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Mahajan S, Feng F, Hu S, Lu Y, Gupta A, Murugiah K, Gao Y, Lu J, Liu J, Zheng X, Spatz ES, Zhang H, Krumholz HM, Li J. Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China. JAMA Netw Open 2020; 3:e209743. [PMID: 33289843 PMCID: PMC7724558 DOI: 10.1001/jamanetworkopen.2020.9743] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE Isolated systolic hypertension (ISH) is increasing in prevalence among young and middle-aged adults. However, most studies of ISH are limited to older individuals, and a substantial knowledge gap exists regarding younger adults with ISH. OBJECTIVE To assess the prevalence, awareness, and characteristics of ISH among younger and middle-aged adults in China. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was performed as part of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, which enrolled 3.1 million community residents aged 35 to 75 years from all of the 31 provinces in China between December 15, 2014, and May 15, 2019. The present analysis included only participants younger than 50 years. Data were analyzed from May to November 2019. MAIN OUTCOMES AND MEASURES Prevalence and awareness of ISH (defined as systolic blood pressure of 140 mm Hg or higher and diastolic blood pressure of less than 90 mm Hg) and individual characteristics of participants with ISH. RESULTS Among 898 929 participants aged 35 to 49 years, the mean (SD) age was 43.8 (3.9) years; 548 657 participants (61.0%) were women, and 235 138 participants (26.2%) had hypertension. Of those with hypertension, 62 819 participants (26.7%; 95% CI, 26.5%-26.9%) had ISH (mean [SD] age, 45.0 [3.5] years; 41 417 women [65.9%]), and 54 463 of those with ISH (86.7%; 95% CI, 86.4%-87.0%) had not received treatment. The prevalence of ISH was higher among individuals who were older, were female, were farmers, resided in the eastern region of China, and had an educational level of primary school or lower. Women and older individuals were more likely to have ISH than to be normotensive or to have other hypertension subtypes. Participants who were obese, currently used alcohol, had diabetes, and experienced previous cardiovascular events were more likely to have other types of hypertension and less likely to have normotension than to have ISH. Among the 54 463 participants with ISH who had not received treatment, only 3682 individuals (6.8%; 95% CI, 6.6%-7.0%) were aware of having hypertension, and awareness rates remained low even among those with systolic blood pressure of 160 mm Hg or higher (7135 individuals [13.1%; 95% CI, 12.4%-13.9%]). CONCLUSIONS AND RELEVANCE In this study, ISH was identified in 1 of 4 young and middle-aged adults with hypertension in China, most of whom remained unaware of having hypertension. These results highlight the increasing need for better guidance regarding the management of ISH in this population.
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Affiliation(s)
- Shiwani Mahajan
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Fang Feng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Shuang Hu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Yuan Lu
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Aakriti Gupta
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Karthik Murugiah
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Jiapeng Lu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Erica S. Spatz
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Haibo Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Harlan M. Krumholz
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
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Figliuzzi I, Presta V, Citoni B, Miceli F, Simonelli F, Battistoni A, Coluccia R, Ferrucci A, Volpe M, Tocci G. Achievement of multiple therapeutic targets for cardiovascular disease prevention: Retrospective analysis of real practice in Italy. Clin Cardiol 2018; 41:788-796. [PMID: 29604091 DOI: 10.1002/clc.22955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/10/2018] [Accepted: 03/27/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Pharmacological therapy in patients at high cardiovascular (CV) risk should be tailored to achieve recommended therapeutic targets. HYPOTHESIS To evaluate individual global CV risk profile and to estimate the control rates of multiple therapeutic targets for in adult outpatients followed in real practice in Italy. METHODS Data extracted from a cross-sectional, national medical database of adult outpatients in real practice in Italy were analyzed for global CV risk assessment and rates of control of major CV risk factors, including hypertension, dyslipidemia, diabetes, and obesity. CV risk characterization was based on the European SCORE equation and the study population stratified into 3 groups: low risk (<2%), intermediate risk (≥2%-<5%), and high to very high risk (≥5%). RESULTS We analyzed data from 7158 adult outpatients (mean age, 57.7 ±5.3 years; BMI, 28.3 ±5.0 kg/m2 , BP, 136.0 ±14.3/82.2 ±8.3 mm Hg; total cholesterol, 212.7 ±40.7 mg/dL), among whom 2029 (45.2%) had low, 1730 (24.2%) intermediate, and 731 (16.3%) high to very high risk. Increased SCORE risk was an independent predictor of poor achievement of diastolic BP <90 mm Hg (OR: 0.852, 95% CI: 0.822-0.882), LDL-C < 130 mg/dL (OR: 0.892, 95% CI: 0.861-0.924), HDL-C > 40 (males)/>50 (females) mg/dL (OR: 0.926, 95% CI: 0.895-0.958), triglycerides <160 mg/dL (OR: 0.925, 95% CI: 0.895-0.957), and BMI <25 kg/m2 (OR: 0.888, 95% CI: 0.851-0.926), even after correction for diabetes, renal function, pharmacological therapy, and referring physicians (P < 0.001). CONCLUSIONS Despite low prevalence and optimal medical therapy, individuals with high to very high SCORE risk did not achieve recommended therapeutic targets in a real-world practice.
