Effective Blood Pressure Control Research Articles

Blood Pressure and Risk of Renal Cell Carcinoma in the European Prospective Investigation into Cancer and Nutrition

Elevated blood pressure has been implicated as a risk factor for renal cell carcinoma (RCC), but prospective studies were confined to men and did not consider the effect of antihypertensive medication. The authors examined the relation among blood pressure, antihypertensive medication, and RCC in the European Prospective Investigation into Cancer and Nutrition (EPIC). Blood pressure was measured in 296,638 women and men, recruited in eight European countries during 1992-1998, 254,935 of whom provided information on antihypertensive medication. During a mean follow-up of 6.2 years, 250 cases of RCC were identified. Blood pressure was independently associated with risk of RCC. The relative risks for the highest versus the lowest category of systolic (>/=160 mmHg vs. <120 mmHg) and diastolic (>/=100 mmHg vs. <80 mmHg) blood pressures were 2.48 (95% confidence interval: 1.53, 4.02) and 2.34 (95% confidence interval: 1.54, 3.55). Risk estimates did not significantly differ according to sex or use of antihypertensive medication. Individuals taking antihypertensive drugs were not at a significantly increased risk unless blood pressure was poorly controlled. These results support the hypothesis that hypertension, rather than its medications, increases the risk of RCC in both sexes, while effective blood pressure control may lower the risk.

Gender-Specific Differences in Hypertension Prevalence, Treatment, Control, and Associated Conditions among the Elderly: Data from a Greek Population

Purpose. In the present study we sought to assess the gender-specific prevalence, treatment rates, and control of hypertension, as well as to identify its associated conditions and additional cardiovascular (CV) risk factors, in a Greek population aged ≥ 65 years old. Methods. This is a population-based study including a clinical interview, an ECG recording, and blood pressure (BP) measurements by sphygmomanometer. Results. The overall prevalence of hypertension was 83.3%, higher in females and increasing with age. In males, hypertension was independently associated with increased body mass index (BMI), a history of stroke, and myocardial infarction, while in females increased age, BMI, and a history of diabetes were independently associated with hypertension. A considerable proportion of hypertensives were treated (77.3%), while an effective control of BP was achieved in 42.5% of treated subjects. Despite the fact that hypertension treatment rates did not differ between the genders, control rates were lower among females. Finally, more hypertensive females presented additional CV risk factors than normotensives. Conclusion. Elderly females exhibit a higher prevalence of hypertension and are characterized by lower hypertension control compared to hypertensive males.

Antihypertensive efficacy and tolerability of candesartan–hydrochlorothiazide 32/12.5 mg and 32/25 mg in patients not optimally controlled with candesartan monotherapy

Aim. To evaluate the efficacy and tolerability of candesartan cilexetil 32 mg in combination with hydrochlorothiazide(HCT) 12.5 mg or 25 mg in hypertensive patients not optimally controlled with candesartan monotherapy. Patients andmethods. A total of 3521 patients with treated or untreated hypertension and sitting diastolic blood pressure (DBP) 90–114 mmHg, entered a single-blind run-in phase with candesartan (16 mg for 2 weeks, followed by 32 mg for 6 weeks). Atthe end of the run-in phase, 1975 patients who still had DBP 90–114 mmHg were randomized to 8 weeks' double-blindtreatment with either candesartan 32 mg (n=654), or candesartan–HCT 32/12.5 mg (n=656), or candesartan–HCT 32/25 mg (n=665). Principal results. At randomization, the mean blood pressure was similar in the three treatment groups(approximately 153/97 mmHg). It was reduced during the double-blind treatment phase by 6.1/5.6 mmHg in thecandesartan 32 mg group, by 13.0/8.8 mmHg in the candesartan–HCT 32/12.5 mg group, and by 15.5/10.0 mmHg in thecandesartan–HCT 32/25 mg group (p<0.01 for all between treatment comparisons). All study treatments were generallywell tolerated. Conclusion. Candesartan–HCT 32/12.5 mg and candesartan–HCT 32/25 mg are highly effective and provideimproved blood pressure reduction and blood pressure control relative to candesartan 32 mg monotherapy, withmaintained tolerability, in hypertensive patients whose blood pressure is not optimally controlled with candesartanmonotherapy. Furthermore, candesartan–HCT 32/25 mg is more effective than candesartan–HCT 32/12.5 mg in thispopulation.

