scholarly journals Efficacy of angiotensin receptor neprilysin inhibitor in Asian patients with refractory hypertension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
W E I Song ◽  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Chinese Patients ◽  
Angiotensin Receptor ◽  
Refractory Hypertension ◽  
Neprilysin Inhibitor ◽  
Angiotensin Receptor Neprilysin Inhibitor ◽  
Angiotensin Type

Abstract Background Angiotensin receptor neprilysin inhibitor, concomitantly inhibits neprilysin and angiotensin type 1 receptor shown an effect of reducing blood pressure. We aimed to study whether it can be used as an antihypertensive agent in patients with resistant hypertension who has already been treated. Methods This is a multiple center prospective study. Thirty-five Chinese patients with refractory hypertension were enrolled. Resistant hypertension was defined as on the basis of improved lifestyle when the application of the three reasonable and tolerable dose of antihypertensive drugs including thiazide diuretics at least four weeks after treatment, the inadequate control of BP is confirmed by ambulatory BP monitoring, or at least four drugs are needed to achieve the BP standard. Refractory hypertensive patient received sacubitil/valsartan 200 mg instead of their angiotensin type 1 receptor blocker while other agents were continued. If blood pressure was uncontrolled, the sacubitil/valsartan dose was increased to 400 mg after 4 weeks. ABPM were evaluated at 8 weeks follow up. Results Reductions in office SBP/DBP at week 8 were 37/17 mmHg. the average baseline ABPM were 154/90 mmHg of 24-h, and daytime BP and nighttime BP were 157/92 mmHg and 145/83 mmHg respectively. he average endpoint ABPM were 134/80 mmHg of 24-h, and daytime BP and nighttime BP were 136/82 mmHg and 125/73 mmHg respectively. Reductions in 24-h ABPM at week 8 were 20/9 mmHg while 20/10 mmHg in daytime and 20/9 mmHg in nighttime. Conclusion The sacubitil/valsartan provided a strategy therapy for refractory hypertension in Chinese patients in reducing SBP and DBP. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Resistant hypertension: a review

2021 ◽  
Vol 8 (9) ◽  
pp. 1433
Author(s):  
Anant Parasher ◽  
Rajat Jhamb
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Resistant Hypertension ◽  
Alcohol Intake ◽  
Antihypertensive Drugs ◽  
Patient Adherence ◽  
Dietary Sodium ◽  
Lifestyle Modifications ◽  
Refractory Hypertension ◽  
Uncontrolled Blood Pressure

Resistant hypertension is currently defined as uncontrolled blood pressure despite the use of optimal doses of three antihypertensive medications, of which one is a diuretic. Several factors have been identified as contributors to resistant hypertension such as poor patient adherence, physician inertia, inadequate doses or inappropriate combinations of antihypertensive drugs, excess alcohol intake, certain drugs and volume overload. Uncontrolled blood pressure is a considerable cardiovascular and neurological risk factor that can lead to possible end-organ consequences of untreated hypertension, including heart failure, stroke, ischemic heart disease and renal failure. A comprehensive history and physical examination are essential for pointing towards to an underlying diagnosis. A PubMed search was conducted for review articles and papers from 1955 to 2019 containing the keywords ‘resistant hypertension’, ‘secondary hypertension’, ‘refractory hypertension’, ‘heart failure’ and ‘stroke’, and the literature was compiled. Non-pharmacological measures chiefly include lifestyle modifications such as smoking cessation, reduction in alcohol intake, dietary sodium restriction, healthy eating plans, increased physical activity and weight loss. Among recommended drugs, spironolactone and beta blockers are the preferred fourth- and fifth-line drugs respectively, in patients unresponsive to ACE Inhibitors, calcium channel blockers as well as diuretics. Although most patients are well controlled on extended drug regimes, some develop refractory hypertension which does not even respond to the five-drug regimen. Interventional therapies such as renal denervation and carotid sinus stimulation have been developed for patients with refractory hypertension, but still require further research and follow up to ascertain their full potency and efficacy.

