mmHg In Diabetic Patients Research Articles

SHOULD MIDDLE-AGED AND OLDER HIGH-RISK HYPERTENSIVE PATIENTS WITH DIABETES BE TREATED TO TARGET BT <130/80 MMHG?

Objective: Diabetes Mellitus Type-2 (DM2) is common in hypertensive patients, increasing the risk of cardiovascular disease. Current guidelines recommend targeting systolic BP (SBP) to 130 - 139 mmHg in diabetic patients >65 years. We investigated whether the middle-aged and elderly hypertensive DM2 patients in the VALUE Trial had reduced risk of cardiovascular disease and death if SBP was lowered to <130 mmHg. Design and method: Of the 15,245 participants, there were 13,803 patients without cardiovascular events during the first six months after randomization, roll-over from previous medication and up-titration of study drugs. Of these 2,458 patients had left ventricular hypertrophy by electrocardiogram. These patients were excluded from analyses due to increased mortality when SBP is lowered to <130 mmHg (submitted). Of the remaining 11,345 patients, 3,932 had DM2. Cox analyses adjusted for age, gender, and baseline variables compared cardiac and all-cause mortality and other pre-specified endpoints for patients achieving average SBP 130 - 139 mmHg (DM2 group 1,605, non-DM2 group 3,260) and SBP <130 mmHg (DM2 group 600, non-DM2 group 1,546). Reference groups were patients achieving average SBP > = 140 mmHg. Results: Mean age in DM2 patients was 66.9 years. The DM2 group achieving average SBP <130 mmHg did not have significant changes in primary cardiac endpoint, all-cause mortality, or stroke (Table). However, DM2 had lower incidence of reduced kidney function (increase in serum creatinine of 50% compared to baseline, HR = 0.43, p = 0.008). In the DM2 group achieving average SBP 130 - 139 mmHg there were significant reductions in cardiovascular events and kidney function. Conclusions: Our findings suggest that lowering systolic BP <130 mmHg in DM2 has little effect on reducing cardiovascular events compared to systolic BP 130 - 139 mmHg. However, we did find an effect on kidney function. In conclusion, our data suggest that treating middle-aged and elderly DM2 patients <130/80 mmHg can prevent reduction of renal function which is an endpoint of high importance in DM2 patients.

Blood pressure distribution and control in coronary patients from 24 European countries in the European Society of Cardiology EURoObservational Research Programme European survey of cardiovascular disease prevention and diabetes. EUROASPIRE IV Registry.

Hypertension is the most prevalent major independent risk factor for developing coronary heart disease (CHD). The present analysis aimed to assess blood pressure (BP) distribution and factors associated with insufficient BP control in coronary patients from 24 countries participating in the European Society of Cardiology (ESC) EURoObservational Research Programme (EORP) EUROASPIRE IV survey. EUROASPIRE IV is a cross-sectional study conducted in 2012-2013 in patients aged 80 years or less hospitalized for CHD with a follow-up visit at a median of 16 months later. Logistic regression analysis was applied to confirm factors associated with BP control defined as less than 140/90 mmHg for nondiabetic patients and less than 140/85 mmHg for diabetic patients. A total of 7998 patients (response rate, 48.7%) attended the follow-up visit. Complete data were available in 7653 participants (mean age 62.5 ± 9.6 years). The BP goal was achieved in 57.6%. Patients failing to achieve the BP goal were older, had higher BMI, had more often a history of coronary artery bypass grafting (CABG) and reported diabetes more frequently. Logistic regression confirmed the following independent significant predictors of not achieving the BP goal: a history of diabetes [odds ratio (OR) 1.75], obesity (OR 1.70 vs. normal BMI), overweight (OR 1.28 vs. normal BMI), age at least 65 years (OR 1.53) and CABG as the index event (OR 1.26 vs. acute MI). EUROASPIRE IV found insufficient BP control in a large proportion of patients with stable CHD, with diabetes, increased BMI, older age and CABG as the index event being independent predictors of poor BP control.

