Reach Target Blood Pressure Research Articles

Visit-to-visit systolic blood pressure variability predicts treatment-related adverse event of hyponatremia in SPRINT.

Hypertension is a common condition and an important cardiovascular risk factor. SPRINT trial showed that the beneficial effects of targeting systolic blood pressure <120mmHg were accompanied by more adverse events. De-identified SPRINT database was used for this analysis. All subjects in each group that achieved their respective target blood pressure (<120, intensive; <140, standard) were included. Only readings after reaching target blood pressure for the first time were included. Subjects that never reached target or had <2 readings upon reaching target were excluded. Coefficient of Variation (CV) of systolic blood pressure was calculated for each subject to characterize variability. Cox proportional hazards regression was used in the overall cohort as well as the intensive and standard treatment subgroups separately, to identify the effect of CV of systolic blood pressure on occurrence of hyponatremia. P<.05 was considered statistically significant. A total of 8884 subjects met the inclusion criteria; 4323 in intensive and 4561 in standard group. Two hundred and sixty five hyponatremic events occurred in the overall cohort; 168 in intensive, and 127 in standard treatment group. CV of systolic blood pressure consistently and independently predicted a greater hazard of hyponatremia on overall (HR 1.08, P<.001), as well as separate regressions by treatment arms (each HR=1.08 and P<.05). In conclusion, visit-to-visit systolic blood pressure variability is independently associated with a small but significant risk of hyponatremia in the SPRINT trial.

Non-steroidal anti-inflammatory drugs and blood pressure control in patients treated for hypertension: results from the Swedish primary care cardiovascular database

Purpose: The aim of this observational cohort study was to investigate blood pressure level and the possibility to reach target blood pressure during concomitant use of NSAID in hypertensive patients.Materials and methods: From the Swedish primary care cardiovascular database (SPCCD) a cohort of 5463 patients (2007 to 2008) with at least one prescription of NSAID dispensed 6 months prior to the last blood pressure measurement were included. Clinical data were extracted from computerized medical records and linked to the Prescribed Drug Register. Multivariable logistic regression models were used for analysis.Results: Patients with NSAID usage were younger, more often female, with lower creatinine concentrations, more musculoskeletal diagnosis and less cardiovascular comorbidity compared to patients without dispensed NSAID (p < .0001 for all). Regular dose of NSAID was not associated with a decreased possibility to reach target blood pressure. A correlation between the dose of naproxen and an increase in SBP of 7 mm Hg was found. Impairment in renal function did not influence the association between blood pressure control and NSAID (p = .27).Conclusion: In hypertensive patients with concomitant use of NSAID the chance to reach target blood pressure was not impaired. In intermediate and frequent users of NSAID there was a dose response relation with naproxen and SBP which was not found in diclofenac and ibuprofen.

EFFECTS OF MELATONIN ON BLOOD PRESSURE, ENDOTHELIAL FUNCTION AND VASCULAR STIFFNESS IN PATIENTS WITH METABOLIC SYNDROME AND SLEEP DISORDERS

Objective. To compare efficacy and safety of metformin monotherapy and metformin in combination with melatonin concerning the parameters of endothelial function and the vascular elasticity, arterial hypertension (HTN), vascular premature aging and sleep status in patients with metabolic syndrome (MS). Design and methods. We performed an open prospective, comparative, controlled, randomized trial in 3 parallel groups. Altogether 238 patients with MS (IDF, 2005), HTN 1–2 degrees (who reached target blood pressure (BP) with the current antihypertensive therapy) and sleep disorders (< 19 scores by the survey of subjective sleep characteristics) were randomized into 3 groups. All patients underwent a lifestyle modification, including changesin diet and physical activity, as well as the normalization of the “sleep-wakefulness” rhythm for 12 weeks. In addition, patients of the first group (n = 80) received monotherapy with metformin, patients of the second group (n = 78) received combined therapy with metformin and prolonged-release melatonin. The control group (n = 80) included patients who adhere to the lifestyle modification recommendations without any pharmacological intervention. The groups were comparable for baseline clinical and demographic characteristics. At baseline and after 12 weeks of therapy the endothelial function was evaluated by flow-dependent vasodilation. Also BP, vascular stiffness, anthropometric and metabolic parameters, adipocytokine status, vascular age, and sleep quality were assessed. Results. The results of the study confirmed the efficiency of the long-acting melatonin in combination with the standard therapy in patients with MS and circadian disorders. Melatonin normalizes the “sleep-wakefulness” rhythm. Moreover, it provides protective effect regarding endothelial function, has favorable profile of cardiovascular and metabolic effects, and slows vascular aging. No serious drug-related adverse events were registered during the follow-up. Conclusions. Melatonin supplementation to the traditional MS therapy in patients with sleep disorders is safe and effective regarding dissomnia, overweight, metabolic disorders, and also has additional benefits in terms of improvement of endothelial function, vascular stiffness, and daily BP profile.