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Affiliation(s)
- Ilaria Figliuzzi
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Vivianne Presta
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Barbara Citoni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Francesca Miceli
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Francesca Simonelli
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Allegra Battistoni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | | | - Andrea Ferrucci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
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Tocci G, Presta V, Figliuzzi I, Attalla El Halabieh N, Battistoni A, Coluccia R, D'Agostino M, Ferrucci A, Volpe M. Prevalence and clinical outcomes of white-coat and masked hypertension: Analysis of a large ambulatory blood pressure database. J Clin Hypertens (Greenwich) 2018; 20:297-305. [PMID: 29370477 DOI: 10.1111/jch.13181] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/04/2017] [Accepted: 09/22/2017] [Indexed: 12/31/2022]
Abstract
The aim of this study was to analyze prevalence and clinical outcomes of the following clinical conditions: normotension (NT; clinic BP < 140/90 mm Hg; 24-hour BP < 130/80 mm Hg), white-coat hypertension (WCHT; clinic BP ≥ 140 and/or ≥90 mm Hg; 24-hour BP < 130/80 mm Hg), masked hypertension (MHT; clinic BP < 140/90 mm Hg; 24-hour BP ≥ 130 and/or ≥80 mm Hg), and sustained hypertension (SHT; clinic BP ≥ 140 and/or ≥90 mm Hg; 24-hour BP ≥ 130 and/or ≥80 mm Hg) in a large cohort of adult untreated individuals. Systematic research throughout the medical database of Regione Lazio (Italy) was performed to estimate incidence of myocardial infarction (MI), stroke, and hospitalizations for HT and heart failure (HF). Among a total study sample of 2209 outpatients, 377 (17.1%) had NT, 351 (15.9%) had WCHT, 149 (6.7%) had MHT, and 1332 had (60.3%) SHT. During an average follow-up of 120.1 ± 73.9 months, WCHT was associated with increased risk of hospitalization for HT (OR 95% CI: 1.927 [1.233-3.013]; P = .04) and HF (OR 95% CI: 3.449 [1.321-9.007]; P = .011). MHT was associated with an increased risk of MI (OR 95% CI: 5.062 [2.218-11.550]; P < .001), hospitalization for HT (OR 95% CI: 2.553 [1.446-4.508]; P = .001), and for HF (OR 95% CI: 4.214 [1.449-12.249]; P = .008). These effects remained statistically significant event after corrections for confounding factors including age, BMI, gender, smoking, dyslipidaemia, diabetes, and presence of antihypertensive therapies.
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Affiliation(s)
- Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Vivianne Presta
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital University of Rome Sapienza, Rome, Italy
| | - Ilaria Figliuzzi
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital University of Rome Sapienza, Rome, Italy
| | - Nadia Attalla El Halabieh
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital University of Rome Sapienza, Rome, Italy
| | - Allegra Battistoni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital University of Rome Sapienza, Rome, Italy
| | | | - Michela D'Agostino
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital University of Rome Sapienza, Rome, Italy
| | - Andrea Ferrucci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital University of Rome Sapienza, Rome, Italy
| | - Massimo Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
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Volpe M, Santolamazza C, Mastromarino V, Coluccia R, Battistoni A, Tocci G. Triple Combination Therapies Based on Olmesartan: A Personalized Therapeutic Approach to Improve Blood Pressure Control. High Blood Press Cardiovasc Prev 2017; 24:255-63. [PMID: 28608025 DOI: 10.1007/s40292-017-0217-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/06/2017] [Indexed: 12/27/2022] Open
Abstract
Recent epidemiological surveys have demonstrated that effective and sustained blood pressure (BP) control is achieved in a relatively small proportion of treated hypertensive patients. Indeed, treatment of hypertension represents a key strategy for preventing coronary artery disease, stroke, congestive heart failure and cardiovascular death. Several interventions have been proposed by international guidelines for ameliorating hypertension management and control, mostly including integrated and multi-dimensional pharmacological and non-pharmacological strategies. In particular, numerous evidence demonstrated that a more extensive use of combination therapy may represent a valid therapeutic option for treating hypertensive patients at different risk profile. This strategy has been definitely strengthened by the availability of single pill fixed-dose combinations. Among potential combination therapies, those based on the association of renin-angiotensin system antagonists, thiazide diuretics and calcium channel blockers are very effective in lowering BP levels and well tolerated. We will provide here an overview of clinical evidence supporting the use of triple combination therapy, with a focus on that based on olmesartan medoxomil, a thiazide diuretic (hydrochlorothiazide) and a calcium channel blocker (amlodipine besylate), which is available in multiple dosages. Finally, in view of the recognised importance of single-pill combination therapy for treating hypertension, we will examine the potential benefits of dual (fixed) combination therapy based on olmesartan medoxomil with either thiazide diuretic hydrochlorothiazide or calcium channel blocker amlodipine in terms of efficacy, safety and tolerability profile.
