Medication In Hypertensive Patients Research Articles

Compliance with follow-up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care.

To determine and compare, among three models of care, compliance with scheduled clinic appointments and adherence to antihypertensive medication of patients in an informal settlement of Kibera, Kenya. Routinely collected patient data were used from three health facilities, six walkway clinics and one weekend/church clinic. Patients were eligible if they had received hypertension care for more than 6 months. Compliance with clinic appointments and self-reported adherence to medication were determined from clinic records and compared using the chi-square test. Univariate and multivariate logistic regression models estimated the odds of overall adherence to medication. A total of 785 patients received hypertension treatment eligible for analysis, of whom two-thirds were women. Between them, there were 5879 clinic visits with an overall compliance with appointments of 63%. Compliance was high in the health facilities and walkway clinics, but men were more likely to attend the weekend/church clinics. Self-reported adherence to medication by those complying with scheduled clinic visits was 94%. Patients in the walkway clinics were two times more likely to adhere to antihypertensive medication than patients at the health facility (OR 1.97, 95% CI 1.25-3.10). Walkway clinics outperformed health facilities and weekend clinics. The use of multiple sites for the management of hypertensive patients led to good compliance with scheduled clinic visits and very good self-reported adherence to medication in a low-resource setting.

The compliance of hypertension patients in taking medication at Sukasada II Primary Health care from January - March 2016

Background: Hypertension is a chronic disease where the adherence to therapy should be given serious attention. Compliance behavior is to obey the doctor's advice or procedure from the doctor about the use of drugs which had been prescribed by a consultation process between the patient and the patient's family physician. The health providers were influenced by two factors: behavioral and non-behavior factors which determined or shaped by three main factors such as predisposing factors, enabling factors, and reinforcing factors. The aim of this study to assess the compliances of taking medication in hypertensive patients at the Sukasada II Buleleng primary health care.Method: It was a quantitative descriptive study. The respondents were all hypertension patients who come to the Sukasada II primary health care from the period of January to March 2016. Data were obtained through interviews and questionnaires distributed to respondents who met the inclusion criteria and exclusion. The univariate and bivariate analysis was conducted in this study.Results: The results of the research show the number of 84 sample contained 1 subjects with good adherence, 14 subjects with moderate adherence, and 69 subjects with less adherence. The cross tabulation showed that poor medication adherence in the elderly (90.9%), followed by male gender (84.1%), low education (82.7%), higher knowledge (85.0%), perception at close distance (85.7%), travel time ≥ 15 minutes (86.0%), route conditions (84.1), do not have access difficulties (83.9), good family support (82.9), the low role of health care (100%), and did not have any comorbidities (83.1%).Conclusion: The trend of hypertensive patients that are not taking medication mostly come from submissive to men, senior citizens, low educational level, and lesser role of healthcare personnel.

‘Integrated Naturopathy and Yoga’ reduces blood pressure and the need for medications among a cohort of hypertensive patients in South India: 3-months follow-up study

Setting and objective‘Manthena Satyanarayana Raju Arogyalayam’ is a 500-bedded hospital in South India that offers ‘Integrated Naturopathy and Yoga’ (INY). Major components of INY package include an unrestricted diet of foods in natural form, daily yogic exercises, meditation for relaxation, patient counselling and health education in a highly structured routine for 15 days. We aimed to determine if INY reduced blood pressure and the need of anti-hypertensive medications in hypertensive patients. DesignObservational cohort study involving pre–post-comparative analysis of patients enrolled between April and July 2015. Blood pressure, anthropometry, blood parameters and compliance to diet and yoga (diet and yoga score on a scale of 0–10) were measured at baseline and 3 months. ResultsOf 104 patients, 80 (77%) had 3-month follow-up. Of them, 79 (99%) achieved target BP control (<140/90mmHg) and 66 (83%) achieved this with >50% reduction in antihypertensive medication dose, and in 8 (10%) patients, all medications were withdrawn. There was a significant increase in diet (2.7–7.4), yoga scores (1.5–5.6) and decrease in body weight, body fat, blood triglycerides and glycosylated haemoglobin levels. ConclusionThese early results are promising and need further study with long-term follow-up.