Switching of antihypertensive drugs at Tertiary Care Government Hospital, Hyderabad, India: A cross-sectional retrospective investigation.

OBJECTIVE:Switching of antihypertensive drugs is attributed to uncontrolled blood pressure (BP) which imposes a great burden on health economics. But again, switching leads to accomplishment of the goal BP, thereby improving the health status. Such studies are well documented in developed nations but rarely reported in developing countries, especially in India. Therefore, the aim of this study was to evaluate various factors associated with switching of antihypertensive drugs.METHODS:A cross-sectional retrospective investigation was performed using a standardized schedule adapting the World Health Organization indicators for drug utilization in a tertiary care government hospital, Hyderabad, India. A total of 429 prescriptions were monitored for a switchover to a different antihypertensive drug in 180 days.RESULTS:The results revealed that the duration of hypertension (HTN) >5–10 years (adjusted odds ratio [aOR] = 3.73, P < 0.05), two or more symptoms of HTN (aOR = 3.42, P < 0.05), 2014 prescriptions (aOR = 4.54, P < 0.001), polytherapy (aOR = 2.85, P < 0.001), noncompliance to National List of Essential Medicine (NLEM) (aOR = 1.631, P < 0.05), and systolic BP (SBP) (aOR = 1.77, P < 0.05) were the predictors, which were highly likely to switch (38.5%) the antihypertensive drugs. Diuretics (0.7%) were poorly prescribed, the first line of therapy suggested by Seventh Joint National Committee (JNC VII). Stepwise logistic regression analysis revealed, the calendar year 2014 (odds ratio [OR] = 3.23, P < 0.001), polytherapy (OR = 2.5, P < 0.001), and the level of SBP ≥140 mmHg (OR = 1.82, P < 0.01) as the three major predictors which showed a likelihood of switching medication.CONCLUSIONS:Findings of the study reveals predictors of the switchover like uncontrolled SBP, duration of HTN, compliance with the list of NLEM drugs, polytherapy, enabling the clinicians to critically analyze the patients' profile, and hence, reach target BP soon, i.e., decreased cardiovascular risk.

ANALYSIS OF THE PRACTICE OF COMBINATIONAL ANTIHYPERTENSION THERAPY BY THE DATA FROM TWO OUTPATIENT REGISTRIES

Aim. To investigate on the ways antihypertension drugs (AD) prescription, including, firstly, combinational therapy, in real conditions, by the data from two outpatient registries done in district polyclinics of Ryazan city (RECVASA) and in specialized scientific center in Moscow (PROFILE). Material and methods . To the RECVAZA registry, 3690 patients were included, with cardiovascular diseases, and in 3648 (98,9%) arterial hypertension was diagnosed. Among 1531 patient’s data included into PROFILE registry during August 2011 —August 2015, hypertension was diagnosed in 1230 (80,3%). Mean age of RECVASA and PROFILE patients was 66,3±12,8 и 63,7±11,4, respectively. In overall data, males and females ratio were 28% and 72%, respectively, in RECVASA, and 54% and 46%, resp., in PROFILE. Results. In comparative analysis of the registries, it was found that RECVASA patients were older, and women predominated (72%). Hypertension was diagnosed in almost 100%, was more severe and more comorbid. By the number of prescribed AD, both registries were almost identical: every third patient was prescribed 2 drugs, every fourth — 3, every fifth was taking 1 drug. Fixed combinations of AD were used in 15%, in both registries. The target blood pressure profile was reached in 26,1% of hypertension patients in RECVASA and in 37,6% in PROFILE; in hypertension of 3rd degree — in 21,9% and 34,2% cases, respectively. Conclusion . In generally analogical approaches to AD, matching with current clinical guidelines, final result of treatment in terms of reached target blood pressure values, was significantly better in specialized cardiological center. This, probably, reflects better adherence to therapy in PROFILE patients.