PREVALENCE OF MICROALBUMINURIA IN HYPERTENSIVE PATIENTS IN DARBHANGA MEDICAL COLLEGE LAHERIASARAI DARBHANGA AND HOSPITAL

Introduction: There are two mechanisms proposed for the greater urinary albumin excretion (UAE) in patients with essential hypertension: increased glomerular hydrostatic pressure or increased selectivity of the glomerular basement membrane. In hemodynamic mechanism regulation of the glomerular hydrostatic pressure is regulated by the relative vasoconstriction vasodilatation of the afferent and efferent glomerular arterioles. Hypertension is one of the major public health problems in the world. In India the prevalence of hypertension is about 25% in urban and 10-15% in rural, adult population as compared to west which is 30%. Essential hypertension is responsible for producing clinical proteinuria and a significant reduction in renal function in 5-15% of patients. Several studies have shown that proteinuria and microalbuminuria are independent predictors of cardiovascular morbidity and mortality in patients with hypertension. Some data suggest that reduction of albumin excretion rate reduces the risk of adverse renal and cardiovascular events (CVEs).
 Material and Methods: Patients, who had high blood pressure based on JNC 8 (Joint National Commission 8) criteria during three subsequent visits to the outpatient clinic and a creatinine clearance greater than 80 ml/min/1.73 m2, were included in the study. A total of 546 essential hypertensive patients whose BP was> 140/90 mm Hg in nondiabetics and BP >130/85 mm Hg in diabetic patients were included in the study. Blood pressure monitoring was done according to the WHO guidelines. Demographic data, age, sex, weight, associated cardiovascular disease, albuminuria, and clinical parameters were all recorded. All routine biochemical tests and microalbuminuria tests were performed by the laboratory. Blood and urine creatinine were measured using an autoanalyzer.
 Results: There were 322 (58.97%) male and 224 (41.02%) female included in the study. Left ventricular hypertrophy was observed in 267 (48.9%) of the patients, retinopathy was seen in 54 (9.89%) and microalbimunira was observed in 297(54.4%) of hypertensive patients. 129 (23.63%) were smokers. Statistical significance was observed renal parameters except serum uric acid levels.
 Conclusion: Prevalence of microalbuminuria in hypertensive patients warns that screening for microalbuminuria is essential for intervention and prevention of complications and renal diseases. Also it is necessary to screen the patients for early nephropathy to halt the disease progression.

A COMPARISON BETWEEN USUAL OFFICE AND FOUR OTHER METHODS TO EVALUATE BLOOD PRESSURE (BP-TRUE, HBPM, ABPM AND CBP) DURING 3 YEARS FOLLOW-UP

Objective: Recently the methodology used to estimate blood pressure (BP) in the SPRINT study (3 measurements with an OMRON device with the patient isolated) has questioned the applicability of a goal of systolic BP below 120 mmHg. We have compared differences between 5 methods of BP measurements. Design and method: A total 615 patients with pre-diabetes (N = 431) and type 2 diabetes (N = 184) were included in the study. Office BP was estimated through 3 observed measurements. The other methods were: BP-TRUE (N = 184), HBPM (N = 431), ABPM (N = 615) and CBP (N = 615) used under the standard conditions. Patients were followed for 3 years during which serum creatinine, pulse wave velocity (PWV), and other biochemical parameters were analyzed Results: Office BP exhibited the highest and CBP the lowest values. At the end of follow-up, Office BP was 133 in pre-diabetic and 135 mmHg in diabetic patients that were 3 and 15 mmHg above at baseline. The Table shows the differences between methods in prediabetic and diabetic patients. A subtle but continuous rise was observed in serum creatinine and PWV during the follow-up of diabetics. Table. Differences between office systolic BP and the other methodologies in prediabetic and diabetic patients.Conclusions: The 5 methods compared require the consideration of different BP goals to attain the maximal benefit of BP reduction. The best approach compared to office BP corresponds to ABPM and CBP followed by HBPM and BP-TRUE. Cardiorenal disease progresses in established diabetics with an acceptable BP control.

Prevalence of Microalbuminuria in Hypertensive Patients

A total of 657 uncontrolled hypertensive patients (BP > 140/90 mm Hg in non-diabetics and BP >130/85 mm Hg in diabetic patients) were studied and followed for 12 months.
 Out of which 374 (56.93%) were male and 283 (43.07%) were female. Retinopathy was observed in 91 (13.85%) cases and Left ventricular hypertrophy was seen in 91 (13.85%) patients. Out of 374 male patients 198 (52.94%) were smokers while 176 (47.06%) were non-smokers. Hypertension is an established risk factor for cardiovascular as well as renal disease. Prevalence of microalbuminuria in hypertensive patients suggests that screening for microalbuminuria is essential for intervention and prevention of further complications like end stage renal disease and cardiovascular disease. It is much more essential to screen for early nephropathy by testing microalbuminuria in hypertensive patients prevent or halt the earliest stages of damage by vigorous control of hypertension. Further studies in large scale population are required to further verification of microalbuminuria as a screening tool to prevent progression of cardiovascular and renal disease.

