Joint National Committee Guidelines Research Articles

ASSESSMENT OF PROFESSIONAL’S ADHERENCE TO JOINT NATIONAL COMMITTEE 8 GUIDELINES IN THE MANAGEMENT OF HYPERTENSION

Objectives: Hypertension is the most insidious ailment in primary care with its management being a daily affair. The avail of antihypertensive medications has affirmed their efficacy in blood pressure alleviation. Yet, the methodical choice of medication with which treatment ought to commence at the precise blood pressure threshold and maintained at a target level was undiscerned. Consequently, the Eighth Joint National Committee grants an evidence-based tool, which was employed in the appraisal of professional’s adherence to joint national committee 8 guidelines.Methods: A prospective, observational study was governed. Aggregate patients with hypertension with/without diabetes mellitus (DM) and/ or chronic kidney failure admitted in general medicine and the dialysis unit of the tertiary health care hospital, for 4 months were enrolled. The rationality of antihypertensive medications and target blood pressure was noted.Results: Patients matriculated to 125, 90 males and 35 females. Average age perceived was between 51 and 60 years, with the length of stay 14.39 (standard deviation [SD]±1.52) and 9.3 (SD±0.46) days in the respective unit. The gross medication endorsed represents 1085 medications, incorporating 337 antihypertensive medications. The optimal choice of an antihypertensive medicine was clonidine and amlodipine. Adherence in the populace with lone hypertension was cent percent, trailed by hypertension with DM 82.35% and minimal in hypertension with chronic kidney disease.Conclusion: 86-medication compiled adherence to the guidelines (25.52%). Rationality of medication depicts 25.6% were rational and 73.6% distinguish as non-rational, amid a demise of a sole victim. A significant high-grade defiance of health-care practitioners to the Eighth Joint National Committee guidelines was evidenced from our study.

Unintended consequences of the new ACC/AHA blood pressure treatment guidelines.

Hypertension is a major risk factor for cardiovascular disease, heart failure, chronic kidney disease and stroke. Therefore, its early detection and treatment are very important according to blood pressure (BP) treatment guidelines issued by the various scientific societies. Over the years, BP treatment guidelines have changed from strict control of BP to more relaxed control, and lately to a strict BP control influenced by the results of the SPRINT trial. The recently published BP treatment guidelines by the American College of Cardiology/American Heart Association (ACC/AHA) recommend a systolic BP (SBP) and diastolic BP reduction to less than 130 mmHg and less than 80 mmHg, respectively, for all ages, and have also changed the classification of hypertension by changing the term "prehypertension" of the JNC 7 (7th Joint National Committee) guidelines to "stage 1 hypertension". These changes could have significant social and economic consequences for the patients. In order to get a better perspective of the current status of SBP control, we conducted a MEDLINE search of the English language literature from 2014 to 2018 in connection with recent (2014-2018) BP treatment guidelines, using the terms 'hypertension', 'blood pressure control', 'intensive blood pressure control', 'blood pressure treatment guidelines', and 'benefits and risks of intensive blood pressure control', and 26 pertinent papers were retrieved. These papers together with collateral literature, which goes beyond the year 2014, will be discussed in this review.

Pre-operative hypertension and its risk factors: A cross-sectional study among patients admitted for surgery at a tertiary health care facility of Eastern India