Итоги международного клинического исследования VICTORY: эффективность и безопасность антигипертензивной монотерапии валсартаном (Вальсакор®) и его фиксированной комбинации с гидрохлоротиазидом (Вальсакор® Н) у пациентов с артериальной гипертонией 1–2-й степени в рутинной клинической практике

Objective. The VICTORY study aimed to evaluate effectiveness and safety of monotherapy with valsartan (Valsacor®) and its fixed combination with hydrochlorothiazide (Valsacor® H) in clinical practice in patients with stage 1 and stage 2 hypertension. Materials and methods. In the prospective, randomized, open-label, international multicentre study involved 356 patients with grade 1 and grade 2 hypertension from 5 countries, including 130 patients from Russia. In Russia the study was conducted in 7 cities, in 8 clinical centers. The patients, who were receiving antihypertensive therapy at the moment of screening, underwent a 7 days wash-out period. The starter dose of valsartan (Valsacor®, KRKA, Slovenia) was 80 mg (except for Russia where 160 mg of Valsacor® were given at the first visit, what did not influence the study results). After 4 weeks of treatment in case of blood pressure (BP) >140/90 or 130/80 mm Hg the dose was increased to 160 mg (in Russia - to 320 mg) or combined therapy with Valsacor® H (KRKA, Slovenia) was prescribed. In 4 weeks the dose of valsartan was increased to 320 or 160/12.5 mg in case of previous dose insufficiency. If target BP levels were not reached in the next 4 weeks, the dose was increased to 320/12.5 mg. The primary endpoints included evaluation of antihypertensive effect of valsartan and its fixed combination with hydrochlorothiazide on BP levels; evaluation of the drugs’ influence on aortal stiffness; comparison of absolute average means of achieved decrease in central and peripheral BP compared with baseline; evaluation of the impact on aortic augmentation index. The secondary endpoints included comparison of primary endpoints when using mono and combined therapy; evaluation and comparison of the effect on erectile function in men by questionnaires at baseline and after 16 weeks of treatment; evaluation of adverse events frequency. Results. Data on 365 patients - 196 (54.0%) female and 169 (46.0%) male aged 54.6±12.0 years were analyzed. Mean initial value of systolic (SBP) and diastolic BP (DBP) were 156.6±8.9 and 95.6±6.0 mm Hg, respectively and 130.1±8.2 and 80.9±5.8 mm Hg, respectively after 16 weeks of treatment. The mean absolute decrease of SBP and DBP was 26.6±10.4 and 14.8±7.6 mm Hg. The decrease of SBP and DBP was statistically significant in all treatment periods (p<0,0001). The mean absolute decrease of central SBP and DBP at the 5th visit was 19.7±12.9 and 13.9±8.5 mm Hg, respectively (p<0.0001). When compared, the mean values of SBP and DBP between groups of mono and combined therapy were statistically significant (p<0.0001). 90,6% of patients reached the target BP levels: 98% in those who received monotherapy with valsartan and 84% in those who received combination of valsartan and hydrochlorothiazide. The mean absolute increase of erectile function score was 0.84±2.45 (p<0.0001). There were no differences in erectile function score dynamics in the two groups of patients. 92.8% of patients did not experience adverse effects and adverse events associated with the medication. There were no cases of severe adverse events in the study. The most frequent adverse effects were headache (1.9%), dizziness (1.6%), and weakness (1.6%). Conclusion. The study demonstrated high effectiveness and good tolerability of valsartan and its fixed combination with hydrochlorothiazide (Valsacor®, Valsacor® H) in patients with stage 1 and stage 2 hypertension. 1. Valsartan in monotherapy (Valsacor®) and in combination with hydrochlorothiazide (Valsacor® H) lowers the SBP and DBP levels to reference levels. 2. At the 16th week of treatment 90.6% reached target BP levels: 98% in the valsartan monotherapy group and 84% in the combination therapy with valsartan and hydrochlorothiazide group. 3. The medications Valsacor® and Valsacor® H have good tolerability: 92.8% of the patients did not experience any adverse effects. 7.1% of patients had at least 1 adverse effect but none of them experienced any severe adverse events. 4. The therapeutic effect was estimated as good and very good in 96.9% of patients. 5. The overall clinical effectiveness was estimated as excellent, very good and good in 95.3% of patients. 6. Most of the patients receiving Valsacor® and Valsacor® H noted an increase in life quality. 7. Treatment with Valsacor® and Valsacor® H resulted in increase of erectile function in male patients with stage 1 and stage 2 hypertension.

The effect of combined antihypertensive therapy on arterial wall rigidity in male patients with hypertension, obesity and obstructive sleep apnea

