Majority Of Hypertensive Patients Research Articles

7B.04

Objective: Paroxysmal hypertension or pseudopheochromocytoma is a quite common problem in clinical practice. Anxiety or panic disorder may be one of the major causes. Optimal treatment for this condition is not established. Design and method: Between April 2008 and October 2014 we prospectively enrolled 70 patients referred to our department for symptomatic paroxysmal hypertension. Patients received sertraline (a selective serotonin reuptake inhibitor, 50 mg once daily) as an add-on to their current medication. Effect of this treatment was assessed on next clinical visit at least 3 months later. Results: Of the 70 enrolled patients, 58 (83%) had also sustained arterial hypertension. Mean office baseline blood pressure (BP) was 146.7/84.3 mmHg and patients used mean 3.0 antihypertensive drugs. 19 patients (27%) were not using sertraline on next clinical visit (6 did not start using sertraline, 10 withdrew because of side effects, 3 were lost to follow-up). Of the remaining 51 patients who were using sertraline on next clinical visit, 46 (90%) reported good effect of this treatment. Symptoms of paroxysmal hypertension fully subsided in 31 (61%) and were partially reduced in 15 (29%). Mean office BP in patients using sertraline decreased by 13.8/8.5 mmHg (P < 0.001 for both). Conclusions: Sertraline effectively takes away or reduces symptoms of paroxysmal hypertension in majority of patients who use and tolerate this treatment.

PP.03.22

Objective: Blood pressure variability, both short- and long-term, is a novel important prognostic factor. Seasonal variation of cardio-vascular morbidity and mortality is observed worldwide and the major determinant of this phenomenon is the seasonal changes in blood pressure. To assess the knowledge and understanding of the presence of blood pressure variation within the year and how it affects the antihypertensive treatment. Design and method: We sent questionnaires to 305 patients, 91% with arterial hypertension, and 174 physicians in various living settings. Besides the demographic characteristics, we asked them whether they were acquainted with the problem seasonal variation of blood pressure and whether they accepted it. There were questions how this phenomenon affected their treatment strategy. Results: The patients were at a mean age 57.3 ± 12.57 years (18–89 years), 42% were males and 74% were medically treated, while the physicians were mainly cardiologists (62%), at a mean age 50.80 ± 8.14 (27–73) years and with on average 25 years of professional experience. The vast majority of patients (62%) and of physicians (94%) accepted the seasonal phenomenon. The same number of patients (163 or 63%) and almost all physicians (167 or 96%) has measured lower blood pressure values during summer. This understanding lead to change in the therapeutic behavior. Only 19% did not change their treatment schemes, while 13.4% reduced or increased medications on their own. Their treating physicians changed the patients’ therapy according to the season regularly in 48% of the cases and sometimes in 41%. They reported that 26 % of their patients changed their antihypertensive therapy regularly and another 66% did it from time to time. More than two thirds of the physicians (120 or 69%) admitted that changes in guidelines are needed. Conclusions: The majority of hypertensive patients and their treating physicians accept seasonal variation of blood pressure. Moreover, a large number of patients change their treatment schemes, either alone or advised by healthcare professionals. Cardiologists in Bulgaria modify the antihypertensive treatment according to the season and recommend changes in current guidelines.