Relationship between the levels of uric acid in diabetic patients aged over forty years and lower extremity arterial disease

目的 探讨中老年2型糖尿病患者血尿酸水平与下肢血管病变的关系.方法 用高分辨彩色多普勒超声诊断仪对212例2型糖尿病患者下肢血管进行检查,同时测定血尿酸、血糖、血脂,分析上述指标与糖尿病患者下肢血管不同程度病变的关系.结果 下肢血管病变组的血尿酸(Ua)、低密度脂蛋白胆固醇(LDL-C)、体重指数(BMI)、年龄和病程均显著高于无下肢血管病变组(P＜0.01),上述指标和甘油三酯(TG)在重度病变组又高于轻中度病变组(P＜0.05,P＜0.01),重度病变组的高密度脂蛋白胆固醇(HDL-C)低于轻中度病变组和无病变组(P＜0.05);糖尿病高尿酸血症组动脉硬化发生率更高,病变程度更严重(P＜0.01).结论 中老年2型糖尿病患者血尿酸水平升高与下肢血管病变的发生、发展密切相关,因此,除了应纠正糖代谢、脂代谢紊乱,减轻体质量,控制血压外,还应重视糖尿病患者的高尿酸血症,并尽早干预。

Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

Hypertension is one of the main risk factors for the onset and progression of chronic complications in type 2 diabetes mellitus (DM). Ambulatory blood pressure (BP) monitoring (ABPM) provides a better correlation with target organ lesions than BP obtained in the office. Furthermore, it allows the evaluation of distinct BP parameters such as the 24-h, daytime and nighttime systolic and diastolic BP means, BP loads and the absence of nocturnal drop of BP, as well as the identification of white-coat and masked hypertension. DM patients have higher daytime and nighttime BP means than non-DM patients. In addition, one third of normotensive type 2 DM patients have masked hypertension, which is associated with an increase in albuminuria and in left ventricle wall thickness. On the other hand, the prevalence and effect of white-coat hypertension in type 2 DM patients have not yet been properly evaluated. The absence of nocturnal drop of BP does not add information to the 24 h, daytime or nighttime BP measurements, but the nighttime BP means seem to be relevant in DM retinopathy. In conclusion, BP determination by ABPM allows better patient risk stratification for the development of DM chronic complications and is an essential instrument for effective BP control in these patients.

Abstract 3466: Hypertension Treatment and Control Among Patients Hospitalized with Heart Failure: An Analysis of Get With The Guidelines Heart Failure

Background: Hypertension is a major factor associated with heart failure (HF).While effective blood pressure (BP) control is recommended in patients with HF, little is known regarding treatment and control rates in these patients. Methods: The analyses assessed HF patients from 195 hospitals participating in the GWTG-HF quality improvement program from January 2005 through September 2006. Patients with hypertension were assessed for number and type of hypertension treatment as well as BP control rates. Analyses were stratified by race-sex groups with multivariate logistic regression models using the generalized estimating equations methods assessed the factors associated with multiple treatment, type of therapy, and BP control levels. Results: Of 37,318 HF patients, 62.3% (23,257) had diagnosed hypertension. The majority (67.3%) of these high-risk individuals were treated with 3 or more hypertension drugs, which was significantly varied by race-sex groups. The use of ACEI (64.6%), beta blockers (79.9%), angiotensin receptor blockers (18.5%), diuretics (62.4%), loop diuretic (73.8%), and calcium channel blockers (13.3%) significantly varied by race-sex groups. BP control rates (&lt; 140/90 mm Hg) at discharge significantly varied by race-sex group (total 70.8%; white males (WM) 76.3%; white females (WF) 71.1%; black males (BM) 63.0%; and black females (BF) 62.9%). Significant factors associated with BP control at discharge included age, race-sex (WF vs. BF, WM vs. BF), atrial fibrillation, hyperlipidemia, coronary heart disease, ICD, pacemaker, history of MI, and not having one or more of the following co-morbid conditions: diabetes, peripheral vascular disease, CVA and renal disease. Control rates considering BP &lt; 130/80 mm Hg (52.3%) showed similar significant variation by race-sex group (WM 57.4%; WF 53.7%; BM 42.3%.; and BF 44.4%). Conclusions: The less than optimal blood pressure control levels and the gender/racial disparities support continued emphasis on hypertension treatment and control among patients with heart failure.

