Efficacy Of Hypertension Treatment Research Articles

Impact of patient knowledge on hypertension treatment adherence and efficacy: A single-centre study in Poland.

Introduction: Recent studies show that treatment of arterial hypertension is unsuccessful. This is due to the patients' insufficient knowledge of about the therapeutic methods and the consequences of not treating arterial hypertension.Objectives: The aim of the study was to evaluate the patients' knowledge concerning therapeutic options, prophylaxis, and complications of arterial hypertension. The study also assessed the effect of such knowledge on hypertension treatment adherence and efficacy.Patients and Methods: The survey included 488 patients (250 female and 238 male), aged over 18 years, diagnosed with and treated in outpatient and inpatient settings at selected healthcare institutions in Poland. A custom-made questionnaire, based on references on this subject, was the key tool in the present study. Information about the course of the disease and evaluation of hypertension treatment efficacy was based on the patients' medical records.Results: The study found that 54.7% of the subjects had good knowledge about arterial hypertension, 40.0% had average knowledge, and 5.3% had poor knowledge. The extent of knowledge about the disease was significantly dependent on the level of education and the place of receiving medical care (p< 0.05). Good knowledge was significantly associated with controlled blood pressure, number of antihypertensive drugs used, frequency of hospitalization, as well as with medication adherence, and healthy lifestyle behaviours (p< 0.05).Conclusions: More than half of the patients presented good knowledge but a large group still had poor knowledge, especially patients with a low level of education and with hypertension treated at a general practitioner's clinic. The results of our study clearly show that knowledge about arterial hypertension affects medication adherence and healthy lifestyle behaviours and improves hypertension treatment efficacy.

Regression of the Left Ventricular Hypertrophy in Patients with Essential Hypertension on Standard Drug Therapy.

PURPOSE: The American College of Cardiology/ American Heart Association 2017 and European Society of Cardiology/European Society of Hypertension 2018 guidelines were a paradigm shift in hypertension management in contemporary medicine. Lowering of blood pressure to less than 130 (systolic) and 80 (diastolic) mm of Hg irrespective of cardiovascular risk is recommended. While intensive blood pressure control is commonly achievable with rational pharmacotherapy, the magnitude of left ventricular hypertrophy regression is an independent factor in improvement in cardiovascular health. The regression of left ventricular hypertrophy has been adjudged as a clinically useful surrogate marker that reflects the efficacy of hypertension treatment. Though angiotensin converting enzyme inhibitors/ angiotensin receptor blockers (ACEI/ARB) are the preferred initial drug for greater regression of left ventricular mass, the choice of add-on therapy, if required, is still debatable. Therefore, in our observational study, we sought to compare the reduction in left ventricular mass index in hypertensives with left ventricular hypertrophy on standard ACEI/ARB based drug therapy. MATERIALS AND METHODS: The cohort (n=217) comprised of patients with uncontrolled hypertension (blood pressure>140/90 mm of Hg) and left ventricular hypertrophy (left ventricular mass index>115 and 95 gram/square meter in males and females respectively). The add-on drug in ACEI/ARB therapy was either thiazide diuretics (TD) or calcium channel blockers (CCB). Four sub-cohorts were constituted: mono-therapy - group A (n=70, ACEI/ARB), dual-therapy - group B (n=48, ACEI/ARB+TD) and group C (n=51, ACEI/ ARB+CCB), triple therapy - group D (n=48, ACEI/ ARB+TD+CCB). Left ventricular mass index was determined using echocardiography at baseline and after 24 weeks of therapy. RESULTS: There was no significant difference in baseline clinical or demographic variables between group B and group C. Baseline blood pressure and duration of hypertension was greater in group D compared to group A (P<0.001). The reduction in left ventricular mass index (mean ±SD) in the four groups (A to D) was 16.7±18.7, 21.0±20.8, 20.5±15.5 and 29.1±21.5 g/m2 respectively (D>A, P=0.011, B versus C, P=1.00). The corresponding change in blood pressure (systolic/diastolic) was 18.5±13.6/8.9±11.2, 27.5±19.2/12.2±9.3, 23.4±16.7/ 5.4±10.1, 26.6±19.5/10.7±12.8 mm of Hg respectively (systolic, B>A, P=0.027, D>A, P=0.048) (diastolic, B>C, P=0.013). CONCLUSION: Anti-hypertensive treatment with angiotensin converting enzyme inhibitors/angiotensin receptor blockers-based therapy produced graded regression of left ventricular hypertrophy with monotherapy, dual therapy and triple therapy. In dual therapy, add-on of either thiazide diuretics or calcium channel blockers to angiotensin converting enzyme inhibitors/angiotensin receptor blockers showed equal efficacy in regression of left ventricular hypertrophy independent of blood pressure reduction.

