scholarly journals Treatment Patterns and Blood Pressure Control With Initiation of Combination Versus Monotherapy Antihypertensive Regimens

Hypertension ◽  
2021 ◽  
Vol 77 (1) ◽  
pp. 103-113
Author(s):  
Jaejin An ◽  
Tiffany Luong ◽  
Lei Qian ◽  
Rong Wei ◽  
Ran Liu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Calcium Channel ◽  
Thiazide Diuretic ◽  
Antihypertensive Medication ◽  
Enzyme Inhibitor ◽  
Heart Association ◽  
Treatment Patterns ◽  
Channel Blockers ◽  
Thiazide Diuretics

Many patients with hypertension require 2 or more drug classes to achieve their blood pressure (BP) goal. We compared antihypertensive medication treatment patterns and BP control between patients who initiated combination therapy versus monotherapy. We identified adults with hypertension enrolled in a US integrated healthcare system who initiated antihypertensive medication between 2008 and 2014. Patient demographics, clinical characteristics, antihypertensive medication, and BP were extracted from electronic health records. Antihypertensive medication patterns and multivariable adjusted prevalence ratios (PRs) of achieving the 2017 American College of Cardiology/American Heart Association guideline-recommended BP <130/80 mm Hg were evaluated for 2 years following treatment initiation. Of 135 971 patients, 43% initiated antihypertensive combination therapy (35% ACE [angiotensin converting enzyme] inhibitor (ACEI)-thiazide diuretics; 8% with other combinations) and 57% initiated monotherapy (22% ACEIs; 16% thiazide diuretics; 11% β blockers; 8% calcium channel blockers). After multivariable adjustment including premedication BP levels, patients who initiated ACEI-thiazide diuretic combination therapy were more likely to achieve BP <130/80 mm Hg compared with their counterparts who initiated monotherapy with ACEI (PR, 1.10 [95% CI, 1.08–1.12]), thiazide diuretic (PR, 1.21 [95% CI, 1.18–1.24]), β blocker (PR, 1.17 [95% CI, 1.14–1.20]), or calcium channel blocker (PR, 1.25 [95% CI, 1.22–1.29]). Compared with initiating monotherapy, patients initiating ACEI-thiazide diuretic combination therapy were more likely to achieve BP goals.

Abstract P108: Side Effects Of Initial Combination Versus Monotherapy For Patients With Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Jaejin An ◽  
Matthew Mefford ◽  
Liang Ni ◽  
Rong Wei ◽  
Hui Zhou ◽  
...  
Keyword(s):  
Side Effects ◽  
Combination Therapy ◽  
Lower Risk ◽  
Antihypertensive Medication ◽  
Proportional Hazards ◽  
Enzyme Inhibitor ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Channel Blockers ◽  
Initial Combination

Clinical guidelines recommend initiating combination antihypertensive therapy for many patients with hypertension. However, data on the risk of side effects are limited. We evaluated side effects associated with initiating combination therapy versus monotherapy among patients with hypertension from Kaiser Permanente Southern California between 2008-2014. Patient characteristics, antihypertensive medication use, and possible side effects were collected using electronic health records. We examined the association of initial combination therapy and incidence of side effects including acute kidney injury, hypotension, injurious fall, hyperkalemia, hypokalemia, hyponatremia, or hyperuricemia using multivariable Cox Proportional hazards models. Of 164,805 patients, 44% initiated combination therapy (34% angiotensin converting enzyme inhibitor (ACEI)-thiazide diuretics (TD); 10% other combinations) and 56% initiated monotherapy (22% ACEIs; 16% TD; 11% beta blockers (BB); 7% calcium channel blockers). Incidence rates of side effects were between 3.8 for hyperkalemia to 55.5 for hypokalemia per 1000 person-yrs during median follow-up of 0.27-0.45 yrs. Initiation of ACEI-TD combination therapy was associated with a lower risk of hyperkalemia than ACEI monotherapy and a lower risk of hypokalemia than TD monotherapy ( Table ). Initiation of ACEI-TD combination therapy was associated with a higher risk of hyponatremia, hyperuricemia, and hypotension, but not associated with injurious falls when compared with other monotherapy groups. Monitoring for side effects following initiation of antihypertensive medication with combination therapy may be useful.

scholarly journals Clinical practice guidelines on the diagnosis and treatment of patients with arterial hypertension and chronic obstructive pulmonary disease