Effectiveness of a specialist nurse-led intervention clinic in the management of cardiovascular risk factors in diabetes

AbstractAim: To evaluate the effectiveness of a specialist nurse-led, protocol-driven and doctor-supervised clinic in the management of cardiovascular risk factors, particularly hypertension and hyperlipidaemia.Methods: Patients with type 2 diabetes attending the diabetes specialist service, who had uncontrolled hypertension or hyperlipidaemia, were recruited to participate in the study. Patients were followed in a specialist nurse-led intervention clinic for effective control of blood pressure (BP), lipid profile and other vascular risk factors. Antihypertensive agents and lipid-lowering drugs were sequentially introduced and dose titrated according to protocols. Patients were discharged once target BP (<140/80 mmHg) and/or target lipid profile were achieved.Results: Ninety-four patients were managed in the clinic between April 2003 and March 2004. The mean age of the patients was 62±9 years and their duration of diabetes was 18±14 years. Seventy-seven patients were hypertensive at first visit and antihy...

Achieving blood pressure goals globally: five core actions for health-care professionals. A worldwide call to action

The prevalence of hypertension continues to rise across the world, and most patients who receive medical intervention are not adequately treated to goal. A Working Group including representatives of nine international health-care organizations was convened to review the barriers to more effective blood pressure control and propose actions to address them. The group concluded that tackling the global challenge of hypertension will require partnerships among multiple constituencies, including patients, health-care professionals, industry, media, health-care educators, health planners and governments. Additionally, health-care professionals will need to act locally with renewed impetus to improve blood pressure goal rates. The Working Group identified five core actions, which should be rigorously implemented by practitioners and targeted by health systems throughout the world: (1) detect and prevent high blood pressure; (2) assess total cardiovascular risk; (3) form an active partnership with the patient; (4) treat hypertension to goal and (5) create a supportive environment. These actions should be pursued with vigour in accordance with current clinical guidelines, with the details of implementation adapted to the economic and cultural setting.

Baseline Pulse Wave Velocity is an Independent Predictor of the Blood Pressure Reduction and Effective Blood Pressure Control: The Reason Study

Baseline Pulse Wave Velocity is an Independent Predictor of the Blood Pressure Reduction and Effective Blood Pressure Control: The Reason Study

Evolution of Left Atrial Systolic and Diastolic Functions in Different Stages of Hypertension: Distinct Effects of Blood Pressure Control

Background: To evaluate the left atrial (LA) volume, and LA systolic (contractile) and diastolic (expansion) functions in different stages of hypertension with or without atrial fibrillation (AF), as well as the effects of good blood pressure control. Methods: A prospective observational study. Individuals including 22 normotensive controls, 23 patients with mild hypertension, 20 with severe hypertension, and 17 with hypertension and paroxysmal AF were recruited for paired echocardiography studies at baseline and 6 months after control of hypertension. Results: With increasing severity of hypertension, left ventricular (LV) diastolic function deteriorated with decreasing LV septal E′/A′ and increasing E/E′ ratios. LA expansion index was reduced in parallel. LA expansion index was correlated positively with LV E′/A′ (r = 0.43, p = 0.022) and inversely with LV E/E′ (r = 0.49, p = 0.009). Significant improvement of LV diastolic function and LA expansion index preceded the reduction of LA volume after blood pressure control. In patients with paroxysmal AF, LA volume reduction was more evident in patients receiving angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers. Conclusions: With progressive LV diastolic dysfunction in hypertension, there was a corresponding deterioration in LA diastolic function. Effective blood pressure control for 6 months improved LA diastolic function.

Association of CYP2D6 and ADRB1 genes with hypotensive and antichronotropic action of betaxolol in patients with arterial hypertension

Betaxolol is a selective antagonist of beta(1)-adrenergic receptors. Personal response to the drug widely varies and depends on its properties and individual features including innate characteristics. Our aim was to study the association between the clinical response to betaxolol in patients with essential hypertension (EH) and polymorphous markers of two genes: beta(1) adrenergic receptor gene (ADRB1) and cytochrome P450 2D6 gene (CYP2D6). Eighty-one patients with EH were selected. Mean age was 52.2 +/- 1.22 years. Betaxolol monotherapy provided effective blood pressure control (BP < 140/90 mmHg) in 68 patients, 56 of them continued treatment with initial dose. The systolic (SBP) and diastolic (DBP) blood pressure declined significantly at the end of the study. We have not found any significant association of rest and exercise BP and heart rate (HR) with polymorphous marker Arg389Gly of ADRB1 gene except the nighttime variability of DBP. But in case of the polymorphous marker Pro34Ser of CYP2D6 gene we have found significant association with response to betaxolol therapy. The rest HR declined more significantly in Ser/Pro genotype carriers (-32.6 +/- 4.77 beats/min and -18.4 +/- 2.01 beats/min, P = 0.023). These patients demonstrated more significant increase of exercise time (4.58 +/- 0.90 and 0.59 +/- 0.58 min, P = 0.045). Maximal exercise HR and DBP were also significantly lower in Ser/Pro genotype carriers in comparison with Ser/Ser genotype carriers. Decline of mean daytime SBP in 24-h ambulatory blood pressure monitoring was more significant in Pro allele carriers (-21.0 +/- 2.55 mmHg vs. -5.2 +/- 2.27 mmHg in patients with Ser/Ser genotype, P = 0.001). Betaxolol effect on HR and BP significantly depends on variability of the gene determining the drug metabolism. The carriers of Pro34 allele of CYP2D6 gene (8.6%) are more sensitive to betaxolol therapy. Because of the relatively small group sizes our data should be considered as preliminary ones. The increase of our groups and the replication in other studies will permit to estimate the contribution of genetic factors to betaxolol effect on HR and BP.