RESISTANT ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: PREVALENCE, PROGNOSTIC SIGNIFICANCE, REASONS AND APPROACHES TO ANTIHYPERTENSIVE THERAPY

2019 ◽  
Vol 23 (1) ◽  
pp. 37-44 ◽  
Author(s):  
O. B. Kuzmin ◽  
V. V. Zhezha ◽  
L. N. Landar ◽  
O. A. Salova
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Refractory Hypertension ◽  
Hypertensive Patients

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

scholarly journals Impact of hospitalization for checking medication adherence due to resistant and refractory hypertension suspicious on short and mid-term blood pressure control

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Pio-Abreu ◽  
F Trani-Ferreira ◽  
G.V Silva ◽  
L.A Bortolotto ◽  
L Drager
Keyword(s):  
Blood Pressure ◽  
Hospital Discharge ◽  
Outpatient Clinic ◽  
Antihypertensive Drugs ◽  
Outpatient Visit ◽  
Target Organ Damage ◽  
Refractory Hypertension ◽  
Gold Standard Method ◽  
Medication Intake

Abstract Background Resistant (HR) and refractory hypertension (HRef) are associated with increased cardiovascular events and target-organ damage. However, appropriate HR and HRef diagnosis require good drug adherence. In this context, the “gold standard” method for assessing adherence is supervised medication intake. However, it is not clear the real utility of supervised medication intake in clinical practice. Purpose To evaluate whether hospitalization for confirming anti-hypertensive adherence in patients with HR and HRef may impact blood pressure (BP) control after hospital discharge in patients with HR or HRef suspicious at a tertiary outpatient clinic. Methods We recruited consecutive patients with HR or HRef suspicious admitted to the Hospital for confirming treatment adherence. HR was defined as uncontrolled office BP (≥140 and/or ≥90mmHg) despite using ≥3 classes at optimal doses (one of them being diuretic) or controlled BP using ≥4 classes. HRef was defined as no BP control despite using ≥5 antihypertensive drugs. Patients with suspected HRef who did not meet the criteria but full field the HR definition were named HRNoRef. During hospitalization, all patients used low sodium diet and had supervised taking of prescribed drugs by the medical team aiming BP control. We defined not only the rate of adherence and HF/HRef status but also BP and number of antihypertensive drugs at hospital discharge and in the two first return outpatient's visits. Results We studied a total of 83 patients with suspected HR/HRef (age 53±14 years; 76% females; pre-hospitalization systolic and diastolic BP: 177±28 and 106±21mmHg, respectively). Of these, 68.7% (57 patients) had suspected HRef in the outpatient clinic. The average number of antihypertensive drugs on admission was 5.3±1.3 classes. After hospitalization, the overall frequency of HR fell to 80% (66 patients). The average number of antihypertensive drugs at hospital discharge as well as systolic and diastolic BP was 4.5±1.3 classes, 131±17mmHg and 80±12mmHg, respectively (p<0.001 vs. pre-hospitalization for all comparisons). Among the HR types, HRef was confirmed in only 27 patients (32.5%). During the outpatient follow-up, the patients remained with lower number of antihypertensive drugs as well as lower systolic and diastolic BP at first outpatient visit (mean returned time: 2.1±1.7months) and second outpatient visit post-discharge (mean returned time 7.1±2.6months) as compared to pre-hospitalization data: First visit: 4.3±1.2 classes, systolic: 152±24mmHg, diastolic BP: 89±17mmHg; second visit: 4.5±1.3 classes, systolic: 150±26mmHg, diastolic BP: 89±15mmHg; (p<0.001 vs. pre-hospitalization for all comparisons). Conclusion Supervised medication intake during hospitalization may help not only to define the HR and HRef status but also to have impact on the number of antihypertensive drugs and lower BP values at short and mid-term follow-up. Funding Acknowledgement Type of funding source: None

scholarly journals Improvement of Blood Pressure Control by Adherence Check in Patients With Apparent Treatment-Resistant Hypertension: A Case Series

2020 ◽  
Vol 13 ◽  
pp. 117954762090488
Author(s):  
Keiko Hosohata ◽  
Ayaka Inada ◽  
Saki Oyama ◽  
Takashi Doi ◽  
Iku Niinomi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Case Series ◽  
Pressure Control ◽  
Supporting Evidence ◽  
Treatment Resistant ◽  
Uncontrolled Blood Pressure ◽  
Important Challenge ◽  
Prescribed Medicines

Adherence to medications is an important challenge while treating chronic disease such as resistant hypertension, which is defined as uncontrolled blood pressure (BP) despite treatment with more than 3 antihypertensive drugs to achieve targets. It is possible that poor adherence is the most significant contributor to rates of pseudo-resistance among treated hypertensive patients. In this report, we describe 4 patients with apparent treatment-resistant hypertension, who received intervention to promote adherence by pharmacists who set the prescribed medicines in a weekly medication calendar and conducted a weekly pill count. The results showed that the intervention of pharmacists to medication adherence improved systolic BP in patients with apparent treatment-resistant hypertension; however, further controlled trials are required to strengthen supporting evidence.

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