SPRINT

The Systolic Blood Pressure Intervention Trial (SPRINT) main results were recently published and presented at the American Heart Association Scientific Sessions.1 These data provide insight into the important question of the most appropriate treatment goal for systolic blood pressure (BP). The results of this study will have a large and lasting impact on the management of patients with hypertension. The study answers a critical question, but important questions remain. The large over-riding question remaining from the SPRINT trial is this: How generalizable are the results? The J-curve relationship between systolic BP and risk is present in every individual and every group.2 What has been uncertain is where the inflection point on the J curve is and how the J curve relationship is impacted by chronic hypertension, age, diabetes mellitus, chronic kidney disease, and atherosclerotic disease leading to stroke and heart disease. The SPRINT has answered some of these questions, but some remain unanswered. Perhaps, the most important question coming from the SPRINT involves a group of patients not included in the trial: patients with diabetes mellitus. A few years earlier, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study3 was done to determine the appropriate goal systolic BP for patients with diabetes mellitus. ACCORD did not demonstrate a benefit for a systolic BP goal of 120 versus 140 mm Hg. On the basis of those results, most current guidelines call for lowering BP to the range of 135 to 140 mm Hg in diabetic patients.4,5 If the interpretation of the ACCORD results is correct, is the reason for lower BP goals leading to better results in SPRINT …

Canadian Society of Nephrology Commentary on the 2012 KDIGO Clinical Practice Guideline for the Management of Blood Pressure in CKD

The KDIGO (Kidney Disease: Improving Global Outcomes) 2012 clinical practice guideline for the management of blood pressure (BP) in chronic kidney disease (CKD) provides the structural and evidence base for the Canadian Society of Nephrology (CSN) commentary on this guideline's relevancy and application to the Canadian health care system. While in general agreement, we provide commentary on 13 of the 21 KDIGO guideline statements. Specifically, we agreed that nonpharmacological interventions should play a significant role in the management of hypertension in patients with CKD. We also agreed that the approach to the management of hypertension in elderly patients with CKD should be individualized and take into account comorbid conditions to avoid adverse outcomes from excessive BP lowering. In contrast to KDIGO, the CSN Work Group believes there is insufficient evidence to target a lower BP for nondiabetic CKD patients based on the presence and severity of albuminuria. The CSN Work Group concurs with the Canadian Hypertension Education Program (CHEP) recommendation of a target BP for all non-dialysis-dependent CKD patients without diabetes of ≤140 mm Hg systolic and ≤90 mm Hg diastolic. Similarly, it is our position that in diabetic patients with CKD and normal urinary albumin excretion, raising the threshold for treatment from <130 mm Hg systolic BP to <140 mm Hg systolic BP could increase stroke risk and the risk of worsening kidney disease. The CSN Work Group concurs with the CHEP and the Canadian Diabetic Association recommendation for diabetic patients with CKD with or without albuminuria to continue to be treated to a BP target similar to that of the overall diabetes population, aiming for BP levels < 130/80 mm Hg. Consistent with this, the CSN Work Group endorses a BP target of <130/80 mm Hg for diabetic patients with a kidney transplant. Finally, in the absence of evidence for a lower BP target, the CSN Work Group concurs with the CHEP recommendation to target BP<140/90 mm Hg for nondiabetic patients with a kidney transplant.

Blood Pressure Control Among Hypertensive Patients With and Without Diabetes Mellitus in Six Public Primary Care Clinics in Malaysia

Hypertension is a common comorbidity among diabetic patients. This study aimed to determine blood pressure (BP) control among hypertensive patients with and without diabetes. This was a cross-sectional study in 6 public primary care clinics in Wilayah Persekutuan, Malaysia. Hypertensive patients aged ≥18 years and attending the clinics were selected via systematic random sampling. The BP control target was defined as <130/80 mm Hg for diabetic patients and <140/90 mm Hg for nondiabetic patients. A total of 1107 hypertensive patients participated in this study and 540 (48.7%) had diabetes. About one fourth (24.3%) of the hypertensive patients with diabetes achieved BP control target, compared with 60.1% patients without diabetes (P < .001). Being diabetic and on ≥2 antihypertensive treatments were associated with poor BP control. Attention needs to be given to these groups of patients when managing patients with hypertension.