Pharmacoeconomic benefits of antihypertensive therapy.

Effective blood pressure reduction reduces cardiovascular risk and prevents later complications. To consider the pharmacoeconomic benefits of antihypertensive therapy. Every managed care pharmacist should consider the balance of cost and benefit of antihypertensive therapies, ensuring that best treatment options for patients with the lowest cost to the health care system are available and implemented. Pharmacists must also evaluate the direct and indirect cost associated with risk reduction for stroke and cardiovascular disease. Using an interdisciplinary approach to hypertension treatment, pharmacists can assume a major role in detection, management, and control of hypertensive patients. As the medical teams' drug expert, they will be expected to recommend best treatment options for effective blood pressure control and cardiovascular risk reduction.

Management of hypertension in diabetes mellitus

Overall, approximately 40% of diabetic patients have hypertension at the time of diagnosis of diabetes and a similar percentage may develop hypertension during their follow-up. Factors contributing to this high prevalance of hypertension in diabetes include obesity, old age, insulin resistance, increased extracelluar volume, diabetic nephropathy and increased arterial stiffness. Well-conducted clinical trials that have been completed in the last decade demonstrated a major impact of hypertension on the micro- and macrovascular complications of diabetes and remarkable benefits of its control. Based on this large trial database, the currently accepted level of blood pressure used in diabetes for definition and target of therapy is 130/80 mmHg. Dietary and behavioral lifestyle modifications should be an intergral part of any management regimen. These include weight reduction, low sodium diet, exercise, moderate alcohol intake and smoking cessation. Effective control of blood pressure to target levels is more important than the drug(s) used. Combination drug therapy is needed frequently to achieve a target blood pressure. Although blockers of the renin–angiotensin–aldosterone system seem to have a favorable effect in diabetes, high-level evidence suggests that low-dose thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and calcium channel blockers are all good choices, both as initial and add-on therapy. Frequently, more than one drug is needed, and a low-dose thiazide diuretic combined with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker is a commonly used effective combination. Other drugs that can be added include calcium channel blockers and β-blockers. In certain clinical situations, specific drug classes are indicated. These include angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in the case of diabetic nephropathy, β-blockers in the case of ischemic heart disease, and calcium channel blockers and loop diuretics in the case of advanced renal insufficiency, where the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers carries a significant risk of hyperkalemia.

Pharmacological, Immunological, and Gene Targeting of the Renin-Angiotensin System for Treatment of Cardiovascular Disease

Effective blood pressure control with a large arsenal of conventional antihypertensive drugs, such as diuretics, beta-adrenergic blockers, and calcium channel blockers, significantly reduce the morbidity and mortality associated with cardiovascular disease. However, blood pressure control with these drugs does not reduce cardiovascular disease risks to the levels in normotensive persons. Only two drug classes that inhibit or antagonize portions of the renin-angiotensin system (RAS), angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor type-1 (AT(1) receptor) blockers, have protective and beneficial effects unrelated to the degree of blood pressure reduction. These drugs may prevent the blood pressure related functional and structural abnormalities of the cardiovascular system and reduce the end organ-damage. The first part of this review presents the components of the RAS, biological actions of angiotensin peptides, and the functions of the enzymes that generate and metabolize angiotensins, including the likely effect of manipulating them. Special attention is devoted to renin, ACE, ACE2, chymase, and neprilysin. The second part of this review presents the rationale for targeting the RAS, based on clinical studies of the ACE inhibitors and AT(1) receptor blockers. Finally, we present the investigational agents acting on the RAS that have a potential for clinical usage, and give the perspective of pharmacological, immunological and gene targeting of the RAS for treatment of cardiovascular disease.

