Abstract P140: Blood Pressure Control in Veterans Following Percutaneous Coronary Intervention (PCI)

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Sloane A McGraw ◽  
Michael Scholfield ◽  
Ragu Murthy ◽  
Burhan Mohamedali ◽  
Anupama Shivaraju ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
Joint National Committee ◽  
National Committee ◽  
Channel Blockers ◽  
Drug Classes

Background: Control of blood pressure (BP) in patients with underlying coronary artery disease (CAD) provides a decreased risk in morbidity and mortality. According to the US Joint National Committee VII (JNC-7) recommendations, patients with underlying CAD should have goal blood pressures of systolic <130 and diastolic <80. These goals can be attained by using multiple classes of drugs including beta-blockers (BB), angiotensin agonists (ACE-I/ARB), calcium channel blockers (CCB), diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on attaining JNC-7 guidelines for BP in a diverse population of 772 patients undergoing PCI between September 2004 and September 2008 at the Jesse Brown Veterans Hospital in Chicago, IL. Data was collected which compared both BP measurements and antihypertensive regimens pre and post PCI. Results: For the 772 patients, the overall population mean systolic blood pressure (SBP) decreased from 134 to 128mmHg (p < 0.0001) and mean diastolic blood pressure (DBP) decreased from 73 to 70mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of patients who reached SBP goals increased from 44 to 54% (340 to 417 of 772) (p < 0.0001) and with DBP goals rose from 72 to 78% (556 to 602 of 772) (p = 0.0031). At 6 months, there was a statistically significant (all p values <0.0001) change in the use of each drug class; the use of ACE-I/ARB increased from 64% (494 out of 772) to 76% (587 of 772) and BB from 73% (564 of 772) to 89% (687 of 772). There was also increased utilization of diuretics 41% (317 of 772) to 43% (332 of 772) and nitrates 23% (178 of 772) to 29% (224 of 772), however a decrease in the use of calcium channel blockers, 34% (262 of 772) to 31% (239 of 772). Conclusions: There was improvement in BP in the six months after PCI and although there were higher rates of attainment of JNC-7 goals for SBP and DBP at six months, overall percentage values are still suboptimal. Additionally, the medication usage improved in most drug classes with exception of calcium channel blockers; however these increases still leave some room for improvement.

Abstract P297: Comparing Blood Pressure Control in Diabetic verses Non-Diabetic Veterans following Percutaneous Coronary Intervention (PCI)

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Sloane A McGraw ◽  
Michael Scholfield ◽  
Ragu Murthy ◽  
Anupama Shivaraju ◽  
Burhan Mohamedali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
Joint National Committee ◽  
National Committee ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
The Mean ◽  
Artery Disease

Background: Blood pressure (BP) control in patients with coronary artery disease (CAD) is beneficial on morbidity and mortality, however the US Joint National Committee VII (JNC-7) also recommends systolic BP (SBP) <130 and diastolic BP (DBP) <80 for diabetic patients because diabetes itself is an additional risk for a cardiac event. This can be attained using beta-blockers (BB), angiotensin agonists (ACE-I/ARB), calcium channel blockers, diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on attaining JNC-7 guidelines, comparing outcomes between 302 diabetic to the 469 non-diabetic patients; all underwent PCI between September 2004 and September 2008 at the Jesse Brown Veterans Hospital in Chicago, IL. We collected data of BP values and antihypertensive regimens on admission and at six month follow up, and correlated these into percentages of which have attained goals. Results: Among diabetics, mean SBP decreased from 134 to 130mmHg (p = 0.002) and mean DBP decreased from 72 to 70mmHg (p= 0.004); in the non-diabetics, the mean SBP decreased from 133 to 127mmHg (p<0.0001) and the mean DBP decreased from 73 to 71mmHg (p<0.0012). With regards to guidelines, the percent of diabetics at SBP goal increased from 41% to 51% (124 to 154 of 302) (p= 0.006), however the percent at DBP goal was not significant. In non-diabetics, percent at goal for SBP increased 46% to 57% (216 to 267 of 469) (p=0.0002) and for DBP increased 69% to 76% (324 to 356 of 469) (p=0.0131). At 6 months, among diabetics the medication usage increased with BB, 80% to 92% (241 to 278 of 302) (p<0.0001) and nitrates 30% to 36% (91 to 109 of 302) (p=0.035). Similarly, among non-diabetics, use of BB, 68% to 87% (319 to 408 of 469) (p<0.0001) and nitrates 19% to 24% (89 to 113 of 469) (p=0.006) increased, as well as ACE-I/ARB 52% to 71% (244 to 333 if 469) (p<0.0001). Conclusions: There were improvements in BP among both populations at six months post-PCI; both attained JNC-7 SBP goal, but only non-diabetics achieved DBP goal. Medication use increased for both groups with BB and nitrates, but also with ACE-I/ARB for non-diabetics only. This analysis suggests that tighter control needs to be obtained among diabetics, especially because they are a higher risk population than those solely with CAD.