Effects of continuous positive airway pressure on blood pressure in hypertensive patients with obstructive sleep apnea

Several studies have reported a small yet significant decrease in blood pressure (BP) with continuous positive airway pressure (CPAP) application in patients with obstructive sleep apnea (OSA). We investigated the long-term efficiency of CPAP in the management of hypertensive patients with OSA on top of conventional antihypertensive medication. We followed 91 nonsleepy patients (aged 54 ± 9 years, 69 men) with essential hypertension and newly diagnosed moderate-to-severe OSA (apnea-hypopnea index, 38 ± 24 events/h on polysomnography) for a mean period of 3.1 years, after switching them to antihypertensive treatment targeting office BP less than 140/90 mmHg (<130/80 mmHg in diabetic patients). Participants were defined as on-CPAP if they adhered to CPAP treatment during the whole follow-up period (N = 41), whereas those that did not follow CPAP therapy served as controls (N = 50). By the end of follow-up, on-CPAP patients and controls exhibited similar SBP and DBP levels (133 ± 12 versus 133 ± 13 mmHg, 84 ± 9 versus 85 ± 9 mmHg, respectively, P > 0.05 for all), number of patients with controlled hypertension (71 versus 70%, P > 0.05), and number of antihypertensive drugs needed to achieve BP control (2.28 ± 1.09 versus 2.11 ± 0.72, P > 0.05). In a subgroup of patients (N = 34) in whom ambulatory BP monitoring was also performed, 24-h BP levels did not differ between the two groups (125 ± 10/76 ± 7 mmHg versus 123 ± 11/75 ± 10 mmHg, P > 0.05). In multiple regression models, CPAP application was not associated with changes in BP levels. In nonsleepy, hypertensive, OSA patients on conventional antihypertensive treatment, long-term CPAP application is not associated with lower BP levels or a need for less antihypertensive drugs for BP control.

Antihypertensive Efficacy of Olmesartan Medoxomil and Ramipril in Elderly Patients with Mild to Moderate Hypertension Grouped According to Renal Function Status

The objective of this study was to compare the antihypertensive efficacy and safety of the angiotensin II antagonist olmesartan medoxomil and the ACE inhibitor ramipril in elderly patients with mild to moderate essential hypertension, grouped according to renal function. We performed a post hoc analysis of pooled data from two randomized, double-blind, parallel-group, multicentre studies. After a 2-week placebo wash-out period, 1453 mild to moderate hypertensive subjects were randomized to a 12-week treatment with olmesartan medoxomil 10 mg/day or ramipril 2.5 mg/day. After 2 and 6 weeks, doses were increased up to a maximum of 40 mg/day (olmesartan medoxomil) and 10 mg/day (ramipril) in non-normalized subjects (office systolic blood pressure [SBP] ≥ 140 mmHg or diastolic blood pressure [DBP] ≥90 mmHg in non-diabetic subjects and office SBP ≥ 130 mmHg or DBP ≥80 mm Hg in diabetic patients). Office blood pressure (BP) was measured at 0, 2, 6 and 12 weeks, 24-hour ambulatory BP at 0 and 12 weeks. 284 patients treated with olmesartan medoxomil 40 mg/day at the end of the double-blind period entered a 36-week, open-label follow-up. Renal function (Cockroft-Gault equation) was evaluated as normal or increased estimated glomerular filtration rate (eGFR) [≥90 mL/min/1.73 m(2)], mild eGFR reduction (60-90 mL/min/1.73 m(2)) and moderate or severe eGFR reduction (<60 mL/min/1.73 m(2)). 181 (12.7%) subjects had normal or increased eGFR, 840 (58.9%) mild eGFR reduction, and 405 (28.4%) moderate or severe eGFR reduction. Baseline-adjusted office BP reductions were superior with olmesartan medoxomil than with ramipril in normal or increased (olmesartan medoxomil - ramipril difference SBP: 5.0 mmHg [95% CI 9.1, 0.9], p = 0.018; DBP: 2.7 mmHg [4.8, 0.6], p = 0.011) and mildly reduced eGFR patients (SBP: 1.6 mmHg [3.5, 0.2], p = 0.080; DBP: 1.2 mmHg [2.3, 0.2], p = 0.022). In the group with moderately or severely reduced eGFR the two treatments were comparable (SBP: 1.9 mmHg [4.6, 0.9], p = 0.185; DBP: 0.8 mmHg [2.3, +0.7]; p = 0.296). At 12 weeks, the rate of normalized patients was 46.1 % with olmesartan medoxomil versus 23.9% with ramipril (p = 0.002) in the normal, and 49.9% versus 42.7% (p = 0.037) in the mild eGFR reduction group. No significant differences in normalization rate were observed in the moderately or severely reduced eGFR group (olmesartan medoxomil 49.5% vs ramipril 46.3%, p = 0.519). eGFR did not show any significant change during treatment. Olmesartan medoxomil provides a more effective BP control, similar if not superior to that of ramipril, independently from the patient's renal function status.