RESULTS OF OUTPATIENT PROGRAM ON EFFECTIVE THERAPY OF REFRACTORY ARTERIAL HYPERTENSION

Aim. To increase in efficacy of antihypertensive therapy in patients with refractory arterial hypertension (HT). Material and methods. Patients with refractory HT were revealed during first month of program. The causes of refractory HT were analyzed. Combined antihypertensive therapy was prescribed to reach target level of blood pressure (BP). This therapy lasted 24 weeks and included angiotensin converting enzyme (ACE) inhibitor, thiazid diuretic (indapamide) and dihydropyridine calcium antagonist (nifedipine XL). Results. 200 patients with refractory HT were revealed. True refractory HT took place in 59,9% of patients and pseudo refractory HT – in 40,1% of patients. Lack of diuretics or combined antihypertensive therapy were the main reason of insufficient BP control. Proposed 3-drugs therapy resulted in reduction of systolic BP from 190 to 132 Hg mm and diastolic BP from 104 to 81 Hg mm. Target level of BP was reached in 94% patients. There were no side effects which demanded to stop therapy. Conclusion. High incidence of pseudorefractory HT (40,1%) is revealed. Significant prevalence of renal disturbances especially chronic intersti???tial inflammatory could be responsible for refractory HT development. Use of 3-drugs therapy (ACE inhibitor, indapamide and nifedipine XL) provides effective control of BP in refractory and pseudorefractory HT.

Intensive management of risk factors for accelerated atherosclerosis: the role of multiple interventions

Patients at high risk of vascular events can reduce their risk by 75% to 80% through a combination of lifestyle changes and medical therapy. These include smoking cessation, a Mediterranean diet, daily exercise, maintaining a fit weight, moderate consumption of alcohol, effective control of blood pressure and diabetes, intensive treatment with lipid-lowering drugs and antiplatelet agents, and perhaps treatment with vitamins to lower homocysteine. Much of this is achieved primarily by the patient; physicians need to become better at assisting their patients in making lifestyle changes. Effective control of treatment-resistant hypertension can be improved by individualizing medical therapy to the underlying cause, based on measurement of plasma renin and aldosterone. Measurement of carotid plaque may be useful by providing feedback on the success of therapy.

Clinical perspectives in the prevention and treatment of chronic nephropathy, including an overview of the DEMAND Study

Background: The prevalence of chronic renal disease is increasing: 1.8 million people worldwide are affected by end-stage renal disease (ESRD) and need dialysis. Preventing the progression of renal disease is therefore important, particularly in patients with type 2 diabetes mellitus (DM), since the number of diabetic patients requiring dialysis--as well as the relative costs of such treatment--are increasing rapidly. Objective: The goal of this article was to provide a summary of how effective control of systemic blood pressure and proteinuria can slow the progression of ESRD. An overview of the design of the ongoing Delapril and Manidipine for Nephroprotection in Diabetes (DEMAND) study is also given. Methods: A literature search of MEDLINE was conducted for the period 1992 through 2005, using the following search terms: diabetes, microalbuminuria, ESRD, hypertension, manidipine, and proteinuria control. Results: Optimal blood pressure and proteinuria control, as well as glycemic and lipid control, are of utmost importance in minimizing the incidence and progression of nephropathy and cardiovascular diseases in patients with type 2 DM. Once overt nephropathy occurs, renal function will decline linearly with time until the patient needs renal replacement therapy, either dialysis or renal transplantation. It should be noted, however, that all patients do not lose renal function at the same rate. Therefore, the aim of treatment is to modify the rate of disease progression from a rapid pattern to a very slow one. The effects of angiotensin-converting enzyme (ACE) inhibitor therapy on proteinuria and the progressive decline in glomerular filtration rate (GFR) in diabetic and nondiabetic patients have been addressed in several trials, including the Ramipril Efficacy in Nephropathy core study. This study showed that at comparable levels of blood pressure control, ACE inhibitors were more effective than conventional antihypertensive treatment at reducing proteinuria, slowing the rate of GFR decline, and limiting the progression of ESRD. The goal of the DEMAND study is to assess the efficacy of the third-generation dihydropyridine calcium channel blocker manidipine, given in association with delapril, an ACE inhibitor, in the treatment of diabetic nephropathy. The results are expected in 2008. Conclusions: The nephroprotective treatment of diabetic patients should start before they develop proteinuria, both to avoid ESRD and to prevent cardiovascular disease. In this respect, the goal of the DEMAND study is to determine if the combined therapy between delapril, an ACE inhibitor, and manidipine, a dihydropyridine calcium channel blocker, slows the rate of GFR decline more effectively than conventional antihypertensive therapy in hypertensive type 2 diabetic patients with normo- or microalbuminuria.

