Patients Reached Target Blood Pressure Research Articles

Survey on the Use of Medicines in Patients with Co-existing Hypertension and Type 2 Diabetes at the Internal Medicine Department of E Hospital in 2020-2022

The study aims to describe the situation of using antihypertensive and hypoglycemic drugs; Initial evaluation of the effectiveness of drug used in the treatment regimen of patients with concomitant hypertension and type 2 diabetes. Methods: a cross-sectional, retrospective study was performed on 179 medical records of patients who had hypertension and type 2 diabetes, examination and treatment at the Internal Medicine Department - Hospital E from April 2020 to December 2022. Information collected from medical records was processed using SPSS 26.0 statistical software. Result: the main groups of hypoglycemic drugs used were metformin (74.9%) and insulin (69,3%). The rate of using multi-drug regimen for diabetes (64.8%) is higher than that of monotherapy, in which the two-drug regimen of insulin and biguanide (metformin) is common (32.4%). The main groups of antihypertensive drugs used were ACE inhibitors and Ca channel blockers (72.6% and 57.5%), 60.3% of patients were treated according to a multi-drug regimen in which combination regimens of 2 groups of Ca channel blockers and ACE inhibitors are common (26.3%). There are no clinically significant interactions between antidiabetic and antihypertensive drugs. The rate of patients who reached the target blood pressure was 83.8%. The rate of patients achieving target blood sugar levels when discharged from the hospital was 40.9%. Conclusion: multi-drug regimen is used more than monotherapy in the treatment of hypertension and diabetes. Most patients reached target blood pressure on discharge, however the number of patients achieving target blood glucose was quite limited . No drug interactions were found between drugs used to lower blood pressure and hypoglycemic drugs.

The Indian REgistry on Current Patient PrOfiles and TReatment TrenDs in Hypertension (RECORD): Final Outcomes of the Real-world Observational Study.

Objectives: The Indian Registry on Current Patient Profiles and Treatment Trends in Hypertension (Record) evaluated the current trends and outcomes related to hypertension (HTN) management at 3, 6, 12, and 24 months in India. This study highlights and evaluates the outcomes and trends noted at 24 months. Materials and methods: The detailed study methodology is provided in the earlier publication (interim analysis at 12 months). Aspects such as changes in the quality of life (QOL), percentage of patients reaching target blood pressure (BP), treatment pattern among patients with comorbid conditions, and difference in treatment patterns between public and private healthcare settings, at 24 months, were evaluated in the current study. Results: The study population included 2,000 patients (55.7% males) with a mean age of 54.45 years. Telmisartan (43.7%) and amlodipine + telmisartan (16.4%) were the most prescribed monotherapy and combination therapy among patients with newly diagnosed HTN. A significant decrease in both systolic BP (SBP) and diastolic BP (DBP) was noted in the overall patient population at 24 months (p < 0.001). The mean change in SBP and DBP was slightly higher at 24 months compared to 12 months. This was more evident among patients on combination therapy. A significant improvement in QOL was noted at 24 months. Conclusion: Treatment strategies in HTN management are changing and are associated with effective HTN control and improvements in QOL. However, there is a further need for improved awareness regarding the optimal usage of combination therapy for better management of uncontrolled HTN. How to cite this article: Rajadhyaksha GC, Reddy H, Singh AK, et al. The Indian REgistry on Current Patient PrOfiles and TReatment TrenDs in Hypertension (RECORD): Final Outcomes of the Real-World Observational Study. J Assoc Physicians India 2023;71(11):43-49.