Abstract 253: Blood Pressure Control at 6 Months After Percutaneous Coronary Intervention at a Veterans Hospital

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Saifullah M Siddiqui ◽  
Dmitry Blumenkrants ◽  
Karthik Challa ◽  
Amit Ladani ◽  
Adhir Shroff
Keyword(s):  
Blood Pressure ◽  
Percutaneous Coronary Intervention ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
Joint National Committee ◽  
National Committee ◽  
Channel Blockers ◽  
Percutaneous Coronary ◽  
The Mean

Background: Blood pressure (BP) control in patients with coronary artery disease (CAD) decreases morbidity and mortality. The US Joint National Committee VII (JNC-7) recommends patients with underlying CAD have a goal systolic blood pressure (SBP) < 130 and a diastolic blood pressure (DBP) < 80. These goals can be achieved by using multiple classes of drugs, including beta-blockers (BB), angiotensin antagonists (ACE-I/ARB), calcium channel blockers (CCB), nitrates and diuretics. Methods: We conducted a retrospective cohort study focusing on the achievement of JNC-7 recommended BP goals in a diverse population of 1052 veterans undergoing Percutaneous Coronary Intervention (PCI) between September 2004 and December 2011 at the Jesse Brown Veterans Hospital in Chicago, IL. Data was collected comparing both BP measurements and anti-hypertensive regimens pre- and post- PCI. Results: In the 1052 patients studied, the mean SBP decreased from 134 mm Hg to 128 mm Hg, and the mean DBP decreased from 73 mm Hg to 70 mm Hg. In regards to the JNC-7 guidelines, the percent of patients who achieved SBP goals increased from 44% (462 of 1052) to 54% (567 of 1050), and the percent of patients who achieved DBP goals increased from 71% (747 of 1052) to 78% (819 of 1050). There was a statistically significant increase in the use of ACE-I/ARB from 61% (645 of 1050) to 74% (776 of 1046), BB from 69% (723 of 1050) to 87% (912 of 1047), and nitrates from 23% (244 of 1050) to 28% (289 of 1046). The use of diuretics increased from 40% 422 of 1050) to 41% (426 of 1047), which was not statistically significant. There was a decrease in the use of CCB from 32% (332 of 1050) to 28% (293 of 1044), which was also not statistically significant. Conclusion: There was improvement in both mean BP and percentage of patients achieving JNC-7 recommended goals for SBP and DBP at six months post PCI, although overall percentages still remain suboptimal. Additionally, medication use improved in most drug classes. Beta-blocker, angiotensin antagonist as well as nitrate use increased significantly. Use of calcium channels blockers, which have no proven mortality benefit in this cohort, decreased, however this was not statistically significantly. Data was collected comparing both BP measurements and anti-hypertensive regimens pre- and post- PCI.