Interacting cogs in the machinery of the renin angiotensin system.

Somatic angiotensin converting enzyme (sACE) is well-known for its role in blood pressure regulation and consequently, ACE inhibitors are widely prescribed for the treatment of hypertension. More than 60years after the discovery of sACE, however, the molecular details of its substrate hydrolysis and inhibition are still poorly understood. Isothermal titration calorimetry, molecular dynamics simulations and fine epitope mapping suggest that substrate or inhibitor binding triggers a hinging motion between the two subdomains of each domain. Ligand binding to one domain further induces a conformational change in sACE to negatively affect the second domain's function and can also cause dimerization between sACE molecules. This has been linked to an increase in sACE expression via intracellular signalling. Inhibitor-induced dimerization could thus decrease the efficacy of hypertension treatment. At present, the only structural information available for sACE are crystal structures of the truncated domains in the closed conformation due to the presence of ligands. These structures do not provide any information regarding the open active site conformation prior to ligand binding, the relative orientation of the two domains in full-length sACE, or the dimerization interface. To guarantee effective therapeutic intervention, further research is required to investigate the hinging, negative cooperativity and dimerization of sACE. This review describes our current understanding of these interactions and proposes how recent advances in cryo-electron microscopy could enable structural elucidation of their mechanisms.

Impact of cumulative SBP and serious adverse events on efficacy of intensive blood pressure treatment: a randomized clinical trial.

Intensive blood pressure lowering is increasingly gaining attention. In addition to higher baseline blood pressure, cumulative SBP, visit-to-visit variability, and treatment-induced serious adverse events (SAEs) could impact treatment efficacy over time. Our aim was to assess the impact of cumulative SBP and SAEs on intensive hypertension treatment efficacy in the Systolic Blood Pressure Intervention Trial (SPRINT) population during follow-up. Secondary analysis of the SPRINT study: a randomized, controlled, open-label trial including 102 clinical sites in the United States. We included 9068 SPRINT participants with 128 139 repeated SBP measurements. Participants were randomly assigned to intensive (target SBP < 120 mmHg) versus standard treatment (target SBP between 135 and 139 mmHg). We used cumulative joint models for longitudinal and survival data analysis. Primary outcome was a composite outcome of myocardial infarction, other acute coronary syndromes, acute decompensated heart failure, stroke, and cardiovascular mortality. Although intensive treatment decreased the risk for the primary SPRINT outcome at the start of follow-up, its effect lost significance after 3.4 years of follow-up in the total SPRINT population and after 1.3, 1.3, 1.1, 1.8, 2.1, 1.8, and 3.4 years among participants with prevalent chronic kidney disease, prevalent cardiovascular disease, women, black individuals, participants less than 75 years, those with baseline SBP more than 132 mmHg, and individuals who suffered SAEs during follow-up, respectively. The initial beneficial impact of intensive hypertension treatment might be offset by cumulative SBP and development of SAEs during follow-up.

