Drugs In Hypertensive Patients Research Articles

Relationship between 25(OH) vitamin D and the number of antihypertensive drugs in hypertensive patients in the area of Blida (Algeria)

The purpose of the study was to evaluate the relationship between 25(OH) vitamin D and the number of antihypertensive drugs (AHTs) used in hypertensive patients. A total of 1145 patients were enrolled in the study between January 2017 and June 2018 in specialized consultation at the department of internal medicine at the Blida university hospital (65.8% female, 34.2% male, age: 52 ± 13 years old). The initial serum 25 (OH) vitamin D level was determined by the enzyme immunoassay for all patients. Antihypertensive therapy was supplemented with 200000 IU/month cholecalciferol for all the patients. A follow-up visit was performed 12 months later. In total, 22.4% of patients received 1 antihypertensive drug, 47.7% of patients 2 drugs, 19.7% of patients 3 drugs, 8.8% of patients 4 drugs, and 1.4% were treated with 5 antihypertensive drugs. The mean number of antihypertensive drugs was 2.5. Glomerular filtration measured by CKD-EPI was 49.3 ± 7.2 ml/min. The mean level of baseline plasma vitamin D was 10.6 ± 5.4 ng/ml. One year later, the mean plasma level of vitamin D increased to 28.3 ± 10.8. Sixty seven percent of the patients were still under vitamin D supplementation at follow-up whereas 32.8% had stopped the treatment. In the former, plasma vitamin D increased to 29.0 ng/ml versus 15.3 ng/ml in the latter group. There was a significant relationship between the 25(OH) vitamin D plasma level and blood pressure ( P = 0.05) and the number of antihypertensive drugs used ( P = 0.013). The difference between those patients who kept the treatment and those who stopped was highly significant ( P < 0.05). The action of diuretics on BP is more synergistic in combination with vitamin D (95.5% vs. 76.4% without vitamin D), followed respectively by calcium channel blockers (67.8% vs. 57.4%), beta-blockers (66.2% vs. 46.5%), converting enzyme inhibitors (50.3% vs. 34.4%) and finally angiotensin II receptor blockers (45.1% vs. 36.2%). The number of antihypertensive drugs have a less significant effect on PA in compared to groups with vitamin D ( P < 0.001). Supplementation with vitamin D improved the control of BP in our studied population. It seems desirable to encourage the prescription of a dual therapy containing a diuretic in hypertensive patients with supplementation in vitamin D. Further studies are necessary to better explore the plasma level of vitamin D and the efficiency of different classes of antihypertensive treatment.

Generic vs. brand-name drugs for the treatment of hypertension

Although antihypertensive generics and their brand-name counterparts are bioequivalent, their equivalence in lowering blood pressure and controlling hypertension is still debated. We thus, sought to compare the effect of generic and brand-name drugs in hypertensive patients. We conducted an open crossover randomized controlled trial ( NCT02853045 ) in which patients were allocated to take their usual antihypertensive treatment either exclusively with brand-name drugs for 6 weeks and then to switch for generics for another 6 weeks or following the opposite order. 24 h ambulatory blood pressure (ABP) was monitored twice, at the end of each 6-weeks period. We tested the hypothesis that generics were not worse than branded antihypertensive drugs for controlling hypertension with a non-inferiority margin of 7 mm Hg. Forty three patients (mean age of 61 ± 12 years, 73% male, 35% of kidney transplant patients) were included. Sixty % of them were under triple antihypertensive treatment (angiotensin renin blockers and channel calcium blockers being taken by 88% and 72% of the patients, respectively). Mean 24 h ABP was 129/77 mmHg and 128/77 mmHg for patients under generics and branded drugs, respectively. 58% ( n = 25) of patients presented optimal BP with generics vs. 69% ( n = 30) with brand-name drugs. 18% ( n = 8) of patients presented resistant hypertension with generics vs. 11% ( n = 5) with branded drugs. The differences of proportion were not statistically significant. Non-inferiority was confirmed in all subgroup analyses independently of age, gender, number of medications, severity/resistance of hypertension and dipper status. Reported adverse events were not different in nature and in frequency between generic and branded drugs. Our findings support the notion that generics are not inferior than brand-name antihypertensive agents and can be safely used at least for the control of blood pressure. These results need to be confirmed in a larger cohort of patients allowing us the performed analysis according the class of antihypertensive drugs.