Abstract P166: Blood Pressure Control Following Percutaneous Coronary Intervention at a VA Hospital

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Chris Healy ◽  
Sloane A McGraw ◽  
Burhan Mohamedali ◽  
Anupama Shivaraju ◽  
Michael Scholfield ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Percutaneous Coronary Intervention ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
National Committee ◽  
Channel Blockers ◽  
Percutaneous Coronary ◽  
The Mean

Background: Blood pressure (BP) control in patients with coronary artery disease (CAD) decreases morbidity and mortality. The US Joint National Committee VII (JNC-7) recommends patients with underlying CAD have a goal systolic blood pressure (SBP) < 130 and a diastolic blood pressure (DBP) < 80. These goals can be achieved by using multiple classes of drugs, including beta-blockers (BB), angiotensin antagonists (ACE-I/ARB), calcium channel blockers (CCB), diuretics, and nitrates. Methods: We conducted a retrospective cohort study focusing on the attainment of JNC-7 recommended BP goals in a diverse population of 857 veterans undergoing Percutaneous Coronary Intervention (PCI) between September 2004 and December 2009 at the Jesse Brown Veterans Hospital in Chicago, IL. Data was collected comparing both BP measurements and anti-hypertensive regimens pre and post PCI. Results: In the 857 patients studied, the mean SBP decreased from 134 mm Hg to 129 mm Hg (p<0.0001), and the mean DBP decreased from 73 mm Hg to 71 mm Hg (p<0.0001). In regards to the JNC-7 guidelines, the percent of patients who achieved SBP goals increased from 44% to 54% (377 to 463 of 857) (p<0.0001), and the percent of patients who achieved DBP goals increased from 71% to 78% (608 to 668 of 857) (p<0.0001). There was a change in the use of each drug class; the use of ACE-I/ARB increased from 72% to 89% (617 to 763 out of 857) (p<0.0001), the use of BB increased from 63% to 76% (540 to 651 out of 857) (p<0.0001), the use of diuretics increased from 41% to 43% (351 to 369 out of 857) (p=0.2997), and the use nitrates increased from 24% to 29% (206 to 249 out of 857) (p=0.0007). The use of CCB, however, decreased from 34% to 30% (291 to 257 out of 857) (p=0.0121). Conclusions: There was improvement in both mean BP and percentage of patients achieving JNC-7 recommended goals for SBP & DBP at six months post PCI, though overall percentages still remain suboptimal. Additionally, medication use improved in most drug classes, with the exception of calcium channel blockers. In particular, both beta-blocker and angiotensin antagonist use increased significantly.

Abstract 159: Comparing Blood Pressure Control in Diabetic vs Non-Diabetic Veterans following Percutaneous Coronary Intervention

2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
Dmitry Blumenkrants ◽  
Saifullah M Siddiqui ◽  
Karthik Challa ◽  
Amit Ladani ◽  
Adhir Shroff
Keyword(s):  
Blood Pressure ◽  
Lifestyle Modification ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
National Committee ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
The Mean

Background As per the US Joint National Committee VII (JNC-7) recommendations, patients with known underlying coronary artery disease and diabetes should have goal blood pressures (BP) of systolic (SBP) <130 and diastolic (DBP) <80 to decrease morbidity and mortality associated with cardiovascular disease. In addition to lifestyle modification, these goals can be attained by use of multiple classes of drugs including beta-blockers (BB), angiotensin agonists (ACE-I/ARB), calcium channel blockers (CCB), diuretics and nitrates. Methods We conducted a retrospective cohort study focusing on the attainment of the JNC-7 guidelines, comparing outcomes between 415 diabetic to 637 non-diabetic patients undergoing PCI between September 2004 and December 2012 at the Jesse Brown Veterans Administration Hospital in Chicago, IL. Blood pressure (BP) measurements and antihypertensive medications pre and post PCI at 6-month follow-up were documented. Results Among the diabetic population, the mean SBP decreased from 136 to 131 mmHg (p < 0.0001) and mean DBP decreased from 73 to 70 mmHg (p < 0.0001). In the non-diabetics, the mean SBP decreased from 133 to 127 mmHg (p < 0.0001) and the mean DBP decreased from 74 to 71 mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of diabetics at SBP goal increased from 42% to 49% (p = 0.047) and percent at DBP goal increased from 74% to 82% (p = 0.008). In non-diabetics, percent at goal for SBP increased from 46% to 57% (p < 0.0001) and percent at DBP goal increased from 68% to 76% (p = 0.003). Among diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 77% to 90%. In non-diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 64% to 86% and ACE-I/ARB from 51% to 70%. Conclusions In both groups (diabetics and non-diabetics) undergoing PCI, both systolic and diastolic blood pressure improved with more patients achieving JNC-7 targets. Among diabetics, there was a significant increase in utilization of BB. Among non-diabetics, there was a significant increase in utilization of BB and ACE-I/ARB.