Renal function in children and adolescents with Duchenne muscular dystrophy

Improved life expectancy and the need for robust tools to monitor renal safety of emerging new therapies have fueled the interest in renal function in Duchenne muscular dystrophy (DMD) patients. We aimed to establish a methodology to accurately assess their renal function. Twenty DMD patients (5–22 years) were included in this prospective study. After obtaining medical history, all patients underwent a clinical examination, 24-hour ambulatory blood pressure monitoring, ultrasound of the kidneys, direct GFR measurement (51Cr-EDTA, mGFR), complete blood and urine analysis. Seventeen of 20 patients were treated with corticosteroids and 5/20 with angiotensin converting enzyme inhibitor (lisinopril). No patient suffered from urinary tract infections or other renal diseases. Hypertension (systolic or diastolic blood pressure >P95) was found in 9/20 patients (8/9 patients were on steroid treatment) and a non-dipping blood pressure profile in 13/20 subjects (10/13 patients were on steroid treatment). Urinary protein to creatinine ratio was elevated in 17/18 patients, whereas 24-hour urine protein excretion was normal in all subjects. Median interquartile range (IQR) mGFR was 130.4 (29.1) mL/min/1.73 m2. Hyperfiltration (mGFR >150 mL/min/1.73 m2) was found in 5/20 patients. Inverse correlation between mGFR and age was observed (R2 = 0.45, p = 0.001). Serum creatinine based estimated GFR (eGFR) equations overestimated mGFR up to 300%. eGFR based on cystatin C Filler equation was closest to the mGFR (median eGFR (IQR) of 129.5 (39.7) mL/min/1.73 m2). Our study demonstrates a high prevalence of hyperfiltration and hypertension in children and adolescents with DMD. Because the majority of hypertensive patients were under corticosteroid treatment, the iatrogenic cause of hypertension cannot be excluded. Serum or urine creatinine measurements are of no value to evaluate renal function in DMD patients due to the reduced skeletal muscle mass.

Combination Therapy with Olmesartan/Hydrochlorothiazide to Improve Blood Pressure Control

Poor blood pressure (BP) control is a serious clinical problem, being responsible for much of the morbidity and mortality associated with arterial hypertension. Although European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guidelines for the management of arterial hypertension strongly recommend to pursue the primary therapeutic goal of BP control in the population of hypertensive patients, currently available data indicate that, in the western world, a large proportion of hypertensive patients have poor BP control. Relevant causes of poor BP control are clinical inertia, defined as failure of physicians to modify or intensify treatment of patients who do not achieve BP targets, and low patient adherence to the treatment. Improved BP control can be achieved by using appropriate antihypertensive drugs at adequate dosage and/or improving patients' adherence rate. In the majority of hypertensive patients, a combination of two or more antihypertensive drugs is nearly always necessary in order to achieve adequate BP control as recommended by current ESH/ESC Guidelines. In such cases, the use of fixed-dose combinations can significantly improve patient adherence, through the reduction of daily “pill-burden”. Olmesartan medoxomil (OM) is an antihypertensive agent belonging to the angiotensin II receptor antagonist (ARB) class which, in several clinical studies, has proved to be effective and well tolerated in the treatment of hypertensive patients. In patients in whom olmesartan medoxomil monotherapy fails to achieve the recommended BP goal, the combination of olmesartan medoxomil with the thiazide diuretic hydrochlorothiazide (HCTZ) can enhance the efficacy of the antihypertensive treatment (compared with placebo and monotherapy with either agent), thereby allowing a greater number of patients to achieve BP control. Combination therapy with OM/HCTZ has shown good efficacy and a favorable tolerability profile in a number of clinical trials. In this review, we will examine the evidence in the literature on this subject and advance suggestions on the most rational way to use this therapy in clinical practice.

Abstract 203: Adoptions of Smartphones, Tablets, and Mobile Applications Among Patients with Hypertension

optimize management, monitoring, and therapy compliance in patients with hypertension (HTN). It could potentially prevent unnecessary emergency room visits and hospital admissions. Methods: We surveyed patients with HTN in cardiology and primary care clinics regarding their use of mobile technology. Results: 148 patients were included (79 female; age 16-64: 47%, &gt;65: 53%, 70 male; 18-64:41%, &gt;65: 59%). Associated diagnosis were coronary artery disease (21%), myocardial infarction (13%), arrhythmias (36%), heart failure (6%), or other forms of heart disease (3%). 83% own a cell phone, 29% are smartphones. 78% own a personal computer, laptop, iPod, or tablet. 35% report using APPS, of which 26% use health-related applications. 2% used APPS for blood pressure monitoring or management. 17% used APPS for diet or calorie counters, 13% for exercise, fitness or heart monitoring. 63% use APPS on a smartphone, 12% on iPod Touch, 62% on Tablet. Among all HTN patients surveyed, 64% report looking up medical information online on a computer, 53% more than once per month. When asked about willingness to pay, 44% were not willing to pay for a smartphone or tablet that would help monitor their condition. 61% were not willing to pay if an ER visit and its copayment could be prevented. 26% were not willing to use these devices if they were free or covered by insurance. Conclusions: A majority of HTN patients surveyed had access to technology with 22% using smartphones with APPS. However, there was limited use of health-specific APPS, especially those related to HTN. Limiting factors may include lack of outcomes-based research, structured programs that incorporate APPS and devices, or lack of familiarity with APPS and technological devices. A comprehensive strategy to develop, market, and demonstrate benefits of this rapidly growing technology is urgently needed.