Background: Hypertension (HTN) is one of the most common diagnoses in a primary health care setting and it is one of the important and preventable contributors to disease and death. HTN is considered as an additional risk factor in anesthesia and HTN is of special importance to the anesthetist for various reasons. Tracheal intubation, surgical incision, recovery from anesthesia, and post-operative pain can increase blood pressure (BP). Objectives: This study aims to find out the burden of pre-operative HTN and its risk factors among patients who were admitted for surgical procedures at a tertiary health care facility of Durgapur, West Bengal, India. Materials and Methods: After obtaining permission from the Institutional Ethics Committee, an institution based, observational, and cross-sectional study was conducted from January 2019 to February 2019. A pre-tested, semi-structured schedule was used to collect Clinic Social data. Anthropometric measurements and BP were taken as per the world health organization STEP-wise approach to surveillance guidelines. BP was classified as per “The eighth joint national committee (JNC-8) guidelines. Results: Data were collected from 150 study subjects and were analyzed using SPSS, version 20.0 for windows. The frequency of pre-operative HTN and pre-HTN was found to be 38.0% and 32.0% respectively. As per JNC-8, 34.7% had Stage-1 HTN followed by 32.0% and 3.3% who had pre-HTN and Stage-2 HTN, respectively. Increasing age, male gender, smoking, increasing body mass index, dyslipidemia, and Type 2 diabetes mellitus (T2DM) were significantly associated with a higher frequency of HTN. Conclusion: There is a very high prevalence of pre-operative HTN and pre-HTN. Increasing age, male gender, smoking, overweight, obesity, dyslipidemia, and T2DM were significant risk factors for HTN. Routine screening of HTN should be done in surgical ward to see if there are cases of “white coat” HTN.

Review of Hypertension Management at University of South Florida BRIDGE Clinic

Background: Hypertension is one of the most prevalent diseases in the United States, and proper disease management is essential in preventing multi-system organ damage. The BRIDGE Healthcare Clinic is a student-run free clinic that cares for a primarily uninsured, immigrant population in Tampa, Florida. This retrospective study aimed to assess the quality of hypertension management provided at BRIDGE Clinic and compare our hypertension outcomes with the 8th Joint National Committee (JNC8) guidelines and national rates of blood pressure (BP) control.Methods: Chart reviews of all patients seen at BRIDGE Clinic from May 1, 2012 to May 1, 2017 were performed. Patients with hypertension, defined by JNC8 as a previous diagnosis of hypertension, a BP >140/90 mmHg for patients <60 years old, or BP >150/90 for patients >60 years old, on ≥2 occasions, were included in the study. Information collected included patient demographics (age, race, gender, body mass index, comorbidities), BP at initial visit, BP at most recent visit, total number of visits, dates of initial and most recent visits, and types of antihypertensive medications being used. Data were analyzed using SPSS statistics software.Results: Of the 599 patients reviewed, 97 patients (between the ages of 29 and 89 years) were found to have a diagnosis of hypertension per JNC8 criteria. Compared to the national average of 53%, 55.7% of BRIDGE Clinic had BPs at goal (defined as BP <140/90 in patients <60 years old, and BP <150/90 in patients >60 years old). There was also a significant decrease in systolic BP by 10.9 mmHg (p<0.0001, 95% confidence interval [CI] 6.9-14.9 mmHg) and diastolic BP by 5.4 mmHg (p<0.0001, 95% CI 3.3-7.5 mmHg) from initial visit to most recent visit.Conclusions: As a student-run free clinic dependent on volunteers and donors, BRIDGE Clinic has been able to achieve clinically and statistically significant decreases in BP, along with rates of BP control that are comparable to national averages for both insured and uninsured Americans.

A0976 Applying a “big data” literature system to recommend antihypertensive drugs for hypertension patients with diabetes mellitus