Labetalol o alfa-metildopa oral en el tratamiento de la hipertensión severa en preeclámpticas

Objetivo. Comparar la eficacia del labetalol oral con alfa-metildopa oral en el tratamiento de la hipertensión severa en preeclámpticas. Diseño. Estudio de casos y controles. Institución. Hospital Central “Dr. Urquinaona”, Maracaibo, Venezuela. Participantes. 200 preeclámpticas que fueron asignadas al azar para ser tratadas con labetalol oral (grupo A) o con alfa-metildopa oral (grupo B). Principales medidas de resultado. Eficacia del tratamiento de la hipertensión, tasa de persistencia de la hipertensión y efectos adversos relacionados con el uso de los fármacos. Resultados. No se encontraron diferencias entre los grupos con relación a edad materna, edad gestacional al momento de la inclusión en el estudio e índice de masa corporal (p = ns). Tampoco se observaron diferencias estadísticamente significativas en los valores de presión arterial sistólica, diastólica y media entre los grupos (p = ns). Se observó que las pacientes tratadas con labetalol oral presentaron valores significativamente más bajos de presión arterial sistólica, diastólica y media comparadas con las pacientes tratadas con alfa-metildopa oral (p &lt; 0,0001). Ninguna paciente en el grupo A presentó persistencia de la hipertensión comparado con 17 pacientes en el grupo B (p &lt; 0,0001). El síntoma más común en el grupo A fue la cefalea y en el grupo B, las náuseas, que mostraron ser significativamente más frecuentes (p = 0,006). Conclusión. El labetalol oral fue más efectivo que la alfa-metildopa en el tratamiento de la hipertensión severa en preeclámpticas.

Arterial hypertension treatment changes in Yaroslavl region: results obtained after 4 years of complex program of regional healthcare system’s improvement implementation

Program’s aim. Cardiovascular morbidity and mortality rates in Russia are among the highest in Europe. The aim of this work was to implement a complex healthcare system improvement program in Russia’s Yaroslavl region, dedicated to increasing arterial hypertension treatment efficacy and prevent complications of arterial hypertension. Materials and methods. The program was developed by a group of healthcare professionals of the Department of Healthcare and Pharmacy of Yaroslavl region together with Novartis Pharma Company’s technical advice within the framework of a private-public partnership. The program consisted of several actions aiming to raise the healthcare system’s attention to hypertension. Achievement of target blood pressure (BP) control by every patient seen by physicians of the Yaroslavl region healthcare system became the main goal and leading criteria for assessing hypertension treatment efficacy. Additionally, significant effort was put into patient education on self-control of BP levels and importance of achieving target BP levels in accordance with Russian national clinical guidelines and on adherence to treatment. Within 4 years, program efficacy was evaluated and reinforced by conducting annual cross-sectional questionnaire-based epidemiological studies. Analysis was performed in a representative sample of patients that evaluated BP control level, mean BP levels, systolic BP level distribution by grades, as well as cardiovascular risk factors and concomitant diseases presence and current antihypertensive therapy. In addition, analysis of official statistics on disease incidence and drug sales databases were performed. Results. From 2011 to 2014 BP control level increased significantly: 17% of patients had BP

Изменения в лечении артериальной гипертензии в Ярославской области: результаты, полученные в результате 4 лет реализации комплексной программы по совершенствованию областной системы оказания медицинской помощи