scholarly journals Blood Pressure Control and Antihypertensive Treatment Among Hemodialysis Patients—Retrospective Single Center Experience

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 590
Author(s):  
Piotr Skonieczny ◽  
Zbigniew Heleniak ◽  
Marek Karowiec ◽  
Stanisław Zajączkowski ◽  
Leszek Tylicki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Blood Pressure Control ◽  
Calcium Channel Blockers ◽  
Antihypertensive Treatment ◽  
Pressure Control ◽  
Hemodialysis Patients ◽  
Channel Blockers ◽  
Renin Angiotensin Aldosterone System ◽  
The Mean

Background and Objectives: Hypertension affects at least 80% of hemodialysis patients. Inappropriate control of blood pressure is mentioned as one of the essential cardiovascular risk factors associated with development of cardiovascular events in dialysis populations. The aim of the cross-sectional, retrospective study was the evaluation of the antihypertensive treatment schedule and control of blood pressure in relation to the guidelines in the group of hemodialysis patients. Additionally, we assessed the level of decrease in blood pressure by each group of hypotensive agents. Materials and Methods: 222 patients hemodialyzed in a single Dialysis Unit in three distinct periods of time—2006, 2011, and 2016—with a diagnosis of hypertension were enrolled in the study. The analysis of the antihypertensive treatment was based on the medical files and it consisted of a comparison of the mean blood pressure results reported during the six consecutive hemodialysis sessions. Results: The mean values of blood pressure before hemodialysis were as follows: 134/77, 130/74, and 140/76 mmHg, after hemodialysis 124/74, 126/73, and 139/77 mmHg in 2006, 2011, and 2016 respectively. The goal of predialysis blood pressure control (<140/90) was achieved by up to 64.3% of participants in 2006 as compared to 49.4% in 2016. Additionally, the postdialysis goal (<130/90) reached 57.1% of the study population in 2006 as compared to 27.1% of patients in 2016. The differences in percentage of patients using single, double, triple, and multidrug therapy during observation were not statistically significant. The most often used drugs were ß-blockers, diuretics, and calcium channel blockers in all points of the study. Blockades of the renin–angiotensin–aldosterone system in 2006 and calcium channel blockers in 2011 and 2016 were the drugs with highest impact on lowering blood pressure. Conclusions: The goal of predialysis or postdialysis blood pressure control was achieved in a lower percentage of patients during the period of the study. Blockade of renin–angiotensin–aldosterone system and calcium channel blockers decrease the blood pressure significantly. It is necessary to achieve better control of blood pressure in prevention of cardiovascular incidents.

Abstract P182: Comparing Blood Pressure Control in Diabetic Versus Nondiabetic Veterans Following Percutaneous Coronary Intervention

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Sloane A McGraw ◽  
Chris Healy ◽  
Burhan Mohamedali ◽  
Anupama Shivaraju ◽  
Adhir Shroff
Keyword(s):  
Blood Pressure ◽  
Percutaneous Coronary Intervention ◽  
Blood Pressure Control ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
National Committee ◽  
Diabetic Patients ◽  
Percutaneous Coronary ◽  
The Mean