Drospirenone with 17β-estradiol in the postmenopausal woman with hypertension

Hypertension is one of the most important risk factors for the development of cardiovascular disease. The prevalence of hypertension increases with age and also after the menopause; therefore, blood pressure monitoring and effective control of elevated blood pressure are very important in postmenopausal women. The knowledge that aldosterone is a dual cardiovascular and endocrine hormone has blurred the once distinct boundary between gynecology and cardiovascular medicine. Aldosterone plays a major role in salt and water homeostasis, but also binds to mineralocorticoid receptors in the cardiovascular system, leading to structural and functional changes and consequent organ damage. Highly selective aldosterone blockade via the mineralocorticoid receptor has long-term antihypertensive effects. Drospirenone is a novel progestogen with aldosterone receptor antagonism (PARA), and therefore has antihypertensive effects through reduced salt and water retention. A new hormone therapy that combines 17β-estradiol with drospirenone has been shown in several clinical studies to have a blood pressure-lowering effect in postmenopausal women with elevated blood pressure, in addition to effectively relieving symptoms of the menopause. These findings suggest a potential additional benefit on the cardiovascular system for the drospirenone/17β-estradiol combination in the treatment of women with menopausal symptoms and elevated blood pressure.

CARDIAC RUPTURE IN MYOCARDIAL INFARCTION: INCIDENCE AND PREDISPOSING FACTORS (15 YEAR FOLLOW-UP)

Aim. To evaluate the incidence of cardiac rupture (CR) in patients with acute myocardial infarction (MI) as well as predisposing factors during 15-year follow-up. Material and methods. 1453 patients with acute MI who were admitted to Krasnoyarsk cardiological center during 1989, 1993 and 2003 years were studied. All patients were divided into three groups: group I - 447 patients, who were on treatment in 1989, group II - 475 patients of 1993, and group III – 531 patients of 2003. There were no differences in groups on patient sex, location and depth of MI, previous MI, arrhythmias, heart failure and diabetes mellitus. Results. CR was found in 18 of 447 patients (4%) of group I (1989), in 16 of 475 patients (3,4%) of group II (1993) and in 10 of 531 patients (1,9%) of group 3 (2003), (p1,3 <0,05). Incidence of CR significantly decreased from 1989 to 2003 in female patients (7,2%; 5,7% and 1,6% in 1989, 1993 and 2003, respectively; p1,3 < 0,01, p2,3 < 0,05). Incidence of CR in male patients didn’t changed (2,5%, 1,8% and 2,1%, respectively). The average blood pressure (BP) during the first day of MI in female patients was higher than this in male ones in 1989 and 1993. There were no significant differences in BP between women and men in 2003. Heart rate (HR) during the first day of MI in female patients was higher than this in male patients in 1989. However in 1993 and 2003 there were no differences in HR between women and men. MI therapy more often included betablockers, angiotensin converting enzyme inhibitors, intravenous nitrates, statins, thrombolythics and anticoagulants in 2003 than in 1989 and 1993. Conclusion. Effective BP and HR control is the most effective way to prevent CR in patients with MI.

Effective Ambulatory Blood Pressure Control in Medical Practice

A large number of studies has addressed the question of how effective is blood pressure (BP) control in the hypertensive population,1–3 with a consistent and unequivocal answer. That is, BP control is disappointingly low, because only a small fraction of patients diagnosed as having a BP elevation show on-treatment BPs <140 mm Hg systolic and 90 mm Hg diastolic, which are the target values for treatment recommended by international guidelines.4,5 This is the case regardless of whether patients are followed by general practitioners or specialists6,7 and have a low or high cardiovascular risk profile,8–10 the latter condition making the need of BP control even more compelling given the imminent risk of a cardiovascular event. Reality is obviously even worse when the lower BP targets that have been shown to be additionally protective in high-risk hypertensive patients, that is, <130/80 mm Hg, are considered.4,5 In a recent study performed in Italy, for example, we have shown that in diabetic (and, thus, high risk) hypertensive patients followed by general practitioners, an on-treatment BP <130/80 mm Hg was achieved in only 3% of the sample,7 the conclusion being that …