent Papers in Hypertension