Should we change the target blood pressure in diabetic patients?

Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality in diabetic patients. Guidelines recommend lowering blood pressure (BP) to less than 130/80 mmHg in diabetic patients. These recommendations are based on several studies in diabetic patients that showed the benefit of intensive BP control. However in all the studies the achieved BP was higher than 130/80 mmHg. Re-evaluation of earlier studies, as well as more recently accumulated data suggest that intensive BP control is associated with a significant reduction in all-cause mortality and stroke rate, but with no benefit for other microvascular or macrovascular (cardiac, renal and retinal) outcomes. Intensive BP control is associated with an increased risk of serious adverse effects, particularly for systolic BPs levels lower than 130 mmHg. When determining the target BP in diabetic patients one should balance the potential cerebrovascular protection against the increased risk of serious side effects, and the absence of benefit for other circulatory system. It seems therefore, that lowering BP to levels close to 130/80 mmHg should be the main goal of treatment in diabetic patients.

Clinical application of interventional renal sympathetic denervation: recommendations of the Austrian Society of Hypertension 2012

Increased activity of the sympathetic nervous system plays a major role in the pathophysiology of primary arterial hypertension. Interventional renal sympathetic denervation (RSD) is a novel percutaneous treatment, decreasing sympathetic activity and consecutively blood pressure by ablating sympathetic nervous fibers located in the adventitia of the renal arteries. The procedure has been tested in several clinical trials in patients with resistant hypertension (defined as systolic office blood pressure > 160 mmHg-in diabetic patients > 150 mmHg-treated with ³ 3 antihypertensive drugs) and caused a meaningful blood pressure reduction, lasting for at least 3 years. So far, no major adverse events have been identified; however, data on the long-term consequences are lacking. The present position paper of the Austrian Society of Hypertension is aiming to assist in choosing possible indications for RSD in clinical routine, based on the available evidence in 2012.

Renal sympathetic denervation as second‐line therapy in mild resistant hypertension: A pilot study

Catheter-based renal sympathetic denervation (CRD) is associated with significant blood pressure (BP) reductions in patients with severe therapy-resistant hypertension (office systolic BP ≥ 160 mm Hg or ≥ 150 mm Hg in diabetic patients). Effects of renal denervation on BP in patients with milder forms of therapy-resistant hypertension have not been examined. We sought to investigate the feasibility, safety, and effectiveness of CRD in patients with longstanding mild hypertension despite treatment with ≥ 3 antihypertensive drugs. Consecutive patients with office systolic BPs of 140-160 mm Hg despite ≥ 3 antihypertensive medications treated with CRD were included in this prospective study. Procedural safety and adverse events during follow-up were assessed. Clinical evaluations were performed at baseline, 3, and 6 months to determine changes in office systolic BPs, 24-hr ambulatory BPs, and medication doses. Twenty patients (mean age 60.6 ± 10.8 years; 45% female) treated with an average of 5.4 ± 1.5 antihypertensive drugs were treated with CRD. The procedure was successful in all patients. There were no procedure- or device-related complications. BP at baseline was 148.4/83.0 ± 6.6/11.0 mm Hg and decreased by 5.7/0.6 ± 20.0/8.3 mm Hg (P = 0.2) and 13.1/5.0 ± 13.6/8.3 mm Hg (P < 0.01) at 3 and 6 months, respectively. Comparing baseline and 6-month follow-up, mean ambulatory 24 hr-BP was reduced by 11.3/4.1 ± 8.6/7.3 mm Hg (P < 0.01). Four patients were able to reduce antihypertensive medications prior to their 3-month visit. As in patients with severe treatment-resistant hypertension, CRD is a safe and effective treatment for patients with milder drug-resistant hypertension.