HUBUNGAN ANTARA PENGETAHUAN, MOTIVASI, DAN DUKUNGAN KELUARGA DENGAN KEPATUHAN MINUM OBAT PADA PENDERITA HIPERTENSI DI PUSKESMAS PEUKAN BADA KABUPATEN ACEH BESAR

Hypertension is a disease that is known as the silent killer disease or quietly because in general people do not know he suffered from hypertension before they check their blood pressure. The purpose of this study was to look at factors related to adherence to taking anti-hypertension medication. Using descriptive analytic design through Cross Sectional approach. The data were collected by interview using questionnaire. Population in this research in Peukan Bada Public Health Center are 56 people. This study used Chi-Square statistic test. The result of the research showed that hypertension patient mostly good (55,4%), hypertension motivation mostly high (64,3%) and hypertension family support mostly good (60,7%). The result of the statistical test shows that there is correlation between knowledge (p value = 0,001), motivation (p value = 0,002) with adherence to taking anti hypertension medication in hypertension patient and no relation with family support (p value = 0,728) with adherence to taking anti hypertensive drugs in hypertensive patients.&#x0D; Keywords: Hypertension, knowledge, motivation, patient family support

Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers in hypertensive patients with myocardial infarction or heart failure: a systematic review and meta-analysis

Angiotensin-converting enzyme inhibitors (ACEIs) are considered primary drugs for the secondary prevention of myocardial infarction (MI), and angiotensin receptor blockers (ARBs) are used when ACEIs cannot be tolerated. However, it is unclear whether ACEIs or ARBs are more appropriate first-line drugs in hypertensive patients with MI or heart failure (HF). The present study aimed to compare the effects of ACEIs and those of ARBs in these patients. Sixty randomized controlled trails (RCTs) that compared the effects of ACEIs and ARBs in patients with MI or HF were extracted by searching PubMed/MEDLINE, Cochrane Database, and the Medical Central Journal database according to the PRISMA guidelines. We finally selected six eligible RCTs and identified three systematic reviews and meta-analyses. The proportion of hypertensive patients ranged from 36 to 69%. Meta-analyses were performed for recurrence or new onset of MI (risk ratio 0.97 [95% confidence interval: 0.88, 1.06]), hospitalization for HF (0.98 [0.84, 1.14]), cardiovascular or total mortality (0.98 [0.91, 1.05]), cardiovascular events or stroke (1.02 [0.94, 1.11]), and adverse events (1.40 [1.11, 1.77]). There were no significant differences between ACEIs and ARBs for all outcomes, except adverse events. Study discontinuation owing to adverse events was significantly more common with ACEIs than with ARBs. Among hypertensive patients with MI or HF, it appears desirable to select the most appropriate drugs, ACEIs or ARBs, in each case by considering the function level, patient background, comorbidity presence, blood pressure target, drug price and other such factors comprehensively in addition to considering tolerability.

A Prospective Study of Prescription Patterns of Antihypertensive Drugs in Hypertensive Patients at a Tertiary Care Hospital

A Prospective Study of Prescription Patterns of Antihypertensive Drugs in Hypertensive Patients at a Tertiary Care Hospital

Analysis of antihypertensive treatment using real-world Japanese data\u2014the retrospective study of antihypertensives for lowering blood pressure (REAL) study

Hypertension requires strict treatment because it causes diseases that can lead to death. Although various classes of antihypertensive drugs are available, the actual status of antihypertensive drug selection and the transition in prescription patterns over time have not been fully examined. Therefore, we conducted a claims-based study using two claims databases (2008–16) to determine this status in Japan. We examined the prescription rate for each class of antihypertensive drugs in hypertensive patients and compared the patients’ ages and the sizes of the medical institutions treating these patients. Among the 1 560 865 and 302 433 hypertensive patients in each database, calcium channel blockers (CCBs) (>60%) and angiotensin II receptor blockers (ARBs) (>55%) were the most frequently prescribed classes. The prescription rate of CCBs increased and ARBs decreased with the patients’ ages. Although the Japanese guidelines for management of hypertension in 2014 changed the recommendation and indicated that β-blockers should not be used as first-line drugs, their prescription status did not change during this study period up to 2016. Use of CCBs and ARBs as first-line drugs differed by the types of patient comorbidities. Although ARBs or angiotensin-converting enzyme inhibitors were recommended for patients with some comorbidities, CCBs were used relatively frequently. In conclusion, the patients’ ages and comorbidities and the sizes of the medical institutions affect the selection of antihypertensive drugs. Selection and use of drugs may not always follow the guidelines.