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Tocci G, Nati G, Cricelli C, Parretti D, Lapi F, Ferrucci A, Borghi C, Volpe M. Prevalence and control of hypertension in the general practice in Italy: updated analysis of a large database. J Hum Hypertens 2017; 31:258-62. [DOI: 10.1038/jhh.2016.71] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/23/2016] [Accepted: 08/18/2016] [Indexed: 12/15/2022]
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Tocci G, Muiesan ML, Parati G, Agabiti Rosei E, Ferri C, Virdis A, Pontremoli R, Mancia G, Borghi C, Volpe M. Trends in Prevalence, Awareness, Treatment, and Control of Blood Pressure Recorded From 2004 to 2014 During World Hypertension Day in Italy. J Clin Hypertens (Greenwich) 2016; 18:551-6. [PMID: 26459236 PMCID: PMC8031560 DOI: 10.1111/jch.12711] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/12/2015] [Accepted: 08/16/2015] [Indexed: 10/23/2022]
Abstract
Estimates of blood pressure (BP) control in real life are not systematically collected in Italy. We evaluated trends in systolic/diastolic BP levels, as well as prevalence, awareness, treatment, and control rates of hypertension among adult individuals visiting open checkpoints during the 2004 to 2014 annual editions of World Hypertension Day. Hypertension was defined as BP level ≥140/90 mm Hg or use of antihypertensive medication, whereas BP control was defined as BP level <140/90 mm Hg. We included 10,051 individuals (53.2% female, age 56.2±16.8 years, body mass index 25.7±7.6 kg/m(2) , systolic/diastolic BP 131.9±18.6/79.1±10.5 mm Hg). Hypertension prevalence and treatment were substantially unchanged, whereas awareness appears to increase over time. Controlled hypertension in diagnosed treated patients increased from 50.0% in 2004-2010 to 55.5% in 2011-2012 towards 57.6% in 2013-2014. This analysis provides real-life snapshots of hypertension over the years in the occasion of World Hypertension Day, showing increased awareness and improved control rates among treated hypertensive patients attending open checkpoints during 2004 to 2014 in Italy.
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Affiliation(s)
- Giuliano Tocci
- Department of Clinical and Molecular MedicineDivision of CardiologyFaculty of Medicine and PsychologySant'Andrea HospitalUniversity of Rome SapienzaRomeItaly
- IRCCS NeuromedPozzilli (IS)Italy
| | - Maria L. Muiesan
- Department of Medical and Surgical SciencesUniversity of BresciaBresciaItaly
| | - Gianfranco Parati
- Department of Health SciencesUniversity of Milan‐BicoccaMilanItaly
- Department of CardiovascularNeural and Metabolic SciencesSan Luca HospitalIstituto Auxologico ItalianoMilanItaly
| | - Enrico Agabiti Rosei
- Clinica Medica GeneraleDepartment of Clinical and Experimental SciencesUniversity of BresciaAzienda Spedali CiviliBresciaItaly
| | - Claudio Ferri
- Department MeSVADivision of Internal Medicine and NephrologySan Salvatore HospitalUniversity of L'AquilaL'AquilaItaly
| | - Agostino Virdis
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Roberto Pontremoli
- Department of Internal MedicineUniversity of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino‐ISTGenoaItaly
| | - Giuseppe Mancia
- Istituto Auxologico Italiano and Centro di Fisiologia Clinica e IpertensioneUniversity of Milano MilanMilanItaly
| | - Claudio Borghi
- Chair of Internal MedicineUniversity of BolognaBolognaItaly
| | - Massimo Volpe
- Department of Clinical and Molecular MedicineDivision of CardiologyFaculty of Medicine and PsychologySant'Andrea HospitalUniversity of Rome SapienzaRomeItaly
- IRCCS NeuromedPozzilli (IS)Italy
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Tocci G, Ferrucci A, Pontremoli R, Ferri C, Rosei EA, Morganti A, Trimarco B, Mancia G, Borghi C, Volpe M. Blood pressure levels and control in Italy: comprehensive analysis of clinical data from 2000–2005 and 2005–2011 hypertension surveys. J Hum Hypertens 2015; 29:696-701. [DOI: 10.1038/jhh.2015.4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/14/2014] [Accepted: 12/02/2014] [Indexed: 02/01/2023]
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Abstract
Effective treatment of high blood pressure (BP) represents a key strategy for reducing the burden of hypertension-related cardiovascular and renal diseases. In spite of these well-established concepts, hypertension remains poorly controlled worldwide. In order to improve BP control in patients with hypertension, several interventions have been proposed, among which (1) preferred use of more effective, sustained, and well-tolerated antihypertensive drug aimed to ensure adherence to prescribed medications and (2) extensive use of rational, integrated, and synergistic combination therapies, even as first-line strategy, aimed to achieve the recommended BP targets. Within the possible antihypertensive drug classes currently available for the clinical management of hypertension, both in monotherapy and in combination therapy, drugs inhibiting the renin-angiotensin system and calcium channel blockers (CCBs) have demonstrated to be effective and safe in lowering BP levels and achieving the recommended BP targets with a good tolerability profile. In particular, CCBs have been one of the most widely used classes of antihypertensive agents in the last 20 years, based on their effectiveness in reducing BP levels, good tolerability, and abundant evidence on reducing cardiovascular and renal consequences of hypertension. This article provides an updated overview of the evidence supporting the use of CCBs-based antihypertensive regimen, both in monotherapy and in combination therapies with different classes of antihypertensive drugs.