First results of Russian multicenter prospective clinical study VICTORY II: Vamloset® and Co-Vamloset effectiveness and safety in patients with stage 2 and 3 arterial hypertension

Abstract&#x0D; VICTORY II study objective. Evaluation of Vamloset and Co-Vamloset safety and effectiveness in reaching target blood pressure (BP) level in patients with stages 23 arterial hypertension (AH).&#x0D; Materials and methods. Russian multicenter prospective clinical study conducted in 8 clinical centers in6 cities in Russian Federation included 103 patients over 18 years of age with diagnosed essential hypertension of stages 23 (in accordance with 2013 European guidelines) who previously did not receive treatment (with office systolic BP sBP160 mm Hg and/or office diastolic BP dBP100 mmHg) or did not achieve target BP levels after receiving mono- or dual therapy. Office BP target levels comprised 139 mmHg for sBP and 89 mm Hg for dBP for patients without diabetes mellitus (DM), and 139 mm Hg for sBP and 84 mm Hg for dBP for patients with DM. All patients with stage 2 AH (group 1) were prescribed Vamloset (amlodipine/valsartan, 5/80 mg), patients with stage 3 AH Vamloset (amlodipine/valsartan, 5/160 mg). Therapy correction Vamloset (amlodipine/valsartan) in doses 5/160 mg, 10/160 mg and Co-Vamloset (amlodipine/valsartan/hydrochlorothiazide) in doses 10/160/12,5 mg, 10/160/25 mg (КРКА-RUS) was performed every 4 weeks according to provided schemes. At follow-up every 4 weeks the decision on necessity of antihypertensive treatment (AHT) correction were made by medical researcher in accordance with analysis of patients complaints, general condition and physical examination, results of office BP measurement, diary of BP self-control. In 40 patients in subgroup with additional assessment 24-hour BP monitoring, pulse wave velocity measurement, central BP evaluation, augmentation index calculation, and endothelium damage markers determination were performed.&#x0D; Results. Active phase of the study included 100 patients aged 59.510.9 years (59% female) suffering from AH for 83.48.4 months. The patients received treatment with study medication (safety population). The protocol population (sampling Per Protocol) included 80 patients who completed the study without severe protocol violation. At the moment of study entrance 83% of patients received AHT. In all patients treatment duration comprised 15.9 weeks. In Per Protocol population target office BP level was achieved by 90.0% (95% confidence interval 81.295.6%) of the patients. Overall clinical effectiveness (extremely high, very high, high, and sufficient) was achieved in 98.8% [95% confidence interval 93.2100%] of the patients. In group of patients with stage 2 AH target office BP level was achieved by 93.8% of patients, in group with stage 3 AH by 84.4% of patients. Mean BP change in study group was -32.2 mm Hg for SBP and -16.0 mm Hg for DBP. Among patients with stage 2 AH target office BP level was achieved by 93.8% of patients, with mean BP change -30,7 mm Hg for SBP and -15.5 mm Hg for DBP. In patients with stage 3 AH target BP levels were achieved in 84.4% of patients with mean BP change -34,6 mm Hg for SBP and -16.7 mm Hg for DBP. After 16 weeks of treatment in Full Analysis Set population with recovery of missed measures using Last Observation Carried Forward 40.2% of patients reached target BP levels according to BP self-control results. Considering the limitations of results evaluation this practice requires further assessment, standardization, and improvement. According to 24-hour BP monitoring reaults after 16 weeks of treatment 26.5% of patients achieved target BP daily profile (for patients from subgroup with additional assessment in Full Analysis Set population with recovery of missed measures using Last Observation Carried Forward), that indicates additional influence of studied AHT on the prognosis of patients with stages 23 AH.&#x0D; Conclusion. In clinical study VICTORY II Vamloset and Co-Vamloset optimal effectiveness and safety in patients with stage 2 and 3 arterial hypertension were shown.