Objectives: The explosive increase in medical literature has changed therapeutic strategies, but it is challenging for physicians to keep their knowledge. Data mining on large-scale scientific literature can refresh knowledge to better improve the quality of disease treatment. Methods: This paper reports on a reformulated version of a data mining method called MedRank, which is a network- based algorithm that ranks therapy for a target disease based on the MEDLINE literature database. MedRank algorithm input for this study was a clear definition of the disease model; the algorithm output was the accurate recommendation of antihypertensive drugs. Hypertension with diabetes mellitus was chosen as the in- put disease model. The ranking output of antihypertensive drugs are based on the Joint National Committee (JNC) guidelines, one through eight, and the publication dates, ≤1977, ≤1980, ≤1984, ≤1988, ≤1993, ≤1997, ≤2003, and ≤2013. The McNemar's test was used to evaluate the efficacy of MedRank based on specific JNC guidelines. Results: The ranking order of antihypertensive drugs changed with the date of the published literature, and the MedRank algorithm drug recommendations had excellent consistency with the JNC guidelines in 2013 (P = 1.00 from McNemar's test, Kappa = 0.78, P = 1.00). Moreover, the Kappa index increased over time. Sensitivity was better than specificity for MedRank; in addition, sensitivity was maintained at a high level, and specificity increased from 1997 to 2013. Conclusion: The use of MedRank in ranking medical literature on hypertension with diabetes mellitus in our study suggests possible application in clinical practice; it is a potential method for supporting antihypertensive drug-prescription decisions.

Blood pressure and mortality in a prospective cohort of HIV-infected adults in Port-au-Prince, Haiti.

The objective of this study was to determine how baseline blood pressure and incident hypertension related to antiretroviral therapy (ART) initiation, HIV-related inflammation and mortality in HIV-infected adults in a low-income country. We conducted long-term follow-up of HIV-infected adults who had participated in a trial of early vs. delayed initiation of ART in Port-au-Prince, Haiti. Between 2005 and 2008, 816 HIV-infected adults were randomized to early (N = 408) vs. delayed ART (when CD4 cell count <200 cells/μl or AIDS-defining condition; N = 408). Blood pressure was measured every 3 months. Hypertension was diagnosed according to the Joint National Committee (JNC-7) guidelines. Biomarkers of inflammation and coagulation were measured from banked enrolment plasma samples. Survival analyses were performed using Stata 14. The median age at enrolment was 39 years. The median follow-up time was 7.3 years. The hypertension incidence rate was 3.41 per 100 person-years, and was similar in early and delayed ART groups. In multivariable models, independent predictors of incident hypertension were older age, higher BMI and plasma interleukin (IL)-6 levels (adjusted hazard ratio, aHR = 1.23, P < 0.001). Systolic pressure more than 140 mmHg at enrolment was associated with increased mortality (aHR = 2.47, P = 0.03) as was systolic pressure less than 90 mmHg (aHR = 2.25, P = 0.04). Prevalent and incident hypertension were also significantly associated with mortality. In a large prospective study of HIV-infected adults, we found a high incidence of hypertension associated with HIV-related inflammation. Baseline hypertension conferred a more than two-fold increased risk of death. Among HIV-infected adults in low-income countries, hypertension should be considered a serious threat to long-term survival.

A Comparative clinical evaluation of Sirodhara with Sukhosnajala, Tila Tailam and Brahmi Tailam in the management of mild to moderate essential hypertension

In worldwide 25% of population is suffering with Hypertension. As it is an instrumental disease, asymptomatic in nature, it was named as Silent killer. The causative factors of Essential hypertension were Genetic predisposition and environmental factors but these factors are triggered by stress hence it comes under stress related psycho-somatic disorder. In Hypertensive patients, Decrease in 5mm of Hg in SBP and DBP results in decrease in cardiovascular risk, stroke which decreases mortality rate worldwide. The management aspect of modern medical science remains symptomatic with troublesome side effects. The Joint National Committee (JNC 8) guideline advise higher blood pressure goals, less use of several types of antihypertensive medications and suggests lifestyle modification and relaxation are the best initial therapy. In Ayurveda, Shirodhara is one of the panchakarma therapy meant for relaxation and stress reducing procedure mentioned in Dharakalpaas a preventive and curative treatment for many stress related disorders. So, Present study is planned as “A Comparative clinical evaluation of Shirodhara with Sukhos̩n̩ajala, Tila tailam and Brahmitailamin the management of mild to moderate essential hypertension”was selected. This paper is going to describe about conclusion drawn from the study i.e. effect of three types of dhara on Objective parameters SBP, DBP, PP, and MAP.