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Affiliation(s)
- Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome IRCCS Neuromed, Pozzilli (IS), Italy
| | - Allegra Battistoni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome
| | - Jasmine Passerini
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome
| | - Maria Beatrice Musumeci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome
| | - Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome
| | - Andrea Ferrucci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome
| | - Massimo Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome IRCCS Neuromed, Pozzilli (IS), Italy
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Volpe M, Tocci G. Challenging hypertension: how to diagnose and treat resistant hypertension in daily clinical practice. Expert Rev Cardiovasc Ther 2014; 8:811-20. [DOI: 10.1586/erc.10.47] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tocci G, Volpe M. Fixed-combination therapy to improve blood pressure control: experience with olmesartan-based therapy. Expert Rev Cardiovasc Ther 2014; 9:829-40. [DOI: 10.1586/erc.11.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Khosravi A, Emamian MH, Shariati M, Hashemi H, Fotouhi A. The prevalence of pre-hypertension and hypertension in an Iranian urban population. High Blood Press Cardiovasc Prev 2013; 21:127-35. [PMID: 24272061 DOI: 10.1007/s40292-013-0035-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/12/2013] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To determine the prevalence of hypertension and pre-hypertension and its determinants in the 40-64 year old population of Shahroud in the north of Iran. METHODS The blood pressure of 5,190 of the 40-64 year old people participating in the first phase of Shahroud Eye Cohort Study was measured using the standard method. Sampling was done in 2009 using a random cluster approach. The prevalence of hypertension and pre-hypertension was determined by age and sex, and we used a multi-nominal logistic regression model to calculate the odds ratio (OR). RESULTS The prevalence of pre-hypertension was 37.2 % in men and 30.9 % in women, and the prevalence of hypertension was respectively 37.1 % and 39.0 %. In both sexes, there was an increase in the prevalence of hypertension and a decrease in the prevalence of pre-hypertension with age. Older age, male sex, higher body mass index, blood glucose higher than 140 mg/dl were found associated with hypertension and pre-hypertension. Also, diabetes increases the odds of hypertension (OR = 1.4) and a history of smoking was correlated with a decreased odds of having hypertension and pre-hypertension. CONCLUSION According to the criteria of Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, the prevalence of hypertension and pre-hypertension was high in the studied population, and considering the epidemiologic transition of diseases in Iran, it can be concluded that a high percentage of the population are at risk of cardiovascular diseases.
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Affiliation(s)
- Ahmad Khosravi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Tocci G, Paneni F, Passerini J, Volpe M. Triple combination therapy to improve blood pressure control: experience with olmesartan-amlodipine-hydrochlorothiazide therapy. Expert Opin Pharmacother 2012; 13:2687-97. [PMID: 23170911 DOI: 10.1517/14656566.2012.745510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Effective treatment of hypertension is a key strategy for preventing and reducing the burden of hypertension-related cardiovascular diseases. In spite of these well-established concepts, hypertension remains poorly controlled, worldwide. Among the different pharmacological strategies required to improve blood pressure (BP) control, a more extensive use of combination therapy is progressively emerging as a cornerstone of a more effective treatment of hypertension. Among different drug combinations currently available for the clinical management of hypertension, those based on the association of drugs inhibiting the renin-angiotensin system, thiazide diuretics and calcium channel blockers have demonstrated to be very effective in lowering both systolic and diastolic, clinic and 24-h ambulatory BP levels with a good tolerability and safety profile. AREAS COVERED In the present manuscript the authors provide an overview of the evidence supporting the use of triple combination therapy with different classes of antihypertensive drugs, with a particular focus on those based on olmesartan medoxomil, a thiazide diuretic (hydrochlorothiazide) and a calcium channel blocker (amlodipine besylate). EXPERT OPINION Available data indicate that triple combination therapy based on olmesartan provides effective and sustained clinical and 24-h BP control in a high proportion of individuals among a broad range of hypertensive patients.
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Tocci G, Rosei EA, Ambrosioni E, Borghi C, Ferri C, Ferrucci A, Mancia G, Morganti A, Pontremoli R, Trimarco B, Zanchetti A, Volpe M. Blood pressure control in Italy: analysis of clinical data from 2005-2011 surveys on hypertension. J Hypertens 2012; 30:1065-74. [PMID: 22573073 DOI: 10.1097/HJH.0b013e3283535993] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Blood pressure (BP) control is poorly achieved in hypertensive patients, worldwide. AIM We evaluated clinic BP levels and the rate of BP control in hypertensive patients included in observational studies and clinical surveys published between 2005 and 2011 in Italy. METHODS We reviewed the medical literature to identify observational studies and clinical surveys on hypertension between January 2005 and June 2011, which clearly reported information on clinic BP levels, rates of BP control, proportions of treated and untreated patients, who were followed in different clinical settings (mostly in general practice, and also in outpatient clinics and hypertension centres). RESULTS The overall sample included 158 876 hypertensive patients (94 907 women, mean age 56.6 ± 9.6 years, BMI 27.2 ± 4.2 kg/m(2), known duration of hypertension 90.2 ± 12.4 months). In the selected studies, average SBP and DBP levels were 145.7 ± 15.9 and 87.5 ± 9.7 mmHg, respectively; BP levels were higher in patients followed in hypertension centres (n = 10 724, 6.7%; 146.5 ± 17.3/88.5 ± 10.3 mmHg) than in those followed by general practitioners (n = 148 152, 93.3%; 143.5 ± 13.9/84.8 ± 8.9 mmHg; P < 0.01). More than half of the patients were treated (n = 91 318, 57.5%); among treated hypertensive patients, only 31 727 (37.0%) had controlled BP levels. CONCLUSION The present analysis confirmed inadequate control of BP in Italy, independently of the clinical setting. Although some improvement was noted compared with a similar analysis performed between 1995 and 2005, these findings highlight the need for a more effective clinical management of hypertension.