Effects of fixed-dose indapamide/perindopril combination on arterial function in patients with hypertension and chronic kidney disease: key results of the CAMERTON program

Aim. To study the effects of fixed-dose indapamide/perindopril combination on endothelial function and arterial stiffness in patients with uncontrolled stage 1-2 hypertension (HTN) and chronic kidney disease (CKD).Material and methods. Total of 100 patients with uncured or uncontrolled with ≥3 months antihypertensive therapy HTN and CKD G3 (67% females, mean age 59,1±12,5 years) were included in the study. Each patient took indapamide/perindop combination in accordance with 1 of 3 existing regimes (depending on doses) for 3 months. Primary aim was to assess the effects of indapamide/perindopril combination on endothelial function and parameters of arterial stiffness after 12 weeks of treatment (assessment by AngioScan diagnostic complex). Secondary aims were achievement of target blood pressure (BP) after 4 and 12 weeks of therapy and assessment of glomerular filtration rate (GFR) and the albumin-tocreatinine ratio (ACR) changes after 12 weeks.Results. Initially, there was an increase in arterial stiffness parameters in all patients, and during treatment decrease was observed: central systolic BP (SBP) from 120±10,1 to 112,9±6,3 mm Hg, median augmentation index from 10,9% to 4,6%, stiffness index from 8,1±2,4 to 7,1±0,9, vascular age decreased by 9,6% (р&lt; 0,001 for trend). Significant improvement of endothelial function was observed regardless of diabetes presence: occlusion index increased from 1,5±0,3 to 1,7±0,5, median phase shift — from -4,6 to -2,4 ms (p&lt; 0,01). After 4 weeks, 27% of patients reached target BP, by the end of the study — 90%. A decrease in the median ACR from 16,3 to 15,0 mg/g, GFR increase from 50,2±7,6 to 53,6±8,7 ml/min/1,73 m2 were observed (p&lt; 0,01 for trend).Conclusion. Therapy with a fixed-dose indapamide/perindopril combination in patients with uncontrolled stage 1-2 HTN and G3 CKD leads to a significant improvement in arterial stiffness, endothelial and renal function, and achievement of target BP in 90% of patients.

Pharmacoepidemiological Research of the Efficacy of Fixed Dose Combinations in the Treatment of Patients with Arterial Hypertension in Ambulatory Practice

Aim. To study the pharmacoepidemiological features of the prescription of antihypertensive fixed dose combinations and their efficacy in hypertensive patients in the real outpatient practice in Vladivostok city. Material and methods . Hypertensive patients aged 1 8 years and older (n=268) observed in Vladivostok polyclinics from October to December 2017 were included into the study. All patients did not have target blood pressure (BP) levels. The analysis of the medical prescriptions of antihypertensive fixed dose combinations in Vladivostok polyclinics was performed. Two-component (perindopril + amlodipine) or three-component (perindopril + amlodipine + indapamide) fixed dose combinations were prescribed by physician in accordance with instructions for medical use and their pharmacological characteristics. The study was non-interventional and included 3 visits for the initial examination, prescription and correction of therapy, considering its efficacy. All patients were determined for glomerular filtration rate using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration Formula), changes in BP. Patients performed self-esteem on a 1 0-point visual analogue scale (VAS). Results. Only 23.4% of patients reached target BP levels in the first month of observation, and 84.5% of patients after 3 months of observation. 30 (1 1.2%) patients had replacement with double antihypertensive fixed dose to triple combination combinations during the study. 68.6% of patients did not have a replacement for the initial prescribed antihypertensive fixed dose combinations due to the achievement of target BP. The number of patients with moderately and markedly reduced glomerular filtration rate was reduced significantly. Initially, the patients included into the study assessed health (according to adapted VAS) for 5.6±1.4 points, and after 3 months of follow-up - for 7.9±1.7 points. Conclusion. The use of antihypertensive fixed dose combinations containing ACE inhibitor (perindopril), calcium channel blocker (amlodipine) and thiazide-like diuretic (indapamide) resulted in achievement of target BP levels in 84.5% of patients after 3 months of follow-up. Also, the use of double and triple fixed dose combinations had a nephroprotective effect, manifested in an increase in the number of patients ( + 19.3%) with a glomerular filtration rate more than 60 ml/min/1,73 м 2 and a positive effect on the patient's well-being.