Goal: to study the effectiveness of combination antihypertensive therapy (AHT) and its influence on the indices characterizing the arterial stiffness of various types in patients with arterial hypertension (AH) in combination with obesity and severe obstructive sleep apnea (OSA). Material and methods. The study included 27 male patients with hypertension [143.0 (142.0; 150.0)/91.0 (85.3; 94.8) mm Hg. century], obesity [body mass index of 33.8 (32.0; 37.2) kg/m2] and OSA was severe [the index of apnea/hypopnea - AHI - 46.8 (33.3; 63.4) events per hour] who underwent AHT titration to achieve target values of blood pressure (BP), a fixed combination of the calcium antagonist amlodipine (10 mg) and the angiotensin-converting enzyme inhibitor perindopril (5-10 mg). At baseline and after 4-6 weeks when reaching target blood pressure was assessed pulse wave velocity (PWV) using different instrumental techniques. Carotid-femoral PWV (CFSP) was determined by applanation tonometry (SphygmoСor AtCor, Australia), aortic PWV - ultrasonic technique in the descending aorta (thoracic spine), the ankle-brachial PWV - using volumetric sphygmography (VaseraVS-1000 Fukuda Dens, Japan). Results. The target pressure (according to clinical blood pressure, daily monitoring blood pressure) on the background of amlodipine 10 mg and perindopril 5 mg was 58% patients and 42% of patients reached the target level of blood pressure against the background amlodipine 10 mg and perindopril 10 mg. On a background of 4-6 weeks of admission AHT 33.8% increase in the number of patients with a normal circadian profile of blood pressure - «dipper». Upon reaching the target blood pressure revealed a significant decrease CFSP, ankle-brachial PWV and aortic PWV 11.4, 11.0 and 15.4%, respectively. Conclusion. A fixed combination of perindopril arginine and amlodipine in patients with arterial hypertension of the 1st degree in the presence of obesity and OSA allows achieving a good level of BP control, to improve the performance of the daily profile and to improve the elastic properties of large arteries, which has a beneficial protective effect in these patients.

Full-dose Perindopril/Indapamide in the Treatment of Difficult-to-Control Hypertension: The FORTISSIMO Study.

Blood pressure (BP) control in hypertensive patients remains poor worldwide, particularly in high-risk patients with hypertension and diabetes. Guidelines recommend that such patients receive prompt pharmacological therapy at maximal doses to rapidly control BP. We aimed to evaluate efficacy and safety of single-pill combination (SPC) perindopril/indapamide (PER/IND) at full dose (10/2.5mg) in hypertensive patients, including diabetics, with BP uncontrolled by previous medication. Twelve-week prospective, observational study in patients with uncontrolled hypertension (≥160-200mmHg systolic BP [SBP] and <110mmHg diastolic BP [DBP]) on a previous SPC or free-dose combination of renin-angiotensin system blocker plus thiazide diuretic, substituted with PER/IND 10/2.5mg. Office BP, quality of life, and blood parameters were evaluated in the whole cohort and patients with type 2 diabetesmellitus. 2120 ambulatory hypertensive patients were enrolled, including 307 with type 2 diabetes. Two weeks after substitution, SBP significantly decreased from 171.0±13.3 to 148.6±13.4mmHg, and DBP from 98.6±8.3 to 88.8±7.9mmHg (both p<0.00001). A similar rapid decrease was noted in the diabetes subgroup. After 12weeks, BP had reduced by 42/19mmHg in the whole cohort (diabetes subgroup: 41/18mmHg). Most (84%; diabetes subgroup: 77%) patients reached BP target (<140/90mmHg). Laboratory tests and quality of life improved in the whole cohort and the diabetic subgroup. Switching to PER/IND at full dose (10/2.5mg) was well tolerated, leading to fast BP reduction and control in the majority of patients with uncontrolled hypertension, including difficult-to-treat patients with diabetes.

Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS).

Functional endoscopic sinus surgery (FESS) is a minimally invasive technique that is used to treat chronic sinusitis. Small bleeding areas can reduce operative visibility and result in destruction of surrounding structures. Deliberate hypotension (lowering the mean arterial blood pressure to between 50 and 65 mm Hg in normotensive patients) using a range of pharmacological agents during general anaesthesia reduces blood loss in many operations. This review was originally published in 2013 and updated in February 2016. We aimed to compare the use of propofol versus other techniques for achieving deliberate intraoperative hypotension during FESS procedures with regard to blood loss and operative conditions. We searched the following databases in the updated review: the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE (1950 to February 2016), Embase (1980 to February 2016), LILACS (1982 to February 2016), and ISI Web of Science (1946 to February 2016). We also searched the reference lists of relevant articles and conference proceedings and contacted the authors of included trials. We sought all randomized controlled trials comparing propofol with other techniques for deliberate hypotension during FESS with regard to blood loss and operative conditions in both adults and children. Our primary outcome was total blood loss (TBL). Other outcomes included surgical field quality, operation time, mortality within 24 hours, complications, and failure to reach target blood pressure. We used standard methodological procedures expected by Cochrane. Two review authors independently extracted details of trial methodology and outcome data from the reports of all trials considered eligible for inclusion. We made all analyses on an intention-to-treat basis where possible. When I2 was less than 40% and the P value from the Chi2 test was higher than 0.10, we pooled data using the fixed-effect model. Otherwise, we pooled data using the random-effects model. We found no new studies. This updated review therefore includes four studies with 278 participants. Most analyses were based on data from few participants and low-quality evidence, so our results should be interpreted with caution. Deliberate hypotension with propofol did not decrease TBL (millilitres) when compared with inhalation anaesthetics in either children (1 study; 70 participants; very low-quality evidence), or adults (1 study; 88 participants; moderate-quality evidence). Propofol improved the quality of the surgical field by less than one category on a scale from 0 (no bleeding) to 5 (severe bleeding) (mean difference -0.64, 95% CI -0.91 to -0.37; 4 studies; 277 participants; low-quality evidence), but no difference in operation time was reported (3 studies; 214 participants; low-quality evidence). Failure to lower blood pressure to target was less common in the propofol group (risk ratio of failure with propofol 0.24, 95% CI 0.09 to 0.66; 1 study; 88 participants; moderate-quality evidence). Using propofol to achieve deliberate hypotension probably improves the surgical field, but the effect is small. Deliberate hypotension with propofol did not decrease TBL and the operation time. However, due to the very low quality of the evidence, this conclusion is not definitive. Randomized controlled trials with good-quality methodology and large sample size are required to investigate the effectiveness of deliberate hypotension with propofol for FESS.