2020 ◽  
Vol 17 (3) ◽  
pp. 7-34
Author(s):  
Irina E. Chazova ◽  
Vera A. Nevzorova ◽  
Lali G. Ambatiello ◽  
Tat’iana A. Brodskaia ◽  
Elena V. Oshchepkova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Combination Therapy ◽  
Arterial Hypertension ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Chronic Obstructive ◽  
Channel Blockers ◽  
Obstructive Pulmonary Disease

One of the most common comorbid condition in people over 40 years old is: arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). The frequency of AH in patients with COPD varies from 6.8 to 76.3%, in average 34.3%. COPD is detected in every fourth patient with hypertension in the age group of 2564 years. The current trend towards an increase in life expectancy and therefore growing pool of elder cohort, will lead to a higher number of patients with comorbid disorders. Diagnosis and treatment of AH and COPD are determined by current clinical recommendations for both nosologies, however, a number of mutual pathophysiological mechanisms lead to a more severe course of these diseases with frequent exacerbations. The choice of antihypertensive therapy in patients with AH in combination with COPD should be given to drugs that can provide an adequate decrease in blood pressure in hypoxic conditions, especially at night and early morning hours, that have prolonged effect or could be prescribed in the evening, and to those that dont worsen bronchial obstruction or exacerbate hypoxia. Patients with AH and COPD should be given recommendations on lifestyle changes, especially smoking cessation. As initial therapy calcium channel blockers, angiotensin receptor blockers or angiotensin-converting enzyme inhibitors should be considered. Calcium channel blockers/renin-angiotensin system blockers should be considered as the first line for combination therapy. Thiazide, thiazide-like diuretics orb1-selective adrenergic blockers could be prescribed in case of insufficient antihypertensive response or depending on different clinical scenarios. Bronchodilators are the baseline therapy in COPD with concomitant AH. According to modern concepts, prescription of combination therapy with different mechanisms of action is the most proven and justified approach, which leads to a decrease in the frequency of exacerbations of COPD and amelioration of the symptoms. The choice of bronchodilator in the case of a COPD and AH combination, should take into account the proven long-term safety regarding the risk of cardiovascular complications. Tiotropium bromide as the monotherapy, including as a liquid inhaler and aclidinium/formoterol, tiotropium/oladeterol as combination therapy showed cardiovascular safety in the long-term studies. The escalation of COPD therapy with the need of inhaled steroids requires careful monitoring of blood pressure and, possibly, a revision of antihypertensive treatment leading to its escalation as well. COPD has many phenotypes requiring different medications, eg.: roflumilast, theophylline, macrolides and mucoactive drugs, that could also require tighter blood pressure control on patients with COPD and AH.

Landscape of Combination Therapy – Which Way Forward? Proceedings of the Satellite Symposium Held at the ESH European Meeting on Hypertension and Cardiovascular Protection, 27 April 2012, London

2012 ◽  
Vol 8 (3) ◽  
pp. 192
Author(s):  
Patricia Fonseca ◽  
Anna F Dominiczak ◽  
Stephen Harrap ◽  
◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Combination Therapy ◽  
Enzyme Inhibitor ◽  
Synergistic Effects ◽  
Term Treatment ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Hypertensive Patients ◽  
Long Term Treatment

Early combination therapy is more effective for hypertension control in high-risk patients than monotherapy, and current guidelines recommend the use of either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) for first-line therapy in patients younger than 55 years. Recent evidence shows that ACEIs reduce mortality, whereas ARBs show no apparent benefit despite their blood pressure lowering action. However, it is important to consider which blood pressure parameters should be targeted given that different drugs have distinct effects on key parameters. Remarkably, a high percentage of hypertensive patients whose treatment has brought these parameters within target ranges still remain at high risk of cardiovascular disease due to additional risk factors. Combination therapy with synergistic effects on blood pressure and metabolic control should thus be considered for the long-term treatment of hypertensive patients with co-morbid conditions.

scholarly journals Calcium Channel Blockers Shorten the Periodicity of Ultradian Variation in Blood Pressure in Patients with Essential Hypertension.

1998 ◽  
Vol 21 (3) ◽  
pp. 179-186 ◽  
Author(s):  
Hiroshi Kawamura ◽  
Hiromi Mitsubayashi ◽  
Tomoaki Saito ◽  
Katsuo Kanmatsuse ◽  
Noboru Saito
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Channel Blockers

scholarly journals Genetic Variation in Blood Pressure and Lifetime Risk of Peripheral Artery Disease: A Mendelian Randomization Study

2020 ◽  
Author(s):  
Michael G Levin ◽  
Derek Klarin ◽  
Venexia M Walker ◽  
Dipender Gill ◽  
Julie Lynch ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Peripheral Artery Disease ◽  
Genetic Correlations ◽  
Channel Blockers ◽  
Peripheral Artery ◽  
Antihypertensive Medications ◽  
Increased Risk ◽  
Genes Encoding ◽  
Artery Disease