Clinical inertia in the pharmacological management of hypertension: A systematic review and meta-analysis.

Clinical Inertia is defined as "failure of health care providers to initiate or intensify therapy according to current guidelines". This phenomenon is gaining increasing attention as a major cause of clinicians' failure to adequately manage hypertension, thus leading to an increased incidence of cardiovascular events. We performed a systematic review and meta-analysis of randomized controlled trials to determine whether interventions aimed at reducing clinical inertia in the pharmacological treatment of hypertension improve blood pressure (BP) control. MEDLINE, Embase, and Cochrane Database of Systematic Reviews were searched from the start of their database until October 3, 2017 for the MESH terms "Hypertension" or "Blood Pressure", their subheadings, and the keywords "Therapeutic Inertia" or "Clinical Inertia". Studies were included if they addressed pharmacologic hypertension management, clinical inertia, were randomized controlled trials, reported an outcome describing prescriber behavior, and were available in English. Data for the included studies was extracted by two independent observers. Quality of studies was analyzed using the Cochrane Risk of Bias Assessment. Data was pooled for statistical analysis using both fixed- and random-effects models. The primary study outcome was the percentage of patients achieving blood pressure control as defined by the Joint National Committee guidelines or study authors. Of 474 citations identified, ten met inclusion criteria comprising a total of 26,871 patients, and eight were selected for meta-analysis. Interventions included Physician Education, Physician Reminders, Patient Education, Patient Reminders, Ambulatory BP Monitoring, Digital Medication Offerings, Physician Peer Visits, and Pharmacist-led Counselling. Pooled event rates revealed more patients with controlled BP in the intervention group versus control (55%, 95% CI 46-63% versus 45%, 95% CI 37-53%) and interventions significantly improved the odds of BP control (OR = 1.19, 95% CI = 1.12-1.27, P < .001). Heterogeneity in the quantitative analysis was moderate. Addressing clinical inertia through physician reminders, ambulatory BP monitoring, and educational interventions for primary care providers was associated with an improvement in blood pressure control. Our findings encourage further research to investigate strategies at reducing clinical inertia in the management of hypertension.

Applying a "Big Data" Literature System to Recommend Antihypertensive Drugs for Hypertension Patients with Diabetes Mellitus.

BackgroundThe explosive increase in medical literature has changed therapeutic strategies, but it is challenging for physicians to keep up-to-date on the medical literature. Scientific literature data mining on a large-scale of can be used to refresh physician knowledge and better improve the quality of disease treatment.Material/MethodsThis paper reports on a reformulated version of a data mining method called MedRank, which is a network-based algorithm that ranks therapy for a target disease based on the MEDLINE literature database. MedRank algorithm input for this study was a clear definition of the disease model; the algorithm output was the accurate recommendation of antihypertensive drugs. Hypertension with diabetes mellitus was chosen as the input disease model. The ranking output of antihypertensive drugs are based on the Joint National Committee (JNC) guidelines, one through eight, and the publication dates, ≤1977, ≤1980, ≤1984, ≤1988, ≤1993, ≤1997, ≤2003, and ≤2013. The McNemar’s test was used to evaluate the efficacy of MedRank based on specific JNC guidelines.ResultsThe ranking order of antihypertensive drugs changed with the date of the published literature, and the MedRank algorithm drug recommendations had excellent consistency with the JNC guidelines in 2013 (P=1.00 from McNemar’s test, Kappa=0.78, P=1.00). Moreover, the Kappa index increased over time. Sensitivity was better than specificity for MedRank; in addition, sensitivity was maintained at a high level, and specificity increased from 1997 to 2013.ConclusionsThe use of MedRank in ranking medical literature on hypertension with diabetes mellitus in our study suggests possible application in clinical practice; it is a potential method for supporting antihypertensive drug-prescription decisions.

