scholarly journals Frailty and rate of fractures in patients initiating antihypertensive medications: a cohort study in primary care.

2021 ◽  
Author(s):  
Marc F Osterdahl ◽  
Sarah-Jo Sinnott ◽  
Ian Douglas ◽  
Andrew Clegg ◽  
Laurie Tomlinson ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Antihypertensive Treatment ◽  
Frailty Index ◽  
Drug Effects ◽  
Fracture Rate ◽  
Channel Blockers ◽  
First Line ◽  
Antihypertensive Medications ◽  
Risk Of Falls

Background Treatment for hypertension improves cardiovascular outcomes. Frailty is common in people treated for hypertension, and associated with increases in adverse drug effects, potentially including falls resulting in fractures. We aimed to determine the association between baseline frailty and fractures in patients initiated on antihypertensive treatment. Methods We conducted a retrospective cohort study using United Kingdom primary care data, including new-users of first-line antihypertensives aged 65 years or over. We reported degree of frailty (fit, mild, moderate, severe) at antihypertensive initiation using the Electronic Frailty Index. We examined the association of frailty with fractures using multivariable Poisson regression, and assessed for interaction between antihypertensive class and frailty. Results 49634 (43%) people initiated on first-line antihypertensives were mildly or more frail. Over 4.1 years mean follow-up, 6567 (5.8%) experienced a fracture, with 3832 (58%) of these fractures occurring in frail people. Among those with severe frailty doubling of fracture risk was observed after antihypertensive initiation, compared with fit people [adjusted rate ratio 2.26 (95% CI 1.93-2.65)]. This pattern was replicated for hip and arm fractures, and strongest for spine fractures. The association between different types of antihypertensives and fractures varied by frailty (P=0.004), with a lower rate in moderately frail users of renin-angiotensin blockers compared with calcium-channel blockers (RR 0.81 95% CI 0.71-0.94) Conclusions Frailty is common among people initiating first-line antihypertensive treatment, and was associated with an increased fracture rate. Awareness of this is important to encourage clinicians to consider risk of falls and fractures when treating hypertension.

Abstract 57: Risk Factors For Severe Reductions In Blood Pressure After Treatment Of Severe Inpatient Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lama Ghazi ◽  
Fan Li ◽  
Eric Chen ◽  
Michael Simonov ◽  
Yu Yamamoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cohort Study ◽  
Hospital Admission ◽  
Antihypertensive Treatment ◽  
Treatment Guidelines ◽  
P Value ◽  
Antihypertensive Medications ◽  
Black Race ◽  
Oral Medications

Background: Incident severe HTN during hospitalization is far more common than admission for HTN, however treatment guidelines are lacking. Severe inpatient HTN is poorly studied, therefore our goal is to characterize inpatients who develop severe HTN and assess BP response to antihypertensive treatment. Methods: This is a cohort study of adults admitted for reasons other than HTN and developed severe HTN within a single healthcare system. We defined severe inpatient HTN as the first documentation of BP elevation (>180 systolic or >110 diastolic) at least 1 hour after hospital admission. Treatment was defined as receiving antihypertensive medications within 6 hours of BP elevation. We studied the association between treatment and BP drop ≥30%. Results: Among 224,265 hospitalized adults, 23,147 developed severe HTN of which 40% were treated. Compared to inpatients who did not develop severe HTN, those who did were older, more commonly women and Black, and had more comorbidities. Of the treated and untreated patients, 45.5 and 46.4% had a MAP drop ≥30% (p-value= 0.2). Risk factors for severe MAP drop include older age, Black race, HTN, and diabetes. Additionally, treatment vs. no treatment and treatment with intravenous vs. oral medications were associated with greater odds of MAP drop ≥30% ( Table 1 ). Conclusion: While there was no difference in the proportion of treated and untreated patients with severe MAP reduction, after adjustment for factors independently associated with HTN we found that treatment was associated with severe BP drop. Further research is needed to phenotype inpatients with severe HTN to help establish treatment guidelines.

scholarly journals First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity: cohort study in UK primary care