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Abstract
Prehypertension is a major risk factor for hypertension. Blacks have more prevalent and severe hypertension than whites, but it is unknown whether progression from prehypertension is accelerated in blacks. We examined this question in a prospective cohort study of 18 865 nonhypertensive persons (5733 black [30.4%] and 13 132 white [69.6%]) aged 18 to 85 years. Electronic health record data were obtained from 197 community-based outpatient clinics in the Southeast United States. Days elapsing from study entry to hypertension diagnosis, mainly blood pressure ≥140 mm Hg systolic and/or ≥90 mm Hg diastolic on 2 consecutive visits established conversion time within a maximum observation period of 2550 days. Cox regression modeling was used to examine conversion to hypertension as a function of race, while controlling for age, sex, baseline systolic and diastolic blood pressures, body mass index, diabetes mellitus, and chronic kidney disease. The covariable adjusted median conversion time when 50% became hypertensive was 365 days earlier for blacks than whites (626 versus 991 days; P<0.001). Among covariables, baseline systolic blood pressure 130 to 139 mm Hg (hazard ratio: 1.77 [95% CI: 1.69 to 1.86]) and 120 to 129 mm Hg (hazard ratio: 1.52 [95% CI: 1.44 to 1.60]), as well as age ≥75 years (hazard ratio: 1.40 [95% CI: 1.29 to 1.51]) and 55 to 74 years (hazard ratio: 1.29 [95% CI: 1.23 to 1.35]) were the strongest predictors of hypertension. Additional predictors included age 35 to 54 years, diastolic blood pressure 80 to 89 mm Hg, overweight and obesity, and diabetes mellitus (all P<0.001). Conversion from prehypertension to hypertension is accelerated in blacks, which suggests that effective interventions in prehypertension could reduce racial disparities in prevalent hypertension.
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Affiliation(s)
- Anbesaw Selassie
- Division of Biostatistics, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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Volpe M, Tocci G. Rethinking targets of blood pressure and guidelines for hypertension clinical management. Nephrol Dial Transplant 2010; 25:3465-71. [DOI: 10.1093/ndt/gfq492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Lee HS, Park YM, Kwon HS, Lee JH, Yoon KH, Son HY, Kim DS, Yim HW, Lee WC. Factors associated with control of blood pressure among elderly people diagnosed with hypertension in a rural area of South Korea: the Chungju Metabolic Disease Cohort Study (CMC study). Blood Press 2010; 19:31-9. [PMID: 19929285 DOI: 10.3109/08037050903424117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Control of blood pressure is important in old age for prevention of hypertension-associated complications. This study aimed to investigate the factors associated with control of hypertension in elderly people (>or=60 years old) diagnosed with hypertension. METHODS The subjects were those who had a self-reported diagnosis of hypertension (532 men and 1078 women) from a stratified random cluster sample of 4201 people aged 60 years or older. Controlled hypertension was defined as a systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg, and SBP <130 mmHg and DBP <80 mmHg for subjects with diabetes. RESULTS The prevalence of controlled hypertension (25.9%) was low. In older women, the prevalence of isolated uncontrolled SBP was increased. After adjusting for other covariates, uncontrolled hypertension was positively associated with body mass index (BMI>or=23 kg/m(2)), and negatively associated with balanced diet and a past history of cardiovascular disease in men, whereas in women it was positively associated with waist circumference (>or=80 cm). CONCLUSIONS In elderly people diagnosed with hypertension general obesity (high BMI) appears to have an important influence on uncontrolled hypertension in men, whereas abdominal obesity (high waist circumference) appears to be an important factor in women.
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Affiliation(s)
- Hong-Seok Lee
- Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Stroke is the most common life-threatening neurological disorder. Based on limited acute therapies, clinicians have opted to focus on preventive strategies to limit its recurrence. Targets for prevention include modifiable risk factors such as hypertension, diabetes mellitus, dyslipidemia, cigarette smoking, obesity, alcohol use, and physical inactivity among others. The American Stroke Association and American Heart Association guideline for the secondary prevention of stroke published in 2006 provides comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of stroke or transient ischemic attack. This guideline helps healthcare providers who have arrived at a potential explanation of the cause of stroke in an individual patient to select therapies that reduce the risk of recurrent events and other vascular events. The purpose of this review is to highlight the recently published American Stroke Association/American Heart Association guidelines for the secondary prevention of stroke.