PRESCRIPTION PATTERN OF ANTI-HYPERTENSIVE DRUGS IN A TERTIARY CARE HOSPITAL IN KERALA AND ADHERENCE TO JNC-8 GUIDELINES

Objective: Hypertension is a leading contributor to the global burden of cardiovascular morbidity and mortality. Worldwide prevalence is continuing to increase. Treatment for hypertension is constantly evolving and many new drugs are added at rapid pace. The objective of this study is to investigate utilization pattern of antihypertensive drugs in hypertensive patients in Azeezia institute of Medical Sciences and Research and to find its adherence to JNC-8 guidelines for management of hypertension. Methods: Descriptive drug utilization study was conducted on 266 hypertensive patients for period of 3 months. Data retrieved from patient's medical record. The study included all hypertensive patients with or without co-morbidities and above 18 yrs who attended out-patient department. Following classes of antihypertensive drugs were analyzed: Angiotensin Converting Enzyme Inhibitors (ACEI), Angiotensin Receptor blockers (ARB), beta blockers, calcium channel blockers, diuretics. ACEI/ARB was mostly prescribed which is in adherence to JNC-8 guidelines which recommends the use of ACEI/ARB as the first choice of drug. Results: Hypertension is more prevalent in males than in females. ACEI/ARB are the most frequently prescribed classes of drugs alone or in combination, supporting the medication adherence to JNC-8 guidelines. Conclusion: The study concludes that the hypertension is more prevalent in males than in females, with its prevalence increasing with age. Peer Review History: Received 27 March 2018; Revised 20 June; Accepted 8 July, Available online 15 July 2018 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6/10 Average Peer review marks at publication stage: 8.5/10 Reviewer(s) detail: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. Heba-Tallah Ahmed Mohamed Moustafa, Heliopolis University Cairo, Egypt, anasweety2003@yahoo.com Similar Articles: CURRENT TREND OF RESISTANT FOR THE COMMONLY PRESCRIBED NEW FLUOROQUINOLONES AMONG HOSPITALISED PATIENTS IN SANA'A, YEMEN

A study of prescribing pattern of antihypertensive drugs in hypertensive patients with co morbid diabetes in a tertiary care teaching hospital

Background: Hypertension and diabetes mellitus are among the commonest non-communicable diseases. Co-existence of hypertension and diabetes increases morbidity and mortality. So co-existence of these diseases requires attention and rational management. Studying current prescribing pattern of drugs provide data for recommendations and decisions regarding rational practice. We undertook this study to study prescribing pattern.Methods: It was cross sectional, observational, descriptive study in outdoor patients suffering from hypertension and type 2 diabetes mellitus for duration of one year. Data of 601 patients were analyzed using descriptive statistics to determine prescribing pattern of drugs.Results: In this study, 71.55% patients were above 50 years age. Female patients were 56.57%. Average duration of hypertension was 4.08 years. Commonly prescribed antihypertensive drug groups were angiotensin converting enzyme (ACE) inhibitors (85.36%) followed by β receptor blockers (33.44%) and calcium channel blockers (29.95%). Enalapril (85.36%) followed by amlodipine (29.95%) and atenolol (21.46%) were commonly prescribed antihypertensive drugs. Single antihypertensive drug was prescribed in 292 (48.59%) prescriptions. The most common monotherapy drug was enalapril (82.19%). Two antihypertensive drugs were prescribed in 231 (38.43%) prescriptions. The most common two drug combination was ACE inhibitors + β receptor blockers (40.69%). Four antihypertensive drugs were prescribed in only 1.50% prescriptions.Conclusions: From this study, the results suggest that the prescribing pattern of antihypertensive drugs reflects recommendations of current guidelines and practices. However, β receptor blockers were prescribed more commonly. There is room for improvement in choice of drugs.