Adoption of e-mail, text messaging, and online medical information among patients with hypertension

The use of web-based resources involving e-mail, text messaging, or medically-directed websites could potentially help optimize the management and monitoring of blood pressure, and aid therapy compliance in patients with hypertension (HTN). They could potentially prevent unnecessary emergency room (ER) visits and hospital admissions. Methods: We surveyed patients with HTN in cardiology and primary care clinics regarding their use of these technologies. Results: 148 patients were included (79 female; age 16-64: 47%, >65: 53%, 70 male; 18-64:41%, >65: 59%). Associated diagnosis were coronary artery disease (21%), myocardial infarction (13%), arrhythmias (36%), heart failure (6%), or other forms of heart disease (3%). 79% of patients own a personal computer (66%), Laptop (31%), iPod Touch (8%) or Tablet (54%). 70% of patients report sending or receiving e-mail, with 63% sending or receiving daily, 22% weekly, and 15% monthly. 48% of people send or receive text messaging, with 54% sending or receiving daily, 18% weekly, and 28% monthly. Only 8% of patients reported receiving text updates or alerts about their health or medical issues. 64% report looking up medical information online on a computer, 53% look up information more than once per month. Conclusions: A majority of HTN patients surveyed had access to all of the proper technology for interventions to work effectively. With the connectedness of most patients in this survey, there are many opportunities to develop HTN-specific programs that can address common areas of need. Limiting factors may include lack of medically focused platforms available, lack of outcomesbased research, and possible lack of familiarity in select patients. A comprehensive strategy to develop, market, and demonstrate benefits of these rapidly growing and popular technology platforms is urgently needed.

Uncontrolled factors of blood pressure in essential hypertension: from“patient’s high blood pressure”to“hypertensive patient”

Hypertension is a significant medical and public health issue which puts an enormous burden on health care resources and the community. It is a chronic medical condition in which the systemic arterial blood pressure (BP) is elevated. Serious complications including cardiovascular and cerebrovascular diseases would be preventable if the rise in BP with age could be prevented or diminished. The majority of hypertensive patients require long-term treatment. Oral antihypertensive drugs, lifestyle modification including exercise and dietary modification are milestones for hypertension therapy. However, the control rate of hypertension hasn't reached the expected requirements currently. "Three lows" status quo, just low awareness, low treatment, and low control, are still the major problems confronting modern medicine. Recently, uncontrolled factors of blood pressure are widely concerned, which include insomnia, constipation, mood disorders, exogenous, etc. What's more, the control strategies of hypertension should not only pay close attention to "patient's high blood pressure", but also to "hypertensive patient". Therefore, the treatment of uncontrolled factors of blood pressure plays an important role in hypertensive therapy, which could be further research priorities.

CHANGES IN THE PARAMETERS OF 24-HOUR BLOOD PRESSURE MONITORING AND ARTERIAL STIFFNESS IN PATIENTS WITH HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE TREATED WITH VALSARTAN

Aim. To study changes in the parameters of the 24-hour blood pressure (BP) monitoring and arterial stiffness (AS) in patients with arterial hypertension (HT) and chronic obstructive pulmonary disease (COPD) treated with angiotensin II receptors blocker, valsartan. Material and methods. Men with HT and COPD (n=23), who have been receiving valsartan with starting dose 80 mg/day for 6 months as antihypertensive therapy were included into the study. If target BP was not achieved, correction of the valsartan dose was carried out with the hydrochlorothiazide addition when needed. Clinical examination, 24-hour BP and AS monitoring using BPLab MnSDP-2 monitor ("Petr TELEGIN",Russia), clinical evaluation of COPD were performed. Results. Abnormal circadian BP profile and the elastic properties of arteries were diagnosed in the majority of hypertensive patients with COPD. Valsartan therapy allowed to achieve target BP levels in 100% of patients, normalization of circadian BP profile in 56.5%, improvement in AS parameters: a significant increase in PTT2 (from 89.6±14.3 to 94.4±18.4 ms), reduction of (dP/dt)max (from 566.6±117.9 to 518.8±146.2 mmHg/s), AIx (from -4.0±15.2 to -11.6±20.8 %) as compared to the baseline. Circadian changes in daily parameters of AS in studied patients with the most obvious night-time abnormalities of the elastic properties of arteries were detected. Valsartan intake led to Alx reduction at night-time. Conclusion. Valsartan-based therapy in hypertensive patients with concomitant COPD demonstrated a high antihypertensive efficacy and favorable changes in the elastic properties of the vascular wall that confirm its organoprotective effect.