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Sarafidis PA, Bakris GL. State of Hypertension Management in the United States: Confluence of Risk Factors and the Prevalence of Resistant Hypertension. J Clin Hypertens (Greenwich) 2008; 10:130-9. [DOI: 10.1111/j.1751-7176.2008.07309.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Lacourcière Y, Poirier L, Lefebvre J. Expedited blood pressure control with initial angiotensin II antagonist/diuretic therapy compared with stepped-care therapy in patients with ambulatory systolic hypertension. Can J Cardiol 2007; 23:377-82. [PMID: 17440643 PMCID: PMC2649188 DOI: 10.1016/s0828-282x(07)70771-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The present study investigated whether initiating therapy with a combination of losartan (L) and hydrochlorothiazide (HCTZ) allows for faster blood pressure (BP) control and fewer medications than the usual stepped-care approach in patients with stage 2 or 3 hypertension and ambulatory systolic hypertension. METHODS Patients with a mean daytime systolic ambulatory BP (ABP) of 135 mmHg or higher were randomly assigned to receive L 50 mg plus HCTZ 12.5 mg titrated to L 100 mg plus HCTZ 25 mg versus HCTZ 12.5 mg plus atenolol 50 mg. Amlodipine 5 mg was then added, if needed, to achieve a BP goal of less than 130 mmHg. Treatment titration was based on ABP. RESULTS Significantly more patients randomly assigned to L/HCTZ (63.5%) than stepped-care (37.5%; P=0.008) achieved the primary end point (daytime systolic BP of less than 130 mmHg). Initial L/HCTZ induced significantly greater decreases in ABP during each 24 h period after six weeks of therapy. Although reductions in systolic and diastolic ABP were not statistically different at the end of the study, ABP reduction was significantly greater (P<0.001) with the L/HCTZ-based regimen. Twice as many patients in the L/HCTZ group achieved the goal ABP with no more than two drugs (30.0% versus 14.7%; P=0.03). Moreover, tolerability was significantly better (P=0.006) in the L/HCTZ group, with a 40.0% incidence of adverse events, versus 65.6% in the stepped-care group. CONCLUSION Initiating antihypertensive therapy with the combination of L/HCTZ in patients with stage 2 or 3 hypertension and ambulatory systolic hypertension reaches a target BP faster in a higher proportion of patients, with fewer adverse events and less need for a third drug regimen than the conventional stepped-care approach.
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Affiliation(s)
- Yves Lacourcière
- Hypertension Research Unit, Centre Hospitalier de l'Université Laval, Sainte-Foy, Quebec, Canada.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Università Milano-Bicocca, Ospedale San Gerardo, Via Pergolesi 33, 20052 Monza (Milan), Italy.
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Abstract
Hypertension is one of the most important risk factors for the development of cardiovascular disease. The prevalence of hypertension increases with age and also after the menopause; therefore, blood pressure monitoring and effective control of elevated blood pressure are very important in postmenopausal women. The knowledge that aldosterone is a dual cardiovascular and endocrine hormone has blurred the once distinct boundary between gynecology and cardiovascular medicine. Aldosterone plays a major role in salt and water homeostasis, but also binds to mineralocorticoid receptors in the cardiovascular system, leading to structural and functional changes and consequent organ damage. Highly selective aldosterone blockade via the mineralocorticoid receptor has long-term antihypertensive effects. Drospirenone is a novel progestogen with aldosterone receptor antagonism (PARA), and therefore has antihypertensive effects through reduced salt and water retention. A new hormone therapy that combines 17beta-estradiol with drospirenone has been shown in several clinical studies to have a blood pressure-lowering effect in postmenopausal women with elevated blood pressure, in addition to effectively relieving symptoms of the menopause. These findings suggest a potential additional benefit on the cardiovascular system for the drospirenone/17beta-estradiol combination in the treatment of women with menopausal symptoms and elevated blood pressure.
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Affiliation(s)
- W B White
- Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, Connecticut 06030, USA
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22
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Abstract
The prevalence of hypertension increases in women after the menopause. Associated with the rise in postmenopausal blood pressure (BP) are increased salt sensitivity and imbalance between the renin-angiotensin-aldosterone system and nitric oxide pathways that lead to sodium and water retention. Drospirenone is the first synthetic progestogen with antialdosterone activity similar to natural progesterone. Drospirenone counteracts the salt- and water-retaining effects of estrogen and causes natriuresis, which leads to a reduction in BP. In preclinical studies as well as early efficacy studies (for menopausal symptoms), drospirenone exhibited antihypertensive and natriuretic effects. Subsequent clinical trials in postmenopausal women proved that drospirenone with 17beta-estradiol has a significant BP-lowering effect in untreated hypertension and has additive effects when coadministered with ACE inhibitors, angiotensin II type 1 receptor antagonists and thiazide diuretics. The lowest effective dose of drospirenone for reduction in BP is 2mg, a dose that is also protective of the uterus in women treated with estrogen therapy. Additionally, clinical trials have shown that drospirenone up to 3 mg/day has an acceptable safety profile with no clinically significant elevations in plasma potassium in patients with concomitant NSAID use, diabetes mellitus or mild to moderate renal insufficiency. In addition to effectively relieving menopausal symptoms and lowering BP, drospirenone reduces bodyweight and lipoprotein concentrations. Thus, drospirenone is a unique progestogen that confers the additional benefit of BP reduction, an effect that could lead to potential benefit with respect to some cardiovascular risk concerns in women taking hormone therapy.