BMJ ◽  
2020 ◽  
pp. m4080
Author(s):  
Sarah-Jo Sinnott ◽  
Ian J Douglas ◽  
Liam Smeeth ◽  
Elizabeth Williamson ◽  
Laurie A Tomlinson
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cohort Study ◽  
Systolic Blood Pressure ◽  
Black People ◽  
Angiotensin Receptor Blockers ◽  
Clinical Care ◽  
Treatment Recommendations ◽  
First Line

Abstract Objective To study whether treatment recommendations based on age and ethnicity according to United Kingdom (UK) clinical guidelines for hypertension translate to blood pressure reductions in current routine clinical care. Design Observational cohort study. Setting UK primary care, from 1 January 2007 to 31 December 2017. Participants New users of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), calcium channel blockers (CCB), and thiazides. Main outcome measures Change in systolic blood pressure in new users of ACEI/ARB versus CCB, stratified by age (< v ≥55) and ethnicity (black v non-black), from baseline to 12, 26, and 52 week follow-up. Secondary analyses included comparisons of new users of CCB with those of thiazides. A negative outcome (herpes zoster) was used to detect residual confounding and a series of positive outcomes (expected drug effects) was used to determine whether the study design could identify expected associations. Results During one year of follow-up, 87 440 new users of ACEI/ARB, 67 274 new users of CCB, and 22 040 new users of thiazides were included (median 4 (interquartile range 2-6) blood pressure measurements per user). For non-black people who did not have diabetes and who were younger than 55, CCB use was associated with a larger reduction in systolic blood pressure of 1.69 mm Hg (99% confidence interval −2.52 to −0.86) relative to ACEI/ARB use at 12 weeks, and a reduction of 0.40 mm Hg (−0.98 to 0.18) in those aged 55 and older. In subgroup analyses using six finer age categories of non-black people who did not have diabetes, CCB use versus ACEI/ARB use was associated with a larger reduction in systolic blood pressure only in people aged 75 and older. Among people who did not have diabetes, systolic blood pressure decreased more with CCB use than with ACEI/ARB use in black people (reduction difference 2.15 mm Hg (−6.17 to 1.87)); the corresponding reduction difference was 0.98 mm Hg (−1.49 to −0.47) in non-black people. Conclusions Similar reductions in blood pressure were found to be associated with new use of CCB as with new use of ACEI/ARB in non-black people who did not have diabetes, both in those who were aged younger than 55 and those aged 55 and older. For black people without diabetes, CCB new use was associated with numerically greater reductions in blood pressure than ACEI/ARB compared with non-black people without diabetes, but the confidence intervals were overlapping for the two groups. These results suggest that the current UK algorithmic approach to first line antihypertensive treatment might not lead to greater reductions in blood pressure. Specific indications could be considered in treatment recommendations.

scholarly journals Frailty and rate of fractures in patients initiating antihypertensive medications: a cohort study in primary care

2022 ◽  
Author(s):  
Marc F. Österdahl ◽  
Sarah-Jo Sinnott ◽  
Ian Douglas ◽  
Andrew Clegg ◽  
Laurie Tomlinson ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Antihypertensive Medications

Patterns of persistence with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care

2005 ◽  
Vol 23 (11) ◽  
pp. 2093-2100 ◽  
Author(s):  
Giampiero Mazzaglia ◽  
Lorenzo G Mantovani ◽  
Miriam CJM Sturkenboom ◽  
Alessandro Filippi ◽  
Gianluca Trifirò ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Newly Diagnosed ◽  
Antihypertensive Medications ◽  
Hypertensive Patients

scholarly journals Failure to Intensify Antihypertensive Treatment by Primary Care Providers: A Cohort Study in Adults with Diabetes Mellitus and Hypertension

2008 ◽  
Vol 23 (5) ◽  
pp. 543-550 ◽  
Author(s):  
Shari Danielle Bolen ◽  
T. Alafia Samuels ◽  
Hsin-Chieh Yeh ◽  
Spyridon S. Marinopoulos ◽  
Maura McGuire ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Cohort Study ◽  
Antihypertensive Treatment ◽  
Primary Care Providers ◽  
Care Providers