A call for wider use of ambulatory blood pressure monitoring in patients with diabetes

Hypertension is one of the most important determinants of micro- and macrovascular complications in patients with diabetes. Recent guidelines on treating hypertension in diabetes patients, based on clinical evidence of protection against target organ damage, especially as demonstrated by renal outcomes, recommended that office blood pressure (BP) be lowered to 130/80 mmHg in these patients.1 However, very few studies have consistently achieved BP levels as low as 130/80 mmHg in diabetic patients.

Dose-Dependent Antihypertensive Efficacy and Tolerability of Perindopril in a Large, Observational, 12-Week, General Practice-Based Study

Current guidelines recommend the use of full therapeutic dosages of antihypertensive agents, or combination therapy, to improve BP control of hypertensive patients in primary healthcare. The aim of this study was to assess the dose-dependent antihypertensive efficacy and safety of perindopril 4 and 8 mg/day in the clinical setting. The CONFIDENCE study was a prospective, observational, multicenter trial. This was a real-world, clinic-based, outpatient study involving 880 general practitioners/primary-care clinics and 113 specialists in Canada. The study included untreated or inadequately managed patients with hypertension (i.e. seated BP ≥ 140/90 mmHg, or ≥ 130/80 mmHg in the presence of diabetes mellitus, renal disease, or proteinuria) without coronary artery disease (CAD). Treatment consisted of perindopril 4 mg/day, uptitrated to 8 mg/day as required for BP control at visit 2, for 12 weeks. Among the patients already being treated at baseline, perindopril either directly replaced all previous ACE inhibitors or angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]), or was added to antihypertensive treatment with calcium channel blockers (CCBs), diuretics, or β-adrenoceptor antagonists (β-blockers). The primary outcomes were the mean changes in BP from baseline following treatment with perindopril 4 and 8 mg/day as well as the proportion of patients achieving BP control (BP <140/90 mmHg, or <130/80 mmHg in diabetic patients) in the intent-to-treat (ITT) population. Secondary analyses included the incidence of adverse events and compliance. A total of 8298 hypertensive patients entered the study: 56% with newly diagnosed hypertension and 44% with uncontrolled hypertension. Mean SBP/DBP decreased significantly from baseline (152.5 ± 10.8/89.5 ± 9 mmHg) over 12 weeks (-18.5/-9.7 mmHg; p < 0.001). At visit 2, 23% of patients were uptitrated to perindopril 8 mg/day, which resulted in an additional mean 10.1/5.3 mmHg BP reduction; this reduction was even greater (15.1/5.7 mmHg) among a separate group of severely hypertensive patients (i.e. SBP >170 mmHg or DBP >109 mmHg at baseline). Target BP was achieved in 54% of the ITT population. Both perindopril 4 mg/day and perindopril 8 mg/day were well tolerated and compliance was high throughout the study. In the clinical outpatient setting, perindopril was found to be an effective dose-dependent and well tolerated antihypertensive treatment, with good compliance. Uptitration to the full therapeutic dosage of perindopril is an efficient approach for the management of a broad range of hypertensive patients without CAD.

Hypertension Treatment and Control Among 28 Physician Practices Across the United States: Results of the Hypertension: Assessment of Treatment to Target (HATT) Study

Chart reviews were conducted at 28 US physician practices to evaluate blood pressure (BP) management. The cross-sectional study included 8250 adult patients diagnosed with hypertension. The primary outcome variable was BP control (BP <140/90 mm Hg for nondiabetic and <130/80 mm Hg for diabetic patients). Mean body mass index was 30.9 kg/m(2), 49% were obese, 54% were women, mean age was 64.9 years, and 25% had diabetes. Mean BP was 132.2/77.8 mm Hg, and 55.8% of study participants had controlled BP. Patients with uncontrolled BP were more likely to be obese or African American, and more than twice as likely to have diabetes. Almost 1 in 5 nondiabetic patients (18%), and 38% of diabetic patients, were above goal BP by >10 mm Hg systolic or >5 mm Hg diastolic; among these patients, 36% used 0 or 1 antihypertensive medication, and 32% used 2 medications. Opportunity exists to improve BP control in this population.