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Affiliation(s)
- Madhavi Mallareddy
- Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut 06030-3940, USA
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Rodondi N, Peng T, Karter AJ, Bauer DC, Vittinghoff E, Tang S, Pettitt D, Kerr EA, Selby JV. Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus. Ann Intern Med 2006; 144:475-84. [PMID: 16585661 PMCID: PMC2577322 DOI: 10.7326/0003-4819-144-7-200604040-00006] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Poorly controlled cardiovascular risk factors are common. Evaluating whether physicians respond appropriately to poor risk factor control in patients may better reflect quality of care than measuring proportions of patients whose conditions are controlled. OBJECTIVES To evaluate therapy modifications in response to poor control of hypertension, dyslipidemia, or diabetes in a large clinical population. DESIGN Retrospective cohort study within an 18-month period in 2002 to 2003. SETTING Kaiser Permanente of Northern California. PATIENTS 253,238 adult members with poor control of 1 or more of these conditions. MEASUREMENTS The authors assessed the proportion of patients with poor control who experienced a change in pharmacotherapy within 6 months, and they defined "appropriate care" as a therapy modification or return to control without therapy modification within 6 months. RESULTS A total of 64% of patients experienced modifications in therapy for poorly controlled systolic blood pressure, 71% for poorly controlled diastolic blood pressure, 56% for poorly controlled low-density lipoprotein cholesterol level, and 66% for poorly controlled hemoglobin A1c level. Most frequent modifications were increases in number of drug classes (from 70% to 84%) and increased dosage (from 15% to 40%). An additional 7% to 11% of those with poorly controlled blood pressure, but only 3% to 4% of those with elevated low-density lipoprotein cholesterol level or hemoglobin A1c level, returned to control without therapy modification. Patients with more than 1 of the 3 conditions, higher baseline values, and target organ damage were more likely to receive "appropriate care." LIMITATIONS Patient preferences and suboptimal adherence to therapy were not measured and may explain some failures to act. CONCLUSIONS As an additional measure of the quality of care, measuring therapy modifications in response to poor control in a large population is feasible. Many patients with poorly controlled hypertension, dyslipidemia, or diabetes had their therapy modified and, thus, seemed to receive clinically "appropriate care" with this new quality measure.
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Affiliation(s)
- Nicolas Rodondi
- University Outpatient Clinic and University Institute of Social and Preventive Medicine, Department of Community Medicine and Public Health, University of Lausanne, Lausanne, Switzerland.
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Mancia G, Ambrosioni E, Rosei EA, Leonetti G, Trimarco B, Volpe M. Blood pressure control and risk of stroke in untreated and treated hypertensive patients screened from clinical practice: results of the ForLife study. J Hypertens 2005; 23:1575-81. [PMID: 16003185 DOI: 10.1097/01.hjh.0000175932.78774.32] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Stroke has a high prevalence in Italy, and is the third cause of death worldwide. Hypertension is the most important risk factor contributing to the risk of stroke. The aims of this study were to assess the risk of stroke in a large cohort of hypertensive patients, and to determine the percentage with controlled blood pressure, to establish the contribution of this factor to the risk of stroke. METHODS The study involved general practitioners to make it representative of clinical practice. They were asked to recruit 10 consecutive hypertensive patients, treated and untreated. Data collection included a full medical history and a physical examination. The 10-year absolute risk of stroke was calculated by an algorithm derived, with some modification, from the Framingham study. RESULTS Most untreated hypertensive patients were grade 1 or 2. In treated hypertensive patients, controlled blood pressure values occurred in 18.4%, the percentage being less in patients with left ventricular hypertrophy and diabetes. In diabetic hypertensive patients the more stringent blood pressure control recommended by the guidelines was achieved in only 3.0% of cases. The average 10-year stroke risk was 17%, a greater risk being more common in elderly patients, diabetic individuals and in those with left ventricular hypertrophy. CONCLUSION Current antihypertensive treatment achieved blood pressure control in a limited fraction of hypertensive patients seen by general practitioners. The risk of stroke in hypertensive patients is by no means negligible, which emphasizes the need for more attention to be paid to the prevention of this disease.
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Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano Bicocca, Milan, Italy.