PP.27.04] BLOOD PRESSURE CONTROL IN RELATION TO THE SEX OF THE PATIENT AND THE PHYSICIAN

Objective: Earlier studies have proposed that the sex of the patient and the physician may influence if target blood pressure is reached. We investigated the associations between the sex of the patient and the physician, and achieved target blood pressure in a large unselected cohort of hypertensive patients.Design and method: This cross-sectional cohort study in the Swedish primary Care Cardiovascular Database (SPCCD) includes 16 248 patients with hypertension treated in primary health care in Stockholm in 2006–2008. The three last blood pressure measurements during the time period was analyzed and the patients were grouped female/male with all female physician visits, all male physician visits, and visits including both female and male physician visits (mixed physicians). The blood pressure measurement of the last visit was used for analysis and was <140/90 mmHg. The regression model and odds ratio for achieved target blood pressure was adjusted for age, diabetes mellitus, and cardiovascular comorbidities. Results: In 15 465 patients (8994 female and 6471 male) the sex of the physician was known. Female patients were older and had less diabetes mellitus, ischemic heart disease, and cerebrovascular disease than males (table). Target blood pressure was achieved in 36.9% of the patients visiting male physicians, 33.5% of the patients visiting female physicians, and 31.6% of the patients visiting mixed physicians (p < 0.0001 for all difference between groups). Male patients visiting a female, compared to a male physician, had a lower likelihood of reaching target blood pressure. Male patients visiting a male physician, compared to mixed physicians visits, had a higher likelihood of reaching target blood pressure (figure). In female patients the sex of the physician and the probability of reaching target blood pressure were not associated. Conclusions: The probability of reaching target blood pressure was associated with the sex of the physician in male but not in female hypertensive patients. Best results were observed in male patients with male physicians while the worst results were seen with mixed physicians.

LBPS 02-60 COMBINED ANTIHYPERTENSIVE THERAPY IN THE TREATMENT OF HYPERTENSION IN THE METABOLIC SYNDROME

Objective: Antihypertensive therapy in the metabolic syndrome must possess contested impact on finite cardiovascular points, have no adverse metabolic effects, affect the pathogenetic components hypertension and insulin resistance have a variety of protective effects with beneficial effects on endothelial function, platelet-vascular hemostasis and fibrinolysis. The purpose of our work to study the efficacy of combination therapy with antihypertensive drugs from the groups blockers angiotensin receptor AT1 (valsartan) and I1 is agonist imidazoline receptors (moxonidine) in patients the metabolic syndrome with hypertension. Design and Method: The study involved 40 patients with hypertension in the framework of the metabolic syndrome. Criteria for inclusion in the study: systolic blood pressure (SBP) ≥140; diastolic blood pressure (DBP) ≥90 mmHg; abdominal obesity; the presence of dyslipidemia; impaired glucose tolerance (glucose in plasma 2 hours after glucose load and in the range ≥7,8 ≤11,1 mmol/l). Results: So patients treated with a combination of valsartan and moxonidine target blood pressure (140/80 mmHg) reached 34 patients (85%). In 6 patients (15%) failed to achieve target blood pressure, although the decrease was recorded as the systolic and diastolic blood pressure. At baseline, the mean SBP was 162.5 ± 1.53, DBP average 92.67 ± 1.37 mmHg. After 2 weeks, SBP and DBP, respectively, decreased by 16.81% and 12.22%. SBP was 135.2 ± 2.31, DBP 81.33 ± 1.22 mmHg. As a result of treatment, the mean diurnal SBP decreased by 6.2% and amounted to 133.5 ± 1.79 mmHg, mean daily DBP decreased by 4.62% and amounted to 84.55 ± 1.04 mmHg the average daytime SBP and DBP decreased by 5.19% and 4.3% respectively. SBP was 133.3 ± 1.39, DBP 84.58 ± 1.04 mmHg. Conclusions: Thus, recommended by us a rational drug combination of valsartan and moxonidine allowed us to reach target blood pressure and normalize circadian rhythm of blood pressure, which in turn should lead to a significant reduction in the risk of cardiovascular complications and improve quality of life in patients.