Pharmacologic Advances in the Treatment of ADHD

CNS Spectrums ◽  
2002 ◽  
Vol 7 (10) ◽  
pp. 725-732
Author(s):  
Thomas J. Spencer ◽  
Sharon B. Wigal ◽  
Jeffrey H. Newcorn
Keyword(s):  
Drug Effects ◽  
Comorbid Conditions ◽  
First Line ◽  
Antihypertensive Medications ◽  
Adequate Treatment ◽  
Stimulant Treatment ◽  
Social Interventions ◽  
Hyperactivity Disorder ◽  
Domains Of Life ◽  
First Line Treatment

ABSTRACTAttention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that affects many domains of life. Studies have shown that adequate treatment of ADHD can affect the course of the disorder in a fundamental manner. While nonpharmacologic treatments such as education and various psycho-social interventions are used in the management of ADHD, pharmacotherapy is the mainstay of treatment for this disorder. Psychostimulants are the only group of agents that have been approved for the ADHD indication and are considered to be first-line treatment for the disorder. Methylphenidate, amphetamines, andpemoline are the most commonly used agents in this group. The stimulants have been successfully used for many years and their efficacy has been confirmed by a large number of clinical studies. Recent pharmacological advances have been made with longer-acting stimulants, new isomers, and more advanced drug delivery systems that enable more convenient dosing schedules with drug effects lasting throughout the day. Other nonstimulant medications have been shown to have anti-ADHD activity as well, although more research is needed on the efficacy and utility of these treatments. Antihypertensive medications and antidepressants, such as tricyclics and bupropion, have been studied and may have applications in the treatment of specific subgroups of patients with comorbid conditions or for patients who do not respond to stimulant treatment.

MO19390 (SAiL): Incidence and management of hypertension (HTN) during bevacizumab (Bv)-based first-line therapy in patients (pts) with advanced non-small cell lung cancer (NSCLC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19002-e19002
Author(s):  
P. Garrido Lopez ◽  
J. Laskin ◽  
G. Jiang ◽  
F. Barlesi ◽  
D. Isla ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Age Groups ◽  
Channel Blockers ◽  
Angiotensin Ii Receptor ◽  
First Line ◽  
Open Label ◽  
Antihypertensive Medications ◽  
Serious Adverse Events ◽  
Grade 3 ◽  
Line Chemotherapy

e19002 Background: SAiL is an ongoing, multicenter, international, open-label trial investigating the safety and efficacy of first-line Bv in combination with a range of standard first-line chemotherapy regimens in >2,000 pts with advanced NSCLC. Methods: Eligible pts had locally advanced, metastatic or recurrent non-squamous NSCLC. Pts received Bv (7.5mg/kg or 15mg/kg q3w) with standard first-line chemotherapy for up to 6 cycles, then Bv monotherapy until disease progression. Pts with uncontrolled HTN (systolic >150mmHg and/or diastolic >100mmHg) or active cardiovascular disease at baseline were excluded. The primary endpoint was the incidence of serious adverse events (SAEs) related to Bv, and AEs of special interest, including hypertension. Bv was interrupted for persistent or symptomatic grade 3 HTN and discontinued if blood pressure remained uncontrolled by medication. Bv was discontinued for grade 4 hypertension. Results: This analysis was based on 2,008 pts who received at least 1 dose of study medication (data cut-off July 2008): median age was 59 and ECOG PS 0/1/2 (%) was 38.1/56.1/5.8. Antihypertensive medications at baseline included ACE inhibitors (11.3%), Angiotensin II receptor blockers (6.2%), beta-blockers (10.9%), calcium channel blockers (7.7%) and diuretics (8%). Pts received a median of 5 Bv cycles and 4 chemotherapy cycles. Overall, 388 patients (19.3%) had a total of 487 incidents of HTN (any grade), occurring equally in patients ≤65 and >65 years of age (18.9% and 20.2%, respectively). Only six pts (0.3%) had grade ≥3 HTN events related to Bv meeting the criteria for SAE. The overall incidence of HTN was consistent across the various types of chemotherapy regimens. Conclusions: The incidence of grade ≥3 HTN was low, and the overall HTN incidence was similar across age groups and chemotherapy regimens. Updated results will be presented, including data on HTN management and evolution of HTN events during administration of antihypertensive medication. [Table: see text]

scholarly journals Measuring daily functioning in older persons using a frailty index: a cohort study based on routine primary care data