Evaluation on Conventional Antihypertension Use and Natural-Conventional Combination on Patient with Hypertension

The proportion of hypertensive disease in Depok city was 57.4% in 2002. Primary health centers had given antihypertensive medication. In addition to the drugs commonly given by a doctor (conventional), many patients took medicinal plants (natural medicine). This study aimed to evaluate the effects of combination therapy of convensional-herbal on blood pressure in hypertensive patients in five primary health centers in Depok. This retrospective cohort study used samples of hypertension patients who came to primary health centers. Patients who were willing to join the study were 123 patients and grouped in to conventional therapy group (74 people) and combination of conventional-herbal therapy group (49 people). The majority of hypertensive patients who came to the health centers area of Depok were women, aged 50-59 years old, married, came from ethnic Betawi, less educated, unemployed/ housewives, low income and suffering from hypertension stage II. Combination therapy of convensional-herbal had better effect on diastolic and convensional therapy had better effect on systolic. However, no significant difference between them (p&gt;0.05). The continuity of treatment affected systolic blood pressure (p&lt;0.05). This study showed that had not seen clearly influence of herbal that is used combination with conventional drugs in lowering blood pressure.

Ruling out secondary causes of hypertension

In the majority of hypertensive patients, no particular cause for abnormal blood pressure is evident (primary or essential hypertension). In contrast, in the minority of patients with secondary hypertension a specific underlying cause is responsible for the elevated blood pressure. The prevalence of secondary hypertension is higher in patients with resistant hypertension than in the general hypertensive population and increases with age. The list of secondary forms of hypertension is long and prevalence of the individual causes of secondary hypertension varies. Hence, this review divides them into two categories: common causes and rare causes. If appropriately diagnosed and treated, patients with a secondary form of hypertension might be cured, or at least show an improvement in their blood pressure control. Consequently, screening for secondary causes of hypertension plays an essential part in the care of patients with arterial hypertension. If the basal work-up raises the suspicion of a secondary cause of hypertension, specific diagnostic procedures become necessary, some of which can be performed by primary care physicians, while others require specialist input.

Abstract 329: Barriers To Hypertension Screening, Treatment And Control As Reported By Patients And Healthcare Providers

Background: Despite established knowledge on the importance of hypertension (HT) screening and treatment to control blood pressure, the majority of HT patients remain uncontrolled. There are many possible barriers causing this evidence-practice gap, but there is no systematic overview of studies assessing these barriers. This review aims to synthesize findings from the literature on the prevalence and importance of barriers to HT control using a theoretical framework. Methods: Electronic databases MEDLINE, EMBASE and Global Health were systematically searched up to August 2011 and experts in the field were contacted. Two reviewers independently selected eligible studies based on the following criteria: 1) subjects were patients with HT or at risk of HT, or health care providers (HCP) managing HT patients; 2) studies examining barriers, obstacles, or facilitators to HT screening, management, or control; 3) qualitative and quantitative studies. Two reviewers extracted data, including study methodological quality items, and labeled identified barriers by expanding on a theoretical framework for behaviour change. Clinical importance of barriers was assessed by means of association with HT treatment and BP control. Results: Seventeen qualitative studies (10 reporting patient barriers and 7 reporting HCP barriers) and 37 quantitative studies (24 reporting patient barriers, 9 reporting HCP barriers, and 4 reporting both HCP and patient barriers) met the inclusion criteria. Of these, 81% (n=44) were from high income countries. Most studies had methodology issues; most commonly was the bias in measuring barriers. Discrepancies were observed between results from qualitative and quantitative studies. In qualitative studies, environmental barriers, specifically availability of care barriers, were most commonly discussed among patient as well as HCP studies. Results from quantitative studies suggest that among HCP knowledge barriers were most commonly reported (83% of the HCP population). Results for patient reported barriers were different: Intention barriers were the most common barriers to HT screening (reported by 17% of the population), lifestyle change (reported by 37% of the population), and HT treatment adherence (reported by 63% of the population). Knowledge was the most common barrier to overall BP control among patients (reported by 64% of the population). Medication related barriers, specifically side effects, appeared to have the largest effect on HT treatment adherence (HR: 1.91, 95%CI: 1.47-2.47). Conclusions: Barriers to HT control as reported by HCP and patients are multifactorial and largely modifiable, but evidence is primarily from high income countries and not comparable among settings due to methodological limitations. A more systematic way of measuring barriers to HT management is necessary.