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Affiliation(s)
- Todd F Griffith
- Duke Institute of Renal Outcomes Research and Health Policy, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
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Abstract
This paper reviews the epidemiology, pathophysiology and clinical significance of isolated systolic hypertension (ISH) in the elderly. Aging is associated with structural and functional changes in the arterial tree. Intimal thickening, migration of small muscle cells to the intima, medial fibrosis, and elastic fiber degeneration result in increased arterial stiffness and ISH. The augmented systemic vascular resistance in the elderly is mediated by increased arterial stiffness. Aging is correlated with overactivity of the sympathetic nervous system, reduced neuronal plasma norepinephrine uptake, and baroreceptor dysfunction. These functional changes all contribute to the development of ISH in elderly persons. Prospective and epidemiological studies have demonstrated that ISH is associated with coronary and cerebrovascular morbidity and mortality. There is good evidence indicating that lifestyle modifications such as weight reduction, increased physical activity, moderation of dietary sodium, and decreased alcohol intake, in combination with pharmacological therapy can effectively reduce blood pressure in elderly individuals with ISH. Primary health care providers can make significant contributions to the care of elderly persons with ISH. These contributions involve educating elderly people to control hypertension through lifestyle modification, monitoring the efficacy of antihypertensive therapy, and preventing complications associated with non-compliance with therapeutic regimens.
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Affiliation(s)
- Julia Wong
- School of Nursing, Dalhousie University, Halifax, Nova Scotia B3H 3J5, Canada.
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Abstract
Hypertension is a leading cause of morbidity and mortality worldwide and its control rates remain poor. In 2003, several official organizations presented new guidelines for hypertension management. These guidelines were developed using an evidence-based interpretation of the available information. Recommendations on hypertension prevention, diagnosis, patients' evaluation, decision to treat, antihypertensive drug selection and goals of treatment are included. There is considerable agreement among the new guidelines and only a few points of disagreement, that are of minor significance. Emphasis has been placed on the simplicity of recommendations in order for them to be easily applied by primary care physicians. This review focuses on the key messages of the 2003 guidelines and the areas of agreement and disagreement among them.
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Affiliation(s)
- George S Stergiou
- Third University Department of Medicine, Sotiria Hospital, 152, Mesogion Avenue, Athens 11527, Greece.
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Abstract
Systolic blood pressure is a major cardiovascular risk factor which is often associated with arterial stiffness. Markers of arterial stiffness, such as pulse pressure and carotid-femoral pulse wave velocity, have been proved independent predictors of cardiovascular risk. Recent evidence suggests that the renin-angiotensin system is involved in the pathogenesis of systolic hypertension and arterial stiffness. Outcome trials have shown impressive cardiovascular protection by reducing systolic blood pressure (BP) with drug treatment. However, in clinical practice systolic hypertension remains largely uncontrolled, first, because systolic BP goal is more difficult to be reached than diastolic and, second, because physicians are often reluctant to intensify treatment in patients with systolic BP close to 150 mmHg. Recent trials have focused on the effects of antihypertensive drugs not only on blood pressure, but also on pulse pressure and pulse-wave velocity. Blockade of the renin-angiotensin-aldosterone system, using angiotensin-converting enzyme inhibitors and more recently angiotensin receptor blockers, has been shown to provide beneficial effects on arterial stiffness that appear to be independent of their antihypertensive effects. Recent outcome trials have shown significant cardiovascular protection with angiotensin receptor blockers. These drugs have an excellent placebolike profile of adverse effects which is maintained when these drugs are combined with low-dose diuretics. Therefore, an angiotensin receptor blocker-based treatment strategy appears to be an attractive and evidence-based approach for the management of systolic hypertension, the reduction of arterial stiffness and the prevention of cardiovascular disease.
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Affiliation(s)
- G S Stergiou
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
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Yuan Y, Chen RS, L'Italien G, Karaniewsky R. Development of a parametric simulation model for forecasting goal-oriented treatment outcomes. Value Health 2004; 7:482-489. [PMID: 15449640 DOI: 10.1111/j.1524-4733.2004.74011.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Treatment-to-goal (TTG) analyses are frequently used to predict guideline-directed population control rates for drug therapies based on mean efficacy data. Nevertheless, estimates are commonly inaccurate because variability in efficacy is not considered. A new methodology was developed to improve TTG forecasting. METHODS Patient-level blood pressure (BP) lowering data sets, designed to simulate clinical trial results, were generated for testing from three underlying distributions: normal, lognormal, and beta. To emulate real-world conditions where patient-level data are unavailable, two approaches were considered: parametric--simulated BP lowering data were generated using the mean and standard deviation of the test data sets; and point-estimate--BP lowering was uniformly assigned as the mean lowering. BP control (systolic BP < 140 and diastolic BP < 90 mmHg) was forecasted by subtracting values generated by these two methods from baseline BP values in untreated hypertensive patients (n = 2483) from the Third National Health and Nutrition Examination Survey. Estimated control rates were compared to analyses where the patient-level data sets were bootstrapped. RESULTS We assumed mean (+/- SD) BP lowering of 20 (12) mmHg systolic and 14 (7) mmHg diastolic. Parametric method predicted a BP control rate of 66.9% [95% confidence interval (CI) 65.7-67.9], similar to the bootstrapping approach (67.3%, 95% CI 65.9-68.8). The control rate projected based on the point-estimate method was 75.5%. The point-estimate method frequently led to substantially different results under a wide range of model assumptions. CONCLUSIONS A new parametric-based forecasting method, which addresses underlying variability, improves on estimates based on mean efficacy only. In the absence of patient-level data, this method is generalizable to different therapeutic areas.
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Affiliation(s)
- Yong Yuan
- Bristol-Myers Squibb, Pharmaceutical Research Institute, Princeton, NJ 08543-4000, USA.
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