Assessment of Blood Pressure Control among Hypertensive Patients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study

Background: Hypertension is a major global concern and public health problem affecting more than one billion individuals worldwide. It is risk factor for cardiovascular diseases (CVDs). The main objective of this study was to determine the prescription pattern of antihypertensive medications among patients on follow-up at cardiac clinic of Zewditu Memorial Hospital.Method: A cross-sectional retrospective study design was used to collect the data from the patient chart by reviewing the hypertension patient’s medical record.Result: Out of the 356 patient cards reviewed, 204 (57.3%) were for females and with the mean age of 56.2 ± 12.4 years. Among total study participants, 124 (34.8%) had co-morbid conditions. Majority of the patients were on combination therapy 252 (70.8%). Angiotensin converting enzyme inhibitor (ACEI), 215 (60.4%) was the most prescribed drug. Blood pressure was controlled in 107 (30.1%) of patients. About 140 (39.3%) and 134 (37.6%) hypertensive patients were appropriately prescribed according to national guideline 2014 and Joint National Committee (JNC 8) guideline, respectively. The result of the multivariate analysis showed that there was a positive statistically significant association between inappropriate prescription pattern of antihypertensive medications with age ≥ 60 years (P=0.01) and uncontrolled blood pressure (BP) (P=0.001).Conclusion: In conclusion, the general use of antihypertensive medications seemed not to be in accordance with the Ethiopia national guideline.

Blood pressure goal for the elderly Chinese: the findings from the Northern Shanghai Study

ABSTRACTBackground: The Eighth Joint National Committee Panel (JNC8) recommended a novel blood pressure (BP) goal for individuals with hypertension, which was less stringent than the Seventh Joint National Committee (JNC7) guideline and is still under debate. In our study, we aimed at finding a better BP goal for the elderly Chinese. Methods: About 1599 community-based elderly participants were recruited in the northern Shanghai and were classified by chronic kidney disease or diabetes mellitus to investigate their BP control conditions based on both the JNC7 and JNC8. Then, participants were categorized into four groups: normotensive individuals (Group 1), individuals at BP goal by JNC7 (Group 2), individuals at BP goal by JNC8 but not by JNC7 (Group 3), and individuals not at-goal by both guidelines (Group 4). Patients’ hypertensive target organ damages as left ventricular mass index (LVMI), peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), pulse wave velocity (PWV), etc. were evaluated. Results: According to the JNC8, 19.0% of the population were reclassified as at-goal. Group 4 had significantly greater LVMI than Group 2 (96.5 vs 91.5 g/m2, p < 0.05) and also had significantly greater E/Ea (10.3 vs 9.7 and 10.3 vs 9.7, p < 0.05) and PWV (10.3 vs 9.3 m/s and 10.3 vs 9.7 m/s, p < 0.05) than both Group 2 and Group 3; however, there were no significant differences of these variables between Group 2 and Group 3. Conclusion: In the community-based elderly Chinese, the JNC8 hypertension guideline may set a better BP goal than the JNC7 in identifying patients’ left ventricular diastolic dysfunction and arterial stiffening.

Drug utilization among hypertensive patients in the outpatient department of medicine in a tertiary care hospital: A cross-sectional study

ABSTRACTBackground: Hypertension is one of the leading risk factors for cardiovascular, cerebrovascular, and renal disease. Its increasing prevalence and treatment costs influence the prescribing pattern among physicians. Drug utilization studies provide insights into the current prescribing practices and help us facilitate the rational use of drugs. We carried out the present study to assess the pattern of drug utilization in hypertensive patients. Method: Adults seeking treatment for hypertension were recruited. Prescriptions were studied for demographic and drug-use details. The World Health Organization indices for drug utilization were evaluated. The percentage of prescriptions adhering to the recent guidelines was determined. Results: Enalapril was the most commonly prescribed drug. Monotherapy was used in 71.8% of the cases. However, 42% of the cases were newly diagnosed. The ratio of prescribed daily dose and defined daily dose showed underutilization of enalapril and atenolol and overutilization of amlodipine. About 87.5% of the prescriptions adhered to Eighth Joint National Committee guidelines. Most of the medications were available at the hospital pharmacy store and were prescribed by their generic names. Total 65.3% of the concomitant medications were not listed in the World Health Organization essential list of medicines. The average number of drugs prescribed was six. A median cost of 14.6 and 94.5 rupees was spent, respectively, on anti-hypertensive and concomitant medications per encounter. Conclusion: The adherence to the guideline was good. Polypharmacy can be reduced by avoiding the prescription of unnecessary medications and promoting the use of fixed-dose combinations.