Background: Blood pressure control in patients with coronary artery disease (CAD) or diabetes is essential to decrease morbidity and mortality. The US Joint National Committee VII (JNC-7) recommends systolic blood pressure (SBP) <130 and diastolic blood pressure (DBP) <80. These values can be attained using beta-blockers, angiotensin antagonists, calcium channel blockers, diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on the attainment of the JNC-7 guidelines, comparing 331 diabetic to 524 non-diabetic patients who underwent percutaneous coronary intervention (PCI) between September 2004 and December 2009 at the Jesse Brown Veterans Hospital in Chicago, IL. Results: Among the diabetic population, the mean SBP decreased 135 to 131mmHg (p = 0.0014) and mean DBP decreased 72 to 70mmHg (p= 0.0014). In non-diabetics, the mean SBP decreased 133 to 128mmHg (p<0.0001) and mean DBP decreased 73 to 71mmHg (p<0.0007). The percent of diabetics at JNC-7 SBP goal increased from 41 to 50% (136 to 166 of 331) (p= 0.0041), however the percent change at DBP goal was not significant. In non-diabetics, percent at goal for SBP increased 45 to 57% (236 to 299 of 524) (p<0.0001) and for DBP increased 69 to 76% (362 to 398 of 524) (p=0.0075). At six months, among diabetics, the medication usage increased for beta-blockers, from 80 to 92% (265 to 305 of 331) (p<0.0001) and for nitrates from 32 to 37% (106 to 122 of 302) (p=0.0465). Among non-diabetics, use of beta-blockers increased from 68 to 87% (356 to 456 of 524) (p<0.0001) and nitrates from 20 to 25% (105 to 131 of 524) (p=0.0054). Use of angiotensin antagonists also increased from 52 to 71% (272 to 372 if 524) (p<0.0001) among non-diabetics. Conclusions: There were improvements in blood pressure among both populations at six months post-PCI. Both groups attained JNC-7 SBP goals; only non-diabetics achieved DBP goal. Medication use increased for both groups with beta-blockers and nitrates. Angiotensin antagonists only increased significantly among non-diabetics. This demonstrates that post-intervention, tighter control of blood pressure is attempted however levels are not yet optimal.

scholarly journals Calcium-channel blockers for the prevention of stroke: from scientific evidences to the clinical practice

2013 ◽  
pp. 37-43
Author(s):  
S. Taddei
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Ventricular Hypertrophy ◽  
Blood Pressure Reduction ◽  
Left Ventricular ◽  
Channel Blockers ◽  
Pressure Reduction ◽  
Drug Classes

AIM OF THE REVIEW The present review aims to analyze the role of calcium-channel blockers, and particularly newer molecules, as first-line therapy for cerebrovascular disease. BACKGROUND Stroke is the leading cause of disability in the general population. Among traditional cardiovascular risk factors, hypertension has a key role in the genesis of both hemorrhagic and ischemic stroke and a direct correlation exists between blood pressure values and the risk of stroke. Moreover, blood pressure reduction has been demonstrated to be the most important route to reduce stroke incidence and recurrence. However, the mere reduction of blood pressure values does not normalize the cardiovascular risk of the hypertensive patient. It is therefore necessary to use drug classes that beyond their blood pressure-lowering effect have also an additional effect in terms of organ protection. Among these, calcium-channel blockers have a crucial profile. Firstly, they are effective in inducing left ventricular hypertrophy regression, with a strength at least equal to that of ACE-inhibitors. Secondly, they have an antithrombotic and an endothelium-protecting effect, mediated by their antioxidant activity. Finally, calcium-channel blockers are the most powerful drugs in preventing vascular remodeling. For these reasons this drug class has probably the strongest antiatherosclerotic effect, and it is the first-choice treatment mainly for cerebrovascular disease. Among different available calcium-channel blockers, the newer ones seem to possess pharmacokinetic characteristics allowing a more homogeneous 24 hours coverage as compared to older molecules, and preliminary data seem to suggest a greater beneficial effect also on left ventricular hypertrophy and lower incidence of side effects. CONCLUSIONS Although blood pressure reduction is the main tool to reduce cerebrovascular risk in hypertensive patients, some drug classes, such as calciumchannel blockers, seem to provide a protective action beyond the mere antihypertensive effect, and represent a key element in the prevention of atherosclerosis.

Sign in / Sign up

Export Citation Format

Share Document