THE USE OF MEDICINES IN TREATING HYPERTENSION IN HUE UNIVERSITY HOSPITAL

Background: Hypertension is a common condition in the world as well as in Viet Nam. If hypertension isn’t treated well, it can cause many serious complications. Controlling target blood pressure will bring positive effects on reducing mortality rate and also disabilities caused by diseases related to hypertension. Objectives: (1) Analyzing the use of medicines in treating hypertension. (2) Evaluating the effects of medicine usage in treating hypertension at the hospital of Hue University of Medicine and Pharmacy. Materials and methods: 388 patients were diagnosed as having hypertension with inpatient care at the Cardiovascular Department of Hue University of Medicine and Pharmacy’s hospital, using cross-sectional descriptive study methods. Results: All antihypertensive drugs in the research were contained in the antihypertensive list recommended by Vietnamese Society of Cardiology. Angiotensin converting enzyme inhibitor and calcium channel blocker were the two most popular drug groups (96.6% and 71.4%, respectively). The rate of using multi-therapy regimens was higher than the rate of using uni-therapy regimens in both initial therapies (64.7%&gt;35.3%) and final therapies (61.9%&gt;38.1%). The rate of patients having interactions between antihypertensive drugs and the other kinds of drugs was 7.5%. The rate of patients having reasonable prescriptions was 84.3%. Evaluating the effects of medicine usage in treatments showed that the rate of patients reaching target blood pressure before leaving the hospital was 67.3%. Most patients were evaluated as having good prognosis after treatment, up to 81.7%. Conclusions: All antihypertensive drugs in the research were contained in the antihypertensive list recommended by Vietnamese Society of Cardiology. The rate of using multi-therapy regimens was higher than the rate of using uni-therapy regimens. The rate of drug interactions was quite low; most patients were evaluated as having good prognosis after treatment. Key words: hypertension, antihypertensive drugs.

2A.02

The aim of this study was to assess the efficacy of blood pressure (BP) control with fixed-dose combination of perindopril arginine/indapamide (Noliprel) in patients with uncontrolled hypertension.A total of 714 patients with uncontrolled hypertension from the PROTECT (noliPRel - efficacy of blood pressure cOnTrol on nEw diagnosed and unControlled patienTs) database, were included. At the beginning of the study the patients (mean age 64.9 ± 10.5 years; 223 men) were switched from antihypertensive drugs that had proven ineffective in BP control to Noliprel. BP was measured in the third and sixth months of the study. The primary end point was the number of patients reaching target BP levels in the intermediate phases of the study. The SPSS v.17.0 statistical software package was used for data collection and analysis. Results are presented as mean value ± standard deviation. Differences in mean values were analyzed using Student's paired-simple test.Mean systolic BP (SBP)/diastolic BP (DBP) declined significantly from 165.6 ± 14.4/96.8 ± 9.0 mmHg to 132.2 ± 10.7/80.1 ± 6.7 mmHg (p < 0.0001) over the course of the study. SBP/DBP reduction at three month was already -18.7 ± 14.2/-10.0 ± 9.6 mm Hg (p < 0.0001). Patients with BP values at target (<140/90 mmHg) represented 19.8% at 3 months, and 66.8% at 6 months. At the end of study, Noliprel was prescribed in 19.6% (perindopril arginine/indapamide 2.5 mg/0.625 mg), 61.8% (5 mg/1.25 mg), and 18.6% (10 mg/2.5 mg) of cases, respectively. No adverse effects were observed.The fixed-dose combination of perindopril arginine/indapamide was effective and safe in patients with uncontrolled hypertension in reducing BP and maintaining it at target levels.

Overcoming barriers in the management of hypertension: the experience of the cardiovascular health program in chilean primary health care centers.

Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs) in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP). Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP) measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP <140/90 mmHg. More women were captured in the sampling (2.1 : 1), achieving better BP control than men. Diabetic patients (26.4%) had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values <140/90 mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics.

Olmesartan/amlodipine vs olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS study

We studied the effects of treatment with olmesartan/amlodipine and olmesartan/hydrochlorothiazide on inflammatory and metabolic parameters (including new-onset diabetes as a secondary endpoint) in non-diabetic hypertensive patients with metabolic syndrome (MetS). A total of 120 patients with MetS and stage I and II hypertension were randomized to olmesartan 20 mg/amlodipine 5 mg or olmesartan 20 mg/hydrochlorothiazide 12.5 mg. If target systolic blood pressure (<140 mm Hg) was not reached, doses were doubled after 13 weeks; doxazosin 4 mg was added after 26 weeks, and doubled after 39 weeks; follow-up ended at 78 weeks. At each visit, blood pressure (BP), fasting plasma glucose, insulin, adiponectin, tumour necrosis factor-α, C-reactive protein (CRP), intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukins-1β, -6 and -8, and albuminuria were measured; BP was similarly reduced in both groups; 80% of patients reached target BP. Reductions in albuminuria were also similar (50%). Only olmesartan/amlodipine reduced the insulin resistance index (24%, P<0.01), increased plasma adiponectin (16%, P<0.05) and significantly reduced all of the inflammation markers studied, except CRP, which showed a similar reduction in each group. The risk of new-onset diabetes was significantly lower with olmesartan/amlodipine (P=0.02). Both olmesartan-based combinations were effective, but the amlodipine combination resulted in metabolic and anti-inflammatory effects that may have advantages over the hydrochlorothiazide combination.

Swedish Hypertension Open care retrospective study in men and Women (SHOW)

The aim of this retrospective study in primary health care was to study gender differences in blood pressure levels in response to treatment of new onset hypertension. Gender difference in blood pressure control and pharmacological treatment was also recorded. A total of 334 women and 332 men aged ≥50 years and <80 years at baseline, with blood pressure ≥140 mm Hg systolic and/or ≥90 mm Hg were included. Men were younger, had a higher frequency of type II diabetes mellitus and a higher body mass index compared with women at baseline. There was no difference between women and men in systolic blood pressure (SBP) before or after treatment. Women however had a lower diastolic blood pressure (DBP) before and after intervention and as a result a higher pulse pressure (PP). Approximately 50% of the patients reached target blood pressure (≤140/90 mm Hg) in both women and men. Beta blocker was the most commonly used antihypertensive treatment in both genders, whereas diuretics were predominately used in women. In conclusion; women and men reached target blood pressure to the same extent but with different antihypertensive treatment strategies. Differences at baseline in risk factor pattern may explain the finding.

Effects of telmisartan on office and 24-hour ambulatory blood pressure: an observational study in hypertensive patients managed in primary care

Although elevated blood pressure (BP) predicts future cardiovascular events, recommended BP targets often is not reached in the general community. In a clinical real-life setting we evaluated BP impact and tolerability of the angiotensin-II receptor blocker telmisartan in patients with essential hypertension. Patients in this observational study not at target BP started or switched to telmisartan monotherapy (40 or 80 mg) or a fixed-dose combination of telmisartan and hydrochlorothiazide (HCT) 80 mg/12.5 mg. Office and 24-hour ambulatory BP (AMBP) were measured before and after 8 weeks of treatment and physicians reported perceived drug efficacy and tolerability as "Very good", "Good", "Moderate" or "Bad". 100 patients (34% female, 60 years, BMI 29.4 kg/m(2), mean office BP 159/92 mmHg) of whom 38% were treatment naïve and 30%, 17%, 9% and 6% respectively were on 1, 2, 3 or 4 BP-lowering drugs, completed 8 weeks of treatment. The proportion of patients with office BP < 140/90 mmHg increased from 3% to 54% for systolic (P < 0.001), 38% to 75% for diastolic (P < 0.001), and 2% to 45% for systolic and diastolic BP (P < 0.001). A significant effect on BP levels was seen in patients being either treatment naïve or on 1 to 3 BP-lowering drugs at study entry, whereas no BP improvement occurred in those who switched from 4 drugs. Overall, mean 24-hour AMBP was reduced from 141/85 to 131/79 mmHg (P < 0.001). Drug efficacy and tolerability were perceived as "Very good" or "Good" by 44%/34% and 66%/27%, respectively. No drug discontinuations or serious adverse events were observed. In this observational study, telmisartan 40 to 80 mg, or the fixed-dose combination telmisartan 80 mg/HCT 12.5 mg, significantly increased the number of patients reaching target BP < 140/90 mmHg if treatment naïve or previously receiving 1 to 3 BP-lowering drugs. The BP reduction achieved was sustained for 24-hour and treatment tolerability was high.