Awareness of Eighth Joint National Committee Guidelines in Hypertension Management among Internists in Al-Ahsaa Area

Background: Hypertension is one of the most common conditions seen in primary care and the consequences are fatal if not diagnosed early and managed appropriately. Patients want to be sure that hypertension management will decrease their disease burden, and clinicians need guidance on hypertension treatment using the best scientific evidence. Objective: The primary objective is to evaluate the awareness of the Eighth Joint National Committee Guidelines among internists in the Al-Ahsaa area.&#x0D; Method: This was a cross-sectional observational study that evaluated 43 internists randomly chosen in Al-Ahsaa area by using a questionnaire containing 16 questions that reflect on their awareness of the Eighth Joint National Committee Guidelines. Passing 80% of the 16 questions is described as fair awareness of the Eighth Joint National Committee Guidelines.&#x0D; Results: The average of right answers percentages among the 43 evaluated internists was 54.07% ± 25.6%. The averages of right answers percentages among 16 physicians, 14 specialists and 13 consultants were 75.78% ± 20%, 47.76% ± 16% and 34.13% ± 20%, respectively, which showed a significant difference (P-value &lt; 0.00001) between them.&#x0D; Conclusion: The awareness of the Eighth Joint National Committee Guidelines among internists in Al-Ahsaa area is not good enough. However, physicians showed significantly better awareness of the Eighth Joint National Committee Guidelines than specialists and consultants. Increasing the awareness of internists about new guidelines for hypertension is highly recommended, through workshops that could be provided by the Ministry of Health.

A prospective study of the association between total sleep duration and incident hypertension.

The aim of this prospective study was to evaluate total sleep duration as a potential risk factor for the development of hypertension after a mean of 2.6years of follow-up. The study participants comprised 1715 Korean adults aged 40 to 70years. The participants were without hypertension at baseline (2005-2008) and during follow-up (2008-2011) to determine the incident cases of hypertension. Based on a self-reported questionnaire, the individuals were stratified according to total sleep duration (<6hours, 6-7.9hours, 8-9.9hours, ≥10hours). Hypertension was defined according to the Eighth Joint National Committee (JNC 8) guidelines. After an average of 2.6years of follow-up, 164 (9.56%) participants developed hypertension. In multivariate adjusted models, the odds ratio for new-onset hypertension was 1.71 (95% confidence interval, 1.01-2.89) in participants with a short sleep duration (<6hours) compared with those who reported 6 to 7.9hours of sleep. Long sleep duration (more than 8hours) did not have any significant difference on incident hypertension. Among middle-aged and elderly Korean adults, short sleepers were independently associated with a higher risk of developing hypertension.

Estimated Effects of BP Lowering with JNC 8 vs. SPRINT Goals

The 2014 Eighth Joint National Committee (JNC 8) guidelines set blood pressure (BP)-lowering goals of <150/90 mm Hg for adults aged ≥60 years and

Observed Blood Pressure and Mortality Among People Aged 65 Years and Older: A Community-Based Cohort Study