Pattern of compliance to anti- hypertensive medications in hypertensive patients in a tertiary care hospital in Bangladesh

Background: Non-adherence to anti-hypertensive medications can have a negative impact on long term cardiovascular outcome. Various studies have been conducted on this issue but factors are not yet explored properly, particularly in Bangladesh. This study was conducted to find out the prevalence and factors associated with pattern of compliance to anti-hypertensive medications in a tertiary level hospital.Methods: This descriptive study was done on 146 indoor hypertensive patients, included by purposive sampling in july’2015 who were taking anti-hypertensive for last 6 months. Data were collected through a questionnaire after obtaining informed consent.Results: This study revealed that 55.47% patients were compliant and 44.53% were noncompliant. Age &gt;60 yrs. are more non-compliant (56.6%). Female (65.11%), house wife and urban population are more compliant. Population, with longer duration of hypertension are more non-compliant. Among the co-morbidities diabetic patients are more non-compliant. Population taking two anti-hypertensive are more compliant (76.47%).Conclusion: In our study most of the populations are compliant but yet significant number of populations are non-compliant. Collective participation of physician, patient and health care delivery system can improve the situation more. As consequence of non-compliance to antihypertensive is grave, community based studies should be conducted to explore the extent of non-compliance.J Dhaka Medical College, Vol. 24, No.1, April, 2015, Page 62-66

PS 08-07 DIFFERENTIAL AMBULATORY BLOOD PRESSURE LOWERING EFFECT BETWEEN HYPERTENSIVE PATIENTS WITH AND WITHOUT DIABETES MELLITUS

Objective: We assessed whether there is dissociation between ambulatory blood pressure (BP) reduction and clinic BP reduction by antihypertensive medication in hypertensive patients with and without diabetes mellitus (DM). Design and Method: We formerly performed randomized, multicenter, open-label trial in essential hypertensives. 105 patients with clinic BP ≥ 140/90 mmHg with amlodipine 5 mg were randomly allocated to aliskiren (150–300 mg)/amlodipine (5mg) (ALI/AML) or high-dose amlodipine (10 mg) (h-dAML) group and were treated for 16 weeks. Ambulatory BP and clinic BP were measured at baseline and at the end of the study. In current post-hoc analysis study, we divided 86 patients (age 77.1 years) who completed treatment period into Non-DM (n = 75) or DM (n = 11) group, and compared ambulatory BP reduction and clinic BP reduction. We defined ‘DM’ as antidiabetic treated DM patients or baseline HbA1c ≥ 6.5, and ‘Non-DM’ as the other patients. No type 1 DM patient is included in this study. Results: There was no significant difference in clinic BP and ambulatory BP at baseline. The reduction of clinic SBP were similar between the Non-DM and DM group (−10.7 ± 18.7 vs. −5.8 ± 18.0 mmHg, p = 0.42), whereas the reduction of 24-h SBP (−7.7 ± 10.9 vs. 1.7 ± 11.5 mmHg, p = 0.01) and daytime SBP (−7.8 ± 13.4 vs. 3.6 ± 13.8 mmHg, p = 0.01) were significantly smaller in the DM group than in the Non-DM group. 24-h SBP and daytime SBP were significantly decreased by treatment only in the Non-DM group. Conclusions: Although the magnitude of clinic SBP reduction were similar, 24-h SBP reduction and daytime SBP reduction were significantly smaller in DM compared with in Non-DM. Our data suggest that ambulatory BP reduction by antihypertensive medication is insufficient in hypertensive patients with DM.

Commentary to: Cost of poor adherence to anti-hypertensive therapy in five European countries.

The study by Mennini et al. [1] uses a decision model to assess cost implications of improving adherence to medication in hypertensive patients in five European countries (England, France, Germany, Italy, and Spain) from a payer’s perspective over 10 years. To this end, the model predicts the 10-year risk for cardiovascular events based on the Framingham risk equation. In terms of costs, it considers drug and hospitalization costs. The model suggests savings through avoiding cardiovascular events in each of the five countries. Leaving aside a lack of consideration of costs of (a) medication side effects, (b) outpatient care, (c) rehabilitation, and (d) life extension, this result cannot be replicated based on the input data listed in the publication. This points to a potential lack of internal validity. To explain, consider that the net cost of making one additional patient adherent to blood pressure (BP) medication can be calculated in two steps:

Use of continuous positive airway pressure for sleep apnea in the treatment of hypertension