Optimal blood pressure control after coronary events: the challenge remains

We identified sociodemographic, medical, and psychosocial factors associated with unfavorable blood pressure (BP) control in 1012 patients, hospitalized with myocardial infarction and/or a coronary revascularization procedure. This cross-sectional study collected data from hospital records, a comprehensive self-report questionnaire, clinical examination, and blood samples after 2–36 (mean 17) months follow-up. Forty-six percent had unfavorable BP control (≥140/90 [80 in diabetics] mm Hg) at follow-up. Low socioeconomic status and psychosocial factors did not predict unfavorable BP control. Patients with unfavorable BP used on average 1.9 (standard deviation 1.1) BP-lowering drugs at hospital discharge, and the proportion of patients treated with angiotensin inhibitors and beta-blockers decreased significantly (P < .001) from discharge to follow-up. Diabetes (odds ratio [OR] 2.4), higher body mass index (OR 1.05 per 1.0 kg/m2), and older age (OR 1.04 per year) were significantly associated with unfavorable BP control in adjusted analyses. Only age (standardized beta [β] 0.24) and body mass index (β 0.07) were associated with systolic BP in linear analyses. We conclude that BP control was insufficient after coronary events and associated with obesity and diabetes. Prescription of BP-lowering drugs in hypertensive patients seems suboptimal. Overweight and intensified drug treatment thus emerge as the major factors to target to improve BP control.

Meta-analysis of the effectiveness of traditional Chinese herbal formula Zhen Wu Decoction for the treatment of hypertension

ObjectivesZhen Wu Decoction (ZWD), a famous classic herbal formula documented in traditional Chinese medicine (TCM), is widely available in China for treating hypertensive patients with kidney yang deficiency and fluid...

Prescription Pattern of Anti-Hypertensive Drugs in Adherence to JNC- 7 Guidelines

The main objective of the present study to investigate the utilization pattern of antihypertensive drugs in hypertensive patients and to find out whether the prescription pattern is in adherence with the JNC7 guidelines for the management of hypertension. A prospective study was conducted and drug utilization data were collected from 137 hypertensive patients who were attended as Out Patient Department (OPD) of Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India. The data was retrieved from patient’s medical records as well as from the interview of patients and their legally acceptable representatives. The following classes of antihypertensive drugs were analyzed; Angiotensin Converting Enzyme Inhibitors (ACEI), Angiotensin Receptor Blockers (ARBs), Beta Blockers (BBs), Calcium Channel Blockers (CCBs) and Diuretics. The inclusion criteria for the recruitment of study subjects were the patients suffering from hypertension with or without other co-morbid conditions. The analysis of the prescription frequency, proportion of the different antihypertensive classes of drugs as monotherapy as well as combination therapy was done. The most frequently prescribed classes of antihypertensive medications were Diuretics (mainly thiazides followed by Loop category) followed by CCBs, BBs, ACEIs and ARBs. Antihypertensive drug combination therapy was given to 72.26% of the total population while monotherapy was received by 27.73% of the total hypertensive population, representing more utilization of combination therapy as compared to monotherapy. The prescription pattern of these classes of drugs was found to be considerately in adherence to JNC7 guidelines for the management of hypertension. It was evident from the study that hypertension is more pronounced in males with increasing age as compared to females. The diuretics were the first choice alone or in combination and pattern of prescription was adhered to JNC-7 Guidelines.