PP.23.03] SCREENING OF PATIENTS WITH AN APPARENTLY RESISTANT HYPERTENSION IN AN ALGERIAN TEACHING HOSPITAL

Objective: Estimate the frequency of true resistant hypertension among uncontrolled hypertensive patients referred to a tertiary health care center. Design and method: The study was prospective and observational. We screened all hypertensive patients, 18 years old or more treated for at least 12 months and referred for uncontrolled hypertension to Tizi-ouzou teaching hospital (hypertension unit). Resistant hypertension was defined as an office blood pressure (OBP) superior or equal to 140/90 mmHg, and 24-hour ambulatory blood pressure (ABP) superior or equal to 130/80 mmHg, despite 3 drugs including a diuretic, a renin angiotensin system blocker and a calcium channel blocker at optimal doses, for at least 4 weeks. Results: A total of 2367 patients were included between January 2013 and April 2015. Of these, 843 had an inadequate treatment regimen (426: less than 3 drugs; 238: suboptimal doses; 179: inappropriate combinations), 364 a poor adherence to prescribed antihypertensive treatment and 202 a white coat effect. Among the 958 remaining subjects, 281 had an excessive salt intake (superior to 15 g per a day, assessed by 24-hour urine sodium), 36 had interfering medications or substances consumption, and secondary causes were documented in 468 patients (Primary aldosteronism: 204, Obstructive sleep apnea:151, Renal artery stenosis:83, other causes: 30). Finally, only 173 subjects of the initial population had a true resistant hypertension, corresponding to a prevalence of 7.3% (CI 95%: 6.3%–8.3%). The mean OBP and 24-hour ABP of these patients were 159.8 ± 22.1/ 94.4 ± 14.7 and 149.4 ± 15.5/ 89.7 ± 12.7 mmHg, respectively. Their clinical characteristics were: mean age (59.7 ± 11.6); women (53.2%); diabetes (27.2%); dyslipidemia (46.2%); smoking (39.3%); mean BMI (30.6 ± 4.7); median GFRe (63.2 ml/min/1.73m2); prior major cardiovascular event (21.4%). After treatment intensification (spironolactone: 51.4%, beta-blockers:26.6%, spironolactone plus beta-blocker:17.9%, spironolactone plus beta-blocker plus central antihypertensive agent: 4.1%), the proportion of controlled patients at 3 months was 64.7% as assessed by ABP measurement. Conclusions: Most of the patients with seemingly resistant hypertension can reach blood pressure target provided they undergo thorough work up and care by a multidisciplinary team.

Evaluation and management of patients referred to a tertiary-level hypertension clinic in Cape Town, South Africa.

Hypertension remains a global health burden, with a high incidence of long-term morbidity and mortality. To evaluate blood pressure (BP) control, factors associated with poor BP control, target organ damage (TOD), white-coat hypertension, treatment-resistant hypertension and secondary hypertension in patients referred to a tertiary-level hypertension clinic. This was a prospective case-control study of patients referred for specialist hypertension management. Patient parameters recorded included age, gender, body mass index, uric acid, cholesterol, screening BP, follow-up BP, TOD and medications. We also recorded causes of secondary hypertension. Net BP change and the percentage achieving target BP were calculated in all patients followed up. A total of 175 patients were sampled (72 males and 103 females, mean age 46.5 years). Of the patients 16.6% had a normal screening BP; 62.9% of patients were followed up, and 43.6% of these achieved BP control. After intervention, there was a net drop of 13.2 mmHg (range 7.9 - 18.4) in systolic BP and of 3.8 mmHg (4.4 - 12.0) in diastolic BP. Of all the patients, 12.6% had resistant hypertension, 49.1% had evidence of left ventricular hypertrophy and 18.3% had microalbuminuria; 13.1% of the patients were diagnosed with secondary hypertension. Specialist intervention was useful in identifying patients with white-coat and secondary hypertension, as well as in improving hypertension control in patients with apparent treatment-resistant hypertension. However, a significant percentage of patients did not reach target BP, and further efforts are required to identify the underlying causes for this.