Obstructive sleep apnea (OSA) and hypertension are highly prevalent and treatable conditions that often coexist and both contribute to an increased cardiovascular risk. The ability of continuous positive airway pressure (CPAP) to improve blood pressure in hypertensive patients with OSA is debated. This review highlights findings from recent studies that have investigated the impact of CPAP on blood pressure in patients with OSA. Comparing the results of various studies is complicated by important methodological differences among them. In hypertensive patients with OSA, treatment with CPAP improves blood pressure to a smaller degree than that derived from antihypertensive medication. Patients with more severe OSA and with greater adherence to CPAP are likely to gain the most benefit from the therapy. CPAP should be used in combination with antihypertensive medications in hypertensive patients with OSA. CPAP has the additional benefits of restoring nocturnal dipping and improving arterial stiffness, thus potentially influencing cardiovascular morbidity in these high-risk patients.

Skin microcirculation reaction to acute hypotensive effects of various antihypertensive medications in hypertensive patients

Aim. To assess the dynamics of skin microcirculation (MC) in response to medications with different mechanisms of hypotensive action in patients with arterial hypertension (AH). Material and methods. In patients with Stage 2–3 AH, MC was assessed by laser Doppler flowmetry at baseline and after a single administration of corinfar (n=38), capoten (n=37), and concor (n=37). Results. In patients with a clear hypotensive effect of the examined medications, the dynamics of skin MC parameters was similar. The reorganisation of peripheral hemodynamics was characterised by dysbalanced and insufficiently effective regulatory processes and restricted reserves of capillary blood flow. The increase in tissue perfusion was due to the increased pulse filling of MC vessels. Conclusion. Similar dynamics of MC parameters in response to the administration of medications with different hypotensive mechanisms suggests that an acute drop in peripheral vascular resistance leads to an urgent adaptive reaction aimed at the maintenance of adequate capillary-tissue metabolism.

Rationale and design of the Newer Versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial

Background. Sub-Saharan Africa experiences an epidemic surge in hypertension. Studies in African Americans led to the recommendation to initiate antihypertensive treatment in Blacks with a diuretic or a low-dose fixed combination including a diuretic. We mounted the Newer versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial to compare in native African patients a fixed combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic. Methods. Patients aged 30–69 years with uncomplicated hypertension (140–179/90–109 mmHg) and two or fewer associated risk factors are eligible. After a 4-week run-in period off treatment, 180 patients will be randomized to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg or amlodipine/valsartan 5/160 mg. To attain and maintain blood pressure below 140/90 mmHg during 6 months of follow-up, the doses of bisoprolol and amlodipine in the combination tablets will be increased to 10 mg/day with the possible addition of α-methyldopa or hydralazine. NOAAH is powered to demonstrate a 5-mmHg between-group difference in sitting systolic pressure with a two-sided p-value of 0.01 and 90% power. NOAAH is investigator-led and complies with the Helsinki declaration. Results. Six centers in four sub-Saharan countries started patient recruitment on September 1, 2010. On December 1, 195 patients were screened, 171 were enrolled, and 51 were randomized and followed up. The trial will be completed in the third quarter of 2011. Conclusions. NOAAH (NCT01030458) is the first randomized multicenter trial of antihypertensive medications in hypertensive patients born and living in sub-Saharan Africa.

Efecto antihipertensivo del valsartán: Estudio multicéntrico nacional

Valsartan is an angiotensin AT1 receptor antagonist. Clinical studies have shown that this is an effective and well tolerated drug. To compare valsartan with other commonly used antihypertensives in a National multicentric study. Between 1997 and 1998, a pharmacological surveillance of patients with mild or moderate hypertension, coming from different regions of the country, was carried out. Patients were followed during 8 weeks. In the group treated with valsartan, the initial dose was 80 mg/day. After four weeks of therapy, and according to patient's response the dose of valsartan or of the other antihypertensives was modified. Five hundred ninety three patients, aged 59 years old as a mean, were included in the study. Of these 434 (265 female) received valsartan and 159 (101 female) other antihypertensive drugs. Fifteen percent of patients treated with valsartan and 25% of patients with other medications required a dose change at four weeks, due to lack of response (p < 0.01). At week eight, 1.5% of patients with valsartan and 17.4% of patients with other medications reported adverse effects such as cough, headache, edema or flushing (p < 0.01). In this Chilean observational multicentric study, valsartan proved to be more effective and to cause less adverse effects than commonly used medications in hypertensive patients.