Olmesartan-based therapies

The main purpose in hypertension treatment is the reduction of cardiovascular disease burden. Among different first-line antihypertensive drug classes, angiotensin-receptor blockers are characterized by their both good effectiveness and tolerability. Furthermore, the interruption of the renin-angiotensin cascade is related with several benefits in target organ protection and cardiovascular prevention. Among different angiotensin-receptor blockers, olmesartan has been examined in several trial of organ protection, showing improvements in several disease markers, such as microinflammation, regression of both plaque volume and vascular hypertrophy, as well as microalbuminuria prevention. Olmesartan has been also widely examined in combination of either hydrochlorothiazide or amlodipine, as well as with both drugs in a single-pill triple combination, showing improvements in antihypertensive efficacy without significant effects on tolerability. This treatment strategy based on a drug with such characteristics and the availability of different types of combinations with other first-line drug classes may represent an effective way for achieving blood pressure control in a majority of hypertensive patients and this could also be related with a better cardiovascular disease prevention.

Hypertension emergencies and urgencies

Abstract Where at one hand, the vast majority of hypertensive patients succumb to the complications of hypertension like atherosclerosis, cerebrovascular diseases and congestive heart failure, a subset of these have an exacerbation in this gradual course that needs acute management in the blood pressure control and plays a role in short term outcomes. These hypertensive crises are now encountered more frequently, in more diverse and aging population than in earlier times. Despite the recognized unmet need of timely evaluation and management, fewer than 10% receive the recommended investigations and appropriate treatment often gets delayed. This review emphasizes the therapeutic implications of correct diagnosis, various treatment options and targets in different clinical circumstances. Nicardipine, clevidipine, esmolol and fenoldopam have emerged as potentially superior drugs in most hypertensive emergencies as compared to other conventional drugs. For hypertensive urgencies, blood pressure lowering at a gradual pace with oral drugs & adequate follow up are two important facets of management, making sure that the blood pressure has been lowered out of a potentially dangerous range. Impact of optimal management of hypertensive crisis should translate into lesser target organ damage and eventually fewer complications of stroke, myocardial infarction, or congestive heart failure.

Therapierefraktäre Hypertonie

Sympathetic overexpression can be found in a majority of hypertensive patients. Resistant arterial hypertension requires a targeted diagnostic procedure in order to exclude secondary causes of hypertension which can be treated specifically with established therapies. If secondary reasons are not identified, the antihypertensive medication is already optimal and lifestyle changes have been realized, but still the goal of antihypertensive therapy cannot be achieved, alternative invasive therapy strategies such as renal sympathetic denervation and baroreflex activation have been developed to achieve blood pressure control. These therapies are restricted to specialized centers which treat well-defined patients with therapy-resistant hypertension. Little long-term data concerning safety and efficacy are available for the two strategies. However, they should preferably be used as an ultima-ratio and add-on pathway to conservative procedures when established medication fails to achieve blood pressure control. To date, the effectiveness of the interventional antihypertensive therapies has only been shown on patients with systolic blood pressure over 160mmHg and a mean oral medication of five drugs.

How do Compliance, Convenience, and Tolerability Affect Blood Pressure Goal Rates?