Value of haemodynamic profiling to the response of antihypertensive therapy

BackgroundEssential hypertension is characterised by alterations in haemodynamics. Hence haemodynamic profiling could lead to improved blood pressure (BP) control in these patients. We tested if baseline haemodynamic indices predict the BP lowering effects of different classes of antihypertensive drugs in hypertensive patients. MethodsIn this double-blind placebo-controlled crossover study we randomised 53 hypertensive patients to receive doxazosin 4 mg, candesartan 16 mg, bisoprolol 5 mg, isosorbide mononitrate (ISMN) 50 mg, and placebo daily for 6 weeks. Brachial and central BP, augmentation index (AIx), aortic pulse wave velocity (aPWV), stroke volume (SV), cardiac output (CO), peripheral vascular resistance (PVR), and pulse pressure amplification (PPA) were measured at baseline and after each drug. ResultsBaseline AIx and PPA determined BP reduction with antihypertensive therapy, particularly with bisoprolol. In patients with low baseline AIx (1.7–28.9%) and high PPA (1.22–1.87), bisoprolol had a weak antihypertensive effect, while the opposite was observed in patients with high AIx (36.3–48.2%) and low PPA (1.05–1.11). With candesartan, BP reduction was the largest, regardless of baseline AIx or PPA levels. ConclusionsOur study suggests that ARBs reduce BP the most irrespective of the underlying haemodynamic profile. Antihypertensive therapy guided by AIx and PPA may have some merit in the guidance of antihypertensive drug treatment, particularly if beta-blockers are considered for treatment. However, larger studies are needed to confirm these results.Clinical Trials Registry number: EudraCT 2006-006981-40.

Abstract 438: Association between Insomnia and Use of BP-lowering Drugs in hypertensive Patients: a Cross-sectional Cohort Study

Purpose: Insomnia and short sleep duration have been associated with increased prevalence, incidence and severity of hypertension. However, the relationship between insomnia and use of different antihypertensive drug classes has not been ascertained yet. Methods: 371 hypertensive patients at their first visit in a tertiary Hypertension Outpatient Unit were enrolled. Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAY-Y2) were administered. Insomnia was defined as ISI&gt;8, depressive symptoms as BDI&gt;10, trait anxiety as STAI -Y2&gt;40. Patients with self-reported sleep apneas or snoring (n=29) or with incomplete data (n=12) were excluded. Results: Data from 330 patients were analyzed (males 51%, mean age 57±13 years, antihypertensive treatment 84%, previous CV events 9%, diabetes 7%, obesity 24%, smoking 13%, hypercholesterolemia 67%). Insomniacs (n=70, 21%) were older than non-insomniacs (60±11 vs 56±13 years, p=0.02); female gender (62 vs 46%, p=0.01), anxiety (68 vs 34%, p&lt;0.0001) and depressive symptoms (30 vs 6%, p&lt;0.0001) were more prevalent in insomniacs. Insomniacs were treated with higher number of antihypertensive drugs (1.8±1.0 vs 1.5±1.0, p=0.04) and more frequently with angiotensin-receptor-blockers (ARBs, 49 vs 31%, p=0.009) and diuretics (50 vs 28%, p=0.0007), whereas the use of other drug classes was similar. In a multiple logistic regression analysis, adjusted for cardiovascular and psychiatric variables, ARBs use (OR 2.4, CL95% 1.1-5.2), depressive symptoms (OR 3.2, CL95%1.2-8.7) and anxiety (OR 2.9, CL95%1.4-6.1) were associated with a higher probability of insomnia. Conclusions: This cross-sectional analysis suggests that ARBs use may be associated with insomnia in a cohort of hypertensive patients

Anti hypertensive prescribing patterns and cost analysis for primary hypertension: a retrospective study.

The present study was conducted to analyze the current prescription pattern and cost analysis of antihypertensive drugs in hypertensive patients in a tertiary care hospital. A retrospective cross-sectional study was conducted in tertiary care hospital, Bangalore for three months and utilized 300 prescriptions for the analysis. The data analysed from the prescription included patients demographics, stage of hypertension according to JNC VII guidelines, type of drug therapy, class of anti-hypertensive, and cost effectiveness of therapy. Drug acquisition costs was calculated, using the cost of the cheapest available drug and the most commonly prescribed dosage, for each drug on a daily and annual basis. Total annual drug expenditure on buying required doses of all antihypertensive prescribed in the study population for a year was calculated. Monotherapy (48.94%) was leading trends of antihypertensive therapy followed by fixed dose combination (35.04%) and polytherapy (16.01%). The most frequent antihypertensive class to be prescribed were CCBs (38.59%) followed by beta blockers (24.07%). The ranking in terms of cost utilized per year from the highest to the lowest found in this study was: alpha blockers> ACE-inhibitors> ARBs> CCBs> beta blockers > diuretics. The diuretics were most cost-effective (Cost per day: 5.89 ± 2.87; Cost per year: 2129.02 ± 1080.49) in relation to the other antihypertensive prescribed.