Resistant Hypertension in Hemodialysis Patients

Objectives: This study aimed to assess prevalence of resistant hypertension (RHT) in hemodialysis (HD) patients. Patients and Methods: We conducted a cross sectional study on 135 HD patients. RHT was defined as failure to reach target blood pressure (BP) control (systolic BP 500 cc/day) or at least 2 L/session ultrafiltration volume in oliguric (<500-100 cc/day) or anuric patients (< 50 cc /day). Patients with post HD hypertension underwent 24h ambulatory monitor for their BP, which hourly measured their BP. Results: In our study; 34 (25.2%) of patients were non hypertensives, 43 (31.8%) were controlled hypertensives, 58 (43.0%) were uncontrolled hypertensives. Uncontrolled hypertensives with inadequate AHT were 53 (39.2 %), where RHT patients were 5 (3.7%)of all study population. Conclusions: We concluded that RHT had3.7% prevalence in HD patients.

Prévalence de l’hypertension artérielle résistante chez des hypertendus non contrôlés adressés dans un centre de soins tertiaires

ObjectivesEstimate the prevalence of resistant hypertension (rHTN) in uncontrolled hypertensive treated patients referred to a tertiary care center specialized for hypertension management. MethodsThe study was prospective observational. Between January 2013 and April 2015, we recruited hypertensive treated patients, 18years age or older, under antihypertensive drugs since at least 12months, and referred to the hypertension unit of Tizi-ouzou university hospital for uncontrolled hypertension. rHTn was defined as an office blood pressure≥140mmHg despite a triple therapy including renin angiotensin system blockers, calcium antagonists and diuretics at optimal doses, since at least 4weeks. ResultsWe screened 2367 patients with a mean age of 61.1±11.2years and 64.2% of men. Eight hundred forty-three (35.6%) patients had suboptimal treatment, 364 (15.4%) a poor adherence to treatment and 202 (8.5%) a white-coat effect. An excessive salt intake and a drug-related hypertension were identified in 281 (11.9%) and 36 (1.5%) patients, respectively. A secondary cause of hypertension was diagnosed in 468 (19.8%) subjects. Finally, only 173 patients showed a true rHTN requiring four drugs or more and its prevalence was 7.3% (CI 95%: 6.3–8.3). ConclusionLess than one patient from ten referred in our center for uncontrolled hypertension had a true rHTN, and more than fifty percent of patients had pseudo-resistance. Most of patients with seemingly rHTN can reach blood pressure target provided they undergo thorough work up and care by a specialized team.

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.

The Efficacy of Perindopril/Amlodipine in Reaching Blood Pressure Targets: Results of the CONTROL Study.

Inadequate blood pressure (BP) control remains a serious concern worldwide. Recent evidence suggests that the combination of a calcium channel blocker (CCB) with an angiotensin-converting enzyme inhibitor (ACEi) in patients with essential hypertension provides effective BP control with decreased adverse cardiac and renal events. This study was designed to quantitatively evaluate the efficacy and tolerability of a fixed dose combination of perindopril and amlodipine in the Kingdom of Saudi Arabia on a population of patients with essential hypertension, as well as to identify the predictors of BP control in this population. This was an observational, multicenter, open-label cohort study of patients with essential hypertension with or without diabetes mellitus, treated with a fixed dose combination of perindopril and amlodipine. Patients were followed up in four-week intervals for a total of 12 weeks. They were initially started on the lowest dose of the ACEi/CCB combination and up-titrated at each follow-up according to their response to treatment. The primary end-point of the study was the percentage of patients with controlled BP at study termination (week 12). A total of 1996 patients completed the study. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) control was observed in 93.3% of patients at week 12. As for the predictors of BP control, it was found that female gender was associated with more BP control [odds ratio (OR) = 1.76, 95% CI: 1.14-2.70, p value = 0.01], whereas older age was associated with less BP control (OR = 0.98, 95% CI: 0.96-1.00, p value = 0.02). Similarly, having type I and type II diabetes mellitus was also associated with less BP control (OR = 0.19, 95% CI: 0.08-0.45, p < 0.0001 and OR = 0.33, 95% CI: 0.22-0.48, p < 0.0001, respectively). In a qualitative assessment, both investigators and patients perceived efficacy and tolerability of perindopril/amlodipine to be excellent. We found that a fixed combination of perindopril/amlodipine is effective in controlling BP in patients with essential hypertension, with older age, male gender, and diabetes mellitus being independent risk factors for less BP control.