Uncontrolled hypertension imposes a substantial global health burden, and poor patient compliance with prescribed antihypertensive medication makes a major contribution to the development of suboptimal blood pressure (BP) control. The asymptomatic nature of hypertension, side effects of medication, treatment complexity, and high pill burdens all have a negative impact on patient compliance. It is important to address the issue of poor patient compliance as studies have shown that good compliance is associated with improvement of BP control and positive health outcomes. As the majority of hypertensive patients require treatment with two or more agents to achieve goal BP, treatment guidelines have acknowledged the value of simplifying treatment through the use of fixed-dose combination (FDC) therapy. Triple FDC therapy comprising an angiotensin II type 1 receptor antagonist (angiotensin receptor blocker), calcium channel blocker, and thiazide diuretic is a novel treatment strategy for the improvement of BP control in hard-to-treat patients.

Angiotensin II type 1 receptor antagonists and their combinations in the treatment of hypertension

The pathophysiology of hypertension is not multifactorial in nature, and there is a complex interplay of mechanisms of control and counter-regulatory responses activated by drugs. The problem for clinicians is that it is not really possible to recognise the various clinical phenotypes of hypertension. In other words, the heterogeneity of hypertension remains a clinical problem. Current overwhelming evidence is that the most important treatment concept in the management of hypertension is that treatment should reduce blood pressure to goal levels. The majority of hypertensive patients will need two or more antihypertensive drugs to control their blood pressure at goal. Conceptually, a strong case can be made for the early use of combination therapy in the treatment of hypertension.

Combination of Amlodipine plus Angiotensin Receptor Blocker or Diuretics in High-Risk Hypertensive Patients

Antihypertensive therapy is effective in reducing the risk of major adverse cardiovascular events. However, blood pressure (BP) control rate remains poor and the optimal combination therapy against hypertension is not established in China. The objective of this study was to evaluate the long-term efficacy and safety of two antihypertensive regimens, amlodipine plus telmisartan and amlodipine plus amiloride/hydrochlorothiazide, in patients with essential hypertension and at least one cardiovascular risk factor. In a multicenter open-label clinical trial, eligible patients were randomized to receive treatment with amlodipine 2.5-5 mg plus amiloride/hydrochlorothiazide 1.25-2.5 mg/12.5-25 mg (Group A) or amlodipine 2.5-5 mg plus telmisartan 40-80 mg (Group T). If a target BP was not reached, other antihypertensive agents would be added. The target BP was <130/80 mmHg for patients with diabetes mellitus or chronic kidney disease and <140/90 mmHg for others. Efficacy variables were changes from baseline in systolic BP and diastolic BP at the endpoint of 96 weeks. Safety evaluations included monitoring of any adverse events (AEs). Of 13,542 patients randomized, 13,080 (96.6%) completed the study: 6529 in Group A and 6551 in Group T. At endpoint, the BP levels were reduced by 27.4/14.3 mmHg in Group A and 27.1/14.5 mmHg in Group T. The BP control rates were similar for the two therapeutic regimens (87.5% vs 86.1%). Less than 4% of patients in each group discontinued their drugs during follow-up. Peripheral edema was one of the most common AEs, and occurred in only 24 patients in Group A and 19 in Group T. Long-term combination therapy with amlodipine plus telmisartan or amlodipine plus amiloride/hydrochlorothiazide was not only well tolerated but also efficacious in reducing BP levels with acceptable control rates in the majority of hypertensive patients. ClinicalTrials.gov number NCT01011660.