Amlodipine Seems To Be Superior to Valsartan in Decreasing Microalbuminuria in Newly Diagnosed Hypertensive Patients: A Novel Effect To Be Explained with Hyperfiltration?

Background: Microalbuminuria (MA) is common in hypertensive population and is a marker for endothelial dysfunction and a predictor of increased cardiovascular risk. A great body of data shows the importance of MA as a strong predictor of renal and cardiovascular disease (CVD) risk in hypertensive population. Aim: In this study, we aimed to compare the anti-albuminuric effects of an angiotensin II receptor antagonist, valsartan, with a calcium channel blocker, amlodipine, in newly diagnosed hypertensive patients. Material and methods: Totally, 20 patients were recruited into the study. Patients were randomized to one of the following intervention protocols: An (a) angiotensin II receptor blocker (valsartan, 80–320 mg/day) or (b) calcium channel blocker (amlodipine, 5–10 mg/day), for 12 weeks immediately after baseline measurements. Ten patients were randomized into valsartan group and 10 patients into the amlodipine group. Twenty-four-hour urinary albumin excretion (UAE) levels of the patient groups were measured before treatment and on the 12th week. Results: Patients of the two groups were matched for age and body mass index. In the amlodipine group, baseline urine microalbumin levels were higher compared to valsartan group, although the difference was not statistically significant (p = 0.082). At the 12th week, there was a significant decrease in urine microalbumin levels in the amlodipine group, but no significant change was observed in the valsartan group. Conclusion: Amlodipine seems to be superior to valsartan in decreasing UAE. To reduce cardiovascular risks, endothelial dysfunction, and microinflammation, these factors are taken into consideration while prescribing antihypertensive drugs in hypertensive patients.

Individual approach to antihypertensive drug choice in hypertensive patients based on individual features of autonomic cardiovascular dysfunction

Objective. Development of differentiated method for selection of antihypertensive drugs in hypertensive patients based on assessment of individual features of autonomic cardiovascular dysfunction evaluated by spectral parameters of heart rate variability (HRV) and synchronization of 0.1 Hz oscillation in heart rate and microcirculation. Design and methods. 105 patients with arterial hypertension stage 1-2 aged 47 ± 8 years were examined. 0.1 Hz oscillations in heart rate and microcirculation were registered during passive tilt test under spontaneous breathing. The signals were recorded before and after three-week treatment by angiotensin-converting enzyme (ACE) inhibitors (fosinopril or enalapril) and β-blockers (atenolol or metoprolol). Phase differences between 0.1 Hz oscillations were used to measure the synchronization index S . Power of low- (LF) and high-frequency (HF) bands of HRV spectrum was also assessed. Results. ACE inhibitors are preferred for treatment of hypertensive patients with initially severe systemic autonomic dysfunction (index S is 250 ms 2 in supine position). β-blockers are recommended for patients with initially severe systemic autonomic dysfunction and dysfunction of autonomic heart regulation (index S 2 in vertical body position). If severe autonomic dysfunction (index S is > 25 % and power of LF band of HRV spectrum is > 250 ms 2 ) is not present the treatment by ACE inhibitors and β-blockers is not recommended. Conclusions. The type of antihypertensive drugs (ACE inhibitors or β-blockers) should be selected based on individual features of autonomic cardiovascular dysfunction. Sensitivity and specificity of this method was 65 and 73 %, respectively.

Pleiotropic Effects of ARB in Diabetes Mellitus

Evidence accumulated to date indicates that inhibition of the rennin-angiotensin system with angiotensin receptor blockers (ARB) may prevent new-onset of diabetes. ARB is also used for the prevention of occurrence and progression of complications in diabetes and diabetic nephropathy. From the results of recent large-scale clinical studies, ARB is considered as a first choice drug in hypertensive patients with diabetes. In this review article, we focus on the effects of ARB on progression and prevention against diabetes as a metabolic-improving agent.