Aims: We aimed to estimate the effect of blood pressure and blood pressure lowering medications (via genetic proxies) on peripheral artery disease. Methods and Results: GWAS summary statistics were obtained for BP (International Consortium for Blood Pressure + UK Biobank GWAS; N = up to 757,601 individuals), peripheral artery disease (PAD; VA Million Veteran Program; N = 24,009 cases, 150,983 controls), and coronary artery disease (CAD; CARDIoGRAMplusC4D 1000 Genomes; N = 60,801 cases, 123,504 controls). Genetic correlations between systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and CAD and PAD were estimated using LD score regression. The strongest correlation was between SBP and CAD (rg = 0.36; p = 3.9 x 10-18). Causal effects were estimated by two-sample MR using a range of pleiotropy-robust methods. Increased SBP, DBP, and PP increased risk of both PAD (SBP OR 1.25 [1.19-1.31] per 10mmHg increase, p = 3 x 10-18; DBP OR 1.27 [1.17-1.39], p = 4 x 10-8; PP OR 1.51 [1.38-1.64], p = 1 x 10-20) and CAD (SBP OR 1.37 [1.29-1.45], p = 2 x 10-24; DBP OR 1.6 [1.45-1.76], p = 7 x 10-22; PP OR 1.56 [1.4-1.75], p = 1 x 10-15). The effects of SBP and DBP were greater for CAD than PAD (pdiff = 0.024 for SBP, pdiff = 4.9 x 10-4 for DBP). Increased liability to PAD increased PP (beta = 1.04 [0.62-1.45] mmHg per 1 unit increase in log-odds in liability to PAD, p = 1 x 10-6). MR was also used to estimate the effect of BP lowering through different classes of antihypertensive medications using genetic instruments containing BP-trait associated variants located within genes encoding protein targets of each medication. SBP lowering via calcium channel blocker-associated variants was protective of CAD (OR 0.38 per 10mmHg decrease in SBP; 95% CI 0.19-0.77; p = 0.007). Conclusions: Higher BP is likely to cause both PAD and CAD but may have a larger effect on CAD risk. BP-lowering through calcium-channel blockers (as proxied by genetic variants) decreased risk of CAD.

scholarly journals Comparing the Efficacy of Angiotensin Converting Enzyme In-hibitors with Calcium Channel Blockers on the Treatment of Di-abetic Nephropathy: A Meta-Analysis

2019 ◽  
Author(s):  
Zhaowei ZHANG ◽  
Chunlin CHEN ◽  
Shiwen LV ◽  
Yalan ZHU ◽  
Tianzi FANG
Keyword(s):  
Blood Pressure ◽  
Diabetic Nephropathy ◽  
Angiotensin Converting Enzyme ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Mean Difference ◽  
Channel Blockers ◽  
Converting Enzyme

Background: The angiotensin-converting enzyme inhibitors (ACEIs) could improve the symptoms of diabetic nephropathy. Whether the calcium channel blockers (CCBs) could be as effective as ACEIs on treating diabetic nephropathy is controversial. Here, we aimed to compare the efficacy of ACEIs with CCBs on the treatment of diabetic nephropathy by performing a meta-analysis of randomized controlled trials (RCTs). Methods: The Pubmed, Medline, Embase and The Cochrane Database were searched up to July 2017 for eligible randomized clinical trials studies. Effect sizes were summarized as mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (P-value<0.05). Results: Seven RCTs involving 430 participants comparing ACEIs with CCBs were included. No benefit was seen in comparative group of ACEIs on systolic blood pressure（SBP） (MD=1.05 mmHg; 95% CI: -0.97 to 3.08, P=0.31), diastolic blood pressure (DBP) (MD= -0.34 mmHg; 95% CI: -1.2 to 0.51, P=0.43), urinary albumin excretion rates (UAER) (MD=1.91μg/min; 95% CI: -10.3 to 14.12, P=0.76), 24-h urine protein (24-UP) (SMD=-0.26; 95%CI: -0.55 to 0.03, P=0.08), glomerular filtration rate (GFR) (SMD=0.01; 95% CI: -0.38 to 0.41, P=0.95). On safety aspect, the risk of adverse reactions between ACEIs group and CCBs group are similar (RR=1.18; 95% CI: 0.61 to 2.28; P=0.61). Conclusion: Both ACEIs and CCBs could improve the BP, UAER, 24h-UP, and GFR of diabetic nephropathy to a similar extent

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