ObjectivesThe 2014 Eighth Joint National Committee guidelines for hypertension management emphasize the upper limit of blood pressure (BP) as the target for treatment in the elderly population. Given the uncertainty regarding optimal BP range, we aimed to investigate the association between observed BP and subsequent mortality in older people. Design, setting, and participantsWe extracted data from 128,765 participants ≥65 years of age who underwent annual health examinations in a retrospective, observational community-based study from 2001 to 2010. Seated BP was measured using an oscillometric device. The outcomes were all-cause and cardiovascular mortality. ResultsAs compared to participants with systolic BP at 130 to 139 mm Hg, the risk of all-cause mortality was significantly higher among those with <110 (adjusted hazard ratios [aHRs], 1.12; 95% confidence interval [CI], 1.05-1.20), 140 to 149 (aHR, 1.08; 95% CI, 1.03-1.14), 150 to 159 (aHR, 1.07; 95% CI, 1.01-1.17), 160 to 169 (aHR, 1.11; 95% CI, 1.04-1.19), and ≥170 mm Hg (aHR, 1.25; 95% CI, 1.17-1.33), whereas the differences were not significant for those with 110 to119 (aHR, 1.06; 95% CI, 1.00-1.12) and 120 to 129 mm Hg (aHR, 1.03; 95% CI, 0.97-1.08). Similarly, diastolic BP at 40 to 79 mm Hg was associated with the lowest risk of all-cause mortality. The J-shaped curve relationship between BP and cardiovascular mortality was also observed. ConclusionsObserved systolic and diastolic BP other than 110 to 139 and 40 to 79 mm Hg, respectively, were associated with a worse outcome. Our large cohort study supports the J-shaped mortality with observed BP in older people.

Current Practice of Hypertension in India: Focus on Blood Pressure Goals.

Recommended Blood Pressure (BP) goals in elderly and those with co-morbid conditions like Diabetes Mellitus (DM) and Chronic Kidney Disease (CKD) vary in different Hypertension (HTN) management guidelines. To understand currently followed BP goals and practices among the physicians involved in management of HTN in India. A cross-sectional, observational survey was conducted at 66th annual conference of Cardiological Society of India (CSICON-2014, Hyderabad). A structured questionnaire related to the BP goals and HTN practices was provided and responses from voluntarily participating physicians were collected. Data was analysed with descriptive statistics. Two-hundred sixty physicians completed this survey. In their routine clinical practice, physicians most frequently referred to Joint National Committee (JNC) guidelines (63.85%) followed by Indian guidelines on HTN (14.23%). In patients aged 60 years and above, BP goal <140/90mmHg and <150/90mmHg was aimed by 43.46% and 33.85% of the physicians respectively. In HTN with Type 2 DM (T2DM), most physicians (61.92%) had a BP goal of <130/80mmHg. A target BP <130/80mmHg was aimed by 48.08% physicians in CKD without proteinuria and 68.85% physicians in CKD with proteinuria. In newly diagnosed hypertensives, treatment modification was practiced after 15, 20 and 30 days by 37.31%, 16.15% and 35.77% of the physicians respectively. Beta-blockers were considered as third-line agents in HTN without co-morbidities by 45% physicians. Ambulatory BP Monitoring (ABPM) is practiced only in few patients (<5%) by most (71.93%) physicians. In practice, Indian physicians follow lower BP goals when compared to the recommendations from the most referred JNC guidelines. Increasing physicians' awareness to the changes in recommendations is the need.

Prevalence of Comorbidity among People with Hypertension: The Korea National Health and Nutrition Examination Survey 2007-2013.

Background and ObjectivesJoint National Committee guidelines attempt to vary treatment recommendations for patients based on considerations of their comorbidities. The aim of the present study is to estimate the age-standardized prevalence of common comorbidities among Korean hypertension patients.Subjects and MethodsWe analyzed the Korea National Health and Nutrition Examination Survey from 2007 to 2013. Among the 58423 participants, 30092 adults, aged ≥30 yrs who completed a health examination and interview survey, were selected. The survey procedures were used to estimate weighted prevalence and odds ratios for 8 comorbidities, including obesity, diabetes mellitus, dyslipidemia, cardiovascular disease, chronic kidney disease, and thyroid disease.ResultsMost chronic conditions were more prevalent in adults with hypertension than in those without hypertension. Common comorbidities were obesity (60.1%), dyslipidemia (57.6%), and impaired fasting glucose (45.1%). Hypertensive patients with two or more comorbid diseases were 42.2% and those with three or more diseases were 17.7%. The age- and sex-specific prevalence of three or more comorbid diseases among male hypertension patients was significantly higher than those patients in the 30-59 (p<0.05) age group.ConclusionComorbidity is highly prevalent in Korean patients with hypertension.

Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study.

The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly affect the aging US population. We performed a cross-sectional analysis of black and white participants in Atherosclerosis Risk in Communities who participated in the fifth study visit (2011-2013). Sitting blood pressure was calculated from the average of 3 successive readings taken after a 5-minute rest. Currently, prescribed antihypertensive medications were recorded by reviewing medication containers brought to the visit. Blood pressure control was defined using both the Seventh and Eighth Joint National Committee thresholds. Of 6088 participants (mean age, 75.6 [range, 66-90] years, 58.4% women; 23.2% black), 54.9% had either diabetes mellitus or chronic kidney disease. The prevalence of hypertension according to Seventh Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the Eighth Joint National Committee thresholds, 79.4% were at blood pressure goal (16.6% were reclassified as at-goal). Reclassification was higher for individuals with diabetes mellitus or chronic kidney disease (20.6%) when compared with individuals without either condition (11.6%). The use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least 1 antihypertensive medication and 46.7% on ≥2 antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, ≈1 in 6 individuals were reclassified as having blood pressure at goal by Eighth Joint National Committee guidelines. Despite these less aggressive goals, >20% remain uncontrolled by the new criteria.

Assessment of Prescribing Pattern of Antihypertensive Medications in Elderly Hypertensive

Introduction : In elderly hypertensive patients, blood pressure is over 140/90mmHg. Diuretics, renin angiotensin aldosterone system inhibitors, beta blockers, calcium channel blockers, alpha blockers and direct vasodilators are commonly prescribed to treat geriatric hypertensive patients. The choice of drugs for a particular patient changes at short intervals because of factors like changes in vascular compliance, efficacy, side effects, cost and launch of new drugs in pharmaceutical market. These facts indicate the need for assessment of prescribing pattern of antihypertensives. Objective: The prescribing pattern of antihypertensive medications was assessed in elderly patients who were suffering from hypertension. Methodology: It was a prospective observational study for six months carried out on in-patients who were admitted to general medicine units. The study protocol was approved by the human ethical committee. The patients of either sex and aged above 60 years and satisfying the study criteria such as diagnosed newly as suffering from hypertension as per Joint National Committee (JNC-7) guidelines and prescribed with antihypertensive medications were enrolled. The clinical, social and medication data was collected from the case records into a specialised patient profile form to analyze prescribing pattern of medications. All the data was analyzed using descriptive statistics. Results and Discussion: Totally 93 prescriptions were collected from the study patients. The proportion of male to female patients was 53:46 and their mean age was 68.74 ± 8.6years. Of 93 prescriptions, 50 (53.76%) prescriptions were containing antihypertensive medications as monotherapy and 43 (46.23%) prescriptions were containing antihypertensive medications as combination drug therapy. Of 50 prescriptions that were containing single antihypertensive medications, amlodepine was frequently 26 (52%) found prescribed among others. The results obtained in our study were similar to the study results conducted by Mohammed A et al. Among 43 prescriptions that were containing combination of antihypertensive medications, telmisartan+ hydrochlorothiazide were the drug combinations that were frequently 22 (51.16%) found prescribed among others.The results obtained in our study were similar to the study results conducted by Arshad HM et al. This combination was reported as fixed dose combinations used in hospitals in for treating patients enrolled in other studies. Conclusion: The medications such as amlodipine and telmisartanand hydrochlorothiazide are frequently prescribed as monotherapy and combination therapy respectievely to treat elderly patients suffering from hypertension.