Program’s aim. Cardiovascular morbidity and mortality rates in Russia are among the highest in Europe. The aim of this work was to implement a complex healthcare system improvement program in Russia’s Yaroslavl region, dedicated to increasing arterial hypertension treatment efficacy and prevent complications of arterial hypertension. Materials and methods. The program was developed by a group of healthcare professionals of the Department of Healthcare and Pharmacy of Yaroslavl region together with Novartis Pharma Company’s technical advice within the framework of a private-public partnership. The program consisted of several actions aiming to raise the healthcare system’s attention to hypertension. Achievement of target blood pressure (BP) control by every patient seen by physicians of the Yaroslavl region healthcare system became the main goal and leading criteria for assessing hypertension treatment efficacy. Additionally, significant effort was put into patient education on self-control of BP levels and importance of achieving target BP levels in accordance with Russian national clinical guidelines and on adherence to treatment. Within 4 years, program efficacy was evaluated and reinforced by conducting annual cross-sectional questionnaire-based epidemiological studies. Analysis was performed in a representative sample of patients that evaluated BP control level, mean BP levels, systolic BP level distribution by grades, as well as cardiovascular risk factors and concomitant diseases presence and current antihypertensive therapy. In addition, analysis of official statistics on disease incidence and drug sales databases were performed. Results. From 2011 to 2014 BP control level increased significantly: 17% of patients had BP<140/90 mm Hg in 2011, 23% in 2012, 32% in 2013 and 33% in 2014. In the same time mean BP level reduced from 151/90 to 145/86 mm Hg and share of patients with systolic BP≥180 mm Hg decreased from 10% to 5%. Stroke incidence declined by 20% (from 4,6 to 3,7 per 1000 adult population in 2011 and 2014 respectively) and antihypertensive drug utilization increased by 16% (2014 vs. 2011). Conclusion. A healthcare system improvement program aiming to increase hypertension treatment efficacy resulted in significant improvement in BP control level and substantial decrease in stroke incidence. Continuous improvement is necessary to increase BP control level further resulting in reduction of cardio-vascular mortality and morbidity in the region. Nationwide system for hypertension drug provision could be an instrument of further improvement.

Trends and determinant factors in hypertension control in a population study with 25 years of follow-up

The present study focused on trend in hypertension control and on determinant factors that may influence efficacy in antihypertensive therapy. Two measures of treatment efficacy were used: population blood pressure and the relative frequency of effectively treated patients (blood pressure <140/90 mmHg). Copenhagen City Heart Study is a prospective longitudinal epidemiological study with 25 years of follow-up. The study population were treated hypertensive patients. The blood pressure measurement was fully standardized and measurement method was unchanged throughout the observation period. A questionnaire was completed by the participants and double-checked by the technicians. The number of treated hypertensive patients increased considerably and hypertension control increased from 21 to 26%. Pretreatment SBP was stable in the observation period indicating that start-to-treat practice was stable. Treated SBP decreased from 157.9 to 148.7 mmHg. Four determinant factors were significant. Men presented a higher pretreatment SBP before starting antihypertensive medication. Elderly patients presented a higher pretreatment SBP and were poorly treated as compared with younger hypertensive patients. Obesity was associated with a high threshold SBP. The fourth factor was diagnosis. Patients with myocardial infarction were better treated in last surveys than patients from other diagnosis groups. Treated DBP was stable. Hypertension treatment efficacy is improving but still far from acceptable. The evaluation of determinant factors identified four areas that need special attention: men, elderly and obese hypertensive patients. The fourth factor is diagnosis. The results may indicate a beneficial effect of systematic control of hypertensive patients during a limited time after a myocardial infarction.

Education: Nationally achievable solutions

Despite the efficacy of hypertension treatment, knowledge and compliance remain poor in Hispanic patients because of language barriers, low educational levels, and cultural differences. Yet effective physician-patient communication is crucial to patient compliance, satisfaction, and understanding of medical issues. Physicians and health care providers therefore need to develop "cultural competence" skills to achieve effective health education and good treatment outcomes in this patient population. Various strategies such as mnemonic devices can help practitioners communicate with Hispanic patients. National initiatives and research studies continue to address the provision of culturally and linguistically appropriate health care.

Correlates of drug therapy of diastolic blood pressure between 80-89 mm Hg by physicians in the community.

We have conducted a random probability survey of primary care physicians (n = 477) to examine the factors which might influence the level of diastolic blood pressure (DBP) felt by physicians to warrant antihypertensive drug therapy in young adults. Of the responding physicians, 18.4% reported treating young adults who had a DBP of less than 90 mm Hg. This practice was correlated with physician opinions about the efficacy of hypertension treatment and the reported influence of pharmaceutical representatives on physician practice. We conclude that reported therapy of DBP less than 90 mm Hg in young adults is highly prevalent. Such therapy is correlated with physician opinions as well as the perceived influence of pharmaceutical sources of information.