BLOOD PRESSURE CONTROL OF FIXED DOSE, PERINDOPRIL/AMLODIPINE COMBINATION TREATMENT IN HYPERTENSIVE PATIENTS UNCONTROLLED ON MONOTHERAPY OR ON TWO DRUG COMBINATION THERAPY: PP.5.167

Objective: The objective of this study is to assess the antihypertensive efficacy and tolerability of a FDC of an angiotensin converting enzyme inhibitor (perindopril), and a calcium channel blocker (amlodipine). Methods: Physicians recruited 855 patients uncontrolled (SBP>140 and / or DBP>90 mmHg) on monotherapy, or on a double combination. Patients were switched to 1 FDC tablet a day of Perindopril 4mg+Amlodipine 5 mg, along with concomitant non-antihypertensive medications for 60 days. The primary outcomes were blood pressure control (SBP<140 and DBP<90 in non diabetic, and <130 and <80 mmHg in diabetic patients) on an intention to treat basis. Results: In the 855 patients recruited, 688 (80.5%) had their BP controlled at day 60. Among the 654 patients uncontrolled on monotherapy, the mean BP declined from 165.4 ± 15.4 / 100.0 ± 8.8 mm Hg to 132.5 ± 9.5 / 82.7 ± 6.0 mm Hg (p < 0.001) at 60 days and BP control was achieved in 82.1% (537) of this population. The subpopulation of patients inadequately managed on double combination (201 patients) have their BP reduced from 167.0 ± 16.5 / 99.2 ± 7.8 mm Hg to 135.3 ± 11.4 / 83.0 ± 5.5 mm Hg, to achieve a BP control rate of 75.6% (152). Antihypertensive efficacy was observed across patient subgroups regardless of the previous antihypertensive treatment, as shown in the table. The number (%) of patients discontinuing treatment, was, due to cough, 3 (0.4%); pedal edema, 2 (0.2%); lack of efficacy, 2 (0.2%); and lost to follow up, 37 (4.3%). Conclusions: The findings from this observational study confirm that the FDC of Perindopril/Amlodipine given as a single daily dose is an effective and well tolerated treatment for patients uncontrolled on monotherapy or inadequately managed on double combination therapy.

EFFECTIVENESS OF TREATMENT OF HYPERTENSION AMONG CORONARY PATIENTS IN POLAND: PP.19.232

Background: Control of hypertension (HT) in Polish general population is poor. However, achievement of treatment goal for hypertension is considered as a basis of secondary prevention of coronary heart disease (CAD). Methods: Consecutive patients in age <80 years hospitalized in years 2005–2006 due to acute coronary syndrome, PCI or CABG in Cracow province(1.2 mln. inhabitants) were included. Data for analysis were taken from subsamples examined in Euroaspire III- Poland (2006–2007). During the control visit, 6–18 months after hospitalization, blood pressure (BP) was measured twice and the rate of antihypertensive drugs was assessed. Treatment of HT among patients <65 and > = 65 years of age was compared. Results: There were 640 patients (455 men and 185 women) recruited in the hospital phase. Six - 18 month after hospitalization 513 patients were examined (80.1%). Systolic BP in patients <65 years of age (n = 305) was 133.8 ± 18.7 mmHg and among elderly patients (n = 208) 142.2 ± 21.9 mmHg (p < 0.05). Diastolic BP was found in both groups, respectively 85.5 ± 10.7 mmHg and 83.9 ± 11.6 mmHg (p = NS). Mean number of antihypertensive drugs in younger patients amount to 2.2 0.9, and in elderly patients 2.4 ± 0.9 (p < 0.05) (Table). Treatment target of BP (<140/90 mmHg or <130/80 mmHg in diabetic patients) was achieved in 44.4% younger patients and in 35.7% elderly. Conclusion: Although, combined antihypertensive treatment is commonly used, achievement of BP control is still insufficient, especially among patients with CAD > = 65 years of age.