Treating the hypertensive patient in a nurse-led hypertension clinic

Aims. This manuscript presents results from 4 years experience in a nurse-led hypertension clinic. The aim of the hypertension clinic was to optimize hypertension treatment and to reduce the number of physician consultations. Materials and methods. All patients were initially examined by cardiologists. All follow-up visits were performed by nurses. They initiated and titrated antihypertensive medication according to a stepwise treatment algorithm or the physicians' instructions. The blood pressure (BP) measurement technique and the recording of risk profile were performed as instructed by guidelines from the European Hypertension Society. Results. During the first 4 years, 186 patients were treated in the hypertension clinic. One hundred and thirty patients were treated by the nurses alone and hereafter discharged to general practitioners; 95% of these patients reached target BP. Most of the patients received combination therapy with two to seven different antihypertensive drugs. The three primary antihypertensive drugs (calcium-channel blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and diuretics) were the first drugs to be used and they made up the main part of the combination therapy. Conclusion. In spite of many risk factors, co-existing cardiovascular diseases and severe hypertension, 95% of the patients achieved target BP when treated in a nurse-led hypertension clinic. We suggest that the data serves as an inspiration for other clinics and GPs to implement the concept.

Optimisation of antihypertensive treatment by crossover rotation of four major classes

Most comparisons of antihypertensive drugs are undertaken in parallel groups. We undertook a crossover rotation of the four main classes of antihypertensive drugs, in untreated young hypertensive patients, to assess the response rate with monotherapy achieved by a systematic rotation. 56 patients, mean blood pressure 161/98 mm Hg, entered the rotation, of whom 36 received all four monthly cycles of treatment with an angiotensin-converting-enzyme (ACE) inhibitor (A), beta-blocker (B), calcium-channel blocker (C), and diuretic (D). Each patient's best drug was then repeated to assess repeatability. Two measures of individual variability in response were used. First, the value of rotation was measured by the increased proportion of patients reaching target blood pressure on their best drug versus their first drug. Second, we assessed whether the responses to each drug were correlated with each other. Significant variability in response was found. 20 of the 41 patients reaching target blood pressure (< or =140/90 mm Hg) failed to achieve this target on their first drug. Rotation increased from 22/56 (39%) to 41/56 (73%) the success of monotherapy (p=0.0001); in half the patients, blood-pressure on the best treatment was 135/85 mm Hg or less. There were significant correlations between the blood pressure responses to A and B (r=0.5, p<0.01), and C and D (r=0.6, p<0.001), but not between the other four pairings of treatments. The responses to the AB pair were, on average, at least 50% higher than those to the CD pair; this difference was highly significant by multivariate repeated-measures ANOVA. There is a marked variability in hypertensive patients' response to different antihypertensive drugs. The basis may be underlying variability in types of essential hypertension. Optimisation of treatment requires systematic rotation through several therapies; however, an "AB/CD" rule is proposed in which one of each of the two pairs of treatments is initially selected to abbreviate the rotation in routine practice.