USE OF ANTITHROMBOTIC DRUGS IN THE PATIENT HYPERTENSIVE OLDER THAN 65 YEARS WITH ATRIAL FIBRILLATION. THE FAPRES STUDY: PP.1.36

Objetive: Age and hypertension are two major factors associated with atrial fibrillation and high risk of embolism. This study was designed to assess the use of antithrombotic drugs in hypertensive patients ≥65 years with atrial fibrillation. Design and Methods: Every researcher included the first three hypertensive patients ≥65 years who went to medical office the first day of the week, during 5 weeks. Risk factors, cardiovascular history of patients, CHADS2 score and medical treatment were collected and electrocardiogram was performed for central analysis. Atrial fibrillation was considered in its presence on the electrocardiogram and / or documented antecedent. Results: We included 1028 hypertensive patients with a mean age of 72.8 years. In total 10.3% of patients had atrial fibrillation (6.7% on the electrocardiogram and 3.6% were in sinus rhythm but with previous history). Factors associated with atrial fibrillation were age, alcohol intake, structural heart disease and glomerular filtration rate. In total 76.2% patients who had atrial fibrillation in the electrocardiogram and CHADS2 >1 received anticoagulant therapy, and decreased to 41.7% in patients in sinus rhythm but with a prior history. Conclusions: The use of antithrombotic drugs is high in hypertensive patients with atrial fibrillation currently known, but is reduced in patients with prior episode.

Rationale and design of the Eplerenone combination Versus conventional Agents to Lower blood pressure on Urinary Antialbuminuric Treatment Effect (EVALUATE) trial: a double-blinded randomized placebo-controlled trial to evaluate the antialbuminuric effects of an aldosterone blocker in hypertensive patients with albuminuria

Although inhibitors of the renin-angiotensin system are effective as first-line antihypertensive drugs in hypertensive patients with chronic kidney disease, they cannot completely prevent the progression of renal injury. Many animal studies, including our own, and a few human studies suggest that mineralocorticoid receptor blockade could inhibit the ongoing renal damage in chronic kidney disease. Thus, we designed this double-blinded, randomized, placebo-controlled trial to evaluate the antialbuminuric effect of a low dose (50 mg day(-1)) of the mineralocorticoid receptor antagonist eplerenone. The study subjects will include 340 hypertensive patients (blood pressure: 130-180/80-100 mm Hg) with albuminuria (urinary albumin/creatinine ratio: 30-600 mg g(-1) in the first morning void urine), who are treated with an inhibitor of the renin-angiotensin system. Other classes of antihypertensive drugs may be added as needed to achieve the target blood pressure (<130/80 mm Hg). The primary study end point is the change in the urinary albumin/creatinine ratio after a 1-year study period. This trial is expected to show whether a low dose of mineralocorticoid receptor antagonists can exert an antialbuminuric effect in patients with chronic kidney disease.

Effects of Telmisartan on Arterial Stiffness Assessed by the Cardio-Ankle Vascular Index in Hypertensive Patients

Background/Aims: This study was conducted to determine the effect of telmisartan on the cardio-ankle vascular index (CAVI), a novel blood pressure (BP)-independent marker for arterial stiffness in hypertensive patients. Methods: One hundred consecutive hypertensive patients were randomly assigned either to a group treated with calcium channel blocker (CCB)-based therapy or a group treated with telmisartan-based therapy. Clinical and biological parameters were then measured before and 12 months after the start of this study. Results: CAVI, the logarithm of urinary albumin excretion, and BP were reduced significantly after telmisartan-based therapy. The decreases in 24-hour diastolic BP and daytime systolic BP associated with telmisartan-based therapy were significantly greater than those associated with CCB-based therapy. Both therapies significantly and similarly decreased the clinical BP, 24-hour systolic BP, daytime diastolic BP and serum levels of low-density lipoprotein cholesterol. No significant differences in the metabolic parameters were observed between the two therapies. Conclusion: Telmisartan-based therapy had beneficial effects on arterial stiffness assessed by CAVI, albuminuria, 24-hour BP and metabolism compared with CCB-based therapy. Since these markers are known to influence the future risk of cardiovascular events, telmisartan could be a useful drug for hypertensive patients.