Quality of chronic kidney disease management in primary care: a retrospective study

Background: Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality. Aim: To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies. Design and setting: Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults). Method: CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics. Results: Kidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex. Conclusion: Room for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model.Key pointsQuality of care for chronic kidney disease patients in primary care can be improved.In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal function in 31%, and reaching blood pressure targets in 43% of chronic kidney disease patients.Quality of care was higher in patients with diabetes.Chronic kidney disease management may be improved by developing strategies similar to diabetes care.

Влияние комбинированной антигипертензивной терапии на жесткость артериальной стенки у пациентов мужского пола с артериальной гипертензией, ожирением и синдромом обструктивного апноэ сна

Goal: to study the effectiveness of combination antihypertensive therapy (AHT) and its influence on the indices characterizing the arterial stiffness of various types in patients with arterial hypertension (AH) in combination with obesity and severe obstructive sleep apnea (OSA). Material and methods. The study included 27 male patients with hypertension [143.0 (142.0; 150.0)/91.0 (85.3; 94.8) mm Hg. century], obesity [body mass index of 33.8 (32.0; 37.2) kg/m2] and OSA was severe [the index of apnea/hypopnea - AHI - 46.8 (33.3; 63.4) events per hour] who underwent AHT titration to achieve target values of blood pressure (BP), a fixed combination of the calcium antagonist amlodipine (10 mg) and the angiotensin-converting enzyme inhibitor perindopril (5-10 mg). At baseline and after 4-6 weeks when reaching target blood pressure was assessed pulse wave velocity (PWV) using different instrumental techniques. Carotid-femoral PWV (CFSP) was determined by applanation tonometry (SphygmoСor AtCor, Australia), aortic PWV - ultrasonic technique in the descending aorta (thoracic spine), the ankle-brachial PWV - using volumetric sphygmography (VaseraVS-1000 Fukuda Dens, Japan). Results. The target pressure (according to clinical blood pressure, daily monitoring blood pressure) on the background of amlodipine 10 mg and perindopril 5 mg was 58% patients and 42% of patients reached the target level of blood pressure against the background amlodipine 10 mg and perindopril 10 mg. On a background of 4-6 weeks of admission AHT 33.8% increase in the number of patients with a normal circadian profile of blood pressure - «dipper». Upon reaching the target blood pressure revealed a significant decrease CFSP, ankle-brachial PWV and aortic PWV 11.4, 11.0 and 15.4%, respectively. Conclusion. A fixed combination of perindopril arginine and amlodipine in patients with arterial hypertension of the 1st degree in the presence of obesity and OSA allows achieving a good level of BP control, to improve the performance of the daily profile and to improve the elastic properties of large arteries, which has a beneficial protective effect in these patients.

Ramipril plus amlodipine and lisinopril plus amlodipine fixed dose combinations and patient's adherence

Patient's adherence has a great significance to reach target blood pressure values. The risk of cardiovascular adverse events decreases when patients are on target blood pressure. The aim of the authors was to investigate the one-year persistence of the ramipril/amlodipine and lisinopril/amlodipine fixed dose combination in hypertensive patients. National Health Insurance Found prescriptions database of Hungary on pharmacy-claims between October 1, 2012 and September 30, 2013 was analyzed. The authors identified patients who filled prescriptions for fixed dose combinations of ramipril and amlodipine, and lisinopril and amlodipine prescribed for the first time, for the therapeutic indication of hypertension. Patients have not received antihypertensive therapy with similar active substances during one year before the study. To model the persistence, the apparatus of survival analysis was used, where "survival" was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied: a generalized linear model was estimated with complementary log-log link function with the kind of drug being the only explanatory variable. During the study period, fixed dose combination antihypertensive therapy with ramipril plus amlodipine and lisinopril plus amlodipine was started in 10,449 and 20,276 patients, respectively. One-year persistence rate in patients taking ramipril and amlodipine as a fixed dose combination was 54%, whereas 36% in those on the fixed lisinopril and amlodipine combination. Considering only the 360-day study period, the mean duration of persistence was 271 days in patients on the ramipril based and 211 days on lisinopril based fixed dose combination. Analyzing persistence on treatment with these combinations showed that the actual rate of discontinuation was about twice higher during treatment with the lisinopril and amlodipine fixed dose combination compared with the use of the ramipril and amlodipine fixed dose combination (hazard ratio = 1.79, p<0.001). There is a significant difference between the one-year persistence of ramipril plus amlodipine and lisinopril plus amlodipine fixed dose combination in patients with hypertension. The result demonstrated that ramipril and amlodipine fixed dose combination has a favourable patients' adherence as compared to lisinopril and amlodipine fixed dose combination.