2020 ◽  
Vol 70 (701) ◽  
pp. e866-e873
Author(s):  
Willeke M Ravensbergen ◽  
Jeanet W Blom ◽  
Andrea WM Evers ◽  
Mattijs E Numans ◽  
Margot WM de Waal ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Older Persons ◽  
Frailty Index ◽  
Routine Care ◽  
Community Dwelling ◽  
Daily Functioning ◽  
Primary Care Data ◽  
Observational Cohort ◽  
Data Source

BackgroundElectronic health records (EHRs) are increasingly used for research; however, multicomponent outcome measures such as daily functioning cannot yet be readily extracted.AimTo evaluate whether an electronic frailty index based on routine primary care data can be used as a measure for daily functioning in research with community-dwelling older persons (aged ≥75 years).Design and settingCohort study among participants of the Integrated Systemic Care for Older People (ISCOPE) trial (11 476 eligible; 7285 in observational cohort; 3141 in trial; over-representation of frail people).MethodAt baseline (T0) and after 12 months (T12), daily functioning was measured with the Groningen Activities Restriction Scale (GARS, range 18–72). Electronic frailty index scores (range 0–1) at T0 and T12 were computed from the EHRs. The electronic frailty index (electronic Frailty Index — Utrecht) was tested for responsiveness and compared with the GARS as a gold standard for daily functioning.ResultsIn total, 1390 participants with complete EHR and follow-up data were selected (31.4% male; median age = 81 years, interquartile range = 78–85). The electronic frailty index increased with age, was higher for females, and lower for participants living with a partner. It was responsive after an acute major medical event; however, the correlation between the electronic frailty index and GARS at T0 and over time was limited.ConclusionBecause the electronic frailty index does not reflect daily functioning, further research on new methods to measure daily functioning with routine care data (for example, other proxies) is needed before EHRs can be a useful data source for research with older persons.

scholarly journals Visit-to-visit blood pressure variability is common in primary care patients: Retrospective cohort study of 221,803 adults

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248362
Author(s):  
Finlay A. McAlister ◽  
Brendan Cord Lethebe ◽  
Alexander A. Leung ◽  
Rajdeep S. Padwal ◽  
Tyler Williamson
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cohort Study ◽  
Standard Deviation ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Blood Pressure Variability ◽  
Antihypertensive Treatment ◽  
Treatment Regimens ◽  
Primary Care Patients

Objective Although high visit-to-visit blood pressure variability (BPV) is an independent risk factor for cardiovascular events, the frequency of high BPV is unknown. We conducted this study to define the frequency of high BPV in primary care patients, clinical correlates, and association with antihypertensive therapies. Methods Retrospective cohort study using electronic medical record data (with previously validated case definitions based on billing codes, free text analysis of progress notes, and prescribing data) from the Canadian Primary Care Sentinel Surveillance Network of 221,803 adults with multiple clinic visits over a 2-year period. We a priori defined a standard deviation>13.0 mm Hg in visit-to-visit systolic blood pressure (SBP) as “high BPV” based on prior literature. Results Overall, 85,455 (38.5%) patients had hypertension (mean 6.56 visits with SBP measurement, mean SBP 134.4 with Standard Deviation [SD] 11.3, 33.2% exhibited high BPV) and 136,348 did not (mean 3.96 visits with SBP measurement, mean SBP 120.9 with SD 8.2, 16.5% had high BPV). BPV increased with age regardless of whether individuals had hypertension or not; at all ages BPV varied across antihypertensive treatment regimens and was greater in those receiving renin angiotensin blockers or beta-blockers (p<0.001). High BPV was more frequent in patients with diabetes, chronic kidney disease, dementia, depression, chronic obstructive pulmonary disease, or Parkinson’s disease. Conclusions High visit-to-visit BPV is present in one sixth of non-hypertensive adults and one third of hypertensive individuals and is more common in those with comorbidities. The frequency of high BPV varies across antihypertensive treatment regimens.

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