LEFT VENTRICULAR MASS IS A PREDICTOR OF FOLLOW-UP UNCONTROLLED BLOOD PRESSURE IN HYPERTENSIVE PATIENTS: 4B.04

Background: Left ventricular (LV) hypertrophy (LVH) is considered as a target organ response to chronic arterial hypertension and is used to stratify cardiovascular (CV) risk. LV mass (LVM) is also increased in subjects developing subsequent hypertension. Whether initial LVM also influences effective therapeutic control of blood pressure (BP) is unknown. Methods: We estimated risk of suboptimal BP control in relation to baseline LVM index (LVMi) in 4693 hypertensive outpatients from the Campaniasalute Network, with at least 1 yr follow-up (mean 4 ± 3yrs) and without prevalent CV disease (age 53 ± 11 yrs, 43% women, 5% diabetic). BP was defined uncontrolled when systolic BP> = 140mmHg or/and diastolic BP>=90mmHg (or BP>=130 or/and 80 mmHg in diabetic patients) at the last available outpatient visit. Results: Poor BP control was detected in 2240 patients (48%), despite treatment with 2 or more antihypertensive drugs. Patients with uncontrolled BP were older, more often obese (28% versus 21%) and diabetic (9% versus 1.6%), with a longer duration of hypertension and higher baseline BP, heart rate, LVMi, and prevalence of LVH (36% versus 26%, all p < 0.0001), with no difference in sex distribution. Of 1440 patients with baseline LVH, 803 (or 56%) had uncontrolled BP at follow-up, compared to 44% of those without LVH (p < 0.0001). In multivariate analyses, odds of uncontrolled BP increased significantly with higher baseline systolic BP, heart rate, BMI, duration of hypertension, diabetes (all p < 0.0001) and greater baseline LVMi (OR = 1.10/10 g/m2.7, 1.04–1.20, p = 0.002) independent of age, gender and number of medications. When specific classes of medications were added to the previous model, only use of anti-Renin-Angiotensin System reduced the risk of uncontrolled BP (OR = 0.83, 0.71–0.95, p = 0.01), with no impact for other classes of drugs (diuretics, β-blockers, Ca++-channel blockers and α-blockers). Conclusions: We conclude that in a large population of treated hypertensive patients, higher baseline left ventricular mass is significantly associated with risk of uncontrolled BP independently of age, gender, body max index, diabetes and antihypertensive therapy.

Effect of cardiometabolic risk factors on hypertension management: a cross-sectional study among 28 physician practices in the United States

ObjectiveThis cross-sectional study sought to determine the prevalence of cardiometabolic risk factor clusters (CMRFCs) and their effect on BP control among hypertensive patients from 28 US physician practices.MethodsEach participating practice identified a random sample of 150-300 adults aged ≥ 18 years diagnosed with hypertension. The primary outcome variable was BP control (BP < 140/90 mmHg for non-diabetic and <130/80 mmHg for diabetic patients). CMRFCs included hypertension in addition to obesity, dyslipidemia, and diabetes.ResultsOverall, 6,527 hypertensive patients were identified for study inclusion. More than half (54.3%) were female, and mean age was 64.7 years. Almost half (48.7%) were obese (BMI ≥ 30 kg/m2). About 1 in every 4 patients (25.3%) had diabetes, and 60.7% had dyslipidemia. Mean blood pressure was 132.5/77.9 mmHg, and 55.0% of all patients had controlled BP; 62.4% of non-diabetic patients, and 33.3% of diabetic hypertensive patients, had BP controlled to recommended levels. Most (81.7%) hypertensive patients had ≥ 1 cardiometabolic risk factor, and 12.2% had all 3 risk factors. As compared to hypertensive patients without additional risk factors, adjusted odds ratios for BP control were significantly lower for all combinations of CMRFCs (ORs 0.15-0.83, all p < 0.04), with the exception of patients who had only dyslipidemia in addition to hypertension (OR = 1.09, p = NS). Prescriber adherence to recommended hypertension treatment guidelines for patients with diabetes, heart failure, or prior myocardial infarction was high. Although patients with risk factors were prescribed more antihypertensive medications than those without, hypertensive patients with all 3 risk factors were prescribed a mean of 2.4 antihypertensive medications compared to 1.7 for those with no risk factors; odds of BP control in these patients, however, was 0.23 [95% CI 0.19-0.29] that of patients with no other CMRFCs.ConclusionsAcross 28 US practices, only 18% of hypertensive patients did not have any additional cardiometabolic risk factors. The high prevalence of CMRFCs presents a challenge to effective hypertension management.