Clinical and economic impact of aliskiren in uncontrolled hypertensive patients

BACKGROUND: the majority of hypertensive patients do not achieve adequate blood pressure (BP) control and thus remain at risk of cardio-cerebrovascular events. Aliskiren, a novel antihypertensive drug acting as direct renin inhibitor, was authorized in Italy for the treatment of hypertension in patients who remain uncontrolled and at risk despite the use of at least two antihypertensive drugs. It was subject to an AIFA web-based monitoring registry. Results of the registry show a decrease of 20.8/9.2 mmHg in systolic/diastolic BP, within 6 months, when aliskiren is added to current therapy.OBJECTIVE: to evaluate the clinical and economic impact of such BP reduction in terms of avoidable cardio-cerebrovascular events.METHODS: an Excel-based Markov model compared aliskiren plus current antihypertensive treatment to current antihypertensive treatment alone over a 5-year horizon. Patients’ baseline characteristics and BP-reduction were taken from the AIFA registry and literature. Using Wilson and Anderson risk equations, the model simulated patient’s transitions from Pre-Event to Post-Event and Death, calculating the number of those who experience an event. Unit costs were assigned to treatments, events and follow-up. Sensitivity analyses considered: efficacy variability and societal costs of events.RESULTS: 2.47% of patients treated with aliskiren added-on to their antihypertensive therapy were expected to avoid an event. As observed in the AIFA registry, 19.8% of patients remained treated only with aliskiren whereas others reduced the number of antihypertensive treatments, leading to a 38.6% reduction of monthly concomitant antihypertensive treatment cost. Considering events and follow-up cost reduction, the per-patient annual incremental cost of aliskiren is calculated at € 187 and generates 0.042 QALYs over 5 years. The ICER was € 22,062 per QALY (€ 16,845 to € 30,771 for an efficacy range of ± 25%). Considering societal costs ICER was € 20,094 per QALY.Conclusions: AIFA registry real-world data confirmed aliskiren’s efficacy in uncontrolled hypertensive patients. Together with reaching their BP goals, patients consumed less medication from other antihypertensive drug classes and are expected to avoid cardio-cerebrovascular events. The ICER remained within acceptable thresholds, confirming that aliskiren represents a good investment in terms of health benefit.

Hypertension - An overview

INTRODUCTIONAs the population grows older and more obese, the incidence of hypertension continues to increase, not only in the United States but in all developed and developing societies[1]. At the same time, despite the widely recognized dangers of uncontrolled hypertension, the disease remains inadequately treated in the majority of patients[2]. As a consequence, cardiovascular risk remains high among the majority of hypertensive patients, whether treated or not.&#x0D; Clearly more attention is being directed towards hypertension, but adequate hypertension control remains elusive, in large part because of the asymptomatic nature of the disease for the first 15 to 20 years, even as it progressively damages the cardiovascular system. In view of these built in barriers to effective control of individual patient, population-wide application of preventive measures becomes inherently more attractive. Although the specific mechanism for most hypertension remains unknown, it is highly likely that the process could be slowed if not prevented by the prevention of obesity, moderate reduction to salt intake, higher levels of physical activities, and avoidance of excessive alcohol consumption[3]. Since hypertension will eventually develop in most people during their life time[4], the need for more wide spread adoption of potentially effective and totally safe preventive measures is obvious. In the mean time, better management of those already afflicted with hypertension must be practiced, starting with careful documentation of diagnosis.

Treatment of 5413 hypertensive patients: a cross-sectional study

Most hypertensive patients are managed in primary care in Denmark, but previous studies have shown that only 21-43% of hypertensive patients achieve optimal blood pressure (BP) control. Antihypertensive drug treatment, risk factors and cardiovascular disease (CVD) are some of the important factors to consider when optimizing the individual treatment strategy in hypertensive patients. To examine treatment of BP according to Danish guidelines (BP < 140/90 mmHg generally and <130/80 mmHg for diabetics) in a population from general practice in relation to risk factors, CVD and diagnosis of diabetes. A cross-sectional study comprising 184 practices and 5413 hypertensive patients was carried out in Denmark. The general practitioners filled in information on each patient's risk factors, CVD and antihypertensive drug treatment. Patients filled in a questionnaire on risk factors. The outcome measures were optimal BP control according to Danish guidelines and antihypertensive drug treatment. Mean patient age was 65.9 years [95% confidence interval (CI): 65.6-66.1]. Optimal BP control was achieved in 29.1% (95% CI: 27.9-30.3) of the study population. Among 842 diabetics with or without CVD, optimal BP control was achieved in 10.9% (95% CI: 8.8-10.3), while 38.7% (35.5-41.9) of patients with CVD achieved optimal BP control. The majority of all patients were treated with 1 (32.5%, 95% CI: 32.5 (31.3-33.8)) or two antihypertensive drugs (39.0%, 95% CI: 38.2-40.8). In hypertensive diabetics, 17.7% were not treated with an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker. In general practice, the proportion of hypertensive patients achieving optimal BP control is inadequate. The majority of hypertensive patients are treated with only one or two antihypertensive drugs.